Ten Realistic Strategies For Managing Postpartum Anxiety (Even During A Global Crisis)

You got this, and you aren’t alone.

It may be difficult to recall your life before the COVID-19 pandemic, but if you struggled with anxiety pre-global-crisis, then your stress response is surely turned up to 11 now. And if you have given birth in the last six months to a year, then your life already may have involved a lot of social isolation. If you’ve been experiencing intrusive thoughts (they can get pretty dark but are not suicidal) and overwhelming nervousness and irritability, you may be struggling with postpartum anxiety (or a Perinatal Mood and Anxiety Disorder, to use the most recent terminology). In case you aren’t aware of the statistics, as many as 6% of women experience anxiety during pregnancy, and around 10% of new mothers develop anxiety in the first year after giving birth. I would bet these numbers are even higher given the stigma around coming clean about the dark side of motherhood. 

Reminding you that you aren’t alone is the main reason I even mention the data here. It’s validating when we find out other women are having a hard time. Women who are anxious tend to get distracted by details, so we aren’t going to start analyzing the statistics. Just know that you can stop googling “Is there something wrong with me?” Our cultural expectations of women and the lack of support for them is a huge part of the problem, not something that’s broken inside you. And even if you’re genetically predisposed to anxiety and depression, that’s not your fault. No one is to blame here. Let’s work on managing and coping with it instead of getting stuck in the weeds to avoid thinking about what we need to work on.  

Moving on . . . 

Postpartum Anxiety and What To Do About It 

There is no secret cure for anxiety. The fear response is the key to our survival, and it isn’t going anywhere, nor should we want it to! Your brain is very good at keeping you safe from danger. And for millions of years, it has evolved to do even higher thinking than simply alerting you to run from that lion or leopard or killer kangaroo. But evolution is slow and lazy, so our lifestyles have outpaced our brains when it comes to managing modern day worries.

Anxiety is what happens when our brain perceives something harmless as a physical threat. The stress response is set off, and once that prehistoric process gets going, it’s difficult for our higher thinking brain parts to keep it in check. In Rewire Your Anxious Brain, Catherine Pittman explains that anxiety can be either top-down (starting in our prefrontal cortex, or PFC) or bottom-up (starting in that ancient “lizard brain” area, the amygdala). If you’re into neuroscience, check it out. It’s sciency enough to quench your geeky thirst for information on the origins of today’s problems but easy enough to understand that you won’t start beating yourself up for not studying more in that undergrad biology class (do I know anxiety or what?!?). 

Now that you’re a mother, you are sleeping much less than usual, learning to breastfeed (or not, I’m certainly not here to advise you on that, and I strongly feel that fed is best. Period.), getting to know this tiny human who is both adorable and terrifying, figuring out how to stop feeling guilty when all you want to do is put this baby down and go pee, wavering manically between begging your partner to not leave your side and ordering them to get out of your face, and overall, wondering why no one told you the truth about motherhood. So, yeah, anxiety is kind of your whole existence. Toss in a global pandemic, and you’re all set. 

The good news is that your brain has everything it needs to learn how to help you manage this shit storm of anxiety. The not-so-good news is that it takes practice and time. That’s right, at this most challenging time of your entire life, when you are already up to your eyeballs in learning new skills, you gotta make a few more changes. You are a mother now, though, so you got this! Let’s get started!

These tips are in no particular order. If I had to sort them, I’d probably put sleep first, but since this is an article for moms (and there’s currently a global pandemic), I’ll aim for realistic and start with the strategies that might be more doable than a good night’s rest.

1. Turn off the damn screen.

You do not need instagram making you feel worse than you already feel. Or that Wonder Weeks app making you obsessed with whether your baby skipped Leap 8 altogether or is still stuck on 7. Or that meditation app telling you to breathe. Oh, wait, that might be one exception. I’ll get back that one in a moment. 

iPhone: friend or foe?

I’m not advising you to toss your iPhone out the window. I’m asking you to limit your screen time (especially at bedtime — or when you get to have a bedtime again) and be mindful about what you do on your screen, how long you’re doing it, and whether or not it’s contributing to your anxiety. If IG Stories really bring a smile to your face, then by all means, enjoy. But if you find yourself mindlessly scrolling and feeling completely numb, then maybe it’s time to take a break from it. 

2. Breathe and be in the present.

You can do this one anytime anywhere, and even though it sounds completely obvious, a lot of us forget that taking a few deep breaths can help immensely with both physical tension and mental stress. And for people who suffer from anxiety, the panic or intrusive thoughts can take over pretty quickly, leaving you feeling like there’s no chance you could take a deep breath. If this happens, quietly tell yourself to stop and count slowly from 1 to 5. It’s likely that by the time you get to 5, you will be a little calmer and able to take some deep breaths. Inhale slowly through your nose to the count of five, and then exhale slowly through your mouth. Repeat three times. Counting from one to five before you begin is a grounding exercise that helps bring you back from being lost in worry to the here and now where your only task is to breathe.

Mindfulness is simply engaging your senses to bring attention to the present (as opposed to the past or future, where most worries reside).

If you can carve out ten minutes a day and you’re ready to try mindfulness meditation, check out the Waking Up app for iPhone or android. It’s a beautifully designed app with education on the theory behind the practice of meditation, as well as lessons (including some for children) that will gently guide you through the process.  

3. Schedule your worry.

This is an old therapeutic technique to give you a sense of control. It’s unrealistic to set a goal to stop worrying. What would be the point in setting yourself up to fail? It’s much more effective to work on managing the worry. This way, you are in control of it, not the other way around. Here’s how it works: Schedule a recurring 5-minute long appointment with your worry. Yes, I’m serious. Put it on your calendar: ’10:00-10:05am - Worry!.’ Extreme worriers could even pencil in two of these appointments per day, one in the morning and one in the evening.

