Perinatal Mood Disorders: What they are and how to get help

This article will mostly discuss Postpartum Depression.  Please note that Postpartum Psychosis, while it only impacts approximately 1.5% of all women, is a very serious illness and deserves its own article.  

This morning I went to a great workshop at Healthcare Alternative Systems on Perinatal Mood Disorders and was once again reminded how prevalent, under-treated, and serious Postpartum Depression continues to be.  I thought it might be helpful for our readers to hear what signs and symptoms of Postpartum Depression (PPD) to look for and to post some helpful resources if you think that you or someone you care about may be suffering from PPD.

Prenatal or Antenatal Depression

First off, PPD doesn’t just happen to women who have already given birth.  You can begin to suffer from a Perinatal Mood Disorder when you are still pregnant.  Sometimes this is called Prenatal Depression or Antenatal Depression.  Whatever you want to call it, it is rarely discussed and can be very debilitating, especially when the reaction that most have when you tell them you are pregnant is “You must be so happy!”  Depression during pregnancy can happen particularly if an expectant mom has a history of depression, but it can happen to anyone.  It can also happen at any point during pregnancy.  This is a real illness and should be treated as such.  Depression during pregnancy can have a negative impact on both the mother and the unborn baby. Women who are experience this sort of depression often are at risk for decreased prenatal care, less self-care, decreased nutrition, increased use of alcohol and cigarettes and are often at risk of being a victim of domestic violence.  It can result in low birth weight in the baby and/or preterm labor, pre-eclampsia and irritability in the newborn or colic.  When a mother is stressed during pregnancy, her levels of the hormone cortisol increase due to the body’s response to prolonged depression and/or anxiety.  This results in elevated levels of cortisol in the baby, subsequently leading to elevated cortisol levels throughout the child’s lifespan, predisposing him or her towards life long health consequences such as hypertension, heart disease, anxiety diorders and adrenal burnout.

Postpartum Depression

Postpartum Depression occurs anywhere from two weeks to 12 months following the birth of a baby and affects roughly 10-20% of all women.  Prior to two weeks, many women experience symptoms that look just like PPD (tearfulness, irritability, emotional reactivity), however, they resolve on their own without any outside intervention needed.  This is called the “baby blues” and it happens to roughly 50-80% of all postpartum moms.  It typically peaks at 3-5 days following the baby’s birth and is a result of the drastic hormonal shifts that occur after a baby is born.  PPD, however, does not resolved without outside intervention and is an illness that should be taken seriously just like any medical problem. Due to the fact that so many moms experience it, PPD is the #1 complication of childbirth in the United States.  However, it often goes untreated due to lack of screening and other factors which we will get into later.  PPD can last for months or longer if it isn’t treated.  Click here for a firsthand story of a mother’s experience with PPD.

PPD Causes and Impacts

There is no one factor that causes PPD, but there are some that can predispose a woman to develop it.  It often occurs when women have a history of mood disorders, mental illness, or have experienced PPD with a prior birth, have a family history of mood disorders or mental illness, a history of sever PMS or PDD (Premenstral Dysphoric Disorder), have had a traumatic birth experience, lack of support from partner, other family or friends, poor nutrition, severe lack of sleep, and/or an unplanned or unwanted pregnancy.  When untreated, PPD can lead to poor mother-baby bonding and attachment problems, compromised care of the baby, conflict with one’s partner, and in the worst cases, suicide and/or homicide.  For the baby of a mom with PPD, there can be problems with emotional bonding with others, delays in language development, low activity levels, anxiety and distress, delayed and/or impaired cognitive and motor development, failure to thrive, and in worst case situations, infanticide.

