Traumatic Childbirth

Each childbirth is a unique experience. The experience can range from ecstatic to traumatic, or anything in between. While you can envision in advance how you want it to be, or plan and prepare as much as possible, the actual outcome is always an unknown.

Unfortunately, for about nine percent of women in the Netherlands the outcome is trauma. Recent research from the University of Groningen shows that of these nine percent of women who experience trauma during childbirth, about 2000 women end up developing full-on childbirth related Post Traumatic Stress Disorder (PTSD). These figures can be quite surprising, since childbirth related trauma is not commonly known of or talked about.

One of the reasons childbirth trauma is so unknown is that it is often misdiagnosed as postpartum depression. Another reason is that in our society, childbirth is mostly seen as something painful but with a great reward. As long as you have a healthy child, you should have nothing to complain about. You should be grateful and happy. No wonder that many women with a traumatic birth experience feel unable to speak about it. They feel ashamed for feeling the way they do, afraid that something is wrong with them, and guilty towards their child(ren).

Symptoms of childbirth related trauma
Some of the symptoms women experience include intrusive thoughts, such as nightmares and flashbacks. “I often had nightmares about the birth and woke up feeling scared,” says Anna. “And I hardly even remember the first year of my baby’s life. I felt so numb after he was born.” This sense of amnesia is another indication that the experience was traumatic. Moreover, women who have experienced childbirth trauma usually do not want to talk about the birth, knowing that all their feelings will come rushing back to them. Nor do they want to hear anyone else’s birth story. Also, the thought of having another child, giving birth again, is too overwhelming and frightening, so this idea is put off or completely abandoned.

Do you recognize any of these symptoms? Does the thought of your birth bring on the same feelings that you had when it actually happened? Do these feelings have the same intensity as if the birth were actually happening right now? Are you even capable of revisiting the events in your mind? Would you describe the events as traumatic? You are not alone.

What is trauma?
Trauma is a big word which you might want to avoid when describing your birthing process. Intellectually, you might think your birth was fine, or not very eventful. But at the same time, something did happen that hurt you and you can’t seem to get rid of it. The birth could have been really fast, or very slow, or medically uneventful. But in case of trauma, a moment occurred where there was a sense of complete loss of control, fear or helplessness. Often, you can pinpoint the exact moment and pause it as if it were a movie. It could have been that your or your baby’s life seemed to be in danger and you found yourself in an emergency situation, or that one of the care providers said something hurtful, or you experienced a pain that you thought would kill you, or you felt so helplessly alone and uncared for.

Whatever it was, the psychological distress you experienced was so intense at that moment, that your brain was not able to process it. Therefore, the feelings remain raw and vulnerable to being activated by anything that reminds you of the birth.

What is so important to know is that traumatic childbirth can happen to anyone. Experiencing something as a trauma is not a choice. You are not doing this on purpose, nor are you weak for feeling stuck in it. You were wounded and you did not choose the depth of your wound.

What now?
You might have been able to push your painful thoughts and feelings aside, but that has probably left you feeling numb and unable to enjoy life fully. Or perhaps you’re pregnant again and you realize you need to face the trauma. What’s the next step?

The first step is to express yourself. Write down the story of your child’s birth. Read it out loud to yourself. Read it to someone you trust. Try to find out if you know anyone else with a similar experience, so you can share it with each other. This process can bring a huge sense of relief and support.

If you feel incapable of taking that step, or if you did and it doesn’t help, you might benefit from EMDR treatment. EMDR stands for Eye Movement Desensitization and Reprocessing and is a therapy designed to process the raw feelings associated with your trauma, thereby desensitizing them. The memory of the experience is kept, but the fear and other negative feelings and associations that went with the experience go away.

Another possibility is to do Cognitive Behavioral Therapy (CBT). This therapy will focus on the thoughts and beliefs that you had in the moment of the trauma. Did you think you had no control and were powerless? The result will be that you felt (and still feel) very scared and vulnerable. CBT can help by challenging the thoughts and beliefs that allow you to feel those overwhelming negative emotions.

If these therapies don’t appeal to you, talk to your family doctor or midwife, or another birth worker such as a doula or postpartum massage therapist to find out if they can recommend an alternative therapy that does fit your needs.
Even though you may think so, you are far from being alone in this experience. And, there are ways to move beyond the trauma. This requires reaching out and talking, which can be frightening, but it is better than carrying the trauma with you throughout your life.

