Category Archives: postpartum

Falling Off the wagon

So I haven’t been blogging here. I do have three blogs coming out soon (stay tuned!) on eating disorder recovery sites. However, in reflecting on my 12-month Butterfly Project for the year, I’m coming back to the intention of: Stay engaged with the process.

In other words, as they say in recovery, don’t quit before the miracle. Or, as Dr. Brene Brown says,

“Stay in the arena!”

I need to remind myself of again and again: in therapy with my clients, in parenting, and in the life-long process of growth.

With my clients, who often struggle with shame if they slip in their eating disorder recovery, we constantly need to re-frame slips as part of the process. Slips are not a detour. As they say in my little one’s school, Mistakes are how we learn.

In our house, when someone drops/spills something by accident or my little one (who has just started writing) makes a “d” instead of a “b,” we say “Hooray! I made a mistake!”

It sounds so easy, but it is not. Simple, but not easy. Re-engage-ing with the process, again and again. I love how Glennon Doyle Melton, mom, recovering bulimic/alcoholic, and author of two memoirs and the blog Momastery has this motto in her household:

“We can do hard things.”

And another relevent peice for recovery and parenting:

“Most of life is boring. What are you going to do/make of that?”

If you have an answer for you, please feel free to leave a comment. I welcome them. And stay tuned as I re-engage with the process!

Guest Blog: PPD may have delayed onset…

…and recovery is always possible

My first year with the baby was dreamy, so when I started to decline, I didn’t think it was Postpartum depression (PPD). The docs had said PPD could occur anytime in the first year. They didn’t say what it was when depression occurred after that. Since my self-esteem was plummeting, which is one of the hallmarks of PPD, I concluded that my downward spiral was my own fault, due to poor management of my time and energy. It got ugly as the chemistry in my brain lost more and more balance.

sun-in-fog

What it felt like is that the sun that energizes the earth and had brightened my day was no longer available. I couldn’t feel its warmth. People often use the sun metaphor when talking about depression. When the depression lifts, they say, it is like the sun comes out again. This is very much what it was like for me. When the sun was absent, it was so frustrating because I knew what was missing – a connection to the universe – but I could not get it back. Movement, light, forward momentum – they were gone.

For me, PPD was closely related to the amount of sleep I got. It resolved almost immediately when I got five consecutive good nights of sleep at my mom’s house. She cooked for me and did laundry while my sister looked after the baby. I wrote this poem about it:

Usually, when you walk, you go forward.
In the dark season, your footsteps dissolve in the mighty, silent ink.

Lost, you have no choice but to sink into what you cannot see.

You reach out but your hands slide down the slick walks of despair,

grasping nothing.

This relentless, downward pitch can only be a vein of hell.

And then,

the baby sleeps through the night, you get a day off, you lie down and rest.

Stop

Stop

Stop,

beats your heart. Your mind says nothing.

You feel heat again in your spine. You see orange at the corners of your eyes.

This quiet place at the bottom where the flame always burns,

must be a chamber of heaven

that it took the darkness for you to see.

I wish that I had known sooner that what I was experiencing was a delayed onset of PPD. I would have sleep-trained the baby earlier, and arranged for more visits like the one I just had at my mom’s. A late-onset PPD diagnosis also might have prevented a lot of anger directed at myself for being such a failure at managing my life. So I say, if you have a child under two and you meet the criteria for PPD, it probably is PPD and deserves to be treated as such. At the risk of stating a cliche, you deserve the support you need to feel better.

smileandlean

Sheira Kahn is a recovered bulimic and Marriage and Family Therapist who practices in the East Bay and Marin County. She teaches self-esteem workshops and classes on reducing emotional eating and is co-author of The Erasing ED Treatment Manual, available on Amazon.

At the age of 50, she gave birth to Alexandria in April of 2014. Her blog can be found on www.sheirakahn.com.

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Motherhood as Rite of Passage

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Scales are for fish: 4 Reasons for Moms to Let Go of the Scale.

  1. It’s not about the weight.

In the original “great palace lie” story, when the emperor’s trustworthy officials couldn’t see the cloth the swindlers were weaving (which wasn’t there), they pretended they could. Why? Because they didn’t want to look stupid or unqualified. Who wants to look stupid or unqualified? And yet motherhood, especially new motherhood, is filled with the experience of feeling unqualified. No one is prepared. That is one of the lies. Transitions are difficult, uncomfortable, and messy. That being a different weight will make you feel more competent/happy/qualified is a lie.

Magazines are filled with articles about “the right amount of weight to gain during pregnancy,” “losing the baby weight,” “mommy tucks,” or skinny celebrities strolling down the red carpet weeks after giving birth. It’s another version of one of the Great Palace Lies. Kate Middleton was alternately shunned and celebrated for still having a baby bump after her first child was born and then shunned and celebrated for looking too stunning just after after her second baby was born. So the lie works both ways: you’re damned if you do and damned if you don’t. The truth is weight is just that: weight. And regardless of your weight, your stomach will never be the same postpartum. Your breasts, whether or not you breastfeed, will never be the same. Your sleep will never be the same. Your relationships will never be the same. And, most importantly, YOU will not be the same. Whatever your weight is and becomes, you will never be the same person you were prior to having a baby. Putting all your energy into the lie that you can be (or at least look like) the same person, and that is the goal, will only succeed in making you tired, depressed, and trying to be something you’re not.

