Tag Archives: Saturday Sundries

Saturday Sundries: Is Postpartum Depression only tears?

Happy Saturday, y’all!

It’s been grey here all day. Within the past hour, we have had torrential downpour, thunder, no lightning, and the sky is now a bright white instead of a dark lingering grey. I have been down for the count since Thursday night with Strep. I’m on the mend though, and managed to go for a drive this morning to escape the house. I ended up in a little town named Good Hope. Lately it seems to be where my car likes to take me when I need to get out and breathe. You can read more about my journey there at The 3six5 Project tonight at 8:00p.m.

There has also been an air of tension over my hometown for the past few days. The situation has resolved as of early this morning and we are all breathing much easier today. I’m not disclosing the reason because I would hate to trigger anyone inadvertently. All that matters is that it resolved without any further tragedy and all is well once again.

Today I am grateful for local law enforcement, tylenol, ibuprofen, and antibiotics. And I cannot wait until I can hug my children close again!

As always – the answer below is not meant to be complete or professional in any sense. Always seek a professional’s opinion in regard to your own situation. Everyone does not always have the same experience.

Today’s Question: Is Postpartum Depression only Tears?

No. It’s not.

Sure, tears may be involved somewhere. But they may not be involved at all. I have had so many mothers share with me that they didn’t think they had PPD because they were not crying lumps. Thing is, there are many different Mood Disorders on the Postpartum Spectrum. These include but are not limited to:

  • Postpartum Depression
  • Postpartum Anxiety
  • Postpartum Obsessive Compulsive Disorder
  • Postpartum Post Traumatic Stress Syndrome
  • Postpartum Psychosis

You’ll notice that I did not include the Baby Blues in the above list. It’s not there because it’s not considered a psychiatric disorder. The Baby Blues happen to many mothers – up to 80%. When the blues last longer than a few weeks and/or go beyond simply weepiness or moodiness, it is time to get checked out by your doctor.

Postpartum Psychosis is a medical emergency. Postpartum Psychosis has a fast onset. It may involve hallucinations (both auditory and visual), an incapability of making decisions for oneself, and delusional thinking. A mother with Postpartum Psychosis should NOT be left alone either by herself or with an infant. This means not even in the next room – someone needs to be with her at all times. She should also be admitted to the ER as soon as possible.

Postpartum Obsessive Compulsive Disorder, the disorder with which I struggled, involves what are called intrusive thoughts. These thoughts often include visualizations of harming our children or ourselves, but unlike Postpartum Psychosis, we are immediately repulsed by these thoughts as soon as they flit through our heads. We struggle to control them and often will create a blizzard of IT’s with no end in sight as we get lost in the ever expanding tunnel of negative “what-if” thoughts. I recently wrote a post about whether or not these thoughts go away. They fade and get easier to control but they never really go away, a difficult reality for many to face. I am a little over 5 years past my last PPOCD episode. I still have the occasional thought but I am able to stop them quicker and they do not happen nearly as often.

Postpartum Post Traumatic Stress Syndrome can be triggered by a negative birth experience or anything within the birth/newborn process which is perceived to be traumatic by the mother. The worst thing you can ever say to a mother with PP PTSD is that she’s silly for being so upset over such a small thing. Clearly, if it is causing her issues to the extent that it interferes with her daily living, it is not a small issue for her. Mothers with PP PTSD will avoid the place at which the triggering event took place – such as the hospital, doctor’s office, midwife’s office, etc. She may also struggle with graphic triggering dreams, intense anxiety, panic attacks, hyper-vigilance, and flashbacks. It is important to note that PP PTSD can occur in conjunction with any of the other mood disorders, and may even be the triggering point for the development of other disorders such as Anxiety and Obsessive Compulsive Disorder. This is my own opinion because I believe I had PP PTSD with my first and second daughters which then led to my OCD. My first birth was very traumatic and my second birth led to a month long NICU stay for our daughter.

Postpartum Anxiety is marked by constant worry about things which don’t need to be worried about, hyper-vigilance, overwhelming sense of doom, inability to sit still, racing thoughts, and possible physical symptoms such as dizziness, hot flashes, and nausea. There is help available for Postpartum Anxiety and you are not alone in struggling with this.