Barriers to treatment

So if this is such a big problem, why do so many women feel as though they have to suffer in silence?  Why are more not seeking treatment?  I think the problem is two fold. Part of the trouble lies with the many providers who come into contact with postpartum women.  Often they are not screening for it.  Sometimes they don’t know how, sometimes they are too busy, sometimes they fear that they won’t know what to do if they find out that a mother has PPD symptoms.  They may be a pediatrician and more focused on the baby, they may be an OB who is doing a follow up postpartum check and is only concerned with the physical outcomes of birth.  The responsibility doesn’t just lie with the physicians though (but they should all be screening, nonetheless).  Anyone who works with postpartum moms can be on the lookout for signs and symptoms.  This could be a lactation consultant, a physical therapist, a yoga instructor, a doula (birth or postpartum), a new moms group facilitator, etc.  The other part of the reason moms are not being treated is because they may not be seeking help.  The reasons for this are vast: denial, shame, misinformation about maternal mental health, the stigma of mental illness, fear that the baby may be taken away, cultural or language barriers, fear of deportation (for non-legal immigrants).  My take home message for anyone who sees postpartum moms:  Pay attention to what that mom is saying or even what she isn’t saying. Is she expressing feelings of frustration, inadequacy, being overwhelmed, helplessness, anxiety, shame, exhaustion (beyond the normal up-at-night with a baby exhaustion), fear of being alone with the baby, feeling as though the baby would be better off with a different mom?  If she is feeling several of these things, there is help for her.

How to help

There are many excellent resources for mom experiencing PPD both in the Chicago area and nationwide.  One of my favorite referral sources is a 24 hour PPD crisis hotline that is run out of Northshore Hospital called The Jennifer Mudd Houghtaling Postpartum Depression Program.  Their number is (866) 364-MOMS.  Moms can call them anomoyously at any time of the day to ask questions and get support from licensed mental health professionals.  They also provide mental health referrals to therapists all over the Chicago area and can find someone who accepts your health insurance.  I often call them myself to find good referrals for moms who contact me looking for a PPD focused therapist.  For other referrals, there is the PPD program at Healthcare Alternative Systems that offers services in both English and Spanish at two locations in the city.  To schedule an appointment with them, please contact Marisol Vega at (773) 292-4242 ext. 32. Healthcare providers with questions related to the diagnosis and treatment of perinatal depression can contact the UIC Perinatal Depression Consultation Service at (800) 573-6121.  You can also contact the Postpartum Depression Alliance of Illinois at (847) 791-7722.  For those not in Illinois, Postpartum Support International is an excellent resource.  If you are unable to physically get out and get help, the internet can be a great source of support as well.  Please check out My Postpartum Voice for supportive articles as well as conversations with other moms who may be suffering as well through their Twitter chat groups.

For better or for worse

For the purposes of this post, most relationships will be characterized as marriages, however, by no means do I believe it is necessary to be married in order to raise a child.  It only takes two people who care about and respect each other and who are dedicated to caring for and loving the baby.  Married or not married, two mommies or two daddies, it makes no difference.

No one ever said marriage was easy.  Having a new baby certainly doesn’t make it any easier.  A very insightful new mom in one of the sessions of The Chicago New Moms Group commented that she doesn’t understand why a couple would decide to have a baby to save a marriage since having a baby can challenge a relationship in ways one may never have previously even imagined.  Shortly after the birth of my first child, my father in law told me, “You aren’t really married until you’ve had a baby.”  Why is this?  Because until this point in time, it is likely that nothing else that you have coped with as a couple has challenged you in quite this way.  I would say the only exception to this would be if you had dealt with a serious illness as a couple.

