Thursday, June 7, 2012

Depression When Weaning?

Although postpartum depression and other mood disorders are not talked about enough and still remain one of the most stigmatized issues in mental health care- depression within other stages of motherhood, such as breastfeeding, are talked about even less.  I'm going to specifically address depression and anxiety symptoms related to weaning a breastfed child.  I am going to utilize the term breastfeeding for the majority of this post, but I want to be clear that the act of lactating regardless of method of feeding can be coupled with these symptoms.  So mom's who pump can also experience this.

Weaning is the process that the mother and child participate in to ultimately stop breastfeeding.  Weaning occurs over a wide variety of ages.  In the US about half of babies are reported to be weaned by the age of 6 months, with the majority weaned by 1 year (more breastfeeding statistics).  Now some professionals have been increasing the length of time they consider a woman "postpartum", and consequently labeling the emergence of depressive symptoms in a woman up to 1 year postpartum as "postpartum depression".  I do not agree with this, and also want to make the distinction between a "postpartum depression" and "post-weaning depression".  Much like the postpartum "baby blues", there is a widely accepted "weaning blues" that occurs.  But these symptoms are short lived and include mild tearfulness and sadness.

Symptoms of Post-Weaning Depression and Anxiety:

  • Overwhelming feelings of sadness, hopelessness.
  • Feeling tired, fatigued
  • Insomnia or marathon sleeping
  • Lack of desire to do things you normally enjoy
  • Negative thoughts (ex. thinking you have failed as mother, your child deserves someone better)
  • Overwhelming worrying, fear
  • Feeling on edge, nervous
  • Thoughts about harming yourself 

During the lactation period (a time when a woman makes milk for nursing or pumping), women experience a plethora of hormone changes.  Lactating, much like the "natural high" some women experience after birth of their baby, causes the release of oxytocin and prolactin.  Oxytocin is a bonding hormone and some professionals believe this hormone may been involved in mood changes with lactating.  If you have high levels of oxytocin during breastfeeding, then weaning with create a drop in oxytocin.  This coupled with the loss of a "special" bonding time with your child may be the main culprit to the symptoms of depression and anxiety.  Or this shift in hormones may trigger those predisposed to experience depression.  Prolactin brings about feelings of calmness and relaxation.  Both Oxytocin and Prolactin dropping quickly can cause more severe symptoms.

Moms who never breastfeed may feel the effects of weaning right after the postpartum period- Although a milk supply can not be maintained without stimulation from a baby, milk/colostrum production still begin and a whole lot of hormone changes happen at once during this time.

In a wonderful blog post on Joanna Goddard's A Cup of Jo, Joanna graciously shares her personal experience with weaning her son.  Joanna is a bright and articulate mother who opens up about the sudden and debilitating effects her weaning depression and anxiety had on her.  Joanna shares about these difficult 6-weeks and touches on one of hallmarkers of the "disease of depression".  She writes:
Depression is something that often isn't completely recognizable by the person experiencing it until there is some relief or return to normalcy.  Joanna shares about waking up one morning and the doom and gloom was gone, over.  It was as if her body had returned to it's previous hormone levels, or at least had become accustom to the hormone changes.  Unfortunately not all women experience a relief from the depression without treatment, but as with postpartum depression and mood disorders, depression and anxiety with weaning is very treatable and women do get better. Following Joanna's blog, the Huffington Post wrote about post-weaning depression.

So who is at risk for feeling symptoms of depression and/or anxiety from weaning?  Women with a personal or family history of depression and mood disorders, especially a history of Postpartum Depression or another mood disorder.  But still women can experience these symptoms without any history at all- it seems that some women's body's are some sensitive the the hormonal shifts that take place during weaning.  Now weaning isn't only about emotions, it's also causes physical changes and some discomfort.  Kelly Mom (what I and many other mothers consider to be THE resource for breastfeeding moms on the web) shares how to cope with the physical stuff as well as a bit on the depression I wrote about.

How do you protect yourself or manage symptoms if they do occur?  Make mindful choices about when and how to wean to reduce discomfort.  Are both you and your child ready?  Examine your intentions, what do you hope to gain from weaning?  More freedom, preparing for another pregnancy, not enjoying the experience, child self weaning?  Enlist support from your partner, family, and other mom friends.  Know that you aren't alone if you feel tired, or sad in the beginning.

Based on the theory that the dramatic and fast change in Prolactin and Oxytocin contribute to the feelings of depression and anxiety, a gradual and slow weaning process may be best.

But weaning occurs for a variety of reasons- some women aren't able to make the choice to wean slowly or gradually on their own time.  Whether it's do to a medical condition, medication, lifestyle change, or advised by a physician.  Being told to wean when you aren't completely ready adds another layer to the process.

When to seek help? Always seek professional help if the symptoms are intense enough to impact your daily life.  Are you not sleeping well, or are you wanting to sleep all the time?  Do you feel tired, are you unable to maintain the same activities, hobbies, going to work?  Do others notice changes and comment on them? Do you question if you are a good mother?  Do you have thoughts about harming yourself or your child?


Thursday, May 24, 2012

Normalizing the Suffering

I came across a wonderful post on Bay Area Breastfeeding & Education (BABE)- a blog run by Leah and Misty who combine both education and experience in the realm of breastfeeding and supporting moms.  

When I saw the title of their recent post I smiled- What if you told me, "I don't like being a mom."

