Friday, February 23, 2007

The Edinburgh Postnatal Depression Scale

This scale was developed to assess depressive symptoms in women after birth, but I think it's one of the most straightforward and easy-to-use screening tools for depression--for anyone!--I've ever come across. If someone you know seems to be suffering from increased irritability, lethargy, social withdrawal or fatigue, please encourage them to take this 5 minute test (and disregard the title if the person is not a new mom!) A score of 12 or higher suggests that problems with depression are having a significant negative impact on one's quality of life.

We probably all know someone who went undiagnosed and untreated for depression. There's no way of telling just how many people suffer needlessly from this illness, though it's fairly safe to assume that the number is well into the millions. With depression, a good offense is a good defense. Being alert to changes in our loved ones' moods--as well as our own--is a good first step in ensuring that no one suffers needlessly from this illness.

Thursday, February 22, 2007

Postpartum Blog Worth Checking Out

Karen Kleiman writes about postpartum issues. I haven't read her books yet, though I'm meaning to get around to it--and add it to the bibliography. In the meantime, please check out her blog at: A great resource for parents!

Annotated Postpartum Bibliography

There are so many postpartum books out there, it's hard to know which ones will speak to a person's condition. I'm including a brief list here along with my notes in the hope that it will save some precious time and money for postpartum parents seeking information. If you know of a book or other postpartum resource that should be added to the list, please add it in the comments section. I'm always interested in hearing about what books or resources have been helpful to others. Also: almost all the books I've found have focused on postpartum mood disorders. I'm having trouble finding books that focus on other postpartum family issues (e.g. learning to become co-parents, maintaining a strong couple relationship, grandparenting effectively, balancing financial decisions and family needs, deciding if/when to return to work, single parenting etc.) If anyone knows of books that address these issues, please let me know--or I may just wind up writing the book myself!

Beyond the Blues, by Shoshana Bennett, PhD., and Pec Indman, EdD., MFT. This book has great descriptions of perinatal mood disorders accompanied by women's real life stories. Advises parents on how to choose a therapist and how partners can give support. The appendix on medical and healthcare professional terms is a great vocab lesson!

Conquering Postpartum Despression, by Ronald Rosenberg, Deborah Greening and James Windell has a good section on alternative treatments for PPD and the importance of a ppd team and a strong social support network. One caveat: They argue mood disorders are more common during pregnancy than postpartum. I would argue that diagnosis is more common during pregnancy because a pregnant woman sees her doctor at least once a month. I believe that ppmds often go undiagnosed because postpartum families tend to be isolated.

A Deeper Shade of Blue, by Ruta Nonacs, MD. I especially like the chapter titled, Helping Yourself, which gives practical medical advice on good sleep, nutrition, exercise, stress management, and parenting practices. It also gives suggestions on how to enlist helpers to support the family while a parent is coping with depression.

Down Came the Rain, by Brooke Shields. Shields is very candid about how ppd affected not just her, but her partner, friends, family, and other support people. Ultimately, Shields recovered with the support of her loved ones, a baby nurse, a good therapist, and medication.

The Ghost in the House, by Tracy Thompson. Part memoir, part investigative journalism. Thompson surveyed 393 women about their experiences with depression and its effects on parenting. Responses revealed that while some suffered PPD, others continued to suffer (often in silence) throughout their children's lives. I especially like Thompson's frank discussion of how depression affects her husband and daughters. The silver lining for Thompson's (and some other mothers') journey through depression is that she was able to recognize the onset and get treatment for her daughter's childhood depression and has been able to model to her kids that--with self-awareness, therapy and medication--she can be a more empathic, hopeful and determined mother than she might have been without depression. Highly recommended!

The Mother-to-Mother PPD Support Book, by Sandra Paulin. This collection of women's stories about ppmd might be good for someone who wants to know there are other people who lived through it and came out the other side but who may not want to join a formal support group.

Overcoming Postpartum Depression and Anxiety, by Linda Sebastian gives very clear definitions of different postpartum diagnoses, treatment options, and coping strategies for the sufferer's partner and support network.

