From Us to You. . .

Dear Mamma, 

As you hold your precious little bundle in your arms, take a moment to acknowledge the arduous effort that has gone into this. You did not get here easily. Pregnancy is filled with joy, pain, anxiety, unconditional love and an inexplicable excitement to meet your little one. And, now that she is safe in your arms, take a moment or two to breathe and bask in this space. 

Give yourself time to heal, mamma! For many of us, breastfeeding did not come easy. It has been a hard, rocky and painful journey. Whether you decide to breastfeed or formula-feed or do a mix of both is between you and your baby. Different people have different opinions; find your tribe that understands and supports your decision. You will feel less alone. Don’t ever feel guilty for the path you and your little one take. This is your story!

Take care of yourself! Let others take care of you. You are not weak for leaning on others. Your physical and mental health is of paramount importance. It is easy to get caught up in all things baby and forget about yourself, but please remember that you cannot pour from an empty cup. Spend time with your baby in your arms; spend time with your baby outdoors; soak in some sunshine; talk to them; read to them;  talk about your feelings, sing, dance and just involve your baby as much as you can in your life. Cherish these moments and cuddle up as much as you want. Don’t ever listen to those who say you will spoil your baby by holding them; remember, everything grows with love. 

“The nights are long but the years are short.”  It is normal for a baby to cry for hours without any reason. It is normal for a baby to fall sick. The effort is superhuman, but the time will fly by before you know it, so hold on tight to the precious munchkins while you can. Before you realize it, your little one will grow up and need you less, leaving you yearning for the days they were tiny and needed you the most. 

Mamma, cherish the highs and lows of motherhood and the time you spend with your little one. Don’t compare yourself to others and worry whether you are doing your best. There is no better mamma for your baby than you! Just be the best person you can be, each day, and you will automatically be the best parent you can be. 

Love ♥

Understanding Postpartum Depression – A Professional Perspective : Mamma Love Series

As part of the Mamma Love Series, I approached Dr. Susan Pawlby, a Developmental Clinical Psychologist, and former Lecturer in the Section of Perinatal Psychiatry at the King’s College, London, UK.  She is also a member of the Multi-Disciplinary Team on the Channi Kumar Mother and Baby Unit at the Bethlem Royal Hospital, South London and Maudsley NHS Trust. Dr. Pawlby is now a visiting Senior Research Fellow at King’s College, London.

She shares below about depression in parents, mothers in particular, from her years of experience working in this field. She also shares what kind of support is offered clinically and how we can support the pregnant and postpartum mammas in our lives.


How is antenatal depression different from postnatal depression and how do they affect the baby? 

A major depressive episode is an illness characterized by low mood and/or loss of interest or pleasure in usual activities, lasting at least 2 weeks, with secondary symptoms being appetite or weight changes, sleep difficulties, psychomotor agitation or retardation, fatigue or loss of energy, diminished ability to think or concentrate, feelings of worthlessness or excessive guilt, and suicidality. The difference between antenatal depression and postnatal depression is only in the timing of the depressive episode, one being during pregnancy and the other after the birth. The symptoms are the same. Antenatal depression may affect the foetus by increasing cortisol, norepinephrine and inflammation which affect the fetal environment and have implications for maternal and infant health. Maternal stress has been associated with poor birth outcomes including preterm birth, infant mortality and low birthweight. Postnatal depression may affect the baby if the mother’s symptoms mean that she finds it difficult to respond to her baby’s physical, emotional and social needs.

How does depression of mothers affect the emotional regulation of babies? 

One of our tasks as mothers is to help our babies regulate their own emotions. When a baby is born their brains are not well-developed. Infants have some limited self-directed regulatory behaviours such as thumb sucking, visual avoidance, and withdrawal but these behaviours have limited effectiveness. When babies have uncontrollable cries, it is up to us, the parents, to help them regulate their bodies and emotions, so that they learn to self-regulate. This is more easily accomplished during the sensitive period when the brain is still flexible. In order to do this a mother needs to notice, monitor and recognize her baby’s emotions and adapt her own emotions according to the situation. If the mother is depressed, her own emotional feelings may overwhelm her and she may not notice her baby’s distress or be able to offer appropriate support.

What kind of intervention is offered to mothers experiencing depression? 

In the UK, we have multidisciplinary teams of perinatal health professionals – psychiatrists, psychologists, nurses, nursery nurses, occupational therapists, social workers – who support women suffering from depression during pregnancy and following the birth, both in the community and in special Mother and Baby Units. They offer different interventions including medication, talking therapies, promoting well-being through support with sleep, nutrition, exercise, and specially tailored interventions promoting the relationship between mother and baby, keeping the whole family in mind.

How many women who experience postpartum depression actually seek treatment? Why do you think many do not come forward for help?

