I’m just getting to know Michelle. She had her first baby 3 weeks ago and has been sad and irritable ever since. Her pediatrician was worried about her at the well-baby visit this week and sent her to me. She’d had a tough pregnancy (morning sickness that wouldn’t quit for what felt to her like forever), made tougher by the financial stress that came from her husband being out of work for several months. The doctor is worried that she and her baby aren’t getting off to a good start.

Sadly, moms like Michelle often feel alone and guilty. Not feeling what they think they are supposed to feel, they are embarrassed to admit to themselves and others that things aren’t going well. Just when they need help the most, many don’t reach out. Some start to resent their babies and begrudge them time and attention. They force themselves to do what needs to be done but don’t provide their newborns with the nurturing they need.

Still others give up on nursing, or holding their babies when bottle feeding, depriving themselves and their babies with the closeness that comes with the quiet feeding times. Propping a bottle is the best they can do. Overtired, irritable, and sinking into depression, life after birth isn’t at all what they expected.

As hormones shift and settle, it’s absolutely normal to feel what is commonly known as the baby blues in the weeks following birth. One of my clients described the first couple of weeks after her first child was born as PMS times ten. Others feel more emotionally fragile than usual and maybe a little weepy. Still others are surprised that they are on an emotional roller coaster, feeling great one minute and set off into tears by something that normally wouldn’t bother them the next. It’s all because the endorphins from delivery are leaving the new mother’s system and the body is resetting itself.

Different women react differently but normal baby blues are usually accompanied by moments of joy and wonder and happiness about the baby and motherhood. The emotions settle down after a couple of weeks and the routines and rhythms of new parenting get established.

But when those up and downs last more than a few weeks, and especially if they get worse, it may indicate that the new mom is developing postpartum depression (PPD). This happens to between 11 and 18 percent of new mothers, according to a 2010 survey by the Centers for Disease Control (CDC). Surprisingly, it can last anywhere from a couple of months to a couple of years.

Symptoms of Postpartum Depression

Postpartum depression looks like any major depression. Things that once gave the mother pleasure are no longer fun or interesting. She has trouble concentrating and making decisions. There are disturbances in sleep, appetite, and sexual interest. In some cases, there are thoughts of suicide. Many report feeling disconnected from their baby and some worry that they will hurt their baby. Feelings of hopelessness, helplessness and worthlessness immobilize them. Many feel guilty that they can’t love their child, which makes them feel even more inadequate.

In some cases, women develop psychotic delusions, thinking their baby is possessed or has special and frightening powers. Sadly, in some cases, the psychosis includes command hallucinations to kill the child.

Who Develops Postpartum Depression?

There are a number of issues that contribute to a woman’s risk of developing PPD:

• A prior diagnosis of major depression. Up to 30 percent of women who have had an episode of major depression also develop PPD.
• Having a relative who has ever had major depression or PDD seems to be a contributing factor.
• Lack of education about what to realistically expect of herself or the baby. Teen mothers who idealized what it would mean to have a baby to love with little appreciation for the work involved are especially vulnerable.
• Lack of an adequate support system. Unable to turn to someone for practical help or emotional support, a vulnerable new mom can become easily overwhelmed.
• A pregnancy or birth that had complications, especially if mother and baby had to be separated after the birth in order for one or the other to recover. This can get in the way of normal mother-child bonding.
• Being under unusual stress already. New mothers who are also dealing with financial stress, a shaky relationship with the baby’s dad, family problems, or isolation are more vulnerable.
• Multiple births. The demands of multiple babies are overwhelming even with substantial support.
• Having a miscarriage or stillbirth. The normal grieving of loss is made worse by the shifting hormones.

What to Do

In cases of the normal “baby blues,” often all a new mom needs is reassurance and some more practical help. Engaging the dad to be more helpful, joining a support group for new parents, or finding other sources of support so the mom can get some rest and develop more confidence in her mothering instincts and skills can put things back on track. As with any other stressful or demanding situation, new parenthood goes better when the parents are eating right, getting enough sleep, and getting some exercise. Friends and family can help by bringing some dinners, offering to take over with the baby for an hour or so so that the parents can get a nap, or by babysitting siblings to give the parents time to focus on the infant without feeling guilty or pulled in multiple directions.

Postpartum depression, however, is a serious condition that requires more than naps and caring attention. If the problem has persisted beyond a few weeks and has been unresponsive to support and help, the mother should first be evaluated for a medical condition. Sometimes a vitamin deficiency or another undiagnosed problem is a contributing factor.

If she is medically okay, those who care about her and her baby need to encourage her to get some counseling, both for the emotional support counseling offers and for some practical advice. Cognitive-behavioral treatment seems to be especially helpful. Since women who have experienced postpartum depression are vulnerable to having another episode of depression in their lives, it is wise to establish a relationship with a mental health counselor to make it easier to seek help if it is needed in the future. If the mom has had thoughts of suicide or infanticide, the therapist can help the family learn how to protect them both. If the birthing center or hospital offers a PPD support group, the new mom and dad should be encouraged to try it. Finally, sometimes psychotropic medications are indicated to alleviate the depression.

The baby blues are uncomfortable. Postpartum depression is serious. In either case, a new mom deserves to get practical help from family and friends. When that alone doesn’t help a new mom adjust, it’s time to seek out professional help as well.

That’s because postpartum psychosis (PPP) is a “psychiatric emergency,” said Margaret Spinelli, M.D., associate professor of psychiatry at Columbia University Medical Center. Think of it as a heart attack, Twomey said. “You might survive it without immediate aid, but why risk it?”

PPP is a temporary but serious illness characterized by delusional thinking. Twomey, a survivor of PPP, described it as “a different reality superimposed onto this reality.” For instance, it’s like watching a TV show and believing that it’s perfectly normal for the actors to be speaking to you, she said.

PPP has a rapid onset, usually starting in the first days or weeks after the baby’s birth, said Katherine Stone, an advocate for women who suffer pregnancy- or childbirth-related mental illnesses and founder and editor of the award-winning blog Postpartum Progress.

This illness requires immediate medical attention because there is a risk of suicide or infanticide, Stone said. In other words, “postpartum psychosis has the potential to lead a mother to take actions that she would never otherwise take that could harm herself or others,” she said.

Still, it’s common for people to dismiss this risk. We know that our loved ones are good people who’d never hurt their kids (as are we), Twomey said. However, this has nothing to do with a woman’s character or ability to be a good mom, Stone said. (It’s also not her fault!) Again, PPP is an illness — and one with unpredictable actions, Dr. Spinelli said.

Fortunately, PPP is fully treatable. Below, experts discuss the warning signs, risk factors and how families and friends can help.

Warning Signs of Postpartum Psychosis

“Since women with postpartum psychosis often experience a lack of insight, it’s usually the people around her who will be the ones to recognize something is wrong,” Stone said. In fact, Twomey called family members “the first line of defense.”

That’s why it’s key for families to step in and call the doctor immediately or go to the emergency room. You might be thinking, “But what if I’m wrong?” What if she isn’t struggling with PPP? As Stone said, “I’d rather have it turn out that you were wrong, than have a person ignore the symptoms and have that lead to a tragedy.”

These are the most common signs of PPP.

• Hallucinations: seeing or hearing things that aren’t there
• Delusions: bizarre beliefs that only make sense to the individual. Delusions often have religious undertones. For instance, she might believe “…that her child is a savior or has been sent to save the world, or is possessed or going to come to some harm from nefarious forces if she doesn’t take action,” Stone said.
• Confusion
• Paranoia
• Mania (high energy)
• Depressed mood or irritability
• Inability to sleep

(In some cases, a woman might be rational enough to seek help. Twomey wanted women to know that “no matter what you experience, [PPP] is recognizable, diagnosable and treatable.”)

