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It is very normal for new parents not to give much thought to how they will feel during the postpartum period until they are into it.

At  MamaDoula, we hear from many second-time Moms who describe feeling unexpectedly isolated and overwhelmed during the postpartum with their first baby.  Or we hear that they or someone close to them suffered postpartum depression.  Many new (and experienced) moms (and families) do not recognize the symptoms of PPD and do not seek (or know where to get) help.  

These days, obstetric care providers are encouraging women to plan ahead by screening them during pregnancy for risk factors of a mood disorder after the baby is born.  There are a number of postpartum depression screening questionnaires, and most can be completed in only a few minutes.  Undergoing this brief screening in pregnancy allows women at risk to be proactive about postpartum wellness.  And it allows women with no risk factors to think about what kind of support might work for them as well.

It's true that there are relatively easy action steps a mom can take to take to optimize her emotional health once the baby is home.  A bit  of prior planning can minimize the sometimes considerable stress experienced by so many new parents.  And, while a postpartum mood disorder does not occur in the majority of women, taking the time to put a few supports in place in case problems develop is a reasonable precaution! 

What steps can you take to help yourself be the healthiest Mom you can be?  First, have a open and honest discussion with your healthcare provider about what your expectations for birth are and if you have any questions or concerns about the postpartum.  If you find that you do have risk factors for a postpartum mood disorder, be sure to discuss these as well.  Consider getting referrals before the baby is born to potential sources of professional help -just in case you need them.  "Just in case"....have the names and numbers of at least 2 lactation consultants, one or two postpartum doulas, and 2 therapists experienced in postpartum mood disorders.  You might also want to consider a massage therapist or other complimentary medicine practitioner. 

Go out of your way to connect with other new moms and expecting parents.  Join a new moms group!   Take a childbirth education or breastfeeding class and get the names and phone numbers of other parents in the group so you can connect with them later.  These are excellent ways to find referrals to various professionals in your community as well.

Excellent nutrition is an essential part of your recovery.  A varied diet, rich in fruits and vegetables, will help your body to heal.  Plan meals and snacks ahead of time.  Be sure to eat at regular intervals (you may need a reminder system).  Schedule your friends and family to prepare and deliver your favorite meals once a week for 2 or 3 weeks.

And, most importantly, seriously consider this question: How are you going to take care of yourself after the baby is born? What steps will you take now to have the care and resources you will need?

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Causes
The actual causes of postpartum depression remain unknown, but it is thought that a combination of genetic, hormonal, and environmental influences may contribute.  Although the "postpartum period" is most commonly defined as the first six weeks after a baby is born, postpartum depression can occur anytime within the first year after a baby is born.  Treatment of postpartum depression can be complicated by many factors--most commonly, new moms don't realize what is happening or they are not sure where to go for help.  In addition, sometimes new moms are reluctant to take medication for depression and may be unaware that other modalities are available.

Treatment
Untreated postpartum depression has documented effects on both mom and baby.  If you suspect you, your partner, or a friend has postpartum depression, run, don't walk, to get help.  There is certainly effective treatment available. Both pregnant and breastfeeding women can safely take certain antidepressant medications while under the care of a physician or midwife. Therapists trained in the treatment of PPD are also available. In addition, the body of research supporting alternative therapies is growing.

Evidence:Complementary Therapy
A new book on complementary therapies for the postpartum has recently been published.  It was researched and written by Kathleen Kendall Tackett, PhD, IBCLC, health psychologist and a leading breastfeeding and women's health researcher.

In Clinics in Human Lactation, she compiles the most up-to-date research on non-pharmacological treatments for depression in new moms.  This book provides probably the most comprehensive evidence-basis for use of complementary therapy in postpartum mood disorders.

Among other therapies, Dr. Kendall-Tacket looks at the evidence for:

• light therapy
• Omega- 3s
• Exercise
• Psychotherapy
• Social Support

The Role of Social Support in the Prevention of PPD
The benefits of social support have not been studied; however,lack of social support for new moms has been demonstrated to be one of the significant contributors to the development of postpartum depression and mood disorders after the baby is born.   This is not to say that not knowing many people causes postpartum depression--what it does mean is that there are steps you can take before the baby is born to decrease the likelihood of developing a depression.   And all new moms need a support system, whether or not they have any risk factors for PPD.

In most cultures, new moms automatically receive loving, nurturing care from community members and relatives and are temporarily released from their usual duties at home and work.  (Read more on how new moms are honored in cultures outside of the U.S. here.)  In the US, however, many women expect to be able to cook, clean, do laundry, run errands, learn to care for a new baby, learn to breastfeed, entertain relatives & friends, and become a new mother--all within a few days of giving birth! 

The Postpartum Plan
The reality of motherhood can be very different than expected and this sometimes comes as a surprise.  Making a postpartum plan, that includes support, can be very helpful. 

Organizing friends and family is an essential task before the baby is born--especially for the fist few months.  Have people drop by, according to a schedule, with prepared meals, to clean up dishes, and care for your precious newborn while you rest or get some fresh air.  If possible, ask a good friend or family member to organize it for you.  Having an understanding friend who is also a mom to talk to (while in your bathrobe & PJs) can be a great help to a new mom.  You might want to consider hiring help, in the form of a postpartum doula.  She can focus on you, answer questions about baby care, prepare meals, clean up, and run errands.  Most importantly, she can listen and be a nonjudgemental supportive presence ready to support you as you become a new mother. 

Chittenden County Resources

Eastern View Integrative Medicine
Therapists specializing in birth trauma, perinatal emotional health, and more.

Sandra Wood, CNM, PMHNP
Experienced nurse-midwife and psychiatric nurse practitioner specializing in perinatal emotional health & women's health.

http://www.findandgoseek.net/
Online calendar of events and resources for families in VT

Mama Says-listserve on Yahoo aimed at Central VT mamas

GreenMountainMoms listserve

La Leche League is a great resource for breastfeeding moms.

Burlington Moms
MeetUp group for Moms & Dads of newborn to five-year-olds

If you like coffee, herbal tea and meeting moms, try the very child-friendly and mom-owned Viva Expresso in the old north end of Burlington. 

Bebop Baby Shop in Essex is now holding various classes and groups for families. 

And don't forget our MamaDoula classes and workshops as well.

Know of some great mom resources?  Please leave a comment!

For all you new adoptive families, here is a list I compiled for your post-adoption guests:

1.  Let me hold my baby or older child-please do not encourage him or her to sit in your lap.  We know you want to hold our precious liltle one, but this is a time when we need to be learning how to be a family.
2.  Do for me all the things recommended in the Postpartum Guest List (except offer to hold my baby or older child)
3.  Recognize that my child or children are probably highly overstimulated and are most likely not needing new toys, physical rough-housing, or general excitement at this time.
4.  Keep your visit short, but know that we truly appreciate your love and support
5. Listen!  Offer your congratulations and support!