Nothing was easy about Desiree Childress’s third pregnancy. Soon after she and her husband, Will, learned they were expecting identical twin boys, she experienced severe nausea. Having trouble holding anything down, she became dehydrated and IV lines for fluids were placed.

At about 18 weeks, preterm labor began and strict at-home bed rest prescribed. With two young daughters at home, Tiffany, 9, and Victoria, 5, Desiree found staying off her feet and reducing stress nearly impossible. Five weeks later, she was hospitalized.

Both nurses, Desiree and Will knew that these early complications and a twin pregnancy increased the likelihood of a premature delivery. Over 50% of multiples are born prematurely (before 37 weeks gestation), or weigh less than five and one-half pounds. Many preemie multiples require weeks of hospitalization and special medical attention.

By getting expert care in the hospital, Desiree hoped her babies would arrive close to term, but she also wanted to be prepared for the unexpected. David and Isaiah were born eight weeks early, each weighing a little over three pounds. “You really can’t prepare for the reality of delivering preemies, but knowing what to expect made it a little less overwhelming,” she says.

Julie Medas, a clinical neonatal nurse specialist at MetroHealth Medical Center in Cleveland, Ohio, agrees. She says that learning about the neonatal intensive care nursery (the NICU) and what a preemie looks like “won’t provide comfort, but it will give parents a sense of familiarity should their babies arrive early and need special care.”

Taking a Tour

Medas recommends that parents experiencing pregnancy complications ask for a tour of the NICU and visit a baby of comparable gestational age. “The perception is that seeing a preemie will overwhelm parents, but sometimes the imagination is far worse,” she says.

A neonatologist or a neonatal nurse can explain some of the medical equipment and common problems of preemies. Your hospital may also offer a video or booklet about the NICU. If information becomes stressful, cut your visit short and come back another day.

“The NICU can seem like a foreign land with an unfamiliar language,” says Medas. Take your time to absorb this new world, and don’t be afraid to ask questions. Some suggestions:

* What are visiting hours, and who can visit?
* Will my babies be placed near each other?
* How can I participate in my babies’ care?
* Does the NICU encourage skin-to-skin contact, music therapy, or infant massage?
* Are multiples co-bedded (placed in the same bed)?
* What resources are available to parents of premature babies and multiples?
* Is there a developmental program (occupational and physical therapy) for preemies?
* Is there a place for parents to spend the night?
* Is CPR training offered?

Researching Resources
On bed rest and with time on her hands, Desiree created a notebook of resources she’d need after the twins’ birth: “I made a list of dependable support systems, those who I could really count on like my church to provide meals and sitters my girls really liked.” She also included important names and phone numbers, such as her insurance provider and pediatrician, and she rented a pager so the NICU could reach her.

To find out what services and help you may need following your babies’ birth, talk with your hospital social worker or a nurse. Also, ask if there are any local preemie parent or mothers of multiples support groups: A parent of preemie multiples can offer first-hand advice. Mothers of Supertwins (631-859-1110) and The Triplet Connection (209-474-0885) offer programs and literature to support expectant mothers of multiples.

Desiree joined a mothers of multiples club in her third trimester. “At first, it was scary because all of the mothers of twins in the group had delivered prematurely,” she says, “but it also gave me hope to see that their children were okay, and they offered great support.”

Breastmilk Basics
When you’re coping with pregnancy complications and the risk of premature babies, thinking about breastfeeding can be daunting, to say the least. But learning about breast milk and how it can help your babies is something important you can do for your babies.

“Some doctors consider breast milk a medicine for preemies,” says Medas. Research shows breastmilk is less stressful on a preemie’s digestive system and kidneys, provides important antibodies that fight infection, and protects against allergies.

Babies who are born very small and very sick will not have the ability to breastfeed during their first days or weeks of life, but they can receive breast milk through a feeding tube placed in their nose or mouth. This means mothers have to pump and store their milk. A lactation consultant with knowledge of a preemie’s special needs can provide instruction. Ask your pediatrician, the hospital staff, or the La Leche League (800-525-3243) for a referral. Many NICUs have lending libraries that include breast-feeding books and videos, too.

“Even if you can’t or choose not to breastfeed, you can still provide your babies with the best nutrition possible,” says Medas. And it’s something only you, a mother, can do.

