“Does everyone do this?”

Recently I read a very moving article in the New York Times  called “Maternal Instinct or OCD?”

Written by Kelly Kautz, it’s a piece that resonates in every  new parent’s mind — is my anxiety about parenthood “normal” or is this something more? Everyone checks to make sure their sleeping baby is still breathing, right? But do they check continuously throughout  the night, forgoing sleep themselves?

Eunice Pinney (American, 1770 – 1849 ), Mother and Child, c. 1815, pen and black ink and watercolor on wove paper, Gift of Edgar William and Bernice Chrysler Garbisch 1953.5.112

Everyone worries about the temperature of the bedroom, the level of air conditioning in the car, the sun glare on the baby, right? But how often? And does this anxiety make it impossible to enjoy being a parent?

Ms. Kautz vividly describes how becoming a new mother triggered a resurgence of the Obsessive Compulsive Disorder she had suffered as a teenager, which she thought she had firmly under control after working with a therapist on cognitive behavior therapy. She writes how she was operating in a fog of anxiety, checking on the baby obsessively, so concerned about her baby she wasn’t enjoying her baby.

But what resonated most with me was the comments section. Reader after reader described their struggles, wondering if others were similarly suffering. Then there were the readers who counseled the writer to relax, just stop worrying, enjoy your baby. (If only it were that easy!) Or those who asked what is wrong with erring on the side of safety when it comes to taking care of an infant.

What is clear throughout the comments is everybody is empathetic, but most are also unsure of when the line is crossed into the region of a mental disorder. Is it OCD, or maternal instincts? Post-partum depression or fleeting “baby blues”?

The truth is, advice from family, friends and neighbors, while always well-meaning, can sometimes send you astray. If your feelings or anxiety is troubling you, I urge you to seek professional advice.

If you  are already working with a mental  health professional, you should alert them to your pregnancy and continue to stay in touch throughout the pregnancy and post-birth. This is particularly important if you are taking medication. While pregnant or nursing,  every health professional you work with should be aware of every medication you are taking.  That includes vitamins, OTC medications, and herbal medications, as well as prescription meds.

(As I wrote in a previous post, many medications are deemed safe to  take while pregnant or breastfeeding, but it’s important to check them all with your obstetrician or midwife and pediatrician.)

If you are not yet working with someone, you can start with your obstetrician or midwife and ask for recommendations.  You can also work with your insurance company to find a mental health professional covered by your benefits.

In addition, national organizations usually have a resource list for you to find local  professionals.

For OCD, the International OCD Foundation has a very helpful resources page with tips for looking for therapists, programs, support groups and information.

Another useful resource is the Anxiety and Depression Association of America. 

It’s also relevant to note that anxiety on the part of new parents is by no means limited to mothers and partners should be alert to their own wellbeing, as well.

The most important thing to remember is there is no reason to be embarrassed or secretive about mental health issues. You wouldn’t want  to hide hypertension and just hope it  will get better, and neither should you try to ignore mental health concerns. Work as a team with your health providers and your partner to do the best for your family.

 

Returning to Work

For many new parents, the return to work after the birth of your baby can elicit anxiety and stress. There are so many decisions to make, childcare situations to consider, and schedules to keep, and through it all you  want to be able to enjoy both work and family life.

As a lactation consultant in a hospital setting, I usually dispensed a few pieces of advice to every family. The one I usually stressed was the introduction of the bottle. When breastfeeding is going well, often parents want to delay introduction of the bottle as long as possible. While I love that idea, the fact remains that babies who breastfeed well, love breastfeeding, sometimes to the exclusion of anything else. That makes the return to work even tougher than it has to be.

I remember, with my first baby, who only took enough from the bottle so as not to starve, I would have my mother bring my disconsolate baby to the train station, where I would nurse her in the car to finally calm her down. Needless to say, this was stressful for me, my baby AND my mother!

I usually advise, if you know your baby will need to  take a bottle,, don’t wait longer than 2-3 weeks to introduce a  bottle. (I used to say 4-6 weeks, but sometimes even that can be long enough for a baby to resist the bottle, so I’ve shortened the time frame.) Usually one bottle a day is enough to keep the baby in the habit of taking a bottle, while still mainly breastfeeding, until it’s time go back to work. This is also a nice opportunity for dads to help with feedings!

Which brings me to my second point… if you’re planning to pump while at work, a fast, quiet, efficient and effective double electric pump is crucial. In my earlier post on  the Affordable Care Act (ACA), I detailed the current benefits accorded to post-partum mothers, which include a pump.

Medela Symphony hospital-grade pump with attachments

Some mothers get advice from other mothers that they should rent a hospital-grade pump, either Medela or Ameda, because that is the strongest, best pump on the market. And they are the best! However, that does not mean you need the best. For many people, a Honda Accord is perfectly serviceable for their needs; they don’t need a BMW.

The downside is hospital-grade pumps are expensive, usually about $50-75 a month to rent and prohibitively expensive to own for a single user, and often not covered by insurance unless your insurance company deems it medically necessary. They are also very heavy, held in a hard plastic case, and not really designed for transporting back and forth every day.

I usually recommend, unless you have a low milk supply or a history of low milk supply, your baby is not gaining well or you are supplementing with formula, or your baby was premature or spent some time in the NICU, start with your ACA pump and see how that works for you. If not, you can always buy a better pump or rent a hospital grade pump here or here.

A side note, if you find the milk expressed by your pump is not as much as expected and/or it is painful to pump, you should check in with a lactation

An Ameda standard flange

consultant to see if the flanges fit correctly. You can find a nearby lactation consultant here.

In terms of retail pumps to purchase, generally speaking Medela, Ameda and Spectra are very well-received. These are also called single-user pumps because they are designed for one mother only. Read reviews before purchasing, but remember, for frequent pumping, you definitely want to have a double electric pump.

One thing to mention, hospital-grade, or rental, pumps have a barrier against cross-contamination and designed to be used by more than one person. It should be wiped down thoroughly after each use, and each user needs her own set of tubing, bottles, flanges and connecting parts. These cannot be shared.

Some breastfeeding-friendly businesses purchase one or two hospital grade pumps for a lactation room for all pumping mothers in the company to use. They just need to have their own pumping attachments to use with it. Maybe you can persuade your company to invest in a hospital-grade pump!

Here are a few other resources that you might find helpful:

  • Lawyer and mother Lori Mihalich-Levin has a website called Mindful Return, where you can find a blog and e-courses about returning to work after childbirth.
  • Idealistmom.com has a good checklist to follow, especially useful for mothers who are choosing to continue breastfeeding after returning to work.
  • Parents magazine
  • What to Expect   

Keeping Track of Healthcare Benefits

 

James McNeill Whistler (American, 1834 – 1903 ), The Doctor, 1895, lithograph, Rosenwald Collection

As we all know, the current state of health care is probably in flux, but I think it is important to outline benefits that parents of newborns and breastfeeding mothers are entitled to under the current law, the Affordable Care Act, passed under the Obama administration. It is often called Obamacare.

First, here are basic rights your family has under the Health Insurance Portability and Accountability Act (HIPAA) as detailed on the Department of Labor website:

If your plan provides maternity benefits, you should be entitled to a minimum hospital stay of 48 hours following a vaginal delivery and 96 hours following a cesarean delivery.

You cannot be required to get a preauthorization from your plan in order for the minimum hospital stay to be covered.

Your plan must provide you with a notice regarding your rights relating to a hospital stay following childbirth.

Contact your health plan or your spouse’s health plan as soon as possible to find out how to enroll your new baby in group health plan coverage.

As long as you enroll your newborn within 30 days of birth, coverage should be effective as of your baby’s birth date, and your baby cannot be subject to a preexisting condition exclusion. This 30-day deadline also applies to the enrollment of adopted children.

In terms of breastfeeding, one of the most important changes with the ACA is the provision that every new mother is entitled to a breast pump from her insurance company. What kind of pump differs from company to company, but my experience in working at a hospital is most insurance companies were offering good quality double electric pumps.

ObamacareFacts is a good website if you have questions about the ACA.

And here is a good rundown of the preventive care benefits for pregnant and post-partum mothers,  as well as infants.

It’s important to note that lactation services are included in this list. You may never need the services of a lactation consultant after you leave the hospital, but if you’d like some help it’s good to know you can get coverage. Check with your insurance company to find out the details of what it will cover.

It’s very possible that some of these provisions will change under the Trump  administration so I will keep this updated.

For those of you who want a more in-depth view of healthcare news, the Washington Post has a daily update called The Health 202.