So your new baby has arrived, a baby who you have hopefully had some fun conceiving (unless this process occurred in a laboratory), now the work begins.  As a mother, your transition to motherhood may not be easy but your identity as a mother begins to consume you the first time you hold your new baby.  For a breastfeeding mother, your presence is intricately tied to your baby’s livelihood and nurishment.  However, often partners struggle to find a role within the family and sometimes this can lead to tension in the relationship.  I frequently hear new moms say that their partners often take a backseat when it comes to child care duties such as feeding, changing, putting the baby to sleep and general comfort measures because the mom just is better at it.  Although this may be true, it is largely due to the fact that she is solely responsible for these duties so much of the time and, well, practice makes perfect, right?  Moms who are at home with their babies during the day, whether it is on maternity leave or because they are staying at home full time, learn to read them better because they spend more time with their babies then fathers if the father has gone back to work. When given as much practice, clearly partners can do just as well, but often moms have a hard time giving up that control (myself included!).  Sometimes it just seems easier to do it yourself rather than show your partner how you do it or, better yet, let him learn for himself.  Even though a partner may not be directly responsible for feeding a baby in the beginning, there are many things he can do to help him connect with his baby.  Dads are often great at comforting babies, they can change diapers, they are often expert swaddlers, getting babies wrapped up snug so that there is no escaping and therefore leading to some longer sleep segments which in turn, helps everyone feel better.  Chances are he is going to have his own way of doing things that are different from you. I know its hard but with all your strength, resist the urge to correct him (unless there is a real safety issue involved) because this can lead to him feeling that his way is always wrong and ultimately, taking a backseat in parenting.  Building his confidence and his skills leads to greater satisfaction in his role as a parent and a greater sense of inclusion in the new family dynamic.  Incidentally, having the positive support of a partner is also one of the strongest predictors for a successful breastfeeding relationship between mom and baby.  All these ways of including your partner and also giving him greater responsibility in his role as a parent are essential to helping your relationship stay strong following your baby’s birth.

The other component to a well functioning relationship that I can’t emphasize enough is communication. This sounds obvious but when everyone is exhausted from being up all night with a baby, the first thing to break down is communication.  We get snappy, we get cranky, we make assumptions about things that we think our partner should know.  For instance, after the first few initially crazy months after your baby is born, he may assume that since you are into more of a routine as a mom, that you are okay with him going back to his original weekend plan of watching football and taking naps.  While you may have spent your whole week counting the minutes until Saturday when he will be there to help you and give you a little parenting respite (maybe you were looking forward to showering before 4pm or even running an errand or two on your own). Unless you directly tell him that you plan on relying on him for some very specific tasks, chances are, he has no clue.  I know, sounds simple but some basic communication can go a long way to keeping your relationship strong as you and your partner begin your new roles together as co parents.

Why do I need a new moms group?

Becoming a new mother is a transition like none other we have ever experienced in our lives.  When you are pregnant you are showered (sometimes literally in the form of a baby shower) with attention.  You visit a doctor or midwife regularly who ask you how you how feel; you are checked to make sure you are eating healthfully and your vitals are monitored- all to ensure that the baby is developing properly inside of you.  Fast forward to Labor Day.  Not the one in early September, the day when you actually begin the labor of parenting by bringing your child into the world.  After the birth of your baby, everything changes. Assuming you, as the mother, are healthy, your birth team’s focus (this applies mostly to birth in a hospital rather than in the comfort of one’s own home) has now shifted to the baby.  Checking all the baby’s vitals, making sure he or she is warm enough, administering various tests and even giving vaccinations if you have given permission.  Often times these activities take the baby away from you at a time when it is most important for you to be together.  And by together, I mean touching, skin to skin. I could go on and on about the importance of skin to skin contact between mother and baby following birth but you can also read about it here.  Despite all the research emphasizing the importance of this special time for mom and baby, it often doesn’t happen.  This can delay the initiation of breastfeeding and essential bonding between mother and baby.  If you are one of the lucky ones, you will be able to get your baby latched on with relative ease or there will be a board certified lactation consultant (not a nurse whose job it is to administer meds, take your blood pressure, etc., who has also been assigned to give you a little breastfeeding assistance, whether she likes it or not) available who can come help you get breastfeeding off to a good start. Sadly, I very often hear stories where none of these things have taken place. Instead, I hear (and these are direct quotes from other new moms), “My baby was separated from me for hours after the birth.”  “He was given formula in the nursery without my permission.”  “The nurse told me that it was my fault I was having trouble breastfeeding.”  All of these situations serve to take power away from you, a new mom.

