Postpartum Adjustment After giving birth, it is normal to cry for no apparent reason, to feel anxious, frightened and sad. Baby Blues affect approximately 80% of new mothers, many of whom feel sad, overwhelmed and tired for a few days after giving birth. Symptoms of the blues are usually short lived and disappear on their own. The arrival of a child is like no other experience in life, especially when one has a premature baby. Having a premature baby is one of the most stressful experiences a parent can have. Most parents find they need emotional support when they have a baby in the NICU (please see Emotional Responses of Parents and Stages of Adaptation, which follows). Many parents feel overwhelmed by stress and are confused by their feelings. It is important to recognise when the Baby Blues are just not going away and when you may actually have a postpartum adjustment problem. Postpartum Depression (PPD) 10% to 20% of new mothers experience a depression that does not go away after a short time. The onset of PPD may occur immediately after giving birth or many months later. PPD is often accompanied by anxiety and overwhelming feelings of guilt, shame, isolation, fatigue, a sense of loss and sometimes, very frightening fantasies. Postpartum Psychosis This is a rare and severe reaction affecting one or two women in a thousand. Periods of lucidness (thinking clearly) are interspersed with periods of thought disorders, and not knowing what is reality. Thoughts of harming oneself, the baby, or anyone else, may be constant. If any of these apply to you, get help right away: My Baby Blues have not gone away after two weeks. I have strong feelings of sadness or guilt. I can t sleep, even when tired. I sleep all the time, even when my baby is awake. I am not able to eat, even when hungry, or because I am never hungry or because I feel sick. I worry about my baby too much: I am obsessed with my baby. I don t worry about my baby at all; it is almost like I don t care. I am having panic attacks. I have feelings of anger towards my baby. I think about harming myself or my baby. 1 How I am Feeling
How can I help myself? Rest during the day, even briefly. Eat nourishing, comfort food. Talk to a support person who really listens to you. Educate yourself about PPD. Do something just for you everyday. Limit the time you spend with people who make you anxious. Ignore such comments as Snap out of it, or You should be happy to have this baby. Exercise or go for a short walk. Try to accept the painful feelings. It s okay to cry. Understand that this is not your fault. Avoid blaming yourself. Avoid feeling like a superwoman. Discourage yourself from doing everything yourself. I think I need professional help There are many professionals you can turn to for help. If you are experiencing any of the symptoms described on the previous page please contact one of the following immediately: Your family doctor Your obstetrician Your baby s pediatrician The public health nurse Parent resource nurse Social worker Where can I go for support? There are many resources available at Mount Sinai to support parents in need: The Parent Buddy program is a great support tool, matching parents with other parents who had a premature baby in the NICU some time ago. The Parent Buddy can offer you a supportive, understanding, sympathetic ear and can share their experiences that may be similar to your own. If you have any questions about this program, please speak to your nurse or the social worker. Parent Group Program. All parents with babies in the NICU or Level 2 Nursery are invited to the Tuesday Evening Educational Support Group series. Please see the insert in this binder for the various topics. When: Tuesday Evenings, 6:30 8:00 p.m. Where: 7 th Floor; see the flyer on the notice board Group Leaders: Parent Resource Nurse and the Social Workers 2 How I am Feeling
From Hospital to Home, Level 2 Nursery, Fridays, 1:00 2.30 pm Learn how you can respond to your baby s developmental needs in hospital and following discharge. Preparation for taking your baby home will be discussed in detail. Group leader: Parent Resource Nurse. Call if you are interested in attending (ext. 5338). CPR classes (every 3 weeks) see information sheet or parent group pamphlet. Baby Steps to Breastfeeding. Every Thursday and Sunday 1:00 2:00 pm This is a pumping and breastfeeding class for mothers (and partners) planning to breast-feed their baby. Group leaders: Lactation Consultant and Parent Resource Nurse. What am I suppose to say? Feel free to mention the symptoms or feelings you are having with whomever you trust and feel will truly listen to you. Tell them frankly that you think you may be experiencing a postpartum mood and/or anxiety disorder. Make a list of your symptoms so you remember to mention everything. Schedule a longer appointment through the receptionist if you need to talk to the doctor. Some women fear discussing their concerns with their doctors because they fear they will be labelled "crazy", or a "bad mother", or in the extreme, that they will either be immediately hospitalized or be reported to a child welfare agency and have the baby removed from the home. This rarely happens. Take your spouse or a trusted friend with you as a "second voice and ear" and to take notes on what recommendations may be made to you. If the doctor or anyone else, minimizes your symptoms (i.e. "cheer up" or "stop feeling sorry for yourself, you have a beautiful baby", or "put some makeup on and go out to dinner with your husband, you'll feel better"), consider changing physicians or talking to someone else. Discuss the possibility of a referral to a psychiatrist. If you are really having difficulty coping, ask your physician to refer you for Mental Health Home Care Support from your local Community Care Access Centre (this is covered by OHIP). S/he should specify a psychiatric nurse with postpartum depression experience. With this, a mental health nurse will visit you at home at least once a week, to provide support, encouragement, and education. S/he will also assess your mental status. Request a Professional Pack from PASS-CAN and take this information with you to the doctor. 3 How I am Feeling
Keep searching until you find a physician or other professional who sympathizes, understands and validates your fears and concerns. Don't give up until you do! This will be vital to your recovery! Phone the postpartum or psychiatric unit of your local hospital, or ask to speak to a social worker there. You can also phone the College of Physicians and Surgeons for their suggestions. Resources After Baby Comes? What about Fathers? A support program for dads only. Contact Dr. William Watson, St. Michael's Hospital, 61 Queen Street East., Toronto, Ontario M5C 2T2; 416-867-7426. The Baby Blues When They Won t Go Away. A Maternal Support Program, Women s Health Centre, St. Joseph s Health Centre, 30 The Queensway, Toronto, Ontario M6R 1B5; 416-530-6850. Post Partum Depression and Anxiety: A Self-help Guide for Mothers, Pacific Post Partum Support Society, #104-1416 Commercial Drive., Vancouver, B.C. V5L 3X9 604-255-7999. Shouldn't I Be Happy: Emotional Problems of Pregnant and Postpartum Women, By Dr. Shaila Mistri, The Free Press (Canadian Distributor Distican), 1995. This Isn't What I Expected: Recognizing and Recovering from Depression and Anxiety after Childbirth, by Karen Kleiman and Valerie Rasking, Bantam, 1994. Postpartum Survival guide: It Wasn't Supposed to Be Like This, by Ann Dunnewold and Diane Sanford, New Harbinger Publications, 1994. to order: 1-800-748-6273. Mothering the New Mother: Postpartum Resource Guide, by Sally Placksin, Key Porter Books, 1995. 4 How I am Feeling
References Dawn Gruen. The New Parent A Spectrum of Postpartum Adjustment. Pennypress, Inc., 1988. St. Joseph s Health Centre. The Baby Blues When They Won t Go Away. A Maternal Support Program, Women s Health Centre, St. Joseph s Health Centre, 1996. Pacific Post Partum Support Society. Post Partem Depression and Anxiety. Pacific Post Partum Support Society Canada, 5 th Edition, 2001. The Society of Obstetricians and Gynaecologists of Canada. Healthy Beginnings Your Handbook for Pregnancy and Birth. The Society of Obstetricians and Gynaecologists of Canada, 2 nd Edition, 2000. Copyright 2003 Mount Sinai Hospital, Toronto 5 How I am Feeling