I never learned to appreciate the delicacies of language until I became a mom. I knew from my education and experience that kids are like sponges; they soak up everything. Though of course, unlike sponges, you can’t remove what has been soaked up no matter how hard you try. My oldest son turned 3 this summer and as his vocabulary and cognitive abilities continue to grow at an exponential rate, I am frequently amused by what comes out of his mouth. Here his top ten (so far) little gems.
10. “I’m okay!”
The boys were being wild after their bath one night, playing with my husband and bouncing on the bed. All of a sudden my son goes flying off the bed in an ungraceful mess of arms and legs on to the pillows below and promptly bounces up with a smile on his face and yells this. I immediately started laughing picturing a scene from movie of a college frat party with a drunken person flopping over and trying to cover up for the faux-pas.
9. “Mommy, I have a problem.”
As I’m making dinner, I hear this from the living room in a very matter-of-fact tone. Absent any screaming or crying, I was both curious and terrified to reply (my first thought was something involving poop as I am sure is the thought of most mothers) My knee jerk response was “so what’s your problem?” It was the tone of my response that topped the entire conversation off because my response came out in a way that to any reasonable adult would have sounded quite snotty. I was struck by a mix of amusement and feeling bad about how I replied to him. Luckily he was simply out of juice.
8. “Piggy says ‘arf arf’”
The first time I heard this, I knew we’d have a problem when he goes to school. You see, I work with a dog rescue and one of our beloved pups’ nicknames is “Piggy” due to his frequent rooting for food and ability to impersonate a garbage disposal by consuming nearly anything remotely edible without chewing. We were reading a book about farm animals and when we got to page about the pig and what sound does a pig make, he pointed to the fat pink animal and said “That’s not a piggy, but Piggy says arf arf.”
7. “Poppy’s name is “Hey Babe.”
Yes, my son thought my husband’s actual name was “Hey Babe.” We discovered this last spring when I told my son to tell Poppy that it was dinner time. He promptly walked to the door, opened it up and yelled outside as loud as he can, “Hey Babe, time to eat!” Of course not only was it amusing to discover that he actually thought this was my husband’s name, but hearing this little 3 year old boy yell “Hey Babe” to his father was priceless. Luckily we’ve been able to explain to him that much as I call him by his nickname “Bear,” I call Poppy by a nickname as well, (though for a period of time if you asked him “what’s Poppy’s name” he would reply with this.
6. “Where is Grammy’s new Tom-Tom?”
No this statement isn’t innately funny. What’s funny about this is that he said it in front of Grammy on Christmas morning as we were getting the presents from Santa out from under the tree and passing them to the appropriate recipient. I guess I should have explained that whole “wrapping so it’s a surprise” thing to him while we were wrapping.
5. “You’re going to get such a chicken!”
Unfortunately, this didn’t mean that I was getting live chickens or prepared meat. This was his attempt at parroting a quote from “Phineas and Ferb”, albeit slightly incorrectly. The statement was supposed to be “You’re going to get such a chickening,” (as said by Dr. Doofenschmirtz to Perry the Platypus while describing how his Chickeninator will turn anything it hits into chickens, since chickens are inherently funny.) Needless to say, the silly look and giggling that came from him before, during, and after the statement was the icing on the cake.
4. “Brother FARTED! Ha-ha-ha-ha!”
I never understood why farts were funny…until I had boys. My husband’s family is full of gas, and the men have no shame when it comes to letting it go, at least in the confines of home. The first time my son heard and acknowledged a fart, he broke out in hysterical laughter and asked what that noise was. After a brief explanation he demanded to hear it again, and pointed and laughed. Take this as fair warning; anyone who breaks wind within earshot of him will be swiftly identified…loudly…with ensuing laughter from both he and his little brother (who laughs at anything his older brother laughs at.)
3. “Don’t forget my baby nuts!”
This priceless statement was unleashed on my mother when she had him at the park one day last spring. She realized he had pooped as she was getting him out of the car. She decided to lay him down in the back of the SUV so she could change him. Much to her shock and dismay, he announces this at the top of his lungs as she is wiping him up. I’m not sure what was more hilarious, the fact that he said this, or the fact that he said it to my mother….in public. (As a side note, we do use the proper terms for body parts, though my husband has occasionally used the term nuts when referring to his testicles after having them accidentally squashed or smashed by the kids…and it would be somewhat insensitive of me to correct his language in the midst of the excruciating pain. Obviously the amusement of the word and the situation has stuck in my son’s head more than the word “testicles” and for what it’s worth, at 3, that’s a pretty difficult word to pronounce.)
2. “Poppy, you are dickless!”
Again, this is one of those “is it context or the statement that’s more amusing?” It’s a tossup in my book. My husband was being silly while playing with the kids and had used the word “ridiculous.” Little did we know that it would be repeated as “dickless” by a 3 year old.
1. Using the “F-Word” correctly, complete with appropriate context and tone.
I’ll be honest, both my husband and I have mouths like sailors and initially, it was quite challenging to modify our language appropriately. We both work with the public and are often confined to being polite for the sake of “customer service” so home was a sort of sanctuary from the censorship that work required. Unfortunately, we were a little late on this and one day my son was mystified by some intricate toy that he couldn’t get to work properly and exclaimed “what the f***?!” The kicker was, it wasn’t in a mad tone, it was in an “I’m baffled” tone, so when we initially heard it, my husband and I looked at one another to see if we actually heard what we thought we heard. As he has gotten older we are better with our language, and have explained to him that sometimes adults say words that aren’t appropriate to say. Of course this lesson has gone to the extreme (as does nearly everything with a toddler) and anytime we slip up, he immediately scolds us.
What kinds of things have your kids said that made you laugh, cry, or wish you had a hole to hide in?
As a long time college student, I’ve spent much of my adult life writing all sorts of things from creative pieces, to literature reviews, to research papers. With the explosion of the internet and various blogs, I always thought it would be great to have a blog, but I wondered who would read it. When I became a contributor for The Birthing Site, I was given a voice and my creativity finally met my academic prowess. TBS has given me an opportunity to expand my writing to a cause that is near and dear to my heart while still being able to infuse a bit of myself into my articles.
When I was told that I was going to have blog space on TBS, I was ecstatic. Here was an established audience who also may know my work! Excitement turned to terror when I realized that if I were to write a blog, it was going to need to live up to all that TBS represents. I was back to wondering what in the world I would blog about.
After a few weeks of contemplation, I decided that since as a contributor for TBS I have a place to provide informative and helpful articles related to pregnancy, birth and motherhood, I would use my blog for more personal accounts of my experience of these things. For the most part I try to keep my opinions out of my articles for TBS, though as a contributor my opinions are obviously in line with TBS’ mission of brining birth and motherhood back into the hands of mothers from a naturalistic perspective. My intent for my blog will be to bring my experience into some of these topics a bit more and perhaps supplement some of the informative articles with a more raw and experiential perspective.
So who am I anyways? I am an almost 30 year old mother of 2 boys who are 18 months apart (though I occasionally tease my husband and count him as a “third”). My oldest turned 3 in August and my youngest will be 2 in February. I am still nursing my youngest and don’t know when he will wean, (I would love to have him keep nursing though this not sleeping through the night thing is a bit of a challenge sometimes.) I am currently in grad school pursuing a M.S. in Mental Health Counseling and I’m currently an intern at a local non-profit clinic where I have my own caseload of clients. I am on staff with a dog rescue that primarily saves pit bulls, and I have 3 of my own rescued knuckleheads…er…pups. I have worked in retail since I got my first job at 16, and spent most of my 20’s working full time and going to school full time (and was pregnant with #1 in there too!) I stopped working when my second son was born because even if I had worked full time, it wouldn’t be enough to pay for daycare for both kids.
I spent nearly a year as a full time SAHM. I decided to go back to school because I wanted more for my kids, and my wonderful husband has been nothing but supportive the entire time. I love being a SAHM, though I must admit that school is a wonderful “getaway” that gives me some adult time, and an excuse to take a shower. I never truly understood the blessing of a daily shower until I had two small children and a husband who was gone 12 hours a day at work.
I can’t promise you will find my blog to be the most riveting you’ve ever read (though I can dream can’t I?) What you will find is honesty, humor, and a realistic perspective on some of the most important experiences that we have in common; pregnancy, birth, and motherhood. Thanks for checking me out!
To Flu Shot or Not?
It’s that time of year again. Pharmacies, OB/GYNs, PCPs, and everyone in between is trying to convince you to get the flu shot to “protect your health.” Sure, nobody wants to get the flu, but before you get stuck (or not), make sure you do some checking into whether or not it’s necessary for you. While it will become clear what my opinion is, my opinion is my own, based on my research, reading, and knowledge. I don’t expect everyone to make the same decision I do, but I hope that whatever decision you make, you do so because you feel it is the right one for you and your baby, regardless of ANYONE’S opinion!