“PPP can wax and wane,” Twomey said. So even if a postpartum woman seems reasonable at times, don’t let that dissuade you from getting help. It’s a myth that women with PPP are either completely delusional or totally normal. As Twomey said, “a woman can seem perfectly normal one moment and psychotic the next.”²

Risk Factors of Postpartum Psychosis

Women with bipolar disorder or schizophrenia (or who have a family history of these illnesses) are most at risk, Stone said. Some women might not even know that they have either disorder. For instance, some moms might’ve never received a diagnosis of bipolar disorder, Stone said. In fact, according to Spinelli, PPP “usually signals a first episode of bipolar disorder.”

If you fit these risk factors, consider writing a letter to yourself explaining that you might have PPP, listing some of the symptoms and including the individuals you trust, Twomey said. If you do experience PPP, you’ll have given yourself important and sound information, she said.

Not having these risk factors doesn’t put you in the clear. Twomey emphasized that every expectant mom is potentially vulnerable.

How Family & Friends Can Help

• “Be informed before it happens,” Twomey said. This way you “can be an advocate, be aware of the warning signs, appreciate the dangers and treat her with compassion, love and understanding,” she said.
• Don’t ignore the signs. “I think family members sometimes want to explain away the symptoms of postpartum psychosis rather than admit a new mom has it and likely needs to be hospitalized,” Stone said. You might worry that she’ll be “locked up forever,” she said. But getting your loved one help is the best thing you can do for them — and their baby. Women with PPP are often hospitalized so they can get proper treatment. (This usually consists of close monitoring and taking antipsychotic medication.) But after they’re stabilized, women can return home. “Please don’t ignore the symptoms because of fear or lack of understanding!” Stone said.
• Don’t confuse your loved one with their illness. Twomey often hears husbands say that this isn’t the woman they married. Women with PPP can act completely out of character, even becoming verbally abusive, Twomey said. This might lead some families to alienate their loved one or view her as the enemy, she said. But it’s vital to understand that this isn’t your loved one, she said. PPP is causing this kind of odd behavior, Stone said. “…It would be unfair to blame her or stigmatize her for that behavior,” she said.
• Support your loved one. Give her your full support both while she’s in the hospital and after she comes home, Stone said. This includes helping her care for the baby and making sure she gets enough sleep, Spinelli said. Also, make sure your loved one is getting the best treatment, and go with her to doctor’s appointments, Twomey added. Stone recommended reading the valuable guides from the UK organization Action Postpartum Psychosis.

PPP is a serious illness that requires urgent treatment. If your loved one is experiencing any of the warning signs, don’t hesitate to get her help — and always be on her side, Twomey said.

Further Reading

Check out Postpartum Support International, a non-profit organization that’s filled with valuable information and resources. Also, Twomey wrote a helpful post on the three important bricks of PPP.

1. Statistic from Postpartum Support International
2. Check out Stone’s site, Postpartum Progress, for more on symptoms “in plain mama English.”

One of the perceived disadvantages is that the breastfeeding mother will get less sleep at night. This is an important and real concern. Sleep disruption is known to have a major impact on the mother’s ability to function during the daytime and is a risk factor for postpartum depression.

Postpartum women need to consider strategies — with their family and support partners — for ways to maximize their consolidated sleep. However, few scientific studies have addressed whether feeding methods really do affect the mother’s sleep. There are a handful of studies (mostly based on mother’s subjective report) that suggest that breastfed infants sleep longer and awaken less frequently during the night. But this does not tell us whether the mother’s sleep also differs.

Therefore, our goal with this study was to determine whether mothers’ sleep or daytime functioning differed based on whether she was exclusively breastfeeding, formula feeding, or using a combination of the two.

To accomplish this goal, my collaborators Dr. Heather Clawges (a pediatrician and lactation consultant), Ms. Eleanor Santy (an undergraduate research assistant) and I asked mothers to volunteer to wear a wristwatch-type device called an actigraph. The actigraph recorded the mothers’ movements, and told us when each mother was awake and asleep.

Every morning, within a short time after awakening, the mothers used a hand-held computer to tell us her perceptions of her sleep: how often she had awakened that night, how much total time she was awake during the night, and her sleep-quality score. During the day, whenever she fed her baby, the mother also used her hand-held computer to report her current level of sleepiness and fatigue.

The 80 women who participated in the study contributed this information for 15 continuous weeks, starting when their babies were one week old. A researcher visited the mother each week to give her a new wrist monitor and hand-held computer, but did not give her any sleep advice. It is also important to note that each woman was screened before the study started and was not eligible for the study if she had symptoms or a history of depression.

The results of this study were very straightforward: We did not find differences between women who had exclusively breastfed, exclusively formula fed, or used a combination of the two methods on any measure. In other words, feeding method made no difference in terms of objectively measured total sleep time, sleep efficiency (the ratio of sleep to wake during the night), or sleep fragmentation (the amount of sleep interruption during the night) as recorded by the wrist monitor. Nor were there any differences based on the mothers’ subjective reports of their number of nocturnal awakenings, total nocturnal wake time, or sleep quality. Finally, there were also no differences between groups on daytime levels of sleepiness or fatigue.

One sidenote is that we also asked the mothers who gave the nighttime feedings at each week. We were surprised to learn that not one single mother had help giving nighttime feedings, even if she was exclusively formula feeding! The contrast between our findings of no differences based on feeding methods and the previous studies showing that breastfed infants awaken more often at night is intriguing. Common sense would declare that if the infants awaken more often, then their mothers should, too. It is possible that despite their self reports, breastfeeding mothers awaken more often during the night to feed their infants but that they return to sleep more quickly or sleep during feedings, and consequently do not remember these awakenings. We cannot test this unequivocally because the wrist monitor is not sensitive enough to identify discrete awakenings.

Our speculation is that if breastfeeding mothers awaken more often at night, then breastfeeding itself may provide a form of compensation. In other words, breastfeeding mothers may return to sleep more quickly and not remember awakening. This could be because they are not exposed to as much ambient light or physical activity as would be required to prepare formula. It is also possible that breastfeeding mothers are sleeping during feedings. Researchers Qillin and Lee have previously reported that breastfeeding mothers who cosleep sleep more than both those who do not co-sleep and those that formula feed. The major limitation of our work was that we did not collect data about co-sleeping, which is very common in our society despite professional recommendations against doing so.

Breastfeeding may also have a soporific effect. Sanchez and colleagues have shown that nucleotides present in breast milk have both strong maternal circadian rhythms and appear to facilitate a “hypnotic action” in the infant. In addition, differences in circulating prolactin are suspected to have a primary role in sleep architecture differences between breast and formula feeding mothers. Prolactin shows a nocturnal peak, which is vital for milk production, and is usually associated with facilitation of sleep onset and the delta wave brain activity important for restorative sleep.

In sum, our study shows that choosing to formula feed does not equate to improved sleep for the mother. The risks of not breastfeeding should be weighed against the cumulative lack of evidence that breastfeeding has a negative impact on the mother’s sleep.

Breastfeeding photo available from Shutterstock

Some mistakenly assume that having a child will fix their relationship problems and bring them closer, said Joyce Marter, LCPC, psychotherapist and owner of Urban Balance, which offers a Pre & Post Baby Couples Counseling Program. Unfortunately, this usually backfires, because the new stressors that come with having a baby just amplify existing issues, she said.

Other couples decide to have kids because they think it’s simply the next step after matrimony. “Many couples do not give themselves permission to thoughtfully explore whether or not having children is right for them because of fears of being different, disappointing others or missing out on life experiences that couples with children experience,” Marter said.

