I have had several people ask me lately about what I did the second time around in order to try and head off another bout of PPOCD or PPD. I know how scary it can be to contemplate having another child. My “another child” is turning 5 this Sunday, so in celebration of her birthday I’m sharing what I did to prepare myself for the next baby. I was very fortunate to experience a disorder-free time!
Here is what I did:
1) I chose to continue on my antidepressant while pregnant. There are risks to this. I’m not suggesting it’s the right answer for every person. It was the right answer for me. Another option would be to go ahead and schedule some therapy appointments during the pregnancy and/or right after. Having someone already set up to counsel you and support you could be very helpful, and if you find as you go along that you don’t need the help because you are doing just fine you can always cancel the rest of them.
2) I had a pretty difficult childbirth experience the first time around, at least as far as I was concerned. So when I got to the hospital to deliver baby number two, I told EVERYONE I could get my hands on about it. I told them I had had PPD (I didn’t say PPOCD because they wouldn’t have know what that was, and it didn’t matter anyway). I told them about my previous negative experience in their hospital, not in a blaming way but to let them know why I was so nervous. I was fortunate that from that point on they treated me with kid gloves. They held my hand. They were very soothing. And my husband was there and had enough experience from the first time around to know what to do if they hadn’t. But they did. Their calm and supportive attitude really helped.
3) I made sure everyone knew I needed and wanted help and that they were expected to pitch in for the health and wellness of my entire family. This would be a team effort, so that we could make sure I either didn’t get sick or had plenty of support if I did. I told them that if I started to withdraw or clam up, it would be a sign that something was going on and they shouldn’t accept an “I’m fine”. I was fortunate that everyone was on the same page as far as that was concerned.
4) When it came to breastfeeding, I decided not to try it again. Breastfeeding caused me untold anxiety the first time around, and I felt it was the right thing for me to do to simply choose to bottle feed from the get go. I then set a boundary that no one was allowed to try and influence me or judge me or guilt me or change my mind. I had a ZERO TOLERANCE policy on that. No discussion. Period.
You need to make whatever choice is right for you and will allow you to be healthy and emotionally available for your baby and family. If that means breastfeeding when others want you not to, dammit you should breastfeed. If that means bottle feeding when others think you shouldn’t, dammit you should bottle feed. If breastfeeding didn’t work out the first time but you really want to try it again, do so and make sure in advance to get help from helpful people.
5) I only accepted the best professional help this time around. I went to specialists for PPD and anxiety, rather than waste months like I did the first time with a psychiatrist who was … well … not so good. Ask around. Talk to other survivors in your area. Find out who they recommend. Meet the person ahead of time if you can and tell them you’d like to work with them in case you become ill.
6) Three words: Sleep management plan.
Please know, some people still become ill again even when they do the things I did. It may be because the circumstances in their life are very difficult. It may be that they don’t have enough support. It may be for other reasons. Those who get it again are not at fault, are not to be judged and are not to be looked at as though they didn’t do enough to prevent it. Just know that if it happens again you know have an army of Warrior Moms behind you.
This is simply a list of the things I did, but there are other things as well. How about other readers out there who were fortunate enough not to have a perinatal mood or anxiety disorder on the next go round? What did you do?
Post update: Please read the comments below because there is a lot of great input from other moms and from healthcare professionals who treat women with PPD. Also, I totally forgot to mention Karen Kleiman’s book, written specifically on this topic, called “What Am I Thinking?: Having A Baby After Postpartum Depression” as a good resource for you.
This is a great help for those who's suffering from PPD(Postpartum Depression) but this is just an illustration on what you need to do but remember to consult first a Doctor to prevent further complications.
THANK YOU for writing this! I'm sending the link to my husband and family. I especially appreciate your candor and willingness to share. Also: happy 5th birthday to your sweet "another child!" You are just wonderful.
