Category Archives: Blog Day

LTM III Page 32

The Hidden Stigma of The Perfect Birth Culture

APA-BlogDayBadge-2013Today is the APA’s Annual Mental Health Blog Day. I’m diving into an aspect of Postpartum Mood & Anxiety Disorders which is often swept under the rug yet brings with it a very divisive and stigmatizing aspect to the birthing world. I dove into this topic somewhat with a blog post just a week ago, but today I’m diving in even further because beneath the exposure of THAT post, there is even more stigma and non-discussion going on among some of the largest birth support organizations (Lamaze, DONA, and CAPPA) in regard to Postpartum Mood & Anxiety Disorders.

If you read the post linked in the above intro paragraph, you’ll read that Henci Goer’s view of Postpartum Mood and Anxiety Disorders places the blame for experiencing them on the breakdown of the system of medical intrusions into the birthing experience. If we could just fix the system, she believes, Postpartum Mood & Anxiety Disorders (which are all PTSD related to intrusive medical occurrences during birth, by the way), would disappear and every single mother would be just fine.

Only it doesn’t work that way. We could have the most perfect birth in the world and still end up with some form of a Postpartum Mood & Anxiety Disorder. I’ve talked to mothers who have had this happen to them. Do the intrusions add to the potential? Sure. It’s a risk. Know what else is a risk? Being female and being pregnant. Researcher after researcher has proven that while yes, there are actions we can take to alleviate our risks or shorten our experiences, we are ALL at risk regardless of our stature in life or the manner in which we give birth. From those at the highest of society (Kim Kardashian, anyone?) to a woman in a third world country with the most meager access to care, we are ALL at risk. Different language may be used to express those experiences, but going “mad” after childbirth is something which has occurred since the time of Hippocrates and doesn’t show any signs of slowing down.

I’m not saying that we are all DOOMED to experience Postpartum Mood & Anxiety Disorders, absolutely not. I’m saying that our risk factors are similar. Additional stress adds to our risk weight but beyond that, pregnancy itself is a risk factor as it does things to our bodies, to our hormones, to ourselves, that we will never fully understand regardless of how much research we do. The best way, I think, to approach pregnancy, is to advocate for the best care for yourself, whatever that may be. If you need an epidural to give birth, then go for it. If you want to give birth naturally, go for it. But be aware that birth is a fluid and organic process over which we truly have no control. Things may happen for which we are either not prepared or not willing to have happen. However, if you’re open to the possibility that they *may* happen, the result may be less traumatic and therefore leave a shorter impression upon your psyche.

In reading through Lamaze’s Listening to Mothers III report, I’m hit with some thoughts about how well the birth community IS listening to mothers. So I decided to go hit some of the other websites to see where they stand on Postpartum Depression Mood & Anxiety Disorders. How well do they prepare Mothers for the possibility of these issues and/or how well do they welcome mothers who have birthed before and experienced these things and are now searching for a “better” way to birth in order to avoid similar issues?

The answers were not good.

ACOG, the American College of Obstetricians and Gynecologists, has a published Opinion Paper on Screening for Depression During and After Pregnancy. It was issued in 2010 and reaffirmed in 2012. This opinion includes a chart mentioning several different methods of screening, notes the amount of time it takes to go through each one, the sensitivity of the screening method, and if it’s available in Spanish. ACOG then concludes by saying the following:

“Depression is very common during pregnancy and the postpartum period. At this time there is insufficient evidence to support a firm recommendation for universal antepartum or postpartum screening. There are also insufficient data to recommend how often screening should be done. However, screening for depression has the potential to benefit a woman and her family and should be strongly considered. Women with a positive assessment require follow-up evaluation and treatment if indicated. Medical practices should have a referral process for identified cases. Women with current depression or a history of major depression warrant particularly close monitoring and evaluation.”

Not only do they recommend screening, they recommend development of a referral process AND note that women with current depression or a history thereof should be monitored. Kudos, ACOG.

DONA has several position papers available at their website. The one for the Postpartum Doula does not mention Postpartum Depression aside from the following sentence:

“We know that women who experience support from their family members, care providers, counselors and peer groups have greater breastfeeding success, greater self-confidence, less postpartum depression and a lower incidence of abuse than those who do not.”

DONA also offers up a Postpartum Plan worksheet for new mothers. Nowhere on this sheet does it at all mention what to do if a Postpartum Mood & Anxiety Disorder appears. To DONA’s credit, however, there are books included on their required reading list for their Postpartum Doula Certification by known Postpartum Mood & Anxiety Disorder experts. The books, however, are older, and the PDF for Postpartum Doulas has not been updated since 2009 while the list for the Birth Doulas was last updated in 2013.

CAPPA’s position paper for Postpartum Doulas makes mention of Postpartum Depression and focuses on the “fourth trimester” as one which must be traversed as carefully as the three trimesters of pregnancy. The Postpartum Doula, according to CAPPA, is not to provide medical care, but to have a network of caregivers (none of which are therapists, psychologists, or psychiatrists) which they can refer the family to if so needed.

According to CAPPA, the Postpartum Doula does the following:

“Postpartum doulas are knowledgeable professionals who assist families during the critical period immediately after the birth of their baby. They “mother the mother” and offer physical, emotional and informational support to the family as well as practical help.”

Makes sense, yes? After all, we do need to be mothered after giving birth. We know how difficult it is to make that adjustment to having the baby on the outside instead of on the inside.

The reading list for the Postpartum Doula at CAPPA has only three Postpartum Mood & Anxiety Disorders books listed, two less than DONA. The Childbirth Educator certification list has NO books regarding Postpartum Mood & Anxiety Disorders.

In discussion with various OB’s, I’m told they spend less than 2 weeks on Postpartum Mood & Anxiety Disorders as they train for their specialty. Two weeks to understand the complexities of Psychiatric issues post-birth.

Bringing things full circle, the Lamaze Listening to Mother’s III report has this to offer about Postpartum Mood & Anxiety Disorders:

LTM III Page 32

I don’t know what’s more disturbing here – that 31% of the mothers were self-reporting as feeling down or depressed or that 44% of these women with regular feelings of depression in the two weeks prior to the survey HAD NOT CONSULTED A PROFESSIONAL SINCE GIVING BIRTH.

Going back to my article about Henci’s comment at a previous post over at Science & Sensibility, you’ll note that she mentions “Furthermore, on-site mental health services would be of little use to women suffering from childbirth-related emotional trauma because one of the prime protective responses is avoidance of environments and personnel that re-trigger traumatic memories.”

I cannot help but wonder if the training, the discussions, the passing down of the believe that if only your birth is perfect and free of all possible interventions (as is impressed upon by the Lamaze Healthy Birth Practices found here), you’ll be just fine attitude held by so many within the birthing community is……

HINDERING MOTHERS FROM SEEKING HELP?!?!?

There are the standard reasons, of course, lack of insurance (due to Medicaid), cost, transportation, childcare, stigma/denial from family members, etc.

But what if… what if this stigma and denial is also coming at women from their caregivers? I know I had it from my OB. I know women who have been told horrific things when they’ve managed to call for help – things from “Well, are you suicidal yet?” to “Oh, just go shopping or take a walk and you’ll be fine…” or what I heard which was “Your hormones slid back into place at 4wks postpartum so this can’t be Postpartum Depression.”

I’m pleading with the caregiving community as a whole – with Obstetricians, with midwives, with pediatricians, with doulas, with anyone and everyone who may come in contact within a medical capacity with a pregnant or new mom to accept what she has to say as truth. To not try to reframe it for her, to not brush it off, to not dismiss her very valid fears and concerns. Listen. Truly listen. Don’t run through all your evidence based research in your head as she’s pouring out her heart to you – because if she’s doing that, it took her a very long hard look inside to be able to do that and if you say the wrong thing, you’re going to shut her down very quickly and do harm to her recovery process.

For those who DO listen, who do educate themselves and go beyond the certification recommendations, thank you. Thank you for bringing awareness to this struggle that so many of us fight.

With every birth, a new mother is born. It does not matter if she’s been born into the role before, she is reborn with each child. For each child and each aftermath presents a different set of challenges with which she must learn to live. Be gentle. Be kind. Be supportive. Listen. Don’t shame. Don’t stigmatize. The trust of a new mother is an amazing thing.

Stop abusing it, stop re-framing it, and above all else, wrap it in love and return it with your own level of compassionate honesty.

We, the women of the world, the mothers of all of you, deserve at least that much.

Senator Coburn: A walking oxymoron

Tom Coburn makes my head hurt!!!!!!!

Seriously. I was doing my homework on Senator Coburn last night and landed a headache miles longer than Route 66.

Senator Tom Coburn, R, OK, has been by far one of the staunchest opposers of the MOTHER’S Act.

