I used to view the month of January as a nemesis. I viewed it as a cold, dark month bereft of any good holidays or other redeeming features. When the calendar would roll around to the month, I'd grit my teeth and tell myself that, once the month was over, I'd gotten past the worst of winter. At best, I viewed it as a challenge to be overcome.
Several years ago, I decided that I'd had enough of hating January. I decided to shift my thinking about it. After all, the hours of sunlight are increasing all month. For that reason, I labeled January as the start of "very early spring." I began to use the month to do a deep "spring cleaning" and rearranged my home. Once I was done with that, I treated myself to pouring over seed catologs and planning my garden. Before I knew it, January was starting to grow on me. I began to look forward to the month. Now, it feels like this great opportunity to get a fresh start and an early jump on spring.
What's your least favorite month? Can you think of a way to reframe it? Or, at least, better ways to care for yourself during that month? Some ideas:
1) Make a list of projects to save for that month (e.g. reorganizing the attic, refinishing a piece of furniture, going through closets for items to donate.)
2) Find ways to keep your body moving, regardless of the weather. Exercise is an essential part of good mental health. Think about joining a gym or buying some exercise equipment for home.
3) Find positive associations for the month. Maybe you love reading. Make yourself a cozy reading spot and a list of books to read. Buy some tea or snacks. If you're a gardener, like me, sign up to get some new seed catologs. No interests coming to mind? Maybe you could use the month to start a new hobby. Consider trying my husband's 28 day challenge.
4) Get outdoors. This is a hard one, but a little time in nature does a lot of good. It's easy to talk yourself out of going for a walk if you're not properly dressed for the weather. Invest in some clothes that work for your hard month.
5) Practice self-acceptance. You may not totally succeed in finding a way to enjoy your tough month. You may fall short of your goals for exercise or getting outdoors. That's okay. Criticizing yourself will only make you less likely to succeed. Instead, revise your goals and re-dedicate yourself to good self-care.
For some, seasonal changes trigger more than the blues or irritabilty. If seasonal changes trigger moderate to severe mood or anxiety issues for you, please seek help from a mental health professional. Anniversaries of loss and trauma can contribute to this. Working with a therapist can help you understand your seasonal triggers and better overcome them.
A study that was presented at the American Society of Anesthesiologist's Annual Meeting last month has been widely promoted as linking the use of epidural anesthesia to a lowered risk of postpartum depression. The idea that opting for an epidural could reduce the risk of a serious postpartum complication is an appealing one. Unfortunately, as with many popular reports of scientific findings, secondary sources have put an inaccurate spin on the findings.
In this study, only women who received epidurals were included. The amount of pain relief provided by the epidural was related to postpartum depression scores on the Edinburgh Postnatal Depression Scale (EPDS.) The study showed that women who got significant pain relief were less likely to have an elevated EPDS score than women who got less relief from their epidural. What this study suggests is the effectiveness of the epidural is inversely correlated with postpartum depression scores (i.e. better pain relief, less depression.) This makes sense. If a woman is in enough pain to request an epidural, and does not get good pain relief from it, it is likely that she will experience one of the major risk factors for postpartum depression: an emotionally traumatic birth. Rather than suggesting that epidurals reduce the risk of postpartum depression, we could say this study suggests that failed epidurals increase the risk of postpartum depression.
What this study does not show is that getting an epidural is going to reduce your likelihood of postpartum depression. Why? Because the study was limited only to women who got an epidural, excluding those who chose an unmedicated birth. Another, larger study found the opposite association: women who got an epidural had a higher likelihood of postpartum depression than women who did not.
What's a mother to believe? The issue is that it is very difficult for us to study the impact of epidurals. The gold standard of research, the randomized study, would not appeal to many women. Nor would it be particularly ethical or safe. So, when we look at epidural use, we face a number of confounds in the research. Women who seek an epidural may have pre-existing conditions or labor complications that are absent in women who have unmedicated births. Because of this, we can't be completely sure if outcomes associated with epidural anesthesia are due to the anestheisa itself or to another condition.
So, what should women know about getting an epidural? Simply, epidurals have risks and benefits. The risks include longer labor, more cesarean births and greater risk of perineal laceration (a.k.a. tearing your lady parts.) You can end up with an epidural that doesn't work, or only works on one side. You have a small (1.5%) chance of developing headaches due to an accidental misplacement of the injection. It is certain that use of an epidural impairs mobility during labor, making it harder to get in an ideal position for birth. Epidurals also impair mobility after labor, making it harder to parent in those early hours of motherhood. The benefits of epidurals are obvious: pain relief & the ability to rest. The reduction or elimination of pain during childbirth is an important choice for women to have, especially when used wisely (i.e. later in labor and when other methods of pain relief have been exhausted.)
Working with pregnant and postpartum women, I often hear feelings of disappointment, even shame, about the use of an epidural during labor. What every woman needs to know: labor and childbirth are not designed as a test of your strength or determination. They are, simply, a way to deliver your child into your arms. Surround yourself with people who support the birth you want. Prepare yourself to have the healthiest birth you can. Make peace with the birth you have. If you find yourself having trouble processing your feelings about childbirth, find someone you trust to talk to about this. Postpartum Support International can help you find a professional or support group near you.
Sarah L. Wesch, Ph.D.