Pregnancy and Postpartum

Drinking and Postpartum Depression

Your world feels chaotic and there’s no escape. There are endless hours between naps, feedings and the constant fatigue. There is no one around to talk to and you feel overwhelmed and frustrated all the time. Having one more drink feels awful, but it gives you that escape you’ve been craving. Sound familiar?

Whether you want to call it an addiction or not, you’re noticing that you’re drinking more than usual. What was initially meant as a treat at the end of the day is starting to become a coping strategy (and, unfortunately, this one comes with some consequences).

If this sounds like your life right now, I get that you’re really struggling. This post is not about judging you or telling what is right or wrong. Addictions is hard. Postpartum depression is hard. For those who are in these circumstances, I hope the following post provides you some clarity and empowerment.

What is drinking doing for you?

Attempts to Self-Soothe:

Life feels chaotic and things feel too difficult to manage. There needs to be an end. It’s not possible to stay hyper-alert forever. You can’t always be watching the baby sleep. It’s overwhelming to be so stressed out at every feed. Drinking helps to balance your window of tolerance. When you’ve become a ball of stress, your body craves a way to settle down. So, a part of you turns toward drinking to help you calm down and relax.

Alcohol is an effective depressant. It forces your body to slow down giving that reprieve you desperately crave. In this way, drinking is an attempt to self-soothe. It’s a coping mechanism for helping slow down, numb out, or block off whatever it is you don’t want to address. You can’t necessarily leave the baby. You don’t want to call it quits as a parent. Drinking provides that mental escape when physical escape is just not possible.

Gabor Mate quote on addiction. Addiction as a coping mechanism during postpartum months. Addressing trauma to address addiction.

Lack of Internal Trust

If you’ve experienced enough trauma, neglect, shame or hardships in your life, you are likely aware that your internal system feels messy. You’re aware that many days you feel overwhelmed by worries, humiliation, guilt, anger, or self-hate. These parts of you are harsh and relentless. However, in their own unique way, they are trying to protect you. For example, you may have a critical part that shames you in order to encourage change. There may be a perfectionist part that nags incessantly so that you do not make mistakes.

Lack of internal trust. Coping with alcohol instead of being with our feelings. Alcohol and postpartum depression

When our system is full of these protective parts, it’s an indicator that there is limited trust inside. Rather than believing you are capable of handling difficult situations, your protective parts take over. For example, when you feel tired of parenting, there may be a harsh part that steps in. It yells at you to be grateful and reminds you of how hard it was to conceive. Your system doesn’t trust you to sit with the distress of parenting. It would rather help you avoid those thoughts by filling you with shame and guilt instead. This is not necessarily a helpful or effective manner of handling things, but it’s been like this for years.

Working with these protective parts are challenging. No amount of reasoning or negotiating in our minds creates that desperately sought after sense of calm. Our guilt, anxieties, shame and internal critics are forever yelling in our minds. So, a part of us starts to drink. It helps to quiet down all of those loud protective layers inside.

Why is it so hard to give up?

You already know that drinking excessively has consequences. But, why is it so hard to give up? If you’ve ever moved towards sobriety or harm reduction, you know this is no small feat. So, let’s take a look at what gets in the way of recovery.

Physical Dependence

So much of the addiction process is physiological. When we drink, the reward centres of our brain become affected. Suddenly, our brain produces an abundance of dopamine (a chemical that makes us feel good and influences our sense of pleasure). Once we get introduced to this experience of high-level dopamine, we start to crave it. By using, our brain is providing us enough dopamine that things feel so much better, calmer, and happier.

When substances are taken away, we feel depleted and depressed. Our brain is not producing the amount of dopamine that we crave. The normal level of dopamine production no longer feels like enough. For many folks, they can work through the triggers and traumas of their addiction, but their brain struggles to find pleasure in normal activities. It’s hard to read a book, talk to a friend, or go for a walk when you continuously feel so flat and apathetic.

Working through Pain Points:

man drinking and postpartum depression. working through trauma and grief to recover from substance use.

When we use substances to cope with our reality, we have to consider what’s happening in our lives that makes us so desperate to escape? Drinking excessively to cope is not anyone’s first solution to fix a problem. Having a baby should not make us so overwhelmed that we’re needing a bottle of whisky every night. So what’s really going on?

When you are no longer drinking, you are left with pain points. Perhaps it is underlying trauma from childhood that keeps coming up. Being around a baby makes you remember all of your toxic and negative experiences as a child. Your pain points may come from unprocessed grief and anxiety. You feel like you ought to be happy with your newborn, but it’s been years of IVF struggles and multiple miscarriages. There’s no way you can let your guard down because what if one more bad thing happens? The part of you that drinks minimizes all of these pain points. Once the substances go, you suddenly have to face your traumas.

Working through pain points means looking at and processing the original trauma. If you continue to be triggered today by situations from the past, that urge to drink will keep coming up in order to protect you.

Russell Brand quote about addiction. Addiction as form of coping. Processing original trauma helps reduce drinking. Working through over-drinking during postpartum months.

Habits

Habit formation can leads us to automatically reach for a glass of wine once the baby goes down for a nap. At the end of the day, we crave those several beers to help feel calm. We don’t even think or question our urge to grab a cigarette or a joint when we start our day. When it comes to these automatic routines, there are ways to change these habits.

4 Tips to Help with Drinking and Postpartum Depression:

1) Address the pain points.

Drinking is not the problem. It’s a means to make the pain stop. Until your postpartum depression, trauma, grief, and other pain points are addressed, that drinking part will want to self-soothe through substances. Healing from these pain points can involve a variety of interventions, including: individual therapy, support from friends and family, psycho-education, group therapy (for those in Kitchener, Stork Secrets provide wonderful care for postpartum depression), or medication.

2) Explore options for self-soothing

For many, accessing the interventions listed above is not possible. If this is your circumstance, you need to find alternative ways to work through difficult emotions. This is where effective coping skills can help. You need quick and reliable ways to slow things down. My favourite recommendation is the DBT temperature change exercise.

3) Find connection

Our shame drives so much of our need to drink. We worry that others will judge us. We assume they’ll reject us or mock us if they knew how much we are struggling. If there are people like this in your life, I’m sorry. These are not the supports you need right now. Find a safe community to talk to about your struggles, such as neighbours, friends, family, partner, colleagues, or a community-based mental health group. Having others who accept you and love you, just as you are, plays a significant role in healing.

4) Get to know your cues and rewards

One of the best tips for changing our habits is understanding our cues and rewards. Pay attention to what triggers you. Are you most likely to use when the baby refuses to go down for a nap? Are you prone to having a bottle of wine starting at supper time? Pay attention to the time, the place, the people and circumstances. Next, notice the rewards that you get when you drink. Are you able to pass out? Can you suddenly tune out the crying and shrieking? Are you able to manage boredom or frustration? Does your anxiety reduce?

understanding cues and rewards for addiction. Changing our habits to help address addictions and postpartum depression.

When it comes to changing habits, we want to make sure that we intervene with a different habit for these cues AND still receive a similar reward. For example, once the baby has done screeching for an hour and finally falls asleep, you may experience an urge to drink. It’s the only way to release all of that pent up anxiety and tension inside of you. In this situation, the cue is the baby shrieking before nap time. The reward is releasing anxiety. We want to bring in an alternative habit that will lead to the same result. You may find that running on your treadmill for ten minutes releases some anxiety. Perhaps playing loud, angry music on your headphones provides you some relief. You could work with a foam roller and target those parts of your body that are carrying the most tension. Pairing these new activities shortly after the baby has gone down for a nap leads to shifting out of the original habit.

Final Thoughts

Addictions is not simple, and one blog post cannot address the complexities of this mental health struggle. If you are struggling with drinking and postpartum depression, please speak with a safe and trusted person or a therapist. This is not a matter of will power. You are worthy of effective support and help.

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum

7 Tips for Parents Going Back to Work

How are you feeling about going back to work? The past few months have been all about baby, and now you’re suddenly expected to balance work, childcare, and other needs. There’s no way this can go smoothly.

If you’re among the many, returning back to work after maternity leave (or paternity leave) can be a difficult transition. Here are seven tips that can help you along your emotional journey and set you and kiddo up for success.

#1: Change habits ahead of time

changing routines. Transitioning back to work from parental leave. Kasi Shan Therapy offers therapy for trauma and perinatal mental health. Online and in-person appointments in Kitchener, Ontario

Unfortunately, your schedule will look different. You won’t have the same flexibility with your morning routine. Things you may have fobbed off (e.g. getting ready on time, wearing clothes that are not pyjama/sweats, putting baby in clothes) have to be reintroduced into your routine. Changing your habits can be challenging, and it’s best to give yourself some time with these transitions.

