Monthly Archives: August 2009

Writer’s Block sucks

Maybe it was my kids being sick for over a month this summer.

Maybe it was struggling to finally celebrate and enjoy my new life with my family (once they were healed).

Maybe it’s having to process the whole Otty Sanchez thing.

Regardless, I’ve been struggling lately to write about anything Postpartum related. And I mean REALLY struggling.

School started a few weeks ago, my husband started a new job, and I’ve been the family chauffeur to boot. In the middle of the day, I now have time to myself with just Cameron. We’ve been laughing, bonding, and just getting a kick out of getting to really know each other. He’s 20 months old now, walking, learning new words, and developing a really hilarious sense of humor while he’s at it. His favorite thing? To walk around in circles whilst screeching “wheeeeee!” almost at the top of his lungs. Second favorite is watching Mama make the cross-eyed and tongue stuck out funny face. His laugh instantly warms the room!

So forgive me for leaving you hanging – I’ve been enjoying the truly important things in my life – my kids, my husband, and just life in general.

I promise I haven’t forgotten about you!

Just Talkin’ Tuesday 08.25.09: Sharing the PPD news with your parents

Communication today is often done via email, text, twitter, facebook status updates. It’s become much less personal and much less formal. For some, this is good. For others, not so good. Some things get lost in translation. It’s easy to type something and hit send without thinking. It’s also easy to apply this short communication style to every day life, leading to quick judgments, misunderstandings, and worse, the planting of grudges and beginnings of the end of relationships. The art of the thoughtful conversation seems to be drifting by the wayside.

Many women and families with whom I’ve worked have expressed to me that the biggest challenge they face is enabling those around them to understand what is going on without increasing stigma or losing their formerly close relationships. It’s a struggle to go through a Postpartum Mood & Anxiety Disorder let alone try to explain the complexity of it to a loved one from whom you need support.

When I spoke with my parents about PPD, they were understanding, compassionate, and actually did their own informative research. The one thing that stood out to me when I was hospitalized came from a phone call with my dad. He said something simple yet profound (my dad is full of those – I LOVE him for it). My father told me not to let anyone tell me I was “crazy” for the way I was feeling given my situation. My situation was that two months prior I had given birth to our second daughter who was then subsequently diagnosed with a cleft palate and by then had undergone two surgeries, one major to help lengthen her jaw in order to allow her to breathe safely. I held it together as long as I could but finally collapsed on day 56. Turns out for me, falling apart was precisely what I needed in order to pull it back together.

I’ve spoken with Mothers and their Parents alike who are frustrated and upset by the lack of information, communication, and the subsequent misunderstandings that follow all too often in the wake of a Postpartum Mood & Anxiety Disorder. Often these very issues only serve to compound a family’s recovery.

Today, I would like to take the opportunity to check in and see how (or if) you told your parents (or in-laws) or kept up appearances with them. Did you let them see inside the dusty window or did you keep the shade pulled down and pray no one would accidentally flip it up?

Let’s get to Just Talkin’!

PPD Survivor Shares her Story for the first time

On Tuesday, this was a comment left by a mom who had never shared her story with anyone besides her husband (who lived it with her). I emailed her to ask if she would be comfortable with me giving it a post of it’s very own. Her story begins when she is 34 weeks pregnant and continues through to postpartum. I hope you find it as inspiring and as strong as I did…..

This is my first time to share my story in any capacity…. I don’t know if I’m ready, but here goes nothing…

My depression started around 34 weeks into my pregnancy… I had never heard of PPD and I didn’t know what ante partum depression was… I started to realize something was wrong somewhere between 30 – 34 weeks. I’m not afraid of medication, and think of it as an aspirin would be to a headache.

I have had depression and anxiety before so, I somewhat, recognized the signs. I told my husband that I wasn’t quite feeling right, and he encouraged me to speak with my OBGYN. At my next appointment I told my doc that I was worrying excessively, and not feeling quite right. It was really a whole new type of depression for me.. I never could and still have difficulty describing the way I felt. But worry was a BIG concern. The OBGYN said it wasn’t a big concern, and not to worry lots of new mom’s worry a lot.

My husband is a member of the “mind over matter” club. While he, I’ll say, tolerates, my need for meds to get my depression under control, he definitely is one of those, “Just push through it,” kind of people.