BUT –

He’s an OB

He’s delivered 4,000 babies.

Statistics would lead you to believe he’s seen at LEAST a few cases of PPD, right?

According to Dr. Coburn, breastfeeding is automatic protection against postpartum mood disorders. (Ok Sen Coburn – so where was my protection when I was exclusively nursing my first daughter or exclusively pumping for my second? seriously – where was it? Was it hiding under some mysterious rock? Behind my back? Did I leave it at the hospital? Perhaps my first OB stole it from me – but wherever it was, I sure as heck didn’t have it!)

His primary argument for being against The Melanie Blocker Stokes Act? He doesn’t support disease specific legislation. Yeah, um, ok.

Let’s delve into some legislation Senator Coburn has authored, shall we? (By the way, everything below was pulled directly off his Senate website)

Guaranteeing Patient’s Rights (author)

A law to guarantee patients’ rights for those enrolled in Medicare and Medicaid, including timely access to primary and specialty health care providers, a timely grievance process with appeals, an explanation of the enrollee’s rights and plan information, and prohibitions on restrictions on communications between patients and doctors and financial incentives to encourage health care providers to deny medically necessary care. Provision contained within Public Law 105-33, signed 8/5/1997.

YET Dr. Coburn does NOT accept Medicaid/Medicare patients at HIS OWN PRACTICE! (OK Medical Board website)

Streamlining the Approval of Disease Diagnostics (author)

A law to improve the review and approval process of radiopharmaceuticals (articles used in the diagnosis or monitoring of a disease). Provision contained within Public Law 105-115, signed 11/21/1997.

(Is it just me or is the word DISEASE not only in the title but the description too?)

Protecting Babies from AIDS (author)

A law to require all pregnant women to be counseled about and offered testing for HIV to prevent the transmission of the virus to unborn and newborn babies.  Provision contained with Public Law 104-146, signed 5/20/1996.

(Hmmm. AIDS is a disease. Pretty specific one too. AND this one requires counseling and an offer of a test)

Treating and Preventing HIV/AIDS (author)

A law to provide access to AIDS treatment for underinsured Americans living with HIV, including counseling for those with HIV emphasizing it is the continuing duty of those infected not to infect others with the disease.  Public Law 106-345, signed on 10/20/2000.

(Wow. Treating AND Preventing HIV, huh? Feeling a little warm over here…)

Providing Access to Affordable Prescription Drugs (author)

A law to allow Americans to import prescription drugs approved by the Food and Drug Administration. Provision contained with Public Law 106-387, signed 10/28/2000.

(So he’s ok with importing drugs that yes, may be approved by the FDA but only God knows from where some of them are sourced. Yet he wants to deny new moms access to care and aid for Postpartum Depression?????)

Preventing Cervical Cancer(author)

A law to educate the public about human papillomavirus (HPV), a leading cause of cervical cancer, including how to prevent HPV infection. The law also requires condoms to be relabeled with a warning that condom use does not protect against HPV infection. Provision contained within Public Law 106-554, signed 12/21/2000.

(Wow. A law to educate the public about a DISEASE. Again – common ground?)

Source: http://coburn.senate.gov/public/index.cfm?FuseAction=AboutSenatorCoburn.Accomplishments on April 21, 2009 @ 1132pm.

Seriously though.

Postpartum Mood Disorders should not be a ping pong ball across the aisles of the Senate. Just as it is not black and white out here in the real world as to who will get it, it’s not JUST a Democratic Issue. It’s not JUST a Republican Issue. It’s an every party issue. It’s a 20% of ALL new moms issue. It’s a 50% higher risk of repeat for survivors the second time around. It’s a 95% risk of repeat for survivors the third time around! It’s a 2.3x higher risk for Moms who have husbands/partners deployed issue. It’s a 3x higher risk for first time Moms over the age of 35 developing Postpartum Psychosis issue. It’s a HUGE issue, ok?

I want to know at what point in the feminist movement Moms got screwed over. When did we become ok with chilling on the back burner? Where is Susan B Anthony when we need her? Anyone out there in need of a kick in your activism spirit? Watch Iron Jawed Angels. It’s about suffrage. And man did those chicks go through it. I HOPE it doesn’t come to that but I am passionately determined to get this bill passed. Thing is, I can’t do it by myself.

Senator Menendez can’t do it by himself. Neither can Congressman Bobby Rush. Or Carole Blocker. Or Susan Stone. We need YOUR help, YOUR voices. Your stories of survival, strength, and experiences with a system that is failing new families each and every day. We HAVE to raise awareness.