But if I get the flu shot, I won’t get the flu, right?
Maybe, maybe not. Getting the vaccine is not a guarantee that you won’t get the flu. If you get the flu shot, you are theoretically protected from a few strains of the flu, but not all of them. There are only a few viruses used in the production of the seasonal vaccine each year, but there is no way to know how many strains are circulating at any given time, (it could be dozens, hundreds, or thousands.) Even the CDC admits that getting the vaccine is no guarantee against getting sick.
The CDC says it’s safe. Isn’t some protection better than none at all?
The word “safe” is apparently subjective. The CDC recommends that all pregnant women get the vaccine, presumably because the immune system of a pregnant woman is “compromised” because her body is so busy making a baby. The thought makes sense, but here’s the kicker: the insert that is found in the packaging of the flu vaccine (detailed information required by law to be in the package) explicitly states that “Safety and effectiveness has not been established in pregnant and nursing women, and children under 4.” Really. Click the link to read the FluVirin insert (a common one used by doctor’s offices and pharmacies.)
There is also mercury in the multi-dose forms of the vaccine (used in doctor’s offices), which, as you may recall, is something that your OB or midwife warned you to watch your intake of by limiting the amount of fish you ate. In fact, it would probably be safer to eat fish (low levels of naturally occurring mercury that your body may already be used to processing through digestion) rather than have mercury injected into your arm and sent directly to your bloodstream and, of course, to your placenta and developing baby. If you do chose to get the vaccine, request a single dose (these do not contain mercury.)
But if I get the flu, isn’t there an increased risk of complication for me and my baby?
Hopefully you can predict my answer to this one. Your immune system may be compromised, but it’s not completely shut down. It is possible that you may be more susceptible to developing anything that is highly contagious while pregnant, but that doesn’t mean you should walk around in a bubble for 9 months. If you get a nasty strain, you might be a little bit more miserable while you are sick than you would have been had you not been pregnant. But pregnancy does not mean that your life will be in imminent danger if you get the flu. As Dr. Sears discusses in this video, in a study of 50,000 pregnant women over 5 years, of the women that caught the flu, only 9 were hospitalized and not a single one of them died or had any complications with their pregnancy, and all of their babies were fine.
Is there any research that supports the flu shot’s safety?
Research is bound by ethical guidelines, one of which restricts researchers from using subjects that may be at risk. Pregnant women are one of them, and essentially a liability. For this reason, there is virtually no empirical research that focuses on pregnant women and the safety of the flu shot. Think about it: do you want to use your baby as a research subject? What if your baby were harmed, or worse, died because of this research? The only way we will have any data about the assumed safety will be years down the line when researchers do meta-analysis by looking at statistics. The results of this will still be skewed because there are so many other factors involved that put people “at risk” for anything that it will be hard to make an unbiased judgment about the safety of the flu vaccine during pregnancy.
If I don’t get the shot, then won’t my baby be at risk of getting the flu since she can’t be vaccinated until 6 months?
If you plan to breastfeed, your breast milk will provide some immunity from the flu, as well as the other complications (pneumonia being one of them) to your newborn. Even if you are not breastfeeding, as mentioned above, the safety of the flu shot has not been tested on children under 4 years old, even though the CDC recommends that all children above 6 months of age receive the shot. The best way to protect your baby from getting the flu is breastfeeding and keeping her relatively free from interacting with people you know are sick. If your baby does get extremely fussy and starts having symptoms of being sick, take her to the pediatrician immediately.
Furthermore, there are a number of reports, articles, and discussions about other serious dangers of the vaccine, including the thought that it actually made people more susceptible to getting the flu, and that it increased risk to the unborn child.
As with everything I write about, I’m passionate and opinionated. But above all, I’m encouraging you to consider what I said here and go out and do more research. The best decision you can make for yourself (and your baby) is an informed decision.
Active labor is often when it really hits home that the arrival of your baby is just around the corner. There are a number of physical, emotional, and mental changes that occur during active labor. If you know what to expect in terms of the physical aspects, you may find it easier to cope with the experience once you are in active labor. This article will help you understand some of the more detailed physical changes that take place during this time, as well as offer some insight about what you may experience emotionally. No amount of stories and descriptions will prepare a first time mother for the physical or emotional sensations of being in active labor; most moms I have talked to said they “had no idea it was going to be like THAT!” While it may be discouraging that you are likely going to be somewhat surprised by the experience, it may be easier you to utilize the techniques you learned in birthing classes and get into your own “zone” quickly if you know what physical changes occur during this stage. If you haven’t had a chance to read about the different stages of labor, I suggest you check out this article first.
Active labor is a phase within the dilation stage of labor. It is the second phase that begins when the cervix is between 4 and 5 centimeters dilated and will continue until around 8 or 9 centimeters. It is during this time that the cervix dilates the quickest (though that does not mean this is the quickest stage of labor.) Thus, the intensity and frequency of contractions are at the highest point during this time. Contractions typically last more than one minute and occur between 2 and 4 minutes apart. These contractions are intense and it is during this time that women begin to experience “pain.” I place pain in quotes because while it is true that many women report these contractions to be painful (and it is at this point that many women request an epidural or other pain relief,) the “pain” of contractions can be managed in many ways other than medication and is not a sign of something bad or negative, but a sign that the contractions are doing exactly what they are meant to do; open your cervix to allow your baby to be born.
In first time moms especially, this part of labor may be the longest and thus the most frustrating and discouraging. The intensity of contractions may tire the mother out, especially if she has had little sleep in the days leading up to labor. For moms who have given birth before, this time may still be intense and tiresome, but is likely to last a shorter period of time. Active labor typically lasts anywhere from 3 to 7 hours, but may be as little as 20 minutes for moms who have had previous births. If this stage lasts longer and vaginal exams show that the cervix is not dilating (or dilating very slow), a mother who is birthing in a hospital may be put on a Pitocin drip to speed things along. As with any intervention, it is important to be sure that you discuss this with your caregiver prior to labor and outline your wishes to your support person(s), care provider and their staff as soon as you arrive at the hospital/birthing center/or your care provider comes to your house (even if you have a birth plan). It is also important to know at what point it may be beneficial for the safety of your baby and you to get Pitocin. Be informed and armed with the information before you go into labor.
For mothers in this stage of labor, regardless of their birthing location, this is when it is helpful for them to get into “the zone” and utilize the coping skills learned in birthing classes such as breathing techniques and visualization. Moms often lose their appetite, sense of humor and desire little interruption so they can stay focused on working through each contraction without distraction. Fatigue may begin to set in, especially if active labor is long. A mom in active labor may not be able to articulate her needs well and may be demanding and vocal, or may be withdrawn. Even the most prepared moms may not even be able to identify what would help, so they should be supported and encouraged to do whatever they want in order to cope. Sometimes mothers adopt rituals to get through and may begin rocking, moaning, and breathing rhythmically through each contraction and resting in between.
While many may argue that this is the prep work for the most important job yet to come (the birthing/pushing stage) this stage of labor may set the stage for the rest of her birthing experience. A positive and supportive environment will help her feel comfortable, be able to rest, and feel confident in her body’s ability to birth this baby. An unsupportive and intervention ridden environment may do exactly the opposite and may result in a birth experience that is disappointing or even traumatic. Active labor is a whirlwind of emotional and physical experiences that are best left to occur naturally when possible. As always, the more you know going into the experience, the more likely you will be to have a positive experience!
Many new moms don’t know that there are more than one or two different stages of labor, especially if they haven’t been around many pregnant women in their lives. Admittedly this was the case with me and I was in for a surprise as I approached my estimated due date and began having pre-labor two weeks before I gave birth! While the different stages of labor progress in various ways, there are four stages of labor that we go through during the birth process; “pre-labor”, dilation, birthing, and placental stages. The “pre-labor” stage is not necessarily part of the “official stages” of labor in the medical community; the dilation stage is typically referred to as first stage labor.
“Pre-labor”, (also known as “false labor” though I don’t like to use that term since it implies that what happens during pre-labor is not actually helpful) is characterized by contractions that do not cause the cervix to dilate. These contractions typically are reminiscent of a strong cramp though many women experience them to be much more intense. These contractions are also known as “Braxton-Hicks.” While pre-labor contractions do not dilate the cervix significantly, they are a sign that your body is prepping for active labor. Even in late pregnancy there may be periods of time when these contractions are close together and strong, but if there is no progression (decrease in time between contractions and increase in intensity) then it is likely that you are still in pre-labor.