One UK study in 2011 showed that only 43% of people suffering from postpartum depression sought help. Among the reasons given for not seeking help were that

  • it was not serious enough to warrant help from a professional
  • they were too scared to tell someone for fear of the consequences, which included fear that their baby would be taken away by social workers
  • they did not realise until later that they were suffering from postpartum depression
  • they felt that the support they were receiving from family and friends was sufficient;
  • they felt that their partner did not support their seeking treatment, they lacked sufficient information about what to do.

How can healthcare providers pay attention to the mental health of pregnant mammas during routine checkup?

In the UK midwives now routinely ask questions about a woman’s mental health at the first antenatal appointment, as recommended in the NICE guidelines (2014)

How common is PPD in fathers? Why might this happen? 

Research suggests that between 8% and 22% of new fathers suffer from postpartum depression. Men may be reluctant to talk about their symptoms and may self-medicate using alcohol. Men whose partners are suffering from postpartum depression may feel that they have to be strong, but once the partner has recovered, their symptoms may become visible. Look at Mark Williams website to learn more about how fathers experiencing postpartum depression can be supported. 

How can new parents be supported to avoid depression during pregnancy and after? 

More discussion in antenatal classes and in the media about the risk factors of becoming depressed and the importance of seeking help. Awareness of keeping stress levels down in pregnancy and encouraging women to take maternity leave from 36 weeks pregnant rather than from the birth. Reaching out to Governments to recognize the importance of supporting mothers-to-be and fathers-to-be in order to avoid mental health problems in this and the next generation. Seeing parenthood as one of the most important tasks that we do.

Are there any ways by which as a society, we can eradicate the stigma around mental health? 

Promote the slogan that mental health is as important as physical health and that Governments should invest as much in one as the other. 

Journey towards Motherhood; Experiences on Pregnancy & Postpartum : Mamma Love Series

Do you think pregnancy focuses on preparing for motherhood as much as preparing or a baby? 

Ramya, who lives in Bangalore with her toddler shares, “I do not believe pregnancy focuses on preparing for motherhood. Throughout pregnancy, a mom, especially a first time mom, usually thinks a lot about the course of pregnancy, how to get through it & how to keep her growing baby healthy. Then there is of course labour and delivery, which preoccupies many moms-to-be. And finally, one thinks about processes and things for when the baby comes – how do you swaddle, what stroller do you need. There is very little mention – from healthcare providers or more experienced moms’, in literature, depictions in popular culture of what motherhood entails, and the mental fortitude required to deal with it. 

Shilpa, mother of baby Dhruv who is 11 months old, writes, “Contrary to what I thought, not in the least. While I was pregnant, it was all about staying healthy, happy and focusing on having a safe pregnancy. Rest, sleep, nutritious food, supplements, yoga – the days just whizzed by. Coupled with long hours at work, there wasn’t really any time to think of anything else. And no one really spoke about motherhood, at least to me. Other than the usual, “Oh, this is nothing, wait for the baby to arrive!” – no one had much to say, and it never occurred to me that we actually do need to prepare for motherhood.

Can you share with us the emotional and physical ride you went through soon after your baby’s arrival?

Shilpa begins, “Remember how I said that people tend to tell you, “Oh, this is nothing, wait for the baby to arrive!”. At the time I thought, well, it would really help if the same people could actually tell me something useful instead of these unwarranted comments,” she says. “But, what I can tell you now, is that, NO ONE can really tell you anything about how you are likely to feel. Every pregnancy is different, every baby is different AND every mother is different. There is really no ‘one size fits all’ advice – and it would really help if that is what people would tell new mothers.”  She continues, “For me, it was much easier to deal with the physical aspects than the emotional ones. I had a C-section, it was not easy, and it was painful, but with the help of doctors and nurses I found it quite manageable. For someone who really really needs sleep to function, the lack of sleep that comes with a new baby hit me like an express train! Even that I managed to deal with in the best way I could. 

She says none of the physical challenges came close to what was going on in her mind. “The answer to what was going on in my mind is, nothing, and everything,” shares Shilpa.  “A lot of the time I was completely blanked out and functioning like a robot, and when I wasn’t in that mode – I was paranoid and overthinking EVERYTHING baby. Is he sleeping ok, is he being fed enough, is he peeing enough, is his poop the right color, is he breathing while he is asleep (yes, even this!), have I covered him enough and so on. ” She assures, “But, things do settle down eventually and the important thing for you and your immediate family is to acknowledge what you are going through.”

