Category Archives: woman

@karma_D finds her Postpartum Voice

@karma_D, Lisa, found me via the #PPDChat at Twitter. At this week’s Just Talkin’ Tuesday, she expressed a desire to share her story but said she wasn’t ready to do so on her own blog yet. Lisa wanted somewhere to share her story anonymously in order to help other moms. I offered her a place here at My Postpartum Voice. This is truly what I want this site to be about – the power of sharing our stories to help one another find our own Voice as we journey through recovery.

Lisa’s story is powerful. Her NICU start reminds me of my own postpartum after the birth of my second daughter. It’s a rough start for sure and I hope Lisa finds the same strength as I have as she journeys towards recovery. Please don’t hesitate to send @karma_D some love. And if you’re a mom in need, you can follow me by clicking here. You can also visit Postpartum Support International to find a Coordinator near you. You are not alone, you are not to blame, and you will be well.

I have post partum depression. That might be a shock to friends and family, but no one was more unprepared for it than I was. My pregnancy was incredible. I felt amazing, better than I have in years, both physically and emotionally. I felt strong, hopeful, like a dream a lifetime in the making was finally coming true. Those months were full of planning, anticipation, expectation, all culminating in the beautiful instant my son was born. It was the best moment of my life, euphoric almost in the sudden absence of pain and joy of meeting him.

Within hours of his birth, he was taken to the NICU for breathing difficulty, and so began the downward spiral, full of broken expectations. Instead of bonding with a newborn in the hospital room surrounded by adoring guests, we shuffled back and forth to the NICU to stand around a helpless baby attached tubes and wires.

The night we came home from the hospital without our son was horrible. Pulling into our neighborhood late that night I vividly remember looking out the car window and feeling like I was witnessing life from another person’s body. Reality seemed unrecognizable. We arrived home to flowers and hospital bags dropped off earlier by our parents, mountains of gifts and food cluttering the house. In that moment I couldn’t see this wonderful outpouring for the blessing it was, but instead as anxiety inducing clutter. Exhausted, my husband went to bed but I stayed up and cried. I felt alone, scared, not myself. It was not at all the homecoming I had anticipated.

When we finally did bring our son home a week after his birth, things didn’t get better. Breastfeeding difficulties often left one or both of us in tears. It was not at all the bonding experience I had hoped for. I pushed through because I wanted so desperately to do the right thing, to act like a good mother even if I didn’t feel like one. I was tearful and scared because I didn’t feel like myself, and when I did manage to communicate this to my husband all I could muster was, “It’s so hard.” He did his best to reassure me and I tried to reassure myself it was just “baby blues” and sleep deprivation. I minimized my symptoms to the OB and Pediatrician, who screened me for PPD but didn’t pick it up early on. I tried to will it away and hoped things would get better, and kept acting like everything was fine.

Months went by and it never did get better, and the mood swings actually got worse. One moment I was okay, the next agitated or enraged, then crying and despondent. I yelled a lot, mostly at the dogs or my husband. One afternoon when my son was crying I yelled at him to “SHUT UP! JUST SHUT UP!” The guilt of yelling at him was awful. I believed it was going to be burned in his psyche forever and he’d always think I was crazy. Still not wanting to think the mood swings could be PPD, I blamed it on my IUD. Eventually I did tell my OB about my symptoms (though admittedly I glossed over them again), and she said she “wasn’t getting a good read on (me).” She agreed it could be the IUD but convinced me to give it some more time, and encouraged exercise and DHA supplements. Finally I demanded the IUD removed as I wasn’t getting better, but even then no one diagnosed me with PPD.

I spent 6 months of maternity leave waiting for things to look up. I kept hoping to turn the corner but never did. Instead, the mood swings continued, and intrusive thoughts began. I pictured horrible things happening to me and my baby and felt helpless to prevent them. I often lacked motivation – even the simplest tasks seemed too much to manage. Once I went an entire week without leaving the house because it was just so overwhelming. My mood wasn’t always down. There were lots of times I felt fine, happy even, and capable, but they never lasted long. These moments of calm made me think I was okay. I never wanted to harm myself nor my baby, I got up and dressed every day, and I didn’t really feel like what I believed depression to be, so I never admitted what was happening in my head and never asked for help.

Returning to work was a blessing and a curse. It gave me a much needed break but the guilt was crushing. The mood swings got progressively worse until one night (Valentine’s Day), I got so worked up over my son’s difficulty going to sleep that I exploded. After slamming the door to his nursery I went and hid under the covers, my body buzzing and feeling like I might explode out of my skin. My thoughts raced and I just wanted to go away. I didn’t want to die but I didn’t want to exist either, at least not then. Later that night I had another fit when the baby woke up. My husband asked, “What is wrong with you?” in a tone I’ve never heard from him, one that suggested disgust. That was my rock bottom. I couldn’t hide it anymore. The next day I finally told my husband I thought I had PPD and made an appointment. I saw a different doctor and started treatment.

