Steps to Recovery

Step 1: Learn all you can about PMD

• Read about PMD. Research the internet, books, journals, etc.
• 15-20 percent of women experience PMD.
• PMD may be caused by a chemical or hormonal imbalance. Women have risk factors that may contribute to the cause.
• Talk to your healthcare provider and other professionals if you think something is wrong. Trust your instincts.
• PMD can occur anytime during pregnancy and within the first 1-2 years after childbirth.
• PMD can be successfully treated. Treatment includes self-help, medication, counseling, and support. The longer you wait, the longer it will take to get better.

“If only I could get a good night’s sleep, I’d feel better.”

Step 2: Get adequate sleep

• Try to get 4-5 hours of uninterrupted sleep each night.
• Nap when your baby sleeps during the day. Turn off your phone.
• Ask for help caring for your baby during the night.
• Choose rest over housework. A messy house never hurt anyone but lack of sleep can.
• If you are having trouble falling asleep try a warm bath, a warm drink (avoid caffeine), a massage, and a warm wrap on your neck and shoulders.
• Your baby should always sleep in his or her own bed. This will help you sleep better.
• When you rest, consider noise and light. Earplugs, music, or white noise may help. Draw the shades or use eye covers to block light.
• Relaxation and deep breathing exercises can be helpful.
• Depression may cause fatigue and lack of energy. This may cause you to sleep too much.
• Let your health provider know if you are having sleep problems. Medications may be helpful.

“I don’t feel like eating, I really just don’t have an appetite.”

Step 3: Continue the healthy eating habits

• If you don’t feel like eating, try smaller meals and snacks. Buy healthy foods that are easy to prepare such as cheese chunks, yogurt, granola bars, fruits, pre-cut vegetables, and nuts.
• If you are eating more than normal, replace cravings with healthy choices.
• Avoid high sugar foods, empty calories and caffeine. Drink plenty of water, milk, juice, or decaffeinated drinks. Avoid soda pop.
• Continue taking your daily prenatal vitamin or a quality multi-vitamin.
• Omega-3 fatty acids (fish oil supplements),vitamin D-3, and vitamin B complex have been shown to improve mood.

“I just feel so over-whelmed.”

Step 4: Ask for help!

• Simplify your life. You cannot do everything you did before your baby arrived.
• Let others know what you need. They want to help but don’t always know how.
• Asking for help is not a sign of weakness; it is a sign of strength.
• Be firm in setting boundaries for your guests. This includes when and how long they will visit. Don’t worry about pleasing others.
• Make a list of household chores and set it on the kitchen counter each day. Enlist others to help with dishes, laundry, and day-to-day cleaning, errands, meals and older children.
• Set small goals for yourself. Take credit for what you did get done that day.
• Caring for a baby is hard work. At the end of the day a happy, well-fed baby is something to feel good about.
• If you are breastfeeding concerns, ask for help and support.
• Take one day at a time. Let someone else help you make day-to-day decisions.
• If able, postpone major life changes such as buying a new home or changing jobs until you feel more in control. This goes for new fathers, too.

“It feels like no one understands what I am going through.”

Step 5: Find non-judgmental support

• Share your feelings with someone you trust. You are not alone.
• Let your partner know how you are really feeling.
• Spend time with people who make you feel good about yourself. Avoid people who make you feel bad about yourself.
• Be careful about asking too many people for advice. Do what you know is right for you and your family. Trust your instincts.
• Don’t isolate yourself from others. Talk with at least one other adult during the day. Make an effort to meet other mothers with young children. Go to the park or playground in your neighborhood and start up a conversation!
• Be kind to yourself. Talking negatively about yourself will bring you down. Don’t compare yourself with others.
• Join a PMD support group in your area or online at http://www.postpartum.net.
• Seek out spiritual support from your religious community.

“Will I ever get to enjoy the things I used to?”

