PPD/PND - The Men’s Section

Special guest post by my husband Jean-Philippe Vine. He's a cartoonist and director of animation, hence the illustrations in today's article.

Dear Husband, Partner, Boyfriend.

My wife asked me to write some advice for you, as someone who’s been a partner of a woman who suffered from severe postnatal depression.

As if I know what I’m talking about. I may not be a certified professional expert source, but I have lived it.

Frankly, I’d like to just look you in the eye and say I know how bad it is. And I’m sorry. But, it really will get better. Your woman will return to you.

When I think back on that period of our life 6 years ago*, my mind settles on one image: a snapshot of emotions taken over a bleak Christmas holiday. One night, out of frustration with this passive, dark creature that my wife had become, I vented my feelings. I knew I needed to be the support, the calm centre, a touchstone for her to hold on to- but I was tired. And I had had enough. Later I found her upstairs, cutting small slashes into her forearm with my craft knife.

I won’t forget that. You don’t really prepare for moments like that in a relationship, do you? You start in a rush of excitement and coiled potential, which plays out hopefully in a full and rich partnership. But- and here is where I will sound selfish- You will feel betrayed and abandoned by a partner with depression. You will be amazed that you, a pretty decent guy, are not able to fix this.

1. You cannot fix her.

Hmm…. where is the reset button?

Face it. As a man, in an argument, your overriding need for process and parameters and a clear bottom line means that you think you can and must fix things now. I’m talking to the average guy; guys like me. If you’re a superstar listener and a rock solid support you’ll be fine. But for the rest of you: You can’t fix her. She is fighting with thoughts that make no sense, overwhelming dread, numbness. This cannot be fixed by what you say. It will be healed over time. Resist the temptation to take control and straighten her thoughts out for her.

2.Carry her burden.

I felt that Sarah really withdrew from me when she sensed my own withdrawal, my frustration with the months of waiting for her to be well- for her spark of vitality to return. She felt judged, another layer of failure to add to the tomb of thought she was struggling to climb out of. Depression is exhausting. Fighting it is a battle that needs reinforcements and nourishment. What can you do to stand beside her, carry her burden, like the strong ox that you are? You can take the kids off her hands. You can cook dinner. You can sit and read next to her. You can find the youtube video of that comedian that she likes. You can take her out, and not talk about ‘it’. You can let her lie in. You show her that you stand next to her, with her, carry the burden that she is carrying.

3. Don’t judge her.

This is vital. She will do, say things that will make you feel like trash and the relationship feel like a sinking ship. The house will be empty of her life giving charisma. You, feeling tired and hassled, frustrated, will start to compare her to other, maybe fictional, women and she will not match up well. No. That route is the wrong one. Don’t judge her. Forgo judgment completely. It’s a tough route to walk, but you can do it and she needs you to. It is not a case of seeing her at her worst. It’s more a case that she is not herself at all. But she will be back.

4. Surprise her.

Date night brownie points? Kerching!

The pattern of the days for someone with PND can be overwhelmingly repetitive and void of joy. You might be tempted to hunker down and wait, allowing that pattern to stay the same until its finished and the storm clouds have moved on. Actually, this is the perfect time to surprise her and keep her on her toes. You are reminding her that the day can be something that brings life and new things, however small. A note in the cutlery drawer, maybe. Or bigger surprises: That Christmas I mentioned earlier was followed by a three day trip to a bed and breakfast on a welsh beach. Sarah and I had for those three days a beautiful respite from the illness, discovering a new place together. That memory is much more powerful than the bad ones.

5. This time, read the manual.

I don’t read the manual, do you? I prefer my expensive purchases assembled by instinct and impatience rather than thoughtful absorption of the instructions. If you are this type, then I suggest that you do read the manual on PND. Find out how it makes other mothers feel, and you’ll realize that this isn’t the great unknown after all. Talk to your family doctor. Speak to the health care professionals who are working with her. Look at online resources, especially those written from a dad’s perspective.