When the time comes for your worry session, set a five minute timer on your phone, and then worry it up! Write down all the things that have been driving you nuts, or think really intensely about them, or both. Take a look at your to-do list and your upcoming calendar events to be sure you haven’t missed anything. But don’t get distracted. This five minutes is all about worry, dread, and the worst case scenarios. When your timer goes off, you’re done (for now). Does this mean you will never, ever find yourself lost in anxious thoughts outside of your worry appointment? Of course not! But when those problems creep into your head, you have a place to put them. Think to yourself, “Not now, worry. I’ll see you at our next session.”

4. Express gratitude.

Research into wellbeing suggests that people who feel grateful report being happier and more satisfied with life. This research is fairly new, however, so I’m not saying, “Just be thankful for what you have and your problems will disappear.” I’m just saying that when we take time to acknowledge what’s going well in our lives and thank the people who make our world a better place, then it can benefit our mood and perspective. It’s another strategy for feeling a little more in control, too, and we know that’s a big deal for those of us struggling with anxiety. When I choose to reflect on the things I’m thankful for and express my gratitude through writing in a journal, talking to a partner, meditating on it, or passing it on by doing something kind of someone else, I’m training my brain to rationally see that life isn’t either one big shitstorm or one big ball of joy. Life is full of both pain and positivity, both sunlight and storms, both good and bad (and a lot of in-between). Now I have evidence that the worst isn’t all I can expect, regardless of what my anxiety is telling me.

5. Get that heart rate going.

A brisk walk with or without baby is good for you.

Humans need to move. When we don’t, our anxious brains start heating up with worry that something isn’t right. A great cure of this aimless, restless, and unfocused state of mind is exercise. It can be as simple as a brisk walk with baby in the stroller or as intense as a spin class. It’s totally up to you. If you’re new to exercise, start slow with a 15-minute walk once a day. You’ll likely discover that you want to keep going. Try out different activities to find something you really dig. There are YouTube videos, the Couch to 5K beginner running plan, workouts you can do with your baby, and video games that get you moving. You could simply crank up the tunes and have a good old dance party in your living room. There is no perfect exercise plan. Do your best to get moving any way that works for you.

6. Relax (your muscles).

Isn’t “just relax!” the #1 worst thing to say to someone with anxiety? You’ll never hear me tell you that. What I will advise, however, is to tense and relax your muscles. It’s called progressive muscle relaxation (PMR). You can even combine it with deep breathing. Here we go: Lie down or sit comfortably. You can close your eyes or leave them open, whatever feels better for you. Breathe in deeply and slowly. Exhale slowly. Now starting with your forehead, relax any tension you feel there. Raise and lower your eyebrows, squeeze your eyes shut and then release them, letting your whole face loosen and relax. It can help to open your mouth slightly and relax your tongue. Work your way down your body, focusing on each muscle group. Roll your neck and shoulders, squeeze and release any tension in your arms and hands, and on down. Many of us hold a lot of tension in our faces, particularly the jaw, and our lower back, so pay extra attention to these areas. This exercise can also be very grounding and mindful.

7. Eat.

While this one may seem obvious, I have often been guilty of pushing through my hunger or grabbing something quick to eat only to notice a half hour later, I’m incredibly sluggish, grouchy, and blah, leading to anxiety about not being productive enough. Personally, I know I need to snack throughout the day so my blood sugar doesn’t plummet, avoid processed carbs, and be sure to include whole grains and some protein. If I’m really pressed for time, I always have a pantry stocked with nuts that I can easily grab by the fistful on my way out the door (or more commonly these days, on my way up the stairs to do a virtual session with a client). I have little ziplock bags of nuts or granola and these delicious mini Clif bars stashed everywhere so there are no excuses for getting hangry in the afternoon! For you, accessible snack options may look very different. Spend a few minutes right now jotting down some yummy whole food items you can have available so at least your tummy will remain satisfied enough to not contribute to your anxiety. And, like everything else on this list, it’s something you are in control of!

8. Go to bed.

While baby is tiny, you won’t be getting much sleep at all, of course, so this one will vary greatly depending on what’s going on. BUT you may be able to manage a four hour stretch of uninterrupted z’s if your partner or other supportive person in your home can take care of baby for awhile. There are many variables at play during the first few months of life with baby, so just do your best here. Never ever discount the value of sleep. It should be a priority, so even during those challenging times when you can’t get as much as you need, keep it up there on your list. This baby will eventually sleep through the night, and you want to be ready with a brain that is fully trained to wind down at a decent hour so it can heal and do its thing to prepare you for the next day. A sleep-deprived brain will not be helpful at all when it comes to managing your anxiety. It will definitely struggle with any sophisticated rational thinking, taking that kind of processing offline in favor of survival instinct. And we know how that turns out. So talk to your partner about how you can work together so that each of you can get a little more rest than you’re getting now. And if you’re beyond that newborn stage and your baby is consistently napping and down for bed by 7pm, GOOD JOB, YOU!!! Think about trying to relax a bit earlier in the evening, starting a nice bedtime routine (taking a hot shower or bath, enjoying a cup of tea, reading a book, whatever floats your boat) that will teach your brain to recognize the signal that it’s time to slow down and prepare for snoozing. Just like when sleep training your baby, you need to optimize your environment for calm and relaxation. A rested mother is a less anxious mother. 