The improvement has been rapid. I feel hopeful again, motivated, more clear headed. I can reason rather than shutting down. The anger is better, the crying is better. The anxiety still creeps in and I do have setbacks. On those days I just try to survive until tomorrow. I’m learning to recognize triggers and figuring out coping mechanisms – Blair’s STOP has been helpful, as has reading and chatting with other moms who’ve experienced PPD. (At the same time, I feel the need to control what I’m exposed to so I’m careful about following blogs and such and limiting potentially upsetting material.) I’m trying to let go of expectations and enjoy the moment more. My bond with my son is growing and I am starting to appreciate those wonderful Mommy emotions I had hoped to experience immediately. I wear a locket every day and inscribed on the back is “Before I understood your words, I understood your love.” I have an amazing son and I know he understands the bond, too.

I think a lot about what it will be like next time – the “do over” as I call it. In the darkest moments of PPD I swore we would be “one and done” – I couldn’t fathom ever going through this again. Now, I am hopeful. Things will be different. Per my doctor, I’ll likely start meds immediately. I’ll make a strategy for how I’m going to get support, something like a birth plan but for postpartum, and share it with my “team.” I am almost certain I won’t breastfeed. The stress of nursing was a huge trigger, even after all the initial issues as I worried about pumping and supply. I’ll also know I’m not alone. I wish I had believed that months ago.

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 forpostnatal depression either via routine care only or supplementedby 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….

Enriching postpartum therapy through at-home activities

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In addition to the different types of therapy we discussed yesterday, there are some at home activities you can do (provided your therapist has approved them) to enrich your professional care and journey toward wellness.

First, start a gratitude journal. But I don’t journal. I hate writing! Don’t worry – this isn’t having to write an entire page every day. It’s a simple two entries a day. In the morning, when you first wake up, grab your pen and journal. Write down three things for which you are grateful, no matter how small that thing may be. As your day progresses, focus on what has made you laugh or smile. Once you have retired to bed each night (even if it’s for two hours), write down at least three things which made you smile or laugh during the day. At the beginning, even just barely cracking a smile counts. This activity is two-fold. First, it forces your brain to refocus on the positive things in your life. Second, it provides physical evidence of the positive influences in your life you can look through on the particularly tough days.

Second, write down all five senses on a sheet of paper. Taste, touch, smell, sounds, and sight. Write down five of your favorite things for each sense. Chocolate, silk, a favorite perfume, a cd or song that makes you smile, favorite color or flower or art. Post the list on the fridge. Treat yourself to at least one thing from EACH SENSE every week. Rotate them out. Putting the list on the fridge helps family members and friends to know what to help keep around the house as well. (Sneaky, I know)

Third, take time for yourself. Schedule it if you have to. One thing I love to do is to dress up my lunch. It’s my quiet time of day and I have been known to make a frozen pizza and a coke look like it belongs on a table prepped by Gordon Ramsey. Lean Cuisine never looked so haute. I’ll also treat myself to the routine of making tea. The key is finding one thing you love and making sure you do it at least once a day. Without interruption.

Some other moms will put positive post-its throughout the house and even in the car to help give them a boost when they need it most.

A successful recovery relies heavily on your active participation. If you’re not participating, you’re not getting better. YOU are the most important quotient in the equation when it comes to journeying toward mental health wellness!

How did you actively participate in your recovery? Have any tips for currently struggling moms? We’d love to hear them!

Be sure to stop back tomorrow for the triumphant return of the Friday Soother, my weekly gift to you!

Therapy Choices for the Postpartum Woman

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Once diagnosed with a Postpartum Mood Disorder, you are then faced with a literal bevy of choices regarding your path to wellness.

Some doctors may toss pills at you. If that happens, run. Run very fast and very far away from any physician who shoves anti-depressants your way before you’ve even finished describing what’s wrong. A good prescribing doctor will sit down with you and hear you out before grabbing for his pen and pad (or these days, keyboard and internet connection). A good physician should also run a couple of simple blood tests first to rule out thyroid disorders or anemia which need completely different types of medication to show improvement.

Some doctors may suggest psychotherapy. And that is where things start to get a little sticky. What kind of talk therapy? Will there be a couch? Will it be comfy? Will I have to talk about how my Great Aunt Edna used to kiss me on the cheeks and leave funny lipstick stains? Will I have to talk about things not related at all to my current state of mind? Will I be hypnotized? Or any other strange mumbo jumbo I’ve seen happen on TV or in the movies or from my best friend who found this website and…

Hold the phone there.

Cognitive Behavioral Therapy proved to be the best option out there for me. There was a couch but I didn’t lay down on it. I sat cross-legged on it as I drank coffee and chatted with my therapist. She sat in a really cool rocking chair with a foot stool. I got along fabulously with my therapist. That’s not to say we were bestest of buds but she knew what she was doing, just let me talk and work a lot of my issues out. I did occasionally talk about things in my past but it wasn’t at all like “So, you were born… let’s start there.” She met me where I was and let things fall where they fell. Or at least she seemed to. She did ask questions to get me to think about issues and how I was reacting to them. I had not planned on staying in therapy for long but once I became pregnant again, I made the decision to stay in through my pregnancy. Therapy gradually stopped at about 6 months postpartum of that pregnancy as we scaled our sessions back.

