Becoming More Mindful: Where to Start?

Photo by Tanushree Khanna on Unsplash

We live in a fast-paced society where it feels like there's rarely (dare I say never) enough time. I know I'm not alone in this feeling; I hear about it daily from friends and family, and of course the clients I counsel in my practice. The overwhelm is folded into the lives of my clients who are struggling to conceive, those grieving, the women who are adjusting to the reality of motherhood, the men who feel a ridiculous amount of pressure to provide and succeed financially. Sometimes the greatest stressors come from within, our attempts to be the best partner/parent/daughter/brother/insert role.

Mindfulness has been a buzz word for the past decade or so and shows no sign of leaving center stage of the $3.7 trillion global wellness market (Reference). And there's good reason-- midnfulness is touted as the antidote for aging, perfectionism, anxiety, depression. The list goes on. But for those unfamiliar with mindfulness, learning what it is and what it isn't, and figuring out how to bring it into your life can cause more of those feelings of overwhelm we're trying to conquer. After all, won't adding something else to your to do list make you even busier?

That feeling of being busy and rushing all the time, there's a choice in that. At least that's what the gurus of mindfulness tell us. With a mindful approach, we get to decide how we interact with the world around us. Mindfulness helps us to slow down and  to pay attention to our thoughts, behaviors and reactions. Mindfulness allows us to respond rather than react.

How to Be More Mindful

So how do we bring mindfulness into our daily lives? Like all things we strive towards, we must develop a mindfulness practice to reap the rewards. We must schedule a time, then stop what we're doing, and sit. Starting with a guided meditation can often be a helpful place to begin for those who have no prior experience with mindfulness. Below is a short 5-minute guided mindfulness exercise. It's one that I introduce to clients in my practice and in my infertility support groups: 5 Senses Mindfulness Exercise. I didn't write it myself, but it's my recording.

I like this exercise because it allows us to recognize the many ways we can be mindful in our own bodies each and every day. By attuning to the senses we can invite ourselves to stay in the present moment when we're eating, resting, gazing, walking, listening-- grounding ourselves wherever we may be, whenever we need it. 
 

The Wandering Mind

Photo by ANDRIK ↟ LANGFIELD ↟ PETRIDES on Unsplash

I like to remind my clients that there's no right and wrong with mindfulness; it's simply about cultivating awareness. Many people incorrectly believe they're "doing it wrong" because their mind wanders. This is normal as our minds are made to think. The practice of mindfulness is to simply guide your attention back to whatever it is you are doing-- breathing, pushing a grocery cart, taking a shower. Yes, each of these activities can be done mindfully. But let's start with sitting.

So find yourself a quiet place to begin. Push the button below when you're ready. You will need to download the link in order to play it on iTunes. I hope this experience allows you to slow down, if even for just 5 minutes

Whether you're a busy parent or longing to be one, mindfulness is an invaluable tool to help cope with the stressors of daily living. If you’re looking for a therapist in the San Diego area, I’m happy to help. Feel free to reach out by phone or email and we can talk about ways you might benefit from counseling. 

Four Reasons to Join An (In)fertility Group

In honor of National Infertility Awareness Week, I’m encouraging anyone who’s struggling with infertility to speak up and get the support they need. If you know someone who’s could benefit, please consider sharing this article; you may not know how to help them, but pointing them to resources and letting them know you want to help will be appreciated.

Infertility is often a lonely and isolating time. It’s unexpected, often coming from out of the blue. But it doesn’t have to be like this. There are groups around that can help you deal with the predictable emotional roller coaster of feeling scared, worried, disappointed and sad. 

You may have considered looking for a group. You may have even located one, in your neighborhood, city or even online, but something has gotten in your way of joining. Hopefully reading this article will encourage you to think about the value of joining an infertility group.

Acknowledging the issue of infertility is often the biggest barrier to seeking help. The word itself may at first be scary, And then there's the fear and shame, which help maintain the loneliness and isolation so many experience. We often think we should be able to handle whatever life throws at us alone. But that's simply unrealistic. We are social beings and rely on others for many reasons. 

