Deby Suchaeri for Dove

A Plan To Prevent Postpartum Depression & Prepare For Everything Else

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After having postpartum anxiety once, I knew to be ready the second time. And what I learned can help any mom have a strong start.

I always wanted to have two kids, but after experiencing crippling postpartum anxiety with my first, it took a long time to decide to try for a second. The road to comfortable motherhood had been way rougher than I ever imagined, and my husband and I were both shell-shocked by that. But one day I just woke up and knew I was not done parenting babies. My body and soul told me I wanted another child. My brain? It was scared.

And with good reason. Women (like me!) who have had a perinatal mood or anxiety disorder (PMAD) such as postpartum depression or anxiety are at increased risk of experiencing one again. So, if you’ve had a PMAD before or have a history of mood or anxiety disorders at other times in your life, it makes sense that you might feel very scared to have another child.

The good news is that if you do want to try, you can use that fear to prepare you for what might — but might not — lie ahead.

“When women tell me they are worried about having another baby after a previous PMAD, I say, ‘of course you are worried, this is good!” says Karen Kleiman, founder of the Postpartum Stress Center in Rosemont, Pennsylvania and author of the new book, Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers. “This puts you in the best position to do the groundwork and prepare for a subsequent pregnancy.”

I was on the phone with both my psychotherapist and reproductive psychiatrist from the hospital when I started to feel anxiety right after delivering my second child.

Kleiman works with her clients to come up with a plan to decrease the chance they will develop a PMAD after delivery and to help them manage and recover if they do. That’s exactly what I did before my second daughter was born, and — while it didn’t stop me from developing postpartum anxiety again — it did help me recover and enjoy motherhood much more quickly.

It was so helpful, in fact, that I now recommend any woman planning to bring a baby into her home follow these easy steps to put in place her emotional first aid kit.

Learn the symptoms of PMADs and ask your friends and family to learn them, too. If you do have a history of a mood disorder, it doesn’t mean that you will experience one again, Kleiman says, but if you do “it can look or feel differently,” Kleiman says. So it’s a good idea to review all of the possible symptoms that might mean you need some professional support to feel better.

Partner with your providers including your midwife or OB, pediatrician, and primary care provider so that they are also looking out for your mental wellness after delivery. Ask that they check in with you and talk about how you can be in touch with them if you need support and what action they will take to get you on the road to recovery. I was on the phone with both my psychotherapist and reproductive psychiatrist from the hospital when I started to feel anxiety right after delivering my second child. My psychiatrist was able to talk to the pediatrician on call and my OB to come up with a medication I could safely take while breastfeeding.

Rope recommends creating a postpartum pact to share anything, no matter how worrisome, with a partner. Stocksy.

Pick a safe person you can talk to if you don’t feel right. When I was pregnant with my first daughter — and before I even knew there was such a thing as postpartum anxiety — my husband and I made a pact: I could tell him anything I was feeling as a new mom and he would not judge me, he would just help me.

Find someone you are comfortable with — your partner, your mom, a close friend, a health care provider — and ask them to make the same agreement with you. Ask them to listen to anything you are feeling no matter how “crazy” sounding and that, rather than judge you, they will commit to getting you help. Kleiman has created a detailed Postpartum Pact that includes symptoms and a plan of action you can review and agree to together.

Be familiar with organizations that offer trained, confidential help and bookmark their websites. Here’s a good list to start.

Plan for good sleep (yes, I said that). Sit down with your partner or whomever will be supporting you in the early days home with your new baby and come up with a solid plan to trade off nighttime baby care so that you can get uninterrupted stretches of at least three hours. That will enable you to go through a full sleep cycle and reach the more restorative phases of sleep that are critical to mental health. Here are more tips for creating a solid sleep plan.

Plan to move your body as soon as your physical recovery allows. Exercise is proven to help both prevent and alleviate symptoms of depression. You don’t have to be a runner or regular exerciser to commit to moving your body every day. Start small with a walk to the mailbox, then build to a walk around the block and go from there. Rate your mood on a scale of 1 to 10 before you walk out the door and jot it down. When you return, do the same. You will quickly see the positive impact of getting outside and moving.

When you’re ready, a great way to get consistent exercise and camaraderie is through group fitness classes for moms and babies such as:

You cannot take care of anyone else well if you are not taking care of yourself well.

Mobilize your village. Did you know that not having good social support increases your chance of developing a PMAD like postpartum depression or anxiety? If you’ve got a good support network in place, reach out to your people and ask them to be ready to pitch in (holding the baby while you nap or shower, running a load of laundry, delivering a meal, spending the night so you can get those three-hour sleep chunks, or just stopping by to chat). If you need to build your village, look for new mom’s groups in your area. A few great places to find them:

  • Local children’s stores
  • Your delivery hospital or birth center
  • Meetup.com
  • MOPS.org (for Christian moms)
  • Peps.org
  • Mochamoms.org (for moms of color)
  • La Leche League (for breastfeeding moms)
  • Facebook
  • Fitness classes (especially mommy and me)
  • Your religious/spiritual organization
Strong social support decreases your chance of developing a perinatal mood or anxiety disorder. Stocksy.

Practice real self-care now. I’m not talking about getting a mani-pedi or drinks out with your friends. As you prepare to welcome a new baby into your life think deeply about what kinds of activities ground you, bring you back to yourself, and feel like a reset button, and then look for ways to incorporate them into your daily and weekly life. Make them a non-negotiable part of a healthy life now so that they are much harder to sweep aside when a new baby and her wackerdoodle schedule come on the scene.

Need ideas? Here’s a starter list:

  • Reading in bed while the baby is cared for by somebody else
  • Walking in nature
  • A religious or spiritual practice
  • Using a meditation app
  • Yoga
  • Exercise
  • Adult coloring books
  • Arts and crafts
  • Listening to your favorite music
  • Going out dancing
  • Dancing in your living room
  • Joining a singing group
  • Knitting or crocheting

Recognize that you are the most important person. I know you’ve heard that oxygen mask metaphor too many times to count, but it’s true. You cannot take care of anyone else well if you are not taking care of yourself well. Your emotional wellbeing matters most, and that means you need to prioritize it. Unlike other parts of parenting, it’s the one job you cannot trust to anyone else.

Kate Rope is the author of Strong as a Mother: How to Stay Healthy, Happy, and (Most Importantly) Sane From Pregnancy to Parenthood.

If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.