"There are other fish in the sea..."

That's probably the most common and cliche phrase associated with the dissolution of a relationship in our American culture.  Over-used, and sometimes hurtful as it is, most of us who have broken up with a partner know it to be true.  There really are others out there and our current relationships are living proof of that.

So, I wonder, if we are so willing to "try again" in love, why are we so hesitant to make a change when it comes to our health?  I hear from people, men and women alike, all the time about the PCP or specialist they've been seeing for years.  "I don't really care for him or her.", they might say.  "But, you know, I've been going there forever, I don't want to make a change now.  I don't know where I'd go and the new doctor would probably the same way."  Or, from moms, "I don't really care for how my first birth experience went or the way my OB treated me, but he/she knows me, and I am just not up for searching for someone new right now."  Understandable?  Absolutely.  But, are they really arguments that you would support if you were a friend to someone making these statements???

Or in another scenario...a very common one in the peer support I do...A woman with PPD seeks treatment.  Perhaps she is early into her experience and being proactive, or perhaps she waited a really long time to get help and is now desperate to feel better.  Either way, she reaches out to her doctor, friend, insurance company or a contact that suggests a resource.  Perhaps it's a psychiatrist, a therapist or a counselor of some sort.  Or, maybe, she's reached out to her OB-GYN or PCP for help...telling her story to them for the first time and scared to death.  What if the reaction she gets is not helpful?  What if the person just writes her a prescription for an SSRI (with no instructions on how to gradually taper on to the medication or recommendation for complementing the drug with therapy)?  What if the therapist or physician she sees for the first time offers no hope for her situation or says something that is hurtful?  And, God forbid this unlikely but possible scenario...what if a mom sees someone for a period of time before realizing that the person is not helping her and perhaps has even done something outside of the code of conduct?

The less severe of these examples happens all the time.  We (postpartum peer support providers) hear from women every week who have a poor experience with something related to treatment.  Sometimes it's an ill-matched medication (remember, prescription drugs are not a perfect science and body chemistry is a huge component into which medication is best for you personally).  Sometimes it's a therapist who really doesn't have expertise in PMADs.  Sometimes it's a physician who wants to rely exclusively on prescription drug treatment and isn't responsive to the mother's preferences or the need for therapy to accompany meds in many cases.  Sometimes it's a physician who is hesitant to treat for PPD because they aren't aware of the dangers of untreated mood disorders.  Sometimes it's someone in the medical community giving a mom poor advice related to medication and pregnancy or breastfeeding.  Sometimes it's a therapist who is just, well...a jerk.  And sometimes, the doc or therapist you see is just not a good match for you, even though your best friend or a woman you like at your support group suggested him/her.

So, what do you do?  Do you give up?  Throw in the towel?  Stop reaching out for help?  Tell yourself you gave treatment a fair chance and just hope it'll get better on its own?  I hope not.  Just as you wouldn't give up dating completely based upon one bad experience, I hope you won't give up on getting help because of one bad apple in the medical field.  You?  You are way too worth it not to forge ahead, seek a new resource, and give him/her a shot.  Is the second time always a charm?  I wish I could say yes, but the reality is not always, though in many cases it will be.  Sure, it may take some time, effort and other investments to find the right treatment plan and provider for you.  But, your health, your family, your future and your happiness are all worth it!

Who is to blame for motherhood being so complicated these days?

The other day, I came across a couple of articles.  This one, entitled Mother Madness, sparked the next two.   In Mother Madness, Erica Jong at the Wall Street Journal tackles boldly all of the unspoken realities and misconceptions about this need to strive for perfect parenting and the competitiveness (and lack of truth-telling) that complements it.  Here's a bit from her piece:

Someday "attachment parenting" may be seen as quaint, but today it's assumed that we can perfect our babies by the way we nurture them. Few of us question the idea, and American mothers and fathers run themselves ragged trying to mold exceptional children. It's a highly competitive race. No parent wants to be told it all may be for naught, especially, say, a woman lawyer who has quit her firm to raise a child. She is assumed to be pursuing a higher goal, and hard work is supposed to pay off, whether in the office or at home. We dare not question these assumptions.

Finally, someone calls out the nonsensical and impractical aspects of Attachment Parenting.  In my personal opinion, she, like so many writers who need to do so to get the attention of readers and to increase the readership of the piece itself, goes a bit overboard.  I am not sure that I would use the words "victimize" and "prison" when it comes to the actual reality of motherhood.  But, Amen to those statements as they relate to how a mother, especially a mother experiencing a perinatal mood disorder, can feel at times.  No, motherhood is not a prison, regardless of how you choose to parent.  But, YES, mothering can sometimes feel imprisoning for sure.  And, absolutely is it possible to feel victimized by a traumatic childbirth, parenting a sick baby, or going through a significant mental health crisis.

