23-week midwife appointment

Anne Rogers wrote:

She also said that I might want to consider using

formula for one night feeding, even though otherwise I'll be exclusively
breastfeeding, because PPD is linked to sleep deprivation.


reporting back from my appointment, when I asked about what I can do to help
things, the first thing the psychiatrist said was sleep, but he did not
suggest missing feeds, or not breastfeeding at all, but that if I start to
not be able to get to sleep easily as happened last time before I slid into
depression that there are things I could take that should help me get back
to sleep easily but not be a problem with waking up, if this is the case,
this could be really helpful for me, as from when ds was about 4 weeks old,
I would take so long to fall back asleep after each waking that I sometimes
only got half and hours sleep between feeds

Were you breastfeeding him? I certainly found that nursing
helped me get back to sleep quickly. If I had to wake and *not*
nurse, I had a much harder time getting back to sleep--yay nursing
hormones ;-) But maybe the PPD interferes with that.

Best wishes,
Ericka

Hi Rivka,
Glad to hear all's well with you. It's great to hear you being in such a
good shape. Being just a few days ahead of you (and physically in the
same metro area), I really enjoy reading your updates. )
Best,
Min

Anne Rogers writes:

: We spent a lot of time talking about post-partum depression. I'm
: probably at higher risk, because I've had two mild depressive episodes and
: because my sister had real trouble with it. I wanted to know if there's
: anything I can do to reduce my chances of developing PPD after the baby is
: born. She said that the most important thing is to make sure I have a
: strong support system in place - including help with the baby, having
: someone else to do the cooking and housework, making sure I have
: opportunities to leave the house without the baby, and possibly joining a
: new mother's group. She also said that I might want to consider using
: formula for one night feeding, even though otherwise I'll be exclusively
: breastfeeding, because PPD is linked to sleep deprivation.

I would like to offer a couple of other suggestions. First, formula
actually changes the ecosystem of the gut flora in a baby, increasing
the percentage of gram-negative bacteria. If you can avoid forumula
supplementation, that would be better.

A couple of possibilities.

1.
Co-sleep and sleep through the night nursings. Now, realistically, sleeping
through a nursing is not going to happen from day one. It actually takes
about 5 weeks to learn if the baby is latching well, longer if not. But it
is an option, and you do get more and better rest not having to get up to
nurse the baby.

2.
Take naps during the day to make up for the lack of sleep at night. This
one fits in with the "support system" recommendations you quoted above. If
the baby is sleeping or if the baby is awake and not nursing let the support
person look after the baby while you nap.

3.
Pump during the day, and let DH feed expressed milk at night. I will have to
say that although I am offering this suggestion, that among the three it is
my least favorite. The reason is that late night and early morning nursing is
the most important to building a good supply. However, if nothing elxe works
and you don't have supply problems, you might try it.

In any case, good luck and I hope the PPD does not raise its ugly head.

BTW, some studies have shown the quality of the birth experience can
greatly affect the liklihood of PPD, a c-section, induction or even epidural
birth can have a higher PPD rate than a satisfying natural vaginal birth.

Good luck,
Larry

Larry, I usually think you are a great guy, but today it feels like you care
more about a baby getting breastfed than a mum who could die. I'm fully
aware of the problems of formula and it isn't an option I'm personally
considering, but having experienced such bad PPD I'm very ready to discuss
any possible suggestions with other mums.

Co-sleep and sleep through the night nursings. Now, realistically,
sleeping
through a nursing is not going to happen from day one. It actually takes
about 5 weeks to learn if the baby is latching well, longer if not. But
it
is an option, and you do get more and better rest not having to get up to
nurse the baby.

tried it, basically cannot sleep with a baby in the bed, had him in a moses
basket right next to me, so we were fairly close, so I barely woke up

2.
Take naps during the day to make up for the lack of sleep at night. This
one fits in with the "support system" recommendations you quoted above.
If
the baby is sleeping or if the baby is awake and not nursing let the
support
person look after the baby while you nap.

I did this and would highly recommend it, I would lie in bed with the baby,
switch the radio on and hopefully get a snooze

3.
Pump during the day, and let DH feed expressed milk at night. I will have
to
say that although I am offering this suggestion, that among the three it
is
my least favorite. The reason is that late night and early morning
nursing is
the most important to building a good supply. However, if nothing elxe
works
and you don't have supply problems, you might try it.

that would definitely be my preference well above giving formula, but as you
say it has major drawbacks

In any case, good luck and I hope the PPD does not raise its ugly head.