9. Talk to a professional.

You knew this was coming, didn’t you? Motherhood is incredibly difficult and overwhelming and a unique blend of conflicting emotions that seem like they’re changing by the minute. And although more and more women are opening up about postpartum depression and anxiety, there’s still stigma around the topic. People tend to have a hard time knowing how to acknowledge the reality of how challenging and exhausting life is with a new baby. They don’t want to bring up anything to upset you, and they seem to think if they ignore uncomfortable conversations, things will magically be ok. There are therapists who are trained in helping new mothers. They know all about the hormonal shifts that are happening, common experiences and emotional changes, and strategies for helping with the symptoms. It takes time to adjust to this new role, and you don’t have to do it alone. A therapist will listen, offer tips and guidance if that’s what you need, give you permission to feel what you feel, and connect you with local resources, including a specialist who can prescribe medication if necessary. I’m one of these therapists, and I’m happy to help. You can schedule a consultation call here or send me a message here. Visit PSI’s directory for an entire searchable list of therapists trained in perinatal mood and anxiety disorders. And don’t wait until post-pandemic. You can get started with virtual counseling now and then transition to in-office later. 

10. Make some mom friends.

We all need a village. The size of that village can be up to you. You don’t have to be a social butterfly. Who has time for that? But having a few other women to chat with about mom life can be incredibly helpful. Many communities have meetups especially for new moms or support groups. Here in the Raleigh area, there’s a wonderful organization called Triangle Area Parenting Support (TAPS). They have groups for first-time parents and second time arounders, for moms of newborns and moms of toddlers. During the current COVID-19 crisis, they are even offering their groups virtually. Ask your pediatrician or OBGYN for resources local to you. You won’t immediately click with every new mom you meet, so don’t give up. Push yourself to step out of your comfort zone to build a support network of people who get it. Postpartum Support International is currently offering online support groups, too, so check out their web site no matter where you are. 

Comment below and let me know which of these strategies you feel you could put into practice today. If you have any questions about maternal mental health, or if you’d like to talk about working together, send me a message. It’s private and secure, and I’ll get back to you within 24 hours.

Not So Surprising Lessons From Pandemic Life

Breaking news: We’re all doing our best. I’m kind of ok, You’re kind of ok. And maybe we’ll all be even more ok both individually and as a whole after this crisis.

But how are we really doing?

The answer seems to be that we’re coping with the stress of the COVID-19 pandemic. And we have some moments when we’re more ok than others. I just watched Tom Hanks’s opening monologue (taped from his home) on this week’s SNL. He says we’re in this for the duration. “The duration” doesn’t tell us much, though, does it? If you’re like me, you can deal with being stuck at home for awhile, but not knowing when this will be over is what is so hard. Also, what does “when this will be over” even mean? This virus won’t just decide to be over. It isn’t as simple as the president seems to want it to be. Like a toddler, he really likes for things to be right or wrong, black or white, this or that, open or closed. “Invisible enemy” and “reopen our country” were a couple of the last phrases I heard him say (I can only tolerate his narcissistic bullshit in bits and pieces).

I guess we often expect leaders to simplify complex situations in order to make us feel better. But I think humans deserve to know the truth, and I do think we can handle it. That doesn’t mean it will be easy. Change is difficult, AND we can get through it. Is it pretty? No, it’s exhausting. Aren’t you completely drained from all of this staying at home? But does this mean you aren’t coping? NO!

Coping does not equal doing great. Coping means you’re getting through it one day at a time (or minute by minute, if necessary).

Regardless of whether or not the curve has begun to flatten, our way of life is likely going to be different from now on in many ways. Let’s embrace the changes that will make us healthier. Why strive to “get back to normal” when we can evolve to be better than before?

Let’s take a look at some ways this crisis may end up improving our physical health, mental health, and overall societal well-being:

- See ya, handshakes. Let’s get better at using our words. 

How will our greeting customs change in the post COVID-19 future?

To be honest, I’m fine with a little more social distance, but I’m introverted and highly sensitive, so this is simply how I roll. Nothing personal, but I never really loved grasping another person’s hand (except my husband’s or child’s, and even that makes me cringe if I think about it too much). We’ve known hands are disgusting for a long time thanks for Ignaz Semmelweis, so why this greeting is still a thing completely baffles me. Humans are so weirdly stubborn when it comes to social norms, aren’t we? These kinds of cultural shifts take a loooong time, even when we know how stupid we’re being. Yes, you can replace a handshake with the Vulcan salute or peace sign if you need a gesture. Or you can use your voice to say words like, “Hi, good to see you. How ya been?” 

- Distributed work can be more productive and enjoyable than being stuck in an office (as long as parents have childcare, of course, but right now they don’t so it’s pretty difficult). 

When you have fewer distractions, if meetings are conducted effectively, and you have the freedom to do your work during times that are conducive to doing your best work, you may feel more satisfied about the quality of your work. If you love your job and are good at it, you will be happier overall. You will likely enjoy your downtime more than you do when work is nagging you in your head. But remember, we’re talking about lessons to take away from all of this. Right now, you are just doing your best. And your best is different from day to day.

And if you’re a healthcare worker, a grocery store employee, a restaurant server who is now delivering takeout, or other essential savior, thank you. Your work, too, has been distributed from the way you previously experienced it to the current extremely more stressful way.

If you’re a new mom, you were already probably feeling isolated with that tiny human who constantly needs you for something and makes it nearly impossible to sleep, much less leave the house. But now you also have the finances to worry about, the pandemic news coverage, a partner hanging around all the time, and perhaps uncertainty about what the end of your maternity leave means with all of this going on. Motherhood is plenty difficult without a virus sweeping the globe, so you have to be extra patient with yourself and your ‘work from home’ reality. Talk to your child’s pediatrician or your OBGYN about how you’re feeling. Check out Postpartum International’s extensive resources and online support groups for additional help. Or contact me if you’re in North Carolina and you’re seeking professional counseling.

