Taken from: Massachusetts General Hospital Center for Women’s Mental Health
Reproductive Psychiatry Resource & Information Center
During the postpartum period, about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety. Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum psychiatric illness.
It appears that about 50 to 85% of women experience postpartum blues during the first few weeks after delivery. Given how common this type of mood disturbance is, it may be more accurate to consider the blues as a normal experience following childbirth rather than a psychiatric illness. Rather than feelings of sadness, women with the blues more commonly report mood lability, tearfulness, anxiety or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery. While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. No specific treatment is required; however, it should be noted that sometimes the blues heralds the development of a more significant mood disorder, particularly in women who have a history of depression. If symptoms of depression persist for longer than two weeks, the patient should be evaluated to rule out a more serious mood disorder.
PPD typically emerges over the first two to three postpartum months but may occur at any point after delivery. Some women actually note the onset of milder depressive symptoms during pregnancy. Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life. The symptoms of postpartum depression include:
- Depressed or sad mood
- Loss of interest in usual activities
- Feelings of guilt
- Feelings of worthlessness or incompetence
- Sleep disturbance
- Change in appetite
- Poor concentration
- Suicidal thoughts
Significant anxiety symptoms may also occur. Generalized anxiety is common, but some women also develop panic attacks or hypochondriasis. Postpartum obsessive-compulsive disorder has also been reported, where women report disturbing and intrusive thoughts of harming their infant. Especially with milder cases, it may be difficult to detect postpartum depression because many of the symptoms used to diagnose depression (i.e., sleep and appetite disturbance, fatigue) also occur in postpartum women in the absence of depression. The Edinburgh Postnatal Depression Scale is a 10-item questionnaire that may be used to identify women who have PPD. On this scale, a score of 12 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) raise concern and indicate a need for more thorough evaluation.
Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth. Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.
It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.
Depression and Obsessive Compulsive Symptoms During the Postpartum Period
Despite several studies which have begun to demonstrate that maternal anxiety during pregnancy can negatively affect offspring neurodevelopment, little attention has been given to postpartum maternal anxiety both by clinicians and researchers. This may be because of the clinical overlap between depression and anxiety symptoms. Routine postpartum screening generally includes assessing symptoms of depression but anxiety disorders are often masked. Educating clinicians about postpartum anxiety can be very helpful for patients.
Recent studies show pregnancy and childbirth are frequently associated with the onset of the Obsessive Compulsive Disorder (OCD), one type of anxiety disorder. Some women do not have OCD but are bothered by obsessive-compulsive symptoms.
Miller and colleagues aimed to shed light on postpartum depression and anxiety, with and without obsessions, in their two recent studies (Miller, Hoxha, Wisner, & Gossett, 2015a, 2015b).
A prospective cohort study of 461 women was performed to examine the phenomenology and the most common obsessive and compulsive symptoms present in postpartum women without a diagnosis of obsessive compulsive disorder (OCD). Of the 461 women included, 11.2% screened positive for OCD at 2 weeks postpartum, while 37.5% reported experiencing subclinical obsessions or compulsions. Both at 2 and 6 weeks, among the women who screened negative for OCD, the most commonly reported obsessions were aggression and contamination, and the most common compulsions were cleaning/washing, checking. Women with compulsions, with aggressive, religious and somatic obsessions and obsessions with symmetry were more likely to screen positive for OCD . Miller and colleagues’ data also showed that women with subclinical obsessions or compulsions were much more likely to be experiencing depression, as nearly 25% of these women also screened positive for depression.
In a secondary analysis of their prospective cohort study, Miller and colleagues examined the clinical course of postpartum anxiety and they confirmed the clinical overlap between postpartum anxiety and depression. A large number of women with postpartum depression had anxiety symptoms and obsessive-compulsive symptoms in the immediate postpartum period. At 2 weeks postpartum 19.9% of women with depression were more likely to experience comorbid state-trait anxiety, compared to 1.3% women who screened negative for depression. At both at 2 and 6 weeks postpartum, women with depression were more likely to report obsessions and compulsions compared to women without depression. While state-trait anxiety symptoms tended to resolve with time, obsessive-compulsive symptoms persisted. By 6 months postpartum, there were no differences in anxiety symptoms in women with and without depression, but the difference in obsessive-compulsive symptoms persisted (p=0.017). All this means severe distress for women and therapeutic implications for clinicians.
Given the potential adverse effects of untreated mood and anxiety symptoms on both the mother and child, careful screening and early recognition of anxiety symptoms during the postpartum period is recommended.
What Causes Postpartum Depression?
The postpartum period is characterized by a rapid shift in the hormonal environment. Within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically. As these gonadal steroids modulate neurotransmitter systems involved in the regulation of mood, many investigators have proposed a role for these hormonal shirts in the emergence of postpartum affective illness. While it appears that there is no consistent correlation between serum levels of estrogen, progesterone, cortisol, or thyroid hormones and the occurrence of postpartum mood disturbance, some investigators hypothesize that there is a subgroup of women who are particularly sensitive to the hormonal changes that take place after delivery. This population of women may be more vulnerable to PPD and to other hormonally driven mood disturbances, such as those occurring during the premenstrual phase of the menstrual cycle or during the perimenopause.
Other factors may play a role in the etiology of PPD. One of the most consistent findings is that among women who report marital dissatisfaction and/or inadequate social supports, postpartum depressive illness is more common. Several investigators have also demonstrated that stressful life events occurring either during pregnancy or near the time of delivery appear to increase the likelihood of postpartum depression.