I smiled because I thought- YES- this is exactly what many mothers wish they could say in the beginning.  The fear of judgement, the societal pressure to be glowing as a new mother, and the leading questions like, "isn't it the most wonderful thing in the world?" make it so hard to honestly share that you are suffering.

I also came across another article stating the most common perinatal (pregnancy/postpartum) complication is depression and anxiety- which effect 15-20% of moms.

But it's not talked about as much as it occurs, sometimes it's overlooked by doctors, and other times women choose to "deal with it" on their own.  In my practice and I think many other perinatal specialist would agree, it's hard to get women in to counseling for postpartum mood disorders.  A colleague of mine stated she often sees women dealing with a postpartum disorder around 8-9 months after the birth of the baby- and usually at the insistence of the partner.  8-9 moth is a long time to suffer, especially while juggling all the new responsibilities f having a new baby.  

Go and read the post on BABE where one woman shares her experience of finding counseling and in her case combined with medication.  I plan to post some links to bloggers who have shared about their personal experiences with postpartum depression/anxiety- the more we talk about it, the more women can feel empowered to share about it.

If you are local and looking for counseling contact me.

The BEST resource on the web and by phone is Postpartum Support International
They offer local resources, lists of therapists, groups, and a warm phone line for support.

Tuesday, May 15, 2012

Are You Mom Enough?

Time Magazine is getting a lot of attention from women, parents, feminists, and people that work in the field of birth, pregnancy, breastfeeding, and early childhood development.  I'm sure by now many people have seen their latest cover shown below with the attention grabbing question "Are you mom enough?" And possibly the more attention grabbing image of a mom breastfeeding.

Without talking directly about the articles content (attachment parenting which includes extended breastfeeding that is depicted in the photo)- I couldn't help but post about the incredible pull/pressure to be "mom enough".  Before I get into this I want to point out that I am not discussing what is better, right, or best for mother and baby.   It's clear that there are strong opinions and choosing what works for the individual is ultimately up to that individual.  Instead, I am speaking to choosing something because not doing so means failure- failure as a mom, as a partner, and ultimately as a woman.  At it's deepest level it is questioning ones own femininity.

In general I see mothers today experience great guilt about doing it "perfect".  This can begin as early as preconception- preparing the body to be the ideal vessel for growing a fetus into a sweet baby.  And if it doesn't start before pregnancy, the thought of a pending birth can really trigger the desire to do it "right".  I think the trend right now is having a natural, unmedicated birth- possibly without Doctors and instead with midwives, and possibly even in the home.  After the birth, the expectation is to instantly fall in love with your new baby and that internal nurturer takes over making motherhood so natural.  Breastfeeding is another area where I see mothers struggle- and not so much with the act (though that isn't always easy or without pain), but rather with their body and relationship with their baby meeting their expectations.  

Again the issue does not lie in the choice to breastfeed or have an unmedicated birth- the issue is in the all or nothing thinking that many women use to dictate how they should perform as a mother- as a woman.  When adopting all or nothing thinking (you are either doing it all correctly or you have completely failed) you have a set up for failure.  Life is unpredictable and many factors impact pregnancy, birth, and parenting choices.  To have a rigid view of what a "mom" is leaves no room for the delicate differences in us all.

I can't speak to motherhood without speaking to mental health of mothers.  The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".  To me this means being free of any serious impairment due to emotional or cognitive suffering.  Postpartum Depression and Anxiety occurs in an estimated 15-20% of mothers.  Most mothers with postpartum depression or anxiety struggle with what I wrote about above- rigid rules about what it means to be a mom, and tremendous guilt about doing it perfect.  Part of the disease of depression includes a negative view of self- what better way to see yourself in a negative light then to create impossible to achieve goals of being the perfect mother.

What can we do about this?  Really examine whats driving your behaviors and your goals as a mother. Do you really want to and are you truly comfortable with a home birth or is that the only way to do it "right"?  Are you suffering due to your choices about baby's sleep?  Maybe co-sleeping isn't what is best for your family even though you heard it was great for bonding?  Maybe cry-it-out doesn't fit in your home or with your baby even though you thought without it you would spoil your child?  Examine what your beliefs are about motherhood, where did they come from?  What are the things you tell yourself about how you are doing as a mother? 

Then take a step back and look at it all. Talk with someone supportive (a friend, family member, new mom support group, or therapist)- enlist them in helping you see areas where you might be setting yourself up with all or nothing thinking.  Despite all the research supporting different ways to birth, parent, or feed a child- being mentally healthy as a parent should be at number one.  Throw out thoughts about being "mom enough" and leave room for time with your child.  Seek professional help if symptoms of depression arise.

More information about Postpartum Mental Health:

Friday, May 11, 2012

The Beginning

Welcome to my blog.  I'm Michelle Cherry and I am a Licensed Marriage and Family Therapist (MFT)- click here to find out more about what an MFT is.  I have always enjoyed reading other blogs; personal blogs by family and friends, as well as informational and educational blogs that relate to Mental Health.  I have kept a personal blog for the last 2 years.  Because I have enjoyed it so much I decided to start this one with emphasis on my work.

My hopes for this blog space are to share relevant information for clients, colleagues, and consumers.   Expect to find information surrounding teenage mental health, transitional age youth (late teens to young adults), women's health, pregnancy, birthing, breastfeeding, substance abuse and addiction, severe mental illness (such as psychotic disorders), and general mental and emotional well being.