When Tala and I first spoke via email, she explained she was a new mom who had left her job in mental health to stay home with her baby boy. She had just moved to a new city and was looking for ways to be an active part of something outside of home. Her note to me was a bit like peering into the future. I am anticipating postpartum to be a challenge and knowing I could tap into Tala’s knowledge when I myself will need timing and space to let my own postpartum run it’s course, felt exactly right. Today Tala is sharing her experience with you and me. I hope you find her words and candor as calming as I did. – Kate

Making Space for What’s In and What’s Around
By Tala Ciatti

While pregnant, I did just enough research to avoid what psychologist Albert Ellis, Ph.D calls “shoulding on myself.” Tying up loose ends at work, working to maintain balance in marriage, and the stuff of life filled the space where I would have been forming an impossibly perfect picture of what early motherhood should be. The bulk of my prenatal education came from pamphlets and conversations in the obstetrician’s office, a book from my sister-in-law and calls to my mother and my friends. I wasn’t the top of the proverbial prenatal research class, but I felt comfortable with what I knew and that there were things I wouldn’t know for sure until the time came.

I didn’t really know how much I didn’t know until the doctor said it was time to push. Then, in one intensely dramatic moment, I realized that I had neither muscle memory nor academic understanding of how to deliver a baby. I believed that my body would just do the things I hadn’t studied up on…but I hadn’t accounted for how unfamiliar it all could feel. Not just physical pain, although that was there; I hadn’t prepped myself to handle the uncertainty of this time when my body knew what it was doing but I wasn’t in on the secret.

And so…I became frantic. There was no real medical emergency – I had half a mind to laugh at myself while this was going on – but the other half was firmly set on panic. I looked at the masked faces in the delivery room, and…there’s no better way to say this…I shouted. “You have to help me!” In that moment, I wasn’t sure if anyone had felt this before, and I didn’t know how I could ever feel stable and comfortable again. I looked around in disbelief and said it again “Help me!” My husband, just as new to this as I, touched my arm and said “Tala. They’re going to help you.” The doctor winked at him, as if to thank him for the vote of confidence. I wanted to appreciate this for the good story we could tell later, but there was too much happening in and around me to parse out and express all that I felt.

The Postpartum Experience (because it deserves capitalization) unfolds in this way: so much is happening in and around a new parent that it can’t be fully and quickly processed. Most don’t know how or if they will be adversely affected by anxiety, depression, even psychosis in this period, although pre-existing mental health issues and genetic makeup may increase the probability. The clinical diagnosis of major depressive disorder with peripartum onset (what most call postpartum depression) focuses on women, but men are subject to many of the same stressors and symptoms. The concept can be so broad, laced with particular and delicate details in each individual story, that it’s difficult to summarize, but it is too important – and too sacred – to leave unmentioned.

When you list the factors involved in pregnancy and parenthood, it’s easy to see how life can get confusing. There are changes to your physical, psychological, emotional, social and professional states, fluctuating hormones, and sleep deprivation. Cultural, societal, and personal expectations, whether silent or spoken, color your experience. Combine these with the negative stigma surrounding psychological distress, and the introduction of a new bundle of joy into the world ex utero becomes extra complicated.

New mothers may be anxious, irritable, sad, overwhelmed, prone to tears or mood swings, and unable to focus, eat, or sleep well in the first two weeks after an infant is born. This is generally referred to as the “baby blues,” or postpartum anxiety, and will subside with adequate rest, nutrition, and patience. Postpartum depression is more intense. Symptoms may appear up to six months after baby arrives, and in addition to daily and persistent “blues,” a parent may feel unable or unwilling to bond with their child, a desire to withdraw from support, loss of interest or pleasure, feelings of shame, guilt, worthlessness, loss of control and panic, change in weight or appetite, insomnia or hypersomnia, indecisiveness, and recurrent thoughts or actions related to death, suicide, or harm to self or child. Postpartum psychosis is a rare but severe condition that can develop in the first weeks following delivery. It is marked by obsessive thoughts, confusion, disorientation, delusions, and hallucinations, sleep disturbances, paranoia, and frequent thoughts or attempts to harm self or baby. When signs of psychosis appear, call a hospital and allow thorough evaluation and regular monitoring by medical professionals.

Some hospitals and clinics screen for mental health issues, and other parents are left to advocate for themselves. I was given this screening at my infant son’s first well-baby visit, answered according to the red flags I felt within me, but was still surprised to receive a list of resources and a letter in the mail from my doctor noting that my score suggested symptoms of postpartum depression. This basic assessment tool, provided here by the Postpartum Health Alliance and regarded in the medical community as reliable, takes roughly five minutes to complete and may shorten a period of suffering.

Anyone can implement small but significant solutions to ease a family’s transition into the “fourth trimester.” Ask new parents how they are coping – and listen well to their answer. Let them know that negative feelings are not uncommon, not their fault and do not make them unfit parents. Bring a meal that they can enjoy in peace, and be sensitive to visit times. Speak of postpartum experiences with those you trust. Read overviews like those offered by the National Institute of Mental Health, the American Psychological Association, the Center for Disease Control, and Mayo Clinic. Utilize online resources such as Postpartum Support International, Postpartum Progress, and the Blue Dot Project. I recently read The First Forty Days: The Essential Art of Nourishing the New Mother, initially skeptical of whether there was space for such beautiful practice in modern culture. By the last page, I was grateful for the perspective and eager to implement what I had learned.

No matter your level of preparedness, confidence, or experience, I invite you to take time to consider and honor all that you know and feel in the early days of a child’s life. Be open to negative feelings but not obliged to follow them. Accept the support you need. You are worthy.

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Image by 2nd Truth