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The LOSS in early motherhood

10/3/2015

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This title seems to be a contradiction; however, I’m writing today to shed some light on a concept I think more new mamas need to hear.  The emptiness one experiences with a life transformation and identity shift is real, y'all!
 
In my work with new moms, what I hear over and over again is, “why do I feel so empty?”  There is a myth out there, perpetuated by our media, which sells us the idea that motherhood is bliss.  That in bringing new life into the world, we will be happy, the perfect mother, and finally feel full and fulfilled as if the new baby was the missing piece to make our life complete. 
 
It seems that what our culture really lacks for motherhood is more ritual for these HUGE transitions in a woman’s life.  Yes we have baby showers, but the festivities tend to center around the baby.  We need more ceremony to honor the changes a woman goes through when she transforms from a childless woman to a mother. 
 
So let’s talk about the loss that comes with motherhood. 
-The loss of your freedom: the ability to be spontaneous and go have lunch with a friend whenever, to stay out 30 minutes longer to finish up an errand, to easily get a work out in without having to orchestrate a huge plan of childcare. 
-The loss of self-care: long gone are the days when you showered daily, shaved your legs, and washed your hair J, and now finding time for massage or pampering feels like a guilt-inducing mess you don’t have time for! 
-The loss of your body: our culture focuses so much on appearance, it places hugely unrealistic expectations on what a new mom should look like.  The body you once knew is now going through a hormonal rollercoaster and things are not working quite the same as pre-baby.
-The loss of your ego:  while this is a temporary loss, early mothering really forces us to our identity.  We realize rather quickly, “it’s not about me anymore.”  Our needs fall by the wayside, as we step into the role of 24/7 caregiver.  Add in questions about work/life balance and who we are in careers now that we are mothers, and the ego takes a back seat.  
-The loss of sleep: sleep deprivation is used as a form of torture in times of war, so please don’t discount the impact sleep disruption has on one’s ability to cope with all the losses!
-The loss of predictability: for those mamas who crave order and control, babies teach you very quickly how to surrender to chaos.  Sometimes this is a painful lesson.
 
When we take the time to honor and grieve what we have lost in becoming a mother, the path to motherhood begins to feel much lighter.  When we can sit with another woman who can truly empathize and hold how hard it is to let go of our old lives, especially when this is the new life we always wanted, we bring healing to our new role.  We all need a hand to hold as we walk down the crooked path of motherhood, so remember to make space for the feelings of loss as you embark on incorporating all that you have gained in becoming a mama.​
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Postpartum Stress and Mental Health after a Preemie Baby

8/24/2014

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By Kelli Foulkrod, MS, LPA, RYT

Having a baby is one of the most life-changing events a person will go through; having a baby born prematurely or with a neonatal intensive care unit  (NICU) experience is not only life-altering, it’s also complicated with extra layers of fear, trauma, and loss of control.  This article highlights mental health functioning and ways to support the mental well being of parents of a preemie baby.   

It is estimated that 10 – 15% of all new moms will experience mood disturbances after birth. The occurrence of postpartum mood disorders in mothers of babies born prematurely and in the NICU is much higher, and is currently estimated at 28% to 70%.  A sense of loss and disappointment impacts the progression of postpartum depression (PPD) in mothers of NICU babies.  A mother of an infant in the NICU may not have had a normal pregnancy or a normal delivery, and she is not able to experience the normal bonding period that occurs immediately after birth. Instead of being held and breastfed, the infant is in an incubator or warmer, connected to monitors, IVs, and other equipment.  With this departure from a normal birth experience, there is a sense of grief and loss.  Loss of the expectation of how we thought our child would enter this world and loss of our sense of control over the female body and safety of the baby.  

It’s important to be aware of the factors that put a woman at a higher risk for experiencing mood disturbances after birth.  Due to the high stress levels involved with a NICU stay, preventive measures for extra support, such as baby sitters and maids, should be put into place for women and their partners who have more than two of the risk factors listed below.  The following list describes the known risk factors for developing a postpartum mood disorder:

-depression or anxiety during pregnancy
-history of PMS or premenstrual dysphoric disorder
-thyroid dysfunction
-unexpected delivery (birth trauma)
-perfectionism
-poor social support
-recent life stress (job loss, move, divorce)
-unwanted or unplanned pregnancy
-poor relationship with a partner
-financial difficulties

Acute stress disorder and posttraumatic stress disorder (PTSD) are also very commonly a consequence of being a NICU parent. Mothers feel guilt that they have done something wrong or have somehow failed. This sense of guilt is compounded when mothers feel they cannot protect their babies, and a sense of loss of control in the predictability of life.  Other times traumatic birth experiences can leave the mother longing for different memory of her labor and delivery. A traumatic experience is defined as an event that goes beyond the range of usual human experience, it is overwhelming physically or emotionally, and there is a threat to your life or the life of the baby during the experience.


