Q&A: depression during pregnancy

Jodi writes:

"This will be short and sweet. This is my
first pregnancy and I am almost three months along. I am very excited
and feel lucky because I got pregnant the first time I ever went
without protection (thank god I was a responsible teen). I am 33 and as
my ob/gyn said "On the senior citizen side of birthing"  (hell of a
bedside manner I know ). Anyway here is my thing I have been feeling
DOWNRIGHT DEPRESSED for a few weeks. I am usually outgoing and love to
have fun but I just feel sad and kind of remorseful that I have not
done more of the things I set out to do. Did you ever experience
this? It is making me feel very guilty."

33? Is old?

Bwahahahahahahahahahahahahahahahahahahahaha. Hahahahaha. Ha.

Excuse me while I wipe the tears from my eyes.

I think your OB must have had extremely limited experience if s/he thinks 33 is "on the senior side" of first-time pregnancy. Even the technical definition of  "older" first-time mother doesn’t start until 35. I had my first baby at 29 and I’ve always been The Kid with other moms of children my son’s age. (Now that the kids are around 4, all the other moms at my son’s school seem to be in the 38-45 age range.)  I know a ton of women who didn’t have a first baby until age 38 or 39 (note that I’m not saying that it’s advisable to wait until that age specifically, or that you’ll have an easy time conceiving then, just that I know plenty of people who had first babies then).

All this is to say that 33 sounds positively early to have a first baby to me. Your OB’s comment is uninformed and a wee bit insulting.

But about the depression. Did I ever experience this?

YES.

I spent the first trimester of my first pregnancy in a serious, almost debilitating depression. I had just started building a little teeny career in something I liked better than my old "career." All of a sudden I was pregnant (with a baby we’d been trying to conceive, but somehow didn’t think would come so soon) and felt like I had nothing to show for my life, which would now, of course, be over, because you can’t do anything with a baby.

I dragged through the days, too exhausted from the pregnancy and too heartsick from the depression to do more than two things each day (and sometimes one of them was take a shower). I started having panic attacks. When I went in to a prenatal visit the midwife could tell I was not doing well and she basically twisted my arm to see the therapist that worked with women at the birth center.

What the therapist told me was this: There are extremely powerful hormones surging through your body when you’re pregnant. Different women react to them in different ways. Many women become depressed under the influence of these hormones. The only thing to be done about it is go through the motions of living day by day as best you can. Getting up in the morning is a victory.

What I know is that the depression may change or lessen or disappear by the end of the pregnancy, or it may not. I felt a little better in the second trimester (until the World Trade Center was attacked a few miles from my apartment), and then the depression came back slightly in the third trimester. Since I have had depression in my "normal" (non-pregnant and non-lactating) life, I knew I was at a higher risk for post-partum depression, but I never developed it (I made a hard-core plan to prevent it and it worked).

There’s a website called Pregnancy and Depression that has collected all the available research studies about depression in pregnancy (it also has some info about treating depression while breastfeeding and during mothering, and some info about bipolar disorder). Most of the studies are evaluating the risks to babies of exposure to antidepressants while in utero, but I thought this study was interesting and kind of sad. The conclusion is "Rates of depression, especially during the second and third trimesters of pregnancy, are substantial. Clinical and economic studies to estimate maternal and fetal consequences are needed."

I can tell you what I think the maternal and fetal consequences of prenatal depression are. I think those of us who are depressed during pregnancy doubt ourselves. I think we feel guilty that we’re not glowing, happy little earth mothers, basking in the miracle of human repoduction and our own fecundity. I think we feel cheated out of enjoying something our culture tells us is the pinnacle of human experience, and terrified that we won’t enjoy being mothers. I think we’re afraid that there’s something inherently wrong with us that means we won’t be good, or even adequate, mothers to our children. I think we think that if we’re so depressed during pregnancy we don’t deserve to have children. I think that’s why no one talks about prenatal depression.

But it’s real. It exists. It’s caused by hormones and the enormous changes we’re going through in our views of ourselves and in our relationships. It doesn’t have anything to do with how much we’ll love or enjoy our children, and it certainly doesn’t mean we won’t be damn good mothers. It does not have to mean that we’ll get PPD. It just means that we’re not the happy preggos in the magazines. But that’s OK. We’ll keep on getting up every morning, and we’ll waddle through our days until delivery, and then when the baby is crying at 3 in the morning we can think "At least I’m not still pregnant."

So, Jodi, don’t feel guilty. You’re going through a ton of changes and you have enough hormones to kill an elephant racing through your system. If you end up coccooning yourself your friends will understand. And life’s not over when you become a parent. You can’t do much of anything for the first year or two, but then you’ll get your groove back, only with renewed efficiency and a BTDT kind of fearlessness (that undoubtedly comes from knowing rightly that once a small person has puked into your mouth there’s really nothing left to be afraid of).

If you’re not already supplementing with flax seed oil, consider starting now–it can’t hurt. But try to cut yourself a break, and know that better things are coming for you soon.

Q&A: weaning a toddler

Michelle writes:

"So how am I ever going to stop breastfeeding? My daughter just turned one. In an ideal world, I’d let her until she was ready to stop. I certainly don’t want to cause her any emotional harm — she LOVES to nurse. But there are a couple of issues that make my world less than ideal.

Issue #1: We’d like another baby. I am 40 and moderately infertile. IVF worked well for us, but I assume she’ll need to be weaned before we can start the process again. Clock is ticking.

Issue #2: She won’t take a bottle and I am tired tired tired of being the only one who can care for he for more than a few hours at a time. I need a real break. She’s in daycare 3x a week. She’ll drink a few sips, once in a while as much as an ounce, from a sippy cup while there. I visit at lunchtime to nurse.

What we have been doing is trying to drop feedings gradually. She is down to a noon-ish feeding, a before-bed feeding and 2 feedings during the night (usually but not always 2 am and 5 am). She had been nursing 3-4 times during the day and 3-4 times at night up until about 2 months ago.

I am at my wits end trying to get her to drop the night feedings. The problem is that she really is hungry. If we let her FIO when she wakes (or rock her, walk her, etc), she’ll go back to sleep but wake again in 15-20 minutes. And will repeat this for hours. I have tried to get her to feed later each night, ie FIO until 2:30 one night, then 3 the next, etc. hoping to gradually stretch this. What happens is that there is no regular pattern, she’ll start waking up 12:30 or 1 for a couple of nights.

Any ideas? Its been a year since I’ve had a full night sleep. Am I crazy to want another baby when this one is giving me such a hard time?"

I think that you’re correct in thinking that you’ll have to wean before you do IVF again, depending on what your protocol is. There doesn’t seem to be any evidence that some fertility meds (like Follistim or Gonal-F) cause any problems in breastfed babies, but they also haven’t been tested. It sounds like other meds (Lupron, for example) are also untested but probably bad news. Better not to use your daughter as a guinea pig.

It sounds like your problem is that she’s still getting a huge part of her calorie intake from nursing. This is completely normal and developmentally appropriate for her age, although it’s not what you need at this point. IME, most kids experience a shift in the balance of breastmilk or formula vs. food in the period from 12-15 months. Once your daughter hits that shift it’ll probably be easier to wean because she’ll just be consuming more food in general and less milk.

I think your overall strategy should be the same thing you’re probably doing all day long with her anyway–distraction. If you can distract her from nursing with other fun things to consume, she won’t miss the nursing and it won’t be hard on her.

What does she drink out of the sippy? Breastmilk? Cow’s milk? Soy or rice milk? She may be pissed about drinking breastmilk in an "inferior container" (my dad’s joke from the 70s–har har), but would drink other beverages more willingly. You might also try switching to a straw cup if the caregivers allow it, because it’s an easier motion and might be more of a novelty for her.

It sounds like you might have better luck getting her to drop the noontime feeding first. I’m assuming you’ll still drop in to daycare to see her at noon (unless you could get your husband to do it for you instead for a week or two, which would be the perfect way to break the nursing at noon habit), so you might have to create some new ritual to do with her then instead of nursing. I’m too lazy to think of anything to substitute that doesn’t involve French fries. If any readers have any ideas, please put them in the comments.

