Progress Needed for Postpartum: Part II
In Part I of Progress Needed for Postpartum, I talked about what’s missing in postpartum care for new parents and how it can impact mental health ranging from the baby blues to postpartum depression, anxiety, and postpartum psychosis. So now we know what those diagnosis can mean and how important they are to treat, now lets discuss the treatment and self care.
Self Care
Self care means something different to everyone. Different people need different things or rituals to recharge. But, do you think manicures, bubble baths, and paper face masks do much when actually caring for ones self? I don’t.
It is hard to be the caregiver of the family. The caregivers often feel guilty when it comes to caring for themselves. Whether that means spending money on themselves or taking true time away for themselves. Have any other moms had these two thoughts simultaneously: I want a break, I want to get away from my kids and family, BUT ALSO, I will miss my kids and family and don’t want to leave them and I’ll come back to a mess anyway? We want it all and want nothing at the same time, amiright?
Everyone’s version of self care is different. That makes sense. Everyone has different needs, different priorities, different love languages. When I polled my instagram, what does your ideal self care look like…
https://www.instagram.com/mental.mommy.nurse/
Self-Care Awareness
A lot of moms responded with “alone time”. Whether that be alone to read and eat in peace, alone to take a nap, alone to watch Bravo (yesss, my people!), or even alone to go to an appointment without having to tote the kids with them and alone to get a haircut. A haircut. Seems so simple, like such a basic need, easy task right? Nope, not for many women. Depending on where you go, you may have to book an appointment several weeks in advance, you definitely cannot even move your head at certain times to watch your kid, let alone chase them around a salon. And depending on what services or transformation you are getting it can take a couple of hours. I can see why having the time and space to get that done alone is self care.
I got a really great response that I think will speak to so many women. To not focus on the way you look and focus on the way you feel. She said she “used to believe self care was just about making you feel/look good”, but now for her, “self care is therapy, getting annual checks ups, and time out with the girls”.
Therapy is Cool.
This is is important. I know for myself, and I am sure soooo many of you out there, one of your main goals and focus was getting that pre-baby body back. Getting off the baby weight. Some people breastfeed, take baby on walks, exercise a bit, and the snapback is on point!… for many of us, that is not the case.
You might think to take care of yourself after a baby is to diet, gotta get to the gym or do those home workouts on your maternity leave because you have got to get out of these maternity clothes. You don’t want to look like you “let yourself go”. This can be a dagger to mental health. And the pressure we put on ourselves is just asking for low self esteem, comparison depression, and disappointment. For some, getting out of the house, again, alone time, and getting to the gym and working off the stress of the day and maybe getting back into their routine is their ideal self care. That’s amazing. I wish I was one of those people.
It’s all about the motivation. What is your goal? I have read that if you are only exercising to lose weight, you will never stick with it. Because exercise alone seldom helps you lose much weight anyway. But if you are exercising for the mental stress relief, to get stronger, to get off you diabetes medication, etc, then power to you!
Now this next response, this is from the enlightened. The women that have already started to do their soul some good. Self care is setting boundaries. Yes. How many times a week do you say yes when you wanted to say no? Did you answer that phone call when you were finally about to lay down for a nap? How many times did you cross your own intuition because you didn’t want to be rude? How about me? I should have told my husband I need HIS help after Kylie was born, I NEED to be comfortable in my own home, and although he is trying to be helpful, that is not the help I need, you are hurting more that helping. Be clear. It’s something I definitely need to work on, so I can’t really give much advice. But I think it’s great that people are doing the soul work and taking charge of their life and their peace.
Is this Really Self Care?
Lets poke holes in the examples of common jokes of mom “self care”:
Bubble bath: How many people have a large enough tub to actually fit all the way in and under and are able to relax and not have to hold your head above water? That might just be me. Also, where are these kids and/or new baby at while you are taking a bubble bath long enough to actually wind down? Who has to clean the tub after you use it?
At home spa services like exfoliation, face masks, amazing smelling lotions: First and foremost, if you have the time and budget, these at home skin care items should be just that, skin care. That should be a given, especially as we women age. What mom chores/household duties are you running around doing while you have this face mask on baking on your face?
Manicures and pedicures: Ok, this one might actually be nice for a lot of people. You get out of the house, and hopefully some time to yourself or with your friends. The reason I put it in the “this isn’t self care” category is because it seems more like a band aid or a Tylenol. It helps a bit in the right now. It can be a nice break and fun, but if you are dealing with thoughts of depression and anxiety it’s often not even close to enough.