Preemie Parenthood
“I was prepared for the monitors and technology in the NICU, but it was still overwhelming to see those two tiny little babies,” says Desiree. “I couldn’t see their faces because of the wires and tape. I couldn’t hold them or feed them. I felt like I had really lost out.”

If your babies’ birth can’t be delayed and you become a parent of preemie multiples, like Desiree and Will, you’ll face many emotions: guilt, anger, sadness, and fear, to name a few. Having more than one baby adds to the stress: You may have two sets of medical complications to cope with, maybe even two sets of healthcare providers.

Making arrangements for help before your babies’ birth is a good idea (whether or not you delivery prematurely). You’ll need time to take care of yourself so that you’ll have the energy to take care of your babies and family.

After a difficult pregnancy, you’ll also need time to reflect on your losses. To help you cope with your feelings before and after delivery, consider starting a journal, or find someone who listens well (another parent, a social worker, a mental health expert, an Internet chat room (such as the TWINS Magazine Message Board), or a clergy member).

“Remember, feeling is healthy,” says Mara Stein, a Chicago clinical psychologist who delivered twin girls ten weeks early. “But if your feelings start getting in the way of your life, affecting your marriage or other relationships, or you find yourself constantly feeling sad, you may need professional help,” she says. Consult a trained therapist, such as a psychologist, psychiatrist, social worker, or family counselor.

“Becoming a parent of preemies is the hardest thing you’ll ever have to do,” says Desiree, whose twins are now eight months old. “But when I look at David and Isaiah and see them smile, I know it’s all been worth it.”

Amy E. Tracy is the author of The Pregnancy Bed Rest Book (Berkley Trade, 2001), and the co-author of Your Premature Baby and Child (Berkley Trade, 1999). Visit her Web site at www.pregnancybedrest.com.

Who’s Who in the NICU

Neonatologist: a doctor who is specially trained in the care of premature and sick babies
Registered Nurse: has graduated from an accredited school of nursing; these nurses provide much of the daily care of preemies.

Neonatal Nurse Practitioner: a registered nurse who has advanced training in neonatal care.

Clinical Neonatal Nurse Specialist: a registered nurse who has additional neonatal training in patient and nurse education.

Social Worker: can provide information on nonmedical care, such as insurance coverage, emotional support, and transportation.

Respiratory Therapist: a specialist who provides the respiratory needs of ill babies.

Developmental Therapists: help enhance a baby’s physical development.

Medical Specialists: doctors with further specialized training in such areas as the eyes, heart, lungs, and brain.

NICU Baby Books
NICU Notebook: A Parent’s Journal
Available from:
Mothers of Supertwins
PO Box 951
Brentwood, NY 11717
www.mostonline.org
877-434-MOST (6678)

The post Expecting the Unexpected: Preparing for an Early Delivery appeared first on TWINS Magazine.

Most people realize that there is a percentage of women who experience feelings of sadness after they deliver their baby or babies. The reality is that many people have no idea of the severity and complexity of life with PPD. 

In fact, there are a number of discouraging myths that keep many women from seeking help when they experience the signs of depression after delivery.  

In this article, we will look at what postpartum depression is, why it occurs, debunk some popular myths, and talk about how to get help for you or someone you love.

Postpartum depression does not have to derail your experience as a new mom of multiples. 

What is postpartum depression?

There is not one single underlying cause of PPD. Instead, experts believe that there is a myriad of contributing factors that lead to developing this form of clinical depression. 

Postpartum or perinatal depression affects as many as 1 in 7 women. It is so common that it is the most common complication of childbirth. 

Who is most likely to develop postpartum depression?

PPD can affect any woman. It strikes women who experience easy pregnancies, as well as, those with difficult pregnancies. First-time mothers and mothers who have one or more children can also experience PPD. It doesn’t matter if a new mom is married or single, and things like income, age, ethnicity, culture, and education make little difference in your risk of experiencing depression after birth.

One group of women who are at a higher risk of suffering from postpartum depression are moms of multiples (or MoMs). MoMs are much more likely to develop PPD than moms of singletons. While not all twin moms will experience symptoms, they are at an increased risk. 

What are the risk factors for postpartum depression?

