Chapter 12

Setting the Supermom Cape Aside: Caring For Yourself

In This Chapter

Eating, sleeping, and exercising for your health

Knowing how to take breaks

Being social only when you’re ready to be

Making PPD easier with seven positive tips

Asking for and accepting help

Using lists and eliminating unnecessary chores

Taking care of a baby is arguably one of the most difficult jobs on the face of the planet. If you have a partner, and especially if you have other children, it’s easy for your needs to get lost in the shuffle. You know how the flight attendants always instruct you to place the oxygen mask over your own nose and mouth first? The same concept applies here. You must take care of yourself so that you’re able to give your best to your child and your other family members. Sometimes new moms think that they should be plopped at the bottom of the list as if their own needs don’t matter — that is, if they’re even on the list at all. And when postpartum depression (PPD) is added to the mix, a mom often feels unworthy and unimportant. Her self-esteem is low. She thinks she’s a bad mother, and she feels like she doesn’t deserve anything that feels good. These thoughts don’t set the stage for good nurturing.

In this chapter, I provide advice to help you pull yourself out of the deep pit of depression and get back to normal. I also give you a handful of ideas to help you take care of yourself.

Eat and Drink Your Heart Out, Baby! (The Healthy Way, of Course)

Feeding your brain properly is necessary if you want it to function at its best. New mothers have certain challenges with eating healthfully, even without a mood disorder such as PPD. Unfortunately, depression and anxiety make matters even worse. Because appetite is often low when you’re depressed, your body may not be giving you the signal that it needs food. So, the whole eat-when-you’re-hungry concept doesn’t apply here. You basically need to force-feed yourself until you begin to experience the pangs of hunger again. Just remember that there are specific do’s and don’ts when it comes to food — some foods may help you crawl out of the darkness, but some can send you back down the spiral.

If you notice a big change in your appetite — either an increase or decrease — this could indicate a thyroid imbalance. If this is the case for you, have your doctor check it out.

Boosting your mood with food

Often women with PPD crave sweets and carbohydrates. For example, you may find yourself unable to pass a cookie jar without indulging in a handful. You’re having these cravings because your brain is low in serotonin and it needs the amino acid tryptophan in order to make more serotonin. However, to raise tryptophan, your body needs carbs — which is when you reach for a jelly doughnut or a handful of cookies. Even though you may feel a temporary lift in serotonin with a doughnut, shortly after eating it you’ll feel a big drop when your blood sugar also plummets. Plus, consuming those unhealthy calories won’t help in the self-esteem department either.

Food offers a much more healthful way of increasing serotonin than snarfing down a box of snack cakes. For example, you can combat depression and curb sugar cravings by

Nibbling protein: Eat foods such as turkey, meat, chicken, fish, or eggs every time your baby eats — which is probably about every three hours. This protein will help keep your blood sugar even and your moods more stable.

Drinking whey protein shakes: These shakes are especially helpful if you have no appetite. Many women find that drinking their meals is easier than trying to chew and swallow solid food.

Avoiding caffeine: Caffeine is public enemy number one for anxiety so avoid it as much as possible. Instead, drink water, water, and more water. If it’s the taste of coffee you desire, wean yourself by mixing some decaf in with your regular-strength stuff.

Eating legumes and grains, such as bulgur wheat and kasha (instead of white rice), pasta, and whole grain bread and cereals (for example, oatmeal): Carbs from these sources can raise your serotonin and are much better for you than the simple carbohydrates you get from white bread and other refined snacks. Simple carbs only spike your blood sugar and increase anxiety and depression. Most grocery stores have at least two of these choices listed.

For women, the most important time of the day to generate serotonin is the morning. So, don’t skip breakfast! Extreme dieting and skipping breakfast are the worst things you can do for your serotonin. A protein shake balanced in protein, fat, and carbohydrates is perfect. Also, don’t eat a breakfast that contains only simple carbohydrates (such as toast, a bagel, or most cereals) because it can shoot your blood sugar levels way up, and mess with your moods. If you can’t give up your morning bagel, always have some kind of protein with it. Eating the protein will help keep your blood sugar more stable, which therefore helps keep your mood more even. For example, if you want a piece of toast in the morning, eat an egg too.

The system that I follow

I’ve always had a deep interest in nutrition and feeding the body what it naturally needs for optimum functioning (including brain functioning). A health nut since the ’60s, I’ve tried every way of healthful eating out there (a couple that were on the weird side, now that I look back!) I believe in nutrition — not diets. My incessant search for a complete, simple system finally ended a little over two years ago — I found it. Since then, I’ve been using this nutritional system and introducing it to my clients (and all others I care about). It’s complete with high quality organic protein shakes, amino acids such as tryptophan (which raise serotonin), live enzymes, the essential fatty acids (Omega 3, 6, and 9) in the correct ratios, vitamins, antioxidants, and ionic plant minerals. The system, which consists of foods that you eat in addition to whatever healthful food you’re already consuming, has a total body cleansing and detoxing component as well. The results have been quick and dramatic, and I’m thoroughly passionate about it. Some of the problems that I’ve seen either totally disappear or at least decrease significantly with this system are depression, anxiety, decreased energy, difficulty losing weight, insomnia, sugar cravings, low sex drive, and difficulty concentrating. (I’m not mentioning this system by name because I want to make sure you’ll be ordering only what you need and should have, depending on whether you’re pregnant, nursing, or finished with both.) If you’re interested, feel free to contact me for more information by going to www.postpartumdepressionhelp.com or by calling 925-735-3099.

Hydrating your brain

You may already know that drinking enough water is essential for cleansing your body and for delivering nutrients to all your cells, but did you know it’s essential for moods as well? For instance, dehydration can worsen your anxiety. You see, without sufficient water, your lymphatic system — which is responsible for flushing toxins out of the body — can’t operate correctly. When your lymphatic system is on the fritz, the liver takes over and stops producing the amino acids necessary for the production of dopamine and serotonin — the brain chemicals needed for normal moods. New moms with panic attacks who go to the emergency room thinking they’re having heart attacks are often given a couple of glasses of water by a perceptive staff person. Often the panic subsides immediately!