Following your brief stay in the hospital, where you may or may not have been given the support necessary to make a good start as a confident new mom, you are sent home.  And there you will stay.  More often than not, I hear that new moms go for weeks without leaving the house and when they do, the only trips they do make out are to the pediatrician–someone who is primarily interested in the well-being of the baby and not the mom who is trying her hardest to feed and nurture this new life. Hopefully, if it is breastfeeding you are struggling with, you have found the help you need in the form of a lactation consultant, postpartum doula, a LaLeche meeting or other breastfeeding support group (PLEASE, if you are struggling, check out Breastfeed, Chicago! for many helpful resources).  Even with these supports, new moms remain very isolated within their homes. You have to now figure out how to take care of your baby, feed yourself, maybe take a shower, and function in general–all on very little sleep.  While you are learning all of these things, your baby is trying to figure it all out as well.  He or she has never pooped until just recently so babies make all sorts of funny noises and faces, sometimes appearing to be in pain, as their brand new GI system learns how to process breastmilk or formula. They are not used to sleeping in the manner that we are instructed to put them to sleep–flat on their backs. They often long for the days when they were snuggled in, cozily nestled in their mommy’s warm,dark, noisy uterus. So when you put your baby down for just a second to do some silly thing like, say, brush your teeth, they often react with screams and cries.  This can make even the most chill new mom frazzled.  If you were lucky enough to have your partner around a bit after returning home (or really lucky and he or she works for a company like Google and gets an awesome leave when a child is born), you may have been able to accomplish some of these activities of daily living.  Or maybe you have some helpful family members or friends who have put together a meal train and you have meals coming in regularly, at least for the first little bit.  This can help tremendously.

The Chicago New Moms Group, January 2011 group participants, 6-8 month old reunion

No matter how helpful our relatives or our partners may be, there is no substitute for the support that women receive from other women.  New moms groups provide essential support at a time when you need it most and in ways you never imaged. Meeting others who are experiencing many of the same challenges as you can go a long way towards helping you realize that you are not alone in your struggles. Finding other new moms who share your experience can ease your transition into motherhood tremendously.  You’ll learn that the women you meet in a new moms group will be one of the most valuable resources you posses as a mother.   A professionally facilitated group, such as The Chicago New Moms Group, not only provides you with peer support but also education on a wide variety of topics that new moms are always asking about like sleeping, feeding, returning to work vs. staying at home, your relationship with your partner, baby temperament and developmental milestones.  These groups also get you out of the house.  This has the added benefit of giving you the chance to practice going out with your baby, feeding your baby when you aren’t in the comfort of your home, and learning to be comfortable when your baby cries around others.  Knowing that you will be going to a consistently supportive and nurturing environment when you do venture out can make the process a bit less daunting.  All of these factors together help to reduce the isolation that often can lead to postpartum depression or a general sense of feeling overwhelmed by all the challenges that come with becoming a parent.  You don’t have to do it alone- join a new moms group.

Sleep, glorious sleep

I love to sleep.  When I don’t get enough sleep, I am a very cranky and grouchy person, and I recommend staying far, far away from me.  I can honestly say that before my first child was born, I really did not know that newborn babies do not sleep through the night.  I remember going to visit my first friend to have a baby about 10 years ago a week or so after her first child was born. At the time I remember feeling stressed out from graduate school, as though nothing could be more work or more exhausting than some studying and paper writing.  I have this fuzzy memory of my friend running around, doing lots of laundry, looking haggard and worn out, and I didn’t really understanding why she seemed so wiped (please see the last post What No One Tells You, under the section The Myth of the Sleeping Baby).  Four years later when my daughter was born, it all began to make sense:  the dark circles under her eyes, her inability to complete a thought, the memory loss.  Sleep deprivation.  It’s linked to decreased immune system function, poor appetite and strains on your mental health.  It can make everything seem more overwhelming than it already is.  Don’t forget, it is used as a method of torture.

