How to Screen Yourself for Postpartum Depression

May is Mental Health Month. As childbirth education advocates, Lamaze believes that mental health during and after pregnancy is critical to the health and safety of moms and their babies. If you are experiencing depression, anxiety, psychosis, or any other mental health issues, contact your care provider and seek support and resources from Postpartum Progress and Postpartum Support International. You don’t have to suffer alone — and you don’t have to suffer. There is support and treatment available for mental health disorders. Also know that you are not alone — it has been found that 1 in 7 women will experience postpartum depression, though that rate is thought to be higher for all postpartum disorders.

So how do you know if you are experiencing a postpartum disorder? Many moms downplay or dismiss their feelings, chalking them up to “hormones,” but it’s important to take notice and check in with yourself. A postpartum disorder is more than just a “bad day,” and even if you feel as though you are coping, a postpartum disorder ultimately affects your quality of life. If you feel as though something is “off” or if your partner expresses concern about your state of well-being, you can take a free, quick, confidential, online screening quiz to determine whether you may be suffering from postpartum depression.

The Edinburgh Postnatal Depression Scale (EDPS) was developed in 1987 to help doctors determine whether a mother may be suffering from postpartum depression. The scale has since been validated, and evidence from a number of research studies has confirmed the tool to be both reliable and sensitive in detecting depression. The EPDS Score is designed to assist — not replace — clinical judgment. If you feel you may be at risk or suffering from post natal depression, please share the results with your care provider.

A Mother’s Essay: “I ‘Have it All’… Just Not All at Once”

By Jennifer Marshall

There has been a lot of talk on the interwebs lately about women and work and family and can we really “have it all?” Some argue yes, we definitely can. Others argue, well sure, if you have unlimited income then, yes, you can. But I think it’s safe to say that it’s definitely not the reality for most working Americans.

For me, it’s all about bursts of “having it all.” You know, those days when you finally get the kids tucked into bed at 8pm and you sit down and realize: “Wow. Today was really awesome.” I know — doesn’t happen all that often, but when it does, I like to savor every drop of it.

Those are the days when the kids are happy and smiling when they hop out of bed for breakfast. When they play together so sweetly as I buzz about the kitchen making them french toast because it’s what they said they were craving. My coffee is perfect and I sip it as I cook. Everyone loves their breakfast and eats it all up without any spills and I even have a conversation with my little ones as they tell me excitedly about what they’re going to do at school that day.

The morning routine continues to go smoothly as I dress my younger one and the older one practically dresses himself after I lay out some clothes. Teeth are brushed, shoes and jackets put on without having to ask ten times, and bookbags are ready so that we make it to school with three minutes to spare. My big kid remarks on the drive to school, “Today was a good morning, Mommy.” And I drive on with a smile.

Back at home, I dive into cleaning up the breakfast dishes and marvel at how it only takes fifteen minutes when there aren’t little ones underfoot. I settle in to get some work done and have a leisurely lunch, actually tasting each bite, before picking up the kids. Their shining smiling faces are so full of joy when I arrive to pick them up. It’s been a good break, but I am ready to have them back again, to hear all about their adventures at school. The afternoon sails by with a nap for baby girl and quiet time for big brother while I finish up where I left off with my work.

We play some board games together and read a few books before I realized it’s already time to make dinner. My husband arrives home around 6pm, and the kids are sitting at the table in the kitchen eating their meals because they were so hungry from all the play that they couldn’t wait for Daddy. I wrap my arms around him for a cozy “welcome home” hug and the kids both smile at our little display of affection. As he goes upstairs to change out of his work clothes into something more comfortable, I think to myself, “How did I get so lucky?”

Now, don’t get me wrong, there are plenty of days when I am counting the seconds until bedtime because it’s been such a rough and draining day. Those are the days when I feel like a terrible mother because I forgot my patience and yelled at the kids too much or because work was so busy that I barely had time to play with them let alone feed them a proper meal. But when the days come where I have juggled everything with ease and I look around me and am in complete awe at all that I have, I am filled with an immense gratitude for life and motherhood.

Makes me want to push my luck and just go for one more. But that’s another post altogether.