To make sure you’re staying adequately hydrated, divide your weight in half and drink that many ounces of water every day. If you’re pumping your milk or breastfeeding your baby, if you’re sweating a lot from hormones, climate, or exercise, or if you’re physically unwell, you may need to drink more. If you feel thirsty no matter how much water you’re drinking, get your thyroid checked. One of the symptoms of a thyroid imbalance is continual thirst.

Well-meaning practitioners (doctors included) and authors sometimes advise women with PPD to drink some wine before bed to relax or to have a beer to help increase their milk supply. Neither is good advice. Alcohol is a depressant that disrupts sleep cycles and feeds your depression — two effects you definitely want to avoid. Also, alcohol doesn’t help with milk production. On top of all that, babies eat less when their moms drink even one alcoholic beverage. So remember, the bottom line is that alcohol isn’t good for you (or your baby) in any way and it can make you worse. If you’re having a difficult time avoiding alcohol and you think you may be using it to self-treat, please speak with a medical or mental health practitioner you trust.

Taking nutritional supplements

Through my research in the field of natural healing and nutrition (especially regarding mood disorders), I’m now convinced that it isn’t possible anymore to take in all of the nutrients your body requires just through food — even if you eat strictly organic food. Brain chemistry is affected greatly by what goes in your body, so it stands to reason that nutritional supplements are particularly helpful for PPD sufferers. Because this isn’t a nutrition book, I’ve picked out just a few tasty morsels for you to chew on.

Minerals

One of the major reasons that you can’t get your nutrition from supermarket foods these days is that soil is now depleted of minerals. And if the soil is mineral-deficient, food grown in the soil is also lacking. When you don’t get the minerals you need, your body and brain chemistry can’t be totally healthy. Among other things, minerals are vital to the production of hormones, including the reproductive hormones involved in pregnancy and postpartum. And, minerals also help your body use the nutrients taken in through the foods you eat. Most people already understand the importance of vitamins, but did you know that vitamins can’t be used by the body without minerals?

Even though organic food has a higher mineral content, it’s nothing like it used to be. Taking in high-quality ionic plant minerals, however, quickly remedies the deficiency problem. Even though you can get these plant minerals into your body in several different ways, the simplest one I know is part of the system I use, which you can find out about by contacting me through my Web site at www.postpartumdepressionhelp.com .

Essential fatty acids (EFAs)

Omega-3 fatty acids are essential fatty acids (EFAs) — good fats — that may help boost brain chemicals important in depression, such as serotonin and dopamine. However, your body can’t make them on its own. So, if your diet is low in these fatty acids, all your bodily functions are negatively affected — including your organs, skin, and brain functions. And it’s worth noting that most Americans, and especially pregnant and breastfeeding women, don’t get enough omega-3 fatty acids in their diets.

With all the promising information about essential fatty acids helping depression, it’s no wonder that omega-3 fatty acid supplements are being studied in pregnancy as a prevention for PPD. The more omega-3 you consume in the third trimester, the less likely you are to be depressed in pregnancy and up to eight months postpartum. When serotonin increases with omega-3, attention, concentration, sleep, and mood improve.

The following list includes many good sources of omega-3 for your body:

Flaxseed or flaxseed oil

Hemp seeds and hemp seed oil (these aren’t marijuana!)

Walnuts

Pumpkin seeds

Salmon, cod, cod liver oil, tuna, and mackerel (helps with mood)

Kidney beans

The omega-3 foods that are known to specifically help with mood are types of cold water fish, such as Atlantic salmon, halibut, sardines, and tuna. They contain two omega-3 fatty acids that are shown to be most beneficial for mood.

Because these days you probably find it difficult enough to get dressed, let alone go out to buy cod liver oil, taking a high-quality supplement with the right balance of the omegas is probably the way to go. Choose an omega supplement that’s high in the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). You should aim for the total amount of EPA and DHA combined to equal 1,000 to 2,000 mg per day. Also, brands vary by taste, so find one that doesn’t have a bad taste. Keeping the pills in the refrigerator may decrease any aftertaste or fishy burps. If you want to try the one I use — which has no fishy aftertaste — contact me.

Multivitamins

If you’re pumping your milk or breastfeeding your baby, talk with the pediatrician about whether to remain on your prenatal vitamins. If you decide to take a multivitamin instead, it should be a high quality one that can be easily absorbed by your body. The vitamin should never be in the form of a hard pill. Instead, choose one in the form of a powder in a capsule. Make sure the multivitamin has a full range of all the B vitamins, vitamin C, and folic acid. Folate is important for mood regulation (and it may also speed up the effects of antidepressants).

Without enough B-12 a person can become depressed because B-12 is required for the conversion of amino acids into dopamine and serotonin. Vegetarians are often deficient in B-12 because fermented soy products, such as tempeh and seaweed, or vitamin supplements are the only known nonanimal sources.

Making Sure You Get Some Winks

Even for moms with fresh buns out of the oven, sleeping is not a luxury — it’s a medical necessity! This is the toughest time of the most difficult job you’ll ever have. Sleep is your elixir.

Humans need 8.4 hours of uninterrupted sleep per night in order to function at their best (the key word here being uninterrupted ). Broken sleep causes serotonin to drop and as I’ve mentioned before, PPD is often caused by a low level of serotonin. If broken sleep continues, depression and anxiety can get worse. You’ll probably be able to handle the responsibilities in your day well enough with a chunk of five to six hours of straight sleep. The more nights per week you get these chunks of sleep, the faster your recovery from PPD will be.

Daytime sleep doesn’t take the place of nighttime sleep. It’s nighttime sleep that restores the brain and keeps the natural rhythms (biorhythms) of the body on track. Arranging to have good nighttime sleep when the baby comes is one of the best preventions for PPD.

Sleep problems are common with PPD. If you have trouble sleeping at night when your baby is sleeping, you may need a medication to help you. Consult your doctor if this is the case.