Take a look at your routine and consider what you can do to fine-tune your schedule before going back to work:

  • What is getting in the way for you to have a successful day?
    • Are you staying up late at night scrolling on your phone? Do you drink too much caffeine to fall asleep on time?
    • Once these problem areas are identified, create ways to make them harder to repeat. For example, put the coffee machine away after 11 AM, turn off the wifi after 10 PM. It may sound silly, but any barriers that get in the way will make these problem areas less desirable
    • e.g. If the cookie is right in front of you, you’re going to grab it. If you have to grab the kitchen stool and reach to the top shelf on your cabinet to get the same cookie, you may reconsider if it’s worth it.
  • Consider the habits you’d like to introduce into your schedule: Do you need to wake up earlier? Are you intending to pack your lunch the night before? Do you have a regular night out with your friends? How will you get your child to eat breakfast on time? This step may involve some creative problem solving. You may also have to rely on the support of friends, family, or childcare providers to make it work.
  • Work on introducing one new habit at a time. Rather than manage all of these changes from the get-go, give yourself plenty of time to get used to forming these habits.
  • Have reminders to cue you about your new habits. e.g. Place your gym clothes near the foot of the bed so that you have it ready to go when you wake up in the morning.
  • Use rewards to motivate. Behavioural psychology works! If you pair your new changes with a reward, you’re more likely to follow through. E.g. If your child finishes breakfast on time, you will set aside 10 minutes to play or read before heading out the door.

It takes time to get used to things. Going back to work is huge change from your daily routine of the past few months. If you’d like to learn more about creating changes, check out Atomic Habits or The Power of Habit.

#2 Remember that you will still have a strong attachment with your baby

A big fear of returning back to work is about losing the bond you have with your child. If this is you, remember that attachments and relationships are not so delicate that they will break with having a few hours apart.

If you’re in a secure relationship, you may notice this pattern more easily. In all likelihood, you go to work, hang out with others, pursue your own interests, and you come home to this person knowing that the relationship is still strong. The time apart has not shifted your feelings towards this person. It’s the same with your child. Your infant trusts that you will come back. Your infant will have strong relationships with other peers and adults. You will always be a solid person in his/her/their life.

Going back to work from maternity leave. parental leave. Kasi Shan Therapy offers postpartum and prenatal counselling in Kitchener, ON. Online and in person counselling.

Rather than focusing on the amount of time you have with your kids, focus instead on the quality of the time. Engage in play, conversations, snuggles. Make sure that your kids feel seen and heard by you. This doesn’t mean you have to provide 100% of your attention when you’re at home with them! Instead, try and create some time in the mornings, afternoons and evenings for hanging out. Some examples can include: sitting down together for meals, having chats in the car, splashing around during bath time, or having snuggles while reading a story at bedtime. Going back to work does not have to stop you from having these wonderful moments.

If all of this does not convince, you, there have been studies have shown that babies do not suffer when their caregivers return to work following parental leave. Instead, the results show that children learn they are being left in safe and nurturing spaces AND that their parents always come back to them.

#3 Talk to People

Returning back to work from parental leave. It takes a village. Build a community. talk to people. Kasi Shan Therapy offers online and in-person appointments in Kitchener, Ontario.

Every single new parent I’ve talked to has varying degrees of concern and worries about going back to work! It’s an adjustment and it’s perfectly normal to feel cautious towards change.

Managing childcare, work, relationships and your own interests is hard. Rather than sitting with these frustrations alone, please reach out to your community. Let your work know about needing time to pump. Talk to other parents at your workplace to see how they managed. Work with your family members to access emotional and practical support. There’s a reason that the saying “it takes a village to raise a child” exists. Gather your village!

#4 Get to know your childcare provider

Get familiar with your daycare. Ask for a tour. Have a list of questions. I promise you, you are not alone in being anxious. Your daycare provider has answered these questions many, many times.

Talk to daycare providers. Transitioning back to work from parental leave. Nervous about going back. Build a community.

If it’s financially feasible, arrange a few half-days for your child to participate in childcare ahead of time. By having this short time period away, you will both become familiar with the routine of doing drop offs and pick ups. This trial period also provides an opportunity for you to see how your child manages when spending time away. Your childcare provider will be able to provide you some feedback (did they cry for 5 minutes or 15 minutes? Were they able to settle? Did they make friends?). You both get used to this routine ahead of time, which is helpful for when you do officially go back to work.

#5 Create a balance between needs and wants

You may have had all the time, energy and resources to invest in twelve different interests and hobbies prior to having your child. But, it’s hard to keep up at that pace. What can you feel comfortable dropping? What are you willing to be a little less “good” at? Be honest with yourself in what you really want vs. what you really need.

work life balance. going back to work from maternity leave. Support with transitions. Kasi Shan Therapy offers online and in person counselling (Kitchener, Ontario).

Find a balance between work, family life AND you-time. It may feel hard to carve out that space for your own interests, but it’s so important to make time for self-care. Without this time for your own needs and interests, it’s easy to burn out, grow resentful or lose yourself in the process of parenthood.

#6 Acknowledge the feelings

No matter what happens, there are going to be feelings. Some good, and some not so pleasant. Rather than pushing these emotions down, allow yourself some time to reflect on what’s coming up as you go back to work. You may experience rage, guilt, anxiety or overwhelm. If this is the case for you, the solutions may vary. You may ned some time to adjust to the transition. It may be helpful to reach out for support. Or, you may require some specific problem solving to address these emotional needs.

Alternatively, you may experience a sense of calm and peace now that you have some time with other adults. You may feel proud that you and your child are handling the transition as well as can be. If this has been your experience, enjoy it! Everyone adjust to change differently, and this transition may be a smooth experience for you.

#7 Cut yourself some slack

Going back to work after so many weeks or months with your child is a huge transition for you and your baby! Give yourself permission to feel all the feels, make a bunch of mistakes AND learn from your experiences. Trust that you are capable of adjusting, and that it will take time before this becomes second nature. Set up manageable expectations for yourself. You are not always going to crush it every day. Sometimes you will half-heartedly parent. Sometimes you will rely on cartoons to occupy your kiddo while prepping a meal. You are human. You are loving. You are doing your best.

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum · Anxiety

Postpartum Anxiety and Feelings of Overwhelm

It may seem that being overwhelmed is just a given. You’re up to your eyeballs in dirty diapers and wet burp clothes. You can’t remember the last time you had more than a few hours of rest. What even is breakfast? You run on a steady stream of coffee and fistfuls of cheerios. When you put this all together, postpartum anxiety (PPA) and feeling overwhelmed seems to be par for the course.

If being overwhelmed or anxious has been your experience for the past few weeks (or months, or years), it is not fair and it’s not okay. It does not have to be like this. Postpartum is not meant to be a painful or miserable time. If you’re struggling with PPA (or similar symptoms), here are some tips to help.

Know the Signs of Postpartum Anxiety

Postpartum mental health gets overlooked because so many of its symptoms are normalised. Unfortunately, because having a new baby comes with lots of questions, PPA can get mistaken as “normal” adjustments to parenthood. Someone out there has claimed it is acceptable that you are this tired and irritable and anxious.

Yes, it’s normal to have questions and worries. This is part of being human, and certainly a part of being a new parent. However, it’s not normal to have these worries keep you up at night, cause conflict with your partner, or make you avoid time with the baby. Anxiety is only considered “normal” when it’s within your capacity to address it (a.k.a. your window of tolerance).

Postpartum anxiety is a genuine illness that requires attention and help. Here are the symptoms to look for:

  • Inability to stop worrying
  • Racing thoughts
  • Difficulty with sleep or appetite
  • Difficulty with focus and concentration
  • Inability to rest or relax
  • Feeling on edge
  • Panic attacks
  • Irritability or rage
  • Physical cues: tightness, tension, dizziness, nausea, hot flashes

One quick way for you to check about the severity of your postpartum anxiety is through the Edinburgh Postpartum Depression Scale. This is a screening tool that is used to identify postpartum mental health struggles (including PPA). Specifically, any score above 12 on this depression scale indicates a high probability of postpartum mood and anxiety disorders.

Three quick grounding techniques

If you’re struggling with overwhelming anxiety, you likely want these feelings to calm down ASAP. Here are three quick grounding techniques that can help reduce the panic and overwhelm.

1. Butterfly Hug

The Butterfly Hug is a popular technique used in Eye Movement Desensitization and Reprocessing (EMDR) to quickly settle your body and mind.

Why it’s helpful:

  • Does not require much thinking: This approach does not need you to think through things calmly. You don’t have to “logic” your way out.
  • Helps your brain process in a unique way: EMDR uses bilateral stimulation to activate both your left and right hemisphere while addressing extreme anxieties, traumatic memories, or distressing events
  • Activates your parasympathetic nervous system (the parts of your brain needed for relaxing)
  • Reduces your cortisol level (a.k.a. your stress hormones)
  • You can use this strategy anywhere. It does not require any “equipment”.
The following video shows the steps of the Butterfly Hug:

2. Temperature Change

The temperature change exercise is a great strategy that comes from Dialectical Behaviour Therapy. This approach triggers the mammalian dive reflex. This reflex occurs when we are submerged in ice cold water. In order to survive, our body is forced to slow down our heart rate and oxygen is only sent to key organs that are needed. Everything that is considered “non-essential” is overlooked.

