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How to Help Your Wife With Postpartum Depression

Published 03.19.2010 | Permanent Link | Comments (9)

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This was left in the comments section of the Birth Control and Postpartum Depression column from a few weeks ago. I trust you'll agree that it's important enough to merit a full response.

I am a concerned husband. My wife and I are very much in love but have had a rocky marriage to say the least, and we had our second son now going on 6 months ago. About 2 months ago my wife started the mini pill and in the last month has become very unhappy. She has very emotional breakdowns and just starts crying and is self proclaimed depressed at times. She is breast feeding and was very aware that her hormones are out of whack just from that. Some days are good but many are very bad. On her worst days she has gone as far to say she thinks she wants a divorce, She now also claims she is no longer in love but is trying. Our sex life was very limited prior because of the breastfeeding and the affect on her hormones and it was similar after our first son but now it is non-existent. All of this feels like it is out of nowhere and in the last month or so. We both agreed it could be the pill and she is finishing this cycle and then her doctor prescribed her the patch. Am I crazy or is this from the current pill and possibly ppd. Is the patch a bad alternative? Should I convince her to be evaluated? (she is very stubborn when it comes to these things) Thoughts?

Adam

No, you are not crazy: this very much sounds like a bad reaction to the mini-pill or postpartum depression, or both. (I'd put my money on both, actually.) Yes, the patch is a bad alternative, as is any other hormonal birth control. Yes, you should VERY MUCH convince -- nay, INSIST -- that she get evaluated for PPD (postpartum depression).

You should also volunteer for couples' therapy to address the stated pre-baby rockiness of your marriage. I mean, that's just flat-out a good idea, especially with the added strain of a second baby and all, but it's important that you don't seem like you're blaming all the stuff she says (divorce, not in love anymore) on the fact that she's "depressed" or "crazy" or "not herself." Whether or not it's simply the pill or PPD, don't devalue what she says she's feeling. It's likely very hard for her to see beyond the clouds that have settled over her right now, but that doesn't mean there aren't some very real feelings under there that need to be addressed.

For the record, symptoms of PPD include: Insomnia or extreme fatigue, anxiety, lack of interest in the baby OR irrational concern over the baby, feeling hopeless or overwhelmed, withdrawing from physical and/or social contact, thoughts of harming self or the baby.

Low (or non-existent!) libido is really common for women after giving birth, even without PPD, but the "emotional breakdowns" and overwhelming sadness and threats of divorce you're describing are NOT. PPD symptoms can start out mild (similar to the "baby blues," just a general sense of sadness, irritability, crying spells, mood swings) but get worse over time. Much worse, and often progress quite rapidly. I'm not a doctor and don't know your wife, but it's possible that she was suffering from an extended case of baby blues and the mini-pill accelerated things into full-blown PPD. Simply changing birth control is not going to cure that. She needs help, and she needs it now. If she won't call her OB or a psychiatrist herself, call for her. Tell them everything you typed here.

Other things to do:

1) Tell her you love her. Tell her you love your family, the children, the baby and that they love her too. Tell her this ISN'T HER FAULT.

2) Attend doctor's appointments with her. I'm guessing, given that her doctor went and prescribed the patch as an alternative, that she's not telling him/her the real story. (A good OB would know to take any and all hormonal birth control options off the table for a woman complaining of possible PPD.) She could be ashamed or in denial -- this is normal, but you might need to speak up on her behalf for awhile.

3) Give her breaks. Take over chores around the house or hire a cleaning service, if possible. Take the kids out with you so she can rest or do whatever she wants without feeling guilty. Send her to the movies, make dinner, basically anything you'd step up and do if your wife was critically ill. Which (if it is PPD), SHE IS.

4) Make sure she's getting enough sleep. Sleep deprivation, though almost inevitable when caring for and breastfeeding a new baby, exacerbates the symptoms. (Maybe this could be the changing factor between her "good days" and "bad"?) If she still needs to nurse at night, let her stay in bed while you retrieve the baby and handle all the night-time diaper changes. Offer to give the baby a bottle (pumped milk or formula) at night, no guilt involved: I am all for breastfeeding but big-picture-wise, the baby needs a healthy, rested, functional mother.

5) Attend a PPD support group in your area -- your wife's OB or hospital or birthing center can help you find one. Go with or without her (though try to find a friend or family member stay with her while you're out). This will help you know how to help her waaaay more than one little online advice columnist. (Check out Postpartum Support International or call 1.800.944.4PPD)

Good luck, dude. Thank you for paying attention and seeking information and advice: Now it's time to bring in the Big Medical Guns and get your wife some professional help. Again, it's not her fault, it's not your fault, it's not the baby's fault. It's extremely common, but even more important than that, it's completely treatable and curable.