Postpartum Depression, while involving symptoms of crying and sadness, also involves feelings of anger and irritability. Not many people think of depression being angry, but for many, this is how it manifests. You may also become overwhelmed with feelings of shame, sadness, and guilt. Motherhood is supposed to be a happy time for us mothers. For those of us who develop a Postpartum Mood Disorder, we become ashamed for not feeling how society expects us to feel. We struggle to ignore these feelings, leading only to a more serious and urgent situation down the road.

Bottom line, Postpartum Depression is not just tears. It might be anger, irritability, anxiety, intrusive thoughts, hallucinations, flashbacks, panic attacks, shame, guilt, and hyper-vigilance. Just because your wife isn’t weeping her way through her postpartum period does not mean she does not have a Postpartum Mood Disorder. There are so many varied ways in which this can manifest.

Please also remember that Postpartum Thyroiditis may masquerade as a Postpartum Mood Disorder. It is important to get your thyroid levels checked to rule this out as if it is Postpartum Thyroiditis, an entirely different type of medication will need to be used to treat the condition. In fact, anti-depressants may make things worse if a thyroid issue is the root cause.

Don’t tell her to snap out of it. Tell her these things. Tell her you love her no matter what. Be there for her. Let her cry on your shoulder if she needs to do so. Encourage her to see a doctor but know you can’t force her to do this UNLESS she is a clear threat to herself or to others (ie, threatened suicide or harm to others). Recruit help for housework. For childcare so she can rest. Having a baby is hard work. Raising one while struggling with a Postpartum Mood Disorder is hell. We need all the help we can get. She may not say thank you immediately but one day, in the future, she will be ever grateful for all you did for her when she needed you most. She will say thank you. One day.

Saturday Sundries 03.05.11: Husbands and Baby Blues

Welcome, y’all!

This morning I jumped out of bed, thinking I only had 20 minutes to get dressed and travel to my church for a Women’s Brunch. Turns out I had 50 minutes. I took the time to do dishes before I left. Once I arrived, I felt so blessed and loved. Women of all ages sat together at tables and shared their inspirations for daily faith and Christ-like living. One of the older women at my table cried as she shared her story. I left filled with a sense of camaraderie and connection with several new women in my Church. I am so grateful for the ability to meet in the open with people of the same faith – to be able to speak freely of my beliefs and of Christ’s power within my own life. There are so many places in the world where if you even mention Christ, you will be put to death. But not here.

I spoke of my Postpartum Depression and how God has used that to change my life and allow me to reach out to several women on a daily basis. You know what y’all? Not ONE woman at that table judged me for my hospitalization. Not one woman at that table loved me any less or told me I failed as a mother because I had Postpartum Depression. I know I speak about Postpartum Depression all the time online but I don’t get the opportunity to talk about it in person very often. To sit in sisterhood at a table with other mothers and not be judged for my experiences – WOW. So very grateful and blessed.

Today, I don’t have specific questions to answer. The questions I’ll be addressing are based on search terms which led people to my blog within the past seven days. If people are looking for these topics, I want to provide information to answer their unasked questions.

I wish every one of you a wonderful Saturday – one filled with insight, peace, and happiness.

And as always, take care of YOU first.

*The answers given here are written by me, a non-health care professional. I’m a mom who has been through hell with Postpartum twice, ante-natal depression once and has dedicated her life to learning all there is to know about Postpartum Mood & Anxiety Disorders. Please check with your healthcare provider prior to implementing any of the information you may find below. It is NOT meant to be and/or replace professional advice or orders.

 

1) Should baby blues last for more than 4 weeks?

