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Tuesday, 27 March 2012

Oxytocin: The Love Hormone – How to Find the Light in the Fog of PND


When a woman goes into spontaneous labour, a hormone called oxytocin is released in her body in huge quantities. Oxytocin (aka ‘the love hormone’) in a labouring woman causes uterine contractions, contributes to natural pain relief and floods her and her baby with intense feelings of bliss, priming them to fall madly in love with each other. Oxytocin is one of the main hormones associated with feelings of pleasure – hugs, kisses, skin-to-skin contact, breastfeeding and sex are some of the notable pleasurable activities that trigger our pituitary gland into oxytocin distribution.

Oxytocin is a shy hormone. It is very sensitive to interruptions; it hides from adrenaline and flees pain. A timid but powerful hormone that needs everything to be just right in order to do its important job effectively.

Is that why I developed postnatal depression? Was my oxytocin flow inhibited by the epidural I thought I needed? Perhaps. I believe the answer is, more likely, a little more complex: yes, but for a hundred additional reasons.

THE FOG

Postnatal depression was, for me, like sinking rapidly into a thick, damp fog that I could not see through in any direction. It was completely unexpected and confronting. Why did I allow myself to wallow in it for so long before I finally admitted I needed help?

Just over four years ago, my husband and I moved to a new city, far from any family or friends. Two weeks later I discovered, to my surprise, that I was pregnant. I suffered through the early months of my pregnancy; loneliness and anxiety exacerbated by all-day morning sickness. Usually a career-focussed employee, I suddenly found myself hurtling toward the realms of not working. Worried about the  perceptions of others, I fiercely judged my life direction and questioned my value in society.

Medically, my pregnancy was relatively uneventful. I underwent the standard checks and tests, all with the dutiful emphasis on finding something ‘wrong’. Medical personnel were busy and ambivalent. I was just another pregnant woman. Labour was overall socially and culturally acceptable – hours of contractions followed by an epidural, finally finished with a vacuum-assisted delivery. The baby was out.

My infant daughter was not the baby that the books described. She did not sleep according to the detailed charts or breastfeed according to the various timetables. She abhorred being alone. Instead, she cried. Often. Loudly and insistently. I held her and I cried along with her. What else could I do?

With my husband working long shifts, there were days when I believed that I could not have even five minutes to myself to eat, shower or brush my hair. Slowly, I found myself sinking into a hole.

Well-meaning advisor: “You just need more sleep. Formula will make her sleep better.”

Isolation and loneliness are essential fuels to depression and they were certainly the founding principles of mine. Although I was isolated geographically from family and friends, I was also isolated emotionally from any like-minded maternal community. Lonely in a house with only an unhappy infant for hours and a market of baby-care books that provided useless, empty promises.

Well-meaning advisor: “Just put her in her cot, and leave her to cry for [x] minutes.”
Well-meaning advisor: “Put her on the bottle – there must be something wrong with your milk.”
Well-meaning advisor: “Don’t put her in bed with you. It’s a dangerous, bad habit.”

Do this, do that. Don’t do this, don’t do that. Purchase this Essential Baby Product, along with a plethora of other Essential Baby Products. Adhere to this expert’s book. Watch this specialist preach on morning television. The complicated discipline of caring for my mammalian offspring was, clearly, a science of which I was proving woefully ignorant.

Well-meaning advisor: “If you hold her all the time, you’re creating a problem for yourself.”
Well-meaning advisor: “Feed her at [x] o’clock for [x] minutes and then she will sleep from [x] to [x].”
Well-meaning advisor: “Just put her in day-care and go back to work.”

Leaving her to cry alone felt physically wrong.  She liked to breastfeed whenever she wanted. She liked to be held. I did not want to be away from her – I just wanted to feel alright. Why were people telling me that the only way to heal myself was to ignore my baby? I did not need ephemeral baby-care solutions – I just needed nurturance as a Mother.