It is important to note that you can still have Braxton-Hicks contractions earlier on in your pregnancy, even many weeks before your estimated due date and still go on to deliver on or around your estimated due date. Mothers may experience these contractions much earlier or more frequently during second or subsequent pregnancies. Other moms may never have any Braxton-Hicks or distinctive “pre-labor” signs (including significant trouble sleeping, low intensity cramps, and soft bowel movements) in the few days before active labor begins. Every pregnancy and mother is slightly different, so don’t be concerned if you don’t notice these things.
In the weeks leading up to active labor, the mother’s cervix will slowly begin to ripen (soften), move to a more forward facing position, thin and shorten (effacement), and even dilate up to 3 or 4 centimeters. All of this is the body preparing itself for active labor, but is not necessarily a sign that active labor is eminent. Many moms report being almost completely effaced (thinning out of the cervix), and partially dilated for a couple of weeks before they went into labor while others had no dilation before they knew they were in labor. Here is a few ways to know you are going to be going into the next stage.
The next stage, which is referred to as the first stage of labor by most medical professionals, is the dilation stage. This is when the majority of dilation occurs and is characterized by contractions that are significantly more intense than those experienced in pre-labor, are closer together, and last longer. The dilation stage has three distinct phases; early, active, and transition. The difference in these is subtle though and once you are in the midst of labor, you may or may not notice your progression through these phases.
For the mother, early labor may feel similar to pre-labor except that the contractions don’t go away for a few hours and then come back. Once the mother is in early labor, contractions will begin to increase in intensity, length, and frequency (though the rate of increase may be different for many mothers.) The other primary difference between this and pre-labor is that the cervix is actively dilating. The length of time to progress through this stage depends on a number of factors; the more dilated you are when early labor begins, the more likely it is that this phase will be shorter, though it can last nearly an entire day for some women.
The active phase (also known as “active labor”) begins when the cervix is between 4 and 5 centimeters dilated and will continue until the cervix is between 8 and 9 centimeters dilated. It may last longer for first time moms (up to about 7 hours) or may be much quicker (as little as 20 minutes for moms who have already given birth. Active labor is typically when the intensity is kicked up; contractions last more than a minute and occur every 3 minutes or so. While it is important to have a solid support base during your entire labor, this is when it is critical to ensure that your support group is fully focused on you. This is also the time when many women describe getting into “the zone,” or consider the use of medications. For more on Active Labor, see this article which goes more in depth about the process both physically and mentally.
Transition is typically the last 1 to 2 centimeters of dilation and may occur quickly. The baby’s head begins to descend; contractions last up to 2 minutes with little break in between but may be slightly less intense than those in the last part of active labor. It is important to know the position of your baby as this can help position yourself for a better delivery. Many women may begin to feel the urge to push though it is advisable to make sure that your caregiver is confident that you have fully dilated before you push strongly so as not to cause the cervix to swell which could slow labor. During this phase, a mom’s body is flooded with hormones, especially adrenaline and other stress hormones. This often produces an emotional response in the mother with an overabundance of physical sensations occurring including the baby’s head moving down, contractions, cramping in her abdomen and legs, and feeling hot or cold. This surge of hormones is prepping the body to do it’s most intense and amazing job; to birth this baby! While it may be hard to feel relieved during this phase, these are all signs that the birthing stage is near and you may be holding your precious baby soon!
The Birthing Stage
The Birthing (second stage) of active labor is also known as the time to push. This stage also has three phases; resting, descent, and crowning.
The resting phase may be obvious, quick, or not noticeable at all. It will seem as though labor has stopped temporarily and serves to give the mother and uterus a quick rest before actively pushing. Some mothers report never experiencing this, and others are surprised by the brief respite. If it lasts close to a half hour, the caregiver may try to get the mom to change positions in order to give labor a jump start.
The descent phase begins as the uterus resumes contracting and the mother experiences an distinct and strong involuntary urge to push. During this phase the baby moves down, rotates through the pelvis, and eventually the head becomes visible. The urge to push lasts anywhere from 4-8 seconds and is virtually uncontrollable for the mother. Breathing in at the beginning of the urge and breathing out through the urge is the most productive and healthy way to breathe and push at the same time.
Once the baby’s head is visible at the vaginal opening and does not disappear after the urge to push is gone, the last phase of the birthing stage has arrived. This is when the baby is actually born. This phase usually takes only a few of contractions and will not last long. The mother may experience the “ring of fire” or the burning sensation as the baby’s head begins to exit through the vagina. It is important for her to tune into her body and listen to her caregivers to protect her perineum and vaginal tissues as best as possible. Pushing out the baby too quickly may result in a tear. Slow gentle pushes will still be productive to birth her baby, and are a good way to help her protect her tissues from damage.
The third and final stage is the placental stage, and usually lasts between 15 and 30 minutes. The placenta detaches from the uterine wall as the uterus begins contracting to expel it. After the baby is born and has been checked, the mother will be asked to give a few pushes to complete the expulsion of the placenta. Some women even report that the soft warm feeling of the placenta coming out is soothing.
Simkin, P. (2008) The Birth Partner. The Harvard Common Press: Boston, MA.
In 2010, President Obama signed into law the Affordable Care Act (originally began by President Clinton in 1997 and set the stage for a “Consumer’s Bill of Rights”) which gave American citizens more control over their health care and required insurance companies to guarantee access to free or low cost preventative care including pre-natal and new baby care.
Perhaps one of the most profound and legally upheld rights for American women is the right to accept or refuse any care that is offered to her at any point in her pregnancy, labor, delivery, or postpartum period. This right is often diminished by health care professionals who think (and are trusted by women) as knowing “what’s best.” While I’m not here to bash the American medical system, there is an overwhelming assumption by many people that “doctors know best.” This is an assumption that has pervaded our daily lives with advertisements for cure-all pills, and encouraged us to leave our health to the professionals because we simply can’t be bothered, and after all, that’s their specialty right?
The fact is, when it comes to pregnancy and birthing, we survived for thousands of years without epidurals, vaginal exams to check for dilation, and constant fetal monitoring. Babies were born (and yes more often than not they survived or we wouldn’t be here today) to mothers who were surrounded by groups of other supportive women who shared their knowledge and experience of birthing in ways that supported and encouraged mothers. The introduction of medical interventions was a worthy cause; “let’s try to save the mothers and babies that are at risk.” But this glimmer of hope for some mothers and babies snowballed into a medical profession obsessed with “managing and reducing risk” which in some ways has arguably increased the risk to mama’s with normal, low-risk pregnancies.
I’m not suggesting that a first time mother with little or no exposure to pregnancy and birthing attempt an unassisted home-birth. What I’m suggesting though is that this mama be encouraged to read, research, and ask questions. Most OB appointments are 15 minutes and consist of a check of vitals for mom and baby, and a few minutes to ask the questions you can’t remember. Most appointments with a midwife are much more intimate, with the opportunity to talk to them about any and every issue you need to, and receive information to help inform your pregnancy and birthing decisions.
After an exhaustive search for an official listing of patient rights, I found this list at The Childbirth Connection. It is a comprehensive list of what is a reasonable expectation of maternity patient’s rights. Those with one asterisk are rights that are legally entitled to women in the U.S.A. Rights with two asterisks do not have specific laws, but according to Childbirth Connection (and based on past legal cases) would likely be upheld in a court of law.
- Every woman has the right to health care before, during and after pregnancy and childbirth.
- Every woman and infant has the right to receive care that is consistent with current scientific evidence about benefits and risks.* Practices that have been found to be safe and beneficial should be used when indicated. Harmful, ineffective or unnecessary practices should be avoided. Unproven interventions should be used only in the context of research to evaluate their effects.
- Every woman has the right to choose a midwife or a physician as her maternity care provider. Both caregivers skilled in normal childbearing and caregivers skilled in complications are needed to ensure quality care for all.
- Every woman has the right to choose her birth setting from the full range of safe options available in her community, on the basis of complete, objective information about benefits, risks and costs of these options.*
- Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of caregivers, with whom she can establish a relationship. Every woman has the right to leave her maternity caregiver and select another if she becomes dissatisfied with her care.* (Only second sentence is a legal right.)
- Every woman has the right to information about the professional identity and qualifications of those involved with her care, and to know when those involved are trainees.*
- Every woman has the right to communicate with caregivers and receive all care in privacy, which may involve excluding nonessential personnel. She also has the right to have all personal information treated according to standards of confidentiality.*
- Every woman has the right to receive maternity care that identifies and addresses social and behavioral factors that affect her health and that of her baby.** She should receive information to help her take the best care of herself and her baby and have access to social services and behavioral change programs that could contribute to their health.
- Every woman has the right to full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention.* She should receive this information about all interventions that are likely to be offered during labor and birth well before the onset of labor.
- Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind.* (Please note that this established legal right has been challenged in a number of recent cases.)
