What to expect when you're expecting (183 page)

Turn up the heat. A heating pad can spell relief from back pain and muscle aches. Apply it often, especially during those marathon feeding sessions.

As your body adjusts to pumping baby, you’ll probably find that pain in your back (and arms, and hips, and neck) diminishing, and you may even find yourself sporting some brand-new triceps. In the meantime, here’s something else that might help ease your aches by easing your load: Empty that diaper bag. Lug around only what you absolutely need, which is plenty heavy anyway.

“I was sure I’d be thrilled once my baby was born. But I’m feeling down instead. What’s going on?”

It’s the best of times; it’s the worst of times. And it’s how an estimated 60 to 80 percent of new moms feel after childbirth. So-called baby blues appear (appropriately) out of the blue—usually three to five days after delivery, but sometimes a little earlier or a little later—bringing on unexpected sadness and irritability, bouts of crying, restlessness, and anxiety. Unexpected because—well, for one thing, isn’t having a baby supposed to make you happy, not miserable?

It’s actually easy to understand why you’re feeling this way if you step back for a moment and take an objective look at what’s been going on in your life, your body, and your psyche: rapid changes in hormone levels (which drop precipitously after childbirth); a draining delivery, followed by an exhausting homecoming, and all compounded by the round-the-clock demands of newborn care; sleep deprivation; possible feelings of letdown (you were expecting motherhood to come naturally—it hasn’t; you were expecting cute and round—you got puffy and cone-headed); breastfeeding stumbling blocks (sore nipples, painful engorgement); unhappiness over your looks (the bags under your eyes, the pooch around your belly, the fact that there are more dimples on your thighs than on your baby’s); and stress in your relationship with your partner (what relationship?). With such an overwhelming laundry list of challenges to confront (and don’t even get you started on the laundry that’s on that list), it’s no wonder you’re feeling down.

The baby blues will likely fade over the next couple of weeks as you adjust to your new life and start getting a little more rest—or, more realistically, begin functioning more effectively on less rest. In the meantime, try the following tips to help lift yourself out of that postpartum slump:

Lower the bar.
Feeling overwhelmed and inadequate in your role as a newbie mom? It may help to remember that you won’t be for long. After just a few weeks on the job, you’re likely to feel much more comfortable in those maternal shoes. In the meantime, lower your expectations for yourself—and for your baby. Then lower them some more. Make this your mantra, even after you’ve become a parenting pro: There’s no such thing as a perfect parent, or a perfect baby. Expecting too much means you’ll be letting yourself down—and bringing your mood down, too. Instead, just do the best you can (which at this point may not be as well as you’d like, but that’s okay).

Don’t go it alone.
Nothing is more depressing than being left alone with a crying newborn, that mountain of spit-up-stained laundry, a leaning tower of dirty dishes, and the promise (make that guarantee) of another sleep-deprived night ahead. So ask for help—from your spouse, your mother, your sister, your friends, a doula, or a cleaning service.

Get dressed.
Sounds trite, but it’s surprisingly true. Spending a little time making yourself look good will actually help you feel good. So hit the shower and maybe even the blow-dryer before your spouse hits the commuter train, trade in the stained sweats for a clean pair, and consider applying a little makeup (and a lot of concealer).

Get out of the house.
It’s amazing what a change of scenery can do for your state of mind—especially when the scenery suddenly doesn’t include that pile of unopened mail (and unpaid bills). Try to get out of the house at least once a day: Take your baby for a walk in the park, visit with friends (and, if your friends are also moms, you can swap sob stories—and then laugh about them), stroll the mall. Anything that will keep you from hosting another self-pity party.

Treat yourself.
Try a movie, a dinner date with your spouse, a 30-minute manicure (someone’s bound to agree to watch the baby for that long), or even a long shower. Occasionally, make yourself a priority. You deserve it.

Get moving.
Exercise boosts those feel-good endorphins, giving you an all- natural (and surprisingly lasting) high. So join a postpartum exercise class (preferably one that includes babies in the fun or at a club that offers child care), work out to an exercise DVD, step out for some stroller exercise (exercises that tone with the help of a stroller full of baby), or just simply step out for a walk.

Be a happy snacker.
Too often, new moms are too busy filling their babies’ tummies to worry about filling their own. A mistake—low blood sugar sends not only energy levels plummeting but moods, too. To keep yourself on a more even keel, physically and emotionally, stash sustaining, easy-to-munch snacks within quick reach. Tempted to reach for a chocolate bar instead? Reach away—especially if chocolate really makes you happy—just not too often, because sugar-induced blood sugar highs have a way of crashing quickly.

Cry—and laugh.
If you need a good cry, go for it. But when you’re done, turn on a silly sitcom and laugh. Laugh, too, at all the mishaps you’re likely having (instead of crying over them)—you know, the diaper blowout, the breasts that leaked in line at the market, the spit-up that spewed only after you realized you left home without wipes. You know what they say: Laughter is the best medicine. Plus, a good sense of humor is a parent’s best friend.

Still blue, no matter what you do? Keep on reminding yourself that you’ll outgrow the baby blues within a week or two—most moms do—and you’ll be enjoying the best of times, most of the time, in no time.

If feelings of depression persist (lasting more than two weeks) or worsen, and start interfering with your functioning, call your practitioner right away and see the next column.

“I feel amazing and have since the moment I delivered three weeks ago. Is all this good feeling building up to one amazing case of letdown?”

