Anyone who has struggled with postpartum depression knows how painful the question can be: “Should I have another baby? Will it be worse?”
The question plagued my husband and I so much that we did not plan to have another.
In my first pregnancy I had psychotic episodes just before the birth and in the first few months postpartum. For two years I was basically incapacitated. From there, my mental health improved each year.
The cost of pregnancy was extreme emotionally and financially. While we did not feel as if our family was complete, we did not plan another child. Instead, I researched nutrient deficiencies and depression and wrote a book about it. The book was in press when I discovered that I was pregnant again.
With the pregnancy discovery, I buckled down, employed my best depression-fighting tools, and tried not to reflect on the irony that I was about to test the worth of a book I spent many months on.
As it turned out, the book works.
I made it through depression-free but you’ll see from the story below that depression is complicated enough that we need to pull out all the stops. I list the main tools I used below as a starting point for you.
Correct Your Deficiencies
Deficiencies come in all forms. Nutritional deficiencies are a big part of my own depression story. I spent the formative years of my life on low fat diets of bagels and imitation cheeses. Nary an Omega-3 fatty acid was to be found. I proceeded through life managing nonetheless until my body was charged with making an entire new person. As my first son’s brain developed in my womb, he sucked the limited Omega-3 stores out of me and I went bananas from the lack. I produced the milk that grew him out of his infancy as well, a food that also required Omega-3 fatty acids and many other nutrients. It took about six years to recover from my task of producing him.
I was seriously deficient in Omega 3 fatty acids, B vitamins, and magnesium, all nutrients that can at least aggravate depression if we do not have enough in our diets. Zinc is another culprit as is iron in the postpartum case. The entire Rebuild From Depression book centers around these nutrients — how to identify and correct the deficiencies — as a testament to how important they were in my case.
If you are deficient in certain nutrients, the change you need to make is typically fairly easy: Take a supplement or eat more food containing that nutrient.
However, many of us face deficiencies that are much harder to correct: deficiencies in sleep, relaxation, and even in fun.
Challenge yourself to improve those deficiencies as you work on your nutrients
Put Yourself First (aka “The List”)
“The List” may be the most powerful tool I used in my pregnancy. Though my book includes “a list” of nutrient deficiencies associated with depression, “The List” is something entirely different and maybe even more important in fighting depression in pregnancy and postpartum.
When my first son was about five years old, I created “The List” for moms-to-be to avoid my extreme case of depression. Jokingly I offered “The List” to my husband as a “Future Baby Agreement.” Of course, we did not expect to have another and he agreed to “The List” readily. We laughed and moved on.
A year later I discovered I was pregnant. I brought the list out, presented it to my husband, and he looked like a deer in the headlights. You will see why.
“The List” — Future Baby Agreement
1) If I say I need something, the correct response is:
“I will figure out how to make that happen.”
The incorrect responses are
“Are you sure?” or
“How much will that cost?”
2) Do not expect me to earn more than $XX a month (5-8 hours of work each week). I cannot be a money machine and a baby machine at the same time. If other money needs to be made, someone else needs to do it. And if my demands from item #1 on the list exceed my own earning power, that should not be my problem.
3) If we need more funds to pay for #1 on the list, reducing retirement savings is far better than me going bananas. Retirement is still decades away. The mental institution is just a few miles away.
4) If it becomes unreasonable for me to earn even $XX a month, then revert to #1 on the list.
5) Should I earn more than $XX a month, the excess will pay for additional household staff at my discretion.
6) I will not require us to move to a deserted island during my pregnancy so that you can harvest wild seafood for my dinner while I bask in the sun. Though it is my pregnancy fantasy, I won’t make it a requirement under Item #1. It would, however, make a handsome holiday gift.
“The List” worked.
I knew how important it was for me to put myself first and so did the rest of my family.
My code phrase in invoking the list was “I need….” When I said, “I need…,” I got it.
I asked for nothing unreasonable, just for what I needed. In one memorable moment I was having difficulty with a client contract and I gave it up to our financial detriment. We could have used the money but the cost was really too high. My husband never even whispered disapproval.
The focus on “what I need” retrained my thinking. During the normal rhythms of daily life postpartum, I lay next to my second baby Alastair thinking to myself, “I need to rest.” This was a coded message to my brain: Forget the house and work, relax your muscles, and just lay here for a while.
“The List” is important and it works.