You may feel uneasy about sharing your dilemma with others. You may be fearful of hearing others’ stories. But here are four reasons why I hope you will consider joining an infertility support group. The old adage, "Joy shared, twice the gain, sorrow shared, half the pain,” rings true for me every time: 

1. EXPAND YOUR COMMUNITY

Infertility is often a lonely and isolating time. Whether you join a group expressly for women, or one for couples, you can expect to meet others who are in a similar situation and can relate to many of the struggles you're facing. Living in isolation can leave us feeling like we're the only ones who feel a certain way. Joining a group helps to validate common worries and emotions that individuals and couples face who are experiencing infertility.
 

2. LEARN COPING SKILLS

Infertility often goes hand in hand with depression and anxiety. Learning how to manage difficult emotions and life challenges associated with your infertility diagnosis is often another benefit to joining a group. Infertility is a crisis and a reproductive trauma, yet most people focus exclusively on medical interventions to reach their goal of having a baby. The emotional impact of infertility is often neglected until the distress is greatly impacting their day-to-day life and relationships.

So what if I told you that learning new tools could help decrease your symptoms of depression and anxiety like stress, worry, sadness, grief and loss? Did you know that deceasing these feelings could have a positive impact on your fertility? Many professionally led groups teach participants a combination of Cognitive Behavior Therapy and Mindfulness skills. Here’s how these skills can help you: 

• Cognitive Behavioral Therapy (CBT), an evidence based treatment for both depression and anxiety, is based on the understanding that our thoughts influence our emotions, but that our thoughts aren't always accurate. CBT teaches us how to challenge our thoughts to make them more realistic. 

• While Mindfulness has been a big buzz word for the past 5-10 years, many are still confused with the objective. Being mindful is about paying attention, slowing down and becoming aware and noticing your thoughts. By slowing ourselves down  on a regular basis we become skilled at approaching difficult moments in a more thoughtful intentional way. Simply slowing down and mindfully approaching stressful situations can have an important ripple effect benefit you in a multitude of ways.
   

3. LEARN FROM OTHERS

It is said, "Knowledge is Power." The treatment of infertility is often diverse and complex. Educating yourself as to the wide variety of treatment approaches and options is important. Joining a group may open your eyes to new options and opportunities.
 

4. FINANCIAL SAVINGS

It's no surprise that infertility treatments can be costly. You're doing everything you can to have a baby and it adds up: consultations with reproductive endocrinologists, acupuncture treatment, appointments with a naturopath, testing, procedures to rule out contributing health issues... And this is all before any costs of medications or other assisted reproductive technology are accounted for.

So how does joining a group save you money, you're wondering? Research shows that women struggling with infertility for 2-3 years have double the rate of depression than their peers without fertility complications (Domar, Broom et al 1992). The good news is that decreasing depression has proven to increase rates of conception by 50%. Joining a group can provide you with new skills to help you to cope with difficult emotions and challenges in relationships that often accompany infertility.

A group isn't necessarily a cure-all, but it's more cost-effective than ongoing individual therapy. By bolstering your support system and learning new coping strategies you may improve your mood and decrease the likelihood of needing an individual therapist as you proceed on your journey with infertility. What do you think, could a fertility group be right for you?

If you’re thinking that a group might be for you and you’re in the San Diego area, you can learn more about the groups I run here. I meet with all new group members before our first group to learn more about you and to make sure it’s the right fit. Give me a call if you'd like to learn more. If you’re outside of San Diego, you can find local fertility support groups through Resolve, the National Infertility Association, and Psychology Today.

Birth Trauma: Strategies for Healing and Prevention

This is the second part of a two part series on Birth Trauma. In Part 1, which you can read here, you met Sara who was fearful of becoming pregnant with a second child. Although she was riddled with anxiety, she was unaware she had a real problem: because she’d experienced trauma after the birth of her first child she feared getting pregnant. Although birth trauma is a real psychological condition, with concrete symptoms and a diagnostic criteria, many people internalize their experience, feeling shameful instead of seeking support.

My chance encounter with Sara was pivotal. A few weeks later she reached out asking for a referral to a local therapist. Through our informal talks I was able to help Sara understand how her unique experience left her vulnerable to experiencing a traumatic birth (also called postpartum PTSD), and that it was not only extremely common but treatable.

Sara, like many women I see in my practice, was unaware that her symptoms were worth paying attention to. The most common coping strategy I hear about is the attempt to ignore symptoms- to sweep them under the rug so to speak. But this approach is rarely successful for very long.