A few days after Jong's piece was published, The New York Times Motherlode blog responded by calling Jong's essay "a mishmash of old accusations against overinvolved parenting".  The writers contend that Jong just doesn't get it and that attachment parents don't generally succumb to the pressure to attachment parent, they do it because they really want to and believe it is the best for their family.  Okay, I see that side, too.  However, I would presume that this is not the case for many, many families.  I see the tweets, blog posts, and other media daily that in my opinion strategically masks over-pressuring and coercing families into everything from bed-sharing, to grinding your own babyfood, to having a VBAC, homebirth, etc...even when it may not be the safest option.  Don't get me wrong...I have NOTHING bad to say about doing any of those things, but I do wish there was a way to know how many people, if they weren't ever exposed to all the media and the play-yard conversations that I believe invoke unnecessary guilt on mothers who don't do things the "right way according to the 2010 media", would actually be cloth diapering, co-sleeping, or claiming that they don't care how many times their 11 month old wakes them in the night...God forbid CIO be considered.

A little while back I wrote a post about parenting styles, specifically about the idea of Attachment Parenting.  Here's a snippet that kind of sums of my post:

There's more to parenting and motherhood than slings and bed-sharing, my friends.  While I totally respect people whose goal is to encourage parent-child bonding and a more gentle, responsive style of parenting than most of us probably experienced as children, I also take pause.  We have to support each other in this journey regardless of the exact path that each of us chooses.  What works for one mama may do more harm than good for another.

Then, just this week in another Motherlode post, Modern Mother's Little Helpers, the author writes about mothers of this generation being seemingly more stressed, depressed and overwhelmed by the same tasks than our mothers or grandmothers.  She writes from the perspective of wondering about the sheer number of moms who are medicated and whether that is a symptom of increased mental health issues in the population or a product of parenting being so much more stressful and meds being so much more available that they are used as a first line of defense.

I don't know much about the stats regarding women who are medicated and whether or not they "need" the medications.  I do know that perinatal mood and anxiety disorders impact at least 20% of childbearing women each year.  And that, my friends, is enough to as Belkin describes, bring about a "need to talk about it".  I am certain that not all the women she's referring to have or are recovering from a PMAD.  I do wonder how many of these women who later have difficulty coping perhaps did have an untreated mood disorder earlier in their experience.  And, how many of them have a family history of mental health issues.  And, how many of them might not be peri-menopausal.  And, how many of them are just overwhelmed by the constant barrage of pressure to "do it the right way"!  

I think we need to fight back.  Not against Attachment Parenting.  Not against what those who practice AP call "Traditional Parenting".  Not against any parenting style.  Rather, against claiming and promoting a particular style in the first place.  If you truly practice an instinctive, responsive way of parenting that suits your family's needs, then why, WHY, do you feel the need to push that on anyone else?  Why is it necessary to label how you interact with your children?  And why would you think that any other family is similar enough to yours that your style would be best for them anyway?

So mamas, I challenge you to take all the labels regarding parenting out of your vocabulary.  To be very careful to say, "this is what works for us, but I am sure what works for you is probably different" when sharing about your parenting methods.  To remind yourself, and others, that no one child, parent, or style is perfect.  Then give yourself and your child a hug and take a deep breath knowing that however you (and others) are doing things is A-OK.

FAQs

Now that the cat is out of the bag, I am getting LOTS of great questions about my pregnancy.  Some of you may be wondering the same things, so I thought I would post a few of them here...

How far along are you?
I am just about 14 weeks.  My due date is in mid-May.

How are you feeling?
That depends on the day.  Early on, I could have pretty much just universally answered, "Crappy.".  Now, it depends on the day, the time of day, and about another dozen or so other factors.

No, I mean how are you "feeling"?
OOOOOHHHHH, you mean as in emotionally?  Of course....Well, I'll tell it to you straight.

The first couple of weeks I think I was in shock, a bit of disbelief and maybe even denial.  Most of all, though, in that period between peeing on the stick and feeling like I wanted to throw up all the time, I was just impressed.  Impressed with my body for working (and fairly quickly at that) the way that it should and with myself for physically and emotionally being open to the idea of another child enough to create the conditions conducive to a pregnancy.

In the 6th and 7th week, I took a bit of an emotional nosedive and the shock turned into a bit of panic.  I found myself unable to think about the pregnancy without feeling really down and as a close friend described me during that time, "my light was turned out".  During this time, I mustered up the energy to reach out to my therapist, contact a new physician and let my husband know that I was struggling.  I also alerted my close friends that I wasn't doing so well, because I knew it was important to give warning that would elicit heightened awareness of my mood to those who spend the most time with me.