Finding a balance has been a lifesaver for me. I enjoy my first career and appreciate the flexibility I have in working from home. For me, trying to “have it all” – all at once – is way too stressful. It makes life miserable for me and my family which is not fair for anyone, myself included. Instead, I have come to terms with the reality that it is better to go with the flow of life than to try to arrange all the responsibilities of work and family into a perfect package. If I work on a contract for 9 months and then want to take five or six months off to give my family my complete and undivided attention, then I’m going to work hard at our family budget in order to make that happen. It’s worth it in the end and the balance it provides our family with gives me sanity.

Balance is the key for me in life and work and I am very thankful for being able to “have it all” even if I don’t always have it all at once.

Jennifer is a 34-year old wife and mother of two young children. Over seven years ago she suffered her first manic episode. Several months and many doctor’s appointments later, she was finally diagnosed as having Bipolar Disorder – Type I. Jennifer’s blog, www.bipolarmomlife.com, documents her progress, and keeps her accountable and healthy for her family. She is currently blogging for WhatToExpect.com’s Word of Mom community and is also working on a memoir. Along the way, she hopes to help fight stigma and inspire other people who are struggling with the same feelings, fears, and insecurities that she was at one point. There is a light at the end of the tunnel. You just need to keep fighting hard to get there. You can email Jennifer at bipolarmomlife@gmail.com.

Last Firsts – An Essay in Motherhood

The following is written by our former Great Expectations columnist and regular contributor, Meagan Church. 

Seven years ago, I was newly pregnant and, honestly, a bit freaked out. Matt and I had been married for seven years and we knew we wanted kids. I just wasn’t sure I wanted to be a mom. You see, I liked my life as it was. I liked my job, I liked my freedom, I liked being in control, plus I wasn’t much of a baby person. I knew having kids would change things and I wasn’t sure I wanted to make those changes.

Fast-forward seven years. Last week we celebrated Adelyn’s first birthday. Addie, our third (and last) baby, is technically not a baby anymore. And that makes me sad. For the past few weeks, I’ve found myself paying more attention to the last moments of Addie’s baby stage. I have been taking more joy in her giggles, rocking her for a few extra minutes and just taking the time to recognize that these moments won’t last forever, and much to my surprise, that saddens me a bit.

With our first two, I often found myself wishing away the early months and years. What got me through the first few months of our colicky first child was setting mini-goals. Okay, if we make it to six weeks, things will get better. Okay, now we just need to make it to three months. Okay, now six months…. The adjustment to motherhood was a tough one and my high-needs baby didn’t make it any easier for me.

When baby number two came along, I was still worn out from the first one. I once again spent most of that first year hoping to speed through it, so we could get back to “normal” life. Then we had our last baby. Suddenly I began to enjoy the baby stage and not wish it away quite so quickly.

Don’t get me wrong; there have been moments along the way that I’ve wanted to speed through. For instance, I very clearly remember that in those last moments of labor before she was born, the mantra that got me through it was, “Just push her out and you will never have to go through labor again. It will all be over. Just push. Just push.” There were also fussy breastfeeding sessions that made me long for toddlerhood when she would be weaned.

Yet overall, I have been enjoying her babyhood more than with the first two. I’m sure some of that has to do with the fact that I have a few years of experience under my belt. But I think a greater part is that I realize this stage of life we are in is about to change and we will never return to it. With every milestone Addie reaches (signing, crawling, talking, walking), I can’t help but think these are our last firsts. This is the last time one of our kids will reach this milestone for the first time…just when I felt like I was actually getting the hang of things.

I know they must grow up and that things will continue to change. But for just a few minutes longer, I want to hold on to my baby and rock her and sing to her and kiss her full cheeks. Seven years ago, I had no idea that I’d ever want those things so strongly. Seven years ago, I was afraid of how motherhood would change me. Yet, seven years later, I realize how blessed I am to get to experience it, and to grow and learn right alongside my kids. Who knew these last firsts would happen so quickly?

