Tuesday, October 23, 2012

Calming the Weremama Within (aka Introducing the Bedtime Pass)

Look, it's a WereMama that loves you.  
My mom always told us kids (there were six of us) that she turned into a Weremama at 9pm sharp.  And since 9pm was when the ornery-yelling started, we half-believed that assertion and stuck to our rooms.  But I didn't truly understand what my mom meant until I, myself, became a mom.  Only, it turns out, I don't have as much patience as she did.  The weremama in me lets loose pretty much anytime after 8pm.  Some days even earlier.

A few months ago, bedtime in our household went something like this.  My husband or I would go through the whole bedtime routine.  Book, song, game, cuddle, prayer, teeth etc.  We would tuck the kids in, make sure they had their last drink of water and leave.  But every few minutes one of our lovely kids (aged 3 and 5) would come up and bug us.  "Mom, I need another toy."  or "Mom, I'm hungry" or "Mom, will you cuddle me." or "Mom, I just remembered that you said I could go down the slide one more time at the park today but then I didn't go on the slide so can we go back to the park?"  You get the picture.  This would continue until one of us went all Werewolf and yelled them back to their rooms for good.  Awesome parenting, I know.  

Then, I decided to put my schooling to work.  Enter the Bedtime Pass.  This is a very simple intervention developed by a fellow behavior analyst.  And by fellow, I mean someone much cooler and smarter than I who has been in the field at least 20 years longer than I have.  Here is the actual study if you are interested.  In a nutshell though, you give your kid a get of of bed free pass.  I made ours on a 3x5 card and let the kids pick the design (it helps to involve your kids in the process as much as possible).

See, nothing fancy
Then we had a family meeting to explain the importance of sleep, parents getting alone time etc. and introduced the Bedtime Ticket.  We explained that while we want them to stay in their room and go to sleep, we also want them to be able to get us if they need us.  So if they need something, they can use their ticket to come get us one time before they go to sleep.  The kids were very excited.  Apparently tickets and control are cool.

That night, we did the bedtime routine as usual and then asked the kids if they needed anything else (water? hug? stuffed animal?).  Before we left, we reminded them that they can always get up to go potty (as long as they go right back to bed) but they can only use their ticket ONE time to get up and then they must stay in their bed.  The difference was amazing.  My kids use their ticket once and then stay in bed.  Aaaahh heaven.  and no more Attack of the Weremama.  Win for everyone.

Easy Bullet Point Summary (I'm not always in the mood to read rambling paragraphs either).

Bedtime Pass
  1. Make Get of Bed Free Ticket on 3x5 card with your kids help.
  2. Call family meeting to explain ticket.
  3. Bedtime routine like normal (making sure to ask about drinks, and potty before you leave).  Remind kids they can only leave their room if they have a ticket. 
  4. Help kid with what they need if they use their ticket.
  5. If they leave without the ticket, say "Sorry, you already used your ticket" and direct them back to their room. Repeat as necessary.  
Sounds simple but it works.  And if it seems like it is working alittle but not quite working enough--stay tuned for my followup post.  As the novelty of the ticket wore off, I have had to add another system as well.  

Wednesday, October 10, 2012

Guest Post: Post-Partum Depression

In the summer of 2011, I found myself sitting on the floor sobbing uncontrollably while my six-month-old and almost three-year-old sons stared at me.  They looked confused and a little frightened of the snotty, red-faced, shaking, wailing blob that was their mother.  That was the ugly moment that I finally acknowledged I had postpartum depression.  It wasn't just the baby blues.  It wasn't a sleep-deprived mom overreacting to one too many diaper changes that morning.  It wasn't a woman with two small children mourning the perceived loss of her freedom and self.  It was the massive black hole that is full-blown depression and it was sucking me down into its depths. 

I'm not unfamiliar with depression.  I'm pessimistic, I nurse my bad moods.  I relish a good mope.  I get the winter blahs (and the spring, summer, and fall blahs) easily.  People in my family have depression.  I'd done the reading, the pile of pamphlets they send home from the obstetricians' office and the hospital.  I knew the signs and symptoms.  I wasn't in the dark.

