Planning for PPD
I’d struggled with anxiety and depression off and on since puberty. After several glorious but short-lived remissions, I got it under control for real in my early 30s—just in time to start a family.
What timing, I thought. After all my work to get healthy, would I fall right back into the jaws of mental illness thanks to postpartum depression? My history, and my anxiety about the demands of parenthood, put me at high risk for it. The thought of going back to that dark place put a rock in my stomach.
But I wanted a kid, and I couldn’t let mental illness strangle my life choices. The only option, I concluded, was to do everything in my power to prevent PPD.
Not everything was in my power, of course. Hormones and brain chemistry do what they want. But could I make a dent in my PPD risk through what I did control, like sleep strategy, social support, and division of childcare with my husband?
Pregnancy resources didn’t give a clear answer to that question. Many of them neglected it altogether, assuming that women will worry about PPD if and when it hits. But waiting until I got depressed to address the problem felt like leaving my house unlocked at night with a prowler on the loose and figuring I’d call the police from under the bed when he broke in. When books and articles did mention lifestyle changes to guard against PPD (always in the “after baby” section, that part you read when it’s too late to plan ahead), their suggestions didn’t always speak to my particular triggers for anxiety and depression.
This was a DIY project, I realized. I knew my triggers for anxiety and depression better than some website, after all. I sat down with my husband, Jaron, to plot a postpartum lifestyle that would set me up for success. We marched into pregnancy with a solid plan—but it looked nothing like the typical expectations of new mom life that I’d read in baby books and seen in my friends’ lives.
Dad steps up
WhatToExpect.com, a popular pregnancy website and one of the first on my PPD research list, urges moms struggling with depression to get their partners involved. “Don’t be shy” about asking said partner to hold the baby while you do chores, they advise.
Shy? About asking my husband to hold a baby that’s 50 percent his? While I do the chores that he’s apparently not doing during his baby-free time?
I was already annoyed that social norms make mom the default caregiver and family maid, but this expectation that even a depressed mom will play that role, asking for help just enough to keep her head above water, troubled me deeply. I read it between the lines of many a PPD article as they suggested bare-bones ways for partners to “help” when mom is losing it.
I knew unrelenting pressure was one of my mental illness triggers and that brief moments of assistance would work about as well as shooting a water pistol at an inferno. So Jaron and I agreed to try for a 50/50 division of childcare so each of us could enjoy a regular escape from baby’s demands. If I felt my mental health slipping, Jaron planned to step up as main caregiver while I took time to get myself well.
We didn’t know other families that intentionally set up dad as primary caregiver. On the contrary, women warned me that even 50/50 parenting is hard to achieve when babies are little, and childcare guides didn’t generally offer advice on that subject. So Jaron and I strung together a collection of choices that we hoped might do the job. We chose to formula feed so I wouldn’t be trapped by the baby’s schedule. Jaron took eight weeks of parental leave along with me so we’d have equal experience caring for baby, and he took the lead in reading baby books so he wouldn’t have a knowledge deficit compared to me. He was now able to step in at the drop of a hat as go-to parent. Already I felt the needle on my stress odometer creeping down.
Sleep strategizing
Sleep (in my opinion, the base ingredient for mental health) can be a major contributing factor to the development of PPD. Yet I discovered that baby care books and articles pretty unanimously assumed that moms will handle most nighttime duty—even moms who don’t breastfeed.
Jaron functions well on little sleep, whereas I go off the rails after just a couple of nights, so we made another unusual choice—we decided he would pull most nighttime duty. I didn’t plan to skip all overnight baby care, but I had the freedom to decide how much sleep I needed to stay stable. Jaron’s utter fearlessness about sleep deprivation fascinated me. I dreaded missed sleep the way a cat dreads a bath, but he took it in stride.
We soon learned that sharing this plan with others would prompt unsolicited predictions of Jaron’s failure. One friend said he, too, had promised to help with the baby at night but given up a few days in; Jaron would do the same, he said. Some people seemed offended or confused by our plan, as if Jaron was setting the bar too high for other husbands and I was refusing to pay my dues as a mom.
I stopped telling people about our sleep agreement and absorbed everyone’s condolences about my upcoming exhaustion with zipped lips.
Pill-popping while pregnant
I was fortunate to have a supportive psychiatrist managing my low-dose antidepressant. Shortly before I got those pink lines on the pregnancy stick, I mentioned my PPD fears to my psychiatrist. She urged me to stay on my medication throughout pregnancy. My particular SSRI carried some risks, but tiny risks, much smaller than the likelihood of mental illness returning if I stopped taking it. Being anxious during pregnancy would make stability postpartum that much harder to achieve, my doctor said.
At an OB appointment just weeks later, my gynecologist said, “You’re on antidepressants, right? You’ll need to stop taking those at least for the first trimester.”
She didn’t ask how severe my anxiety and depression were or how they affect me when I’m not medicated. She didn’t ask how the prescribing physician felt about me stopping the pills, or, for that matter, how I felt about stopping them.
