Having a new baby is usually a wonderful time during those first few days full of quite a bit of emotions – usually a mixture of elation shared with celebrations with friends and family, along with some tears mainly from fatigue and hormonal fluxes.

But during the past few weeks with all the ‘shelter-in-place’ recommendations, many new moms are reporting they feel a rise in anxiety level due to indefinite periods of social isolation, unavailability of family support and more importantly fear of their children acquiring COVID-19.

The entire time of welcoming a new baby has been transformed from a warm, celebration involving family and friends overflowing with hugs and kisses, to a time where only one support person is allowed, with extensive screening and smiles are covered with masks and hugs are replaced with a 6-foot-distanced wave.

Social isolation and lack of physical and emotional support has taken a toll on mothers physically as well and mentally, creating increased anxiety and stress. Not only are new moms tackling the hardest job in the world (being a new parent), but they are doing it during the arguable most stressful time in recent history…and on NO SLEEP!!

If you are a new mom and feel overwhelmed by some of these feelings, you have every right to feel that way! And you can cry a few tears! These are unprecedented times and your hormones are crazy and you have not slept and you are scared. Reach out and call your friend, your sister, your mother or your pastor and ask for help or simply let them know how you feel. Tell your partner you need help or a nap or a drive around the block. Call your obstetrician or pediatrician and let her know you are feeling anxious. Counselors and physicians are providing telemedicine now and are able to screen for post-partum depression and anxiety if these feelings are more than you can handle at home. Here's a good resource to find therapists who may offer teletherapy during these times. 

Prioritizing Self-Care

Every time we fly, we hear the flight attendant share the Oxygen Mask Rule: “Should the cabin lose pressure, oxygen masks will drop from the overhead area. Please place the mask over your own mouth and nose before assisting others.” We know that without our oxygen mask, we will quickly lose consciousness. If we don’t make putting on our mask our first priority, we will likely not be able to help anyone. That is why as pediatricians, we address the health and well-being of our moms in order to ensure that our babies are being taken care of as well.

As a new mom prepares the nest for her baby, remember the “NEST-S principles of Self-Care” : Nutrition, Exercise, Sleep, Time for Self, and Supports! When barriers to nutrition have been placed such as a simple trip to the store, remember to ask those grandparents who want to help to place an order for a grocery or meal delivery. A walk around the house, patio or up and down the driveway can boost the mood, and the Vitamin D! Sleep is a rare commodity, so when that baby sleeps, remember to grab a nap! Take this time of isolation to read a positive quote about what a great mom you are! And investigate some innovative supports for new moms.

New resources have been developed knowing that our moms face special challenges during these times. These include the Postpartum Support International at www.postpartum.net/ , supports groups and information at www.postpartumdepression.org , virtual support groups like www.thebloomfoundation.org/mom-support-group/ and the Mom Center at https://graemeseabrook.kartra.com/page/the-mom-center .

The main point to remember is that even during this period of isolation you are not alone. Reach out and let someone know you need a boost. Know that this will end soon, and you can celebrate your baby with those you love!

1. I’d be Terrified the Day my First Child was Born. Guess what? Reading tons of books about the health of children makes you no less prone to the paralyzing fear that arrives when that new cute little elephant-in-the-room appears. I wish they came with an instruction manual instead of a placenta.
2. Breastfeeding Ain't Easy. I had a lot of difficulties breastfeeding one of my children. He had horrible reflux, a poor latch, and a stubborn disposition. I thought, "hey – breastfeeding shouldn’t be that bad, right? You just put the baby on the boob and they figure out the rest!" Nope. It’s no wonder there are some wonderful people out there who dedicate their whole career to helping women breastfeed. And guess what? I had to use some formula to get my kid through his first year. And that’s OK.
3. Children Sometimes (All the time) Don’t Go By the Book. First teeth don’t always appear when the books say they do. Weird rashes never look like the pictures online. My daughter had lots of motor delays, way past when the books said she should….and she’s fine now. It takes the experience of a good pediatrician to let you know when to worry, since all kids are so different. We gain experience via treating thousands of patients with time. I had to take off my pediatrician hat and only wear my mama hat when it came to my kids. And had a great pediatrician reassure me that everything would be OK.
4. Fevers Make Me Worry, Too. My son once woke up with a 105.6F temperature when he was a toddler. Of course I was supposed to be seeing patients in the office 20 minutes later. That was one of the most difficult mornings of my life. I had to choose who to care for – my son, or my patients? I took some deep breaths and tried to talk myself through what I tell my patient’s parents. Warm bath, dose of ibuprofen, lots of snuggles (with Daddy). He was fine. But it reinforced why I’ll never judge a parent who is worried even about the tiniest of temperature elevations. 
5. Living with a Toddler is Like Living with an Irrational, Angry Drunk Person. I’d read all the books about effective behavior management. Learned techniques for distraction, offering choices, creating reward charts. But when your three year old is flailing on the floor, mopping the tile with his Oscar-worthy tearfest all because I offered the blue plate instead of the red one…one questions how many bottles of wine to buy for the week.
6. Explaining Simple Things Can Become Very Difficult. “Why is that man in a wheely-chair, Mommy?” “Why did Harper’s dog die? Where did he go?” “How do planes work?” “How come kids go to different churches?” Being a board-certified pediatrician doesn’t mean that I don’t struggle with how to explain things to my kids. I want to be fair and accurate and informative…and somehow word it in a way that my little people understand it. It’s hard, I know. And I can’t promise I do it any better than you. But like you, I’m trying my best!
7. The Online Mothering Community Can Be Both Supportive and Judgmental. It really does take a village to raise a child. And I really hadn’t dabbled in the online world of mothering until I became one. What are the best breast pumps available? Where are the best parks in town? Which restaurants are most kid-friendly? I loved all the readily available advice I found online, but with that help also came the judgmental comments, the guilt, and the unintentional comparing of myself to others. I quickly put a stop to the latter in my mind – and now understand how to better reach my patient moms, who struggle with this dichotomy of feelings social media can conjure.
8. Becoming a Mom Doesn’t Mean I Have to Change Who I Am and What I Love. I was fiercely independent and very driven before I had kids. This hasn’t changed since my two little turkeys came into the world. It did however change how much time I’d have to practice my hobbies and be the best doctor I could possibly be. My lifestyle had to change a bit, but I’ve found that staying true to what you need to be happy – whether it's picking up a camera, a book, getting some time at the gym – makes you a better mom. Do it, and don’t feel guilty about some time to yourself.