Meanwhile, Ramya speaks of her experience, “I had been waiting to be a mother my whole life. Since I was five years old, I would play pretend with my dolls, and as I got older, I’d imagine scenarios with my future children, and fantasise about life as a mother. I struggled to get and stay pregnant, which added to my deep yearning to be a mother. This pregnancy and my unborn baby were so precious and important to me – it’s not wrong to say that all my hopes were pinned on them. Then my daughter was born, and all my castles went up in smoke.” She says, “I knew it almost immediately – I did not feel all the emotions that everyone says you must, that I was prepared to feel – the overwhelming love, the immediate affection. I felt removed from my baby, I couldn’t bring myself to feel the quantum of love that I expected and wanted. She was low birth weight, and had experienced some in-utero stress. This led her to being diagnosed as a baby high needs. The intensity of her behaviour and emotions were jarring. She would cry for hours on end, and I would be at wits end, unable to comfort her, and not knowing what to do. Our bonding was not immediate, and took lots of time and effort. I felt deep anguish when I saw how easily my husband and father bonded with and loved my daughter, and I struggled to do the same. 

My angst was compounded by the fact that I moved back to my parent’s house after living away from them for more than five years. My father is a doctor, and was very involved in my daughter from the moment of her birth. My mother- in- law and husband’s aunt were also very keen to help and would come over everyday. I am an introvert at heart, fiercely independent, and deeply opinionated. This combination did not bode well for me in my circumstances. I felt like I was drowning under the torrent of constant advice, comments, and suggestions. I felt that I was not getting the support and rest I truly needed, and started feeling resentment towards those around me. The restrictions on eating, going out, and general to-dos, mild though they were, felt unbearable to me. 

About her initial breastfeeding experience, Ramya shares, “Breastfeeding was probably the worst part of the initial days. I struggled to produce sufficient milk, and felt like I was subjected to an inquisition from all the elders at home. It was deeply anxiety inducing. To add to this, my baby was born with a tooth, which rendered breastfeeding traumatic at times. Physically, my recovery was quite quick and relatively easy, given that I had a vaginal birth. However, I had stitches and some digestive issues that left me in constant discomfort for the first couple of months. Coupled with my lack of sleep, I felt like a zombie. 

Finally, she says, “Of course like all things, the lower the lows, the higher the highs. I could watch my daughter sleep for hours on end. Hugging her tiny 2.5 kg body to my chest on those chilly winter afternoons as we did skin to skin, was tranquility epitomised. I always maintain one of life’s greatest joys is holding a sleeping baby, a truth I realised in those early days. When my daughter would smile in her sleep, or yawn, or I’d count her tiny fingers and toes, I truly understood why it was called the miracle of life.”

Mamma Love Series Set 1

In those initial months, what kind of support comforted you most and what caused turbulence? 

“My husband was my biggest support, my rock and my wall”, begins Ramya. “When he was there, I felt completely confident and comfortable. He always let me take the lead and played the perfect complement. He was ever ready to do any physical task, and give me a break. This rejuvenated me and kept me sane. I found his presence to be calm and soothing because he never questioned me, and instilled in me the belief that I was doing my best. I also found immense comfort in my best friend who had a baby 18 days after me. We were able to go through all the trials and tribulations of new motherhood together. Speaking to someone who was feeling all the things that I was feeling, was an immense reassurance. My parents were very supportive and generous. I feel I took them for granted to some extent, but knowing that they were there for relief and my father for medical help and advice was very comforting. The things that caused turbulence was constant critiques and criticism of my choices and parenting style, and people providing anecdotes about the choices that they made with their children. I felt that there was so much pressure and instruction, it left me dizzy, and unable to think out the best choice for me and my baby.”

Meanwhile, Shilpa says space and privacy were what she needed and when given that, she was able to enjoy the initial days and stay comfortable. She adds, “This was essential to recover, bond with and get to know my baby. I didn’t want a long lines of visitors at the hospital or at home, and that was THE factor that caused turbulence in my case. Being in India, a LOT of people tend to visit – out of courtesy, even when you don’t want/ expect that courtesy!  The cardinal rule of “never wake a sleeping baby” was thrown to the winds, and that was incredibly upsetting for me.”

At any point in this journey, have you felt that you were so unprepared for the task in hand?

“Honestly this happens so often that I have lost track,” admits Shilpa. “While most matters appear fairly routine and ‘everyone has gone through it’, when it is your own baby, and when it is you who are completely responsible – even the simplest of tasks can put a lot of pressure on you. At the start, even changing diapers used to stress me out – have I cleaned him properly so that he doesn’t end up with a rash?! After getting through the first few months, I can now probably tell another new mom to hang in there and that it gets better.”

“Yes!” exclaims Ramya.”Many times in the first three months, I’d cry to myself, asking what I had done to my husband’s and my life.” “The physical and mental exertions were nothing close to what I had expected, and I was completely overwhelmed. At the same time I felt like a complete failure, because I thought that since the start of time, billions on billions have undertaken motherhood successfully, why am I finding it so hard. I also felt a great amount of guilt since I knew the majority of people have minimal amounts of help and I had so much. I was perpetually petrified of what life would be like when I moved out on my own.”