• A change in hormone levels after childbirth 
• Previous experience of depression or anxiety 
• Loneliness, not having close friends and family around
• Family history of depression or mental illness 
• The stress involved in caring for a newborn and managing new life changes
• Having a challenging baby who cries more than usual, is hard to comfort, or whose sleep and hunger needs are irregular and hard to predict
• Having a baby with special needs (premature birth, medical complications, illness) 
• Lack of family support
• The health consequences of childbirth, including urinary incontinence, anemia, blood pressure changes, and alterations in metabolism
• The physical changes during and after pregnancy
• Other emotional stressors, such as the death of a loved one or family problems
• Financial or employment problems 
• Caring for twins, triplets, or higher-order multiples 
• Isolation and lack of social support
• Changes in the sleep cycle 

Difficulties with breastfeeding might also be linked to PPD. New moms who have difficulty breastfeeding in the first 2 weeks after delivering their babies have a higher risk of PPD 2 months later, according to a study at the University of North Carolina in Chapel Hill. 

What is the difference between baby blues and depression?

Many new moms confuse their own postpartum depression with the less serious “baby blues.” Baby blues happen when moms feel more melancholic than is typical for them after delivering their infant. As hormone levels drop, moms can feel moody, sad, tired, and generally “blue.” This is very different from PPD. 

Unlike the baby blues, PPD doesn’t go away on its own. It can impact a mother’s ability to care for her newborn. The symptoms are much more debilitating and longer-lasting. Any mom who is concerned about how she is feeling should talk to their doctor in order to stay aware of what is going on. 

How prevalent is postpartum depression?

Rates of PPD in singleton pregnancies

According to a report and statement issued by the U.S. Preventive Services Task Force, 8.9 percent of all pregnant women and 37 percent of new mothers experience clinical depression in the months before or after giving birth. Less research has been done on new fathers, but some studies suggest that about 10 percent of dads may also experience postpartum depression. For half of the women diagnosed with PPD, this is their first episode of depression. 

Rates of PPD in twin pregnancy

Moms of multiples experience PPD at a higher rate than singleton moms. Researchers have not yet isolated whether these higher rates are due to physical etiology (such as higher levels of hormones) or the additional stress of caring for two newborns. 

A 2009 study, published in the journal Pediatrics found that new MoMs were 43 percent more likely to have postpartum depression than were mothers of singletons. While not all moms of multiples will develop PPD, it is important for these MoM’s and their families to be on the lookout for potential symptoms.  

Recognizing the signs of postpartum depression

In theory, it sounds like it would be fairly simple to identify and treat PPD, right? 

The reality is that after delivering newborn twins, in the sleep-deprived newness of parenting, things can get muddy. MoM’s often think their sadness or anxiety will go away. They often blame their feelings on exhaustion. Understanding the signs of PPD can help to tease apart normal postpartum blues with true depression. 

What are the symptoms of postpartum depression?

The warning signs are different for everyone but may include: 

• A loss of pleasure or interest in things you used to enjoy
• Fear of not being a good mother 
• Eating much more, or much less, than usual
• Anxiety — all or most of the time 
• Fear of being left alone with the baby 
• Racing thoughts 
• Feeling guilty or worthless, including blaming yourself 
• Excessive irritability, anger, or agitation 
• Sadness, crying uncontrollably for very long periods of time 
• Difficulty sleeping, beyond the typical new parent lack of sleep
• Disinterest in the baby, family, and friends 
• Difficulty concentrating, remembering details, or making decisions 
• Thoughts of hurting yourself or the baby (seek help immediately if you experience this symptom).

What to do when you suspect postpartum depression?

If you suspect someone you love may be suffering from any form of postpartum depression, anxiety, or even blues – the first thing to do is talk about it. Many moms don’t even realize what is going on. In many cases, it is the loved ones that first recognize the symptoms. 

However, if you are feeling any of the earlier noted signs of PPD, talk to your doctor right away. There is no need to suffer in silence. PPD is treatable!

Fighting the stigma of postpartum depression

Despite the mountains of research surrounding postpartum depression and dialogue that is opening up, many women still feel a stigma when it comes to PPD. There are a number of myths that keep many people in the dark about the realities surrounding postpartum depression. 

Debunking the myths

Myth #1: Moms who have PPD don’t bond with their babies

Truth: Moms with PPD love their babies just as much as moms who do not have PPD. Depression is in no way a sign that a mom will not bond with her baby and love her twins the same as any other mother.  

Myth #2: You can only get PPD if you had a previous mental illness

Truth: While women with a history of mental illness (specifically a mood disorder) are slightly more likely to develop postpartum depression, any new mom can experience it regardless of health history. What’s more is that MoM’s who have experienced a mental illness in the past, are not necessarily going to develop PPD.  

