Tag Archives: pregnancy

#PPDChat Topic 08.04.14: Getting Pro-active: Facing Pregnancy after a Perinatal Mood & Anxiety Disorder

ppdchat-08-04-14

Along with countless women, I have been in this boat. It’s an intimidating boat, let me tell you what. But, with some preparation, things don’t have to be quite that scary.

My first experience with a PMAD was frightening. I had no idea what was happening in my head in addition to trying to get myself adjusted to motherhood for the first time around. Talk about one helluva screwball. Thanks, life.

I survived. My daughter survived. Did we come out unscathed? No. But I definitely came out wiser. I view my first brush with PP OCD as one heck of a learning curve which prepared me for the second time I found myself in an even deeper valley than the first.

Halle Berry said it best on Oprah: “Once you’ve been through depression, it gets easier to get out because you have a road map.” Each episode, while it may have different nuances and causes, is essentially the same basic experience deep down. You get used to battling your way out of it and yes, you absolutely have a road map. You learn to recognize the curves and know how to adjust for them well before they even appear on your horizon.

Just as with a road trip, preparation is key. While even the best preparation in the world does not guarantee that a PMAD will stay at bay, it does empower you and enables you to seek help sooner rather than later.

I sincerely hope you’ll join us tonight to discuss the importance of preparing yourself and your loved ones for the possibility of another bout of a PMAD after the birth of a sibling. I have experienced both a planned and an unplanned pregnancy after my episodes so there will be lots of insight into both situations, including a very honest discussion about depression and other mental health issues during pregnancy.

Tonight’s chat is an important one. Don’t miss it. See you on Twitter at 830pm ET!

Seeking pictures of REAL pregnant mamas

Hey y’all.

Tonight’s #PPDChat was about depression during pregnancy.

Prior to the first chat at 1pm ET, I decided to search for “Pregnant Woman” via Google images. Wanna know what I found? I bet you already know. 

Smiling pregnant women. All of them happy and glowing. 30 pages in, I gave up.

I asked both chats to send pictures of themselves, pregnant, not glowing, REAL.

Will you share too? I want to show moms that not all pregnant women smile. That it’s OKAY to look (and be) something other than happy during pregnancy. Can you help?

Awesome.

Email your photos to me at mypostpartumvoice (@) gmail (dot) com. Subject Line: Real Pregnancy Photos.

You totally Rock. Let’s show the world pregnancy isn’t all happy grins. Time to get real.

Dear Abby downplays potential Antepartum depression

Yesterday, a letter to Dear Abby from a woman seven months pregnant received an alarming response. This mom-to-be states she never wanted to be pregnant. She goes on to share her inability to find any websites for women like her – only websites filled with women cooing over their bellies, etc. Her husband reacted negatively when she shared with him her emotions regarding the pregnancy. Mom-to-be is frustrated, doesn’t want to be pregnant, and flat out asks Dear Abby if there is something wrong with her.

Dear Abby responds:

“No, there’s nothing “wrong” with you. You’re just not particularly maternal.”

Um.

What?

Now, I realize all women are not maternal. It’s okay to not be maternal. However. There’s a difference between non-maternal and a mood disorder. There’s also great potential for this situation to not resolve itself without solid professional help.

To Abby’s credit, she does recommend the mom discuss her emotions with her OB to ensure she’s not suffering from pre-partum depression. But then she goes on to share something very alarming with this new mother. “When your baby arrives, I’m sure you will fall in love with him or her as many other women have.”

Sighs.

Oh Abby.

Not familiar with the research showing Ante-partum depression as a risk factor for Postpartum Mood Disorders?

What about the risk factor of unplanned pregnancies on Ante-partum and Postpartum Mood Disorders?

Not familiar with mothers who do NOT connect with their infants at birth or months afterward?

I’m all for providing hope. But to be unrealistic about it is downright irresponsible. Perhaps this mother will fall in love with her infant. But she may not. And now she, along with millions of other mothers in her situation who read this piece, are pinning their hopes on a potential unrealistic outcome which will only cause their guilt and shame to increase when they DON’T fall in love with their infants. No resources were provided. Nothing other than “Talk to your OB.” What if her OB is an idiot? What if he/she dismisses this mother’s concerns just as you have? This mother, and MILLIONS others like her are now left with only your words and those annoying cooing websites for cheery moms.

Postpartum Support International is a great place to turn to for support for Ante-partum depression. There are also several blogs with invaluable posts and insight into ante-partum depression. There’s also #PPDChat on Twitter for instant support regardless of where you’re at in your pregnancy or postpartum.

Thankfully, we’re talking more and more about this. Not nearly as much as we need to but it’s a burgeoning topic. Pregnancy does not always equal a glowing mama. Sometimes it equals a sad/anxious mama. It’s okay. You’re not alone. There is hope. There is help. If only Dear Abby had been responsible enough to provide some for this mom. Instead, she jots off a quick unresearched response which leaves her out in the cold.

Way to go, Abby. Way to go.

Guest Post: Contentiously Pregnant, Traumatically Delivered

The following was submitted some time ago by a reader who asked to have this published anonymously. Although this is a quick read, it covers so much – the fear and denial of a new pregnancy, the shock and self blame surrounding a delivery gone horribly wrong, and the anxiety enveloping all of these things. Postpartum Post-Traumatic Stress Syndrome is a very real disorder on the Postpartum Mood Disorder Spectrum. If you think you may struggle with this disorder, there is hope, there is help, and you are not alone. I strongly suggest you check out Solace for Mothers for support or reach out to the #PPDChat community on Twitter. Don’t walk the dark path alone. 

