Postpartum Emotional Adjustment
written by Jenn Paul, MFT and Carol Castanon, Child Development Specialist and Parent Consultant
Postpartum Emotional Adjustment is complicated. To begin with, there is an undeniable shift taking place in each birth mother’s body from inception. This shift includes the adjustments for a healthy physical pregnancy, but also the mental resiliency to accommodate caring for another. So we might say that stress is absolutely natural, worry is common, preparing the nursery is a kind of nesting, and losing sleep one’s preparation for a newborn. Because this stage of woman and baby is complex, experts are not always clear about how to support the “development of mother”. And it turns out life is complex. So added to adjustments for baby there may be extraordinary life circumstances to navigate. For most, stress and excitement are both true. But for others it is not so simple. A woman may be over or under diagnosed during this time of emotional adjustment. You are not alone…
What we understand about the pre-natal and postpartum time:
Feelings of overwhelm, sadness or grief can begin in pregnancy.
The image of the always glowing mother to be or the happy breast-feeding mama is a myth. The perfect parent and the perfect baby is a myth too. This is true for all families.
A “normal” or healthy postpartum adjustment includes plenty of anxiety-filled moments. A mother or father might deeply feel the weight of tending a new baby. It can be isolating to have a new baby, and filled with layers of uncertainty. But, healthy postpartum adjustment includes resiliency and moments of delight. Many mothers in this category will feel better with reassurance and community support. Mothers and Fathers are not meant to tend newborns alone.
The Baby Blues is 2-3 weeks, and no longer. Mothers may feel vulnerable and have surprising mood swings. This mother might be teary or anxious about being the caregiver of this little one. The reason for some of these feelings might not be easily explained with clear reason. “It” is just a feeling. This is normal and an expected part of a healthy postpartum adjustment. Baby Blues is most common between the 3 rd and 5 th day while milk is coming in. The baby blues affect about 85% of new mamas and go away on their own.
Birth is a profound physical and emotional experience. Even the “easy” pregnancy and birth is marked by dramatic biological changes and healing. Almost all new birth mothers to-be will notice changes in appetite, some difficulty sleeping, and a decrease in sex drive. Although these changes might be symptoms of depression, women who experience these are often simply sharing a common experience through the transition into motherhood.
“Approximately 20% of women will struggle with a perinatal mood or anxiety disorder like Postpartum Depression PPD and, for these women, their symptoms will noticeably interfere with their ability to function as necessary, meaning that their symptoms related to depression or anxiety (or both) will intrude on their ability to sleep, eat, work, care for their children, engage in activities that were once pleasurable to them, or connect with others in social situations.”
Postpartum Progress
Some Mother’s have symptoms of depression, however it is quite common for Mother’s to have symptoms of anxiety. Mother’s typically worry about whether baby is getting enough milk, sleeping safely, or having normal bowel movements. Women with anxiety that begins to build, doesn’t diminish, may feel out control, and develop fears that cannot be calmed. Fears of the baby’s well being might escalate into scary thoughts including their ability to keep their baby safe. Women might feel irritable or angry with their husband or partner. They might feel painfully misunderstood. Anxiety is experienced in the body. It is sometimes felt as headaches, chest pains, rapid heart rate, decreased appetite, or inability to sleep. It might present as cleaning and tidying and organizing the house to perfection despite its well put together condition. There may be a quality of not being able to slow down or stop.
Women are more at risk if there is a history of depression or anxiety, or have experienced a difficult or unexpected childbirth experience. Mothers whose babies have been born early or have needed special care in the nursery, or whose babies have special needs are at particular risk for PPMD. Women who have had miscarriages or difficulty getting pregnant, or have waited for a very long time might also experience a difficult transition into parenting a newborn. Multiples can also put an added weight on the emotional well being of family.
Mothers who have adopted, as well as Fathers may also experience mood adjustments around the complex transition of a new baby at home.
Still, there is a vast group of women who get missed in the above facts. There are mamas out there who are really, truly struggling more than we might expect them to in a healthy adjustment to motherhood, or they may have many of the symptoms described but don’t necessarily fit the criteria for a major depressive illness or an anxiety disorder. These are the mamas who hold it all together for those around them but, behind closed doors, fall into a heap on the bathroom floor, or in bed at night, or any place where no one else is looking. It’s these mamas who I worry most about because they aren’t likely to reach out for the support that they need to thrive.
The term Postpartum Stress Syndrome is used to describe this too-common experience. This term was coined by Karen Kleiman, an expert in PPMD; she describes Postpartum Stress Syndrome as “…marked by feelings of anxiety and self doubt coupled with a deep desire to be a perfect mother. This enormous expectation of being the perfect mother, perfect wife, in control at all times, combined with the very real feelings of inadequacy and helplessness, can create unbearable stress.”
Postpartum distress is an entirely subjective experience. Emotions and experiences that may feel tolerable to one mother may feel excruciatingly difficult to another. One mother may be self-forgiving of the uncertainty and vulnerability in new motherhood, while her friend next door may judge herself harshly for this very same experience. Feeling overwhelmed is difficult when caring for a newborn or infant. Understanding yours or another’s individual emotional adjustment is confusing because it is well – confusing. The best guide for this is the experience of the woman, herself. Give yourself permission to listen to your voice.
This is true for the family or friends of a mother in distress as well. Listen to how you feel in the company of this new mama. Sometimes the ones closest to this mother are the ones seeing the clearest. Postpartum adjustment can be unexpectedly different with each pregnancy.