- Every woman has the right to be informed if her caregivers wish to enroll her or her infant in a research study. She should receive full information about all known and possible benefits and risks of participation; and she has the right to decide whether to participate, free from coercion and without negative consequences.*
- Every woman has the right to unrestricted access to all available records about her pregnancy, labor, birth, postpartum care and infant; to obtain a full copy of these records; and to receive help in understanding them, if necessary.*
- Every woman has the right to receive maternity care that is appropriate to her cultural and religious background, and to receive information in a language in which she can communicate.*
- Every woman has the right to have family members and friends of her choice present during all aspects of her maternity care.**
- Every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support.**
- Every woman has the right to receive full advance information about risks and benefits of all reasonably available methods for relieving pain during labor and birth, including methods that do not require the use of drugs. She has the right to choose which methods will be used and to change her mind at any time.*
- Every woman has the right to freedom of movement during labor, unencumbered by tubes, wires or other apparatus. She also has the right to give birth in the position of her choice.*
- Every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.**
- Every woman has the right to receive complete information about the benefits of breastfeeding well in advance of labor, to refuse supplemental bottles and other actions that interfere with breastfeeding, and to have access to skilled lactation support for as long as she chooses to breastfeed.**
- Every woman has the right to decide collaboratively with caregivers when she and her baby will leave the birth site for home, based on their conditions and circumstances.**
While many women would assume that these are her rights, others may not realize that they have the freedom to refuse a procedure, refuse to allow vaginal exams to check dilation, or get all of the necessary information before making a decision about anything. In the throes of active labor, it can be hard to stop and say “Wait, I want proof that this is necessary and safe,” which is often why women are unsatisfied with their birth experience—they felt as though they no longer had a choice because it was implied that their baby’s life was at risk. When we are vulnerable and unable to properly assess a situation, our first instinct is to survive and ensure the survival of our child. If someone who supposedly knows what they are talking about is telling you that something is “necessary,” it is difficult to ask why or say no.
So how do we protect our rights to ensure that we are not only working with an informed and up-to-date provider, but if an unexpected circumstance arises we can make the best choice? Simple: inform, support, and empower yourself. Challenge your care provider with tough questions about inductions, c-sections, fetal monitoring and epidurals. Ask what their views are and when they feel these things are necessary, and do this long before your estimated due date is approaching. If you don’t like their answer, consider getting a second, third, or fourth opinion, and even consider switching providers. Birthing your baby in the safest way for you and your baby is your responsibility. Hire a doula, reach out to like minded moms, read books, Facebook pages, and blogs. Conduct your own research.
The more informed you and your support team are before labor starts, the more likely you are to have the birth you want. While not every birth goes according to plan, taking charge of the plan is the best way to ensure that if an unexpected decision needs to be made, you will feel confident in your ability (and that of your support team) to make the right choice without being left to wonder “is this really necessary.”
In quantum mechanics (physics), there is a principle known as Heisenberg’s Uncertainty Principle. It states that when observing sub-atomic particles, “the more precisely the position is determined, the less precisely the momentum is known in this instant.” In simple terms, you can’t know everything about what you are observing because the world you are observing is always changing. Once you try to precisely measure something, it is no longer the exact same something you were measuring a moment ago. While Heisenberg was speaking about particles that make up atoms, he argued that the idea of uncertainty could have much larger implications on the macroscopic world. He applied this to nature as well and argued that we can predict the probable future based on evidence at hand but there is always an aspect of uncertainty present in nature, thus we cannot predict with absolute certainty the result of anything we do.
If you hadn’t already guessed, I’m a scientist at heart. I believe in sound scientific research and that the advancements in science, medicine, and technology have brought about changes that indeed improve our safety and health. Technological advancements have contributed to the reduced number of deaths in motor vehicle accidents by putting safety features such as side impact air bags, seat belts, and improved structural design in cars. Advancements in medicine have provided microsurgery and organ transplants to children and saved these precious little people who otherwise may not have had a fighting chance at life. Even for those of us who are more holistic minded, science has allowed us to identify which vitamins and herbals are beneficial for certain ailments and provided them to consumers in easy to use formulas.
How have all of these advancements come about? Empirical research using the well respected “scientific method.” The scientific method is thought to be the best way to approach research: make observations, develop a hypothesis, design an experiment to test the hypothesis, test the hypothesis, accept or reject the hypothesis, modify the hypothesis, rinse and repeat. Nowadays, scientists and doctors alike often do this many times before they are able to confirm or discard their hypothesis. Empirically sound research also has a “control” group which does not receive whatever “treatment” was being tested for efficacy. This control group is used to compare to the treatment group. Researchers will also often use blind or double blind studies (a technician administers treatment and does not know if the treatment is a placebo or the real treatment) and then the researchers only see the data. This eliminates the possibility that data and conclusions can be influenced by the researcher’s bias or desire to see a treatment succeed. This is especially important in medical and pharmaceutical studies because the researcher needs to be able to prove without a doubt that improvement in a patient’s health is due to the actual treatment being tested, rather than outside influences such as the “placebo effect.”
Once someone has a research study that has important implications, he will submit the study to a peer-reviewed journal. These journals (like the American Journal of Medicine) have a board of people knowledgeable about the main topic of the journal (medicine, psychiatry, physics, ect.) The board reviews the research study to determine if it was done with professionalism and respect for the scientific method, ethical concerns, and if the conclusions drawn as a result of the study make sense. These journals are in databases across the internet, available to people with certain credentials and often for a price. College students also have access (through their college’s library) to many of these journals for their own research and educational purposes. These journals essentially serve as the primary resource for current and widely respected scientific information about the specific area of focus for which the journal is dedicated.
Good research also reports any and all side effects of whatever treatment was tested. If one person gets hit by a bus while in a drug trial and dies, it is still reported as a death in the trial. Everything that happens is recorded and reported so that the researchers can allow consumers to know that while they may not be able to tell you why (if it was the result of the treatment or other unknown factors) a person experienced frequent migraines while on this medication, frequent migraines were reported while on this medication. The information is there for the doctors and consumers to decide if the risks of a specific treatment outweigh the benefits or vice versa.
So what does this have to do with birth?
I know, you’re wondering what the heck this has to do with anything and why this is on The Birthing Site. Among the natural birthing community, there are a number of widely held beliefs that don’t necessarily have tons of scientific research to back them up. Nonetheless, these beliefs are logical, and often backed up by thousands of years of natural birthing women’s experiences and the modern day experiences of midwives. You may actually find OB’s who agree with these practices, but don’t often educate their patients about them because birthing policies are often instituted by the legal staff for convenience. That being said, many OBs are reluctant to take a more “hands off” approach to labor and delivery and insist on things like fetal monitoring, vitamin K shots, suctioning and immediate cord clamping due to the presumed safety of these procedures and the possibility of eliminating the risks which these procedures are designed to prevent.
So back to research: let’s take for example the connection between epidurals and c-sections. In 2008, approximately 60% of women in the U.S. receive an epidural during labor (many hospitals report rates as high as 90%), and in 2009 our national c-section rate was 33%. Infant mortality rates in the US are also higher than most other developed countries in the world. The WHO’s recommended c-section rate is 15% or below, and the U.S. has one of the highest c-section rates among developed countries. These statistics don’t seem to reflect our advanced medicine and technology.
Do a quick Google search and you’ll find about a zillion pages of people quoting research that declares “epidurals don’t cause c-sections and can’t be blamed for increased c-section rates.” There is a boatload of seemingly trustworthy research that supposedly debunks the idea that having an epidural increases your chances of having a c-section. Here is the problem; much of this “research” was conducted in real time: real women in real labor. The doctors who determined who needed a c-section and who had the chance to labor longer knew which women had epidurals. There is no way to do true empirical research on such an unpredictable process as birth.
So what about statistics? I have a love hate relationship with statistics. While I’d swear that I owe my just barely passing grade in statistics to a professor who gave me points for effort, there are one or two things I did learn and still remember. First, correlation is not causation. The increase in the use of epidurals may not be the primary cause for the increase in the c-section rate; however, this relationship should not be ignored. More importantly though, anyone with motivation can get statistics to back up their claim and make it look convincing, it’s all in the math. The phrase “statistically significant” is tossed around a great deal in research studies but most people don’t understand what this really means. We hear a technical term like this and assume it must be important. The truth is that it is important to a point. Statistical significance is a mathematical assessment of the data that will allow a researcher to determine if the effect of a treatment is due to chance/outside factors, or more likely due to the treatment itself. Here’s a little secret though, the statistical significance part of the math is determined by the researcher. While the researcher has the responsibility to report this value in their research write up, the general public will rarely ever read this, much less bother trying to understand the math. Thus a researcher who has data that doesn’t really support his hypothesis could in theory change the statistical significance value for the mathematical part of the data analysis which could make it look more meaningful than it did before.
