Friday, February 27, 2009

Brief Maternal Depression Screening at Well-Child Visits

Ardis L. Olson, MDa,b, Allen J. Dietrich, MDb, Greg Prazar, MDa and James Hurley, MDa

Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire

OBJECTIVES. The goals were (1) to determine the feasibility and yield of maternal depression screening during all well-child visits, (2) to understand how pediatricians and mothers respond to depression screening information, and (3) to assess the time required for discussion of screening results.

METHODS. Implementation of brief depression screening of mothers at well-child visits for children of all ages was studied in 3 rural pediatric practices. Two screening trials introduced screening (1 month) and then determined whether screening could be sustained (6 months). Screening used the 2-question Patient Health Questionnaire. Practices tracked the proportions of visits screened and provided data about the screening process.

RESULTS. Practices were able to screen in the majority of well-child visits (74% in trial 1 and 67% in trial 2). Of 1398 mothers screened, 17% had 1 of the depressive symptoms and 6% (n = 88) scored as being at risk for a major depressive disorder. During discussion, 5.7% of all mothers thought they might be depressed and 4.7% thought they were stressed but not depressed. Pediatric clinicians intervened with 62.4% of mothers who screened positive and 38.2% of mothers with lesser symptoms. Pediatrician actions included discussion of the impact on the child, a follow-up visit or call, and referral to an adult primary care provider, a mental health clinician, or community supports. Pediatrician time needed to discuss screening results decreased in the second trial. Prolonged discussion time was uncommon (5–10 minutes in 3% of all well-child visits and >10 minutes in 2%).

CONCLUSIONS. Routine, brief, maternal depression screening conducted during well-child visits was feasible and detected mothers who were willing to discuss depression and stress issues with their pediatrician. The discussion after screening revealed additional mothers who felt depressed among those with lesser symptoms. The additional discussion time was usually brief and resulted in specific pediatrician actions.

Here is a link to a great article in its full format about the same topic.

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors

Here is a briefing on some recent research on the correlation between unplanned pregnancies and perinatal behaviors, specifically PMDs...
Cheng D, Schwarz EB, Douglas E, Horon I.

Maryland Department of Health and Mental Hygiene, Baltimore, MD 21201, USA. chengd@dhmh.state.md.us

BACKGROUND: This study was conducted to determine the relationship between unintended pregnancy and maternal behaviors before, during and after pregnancy.

STUDY DESIGN: Data were analyzed from a stratified random sample of 9048 mothers who delivered live born infants between 2001 and 2006 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey 2 to 9 months after delivery. Binary and ordinal logistic regression methods with appropriate survey weights were used to control for socio-demographic factors.

RESULTS: Compared to women with intended pregnancies, mothers with unwanted pregnancies were more likely to consume less than the recommended amount of preconception folic acid [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI) 1.7-3.2], smoke prenatally (OR 2.03, 95% CI 1.5-2.9), smoke postpartum (OR 1.86, 95% CI 1.35-2.55) and report postpartum depression (OR 1.98, 95% CI 1.48-2.64); they were less likely to initiate prenatal care during the first trimester (OR 0.34, 95% CI 0.3-0.5) and breastfeed for 8 or more weeks (OR 0.74, 95% CI 0.57-0.97). Compared to women with intended pregnancies, women with mistimed pregnancies were also more likely to consume inadequate folic acid, delay prenatal care and report postpartum depression.

CONCLUSION: Even after controlling for multiple socio-demographic factors, unwanted and mistimed pregnancies were associated with unhealthy perinatal behaviors.

Tuesday, February 24, 2009

My husband interviewed at the Postpartum Dads Project

My husband, M., was interviewed by Lauren Hale for her fairly new and wonderful project at Postpartum Dads. This interview was a wonderful chance for M. and me to think about the PPD experience of our family went through from the point of view of a husband and father. I am deeply grateful to Lauren for providing this opportunity for sharing, healing and education. Bless you!

Monday, February 23, 2009

Can Men or Partners Really Suffer from Postpartum Depression?

Please check out this link to a great blog post at Perinatal Pro about Men and PPD.

PostpartumMen is a place for men with concerns about depression, anxiety or other problems with mood after the birth of a child.

You may also want to check out PostpartumDads, created by David Klinker for new dads whose wives are suffering from a PPMD.

Here is a link to another great site for postpartum fathers. The Postpartum Dads Project collaboration came about as a result of a month long focus during June 2008 on Dads and PPD at Lauren Hale’s Blog, Unexpected Blessing.

Here's a blog post from '05 about a father's view of being a new dad.

Lastly, below is a 2008 article on the topic...

Post Partum Depression In Men

Almost as many fathers as mothers may suffer from post natal illness

from www.suite101.com

© Rebecca Lucas

Post Partum Depression is thought to occur in anywhere from 10 to 25% of new fathers, compared to between 14 and 30% of new mothers.

Post Partum Depression is a fairly well documented illness for women although there is still a lot to learn. By contrast, there has been almost no research into Post Partum Depression in men despite evidence that new fathers are, statistically, almost as vulnerable to PPD as are new mothers.