Like I said, self care is different for every person and every new mom. But when you are struggling with the dark monster that is postpartum depression and her bitch ass sister, postpartum anxiety, two hours of babysitting services to go get a pedicure isn’t going to cut it. You should be making changes and getting interventions that help treat this disease and keep you and your family safe. And you can’t do it all yourself. Read it again. This isn’t the time to rely on self. It is hard to ask for help. That’s one reason I hope education on postpartum care reaches far and wide. If it the signs, symptoms, and interventions for PPD/PPA was more common knowledge and reinforced to spouses and partners, to extended family and friends, maybe women wouldn’t have to reply on self.
It Is Not a Bad Mood
And yes, postpartum depression and anxiety are diseases. It is not just a bad mood, lack of sleep crankiness, hormonal changes, or a sign of weakness. And that goes for all mental illnesses.
One of my favorite quotes come from the wise and caring Professor Dumbledore, Headmaster of Hogwarts School for Wizards and Witches. And if you don’t know who that is, I highly recommend reading the Harry Potters series or at least watching the movies. I’m not a big reader, but I do agree, the books are better. Ok, back on task: the quote. Towards the end of the last book, when Harry is on the precipice of defeating He who shall not be named, he is in an unconscious sort of place and says “Tell me one last thing,” said Harry. “Is this real? Or has this been happening inside my head?”. And wise Dumbledore replies, “Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”. Boom. Mic drop moment. This is something we all need to learn. I myself read this quote all the time, to remind myself not to feel guilty, weird, or crazy for my symptoms of mental illness and the treatment it involves.
Mental Health is Health
It. Is. A. Disease. We would never question someones medications or treatments for diabetes. We would never question someone for making lifestyle changes and self care for diabetes like exercise and diet. Yet, when it is a disease of the brain, for some reason we don’t respect it.
One HUGE step towards self care for a mom battling depression and/or anxiety is therapy. Really, this is a necessary self care step for everyone. But it is that, it is a pretty big step. It can be a difficult step that seems very steep. But I will tell you from experience, it is necessary to really work through your disease to actually heal.
I am not naive to the fact that there are barriers to starting therapy.
Barriers to Mental Health Care
Cost: Even with insurance, it still usually at least comes with a co-pay. And when you are in the thick of a mental health disease, many people need therapy multiple times a month. So that cost can add up. Also, disgustingly, many mental health services do not have very good coverage on many health insurance plans. And just like not all OB care is equal, not all mental health services are equal. Many providers that work through county services or low cost affiliates might not be as experienced or might not have the availability as I am sure they are inundated with need.
Availability: I myself had a hard journey finding a therapist that was in network and accepting new patients, and that was before March 2020. Per the WHO, after the first year of the pandemic, the prevalence of anxiety and depression increased 25%.
Stigma: This is huge. Even in an unconscious way, so many people deny the need for therapy even if they think it would be “ok for others, but just not for me”, for example. Then, when you get so deep into a mental health disease and the process just finding a provider and calling to make an appointment can be an almost impossible task.
A great resource to find a therapist and/or medication management provider, one I used myself, is psychologytoday.com. Right on the homepage, there is a searcher for “find a therapist”. You can filter your results with so many different criteria: location, accepting new patients*, insurance accepted, gender, race, specialty areas, etc.
- just an FYI, even when filtering by new patients accepted, I have found that is not always up to date.
When you get your search results, you can read bio information, education, areas of interest, types of therapy offered, and more. If you’re like me this can be a blessing and a curse.
My Journey to Therapy
Oh God… journey. I sound like a tool.
When I was searching for a therapist, I read at least 100 different providers bios and judged them harshly. It took me so long to even admit I needed help and then get to the point where I was actually going to try to make an appointment. So once I was there a ready to find someone, I wanted someone perfect. So when I found a few options that seemed to be that great match and called them to make an appointment and was told, oh I am sorry, she isn’t taking new patients right now, I literally had a breakdown. It was crushing. It felt like I had done all this work, I am finally ready to admit I need help, I took so much thought and time, and now I can’t see this person.
So, back to the drawing board. I went through the process again, found another option that seemed equally as perfect and nope. Not taking new patients at this time. I might have even started to cry when I was on the phone with whoever answered the phone in the office. Thankfully, it was a caring soul on the other end of the line. She said she would reach out to the therapist that I was trying to see, and see who she would recommend, knowing I was looking for someone like her. I was so thankful when I got an email directly from that therapist with a list of recommendations.