Once she’s willing to eat more within the next few months, I’d see if you could really stuff her with food at dinner. Then if she nurses at bedtime that’ll top her off and she might end up dropping a feeding at night, or delaying the next feeding so she goes down from 2 middle-of-the-night feedings to just 1. You could also have your husband take a nighttime shift and offer her some easily-eaten food (like banana or oatmeal or yogurt) in the middle of the night instead of breastmilk. That would fill her tummy, but also eliminate a feeding (or two, if the food fills her up enough that she sleeps through until morning). Eventually she’ll start sleeping longer stretches anyway, but this will help take you out of the loop before that happens.

This is one of those things that’s just a logistical nightmare and resembles a logic puzzle from the LSATs. The annoying thing is that if you had the time you could just let it work itself out (which it would), but you don’t have the time so you have to tax your brain with methods to outfox a 12-month-old’s stomach. Yeesh. File that under Things You Don’t Need.

Anyway, you’re not crazy to want another child. Having two is not easy. Not easy at all. But it’s waaaay easier than having one but wanting two. And the part that makes you want to lock yourself in the closet with a pint of Ben & Jerry’s is over in a few years*, but you have two wonderful children for the rest of your life. And they have each other.

I hope some of this helps you, she weans within the next few months, your next IVF works easily, and you have an easy delivery and a healthy baby.

* I hear.

 

Follow-up to the peanut allergy post below

(Sorry for boring anyone who isn’t interested in this discussion. I’ll answer another question in the afternoon.)

The peanut allergy post seems to have sparked a lot of discussion, and it made me think about the whole allergy issue. I think that many people not only "don’t get it" about food allergies, but think that people (or parents of kids) with food allergies are making them up, or exaggerating them, or will somehow lose the allergy if they don’t "give in" to it. It’s almost as if they resent the person for having the allergy and cramping their lifestyle.

I don’t get this (I mean, I get that people think that way, but I think it doesn’t make sense). In trying to work through it in my head, I compare it to making accommodations for other kinds of chronic conditions or illnesses. The best comparison I could come up with was accommodating a child with diabetes. If there was a kid in your child’s class with diabetes, you wouldn’t bring sugary snacks because you know that child couldn’t have one, and it wouldn’t be fair to make one kid have to sit out when all the other kids were eating the sweet. I think most people would agree to bring in something else pretty happily and without comment.

So why the push-back about allergies, which are much more serious because even inhaling the food can cause the allergic reaction?

Is it because we see this as a weakness that can be overcome with grim determination and positive thinking? Or because we see it as a luxurious problem to have? Or something else?

What do you internets think?

Q&A: dealing with other’s lack of concern for your child’s allergies

Megan writes:

"I have a four year old and an (almost) one year old.
The older one has tested positive for a peanut allergy, and we believe the
younger one may have it as well.  This took us by surprise as neither my
husband or myself, or anyone in our families have this allergy.  Before we
found out when he was 18 months old, I knew virtually nothing about allergies.

At preschool, playgroups, park and rec classes, playdates…any
time my son is around anyone else and especially if I leave him in the care of
others, I am constantly explaining and reminding other parents and teachers
about this. I must always leave an epi-pen with him in case of a potentially
lethal reaction.  Many moms (and dads) are sympathetic and helpful and
honestly do their best to help.  The teachers at the school my son attends
have been fantastic.

However, there are some parents who don’t seem to get
it, no matter how much I try.  They bring trail-mix to playgroups when
they know we will be there.  They allow their children to wander at a
playdate after having eaten a peanut butter and jelly sandwich without washing
their hands.   They send things to school for snack that have peanuts
listed as an ingredient. These are people who know he has an allergy! 

Now Moxie, I know that this is primarily my job, and I am willing to police his eating as much as possible.  But, it would make it a lot easier if I could somehow get these parents to understand that, for my son, the peanut butter that is on their child’s hands as they swing could mean death for my son if he has a turn on the swing next.

Also, I have had to approach strangers at the park to ask them to please make sure that all the peanut butter is cleaned off their child before they send them out to play. I feel strange doing this, but luckily so far people have been very nice about it.

So, my question is:  How do I communicate to people how  important this is?  What can I say to them to make it sink in?  To  your readers out there whose kids do not have an allergy, if you were approached by a woman at the park with this sort of thing, what would you want her to say?"