Say yes to sex after children

Dave and Claudia were overjoyed to welcome their son into their lives last July. But six months later, as they struggle with sleep schedules and work schedules, they’re both dismayed to find that they’ve entered a serious dry spell. They haven’t had sex since the birth of their child. Even worse, they say, is that they haven’t at all felt intimate with each other, that emotional closeness that can be felt through a touch, a glance, or a conversation when one’s defenses are down. Without this connection, they realize they feel a sense of loneliness in their marriage.

The importance of sex

Research shows that sex within a loving, committed relationship can have a positive impact on many aspects of your life, including your mental and physical health, energy levels, sleep, and your relationship. In fact, a widespread belief exists that sex is crucial to a good relationship. The idea is that without sex and intimacy, connecting and empathizing with your partner becomes harder, making conflict more likely. As such, your sex life (specifically, the amount of times you are having sex and how satisfied you are with it) is considered to be the barometer that gauges the well-being of your relationship. Because when your relationship is strained, sex is usually the first thing that suffers.

Unfortunately, if you’re like most parents, you will have noticed a decline in the amount of sex you’ve been having since the arrival of your first child. This decline can cause a fair amount of anxiety and conflict within your relationship, exactly because sex is considered so important. On top of this, talking about sex can be quite uncomfortable and embarrassing. This means that couples will avoid talking about it and the problem gets exacerbated.

Why is sex especially important for parents?

If sex and intimacy are vital ingredients for a healthy, loving relationship, it warrants our attention. However, as a (new) parent, you might have loads of legitimate explanations that justify the lack of sex. You’re exhausted. You don’t have time for each other. You don’t feel sexy or have a sex drive anymore.

“I’ll be honest, it simply wasn’t a priority for me,” said Claudia. “I was having enough trouble balancing everything else in my life, sex seemed like another chore.”

But there are many reasons why it is a good idea to keep the flame alive. When you become a parent, working on the wellbeing of your relationship is more important than ever. Reasons why it’s so important now include:

  1. Becoming and being a parent can be quite physically and emotionally trying. Being able to fully count on each other when caring for your kids and support each other through these tough times makes the path of parenthood a lot easier to tread.
  2. Your children benefit from your loving relationship. Kids learn a lot about love through example. Couples who have satisfying sex lives tend to be closer and exhibit more intimate behavior (such as kissing or touching) when others, including children, are around.
  3. Your relationship with your partner influences your children’s sense of happiness, health and school performance.
  4. A good partner relationship affects the parent-child relationship positively.

How to bring sex back

Now that we’ve established the importance of sex and intimacy in your life as a parent, we can discuss steps you can take and important things to remember when trying to improve your sex life.

Know there’s no magic number. A first step in addressing this issue is to establish whether there is even an issue to speak of. There is no magic number for the amount of times that you and your partner should be having sex. The key is that you are both satisfied. In other words, there is only a problem if the couple thinks there is. Plenty of couples can be quite happy when having sex once a month, while others would find that disastrous. The same goes for what it means for sex to be satisfying. For some it’s a question of extensive foreplay or trying new things, while others like a simple routine that will end with an orgasm.

Manage expectations. The initial phase of a relationship, when a couple falls in love, lasts up to two years. This first phase is usually filled with passion and lust. Fueled by the media, we often believe that this passion should live on beyond the first stage of the relationship. The reality is that it doesn’t.  As the relationship progresses, it has the capacity to develop into a deep, long-term connection that is filled with love and respect (and sex).  But this does not mean that you want to jump your partner every time you see him or her. It’s important to let go of expectations of how your sex life should be and focus on your actual needs in the present.

Talk. If you feel like there’s a problem, talk to your partner about it. Most likely, your partner has the same thing on his or her mind. Sex can sometimes be difficult to talk about, because it brings up deep-rooted feelings of shame and guilt, often going back to childhood. We give sex or a lack of sex a lot of meaning. As Dave pointed out: “The times that I did initiate sex, Claudia turned me down. This devastated to me. I thought she didn’t want me anymore and I was afraid to bring it up because she might get upset.” Remember that if you want to improve your relationship in any way, talking is the starting point. If you’re unhappy about the quality of sex you’re having, by all means (gently) tell your partner. If you’re in a loving, committed relationship, your partner will want to know how to make sex a more pleasurable experience for you. To make the conversation easier, make sure to talk about it at a time that you are both relatively relaxed and not at the moment that you’re feeling particularly anxious about the situation.