I saw my OBGYN on Tuesday, and she prescribed me Prozac, I ended up going to the E.R. on Sunday because I felt very overwhelmed; with what exactly, I do not know… They gave me an Ativan shot, made sure I calmed down and sent me on my way, with no real information. Or possible expectations. I then saw my OBGYN again on Wednesday, explained what had transpired over the weekend, and she prescribed me some Xanax. I felt so horrible that day, that we went straight to the nearest pharmacy and filled the script so I could take one. That Sunday I woke up and I felt worse than I thought I ever could. I told my husband that he had to take me to the E.R. So they could take the baby out so that no harm would come to her, if I did end up harming myself.

I thought this was a completely rational thought process; and was even more distressed when they told me that instead of delivering my baby early, they were sending me to the Nut House. All of this scared my husband to death, not only was he in fear of losing his wife, but that there was a possibility that he could end up without a wife and a child, or raising a baby on his own. And it was definitely one of the two, because the baby could not stay in me anymore.

I think that is when he realized, after two weeks of doctors and E.R. visits, that something was really wrong and a real threat existed not only to my life but to our unborn daughter’s life as well! I went to the psych. ward at a private hospital, where they were fairly knowledgeable about pregnancy related depression. The one thing that is VERY FRUSTRATING in my case, is that, since I was pregnant I was having a OBGYN come in and check on me daily, and since I was high risk (because of a blood disorder) I had a specialist coming to see me daily as well. They kept telling me it would be okay for me to get some Ativan, which had provided tremendous relief at the E.R. Visits, but the psychiatrist that was assigned to me when I arrived, REFUSED to give me anything other than Benadryl and Celexa, neither of which were providing any immediate relief.

As I have learned over the past year and a half since this all occurred, most psych. Wards have limited visitation, and mine was no different. My husband could come to the evening visitation and spend an hour with me. The first few days all I did was cry the whole time he was there. He was so scared. I was breaking his heart and that just made me feel even worse. I really just wanted to give him the baby and leave (you know d-i-e…) I didn’t want to burden him with all of my problems anymore. The thought of me not being around anymore, was the thing that was really bothering him. He got it in those moments.

I got out of the hospital and managed to hold it together until 38 weeks!!! YAY ME!!! When my OBGYN, asked if I wanted to go ahead and deliver, I practically took myself straight to the hospital right then. Coincidentally, I went into labor on my own the day I was scheduled to deliver. My delivery was easy… But there were some complications with my epidural, which lead to added stress. It is the most horrible feeling in the world to think back onto that day and to look at pictures and to know in those moments there was no joy, no love, and no want, for my beautiful, brand new baby girl. You can see the blankness in my face and the fakeness in my smile in all of the pictures… It breaks my heart to think of it. Will she understand, what was wrong with me then? Will she know how much she has ALWAYS been loved and wanted!

This was my husband’s first baby, but my second. I have a, now 10 y.o., daughter from a previous relationship, so I had been through the nursing and diapering and everything before. I was uncertain of myself because of my depression and anxiety, but I knew what I was doing automatically. My husband second guessed everything I did. He questioned my positioning of the baby while nursing, and was convinced that she was not getting any milk, despite the fact that the nurses had told him multiple times that everything was going fine. As one would assume this only compounded the problem I was dealing with.

A couple of days out of the hospital and other than the epidural complication I thought I was feeling much better! I look back now and think that the depression was just masked by the Vicodin they were giving me for pain after the delivery. I probably had about a weeks worth of Vicodin, and within a few days after that, I was back in the E.R. I won’t go into all of the how I was feeling… But I ended up back in the psych. Ward.

Telling my husband the second time felt easier to me… With the flawed logic of depression, It seemed very simple. I leave (aka die) and then he doesn’t have to worry about me, he now has his child, life will be easier without me… Yada yada yada… The same visitation schedule existed, naturally, I had just been there little less than a month before… My husband came to all the visitations and brought our daughters. (the first time I lied to the oldest about where I was, she still doesn’t really know why I was there either time) again, in the moment, he was understanding, apologetic, and sympathetic. He just wanted me to do what ever I need to do to get better, and come home to our family.

We had tough decisions to make. Since I was nursing, and since I had the same psychiatrist that I had had previously, she was equally unwilling to provide me with any REAL meds, until I agreed to stop nursing ( as I type that, I think I hate her for that!) Up until the point in which I agreed, I pumped and dumped, my milk every few hours in my room there in the ward. That too was heartbreaking, but I was finally at a point mentally where I knew I had to get better and go home, and without me at home, there wouldn’t be breast milk anyway! So I stopped pumping and finally got some relief!!!

