Category Archives: life

Just Talkin’ Tuesday 03.30.10: Symbols of Recovery

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“Cool ring,” she said, catching me completely off-guard.

I managed to mumble a thank you once I realized it wasn’t my plain gold band about which she was talking.

On my left hand, I wear a silver butterfly ring. It’s a symbol of how far I have come. I know in my heart I’m recovered. But it’s nice to have a symbol.

I also have an African Violet plant in my kitchen given to me by my brother and sister in law on the Mother’s Day shortly before my hospitalization. Back then I did not really want to take care of it, much like I did not want to take care of myself, my family, anything. But now? Now we are all thriving and it is too. I recently replanted it, actually. The thing is monstrous!

Much like holidays have their own symbolism, each one of us may have a symbol we have come to associate with recovery or our journey toward wellness.

What’s yours? What are you holding on to when nothing else seems to help? Is there a story behind it? Share it with us.

Postpartum Depression formal screening not worth the cost, BMJ study says

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According to a recently published study in the British Medical Journal (BMJ), Postpartum Depression Screening is not…. brace yourselves. Worth the cost.

That’s right.

NOT.WORTH.THE.COST.

In their cost effective analysis, the researchers used “A hypothetical population of women assessed for postnatal depression either via routine care only or supplemented by use of formal identification methods six weeks postnatally, as recommended in recent guidelines.”

The conclusion was that overall not using a formal screening method was much more cost effective as it eliminated false positives.

So the mental health of a woman which will then affect her child, her family, her community, the world at large, are just not worth it to the National Health System of the UK. The EPDS scored out at about $67,000 per quality adjusted life years while no screening method scored at a price tag of just $20 – $30,000. No value for the money was found to exist when using the formal identification methods.

Did these researchers not read Murray & Cooper’s Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression which explores the effects of postpartum depression treatments on children?

There is SO much more at stake here than the dollar value to the National Health System.

There’s the potential for broken families. The potential for children growing into their own mental health issues, the potential for continued need for mental health treatment due to an undiagnosed episode of postpartum depression, potential for increased incarcerations due to untreated mental illness, continued sadness, the continued stigma, continued and perpetuated lack of education on the part of physicians in regards to Postpartum Mood Disorders.

The most interesting aspect of this study is that it focused on screening for Postpartum Depression in the Primary Care setting. Primary care physicians are not always comfortable or knowledgeable in screening for mental health issues. If a patient were to screen positive, that physician is then morally responsible for referring them to a specialist. Often times, at least here in the states, a Primary Care physician is unaware of where to refer a patient for help with a Postpartum Depression Disorder. Therefore, they become afraid of screening because they fear what will happen if a positive were to occur. What would they do with the patient? Where would they send them? How would they respond? Are they familiar enough with Postpartum Mood Disorders to recognize a false positive?

I think the key to the results of this study is not so much in blaming the high percentage of false positives but in urging that Primary Care physicians receive more training to enable them to recognize a false positive through more in depth questions after a positive is scored via the Edinburgh Postnatal Depression Scale.

original photo/graphic "Hand holding necklace" by K.Sawyer @flickr

A stronger safety net involving a stronger communication between midwives, Obstetricians, Pediatricians, and General Practitioners is so desperately needed to keep women from falling through the very big cracks which currently exist in the system.

Let’s think about this for a moment, shall we?

A woman gets pregnant. She sees a medical physician to get the pregnancy confirmed. Most mothers seek OB or midwife care for their entire pregnancy. Unless they’re depressed – depressed and mentally ill mothers are less likely to take good care of themselves during a pregnancy, making specialized care even more important even when baby is still in utero. Once mothers give birth, they are then shuttled off to the pediatrician’s office for the bulk of their medical contact. One six week or eight week visit to the midwife or OB to ensure mom is healing properly then an annual PAP visit unless something arises in between. Many Pediatricians focus on babies and not mother. But the tide is changing as more and more Pediatricians are taking into account the family lifestyle and well-being. My own Pediatrician does this and I absolutely adore her for it.

But overall, there is typically no continuity of care, no communication between physicians throughout the birth process. There should be. There needs to be. A woman deserves a team of support. She deserves to thrive. So do her children.

No matter what the cost.

Because once you fail woman and her children, you fail society.

Fail society and we fail to exist.

If we fail to exist….

Just Talkin’ Tuesday 03.23.10: How did you find your therapist?

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Original photo: "Everyday Use Items: a couch" by @foka_kytutr @ flickr.com

Congratulations!

You have broken through the fear to make the call for help.

But now what?

Unless you have a therapist tucked away with the burp cloths or shoved in a random diaper bag pocket, chances are you’ll be scrambling to find one after diagnosis with Postpartum Mood Disorder.

There are a lot of questions to be considered when searching for a therapist. Some are financial, some regarding training, and others regarding how experienced the therapist is with your specific diagnosis.

Just as you wouldn’t see an Oncologist for a Pulmonary Embolism, you wouldn’t visit a Substance abuse therapist for a Postpartum Mood Disorder.