I'm pregnant with my second and the decision to have another was very difficult for me because I did not want to relive PPD/A/OCD. but we decided to go ahead (we are older parents) and decided to stay on the meds, stick with therapy, individually and with my husband. After week 7 I felt so good about our decision that, with consultation with my therapist and doctor, I decided to get off the meds. When week 30 rolled around we had sleep issues with my 3 year old. I tried to "deal" but after 2 weeks of sleep diprivation, I made the decision to get back on the meds. I'm SOOOOO glad I did. We got through that and now we are 2 days past our due date and VERY excited about baby #2. Been playing around with the idea of getting off the meds but decided to stick it out for the first 6 weeks of postpartum and re-evaluate. We also have a wonderful community set up that I found through being more vocal and educated about PPMDs and thus we have a meal and helping out strategy all figured out for the first 6 weeks 🙂 Hopefully all goes well, but if not, I know where I can find help – and that feels awesome!
good luck to all of you out there that are pregnant again or considering it.
I had PPOCD with my first and am now pregnant with the "next one." I agree with what you've written here and the awareness behind all of those decisions seems like the first huge step. I know the asking for help part will be the hardest for me so thanks for the nudge!
Thank you so much for this!! This has been my biggest fear and has kept me from considering another baby.
This gives me hope.
I LOVE this post. There are so many women out there who have struggled with a PMD and are hugely concerned about the potential of going through such an experience again. While we do know that women who have suffered are more likely to struggle with a PMD with subsequent children than those who have not, there are certainly women out there (like you are me!) who have PMD-free postpartum periods the next time around.
I'd like to add a "therapist's" perspective on preparing for subsequent children- and while much of this has already been mentioned, it may be helpful for folks to see some of what we know in list form.
The factors that amplify a woman's risk for developing a PMD are:
1. Biological risk factors including predispositions to mental illness (including depression and anxiety) and hormonal vulnerability (including sensitivity to PMS, PMDD, and hormone-centered birth control)
2. Stress
3. Lacking social support
4. Nutrient depletion
5. Insufficient physical activity
6. Disturbances in sleep and circadian rhythms.
What can moms do to reduce these risks?
1. Consult with a doctor or other trained professional about beginning or continuing medication during pregnancy. Many, many women take medications such as antidepressants during pregnancy and give birth to happy and healthy infants.
2. Develop and practice stress reduction techniques before the baby comes. This may include deep breathing techniques, mindfulness exercises, yoga, or anything else that calls to you.
3. Find a trained a therapist if you do not already have one or, as Katherine mentioned, make an appointment with your current therapist before you think you may need it. Calling on others in your community (family, friends, support providers) prior to the birth is an important way to help you feel like you are not- and do not have to- do it all on your own.
4. Stock up on nutrients and eat for health. Baby will get everything he/she needs, but often mom will become depleted in the process. And our bodies need important nutrients to help produce and utilize the brain chemicals such as serotonin that help sustain emotional health. Along with healthful meals, multi vitamins, Omega 3's, and iron supplements have been helpful for many women.
5. Find a way to get mild-moderate exercise every day… Don't worry- this does not need to mean going to the gym 7 days a week! Simple walking and/or stretches can be enough.
6. Create a sleep plan- many PMD's are triggered by inadequate sleep and extreme fatigue- making a plan with your partner and/or calling on friends and family to help is imperative. If you are having a hard time sleeping when your baby sleeps, talking to a doctor about over the counter or prescribed sleep aids may be helpful. Disrupted circadian rhythms have been associated with depression in many people.
Taking steps may help to prevent a PMD from occurring the second time around. And if you do struggle again, changes are that you will get help and recover much more quickly with preparation and planning.
Oh, and then there is this fabulous blog for community support and the reminder to be kind to yourself 🙂
We are planning on trying for #2 later this year and I'm scared to death. Freaked, really, about the possibility of PPD returning. This time, however, I know that I have a team of people on whom I can lean. I know that there is no shame or failure in walking out of the hospital with a scrip for an anti-depressant in my hand if that's what it seems like I need.