Finding Renewed Trust & Confidence: A Birth Story

I am a childhood abuse survivor and so I didn’t have confidence or trust in my body. That lack of confidence was reinforced when my first birth, a planned natural birth, resulted in a painful and highly medicated induction. I suffered post-partum depression for over a year after the birth. But I am blessed because though I was defeated in spirit, I had great support. When I told my husband, Rob, that I was changing my care to a group of Certified Nurse Midwives who deliver at a local hospital he stood behind me. We did not know it at the time, but the choice to change my provider became one of the pivotal moments in my recovery as a survivor, and monumentally improved my joy in mothering and my marriage.

 

When I discovered I was pregnant again, I fearfully avoided my first prenatal appointment for 12 weeks. My previous doctor wasn’t nurturing. When he checked me he did it in such a way that I was left feeling violated. No “cold touch.” No “gentle pressure.” No bed-side manner. He just walked in, “I’m going to check your cervix.” Check. “Everything looks normal.” It wasn’t his intention to make me feel bad, but when you’re an abuse survivor it’s not unlike being abused again. My midwives gave me care which chipped away at my fears. They talked with me about my feelings about my past birth and my future hopes and concerns, not just my medical history. They treated my whole person. I was more than a body which happened to be wrapped around a baby. Our first appointment lasted over an hour. I felt safe in their care. But I still didn’t feel confident in my self.

 

My due date came and went– nine days, ten days, eleven, twelve– I feared I was unable to go into labor. My midwives gave me the best standard of care and monitored my baby’s health. They trusted my body to go into labor eventually and encouraged me to be patient. On the evening of my thirteenth day post-due my contractions finally started, 15 minutes apart, and I tried to prepare myself to welcome my baby to the world.

 

I called Rob from work, and I drove my daughter to my in-laws’ home and called the midwife. She told me to hang out at  home until I felt I needed more support or contractions were coming very close together. Bedtime came, and Rob put our daughter to bed. I labored quietly in the living room while my husband’s family went to sleep. Everything was normal, peaceful.

 

In the back of my head I feared things progressing, feared going to the hospital and what would happen to me once I got there. Would my body do its work? Would I have spent 7 hours in labor just to be dilated to 2 cm when we finally arrived? As night turned into early morning we decided to make the trip to the hospital. My fears escalated as we arrived. I was defensive towards the nurses and Rob, nervous my labor would stall.

 

When my midwife arrived, she brought her calming presence with her. Within thirty minutes she had the lights turned down, and every unnecessary person removed from the room. She gave Rob instructions on how to rub my back. The three of us fell into a rhythm. Rocking, massaging, humming, moaning… finally I relaxed. Finally I felt like things were the way they should be. I joked between contractions. I was actually enjoying being in labor!

 

Suddenly, I felt the urge to vomit and my contractions started bashing on top each other. I had been lying on my side in bed and I called out for help. While I lay shaking and panting in the bed, my midwife and nurse filled the labor tub with warm water. I climbed in as soon as I could. Laboring wasn’t fun anymore, it was harder work and I had to focus, but I was still calm and relaxed. My midwife leaned against the side of the tub and talked me through contractions, Rob poured warm water down my back with each one and I focused on the sensation of water going down. It was just an hour until I began feeling the urge to push.

 

I don’t know if it’s because of my past abuse, or if it’s common to become fearful during the pushing phase of labor, but I suddenly became panicked. I was thrashing around the tub crying, “Help me!” splashing everywhere. I tried to get up and leave. I was holding back against the pushes, trying to escape my own urges. I will be forever thankful for what came next. My midwife grabbed my arms and looked right into my eyes saying, “Hold it together. Your body is strong, and you can do this. You need to hold it together and your baby will be here.” I started to sob in her arms, “I need to you help me. Help me please.” My heart was breaking because I was so afraid of what I would think of myself if I couldn’t push my baby out on my own. “Moan low. And push into the pain. Push your baby through the pain.” Ten minutes later my beautiful daughter was born into the water and placed on my chest. I rested there with her, relief and joy in my heart. She barely even cried, she just nestled in to me. Rob beamed with pride. We had overcome the obstacles and done it.

 

The next morning the second midwife from the practice came to visit me to see how my birth had gone. I told her how it had been so peaceful except the end. But I had managed to keep it together and go naturally. Besides my pride in my accomplishment, her words built me up: “You are powerful. You birthed a baby. You can do anything.” That was truth.