I share these pieces of vulnerability and advice with you so that you know you’re not alone. Being a great mom means many things, and know that even childhood experts have their daily struggles. I’m still learning every day. And I always tell my patient’s moms: my two best teachers are my kids. At the end of the day, no matter how many arguments and challenges have ensued, if your kids know they’re loved, you’ve reached beautiful success.

The pop superstar gave an interview in the most recent edition of Vanity Fair and talked very frankly about her battle with postpartum depression, following the birth of her son. She said her postpartum depression made her feel "very inadequate" and as if she "made the worst decison of my life."

New moms experience all sorts of feelings, thoughts, and behaviors that their non-pregnant selves would never dream of! In the first few weeks after delivering a baby, about 80 percent of women will experience crying for no reason, impatience, irritability, anxiety, fatigue, sadness and trouble concentrating.

When do these feelings extend beyond “normal” and into the danger zone?

According to Diana Lynn Barnes, PsyD, an expert on maternal mental health, these are common feelings expressed by women with postpartum depression:

• No one has ever felt as bad as I do (helplessness)
• I have made a terrible mistake (anxiety)
• I am all alone and no one understands (isolation, withdrawal)
• I’m a failure as a mother, woman, and wife (guilt, diminished self-esteem)
• I will never be myself again (hopelessness)
• I’m losing it (despair)
• Everything is an effort (exhaustion)
• I have such trouble deciding (disorientation, confusion)
• I feel like I have soda fizzing through my veins (anxiety)
• Sometimes I think everyone would be better off without me (suicidal thinking)

Luckily, risk factors for postpartum depression are known, so at-risk women and their families can be proactive about their postpartum mental health. Make sure your pregnancy care provider knows about:

• Personal or family history of depression, anxiety, obsessive-compulsive disorder, postpartum depression or psychosis.
• Personal or family history of thyroid illness, chemical dependency, or alcoholism.
• Premenstrual dysphoric disorder.
• Past experience of trauma (physical, emotional, sexual abuse).

Postpartum psychosis is a serious, life-threatening illness that increases the risk of a mother committing suicide, killing her baby, or abusing or neglecting her baby. It occurs in about 0.1 percent of births, begins suddenly within two weeks of delivery, and may require emergent psychiatric hospitalization. A personal or family history of bipolar disorder, postpartum psychosis, or a previous psychotic episode are the most ominous risk factors, but women without any risk factors can develop postpartum psychosis. If you notice a new mom experiencing these things, it’s time to get help NOW:

1. Strange ideas or beliefs which are often of a religious nature, i.e. receiving prophecies, supernatural baby, evil baby (delusions).
2. Hearing commands.
3. Receiving secret messages from TV, music, books, online, etc.
4. Unwanted and disturbing urges to commit violent or other terrible acts.
5. Hallucinations involving smell, sight, or touch.
6. Intense fear of what she might do and a desire to escape.
7. Inability to sleep, a drastic increase in energy, euphoria (mania).
8. Not making sense when talking, easily distracted (disorganized speech, flight of ideas).
9. Frequent arguments, irritability, annoyance, and conflict with family members.
10. A false idea that people close to them are dishonest, dangerous, or trying to hurt them or their baby (paranoia or suspiciousness).
11. Confusion about where, when, and who they are time (disorientation).
12. Obvious lack of self-care.
13. Feeling unable to care for her baby, or extreme worry that she can’t keep the baby safe.

The great news is that postpartum depression and psychosis can be effectively treated, especially if help is sought early.

• The widely used screening tool - the Edinburgh Postnatal Depression Scale
• Postpartum Support International
• More about Diana Lynn Barnes, PsyD