6. Take care of yourself.

When she returns, she’ll be wanting to find that you are the same guy you were. You must recognise that this thing that has touched your family is really, really tough. And you can’t carry the load of it all on your shoulders. You are part of the healing, as are the right doctor, the right meds, and healthy food, and walks in the park. You need to be well- that means sharing your burden with a good friend, keeping physically active, it means finding some time each week for yourself. If that means dropping the baby off at grandmas, and going fishing (whatever that is), then it must be done as part the plan for recovery. Do it to come back ready to share her burden again. Recognise the cracks of stress in your life, and back away from high pressure work, deadlines, business, drinking hard, or all-consuming hobbies that take you away from home. This is necessary, to realise that this period is a time for saving your strength. This storm will soon pass, and you’ll both emerge stronger.

I failed at most of these things. I learned slow, and with difficulty, but we are through. Sarah is entirely, utterly different now. She returned, as your partner will. Together, you’ll have some scars that a lot of relationships don’t experience. And you can be proud of them. You’re stronger than you were before.

*This article was originally written in November 2011 and published on my then wordpress doula blog.

Jean-Philippe Vine is an illustrator, animator and film director, and is currently employed by Locksmith Animation in London, UK. More importantly, he’s husband to Sarah Vine, and parent of three wonderful (occasionally baffling) teenagers.

Dads vs Doulas

What is the point of a doula, when dad is already a supportive partner and wants to be fully part of the birth process? Won’t a doula usurp his position, or even interrupt their private experience?

photos by Jackie Knapp

I am fully happiest when I’ve succeeded in teaching the dad or primary birth partner my full bag of doula tools, and taught them exactly how to do a hip squeeze at the same time as moving with the birthing mother’s birth dance, moaning along with her. Then I can move worlessly in with a straw to drink and stay hydrated, and go back to taking notes for her birth story.

Or, when I’ve pointed out where the pressure points in her pelvis are to relieve back pain, how to use acupressure on her hands and feet to increase the strength of surges or relieve pain, and then I can stand back and take some keepsake pictures, moving furniture and props to where she can comfortably move between positions.

Lower back pelvic pressure points during labour

I can quietly point out what I sense she needs next, and make sure that they’ve both eaten and are keeping their strength up, and dim the lights. If dad needs to step out to make a call or grab some food, or sleep, he can do so while knowing the labouring mother is fully cared for. And while staff continuously changes shift a few times a day during a hospital birth, I stay consistent, able to explain medical options in an understandable terms if needed and help a couple feel like they have thoroughly thought their options through and made the choice with which they’re feeling happy.

Importantly, if things change quickly in an emergency situation, dads are often left on their own without understanding fully what’s happening in the operating theatre or what they can expect next, or what they should do. This can be very scary, and is the source of trauma for a lot of dads, and I really hate that. In these situations, I can explain and support, and remind them of the ways they can help, or what their partner had chosen ahead of time in the birth plan just in case. No one in a hospital has the job of caring for primary birth partners during stress - but I do.

It should be clear, I’m not here to replace dads, but to enable them to be the best birth partner and as fully present at the birth as they possibly can be.

New Mum Breakfast Cookies

Okay, so every now and again (or, often) a mother doesn't have time to warm up a bowl of soup. Or to sit down and make a proper breakfast for herself.

These breakfast cookies are packed with goodness, it's like a healthy version of granola in your hand. I've added oats and flax for boosting milk production. Additional nutrition benefits are at the bottom of the page. Yes there are a heck of a lot of in these cookies! I am so used to making them, that I keep the majority of these items in my cupboard at all times. (You don't have to be pregnant or postpartum to enjoy them. Ahem.) 

This recipe is very forgiving. You can easily add more or less of one flour or cereal if you don’t thave an ingredient, more butter and sugar if you don’t have the applesauce, and whichever nuts/seeds/dried fruit you have. The up side of these cookies is that they don't taste like cardboard - they are YUM. Especially if you add a handful of chocolate chips....

Mix together:

180g (2 c.) oats

190g (1 1/4 c.) whole wheat flour

120g (1 c.) white flour

240 ml* (1 c.) cereal - whatever you have on hand, from crushed Shreddies to puffed rice to muesli

42g (1/2 c.) wheat bran 

48g (1/2 c.) oat bran (both very inexpensive at Holland&Barrett)

2 tsp. baking soda

60g (1/2 c.) seeds: ground flax, (tesco does an inexpensive one!) sunflower, pumpkin, sesame, hemp - whatever you have on hand

With a hand mixer, in a separate bowl, blend:

113g (1 c.) softened butter

113g (1 c.) applesauce or mashed banannas

2 eggs

180g (1/2 c.) brown sugar

50g (1/4c.) sugar

1 TBS vanilla

Add:

160g (1 c.) raisins, sultanas, diced dried apricots, chopped dates, dried cranberries, or dried cherries. Again, the choice is yours. I usually add a variety of whatever is in my cupboard. 