While all of these factors may act together to cause PPD, the emergence of this disorder probably reflects an underlying vulnerability to affective illness. Women with histories of major depression or bipolar disorder are more vulnerable to PPD, and women who develop PPD will often go on to have recurrent episodes of depression unrelated to pregnancy or childbirth.
Who is at Risk for Postpartum Depression?
All women are vulnerable to postpartum depression, regardless of age, marital status, education level, or socioeconomic status. While it is impossible to predict who will develop PPD, certain risk factors for PPD have been identified, including:
- Previous episode of PPD
- Depression during pregnancy
- History of depression or bipolar disorder
- Recent stressful life events
- Inadequate social supports
- Marital problem
Click here to read a MGH 2005 blog post on risk factors for PPD.
Click here to read about obesity linked to postpartum risk.
Miller ES, Hoxha D, Wisner KL, Gossett DR.The impact of perinatal depression on the evolution of anxiety and obsessive-compulsive symptoms. Arch Womens Ment Health. 2015
Miller ES, Hoxha D, Wisner KL, Gossett DR. Obsessions and compulsions in postpartum women without obsessive compulsive disorder. J Womens Health (Larchmt). 2015
Reprinted from www.postpartumprogress.com by Katherine Stone (2/3/2011)
I found myself asking that question when I read a heartbreaking comment from Amina, a Muslim mother who had postpartum depression, on a piece I had written about postpartum depression and different religious faiths.
I’m Muslim and had postpartum two years ago with my 4th child. Never had it before then. I remember when I told the Sheik’s(kinda like pastor’s) wife that I needed help. They made me feel so small, like I wasn’t a practicing Muslim, and said stuff like “You don’t need those pills.” or “They are just going to make things worse.” or “It’s all in your head. You just need to pray more, pray harder”. It was like saying you’re not a believer in God because you have this issue. I was devastated. I went looking for support and was dragged down even more. I even bought a book from their library and in the book it blamed “the devil or spirits ” and insisted I needed to pray more, or pray certain prayers. Thing was I prayed and prayed and prayed til I could barely move or speak. Did everything I was told to and it didn’t help at all. I never went back to that mosque after that day. It felt like they made things worse on me. I felt like I was being told I’m not a “real” Muslim or a true “believer” or I was simply “weak”.
This happens so often. Women made to feel horrible by people in their religious communities. This is something I cannot abide. Postpartum depression or anxiety (or antenatal depression or anxiety) are not moral failings. Period.
I reached out to my buddy HK to see if she was aware of what the Islamic position on PPD is, and she, being the awesome person she is, found the following for me from Ask The Scholar. It’s not specifically about postpartum depression, but it does provide an Islamic perspective on mental health issues:
Question: What does Islam say about mental disorders/illnesses? Is it due to the effect of jinn (demons) or Satan? What is the Islamic treatment for mental disorders?
Answer: It is indeed very unfortunate that some Muslims today cling to folklore that was not even accepted by those Muslims who came before us.
Even a casual glance at Islamic history reveals that, while much of Europe in the Medieval Period viewed mental illness as demon-related, Muslim scholars of the time, including Ibn Sina (known in the West as Avicenna – the founder of Modern Medicine), rejected such notions and viewed mental disorders as conditions that were physiologically based.
This kind of forward thinking about mental health by early Muslim scholars is also what led to the creation of the first psychiatric ward in Baghdad, Iraq by al Razi (one of the greatest physicians Islam has ever produced and known in the West as Rhazes). Based on the view that mental disorders were medical conditions, patients in these wards were treated not only humanely and compassionately but also using psychotherapy and drug treatments.
All this should be ample proof that in Islam, mental disorders are considered as illnesses that warrant medical attention and treatment, including medication, if prescribed.
In fact, taking medication and treating ourselves via experts is an important Islamic teaching. The Prophet Muhammad (peace be upon him), is reported to have said, “Treat yourself through medications, for God has sent down a cure even as He has sent down the disease.”
All this being said, one should supplement treatment for all illnesses with prayers asking for God’s mercy, cure and healing.
I welcome other perspectives, as I am not a Muslim myself. I have to tell you, though, that I think this perpsective will remain my favorite. To me, it is beautifully supportive and healing.
Rachel Oshan, MSW, LICSW, Independent Practitioner
Hometown: West Union, IA
Areas of specialty/role within the practice: Depression, anxiety, grief and loss, life and role transitions, family of origin issues, pregnancy and postpartum concerns, infertility and perinatal loss, adjustment to parenting concerns, self esteem, and interpersonal relationship concerns.
Favorite place: My favorite place is my family’s cabin in northern Wisconsin. Its peacefulness resonates with me in the most absolute way. As a mother, I now get to enjoy watching my children love this place as much as I do, which brings me so much joy.
Ideal meal: I love trying new foods and would love to make more time to explore cooking things I’ve never made (which would allow for numerous options). However, after a long day, I usually just want to eat pizza.
Tip for self care: It is so hard to remember that we are worth making time for! I have struggled in remembering that making time for myself isn’t selfish, but necessary. We are constantly faced with societal expectations of go, go, go; slowing down is so often seen as a negative. Creating space to acknowledge the necessity of self care allows us to prioritize its importance and gives permission to make time to explore what it means for each of us individually.
What do I love about my job: I feel so lucky to be able to say I love my work. I am passionate about my role as a psychotherapist and I am truly honored to engage in the experience of having others place trust in me, sharing their narratives and allowing me to come alongside them as they explore their path forward.
Stigma is: prejudiced negative beliefs based on stereotypes of the mentally ill.
What can you do?
