By Cassie Shortsleeve| July 14, 2020
"Six weeks after I gave birth to my first daughter, I found myself in my OB/GYN’s office for my postpartum checkup. After a quick conversation and a physical exam, my doctor told me that I was “cleared.” I could resume all regular pre-pregnancy activity.
I went home, fed my baby and went on a run — and had to stop after a half-mile. My pelvic floor felt like it was going to give out and — although once an avid runner — I felt clumsy. That night, I lay awake, milk-stained and sweaty. Nothing about me felt “cleared.”
Despite the fact that in 2018, the American College of Obstetricians and Gynecologists recommended that, to optimize women’s health, postpartum care should become more of a rolling process rather than a single encounter, for many new moms, the six-week postpartum appointment remains the only touch point with the health-care system that birthed her baby.
If Latin America has la cuarentena — a 40-day period when women take care of a new mom while she rests — and the ancient Indian medical system of ayurveda teaches us that we must nurture women for 42 days postpartum for the health of her next 42 years, the United States, traditionally, has this: one lone appointment that, in many senses, gives a message of closure to the fragile and monumental postpartum period.
"The four- to six-week time frame has historically been thought to be enough time for women to be able to go back to do more physically demanding jobs, like farming, without having any serious medical issues,” explains Heather Irobunda, a board-certified OB/GYN in New York. Your uterus has usually shrunk back to a pre-pregnancy size, lacerations have healed, soreness from birth has resolved.
But physical changes persist for longer — probably six months or so, says Kecia Gaither, director of perinatal services at NYC Health+Hospitals/Lincoln. Around then, pelvic floor and abdominal musculature tone returns, changes in hair normalize, and the menstrual cycle might become more regular (if it’s returned).
Some research even suggests women wait 12 months to conceive again. But how long does it take for the body to recover? It depends on where you look.
The Centers for Disease Control and Prevention, for one, says that a “pregnancy-related” death is a death of a woman while pregnant or within one year of the end of pregnancy, but “maternal mortality” is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of the end of pregnancy.
The Diagnostic and Statistical Manual of Mental Disorders, often called the “bible” of psychiatric health conditions, defines postpartum depression as depression “with postpartum onset: defined as within four weeks of delivering a child.” But, says Cindy-Lee Dennis, a professor at the University of Toronto who studies the postpartum period, “it’s fairly standard in the research literature to consider postpartum depression up to one year postpartum.” (Take a landmark 2013 study published in JAMA Psychiatry of 10,000 mothers: It found that 1 in 7 women develop PPD within the first year postpartum.)
Birdie Gunyon Meyer, a registered nurse and director of certification for Postpartum Support International, a nonprofit group that lobbied to extend the period following delivery in the definition of PPD, says: “I don’t think anybody really believes that the postpartum period is over at four or so weeks, but we give that impression when you come in for your four- or six-week checkup."
The truth is, the adjustment to parenthood takes time. It takes more than a couple of weeks and more than a couple of months. Researchers say Year 1 is critical for children and parents alike. “For the child, the brain is growing rapidly and the experiences that happen and the neurological pathways that are developed stay with the child for a lifetime,” says Dennis."
"Do you ever feel like you’re not doing enough as a parent? Like you might be totally screwing this up and maybe even making things worse for your kids? We’re right there with you. Parenting was already hard, and now we're navigating a pandemic on top of it.
In this webinar, we’ll talk about the self-doubt, anxiety, and uncertainty that has come with pandemic parenting. We’ll also share what the research says about “good enough’ parenting, especially in times of crisis. We’ll be joined by guest, Dr. Sharon Lamb, psychologist and author of The Not Good Enough Mother. Agata Freedle will serve as moderator to guide our conversation and pose questions that you submit.
Join us on Zoom at 9 p.m. Eastern Time for this free webinar."
By: Catherine Pearson| July 14, 2020
"We're facing a year without precedent in modern parenthood. So why do we feel...so detached?"
"When the pandemic first hit New York City in March, abruptly closing my boys’ school and daycare, I was a wreck.
I was terrified of my kids getting sick. I was so anxious sitting in bed at night, listening to sirens scream past my window down the Brooklyn-Queens Expressway, I’d lose my breath. Then sometimes, I’d have moments of delirious happiness: My family was safe and hanging out together at, like, 11 a.m. on a Tuesday. We never do that! It was emotional and logistical chaos all day, every day.
Now, months into this mess, I move through my days feeling basically ... nothing. When I see friends and family (from a safe distance, outdoors, usually wearing a mask) and they ask how I’m doing, I say something like: “We’re good! We’ve kept our jobs, and no one’s been sick. Also, I’m dead inside.”