85g (1 c.) nuts: chopped walnuts, sliced almonds, any kind at all

100g (2/3 c.) chocolate chips (if you want/need them!)

Preheat oven to 350f/180c. Line baking sheet with baking paper. Combine dry ingredients. Beat butter, eggs, sugars and vanilla. Add dry ingredients, mix until blended. Mix in almonds, raisins or cranberries and dates. Shape into balls and lightly flatten onto baking sheets. (They do not spread.) Bake 13/15 minutes, until lightly golden. Makes about 4 dozen cookies.

They freeze exceptionally well and even taste great straight from the freezer.

Here are are a few of the nutritional benefits in each cookie:

oats - iron, also known to promote lactation

wheat germ - vitamin E, zinc, B vitamins, folate

high fiber bran cereal - good digestion regulation

seeds and nuts - good sources of essential DHA fats important for infant (and mother) brain development, and protein.

walnuts - omega 3, calcium, iron, vitamin B6

almonds - increase milk production

dates, raisins and cranberries - iron, carbohydrates, potassium, help regulate the gut.

dark chocolate - makes you happy! And that is always a good thing.

This is an excellent recipe to bake while you’re impatiently waiting for birth and need to distract yourself, or as a gift for a new mother! Just be sure to hide them from dads as they seem to gobble these up.

*This measurement is by volume since different cereals have different weights

How Dilated Am I? Assessing Dilation During Labour WITHOUT An Internal Exam - Updated Repost

This article was originally posted in 2010 on my Wordpress blog at the time, and it blew up. It was the first online article at the time about external assessment of dilation, and since then there have been plenty of more articles about these external signs. I’m re-posting the original article here with updated links and a few edits.

It’s the magic question weighing on most laboring mothers’ minds: (as well as the minds of her partner or birth attendants!) How much longer? Is there any way to tell how far along I am in the birthing process? I’ve seen mothers beg for an internal exam and then be gutted about the answer (What? ONLY 4cm STILL!?) and suddenly *poof* she looses her resolve. It’s akin to having a test and finding out you’ve failed it, in front of your loved ones as well as complete strangers. Everyone knows this feeling is not conducive to labor – suddenly doubt and fear slide in and the laboring mother feels tense. Her oxytocin levels (our body’s natural pain-killer and labor inducer) take a nose dive and immediately she feels much more pain and she starts to run away from the contractions.

Happily, there are a number of external cues that can help you and birth partners get clued in to how much labor is advancing. Some are more subtle than others, but if you are ignoring the clock and keeping focused on staying in tune with your body, you will see them. Listen, embrace, wait.  Enjoy the way it responds! It is amazing what it can do, this body you have been given.

1. Sound. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people – but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people’s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ‘another’ level of awareness – it’s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen – there are deep guttural sounds along with everything you have heard before, just slipping in there. You are about to start pushing.

SMELL

…a cross between mown hay and semen and dampness…

2. Smell. There is a smell to birth, that hits towards the end of dilation, during intense labor, just before birth. It is a cross between mown hay and semen and dampness. It has a fresh, yet enclosed quality, and is subtle yet pervasive. Dr Sarah Wickham (midwife and researcher) has also observed this scent and writes about it here.

3. Irrationality. I love this clue – it often is a sign of transition. It always makes me smile, and I always warn women about this phenomenon so that when we hit it during labor I can remind them that what they’ve just said is irrational, and that I told her this would happen, and here it is! Relax, it means we’re nearing the end. Sometimes a mother will say she wants to go home, she is done now she’ll come back and do this later, she wants to put on her trousers and coat and go out the door. A mother who wants a natural birth and has been coping brilliantly will suddenly say she was crazy and needs pain killers right now, or that she didn’t want another baby anyways, who said they wanted a baby? Some will just curl up and say they’re going to sleep now. If she does this, that’s okay. The contractions may die down, get farther apart, and maybe she (and the baby) will get a few minutes of sleep. This slowed down transition sometimes freaks out doctors or hospital midwives and pitocin is offered – try to see if you can put them off for half an hour. Send every one out, lie on your left side propped up by pillows and have a little nap before pushing; it is such a wonderful gift.