Let’s use another example for this: the claim that circumcision reduces the chances of contracting STD’s including HIV. Many of these studies were done in third world countries where medicine is hard to come by, and condoms are even more rare. So a bunch of doctors swoop in to save these people by circumcising the men and then say “hey the rates of STD and HIV transmission are significantly lower.” But what do they mean by significant? How can you even test for that? You would have to look at statistics in the long term (over a period of years) or design a study.
A study might look like this: 100 men who were not circumcised had sex once with a woman who is known to have HIV and 50 of them got HIV. Another 100 men were circumcised and had sex once with a woman who was known to have HIV and only 10 of them contracted HIV, does that mean circumcision alone reduced your chances of getting HIV to 10% from 50%? Of course due to the ethical implications involved this would never actually be a real study, but for illustration purposes, let’s discuss the other problems with this. Did anyone use a condom? Were these men educated on safe sex practices and given high quality latex condoms and before being circumcised? How long did the woman who has HIV have it for? Was she symptomatic? What was the men’s current state of health? There are so many things that could potentially contribute to the transmission of HIV, and most of the studies that declare circumcision as a means to reduce the transmission of HIV don’t address the human factor.
Let’s be honest here, if an uncircumcised man has unprotected sex with many partners who also have a history of unprotected sex with many partners, he’s probably going to catch something. Likewise, if a circumcised man is careful about whom he has sex with, always uses condoms, and does not have numerous partners; he’s less likely to catch something than the first man.
The real truth is that with all the advancements of science and medicine, there are some things in nature that are both unpredictable and better left alone. Birth is one of these things. While there are certain circumstances where medicine and technology may provide life saving care to the mother and baby, these circumstances are usually in higher risk pregnancies. The c-section, infant and mother mortality rates for midwives are insanely low, in fact they are lower (by a substantial margin) than nearly any OB and hospital. The truth is that we can’t use scientific research and data to predict how things will be, nor what method of intervention is “the best” or the least risky. The truth is that long term studies of the effects of vaccines on children, of epidural medication on mothers and children, and of c-section rates on bonding and breastfeeding are virtually impossible to do for two reasons. First, you can’t really follow someone, much less a group of people for their entire life and record everything about their health and mental status. Secondly, the more we interact with the world, the more uncertain the cause and effect relationship becomes. Did this child develop autism because of a vaccine related issue, because his mother was exposed to a chemical during her pregnancy, or maybe he was exposed to something in the hospital or his home as a newborn? Did this adult develop an auto-immune disease such as Lupus because she received too many vaccines as a baby, or was she just more susceptible to certain chemicals in her environment?
The more we have developed ways to facilitate, speed up, and control risks in labor, the more interventions we have developed to counteract the side effects of the initial interventions. An OB may break a woman’s water to start labor and give her pitocin the next day because she didn’t begin to have contractions and is now at risk of infection. She may begin to have intense contractions and ask for an epidural. She may labor for many more hours once her epidural kicks in because it slowed labor. She may be exhausted and not able to feel anything below her waist and her baby may be in distress and she may then require a c-section. Was it the epidural that caused the c-section? Maybe it was the pitocin that caused her to have intense contractions leading to her exhaustion. What about the OB that broke her water because she was 39 weeks along and hadn’t gone into labor yet? Did the OB tell her what might happen if labor didn’t start on its own? Did she even know to ask?
Research gives us a starting point for information, but it should be simply a way to facilitate your own research and thinking about what is right for you and your baby. Research may show that there are minimal risks to a given procedure or treatment, but it can’t account for the human factor; nothing is ever completely certain. Long term side effects and risks are virtually impossible to test for, but we do know that the less junk we put in our bodies, the more likely we are to maintain our health. The same goes for birth; the less we try to intervene, the more likely a positive outcome will be. Let’s face it, the human race didn’t survive for thousands of years because birth was risky and women and babies died all the time. If that was true, we wouldn’t be here with our laptops, energy supplements, and epidurals.
In closing I leave you with this quote from Heisenberg: “Natural science does not simply describe or explain nature, it is part of the interplay between nature and ourselves.”
If you haven’t read my
first article on Postpartum Depression
(PPD) yet, I highly suggest you read it before reading this one; it will give you some context and background to better understand this article as a whole, as well as my perspectives on PPD through my experiences with PPD as a mother, and through my academic research.
As part of my Master’s Degree in Mental Health Counseling, I recently completed a class on human development. The goal of this class was to help student counselors understand the different theories of development and how life events may impact development, for better or worse. Ideally, this deeper understanding of how one’s experience can affect a person in many ways facilitates a greater respect for an individual’s circumstances, and how this person may have come to be sitting in a counselor’s office.
The Birthing Site was gracious enough to help me with my personal research by posting an online survey I created to supplement my research. I received an incredible amount of responses that helped me gain a better understanding of women’s experiences of PPD. One of the questions I asked was if women thought that understanding the process of child development was helpful. All of the women who had knowledge of child development said that they felt it helped, and nearly all of the women who didn’t have knowledge of child development said they think it might help. After writing the previous article on PPD, (and showing the admins of TBS the academic research project,) they asked me to write a supplementary article explaining the potential impact of PPD on child development. This article will explain what I learned in through this project; the basics of human development, research on PPD and child development, and how PPD may impact child development.
If you are suffering from PPD, please read this carefully. This project was intended for an academic audience, not necessarily for women with PPD who don’t have an education and background mental health. The goal of this project was not to find a way to make women feel even guiltier about what they were going through. In fact, my goal was to strengthen my basis for developing a private practice that focuses on women navigating all things with regard to motherhood from pre-conception and beyond. I never realized how much mothers do without even a simple thank you (which we all know would go a long way) until I became a stay at home mother after the birth of my second son. A secondary goal of this project was to help fellow counselors understand the struggles of a woman with PPD and how appropriate counseling will not only benefit her, but also her children. If we try to support mothers in a more constructive way throughout all of the experiences of motherhood, the benefits to the mother and child are potentially endless.
I wrote this article based on my project because I have a passion for mothers and I am driven to advocate for a better support system for mothers beginning with pregnancy and extending throughout motherhood. I too suffered from PPD. My guilt and shame were compounded by my knowledge of child development that I already had from my undergrad degree. When I realized I may have PPD, I forced myself to seek help because I knew it was best for both me AND my kids. I sat suffering in silence, feeling like I was drowning in sadness, looking at my sweet little boy and wishing I could do something to make things better. When I was able to get help, I was incredibly relieved to have someone to talk to who didn’t invalidate what I was feeling, who listened to me unload my stress, and who helped me find ways to take care of myself so I was in a better place to take care of my baby.
What is the big deal about psychological theories of human development?
Theories of human development attempt to explain how people may come to be who they are based on their life experiences. These theories identify basic needs at different life stages and illustrate how if those needs are not met, (or are met in an unhealthy way) a person may be more likely to experience some type of distress or impairment with regards to mental health.
There is no one theory of development that is regarded as being the absolute truth, and all of the respected and utilized theories allow room for the fact that some people are more resilient than others. So many factors may contribute to the development of psychological challenges (the nature vs. nurture debate) that it is impossible to identify every single event that contributes to the resiliency of one person or the struggles of another. One thing is common among all of the theories; healthy human development occurs when basic needs are met. If basic needs are not met, development does not occur in an ideal way and a person may be at greater risk of mental, physical, social, and emotional challenges during the rest of his or her life. Some people are more resilient than others, and sometimes it’s difficult to determine why.
During my research for this and many other projects, there is a common thread; mental illness (MI) has the potential to affect both the person with the MI, as well as those around her. People with major MI such as schizophrenia, PTSD, or a personality disorder experience a great deal of social impairment and often lack the ability to maintain healthy relationships, even with their parents, siblings, or lifelong friends. Even people with depression may suffer in ways that affect those around her, such as her husband and children. If you’ve ever lived with someone who has major depression, you know how difficult it can be to watch your loved one struggle on a daily basis. For someone who has major depression, tasks that seem mundane and “everyday” such as showering and eating are sometimes too much to do.
So what does any of this have to do with Postpartum Depression? For my final project, I was asked to identify a population who may benefit from mental health services and create a presentation about how this population’s state of being may have been affected by something in their development, or how this population’s challenge may impact development (for the self or others.) Between my passion for mothers and children, my own experiences of PPD after both of my births, and my interest in child development, I had developed the thesis for my project before the ink dried on the syllabus: What potential impact does PPD have on child development, and how can counselors help mothers with PPD?