This post contains some imagery toward the end which may be triggering for you if you’ve suffered/or are suffering with PPTSD.

If you are still easily triggered, you may want to skip this piece.

The big day had finally arrived. The day I was to meet this little boy I still don’t want. Let’s go back a year and a half….

I was sent for a biopsy because of an abnormal pap. I was put on progesterone because I have Polycystic Ovary Syndrome (PCOS). My body was not making enough of this hormone to have a monthly “friend”. I started taking progesterone and within seven days I had a “friend” come to visit, only it was really bad.

I was hemorrhaging. After fifteen days, my wonderful OB decided to perform a D & C. Everything went well; the bleeding and cramping was finally manageable. I was supposed to take the progesterone the first seven days of each month until my body did what it was supposed to do. I lost 65 lbs!

I went to my four month post D & C check up and all was well. I received a clean bill of health and was good to go. My OB said if I wasn’t pregnant by Spring, we would discuss our options (little did either one of us know, at the time of my check-up, I was already pregnant.)

I was under instructions not to take progesterone in November. My OB wanted to see if my body would do what it was supposed to without it. She did say if December 1st came around with no “friend”, I was to take a pregnancy test. If it was negative, start the hormones all over again.

Black Friday came. I am one of those crazy people that is at the stores shopping at an ungodly hour so I bought a test. While at work, I peed on the little stick and before I could blink, two lines appeared. I took six more tests throughout the week at different times, just to verify what the first one said.

I was in complete and utter shock and even denial. It wasn’t Spring and I wasn’t ready to be pregnant. I had just lost a ton of weight, I was a full time student, I worked full time, and I already had a child who was in school full time. I wasn’t ready to have another baby.

The pregnancy was what every pregnant woman wanted, perfect and smooth. As I entered the second trimester, I was still in denial that I was even having a baby. I tried to ignore the movements and the baby’s hiccups. I tried to deny I was carrying in my belly this perfect round shape beneath my clothes.

I wasn’t happy. My days are grew darker and darker. Family and friends said I was aglow and looked wonderful. They couldn’t get enough of my belly. I resented their excitement over this new life I was bringing into the world.

Finally, the end was near. One month before I delivered, I was in a car accident. I was rushed to the hospital because of the cramps, but I wasn’t concerned for the life growing inside me. I just wanted him out. I hadn’t fallen in love with him. I didn’t even want him. I was still not ready. The cramping and contractions stopped. My OB said I would be induced in three weeks.

The day of induction came and family and friends hovered all day long. Labor wasn’t bad. Everything went smoothly. The pain was there, but tolerable. At 9cm, I said fuck this, I am pushing. No more waiting. Maybe that was shame on me, but I was done.

I went from 9cm to crowning in about a minute! My OB arrived and changed when the pain suddenly hit. I couldn’t breathe. I couldn’t think. Why the hell didn’t anyone take this kid out of me?

After five minutes of pushing, he was stuck on my pelvic bone and they were losing him and I wasn’t cooperating. I declined the pain medications earlier on. The next thing I could remember was the look between my OB and nurse. The nurse pressed the “Code Red” button and I still couldn’t breathe. All these nurses came running in and pushing everyone out of their way to get to me. They jump up and on the count of three I am to give one good push, while they push on my stomach, 1…2…3…he is out.

I didn’t want him on me. I didn’t want to see or touch him. He wasn’t breathing and was rushed to the incubator. Everyone was crying with joy around me, but I was disgusted that I sucked so badly at this delivery. I hated and blamed myself.

Because of all the commotion surrounding my son’s birth, the time he was born is a bit foggy; no one was paying attention to the clock. He was born not breathing, the cord around his neck and moderate shoulder dystocia. As his mother I felt as though I had already failed!

Most of this is a blur. I wish I could say that I am over this experience and that after a couple of hours all was well and I was smitten with this new baby. However, my hell was really just beginning, but that story is for another time….

Guest Post from @SavageLaura: A tale of two sisters & the power of social media

Last summer. It was terrifying.

My heart skipped a thousand beats and my butt barely clung to the edge of my office chair when “I’m at the hospital. I’ll call you back” were the last words my mother said before the call ended. My eyes filled with tears. That lump in my throat, hard as a fist, reached down and wrenched my guts.

Rewind a few months, and I will tell you why.

It was the end of April, 2010 when a pretty yellow envelope peeked at me from inside the mailbox. It was addressed to me; my sister’s chicken-scratch handwriting a dead giveaway she was the sender. The cutest card adorned with white buttons and a pastel tree slipped out of the envelope. A cutesy font read “Your Family Tree is Growing More Beautiful Each Day”. Oh my God. I read it over and over, the blurb “See you in November” on the inside written in the same chicken-scratch handwriting.

Excitedly I fumbled with my cell phone to take a photo of myself, card next to a wide grin, and send it to my sister. Within minutes she was calling. An immediate barrage of questions ensued. “Yes, I really am pregnant. No, we don’t want to know what it is. Yes, I already told you I AM PREGNANT. Yes, mom knew. We wanted to wait until we were past the first trimester in case something happened.”

