Susan Newman Ph.D. | Posted October 17, 2017
"Who hasn’t had her child-rearing choices questioned—by family, friends, your spouse, or a stranger? Who in your circle is most judgmental?
As a parent, you are subject to comment on a host of parenting decisions: Whether you decide to breastfeed or not; to co-sleep or not, go back to work or stay home with your children, what you let your children eat for breakfast; how you discipline or dress them, the bedtime you set or the time you allow or don’t on “screens”…Often, the “advice” or “suggestion” is completely unsolicited and makes you feel guilty or uncertain.
On social media, even benign parenting practices are subject to criticism. Unlike the rest of us, celebrities are publicly “mom-shamed” more frequently on the Internet. Mariah Carey received a wave of criticism for posting a photo of her 4-year-old son still using a pacifier. Several stars, from Mila Kunis to Chrissy Tiegen to Maggie Gyllenhaal, have been targeted online for breastfeeding in public. Actress Olivia Wilde was berated for posting a picture kissing her young son on the lips.
A new poll finds a majority of American mothers are being judged, some on the Internet, some in person. The University of Michigan’s C.S. Mott Children’s Hospital conducted a national poll surveying 475 mothers of children aged 5 and younger. They were asked if they’ve ever had their parenting questioned.
Sixty-one percent responded that they have been criticized for their child-rearing decisions. The most common topic of criticism: Discipline. Seventy percent of criticized moms reported this. The second-most-cited denunciation concerned diet and nutrition; the third, sleep; the fourth, breast versus bottle-feeding, fifth, child safety, and sixth, childcare decisions.
Although sometimes the criticism is intended to be constructive, 62 percent of those sampled said they believe mothers receive “a lot of unhelpful advice from other people”; 56 percent said mothers “get too much blame and not enough credit for their children’s behavior.”
Family More Likely to Judge
According to the study, family members comprised the top three groups of “mom shamers.” The moms who felt criticized said their own parents (37 percent), co-parent (36 percent) and in-laws (31 percent) were the most frequent to pass judgment. “This may reflect the high volume of interactions with family members, or that mothers may interpret family criticism as an attack by those who should be more supportive,” the researchers noted.
Remarking on the stress and overwhelming choices of new parenthood, the study points out that 42 percent of the criticized mothers said the judgment “made them feel unsure about their parenting choices.” As a parent, you have the ultimate say—even if you’re conflicted about your choices.
10 Tips for Standing Up To Mom-Shaming
When it comes to standing up to those who judge you, it can be tricky to assert your parenting authority and keep conflicts at bay. Here are 10 insights and suggestions to help bolster you against those who believe they know what you should be doing and how to do it.
By: Auburn Harrison | TEDxUniversity of Nevada
"It's the most common complication of childbirth, yet PPD is a condition clouded with stigma, shame and guilt for mothers who experience it. According to Postpartum Support International, 15% of women suffer from postpartum depression, yet women are forced to suffer in silence and shame. Based on a personal experience with an extremely severe case of postpartum depression, anxiety and psychosis, Nevada-based nonprofit executive, Auburn Harrison, paints a heartbreaking and harrowing picture of why our society's silence on the topic is hurting mothers. Auburn Harrison serves as a nonprofit executive director for nonprofit dropout prevention program for at-risk youth, Communities In Schools of Western Nevada. Her organization provides basic needs and case management to local students living in poverty, including wraparound student support services such as mentoring, tutoring and resources to help students stay in school, graduate and achieve life success. Auburn has been involved in the Northern Nevada non-profit and philanthropic and nonprofit community for over a decade. Auburn spent five years as an on-air television reporter at at KOLO 8 News Now, and five more years as an enlisted journalist in the US Navy. She holds a master's degree in Writing from University of Nevada, Reno. In 2019, Auburn was named one of the Top Twenty Young Professionals Under 40 by the Reno Tahoe Young Professionals Network. Auburn lives in Reno with her husband and three little boys. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx"
By: American Pregnancy Association
"Loving your body image before pregnancy can help you get through the physical and emotional changes during pregnancy. Having a positive body image of yourself is not about what you look like, but how you feel about yourself. This is crucial in pregnancy since there will be body changes that you cannot control. It is also helpful to understand why your body is going through these changes.
According to Ann Douglas, author of The Unofficial Guide to Having a Baby, “A woman who feels good about herself will celebrate the changes that her body experiences during pregnancy, look forward to the challenge of giving birth, and willingly accept the physical and emotional changes of the postpartum period.”
Loving Your Body When You Are Pregnant:
Knowing that your body’s changes are essential to your developing baby is reason enough to embrace these changes!
Understanding what your body is doing for your baby:
As soon as your egg is fertilized and implanted in your uterus, your body begins to go through changes. These changes are a result of your baby’s growth and development. Your baby has a fetal life-support system that consists of the placenta, umbilical cord, and amniotic sac. The placenta produces hormones that are necessary to support a healthy pregnancy and baby.
These hormones help prepare your breasts for lactation and are responsible for many changes in your body. You will have an increase in blood circulation that is needed to support the placenta. This increase in blood is responsible for that wonderful “pregnancy glow” that you may have.
Your metabolism will increase, so you may have food cravings and the desire to eat more. Your body is requiring more nutrients to feed both you and your baby. Your uterus will enlarge and the amniotic sac will be filled with amniotic fluid. The amniotic fluid is there to protect your baby from any bumps or falls.
Here are a few things you can do to love your body image during pregnancy:
Exercise during pregnancy can help you feel fit, strong, and sexy. According to the American College of Obstetricians and Gynecologists, pregnant women are encouraged to exercise at least 30 minutes a day throughout pregnancy, unless your health care provider instructs differently.
Before starting any exercise program, ALWAYS check with your health care provider. For more information on exercise throughout pregnancy, check out the Nutrition & Exercise section.
Treat yourself to a body massage or a makeover. Go shopping, take a warm bubble bath, or go for a walk outside. Focus on activities that make you feel healthy, and make the most of these wonderful 9 months!"
By: Abigail Brenner M.D. | January 16, 2022
"You may be on the same page with your partner for most things, but there will inevitably come a time when you don’t see eye to eye. You have some choices: You can ignore your differences and just circumvent the issue, or you can keep on trying to persuade your partner to see it your way, or you can get increasingly angry and eventually let your partner have it.
It’s probably a better idea to try to tackle your differences, the areas where you disagree, and attempt to iron out the problem in a way that allows both of you to express your opinions and beliefs, with the goal of finding some common ground, some area of compromise.
How do you do that when you feel strongly about an issue or problem, but so does your partner? Surely, you want to please yourself but you want your partner to feel satisfied as well. However, most of us are not taught how to have a constructive discussion. We model what we see around us. We may have seen people angry to the point where they stop talking to each other, or try to intimidate each other through insults and threats. We’ve perhaps seen situations where the conversation ends when one person declares their point of view the “winner.”
Here are some tips to help you navigate disagreements constructively and respectfully.
Be present and focused. Clear away all distractions—no emails, texts, or phone calls. Leave aside all other issues and things you need to do. Put everything else on hold. Pay close attention. Your only job is to listen carefully and to try to understand, not only what’s being said, but the emotions being expressed. Give your partner all the time they need to explain their side of the argument, discussion.
Don’t lecture. You probably have done this already but making time to constructively work on your differences is a completely different kind of exercise. It’s meant to be a give-and-take, back-and-forth discussion to help clarify your different points of view and to reach some kind of reasonable agreement about how to move forward. Your ideas and beliefs are just that—you’re ideas and beliefs. No more or less valid than your partner’s ideas and beliefs. Don’t lecture, or worse, pontificate from a superior position. This exercise is meant to level the field."
By Jean Lee | November 21, 2021
"Shantell Jones gave birth in an ambulance parked on the side of a Connecticut highway. Even though she lived six blocks away from a hospital, the emergency vehicle had to drive to another one about 30 minutes away.
The closer medical center, Windham Hospital, discontinued labor and delivery services last year and is working to permanently cease childbirth services after “years of declining births and recruitment challenges,” its operator, Hartford HealthCare, has said.
But medical and public health experts say the step could potentially put pregnant women at risk if they don't have immediate access to medical attention. Losing obstetrics services, they said, could be associated with increased preterm births, emergency room births and out-of-hospital births without resources nearby, like Jones' childbirth experience.
The dilemma Jones faced is one that thousands of other pregnant women living in rural communities without obstetrics units nearby are encountering as hospitals cut back or close services to reduce costs. Nationwide, 53 rural counties lost obstetrics care from 2014 through 2018, according to a 2020 study in the Journal of the American Medical Association, which also found that out of 1,976 rural counties in the country, 1,045 never had hospitals with obstetrics services to begin with.
The problem is particularly acute in communities of color, like Windham in northeastern Connecticut, where the population is 41 percent Latino, while the statewide Latino population is only 16.9 percent, according to the U.S Census Bureau. The community is 6.2 percent Black. Local activists say they fear low-income residents will bear the brunt of the hospital’s decision because Windham has a 24.6 percent poverty rate compared to 10 percent statewide, according to the census.