 

I took that confidence and power home with me from the hospital. Unlike after my first birth, I suffered no post-partum depression. I started to trust my instincts more. I began to be more open-hearted to Rob and my daughters. I don’t want to pretend that one event changed my whole life, but in some ways it did. My natural birth experience was the first time someone other than my husband trusted and respected my body. I was expected to be powerful, and I was! My daughter’s birth was a foundation of confidence that I can build my strength upon. It can’t be taken from me.

 

Devona Brazier is a wife and mother of three lovely daughters living in Akron, OH. She works to support pregnant and breastfeeding women through La Leche League membership and studying to her Lamaze Educator Certification. She enjoys kickboxing, running, hiking and sewing. She blogs at tobravebirth.com

Postpartum Intimacy: Are You OK Down There?

In anticipation of Valentine’s Day this week, we thought we’d cover one of the big fears that women have about life after baby: sex. Many women wonder if it will ever feel the same, how much it will hurt, and what their sex life will be like once baby comes into the picture. Below, some of the experts at FitPregnancy give the scoop on sex after birth. 

 

By Tamekia Reece, a writer in Houston who specializes in parenting, sexual health and relationship issues.

Will intercourse hurt when we start having it again? Will my vagina be loose? Will my partner still enjoy sex with me? More pregnant women and new moms than you might think fret about issues like these. To put your mind at ease about your after-baby body, here’s the scoop on the biggest sex-related worries women have.

Worry No. 1 > >  Sex will be painful.
Real deal: Having a baby causes the ligaments that support the uterus to stretch, making it lower slightly, says Mark Chag, M.D., an OB-GYN at Harbour Women’s Health in Portsmouth, N.H. While discomfort caused by the penis hitting the uterus during intercourse is normal (and easily remedied by switching positions), pain is not. As long as you wait until you’re given the green light by your doctor (usually six weeks), sex should be painless, Chag says. If it isn’t, talk with your doctor, especially if you had an episiotomy; you could have another tear or an infection. But even when you’re physically ready for sex, you may not feel like having it. Blame fatigue, hormonal factors or the possibility that it’s just nature’s way of making sure you don’t get pregnant again too soon.

Worry No. 2 > >  My vagina will be stretched out.
Real deal:  Nikki Perry, of Salem, Ohio, is worried that her vagina will get “stretched out” during her second delivery. “It’s 10 years later and I’m 10 years older, so I’m concerned,” she says. Although the vagina obviously expands during childbirth, “it is very elastic and returns to its normal contour afterward,” says Jennifer Berman, M.D., director of female urology and sexual medicine at Rodeo Drive Women’s Health Center in Beverly Hills, Calif. If you’re concerned about tightness, do Kegel exercises or other pelvic-muscle-strengthening moves. To do Kegels, repeatedly squeeze and hold the same muscles that control urine flow several times throughout the day. Doing the same during intercourse can help keep your partner happy.

Worry No. 3 > >  Nursing will make my vagina dry.
Real deal:  “Because of low estrogen levels, lack of vaginal lubrication is common after delivery, especially for nursing mothers,” Chag says. However, he adds, most women find the problem corrects itself once they stop breastfeeding. In the meantime, use a vaginal lubricant like K-Y Jelly. If you use a lubricant insert such as Lubrin, your partner won’t even know the difference. If this doesn’t help or if dryness persists for longer than two months after you give birth or stop breastfeeding, talk with your OB-GYN.

Worry No. 4 > >  I’ll look funny “down there.”
Real deal: After a traumatic delivery that resulted in fourth-degree tears, Rachel T., of Newport News, Va., wouldn’t have sex with her husband for weeks after being cleared by her doctor. “I felt like a vaginal Frankenstein,” she says. While your vaginal area may be swollen and discolored after you give birth, it returns to its normal appearance within four to six weeks. “The vagina is like a rubber band,” Berman says. “It’ll bounce back.” And so, probably, will your love life.

Postpartum pointers
Ease into intercourse: You might want to devote more time than normal to hugging, kissing, mutual masturbation or oral sex.

Be prepared: Have plenty of lubricant on hand.