In short, I KNOW so much more now. And that, I think, will make a tremendous difference.
ne of the best post on the topic ever
I was going to do things SO different with my second child. Things had not gone at well at all with my first pregnancy/birth. Had an emergency c-section. Had a difficult pregnancy and I put a lot of stress on myself, I feel. I was nervous to be pregnant and when I found myself in that condition I was like is this really happening?? Then after my daughter was born I spiraled out of control, and did not know what was happening to me. After 2 months of crying non-stop, not sleeping, not leaving the house unless absolutely necessary, really not leaving my bedroom I found some support and got on meds. It took a full year to really recover and get back to myself and understand that I was a mom and had made this decision.
When I became pregnant with my second daughter. I was going to do things different. I was going to eat differently, I was going to accept this pregnancy and not freak out, I was going to exercise and I wanted to have this baby naturally. I had HIGH expectations! This pregnancy did go smoothly and I was much healthier BEFORE the birth. I should mention that I had a different dr. at this point and it was 5 years later. I was living in a different state. My new doctor had my history but I feel fell short on what I should do to prepare and be healthy AFTER the birth. And in my mind I was prepared and thought I can do this and get through this because I had done all the above mentioned things and knew what I had experienced with my first daughter.
Well I could not have been more wrong! The birth experience was different in a good way and my new baby girl was beautiful and things went well for about 48 hrs and then guess what?? I spiraled! Again…..this can not be happening and it did and it was worse! I feel that I fell short on what I should have done which was to ask more of my doctor and I feel also that my doctor should have recognized my history and said maybe we should put you on meds while I was pregnant, maybe you should find a therapist before the birth. Needless to say these things did not happen before the birth and I had to find the resources to help me get better after the birth and that is one thing for sure I knew I had to do even if I did not feel like it.
I did find help and HUGE support. Much more than with my first daughter. I did not type all this to scare anyone, this was my experience and I feel that I just should have been a bit more educated and sought the help I needed and spoke up more. Don't be afraid to have a voice and say something. Although I would change my post pardum experiences for a better one if I could. I am a stronger woman for going through them and I am a proud mother of two beautiful daughters and I would not change that for anything!
Good luck and just speak up and educate yourself, ask questions and get opinions. Then decide what is best for yourself.
In preparation for my second (and then third) child, I had a definite plan in place and support people. I discussed my past symptoms and course of treatment with my midwife, as well as two close friends. I knew that I needed them to be my advocates–I wanted my husband to be able to just enjoy our new family. Breastfeeding did not work for me the first time and in my perception of being a mother, I needed it to work. I read extensively, met with a lactation consultant and attended La Leche League. Breastfeeding was a success with babies #2 and #3. I did not experience symptoms of postpartum depression and attribute that in part to my success in breastfeeding, being proactive in my preparation and the post birth support that I received.
I appreciate this format to share my experience–you do great work!!
My 2nd was born this past summer and while I didn't have the same level of anxiety I did have random pervasive / disturbing thoughts. What got me through was knowing I would get through it. I know that probably isn't helpful for others but it was the trick for me. I don't bond with my babies right away, I wish I did but I don't. I knew that even if I didn't bond immediately it would be ok, because of the depth of love I have for her brother.
Also a way better birth experience was key for me. My son was born into worry, my daughter into joy. Drasticly different.
The other thing was I could pin point my triggers – I am able to get my needs met better, force myself to go to bed and co sleep which for us is key to more sleep.
I am pregnant right now with baby #2 and this post is so practical for me right now. I will be able to make some plans in advance of the birth to hopefully avoid PPD this time around. Sleep! I will definitely take it more seriously.
Thanks again. I find your site is a constant source of both interesting and applicable information.
For me, there is not going to be a next baby. It's as simple as that. After a pp psychosis hospitalisation, ppd hospitalisation and continuing atypical ppocd (not anxiety, but continued violent intrusive thoughts), my doctor has pretty much told me no more babies. I am not willing to put the daughter I already have through it – too much of a risk for me. Of course, I am am in the situation of having a 'spare uterus' so to speak, so we will be having another kid, I just won't be the birthing partner. I do wonder how I will deal with the demands of a new baby in the house and will have to put a plan in place for that. Perhaps not having the hormones and post-birth healing etc will mean my pp issues don't get triggered. I'd be interested in anyone who has been in that situation, but I haven't found anyone yet.