Gratefully, weeks 8 and 9 got busy and my mind was taken off of my "condition".  I began to tell others the news during this time period and each time I did it got a little easier.  I was so caught up in how people who had walked PPD with me three years ago would react that I wasn't able to do much celebrating.  Once I realized that people were much more happy for me that I had anticipated (at least to my face), it got a little easier.

In weeks 10-11 my brother got married and I went to the PSI conference.  Both were fun and social events where I openly shared that I was pregnant and became more comfortable with both telling others and the fact that I was indeed expecting a child.

In the past couple of weeks, the nausea and fatigue are subsiding very gradually.  I notice that as I feel physically better I do emotionally, as well.

As I was writing this, I got a call from the doctor's office that performed my perinatal screening tests.  The results were reassuring...averaging to a 1 in 3000 or so chance of the baby having Down's Syndrome or Trisomy conditions.  While we would welcome and love any baby that God blessed us with, I must say that my concerns over having a child with significant developmental delays were heightened this time.  Knowing that I may suffer from mental and physical health problems postpartum weighs heavily on my heart and I have to be honest in sharing that my age was a risk factor for concern's about the baby's health.  I questioned my capabilities in dealing with my own struggles postpartum as well as possible news or challenges that would arise should the baby have significant special needs.  While the future is uncertain on both fronts, as plenty of other complications could arise, this this piece of hopeful knowledge lightens me a bit.

I am still adjusting to the idea of the newborn stage, possible anxiety and depression, adjusting to two children, and all of the new things that this baby will bring.  But, all in all, I am doing well.  And for that, I am grateful beyond words.

Guess what???

Clues:

• I can house a bag of chips while simultaneously complaining to my husband that I feel like I'm gonna puke.
• I haven't tweeted about wine in 8 (make that 9) weeks.
• Zofran is concurrently my digestive system's best friend and worst enemy.
• I find myself getting carsick...while in the driver's seat.
• I am tired...I mean dog-tired...almost all day long.  Even after a full night's sleep and afternoon nap.
• Owning a mini-van seems slightly more practical for our family lately.
• My desire to move into a larger home has gone from, "Sure, it'd be nice and I hope it happens someday soon." to "M, if you don't figure out a way to move by February I am going to lose my mind!"
• I have weeded my summer clothes out of the closet, but instead of replacing them with winter clothes, there's a big hole waiting for...
• I spent a ridiculous amount of $ today at Gap's Give and Get sale but none of it will fit me (I hope!) in a year.
• Every planning conversation revolves around May 2011's proximity to the event.
• I went back to yoga class today...for the first time in forever...and had to modify the inverted and twisting poses.

Yep, I got a little bun in the oven...named Champ.

"Champ", the Leap of Faith

Some of you may not be surprised because either...
a) I told you in person and totally ruined any chance of you getting to read my blog and make guttural noises in response to my news while at work supposedly doing your TPS reports and such when really you're reading my blog...
OR
b) you've guessed cause I have been practically MIA for weeks and keep referring to this "thing" which I will be sharing "soon" and never seem to get to writing about.

Anyway, about eight months ago L started repeatedly asking for a sibling.  Not in that occasional I saw someone else with a baby brother to beat up on way, but more in a I really, really want to be a big brother way.  So we started talking about it more seriously.  And, while my husband isn't exactly a strategist about such things, y'all know I totally am, so I started working the math, considering how I was feeling physically and emotionally and coming up with a plan.  In April (or was it May?), I went back in to see my doc and had my lovely, beautiful BFF, a.k.a. IUD, removed.  And, we started getting to business.  All the while, L continued to bring up the topic of a sibling, and as time passed determined that only a sister would do and that her name should be either Champ or Chocolate.  Of course we didn't clue him in that we were working on it, but we sort of got a kick out of of all his silliness about it and the irony (and possible disappointment) coming if we did conceive a boy instead.

In early September, I was at work one day and late afternoon took a trip to the ladies room.  I returned to my office disappointed and convinced that we failed to conceive yet again that summer.  I lamented to a girlfriend that I felt both sad and guilty for feeling such a way when folks sometimes took years to conceive and others weren't able to at all.  The next day, a Jewish holiday, my hubby was off from work and we had the rare pleasure of a morning together.  We dropped L at school, went for breakfast and took in a yoga class together.  It was glorious!  After picking L up and putting him down for a nap, we decided to indulge in a siesta, too.  I had to pee and decided that since things were a bit different (and I was feeling kind of "off") that day I might as well use one of the dozen or so pregnancy tests I had gotten when the local drug store closed a few months prior.  Well, I peed on the stick and less than ten seconds later the bold blue letters "PREGNANT" appeared.  I just couldn't manage to get all creative this time around, so I simply walked out and put the stick right in front of M's nose.