I was happy for her. For them. Really I was, but I couldn’t push aside some strange feeling that something wasn’t right. I could hear a smile in her voice, but it was entwined with a sort of sadness. Why didn’t she tell me? I’m her big sister… she could tell mom, but not me? My mind tried to recount the last month or two, searching my memory for something I may have said, or not said, or did or didn’t do. She had been quiet. Her calls had been infrequent.

A few weeks later I confronted my sister. She said she’d been a little down, and having morning sickness. And wanting to sleep a lot. She’d been real tired. Ding ding! I asked her about her meds. The antidepressants. I know my sister, and when the depression starts looming her recourse is to retreat to her bed and stay. For days.

At one point she broke down and cried. I encouraged her with whatever uplifting words I could muster. And then I asked her, “Have you talked to your doctor about this? Pregnancy blues are one thing, but you sound miserable. You really should talk to her.”

And that was the beginning of a long, horrible pregnancy.

I can’t even really recall what happened, or when, or why. But I do know that one summer morning I called my mom, her breath strained and that tone in her voice, “I’m at the hospital. I’ll call you back.” I was scared to death. I managed, somehow, to call my mother when she was walking into an emergency room at a hospital three hours away from where she was supposed to be.

My sister had been admitted by her OB. Delusional and suffering anxiety attack after anxiety attack, an orange band was secured around her wrist. Her shoelaces removed. Her purse and its contents taken. She had been placed on a suicide watch.

The psych ward became her world for a week. My sister had access to psychiatrists, therapists, and even a nutritionist due to a discovery of an eating disorder she had hidden for years. They tried all the pregnancy-safe drugs available, supplements, diets and exercise. But it didn’t help. My sister’s downward spiral was in full force and moving fast.

After she had been hospitalized for a third time, their last resort was electroconvulsive therapy, or ECT. Most patients receive benefits from this treatment, especially pregnant women since it doesn’t harm the baby. I was shocked (no pun intended) and buried myself with articles, anything I could read and get my hands on. My mom had quit her summer job and resorted to living with my sister and her husband, desperately trying to hold it together herself. I became my mother’s confidant. At times she would call, and I’d listen to hours of tears and sniffles.

I believe I didn’t sleep more than four hours straight for two months, my sister’s emotional rollercoaster weighing heavy on my mind.

By October, emotionally spent and drained, my sister had been through it all – gestational diabetes, high blood pressure, preeclampsia, tremendous weight gain, nightmare after nightmare. Her doctor agreed it was time to induce. At 34 weeks she gave birth to my beautiful niece, weighing 4 lbs 14 oz and a headful of silky hair.

But the fight wasn’t over.

Due to the medications, my niece was unable to eat for 24 hours. Even more depressing news, my sister was unable to breastfeed. My mother still scared out of her mind. And then the news that my niece would have to stay in the NICU for four weeks blew my sister down like a violent midnight tornado.

My sister and her husband finally brought their daughter home, it was so foreign. Here was this baby that was in her belly, but had been taken and cared for by these other women. For four weeks. And now she was stuck, all alone, with this tiny person she didn’t know. Loved? Yes, with all her heart. Bonded? No. Once they brought her daughter home, it was as if she’d stepped in the path of a freight train; her world had been turned upside down as it went from being self-sufficient to OMG WTF I have this crying thing 24 hours a day.

As weeks went by, my sister called every couple of days to vent. Until one day she had called me twice a day, at work, for two weeks straight. I had had enough. And as much as I wanted to say “Get the f**k over it. Put your big girl panties on. Shit or get off the pot”, I knew I couldn’t. And until she decided she wanted to do those things, it was pointless to waste my breath.

Now. I’m going to tell you something about being a big sister. No matter how bad you get pissed off, or irritated, or want to haul off and slug your little sister(s), you still love them with all your heart. When they hurt, you hurt. When they’re happy, you’re happy. But when they’re miserable and can’t do anything about it, you do what ever it takes, come Hell or high water, to open their eyes. To fill their heart with golden love and make their soul sing. You roll up them sleeves and take charge. Why? Because you’re THE big sister. That’s why.

For me, taking charge meant scouring the Internet for hours, looking for postpartum resources until my tired eyes would send me into a migraine. I looked up mother’s groups, even though I knew my sister wouldn’t go. Short of myself driving 12 hours in order to MAKE her go, I knew it was impossible. I have a husband, and a daughter, too.

One day (and I’m still not sure quite how it happened) I was on twitter, when a tweet caught my eye. Someone I had been newly following, a friend of a friend sort of thing, tweeted something about motherhood and then put ‘#ppdchat’ at the end. My eyes got huge. I’m telling you, I’m pretty sure I pee’d my pants with excitement. And being the bossy move-out-of-the-way big sister that I am, I simply tweeted: Need #ppdchat info.

I still tear up about it, like right now, but this simple tweet changed my sister’s life. The power of social media came to my rescue. And somehow I am sure God had a hand in it. It all happened so fast that within ten minutes I had a message from Lauren Hale, of My Postpartum Voice, giving me her email. Within 24 hours I had been in contact with a therapist whose office is located five minutes from my sister’s house. FIVE MINUTES. TWITTER. WOW.

It has taken time, months, and will probably take years for my sister to heal. She is receiving help, guidance, and nurturing to become the mother she has always wanted to be. I know it’s not easy. I mean, I had a touch of depression after pregnancy. Nothing to the magnitude my sister has endured. And I hope I never will.

I do know this. Never be afraid to speak up for someone who can’t. Someone so down and distraught is neither sinking nor swimming, just stuck treading water. There’s nothing to be ashamed about. Do not be afraid to reach out and grab a hand for help. Do not be afraid to try. Do not be afraid.

