A nationally recognized expert on women's reproductive mental health offers the first book to reveal the full range of emotional experience for pregnant women

Lucy Puryear is a practicing psychiatrist and a pioneering expert in women's emotional health before, during, and after pregnancy. Through engaging personal stories reflecting her own practice, she illuminates the little-discussed feelings that are virtually universal for pregnant women. She shows just how normal it is to fear loss of control, to mourn what you assume is an irretrievable career, or to worry that you'll be the world's worst mother. She explains exactly what is happening to your hormonal system — and why knowledge is power when it comes to the overwhelming hormonal floods that accompany pregnancy and the postpartum period.

Understanding Your Moods When You're Expecting includes reassuring expert advice on:

how to make a birthing plan for emotional well-being

how and why to get essential rest

real-life bonding with your baby

reducing the risk of postpartum depression

eating disorders and OCD

how to make decisions about necessary medications during pregnancy

This book is as essential to a woman's emotional health during pregnancy as What to Expect When You're Expecting is to her physical health.

"Puryear, a psychiatrist specializing in women's reproductive mental health and director of the Baylor Psychiatry Clinic at Baylor College of Medicine, notes that pregnancy and motherhood are hard work both physically and psychologically. Yet, the author points out, most obstetricians and gynecologists have no training in psychological disorders, and women are often left to attend to their emotional issues without support. Puryear offers an informative resource that takes women from before conception to postpartum, drawing on her own practice and personal wisdom as the mother of four as well as current research. With pregnancy comes a surge in hormones that can make women feel both physically ill and cognitively foggy, and when the first movements of the fetus are sensed, the impending reality can be overwhelming. The third trimester and postpartum period can also bring problems: worries about being a good mother, ambivalence about the baby, concerns about sex or anxiety about returning to work. Puryear reveals that medication and psychotherapy are both options for mothers in distress, pointing out that there are many medical choices moms can make that won't harm the baby. All women, she argues, need more information and support concerning emotional issues during pregnancy: this is a worthy place to start. (June)" Publishers Weekly (Copyright Reed Business Information, Inc.)

"'Puryear, a psychiatrist specializing in women's reproductive mental health and director of the Baylor Psychiatry Clinic at Baylor College of Medicine, notes that pregnancy and motherhood are hard work both physically and psychologically. Yet, the author points out, most obstetricians and gynecologists have no training in psychological disorders, and women are often left to attend to their emotional issues without support. Puryear offers an informative resource that takes women from before conception to postpartum, drawing on her own practice and personal wisdom as the mother of four as well as current research. With pregnancy comes a surge in hormones that can make women feel both physically ill and cognitively foggy, and when the first movements of the fetus are sensed, the impending reality can be overwhelming. The third trimester and postpartum period can also bring problems: worries about being a good mother, ambivalence about the baby, concerns about sex or anxiety about returning to work. Puryear reveals that medication and psychotherapy are both options for mothers in distress, pointing out that there are many medical choices moms can make that won't harm the baby. All women, she argues, need more information and support concerning emotional issues during pregnancy: this is a worthy place to start. (June)' Publishers Weekly (Copyright Reed Business Information, Inc.)" Publishers Weekly (Copyright Reed Business Information, Inc.)

Dr. Puryear lifts the lid off little-discussed feelings that are virtually universal for pregnant women. She explains exactly what is happening to womens hormonal system trimester by trimester, including what she calls the postpartum "fourth trimester."

LUCY J. PURYEAR, M.D., is a practicing psychiatrist specializing in women’s reproductive mental health. She has been director of the Baylor Psychiatry Clinic at the Baylor College of Medicine, and was expert witness for the defense in the trial of Andrea Yates. She lives in Houston, Texas.

Acknowledgments xi Introduction 1

1. ON THE WAY TO MOTHERHOOD 10 I Think I Want to Be Pregnant 11 Working Through Family Relationships 16 Too Much of a Good Thing 25

2. THE FIRST TRIMESTER 29 The Conspiracy of Silence 30 Loss of Separateness 33 Hormones and Their Effects on Your Moods 35 Loss of Control 39 Pregnant While Parenting 42 TIPS: To Tell or Not to Tell; What to Read, Whom to Believe 45

3. THE SECOND TRIMESTER 49 Not-So-Equal Partners 51 Sex and the Pregnant Parent 56 Losing Control of Your Shape 60 How Can I Do This to Number One? 63 TIPS: There Are Two Parents; Eating for Two; Sex Specifics 68

4. THE THIRD TRIMESTER 71 When Will This Be Over? 72 I Can Do It Myself, Thank You 74 Birthing Plans 76 Is It My Hormones or Something More Serious? 78 It’s a Family Decision 85 TIPS: Putting Your Needs First; The Baby Shower; Your Postpartum Plan 91

5. THE BIG DAY 95 Bonding 101 Right-Away Emotions 105 The Circle of Life 106 TIPS: Waiting for Baby; Make the Delivery Yours; The First Few Hours 108

6. BRINGING BABY HOME 112 Why It’s Called the Fourth Trimester 113 Stay in Your Pajamas 118 What About Breastfeeding? 122 Nurturing Yourself 130 TIPS: Visitors; A Bedside Cooler; Diapers Close at Hand; Sleeping Arrangements; Forget Fashion; Sibling Survival 13

7. THE NEW NORMAL 139 The Good Enough Mother 140 Ambivalence 143 Your Relationship with Your Partner 150 Returning to Work 156 TIPS: Good Enough; One Night a Week; The Best of Both Worlds 160

8. WHEN MORE HELP IS NEEDED 164 Baby Blues 165 Postpartum Depression 168 Postpartum Psychosis 179 Postpartum Obsessive-Compulsive Disorder 182 Nonpharmacologic Treatment Options 187

9. WHERE DO WE GO FROM HERE? 191 Support Groups 196 Mother-Infant Units 197 Standards of Care 197 National Changes 198 Conclusion 199 Appendix My Postpartum Plan 205 FDA Drug Categories for Use in Pregnancy 207 Examples of Medications Used in Pregnancy 208 Potential Adverse Effects: SSRIs 208 Nutritional Supplements and “Natural” Drugs During Pregnancy 210 Edinburgh Postnatal Depression Scale (EPDS) 217 Postpartum Symptoms Checklist 220 Resources 224 Index 227