One morning, more than 30 years ago, when my baby was only four days old, a friend drove my carpool. She got into an accident on the corner of Taney and Cross Country, and all the occupants of the car were taken to the hospital. I rushed to the emergency room to be with my children. My father also came. B”H, no one was badly hurt, and my strongest memory of that whole event was how worried my father was that I was walking around. He remembered how new mothers were treated when he was growing up in England and was sure that a woman who had just given birth should not be walking around. I felt fine, but he urged me to go home.
Different
Times
I asked Mrs. S, an elderly lady
whom I used to visit, about childbirth in pre-war Czechoslovakia, where she
grew up. “We children were very excited when we saw the midwife running through
the street with her black bag; we knew that a new baby was coming. As a
teenager, I was sent to a few of my aunts when they gave birth. Mothers were
not allowed to get off the bed at all for two weeks, so I ran the house during
that time. In fact, once, when two aunts were due at the same time, they fought
over me since I was considered more helpful than their other nieces.”
Was there such a thing as
postpartum depression? I asked her. Mrs. S. replied, “One of my aunts had a few
girls and desperately wanted a boy. Wouldn’t you know: She gave birth to
another girl. She didn’t want to look at the baby or nurse her. Maybe it was
her hormones, although we didn’t know anything about that in those days. The
father didn’t know what to do with his wife, so I said, ‘I’ll take her home
with me.’ I was ready to do it, too, and named her after myself. It didn’t
happen because, fortunately, by the time I left, the mother had recovered and decided
to keep her little baby.”
To
Rest or Not to Rest, That Is the Question
The customs and traditions of how
to treat women who have just given birth changes depending on the country and
the time that you live in. Halacha takes into account the frailty of a woman
after birth with various laws and customs. The Gemara says that we treat a
woman within three days of giving birth like a sick person in danger, and we
can do forbidden actions for her even if she says she doesn’t need it. There
are different halachos that
apply after seven days and after 30 days, but the understanding is that a woman
does not just bounce back into regular life the minute the baby arrives.
My son pointed out an interesting
insight regarding Shabbos candles. The poskim mention that it used to be
common practice for the husband to light the candles for the first week after
the wife gave birth. This practice acknowledged the difficulty the new mothers
faced in getting out of bed to light the candles.
Today, in Baltimore, women are
still having babies, but the general perspective is not to make much of a fuss
about it. That might not be a good idea, however, as an expert in our community
explains: Certified
Nurse Midwife Bayla Berkowitz has been practicing midwifery for 17 years in
both hospitals and at home. “Women try to do too much right after
childbirth,” she says. “I advise my clients to stay in bed or on the couch for
two weeks. Resting will
help them heal physically and stabilize their emotional health. It also
strengthens the nursing relationship. I encourage women to plan ahead
during pregnancy by lining
up help to do the other household chores, such as meal preparation,
laundry, and carpool, etc. Their job during those two weeks is to take care of
themselves and the baby. The emotional state of the mother is tied to her
ability to get the rest and
support that she needs. Postpartum depression is more common
today and can be somewhat
alleviated if family and community rally to help the mother rest
after giving birth.”
(You can reach Bayla at info@charmcitymidwives.com.)
How
to Help
I had never heard of a postpartum
doula until I met Avivah Kupfer. A licensed nurse for over 25 years, Avivah has been
helping families after birth since then, providing support, guidance,
education, sleep training, and help with lactation – whatever the family and
the mother need. “Family and friends who want to help should be proactive about
their offers,” says Avivah, who also does travel nursing. “Don’t ask, ‘What can
I do’; rather, say, ‘I am sending supper tonight’ or ‘I am taking the kids out
this afternoon.’ Nobody likes to be in the position of taking help from others,
so make it easy for the family to accept help.
“Don’t forget about the father.
Although he did not have a baby, he is also after birth and needs the support
of his friends and family. He is probably also tired from dealing with a crying
baby at night. I always ask my daughters when they have a baby what I can get
for their husbands. A nice gift for the mother may be something to pamper
herself, like a gift certificate for a manicure or a restaurant. Having a baby
is a big simcha, but it is also a challenging event, and families can use a lot
of support.” (Avivah can be reached by call/text/WhatsApp at 216-800-2816.)
When Things Go Awry
In a Bina magazine letter to
the editor, a woman describes not receiving help for her postpartum depression:
“Days seem endless and lonely,
somehow melding into this mass of tears, burnout, and exhaustion. I end up
feeling uncared for and forsaken…. I longingly await the day when
someone will wake up and say that people suffering from depression also deserve
to be taken care of, loved, and cherished.”
When asked how things
have changed over the last few decades, Chaya Spigelman, PA-C, Perinatal
Mental Health Certified, says that “New mothers sometimes live far away
from their extended family and do not have the help of their mothers or
sisters. Social media puts a lot of pressure on new mothers to look perfect and
bounce back to regular life directly after childbirth – after all, everybody
else seems to! And there is pressure to go back to work as soon as six to
eight weeks postpartum in some cases.”