Take a stand to transform discrimination of mental illness by facing stigma head on.
4 ways to defeat stigma:
- Be supportive.
It is hard to seek help for anyone who’s struggling just to get through the day. Don’t place blame. Keep it simple and factual: for example, say to yourself, she is learning how to manage a mental illness. Remember that people do get better with treatment.
- Stop using degrading language.
Say the truth and respect the person: She has bipolar disorder. She has depression. Stop using words that are not helpful.
- Get the facts.
Mental illness is common, “about 25% of all U.S. adults have a mental illness.” https://www.cdc.gov/mentalhealthsurveillance/fact_sheet.html Show others the dignity and respect that you would like if it happened to you.
- Share your own experience of mental health struggle.
Being open about your own struggles with mental/emotional health “normalizes” mental illness. When you are honest about your experience, it gives others permission & courage to speak up and seek help, too.
If you are struggling:
To get help, contact a trained professional. If you don’t know where to start, please look at Postpartum Support International and the National Institute for Mental Health, NAMI. In the Twin Cities area, contact Psychology and Healing Associates, home of the Postpartum Counseling Center 612-296-3800.
Sara Nuahn, MSW, LICSW, CBIS, Independent Practitioner
Hometown: Minneapolis, MN
Areas of specialty/role within the practice: Depression and anxiety, perinatal mental health, pregnancy, late term loss/miscarriage, infertility, communication issues, identify and life transitions, work/life balance, couples support
The book I most often recommend: I just finished The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Bessel van der Kolk. It is an amazing book!
Favorite place: with my kids driving in my car.
Ideal meal: Baked Ziti and Garlic Bread
Tip for Self-Care: Find your fringe space during the day to reconnect to self, breath, and rest.
What do I love about my job: Connecting with others, seeing growth and change, and being real and in the moment.
Sara Nuahn is part of the team at Psychology and Healing Associates and as an independent practitioner, her office is at 600 W 78th St.10 i, Chanhassen, MN 55317. Call us to set up an appointment 612-296-3800.
Beyond the Baby Blues
Present at the 2017 Beyond the Baby Blues Conference!
NAMI Minnesota is currently seeking submissions for our annual Beyond the Baby Blues Conference. This year’s event will take place Wednesday, June 7th at the University of Minnesota Continuing Education and Conference Center
Beyond the Baby Blues is a full-day conference designed to educate professionals and families about mood disorders and anxiety before, during and after pregnancy.
The submission deadline has been extended to Friday, February 17th.
Below is a list of topics past attendees are interested in learning more about.
- Birth trauma, pregnancy after loss, fertility issues, recurrent loss, & coping with grief while trying to get pregnant again.
- Children’s mental health & behavioral health.
- Cultural competence, including resources and supports for low-income populations and specific cultural groups, particularly Somali women.
- Diagnosed mood disorder and family planning, preventative care, breast feeding and medication, attachment with newborn when diagnosed with PMAD.
- Helping the over 40 first time mom who has taken hormones.
- Holistic approaches, functional medicine approaches in post-partum care including diet, nutrition, herbs, acupuncture, and others.
- Practical applications of treatment approaches and techniques.
- Biology, physiology, hormones and what happens during and after pregnancy as it pertains to the mental health of people of all genders.
- In-depth diagnostic and treatment presentations.
- Presentations on OCD/PTSD, including information on dads.
- Personal stories.
- Working fathers in relation to PPD and PMAD.
- Medication management, integrated care, funding, designing a study, sleep disorders and impact on mood and treatment options.
- NICU, birth trauma.
- Pregnancy loss, infant loss, infertility, interpersonal psychotherapy, case studies, grief and loss.
- Home visiting.
- Same sex couple adoption, births and parenting options.
- Toxic stress, compassion fatigue and historical trauma.
10th Annual Beyond the Baby Blues Conference
Wednesday, June 7th
8:30 AM – 3:00 PM
1890 Buford Avenue
Saint Paul, MN 55108
NAMI Minnesota is also seeking sponsors and exhibitors for Beyond the Baby Blues
. If you are interested in partnering with NAMI Minnesota for the conference, kindly complete this form
. Contact Emily at firstname.lastname@example.org
for more information.
This message was shared from NAMI Minnesota to the PHAWellnes mailing list in the interest of generating great presenters for the Beyond the Baby Blues Conference.
Jennie Laskow, MA, LPCC, Licensed Professional Clinical Counselor
Hometown: Minneapolis, MN
Areas of specialty/role within the practice: I treat women with perinatal mood and anxiety disorders in addition to treating trauma and PTSD. I also have additional training and special interest in treating men and women dealing with trauma associated with a traumatic birth experience or the death of a child. I use EMDR in my practice and wish I could reach more of those suffering with unresolved trauma symptoms. Though EMDR does not eliminate the normal process of grieving, it does treat the trauma symptoms that can leave people feeling stuck in the memories of a tragedy they experienced with flashbacks, nightmares, numbness and/or depression. I love a chance to get the word out that these symptoms are treatable.
Recommended book: The book I most often recommend to women who struggle with body image and have tried to address it by dieting is Big Fat Lies by Glenn Gaesser Ph.D.
Favorite place: I love Grand Marais but am also really happy on the couch, in front of a fire in my living room, hanging out with my boys who are 14 and 12.
Ideal meal: any meal that someone else cooks for me
Dogs or Cats? Dogs, definitely dogs, here is mine
What do I love about my job: I am grateful for the opportunity to work with people in the intimate forum that therapy provides. It is an honor and privilege to join with each client, to build a trusting relationship and provide a safe space for the emotional work that follows. The strong therapeutic relationship provides the setting in which we can explore and treat the issues brought to therapy. I think about therapy as an opportunity to receive support and increase self-awareness, to experience healing from emotional injury, and to work in partnership to decrease suffering.
