Normalizing Postpartum Mood and Anxiety Disorders; article for the Maui Family Magazine

Most people have heard of postpartum depression, but perinatal mood and anxiety disorder (PMAD), is a fairly new term that can better describe what some new mothers may experience after childbirth. PMADs can affect 1 in 5 new mothers and can happen anytime in the first two years of the perinatal period. Mothers of every age, culture, race and income level can experience perinatal mood and anxiety disorders, which are considered to be the number one complication of childbirth.

After birth approximately 80% of new mothers will experience the “baby blues,” which is a normal adjustment period caused by changes in hormones and a major life transition. Symptoms of the baby blues are: sadness, feelings of overwhelm, irritability, trouble sleeping and feelings of isolation. These feelings typically start within the first few days after giving birth and usually go away within a couple of weeks. 

If symptoms do not resolve naturally, or if they worsen, you could be experiencing a perinatal mood and anxiety disorder (PMAD). Symptoms can manifest in many ways, such as: depression, anxiety, obsessive compulsive disorder or obsessive thoughts of the possibility of baby being in danger, panic attacks and post traumatic stress disorder. If a new mother is experiencing any of these symptoms she should contact her care provider for assessment. It is important for her know that she is not alone and that PMADs are temporary and can be treated with a combination of cognitive therapy, peer support, self-care and medication, if necessary. Some risk factors include: if a women has previously experienced depression or anxiety, lack of familial or community support, past trauma or adverse life events and lack of sleep. New fathers are also at risk of developing postpartum depression and the risk may increase if the mother is experiencing any PMADs. Some resources for new families who may be experiencing PMADs are: 

This Isn’t What I Expected by Karen Kleiman, MSW and Valerie Raskin, MD

Postpartum Husband: Practical Solutions for Living with Postpartum Depression by Karen Kleiman, MSW

Breastfeeding Myth Busters; article for the Maui Family Magazine

Breastfeeding is easy and everyone can do it. Fact: While breastfeeding is a mothers natural way of nourishing her baby, it isn’t as easy for some mothers as it may seem and it doesn’t always work as planned. This is why there are lactation specialists who can help in the hospital, as well as make home visits to teach moms and babies how to breastfeed or refer out for any other problems.

The only way to feed a baby is breast or bottle. Fact: There are many ways to feed a baby other than breastfeeding or bottle-feeding. You can also use a spoon, cup, dropper, syringe or a supplemental nursing system to transfer breastmilk or formula.

Breastfeeding is natural birth control (called lactational amenorrhea). Fact: Only if all of the guidelines are met and then only with an effectiveness rate of approximately 98%. These are: baby is six months old or less; exclusive breastfeeding with NO pacifiers, bottles or other foods or liquids, breastfeeding on cue 24 hours per day and co-sleeps. Once your baby starts sleeping through the night (5 continuous hours or more) or your menstrual cycle returns, breastfeeding is no longer a reliable method of birth control.

All breast-pump parts and baby bottles must be sterilized after each use. Fact: Warm soapy water and air drying parts after each use is sufficient; all pump and bottle parts must be sterilized only every few days.

Breastfeeding is how to bond with baby. Fact: There are many ways to bond with a baby and bonding doesn’t solely depend on breastfeeding. An adult will bond with a baby when they respond to their needs, make eye contact, and use touch and language. All will help baby to feel loved and secure.  

Cabbage leaves are safe to use to help relieve breast engorgement. Fact: Using cabbage leaves on your breasts increases the risk of contracting the bacterial infection listeria (food borne illness that can be fatal for newborns). Studies have proven that using hot and cold compresses are more effective and pose no adverse health risks. 

Postpartum Myth Busters; article for the Maui Family Magazine

Postpartum depression happens in the first couple months after baby’s birth, during the time of sleep deprivation and the transition into parenthood. Fact: Postpartum mood and anxiety disorders can look very different from typical depression and can appear anytime during the first two years after childbirth. PMAD’s can appear as anxiety, sleeplessness, obsessive compulsive disorder, etc., Approximately 85% percent of women get the baby blues a few days after birth which can look like sadness and overwhelm.  The baby blues are a natural hormonal balancing act after birth while the mothers body is trying to regulate itself and will go away after two to three weeks. If symptoms persist or worsen see your doctor.