Jenn Paul’s – WELLNESS TIPS FOR NEW PARENTS
1. Sleep
5 hours of uninterrupted sleep is what is required for restoration of optimal brain function. This may seem like an impossible task for parents with a young baby, but do what you can to make sleep a priority. Even if you can only manage to get a stretch of 5 hours of sleep once a week, it will do wonders to rejuvenate your well being. If you find that you are unable to sleep, even when your baby is sleeping, this may warrant a call to a medical professional. This may also warrant other helping hands so you can try to rest/sleep when baby is not in your arms.
2. Nutrition
I know, I know, this is not what you want to hear! It is especially challenging to pay attention to nutrition when you are busy attending to your baby and sleep deprived. For nursing mama’s it is normal to have an increased appetite while you’re nursing. The fact is what you eat effects how you feel. No ifs, ands, or buts about it. Many of the staples in our American diet cause chronic inflammation in our bodies. Inflammation in your body produces symptoms of depression. Take care to eat anti-inflammatory foods, avoid processed foods, and limit your intake of refined sugar. If you are feeling depressed or anxious, you may want to look into limiting or cutting out diary and gluten, as both can cause inflammation. Caffeine, as wonderful as it is, may increase symptoms of anxiety.
3. Social Connections
Socialization is necessary for stress reduction and well being. Support from family and friends can provide essential protection against postpartum mood disorders. Being connected with other parents – who can be an emotional, practical, and non-judgmental support to you, can help you feel that you are not alone in the often isolating world of parenthood. Keep going to your parent-child groups, plan play dates, keep up texting relationships with friends, keep in touch with family members, maintain your relationship with your partner, do all you can to nurture your social connections.
4. Exercise
Take any opportunity you can to get your body moving. Schedule weekly walking times with friends, stretch, dance or do yoga, go for a quick run, any activity that increases your heart rate is a great start. Exercise is a great preventative against a postpartum mood disorder. Exercise also has the power to alleviate some symptoms of a postpartum mood disorder. Aim for a minimum of 20 minutes 4 times a week.
5. Play Time with Baby
Take time throughout the day for uninterrupted play-time or stay-time with your baby. This can be many times a day for short 5 minute intervals or longer times for 20 minute intervals. Make eye contact, giggle together, sing, and talk to your baby. Not only does this provide tremendous benefit to your baby’s experience of safe and predictable attachment, it also improves your feelings of connectedness to your baby. Feeling connected to your baby contributes to your overall well-being and helps you to attune and understand your child’s unique personality. Newborns are so little. They are not yet giggling, but they can hear, see and feel you!
6. Practice Self Regulating Skills
It can be a major challenge to keep calm while attending to a crying baby, especially when you may be feeling overwhelmed and sleep deprived. Just remember, nervous systems are contagious. When you are able to keep calm and accept your child’s crying instead of “fixing” or changing the babies emotion, your baby will begin to trust your safety and care. If you can, take your baby into a quiet and dim area where you can talk to your baby in a calm voice and let them know that you hear they are upset, and you are going to sit with them and hold them while they are crying. A new baby’s cry is powerful. And rightly so, they absolutely need their grown-up’s attention! Of course, you can check if they are hungry or wet but sometimes babies just need to cry and that is okay. It’s also okay if you feel frustrated or annoyed. Acknowledge your feeling, and tell yourself it is okay to feel that way. Take deep breaths, sing your favorite song, tap into the sensations you are feeling in your body and see if you can notice area’s in your body that feel comfortable, locating a “resource” of positive association. This can really help during times where your body and mind feel stress.
7. Time for Yourself
Do what you can to take some time away from your role as a mama. This can be hard to do, but it is important. A 10 minute walk alone, snuggle time with your partner, coffee with a friend, anytime you can spend not having to attend to the needs of the baby is important for identity balance. How you understand what you need is personal. Be curious and creative about what would nurture you. Focus on what is possible. And remember a baby’s first three months are unlike any other time in your baby’s development. This time is unique as your very little newborn is first entering the world.
8. Ask for help
Parenthood has quadrupled your responsibilities and your workload. It can be overwhelming to take care of the baby’s needs, the household chores, your own needs, the needs of your partner, it’s too much! ASK FOR HELP where you can. Don’t assume your partner, kin or friend will know what you need unless you ask. Sometimes making a written list to share with others can be helpful.
9. Time Outside
Fresh air and bright light is essential for equalized brain function. Aim to spend a minimum of 45 minutes outside each day. It is no fun when your baby is an early riser BUT the good news is, dawn light provides the best outdoor light to restore brain function. If you happen to be up during sunrise, sit outside or take a walk to enjoy the morning light. It may be hard to motivate yourself at first but you will feel rejuvenated and refreshed. Babies often calm outside as well. Weather permitting; a blanket under a tree can be restorative.
10. Skin to Skin Contact
Humans need contact. It is essential for overall happiness. Skin to skin contact with your baby releases oxytocin – “happy juice” – for both you and your baby. Skin to skin contact with your partner will also do the trick. Being a parent is never uncomplicated. You are not alone, and with the proper support parents and babies can thrive!
Jenn Paul is a consultant to NTNC and Clinical Director of New Beginnings in Santa Barbara. Jenn also has a private practice in Santa Barbara specializing in PPMD.
Carol Castanon is a board member and Director of Family Services at the Nan Tolbert Nurturing Center. The Center provides programs, resources and referrals for families 0-5.