Don’t wait any longer to pick up that phone and call the H.E.L.P. Committee. Go to your email and send a message RIGHT now to Susan Dowd Stone (susanstonelcsw@aol.com). Include your name, state, and any professional credentials or organizational affilitations. Let others know you support the MOTHER’S Act.

SPEAK UP!

Sharing the Journey with Mary Jo Codey

As those of you who are familiar with Postpartum Advocacy know, Mary Jo has worked tirelessly to increase awareness and education of those around her. In fact, along with her husband, former NJ Governor Ritchie Codey, Mary Jo aided in passing New Jersey’s state-wide legislation for Postpartum Mood Disorder Screening education and screening. She also strongly advocates for the passage of The MOTHER’S Act, a bill that will increase funding for research, education, and awareness of Postpartum Mood Disorders here in the United States. Mary Jo has graciously agreed to Share her Journey today with the hopes of increasing signatures to the Perinatal Pro list as well as calls to the Senate H.E.L.P. Committee.

I sincerely hope her words will help spur you into action. Let me put it this way. If you know ten mothers, at least eight of them have experienced the Baby Blues. Two of them have experienced full-blown Postpartum Depression. And these are only the ones we know about. How many other mothers have suffered in silence? Help them break the silence. Let them know you are on their side. As New Jersey’s campaign says – “Speak Up when you’re Down!”


88_mary_joTell us a little bit about yourself. Who is Mary Jo Codey when she’s not passionately speaking out about Postpartum Mood Disorders?

I’m a teacher at the Gregory Elementary School in West Orange NJ. I love spending time with the children, watching them grow and flourish, and to instill a good self concept about themselves so they can take with them and utilize throughout their lives. When I’m not teaching I love to spend time with my husband Ritchie and my two boy’s, Kevin and Christopher. I also enjoy gardening, playing golf and eating chocolate with my dear friend Sylvia!

In 1984, after the birth of your first son, you began to experience some very frightening thoughts and moods. Would you share with us what you went through?

After the birth of my first child, Kevin, I had terrifying thoughts about hurting him. I had intrusive thoughts about smothering and drowning him. Those scary thoughts raced in my mind over and over throughout the day and night. It caused me such a great deal of pain and shame.

After the birth of your second son, with the aid of medication, you were able to have a “normal” experience. Describe the differences. At any point during this second postpartum period, did you find yourself upset about having missed out on your first son’s infancy?

With the birth of my first son Kevin, I had no idea what postpartum depression was. I never even heard those words before. I couldn’t even get out of my bed to visit the nursery to see or feed him.

With the birth of my second son Christopher, I was immediately put on medication which were extremely effective. I was elated that I could care for him and take care of him. I did however feel cheated by postpartum depression with my first child. At times I mourned and felt guilt for missing the first years with Kevin. I remember reporters coming to my home to do a story on me and I was asked if I had any pictures of Kevin. I was ashamed that I could not provide them with one picture of him.

When you first talked with your sons about Postpartum Mood Disorders, what did you tell them? How have they handled knowing about your experience?

I started to talk to my boys about my experience with postpartum depression at a very young age. I made sure that they understood that, it wasn’t their fault and that I loved them more than they could ever imagine. I explained to them that I was sick at the time. I also told them that they were the two greatest gifts that God had given me. They’ve handled it remarkably well.
New Jersey is the first state to enact legislation for Postpartum Mood Disorder screening and education. How did this law come about and what was your involvement in it’s development?

The minute Ritchie became Acting Governor for New Jersey the first item on our agenda was postpartum depression. Which led to “Speak Up When You’re Down.” It encourages women and their families to talk openly with each other and with their health-care provider if they are feeling depressed after the birth of their child. It also provides a 24/7 PPD Help line and postpartum depression information and resources; 1-888-404-7763.

Name three things that made you laugh today.

Watching my friend Phyllis come out of her home with 5 dog’s on leashes and luggage as we were leaving for the airport!

Trying to get on a large tube for “The Rapid River Ride.” After numerous failed attempts trying to get myself positioned on the tube, a stranger approached me and shoved me on the tube finally! He said that he couldn’t stand watching me struggle anymore…well it finally worked!

Calling my friend Sylvia and listening her imitate her Sicilian mother on the phone. Every time she imitates her mom it literally slays me!! It leaves me in stitches!