Is there anything that you have learnt on this journey that you want to share with other mothers?

Shilpa advices new mothers, “You may have heard a lot of people talk about how they are independent and how they managed to do everything for their baby all by themselves. Now, that’s great. But, if you are in a position to get some help, take it! You will feel much better. While it is beautiful, it is not an easy journey, and every mother needs her rest, as well. You don’t have to feel guilty if you are unable to manage by yourself, taking care of a newborn is no easy task and especially for a new mom who doesn’t sleep nights (or days). Even now, with an 8 month old, I don’t need help with any chores, but I do ask the grandparents to come and just play with the baby. I physically don’t have the amount of energy required to keep my baby entertained for hours and that’s the one thing I ask for even now.”

Ramya puts into words something beautiful for expectant mammas, “I think I would want to share that there are so many narratives, dictats, rules, and expectations. There are so many voices in the background. There is so much stress and tension. Hard as it may seem, block ALL of that out. Remember the only thing that is right is what works for you and your baby. There is no wrong. There are no winners and losers. There is no better and worse. So focus on making yourself happy and content because that’s when you will be able to make the best choices as a parent for your child and family. Learn to trust yourself, that’s how you can be the best mother you can. 

Cut out the competition in toto. It doesn’t matter – epidural or non, vaginal or c-section, breast, bottle or both, co-sleeper or in the crib. These choices literally do not matter at all in the long run in any material way, they have no reflection on you or your child. You aren’t better if they did things one way, nor are you worse. She finally says, “Don’t derive a sense of achievement from your children!  Enjoy each milestone, quietly and peacefully.” 

The Changes that Come with Motherhood : Mamma Love Series

Becoming  a mother is a transformative experience for a woman! The physical, psychological and emotional changes that accompany are often hard for many mammas to express in words. While many may associate the birth of motherhood with the birth of a baby, motherhood truly begins in pregnancy. 

As part of the Mamma Love Series, I approached a few mothers to share with us the changes they have experienced in their journey of being mothers. Each of these mammas have had different experiences and births, reiterating that even with something as universal as motherhood, no two paths are the same. 

How has becoming a mother changed you as a person? Is it anything like you imagined it to be? 

“Motherhood cannot be imagined, only experienced”, begins Apoorva, mother of a 3 year old from Chennai, India. “I started putting my unborn baby’s needs before my own and made so many lifestyle changes in such a short span of time. I was never a morning person, but when I was pregnant, I was up every single day at 5 am to practice prenatal yoga. Once my baby was born, even the slightest movement or fuss would wake me; it was such a contrast to the heavy sleeper that I was who would sleep through blaring alarms.” 

Karuna, mother of a toddler from Bangalore, India opens up about her experience, “ I lost my mother at a young age. Losing her was hard, and as I grew, I began to feel strongly about becoming a mother. I have always feared hospitals, blood draws and injections,” she says, “but when the time came, I had to have a Caesarean Section due to birth canal issues and embraced the situation. Women are designed such that despite the pain, sleep deprivation and hormonal changes, we put our baby’s needs before our own. This was the first change I observed in myself.” About her breastfeeding experience, she adds, “I had latching issues and received a lot of advice from so many people. It finally got sorted only when I went to a professional for assistance.” Her advice to other mammas is, “When it comes to breastfeeding, a lot of people have a lot of opinions. I have realised that no matter what people say, do your own research, find the right person for help and make decisions based on what works for you and your baby.” 

Dhivya, mamma of a 4 year old from Basel, Switzerland shares how motherhood has changed her, “Every single woman changes once she becomes a mother. The biggest change in me has been the happiness my daughter brings into my life with her positivity and innocence. We learn to look at life through their eyes.

How important is self-care for a mamma & how do you think she can fit this in with a busy lifestyle?

“Self-care is very important for new mothers,” emphasises Dhivya. “Newborns consume a lot of our time and in this, we forget ourselves. The mental, physical and emotional changes, along with just the drill of a new routine with a newborn can make a mother feel very low. So, taking some time out for yourself is so important. Don’t hesitate to leave the baby with a family member or a sitter for some time to take a break. You are not a bad mother for doing that! Do what you like to do in that time. It can be watching your favourite show or a fitness activity, a massage, book or meeting a few friends. You won’t  realise how refreshed this can make you feel until you try!” 

Drawing from her practice of self-care, Apoorva feels, “If you want your baby to be happy and satisfied, you as a mother need to be happy and healthy, both mentally and physically. Dealing with a child patiently every single day is simply not possible without self-care. Self-care can be anything from watching a show to heading outdoors, listening to some music, talking to a friend or just treating yourself to a peaceful shower. These things can do wonders to relax you. Once you are relaxed, you can jump right back to being a mother!”