Go. Do. Be.

Laura Savage finds at least four new gray hairs every morning. At thirty, she still wears a retainer (only when she sleeps).
She has battled migraines, college algebra, ugly prehistoric-looking centipedes, and an addiction to Dr. Pepper. And won. 
Laura currently lives in Southern Colorado with her husband, daughter, and three canine companions.

Guest post by @ksluiter: and now my depression is affecting those not yet born…

Hi.

It’s me, Katie, from Sluiter Nation.

I have a problem.

I’m not pregnant.

Sigh.  Yes, this is a problem.

Let me back up the truck for those of you who don’t know my back story.

I have an almost-two-year-old son, Eddie. Three months before Eddie turned a year, I was diagnosed with postpartum depression and anxiety.

I have been fighting this damn disease ever since March of 2010.

The therapist I see and my general practitioner both agree that at this point?  Because I had a pre-existing anxiety disorder?  I can likely drop the “postpartum” part of the label.

I suffer from depression and anxiety.

And I am trying to get pregnant.

Also?  My husband suffers from extremely mild depression.

up until very recently we were both medicated.

Do you know how hard it is to conceive when both players are on drugs?  The med that my hubs was on?  Decreased sperm count and made it difficult to…um…finish.

You can’t get a baby without the finish, people.

My meds kill libido.

So let’s recap.  One of us doesn’t want it and the other can’t complete the task anyway.

And here we are…three months later…no baby.

Not surprising, but still frustrating.

So now the hubs is off his meds.  And he is all raring to go…all the time.

Yay for lots of baby making, right?

Wrong.

It’s still hard for me to want to.  I mean, I so want to.  I want another baby so bad it’s hard to be excited when others are blessed with little lives.  And I want to be close with my husband.

But…stupid medication.  stupid depression sucking the joy out of my sex life.  stupid anxiety about what my body looks like.

People keep telling me to relax.

How do I do that?    How do I enjoy sexy time more than only a couple times…a  month?  Because it’s going to take more than that for us to make a human.

I am so tired of this stupid depression and anxiety taking over every aspect of my life.

It stole so much precious time away from my son and my husband.  And now I feel like it’s taking time away from my not-yet-created baby.

Guest Post: The Most Common Complication of Childbirth by Dr. Jessica Zucker, Ph.D.

Perinatal mood disorders have been called the most common complication associated with childbirth. Mood struggles during the postpartum period run rampant but are consistently quieted by our culture’s focus on the overly idealized “glowing” new mother. Though many women gracefully transition into mothering, many others feel they are riding an emotional, hormonal, and physiological roller coaster- with no seat belt and no way to control the speed. With the glaring statistic of 15-20 % of mothers developing postpartum depression (not to mention all of the other perinatal mood disorders), it seems imperative that this public health crisis be addressed systematically and globally.

Perinatal and Postpartum Mood Disorder Statistics

Roughly 10-20% of pregnant women experience depression

One-half to three-quarters of all new mothers are affected by baby blues

Approximately 15-20% of all mothers will develop postnatal depression

Approximately 2-5% of new mothers develop obsessive-compulsive disorder

About 10% of postpartum women are impacted by panic disorder

1-2% of post-delivery women experience postpartum mood disorders with psychotic features (30-50% of women have suffered a postpartum depression or psychotic episode in a prior pregnancy)

Approximately 10% of men are affected by postpartum mood disorders

Postnatal mental disorders can be incredibly detrimental for infant development and attachment formation. “By 6 months, the infant exposed to a mother’s negative affect learns to extrapolate using that behavior with others. By ten months, the emotional responsivity of infants of depressed mothers is already organized differently from that of normal infants.” Determining primary, secondary, and tertiary preventive approaches to perinatal mood disorders will increase the likelihood of generations of healthy baby-mother attachments.

How do we make burgeoning families more of a healthcare priority? Who routinely has the opportunity to discuss maternal psychological and physical transitions with pregnant and parenting mothers? Through the dissemination of maternal mental health information, preventive education, employing diagnostic screenings, and providing additional supportive resources to women and families, the silence and shame that infiltrate postpartum mood disorders may begin to dissipate. Ideally situated, obstetricians and midwives (among other healthcare practitioners) and their unique relationships with pregnant and parenting women, can provide a way to thoughtfully prevent and carefully identify perinatal mood disorders. Here are some initial thoughts on the impact healthcare providers can have on the lives of pregnant and parenting families with the aim of precluding postpartum mood disorders.

Eight Ways the Obstetrician and/or Midwife Can Make Strides Toward Better Serving Pregnant Women and their Burgeoning Families

1. The obstetrician/midwife should be aware of the potential affects of antenatal mood disorders and maternal stress on fetal development and birth outcomes. Getting appropriate training in postpartum mood disorders will allow families to feel safer in their care.

2. Knowledge of the latest research about the efficacy and safety of psychotropic medications during pregnancy and lactation can facilitate authentic discussions about the risks and benefits if medication is indicated.

3. The obstetrician/midwife has countless opportunities throughout pregnancy and at the postpartum visit to talk with patients and their partners about the various risk factors that contribute to postpartum mood disorders, signs to be concerned about, and available local resources. These discussions can be woven seamlessly into routine appointments and allow the patient to feel more deeply understood. Research states that postpartum mood disorder prognoses are best when identified and addressed immediately.