In many circles, discussions of children’s sleep, and specifically how to get them to sleep, can be extremely polarizing. Often parents either fall on the “Cry It Out”/Ferber/sleep training side or the attachment parenting/cosleeping/anti sleep training side.  When we discuss the subject of infant sleep in The Chicago New Moms Group, I am very up front about the fact that I have a very clear philosophy when it comes to infant sleep.  I believe that learning how to sleep through the night and soothe oneself is a learned skill.  It is a skill that many children have to be taught in order to sleep a solid 11-12 hours without needing external soothing (from their parents).  It is a skill that they will use for their entire lives and therefore, one that, I feel,is extremely valuable to have.  We all know children and adults alike who have poor sleep hygiene.  They have a hard time falling asleep, they are up multiple times in the middle of the night, they have difficulty putting themselves back to sleep.  Although I don’t like to choose sides, when forced to, I guess I would fall on the side of Ferber and his methods.  I prefer not to think of it as the “Cry It Out” method because that puts too much emphasis on crying and not enough on the actual skill that is being learned:  self soothing.  I know there are many parents and experts feel strongly that the only way to help your children become securely attached is to share your bed with them and let them nap on you in a carrier.  I say, if this works for you, Great!  Go with it.  But what about all those exhausted parents out there who have tried this and found it not to work for them?  Sometimes parents can’t get a good night’s sleep with their child/ren in the bed with them and sometimes their child/ren are not getting a good night’s sleep there either.  These families are often left feeling like bad parents for even considering a method that involves any amount of crying and “abandonment.” What’s more is that there are no clear guidelines on this topic from a pediatric/medical standpoint.  When asked about sleep training, pediatricians’ responses as to when is a good time to sleep train a baby often range from 3 months of age to never.

With all the conflicting information, it is no wonder that parents are left feeling confused, overwhelmed and most importantly, exhausted.  I am not going to present the details of one side vs. the other or argue why my way is better.  I am just going to share with you what I have learned through my experiences working with new parents and also the veterans who are looking to make a change in their sleep plans based on where things went awry with their older child.  If you are looking to read studies on this topic, you can read an interesting review of the literature here.

These are my findings:

  • The earlier you teach your baby how to soothe him/herself to sleep, the easier it will be and the less time it will take, therefore, leading to less crying in the long run.
  • Babies, whether breastfed or formula fed, are capable of sleeping through the night (meaning 11-12 hours) typically starting as early as 4 months of age (depending on various weight and developmental factors).  They do not require solid food in order to be able to accomplish this skill.
  • Consistency is the key to success.
  • The “family bed” does not work for all families.
  • You know what is best for your baby, not your pediatrician or any number of sleep books.
  • It is important to have a plan that all adults involved can stick to and fall back on when you are sleep training your child.
  • A lovey/blankie/security object is a wonderful thing!  Please see The Power of the Blankie for more information on this.
  • It is very difficult for a breastfeeding mother to be directly involved in the sleep training process of her baby due to the fact that the baby will want to eat when the mom walks in the room.  The non-nursing partner, another family member or helpful friend should ideally be available to help, at least initially.
  • Children who are sleep trained cry less in general because they are well rested and therefore are less overtired and cranky.
  • The parents of a child who has learned how to self-soothe feel less stressed out due the fact that the burden of coaxing their child to sleep has been removed from them.  These children have learned how to put themselves to sleep after a comforting and familiar routine is consistently implemented.  The parents, in turn, are also well rested, happier and better able to function as parents when given time to recharge and take care of themselves.
  • Children who are sleep trained and taught to sleep on their own are happy and securely attached children due to the fact that their parents provide them with love and affection during their waking hours.

Still feeling exhausted and uncertain of what to do about it?  Do you need help?  Visit the Sleep Tight Consultants.

What no one tells you…

This post is dedicated to my good friend Melissa Dichter who is a first time mom, awesome friend, and all around incredible woman.  She is the new mom of an adorable 6 week old little boy and is really “in it,” and has been so helpful in relaying some of her thoughts on this challenging time because I too have a bit of Postpartum Amnesia (don’t worry, you’ll learn more about this as you read).  Thank you Melissa, for your valuable insights!

I sometimes think that the realities of the postpartum period (which I like to think of as the first year after you have your baby, not just the first 3 months) are one of the best kept secrets of parenthood.  I speak to new moms all the time who say that no one ever REALLY told them it was going to be like after they had a baby. What follows are some of the reason why being a new parent is so hard and why we are often unprepared for this abrupt change in your lifestyle.