Hiding the truth began to feel imperative – a cultural necessity. My perception was that having a baby was supposed to be the greatest joy of my life – filled with tenderness, delight and love – somewhat resemblant of a television nappy commercial. Immense social pressure dictated that I should be like all the other Mothers – organised, efficient, groomed and happily wheeling my quiet, contented baby around.

I had brought this on myself. I deserved this. This was my punishment – a life sentence – just for being Me.

One day by about four months, I found myself sitting on the cold bathroom floor tiles, holding a razor in my hand that I had absolutely no idea with what I was going to do. Who had I become? And why? I did not want to die – but I just did not want to exist anymore. There was no way out. What was the reward for this? Suddenly it was all too hard. I was exhausted.

THE CLEARING

My husband encouraged me to see my GP and implored me to be honest. In tears, I told my doctor that I just couldn’t see the light at the end of the tunnel, that I wanted the ground to open up and swallow me. Gently looking me in the eye, he explained that it was not my fault, that I was doing nothing wrong. What a relief!  Right there and then, I felt the weight sliding from my shoulders.

After questioning me about my support networks and performing a mental-health plan, he recommended some ongoing counselling, urging me to reach out for support and to stop hiding how I felt. He also prescribed a low-dosage antidepressant – a 20mg SSRI, something not contraindicated with breastfeeding – and supported that weaning was not an option I would consider.

After about two weeks of taking the medication I started to notice a difference. Glimmers of light were appearing at the edges of my thoughts – I just had to try. There was time for me to shower each day, to brush my teeth and my hair. It was okay to smile and laugh because sometimes, things were worth smiling about. Happily, I slept beside my baby and wore her close to me in a sling during the day. I breastfed her whenever she needed.

I discovered my oxytocin.

Questioning what had set me onto this path of self-destruction, I embarked on a journey of emotional validation, reading, talking and soul-searching. I sought like-minded mothers to befriend, trawled online forums and joined a breastfeeding group. Most helpful was finding women with whom I shared a similar set of parenting and life values; finding those other mothers, who like me, struggled with the perception of what our culture implies a successful Mother should embody.

Two more months passed and I began to feel like my pre-pregnancy self again. The relief was immense – I felt that the Fog had lifted. By about eight months post-partum I began weaning myself off the antidepressant medication, determined to continue my hard work to keep the Fog at bay. On the inevitable bad days, I turned to those who would empathise warmly with a hug and offer only words of support.

“Oh, sounds hard. Do you need some company? Keep it up – you’re doing so well.”

Finally, I was feeling competent and confident as a Mother.
  
THE WAY FORWARD

A few months ago I gave birth to my second child. My son was born by candlelight, in the warmth of my home, at midnight in the depth of winter. At my side was my trusted midwife, my husband and three-year-old daughter. He was roared into the world naturally, confidently and blissfully by me – because I am a Mother.

Have I struggled with mood disorder this time? On and off. Have I sought help? Yes - from those who know what I have been through in the past. They tell me that they love me, and then remind me to take care of myself.

When my GP asked me if I had any family history of mental illness, I laughed and responded “no, but none of them are normal”. In hindsight, it is evident that there is indeed a genetic history of mood disorder, in particular on my maternal line.

Our parents raised us; we are raising our children. Amongst many other things, we are developing the emotional intelligence of our society – the very essence of our intrinsic human capability to live more emotionally-balanced lives. By more reverently, sublimely valuing our mother-baby dyads, we can in turn pass this strength on to our next generation: to our children as they become parents.

So how can we help mothers? Hold them. Hug them. Tell them that we love them. Empower women as mothers – return mothering to its rightful pedestal by valuing, embracing and nurturing the mother and her baby. Encourage mothers to hold their babies and respond to their instincts. Give childbirth back to women – it matters. Remind mothers that they have the toughest, yet most treasured job on the planet. Love them.

Nurture more oxytocin. What a difference it could make.