4. Understandably, many women feel confused and conflicted by feelings of maternal ambivalence or outright unhappiness. The obstetrician/midwife can help normalize various feeling states as well as educate patients about perinatal mood issues and possible treatment options. Addressing psychosocial issues increases trust and patient satisfaction.

5. If women with mood disorders are identified at the initial prenatal visit, a consultation with a psychiatrist needs to become part of their care. Women who have experienced previous postpartum mood disorders are at increased risk for reoccurrence.

6. The American College of Obstetricians and Gynecologists (ACOG) recommends a timely screening method- asking the following questions:

(a) Over the past 2 weeks, have you ever felt down, depressed, or hopeless?

(b) Over the past 2 weeks, have you felt little interest or pleasure in doing things?

These simple questions may provide a springboard for exploring mood related concerns and becomes a way to check in about potential psychosocial issues at each prenatal visit.

7. Pregnant and parenting women should feel that all of their physical and psychological concerns are valid and have a place within the patient-doctor/midwife relationship. Fostering an intimate environment through relational sensitivity and candor may increase the likelihood that women will not suffer in silence.

8 . Obstetrician’s and midwives would benefit patients by routinely providing perinatal mood disorder literature as well as local and national therapeutic resources to women and their families.

Sources:

Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (2008) edited by Susan Dowd Stone and Alexis E. Menkins

The Pregnancy and Postpartum Anxiety Workbook (2009) by Pamela Wiegartz

Dr. Jessica Zucker is a psychotherapist in Los Angeles specializing in women’s health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and early parent-child attachment and bonding. Earning a Master’s degree at New York University in Public Health with a focus on international reproductive issues led to working for the Harvard School of Public Health. After years of international public health work, Dr. Zucker pursued a Master’s degree in Psychology and Human Development at Harvard University with the aim of shifting her work from a global perspective to a more interpersonal focus. Dr. Zucker’s research and writing about various aspects of female identity development and women’s health came to fruition in her award-winning dissertation while completing her Ph.D. in Clinical Psychology. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). For more information: www.drjessicazucker.com

Saturday Sundries: 1.29.11: Meds, More babies, When PPD becomes more

Good mornin, y’all. How’s it going?

I love Saturdays. LOVE. There’s something so cozy about Saturday mornings. Round here, we take things slow and easy, enjoy a delicious brunch, and just hang out. This morning we’re having Turkey Sausage, cheesy scrambled eggs, whole grain toast, mango juice, and coffee. NOM.

That’s what we’re doing here. We’re just sitting down for coffee, brunch, and chatting about some serious stuff, girlfriend to girlfriend. Or friend to friend.

So get cozy, grab your coffee, OJ, or tea, oatmeal, danish, waffle, Cocoa Puffs or Honey Smacks, and prop up your feet (yes, that’s allowed here), and enjoy. This is for you.

As always, I am not a doctor. I am a Mom who has lived through the same hell you (or someone you love) is currently or has lived through. I’ve been there. I know what it’s like to be alone and not know where to turn. Please check with your doctor before you do ANYTHING mentioned below. What works for one person may not work for another. This disclaimer is brought to you by Common Sense and Covering my, well, you know.

If you have a question, I’d love to hear it. Email it to me at mypostpartumvoice(@)gmail(dot)com. If you want to stay anonymous, that’s fine. Just tell me in your email. You can also catch me on Twitter via @unxpctdblessing or on Facebook at the My Postpartum Voice Fan Page. With any of these, be sure to mention your question is for the Saturday Sundries feature! I’ll answer just about anything including questions about my personal experience with Postpartum Mood & Anxiety Disorders. What I will NOT do is recommend medications or one form of treatment vs. another form of treatment. That’s for you to discuss with your doctor. I’ll be happy to provide resources and information regarding therapies, etc, but I do not get specific in regards to pharmaceuticals here. It’s an ethical thing.

Now, before your coffee gets cold, let’s get onto the questions!

@walkerKarraa asked: How do moms manage their meds during time in hospital when babies come?

This is really specific from situation to situation. If you are on psychiatric meds during pregnancy and will be on them through delivery and postpartum, this is something you will want to discuss with your provider. Many providers have Mom bring her meds from home. When I delivered my son, I was on medication. I brought it with me and gave the prescription to the nursing staff. They wrote down the information and then gave it back to me. Every morning, they checked with me to make sure I had taken my dose.

I would strongly recommend only bringing as many pills with you as will be needed for your stay in the hospital, if that is where you will be birthing. This way, if there is a misplacement of your prescription, you’re not out an entire month’s supply. This is also a question you can ask at pre-registration. Inquire about hospital policies regarding existing patient prescriptions and how the hospital handles them. Do not assume your hospital will know you need to take Med A at x o’clock and Med B at x o’clock. I cannot emphasize enough how important it is to have this discussion with your caregiver AND the hospital staff where you will be giving birth.