Picking up your baby when she cries will create bad habits. Fact: During the first months of life it is necessary for you to respond to your babies cues and to comfort them when they cry. Picking up your baby teaches them that they are safe and creates a more secure toddler and adult.  

Never wake a sleeping baby. Fact: In the first few weeks your breastfed newborn needs to eat every two to three hours. If they are sleeping any longer than that and not waking up on their own, you will need to gently nudge them awake for a feeding. Breastmilk is digested very fast and creates energy for the baby to wake up and eat. If baby does not get enough calories they will not have the energy to wake themselves up to eat.

It is normal to experience pain or incontinence in your pelvic floor after childbirth. Fact: Some women experience pelvic floor pain for months or years after childbirth, these symptoms are often caused by tight, weak or separated pelvic muscles. A physical therapist specializing in pelvic floor rehab can identify any muscles and help to strengthen or release them.

Short naps for a new mother are beneficial during postpartum recovery. Fact: A nap is most beneficial when one gets the full sleep cycle which is 90 minutes and includes both light and deep stages of sleep. 

A New Father's Guide To Nurturing Himself Through The Postpartum Shift; article for the Maui Family Magazine

Nowadays new fathers are more involved with everyday childrearing than in the past, but there is little recognition of the postpartum adjustment period and need for self care for these fathers. Consequently, some new dads can be left feeling unprepared for fatherhood.

Sometimes a new father needs to take time for himself to de-stress, but often his needs are unmet as he does not know how to verbalize them. In our society men are sometimes taught not to express their emotions. Having somebody to talk to who can relate to the challenges and joys of having a new baby can help. Finding other new dads and befriending them is a good way to start. Nurturing another human can be very demanding, and while dad is supporting the new mother, it is important that he does not forget to take care of himself. Dads can practice self care by eating a healthy diet and not letting caffeine and empty calories replace food.   

Skin-to-skin and eye-to-eye contact in the first few weeks can be especially beneficial to baby while helping new dads bond with their newborns. Some ways that a father can bond with his baby are by getting involved with baby care and learning about behavior cues, which will help build confidence as a new parent. Baby care provides never ending opportunities to bond and can be plenty of fun. For instance, dad could sing a special song at diaper time that will help baby look forward to being on the changing table. Baby wearing gives dad the ability to provide comfort and physical connection, while being hands free. Taking older siblings and baby out for a walk can be a great way to get some fresh air and energy, or in the mornings when baby is alert and ready to play. Setting aside a special activity that fathers can look forward to, like the nightly bath or a daily walk, can be very rewarding.

Fathers play a big role in the family and it is important that they have time to bond with their babies, while caring for themselves and others. 

Understanding Your Newborn Baby; article for the Maui Family Magazine

While babies cannot speak they have many ways of communicating.  Some of their behavior cues are clear while others are not so easy to interpret and can be easily missed.  With a little observation parents can learn to recognize their baby’s cues, while gaining confidence in their ability to sooth and care for their newborns.

Infant behaviors that indicate readiness for interaction are called engagement cues.  “Lets play” signals are: staring intently at your face while holding your gaze, following your voice and tracking your face, smiling, using calm body movements and having a relaxed facial expression. Infants move between behavior states quickly. Behaviors that indicate a need for less stimulation are called disengagement cues.  “I need something to be different” signals are: baby looks away, eyes open and close, sneezes, agitated movements and fussiness.  Crying signals that an infant’s limits have been reached.

Babies go through cycles of light and deep sleep, and both types are important for your baby’s developmental growth.  Light sleep can be recognized in babies when you see their eyes flutter, facial expressions change, smiles, and body twitches.  This sleep stimulates your baby’s brain and is associated with processing and storing information.  An infant sleep cycle starts with light sleep then after about 20 minutes moves into deep sleep. Deep sleep is a good time to lie your baby down.  Signs of deep sleep are: arms and legs are relaxed and floppy, little to no body movement, and staying asleep with loud noises.  Deep sleep is restorative and gives your baby the energy to process information. 

Newborns need to feed often and have many cues to signal that they are hungry. These cues are: licking lips and sticking tongue out, sucking on hands, and moving face and mouth around (rooting reflex).  Crying is a late cue, as it can be much easier to feed your baby when he is calm.  

Having a baby can be a very exciting yet overwhelming time.  As you get to know your baby you will recognize her unique language and be able to intuitively respond to her needs.