Hormonal Changes

In women, there are hormonal changes which can lead to difficulties after a birth. In some cases, the woman may barely notice any change while, on the other extreme, it could become the beginning of PPD. However, it is the emotional changes and, sometimes, physical changes to his environment which contribute to PPD in men.

Symptoms

Some symptoms may appear the same in both men and women, particularly withdrawal and emotional disconnection from their child as well as both physical and emotional withdrawal from a partner. However, while women will find emotional ways to cope, for example, may cry a lot or show severe differences in emotions, men are more likely to become withdrawn physically as well as emotionally. Typical behaviour might be seeking distractions in the form of drink, hobbies, television, etc. They may become more irritable, impatient and even aggressive. The worst part being for those around him who must cope with this as, in this situation, he is showing his inability to cope and, typical behaviour may become seen as normal or he may not even realise that anything is wrong.

Diagnosing PPD in Men

While a woman may show extremes of emotion and, possibly, appear isolated from her new baby, this may not be seen in men. It may never be noticed if a man is isolating himself from his responsibilities because, in the main, it is still the mother who nurtures the newborn child. Men might feel left out or not needed. This might make it difficult to diagnose PPD as opposed to simply feeling unneeded.

Looking out for symptoms is important. Usually, it is agreed that showing five or more of a list of symptoms (which can be found on the websites below) may constitute reasons for diagnosis although it may be wise to look for a diagnosis if there are less symptoms. Also, just because the symptoms appear, it should not be assumed that it is due to PPD.

Treatment

It may be difficult to treat a man suffering from PPD, partly because a man, even if he did realize that there was a problem, would not often be willing to admit to it. The first hurdle to overcoming PPD in men is getting him to admit that there is a problem. Once this is achieved, there are treatments available but the best form of treatment for men is counseling as the hormonal therapies available for women would not be appropriate. Helping men to discover the reasons behind their PPD may help them find the necessary treatment. It may be that there are underlying factors in their depression and it may be depression itself spurred on by feelings of, perhaps, not being able to live up to their fatherly expectations, in which case, antidepressants may be available.

More About Post Partum Depression

post_partum_depression

http://menshealth.about.com/od/relationships/a/Postpartum.htm


Thursday, February 19, 2009

Placenta Encapsulation: prevention of PPD?

From http://placentabenefits.info
There are many ways to prepare your placenta for ingestion. Some women feel comfortable putting placenta in a smoothie, or creating a special recipe for it. Some women even consume it raw. These methods will work, but they limit the length of time you are able to utilize the benefits of placenta to a matter of days.

My preferred method of ingestion is by capsule. The placenta can be dried, ground, and encapsulated. The capsules can then be taken daily for a number of weeks. You reap all of the healthful benefits of placenta quickly, easily and discreetly, and the capsules will last indefinitely (for years). When you have recovered from childbirth, you can freeze the capsules and save them for menopause.

Placentas are rare and powerful - make the best use of the ONE available. Encapsulation is by far the optimum choice for ingestion and preservation.
About Placenta Benefits.info

Emotional issues following birth are usually given the vaguely demeaning term of "baby blues", making the condition easy for doctors to dismiss, and leaving women to cope as best they can until it passes. Only now they are often rendered silent, quietly waiting to enjoy what should be the happiest time of their life.

In some cases, the baby blues continue long enough to meet the diagnosis of postpartum depression. Women are then commonly prescribed antidepressant medication and advised to stop breastfeeding so the drugs will not get passed to the baby.

Postpartum depression is a serious condition that is a real concern to many expectant women. Studies are finally being done to discover its roots, but it has not even been considered a valid psychological condition until just recently. As a result, there is much to learn about its causes and any potential cures.

I created this site to provide a central location for placenta information, specifically as it relates to the health benefits for postpartum women. When I began researching placentophagy the articles were often difficult to find, and generally highlighted the strangeness of it more than anything.

I believe that Mother Nature has already provided women with exactly what we need to begin our journey into motherhood healthy, happy and vibrant. Through the ages that knowledge was lost. It is time now to set aside our societal prejudice, and embrace the placenta for what it truly is - a path to wellness.

~ Jodi Selander




Monday, February 16, 2009

ABC Television Puts Murderous Mommy on "Private Practice" Instead of Postpartum Depression Sufferer

by katstone

ABC Television contacted Postpartum Support International several weeks ago to say they were doing a story about postpartum depression on an episode of "Private Practice" and wanted to do a public service announcement (PSA) with information about the illness. I was aware of this project, because as the PR board chair for PSI, I had to write the PSA copy. I was told a message about the PSA would appear at the end of the episode (which aired last night) and would direct people to the ABC website to watch it. ABC wouldn't tell PSI any more about the episode.