This is only a partial joke.
The everyday stresses parents are facing now are arguably worse than they were when the virus first emerged. Where I live in New York City, public schools recently announced they’ll likely open for in-person learning between one and three days a week — as though those are remotely similar. I have no idea if my husband and I are sending our older son in. I have zero idea what we’re doing for childcare for our younger kiddo, because I do not see a solution that feels relatively safe and is one we can actually afford. I have no idea how we are going to get through the fall or winter or any part of next year.
But I’m not freaking out; I’m numb.
And I’m not alone.
“After being on high alert for so long, it’s entirely understandable that numbness would set in. No one can sustain a state of emergency for any length of time. We weren’t built that way,” said Olivia Bergeron, who runs Mommy Groove Therapy & Parent Coaching in New York City. “Fight or flight is supposed to be a temporary state to ensure survival, not a permanent way of living.”
By Pooja Lakshmin|July 29, 2020
"While parents may be feeling unsure about school options this fall, there are ways to feel better as you make the tough decision."
"A combination of dread, panic and sheer exhaustion. This is what I see on the faces of patients (and friends and colleagues) when the conversation turns to the most pressing topic on every parent’s mind: what to do about school in the fall. I’m a psychiatrist specializing in women’s mental health, and I have yet to speak to anyone who feels satisfied with the options presented to them, or who feels particularly confident in the choices they’ve made.
The information on children and the coronavirus has been evolving since March, with the most recent data suggesting that children are less likely to become infected by the virus and less likely to have a severe course when infected. But, those words “less likely” suggest that children are at some, albeit smaller, risk. And, the United States still has not come up with an adequate solution to protect teachers, many of whom are high risk.
As I see it, school stress for parents boils down to two main points: Deciding what to do, and then what to do with the uncomfortable feelings that could arise after that decision. As a psychiatrist, I’m admittedly not so helpful when it comes to the decision of whether or not to send your kids to in-classroom learning this fall. Where I can help is how to deal with the uncertainty and difficult feelings that accompany this process.
A risk assessment system, like the one described by Emily Oster, Ph.D., a professor of economics and public policy at Brown University, can be a useful guide when making decisions with scarce data. Instead of focusing on the illusion of “one right answer,” this framework can give you a reliable process for making hard parenting decisions by focusing on evaluating and mitigating risks, and assessing benefits. While no parent is feeling particularly confident about the school options available to them, it is possible to feel good about the process you use to make those decisions.
In an interview, Dr. Oster wrote, “By making clear the choices, the costs and benefits, we can reason our way to better decisions. But I really think even more important is the fact that we can make our way to more confidence in these decisions by articulating a good process.”
Once you’ve delineated a plan, then you’re faced with the task of coping with the onslaught of feelings, like worry, guilt, fear and uncertainty. For this, here are some strategies, many of which come from acceptance and commitment therapy, a form of behavioral therapy that teaches people to accept their difficult thoughts and feelings as opposed to struggling against them, and to prioritize taking actions that are in line with their values."
Elliot Aronson and Carol Tavris|Social Psychologists| July 12, 2020
"The minute we make any decision--I think COVID-19 is serious; no, I’m sure it is a hoax—we begin to justify the wisdom of our choice and find reasons to dismiss the alternative."
"Members of Heaven’s Gate, a religious cult, believed that as the Hale-Bopp comet passed by Earth in 1997, a spaceship would be traveling in its wake—ready to take true believers aboard. Several members of the group bought an expensive, high-powered telescope so that they might get a clearer view of the comet. They quickly brought it back and asked for a refund. When the manager asked why, they complained that the telescope was defective, that it didn’t show the spaceship following the comet. A short time later, believing that they would be rescued once they had shed their “earthly containers” (their bodies), all 39 members killed themselves.
Heaven’s Gate followers had a tragically misguided conviction, but it is an example, albeit extreme, of cognitive dissonance, the motivational mechanism that underlies the reluctance to admit mistakes or accept scientific findings—even when those findings can save our lives. This dynamic is playing out during the pandemic among the many people who refuse to wear masks or practice social distancing. Human beings are deeply unwilling to change their minds. And when the facts clash with their preexisting convictions, some people would sooner jeopardize their health and everyone else’s than accept new information or admit to being wrong.