Starting with the ideal plan

Sleep deprivation is probably the most under-emphasized contributor to PPD there is. It’s a serious issue, and it needs to be given the proper attention. Not all parents can set up the ideal plan, but I start with it here so that you know what you’re shooting for. It’s okay if you need to compromise it a bit (or a lot) due to extra challenges. Here’s how thousands of new parents set up their sleep arrangements every night:

Split the night’s baby duty with your partner. Unless you’ve had a C-section or you have another medical issue at hand, only one person needs to be up with the baby. The other person should be sleeping. After five hours, when the baby wakes, your partner can wake you up and the two of you can switch.

Sleep in a separate area away from the baby and the adult on duty. Use earplugs and a white noise machine, such as a fan or air purifier if necessary. The goal is to make sure that you aren’t hearing the baby or other noises so you can achieve uninterrupted sleep.

Move the clock away from the bed so you can’t see it. Moving the clock is especially important if you tend to obsess. If a clock is nearby, you’ll be tempted to check it and then obsess even more about not sleeping or about when the baby might wake up.

If you’re breastfeeding or pumping, it’s important to empty both breasts before bed so you won’t be awakened engorged and in pain during your off-duty shift. If you can pump during the day, your partner can use your milk for the off-duty feedings.

Especially if you aren’t breastfeeding or pumping at night and can take full advantage sleeping straight through the night, the following suggestions work great for enhancing the quantity and quality of your dream time:

Alternate nights with your partner. This schedule means that you’ll have one night completely on duty and the next night completely off.

Hire a night nurse or doula so you or you and your partner can both sleep (even if just for a couple of nights a week). This plan is an investment for launching your new family. Because of the importance of sleep to mental and physical health, many moms and couples use up savings accounts or borrow money to be able to hire night help.

Making do with whatcha’ got

Sometimes you won’t be able to arrange your circumstances exactly the way you want, and your wonderful plan for heavenly sleep falls through. Just do the best you can to get more sleep and to enhance its quality, and allow yourself to feel good that you’re continuing to work toward the eight-uninterrupted-hours-a-night goal.

I’m not a big fan of naps because after you’re sleeping as you should at night, naps shouldn’t be necessary (a bonus, maybe, but not necessary). But, many of my clients who still need naps or enjoy them find the following ideas to be mighty helpful for sneaking in naps throughout the day:

When your child is sleeping, sleep if you can. Do remember, though, if you’re anxious, sleeping may be really difficult at night, which means that sleeping during the day will probably be worse.

If you find that you’re just tossing and turning during the day, cross napping off your to-do list! It will be too frustrating and feel like one more failure. If you once enjoyed naps, but can’t right now, don’t despair. I promise you’ll be able to nap again as soon as you recover. Your ability to nap may be one of the signals that your old self is returning.

If you’re breastfeeding, lie down in bed or in a recliner while your baby nurses. Doing so may allow you both to doze.

Nap while your baby gets some visual stimulation. Secure your one-or two-month old (or any baby who’s young enough to stay put) in a baby seat so he’ll be safe, and turn on an educational baby video. Set your nap timer so you can sleep in the TV room for 15 to 30 minutes while your baby gets some enhancing stimulation.

Sleep in the parking lot as you wait for an older child at school. During this time, your baby is in his car seat — hopefully also sleeping peacefully.

Put your baby in a front carrier and nap while you’re in the doctor’s waiting room. Ask the receptionist to wake you when it’s your turn.

Ask a friend, neighbor, or family member (maybe someone you had at your baby shower) to watch your child while you take a short 15 to 30 minute nap.

Hire a babysitter or a mother’s helper to watch your child while you take a nap. A mother’s helper, which may be less expensive than a babysitter, could be a responsible older child who comes to your home after school.

The ideal amount of time to nap during the day is in 15-minute increments (you can have more than one of these naps during the day). However, even if your situation permits, don’t allow yourself to sleep for more than 30 minutes at a time. Napping for too long can throw off your biorhythms and mess with your sleep cycle, just like your baby’s naps can with her sleep cycle.

If you find yourself resisting the idea of sleeping during the day because that’s the only time you get to yourself, you’re heading toward burnout. If this sounds like you, please refer to the section “Taking Regular Breaks” later in this chapter for help.

Working through the challenges

If you think that you have major sleep obstacles (no or little partner support) in your life, don’t worry — you’re not alone! Often with a bit of creativity, these obstacles can be easily overcome. You may relate to the following complaints my new clients sometimes present:

“There’s no way my partner will get up with the baby.” Don’t assume anything until you ask: He may in fact be very willing and it’s your unnecessary guilt about asking him that’s in the way. However, if he really is reluctant, usually when it’s explained to him that he’ll get his wife “back” quicker, he steps up to the plate.

You’re not asking if it’s okay with him that you get sleep. That would be like asking permission to breathe. Instead, you’re lovingly letting him know what you need. If he’s still not willing to be a fully participating parent, you can tell him that you’ll need to hire someone (if nothing else works, this step usually does the trick!).

“My partner works nights, so I’m all by myself.” If your partner sleeps during the day, split the childcare day shift with him and sleep for 30-minute chunks during the day. Or, invite an older child over to be a mother’s helper while you nap during the day.

“I’m afraid my partner won’t hear the baby crying. He’ll probably just sleep right through it.” When he knows you’re sleeping and he’s on duty, you’ll be amazed at what he, the seemingly deepest sleeper on the planet, can hear. Give it a try and you’ll see. Place the monitor (or baby) right by his ear. If he takes a couple of minutes to get out of bed (as opposed to your half a second), don’t worry. It’s fine — your baby won’t be psychologically damaged!

“I have no support. I’m a single mother and my family lives out of town.” Remember the friend or trusted neighbor who keeps offering to help? Call her up. Say something like, “I really appreciate your offer to help me with the baby. I’m ready to take you up on your offer.” Your trusting her will make her feel great. If she’s not able to relieve you during the nighttime, ask for a daytime shift. If the friend can come once a week and the neighbor can come another day, you have two solid sleep times you can count on.

If you’re financially able to hire a doula, do it (I discuss doulas in more detail in Chapter 14). If you brainstorm and still come up empty, try your local church, synagogue, or parent group. Often you can join a babysitting co-op. Remember, if you need to move in with a relative temporarily, that’s no weakness. If you have the support, use it!