Examine the causes. Are you having a dry spell because you’re too exhausted from taking care of your little kids? Or is the problem more complicated? Some other possible factors that play a role are:

  1. Resentment within the relationship due to other events, pre-existing negative patterns, or poor communication.
  2. Outside stress resulting from problems at work, work-life balance, family issues, etc.
  3. Coping with overwhelming depressed or anxious thoughts and feelings.
  4. Body image issues causing feelings of shame of your own body (quite common for women who have given birth).
  5. Decreased sex drive related to physical health problems or hormonal imbalances. Please see a medical professional if this is something you are concerned about.

All of these issues will probably need to be addressed before you can improve your sex drive. You might want to talk to a close friend or a counselor who can help you work through these concerns.

Become aware of a new couple dynamic. If becoming a parent has a profound impact on you as a person, imagine what it does to you as a couple. Think about how you were as a couple before the birth of your child(ren). Did you experience this sense of responsibility and worry that you have now? Probably not. Nor did you spend so much time and effort making others happy, nor were you at complete  physical and emotional service to others. You might have a feeling that your body is in service of your kids, as opposed to having the ability to give or experience sexual pleasure. This can inhibit your ability to shift from your role as parent to your role as lover. On top of this, you are seeing a whole new side of your partner as s/he becomes a parent. It may be difficult for you to accept this new person or their parenting style, which in turn might create distance between you.

Work at it. Bringing sex and intimacy back into your relationship is not easy. Usually, it’s a good idea to plan to have sex. Remember: planned sex is better than no sex, so go ahead and make agreements on when and where to have sex. You might find the anticipation leading up to your sex date to be quite exciting! Moreover, fantasizing about your sex plans in advance will surely help you get into the mood. Contrarily, you might very well be worried that scheduling sex will take all the fun out of it. Don’t worry, once you are having sex that worry will turn into pleasure, especially if you are willing to try new things or new places to have sex. If you think your sex life is unsatisfactory due to other issues in your life or relationship, make it a priority to work on those first. Again, this requires talking to your partner, but you might want to consider seeking counseling to work on communication or other issues.

Be patient with your libido. If sex has been out of your life for a while, your libido, or sex drive, might have dwindled a bit. But once you increase the frequency and quality of sex, your libido will get a so-called kick start. Trust your body and trust your partner. You’ll get there. Also, keep in mind that being exhausted lowers your libido, but that having sex will help you sleep better and feel more energetic. So, the more sex you have, the more well rested you’ll be, the stronger your libido will become.

Treat each other as lovers. When you see your partner, acknowledge him or her with a kiss, a hello, a special look, a hug, or any type of greeting that shows you are not taking your partner for granted. Calling each other “mom” or “dad” is not sexy. So please only do so when referring to each other as you’re talking to the kids. In heterosexual relationships, try taking on traditional gender roles, where men take control in the bedroom.  It gives women the feeling of being taken care of and it allows men to become more sexually assertive, and is therefore a recipe for more passion.

Do exciting things together. Going out to dinner or seeing a movie can be fun and satisfying experiences. But engaging in exciting activities together, such as (extreme) sports, concerts or trying new things in the bedroom, has the ability to bring couples closer together and more interested sexually.

In summary, sex is important to your relationship, also now that you’re a parent. With young children, you can be so exhausted and busy that it might be hard to make an effort to work on your sex life. Just remember, the pay-off is one of love, happiness, fun and connection for you and your family.

This article was also published by Amsterdam Mamas.

Sustaining mental health: a fine balance

On World Mental Health Day, let’s take a moment to look at our own mental health. When are you mentally healthy? The answer is simple: when you feel balanced and ready to cope with life’s challenges. But how to find that balance? That answer is not so simple.

Life can be fun, fulfilling, exciting, even exhilarating.  But for most of us mere mortals it can also be complicated, tough, scary and sometimes depressing. There’s so much going on, so much to manage. You have family with all its intricate relationships and group dynamics. You might lack a family. You have relationships with friends, lovers, colleagues, bosses, employees, teachers, students, public servants, shopkeepers. People are born. People die. The stream of people in and out of our lives is constant.

