Sleep, Motherhood And Postpartum Depression

I see postpartum depression (PPD) a lot in the families who come to me with sleep issues. Exhaustion is a risk factor for depression. And depression makes it harder to sleep coach successfully, which in turn breeds more exhaustion. Women experiencing postpartum depression don't always recognize the signs so it's important for family and friends to be on the lookout.

Postpartum depression is common and doesn't always start in the first few weeks after delivery. It's not good for the mom, and it's not good for the baby, who may have more trouble forming a secure bond with a depressed, unresponsive mother. Postpartum depression has biological components. Pregnancy hormones plummet, affecting brain chemistry; a history of depression adds to the risk. Exhaustion, stress, and new-mom anxiety play a role. Depression does not mean you are a bad mother, an unloving mother, a failed mother. It does not mean that you will not feel better and enjoy motherhood. It does not even mean you will experience a similar depression after every birth (although you are at risk). Check out www.postpartum.net for resources, or call the hotline, 1-800-944-4PPD.

Better sleep, exercise, nutrition, and social support can help. You should also have your ob-gyn or family doctor rule out a thyroid problem. You may also need therapy, drugs or alternative treatments, support groups, or some combination thereof. Doctors can help you find an antidepressant, if necessary, that you can take while breastfeeding.

The Warning Signs of Postpartum Depression

If the baby blues last longer than two weeks, you are in PPD territory. Even if the depression is mild, get help so it doesn't last for months and doesn't get worse. We all have an occasional stressed-out day, and we all worry about our child's eating and sleeping. But if you have several of these signs and they are severe or obsessive, please listen to the warning bells.

• Excessive worry about the baby's health or schedule

• Loss of appetite or excessive weight gain or loss

• Inability to sleep at night even when the baby is asleep

• Hopelessness

• Very poor concentration

• Anxiety or panic attacks

• Deep sadness or an inability to feel pleasure

• Anger

• A lack of energy even if you got sleep

• Feeling guilty

• Prolonged lack of interest in sex (after recovery from labor and delivery)

• Missing doctors appointments (for mom or the baby)

A few other things that friends and family should watch for in the mom -- or in the baby:

• Requiring another adult to accompany mom to all doctor appointments (some couples choose to both go -- the problem is when there's a palpable anxiety about it)

• Has many physical complaints with no apparent cause

• Evades questions about herself

• Cries easily

• Seems uncomfortable being with her baby

• Won't let someone else care for the baby

• Expresses concern that the baby does not like her

• Baby having excessive weight gain or loss

• Delays in the baby's cognitive or language development

• The baby has low or decreasing responsiveness to the mother

Postpartum Depression Action Plan

I've already stressed the need to get professional help. Here are some other things you can do on your own:

Go easy on yourself. Parents are under a lot of pressure. We are bombarded with conflicting advice to do this or to do that, and sometimes we're told we're doing things "wrong." Give yourself a license to be human! If you have the time and inclination to make homemade strained baby food, and you feel good about it, more power to you. But a lot of babies eat food out of a jar and grow up happy and healthy.

Eat healthy foods. Avoid caffeine and definitely avoid alcohol, as it's a depressant. Drink plenty of water and eat a healthy diet rich in fruits, vegetables and whole grains.

Exercise. It doesn't have to be super ambitious -- walking and stretching are good ways to start. For a severely depressed woman who may be having trouble getting out of bed, exercise may seem overwhelming. Friends should encourage her to at least go outside, stand up straight, breathe deeply, and get some sunshine.

Take time for yourself -- a few breaks a week, each an hour or two. Take a walk. Read a book. Meet a friend. Get a manicure. New-mom playgroups, support groups, and baby-mommy yoga classes are great, but they don't count as pure mom time.

Sleep! Getting at least five or six hours of uninterrupted nighttime sleep is essential to treat and potentially lower your risk of postpartum depression.

This last tip -- sleep -- seems daunting when you have a newborn but even breastfeeding moms can do this. Here are some tips:

• If your baby is four to six months old, and the doctor gives you the okay, start sleep coaching now. Have your partner do it if you are too depressed.

• Split nighttime baby duty so you each get at least one five-hour uninterrupted block of sleep. One of you is "on" from 8:00 p.m. to 1:00 a.m., and the other from 1:00 a.m. to 6:00 a.m. (adjust these figures to your family's schedule). When you are "off duty," sleep in a separate area, and try earplugs, a fan, or a white-noise machine. The on-duty parent can sleep, too, but he or she will be the one who has to wake up to respond to and feed the baby.

• Consider pumping breast milk so your partner can feed the baby with a bottle of your milk while you get your "off-duty" sleep. Empty both breasts before bed so you won't wake up painfully engorged.

• If you are bottlefeeding, alternate nights with your partner to get a full night's sleep. If you can afford it, hiring a night nurse or doula for even a few nights can help.

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The above is an excerpt adapted from the book The Sleep Lady's Good Night, Sleep Tight: Gentle Proven Solutions to Help Your Child Sleep Well and Wake Up Happy by Kim West, LCSW-C. The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy.