Avoiding postpartum mental illness?
July 17, 2014 10:29 AM   Subscribe

What can I do to minimize my risk of postpartum mental illness? If I can't completely prevent it, I'd at least like to catch and treat it as early as possible.

(Inspired/prompted in part by this FPP from a few weeks ago, though this has been on my mind for a while.)

Baby Metroid Baby is due in a few weeks. I know it's going to be tough adjusting to parenthood no matter what, but since I have a history of mental illness I'm particularly worried about postpartum depression/anxiety. More than anything else, I want to be mentally present for my child, and I want to appreciate and bond with him from the beginning.

In the past, I've been diagnosed with depression/dysthymia and obsessive-compulsive disorder; I'd say that the depression is currently in remission, and the OCD most of the way there. I've taken Wellbutrin since before the pregnancy, with the approval of my OB, and plan to continue doing so after I give birth. I am not currently seeing anyone for mental health care, though I have before.

It's been a healthy, uneventful pregnancy. However, I've had a few moody/depressed/weepy episodes scattered throughout. Some of them have been triggered by stress or exhaustion, others have been out-of-the-blue obviously-hormonal things (like, getting teary-eyed at that "are we human or are we dancer" song, seriously wtf hormones). They've been isolated, brief, and haven't kept me from functioning or staying optimistic, so I'm not concerned about them - they seem well within the range of normal.

A few other details:

- Regular original-recipe depression and anxiety run in my family, but I don't believe any of the women in my extended family have had any postpartum mental issues. I don't know this for sure, but I come from a large family with lots of babies and little shame about mental illness, so it's likely I would have heard something if it were an issue.
- I exercise regularly and it helps my mood a ton, though I've had to cut way back and I know I'll need to stop completely for a while. I worry that prolonged inactivity will be difficult for me mentally.
- My husband and I do not have any family in the area (parents are visiting, but not for long), so we won't have a lot of hands-on support.
- My OB is aware that PPD is a concern of mine. I got the advice that most women do experience some sadness and moodiness after giving birth, but if I stop liking myself, or I'm not bonding with the baby, then it's time to call. Makes sense to me.

I've already read a lot on postpartum depression and anxiety, and most of the advice seems to be aimed at people who already have it: "if you experience these symptoms, seek help." I'm hoping for advice with a more proactive/preventative approach.

If you've been there, I'd like to hear your experience: when and how you realized something was wrong, what helped you to climb out.

Specific questions I have:

- At what point, time-wise or mood-wise, should I think "okay, this is getting serious"?
- What can I do to check in with myself to make sure I'm mentally staying afloat? What can my husband or friends do?
- I'm familiar with the usual tactics for preventing/managing depression (e.g. getting enough sleep, eating well, exercise, getting out of the house, avoiding isolation) - all of which will be harder with a newborn. Is there anything else I can add that's postpartum-specific?

I appreciate any and all wisdom you might have.
posted by Metroid Baby to Health & Fitness (23 answers total) 23 users marked this as a favorite
I have some similar mental health issues, and I had a rough birth. I was in postpartum therapy less than a week after I left the hospital, with a therapist who specializes in this sort of thing. That has helped A LOT.

posted by Coatlicue at 10:37 AM on July 17, 2014

This is pretty out-there, and something I haven't done myself, but some people believe consuming your placenta helps ward of PPD (and increase milk supply, I think). It's not that uncommon where I live, and most people who do it here hire a doula to dehydrate the placenta, grind it up and put the powder in capsules.
posted by Safiya at 10:55 AM on July 17, 2014 [1 favorite]

You already know that depression lies to you. Postpartum depression is no different, but you'll be on the lookout for the lies, so that's a good thing.

The most interesting thing I saw about postpartum depression (besides the Times articles) is that it may not be post-pregnancy hormones per se, but a "normal" reaction to extremely difficult circumstances. That explains a lot about why moms and dads tend to get depressed in pairs. There is tremendous variability in newborns, so while everyone experiences some sleepless nights, those with more challenging babies are getting 4 hours or less for months. I (a dad) started straight-up hallucinating from sleep deprivation. If you get to that point, I think it's safe to say you need to change things. Beg friends and family to watch the baby so you can nap, hire a night nurse, switch to formula if it would let you sleep, etc. It's better to get the help you need than risk endangering yourself or your baby because you're "supposed" to be able to handle an infant on your own. I knew someone who, in advance of the birth, hired a staff member from a local day care that was closed for the summer.
posted by wnissen at 11:01 AM on July 17, 2014 [5 favorites]

This is an extremely thorough checklist that you can run through with your partner or a friend at pre-determined check-ins.

Honestly, what seems to be the primary component of best outcomes is a support system that is knowledgeable and accepting about PPD as a thing that happens and can be treated. Just having someone in your life who's willing to say, "Is this becoming disruptive for you?" instead of "YOU ARE FINE NO OTHER ANSWER IS OKAY" is generally enough to open the doors to any help you need.

If you don't feel like your OB is responsive enough (and don't confuse unresponsive with a practical sort of we'll deal with that bridge when we get to it type), you can always find a therapist now to do check-ins with along the way.
posted by Lyn Never at 11:02 AM on July 17, 2014 [1 favorite]

Put big emphasis on "eat well."

When I was breast-feeding, I invented a very high protein, high calcium recipe (basically cream of wheat cooked with whole milk, wheat germ, tofu and frozen fruit) to help support milk production. With my first (very high stress) baby, I thought this stuff was food of the gods. I made it once after having my second child and could not choke it down. I found it vile.

So consider intentionally eating things that are very high protein and high calcium (and get enough healthy fats) and keep yourself hydrated. Hydration, hydration, hydration.

Also, yeah, get enough rest.
posted by Michele in California at 11:05 AM on July 17, 2014

You should gather information now about the different PPD resources in your area. Gathering them when you are not doing well will just add to your and your husband's stress.

If you live near a university that has a psychology department, they might have a PPD support group. The person that ran the meetings where I am was able to refer me to a therapist.

Just being able to think it's ok that my house is not as clean as I'd like was a big change for me. Being okay with not bathing daily. Grocery delivery was a huge help. Don't feel guilty asking visitors to leave or take care of the baby while you take a nap or take a shower. When my daughter was 9 months old, I hired a part time nanny that takes her for 4 hours a day Monday through Friday.

For me, the red flag didn't come until about 6 months after when I was feeling both homicidal and suicidal. I called my OB and he told me to go to the emergency psychiatric ward at the hospital. If it gets that bad, it wasn't that scary.

There were also a lot of changes, which I see now were for the better, during my baby's first year - I decided after a month of working that I wanted to stay at home and my husband and I decided to move to another state. They were stressful and triggered my depression. If you don't have to make big changes, put them off.

Sorry I'm rambling. I've just never had to put these thoughts into a coherent message before. Good luck. You can PM me if you want to know more.
posted by spec80 at 11:16 AM on July 17, 2014 [2 favorites]

I was worried about this too. I started seeing a therapist a few month in advance of the birth just to get my head in the right place and saw her afterwards just for checkins. I also joined a breastfeeding mothers' group which met once a week to talk about new baby/new mom issues. Getting out of the house was really helpful. Plus, the group made me more confident/comfortable about breastfeeding in public.

Simple things that worked for me:

1. Sleep when the baby sleeps.
2. Don't forget to eat, and eat decently.
3. Drink water as much as possible.
4. Get some sun and fresh air.
5. Socialize with non-family people. (I wasn't great at this, but whenever I did it, it was worth the effort.)

That stuff sounds obvious, but when you start feeling all wobbly it's good to have people checking on you to point out if it's just new mom hormonal wobbliness or PPD. Because I talked a lot about it beforehand with my significant other instead of just worrying about it to myself, it was a lot easier. I didn't find my OB to be that responsive, but the midwives in the practice were more mindful of it.

I know it's hard to make time to take care of and focus on yourself when you have a baby... but you have to... think of it like when on an airplane, during the safety overview, they say "Put on your oxygen mask before helping those around you." Try to determine what your oxygen mask will be before you need it.
posted by msladygrey at 11:26 AM on July 17, 2014 [2 favorites]

1. Sleep when the baby sleeps.

Oh, god, yes. Do this. A lot of new moms put the baby down for a nap and promptly try to straighten up, clean something, etc. because it is the afternoon and they are an adult and adults sleep at night, we don't do naps, naps are for babies and small children and the house is a wreck and...and...and...and

And they totally forget that they only slept four hours the night before and tonight probably won't be any better.

I will suggest you even print this out on a mini poster and stick it somewhere really prominent to remind yourself to sleep when the baby sleeps. It makes a huge difference.
posted by Michele in California at 11:30 AM on July 17, 2014 [2 favorites]

I see you're already aware that you need to get enough sleep. As the mother of a 7 month old who is an absolutely terrible sleeper, I want to warn you that it may not be obvious HOW to get more sleep. Even if you have help. You may need to be more aggressive about figuring out a way to sleep than you ever thought possible.

My husband is a devoted father who is willing to take on his share of the work in all things. Even so, I am unbelievably sleep deprived.

-We live in a small apartment, so I can't go somewhere else and sleep while others take care of the baby. Even through earplugs and 2 closed doors and a pillow over my head, I *will* hear it if our baby cries, and I CANNOT sleep through those cries. I am a good sleeper; I've never had any trouble sleeping in my life. There is just no way I can stop listening for that sound.

-I'm breastfeeding my baby, so if somebody else takes night feedings, I *must* pump milk to replace what was given at night. This means either pumping first thing in the morning (which means either getting up extra early or having a flexible day) or pumping at night. And it means having a cooler in the room with us with the pumped milk so we don't have to fumble for it at night. AND it means accepting that bottlefeeding doesn't put the baby back to sleep as effectively as breastfeeding, so there may be more crying.

-At times, our baby WILL. NOT. SETTLE. unless he's been nursed in our bed so he doesn't have to be transferred. This means that both adults have to be present, or we need a bedrail and a person who can safely cosleep wit him. This means I MUST be present; my husband is not a safe cosleeper for various reasons. When I am on duty, I wake every 90 minutes with the baby.

-I'm a full time PhD student; "napping when the baby naps" is not a thing I can do without totally screwing up my work and experiments. It requires extra work and planning to take a break. You know? It's not easy. I can't just take a nap - I take a nap and then have to make up all the chores I skipped because I can only do chores when I'm not at work.

-If I nap in the late afternoon after work, I have trouble falling asleep early at night, which is the only way to cobble together enough sleep before morning.

Many of these may not apply to you, but I just want you to see an example of how complex it can be to figure out a way to get more sleep. The more help, the better. If you have an isolated quiet spot to retreat to, fabulous. If you have a place you can go for a night to get respite, AWESOME. Consider giving your baby a bottle of expressed milk once a day starting around 4 weeks (after breastfeeding is established) if you want to be able to use a bottle in a pinch (if you plan to breastfeed, of course).

Severe sleep deprivation has been an eye-opening experience in to JUST HOW FREAKING BAD you can feel, and how ghoulishly your entire world and mind and heart can be rearranged into misery, if you haven't slept. It makes you feel awful, but IT GOES AWAY QUICKLY ONCE YOU GET EVEN A FEW MORE HOURS OF SLEEP. If you find yourself in the trenches, know that. Sleep is a very, very effective cure for the misery of sleep deprivation, obviously, although it's surprisingly easy to forget that.

When our son was born we had tightly budgeted everything except food. We basically allowed our grocery budget to balloon out of control. I eat a ton because I'm feeding the baby; we buy pre-cut veggies and fancy drinks and other things we didn't previously allow ourselves. Organic everything. I won't mention here what the monthly budget for food has become, but it's HUGE. We have cut back on everything else. This has gone a long, long way toward keeping us sane. If you are financially able, I suggest it.
posted by Cygnet at 11:32 AM on July 17, 2014 [3 favorites]

Oh, and: never, ever, ever, ever underestimate the power of talking to other new parents in your position. If you can find somebody to come sit with you on the floor as you entertain the baby, or pace up and down your block as you get the baby to sleep, you will feel 1000% better and you will be amazed what companionship and friendship can add to the wild ride of parenting.
posted by Cygnet at 11:33 AM on July 17, 2014 [1 favorite]

Is there anything else I can add that's postpartum-specific?

I did not suffer PPD but I worried about it a LOT in the weeks before my daughter was born. I ended up writing a "postpartum plan" document that I kept in Google Drive, shared with my husband, onto which I dumped contact information for every single resource I thought there was the slightest possibility I might need to leverage. My own doctor and nurse line, my baby's doctor and pediatric nurse line, the nearest children's hospital and ER. My doula. My therapist. My insurance company and plan information and phone number and my employer's employee assistance program. Lactation consultants. My HR rep, in case I had questions about maternity leave benefits. Knowing that having to dig up that information while exhausted and stressed and unshowered and hungry could be a huge barrier to getting help, having it all in one easily accessible place beforehand was a HUGE load off my mind.

And I still think that joining a new moms group was THE best thing I did while on maternity leave. The internet is wonderful, but connecting with on a twice-weekly basis and being able to physically see other new moms with brand new babies, who were struggling with the exact same issues and questions I was, was priceless and irreplaceable.
posted by anderjen at 11:45 AM on July 17, 2014 [1 favorite]

It's great to read all of this, I didn't get PPD with my first, but that's no guarantee for number two (due about the same time as yours : ).

This isn't so much prevention as awareness, but a relative told me that when his daughter abruptly self weaned, his wife had a really hard time. He said it was like watching someone withdraw from heroine - though I'm not sure if this was an experience based analogy or used to simply underline the dramatic effect it had on her. Apparently the hormonal shift in weaning can be very difficult for some.

Just something to be aware of so you aren't taken by surprise if the hormones effect you strongly during that time.
posted by pennypiper at 11:56 AM on July 17, 2014

My son's 13 months now, and I didn't have PPD - but I do have a history of hormone-mediated depression so was vigilant. And I was hopeless at sleeping when the baby slept, so I was really very sleep-deprived until about 7 months (things got much better after that). The hormones in the early weeks are really no joke, even if PPD is not in the picture, which can be quite confusing I think.

The two key things for me have been:
1. joining a new moms' group - actually several, including a stay&play at a local church (I'm not religious, but no-one there has ever asked) and a breastfeeding support group. These have been invaluable for getting to know local parents and asking all the silly questions.

2. exercise. Since about 2 weeks post partum, when I was recovered enough from my C-section and assorted problems caused by labour, I have been out for a walk with the baby almost every day. He happily sleeps in his stroller and I get to see the world. And even on the most sleep-deprived days, that would make me feel better.

I also like the forums on altdotlife, and I know a number of other Mefites do. But there's no substitute for getting out of the house.
posted by altolinguistic at 12:41 PM on July 17, 2014

I had PPD with my first (but didn't realize that was what was going on until much later) and was terrified I would have it again with my second, so my mission with my second was to try to do what I could to prepare myself. That meant minimizing as many possibilities for stress as possible. So I made a plan.

Because the hugest hurdle for me the first time around was that I didn't want to appear "incompetent" or like a "bad mother" or "crazy," all of which made me reluctant to ask for help or accept intervention when the opportunity arose, I decided to start seeing a therapist while I was still pregnant and feeling "normal." This way, I reasoned, I would have someone who could help me/monitor me who had a baseline for how I usually am and would be able to see any difference in my behavior/thinking, even if I couldn't. Together, we made a plan for ways to prepare, proactively putting support systems in place—I brought my husband in to a few sessions, so we could talk about ways in which he could support me, and how I could signal to him that I needed help when I was too stressed to think about how to ask; we talked about a medication plan that could kick into gear given specific circumstances; that sort of thing.