As a way of coping with the traumatic events and extreme stress, the body can undergo a series of physiological changes in an attempt to regain homeostasis.  The human body has an “on” switch, the fight vs. flight response and an “off” switch, the relaxation response.  Our nervous systems have a mechanism that pendulates between activation and rest and recovery modes, in order to regain balance after stressors in the environment.  When a person doesn’t have the time and space to discharge and process an overwhelming experience, it is as if their nervous system gets stuck in activation mode and their brain and body carry the tension and hyper vigilance to prepare for the next stressor. 

Here are some common symptoms associated with PTSD after childbirth:

-re-experience the events in flashbacks
-nightmares
-intrusive and obsessive thoughts
-hypersensitivity to certain people places and events
-irritability
-feelings of being out of control
-numbness, withdrawal from social support
-depression and anxiety



Therapy can help women to understand and learn to accept their feelings and experiences and openly share and process the traumatic experience.  Talk therapy has been shown to help reduce symptoms of anxiety and depression following a highly stressful birth experience.

Yoga is also another great way to activate the body’s relaxation response and help one to recover from the deleterious effects of extreme stress and trauma.  Learning relaxation and breathing techniques helps PTSD patients learn how to calm themselves down and self-regulate when they sense that a flashback or panic attack is coming.

Here are some simple exercises to practice in times of extreme stress or after a trauma: 

1) Get Grounded – in times of high stress, the nervous system becomes overactive and thoughts tend to race, with an inner experience of constriction or restlessness. Being grounded means being anchored in the present moment. With your eyes open, begin feeling your feet on the floor; sensing the toes and heals making contact with your shoes. Next, begin to notice and touch objects around you and describe them.  For example “I’m sitting in a red chair”, etc.

2) Calm the Breath - Close your eyes and for five breaths, imagine breathing in through your toes and bringing the breath all the way up through the top of your head. Visualize the oxygen illuminating every inch of you: organs, muscles, bones, even your cells. Then, as you exhale, visualize the air going down through your body and out through your toes. See the breath flowing outward from your feet, like a shimmering, billowing fog.

3) Lengthen the Exhale – Making your exhale longer in relation to the inhale shifts the body from sympathetic (fight vs. flight) to parasympathetic (relaxation response) and is useful in calming down the agitation that typically comes with anxiety.  Try this: sit comfortably with your eyes open or closed and inhale for a count of two… hold the breath in for a count of one… exhale gently, counting out for four… and finish by holding the breath out for a count of one.  This deep breathing with longer exhalations helps slow heart rate and respiration, and calms anxiety by sending a signal to the body that it is ok to relax. 

The good news is that there are a variety of options to treat and manage mood symptoms after life’s big stressors. Based on the statistics, it is also plain to see how common mood disturbances are after having a preemie baby or NICU stay.  There is help, hope, and support available; you are not alone! 

References:

1)    Vasa R, Eldeirawi K, Kuriakose V. et al. (2014). Postpartum depression in mothers of infants in neonatal intensive care unit: risk factors and management strategies. Am J Perinatol. 31:425-34.
2)    McCoy, S. J. et al. (2006). Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature. The Journal of the American Osteopathic Association, 106, 193-98.
3)    Ballard, C. G. et al (1995) Post-Traumatic Stress Disorder (PTSD) after Childbirth. British Journal of Psychiatry. 166: 525 – 528.
4)    Czarnocka, J and Slade, P (2000) Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 39: 35-51.
5)    Emerson, D., Sharma, R., Chaudry, S. , & Turner, J. (2009). Trauma sensitive yoga: principles, practice, and research. International Journal of Yoga Therapy. 19: 123-128.