The night Jones delivered her son, her mother, Michelle Jones, had called 911 because Jones was going into labor a few weeks early, and after her water broke they knew the baby was coming soon. Both expected the ambulance to drive the short distance to Windham Hospital, where Jones received her prenatal care.
But the ambulance attendant was told Windham wasn't taking labor and delivery patients and was referring people to Backus Hospital in Norwich, Jones said.
In the ambulance, she was without her mother, who was asked to follow in her car.
“I was anxious and scared and traumatized,” Jones said."
By Sarah Griffiths | April 24, 2019
"Giving birth can be one of the most painful experiences in a woman’s life, yet the long-term effects that trauma can have on millions of new mothers are still largely ignored.
It’s 03:00. My pillow is soaked with cold sweat, my body tense and shaking after waking from the same nightmare that haunts me every night. I know I’m safe in bed – that’s a fact. My life is no longer at risk, but I can’t stop replaying the terrifying scene that replayed in my head as I slept, so I remain alert, listening for any sound in the dark.
This is one of the ways I experience post-traumatic stress disorder (PTSD).
PTSD is an anxiety disorder caused by very stressful, frightening or distressing events, which are often relived through flashbacks and nightmares. The condition, formerly known as “shellshock”, first came to prominence when men returned from the trenches of World War One having witnessed unimaginable horrors. More than 100 years after the guns of that conflict fell silent, PTSD is still predominantly associated with war and as something largely experienced by men.
But millions of women worldwide develop PTSD not only from fighting on a foreign battlefield – but also from struggling to give birth, as I did. And the symptoms tend to be similar for people no matter the trauma they experienced.
“Women with trauma may feel fear, helplessness or horror about their experience and suffer recurrent, overwhelming memories, flashbacks, thoughts and nightmares about the birth, feel distressed, anxious or panicky when exposed to things which remind them of the event, and avoid anything that reminds them of the trauma, which can include talking about it," says Patrick O’Brien, a maternal mental health expert at University College Hospital and spokesman for the Royal College of Obstetricians and Gynaecologists in the UK.
Despite these potentially debilitating effects, postnatal PTSD was only formally recognised in the 1990s when the American Psychiatry Association changed its description of what constitutes a traumatic event. The association originally considered PTSD to be “something outside the range of usual human experience”, but then changed the definition to include an event where a person “witnessed or confronted serious physical threat or injury to themselves or others and in which the person responded with feelings of fear, helplessness or horror”.
This effectively implied that before this change, childbirth was deemed too common to be highly traumatic – despite the life-changing injuries, and sometimes deaths, women can suffer as they bring children into the world. According to the World Health Organization, 803 women die from complications related to pregnancy and childbirth every day.
There are few official figures for how many women suffer from postnatal PTSD, and because of the continued lack of recognition of the condition in mothers, it is difficult to say how common the condition really is. Some studies that have attempted to quantify the problem estimate that 4% of births lead to the condition. One study from 2003 found that around a third of mothers who experience a “traumatic delivery”, defined as involving complications, the use of instruments to assist delivery or near death, go on to develop PTSD.
With 130 million babies born around the world every year, that means that a staggering number of women may be trying to cope with the disorder with little or no recognition.
And postnatal PTSD might not only be a problem for mothers. Some research has found evidence that fathers can suffer it too after witnessing their partner go through a traumatic birth.
Regardless of the exact numbers, for those who go through these experiences, there can be a long-lasting impact on their lives. And the symptoms manifest themselves in many different ways.
"I regularly get vivid images of the birth in my head,” says Leonnie Downes, a mother from Lancashire, UK, who developed PTSD after fearing she was going to die when she developed sepsis in labour. “I constantly feel under threat, like I'm in a heightened awareness.”
Lucy Webber, another woman who developed PTSD after giving birth to her son in 2016, says she developed obsessive behaviours and become extremely anxious. “I’m not able to let my baby out of my sight or let anyone touch him,” she says. “I have intrusive thought of bad things happening to all my loved ones.”
Not all women who have difficult births will develop postnatal PTSD. According to Elizabeth Ford of Queen Mary University of London and Susan Ayers of the University of Sussex, it has a lot to do with a woman’s perception of what they went through.
"Women who feel lack of control during birth or who have poor care and support are more at risk of developing PTSD,” the researchers write.
The stories from women who have developed PTSD after giving birth seem to reflect this.
Stephanie, whose name has been changed to protect her identity, says she was poorly cared for during labour and midwives displayed a lack of empathy and compassion. A particularly difficult labour saw her being physically held down by staff as her son was delivered. “He was born completely blue and taken away to be resuscitated and I was given no information on his condition for hours.”
Source: WebMD Medical Reference | Reviewed by Dan Brennan, MD on March 05, 2021
"What Are Essential Oils?
Essential oils are plant abstracts made by steaming or pressing different parts of a plant to capture the compounds that produce fragrance. It can take several pounds of a plant to produce just one bottle of essential oils.
When evaluating essential oils' effectiveness, research is promising, but the human clinical trials are mixed. Some studies show an improvement for people, while others show no improvement at all.
The most common way essential oils are used during pregnancy is to help treat anxiety, aches, and lack of focus. There are many varieties of oils to choose from. Finding a high-grade quality variety is recommended. It’s also helpful to consult with your doctor before you start using essential oils while pregnant.
Is It Safe to Use Essential Oils While Pregnant?
Essential oils come in different scents and qualities. Certain varieties are safe to use while pregnant while others should be avoided.
Essential oils that are good to use while pregnant:
How to Use Essential Oils Safely
If a doctor or midwife recommends essential oils to help you during pregnancy, use them carefully. A few good tips to keep in mind include:
Safety Risks of Using Essential Oils While Pregnant
Some people may experience an allergic reaction or skin irritation after using essential oils. You're more likely to have a bad reaction if you have atopic dermatitis or a history of reactions to topical products.
Some essential oils that may carry a higher risk of causing an allergic or skin irritation include:
By Melissa Willets | Updated August 22, 2021
"The term rainbow baby may not be familiar to people who haven't experienced a loss. But to those of us who have, it has a very deep and even life-changing significance.
So what is a rainbow baby? It's "a baby born after a miscarriage, stillborn, or neonatal death," says Jennifer Kulp-Makarov, M.D., FACOG. "It's called a rainbow baby because it's like a rainbow after a storm: something beautiful after something scary and dark."
She adds, "It's an extremely emotional and devastating experience to lose a pregnancy [or baby]. To create a life or bring a baby into the world after such a loss is amazing like a miracle for these parents."
I'm currently seven months pregnant with a rainbow baby, and indeed, I feel like I'm walking around with a miracle in my belly. There was a time when I never thought I could feel hopeful again. Just last year, we lost our beloved baby Cara at 23 weeks of pregnancy. The days, weeks, and months after she became our angel baby were the darkest of my life. But soon a dim hope flickered inside my heart, and eventually ignited a flame, that became my desire to try again, in part to honor Cara, and to find meaning in her loss.
Rainbow Babies Can Honor an Angel Baby
Moline Prak Pandiyan, a previous ambassador for March for Babies, March of Dimes Eastern North Carolina, knows this feeling well. She lost her son Niko when he was five months old due to complications related to his premature birth. "Although Niko lost his fight, his spirit lives on, and he continues to inspire many," she explains. Not only is this mama involved in fighting prematurity, but she was also inspired to conceive a rainbow baby.
Not that she previously knew the meaning of the term "rainbow baby." "I remember the feeling that I had when I first heard [it]," says Pandiyan. "It was perfect. I so much wanted to make sure that Niko wasn't forgotten, and the term so eloquently acknowledges the babies who we've lost, while also celebrating the joy of our babies who do survive."
Prak Pandiyan is now a proud mom of a little girl, her rainbow, who truly informs her parenting philosophy. "My husband and I always wondered what life would have been like if our son could be discharged and come home with us," she says. "When we welcomed our rainbow baby into this world, our perspective as parents shifted. Whenever things get hard—feeding challenges, sleeping challenges, mild illnesses—we always make it a point to step back and remember that things could be so much worse."
Parenting a Rainbow Baby May Feel Different
Mama Stephanie Sherrill Huerta, who has one daughter, is also expecting a rainbow baby, via adoption, after several miscarriages and failed adoption attempts. She too acknowledges that parenting her rainbow baby will be different, telling Parents.com, "We will love him a little differently than our daughter because we went through so much grief and pain before meeting him. He will truly be the light at the end of the tunnel, the pot of gold under the rainbow, and the rainbow after our storm."
That same spirit has encouraged me to enjoy my current pregnancy more than before. Morning sickness and heartburn can't take away my gratitude for the chance to carry a healthy baby.
Elizabeth Lorde-Rollins, M.D., MSc, OB-GYN at CareMount Medical says this is normal. "For parents who have experienced the loss of a child, whether that loss occurs before or after birth, the life adjustments associated with pregnancy are accompanied with an acute sense of gratitude even when they are uncomfortable," she notes. "And although most of us have the great fortune of being wanted babies, parents tend to have a special, and in many cases incredibly sharp, sense of being blessed when they are expecting and then giving birth to a baby that follows loss."