Step 6: Make personal time a priority

• Plan time for yourself other than mothering responsibilities. Go shopping, go out to lunch with a friend, take a bath, read a book, sit down with a cup of tea, get a massage, etc.
• Take time to express your creative self. Hobbies such as knitting, scrap booking, music, and crafts can help to rekindle your previous interests.
• Plan time alone with your partner. Nurture your relationship even though your roles have changed.
• Arrange childcare for your baby so you can take time out for yourself. Try swapping babysitting with a friend, asking family to help out, hiring a babysitter or finding a student for after school help.
• Unleash your sense of humor. Laughter is always good medicine.
• Trust your partner to care for your baby. Resist the temptation to criticize the care given to your baby.
• Be specific about what you need from your partner. Share your needs and feelings using “I” instead of “you” statements.
• Thank your partner for helping you. Gratitude is a powerful relationship booster.
• Take time out daily for some physical activity. Regular exercise has been shown to help with PMD. Start slowly and increase activity gradually. Get involved in an organized class (yoga, Tai-Chi, aerobics, etc) where childcare is available
• Daily exposure to light and sunshine can help lift your mood. Go outside daily, open your blinds, sit near bright lights, or consider light therapy.

“I feel guilty because this isn’t what I expected.”

Step 7: Negative feelings are common with PMD

• Express and accept your feelings. These can include sadness, anxiety, anger, scary thoughts, feeling overwhelmed, hopelessness, guilt, shame, feeling out of control, and loss of concentration.
• Daily worry and anxiety can make it hard for you to care for yourself and your family. Consider professional help in managing it.
• If you experience scary and unwanted thoughts related to your baby’s safety, share your concerns with a health care professional. This can be a frightening symptom of PMD.
• Guilt is a common maternal emotion. There is no such thing as the perfect mother. Every mother makes mistakes: admit them, forgive yourself, correct them as best you can, and move on.
• Symptoms of PMD may make it difficult to connect with your baby. Spend time with your baby even though you may not feel like it. These special times might include holding, rocking, talking, reading, massaging, and playing with your baby.
• “Fake it till you make it”. Try to smile at your baby and be positive, even if you don’t feel like it. Your baby won’t know the difference. He’ll love seeing your beautiful and welcoming smile.
• Some women are disappointed in their birth experiences. Sharing these feelings of disappointment can lead to acceptance and closure.
• Find a safe outlet for your feelings and frustrations. A good cry can be cleansing and healing. Allow yourself to grieve, feel anger and sadness. Writing in a journal may help you express your emotions.
• Find ways to release anger safely without directing it to others: pound a pillow, run up and down stairs, count to ten slowly, breathe deeply, get outside, etc.
• Expecting a woman who has PMD to “shape up” or “pull herself together” is as useless as if that advice were given to someone who has diabetes or cancer. You would not hesitate to get professional help if you were physically sick, do not hesitate to get help for an emotional problem.
• The baby will be fine. Sometimes your health needs to take priority.
• Do not blame yourself. You didn’t ask to feel this way, but it is your responsibility to ask for help.
• Take some moments to reflect on the parts of parenthood that you do enjoy. Notice feelings of contentment, joy, love, and happiness when they arise.
• Nurture your spiritual self. Pray or meditate on the wonder of the birth experience and your new child.

“Where do I go for help?”

Step 8: The majority of women with PMD need professional help

• Sometimes self-help measures are not enough. If you notice you are feeling worse or symptoms continue, it is important to let your healthcare provider know how you are feeling. Do not let feelings of guilt, shame, or embarrassment get in the way of seeking care.
• Talk to your health care provider about getting a thorough exam. There may be a physical reason for your symptoms. Sometimes depression may be related to anemia, thyroid problems, etc.
• Request a referral to a PMD trained, knowledgeable counselor or therapist, experienced in treating postpartum depression and anxiety.
• If your health care provider prescribes medication, please do not make changes or stop without checking with them first. Medications, safe to take while pregnant or breastfeeding, are available while taking into consideration the risk and benefits.
• Join a PMD support group. Surround yourself with other women who understand what you are going through.
• Obtain more information about PMD support groups and PMD therapists and providers at http://www.mipmdcoalition.org.
• In an urgent situation, call 911 if needed.
• Speak up for yourself even though it may be hard to do when you’re feeling depressed or anxious. If you feel your concerns are not taken seriously, you may need to seek out another opinion.

You are not to blame. You are not alone. You will recover with help.