No. The blues should not last for more than 4 weeks. It may take up to 4 weeks for the blues to dissipate completely but if you are consistently experiencing what you feel are the blues for a solid 4 weeks, you really should talk with your doctor. Postpartum Depression also does not just manifest as “the blues.” There are other issues which are also included in the Postpartum spectrum. Anxiety, irritability, anger, intrusive thoughts, and obsessive-compulsive behavior are all symptoms that may manifest in an episode of a Postpartum Mood Disorder. Up to 80% of all new moms experience the blues. As many as 20% of those who experience the blues go on to develop a Postpartum Mood Disorder. Just because your symptoms of the blues are continuing past 4 wks does not mean you are developing a serious case of Postpartum Depression. But you should absolutely go see a health professional to explore what’s going on with you. Be sure to ask for a thyroid panel, an iron level check, and a Vitamin D level check to rule out any health issues for your continued struggles. It’s beyond important to get the Thyroid panel as Anti-depressants will NOT help with a thyroid issue – and may actually make things worse for someone with a severe thyroid issue, therefore delaying successful treatment and recovery. It’s also very important (and hard) not to blame yourself for Postpartum Depression. You have not done anything to deserve this or to cause this to happy. There is help, there is hope – and you are absolutely not alone as your journey toward recovery.

2) How does husband cope with postpartum?

There are several ways in which a husband copes with postpartum. The answer to this question really lies in what the person asking meant.

Does she mean if HE has postpartum? Or does she mean if SHE has postpartum? And then – does she mean What’s the best way for him to cope? Or how do most husbands in general cope with postpartum? I want to address all of those below in as succinct  a manner as possible.

If HE has postpartum: Men & women exhibit different symptoms when it comes to depression. Men keep quiet. They will stay at work longer, avoid home, self-medicate, get angry and irritable, shift blame, shirk responsibilities, blame themselves for the failure. If your husband is suddenly not at home as much, angry, frustrated, and not smiling or as easy going as usual – it might be time to try to get him to a healthcare professional. A great website to learn more can be found at Postpartum Men. It’s run by Dr. Will Courtenay, who is an expert in Male Depression. Dr. Courtenay is amazing and truly knows the male psyche. If you suspect your husband is struggling with depression, visit Dr. Courtenay’s site and then sit down to talk with your partner. Let him know you won’t judge him and encourage him to get help for himself and for his family.

If SHE has postpartum: He needs to avoid telling her to snap out of her depression first and foremost. Dive in with the chores, housework, and baby duty. Take older kids out to play. Change diapers before mom nurses at night or if she’s sleeping (those precious extra moments of sleep are heavenly). Also, he should read this cheat sheet for a fabulous list of things to say to his wife. Support her going to doctor’s appointments but don’t force her UNLESS she’s clearly expressed intent to harm herself or others. Never every sneak attack a psychiatric appointment on your wife. Bad juju.Very Bad juju. Ask how you can help. And then do it. Don’t wait for her to ask – because she won’t. Bottom line, love her, support her, and help with the work around the house. Give her time to heal and recover. It’ll be a thankless job but one day, she’ll tell you thank you. Trust me. I’m eternally grateful for the support I received from my husband during Postpartum. (This also covers the BEST way for him to cope)

How most husbands cope: The most common gut reaction is to deny there’s anything wrong. Some husbands even believe their wives are faking symptoms in order to get out of parenting responsibilities. Still others tell their wives to snap out of it. Or they believe that medication and doctors can’t do anything to help so they don’t support their wives seeking help, instead telling them that they need to suck it up and just tough it out. Husbands are just as shattered as we are when Postpartum strikes. They are lost – the woman they love with all their heart has faded away. She’s gone. In her place is a new woman, a shadow of the woman she once was – the woman she was maybe even hours before… they don’t know how to fix us. So they get angry, scared, and frustrated. They snap at us, not knowing how else to react. I would highly recommend getting a husband reacting in any of the aforementioned ways to attend a doctor’s appointment with you. A doctor will legitimize your experience for your husband. Many husbands have what we call “White Coat Syndrome,” ie, until he hears it from a doctor, it’s not real. It helps to get him to the Doctor because it involves him in the solution, thereby allowing him to “fix” the situation at hand in some way, which is what men excel at – solving problems. It’s not an easy ride with a husband who is not supportive. You’re also not alone in this – but when you have Postpartum, it is so very important to have support at home – get BOTH of you to the doctor as soon as possible. There is hope, even in this.