“We live in a one room apartment, so there’s no other place for me to sleep. I hear everything.” If you have a couch in the living room, sleep there with earplugs and a fan on (or something else blocking the noise). Or, while your neighbor watches your baby during the day, go sleep at her house. If your helper can take the child out of your house, you can stay home. By the way, don’t forget the local hotel in your area! Many mothers rent out rooms for a night, at least once in a while, to ensure a quiet night.

Shakin’ It for Your Love

Exercise isn’t just for the physical health of your body — it’s also necessary for your emotional health. As you begin to incorporate exercise into (or back into) your life, your physical healing will be enhanced as well as your mental well-being. Many research studies support this fact that exercise has mood elevating effects. Regular exercise promotes the release of endorphins, which are feel-good chemicals that produce feelings of happiness and well-being and are known to relieve depression. Just remember that before you do any type of exercise, make sure your doctor has given you the go-ahead.

Make sure you accept whatever level of activity you can manage right now. As you probably know, today’s society places a huge emphasis on exercise for many people — sometimes to the point of obsession. Some people may tell you that in order to recover you should go to the gym regularly. But here’s what I (and numerous other healthcare professionals) say: You don’t have to go to the gym at all to recover from PPD! Just getting out of bed and going through your day is a triumph. Most moms with at least a moderate case of depression can hardly get to the gym even once, let alone a few times a week — it’s too overwhelming just thinking about it.

When you’re considering exercise, make sure you keep the following facts:

Any physical movement is exercise. If walking to the mailbox is all you can muster, that’s great. Even just standing outside your front door and taking some deep breaths can help you get some air and sunshine and can lift your mood (even if you are still in your bathrobe).

Depression zaps energy, so any activity can feel like a lot. But, keep in mind that your serotonin levels, which alter your mood, are affected by exercise — so taking two (or three, if you can) brisk walks every week for 30 minutes can increase serotonin and boost your mood. Don’t push yourself too hard, though.

Exercising right before bed isn’t a good idea — especially if your sleep patterns are already screwed up. Right before bed you need to give your body the direction that it’s time to calm down, not get going. Many women think that if they wear themselves out right before bed they’ll sleep better. But, the opposite is typically true, depending on the exercise. For example, yoga and relaxing stretching may be an exception to this rule.

It’s important to wait until you have at least a couple of weeks of good sleep before you begin a heavy exercise program. Especially if you’re prone to panic attacks, start your exercise program slowly and work your way up. I say this because lactic acid, which is released when muscles are worked too long or when they’re not properly conditioned, causes soreness and panic.

When you exercise, your brain produces endorphins that make you feel good. If you feel a need to exercise for long periods every day in order to feel good, that’s a signal that your brain chemistry needs some other help as well. It’s easy to become addicted to overexercising when you’re depressed, because the brain produces endorphins to reduce pain, and when a person overexercises, the muscles are stressed (in pain).

Fortunately, you have a built-in security system: If you overdo your exercise, your body lets you know by making your mood dip or by making your sleep problems worse (flip back to the section “Making Sure You Get Some Winks” earlier in this chapter for more information on disrupted sleep patterns). The difference between how much exercise you should try to do and how much is too much is a fine line. Experiment with the length of time you walk and with your pace. If it’s right for you, you’ll feel good. If you find yourself very tired and your mood is dropping, your exercise level was probably too high. Remind yourself that you’re doing the best you can, and you’ll recover regardless of the amount and speed of your exercising.

Taking Regular Breaks

When you work outside the home, no matter how rough your day is, you can look at the clock and say, “Just another hour and I’m outta’ here!” Saying this makes it easier for you to hang on and not bite the head off the next person who approaches your desk, right? Well, this mom job is quite a bit different. Taking care of a baby is the only job where breaks aren’t mandated by law. You must schedule breaks or they won’t happen. And I don’t mean just talking about taking breaks — you actually have to mark them in your calendar.

Avoiding burnout

Burnout occurs when you have nothing to look forward to. Wednesday may as well be Thursday because everyday feels the same. In fact, you probably feel like Bill Murray in the movie Groundhog Day. But, when your day gets tough and your moods are dipping, knowing when your next break will be makes all the difference. Having pockets of “you” time sprinkled throughout the week gives you something to look forward to.

If you’re a full-time stay-at-home mom, you ideally need three or four two-hour breaks during the week to prevent burnout. Why at least two hours? Because you need about an hour to start relaxing and realizing that no one is hanging on to any of your body parts. Nothing is more disappointing than having to go home right as you start to relax. It’s that second hour that will be the most enjoyable (or as close to “enjoyable” as you can get these days). These blocks of time should be as regular from week to week as possible.

Do the best you can. If your anxiety is so high that the mere thought of leaving your baby even for 20 minutes makes you short of breath, start with just 10 minutes. Leaving your baby will get easier and easier as you see that she’s safe and as you realize that it’s good for her to have experience with other loving caretakers. She needs a change of scenery too, don’t forget.

If you have a partner who’s home in the evenings and weekends, some of your break times can be during those times. But, it’s wonderful for couples when the stay-at-home mom can get some respite before the partner returns in the evening. Then she has some energy left for the couple relationship.

Figuring out what to do with yourself

Are you wondering what you’d do with your time even if you had it? If so, you’ve just received a sign that you’ve been depleted of “you” time for way too long. To get started on regaining your “you” time, make a list of all those activities that gave you pleasure in the past. Each woman’s list will be different. For one woman, shopping for herself or going to the gym are pleasurable. For the next woman those same activities may feel like chores. To each her own!

Tasks aren’t allowed during this “you time.” If you shop, make it exclusively pleasure shopping for you. If you find yourself in the baby aisle, laugh and say “Oops!” Then take yourself back to the women’s section. If you add more time after your break, you can do other shopping chores, such as buying diapers or other baby toiletries — but only after you’re done with your break and only if you add a half hour on to your trip. The point is that the “you time” must come first. Be honest — if, at the beginning of your break you said to yourself, “I’ll just stop at these few stores and get these chores done so I won’t have to think about them later,” would the “you time” ever happen? Probably not. It’s a trap. And that’s often why moms get burned out and resentful. They put themselves last on the list — they only treat themselves if time is left over.

