Monthly Archives: February 2009

Sharing the Journey with Didi

Hedwige St. Louis, or Didi to those who know her, is an amazing woman doing wonderful things here in the state of Georgia. She’s spearheading the development of a statewide Perinatal resource organization, The Georgia Postpartum Support Network. Her passion for working with women struggling with Postpartum Mood Disorders springs from professional and personal experiences. As an OB, she sees women with Postpartum Mood Disorders through her practice. As a Mom, she is a survivor of a Mood Disorder, something which helped to inspire her to develop this network. Thank you Didi, for taking on such a tremendously important and much needed project!

gps-logo

Tell us a little bit about who Didi is when she’s not being an OB or volunteering with Postpartum Support.

When I’m not an Ob or volunteering with GPSN, I am a mom to an amazing little guy who just turned 3. I’m married to a DJ of all things and I have a dog. I love to work out, play piano, and read. I was originally born in NYC, then due to my dad’s job I grew up in Europe, South America and the Caribbean. I came back to the US for College and have been here since.

What has been your personal experience with Postpartum Mood Disorders? Did your training and education prepare you at all?

In 2006, after having my son I experienced postpartum depression with some OCD component to it. At the time I was completely unaware and just felt isolated. I had nothing to go on and just thought something was wrong with me and if I just hung in there eventually I would be myself again. A year later my sister made a comment and that’s when I realised that I was depressed for the entire first year of my son’s life, it also explained my extreme hair loss and all the other symptoms. My training and education did not prepare me, because you never think it’s going to happen to you. Furthermore most physician are more familiar with the extremes of Perinatal Mood Disorders, but the subtle ones, where the person is functioning, are harder to catch if you don’t screen the person for it. Now I know that I was a poster child for PMD: Type A, primary bread winner, in charge of household finances, history of depression. But my experience has made me a much better physician and brought me closer to my patients.

Speaking of your training, share with us what limitations (if any) you are faced with as an OB when a woman may be presenting with a Mood Disorder during her Postpartum visit. What do you feel would give you more of an opening or provide more options for you to help women with a PMD?

Now that I have made my mission to be better educated about this illness and its many facets, I feel better prepared because rather than waiting for my patient to present with the illness, I am working to have our whole practice routinely screen our patients so we can catch them early. I also make it a point to educate my patients towards the end of the pregnancy about all the feelings they will experience and I encourage them to feel comfortable in calling our office to talk to any of the providers or nurses. Working with GPSN has also allowed me to identify more resources than i had in the beginning, both online and in the state. My goal is to have resources available to women across the state.

Share with us three things that made you laugh or smile today.

My spinning class this morning, my son’s smile and laugh and some music my husband gave me last night.

We met as you were developing a statewide support network for women and families with PMD’s. How did you get started on this project?

I started on it because I was frustrated at the lack of resources. I had several patients dealing with a perinatal mood disorders and while some did well with the couple of referrals I had, others did not. And for those who didn’t, I had no alternatives. this was frustrating because as a physician, a mom, I am used to providing my patients with answers, solutions and I couldn’t.

Tell us about GPSN. What do you hope to achieve with this organization and where do you see it going?

GPSN was started as a resource and support organization. Our goal is to provide women with the information they need so they can make informed choices and find the right treatment alternative for themselves as they are battling their perinatal mood disorders. Our goals include developing a database of health-care providers who know how to manage PMD, educate all health-care providers who take care of pregnant women so that screening for PMD becomes routine, educate the public about PMD so that family, friends and spouses will better understand PMDs and be better able to support their loved one as they are dealing with their illness. Five years from now, I would like to see GPSN actively participating in the community through our support warm-line, community workshops, support groups and continuing medical education for health-care providers.

What do you find to be the most challenging about parenting? The least challenging?

The most challenging part of parenting, the unpredictability!! I am very type A, I like to plan everything for the next month, Donovan (my son) has a different take on that, for him life is a series of discoveries, so I have had to learn to pace myself and be patient, so I let him find his path.