  1. You can be more comfortable in your own skin.

If you get rid of the scale, the real feelings will show up. This will probably feel uncomfortable, but freeing. Motherhood, becoming a mother, includes grief: grieving the old self and creating a new one. Anne Lamott says one of the greatest palace lies about grief is that it should be gotten over quickly and privately.

Allow grief, allow imperfection, give yourself more time than you would have expected, and allow your body to be what and where it is right now. Also, you do not have to do this motherhood-thing alone. Ask for help, join a moms group, get into therapy, do whatever you need to do to not be in isolation with believing the great palace lies. Be the truth teller: be the one who is willing to say, “I’m not feeling happy and glowing! I feel like sh*t! I want to go to the coffee shop without carrying a baby and a diaper bag full of butt cream, cheerios, pureed carrots, 3 changes of clothing, 2 pacifiers, wipes, bibs, burp cloths, sleep sheep, and SPF50 sunscreen!” Speaking the truth of your experience can give you more of the feeling of comfort in your own skin than losing weight ever could.

  1. You will not pass on the suffering to your child.

Scales are a way to measure value in an amount, but they don’t really measure what is valuable. When you die, I doubt “she weighed this amount” or “Wow, her stomach was surprisingly flat postpartum!” is what you want people to be saying about the meaning you brought to this world. What do you really value? Be that; do that. Many women are inspired, when they become mothers, to break the generational chains of suffering from their own family of origin and/or cultural experience. If you have suffered from self-hatred or disordered eating in your own experience, this is an opportunity to not pass it on. This is an inspiration to be different, learn to love and appreciate yourself now, flaws and all. Wear the bathing suit. Look kindly, as much as you can, in the mirror. Treat yourself at least as kindly as you treat your child. The way you treat yourself is your child’s mirror. Model that imperfection, eating cookies, and cellulite are normal parts of the human experience. Oh, and destroy the scale (more on this next).

  1. Scales are for fish.

I encourage you to smash your scale. Do it. Get out a hammer and bash away. Have a scale smashing party. Consider freeing all the energy that has been going toward measuring your worth externally to other endeavors. Letting go of your scale can free up so much energy! If you can’t throw out your scale, I encourage you to make it into a YAY scale. A YAY scale is a scale that reads an affirmation to you instead of a number. If you have a daughter, make her a YAY scale, or make one with her. If she is old enough, let her write her own affirmations. Illustrations also work. Though it may sound cheesy that doesn’t mean it’s not effective. Isn’t reading “You are just right,” “You are a sexy goddess,” or “What you’re looking for is not in here” preferable to another “not good enough”?

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Grapefruit, Atkins, Paleo, Pooh: When is it a diet, when is it a disorder, and what is it really about?

bacon-strips-clipart-9Many years ago, when I was in 10th grade, we had to do a “pig lab” in which we dissected a baby pig. As a sensitive 13 year old, this horrified me and I spoke with my Biology teacher about how I would rather not participate. To which he replied, “Do you eat bacon?” The next day I became a vegetarian. By the time I went to college, 4 years later, I became actively anorexic. My concern for others had tipped into self-destruction. I had to spend the next few years sorting out what was helpful and what was not helpful for my recovery in the midst of the concerns I had for others, the world, and the difficult life transitions through which I was travelling. As we say in eating disorder treatment recovery, “it’s about the food and it’s not about the food.”

I recently gave a talk on eating disorders at a bay area hospital and one of the doctors asked me “What do you think of the Paleo diet?” To which I responded:

“I am not a fan of any diet.”

Or, as two of my eating disorder therapist colleagues say, “This is not a die-t; this is a live-it.”

Paleo, Atkins, Vegan

I have spent the past decade and a half working in eating disorder recovery programs and I cannot tell you how common it is for people with eating disorders to be vegan, vegetarian, “Paleo,” “Atkins,” or sugar/gluten free. For the record, there is nothing “wrong” with any of these. And people with sensitive temperaments, physically, psychologically, emotionally, tend to be strongly affected by what they eat. Neuroscience is now showing what we have intuitively known: what, how much, and in what way we eat changes our brain chemistry. Sometimes there are also medical reasons for special food needs. People with celiac disease need to eat gluten free; women with gestational diabetes need to eat in a particular way during pregnancy as a health necessity. However, that being said, from a clinical standpoint, I have noticed a few things:

  • 1) Western culture is obsessed with “good” and “bad” foods as well as diets. The trend changes from Grapefruit, to Atkins, from “juicing,” to Paleo, but there is always one that has the attention of people and the media as the “right” way to eat. Usually this includes moral judgments about how some foods are “good” and some foods are “bad” (with the subtext of how you as a person are “good” or “bad” according to how you are eating.)
  • 2) This same culture of diet-obsession is also obsessed with body sizes/shapes, and how the current “diet” will provide the right body size/shape/weight. Let’s be honest, there is an undercurrent of “The Thin Ideal.” In one 2004 study “Exposure to thin-ideal magazine images increased body dissatisfaction, negative mood states, and eating disorder symptoms and decreased self-esteem, on women.” (Hawkins et al 2004)
  • The thin ideal assumes that thinner is “better” (more attractive, successful, intelligent, young, and on a deeper existential level, provides “freedom” from mortality).
  • 3) People who have a temperamental risk toward internalizing stress, being over-achieving oriented, struggle with anxiety or depression, and are caring toward others (often at the expense of themselves) often obsess about food as a way to resolve complex life problems and issues.