Karuna feels the lack of awareness of a mother’s physical and mental health in many societies is something that needs more focus and care. “With the enormous changes that happen in a woman’s body during and after pregnancy, a lot of people fail to recognise the importance of self-care.” From her experience of being a mother and interacting with other mothers, Karuna says, “Being pressed for time, if a mother can get a jump start to her day with a peaceful shower before the baby wakes up, she can begin her day refreshed.” She emphasises that physical exercise is so important for a mother to feel healthy mentally and physically. “Even if you cannot steal time to go for an individual workout, just involve your child while you are doing yoga or going for a walk. You can even wear your baby on a short hike, if you are up for it! 

Abirami Apoorva

What kind of mindset will help expectant mammas embrace motherhood?

“Be positive and prepared to take things as they come,” says Dhivya. “A first time mother may have countless difficulties; breastfeeding might be an issue, latching might be an issue, baby might cry endlessly, but remember that you are not alone in this. Every mother goes through these difficulties. So, stay calm and just be open to taking things as they come.”

“The first few months make you feel like you never have enough energy and sleep!” sighs Apoorva. So, her mantra is being prepared, “Having all of baby’s things ready and the nursery ready made me very calm. I also made sure to have a strong support system. This can be anyone from your parents to your husband or even a nanny.” She smiles and adds, “Oh, just be open to changes; the baby will change your life for the better!”

Karuna’s go-to mindset is, “I CAN DO IT!”

Sometimes, expectant first-time mothers make detailed plans on how they want their life after the baby to be. What would your advice to them be? 

Both Karuna & Apoorva instantly say, “It is good to make plans before the baby arrives but important to be flexible and open. Being rigid causes unnecessary stress.” Apoorva also adds, “Take each day at a time and proceed keeping in mind what is best for you and your baby.”

Drawing from her experience, Dhivya says, Planning things may and may not work. There are a lot of if’s and but’s when it comes to parenting. One thing that works is trying things in motherhood. Some women fix that they will breastfeed for 18-24 months but are unable to after the first few months. So, while having plans is wonderful, make alternate plans and just be open to accepting circumstances if things don’t work the way you imagined.” 

Is there something you have learnt in this journey that you want to share with another mamma? 

“The first two months are so critical, so bond with your baby,” says Karuna who is also a Montessori guide. “Having eye contact with your baby while they breastfeed can make you both feel even more connected. Talk to your babies, respect them, challenge them!” she adds. “Never hesitate to share your worries with someone who has a kind and non-judgemental ear. This can even be a therapist.” Her biggest advice is, “Mammas, let your partners also be involved. Give them the space to bond with the baby and just back off when they are interacting with them.”

“Everything is a phase and things are bound to change,” reflects Dhivya, as she looks back on her journey so far. “Do not fret over milestones; different babies do things at different times. Just widen your circle and have a network of mammas to talk to about your experiences. This will give you perspective and also lessen your worries.” 

For Apoorva, taking time out for oneself as a mother is vital to having everything else together. “Never hesitate to ask or look out for help from a professional or family member.” She says, “Being a first time mamma can be outright overwhelming on several days. So, seek help, keep yourself happy, be your best self and most importantly, forgive yourself.”

Preparing for a Child; Preparing for Motherhood

The arrival of a child is one of the most defining moments in a couple’s life. In many ways, it signifies the birth of a family. If a child is born from a loving and trusting relationship, most women look forward to this phase in their lives. But pregnancy is not just about the impending birth, it is also about the huge transition towards motherhood. Many mammas spend a large portion of their pregnancies sifting through umpteen options and information revolving around their unborn baby. A major part of pregnancy thus passes and before they realise it, they are facing childbirth and the inevitable role change. We forget that a mamma is born when her baby is born and needs nurture, comfort and reassurance herself. 

The journey towards motherhood requires just as much thought, time and preparation. A small care package with moral, psychological and physical support can be a source of strength and support during the transition.

Personal Support: Something or Someone to lean on

The days and weeks following the arrival of a baby is often overwhelming for a new mamma. A personal care package carefully put together during pregnancy might come in handy during this time. 

  • A hospital buddy 

The moment a baby is born, the attention immediately and naturally shifts from the mother to the baby. While the whole world spins around the baby, having someone exclusively for the mamma can be just the support she needs. Someone whom she trusts – a parent, partner or friend – who is around and able to regularly check on her can be the emotional nourishment that sees her through those vulnerable moments.  

  • A chore buddy

In many cultures, chore buddies are typically the grandparents of the baby. In some other cultures, friends usually pitch in as much as they can. New parents have a lot to grapple with and in this phase, having to worry about shopping, food and laundry might take a toll on resting and recovering. Planning for a chore buddy during pregnancy might be one of the best gifts a mamma can give herself for the fourth trimester.