Why it’s helpful:

  • Tricks your brain: Your body cannot go into “survival mode” and panic at the same time. Your heart rate is forced to slow down. Your oxygen level drops, thereby making it hard to panic.
  • Provides about 5-20 minutes of calmer thinking. This gives you some time to problem solve or find alternative coping strategies.
  • You don’t have to “think through” it to feel calmer.
The following video shows the steps of the Temperature Change technique

3. Mindful conversation with another person

Using distractions is really helpful to get through a distressing moment. However, if you cannot find a distracting enough activity, your mind tends to wander back to its original anxious thoughts. Participating in mindful conversation with another person face to face is more effective in helping you stay out of the overwhelm. Rather than focusing on the anxious thoughts, you’re turning your attention to the other person, asking and answering questions, and staying present.

Why it’s helpful?

  • When your postpartum anxiety is highly activated, your sympathetic and parasympathetic nervous system work overtime. Your body turns to survival strategies like fight, flight, freeze/shut down in order to cope. Social engagement, on the other hand, activates our ventral vagal pathway. This pathway tells our brain that we are in a safe and socially connected space.
  • Focusing on topics outside of your postpartum anxiety helps your system recognize that there are still safe options in your world.
  • Gives you the option to engage with someone else outside of your baby.

Working with your anxiety

So now that you’ve coped more effectively in reducing the anxiety, you may be wondering about your next steps. After all, these earlier coping strategies only resolve things for a short time. They’re not actually fixing the issue, and instead, providing brief respite. This is where the hard work of listening to our anxiety comes into effect. In order for you to gain more clarity, you will need to work with your postpartum anxiety.

Internal Family Systems Therapy (IFS) explains that there is always a positive intention to our worries (even though it rarely feels “positive”). It’s challenging to slow our body and mind down enough to hear what your postpartum anxiety has to say. But, we can break down the steps to better support our mental health.

Step One: Find where your anxiety is in your body.

Daniel Siegel coined the term “name it to tame it”. Basically, when you are able to find the feeling in your body and label it, you can get a bit of space from that feeling. Rather than “being” the emotion, you can observe it. So, call out what and where you are feeling things: “I am feeling scared… There is a ball of anxiety in my chest… my shoulders are feeling tense and stressed.”

Step Two: Stay curious

In this step, you will use a bit of mindfulness to approach your emotions. Now that you’ve noticed the emotion, keep your awareness on this feeling. Be aware of the thoughts, sensations, memories, and whatever else comes to mind as you focus on this feeling.

This step involves staying curious about your anxiety is telling you without judging it, trying to get rid of it, or needing it to change. Your anxiety will start to share more as you stay open to it.

As a word of caution, your anxiety may not share the nicest feedback. It may share beliefs such as: “Get me away from this baby! I can’t do this! What was I thinking? I need this to stop!” Stay aware of these thoughts so long as you are within your window of tolerance.

Step Three: Understand what your anxiety is trying to protect

IFS recognizes that our anxious parts are trying to help out in some way or form. Because they tend to communicate in harsh and overwhelming ways, it’s often difficult to understand what our anxieties are trying to achieve.

As you complete step one and two, you will start to identify what your anxiety is telling you. Then, ask yourself, what would happen if these anxious thoughts stopped? What is your anxiety trying to prevent? For example, if your anxiety is often saying, “Get me away from this baby”, what would happen if this warning was no longer present? You might presume that you’d be calmer. While that’s true, what else would happen? Would you suddenly be considered calm enough that others encourage you to parent independently? Would you spend more time with your newborn and make a mistake? What if your baby keeps screaming and you’re reminded that you’re not cut out for this whole parenting thing?

Sometimes your anxiety gets triggered, and it forces you to escape the circumstances. Your brain says, “This is too much, I can’t cope,” and you turn towards avoidance, drinking, zoning out in front of your phone or some other strategy. I’m not saying that these are effective ways to manage things. In all likelihood, this form of “self-soothing” will create new problems. But, as far as your anxiety is concerned, it is satisfied that it has reduced your distress and gotten you away from the “danger” (e.g. time alone with baby).

Step Four: Befriending

Have you seen “Beauty and the Beast”? The Beast is known for being a lousy character. He’s rude, ill-tempered, and scary. But, we see that meeting the Beast with compassion (mixed with assertive boundaries) helps him shift out into a kinder character. (For those who are cringing reading this example, humour me. It’s an analogy. I’m not trying to condone Stockholm syndrome).

In many ways, your anxiety is like the Beast. It’s loud, frightening and has awful manners. However, what happens when you approach your anxiety with compassion or confidence? Have you ever shown any desire to get to know this part of you? What happens when you acknowledge what your anxiety is actually trying to do? Imagine what it would be like to approach your anxiety by saying: “I get it… I get that you’re really scared of me making a mistake… I know this feels like the only way you can help me.” How would it respond to you?

Becoming kinder to yourself

IFS brings in a different level of self-compassion. We are not only meeting our inner system with kindness, but we’re also identifying what our anxious parts are attempting to achieve. When we treat ourselves in this manner, our anxieties will soften. These steps don’t cure postpartum anxiety. We have to address the actual issue, whether it’s the fear of making mistakes, feeling insecure about parenting, or addressing our own childhood traumas. But, meeting our anxiety in this way will reduce the overwhelm.

Curious to learn more?

Postpartum anxiety is treatable. If you found the above examples helpful in reducing your overwhelm, please let me know. If you have any questions about the above steps, or want to work with your own unique circumstances, reach out.

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum

Shame and the postpartum experience

shame and postpartum. perinatal mental health. shame and pregnancy.

One of the biggest aversions to attending postpartum therapy is shame. You feel ashamed that your emotions are messy. This isn’t like you. Normally, you’re calm and cool. But, suddenly your hormones are all over the place, your hair is a mess and you can’t remember the last time you showered. There hasn’t been a single day where you haven’t burst into tears or rage.

You feel ashamed about your relationships. It feels like a huge risk to acknowledge how you truly act around your family. What would the other person say if you admit you don’t really like your baby? What if you told them you sometimes screamed at your children? Are they going to judge you if you tell them you’ve stopped breastfeeding? Would you get mocked for admitting you haven’t had sex in months? What if you revealed that you suddenly can’t stand your spouse? How will the other person react?

It’s incredibly vulnerable to open up to a stranger, especially if you worry how he or she will respond. So rather than talk, you stay silent. Shame feels awful, but it protects you. It keeps you safe from being judged. But it also means you are stuck with all these difficult thoughts and feelings bubbling inside.

The shame of mental health

Despite all of the social media posts, campaigns, and recognition about mental health today, there is still a stigma in admitting we are struggling with mental illness. You may worry about what it means to be attending therapy or starting medication. Does it make you incompetent? Are you still able to say you are a good parent if you also admit you are mentally unwell? How do you cope with your family members telling you to “suck it up” or “get it together?” All of these shameful questions and thoughts prevent you from admitting that you need help.

shame and postpartum. perinatal mental health. shame and pregnancy.

Perinatal mood and anxiety disorders are genuine illnesses. During pregnancy and postpartum months, an individual could live with anxiety, depression, OCD, bipolar disorder, or PTSD. The chance of experiencing any one of these illnesses is not uncommon (e.g. approximately 1 in 4 Canadian mothers reported experiencing symptoms of postpartum depression or anxiety).

As with any illness, you deserve appropriate treatment and care. It is not a matter of will power. We cannot wish it away. My favourite recommendation is to consider how you’d talk to a friend in a similar position. Chances are you would be more compassionate and open-hearted. For example, following a surgery, you would encourage said friend to attend medical appointments, take prescribed medications, and follow their health team’s recommendations. In the same way, would you be able to give yourself the permission to seek the treatment and attention that your mental health needs?

What if the therapist judges me?

Every therapist claims they are nice and nonjudgmental. That doesn’t mean you truly believe it. For those cautious and skeptical parts of you, I want you to know, that’s okay. It’s absolutely okay to have your guard up. Starting therapy feels awkward. As with every relationship, it takes time to build trust.

Take the time to share slowly, if that is what your system needs. Watch how your therapist responds to your words and concerns. You will notice that you either feel more settled and at peace, or if your shame increases. Trust this internal feedback. If you are comfortable, let your therapists know you feel this way, and see how they respond to your words.

Will I get in trouble?

shame and postpartum. perinatal mental health. shame and pregnancy.

One of the biggest fears that pushes clients away from voicing their experiences is the fear of how others will react. In prenatal and postpartum therapy, I see many clients hesitate to talk about how they truly are with their children and relationships. Not only are they managing their internal shame, but they are weary of judgement and negative consequences. Clients are often fearful because they fear the truth will lead to the therapist ending the relationship, calling the Children’s Aid Society or disliking the person. So let’s address these fears:

1) If I am truthful, my therapist will end the relationship:

In most cases, therapists will only end the relationship if they are outside of their clinical scope or the treatment goals have been met. If you have met your treatment goals, that’s wonderful! Celebrate all of your hard work. You don’t necessarily have to end your relationship with your therapist, but you can talk about tapering off sessions or increasing the time in between appointments. If it’s loneliness that drives you to stay, your therapist will support you in exploring how to improve outside relationships. It is not okay that the therapy room is the only space where you are heard, validated and supported.