As it turns out, the storyline was about postpartum psychosis instead of depression. Yet another story about a murderous mommy rather than the truth about perinatal mood and anxiety disorders. (A mom who initially seems to be having symptoms reflecting perhaps postpartum depression or anxiety turns out to have tried to drown her baby in the bathtub.) Additionally, ABC did not air the message about the PSA as they promised, thus viewers wouldn't have even known it existed. And on the "Private Practice" area of ABC's website today is an awful poll asking people whether the child of the mom in the episode should or shouldn't have been taken away.

This type of media representation of these illnesses must stop. It just continues to stigmatize the women who have them, and put fear into their hearts about being judged and asking for help. Postpartum Psychosis is extremely, extremely rare. Most women with perinatal mood and anxiety disorders never harm their children or want to harm them or attempt to harm them. Please join me in my "Pull the Plug on Private Practice" mission by refusing to watch the show.

As I wrote earlier this morning on my blog "Postpartum Progress":

Last night's episode was promoted, both to the public and to the members of Postpartum Support International, as one about postpartum depression, but -- surprise, surprise -- it immediately devolved into a show about postpartum psychosis and a mom attempting to kill her child by holding her down under the water in the bathtub. Every time the media, whether entertainment or news, chooses to cover perinatal mood and anxiety disorders, the portrayal is always of some out-of-control woman committing or attempting to commit infanticide. They NEVER represent the fact that 99% of women with perinatal mood and anxiety disorders NEVER EVER EVER EVER EVER do anything to harm a hair on their infants' heads. That 99% of them are very good and loving mothers who simply have an illness that requires treatment. They never represent the fact that there is so much more to these illnesses and that postpartum depression is very common and treatable.

In the name of getting more viewers for "Private Practice," ABC and the shows producers have irresponsibly represented perinatal mood and anxiety disorders and potentially traumatized HUNDREDS OF THOUSANDS of new mothers. I do NOT exaggerate when I say that. Just ask yourself how many husbands, family members and friends who saw the show are looking at the new moms around them today wondering whether they're capable of murder? Just ask yourself how many moms are not going to reach out for treatment because they now think their babies will be taken away as the character's was? Just ask yourself how many moms won't get in contact with a healthcare professional because they're afraid the person will behave like Violet, the therapist on "Private Practice"?

Just as I stopped going to Tom Cruise movies (and will not start back, despite his very clever new public relations strategies), I will not watch "Private Practice" ever again. And in case you think I'm the boycotting type who boycotts everything that makes her mad, please know that this is only the second time I've ever done this in my life, Cruise being the first.

I ask you to please join me to "PULL THE PLUG ON PRIVATE PRACTICE" by no longer viewing it as well. We have to speak out. This is very important, even for those of you who have never suffered a mental illness during pregnancy or in the first year postpartum: All women must stand up and let the media know the way they treat perinatal mood and anxiety disorders, and mental illness in general, is unacceptable.

I'm sure they'll say, "But it's just a TV program. No one takes it seriously." Well if that was the case, why do you use a medical consultant (who obviously has no clue, but whatever)? Why did you reach out to PSI? Why am I getting emails from women who are so terribly upset and confused?

We have to tell them that the power they have to influence and move others is much too enormous to be improperly used. We have to make sure the information that moms and moms-to-be receive is correct and measured and encourages them to get the treatment they need. If we don't make our feelings known loud and clear nothing will every change. We owe it to many millions of women who will suffer perinatal mood and anxiety disorders in the next decade.

If you plan to stop watching "Private Practice", I encourage you to write about this on your own blogs and use the tags "Pull the Plug on Private Practice" and "postpartum depression" and "ABC".

Sunday, February 15, 2009

"I was terrified I would never bond with my baby"

This honest if not slightly harsh piece written by British author Helen Walsh is especially interesting to me because of the direct take on the SLOW bonding experience most mothers endure. Take it for what it is, but I hope you will take something from reading it.

First-time mother Helen Walsh had the usual fears during her pregnancy, but the one thing she never expected was to feel indifferent towards her baby. Plunging into a deep depression, she felt growing anger at the silence of the sisterhood...

The first time my newborn was hefted on to my breast - flailing, almost translucent, his stiffened legs still in the breech position; the first time I felt his tiny, blind mouth latch on to my nipple, I felt something akin to terror, as though someone had taken a choke-hold around my throat and wouldn't let go. Like all new mothers, I was acutely and suddenly aware of the awesome responsibility this angry little creation had heaped upon me. Yet it was what Leo's arrival hadn't triggered that scared me most - the rib-crushing swell of emotion, the mother-baby chemistry that is supposedly wired into our DNA. In all those months of quelling potential birthing calamities in my mind, never once had I mooted a scenario in which I'd feel numb, estranged, gutted; that I wouldn't fall instantly and madly in love with my boy.

It wasn't as though I'd spent my pregnancy in a mawkish funk of excitement. I wasn't one for poring over baby manuals, or cooing over miniature vests. I was nervous about motherhood, uncertain whether it would prove the right choice for me. This stemmed partly from my work as a writer: disposable truisms on women writers and motherhood had had a profound impact on my decision to have - or rather delay having - a baby. In his essay, Novels and Children, Roland Barthes makes the misogynist assertion that women can be mothers or writers, but not both. There is an army of contemporary authors proving otherwise - Monica Ali, Kate Mosse and JK Rowling, to name but a few - but, regardless, I harboured real fears that the freedom to dip quill in ink whenever, wherever would be supplanted by a system of scheduling and timetabling. My output would have to be managed - harnessed and condensed into a few stolen hours.