Women who eventually enter my office for therapy are typically struggling with one or more of the symptoms addressed in Part 1 of this series- symptoms that interfere with their ability to function at home or at work.  In this article I’d like to offer some recommendations for healing from traumatic birth and/or preventing a subsequent similar experience. 
 

Treatment of Traumatic Birth, or Postpartum PTSD

While many women who experience some symptoms of Postpartum PTSD will resolve their emotional stress with positive support from friends or family members, others will continue to struggle and will benefit from professional help. Recommended treatment for Postpartum PTSD starts with a thorough assessment by a trained mental health provider.

1. It’s critical to be assessed by someone who specializes in maternal mental health for a correct diagnosis to be made.  Therapists unfamiliar with postpartum PTSD might inadvertently recognize the symptoms as postpartum depression or anxiety. Although some of the symptoms are similar, the underlying experience of a birth trauma calls for a different treatment approach.

2. Both medication and therapy are evidence-based recommendations for treating birth trauma. Many therapies work quickly and effectively with postpartum PTSD, such as EMDR, which I offer in my practice. Narrative, group, and body-based therapy can be helpful treatment modalities.

Avoiding a Subsequent Traumatic Birth 

Whether you're anticipating a future pregnancy or currently pregnant, there are many things you can do to reduce the likelihood of experiencing a subsequent birth trauma.

1. Include your partner in this process. While it might seem obvious to some, others may feel isolated by their initial trauma and not realize the important role a partner can play in providing support and mitigating a subsequent traumatic experience.

2. Hire a doula. Simply put, a doula is a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible. If for some reason the birth is not going according to your ideal plan, a doula will intervene during labor with the intention of alleviating the trauma to reduce a woman’s chances of developing PTSD.

3. Take a childbirth education class. It’s important for women (and their partners) to be educated about what is supposed to happen during childbirth and what happens in the body during the birthing process. Childbirth classes also help to inform expecting parents about options during birth including: pain management, birthing positions, and how to cope with complications during birth.

4. Develop a written birth plan with your birth team. Discuss and include the interventions you are open to, those you want to avoid. Explore your back up plan. Remember to plan for the postpartum period and to consider the support that will help ease your adjustment to motherhood, or to mothering an additional child.

5. Talk to someone you trust. Work through any past traumas with a therapist, or at the very least discuss your history with your care providers to best prepare for the experience of labor and birth.  Meeting with a psychotherapist or body worker specializing in perinatal mental health allows you to focus on beliefs, emotions, sensations and andy past experiences that may influence your upcoming birth.
    

Help Is Available

Birth trauma is highly treatable; the first step of course is to recognize there's a problem.  With help you can avoid additional suffering and complications for both mom and baby. In San Diego, Postpartum Health Alliance offers a warmline with trained volunteers as well as a provider directory to locate trained therapists and other birth professionals. Outside of San Diego, Postpartum Support International can connect you with therapists worldwide who specialize in maternal mental health disorders.

Birth Trauma: Is THAT What I've Been Experiencing?

I met Sara and her 4-year-old daughter, Claire, at our local playground earlier this week. Claire instantly gravitated to my 5-year-old son and within moments they were chasing balls together, holding hands and laughing. Having just moved to San Diego from Boston, she was excited to meet us.

Like many mom-conversations go, Sara asked about the age difference between my two kids and how I felt about it. She told me that although her daughter was begging for a sibling and her husband was also ready, she wasn’t prepared to get pregnant again just yet. She was conflicted about her timing tho, noting her age and the pressure she was feeling to have another baby.

I empathized with her situation and shared some of my own personal experience, as well as my professional experience as a psychotherapist supporting women on their journey through motherhood. I offered myself as a local resource given my knowledge of San Diego’s network of reproductive health providers.  

A few days later we met again by the swings. Sara jumped right into the conversation, saying, "you know, I think I could probably use some help from someone like you. I'm pretty sure I suffered from some postpartum stuff and that's what's holding me back from having another baby." She went on to tell me about her difficult pregnancy, challenging labor and unplanned cesarean birth that left both her and Claire in the hospital for several days. The experience was distressing and she was anxious about becoming pregnant again. She had wanted an unmedicated, natural birth and was understandably afraid of having a repeat similar experience with her next child.

I spent some time talking with Sara about how her traumatic birth might be impacting her. As I spoke her face softened and her head nodded. She appeared to feel validated by my explanation: that trauma after birth is REAL.