If your counselling goals are beyond your therapist’s knowledge and skills, they will admit this to you. It isn’t personal. Consider your experiences with other specialists. You may really love your hairdresser, but this is not the person who can necessarily answer your medical concerns. You connect with the clinician who is best able to meet each of your needs. If you keep asking your hairdresser for advice on all things medical, neither of you will leave satisfied or confident that your goals can be achieved.

2) What if they call the Children’s Aid Society (CAS)?

shame and postpartum. perinatal mental health. shame and pregnancy.

This is a common myth that prevents parents from reaching out for postpartum therapy. Postpartum depression often shows up as rage, anger, outbursts and distress. I see many parents who are frustrated with themselves and with others, but are too scared to ask for help in fear of being reported. Postpartum depression deserves respect, compassion and appropriate support. The only reason to reach out to CAS is if there is a genuine concern about a child’s physical or emotional safety. If there is a worry about abuse or neglect, your therapist will ask you directly. However, yelling at your child does not mean an automatic phone call for outside authorities. Having negative or intrusive thoughts does not mean we are automatically contacting outside authorities.

3) What if my therapist dislikes me?

shame and postpartum. perinatal mental health. shame and pregnancy.

I can’t speak for other therapists, but I can speak for myself about this worry. The beauty of Internal Family Systems (IFS) therapy is that IFS therapists are always looking for positive intentions. This means, irrespective of the behaviour, words, or emotion (anger, infidelity, jealousy, disgust, etc), your IFS therapist is always trying to understand how there are parts of you trying to get you through a difficult moment. It’s not about assessing whether the outcome is successful or whether the efforts are worth it. It’s about understanding the actual intention.

IFS therapists go to their own therapy. It’s how we do the work we do. If I feel triggered in a session, that’s an indicator that there is some part inside of me needing support and attention. It has nothing to do with you; it has to do with my own history and experiences. That part, similar to yours, will need support and processing. I take it to my own session or my supervisor. IFS therapists’ intentions are always to keep our parts out of the session, because in therapy, it really is about the client. It’s not about my agenda or my needs; it’s about yours.

The shame of not meeting our own expectations:

You had lots of hopes and dreams of how your pregnancy or postpartum months would turn out. Chances are you did not wish for mental illness.

Many of us struggle when our expectations are not met. We feel a sense of shame and inadequacy in falling short. You may have hoped to be a Pinterest-parent, and realized you have zero interest in arts and crafts. Perhaps you thought you’d enjoy spending days with the baby, and found you were bored out of your mind by week 4. Maybe you thought you’d ace the whole sleep training thing, only to be struggling 15 months later with a toddler who refuses to go to bed. Somehow these results create a sense of failure that we equate into our self worth.

For any parent who struggles with this sense of “inadequacy”, please know that you are not alone. We all have moments where we worry about being good enough parents. Remember that you have so many years ahead of you to figure this out. We often label ourselves as success or failures, but we fail to pay attention to all the efforts and practice we need to improve our skills. We will screw up many times, and we will learn constantly. In this way, there is always space for us to grow.

goals, high expectations. shame and parenting

It isn’t fair to assume we’ll be great at parenting from day one. Think about how it was like when you first learned to drive. In the start, you were in the “conscious incompetent” stage where are very aware that you have no idea what you are doing. However, with time, you get to a place where you can automatically drive your car. Unfortunately, when we are at this place of “unconscious competence” (a.k.a. “I don’t have to think about it, I can do it in my sleep”), we forget how much we initially struggled. We forget the intensity and shame of not doing well.

Make it safe

We can all play a role in reducing the shame of mental illness and perinatal mental health. Talk about your experiences openly with safe others. Offer validation and compassion to those who are in this phase of life. Reach out to a therapist that you can trust. We can work to shift away from judgment, and instead, appreciate that we are all doing our very best.

Warmly,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Uncategorized

Little Known Ways to Surviving The Newborn Stage

If you are in your first few days of parenting, congratulations! Welcome to the club! 🙂 The newborn stage is exciting and petrifying. If you are a first time parent, you may be tested in ways that you’ve never dealt with previously. I hope the following tips will help you during these early days.

The 5 S’s.

A fussy baby is one of the hardest part of the newborn stage. It’s not like they can communicate through words, and chances are you’re starting to feel frustrated when you can’t figure out how to settle your little one. If you have heard of Harvey Karp and the Happiest Baby on the Block, this tip will seem familiar for you. Dr. Karp encourages a method that helps calm a fussy baby very quickly, which he refers to as the Five S’s:

Step 1. Swaddle:

Yes, it may seem that your baby hates being swaddled. Your baby may kick up a storm or try and escape those tight confines. However, the swaddle resembles the safe and snug cocoon of the womb, which will feel comforting and familiar. Keeping your little one swaddled also prevents him from accidentally waking himself up due to the Moro reflex. Rather than give up right at this stage, get your baby swaddled and move forward to the next step. (TIP: Using swaddles with a velcro attachment will make life much easier because it reduces the likelihood of babies wriggling out).

Step 2. Side/Stomach position:

When babies are lying on their back, it often feels like they are falling. They are likely to display the Moro reflex when this occurs. While sleeping on their back is necessary, holding them on their side or stomach is a fast way to help soothe a fussy baby.

Another influencing factor is that your little one is watching you trying to comfort her. Although you are using a soft and soothing approach, you may end up stimulating her by maintaining eye contact. The next time you are trying to settle your little one, try holding her in this hold, and see how she responds.

Step 3. Shushing:

Your current strategy may involve ensuring the house is completely silent when it’s time for baby’s nap. After all, having a quiet and dark environment is the ideal way for you to go to sleep. Ironically, a silent environment is not as helpful for babies. When babies are in the womb, things are loud. They can hear all sorts of noises coming from inside of you (e.g. blood flow) and from your external environments (e.g. conversations). Rather than keeping a quiet space, it’s best to include white noise to mimic these familiar rumbling and indistinct sounds. Try setting up a white noise machine (or using a free app on your phone) to help introduce some sound to their sleep environment.

Step 4. Swing

The fourth step: Swing

While gentle rocking or swinging motion will be helpful, what is most effective in calming a fussy baby is using a bobblehead-type movement. The womb is not a smooth, gentle place. Instead, it’s quite jiggly. Take a look at the following video to demonstrate how to create the right swinging movement.

Step 5. Suck/Soother

The soother is either your best friend or your nemesis at this point in time. Many parents find that their baby takes the soother right away and it is a fast way to stop the tears. There is an equal number of parents who have bought 14 different soothers and feel frustrated that their baby continues to gag or spit them out. I find this video really helpful for introducing a pacifier.

Seeing it all in action

The following video shows Harvey Karp incorporating all of these tips together. Again, the newborn stage involves a lot of tears. Putting the 5 S’s together is a fast and effective option to help your little one settle.

The 5 S’s in action

Beware of the Google Trap

google trap. anxious parents. Surviving the newborn stage.

It’s easy to keep researching things. If you are anything like me during my first postpartum experience, you will have diagnosed your baby with 20 medical issues (none of which were actually the case). This is super common, and everyone is aware of the vulnerability of searching on WebMD when anxieties are high. Rather than getting into this spiral, reach out to your health care team (e.g. lactation consultant, family doctor, nurses, social workers). You may worry about “bothering” your health team, but I promise you, they are used to parents reaching out. It is common to have questions , especially if this is your first baby. Whether you are struggling with breastfeeding, worried about baby’s health, questioning your relationship, you don’t have to figure it all out by yourself.

Stay Connected

Whether it’s an online forum or with your fellow friends and neighbours, it’s important to have others to talk to. Getting through the newborn stage is tough. There are a lot of questions and anxieties as the baby does new things (or doesn’t do new things). Please know that with every worry you have had, another parent has dealt with the same fear. Anxiety is normal.

Online communities (e.g. What to Expect) are especially helpful for addressing fears that occur in the middle of the night. There is almost always someone available to support you irrespective of the time of day. Speak to your friends, family, and partner. Sometimes our anxieties can escalate. In these moments, it’s helpful to talk them through with a grounded and non-judgemental person.

Get some sleep

In the beginning, when you are on a two-hour feeding cycle, it may seem that sleep is impossible. The idea of sleeping when baby sleeps feels like a joke. This baby never rests unless being held. Whatever the circumstances are with your baby’s sleep patterns (or lack thereof), you still need some rest. I encourage all parents to find opportunities for shift sleeping. Decide among yourselves who is a night owl and who prefers early mornings. Have a bottle ready and let your partner be in charge for those hours. Ideally, you are trying to get a 4-hour chunk of sleep so that you have the opportunity to enter REM sleep. Remind yourself that this is not permanent. While, it’s hard and challenging, your little one will eventually sleep through the night.

Know when your baby is in Active Sleep

I remember that I used to rush in whenever my kids made the slightest noise during the night. I’d assume they were awake, needing another feed, and that I would have to help them settle in some way or form. Unfortunately, my attempts to intervene only frustrated them. This is because I was actually interrupting their active sleep.