My anxiety deepened when, during a routine blood test at 13 weeks, a midwife chanced upon the faded wounds of self-harm. The scars were years old, inflicted during a period in my mid-20s that was blighted with episodes of depression and mania. But I had hitherto managed perfectly without mood stabilisers and I expressed concern that conducting a postmortem on my mental health was more likely to trigger a relapse than prevent one. Nonetheless, I was there in the system as "at risk" and I was coerced into seeing a shrink. The hospital psychiatrist stressed time and again that her role was to support me - this was not a litmus test to deem how fit a mother I would be. And yet there was something about her tone, and the implications she made in letters to my GP, that suggested otherwise.

Expectant mothers who fail to float around in a state of feverish anticipation are regarded with suspicion, especially if the pregnancy is planned. It's a case of: well you wanted the baby in the first place. Our misgivings are expected to be confined to the birth itself and the baby's wellbeing - while the wider concerns of our career, relationships and financial independence are magically supposed to pale into insignificance. Maternal feelings are thought to be so deeply rooted in our "nature" that it is almost deemed "unnatural" to experience anything negative - dread, regret or even resentment - toward the unborn life in the womb. Women who feel this way are viewed askance; they must be suffering from ill mental health (prenatal depression) or they're simply Bad Mothers in the making.

Even more entrenched in women's "essence" is a non-negotiable pre-programming that we love our offspring immediately and unconditionally, right from the start. Antenatal classes dangle the carrot of maternal bliss as pay off for prolonged, traumatic labours. The old midwives' tale has it that the agonies of childbirth are swiftly blown away by an instantaneous and overwhelming surge of love. Like most first-time mothers I took this as gospel. I relied upon it as an absolute given that no matter how exacting the birth might be, whatever the child's gender, however it came out, as soon as it came out, I would love it completely, heart and soul.

By the time I went into labour I had been awake for 48 hours. When my midwife finally established that the baby was breech - which the various scans had failed to pick up - I was rushed through to deliver him via emergency caesarean section. For anyone in any doubt whatsoever, the section is no easy opt out; it's major surgery. After an hour's breather I was wheeled on to a ward full of lively newborns. By now I hadn't slept for almost 60 hours. But in spite of being deemed "high risk" and in spite of the previous role that sleep deprivation had played in triggering manic episodes, I was forced to stay awake. There was an empty ward next door into which I repeatedly begged to be moved so that I could sleep when my baby slept - which was little and infrequently. Such requests were denied. By the fourth night I was figuring out how to detach the system of tubes and drips that fetter new mums to their beds so I could do a runner. I was hallucinating. I was suicidal.

I don't know how Aimee, one of the midwives working the night shift, appeared at my bed; perhaps, in my sleep-starved half-life I'd buzzed for her, or one of the neighbouring mothers had alerted her to my behaviour. Whatever the case, I trusted her instinctively and for the first time I was able to open up to another woman about my deep, dark fears, without being judged. I told her that I was terrified I would never bond with my baby, that breast-feeding had so far failed to solder us together in the ways I'd assumed nature intended. I told her that I was fighting the instinct to bolt and because I would never be able to live with the shame of walking away, suicide seemed like the only option.

She told me the fourth night is always the most difficult, soothed me to sleep, then took my baby away and delivered him to my breast four unbroken hours later. It was the first time I'd slept in days. When I woke up, the world looked less bleak, and I was allowed - indeed, compelled - to take baby home. But back at the homestead and in spite of the relentless support from Leo's doting father and our extended families, the absolute lack of sleep continued to play havoc with my moods. My small boy, suffering from undiagnosed reflux, was up eight, nine times a night, on the breast for hours at a time, but unable to draw succour. Often I found myself stumbling around the village in the small hours of the morning fantasising about acceptable escape routes. When I finally got him to sleep I'd sit in my local cafe casually penning suicide notes as though they were thank-you letters for baby gifts. In fact, the ideation of suicide acted as a safety valve during those first six weeks. The promise that soon I might be able to switch off the black noise in my head and stop the vaulting in my guts kept me going.

Amid the flurry of midwives and militant feeding specialists who crossed the threshold in those first weeks - none of whom picked up on my mental decline - one good health visitor came into our lives. She could see I was coping badly and reassured me it was not uncommon. She didn't say it was "natural" not to bond immediately and automatically with your baby, but it certainly wasn't "abnormal" to feel a degree of anger or resentment.

Her words were like a huge shot of serotonin to the spirit - yet the truth was that I was never angry at my baby. It was the sisterhood I had come to resent. After all, wasn't motherhood supposed to be the glue that binds feminists of all persuasion? Isn't the bond you form with women on becoming a mother as inviolable as the bond you form with your baby? That's the spin, yet in spite of the antenatal and postnatal clannishness that is supposed to accompany childbirth there is paltry discursive terrain for mothers like myself to come clean.