Saturday, February 17, 2007

Dr. Goodnight--Or How I Learned to Love the Baby and Start Sleeping

We Americans, by and large, do not get enough asleep. How many of us have dragged ourselves out of bed and out the door, fueled by too much caffeine and too little sleep? I, for one, can recall plenty of Monday mornings when my body went into shock at being forced out of bed at what seemed an ungodly hour for a human being to be upright. Now, I must admit, it wasn't that I was waking *that* early. No, my morning stupor was brought on by a weekend of staying up--and sleeping in--much later than my usual weekday schedule. Saturdays and Sundays I felt fine, but by Monday my radical sleep schedule departure had caught up with me.

Fast-forward to today: I'm a parent of a 10 month-old, which usually begs the question: How are you sleeping? In short, well. I usually get up once or twice each night to nurse my daughter. In that sense, my sleep is more "disturbed" than it was in my pre-baby days. But when I look at my sleep hygiene overall, I sleep much better than I used to. Raising my daughter has taught me the importance of good sleep hygiene and its effects on health and disposition. If she's not dressed in jammies and in bed by 8:00, I can expect to deal with a tired and cranky baby the next day. Well, my little apple didn't fall that far from this tree. If I'm not nestled snug in my bed by 10:30, Momzilla emerges from the covers come morning.

Parents of little ones often receive loads of advice about how to improve their child's sleep and--by extension--their own. Less common are the questions about how parenthood has improved (yes, improved!) one's sleep. This is not to say that sleep problems can and do exist for many parents; sleep is a serious issue. I am, however, interested in this notion that parents can be taught lessons about good sleep hygiene by studying children's sleep. Some questions for parents of young children might include: What has your child taught you about the importance of good sleep hygiene? Since becoming parents, which lifestyle changes could serve to improve your sleep practices? What cues do family members give to express fatigue, and who recognizes them? Are there bedtime rituals that have been effective for child/ren that could also be effective for their parents? Recall a morning when you awoke refreshed: what happened during the previous day and night that made that good morning possible? Questions such as these can lead to a discussion of a family's good sleep habits--not just their sleep deficits. Increasing a parent's positive thoughts about sleep and decreasing anxiety over not sleeping well may indeed be the first step toward improving sleep hygiene.

Here's to a glass of warm milk, a good book, some comfy pj's, and a really terrific night's sleep!

Friday, February 16, 2007

Unicef Study Finds American Children At Risk

A 2007 study by Unicef finds that children in the U.S. are at much greater risk for poverty-related threats to well-being than children in 20 other wealthy nations. The study looked at six dimensions of children's lives: material well-being, healthy and safety, education, family/peer relationships, subjective well-being, and risk behaviors. Out of the 21 countries surveyed, the US placed 20th, narrowly beating out the UK for the dubious honor of last place. The results are startling, to be sure. But what caught my attention was how poorly American children did on measures of family and peer relationships. The US has more children living in single-parent families and in step-parent families than in any other country surveyed. Now, let me say that the presence of two biological or adoptive parents is not necessarily an indicator of health; however, research has shown a corelation between single-parent households and increased rates of poverty, unemployment, school drop-outs, and poor health. While not included in this study, there is other research that suggests one of the greatest "risk" factors to a couple's ability to stay together is children. So here's what we know: kids do better when they have two consistent parents in their lives, and couples are less likely to stay together once they have kids. Thus, we could improve children's outcomes by investing more in their parents' relationships. Let's hope that this study is a wake-up call for American society to change its priorities and invest more in children and the people who care for them.

Tuesday, February 13, 2007

Swimming Lessons for Depression

One summer my family went to Lake Michigan for a little time on the beach. My sister and I--water-lovers that we are--headed straight for the water. The waves were running a little high this particular day which, to us, was all the better. We had swam out, unbeknownst to us, onto a narrow sand bar. Then, one spectacularly huge wave hit us where we were swimming, knocking my sister and I both underwater. When I surfaced my sister was about 15 feet downshore from where we were swimming. She was flailing about and screaming. I was only about 9 at the time, but I knew enough to know that she was in trouble. I took one step toward her, only to step over the edge of the sandbar into much, much deeper water. Unable to feel the bottom, I surfaced and swam toward her. When I reached her, she was in full panic. I grabbed her around the waist and started swimming toward the shore. She screamed at me to let her go and was trying to squirm out of my grasp. I told her everything was okay and that I would not let her go. (My mind flashed back to swim class where our teacher told us that if the person you're trying to rescue is pulling you under, you should knock them unconscious. With one arm around my sister and the other engaged in keeping us above water, it occured to me that I should have asked more questions about how one might knock a drowning person unconscious while rescuing them.) Miraculously, we made it back to shore, both of us still conscious.