Cognitive dissonance, coined by Leon Festinger in the 1950s, describes the discomfort people feel when two cognitions, or a cognition and a behavior, contradict each other. I smoke is dissonant with the knowledge that Smoking can kill me. To reduce that dissonance, the smoker must either quit—or justify smoking (“It keeps me thin, and being overweight is a health risk too, you know”). At its core, Festinger’s theory is about how people strive to make sense out of contradictory ideas and lead lives that are, at least in their own minds, consistent and meaningful.
One of us (Aronson), who was a protégé of Festinger in the mid-’50s, advanced cognitive-dissonance theory by demonstrating the powerful, yet nonobvious, role it plays when the concept of self is involved. Dissonance is most painful when evidence strikes at the heart of how we see ourselves—when it threatens our belief that we are kind, ethical, competent, or smart. The minute we make any decision--I’ll buy this car; I will vote for this candidate; I think COVID-19 is serious; no, I’m sure it is a hoax—we will begin to justify the wisdom of our choice and find reasons to dismiss the alternative. Before long, any ambivalence we might have felt at the time of the original decision will have morphed into certainty. As people justify each step taken after the original decision, they will find it harder to admit they were wrong at the outset. Especially when the end result proves self-defeating, wrongheaded, or harmful.
The theory inspired more than 3,000 experiments that have transformed psychologists’ understanding of how the human mind works. One of Aronson’s most famous experiments showed that people who had to go through an unpleasant, embarrassing process in order to be admitted to a discussion group (designed to consist of boring, pompous participants) later reported liking that group far better than those who were allowed to join after putting in little or no effort. Going through hell and high water to attain something that turns out to be boring, vexatious, or a waste of time creates dissonance: I’m smart, so how did I end up in this stupid group?"
By: LULU GARCIA-NAVARRO
"So many of us do it: You get into bed, turn off the lights, and look at your phone to check Twitter one more time.
You see that coronavirus infections are up. Maybe your kids can't go back to school. The economy is cratering.
Still, you incessantly scroll though bottomless doom-and-gloom news for hours as you sink into a pool of despair.
This self-destructive behavior has become so common that a new word for it has entered our lexicon: "doomscrolling."
The recent onslaught of dystopian stories related to the coronavirus pandemic, combined with stay-at-home orders, have enabled our penchant for binging on bad news. But the habit is eroding our mental health, experts say.
Karen Ho, a finance reporter for Quartz, has been tweeting about doomscrolling every day over the past few months, often alongside a gentle nudge to stop and engage in healthier alternatives.
Ho first saw the term in a Twitter post from October 2018, although the word may very well have much earlier origins.
"The practice of doomscrolling is almost a normalized behavior for a lot of journalists, so once I saw the term I was like, 'Oh, this is a behavior I've been doing for several years,' " she says.
If Ho's daily reminders aren't enough to break the habit, clinical psychologist Dr. Amelia Aldao warns that doomscrolling traps us in a "vicious cycle of negativity" that fuels our anxiety.
"Our minds are wired to look out for threats," she says. "The more time we spend scrolling, the more we find those dangers, the more we get sucked into them, the more anxious we get."
By Juli Fraga and Karen Kleiman|July 5, 2020
"Soon after her first baby was born in 2014, Crystal McAuley started having catastrophic thoughts about her infant’s health. Throughout the day, random thoughts popped up like tiny speech balloons, each one filled with a newfound fear: “What if the baby overheats?” “What if he stops breathing?” “What if he falls out the window?”
McAuley, 38, shared her concerns with her husband, who told her the baby was healthy. His reassurance, however, didn’t shut down the worry-filled thoughts that looped over and over in her mind. “It was hard to make them stop,” McAuley recalled. And then they changed course: “I started having visions of pulling my car into the opposite lane of traffic, but I didn’t want to die or harm my infant.”
McAuley was experiencing intrusive thoughts, which are unwelcome, negative thoughts, or images that seem to come out of nowhere and are highly upsetting, psychologists say.
“Occasionally, everyone experiences senseless intrusive thoughts,” said Jonathan Abramowitz, Ph.D., a professor of clinical psychology and an anxiety researcher at the University of North Carolina at Chapel Hill. On a turbulent flight, for example, we may see images of the plane crashing, even if we’re not afraid of flying. If we’re driving a friend’s new car, we may have thoughts about getting into an accident.
Most times, we don’t give those thoughts much attention, but when stress arises and responsibilities mount, it can be harder to ignore them, Dr. Abramowitz explained. And with the added strain of the Covid-19 pandemic, many parents are preoccupied with worries about their children becoming ill and dying from the virus, he said.
McAuley said the pandemic has sent her anxiety into a tailspin. “I feel like a new mom again. At unpredictable times, I imagine one of my children falling down a steep ravine or dying in a violent accident.”