Instead there seems to be a collective code of silence governing those first few months of motherhood. Maybe it is born of a time-cherished will to preserve the magical aura of new birth for all expectant mothers. Or maybe it's simply too horrid to acknowledge - the idea that we might not fall head over heels in love with our newborn is plain unthinkable. As a mother, I now know why those women abandon their babies in church yards and hospital toilets. I understand them in a way that I never could before, yet in spite of the hyper-awareness that these days surrounds postnatal depression those women are still viewed as pariahs. Is it because walking out on a child is still seen as a male prerogative? Or is it because there is no worse stick society can beat a woman with than the slur of being a Bad Mother?

It seems illogical that feminism has progressed to a point where many young women no longer see gender as a life determinant or deterrent yet we've wholly failed to twig that the prevailing icon of the unimpeachable mother is in fact a requirement of the patriarchy. It's enough that men assume and expect us to "raise" their progeny without the sisterhood getting in on the act, too.

Sadly, there seems to exist this competitiveness between new mothers based on the precociousness of their newborn. That, in turn, finds its most unrealistic expression in the business of sleep, or rather "sleeping through". The bestselling No Cry and Cry It Out manuals - gospel, if contradictory, texts to all new mothers - suggest that a baby's sleep patterns are within our control. Therefore, in not controlling them we are fallible. We have failed. The one and only time I attended a postnatal group I came away feeling betrayed. Despite the preponderance of hollow eyes, haggard faces and defensive demeanours, most of these women bragged that their babies were sleeping through. Babies that were barely three months old, babies that were breast fed and had yet to even start teething. "F---ing liars!" I wanted to scream. I wondered, if asked directly, how many women would take a deep breath and own up to feelings of isolation, of madness, of sheer despair and naked resentment?

Taking the step to see a different psychiatrist and articulating to her the feelings I'd been harbouring was a step in the right direction. I told her that I fantasised about abandoning my baby. I told her that I thought about suicide a lot, that the biggest dilemma motherhood posed to me was whether or not to take my son with me. Rather than section me as I had expected, involve social services or at best prescribe monster doses of lithium, she recommended that I pop a sleeping tablet. She used the analogy of diabetics who forget to take their insulin and explained how the rapid dip in sugar levels can trigger suicidal thoughts. Sleep deprivation, she explained, can work in pretty much the same way.

She instructed me to leave Leo with my mum, go home and sleep for 12 hours solid. I remember waking the next morning refreshed, mentally replenished. The Smiths were on the radio, birds were bickering outside. I felt that immediate and visceral urge to write - not to purge or exorcise demons, but for pleasure. However, the need to boot up my laptop was quickly overridden by a stronger, unfamiliar pull that came from 20 miles down the M62. There, my little man was waiting - and I could not bear to be without him. I had butterflies in my stomach all the way. For the first time since his arrival I was able to experience that rib-crushing heave of euphoria on picking him up.

I don't think for a moment I'm a Bad Mother for having felt like this, though it's taken a while to be able to admit it. But the bottom line is that sisters aren't doing it for themselves, we're doing it to each other. The sooner we allow that every mother's nature develops in its own individual way, the quicker we join the same side. For now, we're still taking the bait and trying to best one another, doing everything we can to prove that we're the perfect mother, just to give our men what they've always taken for granted.


Friday, February 13, 2009

Does ABC care?

So many of you know that ABC's Private Practice episode last evening included a storyline of a woman suffering from a PPMD. ABC consulted with Katherine Stone of Postpartum Progress before they shot this episode. They would not tell her much about the details of the show or the character, but did share that it featured a woman suffering from Postpartum Depression and Anxiety. So, I invited everyone in my Facebook community to watch, and they all invited everyone in their community to watch. Some were hoping to spread the word about PPMDs. Some were hoping to educate not-so-empathetic or understanding family or friends about the truths of PPMDs. Some were just glad that a storyline that didn't involve a woman killing her kid/s was going to be portrayed.