  • A reflective journal/ friend

A reflective journal can be a best friend in those initial months. When we want to pour our racing thoughts somewhere, a journal might come in handy. This journal can hold some of those emotions, those overwhelming feelings, joy over small wins, a string of  gratitudes, frustrations and worries. For those mothers who find that talking works better than documenting, reaching out to a friend can lend the same kind of support. Sometimes, talking to someone outside might give just the perspective needed to support their own changing dynamics. Both a journal and a friend can show how far we have come and also guide us when it is time to seek help. 

  • A support group 

The power of a support group in helping new mothers is largely undervalued. A support group is a small group of mothers, all going through or having recently gone through the changes of motherhood. The members in this group often answer and support each other because they are all walking in similar shoes. Finding or creating a small support group during pregnancy might make the journey towards motherhood smoother while also being a source of great strength in the fourth trimester. 

Excerpt from Promoting Maternal & Infant Health in the 4th Trimester: “Mothers may be anxious about their baby for good reason and providers must respect that perspective as valuable and valid. In order to support maternal and paternal role attainment, it is important to affirm and encourage all that is going well with the parent–infant relationship and caretaking. Women need affirmation of their newly acquired abilities as mothers; they are very sensitive to any perception of guilt or shaming.”

Professional support: Reaching Out 

After the high of the birth, most women who have had a relatively smooth birthing experience return home and this is when everything starts to feel real: the cycles of breastfeeding, sleep deprivation, the sway of emotions, soreness, tiredness and the drastic hormonal changes. In most countries, a new mother is typically not scheduled to see a doctor for up to several weeks postpartum. While new parents are swamped with the task of ensuring everything is progressing well with the baby, mothers are often not asked how they are coping with the changes. 

Excerpt from Postnatal Care for Mothers & Newborns: According to the WHO, as of 2013, “at 10-14 days after birth, all women should be asked about resolution of mild, transitory postpartum depression, also known as postpartum blues. If symptoms have not resolved, the woman’s psychological well-being should continue to be assessed for postpartum depression, and if symptoms persist, evaluated. Women should further be observed for any risks, signs and symptoms of domestic abuse. They should be told whom to contact for advice and management.”

Despite WHO recommendations, the reality is that most women are left to navigate the changes in surroundings where symptoms of postpartum blues or depression go unnoticed. Putting together a self-care team prior to the baby can help new mothers know that they do not have to navigate every crisis alone. 

  • Breastfeeding Support 

The uncertainty and questions surrounding breastfeeding are not only plentiful, but emerge in the weeks following childbirth. It might help to see a lactation consultant who can reassure new mothers and help them navigate any crisis that might be brewing in their breastfeeding journey. Sometimes, having a professional perspective from someone who deals with many women going through breastfeeding changes is far more reassuring than talking only to a small group of women who share anecdotes from their personal experiences.

  • Postpartum Physical Support  

Many mammas suffer from postpartum perineal pain and some even develop infection from a cut or torn perineum. They return home after childbirth with little or no information on urinary incontinence, back pain, organ prolapse or pelvic-floor weakness. The toll that pregnancy and childbirth takes on women must never be overlooked; mammas need to feel no shame in reaching out to a doctor or physical therapy for support in  the weeks and months following childbirth.

  • Postpartum Psychological Support

According to the WHO, about 10% of pregnant women and 13% of women who have just given birth experience depression. In developing countries this is even higher, at 15.6% during pregnancy and 19.8% after child birth. So, postpartum depression and depression during pregnancy is all too real! By neglecting this important transition, we put new mothers and babies at risk. If a new mamma feels consistently low, it is important to reach out for psychiatric help. 

Excerpt from Promoting Maternal & Infant Health in the 4th Trimester: “Listening to women and families, whose opinions and needs often go unexpressed or unheard, or both, is foundational to providing high-quality care. Well-meaning providers and practitioners may assume they know what new mothers want and need, and should do a better job of asking them, phrasing questions in a manner that solicits their goals and engages them in program design and development. It is likewise important to honor mothers and fathers as experts about their babies. Truly, no one can know or understand the infant as well as the baby’s primary caregivers.”

The Fourth Trimester Agenda

  • Eat. Sleep. Love.

The fourth trimester to every pregnancy is often the most neglected. A mother has months to prepare for childbirth but soon after the baby arrives, her body goes through a sea of immediate changes necessitating plenty of support and rest. This is a period when the mother-baby dyad must continue to to be looked at as a single entity. The mamma needs external support to sync up to her baby’s schedule, eat healthy, nutritious and simple food, sleep when she feels the need to sleep and have plenty of time to cuddle with her newborn. When this is offered, she has better chances at being able to address the needs of her baby.

By nurturing a new mother, we are not just nurturing the bond between her and her baby, but also supporting the emotional & physical wellness of the next generation.