If you take breaks and you feel like you’re just going through the motions — kind of zombie-like without joy — take them anyway. As you recover, you’ll start experiencing the “up” feelings again. And, in this case, you’ll already have the structure in place. The breaks also help boost your recovery, so don’t wait to feel less depressed before you take them. If you’re not up to leaving the house for every break, you can stay home, but be completely off-duty with chores and child care during that time.

It’s a gift to your family when you recharge. Each member of your family benefits when you take care of yourself on a regular basis. No matter what anyone says, taking care of yourself first isn’t selfish — it’s a very important part of your job. If guilt pops up, remind yourself that you’re a good and responsible mom, and that’s why you’re leaving the house right now.

Staying Social

Some women with PPD want to be with people a lot, and they want to talk about what’s going on with themselves — sometimes to excess. They feel better when they’re talking and sharing. There’s nothing wrong with this at all, but if this describes you, make sure to give yourself a break from talking about PPD. Talk about other topics too. This will remind you that you aren’t a walking case of PPD — you’re a woman who happens to be dealing with PPD, but there’s more to you than this illness.

On the other hand, some women with PPD hide away and don’t want much social contact at all. If you’re not answering e-mails, the door, phone calls, or invitations, you’re in good company. Hibernating is very common with PPD, and it’s not necessarily a bad thing. In this section, I explain how you can tell when avoiding other people is helpful to your recovery and when it can make you worse.

Cocooning versus unhealthy isolation

Sometimes you may want to curl up in a blanket, drink something warm, and watch TV instead of going out with friends. Staying in and comforting yourself can be a way of self-nurturing, and it’s considered healthy. I call it cocooning. Even though your usual self, the self before the PPD, loved being social and getting out, now you feel otherwise.

Well-meaning loved ones may think that they should encourage or even demand that you join them at the neighbor’s party. They may say, “You’ll feel better if you just get out and do something.” Here’s how you gauge whether they’re right, or whether cocooning is the best activity for you on that occasion: Ask yourself, “Would I feel better if I could just get dressed and go to the party?” If the answer is yes, ask someone to help you get ready. If your answer is no, because it feels too overwhelming or stressful, you should stay home. You can feel really good about tuning in to yourself and choosing what’s healthy for you. The answer may be different each time an occasion arises, so listen to your intuition.

Sometimes you’ll be involved in a personal tug of war — part of you will want to get out and part of you won’t. At those times, tune in and ask what most of you wants to do. Listen for the answer and go with it. However, if you find yourself lying in bed or on the couch getting more depressed, lonely, or anxious, this is a clear sign of unhealthy isolation, and you should get up, and be active and social (maybe join your family at that party, even for just a half hour).

If you want to get out but don’t have the energy to get yourself ready, ask for help. Unhealthy isolation will make you feel more depressed and you’ll spiral down further, so learn to ask for support in getting up and out of the house or having visitors or phone calls. Becoming social again will take effort, but it will pay off.

Your choices of whether or not to go out may be confusing to your loved ones, since sometimes their encouragement looks like it pays off and other times it doesn’t. Just tell them that at times you may join an activity and other times you won’t, depending on how you feel. Tell them you understand if it’s perplexing to them — it’s perplexing to you too. Ask them to please trust and respect your decision, whatever it may be at any given moment.

If you push yourself to do an activity and it wasn’t right for you, your mood may dip later that day or the next day. You can be sure that your body will let you know if you overdid it. But, don’t be angry with yourself because you “knew better.” Just learn from the experience. You’ll get better at trusting your own wisdom and also at setting boundaries with others (for example, knowing how to say no).

Confiding in people you’re comfortable with

Who you choose to socialize with and what you choose to talk about is important. It’s good to confide about your PPD to a few close people. Disclosing how you’ve been feeling to your good friend, therapist, and spouse may be great for you. Sharing and feeling understood raises serotonin. That’s one of the major theories as to why therapy works. But, if you’re vulnerable to other people’s reactions to PPD, protect yourself. Before you open up, ask yourself whether you trust this person and whether he or she is truly able to support you. If yes, go ahead and offer some information. Hopefully your chat will go well, but if doesn’t, don’t blame yourself (see Chapter 14). You did nothing wrong — it’s the other person’s limitations that caused the negative reaction.

It’s also really important to talk to others about normal, everyday life stuff. You’re not a walking illness — there’s more to you than symptoms. Engaging in normal conversation will help you feel more like your old self. It’s not that you forget you’re dealing with this illness — it’s just refreshing to remind yourself that you’re a new mom who has regular new mom things happening as well.

Creating a Positive Ambience

Although it’s always important to create an atmosphere that’s conducive to your comfort and well-being, it’s particularly important to pay attention to your surroundings now. Accommodating your specific needs during this time will enhance your progress. Your physical and emotional comfort are especially important right now.

For example, making particular alterations in your environment, choosing carefully what you read or watch on TV, and wearing certain clothing, can all make a positive difference. If you’re dealing with rough clothing, loud, shrill noises, uncomfortable air temperatures, negativity blasting from the TV, and so on, this assault on your senses can drain your precious energy even more. And you need that energy to recover from this illness. You don’t have to be obnoxious or demanding to those around you — just keep your awareness high.

Muffling the noise

You may be particularly sensitive to decibel level these days. Loud noises in general may affect your stress level, but the one that probably gets to you the most is your baby’s wailing. Even though the pitch of your baby’s screams may not bother other adults in your house, that sound may make those little hairs on the back of your neck stand straight up.

If you’re not on duty, feel free to leave the vicinity. However, if you’re the one in charge of your little one at the moment of her melt down, help yourself to a pair of earplugs or headphones. If you don’t own a pair of headphones, invest in a pair today — you won’t regret it. Even with the headphones or earplugs, you’ll still hear all you need to hear in order to care for your baby, but at the same time you’ll be protecting your stress level from climbing up your spine and shooting out the top of your head.

Getting away from cabin fever (without leaving the house!)