But when you are in the throes of Postpartum Mood Disorder, you don’t necessarily have the wherewithal to be going down a checklist of requirements for a Therapist. (That is, unless you get lucky like me and develop Postpartum OCD. Then lists and keeping certain things in a very particular order becomes very very important to you.)

So how can you tell your therapist is going to be a good match or is trained in dealing with Postpartum Mood Disorders?

The first thing you need to know is what degrees to look for when ensuring the therapist you are considering is professionally and properly trained. A therapist will primarily hold a Masters level degree and be either a Licensed Social Worker or Counselor/Therapist depending on your state’s licensing office. A solid counselor should not hesitate to provide evidence of his/her training and current license status if requested. You may also see a Psychologist, who will hold either a Ph.D (research) or a Psy.D (Professional) for therapy.

The second thing to consider is specialized training in Postpartum Mood Disorders. If the therapist is truly focused/familiar with Postpartum Mood Disorder patients, he or she will be aware of Postpartum Support International, Karen Kleiman’s Clinician Training at the Postpartum Stress Center, or Pec Indman’s two day training via Postpartum Support International. If your therapist claims to be intimately involved with treating Postpartum Mood Disorder clients yet has no earthly idea who these people or organizations are, be wary. Ask what specialized training they have completed in the area of Postpartum Mood Disorders (if any) and how long they’ve been treating patients with similar diagnoses to yours.

Third, while your therapist is not meant to be your best friend, you should feel somewhat at ease during the appointment. If you feel uncomfortable or on edge during therapy, you’ll be less likely to disclose as much and therefore hinder your own journey toward wellness. It’s worth the search to find a therapist with philosophies similar to yours.

Do not be afraid to ask what their policy is on admitting to Intrusive thoughts. Many many women worry that if they admit they have thoughts of doing horrible things to their children, the children will be taken away from them. I faced this very same issue and asked my therapist this question before I admitted some pretty dark thoughts to her. Her response was that yes, she was required to report situations which indicated imminent harm to oneself or others but that she understood intrusive thoughts and their involvement in my particular diagnosis. This particular concern goes back to finding out what experience the therapist you are considering has with Postpartum Mood Disorders.

Dr. John Grohol over at PsychCentral has some good advice on how to tell a good therapist from a bad one. I would highly recommend you read it and keep these tips in mind.

Another great link to keep tucked away is “Tips for talking with your doctor” by Karen Kleiman over at the Postpartum Stress Center. She suggests starting with the doctor you feel most at ease with even if it’s your primary care physician. He or she can always refer you to specialists once a consensus is made that further help is indeed needed.

I now hand this post over to you, the reader.

What did you do to find your Postpartum Therapist? Any tips? Suggestions? What to look for? What to avoid?

Let’s get to just talking here!

(Tomorrow we’ll be discussing different types of therapy available for the Postpartum Woman. Stay tuned!)


The Power of the anniversary

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"A Floating Red Balloon" by jcarlosn @ flickr.com

Put the past behind you.

Move forward.

Be happy about how far you have come since (fill in the blank).

These are all common phrases people love to shoot off when they know someone is struggling to deal with something which happened in the past. While they are certainly lovely sentiments, the one thing people who give voice to these phrases do not know is that memory is very organic. Sure you can do your best to decide to deal with a tragic event in a positive way but then there are the memories which sneak up on us and scare us to death. The anniversary of the birth of my daughters and the anniversary of my time in a mental ward for Postpartum OCD are a few memories which did just that to me.

I am not alone in this experience.

Many women struggle when reaching their child’s first birthday, their hospitalization date, miscarriage date, or the date on which they lost a child. These are all events that leave more than a glancing blow. The fight to return to the “new normal” is an uphill battle. And once the “new normal” arrives and you’ve unpacked the last box, there’s a looming date trouncing your way ever so cheerfully. Sure you can bob and weave but even the best of us may find ourselves down for the count after a few sucker punches.

A fellow PPD warrior mom, Helen Crawford, shared with me that her 1yr anniversary was very traumatic. She could smell/hear the memories of the year before. “My fingers burned. I talked with my therapist. Surviving severe depression is like surviving extreme trauma. I took the finger burning as a reminder to ‘love myself more’ and say thank you to my body.”

Today my three year old daughter found pictures of herself as an infant. Awwwwww, you say. But these particular pictures included a feeding tube taped ever so gingerly to her less than 24 hour old cheek with cute teddy bear gauze tape. Classic symptoms consumed me – heart in throat, check, rapid shallow breathing, check, rapid pulse, check, dizzy, check. Oh.CRAP. She’s been flashing them here and there for the past week and I’ve been ever so nicely sidestepping the issue. But today, today she wanted to know WHAT that was on her cheek and why it was there. Oh boy. And I thought the hard question with kids was supposed to be “Mommy? Where do Babies come from?” (And for the record, I GOT that one today too from her 5 year old sister – what a day!)

Suddenly, there I was again. Curled up in the hospital bed, crying my heart out, aching, hurting, wanting to go back in time to BEFORE the birth, for someone to warn us about the rabbit hole into which we were about to trip. What.the.hell???