This question came in via email. While the reader did not specify to remain anonymous, I’m going to go ahead and respect her privacy anyway. Given the nature of the question, I immediately emailed an expert on this topic, Karen Kleiman. It was Karen’s book which led me to start this blog, actually. I did not know if I wanted to have another baby after our first one. In fact, we started trying for another one, I totally freaked out, we stopped, and then a few months later, we started up again and bam. Pregnant very quickly. I was on that train. After our second, we were once again on the fence. We had begun to lean toward not when we became pregnant with our son in a very unplanned manner. He’s 3 years old now and the happiest little boy you will ever meet. His happiness is infectious. But I am done. Done done done. I did not have PPD/PPA after his birth. I spent a good bulk of the time during my pregnancy focusing on resources and support for me, not for him. It sounds selfish, I know, but it really paid off. In the end, it WAS for him because the happier I was, the better mother I was able to be for him. Without any further ado, here is the question and the answer from the fabulous Karen Kleiman:

I got PPD/PPA 5 months after my daughter was born and that was 3 years ago. How does a mom like me even consider having another biologically? I read about moms who do it and don’t understand how they get there with the fear, and all. Where are the moms who have had PPD and choose not to have another? Where can I get encouraged from other moms who are like me, and not to feel guilty about not “doing” it again? The guilt is horrible for me.

Karen Kleiman’s answer: The decision to have another baby after experiencing postpartum depression and/or anxiety is complicated by a number of factors:

1) your personal experience

2) your medical history

3) your available support network

4) your course of treatment/recovery and

5) your (and your partner’s) desires, expectations and preferences, just to name a few.

So you can see how complex this decision can be. There are women who decide that having another baby is not worth the anguish of a subsequent pregnancy and unknown postpartum experience. There are women who decide that having another baby after PPD/PPA is worth the risk. It is, to say the least, an extremely personal decision. And one, I might dare say, that is no one’s business, but yours and your partner.

I know there is significant pressure, from society, from friends, from family, etc., but it is perfectly okay for you to determine what course of action is best for you and your family. And the guilt? It can feel overwhelming, to be sure, but guilt can only thrive if you provide the opportunity. You can, with proper support, learn to embrace your decision and more forward with confidence. Find a good therapist, read good books J, find support online, (ppdsupportpage.com, Lauren and her awesome PPD twitterdom, for example). Trust me, there are many many women who struggle with this and there is never one right answer. You will feel better if you can find a therapist who specializes in this area, so you can discuss the pros, the cons, the fear, the guilt, and ultimately make an informed decision that fits your needs the best. Then, take a deep breath, and give yourself permission to stop torturing yourself. All will feel right again soon.

@Zeeke75 asked a question that I’ve been hearing a lot lately. “how do you know when it’s no longer PPD and something else?”

Oh look, a leprachaun – over there! Seriously. Look!

What? You don’t believe m… OOOH! Unicorns! There!

Okay, here’s the deal.

This is a touchy question. This question is really the crux of the current DSM-V debate. It’s very hard to answer. VERY hard.

When I attended the PSI/Marce Conference in Pittsburgh this past October, there was a presenter, Ellen Frank, Ph.D, a volunteer working with the Mood Disorders group. Dr. Frank postulated that due to the lack of research indicating a clear off-set for Postpartum Depression, the current onset of Postpartum Depression and other Postpartum Mood Disorders would continue to show a cut-off date of four weeks. What this means is that according to the new DSM, a woman cannot “officially” have Postpartum Mood Disorder if she presents with symptoms any later than four weeks after birth, something I think is a total crock of BS but hey, what do I know? I’m just someone who did not present with symptoms until 3 months in with my first and was actually told by my physician I didn’t have PPD because I was more than four weeks Postpartum. The DSM’s staff’s argument is that the DSM is merely a reference book and is flexible for interpretation from case to case – well, someone should have told my doc this. He actually pulled out the DSM-IV and read to me.

In the bigger picture, this also means that there is a lack of research in the area of a clear “off-set” of symptoms. This means that it’s really hard to “officially” say that a PMAD has moved from being a PMAD into something else.

Many of us in the field will tell moms that onset for a PMAD is anytime within the first 12 months after birth. We also state that it can take up to 18 months to recover properly. But that doesn’t mean that once your little one turns 18 months you should be running through fields of poppies and floating on clouds.

Recovery time line depends on oh so much. It depends on when you were first PROPERLY diagnosed, when you first received an effective course of treatment/therapy, what kind of support you have, what extenuating circumstances may be present in your life, how cooperative and honest you are in the recovery phase, etc.

How this question is answered from woman to woman varies depending on all of these variables. For some physicians, it’s quite cut and dry. At a certain time, your doctor may consider you no longer Postpartum and into full blown depression, anxiety disorder, etc.

The important thing to remember here is that even if your diagnosis changes, you are still making forward progress even if it doesn’t feel like it. I know it’s overwhelming to go back into that dark place, I do. I went back twice. Each time, it was worse than before. But you know what? I had been there before. I KNEW what I need to do in order to get out. Think of it as playing a video game level. Once you’ve played, even if your character fails and you find yourself at the beginning of the game, you know precisely what to do in order to get through what previously were potholes. So you see, you’re already ahead of the game. You can sides step these really dark holes which trapped you before. Fall into one? Okay. Climb out – you KNOW how to do it. You’ve done it before. You can still do it.

And just because you no longer have the official label of “postpartum depression/anxiety/OCD, etc, doesn’t mean that those of us who have PPD labels, etc, are going to shun you. If anything, we’ll just love you that much more.

Also important to note here is that if you develop a full-blown mental illness, expect your family to struggle with this new diagnosis as well. Many times it is just as hard for them to coped as it is for you. Your loved ones may have previously been accepting, understanding, and supportive. But they may now feel that you are out of the woods and this “relapse” is all in your head. If that happens, send them to me. I’ll set ‘em straight.

Those are all the questions we have for today. Don’t forget to submit your questions for next week’s Saturday Sundries. I KNOW you have them!