You have to make money, enough to feed yourself, clothe yourself, pay for a home and furnish it. You might be supporting someone else. You work, you go to school, you shop, you plan, you don’t plan, you stress, you relax, you go on vacation, you write emails, you pay your bills, you avoid paying your bills, you eat, you clean yourself, you make friends, you argue with people, you try to get along – the list goes on.

At some point, you worry about all of these things. You might worry a bit, you might worry a lot. And you have all sorts of thoughts and feelings about it all. Some thoughts are fleeting. Some keep churning in your mind and seem impossible to shut down.

It’s a minor miracle that most of us get through the day relatively unscathed! To not get overwhelmed by it all, to deal with our challenges in a healthy way, we need balance, a way that allows us to cope with all these complicated interactions, relationships, thoughts, feelings and activities. But how to find this balance? What are some of the most important steps we can take?

To start with, we can keep our bodies as healthy as possible. We can’t control which genes we have and what diseases might come our way, but we can do our best to equip our bodies with some basic health boosters that enhance both physical and mental health:

  1. Sleep. Get enough of it. For some this is six hours, for others nine. You need more than adrenaline and caffeine to make it through the day. You need sleep to stay sane and healthy. It is the most important act of our day. New parents can go a while without it, but eventually they too need their Zzz’s. But keep in mind that it’s possible to get too much of a good thing: sleeping more than nine hours a day can have a variety of negative medical consequences.
  2. Exercise. Yeah, yeah, you’ve heard it all before, you need to exercise. Thirty minutes a day of exercise has a positive effect on every single aspect of your life. Every single health issue you can think of, both physical and mental, will benefit.
  3. Nourish your body and mind. Drink plenty of water and have a balanced, colorful diet. Dehydration and a diet of junk will cost your body loads of energy, and possibly damage it. Keep alcohol to a minimum.
  4. Connect with people. We are social beings. This means all of us, even the introverts. We need people to talk to, share experiences with, rely on, laugh with, cry with, give support to and get support from. We need to connect. Connection nourishes.
  5. Breathe. Take one minute each day to be in room, by yourself, to close your eyes and focus on your breathing. If you enjoy this, increase the amount slowly until you are at ten minutes a day. This type of meditation will increase your happiness and physical wellbeing.

The list above is relatively straightforward, but what if you can’t manage to keep to it, because you’re too overwhelmed? Are your thoughts and feelings distracting you from your daily life? Do you constantly feel tired or have physical complaints that seem to have no medical cause? Do you feel stressed, panicky, forgetful, depressed or overly agitated? Do you cry often for no apparent reason or for too many reasons? Are you worrying about things to the point where it’s doing more harm than good? Are you abusing alcohol or other substances?

Well, you’re not alone. With all life’s overwhelming tasks, responsibilities, relationships and occurrences, coping with it all, on your own, can be daunting for anyone. Some people simply face more struggle than others. Some have learned with time to interpret their lives in a negative way.

Let’s do a quick thought experiment. For as long as you can remember, your good friend has sent you a Christmas card. This year, she doesn’t send one. What do you automatically think?

a)      She probably forgot, she’s been so busy lately.

b)      She must not like me anymore, what did I do wrong?

If you’re someone who would typically interpret such a situation as b) than you have probably learned to have automatic negative thoughts. If you recognize yourself in this, take a moment to think about how this is affecting your daily life and your outlook on the future. How is it affecting your mental health?

What it comes down to is that keeping a sense of balance, a sense of mental health, is a challenge for almost all of us. Know that you’re not the only one who faces this type of struggle. Take comfort in that. If you feel like you’re not coping the way you would like to cope, talk to someone: a friend, a family member, a counselor, a spiritual guide, an online community member – whatever feels right for you. Taking action is the first step towards finding balance.


This article has also appeared on Amsterdam Mamas.

Hello baby! Goodbye relationship?

Did you know that most couples experience a significant decline in relationship satisfaction after the arrival of a baby? Many studies show high percentages of couples facing relationship problems in the year following their babies’ births. The unfortunate side effect is the significant impact that relationship struggles have on children. Research shows that marital dissatisfaction negatively influences co-parenting abilities. Also, when children spend their first years with parents in relationship distress, they are at risk of future depression, as well as social and academic problems.