The biggest decision for me, which helped ENORMOUSLY, was one that might seem controversial but was the absolute best thing we did: I decided to bottle-feed from day one. Breastfeeding had been a huge stressor for me and source of depression the first time around, and even though in hindsight I think it could have worked the second time (my son was a huge eater, had no problems, unlike my daughter, who had prolonged trouble from the start), it was the best decision for me and my mental health at that time to forgo it. For one thing, it helped me get back to "normal" (hormonally) faster, and for another, I was able to SLEEP. Which had also been a huge factor in my PPD the first time around. (I didn't sleep for more than 15 min a night for two weeks. It was awful.) This time around, I took the night shift with my then 3-year-old, which only involved one or two nighttime wake-ups, and my husband fed the baby for all the night feedings. This was so great for both of us: I got precious, precious sleep, and he bonded with the baby in a way he didn't get to experience the first time. (He also gained a lot more empathy for what I went through—I still remember someone calling to see how things were going a few weeks after baby number two was born, and my husband half-weeping into the phone "it's so hard!" We definitely bonded.)

Note that I am not suggesting to you that you shouldn't breastfeed—I'm suggesting that if there is something you can identify as a specific stressor for you personally, it can be a positive thing to find a way to address that specific stressor and lessen it, if possible.

I would say researching PPD resources in your area is a good place to start. Talking to your doctor now, for instance, so that you have someone who's aware of your concerns and the potential for PPD to reach out to, or who can be watchful for you. Hiring a doula is another thing I have heard can be enormously helpful; we couldn't afford it at the time, but our insurance did provide for a visiting nurse to come a few times in the first two weeks, and it was such a relief to have someone there to help, support, and provide a reality check-in. If you have friends who have been through PPD, talk to them, and listen.

For me, the most important thing (besides our decision about the division of labor and night-time feedings) was feeling proactive and having even the tiniest plan. It helped me feel less anxious and overwhelmed. And it made it easier for me to reach out, ask for help, and actually accept that help.

Please feel free to me-mail if you want/need to talk!
posted by mothershock at 1:41 PM on July 17, 2014 [6 favorites]

Load up on Omega 3 supplements.

I remember listening to some science interview on NPR once and IIRC the theory is that while you're pregnant, almost all the Omega 3 you consume goes to the baby's brain development and thus you're deficient by the time you give birth.

One of the great things about using Omega 3 supplements to treat depression is there are almost no side effects (other than fishy burps) and it's safe to breastfeed while taking them.

OmegaBrite sells really high quality Omega 3 supplements.
posted by Jacqueline at 2:27 PM on July 17, 2014 [2 favorites]

Ask your doctor if they do post-partum depression checks. My OB's office called me six weeks after my daughter's birth with questions specifically designed to check for post-partum depression. It helped me consider whether what I was feeling was okay for my situation and whether I needed to seek additional help (I also have a history of depression). I am really, really glad they did this because it put my mind at ease that I was doing okay. Later on, things got rough for other reasons, and I did see a therapist who specializes in traumatic births and new mothers and I found her to be really helpful - if you decide to seek therapy I'd recommend looking for someone who specializes in this weird time.

Get as much sleep as you can, eat as well as you can, and take people up on offers of help - even if it's "can you come over and do my laundry?" But most of all, keep in mind that in the first couple of months, your only job is keeping the baby alive. If you've done that, you've had a good day - even if the house is a wreck and you're getting takeout again. You've succeeded.

Good luck to you and congratulations!
posted by peanut_mcgillicuty at 4:11 PM on July 17, 2014 [1 favorite]

1) prior it is your sleep over all else, really
2) ensure your husband is aware of what to look out for and prioritising your health in addition to baby.
3) avoid reading too many baby books, especially about getting baby to sleep, they will do your head in.
4) be prepared to let things go, do crappy jobs on stuff, spend money you normally wouldn't, etc. This is all only temporary.
5) never ever feel guilty for putting your needs over the baby's. Society is very down on this but healthy happy mother equals healthy happy baby. If the kid is fed, and dry, you're doing great - the rest is gravy. It's okay for them to cry a little bit, for you to take a longer shower etc. Never feel guilty.

Best of luck, it's hard work but also rewarding and fun.
posted by smoke at 5:49 PM on July 17, 2014 [1 favorite]

I wrote a damn book and am editing it down for you and it's still a book, sorry.

Friends/spouse can do your cooking/cleaning/laundry as much as possible in the first 6 weeks. This is the time to be an absolute princess and just rest/eat well (as in chicken soup, quinoa, oatmeal, cookies, vegetables), build your milk supply if you're breastfeeding, and let your body heal. They say for every time your sleep is disrupted you need an extra hour, so even if you are being woken up "only" once or twice a night give yourself some slack about how you're going to feel the next day. Think of the first year as a marathon, and you need to build up stamina. Keep lots of easy, fresh foods (fruits, granola bars, oatmeal cookies) on hand.

For exercise wait until your bleeding has slowed down and go out for walks and build up to longer ones. Carry baby in your arms or use a carrier or a stroller, just get some fresh air. Life can get very small if you are alone inside and your baby can seem larger than life, their cries sound larger too. Going outside would put my baby's absolute tininess and tiny cries in perspective in those early days.

Spouse can learn all the non-boob/bottle-based soothing techniques. The earlier your spouse is alone with baby the better. Not for hours, just long enough that he learns how baby likes to be held, talked to and so on. Let your partner do the diapers wrong, dress him/her wrong, etc. He will learn and you'll all be better for it.

Zen Mama is a great book, I really like it for new parents and still like to reread it.

Don't see your job as keeping baby happy at all times. Babies have so many growing pains/transitions, they will cry sometimes. It is not your fault. I took it so personally when my baby would cry. People also like to blame sleep "issues" with babies on mother's milk, routine, what baby is wearing, etc. Some babies wake up a lot, some don't, it's not you. If you feel overwhelmed put baby down somewhere safe (on the floor on a blanket is safe momentarily if baby isn't crawling yet, crib is safe, stroller buckled in is safe) and try to take a moment to breath, walk around, scream, etc.

AskMoxie has a PPD prevention plan you may not have seen: http://askmoxie.org/blog/2006/02/preventing_ppd_-5.html.

I have a family history of depression and anxiety too, and had full blown panic attacks a couple of years before having my son and went off of an SSRI before getting pregnant. I had no PPD issues. Only once did I resent (like I was experiencing anger) my baby for waking me up and it was when I stayed up online too later and got woken out of a very deep sleep. I woke my partner up and stayed up in a different room until I felt ok being close to the baby again, I really think I was just deeply asleep and responded with the reptile part of my brain. Try to practice good sleep hygiene (going to bed at the same time every night mainly, and no bedtime screens). Do something nice for yourself every day. For me it was a long hot shower before bed. If needed my spouse would take baby out of the house so I wouldn't think I could hear him crying (because of the white noise and my hypersensitivity to his sounds). Rough points for me where I wasn't sleeping and feeling insecure tended to be cyclical and to predictably pass as baby got easier again or I caught up on sleep. I think if it starts to be the norm day in and day out is when you tell people and try to do something about it.

I know breastfeeding can stress mothers out, but I also think the hormones can make things easier too once it's established, and weaning is definitely a tough time, for me it was worse than the early days in terms of how emotional I was, and some people tend to treat it as something to celebrate but it doesn't feel that way necessarily at first. I found nursing at first hard because it's simply so many hours of the day at first, it gets harder, and then much easier for most but it is a huge shock. There is a weird syndrome though where some women will feel super horrible after their milk lets down (most women feel very good at that point). So if you feel terrible when you nurse emotionally look into that, and consider stopping breastfeeding, my friend had it and felt so alone when it happened, weaning helped.

Also the first night with a baby where you are on your own is sort of scary, and feeling like you've been handed a wrinkled little alien you're afraid of dropping does not mean you won't love your baby and think they're absolutely precious very very soon, but I got weirded out by people calling me "mom" while I was still pregnant and talking about how incredible I must feel right after the birth. Feeling protective of your baby, loving your baby, and feeling bonded with your baby all take time so don't overthink your early reactions. I found talking to baby from day 1 helped me overcome that initial trepidation and weirdness. People who say everything is "natural" are not being helpful, you may feel instantly bonded and in love and content and you may not, it doesn't bode well or poorly either way. Same if nursing is hard or easy, or your birth is hard or easy.

Oh and it's normal to imagine something horrible happening to your baby. It doesn't mean you have PPD or OCD to have flashes of picturing something bad happening, like baby falling, it just means you are tuned in to your baby and want to protect them. I was always picturing my baby falling and hitting his head, it never happened, I obviously didn't want it to happen or enjoy the thought, but it was there somewhat regularly. It's like imagining your partner is in a car accident and being upset at the thought, it's just a thing.
posted by lafemma at 6:40 PM on July 17, 2014 [3 favorites]

Schedule appointments with your mental health care providers in advance as soon as baby is born. I would schedule appointments for 4 weeks, 8 weeks, 12 weeks postpartum at the minimum.

My problem was that the first appointment with my shrink was when I needed a refill at 4.5 months post partum and I was pretty far gone by then. I had the lady's number, knew I had a problem, but didn't call. If the appointment was on my calendar I would have went and the depression would have been treated sooner.
posted by crazycanuck at 10:42 PM on July 17, 2014

Oh and it's normal to imagine something horrible happening to your baby. It doesn't mean you have PPD or OCD to have flashes of picturing something bad happening, like baby falling, it just means you are tuned in to your baby and want to protect them. I was always picturing my baby falling and hitting his head, it never happened, I obviously didn't want it to happen or enjoy the thought, but it was there somewhat regularly. It's like imagining your partner is in a car accident and being upset at the thought, it's just a thing.

There is a special permutation of "bad thought" OCD that is most common for parents, though, involving just these kind of intrusive thoughts. You might not have this happen, but since you already know you have OCD, be aware it could.

At what point, time-wise or mood-wise, should I think "okay, this is getting serious"?

In this particular case: if you start having scary thoughts about things happening to your child and they feel like obsessions, or you think that things you do might cause your child harm or suspect yourself of child abuse, and especially if you start developing rituals or avoidance around the way you treat your child--recognize that this is just anxiety, just thoughts, apply CBT and exposure to them, and don't wait to tell your doctor/therapist/etc about it.

I think you are going to be a great parent, BTW. Congratulations.
posted by epanalepsis at 8:40 AM on July 18, 2014 [1 favorite]

Kelly Brogan, MD is a holistic women's health psychiatrist and professor who specializes in pregnancy issues (among other things). She's insanely smart, and has tons of excellent resources on her blog. She talks a lot about how post-partum masquerades as depression, but can actually be caused by thyroid issues. I highly recommend perusing her site for info.
posted by shiggins at 9:11 AM on July 18, 2014

I could have written this question, with the added risk factor of being a single parent. There's great advice in this thread - making a checklist, having a plan, healthy food, sleep, etc. The two other things that worked well for me were 1) really letting my entire community help (mealbaby.com is great - set it up and have people drop by with meals) both to have less work and to feel less isolated and 2) by sheer unexpected luck, I ended up with the hormones that made me really happy instead of really sad. No one told me that was a possibility, especially with my history of depression, but it was a wonderful surprise.
posted by judith at 7:55 AM on July 19, 2014

Response by poster: A belated thanks to all of you for your stories and advice! (I got some wonderfully kind and helpful memails, too.) I haven't marked any best answers yet, but I'll be rereading this thread and applying several of the suggestions. I'm planning to check with my old therapist to see if she'll see me for a few sessions, in case I need it. Overall, I think I'll be okay!
posted by Metroid Baby at 10:22 AM on July 31, 2014 [1 favorite]

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