My work has also been impacted. I am now seeing clients from my makeshift office corner of the bonus room that is also now a homeschool classroom in addition to its original purposes: laundry room, play room, exercise facility, and storage room. I’ve scheduled virtual sessions mostly in the afternoons and evenings after my son has completed his school assignments. His dad’s work schedule has been drastically reduced, so he comes home around lunchtime. I’m both grateful for our privileged lifestyle and flexibility and frustrated with the constant interruptions and lack of personal space.

- Hey, we do need each other!

On a recent episode of Sam Harris’s Making Sense podcast, he talks to Laurie Santos about her research on happiness and the difference between being happy with your life and being happy in your life. Among a long list of insightful findings, Dr. Santos has discovered that it’s the seemingly trivial interactions that people are missing. Who knew the conversation you have with your barista or the brief exchange with that stranger while waiting in line would impact us so significantly? But it does indeed make sense when you consider how much of our lives are spent inside our own heads. Those little bits of socializing probably keep us grounded in the present before our anxiety quickly leads us back to worrying about the past or future. Even while social distancing, try to find a moment here or there to ask how someone’s day is going and be interested in their response. Perhaps while you’re out frantically getting groceries, smile at someone from at least six feet away and comment on the weather or being shocked that the store is still out of pickles. They’ll be able to see from your eyes that you’re smiling behind that mask. 

I found an odd sense of relief that Dr. Santos’s findings probably mean it’s ok that I’m super annoyed with my family members right now. After all, it’s the connection with strangers I’m missing, not extra quality time with the people I love most.

- Getting comfortable with being uncomfortable.

Mindfulness is a practice, not something to cross off your to-do list.

Instead of seeing a stay at home order as an attempt to take away our freedom, there are more constructive ways to frame it: a sacrifice for the health of humanity, being a part of something bigger than ourselves, admitting that we don’t know everything, taking a moment to slow down and think about the consequences of our actions, confronting our fear of boredom, and having to push through or wait out discomfort. It’s ok to acknowledge when you’re struggling and exhausted from this adjustment. Maybe you need to express how hard all of this is by talking to a therapist, writing, facetiming a friend, painting or other artistic expression, or having a good cry.

Part of healthy coping is to be mindful (gently paying attention with your senses) of the icky feelings. It’s natural to be sad and angry when unexpected circumstances arise. It’s upsetting and frustrating when it feels like the world is on fire. Notice these emotions, and be aware of the physical sensations you’re feeling in your body. Close your eyes and inhale and exhale slowly for about five breaths. Progressive muscle relaxation and meditation are also helpful. Don’t tell yourself to not worry or that you shouldn’t be feeling what you’re feeling. Honor that you are both feeling shitty and able to manage, but it isn’t a one-and-done kind of deal. Try not to judge the emotional response. It is what it is. And it will change. Nothing is permanent. If you’re interested in learning to meditate, the Waking Up app is chock full of lessons, tips, meditations for children, commentary, and discussions with experts. Just remember, meditation is a practice, not something you check off your list of accomplishments. It’s a coping tool that you can incorporate into your daily routine when life is super stressful and when it isn’t. When you carve out time to consistently practice something that is relaxing and just for you, you set yourself up to successfully meet the challenges the world will throw your way.

Get moving!

- Appreciation for the benefits of physical exercise.

There’s nothing like being stuck at home to make you want to take a walk outside. Whether it’s having more time on our hands or needing to get away from the people who live with us, it seems like folks are moving more. I’m not sure what the actual data has to say on this. It could be that people who typically enjoy the gym or fitness classes are now taking their workouts outside or online, but whatever is really happening, your efforts to self-quarantine can be an opportunity to make physical exercise a part of your routine. We all know moving is important for overall health, and getting your heart rate up is particularly effective for managing anxiety. Engaging in cardiovascular exercise when you are feeling anxious may send a signal to your brain that you’re safe (in ancient brain terms, you’ve obviously moved quickly to get away from the lion that was about to eat you) and it can calm down, completing the flight/flight/freeze circuit. You can get your heart rate up enough with a brisk 30 minute walk around your neighborhood, by running up and down the steps of your apartment building, or by having a dance party in your living room. 

Comment below and let me know how ok you are right now, one way you’re coping with the pandemic stress, and any suggestions for mental health topics you’d like me to write about.

Remember that you don’t have to wait for the crisis is over to get some professional support. Therapists have embraced technology like never before and are offering secure and confidential sessions online.

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COVID-19 Is A Lot Of Things, But It Isn’t A Reason To Put Off Therapy

You can search for your new therapist, schedule the appointment, and complete the session all while sheltering in place.

There have been countless social media posts over the past couple of weeks expressing gratitude for telehealth, including praise for therapists who have been able to provide virtual counseling sessions in lieu of office visits. In my community of fellow therapists, I’m so happy to see most of them embracing technology and quickly shifting their scheduled sessions to one of the secure, HIPAA-compliant online counseling platforms. 

What I haven’t heard much about in this climate of social distancing is making the decision to start therapy right now. Finding a therapist is already an intimidating experience for most people, so adding the crisis of a global pandemic to the mix could be paralyzing to say the least. Perhaps it’s time to dispel a few myths about starting therapy online during the coronavirus outbreak and addres the reasons why you may be considering COVID-19 to be the perfect excuse to hold off on contacting a therapist. (Psst, it isn’t.)