A quote I love:
“Healing comes from letting there be room for all of ‘this’ to happen: room for grief, for relief, for misery, for joy.” – Pema Chodron
Jennie Laskow is part of the team at Psychology and Healing Associates and as an independent practitioner, her office is in Bloomington at the Southtown Office Park, Suite 252. Call us to set up an appointment 612-296-3800.
By Karen Kleiman, reposted from The Postpartum Stress Center
DISCLAIMER: These points refer to therapists who have been trained to treat perinatal depression and anxiety. If you do not feel like you are in the presence of a therapist you can trust or if you find yourself questioning his or her level of expertise in this area, please find yourself another therapist….
- I know it is hard to talk about the anxiety racing through your mind right now. I know it is difficult to distinguish between what is problematic and what is normal. I can help you figure that out.
- If your thoughts are about suicide, you need to tell me that so I can help keep you safe. If your thoughts are about harm coming to your baby, this is more common than you might know and if you feel too anxious to talk about it now, you might feel better talking about it at a later time.
- Did you know that 91 percent of new mothers report having negative, intrusive, unwanted thoughts about harm coming to their babies?
- You might be surprised to discover that you feel better after you tell me what is worrying you.
- Negative thoughts and images that worry you will not worry me.
- No matter how scary, how intrusive, how overwhelming your thoughts are, I have probably heard worse and nothing you say will alarm me.
- Scary thoughts that are really scary are not diagnostically more serious than any other scary thought. The only thing bad about scary thoughts that are anxiety-driven is that they feel so bad to you.
- I know it can feel like you are going mad. Your high level of distress is an important indicator that what you are experiencing is anxiety, not psychosis.
- Do not let feelings of shame, embarrassment or guilt interfere with what you want to tell me. It will be okay.
- Scary thoughts do not lead to actions.
- Nothing bad will happen if you tell me what you are thinking.
- You will not be judged here.
For additional help, please contact us, The Postpartum Counseling Center at (612) 296-3800.
Please Join us!
For a webcast gathering: Annual 2020Mom Forum –
Emerging Considerations in Maternal Mental Health
Hormones, & Physical Inflammation
February 13th, 2017
10:45am-1:30pm (2.5 CEUs/CMEs)
11:00AM Introduction 2020Mom Forum
11:20AM A Personal Story
11:30AM Keynote Presentation:
The Impact of Hormonal Changes During Pregnancy & Their Effect on Postpartum Depression
Samantha Meltzer-Brody, MD, MPH
Associate Professor of Psychiatry, University of North Carolina, Chapel Hill; Director, Perinatal Psychiatry Program; Director, Taking Care of You Program
12:45AM A New Paradigm for Depression in New Mothers:
The Inflammatory Response and its Relation to Physical and Psychological Stress
Kathleen Kendall-Tackett, PhD, IBCLC, FAPA
Clinical Professor, School of Nursing, University of Hawai’i, Manoa;
Clinical Associate Professor of Pediatrics, Texas Tech University
– and –
Summit Executive Suites – Party Room (in back of building)
1500 McAndrews Road West
Burnsville, MN 55337
$45 (includes CEUs/CMEs)
$10 (no CEUs/CMEs)
Use the payment buttons below to pay using PayPal.
You do not need to have a PayPal account to pay with a credit card.
Make sure to include your email address with your PayPal payment, so that we can email your CEU/CME certificate following the event.
We love this bilingual children’s book about different kinds of families. In Wanted: A Journey to Surrogacy / Un viaje hacia la subrogación, by Carolina Robbiano, many types of families are shown. Some have two parents, some have one. Some have parents living in different houses, or two moms, or two dads. Some children live with grandparents and some families have many children; others have none. “Becoming a family through non-traditional means is barely explored in children’s literature,” Robbiano says, “and yet it is an important story for children of such families. It assures them that they are loved and that being different is not only okay but it is certainly the new normal.”
Robbiano, first searched for a book that could tell her own child the truth about how he came into the world to complete her family. Her search for a book that could ease him into the process without making him insecure came up fruitless. So “I just decided to write the book I couldn´t find in the market” says the author. “WANTED… is my tribute of love for my family,” Robbiano says. “Many people were helpful as we went through our surrogacy journey. I wanted to pay it forward by making this work available to others who may find themselves in a similar situation. It’s a small gesture to say, ‘thanks’ and ‘you are not alone.’”
The illustrations, by Francesca Massai, are colorful and imaginative.
Wanted: A Journey to Surrogacy / Un viaje hacia la subrogación offers a simple message about families of all types to help children between the ages of 4 and 8 understand the many versions of parenthood.
Areas of specialty/role within the practice: Marriage and family therapy, couples work, mental health during pregnancy & postpartum period, and perinatal loss and bereavement
The book I most often recommend for couples: Terrence Real’s How Can I Get Through to You?
Claim to fame recipe: cheeseburgers with grass-fed beef, sesame-seed buns, and grilled onions
No one would guess that: I play the tuba
Your quote for tough days: If I do nothing today besides hug my children, then I’ve done enough.
What do I love about my job? It’s an honor to have people share their stories with me. It’s a privilege to be present together in such an honest, real way. It’s life-affirming and beautiful to me to be constantly reminded of our common humanity.
