• Feeling restless or irritable
• Feeling sad, hopeless, and overwhelmed
• Crying a lot
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Trouble focusing, remembering, or making decisions
• Feeling worthless and guilty
• Loss of interest or pleasure in activities
• Withdrawal from friends and family
• Having headaches, chest pains, heart palpitations (the heart beating fast and feeling like it is skipping beats), or hyperventilation (fast and shallow breathing)

After pregnancy, signs of depression may also include being afraid of hurting the baby or oneself and not having any interest in the baby.

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Depression can be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended time. Depression can be mild, moderate, or severe. The degree of depression, which your doctor can determine, influences how you are treated.

How common is depression during and after pregnancy?

Depression that occurs during pregnancy or within a year after delivery is called perinatal depression. The exact number of women with depression during this time is unknown. But researchers believe that depression is one of the most common complications during and after pregnancy. Often, the depression is not recognized or treated, because some normal pregnancy changes cause similar symptoms and are happening at the same time. Tiredness, problems sleeping, stronger emotional reactions, and changes in body weight may occur during pregnancy and after pregnancy. But these symptoms may also be signs of depression.

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During pregnancy, fat deposits can increase by more than 33 percent. Most women who gain the recommended amount of weight lose the extra weight in the birth process and in the weeks and months after birth.

Breastfeeding also can help you lose extra weight by burning extra calories. Breastfeeding burns at least 500 calories each day. Find out more about what you should eat and avoid while breastfeeding.

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There are different types of individual and group “talk therapies” that can help a woman with perinatal depression feel better and do better as a mom and as a person. Limited research suggests that many women with perinatal depression improve when treated with anti-depressant medicine. Your doctor can help you learn more about these options and decide which approach is best for you and your baby. The next section contains more detailed information about available treatments.

Speak to your doctor or midwife if you are having symptoms of depression while you are pregnant or after you deliver your baby. Your doctor or midwife can give you a questionnaire to test for depression and can also refer you to a mental health professional who specializes in treating depression.

Here are some other helpful tips:

• Try to get as much rest as you can. Try to nap when the baby naps.
• Stop putting pressure on yourself to do everything. Do as much as you can and leave the rest!
• Ask for help with household chores and nighttime feedings. Ask your husband or partner to bring the baby to you so you can breastfeed. If you can, have a friend, family member, or professional support person help you in the home for part of the day.
• Talk to your husband, partner, family, and friends about how you are feeling.
• Do not spend a lot of time alone. Get dressed and leave the house. Run an errand or take a short walk.
• Spend time alone with your husband or partner.
• Talk with other mothers, so you can learn from their experiences.
• Join a support group for women with depression. Call a local hotline or look in your telephone book for information and services.
• Don’t make any major life changes during pregnancy. Major changes can cause unneeded stress. Sometimes big changes cannot be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

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• Talk therapy. This involves talking to a therapist, psychologist, or social worker to learn to change how depression makes you think, feel, and act.
• Medicine. Your doctor can give you an antidepressant medicine to help you. These medicines can help relieve the symptoms of depression.

Women who are pregnant or breastfeeding should talk with their doctors about the advantages and risks of taking antidepressant medicines. Some women are concerned that taking these medicines may harm the baby. A mother’s depression can affect her baby’s development, so getting treatment is important for both mother and baby.

The risks of taking medicine have to be weighed against the risks of depression. It is a decision that women need to discuss carefully with their doctors. Women who decide to take antidepressant medicines should talk to their doctors about which antidepressant medicines are safer to take while pregnant or breastfeeding.

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Postpartum depression can affect a mother’s ability to parent. She may lack energy, have trouble concentrating, be irritable, and not be able to meet her child’s needs for love and affection. As a result, she may feel guilty and lose confidence in herself as a mother, which can worsen the depression. Researchers believe that postpartum depression can affect the infant by causing delays in language development, problems with emotional bonding to others, behavioral problems, lower activity levels, sleep problems, and distress. It helps if the father or another caregiver can assist in meeting the needs of the baby and other children in the family while mom is depressed.