1. The first visit has to be in person.

I’m here to tell you that you don’t have to have an existing relationship with a therapist in order to get some professional support right now. Yes, that’s right. You can find a therapist today who will schedule a free introductory phone call to determine if they can help you and then schedule your first appointment online. Many people think the first visit must be face to face in an office. While meeting initially in person may be ideal for many situations, there are therapists who have 100% online practices and have been operating in this mode for quite some time now. Online therapy isn’t new. I’ve been offering virtual sessions for several years now, mainly for my clients who moved to another city within the state and as a backup method for meeting during inclement weather, when childcare falls through, or travel. Until COVID-19 changed the way we do, um, well, everything, I insisted that a client’s first appointment be in the office, but now that face-to-face simply isn’t an option, I’ve accepted that perhaps a virtual first session can be just as beneficial as an office visit. An online first session is definitely better than no therapy at all! Can I get a virtual elbow bump?

2. Online therapy isn’t as effective as in-person. 

I’ve been guilty myself of expressing skepticism that online therapy “isn’t as effective,” “will only do as a backup,” or, as discussed above, “should never be used for a first session with a brand new client.” But I no longer view online counseling as inferior to traditional office sessions. Let’s be honest, there are downsides to everything. There are body language cues that you can easily miss when you are communicating via video. I can’t assure that a client’s family isn’t listening in on our conversations (a particular worry in our current stay-at-home environment). There are sometimes technological hiccups to deal with, video freezing up, audio dropping out, that kind of stuff. The dynamic is different when you aren’t physically present with the person you’re talking to. So, no, I do not believe that virtual counseling is right for everyone 100% of the time. But that is not a reason to not give it a shot. You and your therapist can determine if it’s appropriate for you right now.  

3. I’m not tech savvy / I don’t have time to learn a bunch of new technology.

It’s natural to be intimidated by anything new. That’s just your trusty lizard brain trying to protect you. If you have an internet connection and a smartphone, you can do this. Therapists are using all kinds of different communication methods to do telehealth. You may have to download an app for your phone or computer at no cost to you. In my practice, I use TherapyPortal, an all-in-one EHR and telehealth platform that’s user-friendly and simple to use. Accept the fear you’re experiencing and be willing to give it a try anyway. If you have any problems, your therapist will help you figure it out. You and your therapist will have already discussed a backup plan in case of any technological mishaps anyway. Worst case is you aren’t able to get the video call to work, and you decide to talk by phone or try again later. Best case is you log right on and have a very helpful therapy session that validates your feelings, leaving you feeling heard and seen with some tools you can use to manage your symptoms. Yeah, I think it’s worth pushing through some trepidation, don’t you?

Quick tips for setting yourself up for a successful online counseling session: 

• Use headphones or earbuds, if possible, to cut down on background noise for both you and your therapist and to ensure a little more privacy. The other people around you won’t be able to hear what your therapist is saying, at least. By the way, in terms of privacy and acoustics, your bedroom closet can often be an ideal location. 

• Spend a few minutes locating a spot where your internet connection is strongest. Depending on where you are, your cell phone may work just fine. I’ve even had people do sessions from their car in the driveway or parking lot using their cell phone’s data connection.

• Most telehealth platforms offer the option to do a test call to try out your audio and video settings. It’s usually an automated interaction, not with a live human.

• Turn off notifications or put your phone or computer on Do Not Disturb.

4. I shouldn’t be spending money on non-essentials right now.

Well, this little piece of internet real estate right here certainly isn’t the place to debate whether mental health should be considered essential (OF COURSE IT IS. IT’S A THERAPIST’S BLOG. AND YES, MENTAL HEALTHCARE IS ESSENTIAL. IT’S YOUR MENTAL HEALTH!!!).

We are all feeling some anxiety about finances right now, and I would never try to scare you into spending money you don’t have or pressure you into trying therapy if you aren’t ready. You know your financial situation better than anyone else. There is a ton of uncertainty about just about everything, and keeping a close eye on your budget makes you feel like you have some control. You know what else makes you feel like you have some control? Intentionally deciding to set aside some funds for something that is helpful. It’s difficult to make your mental healthcare a priority. It isn’t a big gaping physical wound begging for attention. It’s more like that dull headache that starts throbbing when life gets stressful but subsides a little at night when you have some time to yourself. Then the cycle starts over when you wake up to face the next morning. 

Establishing a relationship with a trusted therapist is one of the most beneficial and impactful steps you can take for yourself right now that will not only serve you during this present crisis but will equip you with the tools you need to manage future stressors. 

Yes, therapy is an investment. If you are looking for an in-network provider who is contracted with your insurance carrier, check your specific healthcare plan’s directory. When you contact a therapist listed there, always confirm that they are currently in-network and that tele-mental-health is covered. Paying out-of-pocket may be more expensive, but it gives you and your therapist a lot more freedom to decide how to best work together:

Insurance = The insurance company controls your care, as in number of visits, frequency of sessions, whether your treatment is “medically necessary,” which of your symptoms meet the criteria for a mental health disorder diagnosis (which is, by the way, a requirement in order for an in-network therapist to get paid).

Out-of-Pocket =  You and your therapist control your care, deciding on how often to meet, where to meet (I even offer Walk & Talk therapy, in non-pandemic times, of course, and insurance would never cover such a thing!), whether or not you need a mental health diagnosis (FYI, you don’t need a diagnosis in order to benefit from counseling, but insurance companies aren’t in the business of paying for something that they don’t deem medically necessary), how long your sessions last, what you talk about, etc.

Whether you opt for an in-network provider or go out-of-network, keep in mind that you can probably use your health spending/flex spending account to pay for your therapy visits. Most therapists accept credit cards, including HSA/FSA benefit cards, so just remember that the money you’ve set aside in your HSA/FSA account could be well spent on counseling. If you aren’t sure if you have this kind of benefit, check with your employer’s Human Resources department.

5. Fill in the blank:________________

All the same pre-pandemic worries still apply: What if I don’t know what to say? What if I don’t like the therapist? What if it makes me feel uncomfortable? Where do I even start? Fill in the blank with any excuses you can come up with. Be sure to check my FAQs for more answers to common But-What-If? concerns.