While many around her would like Sara to move on and be grateful for a happy and healthy child, Sara is still reacting to her birth experience with Claire. Although Claire had suffered no long-term effects, Sara did. And her daughter’s health does not negate Sara’s experience and the anxiety and fear left in the wake of her birth experience. As we talked more, I stressed that it’s not the specifics of the birth that is traumatic, but one’s perception of these events. This is such a key aspect of trauma.
 

What Are The Symptoms of Birth Trauma?

Post traumatic stress disorder (PTSD) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a car accident, a natural disaster, or sexual assault. However, a traumatic experience can be any experience that involves the threat of death or serious injury to you or someone close to you, like your baby (birth trauma or postpartum PTSD). Again, it's your perception of your childbirth that matters most.  It is less important whether the hospital staff were in communication about recommended procedures than your interpretation of what happened.

Common symptoms of women who’ve experienced birth trauma may include:

• Feeling socially isolated
• Difficulty bonding with their baby
• Lonely
• Angry
• Depressed
• Irritable
• Difficulty sleeping
• Anxiety or panic attacks
• Worry excessively about the health of their babies
• Worry that their child might die
• Flashbacks or memories that repeat over and over about medical procedures or the behavior of medical staff.
• Nightmares

Why Some People Experience PTSD Postpartum

It’s not always the dramatic events that trigger childbirth trauma but other factors such as a loss of control, the intimidating, aggressive or difficult attitudes of people around you, not feeling heard, or a lack of informed consent to medical procedures.

Risk factors for Postpartum PTSD include a complex mix of objective factors, such as the type of delivery, ability to feed as planned, etc, and subjective factors like those mentioned above. Additional risk factors include:

• Induction
• Length of labor
• Feelings of loss of control
• Unwanted medical intervention
• Traumatic or emergency deliveries/cesarean
• Lack of support from partner or medical staff
• Impersonal treatment
• Not feeling listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Stillbirth or loss soon after birth
• Birth of a disabled baby
• Baby’s stay in NICU
• Poor postnatal care
• Previous trauma (childhood, with a previous birth, domestic violence)
• History of anxiety or extreme fear of childbirth
• History of abortion or infertility
   

How common is Birth Trauma?

It’s estimated that approximately 9% of new mothers in Western societies experience full blown post traumatic stress disorder. However, research shows that 25-34% experience subsyndromal symptoms (symptoms that don't meet the diagnostic criteria for PTSD)! So while not meeting diagnostic criteria for PTSD, up to a third of mothers experience symptoms like intrusive thoughts and memories that may stimulate feelings of fear, anxiety or helplessness that interfere with daily life. That's a huge number! 

It's important to remember that while mothers most commonly receive treatment for postpartum post traumatic stress, their partners and even their medical providers may also suffer. 
 

Why You Should Seek Help

There are numerous potential consequences for women who experience a traumatic birth. They may avoid routine follow-up medical care because it reminds them of their childbirth experience. Like Sara, they may fear subsequent pregnancies and are statistically shown to be less likely to have subsequent births.

Those who do have another child are more likely to have an epidural or a scheduled cesarean; they are less likely to breastfeed and more likely to experience challenges bonding and attaching with their newborns. They’re also more likely to experience difficulties in their relationships and sexual dysfunction. Moms who suffer from Postpartum PTSD are more likely to suffer from depression, which also impacts bonding and attachment with their baby.

In part 2, we’ll look at ways to avoid the effects of birth trauma and ways to support healing. If you’re not sure you can wait to read part 2, please don’t hesitate to give me a call. I’m a licensed clinical social worker in the Banker’s Hill neighborhood of San Diego, California. I’m passionate about helping families cope with trauma and other challenges after bringing home their baby. You can reach me at 619.780.3277 for your free in-person 30 minute consultation. 

Wondering When It Gets Easier, Mama? Why it's harder than you imagined to mother an older infant +7 tips to help you through

Your baby is 6 months old. Perhaps 8 or 10 months. You thought you'd "have it together" by now. Or at least feel like a version of your former self. You've managed to piece together some semblance of a routine and take care of the basics- you go food shopping, hit the park after the second nap occasionally. But you feel anything but together. 

You crossed the threshold into motherhood many moons ago, tho some days it feels like it's harder than the first week after you brought your baby home. You knew the media's portrayal of moms was too good to be true, but this?! You had no idea how hard it could be. 

