One would think that after weeks of bed rest, a new mama holding her precious new baby and free to be up and about would be overjoyed. Yet all to commonly a new mama, whether she spent time on prescribed bed rest or not, may feel sad. While these “baby blues” are common immediately after delivery, symptoms that persist beyond the first few weeks and intensify over the next 3 months are more likely associated with post partum depression.
Post partum mood disorders are reported to be present in as many as 85% of all post partum women (1). Most times these are transient decreased moods that gradually resolve within the first couple of weeks following delivery . However, in the case of post partum depression, the symptoms actually persist and get worse. Women become increasingly sad, fatigued and anxious. They may experience changes in appetite and sleep changes, most notably sleep deprivation. They usually have no interest in sex. They find it hard to take care of themselves and their baby and some even have thoughts of harming themselves or their baby. These are classic signs of post partum depression and if left untreated, post partum depression can have serious long term negative effects on both mama and baby’s health.
Post partum depression affects approximately 10-15% of all women who give birth, but because the methods of screening and frequency of screening for post partum depression vary so greatly, the actual prevalence of post partum depression falls within a range of 1.2 to 25% of all pregnancies (2). Post partum depression was once thought to be merely a manifestation of the hormonal imbalance in the post partum women. But we now know that post partum depression occurs more frequently in women who have a personal history or family history of depressive disorders as well as (3):
- Treatment for infertility
- Childhood Trauma
- Hyperemesis Gravidarum
- Problems with your thyroid
- Mothers of multiples
- Diabetes (type 1, 2 or gestational)
- History of physical or sexual abuse
- Poverty/Low Income
- Military wives
This list encompasses many (of course not all) of the indications for prescribed bed rest, so mamas on bed rest are at particular risk of developing post partum depression. We also know that women who are under stress, are in pain, are sleep deprived, had traumatic birth experiences or had pregnancy loss are at increased risk of developing post partum depression.
But there is an upside to all of this. Post partum depression, when promptly and properly diagnosed is highly treatable. Using a combination of medications, psychotherapy and self care and personal support women who suffer from post partum depression can be freed from the disorder and they and their babies can go on to live happy, healthy lives.
The next few blog posts will address some physiologic causes of post partum depression, some of the socioeconomic causes of post partum depression, treatments options and post partum psychosis. If you have personal experience with post partum depression and would be willing to share your story please add it to our comments section so that other women can benefit from the wisdom of your experience. Also, if you have a post partum depression resource, please e-mail it to me at firstname.lastname@example.org.
1. Beck, CT, Post Partum Depression: It isn’t just the blues. American Journal of Nursing, 2006: 106 (5) 40-50
2. Leopold, Kathryn et al. Post Partum Depression: Women’s Primary Care Grand Rounds. The University of Michigan. OB/GYN.net. 2010
3. List compiled by Katherine Stone, blog owner, Post Partum Progress.
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Dr Jennifer Gunter and “The Preemie Primer”
Last week I had the pleasure to interview Dr. Jennifer Gunter on my podcast show. Dr. Gunter is an OB/GYN and Physiatrist at Kaiser Permanente in the San Francisco Bay Area who surprised me with her revelation that she had been a mama on bed rest with triplet boys. Unfortunately one little boy died when he was born at 22 weeks, but after a cerclage and 4 weeks on bed rest, Dr. Gunter delivered her twins at 26 weeks. Dr. Gunter very candidly shared the challenges that she and her husband faced caring for such fragile premature little boys and how the intense care has resulted in two robust, almost 7 year old boys. Dr. Gunter has compiled all of her professional knowledge and her personal experiences and life lessons into a new book called, The Preemie Primer: A Complete Guide for Parents of Premature Babies–from Birth through the Toddler Years and Beyond.
I keep turning that interview over and over in my mind. Dr Gunter seemed so calm and at peace with her experience. I suppose that after nearly 7 years, you grow accustomed to your life and you learn when to be upset and when not to be. Dr. Gunter admits that she and her husband had to shift their thinking to coincide with their new reality once the boys were born. But I kept sensing an air of faith mixed with subtle wisdom that I found awesome and awe inspiring. It is one that I didn’t have when I had my daughter, a “late preterm” baby.
My experience with a preemie
My daughter was born at 36 weeks and 6 days, just 4 short hours shy of 37 weeks. Due to the timing of her birth and some breathing difficulties, she was labeled a preemie and whisked away to the neonatal intensive care unit (NICU). Of all the things that I had expected to occur with my pregnancy, labor and delivery I had never expected to have a premature infant and nowhere in my mind did I ever anticipate her staying in the NICU. Now granted, she only stayed there for 10 days before she was discharged home, but the first time that I want into the NICU to see her I was completely overwhelmed.
There is no preparation for the NICU. They don’t take you there during the hospital tour; partially because they don’t want to scare and/or overwhelm new parents, but more importantly because those tiny infants are so fragile and so susceptible to infection that the mere presence of a tiny germ on a passerby could prove fatal. At our hospital the NICU was arranged in bays, from the sickest in the farthest corner to those just about to go home nearer to the front of the unit. That is where my daughter was. And even though she was not in an incubator and she did not have oxygen cannulas going into her nose and her IV line was in place but not in use, I was still a bit taken aback to see her on the little warmer bed with various wires taped to her little feet and hands.
No one prepared me for the fact that a baby, my baby, may have difficulty nursing because she hadn’t quite matured enough in utero to know how to breathe while she nursed. When my daughter first started nursing, her oxygen saturations would drop into the low 80′s because she would stop breathing while she sucked. Alarms would sound and I would have to break the latch that we both worked so hard to establish to pat her on the back so she’d resume breathing. There were a couple of other surprises that I had to learn to cope with, which I did, but they were daunting at the time.
Mamas on Bedrest: Prepare for the Worst but Expect the Best
Mamas I highly suggest that you prepare your self for a premature infant. While I am in no way saying that you will have a premature infant, the fact remains that if you have had some preterm labor and are on bed rest, your chances of having a premature infant are higher than those of a woman who has not. I find that when it comes to bed rest and prematurity, no one wants to talk about it. I understand that everyone wants to “stay positive”, but acting like complications could never happen is asking to be shocked. I understand that touring the NICU can’t happen. But that should not preclude a frank discussion between obstetricians and parents about what will be done in the event of complications; what types of complications can be expected if the baby is born at the time of the current OB visit? What protocols do the OB and the hospital or birthing center have in place to support parents of premature infants? What type of assistance is available to assist families once the premature infant is taken home? These can be tough hypothetical questions, but there is no harm in gathering information and even having one or two emergency procedures in place (such as family members ready to help out if needed).
If you have not considered that things could go “not as planned” with your birth, even now that you are on bed rest, I recommend that you at least discuss the possibilities with your obstetrician. Get some information. Prepare for the worst but expect the best. As Dr. Gunter in her wisdom reminded me,
“If we hear that a storm is coming we all go to the store, stock up on food and supplies, board up our windows and wait to see what happens. If it passes us by, so be it. But if the storm hits, we’re ready for it. I’ve yet to ever hear someone say, ‘darn it, I prepared for that storm and look it didn’t happen.”
Dr. Jennifer Gunter is an obstetrician, gynecologist and physiatrist. While speaking about maintaining intimacy on bed rest, Dr. Gunter revealed that she had been on bed rest during her pregnancy and had premature twins. What followed is an intimate account of how Dr. Gunter and her husband cared for their sons and how she used her experience as a physician and mom of preemies to write The Preemie Primer an informative and supportive resource for parents of preemies from birth to about 5 years old.