Your brain will present all kinds of worries to talk you out of doing anything new. Thank it for its amazing life-saving skills, and then reassure it that just because something feels threatening doesn’t mean it is threatening. Do some research by checking out a few different therapists in your area. (Typically, your therapist must be licensed in the state where you reside, even if the services are conducted online.) Ask trusted friends if they have any recommendations. Talk to your OB/GYN or primary care doctor about a referral. (Don’t worry. This doesn’t have to be a formal complicated referral process. Most of the time, they just provide a list of trusted local therapists they know.) You can always just Google “therapist near me,” but for a less overwhelming experience, try one of the online directories. Two of my favorites are TherapyDen and the Secular TherapyProject. Both are inclusive and progressive, screening its participants thoroughly to make sure you’re in good hands.

Your pup may not understand why you’d choose to talk to a human on a screen over taking him for a walk, but he wants what’s best for you.

Review therapists’ websites to see what kinds of issues they specialize in, their communication style, photos, etc. You don’t have to go overboard with your search, but the more information you have, the more confident you will feel reaching out. Schedule a couple of consultation calls so you can get a feel for what it’s like to speak to a counselor. These brief interactions (usually between 15 and 30 minutes) can be very helpful for determining if someone is a good fit for you. You can discuss what you’re looking for help with (for example, feeling overwhelmed, extreme sadness, having a hard time turning off your brain, difficulty sleeping, overly worried, etc.), fees, how payment is processed, and you can ask any other questions you may have about what to expect. 

Take a deep breath and remember that if you decide the therapist you selected is not the right match, it’s ok. There are other wonderful professionals out there you can try. On the other hand, you might discover that you instantly connect and feel immediate relief upon being seen, heard, and supported. Or you might be feeling somewhere in the middle. This is perfectly normal and just means you’re getting to know your therapist and adjusting to a new experience. Give it a few sessions, and you just might find that you’re grateful you took this opportunity to find the kind of comforting validation and trust that only comes from this kind of professional support. And the best part is you got all this accomplished without leaving your house while wearing your fuzzy slippers! Yay for social distancing! Way to get what you need AND flatten that curve!

Hey, I’d love to know what you think about this article. Leave a comment to share publicly,, or send me a message using my secure contact form. Either way, I can’t wait to hear from you! Of course, if you’re in North Carolina or South Carolina and looking for a therapist who specializes in mental health in pregnancy and postpartum, schedule a free consultation call today.

Kayce's Maternal Mental Health Blog RSS

How To Survive Baby's First Christmas

Photo by Tim Gouw on Unsplash

News flash: The holidays are stressful. Why do you think I’m just now publishing this article on surviving them? We feel like we’re getting a head start when we start ordering from everyone's Amazon wish list in October and collecting recipes for homemade goodies we can give as presents, and then we wake up and it’s December 15th, and our to-do list is still a mile long. How does anyone get through it? And what if you’re a new mom with a tiny human to keep alive? Well, the short answer is just breathe and take care of yourself, but I’m sure you expect more from a therapist who specializes in perinatal mental health, so here we go:

1. Say no.

I bet you saw this coming and were thinking, “Please don’t tell me I have to disappoint my entire extended family by saying the baby will not be at Grandma’s for Christmas dinner!” Yep, I kinda am. But only if that seems like it would be helpful. We can not make everyone happy and get the baby on a good sleep schedule and buy all the presents and get enough rest ourselves and breastfeed and pump and breastfeed and pump or mix formula and wash bottles . . . Think about what feels most difficult in your day to day routine (or whatever you’re doing to keep it together at this point) and what helps you get through those moments. Does the following example of a typical outing sound like how you want to spend your time?

Dressing baby in the adorable but impractical Christmas ensemble that will most certainly end up covered in pee, poop, spit up, or all three; restocking the diaper bag with enough diapers, wipes, bottles, and ice packs; packing up all the presents; getting yourself dressed; driving to the family gathering; passing baby around (and worrying about who didn’t get their flu shot); and pretending that you’re having a great time and definitely would not rather be home sleeping while your husband takes over for awhile.

If you answered with a “yes, please,” then by all means, go be festive. If you feel overwhelmed and anxious (and relieved to know I’m giving you permission to say, “no, thanks”), then you can say, “I don’t really feel up to going to Grandma’s this year. We’ll miss seeing everyone, but we’re looking forward to spending Christmas at home.”

2. Ask people to come to you.

If you actually do love spending time with your relatives, friends, and other loved ones, and you really want to make it happen but also manage the stress level, then you can ask people to stop by your house for a holiday visit. This option gives you a little more control (baby can sleep where they are comfortable, you can place hand sanitizer throughout as you see fit, you can feed baby where you like, you decide what food to serve, etc.). You could even call it a “drop-in” to send the message that you don’t expect people to stay very long.

3. Accept that this holiday season will not look like holidays of pre-baby life.

Your life has changed forever, so depending on where you are in your child's life, developmental stages can dictate much of what your days and nights look like. If your baby is still eating every two to four hours, you and your partner may still be feeling sleep-deprived. If you’re six months in and baby is sleeping for five to six hour stretches, you may be up to celebrating a little. Whatever your unique situation, know that your holiday experience will not look like it did last year, and next year (and the year after that . . .) will be different still. Lean into the uncertainty and focus on the both/and. This season is what it is and will be both joyful and exhausting, both exciting and draining, both fun and overwhelming.

4. Know that traditions evolve over time.

11 months into motherhood and still sleep-deprived, I have only a very fuzzy memory of this photo shoot.

