Expert: Sally Wendkos Olds - 6/20/2008

Question
I breast feed my 5 1/2 month old son every 2hr. 30mins during the day  and go 8 hours at night.  I sleep at least 8hrs and sometimes get a nap.  I have no energy and want to sleep all the time.  I do not know what to do.  I take a prenatal vitamin.  HELP.  I need some advice.  It is hard to take care of a family with out any energy.
Thank you,
Candace

Answer
Dear Candace,

First, congratulations for giving your son the best start in life by breastfeeding him!

It can be very exhausting taking care of an infant -- whether breast-feeding or bottle-feeding. It sounds as if you are getting a good amount of sleep and it's good that you're still taking your prenatal vitamin. I think it would be a good idea for you to see your own doctor to have your blood tested just to see whether  you might be anemic. This is often a cause of fatigue.

Another possibility might be the "baby blues" or post-partum depression. I discuss both of these in my book (see below), and I'll just attach an excerpt here for you to take a look. If you think  you are suffering from either of these, please consult your doctor or a mental health practitioner who can help you. It is no disgrace, and the sooner you get help, the better off you and your family will be.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with Laura M. Marks, M.D.
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Differences Between Postpartum Blues and Postpartum Depression*
(This chart doesn't look as clear as in the book. In each category, the first answer is for the blues, the second for depression.)

Time of Onset
  3 to 10 days after delivery (sometimes after a helper goes home)
  Any time in first year after delivery

Duration
  A few days, up to 2 weeks
  At least 2 weeks, but often longer

Incidence
  From 30 to 84% of new moms; average, 56% of them
  10 to 40% of new mothers

Symptoms
  Mood swings, crying easily, headaches, forgetfulness, restlessness, irritability, negative feelings toward baby and other family members
  All those experienced with the blues, plus anxiety, despair, problems with sleep and eating, feelings of helplessness and hopelessness, irrational fears about baby and self

Treatment
  Balanced diet, vitamin and mineral supplements, exercise, help in caring for the baby, emotional support from family and friends, brief psychotherapy or counseling (especially cognitive therapy, which helps you to think positively)
  All those recommended for the blues, plus antidepressant medication if prescribed by doctor and not harmful to baby
(see Chapter 10)

Prognosis
  Good!
  Good!


* This chart is adapted, with permission, from one prepared by Kathleen A. Kendall-Tackett, Ph.D., of the Family Research Lab of the University of New Hampshire, Durham, New Hampshire.

BOX
Ways to Boost Your Postpartum Morale
Many new mothers find the following measures help them to feel better:
• Take care of yourself. You can’t meet your baby’s needs if you don’t meet your own.
• Eat a healthy diet comprising foods you enjoy. Whenever possible, try not to rush your eating. Take vitamin and mineral supplements as suggested by your doctor.
• Get as much rest as you can. Nap during the day when your baby sleeps to make up for losing sleep at night. Set a schedule whereby your partner brings the baby to you during the night, if the baby is not sleeping in or near your bed.
• Develop an exercise routine. If you haven’t followed one before, this is a good time to start. You need those endorphins!
• Forget about housework for now. The Board of Health won’t come for you if there are dustballs under the bed or full wastebaskets in every room. Do what you absolutely have to do, and let the rest wait.
• Ask for help—all kinds of help—from your husband or partner, your relatives, your friends—and don’t forget how much help your older children can be.
• Work out an arrangement so that your partner can spend more time at home and do more in the home, at least for a while.
• Pay for as much help as you can afford. It’s a sound investment in your comfort and peace of mind.
• Cut back on outside responsibilities. Let someone else collect the union dues, bake the cookies, staff the hot line, chair the meeting.
• Take some time for yourself every day, even if some days it’s only fifteen minutes to read a magazine or listen to music. Or you could set aside a few minutes every day for meditation, or playing the piano, or writing in your journal, or just taking what one mother calls her “ten-minute sanity walk.”
• Pay attention to your appearance; you’ll feel better if you look better.
• After the first week, get dressed every day. At first, staying in your nightclothes may help you get your rest, since people won’t expect too much of you. After this time, though, it can be dispiriting to find yourself still in your bathrobe at 6:00 p.m.
• Join a mothers’ group (such as those sponsored by La Leche League, a childbirth education group, or a local family service agency). Other mothers have similar problems and feelings and can help you with yours.
• See a mental health professional who will give you short-term counseling or cognitive therapy to help you deal with stress and think more positively.
• If your symptoms are especially troubling, see a psychiatrist (an M.D.) who can discuss options such as personal psychotherapy or the use of antidepressant medication. Be sure the doctor knows you are breastfeeding. If the medication is not listed among those in Chapter 10 that are safe for your nursing baby, check it out with La Leche League International (see the Resource Appendix).
• Also, check with La Leche League before taking any herbal, homeopathic, or other alternative remedies. Not all substances that grow naturally are safe for breastfeeding mothers to take.
You may look at this list and groan, thinking that any or all of these suggestions are too much trouble. But exerting yourself to take care of yourself may well make you feel better.
END BOX  