So how is it that our cute little babies put such stress on our relationships? There’s a long list of possible answers. Fortunately, there’s also a long list of ways to avoid this stress. This article will shed light on some ways to prevent relationship deterioration. First, let’s look at the most relevant reasons that partners become disenchanted with their relationship after a baby enters the picture.

  1. Exhaustion. The lack of sleep and the sheer amount of work it takes to meet an infant’s needs are overwhelming. Parents are exhausted, and when you’re exhausted your tolerance for just about anything disappears. You start giving the baby all the good that you have within you, and your partner gets the bad and the ugly.  When overwhelmingly exhausted, partners spend less time having significant interactions with each other. Conversations about anything besides the baby decrease, and sex and intimacy become less frequent and enjoyable.
  2. Pre-existing problems. If your pre-infant relationship was highly conflicted, having a baby will make things worse. There are, however, many struggling couples who decide to become parents thinking a child will bring them closer together. Some couples do manage to grow closer once they have children, but these are mostly couples who had very strong and balanced relationships to begin with.
  3. Depression. Parents have higher rates of depression than non-parents. One of the reasons that depression rates are high is that parents in many Western societies do not get much help from others. This lack of social support contributes to depression, and depression in turn contributes to relationship deterioration.
  4. Maternal gatekeeping. This is the process through which mothers shape how involved fathers are with their babies. Often unconsciously, mothers shut fathers out by criticizing how they take care of the baby. This leads to resentment on both sides.
  5. Unmet expectations. Life with a baby usually doesn’t meet parents’ expectations. No one realizes how tough it’s going to be. More importantly, there are expectations about how roles will be divided once the baby arrives, and usually the reality turns out quite differently. Mothers take on a bigger part of the work, often because they are on pregnancy leave, but then start resenting having to do so much. Both parents end up being disappointed with their roles.
  6. Different parenting styles. Differences in parenting styles can lead to a great amount of frustration. If one parent believes it’s ok to let the baby cry for a little bit, but the other thinks this has a damaging effect, relationship tension is sure to follow. For cross-cultural couples this is even more likely to be a point of distress. What you once loved about your partner’s culture might suddenly become a point of tension. As an example, imagine quarrels between a Northern European mom and her Southern European partner about their baby’s bedtime.
  7. Perfectionism. Parents who feel societal pressure to be perfect in their new roles often have a harder time adjusting to parenthood, are less confident in their parenting skills, and feel more stressed. This in turn stresses the relationship.
  8. Money and work. The amount of disposable income available to a couple diminishes with the arrival of a baby. This can cause tension, even when both partners keep working. But when one of the partners decides to stay at home (beyond paid parental leave), resentment can soon ensue. The working partner feels the financial burden and a sense of injustice about working all day while the partner at home gets to ‘do nothing.’ The stay-at-home partner feels guilty, underappreciated, and misunderstood, among other things.

Thankfully, there are plenty of ways you can avoid these pitfalls, or at least work on keeping your relationship in the best possible shape while transitioning to parenthood. Keep in mind though, that these are not necessarily easy steps to take when you are feeling exhausted, angry, and sad. If you think your relationship is in trouble, seek counseling as soon as you can.