4. Feel. Here come some of the more fun tools that you might not have heard of before! Think about the shape of the uterus. Before labor, the muscle of the uterus is thick evenly around all sides, above, below, behind. As the cervix starts thinning and dilating, all that muscle has to go somewhere – it bunches up at that top. The top of the uterus thickens dramatically the more the cervix opens. During a contraction, at the beginning of labor, check how many fingers you can fit between the fundus (top of your bump) and the bra line – you will be able to fit 5 fingers. As the top of the fundus rises higher during labor, you will fit fewer and fewer fingers. When you can fit 3 fingers, I usually tell mothers they can think about going into hospital as they will find they are around 5cm dilated. At 1 finger, you are fully dilated.

5. Look. There is something called the ‘bottom line’, which is shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and it’s length correlates with cervical dilation. Why not look down there before inviting a stranger to put their fingers up inside you? It makes sense to me. Here is research verifying the existence of the bottom line: in their trial it was measurable and had acceptable accuracy for 76% of women checked.

6. Gooey Stuff. Also known as bloody show; there is usually one at around 2-3 cm dilation, and it can happen during the beginning of labor or a few days before hand. Sometimes it’s hard to know what is or isn’t a show, since during the days before labor the amount of vaginal mucus increases in preparation and this can be confusing. A show is up to a couple of tablespoons in quantity, so quite a lot. It can be clear, but is usually streaked with pink, brown, or bright blood. If there is more than a couple of tablespoons of blood flowing continuously then this is a medical emergency, but if there is just a bit and then it stops, then it is just show. There is a SECOND show at around 8cm dilation. This second show means that birth is near.

7. Opening of the Back. This is just at the spot where your birth partner has been doing lower back massage, at the area above the tailbone. It is a little smaller than palm sized, rather kite-shaped area that bulges out during pushing. You might see what is called dilation of the anus as well, which is where the back passage changes in appearance. At this point you’ve waited too long to go into hospital, and you may need to refer to my last post, 4 rules of what to do when delivering a baby!

8. Check yourself. Okay, so technically this one is an internal check, but it done by YOU. You don’t have to announce the results or write them down: it is not an exam. To me it’s obvious that as the owner of your body, you have more of a right than anyone else to feel comfortable with it and understand how it works. It is best to get to know what your own cervix feels like from early on in your pregnancy, if not before, and then to keep a regular check on what feels normal. If you do this through out your pregnancy you are more likely to keep your flexibility into the 9th month. This is also an excellent time to remind you to consider perineal massage since you’re already down there! Check out the website My Beautiful Cervix to see photos and descriptions of what a cervix should feel like. At 1 cm you can fit the tip of one finger inside. Use a ruler to practice discerning how many centimeters dilation feels like, measuring with your pointer and middle finger. This visual aid is also a cute way to imagine dilation. NOTE: Always, always, always wash your hands thoroughly beforehand, up to the elbows, for 4 minutes at least. Do not assess your own dilation after your waters have gone.

For more labor tips and information about external assessment of dilation, I recommend finding a copy of Anada Lowe’s book, The Doula Guide to Birth, Secrets Every Pregnant Woman Should Know.  This is one book packed with practical and useful information!

Fear Increases Pain

Society tells us how everything can go wrong, and all about the trauma of childbirth. Every pregnant woman knows the look on someone’s face when they’re about to launch into yet another horror story. However, I’ve found that quite a lot of the trauma stems from the physiological response of the body tightening up to fight and protect itself from perceived threat, be it a scary hospital environment, a dismissive doctor, a technique or event occurring at the birth that isn’t explained, and even a feeling that birth is happening to the mother, or feels out of control.

Something as minor as bright lights making a mother feel exposed, or the discomfort of not knowing what is normal behavior or not, can make a mother’s body tighten and fight the process.

The uterus is a large muscle that is working very hard, and the added pressure of a mother’s tense body can physically add to that pain.