The least challenging…loving him. He is the best thing I have ever done and for all the pain of that first year, I would do it over in a heartbeat.

As mothers it is so important we remember to Mother ourselves, something we often push to the side. What do YOU do to mother yourself?

This year I am slowly coming into my own, but it’s taken a while for me to start taking care of myself the way I use to before having Donovan. I make time to work out just about everyday, I play with Donovan which is very therapeutic for me and i make time to read. This year I also plan on cultivating my friendships a little better and a little more.

What effect, if any, did your Postpartum experience have on your marriage?

For a while there was a distance between my husband and I. We struggled with communication, but we are working through it and I think my husband understands better the importance of sharing parenting duties, giving me a break and supporting me.

Last but not least, what advice would you give to an expectant mother (new or experienced) regarding Postpartum Mood Disorders?

Don’t be afraid to reach out and talk to someone and if you don’t get helpful response, try again until you find it. Don’t give up on yourself, it’s not your fault and there are thousands of women out there who will readily embrace you and help you through this.

Thanks Lauren, those were some very thoughtful questions.

Didi

UNC Study to analyze CBT for Perinatal Anxiety Treatment

Researchers at UNC are initiating a study to evaluate the effectiveness of CBT or Cognitive Behavioral Therapy for treatment of Perinatal Anxiety. You can read more about the study here.

All participants in the six-week study will receive helpful childbirth counseling as part of free weekly prenatal classes. Half of the participants will receive elements of CBT as well. Those who complete the study will also receive a modest fee at the end.

First-time pregnant women over the age of 18, and their partners, can learn more and complete a screening questionnaire online at www.babyprepstudy.com.

The Anxiety Disorder Clinic is part of UNC’s psychology department. In addition to engaging in studies, the department’s clinics provide low-cost therapy services to adults and children on a sliding-fee scale. They can be reached at (919) 962-6906.

Results of the Great Return

I survived the day.

There were only tears as I made THE turn. They hit me out of the blue and after blubbering for a few minutes, I was fine. The rush of emotions was really quite unexpected. I had no idea how I would react once we got there. I worried the tears wouldn’t stop and I wouldn’t be able to go in with Charlotte but they subsided rather quickly as I forced myself to breathe and Chris reminded me we weren’t going to see her in the NICU.

Overall the appointment itself went well. Her plastic surgeon was very pleased with how well her jaw was growing on it’s own and didn’t seem to think surgery was going to be a necessity unless deemed so by Speech.

Guess what?

Speech said she needs surgery. Her palate is split in the back and he also wants a naso-pharyngeal flap done as well to help her not push air through her nose when it should be going through her mouth.

We go back next week for a session in their speech lab so they can teach me some things to do with her at home to help train her vocal track to do the right things.

We knew surgery was a very real possibility and as I said earlier, we’ve discussed it with her. The doctor’s office will be phoning us to talk scheduling once they get it cleared with insurance so we wait.

I’ll update here once we know more.

In the meantime, continue to pray for strength, guidance, and patience.

Open Mouth. Insert Foot.

As if ABC’s Private Practice hadn’t failed enough recently, there’s a brief interview with Tim Daly in this week’s TV Guide.

Mr. Daly rails against Violet’s character rejecting help from both his character and the other possible father of her unborn child by calling it “sexist and bulls#$%.” Wait. It gets better, I promise.

Then Daly goes on to share his thoughts on way birth is portrayed on the show. (This is where it gets good) “For the sake of the psyche of American women, I’d like to see one woman on the show have a really easy, happy, joyous birthing experience.”

What, so watching a happy birth on a drama is supposed to help the American female psyche? How? Nevermind that your show just totally screwed the American female psyche over with your hack job on Postpartum Mood Disorders. Do you REALLY think they could do better with birth?? And what is your definition of an easy, joyous, happy birth? Medicated? Natural? What? Let’s go there, Mr. Daly.

