Hug Your Baby: Postpartum Depression

Showing posts with label Postpartum Depression. Show all posts

"I think my baby is bored with me!"

"BEFORE and AFTER" HUG Teaching Photos!

Eliza is a special mom in a special situation. She had suffered from severe postpartum depression after the birth of her first child. Fortunately, her family and friends gave Eliza and her family the help they needed to make it through those difficult months. During this second pregnancy Eliza stayed under the watchful eye of a pyschiatrist and hired a birth doula to offer the additional encouragement and support this mom wants. Following a lovely natural birth, Eliza and her baby are doing great. Today the doula is making a follow-up home visit and is surprised to find Eliza is worried.

This young mother is remarkably attentive to her little one. But this morning she describes "the wierdest behavior in my baby." "I am worried that Willa is bored with me," she reports. She goes on to explain. "I'll be real excited talking to and loving on my little gal when suddenly she'll roll her eyes up and look away from me. Now, I've seen my 13-year-old niece do that to my sister, and I know what that means: 'Mom, you are boring me!'"

Like all moms, Eliza wants to feel connected to her baby. Research on postpartum depression shows that the interaction between a depressed mother and her baby is altered from birth. The ability of the mother to accurately "read" her baby's body language is hampered. Worry about being the perfect mom can similarly impact those early parenting days.

Eliza is understandably more sensitive than some moms would be to how her baby responds to her. She is aware of how much she missed out on those early connections with baby number one, and now she wants to gobble up every morsel of love and attention with this little one. But today, Eliza is misunderstanding important NORMAL newborn behavior.

As Eliza is decribing her concerns, I see little Willa do exactly what Mom is explaining. At first her arms jerk just a bit, her breathing increases slightly, and then she looks away from her mother's face. At once I recognize Willa's common behavior as an SOS (Sign of Over Stimulation). I remind Eliza of the HUG DVD we had watched during her pregnancy and how she had laughed when that cute baby had looked away from her mother's face.

Eliza birghtens up as she gently holds Willa's hands against her chest, softly calls her name and is rewarded when her baby slowly turns toward her mother's face.

Eliza's sigh of relief is a clear reminder of how important it is that new parents be given skills to read and respond to normal newborn behavior. And in a case such as Eliza's, this information can help heal wounds of the past and set up this special mom for satisfying and effective interactions with her baby for years to come.

© HUG Your Baby 2012

"I think my baby is bored with me!" the Doula hears.

"I Think My Baby Is Bored With Me!"

"BEFORE and AFTER" HUG Teaching Photos!

Eliza comes in with Willa, her second child. Eliza is a special mom in a special situation. She had suffered from severe postpartum depression after the birth of her first child. Fortunately, her family and friends gave Eliza and her family the help and support they needed to make it through those difficult months. During this second pregnancy Eliza stayed under the watchful eye of an encouraging pyschiatrist and now seems to be doing great. Eliza is here with her robust, healthy two-week-old for her well child visit.

But Eliza is worried. She is remarkably attentive to her little one and describes the oddest behavior. "I am worried that Willa is bored with me," she reports. She goes on to explain. "I'll be real excited talking to and loving on my little gal when suddenly she'll roll her eyes up and look away from me. Now, I've seen my 13-year-old niece do that to my sister, and I know what that means: 'Mom, you are boring me!'"

Eliza is understandably more sensitive than some moms would be to how her baby responds to her. She is aware of how much she missed out on those early connections with baby number one, and now she wants to gobble up every morsel of love and attention with this little one. But today, Eliza is misunderstanding important NORMAL newborn behavior.

As Eliza is decribing her concerns, I see little Willa do exactly what Mom is explaining. At first her arms jerk just a bit, her breathing increases slightly, and then she looks away from her mother's face. At once I recognize Willa's common behavior as an SOS (Sign of Over Stimulation). I remind Eliza of the HUG DVD we had watched during her pregnancy and how she had laughed when that cute baby had looked away from her mother's face. Eliza birghtens up as she gently holds Willa's hands against her chest, softly calls her name and is rewarded by her slow turn toward her mother's face. Eliza's sigh of relief is a clear reminder of how important it is that new parents be given skills to read and respond to normal newborn behavior. And in a case such as Eliza's, this information can help heal wounds of the past and set up this special mom for satisfying and effective interactions with her baby for years to come.