Myth #3: Symptoms show up right after birth

Truth: In many cases, moms will not experience the symptoms of PPD for weeks (or even months) after giving birth. In some cases, women can display signs during the last stage of pregnancy and some won’t develop until as much as a year after delivery. Typically, the condition develops within 4 to 6 weeks after giving birth, but it can sometimes take several months to appear.

Myth #4: PPD will go away on its own

Truth: PPD is a serious condition that requires treatment. It often will not subside on its own and may require a combination of therapy and medication to alleviate the symptoms. Many new moms wait in hopes that the symptoms will retreat on their own, but inevitably prolong their negative feelings. 

Myth #5: Moms with PPD cry nonstop

Truth: Postpartum depression can take many forms. While some moms of multiples will be tearful, others will experience PPD as isolation, anxiety, or withdrawal. A woman does not have to cry around the clock to be experiencing PPD.  

Seeking help for postpartum depression

If you experience these symptoms during pregnancy or after delivering your babies you should talk to your doctor. Also, if you recognize any of these signs in someone you love, encourage them to talk to a medical professional. Many women delay seeking treatment for PPD and suffer in silence for much longer than is necessary. 

Too few women seek help for postpartum depression

In a survey published in the Journal of Psychiatric Practice, parents of twins or other multiples reported experiencing the most difficulty during the first three months of their babies’ lives. The study included 244 parents of twins and other multiples (including 197 mothers and 44 spouses or partners), asking about parents’ mental health during the postpartum period. 

They found that, although 48 percent of the study participants had struggled emotionally after their babies were born, very few got help. Many parents reported that with caring for multiple babies at once, finding childcare, and the financial stress of finding a therapist, often felt like another burden.

Coping strategies

In addition to psychological interventions and medication, there are a number of things new moms can do to help cope with the stress of parenting two babies. Using some or all of these coping skills in the face of PPD can help improve outcomes and manage symptoms. 

1. Get some exercise. Okay, maybe you aren’t ready to hit the gym but simply taking a walk, going for a bike ride, or even a few minutes of dancing with cranky babies can go a long way. 
2. Make time for yourself. While finding a few quiet moments for yourself may seem impossible, they are so important. Make sure to take a break and focus on yourself. Take a shower, talk to a friend on the phone, meditate, or do anything that makes you feel like yourself again. 
3. Stay on top of your diet. This point covers two important aspects. First, if you are breastfeeding make sure you are getting enough calories. Second, be sure you are making good food choices that will fuel your tired mind and body. 
4. Get your rest. This is probably the most laughable on our list. Once you are done chuckling at our suggestion, read on. We realize that adding an extra hour of sleep to your day is highly unlikely, remember that rest is more than sleep. A 20-minute power nap, meditation, or mindfulness and just a micro-break a few times each day can help keep you going. 
5. Connect with people. One of the biggest sources of melancholy new moms report is feeling isolated. Long hours spent just you and your babies can be an isolating experience. Connect with friends or family or join a Moms of Multiples group near you. 

Despite the growing body of information about postpartum depression and its impact on moms of multiples, there is still a gap that needs to be bridged. Too many women are left untreated and suffering in silence. The more information moms-to-be and new moms have, the more they can understand what is going on. 

Postpartum depression is a real diagnosis and is very treatable. Be on the lookout for the signs and symptoms. If you or someone you love are experiencing any, be sure to talk to a medical professional right away. There is no need to suffer in silence.  

Resources:

American Psychological Association – What is postpartum depression & anxiety?

Journal of Psychiatric Practice – Perinatal Mental Health Treatment Needs, Preferences, and Barriers in Parents of Multiples

Journal of the American Medical Association – Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression

Medical News Today – What to know about postpartum depression

National Public Radio – Mommy Mentors Help Fight The Stigma Of Postpartum Mood Disorder

National Public Radio – Pssst: Parenting Twins Can Be Depressing

Obstetrics and Gynecology – Early breastfeeding experiences and postpartum depression

Pediatrics – Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms

Postpartum Support International – Depression During Pregnancy & Postpartum

US Preventative Services Task Force – Perinatal Depression: Preventive Interventions

The post The Truth About Postpartum Depression appeared first on TWINS Magazine.