One of my favorite things about blogging are the connections I have made. Recently, I sent out some information in my weekly newsletter on pregnancy in regards to fitness, health and beauty. Later that day I connected with an amazing lady, Heather Nickelson, who has been working with my husband’s company 1st Phorm on her nutrition and health. She is an OT that specializes in Perinatal Mental Health. She herself has suffered from Postpartum Depression (PPD) so it became her passion to help other women prepare for or get through it as well. Heather will be giving all of you her vast expertise and I am so grateful to help share it.

My Postpartum Struggles

Being a mommy is not easy. I had 3 babies in 14 months. When I reflect back on that first year, no doubt I suffered from some form of postpartum depression. I experienced a lot of sadness that Enzo didn’t get to be a baby very long. He was barely a year old when the twins were born. They needed so much of me and twins require A LOT. I felt so much guilt at times I couldn’t be there for Enzo like I would have wanted to be. Sal really stepped in and he and Enzo had some amazing bonding time while I managed the newborn twins and breastfeeding, etc. Looking back I can see how I was likely experiencing some for of PPD and did not even know it. 

It is crazy how everything we are prepared for as women when having babies is all about taking care and raising that child. We hardly learn what is going on in our bodies, how it can effect us during and after both physically and mentally. I am so pleased to know there are people out there like Heather focused solely on the mama during her pregnancy. I did not have servere PPD but even just knowing that support was out there would have helped a lot. 

Perinatal Mental Health

A little bit about Heather:

Heather graduated from Washington University School of Medicine with her Master in Occupational Therapy in 2016. She focused her research during that time on Pediatric developmental disabilities and depression. Through that research she quickly became passionate about perinatal mental health. This lead her to open her own business, Mindful Momma Therapy Services. Her mission is to help prevent or at least lessen the severity of mood disorders by filling the gaps that are seen within the medical community, which often focuses more on physical health than mental health. At Mindful Momma Therapy Services each client receives individualized care, with topics including: navigating motherhood, self-care, sleep, safeguarding relationships, creating social support networks and more. 

She has curated an amazing blog for you all, so I will let her speak.

From Heather:

As an expecting mom, you think about how wonderful it is going to feel to meet your sweet little for the first time. You think about the bows or the outfits, the announcement post, or the way it’s going to feel to smell their hair as they nuzzle on your chest. You’re not naïve though, you know that there are going to be some challenges. You know sleep is going to be hard to come by, that breastfeeding may not go as planned, and that you’re not going to have the freedom you’re used to. What you don’t hear as often from your friends or your healthcare providers, however, is that sometimes even the happiest person can end up feeling sad, angry, confused, and shame during the postpartum period. That was me. 

I was only 6 months postpartum when I found out I was pregnant with my little firecracker, Rylan. Physically, her pregnancy was a piece of cake, and in fact, easier than the first! Emotionally it was difficult. Not only was I sad for Emery, who I felt didn’t get enough time as the only child, but I was dealing with the emotional rollercoaster as my mother in law had an unexpected long term hospital stay, that resulted in her passing when I was 36 weeks pregnant. 

Rylan came fast and furious one month later on January 15, 2019. In the weeks after her birth, I felt angry, but I ignored it. I mean, sure… My hormones are crazy, my child had colic, and one of my best friends just died. Why would I NOT be angry? The issue is it never went away. Here I was three months postpartum and angrier than ever. I would snap at my husband for no reason. I would binge eat food to help cope with my feelings. I drank more alcohol than I should have. I didn’t want to reach out, to be touched, or to connect with anyone. I didn’t cry much, and I didn’t lose interest in any hobbies. In fact, I was still working out and being active. I talked to my OB and she tried to give me the PPD screening again. I told her “those questions don’t pertain to me. I’m not sad, I am boiling over in anger.” We then discovered that I may have postpartum depression. We discussed ways I could change my routine and my habits to make things easier before hopping on any medicine. I also went to a Natural Procreative Technology (NaPro) facility and started bio-available progesterone shots. I believe this was the start of my transformation. 

I started with journaling, meditation, light therapy, cleaning up my diet, and took part in the 1^st Phorm Transphormation challenge. I was starting to feel alive again. Anger was dissipating, and I was overall a much happier person. That fall, I decided to take my personal experience and turn it into something productive. I never wanted anyone to feel the way that I felt. My experience opened my eyes to the major gaps for moms in the perinatal period. These gaps need to be closed for women to thrive. Many trainings, certifications, and CEUs later, and my biggest passion now is to educate moms of Perinatal Mood and Anxiety Disorders (PMADs).

So, what is a PMAD?

Perinatal Mood and Anxiety Disorders (PMADs) is a broad term used for a group of disorders that take place within the perinatal period and can happen from time of conception to the first year of a woman’s postpartum period. These include depression, anxiety, obsessive-compulsive (OCD), and postpartum psychosis. Each disorder contains a group of symptoms that can affect women during pregnancy and the postpartum period, causing emotional, physical, and social problems that make it difficult to enjoy life, function well, and create / maintain healthy and meaningful relationships.

According to Postpartum Support International: 

• Approximately 15% of women experience significant depression following childbirth. 
• Approximately 6% of pregnant women and 10% of postpartum women develop anxiety, many in addition to symptoms of depression. 
• As many as 3-5% of new mothers and some new fathers will experience postpartum obsessive-compulsive (OCD) symptoms.
• Approximately 9% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth. 
• Postpartum psychosis occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1 -.2% of births

What are the symptoms of some of the most common PMADs?