When I first came home my husband was great!!!! He did the laundry without being asked, he made sure there were meals for everyone, he helped out with our new daughter a lot. But as time passed and things have gotten better his back to his same old self. Mind over matter. He really does spend a lot of time wondering what the hell is wrong with me.

I’m glad to report, that I’m now doing great, as long and I don’t have to talk about the time around my daughter’s birth, (this post has resulted in the need to take some Ativan!) And you don’t talk to me about having another baby, which my husband definitely wants to do, and I’m not so sure I can handle it… I can’t even type out what happened to me without having a panic attack!!!! But for the most part I’m GREAT! ;o) I’m down to 30 mg of Cymbalta a day, and Ativan as needed (which is rare!). We are working on weaning off the Cymbalta, but I’m in no hurry! I want to be well and I want to be here with my family.

I’m looking forward to sharing this post with my husband. I think I have stated fairly well, what I will need him to do better next time. I have also printed of a “Me First” letter (got it from a post on a PPD site) and will be well armed if we decide to have another baby! I wish my husband had a better understanding of depression. I which he could remember how VERY REAL everything we went through during our daughter’s birth was. Maybe then he would have more compassion for my now fleeting struggles, and be WELL prepared for the next time!

Just Talkin’ Tuesday 08.18.09: Telling Your Partner

Original photo by Pingu1963 @ flickr

Original photo by Pingu1963 @ flickr

We’ve touched briefly on seeking support and how you overcame the stigma of admitting something was wrong.

Today I want to take that topic to a more personal level.

How did your partner take the news?

My husband was so confused right after we had our first daughter. One minute I’d be fine, the next – yelling at him for simple things – like criticizing how he blew his nose or something equally inane. Or one of my favorites – the laughing hyena fits. Oh how I hated those! They hit at the most inopportune time! Him: “My day sucked.” My response: laugh so hard milk I had drank that morning would come spewing out my nose. Yeah, peachy, huh?

Once I kind of figured out what might be happening it really helped us both immensely. I stopped believing he had been born with super powers which would magically allow him to know precisely what (and when) I needed him to do with the baby and he started asking what he could do to help out. Before you knew it, we were navigating the perilous yellow brick road of communication quite successfully! (Did I mention he even talked to his parents about PPD for me? How sweet!)

By the time my second episode occurred, he knew more than enough to recognize old habits and encouraged me to seek help. We did have a bump when I was hospitalized but I think anyone with a loved one with a need for mental health hospitalization would be understandably stressed.

Third time around he was just as big an advocate as I was, knew a ton, and fortunately, sailed right through the experience with me. We were both very blessed to be able to fully enjoy the newborn stage with at least one of our children. That experience is something neither one of us takes for granted.

So – what I’d like to talk about today is how you told your significant other that everything was not alright in New Momville. How’d that conversation go? Did you initiate it? Did they? What was the reaction? What did they do to support you as you recovered?

I do want to take a moment to mention that if you have an unsupportive partner, talk with your caregiver about this. See if you can arrange to have your partner attend an appointment with you so that the doc can explain to them how important it is for you to have support at home. Good support at home is essential to a solid recovery and as your partner, they are on the front lines. In fact, it’s always a good idea to take your partner with you to your appointment because they may be witness to behavior you are not aware of in yourself.

Let’s get to Just Talkin’ Tuesday!

Just Talkin’ Tuesday 08.11.09: Breastfeeding & PPD

Original Photo "the breastfeeding lady 2" by Raphael Goetter @ flickr

Original Photo "the breastfeeding lady 2" by Raphael Goetter @ flickr

When I gave birth to my second daughter I saw my dreams of a normal postpartum smashed upon the rocks just 30 minutes after delivery. A delivery after 42 hours of labor, 36 weeks of pregnancy spent un-medicated but largely depressed and unaware of any potential issue facing us. We fully expected (as any parent) a healthy child, normal delivery. A large part of my smashed dreams tied into the hard reality that I would absolutely not be able to nurse her because she was born with a cleft palate so wide and large that it would be physically impossible for us to do so.