So how do you know if you’re making the right choice? There are many key considerations. But the most important one is that both partners want to have a child. “In heterosexual couples, it is critical that, specifically, the potential father, independently desires to — and feels ready to — transition to parenthood,” according to Nicole Massey-Hastings, MA, a Doctor of Clinical Psychology candidate with a concentration in families, couples and kids. One longitudinal study revealed that 100 percent of couples with a husband who didn’t want to become a parent were divorced by the time their kids were 6 years old (Cowan & Cowan, 2000).

Relationship satisfaction also is critical. In fact, research has found that marital quality is one of the best predictors of parenting quality (e.g., Kanoy, Ulku-Steiner, Cox & Burchinal, 2003; Fishman & Myers, 2000). “A couple needs to have a healthy, satisfying relationship with a clear understanding of, and strategies for working with, the pitfalls in their relationship,” said Mudita Rastogi, Ph.D, a licensed marriage and family therapist and professor at the Illinois School of Professional Psychology. Rastogi and Massey-Hastings are currently studying a new program, Choosing the Parenting Lifestyle, that helps couples realistically identify their motivations to have kids and better understand the personal, emotional, relational and financial costs. (Learn more here.)

Questions to Consider Prior to Parenthood

The below questions can help you figure out whether having kids right now is the right choice for you.

Why would you like to have a child? All the experts stressed the significance of both partners figuring out their motivation to have kids. Are you internally or externally motivated? “A motivation is internal if it has to do with your own personal desires and wishes. It is external if it has to do with pleasing others — your parents or your partner — or if it is to meet societal expectations,” Marter said.

According to Cherilynn Veland, LCSW, MSW, a psychotherapist in private practice in Chicago’s Lincoln Park neighborhood, these are other important questions to ponder: “Why now?” “What was your own experience as a child and how might that be affecting your own reasons for wanting children?” and “Are you motivated to do what needs to be done to take care of the needs of someone else?”

How is your relationship? Consider whether you and your partner work well together and whether you tend to agree on important issues — and if you don’t, whether you are good at problem solving and compromising, Veland said.

How do you communicate with each other about your needs, dreams and fears? According to Massey-Hastings, how couples communicate about these issues speaks to their relationship as a whole and provides a window into parenthood.

Have you passed the honeymoon phase? Consider the length of your relationship and whether it’s been stable for at least one to two years, Marter said.

Whether it’s your first or fourth child, your relationship still sees a jolt. As Marter said, “The first child most often brings about the greatest life and relationship change, but each subsequent child affects a couple almost exponentially, widening the scope of responsibilities and compounding family and relationship dynamics.”

Having children can bring couples closer. But it also can chip away at a relationship if you’re unprepared for the potential pitfalls. Take this surprising statistic: Within three years of their child’s birth, about 70 percent of couples experience a significant slump in their relationship quality, according to the Gottman Relationship Institute.

The key in keeping a relationship happy and fulfilling is knowing what these pitfalls are, having realistic expectations and staying committed to each other. Below are three of the most common pitfalls and pointers to help.

Pitfall 1: Sleep deprivation

Everyone knows that having kids is exhausting. But you might not fully appreciate the fatigue. According to Marter, “the chronic and cumulative nature of sleep deprivation during the newborn phase is perhaps one of the most commonly underestimated challenges of new parenthood.”

Sleep deprivation sinks your mood, makes it harder to cope effectively with stress and exacerbates mood swings and anxiety. And that’s just what it does to each person.

Lack of sleep strains the relationship in various ways: Couples may fight about who’s doing more and sleeping less. Because couples are extra agitated and stressed, they might squabble more in general. And the primary caregiver may feel unsupported and alone and eventually resent their spouse, Marter said.

Pointers: Sleep when your baby sleeps, Marter said. “This may mean letting the laundry or scrapbooks wait and forcing yourself to nap. It might mean going to bed at 8 p.m., so that you can sleep during your baby’s longest stretch.”

What if your baby isn’t really sleeping? Marter suggested working with your pediatrician and reading other resources such as Healthy Sleep Habits, Healthy Child by Dr. Marc Weissbluth. If feedings are the reason your family isn’t getting much sleep, she also suggested checking out the La Leche League, and figuring out a feeding schedule that works best.

Ask loved ones for support and, if it’s financially feasible, hire help for household chores, a babysitter so you can take daytime naps or a night nanny, Marter said.

And work as a team. For instance, moms who are breastfeeding can pump so their partners or loved ones take turns doing the feedings.

Pitfall 2: Lack of intimacy

Sexual intimacy declines after having a baby, and not surprisingly, this can negatively affect your relationship. “Because sexuality is intensely personal and sexual connection is a major component of romantic relationships, sexual dysfunction or disconnection can become a significant problem for many couples,” Marter said.

The decline happens for many reasons. Physicians typically suggest that women abstain from intercourse for 4 to 6 weeks after childbirth. Even after that time, “women may experience or fear pain from intercourse due to the effects of delivery, an episiotomy, perineal tearing, and/or vaginal dryness due to hormone fluctuations,” Marter said. Couples also experience a decline in desire because of busy schedules, body image issues, fatigue and other concerns.

Pointers: Expect that intimacy will decline after childbirth. This is normal considering the sleep deprivation, new responsibilities and need for the woman’s body to heal, Marter said. Avoid viewing lack of sex as rejection or a sign of trouble in your relationship.

Be close and intimate in other ways, such as kissing, touching, snuggling or spooning, Marter said. Make time to physically connect with each other. Staying home and watching a movie is one way, she said.

“Good sex requires good communication.” Marter suggested talking openly about your needs, preferences and fantasies with your partner. These are some questions she suggested raising: “What is good about [your sex life]? When was it the best and why? What do you each desire? What schedule seems to work best for you? What gets in the way of having more sex?”

Also, work on your emotional connection. For instance, “Create at least 20 minutes per day to connect and talk about things other than the responsibilities with household and baby,” Marter said.

Pitfall 3: Responsibilities

In Marter’s practice, the most prevalent problem for couples is division of labor. Resentments inevitably peak when one partner feels like they’re tackling more tasks and working harder. “They may compare and become competitive or defensive about their responsibilities, schedules or the pros and cons of their work or role,” she said.

They also might glorify each other’s positions, Marter said. A stay-at-home dad might think his wife’s day at work is filled with swanky business lunches, interesting projects and a quiet commute, while he’s dealing with temper tantrums and dirty diapers. His wife might imagine him playing, cuddling and connecting with their child, while she deals with a difficult boss, endless deadlines and concerns over job security. “Then, when an issue like who is going to do the laundry comes up, the misunderstandings have created an environment ripe for conflict,” she said.

One of the problems is that couples usually don’t have a plan for how they’re going to divvy up responsibilities. Marter finds that many couples make assumptions about who’ll do what — often based on how their parents did things — which typically leads to confusion and conflict.

Pointers: Map out what your routine and responsibilities will look like, Marter said. And make sure it’s fair to both partners. Again, couples get into trouble when responsibilities are vague. One of Marter’s clients wanted her husband to help out in the mornings, but the couple ended up bickering instead. “By sitting down and reviewing the mornings tasks, the husband was able to select several items that his wife agreed would be helpful for him to manage,” she said.

When you’re figuring out fairness, remember that a relationship requires give and take. “For example, the husband of a client who is a teacher really steps it up during her grading periods and she picks up the slack when he travels for work,” Marter said.

Also, lower your standards, and let some things go. Another client of Marter’s, who was super stressed and worn out, used to iron all her baby’s clothes. Of course, getting enough sleep supersedes ironing. “Focus on the big things and let the small stuff go,” Marter said.