What to Expect in Speech Therapy

Published 03.17.2010 | Permanent Link | Comments (8)

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Amy!

What is UP, girl, I haven’t written to you in AGES. You’re like my personal therapist that instead of prescribing pills prescribed wine and I love you and oh hell I’m rambling aren’t I?

I wrote to you about how to tell if your kid is speech delayed. You graciously answered me.

Then, I wrote to you about my Godd*** relatives not buying it when they SAID she was. You laid the smacketh downeth, and LO! They shut the eff up!

We reached a compromise: we’d give it a few months for her to catch up, and have her reevaluated.

I had her retested and OH SURPRISE! She’s speech delayed. And it’s getting worse! YAY! CELEBRATE! I TOLD U SO.

We’ve decided to start on the therapy route, and it’ll start next month. We haven’t a damn clue what to expect. They said they can go to her daycare or we can go to them. Aaaand, that’s about it. Do they drill words into her and tell her to repeat it? Play with her using words? I mean, I’m just lost here and I Googled and it…WOW. Tons of stuff out there that I don’t have time to look at, and I’m at the office right now and my boss considers looking at the internet like looking at smut.

Soooooooooo……Advice?

Thank you!
Heidi

Well, first of all, and I'm sure you've already gleaned this from the FOUR BAJILLIONITY ELEVEN results on Google, there are many, many different approaches and takes on speech therapy. However, most speech therapy aimed at very young children is similar and rooted in play.

And because of this, I really, REALLY recommend that you do the therapy at a time and place where either you or your partner can attend, whenever possible. 45 minutes of therapy a week is NOT going to be what gets your daughter caught up -- that's going to come from you incorporating what YOU learn during the therapy for as much as possible, for the rest of the week.

And yes, that includes daycare providers, so it's not a bad idea for them to sit in on the therapy, but realistically they might not be able to. They might need to simply hand your daughter off to the therapist for that time while they care for other children. You can ask your therapist for short, easy things she recommends that the daycare incorporate though, or make copies of any hand-outs or information sheets she gives you and pass these along. But I have always felt that early intervention therapies are just as much for us, the parents, as they are for our kids.

Because really, you're probably going to be surprised at how subtle speech therapy is. No, it's not flash cards or Henry Higgins-style pronunciation drills. Because think about it: If your daughter responded to stuff like, "Say ball, honey. How do you say ball? C'mon, SAY BALL!"...you probably wouldn't be pursuing speech therapy in the first place, right?

When Noah first started speech therapy, it involved a really nice lady coming to our house with a big bag of toys. She pulled out one toy and a time, speaking slooooowly, with very few words, and incorporating sign language whenever possible. There was usually one goal for the entire session -- on a good session we might have one goal per toy or activity. These goals were anything from getting Noah to use a sign to make a request (like "open" or "more"), or getting him to repeat a simple sound (like "pop" for bubbles), or just generally demonstrate his expressive and receptive language skills (could he point to correct pictures in a book when asked, did he make a wide range consonant sounds, etc?).

The first few sessions are all about establishing trust, figuring out where your daughter's development stands and what toys and activities engage her and will keep her involved. Everything you see your therapist do, file away for future mimicry: the way she talks and uses toys, how much silence she allows before supplying words, how much repetition of a single word or sound she'll do and how she keeps your daughter's interest...while gently pushing her towards participating in a rudimentary conversation, be it with signs or sounds or words, depending on your daughter's skill level.

Noah LOVED speech therapy. It was his favorite day of the week. He didn't know it was speech therapy, of course, but that's the whole idea. His therapist taught him that signing and speaking to make his wants and needs known made a fun time EVEN FUNNER. And then she and I discussed anything that happened during the week that seemed important, or any additional concerns I had (his toe-walking, swallowing skills, texture sensitivity) and whether they warranted more looking into.

Now: We did at one point look into some private therapy at a particular speech-and-language center, and they preferred to have the parents sit out in the waiting room while the kids played with therapists in the back, although you were encouraged to watch the sessions through a one-way mirror. This was mostly for older children -- age three and up, when sometimes having mom or dad around can negatively impact behavior. Now Noah receives the bulk of his therapy at school, though we are in near constant-contact with his teachers and therapists about what's working and what's not and what we can implement at home.