The myth of the sleeping baby

Many people are under the impression that newborns sleep all the time because that is how they are seen out and about: asleep in the car seat/stroller, asleep in a carrier on their mom or dad.  Those of us who have survived this stage know that the reason for this is partly because the motion of the stroller or the coziness of the carrier is what is keeping the baby asleep and the other reason is because no one wants to take their screaming newborn out in public.  Much of the fussiness and crying takes place in our homes.  What ends up happening is that the myth of the sleeping baby is perpetuated and so new moms everywhere are blind-sided by the fact that newborns cry and they often cry a lot.  Babies cry.  This is normal but it can be difficult to get used to.  Also, babies do sleep but not the often in the ways we want them to.  It’s rare when I come across a new mom who tells me that her newborn always sleeps in his/her crib.  More often I hear that their baby only sleeps in the swing or the car seat or on them.  They are often thinking about the big “transition” to the crib.  I feel that there is nothing wrong with a baby, especially one that is in that 4th trimester when all they want is to be snuggled-in and cozy, to sleep wherever it is that they actually can stay asleep.  But that is probably just because I have survived this stage and am not longer in it.

We’ll get you through the birth but then you’re on your own

These days, there are many assorted professionals that help you give birth to your baby.  From the very beginning, if you are having fertility issues, you may even have a doctor that helps you get pregnant.  Then your doctor or midwife follows you throughout your prenatal care, checking in with you, asking how you are doing, how you are feeling.  Everyone is very focused on your physical and emotional well-being.  We spend much of our time and energy when we are pregnant concentrating on whatever discomforts we might have.  When you are pregnant with your first child, your time is your own so you can get yourself that prenatal massage or spend hours surfing pregnancy websites to figure out how to manage your indigestion and nausea.  You can take childbirth education classes to help you prepare for the birth of your child and even newborn care and breastfeeding classes to at least make you feel prepared for your baby’s arrival.  You can hire a doula to help you attain the birth experience you are hoping for. However, once your baby arrives, there is a dramatic shift from all that focus on the mom to the baby.  Now life revolves around meeting baby’s needs for comfort, nutrition, changing, sleeping… Now as the mom of a newborn, you grab quick opportunities to eat whatever’s handy (no cooking as you don’t know when your baby will summon you next), you wear the same spit-up stained pants from yesterday (you haven’t had a chance to shower anyway), and you have learned to pee and brush your teeth within the two minutes in which your baby will peacefully sit in the bouncy chair in the bathroom.  And sleep… what’s that?  Not to mention the fact that all those doctor’s visits that were focused on you with your OB or midwife are now focused on your baby at the pediatrician, a physician trained to be looking for all sorts of red flags with your child’s health but rarely looking at how the mother may be coping.  It’s no wonder that the postpartum depression rates are so high.  And let’s not forget about our own parents who are now so enamored with their new grandchild that they rarely even give you a “Hello” when they walk in the door.  It’s just straight to the baby, who you have probably just gotten to sleep.

Why no one tells you about this

I think there are a lot of reasons that no one tells you how hard it will really be or if they tell you, it doesn’t necessarily resonate that it will be that hard for you.

  1. Many parents who have survived the first year have amnesia.  Let’s face it.  If we remembered exactly how hard it really was, we might never have any more children.  I should lobby the American Psychiatric Association to add Postpartum Amnesia to the DSM IV as a real diagnosis.
  2. When you are in your state of pregnancy bliss, so to speak, is it really possible to hear that what comes next could be anything less than joyful?  Come on, you wanted this and this is going to be the greatest thing you ever did, right? And it will be, eventually.  But at first it is hard.  It is okay to ignore the pressure to be in love with your baby the instant he or she is born.  Many of us have the expectation of a “love at first sight” experience with this baby that we have just spent the last 9 months carrying and sustaining.  The fact is, however, that our newborn requires a lot of giving.  Giving of food, energy, sleep, etc.  Initially, in return, you don’t get very much back other than you will see your baby growing but this, in and of itself, doesn’t really provide instant gratification.  This will finally come when you baby begins to smile but this doesn’t happen until when you have worked nonstop for 6-8 weeks.  Years ago when my daughter was about 8 weeks old and I was on maternity leave, I went to visit my coworkers.  I ran into a doctor that I worked with and he asked how I was doing.  I told him that things were getting a bit better now that she was smiling.  His response was, “Yeah, right when you are about ready to drop kick them, they start to smile.”  So true.
  3. Whether you are a business executive running a Fortune 500 company or you work in retail, especially if you have waited a while to have children, you probably feel that, by this point in your life, you are fairly competent at what you do.  You have a pretty good grip on managing your day-to-day activities.  It can be hard to believe that one small baby can throw you for such a loop.  I always refer to having a first baby as “The Great Equalizer.”  No matter who you are, how many friends of yours have already had babies, or what skills you posses, having a first baby is very likely to be different from your preconceived expectation and will try you in ways your never knew were possible.  Still, when you are pregnant, it is sometimes hard to believe that this is what it will be like for you, someone who is generally an on the ball, functional, showered (ha!) individual.