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Postpartum Hormones

7/9/2014

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Turns out it's NOT all in your head!  Postpartum mood changes are also very much a biological function of your body.  Check out this depiction of some of the major hormones involved in your postpartum period.  When one hormone is slightly off, mood changes can emerge and some women are more sensitive to the hormone fluctuations than others.  
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Perfectionism in Parenting

7/7/2013

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by Kelli Foulkrod

We all know there is no such thing as the perfect parent.  Yet for some new parents and seasoned parents alike, this urge to get it “right” can overshadow the best of loving intentions.  Do you find a sense of looming guilt for never doing enough for your child?  Do you beat yourself up for days over parenting mistakes?  These could be indications you are trying to be perfect in your role as a mother or father.

For some it is an extension of a personal lifelong battle with perfectionism.  For others, the process of becoming a parent stirs up unmet emotional needs from their own childhood and at the surface is an overwhelming urge to make sure their children’s life is “better” than their own.  And for others, the sense of constant competition from our culture pushes them to always want to be the best at everything, including parenting.

Letting go of high expectations gives parents a chance to teach children one of life's most important lessons: that to err is human. Children need to learn that people can be both good and bad; but that, ultimately, they are basically good. The irony is that we need to be able to tolerate that we are not perfect in order to be good parents.

Donald Winnicott was a pediatrician and child psychoanalyst who interacted with literally thousands of mothers and their babies. Through these experiences, he came to believe that the way to be a good mother is to be a good enough mother and coined the phrase the “good enough mother”.

We all lose our patience; we all say the wrong things at times; we all need breaks from our children.  When we learn to accept our mistakes, our own meltdowns, and our blind spots we are teaching our children how to recover from falling, with grace. 

Kids need to learn about life through real experiences. They need to learn to deal with disappointments and frustrations. They need to overcome their greed and their wish to be the center of the universe. They need to learn to respect the needs and limitations of other people, including their parents.  If in an effort to protect and shield our children from the pains of life, we are not teaching them how to cope with the inevitable pains of life. 

What would it be like for you to step into the idea of being a “good enough parent”?  What would it be like to be a good parent but still make space for your flaws, quirks, and epic fails?  Our downfalls are our greatest teachers for our children when we can model to them learning experiences on how to cope with being an imperfect human.  So the next time you make a mistake in parenting, welcome it as a golden opportunity to teach your kid what it means to be a good enough human.  

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Motherhood as a Spiritual Practice

5/12/2013

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By Kelli Foulkrod 

When a woman becomes a mom, her ego takes a back seat. The sleeplessness and intense workload make mothering the ultimate practice of selflessness. 

As children grow, the mother learns the fine balance of closeness and surrender. With developmental milestones, new joys and challenges come and the mother realizes the true impermanence of life. 

Sooner than expected, the child is independent and starting a new life on it's own. Now the mother has the task of truly letting go and keeping faith, while remaining a pillar of support and acceptance.

Each stage of mothering brings experiences to both break a woman down, while simultaneously making her love undeniably stronger.   
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Yoga For New Moms

3/11/2013

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By Kelli Foulkrod, MS, LPA, RYT

How does a new mom have time for yoga?  As a psychotherapist/yoga teacher who works mainly with moms this is a question I am asked a lot.

A new mom is overwhelmed by changes in hormones, sleep deprivation, and role changes.  It might not seem you have time to go to a class let alone unroll your mat on the floor.  My answer tends to be something along the lines of… what better time to set aside time to self-soothe and take care of yourself!

Now I’m not advocating that any new mom carve out a 3-hour block of time and arrange childcare to go to a studio.  I believe expectations should be lowered during this time period.  Let me share an alternative:  a small sample of yogic techniques that can be done quickly at home in between tending to the crying baby, the mountain of laundry, and a much needed nap.

A cautionary note must be included.  If you are suffering from depression or anxiety then meditating alone is not advised in some cases.  In fact, unless someone has a previous meditation practice I never suggest a client take up meditating on their own; guided meditation is much more suitable.  Meditating can confront you with a bunch of feelings and thoughts that can be overwhelming.   Yoga, however, can serve as a buffer from this flood because by moving the body and breath we give the mind a (brief) distraction from the whirlwind.

Yoga is absolutely dose dependent and the more often we place our body in postures or change our breathing patterns, the more benefits we will see.   That’s why we call it a “practice”… the more you do it, the more results you see.