You don’t have to have it all figured out this Christmas. Decide with your partner what is important to you now (baby’s sleep and feeding schedule, getting rest yourself, visiting family, etc) and discuss how to manage the holidays together. Try not to worry about getting the perfect family photo for the Christmas card. So what if the cards arrive after Christmas, just in time for Valentine’s, or not at all? You have life’s biggest adjustment on your hands, so think about what you envision for next year, but don’t allow your future wishes to turn into present-day anxiety.

5. Just do your best.

Your best probably looks vastly different each day, depending on a number of factors, most of which are beyond your control. Take care of you, knowing that if you get a little more sleep tonight, you can feel a little less anxious. You can take a walk, get some fresh air, hand off baby to someone in your support network (or take baby with you), and do some little things that help you feel more confident in your new role. Decide with your partner what your little family needs from each other, be patient with each other, show love to each other, and move forward into the unknown of 2019 together as a team.

If you are a new mom in North Carolina or South Carolina and would like some professional support or are wondering if you may be suffering from postpartum depression or anxiety, schedule your free consultation call here, and let’s chat to see if we’re a good fit.

Let's Talk About Maternal Mental Health

When you are training to be a mental health professional, you learn about the dangers of self-disclosing, or sharing information about your personal life with clients. After many years of being a therapist, I have realized that, as with most things that matter, discernment is the key. Your focus remains on helping the client and doing no harm, and there are instances when sharing a personal story can do just that, particularly for experiences that leave people feeling alone. Mental health issues related to childbearing definitely fit into this category.

After participating in a two-day workshop presented by Postpartum Support International, I feel more strongly than ever that we need to be talking openly about perinatal mental health and educating everyone. As many as 1 in 7 women are affected by postpartum depression and anxiety. I’m sharing my own experience with you on World Maternal Mental Health Day, in hopes that doing so will help move us towards the goal of eliminating the stigma of asking for help.

Pregnancy

From the instant I learned I was pregnant back in 2011, I felt the pressure to make the “right” decision about, well, everything. Even though in my professional life, I regularly help people change their right/wrong, black/white, all/nothing thinking in order to be more rational, I sometimes fail to apply this valuable skill to my own circumstances. A few of the first challenges I encountered during pregnancy included reading the most popular books, registering for the safest baby items, selecting the best pediatrician, and deciding on the healthiest birthing method.

What better way to kick off a pregnancy than sitting down with the father of your child for a viewing of Ricki Lake's anxiety-inducing documentary, The Business of Being Born? We then managed to catch our breath and proceeded to begin interviewing doulas while getting to work on our birth plan. As my expectations piled up, I pretended to remain open-minded about the very real possibility that things may not go exactly according to our wishes. After attending childbirth and breastfeeding classes, I managed to confidently hold onto my intention of delivering a healthy baby and breastfeeding him for at least one year, per AAP recommendations.

Throughout my pregnancy, I exercised (both cardio and prenatal yoga), maintained a healthy weight, had all the precautionary tests (as you do when you are of “Advanced Maternal Age,” a label that was stamped on every single page of my medical record), avoided alcohol, and at the prescribed time, began logging my baby’s kicks. As I approached my due date, I downloaded the most highly reviewed apps to track feeding, diapers, and sleeping. I was all set. Or was I? 

Photo by Heather Mount on Unsplash

Childbirth

Let’s not dive too deeply into this part. It was a long, strange, painful, and horrifying trip. While it is certainly a significant piece of this whole journey, and the trauma (in a non-near-death-but-still-never-wish-to-experience-again kind of way) most definitely impacted the emotional kickoff to motherhood, I’d like to focus on the postpartum aspect of the saga.

Postpartum

I am pretty sure my experience with postpartum depression and anxiety began the moment the nurse wheeled me out to the car 1.5 days after I had my son. I felt sheer panic rush over me as I tearfully told her, “I’m scared to leave you.” I could not imagine why a tiny person would be allowed to be strapped into a vehicle and whisked away by two people who had never done this before. Even with the help of my mother and husband, the next few days at home only confirmed my fear. I was not producing enough breast milk to nurture my baby boy. He was losing weight at a rate that would rapidly lead to what the medical community horrifyingly refers to as “failure to thrive.”

NOT THE BABY BLUES

For the first two weeks of my son’s life, we visited the pediatrician’s office daily to check his weight, took him to have a liver ultrasound (a procedure for which he had to be fasting! Right, explain that to a newborn), and began learning the art of supplementing my meager breastmilk supply with (gasp!) formula. Do you know what we were not doing? SLEEPING!!!! The lack of sleep was, seriously, more evil than vaginal childbirth itself. Well, ok, just as evil, but its impact over time is deadly and makes everything feel exponentially more awful than it actually is. In fact, the CIA regularly employs the use of sleep deprivation as an enhanced interrogation tactic (i.e. TORTURE), but all new parents know it as simply part of the blessed process of loving and caring for their brand new tiny person who cries, pees, poops, demands to be fed, and spits up constantly.

Photo by Luma Pimentel on Unsplash

Intrusive Thoughts

Of all the experiences of early motherhood, one memory stands out as the most disturbing and terrifying: It was probably the second or third day since we’d brought our son home. I was standing by the car in the crowded parking garage of the hospital, where we’d just had to subject our baby to some kind of diagnostic torture (probably a heel prick to measure bilirubin, high levels of which mean the liver isn’t functioning properly) watching my supportive, also sleep-deprived, incredible husband secure our newborn boy into the car seat. In a complete fog of overwhelming exhaustion, guilt, fear, and frustration, I began to wonder what would happen if a car came speeding around the corner. What if the driver didn’t see me? My husband and infant were safely in the car by now, but I was still standing there. I could simply step out in front of an approaching vehicle and get some relief from this barrage of perceived endless misery. 