As a mother of 2 and a psychotherapist specializing in maternal mental health, i spend a lot of time reminding my clients (and myself) just what an enormous transition motherhood is. 
 

Reasons why parenting hasn't gotten easier, yet

Becoming a mother is the biggest transition a woman goes through in her adult life. Many women I see in my support group and my private practice struggle immensely with the loss of self, figuratively and literally. There's no way to prepare for the jolt that assaults the mind and body as you pour every ounce of energy into another human, selflessly abandoning your own basic needs like sleeping, showering, using the bathroom and eating to ensure the health and wellness of your baby. Let me unpack that for you. 

Sleep

The average infant isn’t sleeping through the night at 6 months, despite the myth that society continues to perpetuate about sleeping like a baby. It's just that, a story. Babies. Don’t. Sleep. At least most or many don't sleep well at this age. It's not uncommon for older infants to routinely take 30-minute naps. And wake 2-4 times a night. Or more.

As you well know, if baby doesn't sleep, mom doesn't sleep. Lack of sleep is correlated with both depression and anxiety. Sleep deprivation makes life harder, which is why it's is used as a method of torture! 

Many new moms anticipate they'll have time to clean the house, prep dinner and maybe take a shower when their baby naps. Never had they considered the reality of holding, wearing, bouncing or driving their tired or crying child to try and induce sleep and eek out a 30-40 min nap here and there. That downtime you imagined to effortlessly have-- poof! Being a parent is a sacrifice for sure; you knew that cognitively of course. But when you haven't been able to put your child down to nap since they were two weeks old and it's 85 degrees outside and your walking up and down the street so they'll fall asleep-- it's real. 
 

Relationships

Many women I work with share how struggles with their partners seemingly erupt out of nowhere. Relationships that previously had no cracks feel like they're crumbling. As I prod and question I learn more about the communication gap and the resentment that builds when responsibilities fall on the shoulders of one person more than another. When needs go unmet, feelings of not being appreciated, thought of, cared for and loved begin to grow.
 

Identity Loss

It's not unusual that during the very early stage, if mom is breastfeeding or recovering from birth she spends many weeks at home, bonding with her newborn.  But often, I hear that as partners return to work and resume regular social activities, mom feels more isolated from friends, society and her former identity. She's no longer working and no longer engaging in the activities that previously identified her as the person she though of as herself. Instead she's counting poop diapers and bouncing a baby on a ball so she can maybe check her email or do something for herself if she can get the baby into a bed. 
 

Overwhelm

These aren't unusual issues to face as individuals and couples transition into parenthood but they shouldn't be ignored. So many moms I work with talk about the overwhelm kicking in at this stage. They think it should get easier by now. That having a routine should help. But the sicknesses and lack of sleep bookended by full-time jobs and no babysitter leave little time for breathing let alone a date with her partner.

When we have no time to play, to connect and to nurture ourselves, life feels hard. When you've been going and going, devoting all of your energy to learn about this new incredibly important member of your family, to meet their every need, it's intense. 
 

Small steps towards change

When you reach the point of feeling overwhelmed, of questioning how things will get better and why they feel harder every day, it may be time to consider making some small changes. Here are 7 recommendations I often make to families I work with that are struggling during this stage of their transition to parenthood:

1. Open up. Communicate with your partner. Share your feelings, your expectations, desires. Let them know how they can help you feel more supported during this ongoing transitional time. As much as we might like to have married a mind-reader, relationships are built on communication that must be fostered.
2. Get more sleep. Discuss your sleep needs with your partner. Try and develop a plan to get more sleep if you think you aren't getting enough. If you're getting less than 5 hours in a night, that's not enough for most.
3. Eat well. Make sure you're eating well. Three meals plus snacks.  Balanced meals with adequate fats and proteins are important, especially if you're breastfeeding.  
4. Move. Walking is a great place to start.  Physical exercise has been shown to release endorphins, which naturally trigger positive feelings helping to reduce levels of depression and anxiety, and can actually help prevent depressive symptoms. 
5. Get outside! Being in nature is not only restorative but can improve your positive outlook on life and your ability to cope and recover from stress and illness.
6. Schedule breaks. Schedule time for you, even if you have no hobbies, don't play sports and have no interests that come to mind. Schedule a time for you to do whatever you choose. Regularly.
7. Connect with others. Join a support group of other new moms. Find a way to connect with people and activities that you enjoy and bring joy to your life. 