  1. Learn to have fair arguments. You’re going to argue, this is almost unavoidable, but how you do it can make all the difference. Even though it might seem hard or weird, try focusing on your own feelings instead of on your partner’s faults. So, instead of saying, “You’re always so messy”, say, “I’m upset that there are clothes on the floor.” When arguments become very heated and you’re overcome with emotion, take a 20-minute break to soothe yourself and relax. This way you can avoid saying hurtful things that you will regret later that might have a lasting impact.
  2. Spend quality time together. This does not necessarily mean that you have to set up a mandatory date night. You can have other fun traditions, with or without your children, that are meaningful to you. Try having family dinners together, watching your favorite sitcom, going to a concert once a month, or going to the pool as a family. These are all experiences that strengthen a sense of shared purpose in your relationship. Also, if you’ve noticed a decline in your sex life, schedule time for intimacy. Even though it might seem unspontaneous and unromantic, scheduled sex is better than no sex, and a scheduled activity is more likely to happen. Make a commitment to keep conflict out of these fun, quality times spent together. If something comes up, put it aside and discuss it later.
  3. Plan ahead. During pregnancy, discuss the issues that might cause conflict once the baby arrives. Talk about the division of labor for doing housework and taking care of the baby. Write it down. Who will get up at 2am? Who will change diapers? Who will take out the trash? Go into as much detail as possible and revisit the list at least once a month. Also, share how you were raised and how you think you should parent your children. What are your long-term goals? What kind of home do you want to provide for your kids? Likewise, talk about money, and keep the conversation going frequently. What is each partner expecting to contribute financially? What is acceptable for both partners?
  4. Practice positive maternal gatekeeping. Instead of criticizing your partner’s involvement, encourage and praise involvement. It’s ok if your baby’s clothes aren’t color coordinated in the way that you like. It’s ok if your partner soothes your baby by taking a drive around the block. Let your partner and baby have their time together and appreciate your partner’s ways of doing things.
  5. Create a support network. Make friends. Meet other couples with babies of a similar age. Have trusted babysitters. Having a sense of support and connection to others makes us feel better about ourselves and can ward off feelings of depression. Creating your own support network is not as hard as it seems, because there are plenty of parents like you who are looking to do the same. Seek support through online communities like Amsterdam Mamas, baby classes (yoga, massage, swimming), or your child’s daycare.
  6. Keep communicating. As a couple, don’t think you know each other just because you’ve been together for a relatively long time. People change, dreams change, opinions change, thoughts change. Ask each other questions like, “Where do you see yourself in five years?” or “What events shaped you as a child?” Realize that you can keep learning about each other throughout your lives together. When your partner does something in a way that you don’t immediately approve of, ask him or her why they do it that way, and what they are hoping to achieve. Becoming a parent changes a person profoundly. Don’t assume you know how it will affect or has affected your partner.
  7. Anticipate problems. If you are still pregnant and you are aware of problems in your relationship, seek counseling as soon as possible. The sooner you work on communication skills and other issues you might face, the better off your relationship and your child will be. The same goes for when you are feeling depressed, both during and after pregnancy. The likelihood of counseling helping against depression is much higher than you and your relationship getting through it unscathed all on your own.
  8. Be aware of a new mother’s needs. Mothers go through an intensely emotional, physical, hormonal change during and after birth. This change can last for many months as they try to get a grip on motherhood. Partners, please be aware of this and, although it might be very hard, try to appreciate the intensity that she faces. Marital satisfaction has been shown to improve when partners express fondness and appreciation towards mothers and when they are highly attentive to maternal and relationship needs. Help your partner find supportive maternal figures to help her through these difficult times. Your partner might seem like a totally different person now that she’s a mother. Try to keep a long-term perspective and have faith that it will pass. Seek help yourself if you feel like it’s profoundly affecting you.
  9. Be real. If you feel like things aren’t going well with your partner, talk about it. If you feel like you’re struggling as a parent, share your feelings with other parents. Don’t put on a happy face and go through the day as if nothing is wrong. Every single person out there faces some type of struggle. Sharing it and supporting each other make it so much easier.

Postpartum Depression: How to spot it and when to get help

On the day you give birth to your baby, you go through the greatest physical, mental, emotional, and spiritual change you will most likely ever experience.

Your hormones are raging. Milk production is starting. Stitches are healing. You haven’t slept properly for days. You are dealing with a new, helpless being who might be crying all the time. You start wondering whether you are even capable of keeping your sweet newborn alive until the next day, much less be a fit mother for years to come.

No wonder almost 75 percent of us experience some depressed feelings. These feelings are commonly known as baby blues. We’ve all been there: you cry for no apparent reason, get easily irritated, worry about how you are going to do this thing called motherhood.

Usually, these feelings disappear after a week or two. If they do not, however, you might be experiencing some degree of postpartum depression (PPD). PPD affects about 10 to 15 percent of women, making it the most common complication associated with childbirth. It should be noted that women who have had a miscarriage or an abortion also suffer from PPD.  This condition can seriously impair a woman from taking adequate care of her baby – and even herself.

What causes PPD?

There are several factors that contribute to the development of PPD. Physical factors that can result in depression include a steep drop in hormones as well as changes in blood pressure and metabolism. Also, postpartum thyroid disease affects 10% of women and can be an underlying cause of depression. Having your thyroid levels checked is therefore crucial if you have PPD symptoms.