“The transition to family is simultaneously joyous, miraculous and wondrous and one of the most challenging life experiences and opportunities for growth,” Marter said. It helps for couples to have realistic expectations about parenthood and their relationship and to remain committed to working as a team.

Yet, it’s exceedingly misunderstood — even by medical and mental health professionals.

“You should hear the things I hear from moms across the country — awful things that are said to them by partners, family members, co-workers, nurses and doctors,” said Katherine Stone, an advocate for women with PPD, founder and editor of the award-winning blog Postpartum Progress and a survivor of postpartum OCD.

After reaching out for help, some moms don’t even hear back. Some receive a prescription with no followup or monitoring. Some are informed that they can’t have PPD. And some are told to simply perk up, stop being selfish or get out of the house more, she said.

There’s confusion about everything from PPD’s symptoms to its treatment. Myths also often portray women with PPD in a negative light, which dissuades many from seeking help. Moms worry what others will think, whether they’re even fit for motherhood or, worse, if their kids will be taken away, according to Stone and Meltzer-Brody.

As a result, most moms with PPD don’t get the treatment they need. “Some studies show that only 15 percent of moms with PPD ever get professional help,” Stone said. Untreated PPD can lead to long-term consequences for both mom and child, she said.

The good news is that PPD is treatable and temporary with professional help, Stone said. And education goes a long way! Below Stone and Meltzer-Brody dispel five common myths about PPD.

1. Myth: Women with PPD are sad and cry constantly.

Fact: According to Meltzer-Brody, “Women with PPD usually have low mood, prominent anxiety and worry, disrupted sleep, feelings of being overwhelmed, and can also feel very guilty that they are not enjoying their experience of motherhood.”

But this disorder can look different in every woman. “PPD is not a one-size-fits all illness,” Stone said. She frequently hears from moms who didn’t even realize that their symptoms fit the PPD criteria.

Indeed, some women do feel sad and cry nonstop, she said. Others report feeling numb, while still others mainly feel irritable and angry, she said. Some moms also have fears that they’ll inadvertently harm their kids, which amplifies their anxiety and distress, Meltzer-Brody said. (The myth that moms with PPD harm their kids only heightens these fears and fuels their suffering, she said. More on that below.)

Many moms appear to function just fine but struggle in silence. They still work, take care of the kids and seem calm and polished. That’s because most women experience more moderate symptoms of PPD, Meltzer-Brody said. “They are able to function in their roles but have significant anxiety and mood symptoms that rob them of the joy of being a mother and interfere with their ability to develop good attachment and bonding with their infants.”

2. Myth: PPD occurs within the first few months of childbirth.

Fact: Most women tend to recognize their symptoms after three or four months post-childbirth, Stone said. However, “you can have postpartum depression any time in the first year postpartum.”

Unfortunately, the DSM-IV criteria for PPD leaves this information out. According to Stone, “Since it doesn’t say that in the DSM-IV, I can’t tell you how many moms finally get up the courage to go see the doctor in the second half of their baby’s first year and are told that they ‘can’t have postpartum depression.’ So then the mom goes back home and wonders whether she should have asked for help in the first place and why no one can help her.”

3. Myth: PPD will go away on its own.

Fact: Our society views depression as something to “rise above and overcome,” Meltzer-Brody said. Depression gets dismissed as a minor issue, fixed with a mere attitude adjustment. “I’ve had many patients tell me that they felt so guilty and judged by friends and family for not being able to ‘just snap out of it and focus on the positive,’” she said.

Again, PPD is a serious illness that requires professional help. It’s highly treatable with psychotherapy and medication. The medication part worries some women, and they avoid seeking help. However, treatment is individual, so what works for one woman won’t work for another. Don’t let such misconceptions stop you from seeking the help you need. Both experts underscored the importance of prompt treatment. (See below on how to find help.)

4. Myth: Women with PPD will hurt their kids.

Fact: Almost without fail when the media reports on a mom who hurt or killed her kids, there’s mention of postpartum depression. As Stone reiterated, women with PPD don’t harm or kill their kids, and they’re not bad mothers. The only person a woman with PPD may harm is herself if her illness is so intense that she has suicidal thoughts.

There is a 10 percent risk for infanticide or suicide with a different disorder called postpartum psychosis, Stone said. Moms may harm their kids during psychosis.

Postpartum depression is often confused with postpartum psychosis. But, again, they’re two different illnesses. Postpartum psychosis is rare. “About 1 in 8 new moms gets postpartum depression whereas 1 in 1,000 gets postpartum psychosis,” Stone said.

(Here’s some information about postpartum psychosis symptoms.)

5. Myth: Having PPD is somehow your fault.

Fact: Women often blame themselves for having PPD and experience guilt over their symptoms because they’re not basking in some magical bliss of motherhood. But remember that PPD isn’t something you choose. It’s a serious illness that can’t just be willed away.

According to Meltzer-Brody, hormones play a substantial role in PPD susceptibility. Some women are especially susceptible to rapid fluctuations in estrogen and progesterone, which occur at childbirth, she said. It’s likely that genetics predispose women to mood symptoms during these fluctuations. A history of abuse and trauma also might increase risk in women who are already genetically vulnerable, she said.

As Stone said, “I know it’s hard to believe that it’s not your fault, that you ever should have become a mother, and that you’ll ever get better. I know because I’ve been there. You will get better.”

Again, PPD is a real illness that requires expert help. Dismissing it can negatively affect both mom and baby. Don’t be casual about PPD, and don’t hope for the best, Stone said. Instead, find real hope and recovery with professional treatment.

Getting Help for Postpartum Depression

Below, Stone offered several suggestions for finding a professional for a proper diagnosis and treatment. Many of the links come from Stone’s Postpartum Progress, which is an excellent resource! In fact, just recently it ranked #6 in Babble’s list of top 100 mom blogs.

• Start by reading this page on Postpartum Progress, which lists the best PPD treatment programs.

• Contact the nonprofit organization Postpartum Support International, which has coordinators in almost every state who can help you find an experienced professional in PPD and related illnesses.
• See if your state has its own advocacy organization for moms with perinatal mood and anxiety disorders. Postpartum Progress has a list of advocacy organizations.
• If you’re not sure how to talk to a doctor or therapist about your symptoms, print out Postpartum Progress’s list of PPD symptoms to start the conversation.

Early Development of Food Preferences

Taste (sweet, sour, salty, bitter, savory) preferences have a strong innate component. Sweet, savory, and salty substances are innately preferred, whereas bitter and many sour substances are innately rejected. However, these innate tendencies can be modified by pre- and postnatal experiences. Components of flavor, detected by the olfactory system (responsible for smell), are strongly influenced by early exposure and learning beginning in utero and continuing during early milk (breast milk or formula) feedings. These early experiences set the stage for later food choices and are important in establishing life-long food habits.

The terms taste and flavor often are confused. Taste is determined by the gustatory system, located in the mouth. Flavor is determined by taste, smell and chemosensory irritation (detected by receptors in the skin throughout the head; and in particularly in regards to food receptors in the mouth and nose. Examples include the burn of hot peppers and the cooling effect of menthol).

Children should be fed nutritious foods (e.g., fruits and vegetables) from an early age. Health organizations worldwide recommend multiple servings of fruits and vegetables per day (between five-13), depending on one’s caloric requirement. Despite such recommendations, children are not eating enough fruits and vegetables, and in many cases they do not eat any.

A 2004 study investigating eating patterns of American children revealed that toddlers ate more fruits than vegetables and 1 in 4 did not even consume one vegetable on some days. They were more likely to be eating fatty foods and sweet-tasting snacks and beverages. Of the top five vegetables consumed by toddlers, none was a dark green vegetable, those that are usually most bitter. This can be partly explained by the innate tendency to dislike bitter.