By Jessica Zucker, Ph.D. | April 22, 2021
"Elisha M., 31, a clinical research coordinator for oncology clinical trials living in New Jersey, can hardly put into words the joy she felt the moment she held her rainbow baby in her arms. Having previously experienced a pregnancy loss, she says she felt "so grateful and excited" to finally have her baby earthside, healthy and thriving.
But her son was also fussy and hard to soothe, and before the two were discharged from the hospital, Elisha found herself appreciably overwhelmed and crying nonstop. "By the end of the first week with him, I knew the emotions I was having were more than just the 'baby blues,' because I felt like I wanted to give up. I didn't want to be a parent anymore," Elisha tells me. "I loved him so much, but I also wanted out."
According to Centers for Disease Control and Prevention (CDC) research, one in eight experience symptoms of postpartum depression (though it's believed the rate is even higher, given the lack of reporting, education, and support resources available to postpartum women). In a country saddled with mental health care and health insurance crises—to say nothing of the pervasive systemic racism within the healthcare system that makes support even more unattainable for Black and brown postpartum people—treatment can be prohibitively expensive, if not completely out of reach.
"By the time I spoke to someone about the way I was feeling, counseling was pretty much off the table for me," Elisha says. "I started to have thoughts of hurting myself." Elisha says she took four to five months off from work so that she could work on herself and be mentally present, and recalls her insurance being billed nearly $1,000 for a single visit to simply speak to a doctor.
"We couldn't necessarily afford for me to be out of work, but my husband really encouraged me to do whatever it was that I felt like I needed and he would figure out everything else," she explains. "It did set us back financially for some time, which I think added another strain on our relationship in addition to the strain postpartum depression was already having on us as a couple."
I wanted to give up. I didn't want to be a parent anymore.
On average, mental health providers practicing in major U.S. cities charge anywhere between $75 to $150 per 45-minute session, though rates in places like New York City, for example, can be upwards of $300 per session. And while costs of certain postpartum depression and anxiety medications can vary widely and depend on insurance coverage, the recent $34,000 price tag for a postpartum depression one-time infusion drug that's said to provide "fast relief" highlights just how expensive the cost of postpartum depression can be—and how unattainable it is for those who are not affluent. In 2017 alone, the cost of maternal depression was an astounding $14.2 billion—an average of $32,000 per mom.
Arden Cartrett, 28, who works in real estate and recently started a miscarriage doula business, says she paid anywhere from $150 to $200 per session with a mental health professional after realizing she was struggling with postpartum depression.
"When my son turned exactly 6 months old, I felt a shift," Cartrett tells me. "I had struggled with anxiety, feeling alone, and worrying about the pandemic, and honestly wasn't sure what would be considered normal or abnormal. Physically and mentally, I felt foggy and was having a really hard time keeping up with life."
Still, due to the high cost of care, Cartrett says she spaced out her therapy sessions—to the detriment of her mental health.
"I do have insurance, but it's a high deductible plan, which means I basically pay out-of-pocket expenses until I reach a certain amount (which is high), so I am having to pay hundreds out of pocket per session which unfortunately limits how often I can use that resource," she explains. "However, medication-wise, I'm on a common medication that is reasonably priced."
Of course, the cost of postpartum depression isn't just limited to a person's finances, nor does it only occur when a person experiences a live birth. In my book I Had a Miscarriage: A Memoir, a Movement, I outline the many costs of postpartum depression that exist with or without a baby in your arms—and those costs are physical, mental, emotional, and financial.
Kayte de la Fuente, 41, a California administrative assistant going to school to become a preschool teacher, says she and her husband have spent upwards of $100,000 between postpartum depression treatment, acupuncture, blood tests, medications, chiropractor visits, and IUI and IVF treatments. She has experienced three pregnancy losses in the last five years.
How does one continue to power through postpartum depression and the various ways it affects a life...while also managing the financial toll?
"It wasn't until we had done more rounds of IUI and having them not work that I really started to recognize the depression that I was in because of that [initial] miscarriage and all of the unsuccessful treatments," de la Fuente tells me. She says that she sought out "unconventional treatments" as well, including a 12-week program provided by a friend of a friend that focuses on finding your inner child, and an infertility support group as well. The program cost $1,200 and the group cost $200 for eight-week sessions—none of which was covered by insurance.
"Of course, because you're looking at all of the bills and you're trying to figure out what your next steps are because you already have all of this financial burden," she says. "Do you keep going?" How does one continue to power through postpartum depression and the various ways it affects a life—symptoms such as mood swings, sadness, anxiety, guilt, loss of interest or pleasure in activities, irritability, restlessness, reduced concentration, feeling overwhelmed, trouble sleeping, or all of the above—while also managing the financial toll?
It's a question anyone who identifies as a parent and who is struggling, whether they've had a live birth or not, has to ask themselves: How do I keep going? Can I keep going? How do I find a way to keep going?"
By Loren Kleinman | May 12, 2021
"The day Lily was born, my husband, Joe, took pictures, murmured soft words, and held her every moment he could. "I want to stay home with her for her first year," he said. "I read it's important for their development."
Luckily, he was able to as he was honorably discharged from the Navy. But despite my three-month maternity leave, I wanted to go back to work.
But when we returned home from the hospital, I unraveled. No time to shower, eat, or pay a bill. Our lives revolved around Lily. Everything I imagined about motherhood exploded. Dreams of gardening with my daughter in a Snugli on my chest were replaced with her unrelenting cries and endless diaper changes.
Yet to Joe, she was just a baby. "What did you think having a baby would be like?" he asked.
"Not like this," I snapped, taking off my spit-up covered shirt and replacing it with a clean one.
It wasn't just the dirty shirt. I had thoughts of hurting myself and my baby, an alarming desire to drive us both off the road. I hated myself for these thoughts, but I hated her more. I hated that she never slept, and resented that I couldn't, either. I hated breastfeeding, which was not magical as I'd pictured, but painful and lonely.
I missed our date nights, coming and going as I pleased, and clean clothes.
Darkness settled over me, unlike any depression I'd experienced. I began experimenting with cutting myself just to feel something other than exhaustion, spending long minutes in the bathroom, my only escape. With each cut came relief from the burden of this new, agonizing life.
"You were in there a long time," Joe teased me.
Low spirited, I replied, "I wish I never had to come out."
He reached out to console me and saw the cuts on my arm. I didn't hide them. I didn't care. But Joe called his therapist, who told him about a clinic for women with postpartum depression.
"He doesn't even know me," I argued.
"You're going," a frazzled Joe said. "Today."
My First Dose of Postpartum Depression Treatment
We arrived to find a room filled with infants, dads, and moms, many of the latter red-faced and crying, while their husbands stood by, holding babies. I was amazed to see so many men like my husband, cradling their little ones, in solidarity with their wives, as the women went one by one to meet with a psychiatrist.
When it was my turn, I looked back at Joe and Lily. A concerned smile dusted his face. "We'll be right here when you're done."
During my intake, I asked flatly, "Will I ever love her?"
"This is a classic postpartum depression question. You will love her," the psychiatrist assured me. "But I have to ask, do you have any plans to kill yourself?"
Without hesitation, I said, "I want to drive off the road." Then I wept.
I wasn't allowed to drive until further notice, and if I didn't abide, the psychiatrist warned, "We'd have to consider hospitalization."
Joe ferried me to and from the clinic every day, no matter how many times he'd been up with Lily the night before. On weekends, Joe tended to me and to Lily, making sure we both ate and slept, as his parents flew out from Washington State to lend a hand, a relief to both of us.
For the first time, I felt some hope.
Every week, I attended weekly dialectical behavior therapy sessions (DBT), learning skills for coping with my anxiety and insomnia like radical acceptance and positive self-talk.
Things Only Got Worse
Then, one night, after Joe put Lily to bed, we sat on our back porch, me with my usual glass of wine, him with his Coke and ice.
"Are you OK?" he asked, as I stared, glassy-eyed, into the trees.
Before coming outside, I'd already washed down a handful of Tylenols, along with sedatives and a few glasses of wine.
"I can't live like this anymore." I paused. "Lily deserves a mom, not me."
Joe sighed and said, "I'm calling the clinic's emergency line."
The therapist on duty advised Joe to bring me to the hospital immediately, even though I protested. But I had no choice. I confessed my desire to kill myself, so I could go voluntarily or in an ambulance.
Joe stayed with me for nine hours in the emergency room, until there was a bed ready in the psychiatric unit. His parents watched Lily at home.
"Please don't let them take me away," I called out to Joe, as a nurse led me to the unit.
"I'll see you in the morning," Joe answered back. "You will be OK."
When he arrived the next day, I pleaded with him to get me out.
"Someone tried to kill themselves last night," I cried. "I don't belong here."
"Can you give it a chance?" he begged.
I sat back in my chair and folded my arms. I resented Joe for bringing me here. At the beginning of our relationship, I'd been the strong one, helping him through his own hardships. But Lily changed everything.