I think this is a tough situation, and a tough question, but I think it’s an issue that’s going to affect all parents at some point. Every one of us is going to have to deal with allergies (especially nut allergies), whether it’s our own kid or one of our kid’s friends or classmates.

So, before I get to my answer, I’d like everyone to click over and look at the instructions for how to use an epi-pen. If a child is going into anaphylactic shock from ingesting nuts or some other allergen, you may be the only adult present, so you need to know how to use one. It could mean the difference between life and death for someone’s child.

Did you click over? Seriously, do it now, please. I can’t be the only one who thought you were supposed to plunge it into the heart like they did in the movie "Pulp Fiction." (Update: Be sure to read these helpful tips about the EpiPen. Yikes.)

Now, to me this is an issue of public health. If anyone in the school or playgroup has a life-threatening allergy to a substance, the group as a whole needs to make rules limiting the use of that substance. And everyone needs to help police.

I’d like to think that some of these parents don’t realize how serious a nut allergy is. They may think it means that if your child eats nuts he’ll get hives or a rash. They may not realize it closes off his airway and can kill him by suffocating him. I really hope they don’t know how serious it is. Because if they do know and they still send snack with nuts or bring trail mix to playgroup, it’s the equivalent of bringing a big bag full of candies made out of rat poison.

Yes, you have to be the main advocate for your son, but the other members of your community should take responsibility, too. Ask the director of your son’s school and his teachers to make sure all parents know they can’t bring snacks with nuts in them. (It may also be a liability issue for them, so I’m sure they’ll take it seriously.) Any snack with nuts need to be sent back home immediately. They could even institute a policy of having the kids all wash their hands as soon as they get to school to make sure there are no traces of peanut butter left. (This will also make sure the kids themselves get in the habit of checking to be sure they’re not nut carriers.)

At playgroup, do you have a friend who gets how serious the nut issue is? Maybe she will be the watchdog on your behalf. (If you were in my playgroup I’d rip anyone who brought trail mix a new one.) If more than one person is saying it (and especially someone who has no personal stake in it), then people start to listen and pay attention. Or, you could just start a new playgroup with the parents who get it.

My only problem is with the playground issue. It’s just not going to be logistically possible to make sure it’s an allergen-free zone. That doesn’t mean you don’t have to try, but I don’t think you can lock down a playground the same way you can lock down a school or private property. I think your best bet is going to be to make sure you wipe down any equipment your son is going to play on. You can also approach the parents of any kids your so is playing with to ask if they’ve eaten any nuts and to ask if they’d mind washing hands and faces if they have. Yes, some parents will be offended, but I’m betting most of them will be sympathetic and possibly even sheepish that they didn’t think of it themselves. Readers? How would you react?

The public space issue is one that will continue to plague you, although my guess is that it will get slightly easier when your son gets older and can be more of an advocate for himself.

I really think most people just simply don’t know how life-threatening nut allergies can be. That means it’s incumbent on all of us to keep educating so people don’t think peanut butter crackers are good snacks for preschool. We love peanut butter in my house. I’d guess we probably go through a jar or two a week. I’ve been absolutely anal about not having any at school, but the playground issue honestly never occurred to me. We’re going to have to insititute an "only on the house and then wash your hands and face with soap" policy about peanut butter. Maybe everyone reading this will do that, too.

If you have a peanut (or any other serious) allergy, please let everyone around you know. It could be the difference between life and death.

Q&A: school time vs. time with traveling father

Bobbie writes:

"I have a question about my daughter and waswondering if you could help me.

My daughter is in Kindergarten and
is doing really good. She is where she needs to be and in some cases above where
she needs to be, but due to where school is new to her she has been sick a lot and
has missed 7 days alltogether. But the point I’m trying to get to is this. 
Her dad is gone on a business trip for 2 months and her and her father are very
close and she is missing him really bad. He has been gone for 2 weeks now and she
is to the point where she cries herself to sleep at night!

In two weeks we
planned to go up there for a few days but she can’t wait.  What should I
do?  I don’t want to get into trouble for her missing so many days or them
holding her back for going to the first grade.  Emotionally she is falling
apart because she has never been away from either one of us–maybe overnight, but
not weeks or months at a time. Mentally I don’t want her to behind in
school. Can you please help me?"