Flavor Likes and Dislikes

The preference for specific flavors are determined by:

• Innate factors
• Environmental influences
• Learning
• Interactions among these.

To reiterate, taste preferences are generally strongly influenced by inborn (innate) factors. For example, sweet foods and beverages are highly preferred by plant-eating animals, probably because sweetness reflects the presence of caloric sugars, and may indicate non-toxicity. Natural preferences for sweet-tasting compounds change developmentally — infants and children generally have higher preferences than adults — and they can be drastically changed by experience.

Bitter-tasting substances are innately disliked, presumably because most bitter compounds are toxic. Plants have developed systems to protect themselves from being eaten, and plant-eating organisms have evolved sensory systems to avoid being poisoned. With consistent exposure and intake children may learn to like certain bitter foods, particularly some vegetables.

In contrast to taste preferences, flavor preferences detected by the sense of smell are generally highly affected with learning early in life, even in utero. The sensory environment, in which the fetus lives, changes as a reflection of the food choices of the mother as dietary flavors are transmitted via amniotic fluid. Experiences with such flavors lead to heightened preferences for these flavors shortly after birth and at weaning.

Prenatal experiences with food flavors, which are transmitted from the mother’s diet to amniotic fluid, lead to greater acceptance and enjoyment of these foods during weaning. In one study, infants whose mothers drank carrot juice during the last trimester of pregnancy enjoyed carrot-flavored cereals more than infants whose mothers did not drink carrot juice or eat carrots.

Influence of Breastfeeding

Exposure to a flavor in mothers’ milk influences the infants’ liking and acceptance of that flavor. This is seen when the flavor is encountered in a food.

In one study, researchers found that breast-fed infants were more accepting of peaches than formula-fed infants. It is likely that the increased acceptance of fruit could be due to more exposure to fruit flavors, due to their mothers eating more fruits during lactation. If mothers eat fruits and vegetables, breast-fed infants will be exposed to these dietary choices by experiencing the flavors in the mothers’ milk. This increased exposure to various flavors contributes to greater fruit and vegetable consumption in childhood.

Infants develop long-lasting dietary preferences very early in life. Pregnant and nursing women are encouraged to consume nutritious diets with a variety of flavors. Infants of women who do not breastfeed should be exposed to a variety of flavors, especially those associated with fruits and vegetables.

“Oh, we’re getting a divorce. The baby is her thing, not mine. Doesn’t have anything to do with me,” he replied.

“I don’t understand,” I said to him. “Your child is going to need you whether or not you love his mom.”

“Look. I didn’t ask to be a father so it’s all on her,” he said as casually as if he were talking about the price of bread.

There was nothing more I could say, especially to someone who was so matter-of-fact and distanced from what he was telling me. But it certainly got me thinking about the consequences of that kind of attitude.

It’s not new information. For almost two decades, father absence has been growing to crisis levels in America. According to the U.S. Census Bureau, one out of three children in the U.S. are not living with their biological father. That’s over 24 million kids.

Research also suggests that around 40 percent of American kids are now born to single mothers — some to teenagers but also to an increasing number of women who have become discouraged about ever finding Mr. Right. They are heading to the sperm bank or are settling for pregnancy by a good friend or a one-night stand. The fellow I was talking to doesn’t see his behavior as abnormal because it isn’t. But it’s a sad and disheartening trend.

As a society, father absence is not something that we should get inured to. Study after study concludes that children in father-absent homes are likely to be poorer than their peers and even poorer than the father. They are more likely to use and abuse alcohol, tobacco, and street drugs, fail at school, have an early pregnancy, and be abused. Adolescent boys are more at risk of becoming involved with the law. Girls don’t do much better. Approximately half of the imprisoned women in one study grew up without a dad. Girls whose fathers distanced from them post-divorce often search to reclaim the intimacy of the father-daughter bond well into their adult years, often resulting in a series of unhealthy relationships with men who are older or who seem to be more powerful than they are.

Since children usually model after the same-sex parent, sons who are abandoned by their dads may grow up to be men who don’t bond with their children either.

The kids’ mothers, too, are under stress. Women without partners are less likely to take care of themselves during pregnancy and are more likely to have a baby with a low birthweight. They are less likely to breastfeed, and more likely to suffer from depression. Often, the strain of doing all the parenting means she becomes increasingly isolated, with no time to develop friendships or to cultivate the supports that sustain people in hard times. Without a partner to share in the struggles and with whom to celebrate successes, single moms often explode in anger or implode into depression, taking the stress out on others or on themselves.

This is not to say that mothers can’t successfully raise their children alone. They can and do. But it is much, much harder on everyone. This is not to say that women should stay with an abusive spouse for the sake of the kids. They shouldn’t. There are huge costs to everyone’s safety and sanity when mom and kids live under siege. This is not to devalue households with two mommies. Lesbian couples can and do raise healthy, happy kids, especially when they plan for male presence in their kids’ lives.

Regardless of the success of many families where Dad either was never there or abandoned his role mid-stream, a father’s regular involvement with his children makes things easier all around. The flip side of all those discouraging studies are the ones that show that having a father present in his kids’ lives results in more emotional and financial stability, better performance at school, fewer behavioral problems, and more success in life in general. Mothers with partners are generally less personally stressed, more relaxed with their kids, and more able to develop their own interests and talents. Fathers who actively partner with their kids’ mother to parent their children feel better about themselves and are generally happier.

Men are not simply sperm donors. Regardless of some misguided movies and misplaced jokes, their importance to their children’s welfare can’t and shouldn’t be dismissed. Whether or not a man marries or stays married to a child’s mother, his involvement makes a significant difference in the physical, emotional, and psychological health of his children and builds his own character and strength.

Related Articles

• Fathering in America: What’s a Father Supposed to Do?
• The 3 Cs of Successful Fathering

1. Most people don’t want to talk about still birth and yet you seem to have no problem with it. Why is that?

Ann: Often people choose to be private about the loss of a baby. There is a belief that talking about it will bring more pain, or prolong it when you should be “moving on.” For some there may be feelings of shame and guilt which are hard to face.

Because my mother died when I was young, I knew from experience that there was no advantage to avoiding grief. I dove into it and tried to express as much of it as I could, which is what became the book, Dancing with the Midwives. The act of creating, in my case writing and drawing, was the best thing I could do for myself.

Acknowledging the grief includes talking about it. My book is intended to inspire people to do that. To express it in a positive way.

2. You have talked about the negative effects of suppressing or repressing grief. What are they?

Ann: When my mother died we did not talk openly about our grief. That was simply the culture of the family I grew up in. I ended up with a severe eating disorder at sixteen followed by low self-esteem and depression that lasted through my twenties and mid-thirties. I can’t blame everything on suppressed grief. Yet I was able to break free from depression once I acknowledged the grief that was still there and started working with it, instead of pretending it was over.

When a baby dies, the impulse to silence and censor ourselves is strong. Many families are afraid that grieving openly will damage the other children. In fact, the opposite is true.

3. What was the lowest point in your grieving process?

Ann: In the first few weeks after her birth I had my lowest lows and some of my highest highs. The highs were like a spiritual euphoria that convinced me I had the keys to understanding the meaning of life. I had the answer! (I only wish I could remember it now…) The lows put me at the bottom of a dark pit. I remember being afraid that there was no bottom to the pit and I would only get worse. But I didn’t and those feelings passed, especially when I was patient. When the sadness became more manageable I started to feel reluctant about getting better because the grief was my connection to the baby. I had the feeling that as I began to feel better, I was moving farther away from her.