Saturday Sundries 02.19.11: Talking with your kids about Postpartum Mood Disorders

Hey y’all!  This will be a short yet important post. I’m in the car on my way to the circus in Atlanta with the family. I planned to blog last night but fell asleep on the couch after watching Grey’s.  Woke up long enough to crawl into bed. So here I am. Blogging from my phone at 70mph. Don’t worry. I’m not driving.

Some of you may have older children in the home when Postpartum strikes. They already have a lot to deal with when a baby joins the family. Their role in the family may change from only child to oldest child from youngest to middle child and so on. Issues of jealousy may enter the picture as a result.

Then Postpartum strikes.

Older children may react in one of two primary ways:

  • Self-blame for parental depression
  • Projected blame onto their new sibling for the cause of parental depression

The most important thing kids need to hear is that a parent’s depression is NOT their fault.

I know that’s hard to do when you’re in the midst of hell. We did not talk with our oldest before my Postpartum experience with our second. I had Postpartum with our oldest as well.

We did talk to our daughters about what might happen with Mommy after she had their brother though.  We drove home that it was not anyone’s fault…. not theirs, not their brother’s,  not daddy’s,  not mommy’s. Then, as a family, we brainstormed ways they could help Mommy if she got sad or angry after baby arrived. My oldest planned to tickle Postpartum Depression into oblivion.

Thankfully I did not have Postpartum after the birth of our son. But our daughters knew how to help mommy and would even ask how I was feeling. I think they were looking for an excuse to tickle me!!!

Bottom line: Talk to your kids. Use language appropriate for their age. Answer their questions in an age appropriate manner. Reinforce that Postpartum is not anyone’s fault. Reassure them that Mommy or Daddy will get well. Recruit family members to take older siblings out to do activities and keep their schedule as normal as possible.

Depression affects the entire family but with careful planning your family can come through with flying colors.

Saturday Sundries: DSM 5 & Postpartum Depression Identifier

Hey y’all. I’m late, I know, I know.

Last night, I fell asleep at 10pm while watching Kevin Smith’s “Too Fat for 40.” He was hilarious. I? Tired. Woke up long enough to crawl into bed before 11pm.

Then this morning, as I woke up at 813a, the day rolled on and I didn’t blog. I hung with the kiddos as the hubs ran some errands. Then we put the kids to bed and I went shopping.

When I got home, it was time for dinner. So the kids ate. Put them to bed, hubs ran another errand, I did my 30 minutes of Wii and watched Grey’s.

Then hubs came home and we ate a yummy steak dinner while we watched The Parking Lot Movie.

After we ate, I opened my laptop to blog.

The dog decided she needed to go outside.

Of course.

So she went. With me.

Then I fixed myself some Twizzler Cherry Bites.

Then the Internet wouldn’t work on my computer.

Hubs tried to fix it.

Three router restarts, a firmware update and another router restart, here we are.

12 minutes before midnight with a HUGE question to answer.

Here goes nothing.

@WalkerKarraa asked the following question: how will Pediatricians and ObGyns diagnose ppd with no dsm specifier in dsm v. Will the icd 10 cover?

I’ve been mulling this one around in my head all week. I wish I had more time to do it justice. But I slacked and I apologize.

First off, I’m not sure what you mean by “no DSM specifier in DSM 5.” As far as I know, they are keeping the identifier as I’ve not read anything to the contrary (if there is something out there, PLEASE let me know because Dear LORD they can’t take it out of there.) As far as I know, they just aren’t extending the onset of PMAD’s to beyond 4 weeks, which, as covered here, is total complete BS.

Secondly, Pediatricians do not need to be “diagnosing” PPD. They should absolutely screen for it but then refer Mom to her own doctor for official diagnosis.

I know what the ICD 10 is, have read it, and remember thinking that it would cover it and in fact, be reason enough for the folks over at the DSM to extend the identifier onset period but… apparently there has to be a defined offset in order for the onset to be extended. I know, my head hurts too.