While intrusive thoughts can be a sign of a perinatal mood disorder, such as postpartum anxiety or postpartum obsessive-compulsive disorder, a 2006 study conducted by Dr. Abramowitz and his colleagues followed 85 participants (43 mothers and 42 fathers) from the second trimester of pregnancy to three months postpartum. Of those who participated in the study, 91 percent of mothers and 88 percent of fathers experienced upsetting intrusive thoughts about their newborn.
According to Dr. Abramowitz, it’s not uncommon for new parents to think of the baby falling down the stairs, choking or drowning in the bathtub. One parent told Dr. Abramowitz he imagined “sticking a pencil in the soft spot of his baby’s head.”
Disturbing thoughts and images like these can bewilder new parents. Not to mention, mothers who envision harming their babies may misinterpret their thoughts as ominous signs about their mothering abilities. “I felt like a prisoner inside my own mind,” said McAuley, who worried that if she told her doctor what she was thinking, her baby would be taken away.
While intrusive thoughts can be terrifying, the problem lies in how we interpret them, Dr. Abramowitz said. Labeling such notions as “negative” causes the brain to give them more weight, which is why parents who judge their invasive thoughts often struggle to let them go.
Dr. Abramowitz and his colleague, Nichole Fairbrother, Ph.D., a psychologist and researcher at the University of British Columbia, said intrusive thoughts pop up in new parenthood for a reason. In their research, the psychologists found that the immense responsibility parents feel for keeping their newborns alive can bring on disturbing thoughts about harm striking their babies, especially during the first six months of their children’s lives.
Dr. Fairbrother said: “I remember gazing at my baby’s delicate hands and thinking, ‘I could just cut those right off with the garden clippers,’ but because I’m an anxiety researcher, I wasn’t upset by it.”
Even though intrusive thoughts might seem puzzling, Dr. Fairbrother said, they’re often adaptive. “If a mother worries about the stroller rolling into traffic, she’s going to grip the handle more tightly,” she explained.
For parents bothered by their intrusive thoughts, certain exercises and steps can reduce the anxiety they create. A few suggestions:
Distance yourself from the emotions
One way to disarm intrusive thoughts is to recognize that they don’t define who you are. Repeating the bothersome thought in a singsong voice or saying it aloud, over and over again can help, said Stefan Hofmann, Ph.D., a clinical psychologist and anxiety researcher at Boston University. This behavioral technique, known as distancing, can unhook thoughts from emotions, helping the mind to change direction. No longer seeing the thoughts as a threat, parents begin to realize that “thoughts are nothing more than just thoughts,” Dr. Hofmann explained.
“A mother may think about pushing the stroller down the stairs, but that doesn’t mean she’ll act on it,” he said."
"The process of weaning involves hormonal, psychological, social, and physical changes."
By Cassie Shortsleeve| June 08, 2020
"Last month, one random morning while breastfeeding my 11-month-old daughter Sunday, she bit down (and laughed) then tried to latch back on. It was an unexpected snag in an otherwise smooth breastfeeding journey, but after some bleeding (ugh), a prescription antibiotic ointment, and shedding some tears, I decided it was also the end.
Not only did I beat myself up—I didn't make it to the (albeit self-imposed) one-year marker that I had set—but within days, those teary, dark moments that had been with me in the early postpartum period crept back up. I could almost feel my hormones changing.
If you just had a baby (or have new mom friends), you're likely aware of some of the mood changes that can accompany new parenthood, namely the "baby blues" (which impact some 80 percent of women in the weeks following delivery) and perinatal mood and anxiety disorders (PMADs), which impact some 1 in 7, according to Postpartum Support International. But mood issues related to weaning—or transitioning your baby from breastfeeding to formula or food—are less talked about.
In part, that's because they're less common than PMADs, such as postpartum depression. And not everyone experiences them. "All transitions in parenthood can be bittersweet and there is a wide array of experiences associated with weaning," explains Samantha Meltzer-Brody, M.D., M.P.H., director of the UNC Center for Women's Mood Disorders and a principal investigator in the Mom Genes Fight PPD research study on postpartum depression. "Some women find breastfeeding very satisfying and do experience emotional difficulty at the time of weaning," she says. "Other women do not experience emotional difficulty or they find weaning to be a relief." (See also: Serena Williams Opens Up About Her Difficult Decision to Stop Breastfeeding)
But mood changes related to weaning (and *everything* breastfeeding, TBH) make sense. After all, there are hormonal, social, physical, and psychological changes that take place when you stop nursing. If symptoms crop up, they can also be surprising, confusing, and occur at a time when you may have *just* thought that you were out of the woods with any postpartum woes.