Even so, I didn't have PPD!  Uh uh, not me, no way José.  I was not that weak.  I could hack it.  I didn't get depressed after my first baby, just kind of blue, so how could I have PPD after my second?  Could you get PPD with a second kid?  I was just going through a difficult time, adjusting to having two kids in diapers.  I was physically and mentally wiped out because the baby refused to sleep through the night, and big brother had given up naps and wanted my undivided attention all day.  That's all.  It was because I was MOM! for 14 hours a day with hardly a break.  It wasn't PPD, it was because there was little time that was just for me.  So it couldn't be depression, it was just burnout.  It was exhaustion and frustration, it was just a rough time. 

I was in denial.  It was more than just a rough time.  I realized I was lingering in the shower because I could not face another day.  I felt hollow and bleak, I wanted nothing to do with life.  I wondered how I ever thought parenthood was a good idea.  I lived in a pervasive fog, unable to make the most basic decisions.  I was slowly losing my ability—and desire—to cope with life.  It was overwhelming guilt, uncontrollable anxiety, and unbridled anger. 

It hurt to breathe.

It was blackest hell and white hot oblivion combined.

I was drowning in it. 

And I was powerless to stop it.

I had to get help.  But first I had to admit and accept that I needed help.  I had to face my fear of the stigma attached to the word “depression.”  Get comfortable with the possibility that I might need to be medicated until I was stronger.  I had to be brave, call my doctor and try to keep my voice from breaking while I said the words aloud, “I think I've got postpartum depression.  I need help.”  And then the receptionist asked the question that hurt my heart, not because she asked me, but because I knew that there were other mothers in distress who were never asked and should have been: “Do you think you might hurt yourself or your children?” 

It brings me to tears to think about it now, almost a year and a half later.  The experience was so raw, intense, and overwhelming it doesn't take much to bring it all back.  I'm still too close to it.  And I have found in the months since that I slip toward that dark place easily.  I try to follow the recommendations to keep depression at bay (eat the right foods, cut back on caffeine [that's the tough one], get out in the sun, get some exercise, get away from the family and do my own thing once in a while) but some days I feel like it's still nipping at my heels.  PPD may follow me for a long time, and be something I will have to monitor and guard against.  I don't know.  But I never want to go back there again.  Ever.

I was lucky.  I had a good support system with my husband, family, and friends, I just didn't use it.  I was determined to do it by myself (I'm stubborn that way).  That was my biggest failure.  I hadn't failed at being Super Mom, but at taking care of myself so I could be the best mom for my kids.  I realized that taking care of myself is just another way to help take care of them.

How prevalent is PPD?  There may be far more cases than anyone realizes.  Katherine Stone, the woman behind an amazing postpartum depression blog, www.postpartumprogress.com, breaks it down this way: 

In so many books, articles and news programs, you hear the statistic — approximately 10 to 15% of women suffer from postpartum mood disorders (PPMDs), including postpartum depression (PPD), postpartum anxiety/OCD and postpartum psychosis.  What bothers me about that statistic is that it holds no meaning for most people...I decided to do a bit of quick, non-scientific research to look at the real numbers and to help people understand the real impact that postpartum depression is having on the women of our country.

There were approximately 4.3 million live births in the United States in 2007. This statistic does not include fetal losses, including miscarriages and stillbirths. The National Vital Statistics Report indicates that the total number of clinically recognized pregnancies is around 6.4 million. This is important to know, because all postpartum women are susceptible to postpartum depression, regardless of the pregnancy’s outcome.
So let’s split the difference between the high (20%) and low estimates of PPD (11%) and say that an average of 15% of all postpartum women in the US suffer, as the CDC reported in its 2008 PRAMS research. And let’s use the number of clinically recognized pregnancies and not live births. This would mean that each year approximately 950,000 women are suffering postpartum depression.
BUT, did you know the CDC’s research only reflected self-reported cases of postpartum depression? How many women do you think did not mention they had PPD out of fear or shame? Should we increase the estimate of sufferers to 17% or 20%?
ALSO, these numbers don’t take into account women who may have suffered other perinatal mood and anxiety disorders like PPOCD or postpartum psychosis. Should that make the numbers go even higher?
I’d argue that the average number of new mothers who experience perinatal mood and anxiety disorders is more likely in the 20% range, which would mean around 1.3 million annually.

Some resources describing the symptoms of  and treatment options for PPD:

-Leigh Germain
Mother and PPD Survivor