Category Archives: Breastfeeding

Breast Cancer, Diabetes screening worth it; Postpartum Depression screening not

Leave a reply

Earlier this week, I wrote about UK researchers concluding that Postpartum Depression screening was just not cost effective.

Since then, a couple of other studies regarding screening for other conditions have been released.

It seems that screening for Diabetes in primary care qualifies as cost-effective.

And screening for Breast Cancer saves lives despite the habitual over-diagnosis. For every misdiagnosed case, two lives are saved. In fact, the researchers for this study state that approximately 6 women are misdiagnosed and undergo unnecessary treatment for cancer they may never have developed as a result of a false positive at the screening level. In case you were wondering, these researchers are UK based as well.

Hey. Wait.

The researchers from the UK cited over-diagnosis  as one of the reasons formal screening for Postpartum Depression was not cost effective.

And being misdiagnosed with Postpartum Depression does not lead to expensive radiation treatment or other damaging exposures including surgery. At very worst, you may receive a script for an anti-depressant or a referral to a counselor for some talk therapy.

What the….

So lemme get this straight.

Pumping a woman full of radiation and chemotherapy is hunky dory and cost effective EVEN if she doesn’t need it.

But a quick questionnaire to check on mom’s mental health is NOT?

On what planet does this even BEGIN to make sense??

Let’s also discuss this little nugget. For both the Diabetes and Breast Cancer studies, ACTUAL records were used. The Postpartum Study was compromised of 92 “hypothetical” cases.

When did we stop rating the study of actual records? When did researchers stop including the actual risks and ripples of Postpartum Depression? A woman without Postpartum Depression or who is successfully diagnosed, treated, and recovering is more likely to breastfeed in my opinion. And if she’s nursing, she’s protecting herself and her child from – guess what – Diabetes AND Cancer.

So you really want to practice cost-effective healthcare?

SCREEN women after birth. Ensure their stability, support, and positive outcome with life as a new mom. Encourage them to participate in health practices for themselves and their children. Enabling women to make healthier choices reduces the risk of other issues down the road. Screening saves lives when it comes to Postpartum Mood Disorders. It saves mothers, children, and families. It’s not something you skip over because it’s simply not “cost-effective.” Skip screening and cost will simply shift elsewhere – to diabetes care, cancer care, future mental health care for mom or kids, broken families, etc.

It is simply not acceptable to allow new mothers to continue to suffer. Not acceptable at all.

Therapy Choices for the Postpartum Woman

5 Replies

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

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

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

Hold the phone there.

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

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

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

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

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

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

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

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

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

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

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

Will that be baby or a set of plastic horns?

Leave a reply

More and more mothers these days are turning to exclusively pumping for their babies according to an article over at Time Magazine.

Why?

The article gives several reasons from not wanting a baby at your breast to “having other things to do” besides nurse to not wanting the humility of having to nurse in public.

As a mom who has fed her children via exclusive breastfeeding, exclusive pumping, and with formula, I have to say while I understand and I’m glad these moms are at least giving their children the benefit of breastmilk, I’m a little befuddled.

I exclusively pumped for our second daughter for seven months and hated it. I hated the pump. The horns were cold, hard, and didn’t offer to cuddle with me when we were through. They didn’t fall asleep on my lap, snuggled up next to my breasts. No, instead I had to sterilize them and return them to their waiting positions on the kitchen counter. Why did I pump? I pumped because my daughter was born with a cleft palate and therefore physically unable to nurse. As she was facing multiple surgeries to take care of a few issues including closing her palate, I saw my breastmilk as important medicine that would help get her through those early few months with some extra protection. It wasn’t because I wanted to save time (and by the way, nursing a baby does save time – it’s not a Hoover of time as some of these moms would have you believe), it wasn’t because I had other things I had to do, and I would have proudly nursed her in public if I could have.

What’s interesting is that this article cites a research study which showed that not breastfeeding mimics child-loss.