When you’re waiting for your next break and it seems like ages since the last one, the walls may feel like they’re closing in on you. The room actually feels like it shrinks. This claustrophobia is typical because depression makes everything feel dark and small. Consider the cabin fever that nondepressed people get when it pours or snows for days and no one can go outside — now multiply that by at least ten. Cabin fever will likely be much more difficult for you than the average person. When you start fantasizing about going out to buy diapers and it feels like a trip to the Caribbean, you’ll know that you have a touch of cabin fever.

With PPD, you may start associating your furniture or certain locations in your home with feeling bad. You may grow to hate your bedspread or that couch in the corner where you cry a lot. Many women (I did this too) with PPD imagine living in another home — and they’re sure they wouldn’t be depressed there. “I bet I’d be happy in that house,” I used to think.

If you start feeling trapped or depressed by your surroundings, try rearranging your furniture. Change the bedspread and move the rocking chair. Even though you know you’re tricking yourself, it still works. You’re changing the same old scenery to something new, which gives you a fresh start. Permit yourself to change the scenery as frequently as you desire.

Soaking in some vitamin D

Brightening your home with light — whether natural or synthetic — will also help brighten your mood and lift your spirits. Open your curtains, pull up the shades, and let the sun shine in. If it’s gloomy and gray outside, just turn on lamps in every room. But, remember, this isn’t the time to worry about your electric bill. If you’re resisting these suggestions, ask your partner to do this for you. It may seem like too much energy and you may not have the motivation yet to do this for yourself. In any case, make sure it gets done for you until you can do it for yourself. You can even take care of two needs at a time by exercising near a window with the sun streaming in or by exercising outside. If you’re more anxious than depressed, lots of bright light can be too stimulating. Experiment and see how you feel. If you need less light, adjust to your comfort level.

Trading the rags for britches

Every once in a while, get out of that sour milk- and drool-stained T-shirt and into a clean one! When you’re just going to be spit up upon a second later, why is it worth it, you ask? You know why. Because feeling more like your old self helps your mood. You don’t feel so lost in Babyland when you’re feeling fresh. It’ll be well worth the extra laundry, I promise.

When your energy is low and overwhelm is high, the first tasks that you’ll probably drop are the ones for you. But those are the ones that can really lift your spirits. If you used makeup before the baby, get back in the habit (even just one part of your old regimen). When you go out (or stay in), take a shower, fix your hair (at least comb it), and dress well (that means get out of those big, baggy sweatpants). You count! You’re not just a milk machine and a baby soother. You’ll do better when you feel human and more put together. These suggestions may sound trivial, but you’ll be amazed how well they work.

Shutting off the boob (tube)

Watching TV is damaging to your mental health even if you’re not depressed or anxious. On every channel, at almost every moment, negativity of one sort or another is being shown. (To protect the obsessive readers, I won’t start listing these instances here.) Especially when you’re recovering from PPD, you need to surround yourself with all things positive. If you rent a funny movie, feel free to watch it. Otherwise, unless it’s an educational children’s show for your preschooler, turn off the TV. The TV just isn’t your friend right now. If you’re up in the wee hours of the morning and you want some mindless entertainment, put in one of those (funny) movies you rented. Just don’t flip through the channels — that’s bad news. And speaking of news — it’s forbidden. The worst thing you can do right now is watch (or listen to) the news — nothing is more negative than that.

Reading airy fluff, not serious stuff

This isn’t the time to read heavy-duty material on childrearing, illness (except this book!), or other serious topics. Stay away from newspapers, the Internet and all those parenting magazines. If you have a subscription to a parenting magazine, I suggest you stop your subscription, or at least ask your partner or other support person to temporarily remove the magazines from your mail pile. Most of those magazines are driven by the raising of a parent’s (usually Mom’s) anxiety. Good mothers see the headlines and think, “I better read this or I might miss something and my child will somehow be hurt by my lack of information.” That’s how magazines sell. Many books for new mothers — even some of the very popular ones with loads of marketing — are big guilt-trippers and anxiety-producers. Consider using them for other purposes — they make great door stops!

Instead, choose books and magazines with fantasies or some other light fluff. Basically, you want to choose something that you enjoy — something that can give you a mini-vacation away from the inside of your head. You might choose a mystery novel, a trashy love story, or a magazine on decorating. Motivational material is great too.

Giving Yourself Permission to Set Limits

Do any of the following thoughts sound familiar?

It’s my job to take care of everyone else.

I shouldn’t need help.

I should be able to take care of my baby by myself.

If I say “no,” that’s selfish.

They’ll be disappointed in me if I refuse.

If even one of those statements rang a bell for you, I’m guessing that you’re probably one of those people who put others’ needs and wants ahead of yours, most likely at your own expense. You may have been taught that putting others first is the right thing to do. This way of thinking is an unhealthy paradigm that you need to shift. I don’t mean that you should never do anything for anybody unless you’re 100 percent thrilled about it — that’s not reality. But, if you’ve been living your life from the bottom of the list, you have to make a change.

One of my clients, Emily, told me about the time that she had finally planned to spend some much-needed time with her preschooler (after a long hiatus because of her PPD). Her little girl was so excited to finally be able to spend some time with her mom. They were both looking forward to going to the park together and then to buy the little girl a new pair of shoes. But, just as they were about to leave the house, Emily’s friend called and asked her to come over for a couple of hours to baby-sit so she could go shopping. Emily told her friend that she had plans to spend some time with her daughter, hoping that her friend would withdraw the request. When she didn’t, and asked again if Emily could please come over, Emily agreed. Emily spent the day sad and angry with herself, and guilty about not fulfilling her promise to her daughter. She once again had put someone else’s wishes above hers and above what she knew was best for her relationship with her daughter. Emily told me that she was worried that saying no to her friend would be selfish. But, during Emily’s appointment she realized that her primary obligation shouldn’t have been to her friend. She let herself and her daughter (and her relationship with her daughter) suffer because she had been programmed to believe that saying “no” made her a bad person.

Remember, your family is counting on you to set limits and healthy boundaries. If you don’t, you’ll burn out, and your family will suffer. Setting limits applies to everyone you interact with, including yourself. If you’re taking on too much because of another person’s expectations of you, this section is for you.