  • Music. Mindfulness. Positivity 

Being in a positive frame of mind is the best gift a mamma can give herself and her baby. But, it might be challenging to wonder how to keep this positivity alive when the body is going through changes. So, creating a playlist of songs that lift you up or put a smile on your face, collecting a few books that help you be mindful and joyful  and surrounding yourself with people who lift you up are treasures to keep at your arm’s reach for those blue days.

  • Keeping visitors to a minimum

Sometimes, new mothers are faced with a swarm of well-meaning visitors in the days following birth. While this may be just the source of strength for some, some others find that socialising is overwhelming for both the baby and themselves. From the outside, it is important to respect a mother’s wish and honour this space. The time to socialise will come and when you feel ready, you can step out of your cocoon.

  • Making gratitude your friend

Perhaps the most forgotten of all virtues is gratitude – a dear friend to keep close during trying times. Devoting a few moments in a day to just focus on things that are going well can drastically help shift ourselves to a more positive frame of mind. This simple practice can help significantly improve the quality of our lives and also give us perspective when everything seems to be spiralling down.

In The Fourth Trimester Companion, Cynthia Gabriel says, “The work of mothering and fathering is slow paced and repetitive. Parenting challenges can be measured in hours, while joy is measured in moments. If you can believe the difficult moments are just as normal, as necessary as the delightful moments, you will come out of the 4th trimester with more stamina and reserves for the months ahead. 

The fourth trimester should ideally be a nesting retreat for a mamma and her baby. This is a time when we continue to look at the duo as a single unit, depending on each other for physical and psychological support. From the outside, we can offer them plenty of support, understanding and nurture to adapt to their new lives. It takes a village to raise a new mamma and it is the responsibility of all those who surround her to make this beautiful phase as comfortable as possible.

 

My Journey as a Working Mother: From One Mamma to Another

They say a mother is born when her child is born. Motherhood can be a journey of varied emotions – love, protection, anxiety, frustration and guilt. With more mothers balancing work at home as well as in society, the dynamics of motherhood as well as parenting are changing tremendously.

So, we approached a wonderfully compassionate, working Mamma of a four year old to share with us the joys and learnings of her parenting journey.

Hi Dhivyaa, tell us about yourself and your family.

Hi, I am Dhivyaa Naveen Kumar, a working mother. I moved to Basel, Switzerland in 2012 soon after my marriage and my husband and I have a 3.5 year old daughter named Mila.

Can you share your birthing experience with us?

I actually had a very trying birthing experience; it was not very pleasant. During pregnancy, I had hyperemesis gravidarum which is a case of excessive nausea and vomiting. This lasted my entire first trimester and I couldn’t keep even water down. This led to excessive weight loss and I was on infusions during this period. Eventually, things got better in the second trimester. I went to work until the end of 36 weeks gestation and went on maternity break when my doctor advised me to do so.

During labour, after almost 24 hours, just as I was pushing, my daughter got stuck. Although the doctors tried hard for a normal birth, they had to eventually go for an emergency cesarean section. This led to a lot of physical and emotional pain before, during and after my daughter’s birth.

How soon after Mila did you get back to work?

We had only 12 weeks of paid maternity leave in Switzerland. As a new mother, this naturally increased my anxiety and I had symptoms of postpartum depression; thankfully I was not on any medication. The only medicine for me was my child. I kept admiring her smile and holding her against my skin. Skin-skin contact with the baby is helpful not just for the baby but for the mother as well.

What steps did you take to prepare yourself and your baby before getting back to work full-time?

Mila was completely on breast milk until about 14-15 weeks. She already fell into a routine and would feed every 3-4 hours. Around the 15th week, I began pumping milk and feeding from the bottle. She thankfully took to the bottle immediately although I was worried that she would refuse. After the 15th week, I started pumping milk for two feeds at home and gradually, I increased this to three feeds. I used to pump and store the excess milk in the fridge. I wanted to give her milk as fresh as possible and so would pump and store in the fridge only for a day. The most important tip I can give a working mother who wants to breastfeed her baby is to never change the timing for pumping milk. Once you fix a time and routine and stick to it, even during weekends, the flow is consistent. Although, this might get stressful, it is better than not having consistent flow.

Eventually, I asked my husband and my mother or mother-in-law to begin feeding Mila from the bottle. Just a week before I went back to work, we began transitioning her to this routine.

What steps did you and your husband take to help Mila adapt to a new environment and caregivers? And, what steps did you take to emotionally support yourself from being away from her?

This was the most challenging phase for us. My daughter was with my mother and mother-in-law soon after I went back to work, which was when she was around 19 weeks. So, she was still with family members at home. But once they left at around 32 weeks, we had to send her to a daycare. I was able to trust my family even though I had to go back to work but it was not easy for me to leave her in a completely new environment with many other babies. I could not imagine how she would sleep peacefully or eat well and this used to worry me a lot. Thankfully, we found a place that is literally a 2 minute walk from home. The daycare centre had a transition phase where I could spend a couple of days with Mila. We could also observe how they took care of the other babies. This gave me a lot of confidence and I began to have trust that she was in safe hands. Mila did cry a lot initially after the big separation from home and I used to cry on my way to work, but gradually, she settled down with all the fun activities she could do at school like singing, painting, outdoor walks and was happy to go.