Well, I think we all sighed a bit of disappointment and then later a little relief as we watched the saga unfold. Woman-Rachel takes her baby Cynthia into the Dr. office after a fall in the tub. She states that the baby fell out of her exhausted arms and she just wants to have her checked out. As she begins to share the story it becomes apparent that she is sleep deprived...She repeatedly tries to rationalize the fall, repeating the doctor's statement about how normal it is for a new mom to have a minor "accident" with her child. (I know I did- when L. was 3 months old I passed out while holding him after getting up too quickly and then at 5 months he fell from our very high changing table while I was changing his diaper. Both times were super scary, but I know now that babies are resilient and that most moms have some sort of similar scary "Aha" moment- a fall from a bed, accidentally clipping off the tip of the finger while trimming nails, etc.) Anywho, Rachel begins rambling at a fast and furious pace about how little Cynthia is sleeping and how even when she is sleeping Rachel can't sleep. She is unable to fall asleep and is having racing thoughts. She is obsessively watching infomercials. She is constantly breastfeeding to try to make it work. The actress did a terrific job of portraying a woman in the hell that is a postpartum mood disorder. She was spot-on in her delivery of the combination of adoration and loathing that you have for your child and being a mother when you are sick. The writers did a great job of including the many symptoms that accompany Postpartum Anxiety. BUT...they fell super short of educating the public when they went the traditional path of including an attempted harmful act to the child. WHY did Rachel have to hold the baby under the bathwater when she fell? What made those writers compelled to turn severe Postpartum Anxiety into Postpartum Psychosis which is so much more rare and already so over-dramatized and associated with stories of mothers taking their children's lives and/or their own? I have extreme sympathy for those families and the mothers...from Andrea Yates to Jenny of Jenny's Light, I know how much this illness can change you and allow you to do things that would be unthinkable while well. But, come on! This was a great opportunity to go down a different path. To talk about something more common and educate a population of Americans who are VERY unsympathetic and completely filled with rage. Below each and every national media article about postpartum psychosis you see hundreds of comments from angry people who do not understand postpartum mood disorders. They chastize the women who suffer and offer no sympathy. They make statements like, "How could she do this to a helpless child? She was not sick, she was just selfish." Those of us who have suffered or know someone who did know better. But look people, MOST Americans are not educated and need to be. Let's utilize the means that we have to help them to learn...to understand...to see the full story and to find their way to a place where in America routine screening, referral and treatment are no longer options but mandatory steps in the postpartum period.

I think ABC lost an opportunity here to shed light on a real and prevalent illness for their selfish desire to get ratings and viewers from the more dramatic and interesting spin that just one aspect of the story illicited. Oh well. At least it got people talking about PPMDs.

Lauren Hale at Unexpected Blessings shares her thoughts about the episode here.

Here is the link to the PSA that ABC posted to their site. They had promised to air a mention of the web PSA after the show last night. Unfortunately, it seems that they chose to spend their air time playing and replaying a plug for the 3rd and last Grey's/Private Practice show next week. Shame on them.

Lastly, you know that another ABC drama, daytime's General Hospital has been protraying the character of Dr. Robin Scorpio as having some postpartum issues. Yesterday's episode seems to be leading to a "miraculous recovery" without treatment for Robin. Yet another lost opportunity if ABC sends the message to its viewers that PPMDs will get better on their own, with time, or if in the case of Robin's situation when your daughter gets sick and almost dies and then gets better when you hold her. I totally believe in the power of a mother's love to help heal her child...but seriously...you don't put your baby in a tree in a blizzard one day and then later on that day get totally well just because.

Getting it

Sometimes in life God creates wonderful opportunities for our eyes to be opened through seemingly insignificant or significant, but seemingly negative situations. Last Thursday, my nanny L. had her baby more than 2 weeks early. It was her first child and when preparing her schedule for the month of February, we never dreamed that she would need to prepare for an early baby. God had a different plan! L. went into labor on Weds. at our house, didn't even tell us and at 5:45am on Thursday morning she gave birth to a beautiful baby boy. She had what many of us in the PPD community would label as the "blissful birth." She didn't even really know that she was in labor for sure and she accomplished a peaceful, natural, vaginal birth after just a few hours at the hospital. In fact, she arrived at the hospital 9cm dilated!

L. notified me in the typical L. way. She sent a text message with a photo of her baby at her breast and the text just said, "B. was born today. I don't think I will make it to your house." Haha! That's my L. She's easy, calm, matter-of-fact...everything I am not and LOVE about her! Her text sent me into a state of shock and panic, as well as JOY and if I am honest a little bit of jealousy, too. How happy I was for L. that she had this idealistic birth. Not that it was not at times painful or that the hospital staff did everything "right," but that she trusted all along that she would know what to do, to the point where she did not take ANY birthing classes and was not at all nervous about her ability to birth without any interventions or pain meds. But, that she was able to achieve her goal of a natural, vaginal birth with just a short hospital stay and a successful start to breastfeeding. No one deserves it more than this angel who takes care of my child with passion and love like he is her own.

So my panic related to the childcare pickle I was now in ensued after a few minutes of celebration for L. and her family. OK, first things first. I have to cancel the playdate I had scheduled with the woman I met for only a minute or two at a local restaurant...don't have ability to focus on conversation and getting to know new person while in state of panic. 2) Need to begin to formulate plans A through at least G to cover the next 2 weeks before L. is supposed to start daycare. The next day included phone calls to friends and family. Some for support, some for ideas, and some to actually ask for help. While most of the time I am glad we live so far from "home" and the drama that would include, I do feel sad that we don't see family as much as we'd like and know that a consequence of the "ignorance of not being in the middle of daily family drama is bliss" when you live out of state is that we do not get the constant free childcare that our siblings get from our parents.

Over the next 24 hours M. and I made LOTS of calls and finally settled in that his teenage niece who happens to be expecting in May would come down for 2 weeks to watch L. until he got into daycare. We were about to buy the plane tickets when I got a call from the daycare. L. could start on Monday- two weeks early! Yay! So we canceled S. for the two weeks and told her she could come down next month and went into the daycare to fill out the paperwork that afternoon.