The transition to motherhood

They say that change is inevitable.  But let’s face it, change is hard. Change is uncomfortable because it often leaves us in unfamiliar territory and with a feeling of not knowing what we are doing.  This is an understatement when it comes to having your first baby.  The transition to motherhood, and I’ll argue fatherhood too,  is something that (and I think most would agree) you can’t really understand until you have experienced it for yourself.  Sure you can go to childbirth classes, you can take a class on newborn care and even one on breastfeeding.  All of these things you think will prepare you for the task of becoming a parent but in reality, its mostly just trial and error or really trial by fire.  You go from one minute being this glowing pregnant woman whom people shower attention over, to a mother who is often overlooked in favor of her small child. It’s a sharp contrast.  Many women with whom I have spoken, myself included, say that even minutes after giving birth, you can no longer remember the feeling of having that small life inside of you.  Aside from having an extra 30 or so pounds to lose, it’s as though it never happened. Except for the fact that you are now responsible for taking care of this new life.

This is great, right?  This is what you wanted (assuming you became pregnant through planning and choice).  Immediately following the birth of your baby, there is an unbelievable sense of euphoria.  It’s all you can do to keep from staring at this person you have waited so long to meet.  Even though you really should take this time when you are in the hospital with a fully staffed nursery to get some sleep, closing your eyes and shutting down your brain is nearly impossible. It really is hard to conceptualize that one minute this small person was inside you and now he or she is out and here to stay.  I think this sense of disbelief continued for several months after the birth of my first child.  My husband and I would look at her and then at each other and ask, “where did she come from?” Because even though you have been planning this for the last 9 months (or maybe longer if you have been dreaming of having a baby for quite some time), when it actually happens, its kind of hard to wrap your brain around.

It’s a HUGE adjustment.  Every day things that we once took for granted such as sleeping, showering, going to the bathroom, making a meal, grocery shopping, the list goes on…now have to be prioritized. Let’s see..I have a couple of minutes until he wakes up and I will be spending the next hour or more feeding, changing, and soothing him. I now need to choose from one of those activities of daily living that I want to try to accomplish.  Good luck.  The simple task of leaving the house can seem overwhelming and sometimes impossible.

Some of the highly productive and professional moms who participated in one of my new moms groups said that they had all sorts of lists of things they figured they would be able to accomplish while on maternity leave.  They all thought, “with three months off of work and only one small baby to take care of, think of how much I can get done.” Needless to say, they were all amazed at how little of that list was crossed off at the end of three months.

All of this is to say while the actual act of becoming a mother happens the minute you give birth, the process of becoming a mom, learning all there is to know about your baby, figuring out what kind of parent you want to be and how to achieve a balance between your role as a mother and your own identity, takes time.  It also takes help.  You do not have to navigate this transition alone.  All too often, I find that new moms go “radio-silent” following the birth of a baby.  Please ask for help.  Whether it is from your own mother, a sister, a hired babysitter, a postpartum doula (which is an excellent support but that is a conversation for another time), or a friend. And once you have mastered the task of leaving the house with your newborn, finding other new moms who share your experience can ease this transition tremendously.  These may be women you meet at the park, at a mom and baby fitness class, at an organized new moms group or even just moms you start chatting with walking down the street with their strollers. You’ll find these women will be one of the most valuable resources you posses as a mother.