Pumping milk at work is not an easy experience both physically and emotionally. How did you deal with this and what kind of support did you receive?

I made it a point to pump milk regularly at work at the fixed time and thankfully, I had the support to do so. Although, initially, I used to miss my daughter and our skin-skin bonding, I used to watch her videos and pictures while pumping at work. We both fell into a routine; Mila used to drink milk around 8 times a day. Three meals were from a bottle with expressed milk and the other meals were directly from me at home. I would feed her from my breast at 7 am, then leave for work at 7.30 am. I pumped consistently at 10am, 1pm and 4pm. I used to store the pumped milk in the fridge at my workplace for her next day meal.

For interested parents, I used the Medela swing maxi double electric breast pump which worked like a charm. And for storing milk, the lid on the bottles came with labels to mark the date and time. They also came with a tray which helped me organise them by time and date in the fridge.

Did Mila find it difficult to transition between breast and bottle everyday? How did you address challenges around this?

Right from the first day, luckily, Mila never had difficulty transitioning between bottle and my breast. I did notice that she used to wake up a lot more in the nights and feed directly from me. Gradually, as I started weaning her, she used to feed from my breast only in the nights. I started replacing every ‘expressed-milk’ meal with solid foods. By the 7th month, I stopped pumping milk at work. However, until she turned three, she used to wake up in the nights to feed from me. I attributed this to her longing for skin-skin contact and bonding with me and enjoyed it.

How did you manage to strike some kind of balance between healing after a cesarean section, being available for Mila and also working both at home and outside?

I have to thank several people for this. My husband is my biggest support and shares all the household chores with me. There is no task in the house that is done only by me. I also have to thank my work environment as I never had to bring back any work home. In the initial months, my mother-in-law and mother helped me a lot. I definitely have to thank Mila’s caretakers at her daycare who gave me the trust and confidence.

dhivya

We made this work by always waking up and going to bed on time. We tried and planned ahead. For example, it would take me only 5 minutes to come up with a meal plan, but this saves time and energy instead of worrying what to cook and what to shop everyday. I also learnt to listen to my body and never pushed myself beyond a certain limit. When I knew I couldn’t handle something, I learnt to ask for help and look for alternative solutions. On those days when the routine becomes mundane, we helped each other or just went out as a family to break the repetition. I also helped my body and mind heal by engaging in activities like swimming and running, watching movies once in a while and taking breaks to relax when needed. All of this helped me rejuvenate and get better.

Many working mothers go through a lot of emotional turmoil for not being with their baby the whole day. Did you also experience this? 

Yes, of course I did. Hundreds of thoughts ran in head. “Did I dress her appropriately for the weather?, “Will she eat?”, “Will she be happy?”, etc. I used to chat quickly with her guides at drop off and pickup. I started noting down what she ate, how long she slept and how she was. In the mornings, I used to update the guides at daycare on how her morning was so far, which helped them plan better and I used to ask them the same at pickup. I had an open and honest relationship with the guides at daycare which helped me communicate my needs clearly with them.  At home, my husband participated in all household chores and has been my biggest support. It was he who took care of Mila during most of her sick days. Only because it is a 50-50 partnership, we have been able to keep the family going smoothly. 

From your experience, what kind of support do you think working mothers require from family and society?

I strongly believe that fathers play an equal role in raising a child. We did not have a baby-sitter. We just used to take turns in being with Mila and did our best to balance it all out. Our society must understand that fathers are important figures in children’ lives and willingly offer emotional and physical support to mothers and fathers who work both at home and outside. Of course, every family has their own style and there really is no right or wrong way in parenting. We need to figure out between each other and go from there.

We all do what is best for our children. It is important for us as mothers, as women, to be strong, positive and have faith in what we are doing. Everybody likes to advise us but I have learnt to take what makes sense to me. 

dhivya-2.jpeg

Can you please share a word of support and love to other mothers in similar situations?  

Dear Mammas,

Please speak out when you think something is not correct and ask for help when you cannot do something. There is no shame in asking for help!

Don’t blame yourself and think that it is always ‘you’ who is responsible for your child. Many of us hold onto our children tightly; we must learn to let go and find trustworthy people to engage with and interact with our children. Being with different people will help our children socialize better and grow.

Take some time for yourselves. Be grateful when people around you respect your feelings and, again, speak out when you need something. You get only when you ask for something. Lastly, stay positive and pat yourself on the back once in a while for doing the best that you can!