Two of my favorite books ever: Middlemarch by George Eliot and The Corrections by Jonathan Franzen
Tuba player extraordinaire, Michele Michaelson
Find out more about Michele Michaelson, Psychotherapist, at Psychotherapy and Healing Associates, Ltd.
Krista Post, MA, LP to Speak at Upcoming Conference
Exploring Paths of Hope: 32nd Annual Infertility & Adoption Family Building Conference, Saturday October 1st
One in eight U.S. couples of childbearing age has trouble conceiving or sustaining a pregnancy. If you are part of this journey, you want to be a part of RESOLVE, The National Infertility Association, which works to improve the lives of women and men living who face challenges with family building. Their 32nd midwest conference, Exploring Paths of Hope, will help provide the community and information you need to move forward. Krista Post will speak on a couple panels about Donor Egg, Donor Sperm & Embryo Donation and Working Well as a Couple through Infertility/Family Building. Krista Post is the Clinic Director at Psychotherapy and Healing Associates, and the founder of The Infertility Counseling Center.
At the RESOLVE Infertility and Adoption Family Building Conference, you will learn about new treatments, be able to talk directly to doctors and specialists, explore parenting options and network with others experiencing infertility.
To attend, register here: http://www.resolve.org/Regions/midwest/midwest-family-building-conference.html
Date: Saturday, October 1, 2016
Time: 7:45 AM – 5:15 PM
Address: Normandale Community College, 9700 France Ave South, Bloomington, MN 55431
Please be aware that RESOLVE events are open to everyone in all the various stages of their family building journey. We are sensitive to the emotions of all involved and want to inform you that attendees, volunteers, speakers and exhibitors may include those recently diagnosed, in treatment, expecting, and resolved. Please no children, childcare is not available at this event.
#FamilyBldgConf #Infertility #FamilyBuilding #RESOLVE
Learn how to manage emotions with DBT skills
New parenthood is a transition time and of course there will be moments of stress and frustration. But for some new moms, stress and frustration lead to harmful or self-destructive behaviors. There is a tried and true set of coping skills for dealing with these stressors: Dialectical Behavioral Therapy or DBT. It’s a therapy that teaches coping skills for how to manage intense emotional states.
Dialectical simply means taking two opposites, and bringing them together. For example, the balance of acceptance and change. It is one thing to accept yourself in the present moment. In dialectical behavioral therapy (DBT), you learn skills to help you change in order to meet your goals. New parents who learn these skills are able to manage intense stress and difficult emotions like hopelessness, guilt, worry, fear, and anger.
A few types of moms benefit from Dialectical Behavior Therapy:
- Highly sensitive people, easily overstimulated. Baby’s cries, little messes, overstimulation can lead to a meltdown for highly sensitive adults.
- Moms with a history of depression or anxiety. If you’ve had depression or anxiety in the past, you may benefit from learning stress coping skills in DBT.
- Anyone who can’t trust their inner feelings, or who don’t know how to listen to their inner voice (including those who were told, “don’t cry” or “you’re not full, keep eating.”)
- Those who learned negative coping skills from their own families, for example, substance abuse or lashing out at loved ones.
The DBT coping skills techniques relieve suffering. And with less suffering comes the ability to learn concrete, practical ways to address and change harmful behaviors.
At the Postpartum Counseling Center, we have a unique way of presenting the techniques of DBT especially for moms in a small group led by Lindsey Henke, trained in DBT and postpartum mental health issues. Join our small group to learn these skills: Coping Skills for Moms. Contact us to register and submit your insurance. Our Coping Skills group has open enrollment and is ongoing, Thursdays, 4:30 – 6:00 pm., 4725 Excelsior Blvd., St. Louis Park, MN 55416. More info »
* This group incorporates skills developed by Marsha Linehan, creator of Dialectical Behavior Therapy (DBT). DBT was originally used to treat people with severe mental health & relationship issues. It was soon discovered that this approach is helpful to people experiencing a wide range of issues: managing stress, overwhelming emotions & relationship problems. DBT is an evidence-based approach that anyone can benefit from. For a review of the research on DBT, http://www.linehaninstitute.org/resources/fromMarsha/
Lisa Miles, CNM, NP, Adult Psychiatric Nurse Practitioner and Certified Nurse Midwife
Hometown: Born in Lancaster, South Carolina. I returned most summers as a child to visit my fathers family. I was a military brat, I lived overseas as a little girl. When I was nine my family settled in North Dakota.
Areas of specialty/role within the practice: I’m a nurse midwife and a nurse practitioner in mental health. My specialty the care of women throughout their lifespan with an emphasis on the childbearing years.
The book I most often recommend: It’s really hard to pick one book.
The Noonday Demon: An Atlas of Depression is a memoir written by Andrew Solomon about the pain of depression and its treatment.
Madness: A Bipolar Life by Marya Hornbacher written by a Minneapolis author, this is an amazing account of life with bi-polar illness.
I Stand Here Ironing is a short story by Tillie Olson. The story is about the guilt that occurs with mothering.
Beloved by Toni Morrison – A fictional account set in the the time of slavery about of the love a mother feels for her children. Morrison won the Nobel Prize in literature in 1993.
Love Medicine is a novel by Louise Erdrich — From the experience of a family of Native Americans in North Dakota the story explores the complexities of parenthood.
Favorite place: Lake Harriet.
Ideal meal: I love a great hamburger with the ”works” and a chocolate malt.
Tip for home care: Music, candles and a bath
What do I love about my job: Observing women recover from depression and anxiety is the best part of my job.
We’ve heard the saying – yes – that “it takes a village.” We’ve also heard that, sadly, our villages are disconnected, dismantled – spiritually broken by the almighty smart phone…and the news. Oh, the news.
