Postpartum Depression: A father's comment -- strategy for relief

My job, as I see it, is to make a child’s life better if I can. The comment that this father emailed to me about a blog post gave me a glimpse into the first days of their lives as new parents. So I tried to break this situation down into problems that I could solve.

First, the wrist. This was my first target because it was the easiest. With sleep deprivation, small but persistent annoyances can appear as giant and impenetrable problems. They can be the spark that starts big fires. I brought the parents into my office and found the right kind of splint on my computer. I gave them the printout and told them to buy it that same day. Mom was to wear it all the time, except when showering or sleeping. The thick aluminum bar in the splint would prevent the wrist from flexing, allowing the tendons to heal on their own.

Then, the breastfeeding. The father said in his comment, “…we keep telling ourselves the benefits the baby will receive from breastfeeding will far out way [sic] a strictly formula diet.” Maybe it’s heresy, but breastfeeding may be best for the baby, but by how big a margin? Will one bottle of formula a day (maybe less than 10% of the baby's total nutrition) make a real difference? There's an interesting article on this from The Atlantic magazine, which poses this question. My priority is clear: what’s best for the baby? Breastfeeding dogma, which is powerful here in Berkeley, would have us believe that there is no other way. I saw an alternative path that I’ve used before.

• First, I need to relieve some of the relentless pressure on this first-time mother. By giving her permission to feed the baby pumped breastmilk or even a couple of ounces of formula once a day, I might be able to absolve her of some of her performance anxiety. She’d worry less about the baby not getting enough and worry less about her own inadequacy. And skipping a direct feeding might give her a needed relief for her soreness.
• Second, I needed to find a way for her to get help she could have confidence in. This would also take some pressure off.
• Third, dad needed to be involved. He needed the opportunity to shoulder some of the burden his wife had been under alone. He also deserved an opportunity to step into his baby’s life.

Every night, they were to give the baby one bottle feeding. Dad would do this feeding by himself, so mom could sleep. True, it would be in the middle of the night. But dad would have this precious time for just him and his baby, in which he was meeting all the baby’s needs and the needs of his wife, too.

I saw this family again about a week later in the office, though I had called and spoken to them on the phone several times in the intervening week. Everything was better. They were still tired, but mom’s mood had brightened a lot and dad was now king of the night-time feeding. When I asked how things were going, mom told me a lot but when she was done, dad had a lot to add about the baby’s expressions and actions and feeding behavior and sleep pattern. He really knew.

Postpartum depression, and perhaps depression in general, seems sometimes to blind us to paths leading out of the dark places in which we sometimes find ourselves.


Next Post: Do 8-year-olds get depressed?

Postpartum Depression: A father's comment--observed

A father’s Comment, observed.

In my last post was the comment of a new father. This story has many elements in common with a lot of the cases of postpartum depression that I have seen. The mother isn't overtly depressed, and wouldn't identify herself as depressed. Dad says that he is, but is quick to say how happy he is. But when I read this, I don't get a happy feeling. I think most readers will hear the tone of sadness throughout the comment. Professionally speaking, I don't think things are going all that great for these parents and I don't fully believe that either one of them are really happy with the situation.

Can I relieve some of this suffering? Does it have to be this way?

Her Mood:
When I received this comment, I called the family and asked them to come in to the office. The baby was doing fine, which enabled me to focus on the parents. Just as hinted at in the father's comment, mother was at the same time territorial about the baby's care and yet feeling overwhelmingly pressured to do everything herself. I started with the usual, ‘How are things going?’ She said everything was going fine, and she felt good. But every time I asked about something specific, it was a different story. Mom used a lot of tissues during the visit.

Breastfeeding:
For this mother, as she saw it, nothing was going the way it should. Breastfeeding was very painful, and she had been told it wouldn’t be. She was very afraid that the baby wasn’t getting enough, even though his weight gain was good. To her, he always seemed hungry after nursing because he continued to want to suck. She couldn’t stand his screams. The baby was telling the world that what she was producing, what she was doing, just wasn’t good enough.