"I have to get back," he said. "Focus on getting better, not getting out."
When Joe leaned in to give me a kiss goodbye, I stopped him. "I want a divorce when this is over," I whispered.
He teared up and said, "You've said some of the meanest things anyone has ever said to me."
I felt no remorse. Before the baby, we never went to bed angry. Now, I loathed him for keeping me here. I was determined to punish him, and I did, lashing out constantly, but he kept visiting and taking my phone calls. He never stopped trying.
I was discharged after five days. Joe and I argued for the entire ride home. When we arrived at the house, I imploded: "I can't take this anymore!"
I threw chairs and baby toys, wailing, and punching the wall. Joe couldn't calm me, so he took Lily and his parents to the farthest part of the house.
The next morning, Joe gave me a choice: "You either go to your parents' house and take a break, or you go back to the hospital."
I chose the first option.
A few days later, Joe called me. "I told my therapist what happened. He called Child Protective Services," he said matter-of-factly.
"They're going to take Lily away?" I asked.
Shocked, I suddenly realized how much I wanted her."
By Paige Glidden | May 07, 2021
"During TheBlueDotProject's Maternal Mental Health Awareness Week, it's time to focus on the mental health of mothers—especially during a life-changing pandemic. The most recognized maternal mental health disorder is postpartum depression, but there are other common mental health concerns to look out for.
Juggling societal and familial expectations is a heavy burden for anyone. But when you add a new baby into the mix (during a pandemic!), it can become overwhelming. Sleepless nights, hormones, and new emotions all feed into overwhelm after the birth of a baby, not to mention that maternal anxiety and depression are the most common complications of childbirth, impacting up to 1 in 5 women.
The first week of May serves as Maternal Mental Health Awareness Week, bringing to light the challenges that moms face and the reality of postpartum depression and anxiety. Maternal Mental Health Disorders (MMHDs) include a range of disorders and symptoms, including depression, anxiety, and psychosis. Although often referred to more commonly as "postpartum depression," there are several different types of postpartum mental health disorders that affect new moms.
Symptoms can occur during pregnancy and/or the postpartum period (together often referred to as the perinatal period). These illnesses can affect anyone—and they are far more common than you'd think. Although an estimated one in five women have a maternal mental health disorder, most cases go undiagnosed, leading experts to believe that the number should be much higher. New parents also experience the baby blues, which is not formally considered an MMHD—up to 80 percent of women suffer from this in the initial two to three days postpartum, according to Bridget Frese Hutchens, Ph.D., CNM, RN, CNL, PHN.
What's worse is that only 30 percent of women who screen positive for depression or anxiety seek or receive treatment. When left untreated these disorders can cause devastating consequences for moms, babies, families and communities. The good news is that risk for both depression and anxiety can be reduced (and sometimes even prevented), and with treatment, women can recover.
It can be hard to identify some of the symptoms of postpartum mental health challenges, but it's worth paying attention to. Here are five types of maternal mental health conditions to look out for:
Common Maternal Mental Health Disorders
1. Postpartum Depression
Pregnancy and Postpartum Depression (PPD) is a mood disorder that can begin during pregnancy or in the first three weeks after having a baby, according to ACOG, the American College of Obstetricians and Gynecologists. Symptoms can range from mild sadness, trouble concentrating, or difficulty finding joy in once-loved activities to severe depression, and mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression, according to The Blue Dot Project. While there is no single cause for PPD, experts attribute it to the drop in hormones estrogen and progesterone following childbirth and general stressors which increase during pregnancy and the postpartum period. With proper mental health care, PPD is treatable and the risk of severe depression can also be prevented.
2. Dysthymia, Persistent Depressive Disorder
Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression. According to the Mayo Clinic, people with dysthymia may lose interest in normal daily activities, feel hopeless, or have overall feelings of inadequacy. Women with pre-existing dysthymia may be at a higher risk for severe symptoms/depression during the perinatal period, according to The Blue Dot Project.
3. Pregnancy and Postpartum General Anxiety
It might seem normal to worry before or after having a baby, but if your anxiety is more than just the baby blues and you can't get these worries out of your brain, you might be suffering from pregnancy or postpartum related generalized anxiety . Around 10 percent of women will develop anxiety during pregnancy or after childbirth, according to the American Pregnancy Association. Anxiety is treatable during pregnancy and postpartum.
Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the "what if's"—questions like "what if my baby experiences SIDS" or "what if my baby has autism," and extreme worry about not being a good parent or being able to provide for her family, according to The Blue Dot Project."
By: Lindsay Dolak | Editor at Aaptiv | August 6, 2020
"No matter how fit you were before and even during pregnancy, postpartum exercise presents a unique set of challenges. Your body is still healing from delivery, and with a newborn in the house, you might be feeling more tired than ever. But finding time to fit in fitness is amazing for both your body and mind—it can be just what you need to get back to feeling like your pre-pregnancy self. No, we’re not talking about “getting your body back.” We’re talking about a boost to your energy, self-confidence and physical strength. Plus, you’re bound to sleep better too. Do we have your attention now? Here, two trainers from Aaptiv—a fitness app offering trainer-led, music-driven audio workouts—break down why you should start a postnatal fitness routine, and how to do it.
Benefits of Postpartum Exercise
Postnatal exercise brings a host of positive benefits to your body, but also for your mood and stress levels. Fitness not only helps your body heal but also provides an outlet to recenter and focus on yourself—something that might feel a bit out of reach now that you’re caring for another tiny human. “Postpartum exercise gives moms back that feeling of being in control,” says Aaptiv trainer Candice Cunningham, an ACE-certified personal trainer and Fit For Birth pre- and post-natal corrective exercise specialist. “It’s a huge stress-reliever and also gives new moms something to really focus on for themselves.”
Aaptiv trainer and mom Jaime McFaden, an ACE-certified pre- and post-natal fitness specialist and health coach, agrees, adding that consistent exercise post-baby provides a huge boost in not only physical strength, but mental strength as well. “You just went through so many changes—things have shifted. Exercise helps you heal from the inside out,” she says.
In addition to the many mental and emotional benefits, postnatal fitness can lead to weight loss, improved strength (carrying around a baby all the time is no joke), better sleep and more balanced hormones—a must after nine months of ups and downs.
When to Start Postpartum Exercise
First things first: Don’t jump into a postpartum exercise routine without your doctor’s approval. Many doctors recommend waiting six to eight weeks after birth before starting trying any type of exercise, but it often varies. Some women may experience complications during pregnancy or labor that might set them back a few more weeks. For example, a mother who had a vaginal birth will likely have a different timeline than one who had a c-section. And others may even be able to work out sooner than six weeks.
According to McFaden, working out during pregnancy may help when it comes time to start exercising again. “Your body’s muscle memory will kick in and you’ll have an easier time getting back into it after birth,” she says. “You still want to give your body time to recover, though. Never push yourself too hard post-baby. Patience is key.”
No matter what, it’s crucial to work with your doctor to find out exactly when is right for you and your body. “Every mom is different and it’s important to pay attention to stresses the body may undergo post-pregnancy,” Cunningham says. “A doctor will be able to check for an indication of diastasis recti (the separation of the abdominals) and be able to recommend the appropriate physical work to heal that or any other side effects of childbirth.”
There’s no real reason to rush back into exercising early anyways. In fact, it can cause you more harm than good down the line. It might be hard for women used to high intensity workouts or long runs, but taking it slow is key.
When you’re ready, start by adding walking and low-impact bodyweight exercises at first. Aaptiv’s fourth trimester program meets new moms where they are and focuses on building back up to regular workouts. It covers core, strength training, outdoor walking and elliptical, and places special emphasis on healing the pelvic floor muscles and not aggravating a diastasis recti—both of which are crucial for new moms with recovering bodies. Don’t worry, you’ll gradually work your way back to sprints and burpees in no time.
Best Postpartum Workouts
Before you starting working out again, it’s important to temper your expectations. Your body is different now and you won’t immediately be as strong as you once were. Start with simple, functional exercises you can ultimately build on. To get you started, we asked McFaden and Cunningham to share some of their favorite postpartum exercises to work your entire body."
Medically reviewed by Lynn Starr, RNC-OB — Written by Shannon Conner on September 9, 2015
"Most moms-to-be spend a lot of time worrying about their developing baby. But remember, it’s just as important during the next nine months to tune in to someone else’s cues: your own.
Maybe you’re exceedingly tired. Or thirsty. Or hungry. Maybe you and your growing baby need some quiet time to connect.
Your doctor or midwife may say, “Listen to your body.” But for many of us, that’s followed by, “How?”
Meditation can help you listen to your voice, your body, that small heartbeat — and help you feel refreshed and a bit more focused.
What Is Meditation?
Think of meditation as some quiet time to breathe and connect, be aware of passing thoughts, and to clear the mind.
Some say it’s finding inner peace, learning to let go, and getting in touch with yourself through breath, and through mental focus.