Those thoughts are not the same as intent and are actually a very common symptom of postpartum depression. It was not about leaving my husband and new baby behind. It was about feeling ill-equipped to cope with this intense helplessness and fear. Giving birth is part of the natural circle of life, but nothing about it came naturally to me. I felt like I didn’t do the labor part right because it took so long, I was not able to feed my baby because my breasts weren’t up to the task, and I couldn’t figure out why I wasn’t dealing more gracefully with the lack of sleep. Was I weak? How do women do this???? And why would anyone do it more than once?!? 

I can look back on those first few weeks after giving birth and recall funny moments, too. My husband somehow can always manage to make me laugh no matter the circumstances, but I recognized that my laughter was not quite as full as it usually was, and my sense of humor felt like a forced and stunted version of itself. I recall laughing and crying as I nervously attempted to ‘wear’ my baby using a Moby wrap, a stretchy piece of fabric, oh, about 20 feet long (not really but seems that way and feels longer and longer the more you wrap it around yourself), the purpose of which is to securely hold your baby close to you while freeing you up to take care of all the other domestic chores that still need tending to. My experience looked nothing like those smiling new moms pictured on the web site gallivanting around with their bundles of joy, living their fabulous hands-free lives! After about a dozen tries and countless youtube tutorials, I felt the Moby pulling me further and further down the path to complete failure. Right then and there, I resolved to not leave the house until my child was ready for kindergarten. 

Two months into my life as a mother, I returned to work and was functioning at a decent-ish level, thanks to getting more sleep. I remember the panic we felt when our infant son finally met the developmental milestone of sleeping four hours in a row. We seriously considered calling the pediatrician because nothing this wonderful could be normal. The elation was, however, short-lived, and I soon slipped back into despair. Everything was still mostly covered in a fog of overwhelming sadness, even though I was pretty good at pretending I was “just tired.” I recall no matter what I was doing, I didn’t want to be there. I didn’t want to be at work, but it wasn’t because I missed being at home. I didn’t want to be getting a manicure, but not because I felt guilty. And I didn’t want to be at home, even though it used to be my safe place. That’s what was most unsettling. I didn’t want to die, but I also didn’t want to be anywhere. I know my husband felt helpless. He did all the right things: cared for the baby while I rested, came home from working all day and took over so I could shower, purchased a Massage Envy membership for me, and declared Saturdays as my day to do whatever I wanted. Nothing was enough.

Asking For Help

At my husband’s urging, I called my therapist, whom I had not seen in years. It was the best decision I could have made. (Yes, therapists need their own therapist. Doctors go to the doctor, don’t they?) I told her about that day in the parking garage, and she did not judge me, nor did she conclude that I was suicidal. I was adjusting to a new role, a new identity, and new responsibilities. I needed to learn how to somehow include a little bit of Me Time in this new roller coaster of a life. Self-care would no longer look like spending a rainy day curled up on the sofa with a good book. But it could look like having my husband care for our son while I read a few chapters or took a nap. I started spending Saturdays working for a few hours and taking some time for myself. I found that I resisted leaving the house due to anxiety, but if I pushed myself to do it anyway, I never regretted the decision. 

My primary care doctor and OBGYN collaborated to find an effective antidepressant dose, and I had to work on finding ways to cope. If I could go back and do one thing differently, I’d spend more time looking for a support group. The only one I came across didn’t work out for me because I showed up on what was, unbeknownst to me, Bring Your Partner Night. The courage I had summoned to attend this group instantly vanished as I walked in and saw several male faces staring back at me. I simply turned around, walked right back out to my car, where I cried for a half-hour before driving back home. 

Support groups (online or in-person) are wonderful and extremely helpful, and I highly recommend them, especially in conjunction with individual therapy. Just remember to ask questions and do some research before you choose one. I wish I’d been in a healthier emotional place at that time because I am certain I could have found another group, or I could have returned to that particular group the next week. I could have even stayed that night and benefitted from the discussion. But that’s incredibly difficult when you are at your most vulnerable and physically and emotionally drained.  If I’d only known about postpartum.net, I could have connected right away with someone who would have walked me through the process of finding the right group for me. 

Now

That little baby did indeed thrive, and so did I. Of course, there have been, and still are, moments when I question my capabilities and wonder how I’ve survived this madness. Motherhood rarely involves clear cut perceptions of our world or hard and fast rules of the road. It’s mostly both/and. I love BOTH kissing my son’s sweet little face AND putting him to bed at night. I look forward to BOTH Sundays hanging out at home with my family AND when they go back to school and work on Monday (I have Mondays off — self-care at its best!). 

Life as a parent gets better as you adjust and your child grows. Babies start sleeping more than two hours in a row, they don’t need bottles or breastmilk forever, they grow into children who can go to the bathroom by themselves, and a little at a time, mothers figure out how to nurture both themselves and their offspring. 

Whether you have been diagnosed with PPD, suspect that you are depressed, or simply would like someone to talk to about how freaking hard it is to be a mother, visit postpartum.net to find local resources. If you are in Wake Forest, NC, and are ready to talk with someone who gets it, please contact me via my secure contact form, or schedule a consultation call. If you aren’t quite ready to leave the house, that’s ok, too. All you need is an internet connection to get started with a virtual session. 

Until we meet again, remember PSI’s message:

You are not alone. You are not to blame. With help, you will be well.

Photo by Johannes Plenio on Unsplash

Resources

Postpartum Support International

The Postpartum Stress Center

Triangle Area Parenting Support

National Coalition for Maternal Mental Health

The Blue Dot Project

UNC's Center for Women's Mood Disorders

To participate in important genetic research, visit this web site. 

http://www.pactforthecure.com