Anytime we can manage to put our needs first as our bodies grow a new human, everyone will benefit.
(I really do want to add as an aside that I love the fantasy in my list about all of that household staff I was going to hire. It’s sure a good idea if you have the money. There are obviously plenty of people out there right now looking for work.)
Do Nothing That’s Not Necessary
It’s difficult to emphasize how precisely I am using the word “nothing” here, but on many days of my pregnancy, I did nearly nothing. I did shower and I tried to work for about three hours each day. I ate food that my mother cooked for me. (Thanks Mom.) Beyond that, I learned all of the games I could play with my son while lying on the couch. Saving my energy was critical in my case. It probably is in yours too.
Sleep Is Everything
I can get by with one night of just a few hours of sleep, but I cannot get by with two sleepless nights and certainly not in pregnancy. If one night was a bad one, I had no assurances that the next night wouldn’t be equally bad. I treated every night like sleep was the most important thing in the world.
It probably was.
Postpartum I actually kept a stash of over-the-counter sleep aids to use as I needed them. Although I would normally pass on any medication while breastfeeding, I saw the sleep aids as a tool in a pinch to avoid a path to stronger pharmaceuticals.
Focus Your Brain On Something Analytical
I made a great personal discovery while I was pregnant: When my brain was focused on an analytical problem, it could not worry or feel anxious or be depressed. If I could engage in such an analytical activity in the first place (which would have been difficult if I had already been feeling pretty lousy), I was home free.
I found my activity in my second pregnancy: C programming to make graphic displays of data. I do realize how absolutely obscure this is but you can find some of my food graphs on the website. All of those graphs are programmed, not generated through a point-and-click software. Programming requires a great deal of focus which makes it difficult to worry about climate change or the economy. You might want to poke your eyes out when you cannot find a missing semicolon in your program, but if you can get past those frustrations and produce something cool, you have distracted yourself and been productive.
The absolute obscurity of this example is probably evidence that our brains are so different that we need to find our own solutions.
As a less obscure idea, I discovered a second brain tool in my pregnancy. My son and I were in a restaurant playing the card game “war” while my husband was playing my son’s game “Rush Hour Junior.” My husband couldn’t find a solution so I couldn’t resist attempting it myself. It was a difficult puzzle even though it was intended for children and took me about five minutes to solve. I then tried another and another and said, “Is there a senior version?” Indeed there was a senior version and I am now a proud owner. During my pregnancy I could lay down, play the game, and keep my brain engaged.
If my brain is engaged in “Rush Hour,” it cannot be anxious or stressed.
Avoid Unnecessary Worry
We moms worry too much on our best days and pregnancy is just a giant worry invitation. I did two things in my pregnancy that may have saved my life. Adapt them to fit your situation if you can.
(1) I asked a friend to be my pregnancy case manager. I am extremely lucky to have a good friend whom I trust who was the director of a county mental health agency. She understood well my desire to avoid medication but she knows how serious depression and psychosis can be. In my first trimester I talked to her about my wishes and asked her to intervene if she thought it was appropriate. I knew that she would institutionalize me if she thought it would save my life but I knew she would also find the best situation for me if she had to do so. I asked my midwife to contact my case manager if she thought there was something serious in my pregnancy that needed to be addressed or if she felt it appropriate for any reason. In doing so, I was able to let go of my greatest fear: harming myself or my baby. I knew my situation would not escalate to that point.
(2) At my 20 week ultrasound, I asked not to be told about markers for Downs or other congenital conditions unless they needed to be acted on in the pregnancy itself. If action was necessary, they were to contact my case manager. I was just weeks shy of forty years old and I knew I was rolling the dice anyway in terms of risks to the baby. I didn’t need more fear in my pregnancy from the presence of one “marker” that may or may not be “fear-worthy.”
This decision turned out to be an important one. My son was born with a birth defect: bilateral club feet. From twenty weeks in pregnancy to forty is a long march as it is. It would have been unbearable for me had I known about the club feet. I would have ruminated on all of the possible related conditions, none of which were present in my son’s case. I very likely saved a complete breakdown by not knowing about the feet.
While the images of “joyful pregnancy” are compelling, change your expectations and get creative with your depression-fighting tools.
Some women have an easy time being pregnant and then there are the rest of us.
For more on climbing and staying out of “the pit,” check out Amanda Rose’s “Good Day Strategies” here.
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