4. How did your family react to the still birth?

Ann: I was concerned about my 2 1/2 year old daughter Grace, so I paid close attention to her behavior, and talked to her as openly as possible. The conversations I had with Grace about what happened showed me that she was fine and grieving her own way, on her own level, at her own pace. I liked talking to Grace about her sister because Grace was curious and wanted me to explain why she died, which of course I couldn’t. I had to tell her I didn’t have all the answers, which was comforting in a way.

We were all expecting a new baby to join our family and coping with the hole that she left. We had little ceremonies every month as a way to share our feelings and continue to acknowledge the baby, who we named Keirnan. Sometimes the ceremonies would feel awkward or forced, but for the most part I think they helped us feel more grounded, which we needed.

5. Did you and your husband have similar reactions to the still birth? How did it affect your marriage?

Ann: Since I was going through the hormonal changes associated with childbirth, and because she had dwelled in my body, it was by definition different for each of us. At times it was a challenge to understand what the other person was going through. One of us might want to be close when the other needed space. We had to negotiate things like that and be as understanding and forgiving as possible.

It was hard. Grieving made us both very vulnerable, and if we’d had very different feelings about it, our relationship might not have survived as well as it did. In our case, the experience strengthened our bond.

While reading this book I was saddened by the lack of understanding that is often surrounding these problems but also hopeful that with reading materials like this, things will get better because they will be better understood. We now know that there is what is called simply the “baby blues,” which is not one of these disorders but simply a mild depression brought on mostly by physical changes in the new mother’s body. Although it should be treated and understood, it should not be mistaken for the more serious disorders that “Beyond the Blues” discusses.

This book set out to help caretakers of new mothers diagnose such problems as well as give several types of solutions for the various types of PPD. It also was written in such a way that the average person can understand what this terrible disease really is and how we might better help our families and friends through these hard times. It does a good job of removing the stigma and shame that has surrounded such problems. Hopefully, this will give pregnant women the courage to let their doctors know what’s going on even if it might feel embarrassing or confusing to the patient herself.

I especially enjoy the fact that the authors wrote several pages of questions the patients might have with answers that would make anyone feel more “normal” rather than the lepers they’ve been made to feel like in the past. One question is “Won’t medication be a crutch?” and the answer is, “A crutch is a temporary tool that you use until you no longer need it. If you broke your foot you wouldn’t think twice about using crutches to support you while your foot heals. Medication restores your brain chemistry to a normal state, allowing you to get back to feeling yourself and back to your life. As you become well, you and your doctor will develop a plan to wean you off the medication.”

Now, this might seem like a “no big deal” conversation, given the topic. However, I felt as though this was one of the ways that the authors legitimately make the once hidden topic seem as normal as breaking a foot.

Since giving birth and raising healthy, well-adjusted children is probably one of the most important jobs there is, it behooves us all to help keep mothers well-adjusted too. I believe in the fact that it “takes a village” so in that sense it takes a village to watch for problems with the mother, who is the main caregiver for the children in this world. We’ve seen and heard some horrific stories, which certainly aren’t the norm for mothers with PPD but the possibilities of tough and difficult to horrific are not possibilities that a new mother needs. If all of us read this book and understand more than we’ve understood in the past about this problem then maybe we can make it as easy to talk about as the “broken foot” scenario. That’s a nice thought when you consider we’re really on the fast track from hiding something in the basement to bringing it to the light of day.

I’m a 63-year-old woman who was lucky enough not to suffer from any of these problems when I had my two children. However, I was having my babies during the time when everything was simply called the “baby blues” and the mother was patted on the head and probably given the old standby in that day, valium, otherwise known as Mother’s Little Helper — which helped very little in most cases! I had several friends who suffered from what I now believe was PPD but were never diagnosed because they were ashamed or they were told by their doctors to “get over it.” Only through friends and families did some of them make it through without dire consequences and it’s good to know that this problem is now being brought to light.

This book, in my opinion, is something that should be in caregivers’ offices and even offered in whole or in part to women to take home and offer this information to the father, family and friends. If the mother never suffers from any form of PPD then she’ll be lucky but have also learned something she can pass on to someone else who might one day need it.

Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression & Anxiety

By Shoshana Bennett, Ph.D. and Pec Indman, Ed.D., MFT

Paperback, 157 pages

Publisher: Moodswings Press; 2011 updated edition (Nov. 1, 2010)

But many women can feel almost overwhelmed during pregnancy by a combination of unpleasant symptoms, money and relationship fears, job stress, dealing with small children, elderly parents, or a pre-existing mental or physical illness.
These can all be a trigger for anxiety.

Unfortunately doctors and midwives often fail to identify women struggling with anxiety, despite the high risk during pregnancy. Studies show a quarter of pregnant women will experience significant anxiety, particularly those who have had complications in previous pregnancies, but only a small number are offered treatment. Both drug and non-drug treatments are available, although no treatment was found to be risk-free in a recent review of the evidence. The long-term effects of exposure to either medications or severe maternal anxiety are as yet unknown, say researchers.

It’s quite common for women to want to be as well-informed and prepared as possible; however, sometimes the information we receive can trigger worries rather than alleviate concerns. Luckily there are some reliable and honest websites that can put our minds at rest. A few days ago I noticed something I hadn’t expected, and within five minutes I discovered it was completely normal and healthy, thanks to www.mumsnet.com (highly recommended).

I’m definitely one of the women who likes to be well-informed. In fact, there’s been a pile of childbirth books waiting patiently on the coffee table for some time. Perhaps there is an element of nerves after all! Fortunately one of the books contains a relaxation DVD. Sounds like a very good idea.

The risk of postpartum depression

I’ve got several friends who have experienced depression after having a baby, so I’m reading up on the risk factors. No one is sure how many women are affected, because many women don’t seek medical help. Apparently it usually develops in the first four to six weeks but could happen later on.

One possible factor is the inevitable hormone changes after pregnancy, but I can’t do anything about that. Other suggested risk factors include a history of depression, abuse, or mental illness, smoking or alcohol use, fears over childcare, a difficult relationship, a lack of finances, the baby’s temperament or health problems such as colic, and especially lack of social support. Some experts think there’s a genetic role too. Lack of sleep can also contribute. Oh dear, that’s already started and I haven’t even had the baby yet!

Sleep troubles in pregnancy

After having the ideal pregnancy until now, I’m starting to have a noticeable nighttime niggle: sleep is no longer my friend. Some nights are OK, only waking once or twice for bathroom visits, but it’s definitely going downhill. I’m 30 and a half weeks pregnant with a fast-expanding bump so it’s hardly surprising that getting comfortable at night is tricky. I use a complicated arrangement of pillows which is fine for a while, but turning over takes a fair bit of effort and coordination — so much so that I’m often too awake afterward to drop off again. Added to which are the baby’s movements. I don’t know if I’m concentrating more or if he really is busier at night, but it can sometimes feel like my midsection is being driven over a bumpy road while the rest of me is lying still.

As expected, I’m a lot hungrier than usual, and this can even wake me up. Then if I do have a midnight snack, the baby gets an energy boost (this happens after every meal) and starts jumping around even more energetically. He’s moving as I write this, as if to agree.

Luckily I’m already limiting my caffeine intake, so that won’t exacerbate the situation. The mattress is very good, and I use excellent (silicon) earplugs and an eye mask due to living in the center of a city. Having a bath before bed tends to help, too. But certain factors are outside of my control, and I get the feeling this might be a very warm summer, oh dear.