Your daughter needs to see her father.

Call the school and ask for a meeting with the teacher and principal for the next day, and go in and tell them what you told me. A kid who can’t function because she misses her dad so much is not going to do very well in school anyway, and the teacher and principal will understand that.

The principal will know what the legal guidelines are for your state about how many days she can miss and still go on to first grade. If she’s been sick those days shouldn’t count against her (but it depends on state law and whether she was sick enough to get a doctor’s note). You might have to get her assignments for the days you’re going to miss and do them with her while you’re gone.

Good luck. I hope the principal can give you good news that she’s in no danger of being held back, so call as soon as you can to talk to them. Your daughter sounds sweet, and the attachment she has to your husband is heartwarming. I hope the rest of his time away from your family flies by quickly so you can all be together again.

Q&A: Too much grandma time?

Liz writes:

"I have a wonderful, child-loving Mother-in-law. She loves taking care of my 18 mo. old son and often volunteers to take him on weekends. As a parent, I’m thrilled (duh!) to have some free time with my husband or just some extra wine and sleep. The problem is how much is too much of a good thing?? I’m sure it’s a reflection of my own insecurity but I’m afraid that my son will think grandma is more fun and will want to be with her more than us. I know that time will come when he will definitely prefer gramma to his own parents simply because she’ll let him get away with more. But, it broke my heart one day to hear him say "Mama" to my MIL.

It’s not that he stays at Gramma’s every weekend all weekend but probably every other for either one night or two. I absolutely want my son to have a wonderful relationship with a Grandmother that loves him but how do I do that without feeling guilty that I’m handing him off or that he’ll prefer her to us? I guess that other side to the equation is my own parents. They live further away from us than my MIL so they obviously don’t see my son as often. I’m so worried that my MIL is going to be become the preferred grandparent and my own parents will be the outsiders. However, the geography is a valid hurdle and it’s just not possible to see them all the time.

Wait, I’m not done yet 🙂 there’s more. I also have a nephew (my sister’s son) that lives very close to my parents. My folks see him all the time and he recognizes them and loves seeing them. They seem to lavish so much attention on him and I feel like my son gets the shaft. Again, the travelling is the issue. Maybe this is all very normal and I just don’t know how to deal with the guilt and worry on all issues. How do I deal with "super grandma" on the one side and "absentees-thru-no-fault-of-their-own grandparents" on the other side? I know that if the roles were reversed and my parents were super-close prandparents getting my son on the weekend and my MIL was absent I probably wouldn’t feel so twisted-up about it…."

Release the guilt. You’re in a mostly great situation, and once you start accepting that it’s normal and healthy you’ll be able to relax and enjoy it more.

It’s wonderful for your son that he gets to spend so much time with his grandma, who sounds just thrilled to be so involved with him. It sounds like the ideal situation, really, to have someone you love and trust who can take him enough to give you and your husband a break. You’re probably better parents because you have someone to share the load. It’s so much closer to the way humans are designed biologically to parent–in groups, not just lone families marooned in their own houses trying to hold it all together by themselves.

Actually, I take it back. It’s not the ideal situation. The ideal situation would be if your parents also lived close to you so your son could spend a bunch of time with your MIL and a bunch of time with them, too. I think you’ve correctly identified that a lot of your misgivings about your son spending so much time with your MIL stems from the fact that you’re sad he can’t spend as much time with your parents, and jealous that your sister’s son gets the attention your son can’t have because of distance. I’d say that you should think about how important it is for your mental health for your son to see your parents, and what form those visits should take.

As an example, we lived in the same town as my dad’s parents and 12 hours by car away from my mom’s parents. She and my dad decided that there was no way we could see my mom’s parents often, but we could see them for long enough visits that we got to know them that way. So every summer we’d spend at least two weeks with them at their house, and we’d try to go once during the school year for at least a week, too. I’m trying to do the same thing now with my kids (we live close to my ILs but 600 miles away from my family). There are things we can’t do because we prioritize visits to my family above other things we could spend money on. I sometimes feel like a pauper (especially compared to other families we know in NYC), but my sons know my parents as well as they can at this age.