Active sleep is noisy! It involves grunting, squirming and even crying. Of course, in my sleep deprived and anxious state as a first time parent, I would see these cues and rush over to “soothe” my eldest, not knowing he was still resting. This tip involves identifying active sleep, and learning to stay out of the way when baby is resting. This video is a great resource to help you identify active sleep:

Attachment can take time

Some parents feel enamoured with their baby from day one. However, many parents do not feel this way. Building an attachment with your baby can take time. It is perfectly normal to feel scared, overwhelmed, confused, nervous or a variety of other emotions when you first meet your child. The newborn stage is meant to be a time where you develop a relationship. You get to know your child, and like any other relationships, you build trust and communication.

Will this tiny person ever stop crying?

There is a hormonal surge that kicks into full gear as soon as we hear the baby cry. You may be among the few who dash from one end of the house, leaping through obstacles in order to stop the tears ASAP. Alternatively, you may feel a rush of anger coursing through your body when you hear your baby wailing. Both responses are common. Our lovely friend, oxytocin has turned things up a notch making parents incredibly sensitive to a newborn crying.

When you hear someone in distress, it triggers you to respond. You will reach for your baby and start to sing, rock, or nurse. You will use any old tricks to help her calm down. However, if you have found this experience tiring or unsuccessful, those tears can make you feel plagued by helplessness and anger.

What to do if you feel anxious or angry about your baby’s tears:

  • Pause for 15 seconds. Yes, your natural instinct is to rush and rescue, but give yourself a moment to regulate. Give your baby a chance to settle.
  • Remind yourself it’s not personal. Your baby is not mad at you. You are not a bad parent. Babies cry. All. The. Time. It’s their only way of communicating. Sure, it makes your blood pressure skyrocket, but it’s the only way they can let you know something is up. Trying to decipher those tears will take time and practice, but you and your baby are doing your very best in figuring it out.
  • Write a plan for yourself. When your baby is fussy, what will you do? Perhaps you will follow the 5 S’s listed above. You may choose to sit in a rocking chair. You might whip out a bottle to nurse him back to calmness. Whatever option you decide, it’s helpful for you to feel confident and aware of your next step.
  • Ask to switch out. If you’ve already been taking care of a fussy infant all day, you may feel at your wit’s end. Tap out. Have your partner, friend, family member take over for an hour. Try and get out of the house during this time if you’re fighting the urge to run in and fix, correct, or offer suggestions. Take this time for self-care.
  • Shower yourself with positive affirmations. Ideally you’re saying these positive thoughts to yourself. However, if that is too hard, have a loved one reassure you. Get your daily reminder that you are doing your best. These difficult moments do not make you a bad parent.

Reach out

Postpartum anxiety and depression are common and difficult struggles. They go beyond the stressors of the newborn stage. You may find that you are constantly irritable, overwhelmed, unable to sleep, feeling miserable, or disinterested. If you are struggling, please do not stay silent. Your moods can get better. Reach out to find out more.

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum

The pressures of breastfeeding

That first year with a baby is all about feeding, feeding and more feeding. For every parent, there is a time when he or she decides whether to breastfeed, exclusively pump, stick to formula, or use a combination approach. There are a variety of factors that push a parent towards one choice over the other. There is no “right” choice outside of what works best for a caregiver and baby.

pressures of breastfeeding. support for parents who are struggling to breastfeed

Unfortunately, there is a push in our society to breastfeed. We see signs of it right from the day we deliver. There are subtle cues from healthcare staff as they share latching tips before inquiring whether formula is preferred. We are provided pamphlets of breastfeeding support in our care packages before bringing our newborns home. There are posters for breastfeeding help at our midwives’ office.

This blog post is not to push formula feeds. I have no right to claim whether formula is better than breastfeeding, or vice versa. Ultimately, I am true believer that fed is best. As long as your baby is getting the nutrients he or she needs to develop, I consider it a win. Instead, this post is for the parents who are struggling to breastfeed. Whether by choice or by capacity, they are stuck in that internal battle of guilt, frustration and helplessness as they face yet another feed.

The pressures of breastfeeding:

We live in a culture where breastfeeding is encouraged and subtly (or sometimes, not so subtly) pushed as the best option for our baby. New mothers face an onslaught of judgemental messages about breastfeeding, and these comments are made in permanent and absolute terms: “breastfed babies have higher IQs”, “breastfeeding will prevent illness, infections and chronic conditions,” “breast is best,” “you won’t have a good bond if you formula feed,” etc, etc.

struggling with breastfeeding. postpartum support. new mother.

I agree that there are a lot of values to breastfeeding. However, I also work with parents who are driven to the point of exhaustion and anxiety in trying to produce enough supply for their baby. These parents are so angry at their bodies for failing them and not doing enough to support their baby’s growth. If the option of working with a lactation consultant or consuming fenugreek daily is working, then please keep it up! In fact, I encourage you to start here if you truly want to breastfeed. However, if your baby is losing weight, you are feeling stressed out, or are experiencing any number of production difficulties, I want you to take a moment and consider why you are trying to keep up with this expectation.

The “Mommy Wars”

New parents would love to have the ideal postpartum experience. We see images of celebrities looking beach-wear ready a few days after delivery. We see influencers posting feeds of their babes sleeping through the night. There are endless tweets and posts about the “right ways to parent”.

pressures of parenting. super mom. mommy wars.

With all of these messages of ideal parenthood, it makes sense that we are self-conscious about our own parenting. The Times wrote a beautiful article in reference to the Goddess Myth: “Like millions of other American moms, [mothers have] been bombarded by a powerful message: that she is built to build a human, that she will feel all the more empowered for doing so as nature supposedly intended and that the baby’s future depends on it. ” With this constant push for doing things “naturally”, moms carry the stress of parenting a certain way. There is a need to delivery vaginally, breastfeed on command, only feed your body the “right” foods, and of course, look stunning throughout the process. Of course, mothers then bear the burden of immense guilt when they are unable to meet these pressures.

This push to parent in a specific way also comes from mom-shaming experiences. These experiences can include rude comments and glances from others as a new mother orders a second cup of coffee, buys a drink, and of course, pulls out some formula. It’s as if there is a moral obligation that has been violated by not following the rules others deem best for our children. It’s no wonder that new parents are surrounded by a sense of failure and dread as they step into parenting.

Know that you’re not alone

The American Pediatric Society encourages breastfeeding for the first six months of your baby’s life. While 80% of mothers start off with this intention, the Center for Disease Control and Prevention state that only about 58% make it to the six months.

Why is this? Breastfeeding is described as natural and easy; however, any parent who struggles with breastfeeding can vouch that this is not the case. From poor latches, supply issues, mastitis, and other complications, many women start to experience a sense of dread when it comes closer to feeding times. These parents may undergo a period of grief as they cope with the disappointment of needing to put aside their hopes for breastfeeding.

Other parents prefer to not breastfeed. This decision could be based on a variety of reasons: struggles with hormonal shifts while breastfeeding, managing the demands of other children, returning to work, wanting support with nighttime feeds, sexual abuse histories, or simply not wanting to feed in this way. These are not selfish or bad parents. They care deeply for their children while also respecting their own boundaries. At the end of the day, a happy parent is better able to support their baby. If formula feeds provide a calmer structure for the parent, then this is the right decision for this family.

Worries about attachment

Sometimes we push ourselves because we think it’s what’s best for the baby. Sure there are physical benefits to breastmilk, but there are significant benefits to having a grounded and calm parent. If you are overwhelmed everytime you start nursing, that bond is going to feel so much more difficult. You have years to build and nurture the relationship with your child. It does not have to be perfect from day one. Listening to your mental, emotional and physical limits will set you up for success.

For those who feel that nursing creates a better attachment, I encourage you to consider your attachment with your own parents. Are you truly better connected with your mother because she chose to breastfeed versus formula feed? Is your IQ significantly higher than a peer who was formula-fed? Who even asks these questions today of other adults?

You are doing your best for your child

cheerful young multiethnic parents admiring sleeping baby on bed
Photo by William Fortunato on Pexels.com

A hungry baby is a cantankerous baby. A guilty mother is an unhappy mother. Pressures that come from strangers, the internet, and sometimes our own friends and family are perhaps meant with good intentions. However, you are this child’s parent. And if you are feeling stressed and guilty about breastfeeding, you are allowed to stop. You will always be this child’s caregiver, and your bond can be secure irrespective of how you feed this little one. Your baby will grow up and eventually eat food, and this pressure to breastfeed will no longer be the central focus of conversations. So for now, go and enjoy your child. Focus on getting those baby snuggles. Spend time playing, singing, talking, and teaching him or her. And when your little one gets hungry, feed them in whatever way is feasible for you.

All the best,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum

What is happening with my mood?! D-MER and Breastfeeding

What is your experience with breastfeeding? Do you feel angry or tearful as soon as you start? Is there a sense of dread when you begin another pumping session? How intense is your anxiety during these moments? When it comes to nursing, there are many parents who enjoy the experience and feel it’s an opportunity to connect with their infants. However, there are also many parents who are frustrated and distraught by the same encounter. Before we assume that the reason we are struggling with nursing is due to postpartum mental health, we want to rule out a physiological illness called D-MER.