Other factors that can cause PPD include everything from more general health and life issues to stressful baby-specific problems: a traumatic birthing experience, a colicky infant, difficulty breastfeeding, anxiety about the overwhelming responsibility of caring for your newborn, having trouble identifying with your new role as a parent, body image issues, relationship problems, financial problems, feelings of solitude caused by a lack of social support, single parenthood, unwanted or unplanned pregnancy and cigarette smoking.

Who is at risk for PPD?

In principle, any woman could be afflicted. However, certain risk factors, or predictors, have been identified that are found to be common with women suffering from PPD. These include:

  • psychological disturbance (such as depression or anxiety) during pregnancy
  • stressful life events (such as death, divorce, traumatic birth)
  • previous history of depression
  • low levels of social support

This last risk factor is especially relevant for the expat mom, who is away from her normal support network. Add to that the fact that most new mothers spend a lot of time indoors alone with their babies, and you are left with serious social isolation.

What are the symptoms of PPD?

According to the DSM-IV, the main diagnostic manual used by mental health professionals worldwide, women suffering from PPD experience at least two weeks of depressed mood and/or loss of interest or pleasure. Additionally, at least four of the following symptoms are experienced:

  • rapid weight loss or gain
  • excessive or lack of sleeping
  • restlessness
  • loss of energy
  • hopelessness
  • excessive guilt
  • diminished ability to think or concentrate
  • recurrent thoughts of death

Some of these symptoms, such as lack of sleep, are of course normal when you have a newborn. Sometimes, however, these symptoms are outside the norm. For example, you can’t sleep even though your baby is sleeping or being taken care of by others, or you lose weight quickly because you are not eating enough.

If you are experiencing these symptoms and they are interfering with your daily activities and your ability to take care of yourself or your newborn, it is time to get help.

Getting help

The first and often most difficult step is to acknowledge that there is a problem. To help you do so, take this self-test. PPD might be common, but you do not need to go through it alone. Don’t try. It’s not worth it. You and your baby deserve and need better. Coming to terms with the fact that there is a problem is the biggest hurdle. When you are depressed, it is possible that you can’t imagine feeling better is an option, don’t have the energy to find help, and think you must be the only mother out there who could feel so bad and have such horrible thoughts.

The reality is this: You are not alone. Talk to someone you feel close to. They will not think you are crazy or a bad person. Call your family doctor (huisarts) or one of the organizations or therapists listed below for support. If that is difficult for you, ask your partner, a close friend, your midwife, or someone else that you feel comfortable with, to call for you. Having someone by your side will make the process easier.

Why do you need help?

If you don’t acknowledge the problem and you allow yourself to go untreated for PPD, you will be undertaking a long, lonely, difficult journey. The long-term emotional effects are adverse and wide-ranging. Everyone close to you can be affected adversely: yourself, your baby, your family.

But with the help of counseling and support groups, many women recover very well – and so can you!


List of organizations and practices that deal with PPD

Large organizations that have access to a variety of expertise and facilities. These possibly have waiting times and you might see several therapists:

Pop Expertise Centrum (also known as PopPoli) at Sint Lucas Andreas Hospital: You cannot make an appointment here yourself, but need to be referred by a family practitioner (huisarts) or a therapist.

PuntP: Go to the website for different locations and phone numbers. You do not need a referral here.

Mamakits (affiliated to the VU Hospital): No referral needed. Phone numbers are 020-7884570 (Amsterdam/Amstelveen) or 023-5187604 (Hoofddorp/Haarlem).

Infant Mental Health CentrumNo referral needed and they strive for first appointments to take place within 14 days. Can be reached through 020-5904949.

Independent practices without waiting times and with one-on-one therapists. Possibility of being referred to one of the organizations listed above when medication or hospitalization seems necessary.

Perspectief Praktijk: Private group practice, no referral needed, phone number is 020-6128290.

Access Counseling Service Network: Contact the counselor on call and you will be referred to a counselor who can support you through PPD. See who is on call here.

Of course you can also see me and reach me through 06-45180342 or I see individuals and couples with a range of concerns, including postpartum adjustment and (new) parenthood issues.

This article was also published on the website of Amsterdam Mamas.