Being a light sleeper at the best of times, I suppose pregnancy sleep issues are only to be expected. And of course there’ll be another major distraction in about ten weeks so maybe it’s better to get used to interrupted sleep sooner than later

Luckily all was well and the sonographer said she was 99.9 percent sure it’s a boy! I’m very pleased, although I had no preference either way. A lot of people choose to wait until the birth to find out the gender, but I’m too curious and impatient. Also I wanted to be able to have a good look at the screen. We bought four photos, which have done the rounds of countless friends and family and have been emailed around the country.

Now I’m getting used to calling it “him,” which together with the regular movements makes it all feel much more real. We’ve already decided on a name, but keeping quiet about it for the time being.

I wouldn’t say we’re bonding yet, as such, but I’m aware that he can hear my voice and I’m thinking about the noises he’s being exposed to. Yes, I have found myself playing classical music when I probably wouldn’t otherwise! My husband is away at the moment, so I’m also playing a recording he made of his voice (reading Winnie the Pooh).

It’s strange to think that soon, when I reach 24 weeks, he would have roughly a 50 percent chance of surviving outside of the womb. The time has passed very quickly. His main objective from now on is to grow thicker skin and put on a lot of fat – he’ll probably weigh about six or seven pounds more by the time he’s born. Trying not to think about that day too much yet!

Over halfway already

The pregnancy is still going worryingly well, no new discomforts but the general itchiness remains along with a much higher appetite.

I recently attended a one-off antenatal physiotherapy session at my local hospital where I learned a lot and the nurse leading it was excellent. I saw lots of other bumps and discovered that mine’s quite small compared with others at my stage. All the other women (about seven of them) were having pain around their bumps and at the top of their legs from the muscles relaxing and I felt so lucky because I don’t (yet).

The nurse emphasized the importance of Kegel exercises, which I must admit I have been slightly lazy about doing. She said that pregnancy can place a lot of stress on your pelvic floor muscles, but keeping them strong can prevent urinary incontinence and prolapse, and shorten the second (pushing) stage of labor. All very good reasons!

Gentle exercise such as walking, swimming, pregnancy Pilates and yoga, is also important, she told us. But activities that put a strain on the joints or ligaments are best avoided.

On a different topic, I’ve investigated some of the alcohol-free wines available, and I can report it’s a losing battle. I can strongly recommend grape juice instead. I also haven’t found a particularly good brand of decaffeinated coffee, but at least some are drinkable. Am missing blue cheese and pate too, so I’ve promised I’ll make it up to myself in September. Frighteningly, that’s now only 16 weeks away!

Money, money, money

One of the things that’s surprised me as I prepare to enter the world of parenting is just how expensive or cheap having a baby can be. Newspaper articles would have you believe that the cost of raising a child is enormous. Others ridicule this as nonsense, and claim the cost in the first year can be almost nothing. How? Well, I’ve looked into this carefully and my top tips are: borrow as much as possible, ask around for hand-me-downs, and use Freecycle or Gumtree. Check out the baby clothing “bundles” and maternity clothes on eBay, and get advice from thrifty websites. Of course, you’ve got to wash everything that’s previously used, and be absolutely certain that car seats have not been involved in an accident. Many parents choose to buy a new one, and new mattresses. Some very kind friends have already asked for present ideas, so I recommend keeping a list of what you need close at hand.

Breastfeeding, if possible, will clearly save money although it’s unlikely to be completely free. I’d like to have a breast pump and bottles so my husband can feed him in the night, and I need breast pads, nipple cream and nursing bras. Reusable diapers could save up to a few hundred dollars a year. But getting the hang of them is another matter, so we’ll see. Disposables can also work out very cheap if you shop around.

In practice, it’s hard to resist every piece of persuasive advertising that comes your way. I’ve bought some not-strictly-necessary maternity tops, and spent a fair amount on childbirth books. But I’ll cover that delightful topic another time!

I must admit, the media scare stories on fertility probably gave me the final push. I’m 34 now, which is fine, but considering I (currently) want two children, I realised I didn’t have forever. So we moved out of our thin-walled upstairs apartment to a larger house, with garden. I started on folic acid a couple of months in advance, and pretty much stopped drinking alcohol. Luckily I’ve found this easy and I’m enjoying the clear-headedness.

After two months without success I turned to technology and bought a digital ovulation kit which indicates your fertile “window”. It worked immediately. On the first day of the new decade we got our positive result. I felt strangely calm but very happy, and that’s how the pregnancy has progressed so far. I don’t know what I’ve done to deserve it but I haven’t felt any morning sickness, tiredness, or any unpleasantness at all. Apparently this isn’t uncommon, but of course the women who are suffering most are the ones who speak up. I could easily be in the same boat next time, especially with a toddler running around.

I had been hoping for some exotic cravings, but none so far. The best I’ve had is a violent aversion to raw mushrooms. They’ve been banned from the house and I have to run past them when food shopping.

The rollercoaster continues…

I rang the local midwives at about six weeks, and visited them a fortnight later. At each visit they check blood pressure and do a urine test for protein and glucose. They took some blood at this first visit and sent it off to be tested for everything they can think of. You’re not told the results for a while, lucky I’m not a hypochondriac!
At 12 weeks I had a scan which calculates the risk of Down’s syndrome and two other genetic conditions. I’m low risk, but if not, further tests such as amniocentesis can be done. These do bring a small risk of miscarriage, so it’s not an easy decision.

It was fantastic to finally see my little bean, and hear its heartbeat. Without any symptoms, I must admit I had been concerned. Luckily I didn’t burst into tears (quite possible) and my husband was fascinated to see its arms, legs, and especially its jaw moving. We were on cloud nine afterwards.

Since then I’ve had another midwife appointment and they found the heartbeat when I asked (yes I had been worried again!) Now, at 17 and a half weeks, my bump is obvious so I’m much more relaxed. Any day now I should start feeling it move. I can’t wait, although I expect it’ll get a bit wearing after the 20th kick to the bladder.

Highs and lows

As I’m almost half-way through my pregnancy, I thought I’d look back at the highs and lows so far.

Getting a positive result on the test was a wonderful moment. I took a while to sink in, but soon I was walking round with a glowy feeling and a special secret. Telling my friends (on Facebook, naturally!) caused a huge response and put me back in touch with some distant acquaintances. My family were very excited by the news, despite my sister already having three children.

Seeing the first scan and hearing the heartbeat were also great moments, although I’d been very nervous beforehand. Since I felt it move at about 18 weeks, my worries are almost silenced.

Now for the low points… Luckily there are not so many, but I have missed eating blue cheese and boiled eggs with runny yolks. The mushroom aversion (previously mentioned) wasn’t great, but now they’re banned it’s not a problem. Over the past couple of weeks I’ve started to feel achy twinges every so often, usually if I stand up quickly. I believe this is due to muscles expanding and relaxing. I’ve also become more itchy, which could be my skin stretching. I enjoy having an obvious bump, but I’m not liking the overall expansion, particularly being a pear shape to start with. On the other hand I realise this is healthy and I’ve gained the recommended weight so far, heading for the recommended 22-28lb by 40 weeks (but many women who go outside this range have healthy babies).

Getting up every night to visit the bathroom is manageable, however the famous pregnancy insomnia may well be on its way, along with enormous list of other potential issues. All I can do is trust my body to know what it’s doing!

Pro-choice woman: “Once a woman decides to have an abortion she has to try to cope with her experiences and her emotions on her own.  I wish that women could share their stories openly without fear of being judged by society.  Abortion is such a hot topic and there are many people shouting loudly on both sides of the argument.  Sadly, the one voice you never hear, and perhaps the voice that is most important, is the woman who has had an abortion.”

Pro-life woman: “I might have found healing years earlier had I not been so terrified of the Church.  Had I been able to address the pain emotionally, maybe then I would have been able to face the spiritual side of this.”