Diets don’t work

This has been proven, again and again. Diets do not work. According to the National Eating Disorders Association (NEDA):

  • 95% of all dieters will regain their lost weight in 1-5 years (Grodstein, Levine, Spencer, Colditz, &Stampfer, 1996; Neumark-Sztainer, Haines, Wall, & Eisenberg, 2007)
  • 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders (Shisslak, Crago, & Estes, 1995)
  • Even among clearly non-overweight girls, over 1/3 report dieting (Wertheim et al., 2009)
  • Girls who diet frequently are 12 times as likely to binge as girls who don’t diet (Neumark-Sztainer, 2005)

Geneen Roth, who has been writing and teaching about the connections between emotions, food, and spirituality for decades, came up with a beautiful fourth law of Physics, which states “Every diet has an equal and opposite binge.”

Diets don’t work. They are a set up for deprivation that inevitably has a backlash. And obsessing about food is never about food.

Canaries in the Coal Mine:

So if diets don’t work and disordered eating is not about the food, what IS it about? That is the (hopefully less than) 10 million dollar therapy question that takes rigorous and compassionately curious work. I often think of people with eating disorders or people practicing disordered eating (including dieting) as canaries in the coal-mine. They are the ones that are extra sensitive to family, cultural, and environmental toxicity. If there is something not right in the family system, in the environment in terms of treatment of other sentient beings, or in the balance of power culturally (Have you ever wondered why women and GLBTQ people often struggle more with body image distress than straight men? And what they do and do not have access to?), then the person who develops the eating disorder is going to be the one saying (or acting out) “Something’s not right here! There is suffering! We’re not all going to survive!” They are the ones that are showing things are out of balance.

I share with my clients recovering from compulsive eating that putting a sign on their fridge stating “Its not in there” can be helpful. If you are looking for something in the food or a diet that’s not in the food, I invite you to ask the question what are you truly looking for? Is it kindness toward yourself and others? A feeling of well being? Is it to be seen or feel loved? Is it comfort or companionship? Relief from disappointment, embarrassment, resentment, jealousy? Is it a friend to be with you during grief? Connection with your family or community? Food can’t provide any of these. It’s not in there. I want to invite you, the next time you are considering going on a diet or eating ice cream in order to resolve any of these, to turn toward the discomfort of what is going on within you. Try not to fill it up with the distraction of food. Imagine

“…feelings like disappointment, embarrassment, irritation, resentment, anger, jealousy, and fear, instead of being bad news, are actually very clear moments that teach us where it is that we’re holding back. They teach us to perk up and lean in when we feel we’d rather collapse and back away. They’re like messengers that show us, with terrifying clarity, exactly where we’re stuck. This… [how to stop protecting your soft spot, how to stop armoring your heart] is the perfect teacher.”

―Pema Chodron, When Things Fall Apart

 

Resources:

The Don’t Diet Live it workbook, Wachter and Marcus, 1999

Neuroscience

http://www.anad.org/news/binge-eating-disorder-affected-by-brain-chemistry/

http://www.ncbi.nlm.nih.gov/pubmed/21350434

Scott E. Moseman, MD Medical Director, Laureate Eating Disorders Program Investigator, Laureate Institute for Brain Research, “Neurobiology for Clinicians” 2014 International Association of Professionals Treating Eating Disorders (IADEP) conference

The Thin Ideal:

Hawkins N1, Richards PS, Granley HM, Stein DM. “The impact of exposure to the thin-ideal media image on women,” Eating Disorders: The Journal of Treatment and Prevention, 2004 Spring;12(1):35-50.

Your Dieting Daughter (Chapter 7 “The Thin Commandments”) By Carolyn Costin

Dieting Stats:

National Eating Disorders Association (NEDA) website

https://www.nationaleatingdisorders.org/get-facts-eating-disorders

For Partners: Navigating the Land-mines of Postpartum and Eating Disorder Recovery

I just finished reading The Postpartum Husband, by Karen Kleinman.* This is hands down the most fabulous book I have seen for partners (except for the non-PC title that excludes same sex or unmarried partners) supporting women through Postpartum Depression. It is basically the Men are from Mars Women are from Venus of Postpartum Depression Recovery sourcebook. The style is direct, informative, non-shaming and concise. The chapters are 1-2 pages long- perfect for men and partners wanting bullet point versions of information that are most likely sleep-deprived and potentially in-crisis-with-a-depressed-new-mom-and-baby. Some gems that stood out for me were: YOU CANNOT FIX THIS.

And also:

What works for you may not work for her:

You’d want to be alone; she wants you there all the time

You’d get up and out and run yourself through this; she stays inside and can’t get up and go

You’d isolate yourself at work; she craves support and comfort from others

You’d turn your sadness into anger; she feels inadequate and worthless.