All children deserve the chance to have a healthy mom. All moms deserve the chance to enjoy their life and their children. Don’t suffer alone. If you are experiencing symptoms of depression during pregnancy or after having a baby, please tell a loved one and call you doctor or midwife right away.

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There are some factors to consider before breastfeeding your baby. We have compiled a list of some reasons breastfeeding may not work for you. In any case, it is of utmost importance that you consult with your health care provider and be certain that breastfeeding is safe. Most everything you put into your body can be transferred to your baby through breast milk.

• Some medicines, especially mood stabilizers and migraine medications, can be transferred to your baby through your breast milk.
• If you are taking any over-the-counter medications, prescriptions, or herbs, check with your doctor.
• If you have tuberculosis
• If you have a history of alcohol abuse or currently have an alcohol problem
• If you have a history of illegal drug use, or are currently using drugs
• If you have certain chronic illnesses (your doctor can advise you)
• If you have diabetes, you must eat a bit more to insure your blood sugar will not drop
• If you have had breast surgery, breastfeeding may not work for you
• If you HIV/AIDS

Other Breastfeeding Symptoms

There may be times when breastfeeding becomes too discouraging. You may wonder if you should stop nursing your baby. If any of the following happen, do no give up easily. You can still successfully breastfeed.

• Engorgement or hardening of the breasts
• Breast abscess
• Sore, cracked, or bleeding nipples
• Fever
• Use of antibiotics or some pain medications

If your breasts become engorged or hardened, it may solve your problem if you empty them by hand expressing or with a breast pump. The best way is to see if your baby will nurse away the excess milk. In the first few days of breastfeeding, it is normal for your breasts to become very tender, chapped, cracked and very sore. Ask your doctor about what creams or ointments your can safely use to help them heal quickly and are still safe for baby. In any case, the tenderness will go away as your nipple get used to nursing. In the case of antibiotic or pain medication use, your doctor can advise what is safe.

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Risks and Benefits of Planning a C-Section

What is more natural than a vaginal delivery?  It is the accepted way of bringing a child into the world.  Not so many years ago a c-section delivery was only done if there were some sort of complication.  Indeed, women who ended up having a c-section where considered deprived in some way because she didn’t get to “do it right”.  Well, times have changed.

Some mothers are concerned that a c-section baby may not take to the breast as easily as one born vaginally.  Another worry is that the bonding processes will somehow be disturbed.  But neither is true.  All studies have shown that babies born vaginally and the ones born by c-section react to breastfeeding appropriately.  The bonding process happens over time.  Nevertheless, now days a c-section mother can hold her baby right after birth just the same as long as she communicates her wishes to the doctor.

The death rate for full term babies born vaginally is 2 in 1,000. Those numbers go up if the baby is 10 pounds or more, is in a breech position, or in the case of multiples.  In those cases it is more likely that forceps are used to get the baby out. Use of forceps can cause damage to the baby.  The main reason for this is that the trip through the birth canal can cause brain injury, it’s rare but it happens.

The medical world could really benefit from more thorough research on the subject of vaginal versus c-section delivery.  Many obstetricians feel it is their ethical obligation to talk women out of elective c-sections.  Others believe that women should be informed and choose for themselves.  Those who believe that c-sections should only be performed for medical reasons refer to the risks involved.  C-sections are major surgery which brings risks of infection, excessive bleeding, and painful recovery.  C-sections also mean risks in future pregnancies.  If the uterus ruptures, although it is rare, the life of the mother and the baby is in serious danger.  Babies born by c-sections have more breathing problems right after birth.

Physicians and other health care workers who support elective c-sections say that the surgery can protect a woman’s pelvic organs, reduces the risk to bowel and bladder, and is at least as safe for the baby as vaginal delivery.