On Monday, L. had a rough transition to the regimented schedule of daycare. Though no one is more routine and scheduled than me, L. is used to being responded to so that he can eat, drink and play as he initiates. Daycare means scheduled snack times, naps only once a day, and sleeping on a cot instead of a crib. That and a whole room of new faces in a new place would be enough change for anyone. L. cried on and off all day Monday and refused to eat. I cried the entire drive home and was not sure I could take him back the next day. Tuesday, he ate a little, napped a little more and cried and a little less. When I picked him up he felt warm to me, but he had just been on the playground. That night, I took his temperature and it was 101.5. 2 days in and he was already sick. Over the past 3 days I have stayed home, missed work, and played with, comforted, held, rocked, fed, and loved on my baby. I stopped worrying about how many hours until the next nap or bedtime and started worrying about how much I wanted to be with my child, especially when he was sick. I stopped obsessing about how much I wanted to be at work and how guilty I felt about it and stayed in my pjs until 1pm one day. I started realizing that I am a good mom and that I can care for my child. I don't know when L. will get well or when I will have a day to myself again. I do know that I finally GET it and I am so grateful. What I thought was a challenge and cause for panic- childcare pickle, illness, rocky start to daycare, etc. showed me that I AM a mom. I am L's mom. I am a good mom...and I am actually enjoying it.

Monday, February 9, 2009

In the moment

Lately I have been trying to live in the moment. This overused phrase seems be to thrown around quite excessively, yet seems to have much value in its meaning. For those of us with anxiety, living in the moment can seem impossible as we constantly anticipate what is next, and sometimes even obsess or worry about those possibilities.

When you have children it seems really important to cherish each moment holistically. So many times each week I am told by parents of teenagers how much they wish that they had treasured each and every day with their children when they were younger. How with their second or third they make more of an effort to be home, to be at sports games, to be involved in leadership in their clubs or groups. I want to heed this advice.

My anxiety (some a result of a PPMD and some my natural state of being) often robs me of the moment. Growing up in a state of chaos and instability bred fear and preparation for the worst as my everyday existence. Unfortunately, I still, at 32 years old, find myself often anxious about the moments to come rather than enjoying, or at least focusing on, the one I am living.

This month, my goal is to concentrate on what is really at hand. Rather than being overwhelmed by a full day one on one with a toddler, simply going with the flow and following his lead where appropriate may actually be easier and more enjoyable. I know that I will be okay no matter what the day will bring us. I just need to transform that knowing into living. If I go throughout each moment of the day with a certainty that I can handle what is ahead perhaps I can do more than simply to get through the moments, but actually live in them.

Thursday, February 5, 2009

Postpartum Process Group begins in Roswell, GA in March

Jacqueline V Cohen, LAPC is starting a postpartum depression/anxiety process group in Roswell starting March 17. It will be located at the address below. This group is for women who have a newborn up to a one year old child. It will consist of 6 to 8 women. Topics will include any symptoms of depression and anxiety, adjustment to motherhood, body image after baby, partner/family/community/support, communication, family boundaries, motherhood in the 21st century, and what it means to be a "good enough" mother.
The group is an 8 week commitment. It begins Tuesday, March 17th and will be held every Tuesday for 8 weeks from 11-12:30. Non -mobile children are welcome. Cost is $40 per group, plus initial interview. If you know anyone who would be interested, please have them contact her at 404-822-1026.

Postpartum and Women's Issues Counseling
115 Vickery Street
Roswell, GA 30075
(404) 822-1026

Check out my interview at Unexpected Blessings

Dear readers,

I am thrilled and honored to have been asked by Lauren Hale, PSI Co-coordinator for the state of GA and PACE founder, to do an interview about my postpartum experience. This interview was posted today. You can find it HERE.

Tuesday, February 3, 2009

Hormone may predict postpartum depression: U.S. study

By Andrew Stern
CHICAGO (Reuters) - Spiking and sinking levels of a hormone that prepares a pregnant woman for the strain of childbirth may hold the key to why some women suffer postpartum depression, researchers said on Monday.

In a study of 100 women, researchers at the University of California, Irvine, found 12 out of 16 women who had postpartum depression also had high levels of a hormone circulating in the placenta midway through pregnancy.

Corticotropin-releasing hormone, or CRH, is normally produced in tiny amounts by the hypothalamus near the brain in response to stress.

In pregnant women, the placenta pumps out 100 times more CRH than is normally produced by the hypothalamus. The hormone has been nicknamed the "placental clock" because it is thought to prepare the woman's body for childbirth, said psychologist Ilona Yim, who worked on the study.

Levels of CRH and other hormones drop after the mother gives birth, which Yim said causes hormone "withdrawal" that can create havoc with the endocrine system.

"It puts the whole system out of whack," she said in a telephone interview.

CRH triggers a cascade of reactions in the pituitary and adrenal glands that culminates in increased output of stress hormones like cortisol.