BTW, some studies have shown the quality of the birth experience can
greatly affect the liklihood of PPD, a c-section, induction or even
epidural
birth can have a higher PPD rate than a satisfying natural vaginal birth.

my experience agrees with that, I had an induction with an epidural,
necessary due to PROM and concerns about the health of the baby and being
out of control was very distressing, there is only so much you can do, I was
booked for a home birth, had educated myself well, but when it came to it I
couldn't prevent my waters from breaking, and we did wait 36 hrs before
induction.

"Anne Rogers" wrote in message
...
Larry, I usually think you are a great guy, but today it feels like you
care
more about a baby getting breastfed than a mum who could die. I'm fully
aware of the problems of formula and it isn't an option I'm personally
considering, but having experienced such bad PPD I'm very ready to discuss
any possible suggestions with other mums.

Co-sleep and sleep through the night nursings. Now, realistically,
sleeping
through a nursing is not going to happen from day one. It actually
takes
about 5 weeks to learn if the baby is latching well, longer if not. But
it
is an option, and you do get more and better rest not having to get up
to
nurse the baby.

tried it, basically cannot sleep with a baby in the bed, had him in a
moses
basket right next to me, so we were fairly close, so I barely woke up

In addition, since PPD also can lead to high levels of anxiety, it may be
more stressful to have the baby in bed than separate. I cannot sleep with
Allison in bed with me, at all. Even though I can see that she rests more
easily when she is right next to me.

And if you're having difficulty nursing, having the baby next to you doesn't
help. Alli will latch on and will try to nurse, but at this point, she
simply CANNOT get milk from my breasts directly. The result is a crying,
hungry baby, often too upset to take milk even from another source, and a
crying mother. I am still convinced that the reluctance of the hospital
lactation nurses to consider that Alli's nursing difficulties were due to
her prematurity is one reason why I'm dealing with PPD now-because I was
being hit with failing at something which was so important for my baby,
every 2 hours, day and night. The best relief I got was when we were told
that it was simply that she wasn't ready developmentally, but should be in a
few weeks.

2.
Take naps during the day to make up for the lack of sleep at night.
This
one fits in with the "support system" recommendations you quoted above.
If
the baby is sleeping or if the baby is awake and not nursing let the
support
person look after the baby while you nap.

I did this and would highly recommend it, I would lie in bed with the
baby,
switch the radio on and hopefully get a snooze
And right now, this is working. But in another month, my mother has to go
back to her regular life.

3.
Pump during the day, and let DH feed expressed milk at night. I will
have
to
say that although I am offering this suggestion, that among the three it
is
my least favorite. The reason is that late night and early morning
nursing is
the most important to building a good supply. However, if nothing elxe
works
and you don't have supply problems, you might try it.

that would definitely be my preference well above giving formula, but as
you
say it has major drawbacks
Sometimes, things have to give. While night and early morning nursing is
important to building supply, so is sleep. One of the things the Lactation
consultant who WAS actually helpful was definite on was that it was OK not
to pump every 2 hours at night, because the mother needs rest. I've found
that I can't go more than 4 hours, even overnight, without pumping, because
my breasts will wake me up, even if DH or someone else is caring for the
baby.



In any case, good luck and I hope the PPD does not raise its ugly head.

BTW, some studies have shown the quality of the birth experience can
greatly affect the liklihood of PPD, a c-section, induction or even
epidural
birth can have a higher PPD rate than a satisfying natural vaginal
birth.

my experience agrees with that, I had an induction with an epidural,
necessary due to PROM and concerns about the health of the baby and being
out of control was very distressing, there is only so much you can do, I
was
booked for a home birth, had educated myself well, but when it came to it
I
couldn't prevent my waters from breaking, and we did wait 36 hrs before
induction.
I'll believe that. But I also believe that the mother having too much
pressure on her to do things the "right" way also contributes. On the
Pre-eclampsia foundation boards, there are a lot of mothers who have ended
up very depressed and upset over having to supplement and/or pump, and even
more so if they end up not breastfeeding or pumping at all, no matter what
their health is at the time. I know my experience was that the hospital was
SO pro-breastfeeding that they didn't listen when I told them there was a
problem, until Allison had lost 12 oz-and even then, when I ASKED about
pumping, I was discouraged from it until she had lost 18 oz. The assumption
was that I was doing something wrong in the positioning or the latch,
because since Alli had a full-term baby's birthweight, it was assumed she
was developmentally more mature than she really was.

