Treatment of Depression during pregnancy-Dont wait!

 In my practice, I find that there are so many issues on the the minds of pregnant women and sometimes anxieties that they don't know the cause of but keep them tossing and turning at night.  What makes it even more baffling and upsetting is that this is true even though  the pregnancy may be welcome and thrilling.   Some women fear that talking about an issue will make it more real and therefor worse,  while others may feel ashamed of the thoughts and feelings they are having.  For these reasons and more the tendency is to wait and hope that things will spontaneously get better.  The obvious consequence of this is that things get worse and mild to moderate anxiety or depression becomes severe.

This past Fall (2009), the American Psychiatric Association and The American College of Obstetricians and Gynecologists joined forces to review the existing data regarding treatment of depression in pregnant women and make recommendations. Because there can be consequences to taking medication and also to untreated depression, the report emphasized the need for decisions to be made on a case-by-case basis.  It's no wonder doctors and their patients may feel stuck between a rock and a hard place. However, one finding was clear, that talk therapy should be the first-line treatment for mild to moderate depression in pregnant women.

So don't let mild symptoms reach crisis proportions.  Talking with a competent mental health professional can shed new light on dark issues, which is why I urge women and the doctors who treat them to choose action over non-action.  It's always a better choice.

The Joys of Being a Hands on Dad

What I call a “hands on dad” is one who changes diapers, bathes, comforts and generally tends to the needs of their baby at least some of the time. Traditionally moms do these tasks more often then dads and in many cases she’s home while dad is out working. But most dad’s are home some of the time and whenever they are they owe it to their wives, their babies and most especially to themselves to participate in this care taking.

Infants are basically a bundle of need; they need to be fed, bathed, dressed, soothed, etc. It’s through these tasks that we bond with them. So while it may seem only natural for mom to be tending to these needs, even when dad is at hand and in fact your baby may protest the change, there are at least three reasons to persist.

One reason is simply that by not doing these things you are missing out on the beautiful experience of creating a strong bond with your child. Secondly, by sharing this part of parenting you maintain and strengthen the bond with your wife. The third reason is that at some point mom may be unavailable. Unforeseen events can and do occur.

So my strong advice to men is to roll up your sleeves, put aside old -fashioned notions and be a part of this very magical, if fleeting, phase of parenting.

The Best Layed Plans

When a couple is contemplating parenthood, they often make decisions about how they will handle life with children; who will work, how household tasks will be divided, will one parent or the other be a full-time parent, what kind of outside childcare will be used, will mom breast- feed, etc. Planning is good, and it's fun. But be prepared to amend and possibly radically change those plans once the dream of parenthood is a reality.

The truth is that you really don't know how you will feel in any future scenario, much less one as life altering as having a baby. The more able you are to accept uncertainty the better off you will be. Entering into the business of parenthood takes courage, a good sense of humor and most of all adaptability.

Expect the unexpected, roll with the punches and keep an open mind.

What's a Doula?

A Doula is a trained professional who comes into your home to provide care, nurturing, empowerment and education to women and their families before, during or after the birth or adoption of a new baby. They perform a broad array of tasks from household chores to caring for other children in the home or just giving mom a break so she can get some much needed rest. They also give classes on topics of interest to expectant and new moms.

This is a wonderful service. If it existed 26 years ago when I became a new mom, I certainly didn't know about it. So spread the word!

For more information about Doulas check out:
www.dona.org
www.lidoulas.com

Guilt-Free Solitude

According to Wendy Regoeczi, Ph.D, sociology professor at Cleveland State University, men typically cope by spending time alone but women often feel guilty about taking time for themselves. Mothers with small children rarely get time alone, often having to bring baby into the bathroom or the bed. This lack of peaceful solitude adds to the stress of motherhood. While dad may feel that he is out working all day, he gets to shower alone, drive or take public transportation alone and certainly use the toilet alone.

Getting time alone need not be complicated or lengthy. It can be as simple as taking a longer shower or leisurely bath while someone else is dealing with baby. The main point here is grab it when you can, relish it and don't ever feel guilty.

Sleep, Baby, Sleep

Let’s face it; when it comes to getting our kids to fall asleep we will do just about anything. We rock them, sing to them, walk the floor with them, lay down with them and sometimes drive around the neighborhood with them. Obviously we do these things for the sake of peace and quiet and because we think it’s the only way to get them to sleep. But sometimes there is a price to pay.

According to Dr. Richard Ferber, author of “Solve Your Child’s Sleep Problems”, brief awakenings during the night are a normal part of the sleep cycle. What becomes problematic is when your child awakens to conditions that are different than they were when they fell asleep. In other words if your baby falls asleep while nursing, in your bed and then awakens alone in a crib, she will become upset and cry until you recreate those conditions. The same theory applies to the three year old who falls asleep with a parent lying down with him. The key here is that in both cases the child falls asleep under certain conditions then when they awaken they look for the same condition thus becoming more awake and …well, you know the rest. Dr.Ferber calls these habits “sleep associations”. So by all means, help your baby or child prepare for sleep by whatever means but leave before they actually fall asleep.

If you are already deeply entrenched in bad habits that are making for a poor nights sleep for you and your child I suggest you read Dr. Ferber’s book which has very detailed suggestions for making step by step changes with the least amount of distress.

Parenting without "Shoulds"

If you’re feeling stressed or unhappy about how you are doing as a parent then I'll bet things are not going the way you think they “should” be going. Maybe your baby doesn’t easily respond to your efforts at soothing, or perhaps your 10 month old kicks and cries when you attempt to change his or her diaper. Maybe your toddler never remembers to put the toys back in the toy-box. The more fixed our ideas are about the way things “should” be, the more disappointed we are with our children and ourselves.

The word "mindfulness" is used a lot these days, mostly in connection with meditation, eastern religion and the practice of yoga. But while the latter are ways to cultivate mindfulness they are not mindfulness itself. Mindfulness itself is a kind of attitude. It involves awareness in the present moment without judgment. For instance, imagine noticing that your house is a mess; toys everywhere and dishes piled in the sink. You may be saying to yourself, “Jeez, I should be able to keep up with this. What is wrong with me? I should be more organized, less lazy…etc. etc.” Not a pleasant feeling right? Now imagine you simply notice what needs to be done without the “shoulds”. Maybe you tell yourself, “Wow, we sure made a mess today. Let’s see, maybe I can get at least some of it done while the kids are napping.” Can you see the difference in the two reactions? Quite simply, one is a put down of self and the other isn’t. While it may be stressful to be faced with a messy house, the stress is multiplied when we add self-judgment to the mix. To be observant and attentive without judgment opens the door to acceptance, openness, and empathy for self and others.

So next time you feel yourself stressing out, listen to what you’re saying, aloud or to yourself and try dropping the "should" statements. You’ll feel better and get just as much or more accomplished.