In either case, child birth is going to be painful.  In vaginal deliveries, the pain of labor lasts hours and you just can’t know when it will end until the baby is actually born.  But, recovery is only slightly painful; in many cases it’s just uncomfortable.  In the case of c-sections, there is no unlimited time of painful labor but recovering from major surgery can be very painful.  Recovery can take up to 6 weeks.  If you are considering an elective c-section, you must find a doctor willing to do it and educated yourself to the pros and cons.  Only then can you feel confident in your choice.

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Prolonged labor may lead to the decision to perform a c-section. If labor has been intense and more lengthy than advisable, a physician may decide on surgery.

Dystocia is an abnormal or particularly difficult labor or childbirth.

Fetal distress is the presence of signs in a pregnant woman that that the fetus is not well or is becoming excessively fatigued. These symptoms may present either before or during childbirth.

Cord prolapse is when the umbilical cord precedes the fetus’ exit from the uterus.

Uterine rupture typically occurs during early labor, but may already be present during late pregnancy. The reliability of the middle layer of the uterine wall is breached.

Placental problems such as placenta praevia where the placental lining is separated from the uterus. Or, placenta accrete, an abnormal attachment of the placenta to the middle layer of the uterine wall.

Breech or traverse positions. Breech is when the baby enters the birth canal with the buttocks or feet first. Traverse position is sideways.

Failed induction of labor. When labor has been induced by various methods, but has failed to cause productive results.

Failed instrumental delivery. The use of forceps and other instruments.

Overly large baby. When the baby is just too big to fit through the birth canal.

Umbilical cord abnormalities.

Other complications of pregnancy and preexisting conditions include but not confined to:

• Pre-eclampsia
• Hypertension
• Multiple births
• High risk fetus
• HIV infection of the mother
• STDs
• Previous c-section
• Prior problems

There are many factors involved in the decision to perform a c-section. We have only touched on the more frequently presented ones. You should always consult with your physician if you any concerns and questions.

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Studies show that VBACs are more risky for the woman and baby than a repeat c-section. The most serious danger of VBAC is the chance that the c-section scar on the uterus will open up during labor or delivery. This is known as an uterine rupture. While extremely rare, uterine rupture is very dangerous for the mother and the baby. Less than 1 percent of VBAC lead to uterine rupture. Even so, uterine rupture can lead to life threatening bleeding for the mother and brain damage or even death for the baby.

In a study of over 30,000 pregnant women who had prior c-sections, 73% had successful VBACs. The remaining 27% tried to deliver vaginally, but ended up having another c-section. While rare, problems with the mother and the baby were more common in the VBACs compared with the repeat c-sections. Only 0.8% suffered a uterine rupture. Women who tried VBACs required more blood transfusions and a greater risk of endometriosis than those who had repeat c-sections. Babies born by VBAC had a higher risk of brain damage than those born by repeat c-sections.

The number of VBACs is dropping in the United States for a number of reasons. Doctors and hospitals are threatened by the number of possible lawsuits brought on by unsuccessful VBACs. Stiff guidelines are often imposed, requiring a standby surgical team be available during a VBAC. The expense and the risk, the health care workers construe, are just too high. Doctors are also discouraging or simply refusing to perform VBACs. Often this is because their affiliated hospital doesn’t allow them to. In other cases, doctors cannot get malpractice insurance to cover claims related to VBAC.

The decision to try VBAC is a serious one. Discuss the pros and cons with your physician and understand his/her level of confidence in the matter.

VBAC Considerations

Doctors may evaluate some of the following considerations when making the decision whether or not to go ahead with a VBAC:

• A women has had 1 previous planned c-section done with a low horizontal cut (bikini incision)
• A woman has no other uterine scars (aside from the prior c-section) or problems
• A woman has no known problems with her pelvis
• A doctor is present during all the labor and delivery and can perform an emergency c-section if needed
• An anesthesiologist and others of a surgical team are standing by in case an emergency c-section is required

The decision is not an easy one, nor should it be. The risk of a VBAC has its positives and negatives. Do your research and know yourself. Have serious conversations with your doctor, then make the decision for VBAC or not.

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