Families, who once dwelled in a one-room prairie house and – then, later – in the same duplex, are now scattered. Grandmas and aunties who used to tend to moms and babies are today’s career women…with active social lives and triathlons to train for.
Things have changed – in some ways for the better and for the sake of progress and equality, while also causing a shift in the way we view the postpartum tradition of taking rest.
We talk often of needing help, calling neighbors, hiring doulas, sparking up the church meal tree. We talk of creating our own village, reclaiming the “lying in” period, doing things right. But for modern mothers, raised in the afterglow and subsequent backlash of feminism, asking for help doesn’t come naturally.
Beyond the actual NEED for both practical and emotional help, ASKING for help is actually a therapeutic process. Even in prayer, in yoga class, to the stock boy in the cereal aisle – to admit that we need help allows us to soften. Paradoxically, to ask for help (knowing that you need it) is a sign of strength.
Softening, strength and HELP were never more important than they are during the postpartum period. Ask for it, hire it, ACCEPT IT (for crying out loud) when it is offered willingly!
Hometown: Los Alamitos, California
Role in the practice: Writer and editor of blog and newsletter, with a helpful background as a certified postpartum doula.
Favorite Movie: Love Actually
Favorite Book: Peter Pan or To Kill a Mockingbird
Claim to Fame recipe: Either apple crumb pie or tortilla soup.
Dream Vacation: London or Greece
Go-to for self-care and wellness: Yoga, yoga, yoga. Laughter, fresh air, cats.
“This above all: to thine own self be true, and it must follow, as the night the day,
thou canst not then be false to any man.” – Shakespeare.
“Clear eyes, full hearts can’t lose.” – Coach Taylor
Written by Sam Chadwick and modified from her personal blog
We returned from our 3-month expat to Sweden at the very end of July and lived the next few months in limbo a little bit, uncertain about future living situation and jobs.
About two weeks before we departed Sweden, I started worrying a lot. Worrying so much that I got worried about the worrying. That’s how I first described it, I think.
Many of the worries were about my daughter. I couldn’t help thinking about and dwelling on nightmare scenarios. I thought she would be kidnapped while we walked around the city. I thought someone would come up behind and attack her while I carried her on my back in the carrier. I thought we would get caught in a revolving door and be squished. That the ceiling would crumble and fall on her crib. It’s like everything was a big, scary what if. What if we fell over that railing? What if she fell and got stabbed with a fork?
And it was getting to the point where I was just plain worried about having these thoughts, and they wouldn’t stop. Why was my brain doing this? I worried about why I almost constantly went over these awful ideas in my head. And it wasn’t just in my head; I began feeling physically anxious, and sick to my stomach. Then I had actual panic attacks. I was self-aware enough to realize that’s what was happening — but it was really very terrifying. Like maybe I’m having a heart attack. Mine happened while lying in bed at night. Waves of tingling panic, getting hot then cold, nausea, racing heart, wondering whether I should go to the hospital. Even when I wasn’t having the bad thoughts, I felt generally anxious, like pins and needles on my skin, for no apparent reason. I could forget about it for sometimes hours at a time but it always returned. Distraction was all I knew to do to try and avoid it, and that can work temporarily but tends to make it come back worse.
I would say it bothered me more than half the time, and so after a couple weeks, the struggle with anxiety started making me depressed. Why couldn’t I shake this? Would I ever feel normal again?
I resolved to see someone when we got home about what I was now referring to, when I talked to my husband, as my “mood issue.” I’m not sure why I didn’t feel like I could reach out to another friend or family member. I guess I felt like I needed to see a professional first? But not finding support from people I’m close to probably just made it worst.
So I went to a therapist specializing in perinatal mood disorders (a much more apt term, I believe, than the typical “postpartum depression”). I was a giant ball of anxiety, perched on the edge of her couch, describing what I’d been experiencing — until I started just completely sobbing. I had not seen that coming. I guess I cried of relief, and of fear. Perhaps the admission that I had a real, clinical problem – and the validation from her that it actually was, and that it was ok, and that help was available. But after all those tears (I cried more later in the car), I felt more relaxed than I had in weeks!
I had felt pretty strongly at some points that I might need some medication to help me, and I did see a nurse-midwife about those options. But in the days following that first therapist visit I felt so much better. Just learning about the physiology of what was happening with all that cortisol in my body (aka the “fight or flight” hormone) helped me figure out how to tolerate and calm it. Even though I knew that other people suffer from this kind of thing (the midwife called mine “garden variety anxiety and depression”), it still felt very lonely and helpless at times, which is just a terrible, scary feeling.
Another thing – the first week I noticed something was off, we had also just recently “night weaned” my daughter — meaning I abruptly stopped breastfeeding her in the middle of the night. My husband got up with her at 2 or 4 am for a couple weeks and offered cow milk or water when she wanted “mommy moke.” After a few weeks of my anxiety, I had almost forgotten about the weaning – until the therapist and nurse-midwife both said they thought it could be part of why I started feeling this way, given that chemical change in my body. Now I am even more committed to the gradual weaning process as only my daughter and I can work out together.
If I had been doing the wrong things before seeing the therapist (trying to distract myself and ignore it, keeping it secret, not going to bed until I was overtired, letting the worry consume me) now I was spiraling in the opposite direction – and feeling better and better. Therapy helped as well because she asked me to do exactly the opposite of what I would have known to do myself. She didn’t tell me I could just kick this anxious feeling. She asked “what would it be like to just sit there, in your anxiety?” I would describe all these physical sensations leading me to worry that I probably had some serious health problem. “What if that feeling is just anxiety?” I was never as honest as I was sitting on her couch. It was not uncommon for me to be chipper or chatty, holding it together, until inevitably some certain question from her, or something I heard myself say in response to her coaxing, and my entire facade would unravel, leaving me shaking and sobbing and…relieved.