Later that day I was faced with a crucial decision. What kind of formula would I prefer for my daughter? I cried. She wasn’t SUPPOSED to get formula! That evening found me hooked up to a hospital grade pump praying for anything to happen. I barely squeezed out a drop. But I persisted and pumped for her faithfully until she was seven months old. I even researched everything I could in order to try to get her to nurse – books, cleft organizations, the La Leche League, the local Lactation consultants and even going to a training to become a trained Certified Lactation Counselor (which I completed one month AFTER we stopped nursing!) I left no stone unturned! Charlotte and I used SNS, nursing shields, and sheer determination. She eventually nursed for almost five minutes! Those five minutes were so amazing words cannot even begin to describe. In fact, it was tears falling from my face which interrupted the glorious event.(You can read more about our journey here: Breastfeeding Charlotte)

But at seven months, I faced a decision. My desire to continue to give breastmilk to my daughter or my mental health which had deteriorated so much it was adversely affecting my relationship with my husband and other daughter. With a heavy heart, I drove to Wal-mart to purchase formula. I cried the whole way home. Eventually I made peace with the decision. “Hanging up the Horns” or HUTH as it’s called in the world of exclusive pumpers, was a difficult decision. But one I was glad to make as it allowed me to bond with my entire family. I had come to resent Charlotte for all the extra work she required. But now, all I had to do was pour, heat, and I was done. I made strides towards better mental health and so did the rest of the family.

For me, the decision centered around the stress providing breastmilk created. I was also on medication which can be another tremendous issue for new moms. Many mothers don’t want anything crossing over to their infant through their breastmilk. Dr. Thomas Hale, author of Medications & Mother’s Milk, is a wonderful authority on the topic as are the researchers at Motherisk in Canada. When nursing while on any medication, it is important for the infant’s pediatrician to be aware of the medication and dosage amount so baby can be monitored for any adverse reaction. The decision to take medication is a personal one and should be made carefully with the help of professionals. Ask questions. Make sure the prescribing physician KNOWS you are nursing. And do not let them force you into quitting nursing if it is the one thing in which you find comfort. If you are currently struggling with this decision, please read this wonderful essay by Karen Kleiman: Is Breast Really Best?

So let’s get to Just Talkin’ Tuesday already!

Did your Postpartum Mood & Anxiety Disorder affect your nursing decision? Did you decide to formula feed to help improve your mental health? Do you regret your decision? Made peace with it? Did stopping help? Did your desire to nurse increase your desire to seek natural treatment? Speak up! Share!

(Absolutely no bashing for deciding to formula feed will be tolerated here. We respect the decision of all mothers to choose the course of treatment/feeding they feel is right for their families. Any posts discrediting or attacking a mother for her decision to formula feed will not be approved.)

Low Omega-3 Fatty Acid Intake from Fish correlates with High Levels of Depressive Symptoms in Pregnancy

Published in the July issue of the Journal Epidemiology, researchers put to the test the relationship between fish intake and depression based on the observation that “Although common in western countries, depression appears to be virtually absent in countries with high seafood intake.” (Abstract, High Levels of Depressive Symptoms in Pregnancy with Low Omega-3 Fatty Acid Intake from Fish)

The researchers collected data from women as they progressed in their pregnancy during 1991-1992. At 32 weeks, the women then completed a questionnaire which included symptoms of depression as well as a food frequency questionnaire from which the amount of Omega-3 Fatty acid from fish was calculated.

The results? Both adjusted and unadjusted analyses showed that lower maternal intake of omega-3 from fish was associated with high levels of depressive symptoms.

So just how much fish do you have to eat in order to achieve these results? Women consuming more than 1.5g of Omega-3 from seafood vs. those consuming none were less likely to have depressive symptoms. And how much fish equals 1.5g of Omega-3 fatty acids? FDA guidelines suggest women and children eat up to 12 oz of fish per week. Some of the healthier fish to eat (in order to avoid mercury build-up) are: Anchovies, Catfish, Crab, Herring, Mackerel, Mussels, Wild Salmon (Alaskan), Sardines, and Whitefish (source: Fish Intake During Pregnancy, Dietriffic.com)

What if you don’t like fish? You can take a supplement and there are non-fish sources of Omega 3 such as walnut, kiwi-fruit, flax seeds, pecans, hempseed, hazel nuts, and butternuts. Eggs and milk from grass fed chickens and cows are also higher in levels of Omega-3 fatty acids than other eggs and milk. But remember this particular study dealt specifically with Omega-3 from fish.

You can also check out the following blog, Rebuild from Depression, for additional sources and information regarding Omega-3 fatty acid sources.

I have been taking Omega 3/6/9 for quite some time now as part of my regular routine. I can tell when I forget to take my supplement as well. (So can my husband!) Make sure you talk to your physician before adding a supplement to your routine though. Also discuss adding more fish to your diet as well to make sure it fits with your particular situation.

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Pregnant? Better avoid stress too!