Nevermind that birth isn’t always easy. And let’s just totally ignore the work of people like Ricki Lake and The Business of Being Born or Karen Brody and her play BIRTH. Or Susan Hodges and her organization, Citizens for Midwifery. Let’s show a Mom giving birth at home with a midwife instead of with an OB in a medical environment – that’d be happy and joyous!

And FYI, Mr. Daly, there is nothing EASY about birth. Try it sometime. Oh wait, you can’t. Sorry.

Association discovered between Diabetes & Perinatal Depression

"Drink Me" by Ara Alexis

"Drink Me" by Ara Alexis

A new study by researchers at Harvard Medical School and the University of Minnesota School of Public Health focusing on Medicaid Records of over 11.000 NJ moms found an association between Diabetes & Perinatal Depression. The conclusion of the study is that Moms with Diabetes are 55-60% more likely to develop Perinatal Depression. The researchers are quick to point out the Diabetes isn’t necessarily the source of the Depression and that they didn’t take into consideration a family history of mental illness or other risk factors for Perinatal Depression. Their requirements for identification of depression relied on a written diagnosis or filling of anti-depressant prescription during the course of the study. Mothers included in the study had been eligible for Medicaid 6 months prior to birth and up to one year post-delivery.

While the study isn’t conclusive due to the focus on such a local and specific population, the researchers encourage health care providers with Medicaid patients and a Diabetes diagnosis to focus a little more on depression prevention. You can read more about the study here.

My thoughts on this? The beginning of my Postpartum Mood Disorder journey began when my husband had a good job and we had private insurance. I DID develop Gestational Diabetes during pregnancy and went on to develop full blown Postpartum Depression & OCD but was never officially diagnosed. My second pregnancy we still had good insurance but were struggling a bit financially but I did not have Gestational Diabetes – landed in the hospital. Third pregnancy was a Medicaid pregnancy as we did not have access to private insurance. I did not develop Gestational Diabetes and did not have a Mood Disorder either. But I had also become quite educated about PMD’s by then and was very forceful in my advocacy of care.

Research like this should always be taken cautiously and with a grain of salt. It’s encouraging and exciting that so many researchers have taken an interest in Postpartum Mood Disorders but always make sure to look at the big picture and do your own homework before taking someone else’s word for it!

The Great Return

Tomorrow we go to Atlanta with Charlotte for follow up with the Cleft Palate Clinic.

I would be lying if I said I was not nervous.

This appointment was supposed to have taken place when she was nine months old.

She’ll be three years old next month.

Charlotte in the NICU

Charlotte in the NICU

It took me this long to get to the point where I could even think about facing the hospital where she spent her first 21 days of life without having an anxiety attack.

This is the same hospital in which I tucked myself into a corner of the sleep room in the NICU area, blasted Linkin Park over the MP3 player and checked out. No desire to come back. Just wanted to stay curled up under the blanket and pretend none of this was happening. Nope. Not to me. I didn’t have a baby in the NICU. She wasn’t downstairs having major jaw surgery at just nine days old. We weren’t doing this. I was stuck in the middle of a really bad dream and I’d wake up at home with a normal baby.

I can still see that hallway, that sleep room, my nostrils fill with the scent of the surgical soap that killed my hands as I washed them every time we went into the NICU, every time i pumped, every time I went to the restroom there.

I remember the pumping rooms in which I spent most of my time staring at the clock wishing I could nurse my daughter instead of shoving my breasts into hard cold flanges, flicking a switch on a massive antique pump, adjusting the suction to just below Holy Crap that Friggin Hurts.

But tomorrow is the day we finally go back.

Chris is going with me as a safety. I don’t know how I will handle this. I’m hoping for the best. Praying for the best. I keep thinking about how far we’ve come since then and how lucky we are that we don’t have a lot of the problems a lot of parents have with their Pierre Robin kids. She’s talking, using sentences nonetheless. She’s breathing on her own. She eats – oh lord, she eats – she’d eat herself sick (and has) if we let her. No oral aversions here.