Previous research suggested an overactive stress response plays a role in heart disease, Alzheimer's disease and autoimmune disorders. Stress hormones produced by a dysfunctional endocrine system may also trigger mental disorders like depression.

"When they look at the brains of suicide victims, they have elevated levels" of these stress hormones, Yim said.

Postpartum depression strikes those who experience the biggest change in the hormone levels, Yim found. Women who had high levels of CRH 25 weeks into their pregnancy were more likely to experience postpartum depression.

"This is the first study that implicates CRH in postpartum depression. That has implications for understanding this disorder," she said, adding the results needed to be replicated on a larger scale.

Postpartum depression affects as many as 1 in 5 women four to six weeks after childbirth, and 7 percent of new mothers suffer a major depression. If not addressed, women can become so despondent they attempt suicide, and some harm or neglect their newborns.

Previous bouts of depression, a lack of social support, low self-esteem and a stressful pregnancy all increase the likelihood of postpartum depression, according to the study, which appeared in the Archives of General Psychiatry.

The report suggested that a routine blood screening, which would coincide with a commonly performed prenatal diabetes test, could determine levels of the hormone at around 25 weeks to identify women at risk.

While antidepressant drugs can sometimes relieve postpartum depression, Yim urged a preventive approach, such as having at-risk women learn relaxation techniques common in prenatal yoga classes, and bolstering the emotional ties they may need.

Monday, February 2, 2009

ICAN conference in Atlanta includes resources for PTSD and PPMDs after childbirth

My friend Maureen asked me to pass along this info on the upcoming conference to any moms you know who might be interested.? There will be a session on birth trauma (from a SOLACE session that was done by some of our members...info about that group is here: http://www.solaceformothers.org/) and one about healing from birth, among many others. Pam England, author of "Birthing From Within" will be speaking and we're also showing the film Pregnant In America. ICAN is a group for mothers who have had cesareans, but there are plenty of sessions there for anyone interested in any aspect of birth, so we hope to get women from all different backgrounds to attend. In addition, we have lots of opportunities to share our birth stories with other women who "get it."

Considering, thinking about, maybe having a second baby after a severe Postpartum Mood Disorder

As you can see from the title of the post I am very clearly decided (insert sincere sarcasm) about whether or not to have another baby (soon or in the distant future) after struggling with such a severe postpartum reaction with my first child. I don't believe I am alone in this struggle. In fact, What Am I Thinking? Having a Baby After Postpartum Depression by Karen Kleiman addresses this very topic. I have owned the book as a resource for the support group for almost a year, but I have yet to crack it. Even acknowledging that fact that concretely that I may indeed become pregnant again and endure another postpartum period (though I am prayerful it will be much easier this time) creates anxiety, and I believe rightfully so. Any woman who has overcome this horrific and hopeless/helpless experience knows just how much your innocence, blissful ignorance, and sheer first pregnancy joy is stolen by the PPMD demon. Never again will I eagerly await my little bundle while napping at will and nesting without anyone to interrupt me. If I do this, next time around I will have a little boy to care for and a home filled with toys, arts and crafts, and other kid messes. I will not be able to nap as I please or get a full night's sleep without listening for my child.

Last night, during the Superbowl (how romantic!- reinsert sarcasm) my husband asked me when I was going to get my IUD out. Humph! While the Steelers were playing (and winning at that moment) and we were having a good time together, it seemed like an awfully strange time to mention such a serious matter. Rather than go down the road of recalling all the terrible days and weeks of PPD and the risks associated with another pregnancy and postpartum period for me, I simply said, "when we have a bigger house we can talk about it." This seemed like a perfectly logical response to me. Trying to appeal to my want/need for a larger home since it was apparent, he said cleverly (he is SUCH the salesman), "well, wouldn't it be nice to have some motivation to move if we had another baby on the way?" GRRRR! No, it wouldn't be nice! It sounds to me like a ridiculous amount of stress to be pregnant, have a toddler, work, do volunteer work, and MOVE! You have got to be kidding me. Shocked, he responded, "you mean we have to wait until we are living in another house to even try?" I didn't even answer.

While my psychaitrist has assured me that she will be there for me during a second pregnancy if I decide to have another child, and that she promises I will not have severe PPD again because of the care I will receive during and after birth, I still feel nervous. Feeling nervous makes me concerned about pregnancy again. The first time I was feeling good most of the time, had plenty of time to rest, to have good times traveling and spending time with friends, etc. and I still struggled after. This time, I will be chasing after a toddler and will spend the entire 9 months worrying about the possibility of feeling as bad as I did the first time after I give birth. On top of that, what about the physical challenges I will have to endure- a c-section, possible anemia and thyroid issues again, and the rest that goes along with the first months?

I really do want to give L. a sibling someday, but for me someday is a bit farther away than 9 months. That's okay...repeat...that's okay...THAT'S OKAY!

If you are considering having another child after a battle with PPD or are pregnant already, I would love to hear from you. Please comment here or email me at atlantamom930@gmail.com.