For some of us, it can be as simple as deep, in-and-out breaths in the bathroom stall at work as you try to focus on you, your body, and the baby. Or, you can take a class or retreat to your own special place in the house with pillows, a mat, and total silence.
What Are the Benefits?
Some of the benefits of practicing meditation include:
Moms who have high levels of stress or anxiety during pregnancy are more likely to deliver their babies at preterm or low birth weights.
Birth outcomes like those are a pressing public health issue, especially in the United States. Here, the national rates of preterm birth and low birth weight are 13 and 8 percent, respectively. This is according to a report published in the journal Psychology & Health.
Prenatal stress can also impact fetal development. Studies have shown that it can even affect cognitive, emotional, and physical development in infancy and childhood. All the more reason to squeeze in some meditation time!"
"After the birth, there are oh-so-many ways your body will ache. We asked midwife Tracy Hydeman and other experienced parents for their soothing suggestions.
1. When you’re breastfeeding, massage your breasts to ward off mastitis. You can also use warm compresses or take a hot shower.
2. Get hydrated with natural electrolytes (which help regulate nerves and muscles) by mixing water, sea salt and freshly squeezed orange or lemon juice.
3. Soak your bottom in an Epsom salt bath at least two times a day. Add herbs like comfrey leaf and witch hazel to help tears heal and reduce inflammation.
4. Cabbage leaves are a “fantastic thing for engorged breasts,” says Hydeman. They cup the breasts naturally and relieve inflammation.
5. Eat a beef and barley stew—the beef is good for replenishing your iron, and the barley will help your milk come in.
6. If necessary, book an appointment to see a physiotherapist for pelvic-floor and diastasis recti physio ASAP.
7. That little peri bottle you got from your hospital nurse or midwife? It’s a new mom’s best friend when it comes to keeping things clean down there postpartum. (Any tearing or incisions will make it difficult to wipe after delivery.) Simply fill it with warm water and squirt to cleanse yourself after using the toilet or squirt while peeing to dilute the urine if you have any burning or discomfort.
8. Homemade “padsicles”
– Spritz sanitary pads with water or top with witch hazel. Many moms also swear by adding aloe vera gel and lavender oil.
– Fold up the pad and insert it into a zip-top bag or seal with plastic wrap. Freeze. Place on the perineum for cold comfort.
9. If you have a supportive partner or help at home, take advantage of that by embracing the “babymoon” period. Try to stay in bed for at least 72 hours after the birth.
10. Organize (or ask a friend or family member to organize) a meal train, which is a system in which people can sign up to bring you meals. Don’t be shy about mentioning any food preferences or allergies."
BY ANNE LORA SCAGLIUSI | May 25, 2021
"Jen Schwartz, mental health advocate and CEO of Motherhood Understood, first experienced perinatal depression a day after giving birth. “The biggest red flag was that I was having scary thoughts about wanting to get hurt or sick so I could go back to the hospital and not have to take care of my baby,” she says. “I had no interest in my son. I thought I had made a huge mistake becoming a mother and I couldn’t understand why I was failing at something that I believed was supposed to come naturally and that all other women were so good at.”
According to the World Health Organization, about 10 percent of pregnant women and 13 percent of new mothers will experience a mental disorder, the main one being depression. Without appropriate intervention, poor maternal mental health can have long term and adverse implications for not just these women, but their children and families, too. In most cases, however, women may not be aware of the help available or even that they might need it.
“Most of the time, they mistakenly think they are failing at parenting,” says Wendy Davis, executive director of Postpartum Support International (PSI). “They don't realize they are going through a temporary, treatable experience that many others have gone through.”
To find out more during World Mental Health Awareness Month, Vogue speaks to a range of global mental health experts and women who have experienced perinatal depression.
What is perinatal depression?
"Perinatal depression is the experience of depression that begins during pregnancy [prenatal depression] or after the baby is born [postpartum depression]. Most people have heard of perinatal depression, but what’s equally common for mums to experience is perinatal anxiety either separately, or with depression,” explains Canadian therapist Kate Borsato. Perinatal depression does not discriminate. “Some people are surprised when I tell them that I experienced postpartum anxiety, because of my job as a therapist for mums. But mental illness doesn’t really care who you are or what you know.”
While anyone can experience it, there are some known risk factors that increase women’s chances of developing mental health difficulties in the perinatal period. According to Australia-based social worker and founder of Mama Matters, Fiona Weaver, these include a “previous history of depression or anxiety, those who have limited support networks, have experienced birth or pregnancy trauma, infertility or who may be genetically predisposed to it.”
What are the signs and symptoms to look out for?
Symptoms differ for everyone, and may include feelings of anger, anxiety, fatigue, neglecting personal hygiene and health or surroundings, fear and/or guilt, lack of interest in the baby, change in appetite and sleep disturbance, difficulty concentrating/making decisions, loss of enjoyment or enthusiasm for anything, and possible thoughts of harming the baby or oneself.
Women can also develop postpartum obsessive-compulsive disorder, and postpartum psychosis. Copenhagen-based content creator Clara Aatoft was diagnosed with severe postpartum depression and psychosis months after becoming a new mum. “For the first three months, I didn't sleep at all. I was constantly aware of my daughter’s needs. She was later diagnosed with colic. When I gave up breastfeeding and switched to the bottle, my depression and psychosis went full-blown.” She continues, “I started thinking that my daughter was a robot that someone placed a chip inside at the hospital. I attempted suicide and ended up in the psychiatric ward. I’m very well now, still medicated on antidepressants. But my daughter and I have the best relationship.”
By Christin Perry | February 25, 2020
"Almost as soon as those two pink lines pop up on a pregnancy test, your hormones get the message that something's different at mission control. Progesterone and human chorionic gonadotropin (hCG) begin pumping to signal your body to halt production on your next menstrual period, and begin forming that cluster of cells into a mini-you instead. As you probably already know, as these hormones get to work, you'll experience an onslaught of early pregnancy symptoms like nausea, fatigue, and breast tenderness.
As pregnancy progresses, our bodies produce extraordinary amounts of estrogen and progesterone, says Aumatma Shah, fertility specialist and naturopathic doctor at the Bay Area's Holistic Fertility Center. "These two steroidal hormones are key to creating dopamine and serotonin, two neurotransmitters in the brain that are important in feeling calm and happy. This is why a lot of women feel amazing when pregnant: Pregnancy offers a surge of hormones and neurotransmitters that help us feel great."
But what happens to those feel-good pregnancy hormones once your baby is born? "Unfortunately, immediately postpartum and the week following delivery, estrogen and progesterone will both plummet. Simultaneously, there will be a surge in prolactin and oxytocin," says Shah.
These wildly swinging hormones are to blame for those crazy emotions you'll experience after giving birth. Here's a closer look at what happens to your hormones postpartum and when so you know what to expect—and so you know the loony emotions you're feeling are all completely normal.
What Happens to Hormones Immediately After Giving Birth?
The birth of your sweet bundle of joy is undoubtedly one of the most exciting moments of your life. No matter how long you labor or what time you give birth—yes, even if it's at 3 a.m.—you'll likely feel an amazing, indescribable high when you meet your baby for the first time, or shortly thereafter. But those surging hormones will plummet over the next few days. Here's what's going on:
Postpartum Hormones at 3 to 6 Weeks
After those first few weeks pass, you may start to feel those rollercoaster-like emotions start to regulate a bit as you begin to get into the groove of caring for baby and get used to the lack of sleep. Ashley Margeson, a naturopathic doctor says, "the first three months are a bit of a whirlwind of sleep loss and emotions as your system runs mostly on adrenaline to move you through the day."
Around the six-week mark, she says, symptoms of postpartum depression may begin to show as those positive post-birth hormones continue to fade. "The changes you should look for closely are not wanting to shower or focus on hygiene, being afraid of leaving your baby with someone else, not being able to sleep fully due to continually checking on baby, and lack of desire for common tasks like eating, drinking, being around people, and leaving the house."
By: Jessica Grose | February 4th, 2021
"In early September, as the school year inched closer, a group of mothers in New Jersey decided they would gather in a park, at a safe social distance, and scream their lungs out. For months, as the pandemic disrupted work and home life, these moms, like so many parents, had been stretched thin — acting as caregivers, teachers and earners at once. They were breaking.
As are mothers all over the United States.
By now, you have read the headlines, repeating like a depressing drum beat:
“Working moms are not okay.” “Pandemic Triples Anxiety And Depression Symptoms In New Mothers.” “Working Moms Are Reaching The Breaking Point.”
You can also see the problem in numbers: Almost 1 million mothers have left the workforce — with Black mothers, Hispanic mothers and single mothers among the hardest hit. Almost one in four children experienced food insecurity in 2020, which is intimately related to the loss of maternal income. And more than three quarters of parents with children ages 8 to 12 say the uncertainty around the current school year is causing them stress.
Despite these alarm bells clanging, signaling a financial and emotional disaster among America’s mothers, who are doing most of the increased amount of child care and domestic work during this pandemic, the cultural and policy response enacted at this point has been nearly nonexistent.