She knows about her cleft palate and knows doctors fixed it. She also knows which belly button came from mommy and which one belongs to the doctors. But we have never discussed the tubes. NEVER. As playfully as I could, I explained to her that because her mouth had a hole in it when she was born, she had to eat with a tube which went in through her mouth and went allllll the way down to her stomach. (I can still hear her laughing because I tickled her as I told her this.) Inside, I was dying. I smelled the NICU. I heard the sounds, the crying, saw the tense faces, the reserved mouths as they asked about worst case scenarios. I thought I was going to pass out when she said she wanted these pictures – the tube pictures – up on her bedroom wall. I softly replied that Mommy would have to think about it.

I thought about it all day. ALL day. Once she got home from her 2 hours of special needs pre-k for her speech, we talked. Honestly and age-appropriately. I told her that when she was born while I was very happy to meet her and get to know her, all of the medical stuff surrounding her birth like the tube feedings and surgeries were very difficult for Mommy to handle. And that it was very hard for Mommy to look at pictures of her with tubes and such attached to her. I promised her we would find some different baby pictures to put up on her wall. I also told her that it was ok she had to use a tube – and I was glad the nurses and doctors knew just what to do to help her grow strong so she could become the amazing silly little girl she is today. She was sad but seemed to take it in stride.

To top things off, 12 years ago today, my maternal grandfather passed away suddenly after experiencing congestive heart failure. Yay for anniversaries, right? (And in 19 days, I’ll be marking the anniversary of my paternal grandfather’s death which left me grandparentless. I was a real ball of joy 12 years ago, I tell you what!)

Grief is a tough thing to handle. 12 years ago I dealt with it in a very physical and raw manner. I remember crying, screaming, and punching my then boyfriend until I would literally black out. Healthy, right?

The thing is to give yourself PERMISSION to mourn/remember/accept whatever it is that your anniversary centers around. Celebrate how far you’ve come since said event. Honor the event but also do something to help propel yourself forward. One of the last things my maternal step grandmother said to me (in what I now know was her I know I’m dying soon so I better get this out while I can speech) was to always be the best that I could be no matter what stood in my way. Those words have stuck by me. And even in failure, I’ve always strived to do every single thing that I possibly could before giving up. It’s part of what got me through my PPD. I knew I was better than PPD. I KNEW I had to turn and fight. And every time I have an opportunity to help another mom through her struggles, I am celebrating my anniversary. I am celebrating no longer being alone. I am paying forward the help I received. I am choosing to walk the line between remembering the past yet striving for the future. I AM HERE to do that. And for that, I am grateful.

Remember to celebrate YOU on your child’s birthday too. It’s not just your child’s birthday – it’s YOUR own personal Mother’s Day. Don’t rush around for the kid without stopping to breathe for yourself too. Sure, Hallmark doesn’t make a card for this but that makes it all the more special, right? You’ve earned it. You’re worth it. And doggonnit, we like you. In addition, the more positives you make out of a negative, the less power it holds over you. Darkness cannot win when bathed in light. Choose to regain those reins as you approach your anniversary – whether it’s childbirth, miscarriage, hospitalization, recovery – it’s ok to cry. But it’s totally awesome to party too.

Just Talkin’ Tuesday 09.15.09: What lessons did you learn?

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just talkin tuesday chalkboardWhen I was struggling in the trenches I learned some very hard lessons. I’d like to share five of them with you.

Lesson #1: Taking care of myself was not selfish; it was necessary

If I missed out on sleep, skimped on my diet, forgot my supplements or didn’t allow for “me” time, I wasn’t the only one to pay the price. The WHOLE family paid the price. And that’s just not fair. The better care you take of YOURSELF, the better care you are able to take of those around you and the better care they take of themselves thereby enabling those around them to improve as well – you see how this goes and goes on?

Lesson #2: You can’t take people’s reactions to your life personally. They’ve got their own baggage too. Don’t claim theirs – worry about yours to the best of your ability.

THIS one was hard. I still struggle with it on a daily basis. Oh, I’ve drastically improved but I still have to sit on my hands from time to time. It’s that or sew my mouth shut. Sitting on my hands keeps me from typing something I’ll regret AND from getting my sewing kit.

Lesson #3: God has a plan for me and I am grateful for all the hardwork He is pouring into me.

James 1:2-4 sums it up best: “My brethren, count it all joy when you fall into various trials, knowing that the testing of your faith produces patience. But let patience have it’s perfect work that you may be perfect and lacking in nothing.

Lesson #4: Helping others is a powerful source of healing yourself.

I cannot even begin to express how much of my own healing has come from giving to others as they face the same beast I have beaten. It is a harrowing path indeed and I have leaned on those I have helped as they have leaned on me. What is humanity if we cannot help each other through our struggles?

Lesson #5: Riches cannot be counted in monetary value. Riches come in baby food stains, innocent laughter of an infant, the purposeful cuddle of a toddler and the smile of triumph as you kick back your feet richer at the end of the day than at the beginning with even more riches on the way.

(In other words, don’t lose sight of the truly important thing in life – FAMILY)

There are five lessons I’ve learned on the journey so far.

What lessons have you learned?

Let’s get to Just Talkin’, ladies (and gents)!