PANDA Perinatal Depression Video

I just watched the most amazing trailer for a Perinatal Depression Video, entitled “Behind the Mask: The Hidden Struggle of Parenthood.”

It’s done brilliantly, respectfully, and you HAVE to watch it. And then you have to share it with every single person you know.

This DVD is part of an initiative to get people talking about Perinatal depression in Australia. According to their profile at YouTube, PANDA is a national, not for profit organisation whose helpline provides confidential information, support and referal to anyone affected by depression and anxiety during pregnancy and after childbirth, including partners, family members and friends.

Thank you, PANDA. Thank you.

Go here to watch the video. Now. Why are you still here?

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Saturday Sundries 01.22.11: Stigma, Meds, Relapse, Pregnancy

Saturday Sundries: A Postpartum Q&A Series (Original Graphic created by Lauren Hale for MPV Copyright 2011)

Welcome to Saturday Sundries, A Postpartum Q&A Series. This series will be dedicated to answering questions asked by you, the readers of My Postpartum Voice and Twitter friends of @unxpctdblessing. Ask away. I will answer, to the best of my ability, any question. Sometimes the best answer I will be able to provide will involve discussing the issue with your physician. I am not a doctor, I am not a therapist, I’m just a Mom turned advocate after experiencing Postpartum Mood Disorder twice. I provide peer support and nothing more.

In the interest of furthering discussion about Postpartum Depression and tearing down the walls of Stigma, I hope you will ask questions. Don’t make them easy. Ask the hard questions. If you want to ask a question and stay anonymous, that’s cool too. You can email me at mypostpartumvoice(@)gmail(dot)com with your questions. Just specify you would like it answered anonymously. There’s no shame in not wanting to reveal yourself or your struggles. I get that. But you still deserve to have your questions answered. Someone else out there may need to have that exact question answered but they may not be able to ask it at all.

This week’s questions come straight from Twitter. There are only four this week (the most I’ll take each week is five) but they are excellent questions.

Let’s get to answering them!

 

First up: @MamaRobinJ asks: How would you recommend making a decision about another pregnancy when still dealing with #PPD & on meds?

Awesome question. The simplest answer I could give to this one can be summed up in one word: Carefully. But you didn’t ask me this question to get an ambiguous one word answer, did you?

There are a two books I  highly recommend to any mother considering this very issue. The first book is Karen Kleiman’s What Am I Thinking? Having a Baby After Postpartum Depression. It proved to be very helpful for me. (That book is why I started this blog!) The second must-have book for any mother considering this issue would be Pregnant on Prozac by Shoshana Bennett.

One of the most important things Karen addresses is the level of fear a mother should have when faced with another pregnancy after PPD. Karen states that a healthy fear of relapse, etc, worries her less than a mother who is convinced she can breeze right through a pregnancy and postpartum after a Postpartum Mood Disorder experience. She’s right. She also talks about reframing the experience in a positive manner. (Hence, my blog.)

If you are already on meds, hopefully you are already in therapy as well. I would strongly recommend discussing this choice with your caregivers, your therapist, etc. Assemble your team, focus on your care, and prepare for the possibility of a relapse after giving birth if you decide to go ahead with getting pregnant. You’ve done the baby care thing before. You’ve done the PPD thing before. Think like a Boy Scout here and Always be Prepared!

It’s important to note here that no one should ever EVER EVER EVER EVER go cold turkey off their meds. Again, I am not a doctor. But if your doctor tries to tell you that you need to immediately drop any psych meds, run, don’t walk, to another caregiver who is willing to work with your own personal beliefs and needs. The issue of medication during pregnancy is very well covered in Pregnant on Prozac. Shosh even covers how to handle uncooperative doctors. Seriously. If you’re on meds and thinking about pregnancy, or you might end up back on meds, GET THIS BOOK. Make your husband/partner read it too. Make him read the Karen Kleiman book too, if he will. Reading both of these books will profoundly influence your experience.

I should mention that some women do relapse no matter what level of prevention they take. But if you assemble your team, have everyone ready to go before hand, even if you relapse, it will be caught quicker and your healing time should be less than if you take no prevention at all. The key here really is to be as pro-active as possible. Halle Berry once said during an interview with Oprah that when you fall back into the valley of depression again, the journey out is quicker than the first visit. Why? Because this time you have a road map. You know yourself, what works, and how to move through that valley better than you did the first time.

 

Second Question: @WalkerKarraa: Why is there so much stigma re: #PPD?

Wow, Walker. I could write a very long post about just that question.

Since Hippocrates, there has been stigma about PPD. These days, there is a silence around the issue of Postpartum Mood Disorders which infects almost every walk of life.

Every time you see an infant product commercial, regardless of the product, the Mom and baby are together, smiling, happy. Cuddling, bonding, cooing, grinning, etc. Don’t get me started on Baby Showers, the biggest sham this side of the Atlantic. Instead, we all smile and grin at each other, eat cucumber finger sandwiches, drink tea, all while ooohing and ahhhing over tiny baby clothes and annoying toys you may one day want to heave through the window of your home because Junior won’t stop screaming for the zillionth hour in a row and you’ve not slept in nearly a billion hours. Your eyes are crossed, your hair looks like you stuck your finger in a socket, and you’ve long forgotten what a shower is or even where the shower is in your home. Hot food? Distant memory. You can pee in 1 second flat, change a diaper even faster, and yet still you find yourself trapped on the couch or pacing the floor with a grumpy infant.