As a pragmatic clinician and eating disorder specialist, I am always asking the question, how does this apply to eating disorder recovery? Here are Karen Kleinman’s thoughts on supporting women in PPD recovery followed by my thoughts on supporting women in eating disorder recovery:

  • The single most important thing for you to do to help is to sit with her. Just be with her. No TV, no kids, no bills, no newspaper. Just you and her. Let her know that you are there. (DITTO)
  • This isn’t easy to do, especially with someone who seems so sad or so distant. Five minutes a day is a good place to start. (DITTO)

Here’s what you’re up against:

  • If you tell her you love her, she won’t believe you (Ditto)
  • If you tell her she’s a good mother, think you’re just saying that to make her feel better. (Substitute “good person.”)
  • If you tell her she’s beautiful, she’ll assume you’re lying. (Ditto. If you tell her “you’re not fat,” she will think you are lying or are minimizing her distress.)
  • If you tell her not to worry about anything, she’ll think you have no idea how bad she’s feeling.(Ditto)
  • If you tell her you’ll come home early to help her, she’ll feel guilty. (If you tell her you will eat with her to help her, she will feel guilty, ashamed, anxious)
  • If you tell her you have to work late, she’ll think you don’t care. (If you tell her you have to work late, she will think it is to be with someone else because you hate her company or are sick of her.)

You may (as the partner) be thinking, THEN WHAT IS THE POINT? Anything I do is fruitless. That is where I would encourage you to be aware of the cognitive distortions rampant in depression and eating disorders that you are up against: all or nothing thinking, personalizing, perfectionism, minimizing, control fallacies… However, there ARE things you can do. Here are some examples:

  • Tell her you know she feels terrible. (Ditto)
  • Tell her she will get better. (Ditto)
  • Tell her she is doing the right things (therapy, medication) to get better. (Ditto)
  • Tell her she can still be a good mother and feel terrible. (Substitute “person.”)
  • Tell her it’s ok to make mistakes she doesn’t have to do everything perfectly. (Ditto)
  • Tell her you know how hard she is working right now. (Ditto)
  • Tell her to let you know what she needs you to do to help. (Ditto)
  • Tell her you love her. (Ditto)
  • Tell her your baby will be fine. (Tell her that her eating disorder is not destroying you and that you can handle all of her feelings.)

For eating disorder recovery, I would add the following DO’s and DON’t’s:

  • Do NOT try to be “the food police” or try to be her nutritionist/dietician. DO redirect her to her nutritionist/dietician for advice on her food plan recovery.
  • Do NOT bring up emotionally difficult conversations during meals when she is already struggling. DO know that meals will most likely be uncomfortable for her and keeping conversation “light and polite” or simply giving her a kind look that acknowledges you know meals can be tough for her, but you are right here beside her. DO ask when a good time to talk about difficult things is for her and for you (ex in the morning, at night before 8pm, on the weekend).
  • Do NOT assume she is feeling or will feel better if she is eating according to her food plan, gaining/losing weight as a result of her recovery action steps. Do NOT comment on her body size, even if you think she looks “better” or “healthy.” . She is most likely feeling WORSE. DO validate that she is most likely feeling worse and know that she will cultivate tools for managing these distressing emotions without using her eating disorder behaviors as she continues her recovery (therapy, group, nutrition) work.
  • Do NOT comment on her appearance or “level of fatness,” even if she asks (ex “Do I look fat in this?”) DO instead say “How can I support you through this difficult feeling right now?,” “I trust your ability to find the right outfit that feels comfortable to you,” or “I’m not going to comment on that but love you.”
  • DO access your own support system or if you don’t have one, develop one! CODA and Al-anon are great 12 step resources for partners.

For women recovering from eating disorders/body image difficulties AND postpartum depression:

DO remind her that you love HER and that her body made a baby. Remind her that postpartum media images are NOT realistic. Remind her she is a whole person that you love, not simply a body. Remind her that you are with her as a partner and friend with all of your own age-ing postpartum imperfections.

Above all, try to hold a big picture of this time as limited and it will get better. Take very good care of yourself and put your own oxygen mask on first.

As always, this blog is not intended to diagnose or treat any mental illness or eating disorder. Please contact your therapist for individualized diagnosis and treatment. If you would like to schedule an assessment with Dr Linda, you can call 415-335-2596

Resources:

* Kelinman, Karen, MSW (2001) The Postpartum Husband: Practical Solutions for Living with Postpartum Depression

http://www.postpartumdads.org/ is a support resource for Dads run by Postpartum International.

I had one, I’m done vs. I’m having two, woo hoo!

family-reunion-clipart-ycoeaoKcEContemplating the complex decision to have a child, and whether to have another 

The question, of whether to have a child, followed by of whether to have another child, is a question with which most women (and men) wrestle. As one Mom put it:

“I was newly married and it suddenly became very clear that it was time to try for a baby. The fear that I’d held onto for so long had simply evaporated and I found myself eager to take that path and meet my baby. My husband and I conceived right away…I think I have been waiting for that kind of clarity ever since, and I am starting to realize that it might not come.”