Theories of Child Development
I utilized four theories of development to help illustrate how PPD has the potential to impact child development, (I will discuss how the theories connect to PPD after I explain the theories.) The first theory is Maslow’s Hierarchy of Needs. Essentially Maslow created a psychological pyramid that constitutes different needs that must be met in order for a person to progress up the pyramid of healthy development. A figure of the pyramid can be seen here. The first four needs (beginning at the bottom) are basic needs: Food, Security, Love and Belonging, and Esteem. If one of these needs is not met appropriately, it may be difficult for someone to progress to building stable friendships, intimate relationships and realizing their full potential and sense of self.
The second theory I utilized is Eric Erickson’s Psychosocial Stages of development. Each stage is described as a challenge between two opposing forces. The first stage is Trust vs. Mistrust. A newborn who cries and his needs such as being fed, diapered, and comforted learns the basic idea of trust and will likely be easier to calm and comfort than a child whose needs are not consistently met. This latter child may develop a sense of mistrust: “even when I cry, I don’t know if I’ll be fed.” This child may begin to cry excessively in an attempt to get his needs met and may learn that there is not someone he can depend on to care for him.
The third theory I discussed was Bowlby’s Attachment Theory. A baby’s attachment style is mostly based on that baby’s opportunities to bond with a caregiver, the characteristics of that caregiver, the characteristics of the baby, and general family environment. If a baby bonds with a warm and attentive caregiver in a generally warm environment, that baby will likely develop a healthy attachment known as secure attachment. This child may be distressed if separated from her mother, but will be comforted upon her mother’s return and resume previous activities. If a child does not have opportunities for healthy attachment, she may develop a less healthy attachment and have more difficulties adjusting to changing situations in both the short and long term because either she does not know that the mother’s return will bring comfort, or she is unsure if the mother will actually return.
The fourth theory I utilized is Bandura’s Social Learning Theory. This theory says that personality is the result of complex interactions between the environment, behavior, and psychological processes. (Behavior causes the environment and environment causes behavior.) Children learn from watching others, attempting to replicate what they see, and their motivation to do it again is based on reinforcement.
What all of these theories have in common is that healthy development requires positive interactions with caregivers. Of course, there is no guarantee that healthy development will guarantee a person free of all MI and unhealthy behaviors. Conversely, there is no guarantee that unhealthy development will guarantee that someone is destined to live a life of MI and unhealthy behaviors. Generally speaking however, nearly all of the research illustrates that healthy development increases the likelihood of sustained mental health and generally healthy behaviors (or at least the tools to navigate the process of mistakes) throughout life. Research also indicates that unhealthy development may put children at a disadvantage (cognitively, intellectually, and socially) and at higher risk for MI and behavior problems.
Connecting PPD and Child Development
Now that we have a little background on both PPD and Child Development, let’s tie it together. In some extreme cases of PPD, a mother is completely unable to care for her newborn. Many women who suffer this form of PPD are suffering so much that they can’t physically get out of bed to care for their child. If a newborn is not being fed on demand, changed regularly, and held and interacted with often, his development is at an increased risk of being jeopardized, (physically, mentally, emotionally, cognitively ect.)
Babies are social creatures; they need us to interact with because it is the most salient way they learn about the world in their early life. Even mothers who may not be suffering from PPD in such an extreme way, but who are distant, isolated, and suffering feelings of shame and guilt may be communicating this negative atmosphere to their baby. Perhaps their baby is being physically cared for, but he may be learning that his mom is not a source of comfort (maybe she doesn’t hold him often) or that being fussy is the only way to get her attention. If this occurs, he may grow into a toddler who is demanding, has tantrums, or acts out because it is the only way he knows how to get the attention he so desperately needs.
There is limited research on PPD and child development, mostly because research would need to be long term which requires both the researchers and the participants (mothers and children) to stay in communication for a number of years. The research that does exist indicates that children whose moms suffered from PPD may be at a higher risk for cognitive, intellectual, and social challenges, especially if the mother does not receive any treatment and the depression does not go away, (or goes away and comes back frequently.) When mothers who did not suffer from PPD and their children were compared to mothers who did suffer from PPD and their children, the interactions between mother and child, as well as the child’s behavior in middle and late childhood were often drastically different. Children of mothers who had PPD had increased behavior problems in school, increased challenges with social interactions, and lower academic performance. Mother-child interactions were often lacking in warmth and attunement, and when mothers did appear warm to their children, the children often mirrored the mother’s behavior while in her presence (appearing sad or fussy/anxious).
So where does this leave us?
American society tells mothers that they should be happy they have a baby, regardless of their experience of pregnancy, birth, and the postpartum period. This is not only ignorant, but a slap in the face to mothers everywhere. We willingly sacrifice so much to bring these precious babies into the world, and we are expected to come through it as if nothing drastic happened. The truth is, any life changing even has the potential to impact and change you, no matter who you are. We must revive a society that supports mothers, allows mothers to connect, and informs mothers of their options, choices, and freedoms so that they are empowered to seek help (and not be criticized for it) if need be. When we help mothers, ultimately we help children too. Perhaps the ways in which this help manifests will not be obvious, but shouldn’t we try? Shouldn’t we support mothers so that we are helping them give their children the best chance at success? PPD isn’t about being weak, it’s about how some women need some extra help to get through such a significant event in their lives, and it shouldn’t matter how they got there (being a mom, or having PPD.) All that matters is that PPD can take a toll on both the mother and her baby, and it is our responsibility to help, in any way we can.
- Banti, S., Mauri, M., Oppo, A., Borri, C., Rambelli, C., Ramacciotti, D., Montagnani, M.S. … Cassano, G.B., (2011). From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Comprehensive Psychiatry, 52(4), 343-351. doi: 10.1016/j.comppsych.2010.08.003
- Dennis, C., & Chung-Lee, L. (2006). Postpartum Depression Help-Seeking Barriers and Maternal Treatment Preferences: A Qualitative Systematic Review. Birth: Issues in Perinatal Care, 33(4), 323-331. doi: 10.1111/j.1523-536X.2006.00130.x
- Field, T., Sandberg, D., Garcia, R., Vega-Lahr, N., Goldstein, S., & Guy, L. (1985). Pregnancy problems, post partum depression, and early mother-infant interactions. Developmental Psychology, 21(6) 1152-1156.
- Goodman, J.H., & Santangelo, G. (2011). Group treatment for postpartum depression: A systematic review. Archives of Women's Mental Health, 14(4), 277-293. doi: 10.1007/s00737-011-0225-3
- Halonen, J.S., & Passman, R.H. (1985). Relaxation training and expectation in the treatment of postpartum distress. Journal of Consulting and Clinical Psychology, 53(6) 839-845.
- Hay, D.F., Pawlby, S., Angold, A., Harold, G.T., & Sharp, D. (2003). Pathways to violence in the children of mothers who were depressed postpartum. Developmental Psychology, 39(6), 1083-1094.
- Hopkins, J., Campbell, S.B., & Marcus, M. (1987). Role of infant related stressors in postpartum depression. Journal of Abnormal Psychology, 96(3), 237-241.
- Leadbetter, B.J., & Bishop, S.J., Raver, C.C. (1996). Quality of mother-toddler interactions, maternal depressive symptoms, and behavior problems in preschoolers of adolescent mothers. Developmental Psychology 32(2) 280-288.
- Leahy-Warren, P., McCarthy, G., & Corcoran, P. (2011). Postnatal depression in first-time mothers: Prevalence and relationships between functional and structural social support at 6 and 12 weeks postpartum. Archives of Psychiatric Nursing, 25(3), 174-184. doi: 10.1016/j.apnu.2010.08.005
- Juntunen, C.L., & Atkinson, D.R. (2002) Counseling across the lifespan. Thousand Oaks, CA: Sage Publications, Inc.
- Mauthner, N. S. (1999). Feeling low and feeling really bad about feeling low: Women’s experiences of motherhood and postpartum depression. Canadian Psychology, 40(2), 143-161. doi: 10.1037/h0086833
- Poobalan, A. S., Aucott, L. S., Ross, L., Smith, W.C. S., Helms, P. J., & Williams, J. H. G. (2001). Effects of treating postnatal depression on mother-infant interaction and child development: Systematic review. The British Journal of Psychiatry, 191(5), 378-386.
- Tronick, E., & Beeghly, M. (2011). Infants’ meaning-making and the development of mental health problems. American Psychologist 66(2), 107-119.
For those of you who are not familiar with my writing, I am a 29 year old mother of two little boys (1.5 and 3). I worked full time (while pursuing my undergrad psychology degree) while I was pregnant with #1. After #2 was born, I stopped working (since it would have cost me more than I made to put the kids in daycare) and became a stay at home mom. I am now pursuing a Master’s Degree in Mental Health Counseling. From the incredible amount of research and reading I’ve done as a result of my schooling, I’ve become passionate about the challenges of becoming a mom, especially when it comes to postpartum depression (PPD).
