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Planning Your Postpartum Period

After having this conversation with almost client I've ever had, I think it's time I put it to paper. It seems most everyone is afraid of PPMD (post partum mood disorders). I can understand why, they're really scary, and who wants to be incapacitated when you have a new child to look after?

Well, here's some information that may or may nor be new to you. Postpartum mood disorders are NOT limited to depression. It can surface as any type of common mood disorder people can get when they're not postpartum as well, such as PPD, anxiety/panic disorder, OCD, PTSD, and psychosis. These diseases look and act EXACTLY the same as your standard disease by that name, except that they are linked to a 'specific onset' of childbirth, or being postpartum.

This said, they have the same treatments as standard mood disorders do. Keep in mind though, that once a mood disorder is triggered, it may stay with you for life. In may cases, the mood disorder was not caused by having a baby, but there was a strong predisposition, and childbirth was just the right circumstance to set it off. In these types of cases it is likely the symptoms would have been set off later in life, regardless.

Some of the reasons cited for PPMD are changing hormone levels, the massive physiologic stress of childbirth, and the stress associated with adapting to your family's 'new normal' once the baby is home. I can't get my hands on it, but Sarah Fields, an author on PPMD has a GREAT article on this in Mothering Magazine from May/June 2007. Other respected authors on the topic are Heather B. Armstrong, and Susan Dowd.

A great test you can take to objectively assess whether or not you have PPMD is the Edinburgh Postnatal Depression Scale. Though it is important that if you have any of the risk factors for PPMD, you discuss them with your care provider, and intervene earlier rather than later.

The risk factors for PPMD are*:
-a history of severe PMS or hormonal troubles
-family or personal history of mood disorders
-assisted fertility treatments previous to pregnancy
-prior or current perinatal loss, miscarriage,or stillbrith
-personal history of violence rape or abuse
-a complicated pregnancy or delivery, or a cesarean delivery
-early or prolonged separation from baby
-difficult infant temperament
-poor social support
-lower socioeconomic class
-single marital status or a troubled marriage
-having multiples.
*list taken from multiple sources on PPMD, and hospital handouts on the topic

The things we can do to PREVENT PPMD are as follows:
-breastfeed your baby exclusively for 9-12 months
-have a doula present at your birth
-avoid interventions at birth
-have baby on your chest and nursing right away
-do lots of kangaroo care
-eat well for you and your baby
-exercise moderately

How you can make a plan for prevention before the baby comes:
-Either have dinners by design, or a whole freezer worth of food-- not worrying about lunch and dinner takes a large burden off a new family, as well as making sure you are eating healthy food. Have healthy snacks and water on hand as well.

-Have planned visits from friends and family that break the monotony of he day, and to provide support in the immediate postpartum period.

-If overburdened by visitors, simply don your robe before answering the door. No one will stay long if you're in your robe-- it's a subtle hint that this is family time.

-Let people help you! When they ask if you need anything, have a grocery list ready or ask them to change laundry or do dishes. This is the one time in your life people are really willing to help, so please let them. It makes them feel helpful as well.

-Don't worry about acting as 'host' when people come to see your baby. They can fend for themselves. Your ONLY job is to rest, eat, nurse, and snuggle. Let the mess be messy, and DO NOT feed your guests!

-Have a calender where each day you rate how your mood was on a scale form 1-10. Make sure you fill it in at the same time of day every day. This is to help you and your partner monitor any changes or worrisome behavior. If your partner notices you are not filling it in, s/he should check in on you and why that isn't happening, as it could be a sign of emotional issues.

-Remember that the baby blues are normal, PPMD are NOT. Seek help if you feel you need it and don't wait too long.

-Continue taking your prenatal vitamins, and consider supplementing with B vitamins, folic acid, or fish oils.

-Have things on hand that are simple pleasures for mom, like favorite candles, bath salts, movies, etc, and have them all set up with easy access for a mom with one arm dedicated to holding infant to breast.

-Find a moms group and go to it.

-Find a La Leche League meeting and go to it.

-Plan time to talk to your partner about things every day, or a special night once a week where you do a special activity to stay connected through all the changes in your life.

I also think it's important not to dwell on the possibilities here, there is every likelihood that you will be fine! There are memoirs out there, written by women who have survived PPMD, and they can be great help if you do find yourself with a little more than the blues. But take care of yourself, take care of your baby, let people take care of you, and in time, things will feel right again.

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