The pandemic has touched every group of Americans, and millions are suffering, hungry and grieving. But many mothers in particular get no space or time to recover.
The impact is not just about mothers’ fate as workers, though the economic fallout of these pandemic years might have lifelong consequences. The pandemic is also a mental health crisis for mothers that fervently needs to be addressed, or at the very least acknowledged.
“Just before the pandemic hit, for the first time ever, for a couple months, we had more women employed than men,” said Michael Madowitz, an economist at the Center for American Progress. “And now we are back to late 1980s levels of women in the labor force.” The long-term ramifications for mothers leaving work entirely or cutting back on work during this time include: a broken pipeline for higher-level jobs and a loss of Social Security and other potential retirement income.
“Covid took a crowbar into gender gaps and pried them open,” said Betsey Stevenson, an economist at the University of Michigan. Her long-term concerns are even more fundamental: Will watching a generation of mothers go through this difficult time with little support turn the next generation of women off from parenthood altogether?
The economic disaster of the pandemic is directly related to maternal stress levels, and by extension, the stress levels of American children. Philip Fisher, a professor of psychology at the University of Oregon who runs an ongoing nationally representative survey on the impact of the pandemic on families with young children, points out that the stressors on mothers are magnified by a number of intersecting issues, including poverty, race, having special needs children and being a single parent.
“People are having a hard time making ends meet, that’s making parents stressed out, and that’s causing kids to be stressed out,” Dr. Fisher said. This buildup can lead to toxic stress, “And we know from all the science, that level of stress has a lasting impact on brain development, learning and physical health.” Almost 70 percent of mothers say that worry and stress from the pandemic have damaged their health.
The statistics on stress levels are shocking, but they are sterile; they don’t begin to expose the frayed lives of American mothers and their children during this pandemic. A young mother who self-identified as American Indian/Alaska Native summed up her situation in response to Dr. Fisher’s survey: “We are requesting government help for food. Relationship between partner and I are tense. I am personally struggling more now with depression and anxiety. My toddler has become more anxious as well and shown aggressive behavior. She seems overwhelmed most of the time.”
Times editor-at-large Jessica Bennett spent months communicating with three women, who kept detailed diaries of their days, for a look at just how much American mothers are doing every waking second."
By: Robin Elise Weiss, PhD, MPH | June 14, 2021
"Affirmations are statements that you use intentionally to instill a sense of positivity and purpose in your mind about a particular subject. You can use these short phrases and sentences to help yourself focus on and accept a positive message that you wish to remember.Affirmations are an example of using positive thinking to set an intention and increase the likelihood of positive results. Even better, they are simple to do, free, and accessible to all.
Why They Work
While there is no guarantee that affirmations will actually change the outcome of your pregnancy, some studies suggest that affirmations can reduce stress and anxiety—which can make it easier to rest, eat, and avoid issues such as headaches and fatigue. Plus, positive thoughts tend to cultivate positive feelings, which may help to make your pregnancy experience more enjoyable and relaxed.
Studies show that using positive affirmations impacts brain pathways, increasing activity in the areas of the mind responsible for self-worth, self-regulation, and core values. Researchers believe that making a regular practice of saying affirming statements can effectively shift your focus from negative emotions or stressors to your own expansive capacity to cope, bolstering your confidence and bringing you new ideas, strategies, energy, and hope for the future.
Write Your Own
The beauty of positive affirmations is that you can write your own to use whenever you like. They can be said out loud or silently in your head, quietly whispered to yourself, or written down. In lieu of writing your own, you can also use one you have read or heard elsewhere. If it makes you feel strong, positive, and hopeful, then you're on the right track.
Remember, your affirmation should be in the present tense, as if what you wish to happen is already occurring. For example, someone who is worried about coping with childbirth might say, "I am strong." A person who is trying to get pregnant and having difficulty might say, "I am a good parent to my child."
This person might decide to repeat the affirmation every morning as a reminder of their goal and to foster their hope for this desired outcome. During infertility treatments, they might visualize this affirmation while undergoing procedures and tests, as well. During pregnancy, daily pregnancy affirmations may serve to enhance the mother's bond to their growing baby while also alleviating the worry that something might go wrong.
How to Do It
Anything that speaks to you can work as an affirmation. If you're unsure, brainstorm statements that connect to the feelings, values, and intentions you want to affirm. If you have a specific worry or negative thought that keeps coming to mind, try flipping it around to a positive one.
If you catch yourself thinking, "I can't do this," counter that with, "I can do this." "Childbirth is scary" becomes "childbirth is beautiful." Simple is good. Setting your positive intention can literally change your mind.
To help you get started writing your own affirmations, consider beginning with phrases like the following:
By MGH Center for Women's Mental Health | June 10th, 2021
"When we meet with women for perinatal psychiatry consultations, we now ask about vaccinations. It’s not something we typically do, but after the last year, we are now getting involved in their decisions regarding vaccination against COVID-19. Just as we counsel women to avoid alcohol and to consistently take their prenatal vitamins, providing information on the COVID-19 vaccine is an important aspect of promoting the health of pregnant and postpartum women.
Considering a growing body of evidence indicating that pregnant women are more likely to have certain manifestations of severe COVID-19 illness, including admission to the ICU and mechanical ventilation, the American College of Obstetricians and Gynecologists (ACOG) has urged the CDC’s Advisory Committee on Immunization Practices to include pregnant and lactating women in the high-priority populations for COVID-19 vaccine allocation. ACOG clearly states that all pregnant and lactating people should be allowed to receive the vaccine, and that their decision to do so should be based on a careful discussion of risks and benefits with their healthcare provider.
From our vantage point, there are other benefits to the COVID-19 vaccine. During the past year, before the vaccination was available, we watched as pregnant and postpartum patients undertook the most extreme forms of lockdown. Many of these women were literally housebound: never leaving the house and cutting off contact with friends and family, while at the same time taking on more childcare responsibilities as outside care providers and day care centers were no longer available. And all the while wondering what would happen if they or a member of their family felt ill?
We are yet to fully appreciate the impact of the COVID-19 pandemic on perinatal women, but preliminary studies indicate that during the lockdown, pregnant and postpartum women reported higher levels of stress, loneliness, depression, and anxiety. And this is not really a surprise. So many of the things we typically recommend to reduce stress and social isolation, such as exercising regularly or spending time with friends and family, vanished.
While it might seem like the pandemic is fading into the distance, the resurgence of the pandemic in places like India and Brazil where immunization rates are low, we cannot be so sure about this. So far the most successful way to avoid becoming seriously ill with COVID-19 is to get vaccinated.
A recent article in Medscape, however, suggests that mothers appear to be less likely to get vaccinated than others in the general population. According to a recent poll from Morning Consult, about two-thirds of adults in the US have either already been vaccinated against COVID-19 or plan to do so. In contrast, mothers are the most likely to be hesitant about the vaccine. In this study, 51% of the mothers reported that they are unwilling to get vaccinated or are uncertain about getting vaccinated, at 51% (compared to 32% of other women and 29% of fathers)."
By familydoctor.org editorial staff.
"The amount of sleep you get while you’re pregnant not only affects you and your baby, but could impact your labor and delivery as well. Lack of sleep during pregnancy has been tied to a number of complications, including preeclampsia (a serious condition that affects your blood pressure and kidneys). This condition could result in pre-mature birth. Now is the time to take sleep seriously.When you become pregnant, one of the first symptoms you may notice is being overwhelmingly tired, even exhausted. Sleep will be irresistible to you. You can most likely blame your changing hormones for this, especially the extra progesterone that comes with being pregnant. In the beginning, pregnancy also lowers your blood pressure and blood sugar, which can make you feel tired.
Shortly after the first trimester, your energy should return. Sometime during the third trimester, you’ll begin to feel tired again. Some of this feeling can be blamed on the sheer physical exhaustion that comes from growing a baby and the stress that it puts on your body. However, your weariness during this time is in direct relation to your inability to get a good night’s sleep.
Even if you’ve never had trouble sleeping before, you may find it much more difficult while you’re pregnant.
Path to improved health
Sleep should never be seen as a luxury. It’s a necessity — especially when you’re pregnant.
In fact, women who are pregnant need a few more hours of sleep each night or should supplement nighttime sleep with naps during the day, according to the National Institutes of Health.
For many pregnant women, getting 8 to 10 hours of sleep each night becomes more difficult the farther along they are in their pregnancy. There are many physical and emotional obstacles to sleep in this stage. Anxiety about being a mom or about adding to your family can keep you awake. Fear of the unknown or about the delivery can cause insomnia. Plus, there is the getting up every few hours to go to the bathroom. It also can be difficult to find a comfortable position in bed, especially if you are a former stomach sleeper.
If any of the following is keeping you awake at night, try these strategies for getting a good night’s sleep.
At some point in their pregnancy, most pregnant women suffer from heartburn, which is a form of indigestion that feels like burning in your chest and throat. Heartburn can wake you up in the middle of the night and ruin a good sleep. Minimize the chance for this by avoiding spicy foods. Also, cut down on rich foods for dinner.