While I will not be covering every single last type of therapy out there, my goal is to provide some basic information for the most common therapies used with Postpartum women.

At the top of the list is Cognitive Behavioral Therapy which is actually a blanket term for several types of therapies with similar traits. Primarily Cognitive Behavior Therapy (CBT) promotes that WE have power over our moods through our thoughts. You can read more about it by clicking here. A great resource now available for women and clinicians alike when it comes to treating Postpartum Depression is Karen Kleiman’s Therapy and the Postpartum Woman. You can read more about it by clicking here. (In the interest of full disclosure now required by the FTC, I have not been compensated at all for including this link. I sincerely believe it’s a good resource.)

EMDR or Eye movement desensitization and reprocessing is gaining popularity as an option. EMDR is most effective with Post Traumatic Stress Syndrome. You can read more about this approach by clicking here.

Peer Support/Group therapy is also an option. The primary benefit of this option is the realization it provides to women of not being alone. They really aren’t the only ones having a panic attack when they get in a car or experiencing frightening thoughts prancing through their mind at the most inopportune moments. Many times this option is a cost-effective option as well because many groups do not charge. A group led by a therapist may only charge a small fee such as $10-15 for attending. While peer support should absolutely not replace professional medical care for Postpartum Mood Disorders, it is an important aspect to add to recovery. If your area does not have a local peer group, you can find help online. The Online PPD Support Page has a very active forum for postpartum women. You can also visit the iVillage Postpartum or the Pregnant & Depressed/Mental Illness Boards. (Shameless plug on the iVillage boards, I am the Community Leader for both.) Another bonus of peer support? It reduces the recovery time.

Pharmaceutical therapy is also an available option. Some women are against taking medication and that’s perfectly okay. No one should ever be forced to take medication. Typically, pharmaceutical therapy is paired with another type of therapy. In fact, combining pharmaceutical therapy with a type of Cognitive Behavioral Therapy has proven to be one of the most successful approaches for the Postpartum Woman. Sinead O’Connor really put it best during an appearance on Oprah in regards to the function of psychiatric medications. They are the scaffolding holding you up as you revamp yourself. There are risks involved with taking medications and you should absolutely educate yourself, talk with your doctor, and if you end up deciding to take medication, be sure to inform your child’s pediatrician if you are nursing so they can be involved in monitoring for any potential issues.You should also familiarize yourself with the symptoms of Serotonin Syndrome, a fast-acting reaction which occurs for some people when they do not metabolize medication quickly enough. The build up results in a severe toxic situation. You should also avoid stopping any pharmaceutical therapy without consulting with a physician. Stopping suddenly can cause very negative symptoms similar to Serotonin Syndrome. If you have any signs or symptoms of Serotonin Syndrome, get medical help immediately.

For more serious cases of Postpartum Depression that do not respond to medication, Electroconvulsive Therapy may be suggested. ECT has come a long way since the 50’s and is a viable choice for many women who do not respond to medication. Now, I am not saying that if you choose not to take medication, you’ll be given ECT. This is for women with severe depression who cannot metabolize or do not respond at all to medication. Choosing not to take medication does not buy you an ECT ticket at all.

For women who want to use a more natural approach, there are a lot of choices. Again though, I have to urge you to make sure you are seeing a professional during your recovery. Don’t take something because it worked well for Aunt Martha. Check with your doctor and make sure it’s applicable to your situation and okay for you to take in combination with any other medication you may already be taking. Be sure your naturalist or herbalist is licensed and trained. You’ll also want to make sure that any herbs/natural supplements you are taking are compatible with breastfeeding if you are doing so. You can visit the blog over at Rebuild from Depression for a food/diet based approach.

Note: I had a reader, Steve, from Noblu.org leave a comment regarding IPT or Interpersonal Therapy. You can click here to read his comment. Thanks, Steve, for stopping by and sharing your knowledge with us!

As you can see, there are a lot of options available if you are diagnosed with a Postpartum Mood Disorder. More and more practitioners are becoming familiar with these disorders. More help is available today than even 6 years ago when I was first diagnosed. Remember to ask questions when choosing a therapist, advocate for yourself and what best fits your personal lifestyle philosophy. Don’t settle just because you want to heal. You have the power to say no. It’s your body, your mind, your say.

Tomorrow we’ll be discussing some things you can do on your own to help your recovery along. Stay tuned!

Did you watch Postpartum Nightmares?

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What were your thoughts?

Did you think Discovery Health did a good job? Or was it just more sensationalism that hurt the public perception of Postpartum Mood Disorders?

What did you like?

What did you not like?

Let me (and Discovery) know what you thought of this documentary!