Here, what's going on in your body and how to ease the transition for you.
The Physiological Effects of Breastfeeding
"There are basically three stages of hormonal and physiological changes that allow women to produce breastmilk," explains Lauren M. Osborne, M.D., assistant director of the Women's Mood Disorders Center at The Johns Hopkins University School of Medicine.
The first stage happens in the second half of pregnancy when the mammary glands in your breasts (which are responsible for lactation) begin to produce small amounts of milk. While you're pregnant, super high levels of a hormone called progesterone produced by the placenta inhibit the secretion of said milk. After delivery, when the placenta is removed, progesterone levels plummet and levels of three other hormones—prolactin, cortisol, and insulin—rise, stimulating milk secretion, she says. Then, as your baby eats, the stimulation on your nipples triggers the release of the hormones prolactin and oxytocin, explains Dr. Osborne.
"Prolactin brings a feeling of relaxation and calmness to mom and baby and oxytocin—known as 'the love hormone'—helps with attachment and connection," adds Robyn Alagona Cutler, a licensed marriage, and family therapist who specializes in perinatal mental health.
Of course, the feel-good effects of breastfeeding are not just physical. Nursing is an extremely emotional act in which attachment, connection, and bonding can be cultivated, says Alagona Cutler. It's an intimate act where you're likely snuggled up, skin-to-skin, making eye contact."
Pregnant women and new moms are experiencing 'shocking' rates of anxiety and depression during the pandemic
By Anna Medaris Miller| June 19, 2020
"Pregnant women and new moms are experiencing higher rates of depression and anxiety amid the coronavirus pandemic, a new study suggests.
In the study, researchers asked 900 women – 520 of whom were pregnant and 380 of whom had given birth in the past year – about their depression and anxiety symptoms before and during the pandemic. They found that the crisis elevated depression symptoms from 15% to 41%. Moderate- to high-anxiety symptoms went from 29% to 72%.
Pre-pandemic, about one in seven, or just under 15%, of women experienced such symptoms during the perinatal period.
"I was pretty shocked at the magnitude of the increases," said Margie Davenport, a co-author of the study and associate professor of the pregnancy and postpartum health program at the University of Alberta, Canada.
A number of factors – like physical isolation, increased household and childcare duties, and fears about the state of the world – have contributed to the higher rates of mental health issues among pregnant women and new mothers, a demographic that was already susceptible to developing perinatal and postpartum depression disorder.
Davenport suspects the rates are even higher in people who already face healthcare and social disparities.
"I'm worried that this [data] is potentially underestimating the effects on women who've lost their jobs, and women who don't have secure housing and secure healthcare," she said.
Most participants were white, employed, partnered, and living in a single-family home — in other words, had the types of supports that would typically put them at a lower risk for perinatal mental-health issues. Davenport fears the effects of the pandemic, and now racial justice issues, on pregnant women and new moms in more marginalized communities may be even worse."
"Women exposed to high temperatures or air pollution are more likely to have premature, underweight or stillborn babies, a look at 32 million U.S. births found."
By Christopher Flavelle| June 18, 2020
"WASHINGTON — Pregnant women exposed to high temperatures or air pollution are more likely to have children who are premature, underweight or stillborn, and African-American mothers and babies are harmed at a much higher rate than the population at large, according to sweeping new research examining more than 32 million births in the United States.
The research adds to a growing body of evidence that minorities bear a disproportionate share of the danger from pollution and global warming. Not only are minority communities in the United States far more likely to be hotter than the surrounding areas, a phenomenon known as the “heat island” effect, but they are also more likely to be located near polluting industries.
“We already know that these pregnancy outcomes are worse for black women,” said Rupa Basu, one of the paper’s authors and the chief of the air and climate epidemiological section for the Office of Environmental Health Hazard Assessment in California. “It’s even more exacerbated by these exposures.”
The research, published Thursday in JAMA Network Open, part of the Journal of the American Medical Association, presents some of the most sweeping evidence so far linking aspects of climate change with harm to newborn children. The project looked at 57 studies published since 2007 that found a relationship between heat or air pollution and birth outcomes in the United States.
The cumulative findings from the studies offer reason to be concerned that the toll on babies’ health will grow as climate change worsens.
Higher temperatures, which are an increasing issue as climate change causes more frequent and intense heat waves, were associated with more premature births. Four studies found that high temperatures were tied to an increased risk of premature birth ranging from 8.6 percent to 21 percent. Low birth weights were also more common as temperatures rose."