Use protection: Remember, breastfeeding is not a reliable form of birth control, and you can become pregnant again before your menstrual periods resume.

 

Breastfeeding & Parenting: One Family’s Experience

By Lauralee Moss

Creative Commons photo by Raphael GoetterColds and the flu always surrounded my poor babies. Before I stayed home with them, I taught high school language arts. My students gave their nasty germs to me, and even though I nursed my children, they still got “lighter” versions of my illnesses. Seeing sick babies is always difficult for me, but it’s even more tough with a nursling who struggles to latch with a stuffed nose.

My husband and I created a routine to make nursing a sick baby easier: I showered and dressed before work, and then he showered. Only about five minutes into his time, I handed him a small towel and an infant. The warm water and steam rinsed off goopy eyes and cleared stuffy noses. Daddy finished showering, and I nursed a relaxed and latch-able baby.

I no longer teach, but my older two children are in school and bring home germs to the baby. We continue our routine, as he still volunteers to shower the baby if the tiny nose stuffs up again.

This seemingly small task makes my nursing life easier, as does all of my husband’s help. Nursing is an important, but fractional part of our larger parenting work. I may do the actual, physical feeding, but their father provides indispensable support as I nurse.

I’ve heard friends make the argument that by formula-feeding, they are not the only ones responsible for feeding — that the father will bond with the baby and will do “just as much work” as the mom.

In our family, we have found ways, apart from feeding, for my husband to bond with our babies. Showering tiny sick ones is just one of those ways. He lifted our babies’ tiny arms to wake them when they fell asleep at the breast. He carefully positioned them around my cesarean section incision for more comfortable nursing. He remembered advice from the lactation consultants and pediatrician as I sat in a new-mom daze. He helped me cover myself with a blanket as I ventured out as a new mother. As I grew in my confidence, he stood beside me as I publicly breastfed without a cover. He has listened to me discuss my breastfeeding theories and observations and defended me when family members questioned why I was still feeding our baby “on the boob.” When others question why I didn’t start feeding our first baby solids at four months, he quoted the American Academy of Pediatrics and World Health Organization statements about breastfeeding for six months.

Now that I nurse our third child, he provides healthy answers for our older two children when they ask: “How does the milk come out? Where does the milk go? Why does Cara not drink from a bottle? I want to see the MILK!” Most importantly, when my impressionable son asked why I nurse the baby, my husband said, “Because that is how it is supposed to be.”

Normalizing the process for the next generation — acting as a role model for a son — is important work. My husband has defended, physically helped, and mentally supported my breastfeeding. He does it all, not because he came to our parenting relationship as an outspoken breastfeeding advocate, but because we parent the best way we know how, and we do that together.

We have always seen breastfeeding as a part of parenting — and we parent together. I supply the food for a tiny fraction of our children’s lives. He has at least seventeen years to feed our babies.  I have breasts for food — he has big bear shoulders for the kids to ride around the house. Together, we provide both the physical and mental nourishment for our children.

 

Lauralee Moss lives in Illinois with her husband, three children, and crazy dog. She writes at switchingclassrooms.com.

Postpartum Fitness: Stretching with Your Stroller

In continuing our discussion on fitness in the new year, we present a step-by-step piece on how to stretch your body while out and about with your baby. Christine Krauth, a pre- and postnatal Pilates instructor, shows us how to achieve an all-over body stretch using simple movements.

 

By Christine Krauth

I recently taught a “Pilates and Running” workshop to some members of Moms Run This Town: a very cool group of gals who run. A lot. With strollers. I am also a stroller runner and I think that if you run with a stroller you are a) a rock star and b) should be given extra mileage credit: like, 3 miles with a stroller is the equivalent of 4.3 miles without.

So, with that figured out let’s learn some cool stretches you can do WITH your stroller at anytime: before, during, or after your run or walk.