  Before you have a baby, it’s impossible to know what life with one will be like. Most women—including adoptive mothers—find that taking care of a newborn is more exhausting and time-consuming than they had ever imagined. Your sleep is constantly being interrupted to feed your baby and your body is working to recover from your labor.
  In our society the typical new mother tends to lack self-confidence in her maternal ability. You know motherhood must be difficult because there are so many books telling you how to handle your children’s psyches, how to raise their IQs—even how to feed them at your breast! And if the professionals disagree about the best theories of child rearing, how are you to have confidence that you know what’s best?
  Although the “baby blues” are not a new phenomenon, new stresses around motherhood may provide a fertile soil for them to develop. Having idealized both childbirth and breastfeeding, some women find that neither experience has lived up to their expectations. They’re disappointed with the experience and disappointed in themselves, feeling that they have not quite measured up. Women who had planned to have a completely unmedicated delivery and then needed anesthesia, women who had practiced their breathing exercises and then needed a cesarean delivery, and women who have a rocky start with breastfeeding are apt to forget that the ultimate goal of childbirth and child rearing is a healthy baby and a healthy mother.
  Then, in an age when women are urged to have it all, many women learn that having it all at the same time can be overwhelming. Combining career with motherhood is much harder than most women expected it to be. As a result, you may feel that there’s something wrong with you—rather than with the unrealistic expectations that only Supermom could fill.
  Ideally, as a breastfeeding mother, you should feel empowered that your milk is helping your baby bloom. However, because of cultural pressures your confidence may be actually undermined by the fact that you’re the exclusive supplier of your baby’s food. When a bottle-fed baby cries, or has frequent or sparse bowel movements, or sleeps too little or too much, a mother (and the people around her) will blame the formula or the baby’s personal inclinations. When the same thing happens with a breastfed ]baby, the first reaction is often to blame the breastfeeding. You worry that your baby’s not getting enough milk or that your milk isn’t good enough or that you’re doing something wrong. The unhelpful remarks of other people often feed this anxiety. No wonder your confidence is shaky and your feelings can run away with you!
  If you’re having major problems with breastfeeding—if your baby isn’t gaining enough weight or if you have developed a medical condition that makes it very difficult to continue nursing—it’s not surprising that you should be upset. Almost always, with the right help you will be able to overcome such difficulties and to move beyond them.
  Similarly, almost always, the blues will leave as suddenly as they came. To help them go away, you may want to try some of the suggestions in the box on page 166.
  If, however, you are still feeling depressed more than two weeks after your baby is born, you may benefit from speaking with a mental health professional. Some of the differences between the milder “blues” and the full-blown clinical depression are listed in the box on page 165. The most important difference is that the “blues” are temporary and will pass within a couple of weeks after they appear, without doing anything in particular about them. A clinical depression, on the other hand, does need more attention and treatment.
What You Need to Tell Yourself
You may be feeling blue if you have to or decide to wean your baby earlier than you had originally planned to. If so, it’s only natural to feel sad and disappointed, to mourn the loss of an experience that was highly meaningful. There is no reason, however, to feel guilty or like a failure as a mother. By nursing for whatever time you did, you gave your baby more benefits than he would have received if you had never breastfed him at all.
  Be reassured that you are doing the best you can for your baby. Then accept your negative feelings along with your positive ones and realize that you’re neither bad nor inadequate for having them.
  We can’t help how we feel about things, even though we can control what we do about our feelings. You’ll learn to live with these mixed feelings as you learn to live with mixed feelings about every other aspect of life—your marriage, your work, your schooling. So it is with parenthood. We learn to take the bad with the good—the dirty diapers with the joyous gurgles, the waking up at three in the morning with the bright smile that rewards us as we go to our baby, the burdens of responsibility with the all-embracing love of a child.
  When you come right down to it, most parents feel that the joys of having and raising children far outweigh the demands they make.
  The thought and care that you put into both the inner and the outer you will pay off in many ways. The better you feel, the happier your breastfeeding—and parenting—experience is likely to be. And the better cared for you are, the more both you and your baby will benefit.