Connecting with this Teen Mom

It saddened me when I walked into the room. Carrie, a sixteen-year-old new mom, was gazing out the window - at nothing in particular. Just gazing out, not looking in, or over at the baby in the room. Grandma sat beside the exam table and patted the back of three-week-old Ricky, a healthy, full-term guy who appeared to be under the watchful care of his grandmother. I asked questions about the delivery and feeding. I commented on the little one's abundance of hair and his sweet nose. I mused over the wonder of a new baby. But Carrie still glanced out the window, unengaged by the swirl of attention her newborn was receiving.

Ricky began to squirm on the exam table, wrinkle up his face, and hover on the verge of changing from a calm to a fussy baby. As he wiggled he seemed, quite by accident, to hit the side of his face with his fisted hand. This movement triggered his in-born rooting reflex. His tiny mouth opened wide and clamped down on his first and second finger. He started to suck.

"Wow!" I exclaimed. "Look how smart you are to get that finger in your mouth all by yourself!"

Carrie was jolted by my enthusiastic response. She pushed her chair a few inches away from the window and turned her head a full 20 degrees in our direction.

I chatted on in my nurse-to-baby style, next noticing Ricky's eyes turning to focus on me. "My goodness! You heard my voice and turned right toward me! What other amazing tricks do you have?"

Carrie eased toward the exam table and, now, glanced down at Ricky. Her son demonstrated an amazing ability to get to and stay in that Ready Zone. His eyes were bright, his movements relaxed, and his shoulders dropped in an "I'm-ready-for-the-next-event" kind of look.

I picked up Ricky and encouraged Carrie to call his name. She did, at first tentatively, but with a bit more gusto after some encouragement. As I expected, Ricky slowly turned in his mother's direction, and then he looked into her face, contentedly.

A smile crept over Carrie's face as she looked down at her child. With some hesitation she received the newborn I gently placed in her arms. Carrie surprised me when she put her nose into Ricky's face and nuzzled for a moment. Ricky seemed to tilt toward his mom and into an awkward, but warm, cuddle.

Helping this new and fragile mom appreciate her baby's effort to connect made my day. "He's a real person," Carrie whispered.

"Yes, and he knows his real mother," I responded. Now, I didn't feel so sad.

Postpartum depression in DAD!

Fred works at a local insurance company. He is a good employee: shows up on time, is punctual with his reports, courteous to his customers, and kind to the staff. Lately, however, he "keeps to himself," and likes his door closed when he has a stack of forms to complete. Recently there have been a few lay-offs at his company; Fred is determined to "stay below the radar."

Fred's wife, Jessie, is expecting their first child, and the pregnancy is going well.

But midway into his wife's pregnancy, life has gotten tense around the house. Fred is a bit hyper. He is quick to criticize Jessie if dinner isn't ready by the time he gets home, he spends more time in front of the TV with an extra beer, and he reports that he is too tired to make his customary morning trip to the gym. Instead, Fred has made an uncharacteristic number of trips to the doctor these past few month for an ache or pain here, indigestion, and headaches. While he seems exhausted in the evening, he tosses and turns at night. Jessie often finds him dozing on the couch when she gets up in the morning.

Like 7% of men in the United States, Fred is suffering from depression. However, he doesn't "look depressed." He has no crying spells and his mood is not slowed down. On the contrary, he is revved up a notch or two. Fred remembers being "kinda blue" for a semester or two in college and reports that his mother was treated for depression years ago.

Fred needs help...for the sake of his well being...for the sake of his marriage...and, ultimately, for the sake of his baby.

A recent study by the American Psychiatric Association confirms the increasing incidence and importance of postpartum depression in dads. APA President says, "The life changes for a new dad are enormous. Just thinking about the costs of raising the kid to 21, maybe for life, can be terrifying. And all the unspoken fears: Will my wife still be as interested in me? Will my baby be as cute as my brother's baby?" "Moreover, male postpartum depression may have more negative effects on some aspects of a child's development than its female counterpart," says James F. Paulson, PhD. A dad's depression during his wife's pregnancy is a significant risk factor for her postpartum depression.

Furthermore, a new study in Pediatrics confirms that depression in dads is linked to increased crying in their newborns. Does dad's depression cause more tension in the home and less responsiveness to the baby, or is it the other way around? No one yet knows.