Signs of D-MER:

Dysphoric Milk Ejection Reflex (a.k.a. D-MER) is a breastfeeding struggle that occurs during letdown of milk. This includes nursing, pumping, or manual expression to release milk. Normally when lactating, parents experience the warm and loving feelings that come with an increase in oxytocin. However, with D-MER, a caregiver has a sudden drop in mood, and can experience any of the following difficulties:

Breastfeeding and D-MER. Anxiety, sadness or distress during pumping
  • dysphoria, or a state of unhappiness
  • panic
  • restlessness
  • hopelessness
  • anger
  • anxiety
  • sense of dread/doom
  • paranoia
  • thoughts/urges about suicide or self-harm

D-MER most commonly shows up as anxiety, agitation or sadness. The intensity of these experiences can vary from mild to moderate to severe. These symptoms can last anywhere from a few seconds to 2-3 minutes. It typically shows up about 30 seconds prior to milk release. D-MER struggles subside as you continue to nurse, but reoccurs as soon as another let down happens. Typically, parents start to feel better after 3 to 6 months once milk production regulates. Unfortunately, there are no specific tests or assessments to confirm you have D-MER. If you notice an abrupt shift in mood when you are pumping or nursing, it warrants considering whether D-MER is a factor for you.

D-MER versus Postpartum Mental Health

Breastfeeding and D-MER. Anxiety, sadness or distress during pumping

D-MER is a physiological issue. It happens because of hormonal and chemical changes in the brain during breastfeeding. This is not a psychological issue, although it certainly feels like one. Folks who have a history of mental health struggles are not more vulnerable to experiencing D-MER. It is completely by chance. Parents who have experienced D-MER with their first child have a higher likelihood of experiencing it again with future children.

D-MER is not the same as postpartum mental health. While an episode of postpartum anxiety can last for hours or days, D-MER lasts a few minutes and only occurs during the release of milk. Once breastfeeding is completed, parents moods regulate and they are able to re-engage in their daily activities. Unlike any prenatal or postpartum disorder which involves a combination of biological, psychological and social influences, D-MER is caused solely by hormonal shifts.

This does not mean that the two are mutually exclusive. Parents with perinatal mood and anxiety disorders can also struggle with D-MER. If this is the case, then a combination of treatment is useful in order to address both needs.

Why it happens:

D-MER has only recently been identified as a breastfeeding struggle, and research has started in the past 10 years. However, dopamine has been identified as the primary influencer to experiences of D-MER. Dopamine (a hormone connected to feelings of pleasure) must drop in order for prolactin (the hormone which helps produce milk) to increase. What research has found with D-MER is that the drop in dopamine is too significant during milk letdown, which triggers an abrupt drop in moods.

What you can do if you have D-MER:

The first and most important thing to remember about D-MER is that it is not your fault. You are not doing breastfeeding or parenting incorrectly. This is truly a chemical change that is happening outside of your will power. It is not a psychological issue, and there is absolutely nothing “wrong with you.” It’s an automatic reaction, and the emotions and thoughts that come with D-MER are not based on facts, reality, or any truth to your capacity as a parent.

Approximately half of nursing parents stop breastfeeding by 6 months. This can happen for a variety of reasons, and only you are the judge of what is right for your body. If D-MER is one of the reasons to stop breastfeeding, it may be helpful to know that most parents struggling with this issue feel an improvement of symptoms in 3 months once milk production regulates.

Connecting with your health care team:

Lactation struggles. Perinatal mental health. Speaking to physician

Knowing that this ailment is a chemical imbalance, it’s best to speak with your physician or lactation consultant about your experience. In moderate to severe cases of D-MER, treatment options will likely involve medication or herbal supplements to support adequate dopamine production.

Behavioural Strategies

With milder versions of D-MER, there are several behavioural strategies that can be used to support your nursing experience. Firstly, it is helpful to keep track of your symptoms. What varies on days when your D-MER symptoms are worse? Common factors that can improve or exacerbate D-MER include: stress, rest, caffeine intake, hydration, and exercise.

Changing the Pattern:

Using distractions to help during breastfeeding.

Secondly, we want to create a more positive experience when nursing or pumping. When we know we are walking into a stressful event, our system braces in anticipation. With enough occurrences of D-MER, parents are typically anxious about lactation. To break this pattern, we want to pair positive experiences with breastfeeding. While nursing or pumping, add in a pleasurable activity that you can use as a distraction. Options can include: listening to your favourite podcast, reading a novel, playing a game on your phone, watching your favourite TV show, eating a delicious piece of cake. Use this activity only when you are breastfeeding to help your system create positive anticipation.

Mindfulness

Thirdly, mindfulness practices can be used to help during this time. When our system anticipates threat, we are hypervigilant of all signs and symptoms related to the threat. Unfortunately, this can make things worse because we are fixated on every nuance that can go wrong. We can also get caught in a negative spiral after breastfeeding is done because we continue to think about the experience and fret about what did not go well.

Mindfulness involves choosing a neutral anchor to focus our attention. For example, you can focus on the sensation of holding your baby, or keep count of baby’s gulps during a feed. You can pay attention to your own body or breath. You may also focus on external anchors like listen to music or noticing what is outside in your backyard. Your mind may wander, and mindfulness involves re-directing your attention to the safe and neutral anchor whenever this occurs.

Breastfeeding is Tough

There are a lot of factors that can influence our postpartum year, including breastfeeding struggles and D-MER. At the end of the day, no one can or should make the decision to start or end breastfeeding other than you, the lactating parent. If you find your mental health is influenced by your breastfeeding experience, please reach out. You do not have to struggle in isolation.

Take care,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum · Parenting

Building a bond with your baby: Strategies to help when you struggle with postpartum mental health

When it comes to postpartum mental health, many parents struggle to building a connection with their little ones. There may be feelings of resentment that our lives have changed. You may feel too tired to want to play or sing nurseries. Your anxiety feels too high for you to be comfortable spending time alone with your infant. Whatever the reasons may be, you’ve been coping these months by maintaining an emotional distance from your child and feel desperate to build a bond with your baby.

I want you to know that attachment can be formed irrespective of postpartum mental health. Our relationships can always grow and develop, even when the onset was rocky. The first five years with your child are pivotal, and there are many things that can be done from hereon in to nurture this new relationship safely and without overwhelming your nerves or emotions.

The following strategies will help you feel more secure to meet your baby’s needs. No, they’re not all about singing songs or giving massages. I recognize that singing and massages are great options, but not everyone is at this starting point. So, let’s start slow so that we can get you to a place of feeling more confident to building a better relationship.

1. Introduce your infant to activities that you enjoy doing.

bonding with your baby, attachment, postpartum depression, postpartum anxiety, strategies to cope

When the bond with your baby is already feeling tested, it’s incredibly hard to push ourselves to do “baby-focused” activities. Your motivation and desire to encourage tummy time or play peek-a-boo is next to nil. When you feel this way, it’s not helpful to ask you to force it. This may work for a day or two, but a stressful event will likely bring you back to square one. Instead, I want to encourage taking small steps that will feel more manageable for your system.

When you focus on your hobbies and interests, you’re often able to relax. There’s less pressure to perform. You have less anxieties about ensuring you’re “doing it right” and, instead, can just enjoy the task at hand. Whether it’s going for a run, cooking a meal, painting, reading a book, playing dungeons and dragons, there are creative ways to bring your baby into your world. Bust out that jogger to take your little one on a run with you. Introduce your baby to different smells, and speak to her about the different spices that are going into your meal. Show her the different colors you’re using while painting. Read outloud from your book so that your baby learns new words. Have her roll large dice for your various rounds in a board game. There are ways to still be you and foster your own interests while including your baby.

2. Build confidence with a support person

When you’re feeling insecure about being a parent, the pressure of parenting independently can feel like too much. Let your partner, friends, or family members know how you feel. Your sense of overwhelm with the baby does not mean you cannot be a good parent. Attachment struggles are a common sign of postpartum anxiety. Rather than avoid your baby all together (many have been here!), or become flooded with frustration or resentment, try and share the load.

postpartum mental health, attachment, bond with baby. family support.

Speak with your family members about spending more time together so that you can grow into this role. It’s easier to play with the baby or learn to handle colicky moments when you have a safe friend or family member supporting you. Your trusted person may give tips (tell them to cool it if it feels too much), or may provide you encouragement as you try. They may be wonderful at providing a distraction, so that you’re less focused on doing things perfectly. This support should also include your friend providing you a time out when you have met your limit and need to take a breather.

adult affection baby child
Photo by Pixabay on Pexels.com

A word of caution that it can feel tempting to step away and allow your family member to take over. But if you are hanging out with your little one and there’s a fellow adult around, the conversation feels easier, and there’s less strain to manage by yourself. When you’ve had enough practice with your infant, speak with your support person about coming over for shorter visits. By slowly reducing the amount of support available, you are practicing gradual exposure. This type of practice helps you work set realistic goals within your window of tolerance, and slowly build confidence as you spend more time independently parenting.