One reason mothers (and fathers) often state to have another is “I had the first one for me and the second one so they would have a sibling.” Research shows there are actually some benefits to having siblings. According to Colin Brazier, author of the book Sticking up for Siblings, having a sibling while growing up can help:

  • Resist allergies, obesity, and depression (As an eating disorder therapist, and someone who recovered from disordered eating, I would dispute the reasons stated for resisting obesity, as his research shows that parents are more likely to be aware of kid portions if they have more than one child, and serve adult portions if they have one child. I don’t imagine anyone recovered from an eating disorder would make this mistake.)
  • Be the antidote to helicopter parenting. Siblings can teach each other how to take risks, help with language and social skills.
  • Make it easier to look after an elderly parent, deal with parental divorce, or cope with death of a parent if shared between siblings. (1)

On the other hand, there are many myths about only children that simply aren’t true. Lauren Sandler, an only child and mom of one and the author of One and Only: The Freedom of Having an Only Child and the Joy of Being One states:

The three biggest myths, she says, turn into one word — lonelyselfishmaladjusted — when people talk about us, despite the hundreds of only childstudies that show only children are no different than people with siblings. She shows how only children are not lonely or maladjusted and actually have some strengths that siblings don’t.

“Only children become generous and respectful people. We put a lot of weight on our relationships. We tend to be very giving friends, and we are no more narcissistic than anyone else. For some reason, researchers cannot believe this, and just keep testing it.” (2)

And all of the data around that shows us that as long as kids go to school they’re socialized. Only children tend to have higher achievement, intelligence and self-esteem. Raised in a “rich verbal environment” they talk a lot — and with depth. (2)

It is interesting to note (as most research is “Me-search”) that the authors of each of these pieces are not only citing research, but sharing from their own family of origin and now parental experiences (of having siblings or being an only). In other words, there is no right answer, only living your way into the question. Here are some interview questions I asked three fellow “Recovering/Recovered Mama’s” and their unique answers to the process of deciding to have a child/children:

1. What made you decide to have one/more than one child?

“We always wanted a big family.”

“We went back and forth with the decision of another after our first was born. Before our first, we were certain we would have more than one but then after we were in the REALITY of what life was like as parent (CRAZY) we were back and forth. When I wanted a second child, my partner said no. When my partner wanted a second child I said no. Ultimately, we had our second child when we somehow both landed in the world of yes.”

“I have been sitting with the question of whether or not to have another child for some time. For a number of reasons, mostly to do with completing graduate school, starting new careers and a couple of inter-state moves, we have chosen to wait until things settled down…My son starts kindergarten in two weeks. Our life is good. And we’ve begun discussing the possibility of trying for another baby. Most of the time, during the day, I am feel positive and excited about the prospect. Then night arrives and my son has fallen asleep and I get my downtime. I generally sleep through the night, but when I wake up I often become anxious and overwhelmed with thoughts of all that could go wrong and by the idea of sleepless nights, breastfeeding challenges, and a few more years away from my career path. I’ve been having a difficult time getting clear about whether to try for another baby, or simply be grateful for the family that I do have and accept that we are enough. We are enough.”

2. What went into the process?

“I interviewed a handful of friends who grew up as single children about their experience. A lot of them shared feeling lonely and wanting a sibling but it also helped them find deeper connections with cousins and friends. Both [my partner] and I grew up with siblings and although there were challenges and frankly still are, we both agreed we wanted our first to have a brother or sister  with whom she could connect on having the same parents. We joke about them saying ‘our parents are nuts,’ which will create a bond for them.”

“We were originally planning on having 3, possibly 4 children, but baby #1 took us years to conceive due to (a medical condition). After that resolved, we got pregnant 6 months later. However, it was 3 years after we began trying, so we felt that our time was running short. We started trying when I was 34 and my husband was 36…But our first baby came 3 months before I turned 38 and so the idea of a big family with our ages into consideration was not as strong.”

“My mother’s first child, five years before me, was born with a chromosomal abnormality and only survived for a few hours. The experience was traumatic, her baby girl was instantly whisked away and she was left alone (my father was in the waiting room) to wonder what happened. Her first birth experience had a significant impact on her second birth experience. I was born into the emotional baggage of that earlier trauma. I carried the remnants of that trauma with me well into my 30s. I was terrified of being pregnant, terrified of giving birth, terrified that I would be unable to birth a healthy baby.”

3. Did you do fertility treatment, adopt, have more or less difficulty with pregnancy?

“We did several fertility treatments the first time around, none worked until we found out the true problem, which was [something else]. After we got that fixed, we got pregnant quickly. The second baby was conceived on the first shot, as soon as I thought I was ovulating again, in fact, I never even got a period. ”

“I have had 5 pregnancies and 2 children. I had 2 miscarriages before [my first] and one before [my second]. I used acupuncture to help me in the pregnancies with both.”

4. How was your experience with having one child vs two children? What was the same /different?

“It was and is very difficult. More difficult than I thought. I wanted to bond with my new baby but my 22 month old still very much needed me and it was hard for him to see me with the baby. I had a hard time nursing the baby in front of the toddler because he would cry for my attention and climb all over him. He was very distressed for awhile. I found the newborn stage to be so much easier the second time around, it was my toddler who I found difficult. It was also difficult not to be able to take naps with the baby because when he slept, I still had a toddler to tend to, so I was extremely tired. I also had a harder time healing from my C-section which caused me a lot of pain because I was holding both a 9 pound infant and a 28 pound toddler.”