During my first pregnancy, I lost my libido, and it has never fully recovered (more than 3 years later.) This (among a number of other things) contributed to serious relationship issues with my husband (though we have since been able to work through our struggles and have devoted ourselves to improving communication and understanding). What does any of this have to do with PPD? Well among the diagnostic criteria for PPD, a libido that has not returned after you have been cleared to have sex again by your doctor is included. Of course, everyone’s comfort level with postpartum sex is going to differ, especially if there was tearing that needed stitching. That being said, if your baby is now a few months old and you still have no interest whatsoever in sex, it could be a sign that something else is going on.
The following is a list of diagnostic criteria (symptoms) for PPD. The bold symptoms, even if they occur alone (but very frequently occur with other symptoms) are a major signal that a woman is experiencing some level of PPD. The symptoms that are not in bold are still important. I never had thoughts of harming myself or my children, nor did I have problems bonding with them; however, I did isolate myself and have excessive feelings of being tired, sad, and overly emotional about seemingly insignificant things even after my son was over a month old (and in general, your body’s hormones have leveled back out.)
- Difficulty caring for baby’s basic needs
- Difficulty bonding with baby
- Shame or guilt (even if there is “no reason”)
- Loss of interest in activities for pleasure
- Loss of libido (after being cleared by M.D. or O.B. for resuming sexual activity)
- Social isolation
- Exhaustion and fatigue (beyond the normal adjustment period)
- Thoughts of self harm, or harming the baby
Many of these symptoms are also symptoms of depression in people who are not postpartum, but have been modified according to research with women who are experiencing depressive symptoms and who are also postpartum. It is estimated that up to 85% of women will experience some sort of mood disturbance after delivery, but most of this is contributed to the physical, emotional, and social adjustment that comes with having a baby. Anywhere from 7% to 25% of women may develop PPD (these numbers are estimated because most researchers believe that PPD is underreported). Even if you have only two or 3 of the less severe symptoms, you may be suffering from PPD if you have been experiencing them within four weeks of giving birth and the severity of the symptoms is not declining as time passes.
I recently completed a project for my human development class on the potential impact of PPD on child development. While doing my research, I discovered a wonderful paper on PPD which attempted to analyze the current state of research and views of PPD. The author completed her own study and subsequently came up with a number of recommendations to enhance the way we diagnose, treat, an ultimately view mothers with PPD. The most important aspect of Mauthner’s research was that while it may be physiologically and emotionally “normal” to have a challenging adjustment period after giving birth, we must normalize and validate each woman’s experience without causing women to assume that it is normal to be depressed. Indeed the drastic hormone changes that come with labor and delivery can wreak havoc on one’s body and mind, but by saying that PPD should be seen as a “normal” experience leaves women feeling as though they are inherently damaged.
The shift in American society to small nuclear families means that instead of growing up with child bearing women around us, we often grow up seeing a mainstream, medicalized view of birth. Instead of navigating pregnancy with our mothers, sisters, grandmothers, aunts, and friends around to help, we are often left to our own devices while still working, going to school, tending to other children, and all of the other roles that often come with being a woman,tyle:italic;font-variant:normal;text-decoration:none;vertical-align:baseline;">and we often do so alone.
Mauthner sat down with 40 women and asked them to describe their experiences in an attempt to better understand and redefine PPD. The following bullet points are a “nutshell” version of the meaningful information from this paper.
- Mothers with PPD frequently experience a conflict between their idea about the mother they should be and the mother they actually are.
- The expectation of culture is that mother’s should be happy post partum. This often leads to mothers remaining silent about their struggles because when they do reveal their feelings, they are often invalidated or criticized. This may lead to increased feelings of social isolation and withdraw.
- Mothers who experience PPD may be facing the challenge of a difference in what they expected the experience of motherhood to be versus their subjective experience of new motherhood.
- A combination of factors may contribute to the development of PPD including: access to social support, quality of social support, partner support (quantity and quality), relationship strain with a partner who is present, predisposition and/or history of depression, differences between expectations and reality of motherhood, a challenging or not as expected pregnancy and/or birth experience, self esteem issues about one’s body after having a child, infant health, infant characteristics, breastfeeding challenges, and level of fatigue and exhaustion.
Inspired by Mauthner’s study, and in an an effort to better understand women’s subjective experience of PPD, I created a survey to supplement my research project. I created a brief (10 question) online survey an asked for volunteers to respond to the survey at their convenience. Respondents varied in locations across the world due to solicitation for volunteers through the internet (a big thanks to TBS for posting it on the wall!) Women were asked if they experienced PPD and what their experiences of the post partum period were. Respondents (N=74) reported on level and quality of support systems, whether or not they took medication and/or attended counseling, what helped, what did not help, and their history of family and mental health.
What women with PPD said about their support systems.
- Report less support (or significantly limited support) from friends, family and partners than women without PPD.
- Those who felt somewhat supported often described a partner who worked and thus was not around to help as much, multiple children, and/or lack of local friends and family available to help with every day needs.
- Report greater frequency of relationship strain with partner, and higher levels of relationship strain with partner than women without PPD.
- Report lower frequency of partner support and involvement than women without PPD.
What women without PPD said about their support systems.
- Are more descriptive about positive support systems and report greater levels of family involvement such as their mothers coming to stay for a week or more, and friends frequently coming to help with household chores.
- Describe their partner as being “very supportive” more often than women with PPD.
- Those who do report relationship strain still describe their partners as being supportive and helpful, as well as being able to mediate relationship difficulties more easily than mothers with PPD.
Women with PPD were asked about what they think might have helped them manage their PPD and daily life.
- Someone to talk to
- Not being told “You’ll be fine, just be happy you have a baby”
- Validation and acknowledgement of their experiences and struggles
- Greater frequency and quality of social support
- Self care opportunities (such as showering, naps, or reading a book while someone else watched the baby)
- More preparation about what to expect life with a new baby would be like
- Talking to other women with PPD
- Many reported they would have liked to try counseling but were unable to due to cost and opportunity
What women with PPD who received counseling or other services said about what helped them manage their symptoms.
- women who saw a female counselor reported positive experiences while women who saw a male counselor reported negative experiences.
- Medication to manage extreme depressive symptoms
- Networking with other moms (play dates, moms-only groups)
- Self Care opportunities (and encouragement by others to engage in self care)
- Dietary changes towards better nutrition
- Breastfeeding success (and support from others to do so)
- Faith based activities such as attending church
So what does this all mean? Essentially, I believe that PPD should be considered as being on a spectrum: some women have more difficulties, while others have fewer difficulties. Women with fewer difficulties should not be overlooked as being “less important” than women suffering from severe PPD. Between the physical, emotional, and social changes that take place when we spend 9 months creating a life and then bringing that precious live into this world, it is a TON to handle, much less handle it without much help. Even mothers who have a great deal of help still get PPD, and there are mothers with no help who never develop PPD. There are so many things that contribute to any mental health challenge; thus there should not be a “one size fits all” idea about PPD or any other mental health disorder. It should not be assumed that PPD is normal, but that if it does occur, it istyle:italic;font-variant:normal;text-decoration:none;vertical-align:baseline;">not necessarily abnormal.
Many women get through PPD without any outside help, but nobody should have to. If you have had depression before, or are depressed while you are pregnant, take a few moments to listen to yourself if you begin to feel overwhelmed after giving birth. Just because you experienced depression before doesn’t mean that you necessarily will after giving birth, but you may be at a higher risk than mothers who have never been depressed. Also, just because you have never been depressed does not mean that you have a significantly less chance to develop PPD than someone who had depression before.
If you are experiencing PPD, consider seeing a licensed mental health counselor. A good counselor will not think that you are a hypochondriac because you are concerned that you might have PPD. In fact, most counselors believe that everyone could benefit from counseling from time to time, regardless of whether or not they meet the criteria for a mental health diagnosis. Counseling is especially beneficial to people navigating a drastic life change, even if it is not causing extreme distress. The benefits of having someone listen to you talk about your feelings and struggles can make a world of difference; especially when that person does not tell you that “everything will be fine,” “you’re overreacting,” or try to fix you. Skilled counselors will refrain from trying to cheer you up and giving you advice; they will listen to you talk because they know that sometimes the best healing and change comes from acknowledging and accepting the emotional struggles we deal with on a daily basis.
The journey of motherhood is full of joys and wonders. If you are struggling, reach out to someone for help. It is a failing to mothers and children that society often sweeps the struggles of mothers under the rug as if our challenges are not worthy of meaning. There are lots of people who can help, and many will be happy to help if they know it is needed.
