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		Steps to Wellness The following outline is a systematic approach to help women who have given birth, miscarried, or adopted and who are encountering problems to these major life-changes. They can work for every member of the family because they are based on common sense. 1. Education 2. Sleep 3. Nutrition 4. Exercise and time for yourself 5. Nonjudgmental sharing 6. Emotional Support   7. Practical support 8. Referrals to resources Please note the natural progression of these words.  They are in an order that builds one upon the other. Make notes as you read and "listen" to your responses. Step One: Education I believe that knowledge is power.  Without accurate information we become passive victims, whereas if we can learn about something, we fear it less.  Contrary to the unfortunate and dangerous premise that if a woman finds out about depression and anxiety, she is likely to become depressed and anxious, ignorance is a major barrier to finding appropriate care.  Read books specifically written to answer your questions about how you are adjusting to your pregnancy and postpartum experiences.  The internet is an incredible wealth of information. Start with www.postpartum.net Step Two: Sleep The KEY question to ask yourself is “Am I able to sleep given the opportunity to sleep?”   This isn't intended to be a funny topic, but hearing "new baby" and "sleep" in the same sentence is almost a joke.  First, the pregnancy disrupts your regular sleep cycle, and then the labor and birth upset your inner clock.  The next challenge is learning to decipher the infant's needs.  During all of these changes, the mother's recovery depends upon sleep.   We all need sleep in order to stay healthy and to heal.  To repair the body from pregnancy, labor, and delivery takes a certain amount and quality of sleep.  Being pregnant and giving birth are major biological, psychosocial, and emotional experiences. Please respect these changes and allow your entire body, from the brain down, to heal through quality sleep.  This applies to parents who adopt too.   SPECIAL NOTE:  A new mother's partner and support team have to monitor both whether she CAN sleep and if she IS sleeping. Days without sleep can bring on agitation and other symptoms of mania.  A woman in such a condition may be a danger to herself and her baby, and should never be left alone!  The woman who becomes severely depressed after delivery of her child often loses the ability to function normally. She may drag herself to attend to the baby's physical needs, but her brain chemistry is unbalanced.  Even many hours of sleep are not restorative. Psychiatric evaluation is absolutely necessary in extreme cases.   Remember, the word "postpartum" is used clinically to indicate the entire year following birth.  This correctly implies that a mother requires a full 12 months to recover from the rigors of pregnancy and birth.  If you are not sleeping, get help NOW!  There's no reason to wait and struggle. Step Three: Nutrition Adequate nutritional intake requires an appetite. That may sound obvious, but it's an often overlooked factor in the health of postpartum women. During pregnancy, your diet and weight gain are primary issues. You’re weighed at each prenatal visit and this information is recorded in your chart. Your health professionals may lecture you about which nutrients your body needs to grow a healthy baby. But what happens after the birth? Ask yourself the following key questions: "Do I have an appetite?" "When did I last eat?" "What have I eaten today?" "What's there to eat in my kitchen?"  “Is there anyone who can take care of ME?”   Remember that eating well is part of nurturing yourself. We owe it to our children to give them a healthy mother. Step Four: Exercise and Time for Yourself  I put these two Steps together so you can contemplate your self -worth. It is important to consider your own needs beyond the basics of sleeping and eating. I know that a new mother is lucky if she has time to shower and get dressed, much less be organized and motivated enough to exercise. I hope that the concept of "time for yourself" will promote the fact that exercising does make a person feel better. While this may be true and a good tip, take it easy. Ask yourself “When was the last time I took a walk all by myself?”    Remember that if you can sleep well, eat nutritiously, and exercise regularly, you'll generally feel healthy. Step Five: Nonjudgmental Sharing  This is about sharing your emotions with appropriate listeners.  Have you told anyone about your feelings?   I know that as a new mother or father it is difficult to open up and speak from your heart. The myths surrounding motherhood and fatherhood are so pervasive that we fear others will judge us when innermost feelings are expressed. I want to validate these feelings and encourage you to reach out for help.   Ask yourself “whom do you trust?” Is it your doctor, best friend, partner? Step Six: Emotional Support  In response to how you answered Step Five, you should be receiving a generous amount of emotional support. However, sometimes it's hard to find someone who is willing and able to take the necessary time to listen. Empathy requires caring and a sense of self. If the person with whom you try to share is dealing with his or her own personal problems, that person is unlikely to be able to offer support right now. New parents usually seek advice and emotional support from people who have "been there." Ideally, such support comes from family members and friends. However, professionals, acquaintances at work, and people in the faith communities are also viable options. Phone networks like 211, and the Internet are excellent sources of support with chat rooms and bulletin boards. It's unfortunate that it sometimes takes a long-distance call or a computer to receive something as essential as emotional support, but here you are reading this website! We're fortunate to have technology that allows us to extend our search for ways to maintain our emotional health. Step Seven: Practical Support  Ask yourself “who is cooking meals and cleaning the house?"  