3. Make sure you are getting enough time to sleep.

postpartum mental health. building bond with your baby. sleep.

I know this point sounds strange as far as suggestions to improve the bond with your baby. However, one of the biggest turning points for postpartum mental health is having enough rest. You will never feel at your best if you are working off days or weeks of sleep deprivation. Trust that you will feel calmer, more energetic, more engaged and more like yourself when you’ve had sleep. Once you’ve had a solid week or two of rest, check in on your feelings towards your baby. Are you still feel that intense aversion or fear or has it shifted a bit?

For new parents, I strongly encourage working collaboratively to at least have longer segmented sleep. This might mean that one parent takes an early morning shift so that the other gets to sleep in. Or vice versa, whoever is the night owl takes on the later evening feed so that the other can rest. Understandably, parents will have to consider their comfort levels with pumping or formula feeding. While this is a personal choice, I want to emphasize that your system will feel significantly better after having at least four solid hours of rest.

4. Eye contact and Communication

Eye contact and verbal communication are effective ways to building a bond with your baby. These verbal and non-verbal cues help foster language skills and emotional intelligence in your little one. Your baby starts to recognize faces, understand facial cues, and builds a sense of safety with you. By communicating more, your baby will pick up on various words and gain a stronger understanding of language.

attachment and bond with your baby. Eye contact. postpartum in moms and dads

Maintaining eye contact can be incredibly difficulty, particularly if you struggle with attachment traumas or social anxiety. This strategy may not feel right for everyone, and I encourage you to be kind to yourself and where you are in your healing process. If it feels manageable, try and look directly at your baby while breastfeeding, changing diapers, and when doing any tasks related to your little one. Feel free to look away when the baby loses interest or is over-stimulated. I want to emphasize that doing even a little bit is better than nothing at all. If you are able to maintain eye contact while changing a diaper but feel overwhelmed during breastfeeding, work with that capacity.

Many parents with postpartum depression struggle to spend time with their babies, and it’s a big ask to encourage them to speak to their infants more often. If you are not “feeling it”, you don’t have to coo, speak in baby-talk, or sing nursery rhymes. Keep it simple. Describe what you’re doing in that moment with your baby, even it if it sounds like a tedious play by play. Talk about things that interest you in front of your infant so that they hear the variance in your speech patterns. Have conversations with other adults in front of your babies so they can witness different verbal and non-verbal expressions.

5. When there are no words, use hugs.

Perinatal mental health. Crying, fussy baby. Improving bond. improving attachment

Sometimes the baby cries, and it’s the most aggravating experience. You can’t figure it out. You have tried changing diapers, feeding, rocking, and nothing is working. Rather than stress yourself further, if you have the ability, focus on just holding your baby. There’s no need to walk around or figure out a soothing gait. Spend that effort on giving your baby a gentle hug. Touch is one of the most reassuring options for your infant and it provides them a sense of safety. Having that skin to skin contact, when you don’t know the right words or actions to take, can help both you and the baby feel calmer. Building a bond with your baby can involve a variety of different strategies, but sometimes the simplest action of being held can be enough.

6. When there are no words, walk away.

time outs. improving bonds. frustrated dad.

I know this seems contradictory to the previous point, but this is to give you the option to decide your current capacity. I encourage you to start with hugs when you are capable of this action. When you feel you cannot take it, and you are at your max, it’s essential that you have permission to put the baby in the crib and walk away. Giving ourselves timeouts is a wonderful option to take a break, find ways to regulate, and try again after a few minutes. I encourage using a distress tolerance skill (e.g. dialectical behaviour therapy skills like ACCEPTS or changing temperature) during your timeouts as it is a fast way to calm your system.

7. Plan your day

Boredom can be a significant trigger for many people. When you are bored, your mind starts to wander and, oftentimes, you’re back to that pattern of anxious, racing thoughts. Boredom can lead you to that rabbithole of social media where you fall into the trap of comparing your life to others. Boredom can be a common push factor towards drinking. When we are aware that boredom plays a role in our emotional struggle, we can form a plan. When your mental health improves, your ability to build a bond with your baby also improves.

While parental leave can be wonderful, it can also involve long and tedious days. In many ways, going to work provides us a lot of stability: we have a consistent routine of getting up, tasks to accomplish, opportunities for social interaction and consistent break times. If we know what the day will include, it can ease our anxieties, and we can plan ahead for boredom.

So, what will you do this week? Can you try and wake up and go to bed at the same time each day? Do you have opportunities to socialize each day? Are there playdates that you can schedule, outings that you can plan, activities that you’ve wanted to try out? Are there new play gyms that are available in your city? Will you register for a new online parent and baby class? Are there some new and exciting activities or hobbies that you’ve been wanting to take up (with or without your little one around)?

8. Building a bond with your baby does not require perfect parenting

Parenting has become a dreaded term. It’s a job that involves a lot of effort and patience on your part, and very little on the part of your babies. And as with any job, you may be striving to do it right. While your intentions are commendable, the desire to parent well can sometimes lead to additional stress.

When it comes to providing for your baby, “good enough” is more than enough. We are not able to get it right all the time, and it’s unrealistic to expect this of anyone. There are always going to be factors that pull our attention and that prevent us from being able to attend to our child’s emotional cues. In reality, we only get it right about 30% of the time. Other times, we are completely missing the mark on our babies’ cues or working to repair that misattunement. This is perfectly normal and expected in all parents. Rather than getting our hopes up to parent perfectly, we can focus our attention on repair if we have made a mistake. Repair work may involve: apologizing if you’ve been cross, paying attention if your child is trying to engage you in play, or providing that gentle hug if your baby gets frightened by your exasperated sigh. Our expectations can ease when we know that we will only get it right 30% of the time AND that this 30% attunement is what we can expect even in the most loving and secure of relationships.

Reach out

Everyone’s situation is unique. I don’t want to assume that the points I’ve listed out are going to meet your specific needs. If you are struggling with postpartum mental health and you’re concerned about the bond with your baby, reach out for a free consult. Postpartum mental health is treatable. You can get better, and your relationship with your child can be positive.

Take care,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Trauma · Pregnancy and Postpartum

Understanding Birth Trauma

You’ve been patient, waited 9 months, and dealt with all of the aches, nausea and fatigue in order to get to your delivery date. You may have an ideal birth story in your mind; many of us do. Some parents imagine a specific atmosphere while delivering (e.g. support people around, delivering at home). Some parents plan pain management strategies (e.g. I want an epidural). Others are keen to have skin to skin contact immediately after delivery. No matter what your plans are for delivery, there is hope that things go smoothly. Unfortunately, birth trauma can pull us far away from our ideal birth story.

Trauma is an unexpected and stressful experience that alerts our system of danger. We become acutely aware of impending harm or threat to our being. A birth becomes traumatic when we are fearful that we, or our baby, will die. Birth traumas happen in about 1 in 4 deliveries. These parents experience feelings of being abandoned, helpless, disrespected, scared, overwhelmed or powerless during their birth experience. Approximately 9% of parents experience their moods worsening into a diagnosis of postpartum post-traumatic stress disorder.

Types of Birth Traumas

There are various complications that can happen during or after delivery. Common birth traumas include:

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.
  • Emergency treatment following birth (e.g. stay in NICU)
  • Stillbirth/neonatal death
  • Preterm deliveries
  • Assistance during delivery (e.g. use of forceps)
  • Unplanned c-section
  • Prolapsed cord
  • Feeling a sense of abandonment or powerlessness
  • Lack of support or clarification during and after delivery
  • Lack of privacy or dignity
  • Physical complications (e.g. postpartum hemorrhage, unexpected hysterectomy, perineal tears, prolapsed uterus)

Following these birth traumas, caregivers begin to notice a change in their own moods and capacities. Similar to post-traumatic stress disorder, survivors can experience:

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.
  • Extreme sensitivity and awareness to surroundings (a.k.a. hypervigilance)
  • Easily startled
  • Difficulty concentrating
  • Change in appetite
  • Memory blocks (unable to remember parts of the traumatic experience)
  • Difficult coping behaviours
  • Intense shame, irritability, or anger
  • Suicidal urges
  • Sleep difficulties and nightmares
  • Difficulty in social relationships
  • Unpleasant intrusive thoughts
  • Flashbacks
  • Pain, sweating, trembling, when thinking of the birth
  • Avoidance of birth reminders (e.g. being with own child, seeing other babies, hearing other birth stories, medical settings)
  • Anger towards medical professional or others involved during delivery
  • Poor attachment with baby

As with any mental health struggle, this is not a matter of will power. You are not choosing to respond in this way. You are not in control of these overwhelming emotions. When traumatic experiences occur, our system cannot always manage. We lean into whatever coping strategies are available to help us survive. Some of these coping strategies are done intentionally (e.g. avoiding the baby), and other times, we have limited control over them (e.g. bursts of anger).

What influences PTSD?