Dad’s Mood:
She didn't think the father could do a lot of the tasks she did, but never asked him for help or showed him what she wanted. She never let him help, and was angry at him for not helping. He felt like an outsider looking in, saddened by his isolation and by his own helplessness.

The Wrist:
The mother felt bad enough without the excruciating pain in her wrists. Every time she went to pick up the baby, she felt that she was destined to wince in pain. She didn't know who to tell about this problem, but I'm glad the father told me. She had something called nursemaid's wrist. (Important note: this has nothing whatever to do with nursemaid's elbow.) It's an overuse injury that you get from picking up babies all the time. The fix is rest. What I told her to get was a wrist splint with a metal bar in it for stiffness. All the wraps and elastic things won't help. The wrist has to be immobilized for the inflamed tendons to heal.

It’s tough enough to keep your spirits up when you’re in pain. But she told me that her wrist pain made her feel bad. She explained that every time the baby cried, she dreaded having to pick him up, as if he were causing her pain. She felt terribly guilty about these feelings and knew it wasn’t the baby’s fault—it was her fault.

As an aside, this brings up once again a philosophical problem with medical care. I'm the baby's doctor and the baby was doing OK. Should I mind my own business about everything else? Hint: what do you think?

Next Post: A strategy

Postpartum Depression: A father's comment

Shortly after posting New Mother, Breastfeeding I received a comment online. The original comment had a lot of names in it, which I have removed. I am posting the comment with permission.

Hey Dr. Wolffe,

[Our son] was born Jan 18th, which makes him just eight weeks old today. You've been seeing his mother since his second week or or so. His mother will be in with him on Tuesday I believe. We were so thankful for gaining you as [his] pediatrician.

Now for the topic of discussion. my wife still struggles daily with breast feeding. We've had many a discussion, and for the most part I try to back off and let her handle it. Their her breasts, not mine. Her mothers made comments about her sister not having the same troubles. She's had problems with engorgement, so on and so forth. But, everything is getting better from day to day as well. He screams at the top of his lungs when he's hungry. My wife still gets up at all hours of the night. We hardly sleep together since she's up so much. We've had lots of help over the past few weeks from her mom and sister. During the first couple of weeks my mother was here helping out with what she could. Every now and then I see the PPD monster climb out, but after a little bit of rest and noticeable improvement with the baby, PPD settles down. I am the husband, and I feel a little depressed from time to time. I'm not to worried about it since overall, I am happier than I've been in years. Marriage and fatherhood have been great for me. Now if we can just keep ironing out all the wrinkles that come along with being new parents.
My wife's number one complaint is pain from him tugging on her breasts.
#2 is her sore wrists. He's getting heavy fast. Heck I'm twice her size and he strains my wrists too.

For her first complaint, I've asked her to continue to go to breast feeding class, so they can help her master the technique. I notice sometimes her posture and technique of latching don't go hand in hand with what I watched her being taught at Alta Bates [Hospital]. I tried to point these things out, but it mainly causes arguments.

I have sat with her and helped with the entire process. I do admit, she's getting better, and the baby's feeding better. In the evening I don't think she's producing so much milk, so a couple of times we have supplemented formula to give him a full belly. This takes care of the crying.
Her sore wrists don't seem to be getting any better yet. I have purchased her several different athletic supports (splints) to help out, but they aren't working too well. I've asked her to ice, but I've never seen her actually do it or heard her say she has. Being an wrestler in high school, college, and post college, I can attest to ice being the miracle drug for joint pain, bursitis, strains, sprains. Icing twenty minutes on and ten minute ice massage are uncomfortable at first, but they works.

Today we went out to REI in Berkeley, and ended up cutting our trip short as she was having too much pain in her wrist to breast feed him in the car. I realize this is uncomfortable, so I encouraged her to put a pillow or something in the car so she can feed him comfortable. We went home.

I was very pleased this afternoon to get him to take a pacifier for about twenty minutes. He did well. I can see smoother sailing ahead for all.

So for all concerned, we keep telling ourselves the benefits the baby will receive from breastfeeding will far out way a strictly formula diet.

Next Post: My response and follow up