Wednesday, 21 March 2012

Not Guilty: When Judgment is in the Eye of the Beholder

Is it guilt? Or is it better described as regret, grief or sadness?

Imagine this: Your dear friend has a 2-week-old baby. On visiting her, you observe that she looks absolutely exhausted. She is alone all day. Her house is a mess; she is eating toast crusts for lunch. Her baby cries quite a lot, and she is struggling with overwhelming advice from all angles about how she should care for her precious baby. Your friend says, “I’m so stressed right now. I’m just so hassled and tired. I’m thinking of taking up smoking – not too many cigarettes a day, just enough to take the edge off."

What would you say?

Or perhaps: Your dear friend has an eighteen-month-old toddler. Visiting you one day, she collapses on a chair in the kitchen as her tot, dressed in little sundress, follows your child into the sunshine-filled yard. It is a bright mid-day, the sun is high in a flawless blue sky. “I’m so exhausted,” she says, sighing. You watch the tots playing on the grass, your child shaded under a hat and t-shirt, the sun beating down onto your her child’s bare skin. “I know she’s in the sun,” your friend continues, “but I just need to rest. She’s happy playing right now. I’m not going to go out there and bother her because I just need to take a break.”

What would you do?

Whenever something appears in the media in support of breastfeeding, or the risks of baby routines and sleep training, or the latest evidence about circumcision, or the risks of certain interventions in childbirth… the list goes on; the floodgates inevitably open with an influx of the accusation: “Parents should just support each other, instead of judging each other, and not make others feel guilty.”


Let’s have a look at guilt for a moment:

guilt  n.
1. a The fact of being responsible for the commission of an offense.  b. Law: The fact of having been found to have violated a criminal law; legal culpability.  c. Responsibility for a mistake or error.
2. a. Remorseful awareness of having done something wrong.  b. Self-reproach for supposed inadequacy or wrongdoing. (http://www.thefreedictionary.com/guilt)

The emotion of guilt is internal. By that I mean that it comes from within – if a person feels guilt, it is self-generated. No one can ‘push’ the emotion of guilt onto another. Looking at the definition of guilt, one can see that it overwhelmingly implies the sense of having done something wrong. So, is it possible then, for supplied information to impose guilt on another? Perhaps, by inference – but the feeling belongs to the person feeling it. If, by definition, guilt insinuates a feeling of having done wrong, then it is not possible to feel guilt if you are happy with what you have done. Is guilt the emotion you feel when someone mentions that breastfeeding to a routine could have been what contributed to a low milk supply and early weaning? If guilt implies knowing better but acting anyway – perhaps it would be better described as ‘regret’ – wishing you had known then, what you know now? Or perhaps sadness, or grief, that the incorrect information was given to you at the time.


Now, let’s have a look at judgement.

judg·ment also judge·ment  n.
1. The act or process of judging; the formation of an opinion after consideration or deliberation.
2. a. The mental ability to perceive and distinguish relationships; discernment:  b. The capacity to form an opinion by distinguishing and evaluating:  c. The capacity to assess situations or circumstances and draw sound conclusions; good sense:
3. An opinion or estimate formed after consideration or deliberation, especially a formal or authoritative decision (http://www.thefreedictionary.com/judgment).

So, what constitutes as judgement? Is a public reminder that feeding infant formula carries potential health risks a judgement of parents who artificially feed their children? No. Certainly not when parents who use it are led to believe it is their best option. Warning the risks of formula feeding, or advocating for breastfeeding is, quite simply, information. Is it a judgement of parents to publicly speak out about the misinformation supplied by Tizzie Hall, or the damage Gina Ford’s advice can do to a developing infant’s brain? No. It is, quite simply, information. Information that parents deserve, and have a right to hear. What parents then choose to do with that information, and how they feel about it, is very much their own volition.