Reaching out and asking for assistance

Many women (and men, for that matter) believe that they should be completely self-reliant, and they feel that asking for assistance of any kind is a sign of weakness. The truth is, this baby thing does take a village, and the sooner you accept that you’re part of the human race and that you need people too, the better life is for all concerned.

Have you ever said to yourself, “I wish I had help, but I don’t want to burden my friends”? Put the shoe on the other foot, and think about how you feel when you help someone you care about. I’m guessing you feel pretty good, which means that your friends probably feel the same way. Don’t ruin your friends’ chances of taking advantage of the opportunity to feel good! Allow them to help you.

If you’re thinking about how nice it would be to have just one person offer to help, you’re on the right track. Now you just have to elicit the help you need. If your friends aren’t offering, just ask them. You may be assuming that if an individual isn’t coming forward, he or she doesn’t want to or is unwilling to help. That assumption is completely wrong. Often these very people aren’t asking if you want help because they don’t want to interfere or appear pushy. They may be trying to respect your wishes and are waiting for you to approach them. The point is that you should never make assumptions. The worst that can happen is that you ask and they say they can’t this time. That wouldn’t be a tragedy, and you can pat yourself on the back for trying.

Accepting help when it’s offered

You may have a number of people offering to help you in a variety of ways. Some may be offering to cook, clean, shop, or baby-sit for you. Others may come forward to keep you company and take you for walks. (Refer to Chapter 14 for suggestions on how to assign jobs to people so that you’re well-covered and the jobs fit the strengths of the helpers.)

Whatever the offer, unless you have a good reason to refuse, always accept! And be specific so that you receive exactly what you really need. For example, consider this vague question that could have many different meanings: “Can you help clean?” Instead, you want to say, “I would really appreciate it if you could clean the downstairs bathroom.” Even if you suggest something other than what they’re offering, let them help you. Accepting help isn’t a sign of weakness, inadequacy, or incompetence on your part. The opposite is true — it’s intelligent to accept help.

Sometimes you’ll have friends come by to help, but they’ll end up being anything but helpful. These people usually fall into two categories. One group includes those who sit around expecting you to take care of them, as opposed to the other way around. The other group includes those people who are truly trying to help, but instead are actually making your life more chaotic. Remember that you don’t have to protect their feelings. Don’t worry about offending them or about what they might think. I don’t mean that you should blast them or go out of your way to make them feel bad, I’m just saying that it’s your well-being that should be on the front burner.

Structuring Your Day

Moms with PPD often have the sensation that they’re in a time warp — perceptions of time are definitely altered. When I had PPD, everything seemed to slow way down. It was like moving through sludge (I’d say molasses, but it wasn’t that sweet). A minute would feel like an hour. I remember being so sure that my husband was on his way home (he usually came home at 5 p.m.), only to realize with dismay that the clock said 10:30 a.m.

If you’ve worked outside the home, chances are you’ve had some kind of schedule: You got up at a certain time, got to work by a particular time, and so on. As much as you may have disliked the schedule, it did provide you with something very important — structure. One of the biggest adjustments to staying at home after having a baby, even if for only a few weeks, is the lack of structure. Suddenly your structure flies out the window and throws your life upside down. Whether you’re in bed, out of bed, dressed, or in your nightgown make no sense anymore. Without the reference point of going to work outside the home, everything is topsy-turvy.

Because it provides you with a guide, having some kind of structure will help you move more easily through your day. I’m not talking about making a rigid schedule where every fifteen minutes is spoken for. Instead, I suggest that you just create an easy plan that you can follow.

Making lists

One of the best ways to build structure into your day is by using lists. If you dislike lists, bear with me for just a moment. You may have this dislike because of the way you or someone else used lists in the past. Just listen to my suggestions and see if any of them are useful to you. If you’re already a list-maker, or at least used to be, hear me out because my way may be an even easier way for you to use them (at least for right now). With my system, you make two different lists: the master list and the daily list.

You can pull items off your master list and transfer them onto your daily list, but be careful. If you’re dealing with a major project, such as cleaning your garage, break down that task into a few smaller ones and put the smaller ones on your daily list until the whole garage is done. If you put “clean garage” on your daily list, you’ll be too overwhelmed and won’t go near your list.

The master list

To use my list-making system, begin by making a master list. This master list includes everything you need or want to do, from the tiniest chore (writing a thank-you note) to the most massive overhaul (landscaping the backyard). Think of this list as the brain dump list. Every time you think of something that needs to be completed, write it here. You’ll find that as you write down the things that have been buzzing around your mind, your head can begin to clear.

Keep this list where you’ll always be able to find it, but not right in your face — such as on the refrigerator. Here’s why: If this long list is posted in a place where you see it frequently, it will drain your energy. You’ll always be thinking, “Ugh! Look how much I have left to do!” So, keep it in a kitchen or desk drawer, or another place that’s easily accessible, but tucked away.

The daily list

Each day, preferably when you have some support, make the second list, called the daily to-do list, for the following day. This list provides you with a structure, but you’re allowed to do these tasks in any order that you want. Many moms make this list before going to bed, because the likelihood of having a partner there at that time is greater (and having a partner around can help you concentrate better). If you don’t have that support, make this list during your baby’s nap time so you can focus a little.

Only put three or four items on this daily list. Three of them can be tasks, and at least one of them needs to be something for you. Using this system allows you to literally put yourself on your own to-do list so that you’re not forgotten. You should schedule three or four larger chunks of time throughout the week during which you can take care of yourself. If you’re extremely depressed right now, the following list may be all you can handle (and everything listed, even though some are for you, may feel like chores):

1. Get up (task).

2. Feed the baby (task).

3. Take a shower (for me).

4. Eat breakfast (for me).

If you’re more functional and you’ll automatically do these basic items, you don’t need to list them. At this point, your list may look more like this:

1. Go food shopping (task).

2. Dust office cabinets (task).

3. Walk the dog (task).

4. Read my book for a half hour (for me).

Here’s the rule: After making your daily list, take a look at it and see how you feel. It should feel totally workable and not overwhelming. So, if you find that your shoulders start rising up by your earlobes and you’re thinking, “I think I might be able to get this done,” you have your first signal that the four items you’ve listed are feeling like too much for one day. Adjust it until it feels so simple that you know you can get it done.