5. How was food/sleep/sex/self-care/work load/work outside the home/childcare with one vs two?

“I don’t know what any of those things are. I am hopeful though that eventually I will be able to integrate more self-care when my children are a little more independent. Right now they still need so much from me.  The one thing that changed a lot was my body image. My body changed a lot after baby, lots of loose skin and dark circles under my eyes and much higher body fat– and I don’t care one bit. I feel in awe to have a body that can make, grow, and nourish two children. The way my body looks is so low down on my list of priorities that it’s felt like a giant relief.  Food has been different too, I’m less aware and careful about what I’m putting in my mouth, which has also been a relief. I think that there were times that I was too cautious despite being ED free, I still thought about it. Now, I just eat lots of food whenever I want  it to keep my energy up for breastfeeding and toddler chasing and playdates.”

“OMG, it is ALOT of work with two. Not just two times the work, but more like ten times the work. It is intense. The biggest challenges for me right now is competing needs. Whose need do I tend to first? How do I keep my patience when they are both screaming for me? They are in different developmental stages and need to do different things to occupy their day/time. They are starting to play together at moments which is great, hoping that increases as they get older.  With a second, we had the stuff we needed with and were seasoned with the car seat, diaper bag, snack bag routine ect… We had adjusted to life with a child, which I think is a bigger transition than adding a second child, as there is so much personal sacrifice in life to be a parent, especially an older parent. Both my husband and I had LIFE experiences before having kids. We knew freedom really well. Our experience of having a child was transformative. When [our second child] came into our lives, there was not as much transformation as the stress of caring for two children vs. one child.

“We were starting to feel some more freedom when I got pregnant with our second, which led to more date nights, connection, some ease. But once the second came, it felt intense for the first year. This second year has been intense due to my Dad’s passing, moving, and buying our house. A lot was on our plates along with having two kids. So my perspective might be different if we had just had two kids without all the external stresses.”

“Sex we are working on. Mostly we are TIRED. But I think regular date nights would help.”

“We keep food simple. I feel like I ate better before kids but I also had more time to experiment and play. AND my kids are picky eaters like most kids. I have food in the house I would not eat prior to kids… ”

“Childcare has been stressful to figure out when it changes, especially balancing our older child going to school, while the younger stays with the nanny. And it is EXPENSIVE!”

“Self-care is always a work in progress.”

“I am still learning to balance it all. But I feel like that will always be the case until they leave home!”

Resources:

1. Brazier, Colin, (2013),  Sticking Up for Siblings

http://www.bbc.com/news/magazine-23778123

2. Sandler, Lauren (2013) One and Only: The Freedom of Having an Only Child, and the Joy of Being One.

http://www.huffingtonpost.com/2013/06/12/only-child-myths-lauren-sandler_n_3424272.html

On deciding to have a child/children, Part two: Some issues unique to women in recovery

scaleBody image can be a source of distress and/or relapse trigger for recovering women. This is not a superficial issue, but a deeper question around identity transition and transformations that happen for moms-to-be. For more on body image during pregnancy and postpartum, see “Does being a mom make me look fat?”

Fertility and secondary infertility can be challenging for women with histories of disordered eating or drug/alcohol use. Many women have damaged their fertility due to the eating disorder and can be challenged at becoming or unable to become pregnant. According to one study (Sterwart et al, 1990) “a total of 16.7% of infertility patients were found to suffer from an eating disorder. Among infertile women with amenorrhea or oligomenorrhea 58% had eating disorders. Because women often fail to disclose eating disorders to their gynecologists and may appear to be of normal weight, it is recommended that a nutritional and eating disorder history be taken in infertility patients, particulary those with menstrual abnormalities. It has previously been shown that disordered eating and nutrition can affect menstruation, fertility, maternal weight gain, and fetal well-being.” (1) 

Along with the choice about whether to and if so, how long and to what extent do fertility treatment is the often grueling process of trying successfully or unsuccessfully to become pregnant. Therapy can be helpful in this process in dealing with all the complicated issues and feelings this can include. One recent blog resource by Susan Allen, who is a LMFT in San Francisco, is: coping skills to center yourself through infertility

Family of origin attachment patterns can be deeply imprinted in the way we parent. This is something to be mindful of in not repeating past traumas and being conscious of what patterns we would like to keep and which we would like to change. Therapy is the most helpful resource in this regard.

Childcare Support from their families may be closer geographically or more emotionally available to women from families without eating disorders, alcoholism, or depression/anxiety. Building an “attachment village” of fellow mom friends and/or professional childcare support like nannies, babysitters, daycare, preschool can be an important part of keeping recovering moms sane and supported if the grandparents, aunts, uncles, etc aren’t available to help. One local mom resource is: Golden Gate Mother’s Group

Self care practices like getting enough sleep, the right kind of food, and not using/abusing substances such as alcohol, caffeine, and other drugs that can be difficult to maintain become excruciatingly during pregnancy and postpartum. Night doulas can be a helpful support resource for some moms. In the bay area, one such resource is bay area night doulas.