According to Chaya, more
cases of postpartum depression are reported today than approximately 30
years ago. That may be because of heightened awareness of the problem,
increased screening, and decreased stigma about mental illness rather than an
increased rate of the illness itself. Yet such issues as financial
insecurity, lack of adequate maternity leave, and minimal options for
affordable childcare are important factors that have led to increased emotional
strain on childbearing women. “While awareness is improving, many women still
do not receive timely diagnosis or treatment,” says Chaya. “There is a need for
continued education, access to care, and supportive policies. In the meantime,
family, friends, and neighbors can be a lifeline for a new mother by offering
support in the form of meals, cleaning help, and childcare.”
Other important resources include lactation professionals for nursing mothers, general
feeding consultations, postpartum doulas, AIM, here in Baltimore, and baby
sleep coaches and night nurses. This is because problems with feeding, lack of
postpartum support, and disrupted sleep are risk factors for development of
postpartum depression and anxiety. (Reach Chaya at 646-397-7210)
* * *
Since postpartum mental health
problems are becoming more common, it would help for the community to be more
aware of the symptoms. A local therapist shared this list of symptoms of
postpartum depression, which become more serious the longer they last:
irritability, sadness, ruminative thoughts, racing thoughts, anxiety about
getting sick or hurt, feeling of guilt or shame, a distant or withdrawn look in
the eyes, not connecting with the baby, not being able to sleep when the baby
sleeps, not eating or drinking, anger, sleep disturbances, and decreased
interest in preferred activities.
·
Normal: mood swings that come and go for
the first week or two, mixed feelings, feeling misunderstood, brain fog,
difficulty concentrating, and decreased motivation.
·
Yellow flag: Any symptoms lasting more than a
few days.
·
Orange flag: Any symptoms lasting
approximately two weeks. Note: a
mother is more at-risk if she has a history of trauma, abuse, chronic fatigue,
chronic pain, mental health concerns before delivery, pregnancy/delivery
complications or birth trauma, or postpartum anxiety or depression following a previous
pregnancy.
·
Red flag: Any symptoms lasting more than
three weeks. Note: look out for
not attending appointments or taking psychiatric medication and overuse of pain
medication or sleep aids (including Benadryl, ZQyl, ambien, etc.)
·
Pikuach nefesh: paranoia, hallucinations, fear of
hurting the baby, thinking the baby is “evil” or the baby “hates me,” thinking
the baby or family would be better off without her, fantasizing about her death
or the baby’s death, sudden reckless behavior, decreased need for sleep for
more than two days, acutely elevated mood with increased confidence,
and reference to spiritual themes. If she mentions self-harm or
harming the baby, do not leave her alone. Remain calm, call Hatzalah/911, and
follow-up with a perinatal mental health professional.
When offering help, says the
therapist, “Remember that what you would want others to do for you is not necessarily
what someone else wants. Some very well-meaning people inadvertently make
things worse because they think they know what is better for the mother than
she knows herself.” To help a new mother who is struggling:
·
Open the “door” gently:
Ask twice. Start
with: “How are you?” and follow with, “And how are you, really?” Maintain eye
contact, soften your tone, and stay silent long enough for a real answer.
·
Validate, don’t fix: Swap advice for empathy. Try: “It
sounds exhausting and scary. Many mothers feel that way and deserve support.”
Avoid anything starting with “At least….” Such statements shut conversation
down.
·
Offer options, not
orders: “Would you
like me to call your midwife for you?” “Our community has therapists who
specialize in perinatal care. Do you think that could help?”
Take
AIM
In Baltimore we are lucky to have
an organization called AIM, whose sole purpose is to provide support to new
mothers. They have elevated “help” to an art form. I spoke to Yael
Schwarzenberger, executive director. Her enthusiasm could barely be contained
over the phone lines.
“Since AIM started three years
ago,” she said, “we have helped about 1,000 families. By helping the mother, we
help the family and, by extension, the community. We send meals and cleaning
help, as well as help with the other children in the family. We partner with
Bnos Yisrael and Bais Yaakov with a Helping Hands program that provides
volunteers to help with the needs of the family.
“We have expanded our program
recently to include support groups, such as our lactation support group and our
Mommy and Me program. We also have a WIC liaison program to help people access
government funds if they are eligible.
One in five women suffers from
postpartum depression after birth, and since we are already connected to the
women through our other programs, we are available if serious problems develop.
We help mothers by recommending resources that help with mental health issues.
We follow up with our mothers after AIM’s services are over to make sure
everything is going well.”
*
* *
Helping new mothers when they have
babies is a universal chesed that is
available to everyone. Supporting families as they grow helps create a stronger
community.