And lastly, ask for help! If you're not sure if what you're experiencing is part of the normal transition to motherhood or something more, like postpartum depression or anxiety, I encourage you to reach out for help from a therapist trained in maternal mental health. Many people are surprised to learn that they can develop a perinatal mood or anxiety disorder at 6, 8 or even 12 months postpartum. Here are some of the symptoms of perinatal mood or anxiety disorders (aka postpartum depression or anxiety). 

It's not realistic nor do I anticipate that someone would adopt all of these changes at once. I'm a strong believe that small acts change lives. See if you can find just one thing from the list above that you can do this week to help improve the way you are feeling. What will it be? Make a commitment! I'd love to hear your plans for change in the comments. 

If you're reading this article and thinking about a friend or loved one, you can help them get the support they need. If you'd like some tips on how to do that you might find this article useful. If you're in San Diego, please feel free to reach out. I maintain a private practice in the Banker's Hill neighborhood where I women struggling with infertility, loss, and pregnancy and postpartum mood and anxiety disorders.. I offer a free 30 minute in-person consultation to find out if I'm the right therapist for you. Postpartum Support International (PSI) is a national organization that maintains a warmline and a list of trained providers specializing in Maternal Mental Health.  If you’re in San Diego, CA, The Postpartum Health Alliance is our local chapter of PSI and a wonderful resource.

Spread the Word: Ask that New Mom About Her Mental Health #AskHer

May is Maternal Mental Health Awareness Month worldwide, and today kicks off the May Campaign (May 2 - 6, 2016).  The goal of the May Campaign is to increase knowledge about and awareness of the serious and devastating emotional complications that many women experience during pregnancy and after the birth of a child. 

When a woman is pregnant people are so eager to chat, engage and support her.  Doors are held open by strangers. Family and friends gather to shower the expectant mother and her baby to be. Couples take babymoons to celebrate their time together as a couple and the new beginning that lies ahead. However, once baby is born, it’s not uncommon for mothers to be left behind while their new baby becomes the focus of attention— theirs and everyone else’s. 

This year the May Campaign is focusing on the importance of shifting the conversation from baby back to mom and encouraging you/me/us to #AskHer about her mental health. Ask the mothers you love and care for about: How are you sleeping? How are you eating? How are you feeling?
 

Why should you #AskHer?

You might be wondering why it's so important to ask her. One in seven women experience postpartum depression. There are many risks to both mom and baby if postpartum depression or anxiety goes untreated, including: a lower quality of life for mom, a decreased ability to function at home and at work, recurrent depression and suicide. Yes, suicide!

An infant with a mother whose depression goes untreated is at risk for an insecure attachment with their mother and delays in cognitive development. These are significant risks to both mom and baby. 

But it doesn’t stop there. According to research, half of all men whose partners have postpartum depression are depressed themselves. Additional risks include a decrease in care of other children in the home and an increase in overall stress and discord within the family unit.
 

How to help a postpartum mom you’re worried about: 

If you’re not sure if what she’s experiencing is part of the normal postpartum adjustment to motherhood or something more serious, this article can help you learn about 3 Differences Between Postpartum Depression and the Baby Blues. If you’re worried about her, below are three things you can do to provide support.

1. Speak Up! Share your concern for her. Most struggling moms are relieved to hear there’s actually something wrong. Feeling so overwhelmed, it’s difficult to imagine how they’ll manage if what they’re experiencing is truly normal. This article here talks more about why it’s important for YOU to say something.
2. Call her local chapter of Postpartum Support International. You can get her connected with the warmline, which can provide her with referrals to trained therapists and local support groups. There are even online groups if needed. If you can call with her, that’s even better. 
3. Be there for her. Listen to her. Hold her baby so she can shower, or rest. Make her food. Clean her house. Walk her dog. Fold her laundry. Listen. 

At the end of the day, please don't forget to #AskHer. Ask the mothers you love and care for about their mental health: How are you sleeping? How are you eating? How are you feeling? If you suspect that you or someone you love is struggling with a perinatal mood or anxiety disorder, reach out for help. Rachel Rabinor, LCSW is a psychotherapist in private practice. She sees women struggling with their transition to and through motherhood in her private practice in San Diego. She also offers in-home counseling to help ease this transition See above for other San Diego and national resources.