My other “medicines”: Yoga. Seriously yoga. Fish oil. Essential oils. Crying. Quitting caffeine. Routine. My amber bracelet. Mindfulness meditation.
I have had a lot of tough months since that, ups and downs.
I’m writing this because I need other people to know about it. This has got to be SO MUCH more common than we all think. But we don’t like to talk about it. I sure didn’t.
Pregnancy, birth and motherhood affects our brain and body chemistry so much, but I also know that many people close to me have experienced similar problems and it’s not a just a postpartum issue. I’m really thankful to the handful of people who have revealed their own similar struggles to me so that I knew I wasn’t alone and that I had someone to go to.
I am lucky to be the writer and editor for the Postpartum Counseling Center, an organization I 110% support. I support this organization wholeheartedly because I used to work as a postpartum doula. Once a doula, always a doula. The work still finds it’s way into my life – when I see a mom of three little ones struggling at the grocery store, when (clearly) a girlfriend needs to TALK. The love and appreciation for motherhood and the perinatal period is in me.
I’m going to be honest. The job was hard. The work was demanding. And as we often, here at Psychotherapy & Healing Associates and The Postpartum Counseling Center, RECOMMEND hiring a doula, I wanted to shed some light from the other side of the coin. From the doula’s perspective.
On any given day, walking into a home that was either completely foreign to me or only slightly familiar, I would need to adopt many rolls, depending on the pressing needs of the family. Lactation counselor, marriage therapist, nanny, maid, massage therapist, cheerleader, chef, advocate. Though I was none of these things in credentials, I was ALL of these things DAILY. I needed to be.
I saw everything from the baby blues to severe postpartum anxiety. I shouldered a new mom’s guilt at her extra marital affair. I put aside my own way of raising my babies many, many times. I washed dishes. I felt bored. I felt useful. I felt that I was a mere handmaiden. And I felt that I was a life saver. I saved at least one life due to medical knowledge I acquired during training. I saved at least one life due from cataclysmic emotional trauma. I messed up the laundry more than once. I had occasional uncomfortable discussions with fathers and grandmothers. I got to know the family dog. I accidentally let out the cat. I helped find the cat. I was trusted with a mother’s whole heart – her baby, for crying out loud. I was trusted. I was taken for granted. I was talked down to. I was family. I was adored.
I am out of the field now – as much as I can be – because I am a writer, but also because the work was not the kind I could do forever. Because it was too much – too draining, too raw, too real, too scary, too much in competition with the mothering energy I need to focus on my own kids.
I say this with so much respect for those who doula for a few short years, as I did, and with complete awe of those who do it for a lifetime.
Most of all, as you consider seeking support from a postpartum doula, I want YOU to consider everything I was and everything I saw and everything I did. Think about what that kind of support can do for you.
While this was never something I was planning to do forever, I value the importance of the role and the work very much.
(Story written by and shared with permission of Katie)
For 3 years, I have tried to write this story. I have tried to soften it, make it sound polished, make it sound that at the end, it all came together and culminated nicely, creating this sound, strong person. But the truth is, the ending isn’t there yet. The ending is still being created, and instead of the ending, it’s the beginning of another journey…the journey to hold the space to forgive myself.
I gave birth to my first and only child in March of 2013.
Labor was painful and quick – within an hour I was dilated to a 7. Although my plan was to have a “natural birth,” I wanted nothing to do with that plan in the moment. They told me there was no time for any pain management medication.
Within 30 minutes I was pushing, for quite awhile. Oxygen levels were dropping. More people were brought in. If I hadn’t been in so much pain, I would have been scared beyond belief. I was told I could have one more push, that he needed to come out.
I mustered all I could, and pushed him out; but he was not a healthy color. The cord was snipped and he was handed over to the NICU team to get oxygen. I am not sure what happened next. I have blacked out the next moments. I cannot remember meeting my baby for the first time, seeing him or holding him. I have no recollection. As I periodically look back to this moment, I think, “What kind of mother am I? Do I have a soul? Do I care?” I ask these questions more times than I can count.
My husband and I had grand visions and expectations of what our lives as parents would be, what our children would be like. Everything seemed to fit into this perfect, magical mold created somewhat by our imaginations, somewhat by society.
On Day 3 of our son’s life, we were given devastating news that they felt something was terribly wrong with him. Scary tests were ordered, confusing explanations were given. Add to this news over 48 hours with no sleep, an extremely fussy baby, adjustment to new parenthood, poor breastfeeding and jaundice. It was the perfect storm to push me over the edge. I sobbed and sobbed, and then was left completely alone.
Overwhelming dread began to fill every inch of my body. After 24 hours of my baby being in the special care nursery, we were sent home and told the results would come within a week.
Life did not settle into this picture of a happy home. Instead, it was a mess. Long visits from in-laws, a baby that wouldn’t settle, breastfeeding struggles and hormones. Even when my husband was holding the baby, I could not sleep. I did not sleep. I was devastated by the thought of having my husband go back to work. I could not be alone with this “thing that never stopped crying.”
I was at a complete disconnect. Rationally, I knew that he was my baby. Emotionally, I was not bonded whatsoever. I met his needs the best I could, I held him because otherwise the crying would be 100 times worse. But there was no love.