In an intriguing paper published in July in the journal Medical Hypotheses, Gordon Gallup, a professor of biopsychology at the University of Albany, posits another upside to sticking with the breast: a mother’s decision not to breast-feed may unwittingly mimic child loss, evolutionarily speaking. Given that bottle-feeding technology did not exist for the last 99.9% of human evolutionary history, Gallup reasons, the likeliest reason a mother of yore would not have breast-fed is the death or loss of the child. He suggests that the consequences for the bottle-feeding modern-day mother could include an increased risk of postpartum depression and difficulty producing milk. (Read More from the article by clicking here)

There are several other reasons to nurse directly:

  • Heating breastmilk may cause some nutrient loss
  • Pumping requires a high level of sterlization of pump parts and bottles. (Trust me as someone who’s been there – this is time consuming! And I even used Medela’s microwaveable steam sterilization bags!)
  • Freezing milk also causes nutrient loss
  • Some breastmilk does not store well due to an enzyme that cause it to become foul smelling and tasting
  • Time limit on how long breastmilk can be at room temperature. While it CAN be out and about longer than formula, there is a limit. Nursing directly does give you more freedom to do whatever you want to do.

I have always been very supportive of moms doing whatever they feel they need to according to their own family philosophies but this takes the cake. With our third child, I was faced with having to pump again because he wasn’t gaining enough weight with just breastmilk. (My supply had dipped due to some severe emotional trauma). After a day of consideration, I decided to move straight to formula. I could not go back to pumping because I knew where that would lead me and frankly, I just was not ready to return to that dark place.

For any mom out there who is considering to exclusively pump instead of nurse, please know that it is a LOT HARDER to EP than it is to nurse. It takes a lot of dedication, a hospital grade pump to really get a decent supply going and continued, and EP’ing is a lot more time consuming than nursing. Please educate yourself about the pro’s and the cons before jumping into the exclusively pumping pool. It’s filled with some deep water, ladies.

Given the choice, I’d choose baby over horns ANY day.

PPD Survivor Shares her Story for the first time

Leave a reply

On Tuesday, this was a comment left by a mom who had never shared her story with anyone besides her husband (who lived it with her). I emailed her to ask if she would be comfortable with me giving it a post of it’s very own. Her story begins when she is 34 weeks pregnant and continues through to postpartum. I hope you find it as inspiring and as strong as I did…..

This is my first time to share my story in any capacity…. I don’t know if I’m ready, but here goes nothing…

My depression started around 34 weeks into my pregnancy… I had never heard of PPD and I didn’t know what ante partum depression was… I started to realize something was wrong somewhere between 30 – 34 weeks. I’m not afraid of medication, and think of it as an aspirin would be to a headache.

I have had depression and anxiety before so, I somewhat, recognized the signs. I told my husband that I wasn’t quite feeling right, and he encouraged me to speak with my OBGYN. At my next appointment I told my doc that I was worrying excessively, and not feeling quite right. It was really a whole new type of depression for me.. I never could and still have difficulty describing the way I felt. But worry was a BIG concern. The OBGYN said it wasn’t a big concern, and not to worry lots of new mom’s worry a lot.

My husband is a member of the “mind over matter” club. While he, I’ll say, tolerates, my need for meds to get my depression under control, he definitely is one of those, “Just push through it,” kind of people.

I saw my OBGYN on Tuesday, and she prescribed me Prozac, I ended up going to the E.R. on Sunday because I felt very overwhelmed; with what exactly, I do not know… They gave me an Ativan shot, made sure I calmed down and sent me on my way, with no real information. Or possible expectations. I then saw my OBGYN again on Wednesday, explained what had transpired over the weekend, and she prescribed me some Xanax. I felt so horrible that day, that we went straight to the nearest pharmacy and filled the script so I could take one. That Sunday I woke up and I felt worse than I thought I ever could. I told my husband that he had to take me to the E.R. So they could take the baby out so that no harm would come to her, if I did end up harming myself.

I thought this was a completely rational thought process; and was even more distressed when they told me that instead of delivering my baby early, they were sending me to the Nut House. All of this scared my husband to death, not only was he in fear of losing his wife, but that there was a possibility that he could end up without a wife and a child, or raising a baby on his own. And it was definitely one of the two, because the baby could not stay in me anymore.