Looking back, I don't know how we survived. My sister was about 6 years old at the time, and while she was smaller than me, it wasn't by much. The lifeguard later told us the waves that knocked her off the sandbar were around 4 feet. I routinely failed my swim test for not having enough stamina to swim the length of a placid pool. The only way to explain how we survived was the power of the emotional bond of siblings. She is my sister, and there was no way I was going to leave her to the waves to fend for herself.

So it is with depression. Depression is like that wave that knocked my sister off the sand bar. A person can be caught unawares by a sudden wave of depression that leaves them flailing. When a loved one sees what's happened, s/he might try to lend support, but in doing so, s/he subjects herself to the power of the waves as well. Now, two are stronger than one, and together they might emerge safely. Depression is strong, but love is often stronger.

If someone you love is struggling with depression, you know that depression affects more than just the person who "has" depression. Depression takes its toll out on anyone close to its wake. In Brooke Shields' memoir, Down Came the Rain, I was struck by just how affected her husband, friends, and family were by "her" post-partum depression. Her story is a strong testament that while loved ones can help one overcome depression, it is dangerous to underestimate its powerful effects on one's support network. When seeking professional help for depression, it would be wise to invite them into the treatment process. Not only may support people be the key to swimming to safety, they may need to be thrown a lifesaver, too.

Wednesday, February 7, 2007

The leaves are red; the leaves are brown.

My father is color-blind. Growing up in Michigan, I enjoyed watching the leaves on the maples turn from their usual green to a deep claret red. My father, too, noticed the change, but for him the leaves went from greenish-brown to a darker shade of greenish-brown to just plain brown. Every fall he'd ask me with an air of detachment, "Are those leaves red?" Sometimes they were; sometimes they weren't. The shift was so subtle that it barely registered to him at all.

So it is, sometimes, with postpartum couples. For one partner, the postpartum period can be the most wonderful time in life. Having a new little one in the family is awe-filled experience, often drawing extended family, friends and kin together to support the baby and her/his parents. This period can deepen one partner's feelings of joy, responsibility, love, creativity, and playfulness.

To the other partner, postpartum can seem like the darkest period of life. Sleep-deprivation; health challenges; tense relationships with extended family; a loss of identity, spontaneity and intimacy can make one long for the days before baby's arrival.

It's easy to fall into the trap of trying to prove who's right and who's wrong when two very different perspectives on the same situation arise. Rather than get pulled into this binary thinking, I am curious about what might be helpful or useful from each of these perspectives.

The view that postpartum is a great challenge could lead to discussion of unmet needs or wants. Perhaps parents need to explore the need for more help--or different types of help--from their support network. Professional support (a doula, a therapist, or a nanny) may be needed. It could be necessary to acknowledge what they've lost as a couple--spontaneity, intimacy, etc.--and to explore ways they can nurture their couple identity while their parenting one is at the fore. And while postpartum can bring about a great deal of love and excitement, what's less talked about is how tough a job being a new parent can be. Sometimes simply acknowledging to each other that there are going to be low moments can help mitigate them when they do happen. And they do happen...

Which is why it's useful to recall what's wonderful about postpartum. This new little one is a gift--often a hard-fought one. No one will know or respond to her needs or wants as well as her parents. Perhaps baby's presence can help mend previously broken relationships in a family. A baby has a way of getting one out of one's serious adult mind and into a more creative, playful one. And babies can be so darn cute.

If one can detach from one's own perspective, it's possible to see how two seemingly contradictory statements can be true at the same time. The leaves are green; the leaves are brown. It all depends on how you see it.

Friday, February 2, 2007

Book Recommendation

I cringe at most parenting books. To me, they come off preach-y, too obvious, or just plain hokey. One book that I can recommend whole-heartedly is Becoming the Parent You Want to Be. As a mom with a little one still in diapers, I especially appreciated the section on "toilet learning" (as opposed to toilet training.) It's one of those rare books that has specific practical advice as well as a "wisdom for the ages" appeal. Parenting, after all, is as much an art as it is a science, and this book speaks to both sides of the brain. It's the one parenting book that I could see myself re-visiting time and again.