Lower Back and Shoulders Stretch

This first one is great for a tight lower back (lumbar spine) and tense shoulders ( ’cause you know as you are pushing that thing up a hill you are using your shoulders, girl):

  1. Stand with your arms long out on the stroller handle bar, your feet in a parallel position, hip width apart and in line with your knees.
  2. Gently lower your chin and engage your abdominal muscles (think belly button to spine!), keep your shoulders down and round over your hips extending your torso out from your hips. Try and keep your hips over your ankles.
  3. Get a nice lengthening in your spine by sinking your weight into the stroller bar and reaching your arms as long as you can.
  4. Round your spine (imagine you are a Halloween cat!) and roll up one vertebrae at a time back to your starting position.
350true dots under 264true false 800http://givingbirthwithconfidence.org/wp-content/plugins/thethe-image-slider/style/skins/frame-black
  • 3000 fade false 60 bottom 0
    Slide10
  • 3000 fade false 60 bottom 0
    Slide10
  • 3000 fade false 60 bottom 0
    Slide1
  • 3000 fade false 60 bottom 0
    Slide2
  • 3000 fade false 60 bottom 0
    Slide3
  • 3000 fade false 60 bottom 0
    Slide4
  • 3000 fade false 60 bottom 0
    Slide5
  • 3000 fade false 60 bottom 0
    Slide6
  • 3000 fade false 60 bottom 0
    Slide7
  • 3000 fade false 60 bottom 0
    Slide8
  • 3000 fade false 60 bottom 0
    Slide11
  • 3000 fade false 60 bottom 0
    Slide12
  • 3000 fade false 60 bottom 0
    Slide13
  • 3000 fade false 60 bottom 0
    Slide14
?

 

Hips and Lower Back Stretch

The second part of the Stroller Stretches is specifically for your hips but also feels good if you feel tight in your lower back. Honestly, it feels good regardless! If you feel a little pain in your hips while you run or walk, take a moment and try this stretch:

  1. Stand with your feet hip width apart, hands on the stroller, feet parallel.
  2. Lift your right leg off the ground and cross it over your left leg (like a man would sit in a chair). Make sure your right leg crosses above the knee on top of your left quad.
  3. Bend your left leg watching the alignment of your knee and foot. Do not let your knee pass your ankle!
  4. You will feel a stretch in your gluteals and hip on the right side. Try and keep your right leg as open as possible. Count to 10 as you breath deep (slowly. sometimes it’s hard to count slow if you are in the middle of a run).
  5. Repeat on the left side.
350true dots bottomright 264true true 800http://givingbirthwithconfidence.org/wp-content/plugins/thethe-image-slider/style/skins/frame-black
  • 3000 fade false 60 bottom 0
    Slide2
  • 3000 fade false 60 bottom 0
    Slide1
  • 3000 fade false 60 bottom 0
    Slide3
?

 

Calf and Hip Flexor Stretch

The third installment is a calf and hip flexor stretch. Your calf muscles induce foot flexion AND help stabilize your ankles. Your hip flexors are a group of muscles whose primary action is to lift the upper part of the leg to the body. If you are walking or running, you use your hip flexors and your calves.

  1. Stand with your feet parallel, hip width apart.
  2. Lunge your right leg forward. Remember: your knee should be directly on top of your right foot and your foot should still be parallel.
  3. You will feel a stretch in the hip flexors on your left leg at this point. If you want more of a stretch, try pulling your left hip forward a little. Be subtle; it won’t take much.
  4. Lift your left heel and press into the ball of your foot.
  5. Lower your left heel slowly, pressing the heel into the ground. This is your calf stretch.
  6. Switch sides by bringing your right leg back and lunging out with your left leg.
350true dots bottomright 264true true 800http://givingbirthwithconfidence.org/wp-content/plugins/thethe-image-slider/style/skins/frame-black
  • 3000 fade false 60 bottom 0
    Slide2
  • 3000 fade false 60 bottom 0
    Slide3
  • 3000 fade false 60 bottom 0
    Slide1
  • 3000 fade false 60 bottom 0
    Slide4
?

 

Christine teaches Classical, Prenatal and Post Natal Pilates at ProHealth, a Physical Therapy and Pilates Studio. Christine practiced Pilates throughout the pregnancy and after the birth of her first child in 2009. She found that Pilates helped her body tremendously to adapt, support and facilitate the work of carrying and birthing her child. This revelation motivated Christine to empower other women through Pilates during their pregnancies.