I think that is when he realized, after two weeks of doctors and E.R. visits, that something was really wrong and a real threat existed not only to my life but to our unborn daughter’s life as well! I went to the psych. ward at a private hospital, where they were fairly knowledgeable about pregnancy related depression. The one thing that is VERY FRUSTRATING in my case, is that, since I was pregnant I was having a OBGYN come in and check on me daily, and since I was high risk (because of a blood disorder) I had a specialist coming to see me daily as well. They kept telling me it would be okay for me to get some Ativan, which had provided tremendous relief at the E.R. Visits, but the psychiatrist that was assigned to me when I arrived, REFUSED to give me anything other than Benadryl and Celexa, neither of which were providing any immediate relief.

As I have learned over the past year and a half since this all occurred, most psych. Wards have limited visitation, and mine was no different. My husband could come to the evening visitation and spend an hour with me. The first few days all I did was cry the whole time he was there. He was so scared. I was breaking his heart and that just made me feel even worse. I really just wanted to give him the baby and leave (you know d-i-e…) I didn’t want to burden him with all of my problems anymore. The thought of me not being around anymore, was the thing that was really bothering him. He got it in those moments.

I got out of the hospital and managed to hold it together until 38 weeks!!! YAY ME!!! When my OBGYN, asked if I wanted to go ahead and deliver, I practically took myself straight to the hospital right then. Coincidentally, I went into labor on my own the day I was scheduled to deliver. My delivery was easy… But there were some complications with my epidural, which lead to added stress. It is the most horrible feeling in the world to think back onto that day and to look at pictures and to know in those moments there was no joy, no love, and no want, for my beautiful, brand new baby girl. You can see the blankness in my face and the fakeness in my smile in all of the pictures… It breaks my heart to think of it. Will she understand, what was wrong with me then? Will she know how much she has ALWAYS been loved and wanted!

This was my husband’s first baby, but my second. I have a, now 10 y.o., daughter from a previous relationship, so I had been through the nursing and diapering and everything before. I was uncertain of myself because of my depression and anxiety, but I knew what I was doing automatically. My husband second guessed everything I did. He questioned my positioning of the baby while nursing, and was convinced that she was not getting any milk, despite the fact that the nurses had told him multiple times that everything was going fine. As one would assume this only compounded the problem I was dealing with.

A couple of days out of the hospital and other than the epidural complication I thought I was feeling much better! I look back now and think that the depression was just masked by the Vicodin they were giving me for pain after the delivery. I probably had about a weeks worth of Vicodin, and within a few days after that, I was back in the E.R. I won’t go into all of the how I was feeling… But I ended up back in the psych. Ward.

Telling my husband the second time felt easier to me… With the flawed logic of depression, It seemed very simple. I leave (aka die) and then he doesn’t have to worry about me, he now has his child, life will be easier without me… Yada yada yada… The same visitation schedule existed, naturally, I had just been there little less than a month before… My husband came to all the visitations and brought our daughters. (the first time I lied to the oldest about where I was, she still doesn’t really know why I was there either time) again, in the moment, he was understanding, apologetic, and sympathetic. He just wanted me to do what ever I need to do to get better, and come home to our family.

We had tough decisions to make. Since I was nursing, and since I had the same psychiatrist that I had had previously, she was equally unwilling to provide me with any REAL meds, until I agreed to stop nursing ( as I type that, I think I hate her for that!) Up until the point in which I agreed, I pumped and dumped, my milk every few hours in my room there in the ward. That too was heartbreaking, but I was finally at a point mentally where I knew I had to get better and go home, and without me at home, there wouldn’t be breast milk anyway! So I stopped pumping and finally got some relief!!!

When I first came home my husband was great!!!! He did the laundry without being asked, he made sure there were meals for everyone, he helped out with our new daughter a lot. But as time passed and things have gotten better his back to his same old self. Mind over matter. He really does spend a lot of time wondering what the hell is wrong with me.

I’m glad to report, that I’m now doing great, as long and I don’t have to talk about the time around my daughter’s birth, (this post has resulted in the need to take some Ativan!) And you don’t talk to me about having another baby, which my husband definitely wants to do, and I’m not so sure I can handle it… I can’t even type out what happened to me without having a panic attack!!!! But for the most part I’m GREAT! ;o) I’m down to 30 mg of Cymbalta a day, and Ativan as needed (which is rare!). We are working on weaning off the Cymbalta, but I’m in no hurry! I want to be well and I want to be here with my family.