As I close I leave you with this task. Next time you are standing behind a new mom at the checkout line in the grocery store and want to tell her how lucky she is and how happy she must be, instead, say this to her: “Your baby is beautiful! How are you feeling? I’m a mom too and I know how it can be both wonderful and occasionally challenging.” Maybe she won’t open up to you (especially if she is a stranger) but instead of walking away feeling guilty about her sadness, she may have some hope that she isn’t alone in this journey. By doing this, you will be working to bring women one step closer to joining together for the greater good, rather than segregating us through the one thing we all have in common; our ability to create and nurture life.
A note to the reader: I am not yet a licensed counselor and I am in no way offering medical advice. If you are concerned, please contact your practitioner immediately. Also, please be aware that there is a difference in mental health licensing and titles. Counselors are trained to listen, cannot prescribe medications (but can consult with a psychiatrist who can) an provide an opportunity to “talk through” your struggles. Psychiatrists have a medical degree and the emphasis in their education is diagnosis and treatment. If you have had a negative experience with a mental health professional before (such as a psychiatrist who prescribed meds and “didn’t listen,” consider seeking a counselor instead. They can be identified by their title of LMHC. (I’m not trying to bash psychiatrists and I know of many who are great listeners, but many people are not aware that there is a difference between a counselor and a psychiatrist.)
Mauthner, N. S. (1999). Feeling low and feeling really bad about feeling low: Women’s experiences of motherhood and postpartum depression. Canadian Psychology, 40(2), 143-161. doi: http://psycnet.apa.org/doi/10.1037/h0086833
Continue reading: Postpartum Depression (Part 2): Why We Must Support Mothers Struggling With PPD in More Constructive Ways
Bringing home your baby for the first time is one of the unexpected joys of motherhood. Introducing him to the dogs, the bed, the couch, the bouncy seat: it is fun to start doing all of those “firsts” with the baby! The comfort of being able to snuggle and nurse my boys in my own bed while watching Star Trek and drinking my tea (yes I’m a super Trekkie) was probably the best time for me. I spent days in bed just taking in every little bit of them while enjoying integrating them into my life and introducing them to the things I loved. Eventually though, you start to get back into your usual responsibilities and if you are anything like me, you may find yourself doing all sorts of crazy housework. If you have other children who are home, this “back to reality” may come even quicker. I had the luxury of my mother taking my oldest for a week after I delivered my second so that I could recover and not be quite so tired and sore while trying to handle two little ones. It was a huge help, but of course, I also missed my oldest and it was great to have him back home.
There are many things about postpartum recovery that you may hear, and many things you won’t. You’ll probably hear a lot about other women’s accounts of their levels of pain and soreness after coming home. The key to remember is that there is no way to predict how your body will handle the return home. Being in the hospital afforded me the opportunity to sit around and do nothing if I so chose. But once I returned home, the dishes, laundry, and dogs were staring at me wondering why I was being so lazy and after a few days, the guilt got to me and I started getting “back to work.” Here’s where you want to accept any and all help you can get; if someone wants to come see the baby, ask them if they can throw in the laundry for you, take out the garbage, or watch the baby while you take a shower. We often don’t ask for help, even when we need it, so here’s your opportunity to ask for it without feeling like you are imposing. Your activity level will be dictated by how you are feeling physically and emotionally, so try to take it easy on yourself on both accounts. I realized I was doing too much physical activity when on my 4th day home, I began bleeding much heavier than I had since I had returned home. When I called my OB, she told me that it was my body’s way of telling me to slow back down. This wasn’t something anyone had warned me about, but it was nice to know that my body was trying to send me a message and trying to “push through the pain” (I had a 3rd degree tear so I was incredibly sore and in a lot of pain) was actually doing more harm than good. My OB instructed me to slow down and continue to rest with ice packs between my legs to help relieve some of the discomfort. Within a day of moderating my activity and tuning back into my body, I was feeling much better.
You Will Likely Be Exhausted.
I always tell people that even though I was never a big party person as a young adult, my late nights of socialization and nights where I got nearly no sleep, got up and went to work just to come home and go socialize again were NOTHING compared to the “tired” I felt as a new mom. This too shall pass though. Again, your body just did an amazing thing by giving birth; your body feeling tired is its way of telling you to take it easy so it can regenerate and recover. Nap when the baby naps, (this is how I became a huge proponent of safe co-sleeping) and don’t go on a spree of doing chores. Break it up into small tasks and do them every so often. Don’t unload the dishwasher, re-load it, clean the counters, take out the trash, sweep and mop the floor, sort and start laundry. Unload the dishwasher after breakfast and don’t worry about putting the dirty ones in until after lunch. Sort the laundry and let the next person who comes to visit you and the baby carry the basket and throw the load in.
Taking it easy is going to allow your body and mind to recover, as well as facilitate bonding and the nursing relationship (if you are breastfeeding). The more time you spend with the baby, (even if it’s just sitting next to him reading a book while he sleeps next to you - or in my case on my chest) is beneficial. Babies who are breastfeed and have ample opportunities for attachment and bonding their moms are at an advantage. Babies who do not get these things as often are at greater risk for attachment issues, social interaction difficulties, intellectual challenges, and many more.
If You Are Physically Able, Wear Your Baby!
Oh I can’t tell you how much easier it was to get stuff done when I wasn’t running back and forth between wherever I was doing something and where the baby was sleeping. I had a video monitor and I still had to check on #1 every few minutes because I was just beside myself with joy and worry (the worry eventually subsided a little bit once I got used to being a mom.) I had a Moby wrap, a generic sling, and a Baby Bjorn, all of which got a ton of use. Plus, if my son was a bit fussy, he usually calmed down pretty quick by the motion of being carried around while being able to rest his head on my chest. Here is a great article on babywear.
Use That Peri-Bottle (And Put Witch Hazel In It)!
I still have mine, and I STILL use them occasionally! Especially if you have stitches, you’ll love the relief of being able to rinse yourself with the peri-bottle both after using the toilet, as well as when you’re in the shower. I didn’t want anything to do with putting pressure much less touching myself below the waist after I gave birth, so it was nice to have a clean alternative to relying on wiping to clean up. Of course a little pat dry was necessary, but much less terrifying than the thought of wiping anything.
Try to make some time for yourself, and for your partner. Especially if you are nursing, you are going to be literally attached to that baby for the next few months (at least). It’s easy to get wrapped up in the love and responsibility of motherhood, but don’t lose yourself in it. Ask your partner or another support person to watch the baby so you can take a long shower or bath, or go to the store to grab milk. Even as little ten minutes to yourself each day where you aren’t responsible for running to the baby if he wakes up will help you retain some sense of your individuality. Also, remember that your partner may be feeling a bit sidelined now that the baby is here. It’s okay that you are paying so much attention to the baby, and it’s okay that your partner feels a bit left out; this is all part of trying to figure out and adjust to the dramatic change that your lives and relationship have just gone through. Trying to make a point to spend some time together each day will allow you to retain (or potentially restore) your intimacy and relationship so that nobody feels left out.
Here’s where I’m going to get on my soap box...
You can find my full article on Postpartum Depression here, so I won’t get too in depth here since this is about general recovery. It is imperative that you keep your eyes and ears open to your mind and body; if you are not beginning to feel as though you are getting back to normal, talk to your practitioner. Bringing a baby into this world is full of wonderful and challenging events. There are a number of symptoms of PPD, but not all are required for an official diagnosis. It is normal to feel tired and overwhelmed, but if you are feeling significantly exhausted and down for more than a few weeks, it may be in both you and your baby’s best interest to seek the help of a licensed mental health counselor. As a counselor in training, a mother who had PPD, and as a student who just completed a major research project on PPD, I can’t stress enough that it is not something you need to suffer through alone. If your practitioner just wants to put you on medicine, consider asking for a referral for a counselor in addition to meds (and ask if you can try counseling without using the medicine first.) We often feel alone (even when we are surrounded by support) and sometimes just having someone to vent to that won’t judge you or feel hurt by your feelings can make a world of difference. One of the most shocking things about the postpartum period for me was that it put a lot of strain on my relationship with my husband. Luckily, we managed to get through, but it wasn’t easy. PPD can also affect your baby’s development; if you are having a difficult time bonding or caring for the baby, the baby’s physiological and psychological development is potentially at risk. Of course, not every woman will get PPD, and their babies are not necessarily at a huge risk of being damaged; but there are ways to help yourself feel a bit better which will only benefit your baby even if you aren’t suffering from PPD, but still feel a little overwhelmed and isolated.
Everything may be wonderful and stay that way once you arrive home. If it isn’t though, that’s okay too. Having a baby is a life changing event in ways you can’t truly understand until it happens for the first time. Postpartum time is your time to reevaluate and adjust your life. This may take a while, and that’s okay too. Just like your EDD was estimated your recovery time is not set in stone so take the time you want and need to ensure that you can enjoy this journey of motherhood as you should-the best way that is right for you!
Go back to: Step #8: Initiating & Maintaining Breastfeeding
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