Restless leg syndrome
Few things are more distracting than restless legs syndrome (RLS), especially when you are trying to go to sleep. While you can’t take traditional RLS medicines when you are pregnant, you can try to reduce the feelings of RLS with a good prenatal vitamin that includes folate and iron.
Morning sickness — at bedtime
Despite the name, morning sickness can occur any time and is often worse later in the day. Try eating a few crackers at bedtime and keep a stash in your nightstand in case a wave of nausea hits as you are trying to go to sleep.
There are many ways insomnia can creep in and compromise your sleep time. Often, it’s just about being able to shut down your brain. Most medicines for insomnia should not be taken while you are pregnant. Instead, try journaling some of the things you are anxious about. Write down what is stressing you and try to let it go as you go to sleep. Also, stop drinking caffeine by early afternoon. Try not to take long naps during the day. Doing any — or all — of these things can help ease you back into sleep at a reasonable bedtime.
Not many things can wake you as quickly and painfully as a leg cramp. Sometimes called a charley horse, these cramps are usually a contraction of your calf muscle. Less frequently, they can occur in your thigh or your foot. These can plague you in pregnancy because of a lack of minerals, especially calcium and magnesium. They also are more common if you are dehydrated. To guard against leg cramps, make sure that you continue to take your prenatal vitamin and drink plenty of water and other fluids during the day.
Finding a comfortable position
As your body grows, sleep becomes a little harder to come by, especially in the third trimester. It’s difficult to get comfortable. It’s harder to move around and shift positions in bed. If you’ve been a stomach or back sleeper, it can be hard to adjust to sleeping on your side. The best position to sleep in when you’re pregnant is on your left side. This improves blood flow and, therefore, nutrient flow to your baby. Try lying on your left side, knees bent with a pillow between your knees. It also helps to tuck a pillow under your stomach, as well, for extra support.
Frequent bathroom breaks
With the baby pushing down on your bladder, you likely can’t make it all night without waking at least once to go to the bathroom. You can help minimize nighttime bathroom trips by cutting down on how much you drink in the evenings. Just be sure to get adequate hydration during the day. Bright lights can make it harder for you to fall back asleep, so use nightlights so that you will not need to turn on the lights when you get up to go to the bathroom.
In addition to minimizing the common obstacles to getting a good night’s sleep, there are also ways to encourage good sleep habits. This is called good sleep hygiene.
Things to consider
Sleep is essential to health. Lack of sleep is associated with many chronic diseases, including type 2 diabetes, obesity, depression, and even heart disease. If you’re pregnant, not getting an adequate amount of sleep can put you at risk for some serious conditions. Lack of sleep can also complicate your delivery.
In one research study, pregnant women who slept less than six hours at night late in pregnancy had longer labors and were more likely to have cesarean deliveries.
Another study reports that the sleep you get in your first trimester can affect your health in the third trimester. Women who don’t get enough sleep (less than five hours per night) in the first trimester are nearly 10 times more likely to develop preeclampsia late in pregnancy. Preeclampsia is a condition associated with pregnancy-related high blood pressure, swelling of hands and feet, and protein in urine.
If you’ve ever had a sleep disorder, it could be made worse by pregnancy. If you’ve had sleep apnea in the past, your snoring may get worse during pregnancy. This is especially true if you were already overweight when you became pregnant. Expect that RLS will worsen during this time. Heartburn will intensify, too."
"For a new mom-to-be, experiencing sleep deprivation after the baby is born is a given. But you probably didn’t realize that it could also occur during the first trimester of pregnancy.
Most women experience sleep problems during pregnancy. Pregnant women tend to get more sleep during their first trimesters (hello, early bedtime) but experience a big drop in the quality of their sleep. It turns out that pregnancy can make you feel exhausted all day long. It can also cause insomnia at night.
Here are some of the most common culprits for insomnia during early pregnancy, plus a few tips to help you get a better night’s sleep.
What is insomnia?
Insomnia means you have difficulty falling asleep, staying asleep, or both. Women can experience insomnia during all stages of pregnancy, but it tends to be more common in the first and third trimesters. Between midnight bathroom breaks, out-of-control hormones, and pregnancy woes such as congestion and heartburn, you might be spending more time out of your bed than in it. The good news: While insomnia might be miserable, it’s not harmful to your baby.
Sheer logistics play a role as well. By the end of a pregnancy, many women have a hard time just getting comfortable enough to sleep well. During the first trimester, you might not have much of a baby belly to accommodate, but there are other issues that can prevent a good night’s sleep.
What causes insomnia during pregnancy?
Expecting? There are many reasons you might be wide awake in the wee hours. These can include:
It can be difficult to distract yourself from these thoughts, but try to remember that worrying isn’t productive. Instead, try writing down all of your concerns on paper. This will give you a chance to consider possible solutions. If there are no solutions, or there is nothing you can do, turn the page in your journal and focus on another worry. This can help empty your mind so you can rest.
Being up front with your partner about your feelings and worries can also help you feel better.
Develop a bedtime routine
One of the best things you can do to manage insomnia while you’re pregnant is to set up good sleep habits.
Begin by trying to go to bed at the same time every night. Start your routine with something relaxing to help you unwind.
Avoid screen time at least an hour before bed. Blue light from the TV, your mobile phone, or tablet can have an impact on your body’s circadian rhythm. Try reading a book instead.
Taking a soothing bath might also make you sleepy. Just be careful that the temperature isn’t too hot — that can be dangerous for your developing baby. This is especially true during early pregnancy.
To be safe, avoid hot tubs.
Diet and exercise
Diet and exercise can have an impact on your sleep.
Drink plenty of water throughout the day, but minimize drinking after 7 p.m. Try to avoid caffeine starting in the late afternoon.
Eat to sleep
Eat a healthy dinner, but try to enjoy it slowly to reduce your chances of heartburn. Eating an early dinner can also help, but don’t go to bed hungry. Eat a light snack if you need to eat something late in the evening. Something high in protein can keep your blood sugar levels steady through the night. A warm glass of milk can help you feel sleepy, too."
"Seaneen Molloy was excited to discover she was expecting her second baby during lockdown. With a history of mental illness, she carefully planned the pregnancy, but when her baby arrived she experienced the "terrifyingly rapid" onset of a crisis which left her unable to hold baby Jack."
"Having a baby is supposed to be a joyful experience, and for lots of women it is. However, up to 20% experience mental ill health during pregnancy and the year after birth. Tragically, suicide is the leading cause of death in new mothers.
Women who already have a mental illness are at a high risk of relapse during pregnancy - that's women like me.
I have a diagnosis of bipolar disorder and an anxiety disorder. This meant that pretty much from the moment I became pregnant, the perinatal mental health team were involved.
This includes specialist midwives, psychiatrists, nurses and social workers whose goal is to support women to stay well, and intervene quickly if they don't.
Normally, I manage my mental health by being careful with my sleep and leading a pretty boring life away from overwork and alcohol, but pregnancy chucks in a host of factors you have no control over.
Hormones rage through your body, wreaking havoc upon your mood, your energy levels and your ability to keep your lunch down. You either can't stay awake or are awake for hours - peeing a thousand times and being hoofed by tiny feet.
I had managed to stay well, and off medication, for years, but in the run-up to birth antipsychotic medication was introduced to prevent postpartum psychosis. This can cause women to develop delusions and lose touch with reality.
It's the one I was most at risk of developing due to my history of bipolar disorder, but in the end, I experienced postnatal anxiety.
My mental health had been largely OK during my pregnancy and my labour and after-care were carefully planned.
I had a calm elective Caesarean section due to a traumatic first birth, a room of my own and the baby was whisked away on his inaugural night so that I could get some all-important sleep (this bit was hard - it went against every natural instinct). A procession of midwives, doctors and social workers visited to see how I was doing.
Although I found it intrusive, it helped me feel safe. When I was discharged from hospital with my baby, Jack, I felt swaddled in care and confident everything would be OK.
It was a complete shock that I did get ill.
In the chaos of newborn-life I forgot a dose of my anti-clotting medication which is given to mothers after C-sections.
And this one tiny event broke my brain.
I went from mildly chiding the home treatment team for their postnatal visits, because I was fine, to a full-blown mental health crisis within about 12 hours. It was terrifyingly rapid - which is why perinatal mental illness can be so deadly.
My mild anxiety exploded into an all-consuming panic that I was going to die imminently from a blood clot in my lung. I couldn't think of anything else but the black terror of certain death that was coming for me - how I was going to leave my children, how I'd brought a new child into the world never to know me.
I called out-of-hours GPs describing symptoms I was convinced I had, sobbed, screamed and couldn't breathe. I terrified my husband and myself.
Then we hit the emergency button.
The psychiatrist came over with the home treatment team. They took my fears seriously, which I appreciated, and gave me a physical examination and the missed dose of medication. My antipsychotic medication was increased to the maximum dose and benzodiazepines - a type of sedative - prescribed, to try and calm me down.
I wasn't allowed to be left alone and the mental health team were to visit me every day where I tried to articulate my terror to their masked faces.