Fred's brother notices that Fred is "just not right." After considerable support and encouragement, Fred finds a doctor who has experience treating depression in men. A few weeks after treatment begins, Fred finds his was back to the gym, opens his office door at work, and is back to patting his wife's growing tummy. Fred thankfully feels like hemself again and is ready now to be the dad he wants to be.

The New Mom Worries All the Time

Janine held her two-month-old as we spoke. Her arms were a bit stiff, and she looked uncomfortable. As little Johnnie looked up at his mom a smile began to spread across his face. Mom didn’t notice. She aims to keep Johnnie on a very rigid eating and sleeping schedule and describes how upset she becomes when her son doesn’t comply. She reads everything she can find on the Internet about baby care and is distressed because one person’s advise contradicts another’s.

Mom’s looked to me for reassurance, asking, “Are you sure he is growing ok?” Though Johnnie’s regular eating habits, his “output” (pees and poops), and his growth chart demonstrate a child who is growing well, Janine cannot be confident he is doing well.

Janine loves her baby deeply, but she is one of the 10% of postpartum mothers who suffers from postpartum depression.

Depression can present two ways in a new mother. Typically parents think of the “Baby Blues:” a mother who continues to be emotionally tender and tearful even after the first week of her child’s birth.

But Janine demonstrates the other face of postpartum depression: the hyper-vigilant mother who worries all the time. New parents normally present greater-than-usual vigor and intensity as they struggle with their early days of parenting, but a depressed mom cannot be reassured by those who are ready to help and give guidance. She finds very little joy in the job of parenting—and sleeps and eats poorly, even though her baby may do both well.

Postpartum depression research by Dr. Ed Tronick from Harvard University has identified behavioral changes in two-month-olds whose mother is depressed. While parenting has been described as a dance between a parent and a baby (a parent reaching out to understand and care for a baby, and a baby seeking care from a parent), the hyper-vigilant, depressed mother has difficulty participating in the dance. She doesn’t seem to see her baby’s efforts to connect with her, and she attempts to interact when the baby is shut down and unavailable. In this mother-baby dance, the partners are constantly stepping on each other’s toes!

Janine now understands what postpartum depression is, and she sees that without help she is putting both herself and her baby at risk. During the past month Janine has accepted both counseling and medication and now is smiling more. At Johnnie’s four-month-old visit with me, Janine is distracted when her baby starts to giggle. I’m happy to feel like an outsider for a moment as this “dance couple” linger in one another’s gaze.

"I worry all the time!" Mom says

A Worried Dad Finds Relief

Howard is the Dad of two-month-old JT and he has lots of questions. As I mentioned in the last two blogs ( Feb.5th and 7th) Howard has many worries as well.

Reseaarch by M Sills, S.Shetterly, et al (http://pediatrics.aappublications.org/cgi/content/full/119/4/e829) confirm that depression in even one parent increases visits to the primary care provider and ER and reduces well-child visits (especially with the older children). When patients are "frequent fliers" as we call them in our practice, consider depresion in either the mother or father.

Now my "rule of three" kicks in. When Howard ask his third question I stop trying to reassure Howard. Instead I say, "I can see you love you baby so much that you want only to do what's best for him." Acknowledging his list of questions as an expression of Dad's love seems to slow down the questions. Howard takes a deep breath, smiles, and admits to being a "bit worried about the baby." Now we are talking about his real worries not the symptoms of his concern.

Dr. T. Berry Brazelton would describe this approach as the Touchpoint's technique of "acknowledge the parent's passion." In this case this acknowledgement opens the door so now we can discuss the difference between everday worries and anxious depression. (It surprises men to learn that research shows that spouses can have hormone changes during their wife's pregnancy and that these changes can contribute to his depression as they do in the woman.)

Howard describes his new job responsibilites and the extra time he now must spend away from home. Research shows that many new fathers worry deeply about the strain on time and money that new parenthood creates.

Next, I set up a specific time to call Howard weekly for the next three weeks and set up a followup visit in a few weeks. Knowing that I will contact he and his wife seems to harness his worries and decrease his calls to me. I suggest he jot down any worries so we can be sure to discuss them at the phone call or visit.