Just as Jane said at the conference this past year, when the DSM was last revised, they too, fought hard for PMAD’s.

We can’t give up and let our voices be silenced. We also cannot let a book define our own experiences. It is what it is – label or not. Just because a doctor chooses not to label you as Postpartum doesn’t mean that those of us who have struggled with mental illness after the birth of a child will love or accept you any less. We will still love you and support you. We will still be there for you. Always.

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Saturday Sundries 02.05.11: Nutrition and taking Postpartum out on your husband

Hey Mamas and Dadas! How’s it going?

Hopefully your little ones let you sleep in today. If not, then my sympathies. Lots of coffee. Lots.

Our family has been taken out one by one this week with something which can only be described as a Plague from Dante’s fifth circle of Hell. It starts out with a nasty sore throat, proceeds to cold and congested status, then a cough, and then it steals your voice in the middle of the night. Oh, and while I had the girls at the Pediatricians, I was lucky enough to slam the four year old’s hand in the door of the car. Her middle finger? Broken. We had to trek (in the rain) to the hospital for x-rays. Then yesterday out to an Orthopedist 30 minutes away. Trying to drive a car with a gabby four year old in the backseat whilst fighting off the Black Plague should be an Olympic Sport. Turns out her finger is barely broken and we only have to tape it together for two weeks. In three weeks, we go back for a re-check to make sure things have healed properly. Here’s to hoping.

We have humidifiers going, homeopathic cough and cold medicine, Dayquil and Nyquil for us big people, OJ, chicken noodle soup, and rest. Lots of rest. Thanking God for Netflix.

If my kids aren’t well enough to go back to school on Monday, I’m going to Lowe’s to buy what I need to build them their own bubbles. They can go in bubbles, right? Right?

Enough about my family’s close brush with the Plague.

This week, I only got one question for today. The second question is from a statements/concerns from search terms for my blog. They seem to crop up quite often so I wanted to bring them to light and share them with y’all. I had plans to do more than just one but I’m flat worn out from this past week.

Enjoy today’s Saturday Sundries!

1) @Granolamom asked about using Vitamin D to ward off Postpartum Depression. I took the question to the most knowledgeable person I know when it comes to Postpartum and Nutrition, Cheryl Jazzar. Her website is linked at the end of the post. In the interest of full disclosure, I have not received any compensation for linking to it. And as always, if you are already under the care of a physician, check with him/her prior to discontinuing any current treatments and/or introducing any new therapies.

 

Thanks for this interesting question! The use of vitamins for perinatal mood and anxiety issues is becoming very popular. As with any treatment options, it is important NOT to self-treat. Having support and guidance from a professional can prove invaluable. There are many different types of care providers out there, including those who can help with non-pharmacological options.

First, using nutrition for mental health challenges is a strongly emerging treatment for a reason: there is a great deal of scientific data to support it’s use. The problem with scientific data is similar to the problem of using one supplement to help with symptoms: one ‘ingredient’ usually doesn’t work for either symptom control or data collection!

Many women find a great deal of symptom relief by using a few different things together, depending on their presenting symptoms. Typically the same things that new mothers are lacking are the same things curiously absent from prenatal vitamins- things like calcium and magnesium. Some women have a higher need for stress-busting b vitamins; and some have a need for natural progesterone cream. Normally these moms are suffering with a more severe anxiety reaction and they could be high in postpartum copper stores. In these cases, specific trace minerals also play a part in healing.

The good news is that nutritive approaches can work very quickly! This was the case for me when I suffered a severe, lethargic postpartum depression 13 years ago. I was guided in using nutrition by my mentor, Sheryl Cozad of Postpartum Support International and significant relief came so fast I thought it was a placebo effect! Years later I was visiting with a world-famous perinatal mental health expert who said her patients mood symptoms turn around dramatically using supplements, too.

The short answer is, yes, vitamin D is a fantastic element to get more of at any phase of life. However, most postpartum moms are so deficient in so many different vitamins (according to the USDA), that a deeper look with a qualified practitioner can yield quick, lasting results.