Don’t wait until tomorrow to make tomorrow’s daily list. If you wait until the day is upon you, and you’re feeling down, you won’t be motivated to make a list. You need to wake up and already have that structure in place. Then you have a plan to follow no matter how tough the PPD is that day.

Setting yourself up for success

You can plan the best you can with the structure of the daily list, but some things may pop up (as they often do). For example, suppose your baby is particularly fussy that day or you receive a phone call about an insurance paper that needs to be turned in right away. Adjust your list accordingly. Sometimes you can just trade one task for another. Other times a task on your list needs to wait until tomorrow’s list — and that’s okay because you did the best you could.

Compare these two moms who are suffering from PPD — Anne and Jenny. Anne doesn’t make a daily list. She only uses a master list. Jenny uses both. At the end of a particularly productive day, each had accomplished the exact same four items. However, their outlooks are quite different. Anne looks at her master list and says, “I only did four things on my list! Look how much I still need to do.” She may feel dejected, unproductive, and defeated.

Jenny, on the other hand, crossed off each item she put on her daily list as she completed it. At the end of her day, she looked at her crossed off list and exclaimed, “Wow! Look what I did. I completed every single task I set out for myself today. I feel proud that I actually got everything done.”

Each of these women accomplished exactly the same items, yet one feels bad about herself and the other one feels good. The key is to keep your expectations manageable so you set yourself up for success — not failure.

Knowing It’s Okay to Lighten Your Load

You may have already been great at setting boundaries and limiting your activities before the PPD. Even so, you may have noticed that trying to take on the same number of tasks is not only difficult when you have a baby, but almost impossible when you have PPD. It can be frustrating when you know you were always able to handle certain things, such as balancing the bank accounts or organizing a birthday party, and those functions are now, to say the least, challenging. You haven’t lost IQ points. This is just what PPD does.

It’s not only okay to move some of these usual tasks off your to-do list whenever possible, it actually helps your recovery if you do. As you feel better, you start doing these tasks again, but for now, get them off your plate.

Spending quality time with your kid(s)

Even though you do need to take ultimate care of yourself right now, remember to put time in your calendar to spend special time with each of your children. Many times moms with PPD are feeling guilty (so what else is new?) about not spending enough time with their kids. Even if you’re feeling so low that you can’t leave the house — or in some cases, your bed — make a time for each child to have Mom all to herself. When your 4-year-old knows that every Wednesday afternoon, for instance, you’ll read him a book and play a game, he won’t be vying for your time as much when you’re with the baby. Similarly, Dad should make sure that he sets up special time with each of the children as well. Not only is it good for dad, and good for the other child or children, but this helps to take more of the pressure and demand off the new mom.

Deciding whether to take it on

When the PTA president calls you and compliments you with, “You’re the best person to do this. You’re so good at it. Can I count on you to come through?” you have to remember to take several steps before saying yes or no. If you’re thinking that because you can take charge of the parent-teacher party at your kid’s school, that somehow you ought to, beware — this thinking is a trap. Follow these steps to avoid taking on projects you shouldn’t:

1. Always buy yourself time.

No matter how sure you are that you want to accept, never do so on the spot! You may end up regretting your decision, and it’s a lot more difficult to get yourself out of a commitment than it is to turn it down at the beginning.

Answer the PTA president or other person wanting you to participate, with this: “Thank you for thinking of me and for your kind words. I’ll need to think about it and get back to you.” If they’re persistent, just keep repeating that sentence. Don’t let them wear you down until you say yes. Stick to your boundaries, and get some distance from the request so you can evaluate the proposition objectively.

2. Ask yourself the correct question, not the wrong one.

For example, the wrong question is “Can I do what this person is asking?” Your decisions shouldn’t be based on whether you’re able to do the task, but rather, if it’s right for you to do it. So, the correct question is, “Is it healthy for me and my family if I take on this task?” The answer to the first (wrong) question is usually yes. But, the answer to the second (correct) question is often, absolutely not. Just be sure to listen to your gut feeling regarding the answer to the correct question.

Slacking for the good of your health

You may have been taught that slacking on your chores is irresponsible, but right now, slacking is exactly what you need. You need to save your energy for the important things, like spending quality time with your family. So, here are some tips to get you started:

Let the laundry pile up. The concept of “getting your house done” is a myth. A house is never “done” — it’s always a work in progress. It’s you who decides when it’s “done” for the day. Just like the house is never done, the laundry — especially when you have a baby in the house — is constantly a work in progress. If you’ve put two loads of laundry on your daily list (see the section “Making lists” earlier in the chapter) and they’re complete, you’re done. If other tasks take priority for the next few days, let the laundry wait. No one ever died from lack of a clean undershirt.

If you can delegate your laundry duties to someone else, either lay or professional, do it (unless you get satisfaction from doing laundry, which some do).

Allow the dust to settle. If you’re in charge of at least half of the housework, it’s okay to let the dust build a bit before you wipe it off. Unless the dust is really impeding someone’s health, let it go for a while. If other chores take precedence, put dusting on the list for the end of the week or next week. So what if your great aunt runs her finger over your mantle with a white glove to examine its cleanliness. If she wants to clean your house, make sure to accept!

If you can hire a person to clean your house twice a month, now is the time to do so. If someone wants to buy you a gift, tell them you want a housekeeper.

Order take-out. Putting dinner on the table doesn’t always have to involve cooking. You may typically enjoy cooking, but right now with your lack of appetite and a master to-do list a mile long, cooking can feel like one more grueling task.

Many happy couples divide the nights that each is responsible for providing dinner. And here’s the deal. The agreement needs to state that any way food is provided on the person’s night is okay — barbecue, stove-top cooking, frozen dinners, or takeout. If you need to do a couple of weeks at a time with straight takeout, so be it. Pick whichever restaurant has the healthiest food and you’ll probably feel better about it.

You won’t be responsible for single-handedly destroying the environment if you use paper plates and plastic utensils for a few weeks.