Many 12 step meetings also have phone support meetings for those people (like new moms) who are having trouble gettingmommy juice out of the house. Here is a link to phone meetings for Alcoholics Anonymous: aa phone meetings, and here is one to eating disorder anonymous phone meetings.

Perinatal mood disorders (ex Postpartum Depressiona and Anxiety) are common for women in recovery, as these are often what were beneath the disordered eating or alcoholism. Having a treatment team (Psychiatrist, Psychologist, support group specializing in perinatal mood disorders) ready and in place can be a crucial part of prevention and treatment for ongoing recovery. Postpartum Support International is a wonderful resource for moms and families struggling with perinatal mood disorders.

Survivors of abuse are often triggered at many points during the labor and delivery as well as breast feeding process. Many aspects of feeling one’s body is not your own or physical experiences that mimic what happened in abuse can be confusing for mothers who have abuse in their history. When Survivors Give Birth is a book published this past year that provides survivors and their maternity caregivers with extensive information on the prevalence and short- and long-term effects of childhood sexual abuse, emphasizing its possible impact on childbearing women.  For more information: Penny Simpkin’s website

Being “Advanced Maternal Age” (or over 35 years old) is becoming more common for many women during pregnancy, especially those that have chosen to solidify their own recovery and/or career path prior to having a child/children. Being an older mom brings with it potential medical challenges and choices during pregnancy as well as postpartum. The “advanced maternal age” project is a resource of information and stories: advanced maternal age project

References:

1. Stewart, Donna, Robinsonm Erlick, Goldbloom, David, Wright, Charlene, 1990, “Infertility and Eating Disorders,” American Journal of Obstetrics and Gynecology, Volume 163, Issue 4, 1196–1199.

This blog is not to be used to diagnose or treat eating disorders, alcohol use problems, or psychological illness. If you would like to schedule an assessment for treatment, including a perinatal mood disorder, you are welcome to contact Dr Linda Shanti at Linda@DrLindaShanti.com.

For immediate assistance/crisis, call 911 and for a National Suicide Prevention Hotline and Website: 1-800-273-8255 www.suicidepreventionlifeline.org

Bitchy is not a feeling (but it could be the baby blues or Postpartum Depression)

bitchy clip artOne of the most surprising aspects of the baby blues and Postpartum Depression for me to learn was how it can show up as irritability, anger, or anxiety. I know I personally never felt like a b*tch (Yes, I know from 16 years of recovery, 14 years of working in mental health settings, and a doctorate in Clinical Psychology that “bitch” is not a feeling) nearly as much as I did after becoming a mom. After becoming a mom, my “b*tch” feeling levels skyrocketed.

How does one know if these feelings (irritability, anger, sadness, loss of self-esteem) are in normal range of mommy/personhood and when they are of concern and needing attention and mental health support?

Shoshana Bennett, Ph.D. (co-author with Pec Indman, Ed.D. of Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression, 2010) offers two simple criteria:

1. The symptoms last longer than two weeks
Postpartum Depression, like non-perinatal depression, includes symptoms for at least two weeks that can affect changes in appetite, sleep, loss of self-esteem, and lack of pleasure. Hormone changes are dramatic postpartum and the baby blues are usually a result of feeling this dramatic change and resolve within two weeks postpartum. 50-80% of women experience the baby blues. The baby blues are much shorter in duration. PPD can be difficult to detect as what new mother isn’t struggling with changes in appetite, sleep, and self-esteem?! However, PPD is more persistent, and:

2. The symptoms are severe enough to get in the way of normal functioning, even if they occur during the first two weeks.
Perinatal mood disorders (including not only depression, but also anxiety, OCD, psychosis, and Bipolar) are more persistent and pervasive and can interfere mildly or dramatically in functioning and care for yourself and your baby.Postpartum Depression (PPD) affects 1 in 5 women (this is the latest evidence- it used to be 1 in 7. I imagine this is due to more women speaking up and receiving help, not more women being affected).  If the symptoms are severe enough to get in the way of normal functioning, even if they occur during the first two weeks postpartum, it is considered to be PPD.

But what ARE the symptoms and how do they show up?
The following are a list of symptoms interspersed with statements made by women suffering from PPD (excerpted from This Isn’t What I Expected by Karen R Kleinman, LCSW and Valerie Davis Raskin, MD, 2013) and comparisons between the baby blues and PPD (excerpted from Kristin B. Hodson, a psychotherapist, and founder of The Healing group.com, a center for Women’s relationship health):

Anger

“Every little thing gets on my nerves lately. Sometimes, I am even furious with my baby. Often, I am angry at my partner.”

The Baby Blues: One minute you love your husband and the next you want to bite his head off.Postpartum Depression: You are beginning to wonder why you married your husband in the first place, you are continually angry at him, and you consider throwing the vase at him.

The Baby Blues: One minute you are smiling at the baby and the next you feel irritated that you have to get up to feed them the fifth time that night.
Postpartum Depression: You’re dominated by anger daily, not just waking up to feed but towards others and life’s situations that you used to be able to handle.

Sadness/hopelessness

“I cry at least once per day.”

“I feel sad most or all of the time.”

The Baby Blues: You haven’t showered in three days, you have dried milk on your clothes, and you burst into tears at a moment’s notice.