Recently, world-renowned breastfeeding expert Dr Jack Newman appeared in Australia to speak at the Australian Breastfeeding Association’s series of Health Professional Seminars 2012.  On March 7 he was interviewed on Channel 10 Breakfast.  Although the interview was, I assume, intended to discuss the potential risks of bottle feeding, and the complications this can pose to a breastfeeding relationship despite the advice being perhaps well-intentioned, he was instead hounded by the interviewers, constantly interrupted and accused of making parents feel guilty. In fact, Kathryn Robinson began the interview with the statement, “When you have a baby... you’re handed your baby, and you’re handed your guilt.” Really? I don’t remember seeing any of my babies coming out with a side-order of guilt along with their gush of amniotic fluid. 

Finally, let’s take a look at support.

support  vb (tr)
1. to carry the weight of
2. to bear or withstand (pressure, weight, etc.)
3. to provide the necessities of life for (a family, person, etc.)
[...]
6. to give aid or courage to
8. to endure with forbearance
9. to give strength to; maintain

So essentially, what defines support? Among other technical definitions, it means help, encouragement and assistance; to hold up, to bear strength. Does help, encouragement and assistance mean remaining quiet when one has important, helpful information? Does it mean infantilizing parents by not telling them anything potentially upsetting, in the assumption that it may offend them? While I acknowledge that potentially upsetting information can be delivered in a disrespectful way, (eg. “Hey, formula KILLS babies. What the hell are you doing?”), it is doing parents disservices not to not give them the information they deserve. (Eg. “You sound exhausted. I know you want some sleep, but did you know that it will take up to a month of exclusive breastfeeding to return babe’s gut flora to normal after just 1 bottle of formula? How about I come and cook you some dinner while you take baby to bed for a nap.”)

Let us look again at those first two scenarios. In the first, would you be likely to say, “Well, you need to do what feels right to you. If you want to smoke, then go right ahead. A few cigarettes won’t harm you or your baby.” I’d hope not. I would imagine you would probably say something more like, “Gosh, you sound so tired right now. Is there some way I can help? Smoking carries quite a few health risks. I can give you some information, if you like. Otherwise, what can I do to help you get through this rough patch?”

And in the second, perhaps less dramatic scenario, what would you do? Would you just sit quietly, careful not to offend your friend? Or would you smile, perhaps give your friend a hug and make her a cup of tea, then grab a spare hat and sunscreen from the cupboard, and offer to go outside and pop it on her toddler while she enjoys a quiet cuppa?

As parents, we are all adults. We deserve encouragement, empowerment and information. And yes, we deserve support – a lot of support. But should that support come in the form of someone else blindly agreeing with you, or patting you on the hand and remaining silent, when they know something that might help you make a more informed decision? Does someone else’s passion for a topic mean they are judging you if they say something strongly converse to your own choices or beliefs?

If a parent has made what they feel to be an adequately informed choice, and they are happy within their family unit and everything is going swimmingly for them – then no matter what information is provided, they should have no reason to feel guilt. If they do – I would suggest there are some underlying issues that perhaps they could benefit from exploring and working through.

As adults, we need to own our emotions. We need to own our feelings – not blame others for putting them there. Sure, stand up for yourself and enforce boundaries if others are crossing them, (eg. "Hey, Joe Bloggs, that really hurt my feelings and I took that personally. Can we talk about that?") By listening to our feelings and acknowledging them, we allow the growth of our emotional intelligence. Fostering emotional intelligence is a gift we can give our children that was, for the most part, not given to many of today's adults.

Breastfeeding advocacy – only to empower and support mothers


The progression of life means that we are always going to learn things along the way that we wish we had known ‘back then’. Hindsight is 20/20, right? Let’s not fear the repercussions of providing information. Let’s treat parents like adults, and remind them that they are perfectly equipped to parent from their instincts; that mothers are perfectly equipped to breastfeed the vast majority of the time, and that their babies are babies – not miniature adults capable of adult cognition. You however, dear parent, are. And you deserve to be treated so.

Peace and love to you, xo.