But for a young child just starting out, really: BE THERE WITH HER. You (and she) will get much more out of it if you do. The therapist is your resource and teacher too. If you ever feel like the therapist is not a good fit for whatever reason, call and request someone new. (It can be nothing against the therapist, even. Some kids just don't click with certain adults.) Speech therapy is not a task you outsource, it's bringing on additional members of Team Let's Kick This Problem To The Curb, of which you are a charter member.


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Spreading the News

Published 03.15.2010 | Permanent Link | Comments (35)

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Dear Amalah,

I know you are busy solving some of the world's most Giant and Tremendous Problems for your readers, like evil in-laws, inconsiderate husbands, explosive poops, and really ugly purses. But I have a Tiny and Tremendous Problem I would dearly love some advice about.

After one year of fertility treatments, the pregnancy test was positive. Eeek! (Plus means positive, right?) I *think* I am about 6 weeks along, but I need to have it confirmed. My husband and I are so excited, but he wants to wait until MOTHER'S DAY to spring the news on our moms in a really special way. Well, there's no way our moms will forgive us if anyone else finds out before they do, so that means I can't tell anyone (ANYONE!) about it for another two months?

I don't see it happening. Even though I realize that miscarriage is always a possibility early on, I think I would want their support if that happened anyway.

Please give me some really excellent reason that we shouldn't wait that long, OR ways to keep myself occupied so that I don't spontaneously combust. What should I do with myself?

Thanks for your help,
Sarah

So the current non-pregnant version of myself read your husband's idea about Mother's Day and went "ahhh, that's nice, and really not that far away, waiting would probably be worth it in the end, for the memories and stuff, since you only get one shot and we always just did a 'hey, guess what?' phone call and I think my husband even FORGOT to tell his mom the first time they talked, so it's sweet that her husband actually wants to make it all special."

Then the ghost of my former pregnant self rose up next to me and delivered a merciless bitchslap, because I never, ever lasted more than a few days before the unprovoked "I'M PREGNANT!!" eruptions began.

Some women and couples seem to have no problem keeping the news quiet. Some actually like having a not-so-little secret that no one else knows about. Some just don't want to jinx things or lose control of the info at work or during prime miscarriage risk time. (Yes, you can tell people who you would "want support from" in the event something goes wrong, but you cannot 100% keep them from spilling the news to other people -- people you might not really want to talk about a loss to, or who might continue to pass on the good news but not the bad, leading to a "congratulations!" from a totally clueless person at a dinner party in a few months. AWKWARD.)

There are a lot of good reasons to wait, aside from having the announcement coincide with Mother's Day. But you sound a lot like me. And I was completely unable to think of a single one after that second line showed up.

So it sounds like it's time to come up with a compromise. Find a way to make the announcement super-special and meaningful...on a perfectly normal random non-Hallmark-Holiday day. I really don't think your moms will mind -- I'm predicting your husband will get whacked with a dinner napkin from his mom once she hears how long he wanted to make her wait -- but let him make it special. Get them some "just because" cards made out to Grandma and stick a copy of your first ultrasound in them. Take both sets of parents out for dinner and do a toast or a casual slip that everybody goes bonkers over. Or whatever he originally wanted to do, a little earlier. As sweet as his plan sounds, this is a decision that you BOTH need to agree on. If he feels passionately about keeping things quiet until 12 weeks, that's different, and requires a separate conversation. If making the announcement "special" is really his only sticking point...well, it WILL be special, provided it happens before you burst from excitement and start telling the mailman and cashiers at Target.

A final bit of caution, though: I (obviously) never had to go back to people I'd told with bad news, but there were points in both of my early pregnancies when I regretted telling people so early and kind of wished I could pull the news back. Suddenly the number of people I'd gleefully shrieked "I'M PREGNANT!" at seemed so very high, and the reality of just how many crappy conversations I'd be having and how many people I'd be "disappointing" if I miscarried...ugh. It actually made the wait until 12 weeks harder at times, if that makes any sense. (I do think moms are different and should be the first bit of wiggle room in the "no telling until the second trimester" rule, though. So I still say you and your husband move up that announcement date to something you can live with.)


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About

Amalah is a pseudonym of Amy Corbett Storch. A Washington D.C.-based freelance writer. The Smackdown is published on Mondays, Thursdays and Fridays. You can follow Amy's daily mothering adventures at www.amalah.com. Also, it's pronounced AIM-ah-lah.

Amy also documented her second pregnancy in a Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to delicious preschooler Noah and baby Ezra. NomNomNom.

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