At first I resented their visits, but they became a 30-minute space where I could let down the exhausting facade and share how I was really feeling.
My anxiety then transformed into an obsession that Jack was going to die. I was afraid to leave the room and rested my hand on his chest all night.
If my husband took him out to the shops with his brother, I cried and paced about, imagining they had all been hit by a car. I texted him incessantly.
Everyone was saying I needed "rest", so he tried to give me space. But after the second or third breakdown, he agreed to keep his phone on loud and to answer quickly. The home treatment team also advised he give me clear timescales so I knew when to expect them home.
But the medication also caused intense restlessness. I couldn't sit still. I couldn't get comfortable enough to hold my baby for more than a minute."
By MGH Center for Women's Mental Health | May 19th, 2021
"This is a question we often hear. One of the challenges in answering this question is the interpretation of the word “best”. On one hand, the best antidepressant is the one that is the most likely to be effective. On the other hand, the best antidepressant is the one that carries the least risk when used during pregnancy. What this means is that there is no single answer. Each situation is different, and our recommendations are based on a careful assessment of the patient’s course of illness, treatment history, past medication trials, and the most up-to-date information on reproductive safety. Added to this calculation is the understanding that untreated depression also carries some risk in terms of maternal well-being and has been associated with worse pregnancy outcomes.
Stay with the Same Treatment or Switch?
We often meet with women who have switched to a different antidepressant medication in preparation for pregnancy. Other women make a switch when they discover they are pregnant. These switches are motivated by the belief that there is a “safer” medication to be used during pregnancy. The reality is that most of the antidepressants taken by women today are relatively safe and carry a very low risk to the developing fetus. What separates one antidepressant from another is that some medications have more data to support their reproductive safety than others. But even this distinction is disappearing; we have data to support the use of most SSRIs (with less data on fluvoxamine or Luvox), the SNRIs duloxetine (Cymbalta) and venlafaxine (Effexor), and bupropion (Wellbutrin). Tricyclic antidepressants, although not commonly used today, also have data to support their reproductive safety.
We have very little data on the reproductive safety of the MAO inhibitors. In addition, MAO inhibitors may have serious interactions with other medications frequency used during pregnancy and labor and delivery, specifically medications used to manage pain, such as nalbuphine (Nubain) and meperidine (Demerol). In women taking these medications, we are likely to suggest switching to another antidepressant with a better reproductive safety profile.
At this point, we have less data on the use of the newer antidepressants. There is some data on mirtazapine, with the most recent study including 334 cases of neonates with prenatal exposure to mirtazapine. While these data are reassuring and there is no indication that mirtazapine carries significant teratogenic risk, the number of mirtazapine exposures remains small. Ideally we would like to have data from 600-700 exposures to get a better estimate of risk. Making decisions regarding safety on studies with small sample sizes can lead to miscalculations of risk in either direction.
The data is even more limited with regard to the use of vortioxetine (Trintellix), vilazodone (Viibryd), levomilnacipran (Fetzima). If there are effective alternatives, we typically recommend switching to another antidepressant.
In settings where we have limited data regarding the reproductive safety of a particular antidepressant, we may consider switching to an antidepressant with a better characterized reproductive safety profile. It is important, however, to carefully consider the benefits and risks of making this switch. With any switch, there is the risk of relapse when making a change in the maintenance treatment. Thus, there are situations where we recommend continuing an antidepressant with limited reproductive safety information because there are no effective alternatives and the risk of relapse is significant.
What About Zoloft? Isn’t Zoloft the Safest?
At some point in the early 2000s, there emerged the belief that sertraline (Zoloft) was the safest antidepressant to use during pregnancy, and many women taking other antidepressants were encouraged to switch to sertraline during pregnancy. It is somewhat unclear where this opinion came from — maybe one paper suggesting lower placental passage of sertraline compared to other antidepressants; however, there is and never was any solid data to support the assertion that sertraline is safer or the safest antidepressant. Reflexively switching women to sertraline puts women at risk for recurrent illness.
While sertraline is effective for the treatment of depression and anxiety and is a reasonable choice for many women, one problem with sertraline is that it tends to be under-dosed. The typical starting dose is 50 mg; however, many individuals will need 150 mg to 200 mg to effectively manage their symptoms. Especially when sertraline treatment is initiated in the primary care setting, we often see women whose dose is too low to effectively manage their symptoms.
What About Paxil? Doesn’t It Cause Heart Defects?
The most current data regarding the use of paroxetine (Paxil) during pregnancy does not indicate an association between the use of paroxetine during pregnancy and risk for cardiovascular malformations. However, in 2006, GlaxoSmithKline (GSK) elected to change product label warnings for the antidepressant paroxetine (Paxil), advising against the use of this drug by women who are pregnant. This decision was based on two preliminary studies which suggested a small increase in the risk of cardiovascular malformations among infants exposed to paroxetine in utero. For many years, this concern regarding risk of heart defects resulted in recommendations that women taking paroxetine should either stop paroxetine or to switch to a different antidepressant during pregnancy.
However, in 2008, a study from the Motherisk Program in Toronto reported on the outcomes of over 3000 paroxetine-exposed infants and found no association between the use of paroxetine during pregnancy and increased risk of cardiovascular malformations. Nonetheless, some women and their treaters continue to feel uncomfortable with the use of paroxetine during pregnancy. Furthermore, many websites (including reputable sites like the Mayo Clinic) continue to urge women to avoid paroxetine during pregnancy because of the risk of malformations.
At this point, we typically do not recommend switching from paroxetine to another antidepressant for pregnancy. Although paroxetine is an SSRI, there are definitely situations where an individual may respond better to paroxetine than to other SSRIs. Thus, switching to a different antidepressant may increase risk for relapse.
What About Lexapro? And Pristiq?
There are some newer antidepressants that are derived from older parent antidepressants. For example, citalopram (Celexa) is a racemic mixture, composed of R- and S-enantiomers (or mirror images) of citalopram. While the S-enantiomer is clinically active, the R-enantiomer is not. Escitalopram or Lexapro contains only the active S-enantiomer. Because the S-enantiomer is contained in the original citalopram formulation, we can infer that the reproductive safety of escitalopram (Lexapro) is the same as that of citalopram (Celexa).
Another example is desvenlafaxine or Pristiq. For venlafaxine to be effective as an antidepressant, it must first be metabolized by the body to desvenlafaxine. Pristiq contains only the active metabolite desvenlafaxine. Because desvenlafaxine is a metabolic byproduct of the original venlafaxine formulation, we can infer that the reproductive safety of desvenlafaxine (Pristiq) is the same as that of venlafaxine (Effexor).
The Bottom Line
No two situations are identical; thus, we must carefully consider each woman’s clinical history and preferences in order to select a treatment plan that makes sense. Ideally this discussion should occur long before a woman is pregnant, so that there is ample time to consider the various options and to make changes, if necessary.
When we meet with women to discuss the use of antidepressant medications during pregnancy, we typically consider a number of issues:
The perinatal psychiatry consultation should be viewed as a collaborative venture, where provider and patient decide together what is the best option for treatment during pregnancy."
-Ruta Nonacs, MD PhD
By: Love Amy Michelle | October 28, 2017
"Love Amy Michelle is a space for you to reconnect with yourself + to find some peace amidst the chaos."
Depression During the COVID-19 Lockdown Highlights the Importance of Social Connections for New Moms
By MGH Center for Women's Mental Health | May 18th, 2021
"Because pregnant and postpartum women face unique challenges in the context of the COVID-19 pandemic, they may be at increased risk for mental health problems in this setting. In a recent study, researchers from the University College of London surveyed 162 new mothers in London between May and June 2020 using a social network survey designed to assess the impact of the COVID-19 lockdown.
Almost half (47.5 percent) of women with babies less than six months of age had depressive symptoms suggestive of postpartum depression assessed using the Edinburgh Postnatal Depression Scale. This is a huge increase in the expected prevalence of postpartum depression; studies carried out prior to the pandemic have shown that about 10% to 15% of women report depressive symptoms during the postpartum period.
The researchers also observed that the more contact new mothers had with other people — whether remotely or face-to-face — the less likely they were to report depressive symptoms. While this finding suggests that social isolation incurred as a result of the COVID-19 lockdown may have increased risk for depression, another interpretation is that women with greater social networks are less vulnerable to depression (whether or not there is a lockdown). However you interpret the data, multiple studies have demonstrated that social isolation is a risk factor for depression, in general, and having adequate social support reduces the risk for postpartum depression.
We often encourage new mothers to bolster their support networks and often recommend new moms groups. While this is a reasonable approach to managing the social isolation of new parenthood, many new mothers struggle to get out of the house and are unable to establish new social networks. One of the silver linings of the pandemic has been increased access to support groups on virtual platforms. For example, Postpartum Support International or PSI now offers a wide array of online group meetings for women who are pregnant or postpartum. Whether or not a lockdown is in effect, these social networks are so important to a new mother’s emotional well-being and may potentially decrease risk for psotatum illness."
-Ruta Nonacs, MD PhD