Postpartum Depression: You haven’t showered in a week, you don’t remember the last time you did laundry, and you are crying most of the day, every day.

Poor concentration

“I can’t concentrate.”

Baby Blues: You walk into a room and forgot what you were looking for.
PPD: You cannot remember/memorize facts and figures needed in your professional life, that prior to pregnancy, were easy for you and your baby is 9 months old.

Loss of pleasure/lack of sex drive

“I can’t remember the last time I laughed.”
“I have no interest in making love at all, even though my doctor says I’m now physically able to resume sexual relations.”
“I don’t enjoy the things I used to enjoy.”

Fatigue and difficulty sleeping

“I can’t sleep, even when my baby sleeps.”
“I have no energy, I’m tired all of the time.”
“I have no appetite and no enjoyment of food or I am having sugar and carbohydrate cravings and compulsively eating all of the time.”

Low self-esteem

The Baby Blues: You haven’t had a thought about putting makeup on in a week and you don’t care that you are wearing your pregnancy pants because your focus is on recovery and the baby.

Postpartum Depression: You’re feeling so overwhelmed and out-of-control that you start focusing excessively on your outward appearance so people don’t know how bad and out of control things really are for you.
The Baby Blues: You wonder from time to time if you are really cut out for this mothering thing.
Postpartum Depression: You think you are not cut out for the mothering thing and start having regular fantasies about getting in your car, driving to Canada, and never returning because everyone would be better off.

This list is not intended to diagnose or treat PPD. A full assessment and screening can be done by a therapist (MFT, Psychologist or Psychiatrist) trained in perinatal mood disorders.

If you are having thoughts or a plan of hurting yourself or your baby, you need immediate attention and support. The following is a 24-hour crisis line for new moms.Postpartum Depression Phone Support: 1-800-773- 6667 (1-800-PPD-MOMS). This helpline is available 24 hours a day, 7 days a week for anyone experiencing depression during and after pregnancy, as well as for anyone concerned about a new mother. The telephones are answered by trained crisis counselors who can provide information and referral for treatment.

Fat Chat

I remember attending a class postpartum in which all the moms brought their babies in strollers and exercised together. I was in that early phase of exhaustion and urinary incontinence (Who tells you about this prior to having children?!) I was just trying to get out of the house with baby and get some fresh air and exercise. Any exercise. There was this one woman who mentioned taking (__________) the name of a supplement supposedly helpful for losing weight. She desperately wanted to lose the baby weight. (I am deliberately leaving it blank the name of the supplement not give anyone’s ED any ideas. More on “ED” later). I have to admit in that moment I had a dual response. My Healthy-Self thought:

“Uh Oh! Steer clear! Eating Disorder false promise of thin-ness= absence of all discomfort! You know that no supplement is going to take away feelings or give you the nonexistent ‘perfect body’! Lovingly challenge her now! Tell her to love herself the way she is now and ask what else is going on? You know you are talking to yourself when you are talking to her.”

 And my very tired postpartum self, who was subject to “ED” (aka the voice of an “Eating Disorder”ed self-critic) thought:

“Ooh a way to lose weight quickly postpartum! Woo Hoo!”

Did I get that supplement? Of course not. I was 13 years recovered! from an eating disorder at that point and knew better. Did I have a vulnerability to an ED thought during that moment? Of course! I was exhausted and in the huge, life-changing rite of passage of mommy boot-camp! My body was different, my Psyche was different, and I was walking around in a sleep-deprived fog. My Healthy-Self left that group disappointed that my usually strong Eating-Disorder-Psychologist-Feminist-Crusader had not spoken up to what I knew to be true: No supplement will change the difficulty of being and becoming a mom! No supplement will teach you how to love yourself the way you are!  Losing weight is never the answer to complex life difficulties.

This is what I know to be fundamentally true for eating disorder recovery (and cultivating a foundation of love from which to live): Losing weight or trying to change your body is never the answer. The solution is never about hating, punishing, or trying to escape from your body and always about loving and accepting yourself. My clients often ask me: Always? Yes. Always. And yet it is hard to talk about this with women, in groups, where “fat chat” is so common. Andrea Wachter and Marcea Marcus, Licensed Marriage and Family therapists who also specialize in eating disorder recovery, and authors of the book The Don’t Diet, Live-it workbook (www.innersolutions.net) coined this term:

Fat chat is complaining about eating or weight, gossip about who has gained or lost weight, conversations about the latest diets, discussions about cosmetic procedures [Mummy tucks], etc…when we engage in fat chat we are missing opportunities for more meaningful conversations about our lives.

What would a meaningful discussion have been in that moment? Maybe “I feel very alone in this new mom thing. Do you ever feel that way?” Or “I wish my baby weight would go away, too, but I’m also proud I had a baby and of the baby my body grew. My body needs to rest and recover from childbirth more than lose weight right now.” Or maybe if I was being fiercely challenging “I can’t afford the luxury of fat chat right now. I am trying to find my way into who I am as a person, as a Mom, and as a strong woman who has given birth.”

The good news? I can absolutely say that now. Any of those. All of those. My warrior-self is back. Look out ED voice! Look out fat chat! Boot camp is over! And Healthy mama is in the house! Thanks to “How to be a dad” for this beautiful image:

tiger belly

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