It should not be a new mother! I like the story of a new mother who put this message on her answering machine: "Hi, thanks for calling. Mother and baby are doing well. Please don't ring the doorbell when you stop by, and if you've been kind enough to bring us food, just leave it at the front door. Thanks again!" This example of an assertive request for practical support is rare. Many parents are reluctant or embarrassed to ask for help. There seems to be a vicious rumor circulating these days that it's possible -and even expected -that you can care for yourself, a home, and an infant alone. But, like most malicious gossip, this is false. Women were never intended to mother alone. It takes teamwork to parent! Only in very recent times have humans forgotten the ancient concept of a clan comprising many families helping each other. During pregnancy or preadoption is the ideal time to prepare for the practical side of life after baby comes. The concept of preparation for parenthood is a noble one. Unfortunately, it can only be tested with reality. Every "things to do" list looks good on paper before the baby arrives, but bringing that beautiful newborn into the picture will wipe out even the best-laid plans. Thus, it's worth the effort to talk about options for getting help. If relatives or friends can't help your new family, then make an investment in the your family’s mental health and pay for household assistance, childcare, and/or take-out meals for a while after the baby comes. A new industry, doulas, has emerged in many developed countries that fills this need, offering professional postpartum care assistants who cook, clean, shop, and, most important, mother the new mother. Step Eight: Referring to Professionals and Other Resources  Are you looking for a support group or professional in your own community with experience in postpartum depression?  Perhaps you’re feeling upset or confused in this search? There still isn't an extensive resource list of trained professionals and support organizations in the field of maternal mental health, although the numbers are slowly growing. It remains a hit-and-miss process and, in my opinion, is completely inadequate. It's an affront to families everywhere that this situation continues. The current system of referral requires you to think of the following issues: Your Financial Resources "Is money an issue?" "Do you have insurance?" (look on the referral list from your insurance company, where you will find names divided by profession.) Medical Resources "Do you have a primary-care doctor?" Your doctor will likely be able to give you a referral to a psychiatrist and therapists.   The two most effective forms of therapy for people suffering from PPD are cognitive and interpersonal. They're both short-term and task-specific therapies - a combination that seems to get PPD resolved as fast as possible, so they save time and money. Remember that if you can't make arrangements to find and get to a counselor or doctor, you should immediately find someone who can do it for you and even take you to the appointment. There's simply no reason to be miserable when help is available if you just ask. "How are you feeling now?" or "How has this made you feel? Do you feel any better?" Do you feel more calm, focused, and able to use the information I’ve  presented to improve your situation? If so, let's move ahead to find out how to create your own plan of action to get better.   Creating a Plan of Action Start with a clean piece of paper and write at the top "My Plan of Action". Steps to Wellness is geared toward becoming physically, spiritually, and emotionally balanced. This is a holistic model, meaning that the body and mind - how you feel and act - are intertwined. Let’s start with the idea of being in denial or ignorant about exactly how you’re feeling. If you’ve read this far then you’re not in denial nor ignorant! This is your bridge from the cognitive to the practical, transforming knowing into doing. The top priorities of the action plan are dealing with your symptoms. If you have thoughts and/or plans of suicide, you should regard it as a medical emergency. GET HELP NOW! You must NOT be alone. If you are NOT sleeping or eating and you haven’t told anyone about these problems, you MUST do this first. If you are sleeping and eating but not getting out of the house despite wanting to, this becomes your priority. If there are no friends or family members to care for the baby, your next step is to get the phone book out - and look up resources. I want to encourage you to make a list of phone numbers of parent-friendly centers. Call your local public library to find help. What are your reactions to each of the eight Steps to Wellness? Your answers form the basis of your personal plan of action. I'll restate the Steps here:   1. Education: What have you read? online or from the public library? 2. Sleep: Is your sleep restorative? 3. Nutrition: When and what are you eating? 4. Exercise and time for yourself: Are you getting either of these? 5. Nonjudgmental sharing: Can you talk to someone about how you're feeling? 6. Emotional support: Do you have this and from whom? 7. Practical support: Do you have any? 8. Referrals to resources: Do you need any?   A simple self-scoring method I’d like you to use is to draw a "sunshine smile" or a "frown face" beside each one to indicate how you’re doing in each area. A plus or minus sign next to each item works as well. Either method reveals areas where YOU need to get help.  My email is jane@janehonikman.com if you’d like to share your plan of action with me.  I look forward to hearing from you!

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