How on earth could I not love my own baby? My Facebook wall was filled with pictures of moms and their babies sharing sweet tender moments. “We are so much in love with this new person and we just met,” seemed to be a common phrase.
My husband went back to work and I was left with the baby. Long days were filled with me holding my son, poor attempts at breastfeeding, sore nipples and both of us sobbing.
I tried to express my feelings to my midwife, but I don’t think she quite understood the extent of my despair. She patted me on the back, told me I was a good mother and prescribed me a low dose of Zoloft to be therapeutic in the postpartum time.
Anxiety and depression were filling my days, not that I completely knew it at that time. I could not bring myself to take the Zoloft. I was too consumed by the thought of all the adverse side effects and the idea that I needed something like this. I was in denial.
The days cycled into nights, in a constant pattern of nothingness. There was no day, and there was no night, they just meshed together because this baby had no desire to succumb to any circadian rhythms.
There was never a chance to restart in our cyclical world of sunsets and sun rises. Mine was just one big blur of grey, filled with the sound of an unhappy baby’s wails. Bouncing on a yoga ball for hours seemed to be the only thing that semi-calmed him. This required great effort to an already exhausted set of parents. I was told that he would start smiling at us around 6 weeks. I was living for this moment, some feedback, something to show that everything we were doing could provide us with some sort of response, but we got nothing. He didn’t look at us, he didn’t smile; we barely seemed to exist.
The thought of being the worst mom in the world filled my head and my heart. My own baby won’t even look at me. What kind of despicable person am I?
I started having thoughts of disappearing, running away. On the extreme days, I thought of taking the entire bottle of Zoloft that I had filled, but never taken. I have never in my life felt that empty, that desperate, that sad and that lost. I struggled to find an outlet for all this. I attended a New Moms group, but struggled for connection because taking my baby anywhere seemed like a huge task, considering how much he cried. I truly took it as a reflection of my parenting. The protection of being isolated in my house seemed to feel better than the social scrutiny that was probably more self imposed, than actual reality.
Life threw us another curveball when our son was just over 2 months old. With our description of the lack of smiling and unresponsiveness to us – and also an unresponsiveness to light – we were sent to a pediatric ophthalmologist and told that he was probably blind and had a genetic condition that would cause a variety of other issues. We were sent to the U of M to see a specialist, but told we wouldn’t be given an appointment for 6 months. So there we were, left with this news to hold.
I was devastated. I couldn’t get out of bed. I didn’t want to wake up. This news, the feelings that I had already been experiencing, the lack of sleep and the inconsolable child…it was all too heavy. I left the house, drove my car, and kept driving. I cried and cried. I wanted to be done right there, with everything. I had already self diagnosed myself with postpartum depression and poured over any personal experiences I could find on the internet that I could relate to. The only thing that saved my life at that time was a story I read about a woman suffering from postpartum depression who wanted to end her life. Her doctor told her, “No child is ever able to get over knowing their mother killed themselves…”
We were able to get into the U of M earlier than we thought, and that is when the anxiety went into overdrive. We were told a number of different possibilities, given a number of different tests, genetic testing, sent to see many different specialists and were told so many things were wrong.
We were going there once a month by this time for extremely long appointments. The week before and the week after were filled with so much worry, I was having a hard time just living.
I was referred to a therapist by my midwife. I saw her once. She seemed to look at me as though I were crazy, and didn’t seem to have any particular specialized training in this area. I was unimpressed, and never went back. I avoided therapy after this for some time.
The struggles continued and our baby still wasn’t responsive to us. It took 9 months and an eye surgery to actually get a visual response from him. Pouring our hearts and souls into someone without any feedback became so difficult, when all we heard was crying all day. The crying didn’t stop, but at least we were given some infrequent smiles from time to time.
Around 11 months, I couldn’t take all the pent up feelings, the crying, the sleep deprivation. I reached out to Google and somehow connected with a therapist. This finally began my journey of healing.
To say I am completely recovered from all this would be a false statement. To say I am a survivor would be more realistic. Anxiety and depression became somewhat a fixture in my life after I had my son, two companions I never experienced so heavily before that time. I am slowly learning how to live with each. It’s not easy, and there are definite downfall spirals into each at times. What I can say is that it does get better. I eventually came to terms with taking some medication, and at the time, I think it did help with the process.
Healing has been slow for me. I am slowly forgiving myself for the moments and times when I felt as though I was a disconnected and detached mother. I was traumatized by that experience, but have come to learn so much about myself through it. There is no perfect picture for any of this. There is no perfect picture for having a child or raising a child. There can’t be, because when it comes to conception, pregnancy, childbirth and beyond, so much is out of our control. We can only manage what we can and surround ourselves with support. We must find ways to connect, soothe and nurture ourselves, so we can in turn be the mother we want to be.
Birthplace: Minneapolis, MN
Areas of Specialty/Role within the practice: Marriage and Family therapy practicum therapist, Postpartum anxiety/depression & infant loss
Favorite movie: Labyrinth
Favorite place in the Twin Cities: Magers and Quinn Bookstore or any farmers market.
Ideal Meal: Anything off the menu at restaurant Alma. I’m also a sucker for any type of quiche.
Your best tip for at-home self care and wellness: If you find something that relieves stress, creates joy, or allows for self-compassion, do more of that. Everyone has a different path to wellness.
Your quote for tough days: “Highly sensitive beings suffer more, but they also love harder, dream wider, and experience deeper horizons and bliss. When you’re sensitive, you’re alive in every sense of the word in this wildly beautiful world. Sensitivity is your strength.” – Victoria Erickson