“Actually,” I said, “my psychiatrist wants me to stay on them.”
To my OB’s credit, she accepted that graciously. But I left the office unnerved. She’d suggested a major change to my mental health care despite having never treated me for it, and if I hadn’t had a psychiatrist beforehand, I wouldn’t have known that antidepressant use in pregnancy is a gray area that can be negotiated based on each mom’s particular needs.
Women seeking information about PPD prevention may be told that antidepressants should be taken only late in pregnancy, or advised to boost their brain chemistry with a healthy diet and supplements. Seldom, if at all, will antidepressants throughout pregnancy be acknowledged as an option. After discovering this, I began to wonder how many pregnant women discontinue their antidepressants without any conversation about options.
Protecting “me time”
Some PPD prevention tips urge acceptance of major life changes as the trick to heading off depression. According to this advice, mothers will cope best if they accept from day one that they have just surrendered their life to their child. I heard this from all kinds of parenting sources, not just those focused on mental health.
Unfortunately, I knew that wouldn’t work for me. I understood the need for flexibility once my baby arrived, but losing important lifestyle activities was one of my greatest fears. Mental surrender sounded like a recipe for discouragement and frustration. Didn’t it make much more sense, I thought, for women in danger of depression to guard the daily routines and habits that mean the most to us?
So that’s what I did. I sat myself down and asked what corners of my life I absolutely needed to maintain in order to be okay.
It came down to four essentials: my job, my writing, fitness, and a few key social events.
So I decided, come hell or high water, that those four things would survive the coming baby. If I had to give up Friday night movies, so be it. If I had to abandon my morning breakfast routine, fine. If housework suffered and a new species evolved in the mold of my uncleaned fridge, bring it on. But I would show up to the office at 8 a.m. each day, I would buy a jogging stroller for workouts, I would book a babysitter for New Year’s Eve, and I would finish my novel if I had to type it five sentences at a time over the next decade. Jaron agreed; my time for these activities would be protected, at least after the initial weeks of intense round-the-clock feedings.
Most importantly, I had control over selecting my “essentials,” rather than feeling that I had turned my life over to the caprices of my child.
Results
In the weeks leading up to my son’s birth, I wondered if our plan would really work. Would my safeguards against PPD play out the way I wanted them to, or would our family end up as just one more cautionary tale of how parenthood never goes “according to plan”?
To my relief, and probably the chagrin of all those smug cautionary tale-tellers, the plan paid off—yes, even when the unexpected happened.
In fact, our efforts bolstered my mental health before my child even arrived. My confidence in our proactive approach freed me from fear about the postpartum period. With fear out of the way, I had a stronger emotional framework from which to enter motherhood.
When our son arrived, we stuck to our commitment on how to divide childcare. Jaron pushed up his sleeves and mastered every baby care task alongside me. I could hand the baby to him and walk away for a needed break without a backward glance, and that security actually gave me more stamina for baby care. These mental breaks, and the short chunks of time to work on my novel and pitch freelance articles, gave me a sense of control over my life and identity.
The same thing happened with sleep. Knowing I could catch up on Zs when needed actually made night duty feel easier. Midnight feedings became sweet and memorable rather than sanity-killing.
As with any life event, not everything went as expected. Jaron needed more help with catch-up sleep than he’d estimated. We struggled more than I anticipated to fit my exercise routine into the early months; my son was born in the fall, and by the time I got back to regular walks, I was plodding down snowy streets looking at Christmas lights. Some planned social events went well, others were sabotaged by surprise bouts of the flu.
Even in the face of surprises and frustrations, my anxiety and depression did not return. Having a plan in the first place, even a flexible and imperfect one, made me feel in control, supported, and free to meet my crucial needs. It helped me think through issues that might have blindsided me otherwise, and fostered my creativity for addressing newborn challenges.
When I look back on everything we did to plan around my mental health, I’m struck by two things: how reasonable my needs were, and yet how radical it felt to address them.
The behaviors that kept PPD at bay for me—a true parenting partnership with my husband, guarding my rest and relaxation, an attitude of caring for other parts of my life—are basic ingredients to avoid postpartum overwhelm. They are lifestyle choices that any woman should have the right to discuss. Yet by and large, the discussions of PPD I observed in modern mom culture don’t encourage women to engage these ideas in a meaningful way. Resources for suffering moms rightly encourage medication and evaluation by a healthcare provider but don’t often acknowledge how our culture’s expectations for moms push women to the breaking point in the first place. They urge women to accept assistance with the new baby but stop far short of giving women permission to push back on unequal division of labor and unfair expectations. They often treat PPD as something a woman won’t address until she’s neck-deep in it, when choices about division of childcare and parental leave are already made and difficult to reverse.
Of course many women suffer PPD due to brain chemistry and hormones alone. Lifestyle changes and planning can’t stop every case of PPD. But for women like me, whose anxiety and depression often respond to life circumstances, feeling empowered to make a plan can mean the difference between a calm postpartum experience or a painful one.
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