So maybe instead of focusing on what your son isn’t getting because he doesn’t get to spend every weekend with your parents, you could think in terms of trying to give him one or two long visits with them in which you go to them or they come to you. Your sister’s son is still going to be the Everyday Grandson, just as your son is the Everyday Grandson for your MIL. Speaking from experience, that’s not such a bad thing. We got spoiled by one set of grandparents, and my cousins got spoiled by my mom’s parents. It kinds of balances out, and I didn’t feel any less love from my mom’s parents. And I knew both sets pretty intimately, because I saw one set all the time at home, but I’d spend intense time with the other set (14 days in a row) at regular intervals.

I’m sorry he called your MIL "mama"! That must have been brutal. But he absolutely knows who you are and who she is. If he hadn’t called her "Mama" that day he probably would have said it about the dog–18-month-olds are testing limits all the time, including limits of language. THis, in my opinion, is probably going to be the biggest challenge you’re going to face in the next two years of having him spend so much time with your MIL, since she’ll have different rules and expectations than you do. But your son is smart, adn he’ll test you all but you’ll figure it out. And it will be so valuable to him to have a grandmother he knows so intimately in his life.

So please don’t feel bad about it. Make your plan to get him more time with your parents, and then go have a glass of wine with your husband while your MIL is sitting through another round of Dora.

 

Q&A: first child doesn’t want another

Sky writes:

"I am 30. Had a son at 20. Always wanted more kids but I’ve been busy with school and was just married to (not the father) last year. Now I’m (finally) ready for more kids, but my son is not. He says "You will love them as much as me!" and cries. How does one answer something like this? Any ideas would be great, thanks!"

If I were my MIL or Dr. Laura or a hard-liner like that, I’d say something like, "It doesn’t matter what your son thinks. You’re the parent, and if you want to have another baby, you should do it."

But I’m not a hard-liner, so instead I’m going to say that your son’s feelings matter very much, and if you want another baby you should have one.

Siblings don’t always get along, and yes, it’s possible that your son and this baby won’t end up being best friends or having much in common as adults. But that doesn’t mean the experience of being a big brother won’t be fun or worthwhile for him, or that it will ruin his life. And what if this sibling becomes the most important person in your son’s life? There’s no way to know until they’re both a lot closer to grown up.

It sounds like your son is used to the way things have always been. The marriage itself must be a huge thing to adjust to, and he’s probably already wondering about his place in the new family (no matter how great his relationship is with your new husband). So thinking about being "displaced" with a new baby can’t make him happy.

But his feeling of belonging within the family is a separate issue from whether or not you should have another baby. I’m sure he knows this intellectually, but it wouldn’t hurt to reassure him again repeatedly that you want another baby precisely because he’s so great and you know a new baby will be, too, and not because there’s anything wrong with him, or that he’s no "fun" now that he’s practically a grown-up. A new member of the family is going to divert some of the attention from him, but it’s also going to create more love and more fun in the family.

My advice once you do get pregnant is to involve your son in as much of the pregnancy process as possible, but without attaching any expectation for his participation or enthusiasm. Talk about pregnancy, birth, babies, siblings, etc., but don’t expect him to be interested or happy about it. Let him talk about his negative feelings and acknowledge them without judging them. As long as he knows that he doesn’t have to like or love the baby as long as he doesn’t hurt the baby, he has the freedom to form his own relationship with the baby without going through you or your husband as gatekeepers of emotion.

I’m going to plug, once again, the amazing book Siblings Without Rivalry. The central idea of the book is that there’s no way you can force your kids to like each other, but you can treat them as individuals and make sure they know how to resolve conflicts with each other. I read it while I was pregnant with my second and found it to be helpful even then in framing how I talked to my son about the sibling he was about to have in a few months.

FWIW, the new baby will probably idolize your son. It’s a ton of fun to have someone who thinks you’re just the best thing ever. I’m sure your son isn’t thinking about it now, but when you have another child your son is going to get an adoring fan who wants to be just like him. He’s probably been thinking in terms of sharing you instead of in terms of getting yet another person who thinks he’s the greatest.

Good luck with building your family. Your son may not be thrilled about it initially, but if you can make sure he knows how much he’s loved and you avoid comparing your children, he’ll enjoy being a big brother. Most of the time, at least.