 

Cheryl Jazzar, founder of WellPostpartum Consulting, has provided support and encouragement to thousands of women suffering with postpartum depression and related issues.

2) Why am I taking my postpartum out on my husband?

Ever been to the beach? I ask because going to the beach sounds awesome in the middle of February. Unless it’s a beach in the northern part of the US in which case you’ll freeze your bum right off. But I’ve digressed.

So.. let’s say it’s a warm summer day. You pack up the kiddos to go to the beach. Lunch, towels, sunscreen, you’ve got everything. Everyone goes and has a blast. You shower off before you come home. Shower again when you get home. Cook dinner, hang out, put the kiddos to bed. Then you and the hubster cuddle to watch a movie. About thirty minutes into the movie, you start to squirm. There’s something stuck down THERE. It’s uncomfortable. Begins to burn. You can’t shift into a comfortable position. You go to the restroom to try to see if it’s your underwear or toilet paper. Then it hits you – it’s a piece of sand. So you hop into the shower and try to get it rinsed out. But you can’t. It’s stuck. It’s not going anywhere. You go back to the living room. There’s your husband, conked out in the chair. HE’s not dealing with this sand in his vag issue, now is he? Nope. He’s all comfortable and drifting off into la-la-land. You? Want to smack him clear to Beijing. But you can’t because it’s illegal. And mean. So instead you do a few deep squats and jiggles. Take a bath. Eventually the sand dislodges and it’s a distant memory.

Postpartum is that damned piece of sand. It gets lodged in your mind though instead of your vag. You find yourself stuck in a whirlwind, crap flying at you from every direction while your husband seemingly sits in his recliner, completely un-phased by your discomfort and struggles. He’s not doing enough to help with the baby. Where the hell was HE at 2am this morning anyway as you tried to nurse/feed Jr back to bed for what felt like the billionth time in three hours? Asleep. In bed.

Often times, when we are hurting, we lash at those closest to us. Why? Because they are there. We want them to catch us when we fall. Thing is, if we push them too hard, they’ll fall right along with us and won’t be able to or want to catch us. When loved ones react negatively to our behaviour as we fall into a mental illness, it is often hard for us to handle. We react negatively as well, not because we mean to – but because it’s a natural reaction. Not logical, but natural. When mental illness surrounds us, it’s as if we are lost in a dense fog or deep jungle. We have to fight to get out. Sometimes, our loved ones get in our path.

I had tremendous arguments and fights with my husband when I was in the middle of my own episodes with Postpartum OCD. We yelled and screamed at each other. Often, I assumed he would know just what to do – that he could read my mind. When he didn’t do what I had not communicated to him needed to be done, I got angry. But it wasn’t his fault. I also became terribly jealous that he got to go to work every day and spend time with adults. He got out of the house. I was stuck at home with an infant.

Turns out he was jealous of me. I got to stay home with our daughters and watch them grow up. I didn’t see it as spectacular. For me, it was torture. Our communication had completely failed. We were totally jealous of each other, not sleeping, frustrated, angry, and as a result, had become very short with each other. It sucked.

So many postpartum women report issues with their husband as part of what is going on. He doesn’t know what you’re going through. It’s hard for him to relate, hard for him to support you when he doesn’t understand. Take him to the doctor with you. Have them talk with him about his part in your recovery – how he is an integral part of the equation to heal his family. You have to be willing to work too though. Anger is a two way street. BOTH of you have to agree that it’s closed. It’s okay to disagree and have a rational discussion about what’s going on – but rage and tantrumming is not cool. At all.

If you find yourself angry at your husband – start asking yourself why you’re mad at him. Walk away if you have to. Breathe. When you go back, talk with him calmly.

I’ve found the following formula very useful:

“When “x” happens, it makes me feel like “X.” How can WE fix this?”

This approach does two things. One, it doesn’t accuse him of anything. It’s non-attacking. Two – it presents a problem/issue which he can then help solve, creating a teamwork atmosphere. It takes a bit of practice, a lot of compromise on both parts, and time to get back to a place in which you don’t hate him. But eventually you’ll get there if both of you are dedicated to making things work.

 

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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!

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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