I am 4 weeks postpartum with baby number 3, five years after I was hospitalized with severe PND. It took us this long to feel strong enough to try again! Besides what you said, which is all good:
1: I have loads of support with breastfeeding, and have my breastfeeding consultant teacher on call. She has already helped me through two bouts of mastitis and all is going well!
2: We moved closer to my family for support.
3: Friends and relatives have stocked our freezer with food, so my kids don't go hungry this time! (I didn't feed them well last time.)
4: I am exercising from 6 weeks, my husband has organized babysitting so I can do this. Physical exercise made a huge difference for me when getting better.
5: Cleaner – once every 2 weeks!
x
Sarah Vine
Stayed on medications during pregnancy, saw my psychiatrist regularly, saw a naturopath during pregnancy and took supplements, had my psych write a letter to the hospital where I gave birth to ask them to put me in a quiet room, support my decision to bottle feed overnight, watch for symptoms and transfer me to psych mother and baby unit following discharge, went to mother and baby psych unit for 4 weeks after birth for support and help with overnights to prevent re-lapse, obtained in home care (from government, based on mental health) to feed baby overnight so I could sleep – still getting this and my baby is 13 months old, got out of the house a lot, had a better community support network, less anxiety being a second time parent and having a 5 year old who was doing well, being more assertive and confident in my decisions to do what was right for my family and myself, wrote a list of simple activities to do with kids/babies and simple meals in case needed – darling daughter is now 13 months old and I turn 43 shortly – happy to have confronted my fear
Great post, Katherine. Thanks to you and your readers for sharing so much wisdom and insight. I, too, did not experience PPD/Anxiety following the birth of my second children (twins). I prepared a postpartum plan that included what to do in the event I started down the PPD/Anxiety road. This was many years ago in 1990. Now, as a psychotherapist in private practice, when I work with moms in this situation, I refer them to Karen Kleiman's great book, "What Am I Thinking? Having a Baby After Postpartum Depression." I especially like the chapters on "Taking a History," "Assessing Your Resources," and "Our Postpartum Pact."
I copied this and tucked it away for when that time comes. Thank you so much 😉
Oh Katherine…thank you SO much for this post. We are in discussions about baby #2 and I am so afraid. But this time I have people who know what can happen watching over me.
I am a 38-year old mother of a little 3 and a half year old boy. I had severe PPD after his birth (a c-section….couldn't sleep, excrutaiting headaches, crippling anxiety, anger, physical pain etc. We are now contemplating trying to have another this year. It has taken me over 3 years to get to this point. I am not sure I am ready yet (or will ever be) and my husband is scared to death. But there is a yearning inside of me to go for it…not sure where it comes from but it is powerful.
I am writing to thank you so much for the article and all the comments as I feel in this moment that I am not alone. I will take all of the advice seriously. Still not sure what to do about my meds…going off of one right now for other reasons so we will see what happens with the other one. More importantly, I want to feel strong and stable for my family and, if that means staying on my medicine, so be it.
I feel so blessed to be feeling healthy again and am grateful to my parenting coach, therapist, psychiatrist, family and friends who have gotten me this far. Blessings to all.
prepared a postpartum plan that included what to do in the event I started down the PPD/Anxiety road. This was many years ago in 1990. Now, as a psychotherapist in private practice, when I work with moms in this situation
Do you live in the United States? I've never heard of mother/baby psych unit after birth. I'm intrigued.
Breastfeeding caused great anxiety for me also and when I switched to formula I felt like a failure of a mother which I too feel was a piece of the PPD pie for me. Also, I have concluded that bonding is different for everyone. I don't feel like we were able to bond until my daughter began to recognize me as something more than meal time and began smiling at me. Thankfully I am now beginning to feel that strong bond that people talk about. Now she will put her arms up at me because she wants her Mommy to pick her up and that makes me feel a loving connection.