Depression: 

• Feelings of anger or irritability, crying, and sadness 
• Lack of interest in the baby or loss of interest, joy, or pleasure in things you used to enjoy
• Appetite and sleep disturbance
• Feelings of guilt, shame, or hopelessness
• Possible thoughts of harming the baby or yourself

Anxiety:

• Constant worry or feeling that something bad is going to happen
• Racing thoughts
• Appetite and sleep disturbance
• Inability to sit still
• Physical symptoms like dizziness, hot flashes, and nausea

Postpartum Rage:

• Reacting quickly and passionately over small things (like a spilled drink)
• Heart races and blood pressure rises when you start to get upset
• Feeling violent urges or imagining doing something violent to yourself or someone else
• Screaming, swearing, punching, throwing things
• Unable to “snap out of it” and needing someone else to intervene
• Inability to remember everything that happened during the outburst of rage
• Immediately feeling regret or a flood of emotions afterwards

Risk Factors for PMADs

There are certain risk factors for PMADs that can help you prevent or lessen the severity of these disorders. These risk factors can and should be discussed prior to your baby’s arrival to help you thrive in the postpartum period:

• Personal or family history of depression, anxiety, OCD, or PPD
• Premenstrual Dysphoric Disorder (PMDD) or previous history of sensitivity to hormonal changes
• Inadequate support in caring for the baby
• Financial stress
• Marital Stress
• Interpersonal violence
• Complications in pregnancy, birth, or breastfeeding
• Previous pregnancy loss or traumatic birth experience
• A major recent life event: (loss, house move, job loss)
• Mothers of multiples
• Mothers whose infants are in neonatal intensive care (NICU)
• Mothers who have gone through infertility treatments
• Women with endocrine dysfunction /thyroid imbalance
• Women with any form of diabetes (Type I, II, or gestational diabetes)
• Climate stressors (seasonal depression)
• Perfectionism with high expectations

Protective Factors

Just like risk factors put you at an increased risk for PMADs, there are quite a few protective factors that women possess that can act as a barrier to PMADs. 

• No personal history of mood disorders
• No family history of mood disorders
• Good social support
• Access to healthcare
• Steady relationships (spouse, family, friends)
• No history of trauma or loss
• Stable finances and living situation
• Education about issues PRIOR to experiencing 
• Any trusted system in place that you will feel comfortable communicating and/or advocating for yourself with

Preparing Yourself for Postpartum

So, what can you do to help prepare yourself and your family for the transition to motherhood? PLAN. Just like we prepare the baby’s nursery and our birth plan, mommas need to take some time to plan their postpartum period (otherwise known as the “fourth trimester.”) 

The 7S’s of Protecting Mom’s Mental Health: 

• Screening 
• Sleep
• Self-care
• Support
• Sustenance
• Sunlight
• Safeguarding relationships

Here are the basics that you can start with to create a more supportive and nurturing environment for your family: 

• Screening: This should be done DURING and after the baby arrives on more than one occasion, especially if mom has risk factors or is experiencing symptoms
• Sleep: Sleep is considered the most essential “medicine.” If you are not getting adequate sleep (4-6 consecutive hours) you will not improve significantly, even with medication. Sleep and breastfeeding do not have to be mutually exclusive. Coming up with “mom” windows for sleep are important. If mental health is an issue, introducing a bottle after the breastfeeding relationship has been established can help tremendously. 
• Self-care: Taking time for yourself, away from distractions, and doing whatever it is that helps you recharge. Self-care should be GUILT FREE and should meet you at where you’re at. Self-care on low functioning days will look different than high functioning days. Daily movement should be considered a part of self-care, as this is important to your overall mental and physical well-being. 
• Support system: Most women will need more than their partner for support, and sometimes women may be facing the challenge of raising a baby alone. Call upon trusted extended family members or close friends. They won’t know you need help unless you ask. They can help you with chores, food, errands, childcare, or anything you need them. Arrange ahead of time so they can expect to hear from you. 
• Sustenance: Eating a balanced diet during and after pregnancy can help your mental state (and not to mention, make you feel amazing physically!). Throughout scientific literature, there are common nutrient deficiencies that have been implicated in patients with depression: Essential fatty acids (EPA/DHA), Vitamin D, B-vitamins (specifically B6, B9, B12), and trace minerals (specifically zinc, iron, and selenium). 
• Sunlight: Sunlight is one of nature’s natural mood enhancers. Exposure to sunlight is thought to increase the brain’s release of a hormone called serotonin. Serotonin is associated with boosting mood and helping a person feel calm and focused. It can also reduce cortisol (the stress hormone) levels. Sunlight also helps your sleep/wake cycles regulate, helping you with insomnia. 
• Safeguarding relationships: You and your partner are going to be changing roles. It is imperative to keep lines of communication open, to address expectations, and to show compassion and appreciation. Understanding each other’s needs prior to the baby’s arrival, having an action plan, and having daily or weekly “state of the union” meetings can help tremendously during this transition from lovers to parents. 

“When a child is born, so is a mother.” Motherhood is beautiful, chaotic, challenging, and life-altering in so many ways. 

You deserve a beautiful life as a mom. You deserve happiness. You deserve peace. With help and support, you can go from surviving to thriving.

Thank you, Heather for this amazing information. Please share this with any new or expecting mamas in your life. If you are wanting to get in touch with Heather, you can reach her through her website, or her email: mindfulmommatherapy@gmail.com

XO

Racquel