Our breathing patterns are intimately connected to our mental state.  We tend to hold our breath when we are anxious and not take full enough breaths when we are sad. From a yogic perspective, extension of either inhale or exhale is the key to mental balance.  For someone experiencing anxiety, we work to increase the time of exhalation, which sends a signal to the brain to activate the parasympathetic nervous system.  For someone experiencing depression, we work to increase the inhalation, which activates our body and creates more energy.

Here are some ideas to get started on taking deeper breaths for more calm.

Taking about ten slow, deep breaths just like this can make you feel more relaxed and refreshed, can ease anxiety and depression, and can help you think more clearly.

  1. Come to a comfortable seated position, or lie down on your back.
  2. Rest one hand on your belly, and the other over your heart.
  3. Breathe in slowly through your nose, feeling your belly rise, and then your chest rise, and then maybe feel your collarbones lift slightly.  These are the 3 parts to the breath:  belly, then chest, then collarbones.
  4. As you exhale deeply, let your mouth fall open, and feel the collarbones drop, then the chest drops, then the belly contracts.
  5. Try to make your inhalations as long as your exhalations.  Inhale for a slow count of 3, and then exhale for an equally slow count of 3.
  6. Repeat this at least ten times.  To see maximum effects, set your timer for 3 minutes of slow breathing.
As with any new exercises, consult your doctor before starting a new exercise regimen.  Listen to your body.  Yoga is not one size fits all (despite those pictures on yoga journals!).  You should adjust poses to feel good to your body HGH.  If anything hurts, pulls or makes you uncomfortable, stop immediately!  

A female’s hormones go on a huge roller coaster ride after birth.  These hormone fluctuations continue with a vengeance if the mother is breastfeeding.  Through yoga postures, we can nourish and rebuild hormonal imbalances.  Here are two poses to try for balancing hormones:

This pose stimulates the relaxation response, massages abdominal organs, kidneys, and adrenal glands.  Make modifications to this pose to achieve as much comfort as you can.  This pose doesn’t feel comfortable for every body type:  if you don’t feel comfortable, then forget this one.

  1. Kneel on the floor. Touch your big toes together and sit on your heels, then separate your knees about as wide as your hips.
  2. Lean forward and drape your body over your thighs so that your forehead rests on the floor and your belly is between your knees.  If you have tight or sensitive knees, put a blanket or thick towel between your calves and your thighs to relieve any stress on the knees.  For some, a large bolster or pillow and feel comfortable under the chest.
  3. Reach your arms out in front of you or you can leave your arms along your sides or bent with your hands near your face. Try both and see which feels best to you.
  4. Breathe deeply. Release any tension you might be feeling in your back, neck, or hips. Give this exercise time to work. It can take a few minutes to allow your body to deepen into the stretch.
This pose puts pressure on the pituitary and pineal gland, the thyroid and parathyroid, the thymus, the pancreas, and the ovaries, which helps balance the function of each of these.  NOTE: this posture should not be practiced if you have recently had a Cesarean delivery.
  1. Begin kneeling.  Grab your heels with thumbs on the outside, fingers on the inside.
  2. Roll forward until your forehead is close to your knees.
  3. Pull on your heels, lifting hips high, putting very little weight on head with heavy knees.
  4. Keep 25% of weight in head, and 75% weight in the knees.
  5. Keep shoulders away from ears, stomach tight and heels together.
  6. Try to get your forehead and knees closer and closer together.
  7. Eventually you should pull on your heels so much that your arms straighten.
  8. Hold for 5 breaths.
  9. Come out of the pose slowly, vertebra by vertebra, and rest in child’s pose.
In my opinion, sleep deprivation is the biggest hurdle to feeling good post-partum.  Yoga Nidra, also known as “Yogic Sleep” is a guided meditation practice, which walks the participant through awareness of different parts of the body.   In doing this, the mind cannot think about anything else.  When we bring our awareness to a bigger image of our selves, our muscles and mind relax more fully.  This technique works with the homunculus, or the motor strip within the brain, which has a map of our bodies.  By rotating awareness on this body map, it is as if we are giving our brains a massage.

Ideally, this practice is done in a lying down position.  While it is encouraged not to sleep, falling asleep and taking a nap would also benefit a new mom!  Scientific research studies have shown that 45 minutes of a yoga nidra practice is equivalent to 3 hours of REM sleep for the brain.  This is such a bonus for the sleep-deprived mom!

Lie down, get comfortable, and try out this great mp3.

Yoga Nidra for Sleep

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    Kelli Foulkrod, MS, LPA, RYT

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