At the following visit I discuss the concept of anxious depression a bit more and ask about Howard's personal and family history of depression. In addition, I ask about alcohol use since this can contribute to or cause depression at any time in a patient's life. Howard promises to go back on his exercise program and cut back on his caffiene. He agrees to accept a little more help from family and friends and he his wife plan a time to go out to dinner on a well-deserved "date night."

Howard's history and symptoms were significant enough to put him on an antidepressant. After three weeks Howard said "I feel like myself again." By JT's four-month-visit Howard, his son, and wife are much better. Howard brags about his son's new trick of rolling over, and laughs when JT swats at Howard's nose. Howard is back, more able to be present with his son and to find joy in these precious moments. Likewise, I'm back on track as their provider. Addressing the cause rather than the symptoms allow me to feel more compassion and be more able to use my skills and knowledge to help these parents be the parents they want to be.

"Three strikes and you're OUT"...or "In"...Trouble, that is!

I was really ready to see eight-week-old, JT. In addition to several office visits, I had spoken over the phone to Howard, his Dad, numerous times since the child's birth. I was starting to dread the moment his cell number would appear on my desk. I had it memorized.

J. T. is in for his routine visit and is growing at the 80% in height and the 60% in weight. He cackles once when I palpate his abdomen and looks up at his dad when I listen to his lungs. Though I'm finding this behavior delightful, Howard hardly notices. He looks worried. "Is his head big enough?" "Does it hurt J. T.'s back if he lies on his stomach?" "He always strains his face when he poops. Is that ok?"

Worry seems to be on the job description of most new parents. Each of Howard's questions alone seems resonable; however, this dad has an extraordinarily long list of questions and can't be reassured. He is an attentive father who reads everything about babies on the Internet. He collects ideas from friends and family. He is hypervigilant in his care: getting up several times at night (while the baby sleeps!) to be sure everything is ok, counting every calorie the baby eats, keeping an elaborate diary of the child's sleep, eating, and elimination. Though the data piles up, the questions and worries keep coming. "Anxious attachment," a term used by some professionals, describes the budding relationship between Howard and his baby. Though J. T. is thriving now, babies can eventually sense this anxiousness and over time can look and even act anxious themselves.

Anxious attachment is seen as a form of postpartum depression and can occur in either the mother or the father. This conditiion does not look like classic depression: a "slowed down" parent who becomes teary and sad, has trouble concentrating, appears distracted, and becomes less involved with their baby. Howard is super involved but cannot trust his instincts or learn to read his baby's behavior accurately. When asked, Howard will state that he is "not depressed." "I'm just worried," Howard explains. He, and others like him, need help: frequent contact and support, counselling, and sometimes medication.

When I care for young families I follow the "rule of three." If a parent asks a third question and cannot be reassured, but follows with yet another concern, I start looking for anxious postpartum depression. See the next blog for some strategies to help Howard cope with this situation.

Listening to your Baby Talk!

Debbie came to see me for a check up with Rebecca, her six-month-old daughter. Though I do not provide prenatal care, I had seen this mother a number of times during her pregnancy. She described herself as "a worrier” and wanted to discuss with me the things she was worried about or the things she might find worrisome in the future. I realized that Debbie was at significant risk for post-partum depression and wanted to keep a close eye on her when the baby was born.

I meet Rebecca when she was only a few days old. She had newborn jaundice and was struggling to wake up to nurse. Debbie was determined to succeed with breastfeeding so was open to any ideas which might help. From my first visit with Rebecca, I focused on helping Debbie tune into what “Rebecca is telling us.” Debbie and I watched together as Rebecca “told us” about her sleep cycles and how she could be aroused from active/light sleep but not quiet/deep sleep. (See http://www.hugyourbaby.com/sleeping.html to tell sleep cycles apart) Debbie learned to read her daughter’s SOSs (Signs of Over-Stimulation) and to tell when Rebecca needed a rest or could handle more interaction and play. (See http://www.hugyourbaby.com/skills.html for tips on SOSs)

Debbie taught me something very important. The more a mom learns to read her baby’s body language, the less she will worry. This mother, who had worried and suffered much during her pregnancy, never did develop post-partum depression. Instead, she learned to read her daughter's "body talk," and she gained confidence as a mom while learning to do so. At our last visit Debbie summed it up this way: “I worried a lot when she was inside of me. It’s easier to have her on the outside telling me just how she is doing.” And, Rebecca seemed to say, “Gee, Mom, I’m doing great!”