Baby blues are common, but they’re by no means on every newly delivered mom’s to-do list. In fact, there’s no reason to believe you’re in for an emotional crash just because you’ve been feeling upbeat. Since baby blues usually occur within the first or second postpartum week, it’s pretty safe to assume you’ve escaped them.

The fact that you’re not feeling down, however, doesn’t necessarily mean that everybody in your house has escaped the blues. Studies show that while new fathers (who, believe it or not, also go through hormonal changes postpartum) are unlikely to be depressed when their wives are, their risk of falling into a postpartum slump increases dramatically when the new mother is feeling great. So be sure your spouse isn’t down with the baby blues; some new dads try to hide such feelings to avoid dumping on their spouses.

“My baby is over a month old, and I still can’t stop feeling depressed. Shouldn’t I be feeling better by now?”

When the blues just won’t fade, chances are postpartum depression is the reason why. Though “baby blues” and “postpartum depression” are often used interchangeably, they’re actually two very different conditions. True postpartum depression (PPD) is less common (affecting about 15 percent of women) and much more enduring (lasting anywhere from a few weeks to a year or more). It may begin at delivery, but more often not until a month or two later. Sometimes PPD is late onset; it doesn’t start until a woman gets her first postpartum period or until she weans her nursing baby (possibly because of fluctuating hormones). More susceptible to PPD are women who have had it before, have a personal or family history of depression or severe PMS, spent a lot of time feeling down during pregnancy, had a complicated pregnancy or delivery, or have a sick baby.

The symptoms of PPD are similar to those of baby blues, though much more pronounced. They include crying and irritability; sleep problems (not being able to sleep or wanting to sleep the day away); eating problems (having no appetite or an excessive one); persistent feelings of sadness, hopelessness, and helplessness; an inability (or lack of desire) to take care of yourself or your newborn; social withdrawal; excessive worry; aversion to your newborn; feeling all alone; and memory loss.

Getting Help for Postpartum Depression

No new mother should have to suffer from postpartum depression (PPD). Sadly, too many do, either because they believe it’s normal and inevitable after delivery (it isn’t) or because they’re ashamed to ask for help (they shouldn’t be).

Public education campaigns are under way to spread the word about PPD, to make sure that a woman who needs help gets it as quickly as she can—so she can start enjoying her new baby as soon as possible. Hospitals are, or will be, required to send new mothers home with educational materials about PPD, so that they (and their spouses) will be more likely to spot the symptoms early and seek treatment. Practitioners are becoming better educated, too—learning how to look for risk factors during pregnancy that might predispose a woman to PPD, to screen routinely for the illness postpartum, and to treat it quickly, safely, and successfully. Several standardized tests (Edinburgh Postnatal Depression Scale and Cheryl Beck’s Postpartum Depression Screening Scale) are effective in screening for PPD.

PPD is one of the most treatable forms of depression. So if it strikes you, don’t suffer with it any longer than you have to. Speak up—and get the help you need now. For more help, contact Postpartum Support International, (800) 944-4PPD (4773);
postpartum.net
.

If you haven’t already tried the tips for fading the baby blues (see
page 456
), do try them now. Some of them may be helpful in easing postpartum depression, too. But if your symptoms have persisted for more than two weeks without any noticeable improvement or if you’re having more serious symptoms for more than a few days, chances are your PPD won’t go away without professional attention. Don’t wait to see if it does. First, call your practitioner and be up-front about how you’re feeling. He or she may run a thyroid test; because irregularities in thyroid hormone levels can lead to emotional instability, this is often one of the first steps taken when evaluating postpartum depression (see next page). If your thyroid levels check out normally, ask for a referral to a therapist who has a clinical background in the treatment of postpartum depression and make an appointment promptly. Antidepressants (several are safe even if you’re breastfeeding), combined with counseling, can help you feel better fast. Some physicians prescribe low doses of antidepressants during the last trimester of pregnancy to women with a history of depression; others recommend that women who are at high risk take antidepressants right after delivery to prevent postpartum depression. Bright light therapy may also bring relief from the symptoms of PPD. (In light therapy, you sit with your eyes open in front of a box that emits a type of light that mimics daylight, causing a positive biochemical change in your brain that can cheer you up.) Whichever treatment (or combination of treatments) you and your therapist decide is right for you, keep in mind that swift intervention is critical. Without it, depression can prevent you from bonding with, caring for, and enjoying your baby. It can also have a devastating effect on the other relationships in your life (with your spouse, with other children), as well as on your own health and well-being.

Thyroiditis Got You Down?

Nearly all new mothers feel run-down and tired. Most have trouble losing weight. Many suffer from some degree of depression and a certain amount of hair loss. It may not be a pretty picture, but for the majority of moms, it’s a completely normal one in the postpartum period—and one that gradually begins to look better as the weeks pass. For the estimated 5 to 9 percent of women who suffer from postpartum thyroiditis (PPT), however, this picture may not improve with time. And, because the symptoms of PPT are so similar to those weathered by all new mothers, the condition may go undiagnosed and untreated.

PPT may start anywhere from one to three months after delivery with a brief episode of hyperthyroidism (too much thyroid hormone). This period of excess thyroid hormone circulating in the bloodstream may last a few weeks or longer. During this hyperthyroid period, a woman may be tired, irritable, and nervous; feel very warm; and experience increased sweating and insomnia—all of which are common in the immediate postpartum period anyway, making an easy diagnosis more elusive. Treatment isn’t usually needed for this phase.