But she does have a fistula – an opening in her palate repair. It’s at the back of the throat. And her enunciation is off – it’s nasal. She can’t say “s” without blowing air through her nose. Chris and I understand maybe 75 – 80% of what she says and it breaks our hearts that we can’t even understand our own child all the time. It’s led to frustration on both sides and is now turning into a discipline issue.

I’m afraid we’ll be told she needs surgery. I’m afraid of what that will mean for us and for her. I’ve talked with her about the possibility of surgery. She knows that they would give her some medicine to help her go to sleep and fix her mouth while she was asleep. That she might be owwwy when she wakes up and that they’d have medicine ready to help with the owwwy.

She seems cool with it.

I’m not.

I have forgotten how to let her go with the doctors – I got so good at it when she was in the NICU but she’s been all ours for almost three years now. I don’t want to hand her over to be taken to surgery. I want to go with her! That’s my baby you’re taking!

But now I’m thinking too much and need to stop and let God do all this worrying for me.

Please pray for us as we face tomorrow.

Pray for a peaceful heart and soul for me.

Pray for a pain-free and comfortable day for Chris as he goes with us.

Pray for a positive evaluation.

Pray that I am able to handle any news of surgery with strength and grace and truly give it to God.

A Little Slice of…. Normal?

photo from flickr

photo from flickr

As my Postpartum OCD slammed against my shores, the skies darkened and angry bolts of lightning seared through the atmosphere. I hunkered down in a deep dark cave, curled up in the fetal position while wishing the skies would clear. Eventually they did and as puffy white clouds took the place of the dark angry ones, I began to realize the island I now found myself on wasn’t so bad. The laughter and comraderie filling the valleys no longer grated on my nerves. Not even the whining and crying could push me back to my cave. In fact, I slowly began to forget where my cave was – I think it’s been overgrown with dense vines or is hidden away behind a waterfall.

This afternoon with the kids was completely blissful. All three of them played together in the floor without arguing. They peacefully shared with their toys and burst with laughter. Allison wove a wonderful tale of marital bliss with Cameron’s toy cars. Charlotte giggled at Cameron’s newfound block playing skills. And Cameron just soaked up the attention from his big sisters as they surrounded him.

I immersed myself in the joy of watching my three children enjoy each other’s company. THIS is what motherhood is like without the angry and confusion of a mood disorder. Wow. I didn’t have a mood disorder after having Cameron but there were all the issues with Chris’ addiction that threw me for a loop. Moments like these- moments so tantalizingly perfect never fail to blow me away. They make all of this worth it – all the struggling, the fighting, the tears, the pain – all of it makes the joy I now feel so much brighter.

And it’s this joy that i wish for all the families I come in contact with because I remember all too well not knowing it.

Blogger shares experience with Antepartum Depression

Jill over at Owner of the Band, bravely opens up about her current experience with Antepartum Depression.

photo by mahalie @ flickr.com

photo by mahalie @ flickr.com

Pregnant woman DO get depressed – at a rate of about 10-20% at that. Many expectant moms dismiss their emotions as pregnancy mood swings. Then, just as with a Postpartum Mood Disorder, there’s the whole “you’re supposed to be happy” expectation – you know, the whole glowing pregnant mama thing. But not all Mamas glow. Even fewer of them bravely share their experience with depression.

The biggest issue depressed pregnant mothers face is one of medication. Should I take medicine that might affect my baby? Should I just tough it out even though depression too crosses the placenta? What do I do?

There are three sources of help that I would recommend –

Wellpostpartum.com, a blog dedicated to natural approaches for Perinatal Depression.

Pregnant on Prozac by Shoshana Bennett, a book dedicated to the situation more and mamas are finding themselves in – pregnant on psychiatric medications and the issues that go along with it.

iVillage’s Pregnancy and Depression/Mental Illness Board – a message board I moderate for expectant mamas struggling with Depression or the maintenance of other Mental Illness Diagnoses during their pregnancies.

You can read some more about Antepartum Depression by clicking here.

The most important thing to remember if you find yourself not glowing during pregnancy is to be honest, talk with your caregiver, and above all, remember that YOU ARE NOT TO BLAME!