All through my pregnancy, I had people questioning WHY I was having a second
C-section (without considering that there was a reason other than personal
choice-even once I explained that I had an upper vertical incison didn't
sway some people), had medical decisions questioned, etc. By the time I gave
birth, I was pretty convinced that breastfeeding was the ONE thing I could
do right for this baby. And that didn't work either. If that doesn't set up
a situation where depression is pretty likely, nothing does.

IOW, I don't think it's the interventions so much which can lead to
depression. It's the perception of them, in the mind of the mother and of
everyone around her, as a personal failure on her part, combined with the
physical recovery AND the stress of caring for a baby.

Larry McMahan wrote:

[I wrote]
group. She also said that I might want to consider using formula
for one night feeding, even though otherwise I'll be exclusively
breastfeeding, because PPD is linked to sleep deprivation.

I would like to offer a couple of other suggestions. First, formula
actually changes the ecosystem of the gut flora in a baby,
increasing
the percentage of gram-negative bacteria. If you can avoid
forumula supplementation, that would be better.

Can you point me to research data demonstrating that this happens, and
what problems it causes in a baby who is mostly breastfed?

Co-sleep and sleep through the night nursings. Now, realistically,
sleeping through a nursing is not going to happen from day one.
It actually takes about 5 weeks to learn if the baby is latching
well, longer if not.

The onset of post-partum depression is typically within 3-5 weeks of
birth. So a technique that might improve sleep quality sometime
*after* 5 weeks is probably a good thing in general, but not much help
in preventing PPD.

Take naps during the day to make up for the lack of sleep at night.

I bet all new mothers do this. I'm certainly planning to!

Pump during the day, and let DH feed expressed milk at night.
I will have to say that although I am offering this suggestion, that
among the three it is my least favorite. The reason is that late
night and early morning nursing is the most important to building
a good supply.

This is another option we're strongly considering, although I don't
know how long it would take me to get good enough at pumping to have
enough for an extra feeding every day.

Larry, I don't think anyone in this thread - including my midwife, who
gave me the original advice - is not aware of the substantial
advantages of breastfeeding. Yes, ideally a baby is 100% breastfed
from the breast at all feedings.

But PPD is a serious health crisis. It can be fatal for the mother,
and it has significant developmental effects on the baby. You have to
weigh the benefits of 100% breastfeeding against the risks of PPD, and
I don't really get the impression that you're doing that.

BTW, some studies have shown the quality of the birth experience
can greatly affect the liklihood of PPD, a c-section, induction or
even
epidural birth can have a higher PPD rate than a satisfying natural
vaginal birth.

Great, one more reason for women to feel guilty if they don't have the
"perfect" birth.

Rivka
feeling cranky today
Li'l Critter due 4/3/05
--
Visit my weblog at http://respectfulofotters.blogspot.com

Anne Rogers wrote:
Of course true PPD can set in absolutely regardless of how
perfect your circumstances are, and everyone has moments of
thinking, "Oh, my gawd, what
have I *done*, I must have been crazy to think I could do this ..."

yep, but you can delay its onset and make it less severe, I think

I think there's a continuum. Some women have such a biochemical
predisposition to PPD that, no matter what their circumstances and how
much support they have, they're likely to develop it. Other women have
such horrible circumstances that almost anyone in the same position
would develop PPD.

In the vast middle ground, there's some chance that improving supports
or circumstances will prevent PPD, delay its onset, or lessen its
severity. I'm recognizing that I might turn out to be in that first
group, given my personal and family histories of depression, but I'm
also planning to do everything I can think of that might help mitigate
whatever happens.

Rivka
Li'l Critter due 4/3/05

--
Visit my weblog at http://respectfulofotters.blogspot.com

Min E wrote:
Hi Rivka,
Glad to hear all's well with you. It's great to hear you being in
such a good shape. Being just a few days ahead of you (and
physically in the same metro area), I really enjoy reading your
updates. )

Thanks! How are you doing? I think it's been a while since I've seen
an update from you.

Rivka
Li'l Critter due 4/3/05
--
Visit my weblog at http://respectfulofotters.blogspot.com