Professor Vivette Glover, a prenatal studies expert at Imperial College in London, has just released new research showing that stress during pregnancy may affect children for years to come.

According to a recent article appearing in The Irish Times, Prof Glover’s study discovered 15% of the most anxious women in her study had double the rate of offspring with ADHD. Another study also revealed that if mom is stressed during pregnancy her child may perform poorly on infant IQ tests or be more fearful.

The most important relationship in this factor was the one the expectant mother had with her partner with emotional abuse seemed to be one of the red flags for behavioral issues later in the child’s life.

Based on Prof Glover’s research, it seems cortisol (that stress hormone) is at the basis of this issue. The Placenta is actually designed to block up to 90% of cortisol from the developing fetus. However, in mothers with additional stress, more cortisol seems to “leak” through and may be at the root of early delivery as well as affecting the development of the brain. Animal research has shown that cortisol “can kill nerve cells in the hippocampus area of the brain which is important for learning and memory.” (Irish Times, August 4, “Don’t Mix Stress with Pregnancy”) Glover hopes to translate these findings in animals to people.

The most noted statement by Glover in this article for me was the following:

“Physical care of pregnant women has improved enormously in the past 100 years but emotional care has not.”

I’d have to agree. Through all three of my pregnancies, the only time anyone really seemed to care about how I was feeling emotionally was when I advocated for attention to that particular area. The myth that all pregnant women are automatically happy is just that – a myth. (And FYI, not all of us like it when you complete strangers approach us to pat our belly and offer your sage advice either!)

So if you’re stressed and pregnant, what can you do? You can talk about anything causing you stress. Back off from making large decisions about life such as moving, going back to school, or finding a new job unless these things are absolutely necessary. Recruit family members to help keep things as even and calm for you as possible. Have that one pessimist in your life? Minimize contact with him/her while you’re pregnant. Don’t watch the news or read the paper if negativity stresses you out. I still filter the news I read and hardly ever watch CNN or the 6 o’clock news. In fact, I can’t even tell you who the anchors are anymore which I think is a great thing. While you can’t control everything around you, you CAN control what reaches you. My husband knows not to tell me about certain news items and I only receive certain topics on my phone – Politics, Entertainment, Health & Wellness, Science, Strange News (hey, I like to laugh), and Technology (yeah, I’m a closet geek).

Also remember that life will happen. It is literally impossible to protect yourself from ALL stress. But when you can minimize, make a concerted effort to do so. Your body (and your child) will thank you.

(You can read the complete article “Don’t Mix Stress with Pregnancy” @ The Irish Times by clicking here.)

Just Talkin’ Tuesday 08.04.09: Seeking Help – How did you do it?

Base photo: "Call" by barejon @ flickr

Base photo: "Call" by barejon @ flickr

Any mom who has made the phone call to her doctor’s office or timidly admitted to another person that things are not all glowy like the Johnson & Johnson commercial’s make them out to be will tell you that it’s a very hard thing to do.

It took me three months to seek help after the birth of my first daughter. 10 days after the birth of my second (but hers included NICU and major surgery so things were sped up a bit in that situation) and when I was ultimately hospitalized it took me 4 days of calling and hanging up before I would admit things had taken a turn for the worse.

That phone call was the hardest phone call I’ve ever made in my entire life. I mean, c’mon – I just had a baby. She was healthy, she was home from the NICU, doing well – why the hell weren’t things getting better? I thank GOD every day I had the courage to make the call. It completely changed my life for the better. Looking back I see how all of it fit together now. It makes sense. At the time though, I felt adrift, like a random puzzle piece left out in a horrific rain storm.

So today I’d like to ask you to share your story of how you first asked for help. What led you to do so? What were some of the difficulties you experienced when you did ask for help? Share with us! Let’s get to Just Talkin!

Eli Lilly Releases “Faculty Registry”

Today Eli Lilly released a list of doctors who received payment from them for various activities including Patient Education, Healthcare Professional Education and Advising/Consulting. In Q1 of this year, Lilly paid out a total of $22 million to those on this list.

I am hopeful other pharmaceutical companies will follow in Lilly’s footsteps. After this past year filled with failed disclosures from faculty members across the country it is encouraging to see a movement towards transparency. As patients and consumers, we should be aware of the finances which may affect our treatment. If our physician has been paid by a pharmaceutical company we should be made aware of this.

Lilly’s site also includes a guide explaining how to read the Registry although it seemed pretty straightforward to me.

You can see the registry by clicking here.