I’m looking forward to sharing this post with my husband. I think I have stated fairly well, what I will need him to do better next time. I have also printed of a “Me First” letter (got it from a post on a PPD site) and will be well armed if we decide to have another baby! I wish my husband had a better understanding of depression. I which he could remember how VERY REAL everything we went through during our daughter’s birth was. Maybe then he would have more compassion for my now fleeting struggles, and be WELL prepared for the next time!

Just Talkin’ Tuesday 08.11.09: Breastfeeding & PPD

Leave a reply
Original Photo "the breastfeeding lady 2" by Raphael Goetter @ flickr

Original Photo "the breastfeeding lady 2" by Raphael Goetter @ flickr

When I gave birth to my second daughter I saw my dreams of a normal postpartum smashed upon the rocks just 30 minutes after delivery. A delivery after 42 hours of labor, 36 weeks of pregnancy spent un-medicated but largely depressed and unaware of any potential issue facing us. We fully expected (as any parent) a healthy child, normal delivery. A large part of my smashed dreams tied into the hard reality that I would absolutely not be able to nurse her because she was born with a cleft palate so wide and large that it would be physically impossible for us to do so.

Later that day I was faced with a crucial decision. What kind of formula would I prefer for my daughter? I cried. She wasn’t SUPPOSED to get formula! That evening found me hooked up to a hospital grade pump praying for anything to happen. I barely squeezed out a drop. But I persisted and pumped for her faithfully until she was seven months old. I even researched everything I could in order to try to get her to nurse – books, cleft organizations, the La Leche League, the local Lactation consultants and even going to a training to become a trained Certified Lactation Counselor (which I completed one month AFTER we stopped nursing!) I left no stone unturned! Charlotte and I used SNS, nursing shields, and sheer determination. She eventually nursed for almost five minutes! Those five minutes were so amazing words cannot even begin to describe. In fact, it was tears falling from my face which interrupted the glorious event.(You can read more about our journey here: Breastfeeding Charlotte)

But at seven months, I faced a decision. My desire to continue to give breastmilk to my daughter or my mental health which had deteriorated so much it was adversely affecting my relationship with my husband and other daughter. With a heavy heart, I drove to Wal-mart to purchase formula. I cried the whole way home. Eventually I made peace with the decision. “Hanging up the Horns” or HUTH as it’s called in the world of exclusive pumpers, was a difficult decision. But one I was glad to make as it allowed me to bond with my entire family. I had come to resent Charlotte for all the extra work she required. But now, all I had to do was pour, heat, and I was done. I made strides towards better mental health and so did the rest of the family.

For me, the decision centered around the stress providing breastmilk created. I was also on medication which can be another tremendous issue for new moms. Many mothers don’t want anything crossing over to their infant through their breastmilk. Dr. Thomas Hale, author of Medications & Mother’s Milk, is a wonderful authority on the topic as are the researchers at Motherisk in Canada. When nursing while on any medication, it is important for the infant’s pediatrician to be aware of the medication and dosage amount so baby can be monitored for any adverse reaction. The decision to take medication is a personal one and should be made carefully with the help of professionals. Ask questions. Make sure the prescribing physician KNOWS you are nursing. And do not let them force you into quitting nursing if it is the one thing in which you find comfort. If you are currently struggling with this decision, please read this wonderful essay by Karen Kleiman: Is Breast Really Best?

So let’s get to Just Talkin’ Tuesday already!

Did your Postpartum Mood & Anxiety Disorder affect your nursing decision? Did you decide to formula feed to help improve your mental health? Do you regret your decision? Made peace with it? Did stopping help? Did your desire to nurse increase your desire to seek natural treatment? Speak up! Share!

(Absolutely no bashing for deciding to formula feed will be tolerated here. We respect the decision of all mothers to choose the course of treatment/feeding they feel is right for their families. Any posts discrediting or attacking a mother for her decision to formula feed will not be approved.)