Have you had an abortion and feel like you have never emotionally recovered from it? Are you unsure about how to go about recovering from the abortion? If you answered “yes,” you are not alone. Many women have the same experience and have never worked through the recovery process. Here’s some input to help you understand common thoughts and feelings a woman experiences after an abortion and the kind of impact an abortion may have. I’ll also share some tips for recovering from an abortion.

Common feelings a woman experiences after abortion

I believe the most common thought and feeling immediately following an abortion is relief.

Unfortunately, this sense of relief is not always permanent.  Every circumstance surrounding an abortion experience is as unique as the woman who chooses the procedure.

Sometimes a deep feeling of sadness will set in immediately.  Because abortion is a final decision that can’t be taken back, I believe most women, myself included, are forced to go into a period of stuffing down the sadness and getting on with life.

Herein is “the rub.”  Combine the emotions of relief and deep sadness and what sort of emotional cocktail do you get?  Confusion!  The days, weeks, months and years following the decision can result in a lot of confusing emotional distresses.  On one end of the spectrum is an overwhelming relief to be out of the crisis, and on the other end there is an amazing depth of sadness that resonates to the core of one’s being.

The impact an abortion can have on a woman’s overall life

What I learned from my personal experience and what I see with the women I work with is that in order to survive the dialectical thoughts of “I’m so relieved and I’m so sad,” a woman has to go into a shut down mode emotionally.  Imagine dealing with thoughts like “what made me so relieved also made me sadder than I’ve ever been and what made me sadder than I’ve ever been actually gave me relief.”  This thought pattern has no positive return for the person stuck in it.

It is necessary to put these two thoughts and emotions “somewhere.”  We build a box in our minds, hearts and souls and vow to never talk or feel about the abortion again.  The box eventually becomes a fortress we don’t even dare try to scale ourselves, much less let any other human being touch. Occasionally, there is a chance we will let some of the sadness ooze out.  Maybe the anniversary of the procedure or driving by a school yard where children are playing give us leave to experience a small amount of grief.  Yet some women consider their choice a “done deal” and they do not dare navigate the thoughts or the emotions of it again.

The majority of the women I’ve worked with have never told a single person about their abortion.  This oftentimes even includes the father of the baby, which can sometimes actually be the husband.  It has been my experience in my private practice that it takes at least nine hours of therapy before a woman will admit a past abortion.  The average time frame I see for women finally being able to process the emotions and grief around their choice is at least fifteen years after the fact.  Until the shell of denial breaks around the “abortion box” women of choice live in a strange sisterhood of silence.

Because most in our culture confuse the legalities of abortion with the actual process of resolving the natural loss that follows, there is an implied message that the abortion is the closure.   This simply is not true.   Women need a safe place to grieve an abortion loss separate from a political or religious discussion.

The impact of not grieving the loss incurred

Abortion choices create a situation of disenfranchised grief in women’s lives.  Disenfranchised grief is grief experienced by an individual that is not openly acknowledged, socially validated or publically observed.  The loss experienced is real, but survivors are not accorded the “right to grieve” by anyone around them.

A common effect of disenfranchised grief is depression, manifesting itself in small periods of sadness or more full-blown stints of depression.  These periods may be accompanied by crying spells and low times of “blue” days.

Unprocessed grief can also cause people to “stay stuck” in anger without even realizing the source of their anger.  Not connecting the depression with the unprocessed grief surrounding an abortion choice is typical.

Other ways to avoid “the abortion box” stashed in the corner of one’s mind are medicating the pain with drugs or alcohol, becoming dependent on people and even eating disordered behaviors.  It is a known fact that limiting food becomes a way to process grief.

They recruited 1,241 women aged 20 to 24 years, and tested their cognitive speed, working memory, and immediate and delayed recall. The women were retested after four years and again after eight years. At followups, 76 women were pregnant. A further 188 became pregnant between testing sessions.

No significant differences were seen in their cognitive abilities. The experts believe that neither pregnancy nor motherhood have a detrimental effect on women’s cognitive capacity.

Professor Christensen said, “Part of the problem is that pregnancy manuals tell women they are likely to experience memory and concentration problems, so women and their partners are primed to attribute any memory lapse to the pregnancy.

“Pregnant women may also shift their focus away from work issues to help them prepare for the birth of their new baby, while new mothers selectively attend to their baby. However, this shift in attentional focus is adaptive, and certainly cannot be labeled a ‘cognitive deficit.’”

Details of the study are published in the British Journal of Psychiatry. The team writes, “Not so long ago, pregnancy was ‘confinement’ and motherhood meant the end of career aspirations. Our results challenge the view that mothers are anything other than the intellectual peers of their contemporaries.

“Women and their partners need to be less automatic in their willingness to attribute common memory lapses to a growing or new baby.”

The authors also call on doctors and midwives to put an end to this belief. However, the results of this study directly contradict previous findings which have shown that pregnant women perform worse than nonpregnant women on memory and other cognitive tests. Professor Christensen suggests that the earlier studies were biased because the participants were not tested prior to pregnancy.

“We already tested their cognitive function before they became either pregnant or mothers,” she pointed out. “This is critical as it is the first time that pre-pregnancy cognitive scores were available. We could thus see if pregnancy or motherhood produced any greater change in cognition compared to the controls. Our study used a representative population sample too, rather than a convenience sample.”

A recent study of rats found that pregnancy, motherhood and caring for offspring led to brain changes that suggested “greater resilience to stress, decreased anxiety, and better memory abilities.” The researchers believe the findings could hold true in humans. They say, “It appears that reproductive experience may confer some beneficial changes to human mothers in terms of lowering the anxiety/stress response and enhancing certain aspects of memory.”

Nevertheless, these recent findings contradict the majority of earlier studies. Dr. Julie Henry of the University of New South Wales, Australia, analyzed 14 studies comparing pregnant women with comparable nonpregnant women on memory.

Dr. Henry writes, “Although until recently much of the evidence for pregnancy-related deficits in memory was anecdotal or based on self-report, a number of studies have now been conducted that have tested whether these subjective appraisals of memory difficulties reflect objective impairment.”

She found that the studies “failed to yield consistent results,” but that pregnant women “are significantly impaired on some, but not all, measures of memory, and, specifically, memory measures that place relatively high demands on executive cognitive control.” There is a need to understand the causes of such pregnancy-related memory difficulties, she concludes.

There seems to be a wide gulf between pregnant women’s own self-reports and studies that use objective measures. About two thirds of women report having some kind of memory or attention problems due to their pregnancy. But objective tests are inconsistent.

Dr. Ros Crawley of the University of Sunderland, UK, believes, “Some of the inconsistency in objective tests might be methodological. There’s a lot of different tasks used to measure the same cognitive functions and when people talk about the tasks that they use, sometimes one paper uses it to measure one thing and another paper uses it to measure another, so it’s quite complicated.”

Dr. Crawley’s findings have convinced her that pregnancy is not associated with cognitive decline. “It’s absolutely time we exploded this myth,” she says.

References

Christensen, H., Leach, L. S. and Mackinnon, A. Cognition in pregnancy and motherhood: prospective cohort study. British Journal of Psychiatry, Vol. 196, February 2010, pp. 126-32.

Macbeth, A. H. and Luine, V. N. Changes in anxiety and cognition due to reproductive experience: a review of data from rodent and human mothers. Neuroscience and Biobehavioural Reviews, Vol. 34, March 2010, pp. 452-67.

Henry, J. D. and Rendell, P. G. A review of the impact of pregnancy on memory function. Journal of Clinical and Experimental Neuropsychology, Vol. 29, November 2007, pp. 793-803.