During the first month following a birth trauma, we want to monitor a parent’s well-being. This time is pivotal. Trauma survivors continue to assess the world and whether it is safe and predictable once again. They need to see that this birth trauma is a unique experience, and that it is highly unlikely to reoccur. Grief, anger, anxiety, wanting to understand, and seeking support are all natural forms of processing that tend to occur during this phase. The body’s ability to naturally process and return back to a sense of safety can be influenced by the following factors:

Prenatal Stressors

Prenatal stressors can include miscarriages, unplanned pregnancies, health scares, physical complications, unexpected bed rest, or fertility stressors. During these months of pregnancy, an individual can survive a variety of unexpected hardships, such as financial burdens, divorce, or bereavement. Furthermore, some pregnant couples have lived through a traumatic experience earlier in life (e.g. medical traumas).

It is understandable that these parents enter the delivery room feeling more cautious and nervous. If we have experienced any of these earlier adversities, our nervous system has already been fighting for some time to cope. It is already experiencing symptoms like hypervigilance, intrusive thoughts and nightmares. When we have already experienced trauma, our window of tolerance becomes narrower. Another stressful event can push us past our limit of tolerance.

Interactions with medical staff

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.

The interactions you have with your healthcare team can immensely influence your experience of child birth. How did your healthcare provider connect with you following a miscarriage? Was there space for you to grieve or did your provider seem too busy? Was the physician empathetic or was he or she scornful? If you are already wary of medical staff, how would you feel entering a delivery room?

Deliveries are busy times times, and your healthcare team is focused on moving things as efficiently as possible. However, at a time when you feel vulnerable, it can easily feel like your healthcare providers are curt, dismissive or inconsiderate of your emotional needs. When decisions like C-sections or taking the baby immediately to NICU are outside of your decision making, it can feel like your autonomy and sense of control has been taken away. The medical team’s decision to take these steps are likely valid; however, caregivers are left feeling powerless and confused.

Lack of support

It is natural to want to hide when we are grieving. It is natural for us to avoid others if we feel ashamed or responsible for a difficult birth. Isolation and loneliness tend to worsen our moods. There is so much healing that occurs when we feel someone truly understands and recognizes our pain.

When parents express grief and distress following a birth trauma, many family members do not know how to respond. Our friends and family have good intentions when they reassure with comments such as: “At least the baby is here,” or “Count your blessings,” or “Be grateful for what you have”. These types of comments are, unfortunately, invalidating. A parent continues to feel alone and misunderstood by their support team.

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.

To offer better support, please ask caregivers if it’s okay to be with them during this time. If these parents want to talk, please listen with an open-heart. When we are grieving, our support team cannot fix the past or make the pain go away. However, by offering a safe space for these intense emotions, our friends and family provide us opportunities for healing.

Healing from a birth trauma:

Not everyone requires extra intervention following a birth trauma. Support from loved ones and time can be enough to help someone work through this intense and difficult experience. However, for more complicated situations, like postpartum PTSD, it’s imperative we reach out for help.

Eye Movement Desensitization and Reprocessing (EMDR) is an incredibly effective way to process and heal from birth traumas. This therapeutic modality helps an individual speak about traumatic memories while using bilateral stimulation (e.g. eye movement, audio cues, tapping) for short sets of time. In using this combination, EMDR triggers the traumatic memory network in the mind. Participants notice a reduction in distress and vividness to a traumatic memory. They also notice how the mind works to form connection with other events that have impacted this trauma, or have been impacted because of this trauma. Depending on the complexity of the traumatic events, clients can start to see improvement within 6-12 sessions. If you would like to learn more about EMDR, I encourage you to read this earlier post.

If you are struggling following a birth trauma, please do not stay silent. Reach out to a safe person such as a family member, friend, or a professional. If you would like to work through your birth trauma using EMDR or other effective therapy styles, please reach out.

Warm regards,
Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum · Mental Health

Postpartum OCD: The Curse of Never-Ending Scary Thoughts

While postpartum depression and anxiety have become more widely-understood, there is still limited research about postpartum obsessive-compulsive disorder. This mental health struggles occurs in approximately 1-10% of parents. Since postpartum OCD presents as excessive worrying and helplessness, it is commonly misdiagnosed as anxiety, or worse, it is dismissed as “normal worrying”.

person washing his hand
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When you think of OCD, your mind may jump to stereotypical examples like excessive hand washing due to a fear of germs. With postpartum-OCD, parents are often struggling with scary thoughts regarding the safety and well-being of their baby. As a forewarning, some of the examples shared below can be triggering. Please read with caution, and reach out if needing support.

The first element of OCD: Obsessions

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There are two key components that make up OCD. The first is obsessions. Obsessions involves intrusive and distressing thoughts, images, or beliefs that continue to repeat incessantly. Individuals struggling with obsessions do not feel in control of these thoughts, and are quickly overwhelmed. Common OCD obsessions include:

  • needing order or symmetry
  • fear of harming yourself or other people
  • unwanted sexual thoughts
  • religious obsessions (e.g. fear of offending God)
  • fear of limited or lack of control (e.g. acting on impulsive urges to shoplift)

Common obsessions with Postpartum OCD:

crop mom dressing newborn on bed
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  • Contamination fears (e.g. bottles not being cleaned thoroughly)
  • Fear that baby will get sick or die (e.g. sudden infant death syndrome, car accidents)
  • Sexually intrusive thoughts (e.g. what if I am turned on when changing my baby’s diaper?)
  • Concerns about hurting the baby. For example:
    • What if I drop the baby and her head cracks open?
    • Intrusive thoughts about stabbing/shaking the baby
    • Image of drowning baby in bathtub
    • Urge to scream at baby
  • Concerns that others may harm the baby
  • Stress about making the wrong decisions (e.g. feeding the wrong food)
  • Rigidity to schedules/routine (e.g. nap times, feed times)

The second element of OCD: Compulsions

An individual with OCD is aware that these obsessions are not valid or logical. However, because the images or thoughts are so distressing, it feels important to get rid of them quickly. This is how compulsive behaviours start. When an obsession becomes too much to handle, compulsive behaviours are used to manage them. If you’re scared of germs, you start to wash your hands. If you’re scared of your baby dying during sleep, you may need to check repeatedly during the night to ensure safety. These compulsions are not effective in actually eliminating or addressing the fear; however, they provide a quick fix in that moment. Because the intrusive thought comes back quickly, the compulsive behaviour is repeated in order to help the individual calm down.

Common Compulsions with Postpartum OCD

When it comes to postpartum OCD, these parents are overwhelmed by the idea of harming their baby or being unable to protect their baby. Compulsive behaviours involve any means in which to offer their baby protection. Examples include:

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  • Avoidance of the baby
  • Checking repeatedly to see if bottles/supplies are clean
  • Excessive-reassurance seeking from health care professionals to confirm that baby is safe and healthy
  • Removing all sharp objects from the home
  • Avoiding any news or media related to child abuse (due to fear of being turned on)
  • Refusing to give baby a bath
  • Refusing to change diapers (due to fear of sexually abusing baby)
  • Avoiding breast feeding or eating certain foods to prevent contamination
  • Excessive praying
  • Isolating baby from loved ones
  • Not driving in the car with baby

Some compulsive behaviours seem normal. After all, double checking that the bottles are clean, or peeping in to the nursery to ensure your infant is asleep are perfectly normal tasks that all parents practice. The concern with compulsions is when these behaviours are done repeatedly. When intrusive thoughts are too distressing and compulsions take up a large chunk of time, our quality of life starts to suffer.

The commonality of intrusive thoughts

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Most of us, irrespective of having a mental health diagnoses, will have disturbing thoughts from time to time. In fact, intrusive thoughts happen to approximately 80% of new parents. We’ll have a fleeting thought about falling off a balcony, driving into oncoming traffic, or yelling at our family members. When we are not fraught with distress and fatigue, we can usually shake our heads and call it for what it is: a strange thought. We may scoff and think it’s odd, but we don’t put too much thought into it, and can move on. For those with postpartum OCD, intrusive thoughts are so distressing that these parents assume there is some truth or meaning to these obsessions. Rather than shaking their head and saying “what a weird thing to think”, they become overwhelmed with guilt and shame at ever considering these thoughts.

Fears in reaching out

In a previous post, I had talked about some of the barriers that prevent parents from seeking help. One of the biggest blocks in reaching out for help is the fear that expressing these intrusive thoughts will lead to a call to the Children’s Aid Society. For those who struggle with this fear, I would like to reassure you that having a scary thought does not mean you are going to act on them! Parents with postpartum OCD have the best intentions for their children. They are overwhelmed by the fear of causing any harm that they are willing to practice whatever forms of compulsive behaviours to avoid this potential issue. Seeking help does not mean a call to the authorities.

postpartum OCD and anxious thoughts
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Postpartum OCD is not a “mom’s issue”; it can also be experienced by dads, adopted parents, and other caregivers. If you or a loved one is experiencing intrusive thoughts during the postpartum months, please do not stay silent. Postpartum mental health is treatable. If you are concerned about your own symptoms, but are not ready to talk, you can fill out the Yale-Brown Obsessive-Compulsive Scale to complete a self-assessment.

Take care,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.