I was able to search on psychologytoday.com by name and see if anyone out of the list seemed to fit the bill. Then, I reached out to yet another therapist and guess what? Wasn’t taking new clients. BUT… she said she would have some availability in January. I don’t remember exactly when this was, but it wasn’t too long. Maybe it was October or November, so January was doable. After all I had been through just to find someone to see, I couldn’t do that anymore. Having someone to see checked off the to-do list was such a triumph.
Trained Professional
A therapist is someone trained to help you with your problems. A friend or family member can be a helpful sounding board and even give great advice. But a therapist is trained to give you the right advice. They are even trained how to listen to you the right way. Also, the fact that they are neutral in your life, with no preconceived knowledge about your situation, your husband, your friends and legally couldn’t tell those people in your life your deepest and darkest thoughts is important. It can create a safe space. And you need to be able to get your thoughts and fears out to heal.
Medication
Another important component of healing and care when you have been diagnosed with PPD usually involves medication. Starting medication can be scary for some people. That said, would you judge someone for taking albuterol and steroids for their asthma? Then we shouldn’t judge someone or be scared of judgement for taking Zoloft or Klonopin.
“But I took Zoloft once, and it didn’t help”
I won’t get too deep into all the different classes and brands of medication for mental diseases, but it’s important to know and expect that after you give birth, if you experience PPD or PPA, medication will more than likely be prescribed for you. And you need to know that if the first medication prescribed to you doesn’t work, that is ok. The next things might, or it might not. Then you keep working with your provider and try something else.
A huge piece of advice I can give is you might need to change your care medication management and to a trained mental health provider (psychiatrist, psych NP, psych PA). ESPECIALLY if your OB or primary care provider prescribes a medicine that you don’t feel like is effective and need to try another one.
Another essential component when taking these medications, well, really most medications, do NOT stop them when you feel better. So many patients do this with all sorts of prescriptions. Their blood pressure is lower, so they stop their BP medication. Guess what happens? Their blood pressure goes back up. Same with these medicines. Do not stop a prescription when you start feeling more like yourself, especially because you feel some type of way taking a medication labeled for psychiatric disorders. After discussion with your provider, when some time has passed, you may decide together to lower the dose and see how you feel. But, unless you’re having some terrible side effects that just don’t seem worth the benefit, don’t be in a rush to get off these things. They help so many people.
Alternative treatments
In many cultures, societies, even within families, mental illness is highly misunderstood. And as a result, well meaning people in your life may think it’s something that just takes willpower and “mind over matter”. Well, if your mind (brain) isn’t functioning properly and the neurotransmitters aren’t in balance and your synapse connections are short circuiting, then how is that mind supposed to fix itself?
Some naturopathic and other interventions you can do for yourself can help:
Prayer. That’s a big one. MANY cultures believe if you pray and talk to God, you can get through this tough time. Having faith and purpose definitely helps. Keeping your grounded, keeping you tied to your purpose in this world, helping you feel less lonely. But do not let that make you think, you can pray this away. If you are to the point of clinical depression, PPD, PPA, other thoughts of self harm, etc, you need more than prayer.
Sunshine. Low levels of vitamin D is proven to effect our mood and many bodily processes. So adding in a vitamin D supplement and getting outside in sunshine and fresh air is something we all should be doing to help a bad day turn around.
Supplements. You need to be careful with these. Many people don’t know that there are toxic levels of certain vitamins in our bodies, and some supplements adversely interact with prescription medication. Consulting with your doctor or someone well trained in this field would be very useful. Functional medicine doctors are practitioners that believe in and lean towards more alternative treatments and eastern medicine. The supplements (that I know of) that can helpful range from vitamin B and vitamin D to help with mood and energy, to lesser known L-theanine which is reported to help anxiety. I have also read if can help with focus for those with ADHD.
Other than vitamin D, one supplement I take is a methylated form of folate. I have the MTHFR gene mutation, which can many effects on your body, but one is that you tend to not absorb medications well. Taking methylated versions of supplements are supposed to make them increase the bioavailability of medications you take. This was actually prescribed by my doctor, but she even said that the version you can buy on amazon is about the same thing, as long as you are researching and getting a high quality product.
Stay Tuned for Part III
I think that’s plenty to absorb for part II. Please share with a friend or family member who might find this information helpful. Next, I will be focusing on postpartum care in the United States and how it compares to other parts of the world. Along with that, how the quality of care for minority women in the postpartum period is severely lacking. Follow my IG page, mental.mommy.nurse, so you see posts that link to blog articles and polls that I use for blog research.