No one tells us about the hell we might face. No one opens up until we fall apart. Our society has built up such a high expectation of perfection – at this time the level of perfection is so high it is virtually unattainable. And when moms go to extreme lengths to reach those goals set by society and fall short, they blame themselves. We begin the Mommy guilt game earlier and earlier with each generation. We begin the Judge the Mommy game even earlier. The instant someone finds out another woman is pregnant, they feel they have a right to “inform” her of all her decisions and then expect her to choose to be pregnant and/or give birth THEIR way instead of HER way. So many choices, so much pressure, so many things which can go wrong. When things do go wrong, the mother is judged. She didn’t birth at home. She had a c/s. She had an epidural so… She didn’t breastfeed, she didn’t, she didn’t, she didn’t, she didn’t, she didn’t, she isn’t, she isn’t… she isn’t happy because….

Fact is, any Mom can get a Postpartum Mood Disorder. It’s the most common complication of childbirth. 1 in 8. But we’re not talking about it in the birthing or breastfeeding communities. We’re not talking about it in childbirth classes. We’re not talking about it at prenatal appointments. At 6 week check up appointments. At pediatric appointments. We’re just not talking about it.

Because if we don’t talk about it?

It’s not real.

And that’s why there is so much stigma.

Because if we just shut up about it, it’ll go away and we can pretend it doesn’t exist. It’s a shadow in the corner of the room and if we move just right, it will disappear. It’s the monster under the bed we convince ourselves isn’t really there.

It does exist. It IS an issue. And I refuse to shut up about it. I will get LOUD about Postpartum Mood Disorders until I am physically unable to do so any longer. Why? Because no one got LOUD with me and I nearly lost my life because of them.

If you think I’m going to let that happen to another mom on my watch, you, sir, or madam, are seriously mistaken.

 

Third question: @thewilsoncrowd asked: Is it possible to relapse in the middle of treatment? Suddenly back to feeling like I’m at square one this week. #PPD

Oh dear, yes. Yes indeed. Especially if something has triggered you.

But it’s so very important to put this in perspective – you say this week. Has this “relapse” feeling lasted all week? Longer than all week? Or has it just been a few days?

Again, not a medical professional, but relapse is usually more than just a few days here and there. For me, relapse would have to be a good solid week or more of just horrible bad days in a row during which I felt no motivation to try and heal through the methods that worked before.

If you feel you are relapsing, definitely get in touch with your doctors. It’s important to note here that any change in med dosage, sleep habits, PMS, or an increase in stress can make it feel like a relapse. Regardless of the root cause, you need to discuss this issue with your physician so the two of you can formulate a plan to help you stay out of this rut and continue on your journey toward recovery. Make it a pot hole instead of a sink hole.  You can do this!

 

Fourth question: @Preparing4Birth What medications are safe for breastfeeding… why is rapid weaning not a good idea?

I wish I could answer the meds question. I do. I don’t recommend specific medications over other medications. It’s really for a physician to do after discussing a patient’s situation with them. Your doctor should have a copy of Thomas Hale’s Medication & Mother’s milk for reference. If he doesn’t, get them one. Or encourage them to get one for themselves. You can also call your local IBCLC or talk with a La Leche League leader. Another great place for you to get information re: meds during breastfeeding is from OTIS Pregnancy. They even have handy fact sheets available at their website for specific medications. Go check to see if a med you have a question about is there.

Rapid weaning is not a good idea as it can cause several issue with both you and your infant. If you are talking about rapid weaning from nursing, that alone can cause severe issues with both the mother and infant dyad. The mother may experience engorged breasts as her system is absorbing the shock of no longer nursing the way to which it had become accustomed. Engorgement can lead to mastitis and infection. Mastitis is very painful and is considered an urgent medical condition. The infant is suddenly switched over to formula and his/her young and immature digestive situation is flung to the wind as those in “charge” wait to see what will happen. You may end up with a mother who may want to nurse, despite the risks of whatever med she is on. It is of the utmost importance for a physician to be sensitive to the nursing desires of a new mom. Nursing is either not working out at all or it is the ONE thing she is doing right. To take nursing away from the latter mom is to remove a positive left in her very dark world which is a bad idea.

Rapid weaning of any psychiatry medication is strongly advised against as it can cause some severe and even worse issues than being on the meds. Not only will you go through withdrawal, but your infant may go through this as well. And that’s just not good for anyone. If you are nursing and on medication, it is important to let your child’s pediatrician know what medication you are on and at what dosage so they can monitor your infant for any possible side-effects. Primary side effects with psychiatric medications with infants are sleepiness and weight gain. If your infant seems to sleep a lot or is struggling to gain weight, it’s important for your pediatrician to know you are on medication that might be causing these issues. Again, Thomas Hale’s Medication & Mother’s Milk is a very solid resource for this information.

Another important thing to note here is that, as with question one, preparation here really is key. Find out what meds you can take. Let your doctor know what your issues are, honestly. Also know what the risks are to both you and to your infant. It is also important to know the characteristics of the medicine you are prescribed, if you are prescribed one. Some meds may dry up your breastfeeding supply. Others make make you more annoyed than ever. It’s important to work with your doctors to find the approach which fits your philosophy the best. You are advocating for yourself AND for your infant here. Don’t be afraid to question things. Ask why. There is no line when you are protecting yourself and your infant. Question everything.

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