Having a Baby After Postpartum Depression?

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The decision to have a baby after a previous experience with postpartum depression or anxiety is understandably accompanied by tremendous anxiety. The postpartum pact was created to help couples initiate a productive conversation about their concerns as they develop a plan of action and coping strategies.

These are not just statements to be read aloud. They are talking points to be discussed together in order to acknowledge what worked in the past, what didn't work, what needs to be done differently, and how best to proceed given the current concerns and areas of vulnerability. This contact will augment your communication and promote a greater sense of control for you both.

Find some time when you have no distractions so you can devote total attention to reading this together and review every detail.

*The "I" in this pact can refer to either partner and will be useful regardless of who is at risk for depression/anxiety.

We are reading this together because I need your help.

It’s possible that after the birth of our baby, I might not feel well. Since I’m at risk of experiencing depression again, we need to be alert for some of the signs so we can take care of things right away.

I need to trust that you will be observant and candid about what you see and your concerns.

You need to trust that I am a good judge of how I am feeling.

In the event that my symptoms interfere with my ability to determine how I am feeling or what is best for me, it is crucial that you solicit help from our family, our friends, my doctor, and my therapist.

We both know that it is better to be overly cautious than to assume things will get better on their own.

I need you to tell me now that you understand how important all of this is and that you are prepared to act accordingly. Knowing this will give me great comfort.

These are questions that may help you determine how things are going after our baby is born. They may not all apply to us, but they will provide a general outline for us to follow.

As we review each point together, we will highlight those that feel particularly relevant to our situation so we don’t miss a thing.

If any feeling or experience that we went through has been overlooked, we will discuss that together and add it to the pact.

After our baby comes, I will depend on you to go over these items a number of times at various stages, since things can potentially change.

Here’s what I need you to look for

• Am I acting like myself?
• Is there anything I am saying or doing that seems out of character to you or not like my usual self?
• Am I too worried, too withdrawn, too talkative, too euphoric, too exhausted, hyper, too unhappy, too uninterested?
• Do I seem confused?
• Am I crying all the time?
• Am I eating the way I usually do?
• Am I taking care of myself the way I typically do?
• Am I spending time with the baby?
• Am I reacting appropriately to the baby?
• Do I seem too worried or too detached regarding the baby?
• Am I less interested in things that used to interest me?
• Is my anxiety getting in the way of doing what I need to do?
• Do I seem preoccupied with worry or fear that seems out of proportion to you?
• Do I resist spending time with people who care about me?
• Do I seem too attentive or concerned with the baby’s health?
• Am I having trouble sleeping, even when the baby is sleeping?
• Am I overly concerned with things being done perfectly with no room for mistakes?
• Are you noticing that I am isolating myself though I am fearful of being alone?
• Am I too angry, too irritable, too anxious, too short-tempered?
• Am I having panic attacks, where I say I can’t breathe or think clearly?

Here’s what I need you to listen for

• Am I saying anything that scares you?
• Do I say that I think something is wrong?
• Do I say I just don’t feel like myself?
• Am I telling you I can’t or don’t want to do something that surprises you?
• Am I telling you I want leave or stop all this or hurt myself?
• Am I asking you for things I don’t usually ask for?
• Am I saying I’m too scared or too tired or too unable to do what I need to do?
• Am I asking you to stay home with me all the time?
• Am I telling you I can’t do this without your help?
• Am I expressing feelings of inadequacy, failure, or hopelessness?
• Do I keep asking you for reassurance or ask to you repeat the same thing over and over?
• Am I complaining a lot about how I feel physically (headaches, stomachaches, chest pains, shortness of breath)?
• Am I telling you we made a mistake and I don’t want this baby?
• Am I blaming everything on our marriage?
• Am I worried that you’ll leave me?
• Do I tell you that you and the baby would be better off without me?
• Am I afraid I will always feel this way?
• Do I tell you I’m a bad mother (father)?

Here’s what I need you to do

• Check in with me on a regular basis, several times a day
• Ask me how I’m feeling and ask me what you can do to help.
• Enlist our friends and family to help whenever possible during the early weeks. Even if I resist, please insist that it’s better for me to accept the help.
• Remind me that I’ve been through this before and things got better.
• Help me even if I don’t ask.
• Insist that I rest even if I’m not able to sleep.
• Make sure I eat, even if I’m not hungry.
• Spend as much time caring for the baby as you can.
• If you are the slightest bit worried, encourage me to contact my doctor and therapist. If I protest, tell me that you will call them for me and come with me to the appointment.
• Remind me that even if everything’s okay, it may be helpful and reassuring to make an appointment so we know for certain.
• Take a walk with me.
• Help with the baby during the night. If you’re not able to, please make sure someone else is there to help out so I don’t get sleep deprived which would make everything worse.
• Trust your instincts if you are worried or you think something needs to be done differently.
• Talk to me. Tell me what you’re thinking.
• Sit with me. Stay close even when there’s nothing to say.
• Help me get professional help.
• Help me find the joy. Help me stay present and appreciate the little things. Help me find and feel the butterflies, the giggles, the hugs, the sunshine, the belly laughs, the smiles.

Here’s what I need you NOT to do or say

• Do not assume I am fine because I say I am.
• Do not leave everything up to me if I am feeling overwhelmed.
• Do not use this time to work harder or later or longer if Ineed you home during the first few weeks.
• Do not tell me to snap out of it. I can’t.
• Do not let my resistance or denial get in the way of what we need to do.
• Do not tell everyone how well I’m doing if I’m not doing well.
• Please do not tell me I am strong and can do this without help if I need help.
• Please do not sabotage any effort I might need to make to seek treatment, such as resisting medication or pressuring me about the financial strain.
• Do not complain about the cost of treatment.
• Do not pressure me to have sex while I’m feeling so bad.
• Please do not do anything behind my back. If you are worried, let me know. If you want to call my doctor, let me know you are doing this.
• Do not forget to take care of yourself during this time.
• Make sure you are eating well, resting as much as possible, finding support for yourself from friends and family.

Here’s what I need you to say

• Tell me you will do whatever I need you to do to make sure I feel healthy.
• Tell me you can tolerate my anxiety, my fears, my irritability, my moodiness.
• Tell me you are keeping an eye on how I am feeling so things won’t get out of hand.
• Tell me you love me.
• Tell me I’m a good mother (father).
• Tell me its okay if things aren’t perfect all the time.
• Tell me you are not going to leave me no matter what.

Here’s what I need you to remember

• I’m doing the best I can.
• Sometimes the big things that seem scary at first aren’t as scary as more subtle things. For instance, if I have an anxiety attack or snap at you, even though it’s upsetting, it may not be as troublesome as if I’m isolating myself in the bedroom and quietly withdrawing.
• If you’re not sure about something regarding how I am feeling or how I am acting, please ask for help and tell me you will call my doctor or therapist.
• If I become symptomatic, chances are things will not get better on their own.
• Do not underestimate how much I appreciate the fact that I know I can count on you during difficult times.

Depression Essential Reads

How We Can Exercise Away Addiction and Depression

What You Should Be Feeding Your Depressed Brain

Things we need to add to our list

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Printable pdf of the postpartum pact

Material excerpted from What Am I Thinking? Having a baby after postpartum depression by Karen Kleiman, MSW