Easing Back Into a Fitness Routine After Birth

With the start of the new year, many women look to begin a new or revived exercise regimen. After all, ’tis the season for gym membership deals! If you’re entering the new year as a new mom, you might also be eager to return to your pre-baby workout habits. Finding time postpartum to focus on exercise can do wonders for your energy and emotional state (but don’t worry if you DON’T feel ready to be active again — take your time and do what feels best). Debra Flashenberg, a doula, Lamaze Certified Childbirth Educator, and prenatal yoga instructor, offers tips on how to ease back into fitness after the birth of your baby.

 

By Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 and Director of the Prenatal Yoga Center

I remember chatting with a friend about a month before I was due with my son about my po

st-baby gym routine. At that time, I was an avid morning gym goer — 6:30 am spin classes — things one can do before baby! I was under the great delusion that I would miss a couple of weeks and then be right back into my fitness regimen.

Reality struck me rather quickly after giving birth that it would take more time to ease back into physical shape than I had estimated. My pelvic floor needed work, I was hopelessly looking for any sign that I still had core muscles and I was downright tired and delirious from sleep deprivation. Many of the mothers I talked with experienced a similar awakening. We all had been somewhat surprised by the postpartum body compared to that of pregnancy. (Full disclosure: these women had been steady prenatal yoga students and were in very good shape during pregnancy.) The shared experience was atrophied muscles, bad posture, achy body and general fatigue. Given that was the physical state postpartum, it would take a mindful approach to returning to a fitness routine.

The first thing to take into consideration when easing back into a fitness routine is to be realistic and patient. It took around 40 weeks to form the pregnant body and it could take nearly as long to fully return to your pre-pregnancy physical self. Birth is a transforming event. I remember very clearly my midwife announcing to me, “the landscape of your pelvis will never be the same.” No matter if your labor is quick, long or surgical, the body undergoes a huge transformation to expel a baby.

Starting Back Slowly
As a general rule, I recommend that women do not return to postnatal or mommy and me yoga until their bleeding has stopped. If a woman gave birth via cesarean section, she needs to wait 6 weeks before rejoining class. If you push yourself too hard in the beginning, then you can actually be setting yourself back from real recovery. That of course does not mean you need to be held hostage in your house for 6 weeks. A walk can be considered a good start to your road back!

Watch for Your Bleeding to Stop
Once you do embark on some heavier activities, pay attention to signs from your body. Some women find that their bleeding that had tapered down starts to get heavier again, which is a sign that the body needs more time to heal.

How Is Your Pelvic Floor?
Also, if the pelvic floor is weak, putting intra-abdominal pressure (like crunches, pilates or general ab work) can put too much pressure on the pelvic floor and inhibit healing or even lead to a chance of organ prolapse. One of the first forms of exercise you can start to incorporate daily can be a kegel routine, restrengthening or even re-familiarizing yourself with your pelvic floor muscles.

Repairing Diastasis
It is very common that women experience a separation of the abdominal muscles, specifically the rectus abdominals — aka the six-pack muscles. Your care provider can check this for you when you return for your six week check up. If it is severe enough, you may need to work with a physical therapist to help draw the muscles back together. So, when easing back to an abdominal workout, be mindful not to overdo it. In postnatal and mommy and me yoga, we focus more on plank pose and variations of plank instead of old fashion crunches. It is also advised not to do extremely deep twisting poses which can also inhibit the muscles from repair.

Wiggly, Wobbly Joints
Relaxin, the hormone that is responsible for softening the ligaments and joints during pregnancy and childbirth, can stay in the body for up to six months postpartum. This can lead to wobbly, unstable joints and a loose pelvis. Again, just be mindful that the activity your choose is not too jerky in movement.

Find All Sorts of Exercise!
You do not need to attend a scheduled class to start to return to a general fitness routine. As I mentioned earlier, walking is a great place to start: don’t discount walking as a gentle cardiovascular exercise! At one point, I was told to avoid higher impact cardio since I was healing from some pretty severe pelvic floor issues and was instructed to try swimming. Fortunately, I have been an avid swimmer for years, so it felt like a nice welcome back to exercise and rediscovering my body. The nice thing about swimming is that it is gentle on the joints and pelvic floor, and is great for strengthening the core and back muscles.