Not only that, but the hormones that facilitate birth are produced in the brain. Oxytocin is a powerful hormone the synthetic form of which is used to induce contractions in labor (pitocin). Natural oxytocin is produced when we feel loved, safe, in the quiet and the dark. It’s the love hormone, and one that helps us go to sleep every night. When we’re afraid, we produce adrenaline which is the antithesis of oxytocin - they don’t coexist comfortably. It’s widely known that animals in the wild have been known to stop birthing, in order to run away and continue to birth when they feel safe! Ina May Gaskin, the only midwife with an obstetric medical maneuver named after her (the rest are all named after men!) writes “I was fascinated to learn that most doctors once knew that an unwelcome or upsetting presence could stall labor…. but that pool of home-birth knowledge has dried up, becoming rare or even extinct.” *

If our birth environment is fighting against our body’s natural birthing process, of course we’ll feel more pain!

Eliminating fear lessens pain.

• Consider Hypnobirthing. I always feel the term Hypnobirthing is a misnomer: the techniques taught aren’t about being hypnotised, what it actually is, is a method to teach yourself to relax on command. Hypnobirthing is used to practice relaxation according to audio or tactile cues, so that you can tap into that relaxation and quickly and easily soften your muscles. Softening those muscles physically allows your uterus to do its work without squeezing it or fighting the process.

• Use Comfort Techniques. One of the first things I did as a doula was to compile a list of physical comfort tools, from massage and acupressure, to position changes, thoughts to visualise and focus on, and numerous other techniques to reduce pain and distract a mother’s mind from focusing on pain. When one technique is no longer working, there are many more to choose from next, thus breaking up the time into smaller chunks.

• Carefully choose your birth support team. Choose people who will help you feel cared for and safe. If someone is making a mother feel tense, she needs to feel free to tell that person to take a step away. Never feel pressured to allow someone to be in the room if you will want to feel the need to behave a certain way or protect yourself from them. The birthing room is not a place for tension.

• Foster those natural oxytocin painkilling hormones. Oxytocin is the hormone of love, one that is given off when we feel safe to sleep at night. Change the lighting, bring comfort items, speak words of love and kindness to foster that sense of connection and safety. One of my favourite oxytocin boosting methods is when the baby’s father storytells between contractions - remembering the day they met, future dreams for the baby, little quirks they hope their child inherits from their mother - all these little bonding stories help release oxytocin and the birthing mother finds she looks forward to the next contraction because it will bring another tale of connection and love.

• Try a TENS machine. While I initially was repelled by the idea of using a machine with wires at my first birth, I didn’t understand that the TENS is an empowering tool - the physical act of pressing the button puts you in control. The buzzing sensation sends a request for oxytocin to your brain, which is your own natural pain relief drug. The distracting feeling also interrupts the messages to the brain sensing pain, giving it something else to sense and think about, exactly the same way water does, which is why taking a shower can also provide powerful pain relief.

• Do whatever you can to choose an environment that will lessen your fear. Do hospitals make you feel stressed and afraid? Then maybe a homebirth is for you. Does the idea of a homebirth make you feel panicky? Then the hospital may be the place where you feel the safest to let go and give birth! Do your research on the hospital and choose one where their reputation for being a mother-baby friendly hospital is good, where the midwives speak well of how they are treated, and where their cesarean section rates are low. Wherever you give birth, adjust lighting to be soft and private, and bring your own pillow or blanket for comfort. If smells and sounds are important to you, consider using aromatherapy or bringing your own music according to your mood. Use earplugs and even an eye mask to muffle the hospital sounds and allow yourself to dive deep into your own world.

The power of touch

Lower lumbar massage and acupressure can relieve pain and reassure. Choose to surround yourself with people who will comfort and support you during labour.

These practical ways to keep you feeling connected to your body and reduce the experience of pain. That said, I am not shaming anyone for the pain they feel in childbirth, nor am I claiming that these techniques offer a pain-free birth, only that fear compounds the intensity of pain. Let me remind you right now that there is no shame in choosing pain medication if that is the right tool for you! There are many variables and no birth is the same, and as your doula I help you negotiate that journey and figure out where you are in the birth process, and support you in finding that path to a safe, joyful birth-day of your child.

1. Ina May’s Guide to Childbirth by Ina May Gaskin, 2003 Bantam Books