Senator Robert Menendez, NJ, introduced The MOTHER’S Act earlier this year to Congress. Share with us what this bill would do for women and families.

This bill is so very crucial for all women and families suffering with postpartum depression. It will help provide support services to women suffering from postpartum depression and psychosis and will also help educate mothers and their families about these conditions. In addition, it will support research into the causes, diagnoses and treatments for postpartum depression and psychosis.

Stigma plays a large role in women not reporting symptoms of Postpartum Mood Disorders. What can we do to overcome this stigma and replace it with acceptance and compassion?

Having women share their experience with postpartum depression, rather than keeping it to themselves is very important. To not be ashamed or afraid to speak up to their family members, health providers and women’s groups when they are grappling with postpartum depression. This will help replace the stigma of postpartum depression with acceptance and compassion.

How did your husband handle the changes your struggle with Postpartum Mood Disorder brought into the home? What can new dads do to support their wives as they fight to move back to “normal”?

At first my husband Ritchie blamed himself for what I was going through. He thought it was because he didn’t pay much attention to me because he was too involved with sports. He couldn’t understand what and why I was going through this. He was angry that I asked him to find another wife when I went to the hospital because I believed that I wasn’t going to get better. He never gave up on me! He stayed with me and understood that postpartum was an illness that we were going to overcome as a family. He never stopped praying. New dads need to be supportive and understanding towards their wife who is suffering with postpartum depression. Most importantly, they need to be patient and compassionate.

Last but not least, if you had the opportunity to give an expectant mother (new or experienced) just one piece of advice about Postpartum Mood Disorders, what would you tell her?

Women suffering with postpartum depression need to know that they are GREAT MOTHER’S! Do not worry about not being able to bond with your baby, it will happen. First you need to get well. Most importantly please, please, please don’t be afraid to reach out for help.

MOTHER’S Act Blog Week Participation List

Welcome to Blog Week for the MOTHER’S Act

Above you’ll see a tab for the MOTHER’S Act Blog Week. Clicking on it will take you to more information (including a snazzy graphic) for this week’s action.

We want you to email Susan Stone @ Perinatal Pro to be added to the growing list of supporters for The Melanie Blocker Stokes MOTHER’S Act. This important legislation will aid with funding for increased legislation, education, awareness, and treatment services for mothers who struggle with insidious Perinatal Mood Disorders silently every day.

We also want you to call the Senate HELP Committee. Raise your voice and let them know you care and new Mothers DESERVE this legislation. They NEED it. The MOTHER’S Act will save lives!

Our movement here is applauded today by Sen. Robert Menendez, the primary sponsor of the Melanie Blocker Stokes MOTHER’S Act.

“Postpartum depression is a condition that is not only more widespread than most realize but also more debilitating than most realize,” said Menendez. “We need to make sure these mothers are fully supported and informed, rather than scared and alone. Working together with a nationwide community of mothers, we are so close to enacting this important legislation into law. What we need is an intense dose of public pressure. This Blog Day helps reinforce the type of grassroots movement that will create the pressure that is needed, and I commend the participants. I invite mothers, fathers and anyone else who believes we need to better support those with postpartum depression to contact their Senators and urge them to vocally support S.324”

Please leave a comment on this post with your blog post URL in which you encourage others to:

Email Susan Stone (susanstonelcsw@aol.com)

Provide a Link to Read the Bill

Include a link to Mary Jo Codey’s Interview

State whether or not you’ve called the H.E.L.P. Committee.

You can find links and more participation guidelines by clicking here.

Thank you for your participation. Don’t forget to pass it on!

Blog Week for Melanie Blocker Stokes MOTHER’S Act starts at midnight!

candle-wicks1Are you excited?

I am!

Starting tonight at midnight, you’ll be able to get the low-down on all the details of this week’s blog campaign to show support for the Melanie Blocker Stokes MOTHER’S Act.

(By the way, there’s an interview with Mary Jo Codey on the way too!)

There will be blogging, twittering, facebooking, myspacing, DIGGing, and whatever other form of social media you’re into.

There will be calling.

There will be sharing, paying it forward, and strength in numbers as those of us dedicated to supporting new moms in the perinatal period raise our voices in support of this important legislation.

Even if you don’t do blogging or social media, call the H.E.L.P. Committee members to let them know you support this legislation. There will be a call script provided at midnight as well. And if you’re in the mood, there will also be a suggested letter to the editor for you to send into your local papers.

Let’s make this one for the record books, folks!