Hydrate
Once you do start to ease back into your routine, please remember to hydrate well, especially if you are breastfeeding. If you are out for a stroll with your baby, put your water bottle in the cup holder as a reminder to drink often.

Rest
At the end of every postnatal or mommy and me yoga class we incorporate a few restorative yoga poses and then savasana (corpse pose). Even though many new moms hear the old saying, sleep when your baby sleeps, very few (I believe) adhere to these wise words. So, including a few moments to simply relax post-workout can really help replenish you. If you are feeling rested and restored, you will have so much more to offer to those that need you.

I hope that these ideas of how to ease back into a fitness routine post-baby have been helpful. Enjoy your baby and your new life!

How did you ease back into a fitness routine post-baby? What tips can you offer to other new moms?

Pregnancy, Birth & Postpartum Resolutions

New Year’s resolutions may take on more meaning if you’re preparing for the birth of a child in 2013. This year, perhaps for the first time, “join the gym and lose 10 pounds” isn’t on the list. At the same time, many of the resolutions you make for a healthy pregnancy look a lot like those you would make for a healthy lifestyle, pregnant or not. For example:

  • eat fruit and vegetables daily
  • get 8 hours of sleep
  • exercise 30 minutes a day
  • carve out time for yourself
  • ask for help when you need it

For a healthy pregnancy, birth, and postpartum period, we’ve compiled a few significant resolutions for you to consider adding to your list this year.

 

Pregnancy

Listen to your body. If it’s telling you to slow down, do all that you can to make it happen. Cereal for dinner? Why not. Nap at 6 p.m.? Yep. On the other hand, if you’re feeling great, don’t let pregnancy slow you down — continue your exercise regimen, meet up with friends for dinner, enjoy life!

Learn about evidence-based maternity care. You can’t always count on your care provider to give you the best, most up-t0-date care. How will you know if you’re not receiving the best care? Learn how to navigate the maternity care system and how you can get the best care.

 

Labor & Birth

Plan for the best support. Who will attend your birth? Do they support your wishes? Will they provide positive energy? Think carefully about your birth support team. Look into hiring a doula. Share your birth plan with everyone well before labor begins.

Take labor one step at a time. Humans seem to be hardwired to think about what’s going to happen next. With labor, it helps to only think about what’s happening now. If you can take each contraction, each stage, each moment as it’s happening, you’ll be better able to put complete focus on the task at hand instead of worrying about what’s to come.

 

Postpartum

Speak up. It’s wonderful to have friends and family ooo and ahh at your new little joy. But a house full of visitors can be overwhelming during a time when you’re trying to understand a brand new world. Feel free to ask for some time and space alone with your baby. Post visiting hours on your front door or update your Facebook status to let friends know when you’re accepting visitors.

Know the signs of postpartum depression/disorders. Postpartum mood disorders (anxiety, depression, OCD, psychosis) affect hundreds of thousands of women every year. With knowledge of the warning signs and access to resources, women who suffer from postpartum mood disorders can and do recover.

Maternal Mental Health: Pre-Existing Risk Factors for PTSD and Childbirth

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

 

 

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Heidi Koss, MA, LMHC

Health care providers aren’t exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Your inherited mental health risks, such as an increased risk of anxiety and depression
  • Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
  • The inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

  • Being female — women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD and depression
  • History of abuse (such as childhood abuse, sexual abuse, rape)
  • Combat exposure
  • Physical attack
  • Being threatened with a weapon
  • Car accident, plane or train crash
  • Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

  • Flashbacks of the event — vivid and sudden memories
  • Nightmares
  • Insomnia
  • Fears of recurrence
  • Emotional numbing
  • Panic attacks
  • Inability to recall important aspects of the event — psychogenic amnesia
  • Exaggerated startle response, hyper-arousal, always on guard
  • Hyper-vigilance, constantly looking around for trouble or stressors
  • Avoidance of reminders of the traumatic event
  • Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it’s hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Resources
Recommended Books:

  • Postpartum Mood and Anxiety Disorders, A Clinician’s Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
  • Beyond the Birth, A Family’s Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.

 

 

 

PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.