And, that, my friends, is the story of how we learned that Champ, my little leap of faith baby, is the newest member of our family.

Meet Champ:

Anxiety triggers post-PPD

Oh, y'all I have pages and pages of notes from the conference last week to share with you!  One page is filled with ideas of ways we could expand work here in Georgia via the partnerships I currently have.  One page is filled with bulleted blog topics- enough ideas to last until at least mid-2011.  The rest of the legal pad...yes, the entire pad, is filled with notes from sessions I attended on everything from screening to treatment to studies on rat brains and the how the genes which communicate with hormones are correlated to whether the rats lick (or instead eat) their babies.  My brain is like a sponge right now, still sitting in the half-full sink of water trying to absorb that last 10% of water before it is truly saturated.  I promise, promise, promise to write and write some more about everything I learned...and to answer the great questions (or to tell you that even those brainiacs who study this stuff all day, everyday still aren't sure) in response to the stuff you sent me just before I headed North.  And, I have some important personal stuff to share, too, so I promise to catch you up in the next couple of weeks.

But, in the meantime, the dreaded time change is here.  For those of you with itty-bitties or grown children, the whole "Fall-back" thing may be translated into, "Oh, gee, this is the kick-butt weekend I gain an extra hour of sleep!"  However, for those of us mommies to children older than one, but younger than teens, this is that weekend which we dread as soon as we turn the calendar to a month that ends in "-ber".  On Sunday morning, 6:00am will really be 5:00am.  There's no way to guarantee that L's internal clock will adjust automatically like our cell phones do, and in fact, I can most assuredly tell you that it won't.  Of course, we've been putting him to bed later, hoping that he will use this week of preparation to reset his circadian rhythm.  But, at 6:15am this morning (which will be 5:15 in just a few short days), he was yelling for mama.  Gratefully, I convinced him it was much too early (thank you rainstorm for your dark and sleepy state) and he did settle back in for another hour or so- VICTORY!  However, I of course lay there awake the whole hour, wondering whether and when he'd call me again and show me that my attempts to get him back to sleep were futile.

As I lay there, I realized that the thoughts, feelings and physical sensations were familiar, though in a distant sort of way.  Yes, this feeling, amplified by ten and spread across 24 hours per day, 7 days a week, was just how the weeks of anxiety and panic that pervaded my postpartum and L's newborn experience had been.  The insomnia.  The waiting to hear a baby cry.  The "oh, I think he just moved, I wonder if he's awake" thoughts that zoomed through my mind each time the house creaked.  The counting of not just hours, but minutes, of sleep that he had gotten and then the analysis of how that would impact his days sleep...you know the whole, if he sleeps too much he won't take good naps, but then again that expert says that sleep begets sleep so if he sleeps to little he won't take naps either because in just 12 short hours his little body must have completely unlearned how to sleep!  You get the picture.

Sleep was my obsession, nemesis and a mirage throughout my PPD experience.  So, it's no surprise that even years later I still worry about sleep.  While PPD might be a distant stranger, the remnants of it aren't so much.  In fact, I believe our anxiety triggers stay at the surface, waiting for opportunities to rise up when we are even the slightest bit vulnerable.  The trick is recognizing them and using strategies you've learned to overcome or move past them.  Time and time again recently, I have read and heard that research (real, scientific research) shows that 98% of things study participants worried about never happened at all.  And, in fact, of the 2% of worries that did actually occur, nearly all of the participants reported that those occurrences were actually less severe and traumatic than they had anticipated.  Rest assured, my friends...you can and will handle most anything that comes your way...even a 5am wake-up call.

(Brief) Recap from PSI Conference

Last week I attended the annual conference of Postpartum Support International in Pittsburgh, PA.  The Marce Society joined forces and it was quite an experience!  Doctors, therapists, researchers, scholars and advocates from 25 countries!  People presenting research around perinatal mood disorders that was conducted in diverse populations, for diverse purposes and that (sometimes) had diverse results...

I am still digesting everything I learned, but here are a few personal highlights:

• I left my son for more than one night for the first time ever!  Included in this milestone is that while he had childcare help while he was at work, my husband handled the everyday tasks that he's never had to tackle before like getting L to school, putting him to bed 4 nights in a row, and dealing with the everyday minutiae of running a household while I was gone.  
• I read AN ENTIRE BOOK while I was gone.  Start to finish.  I can't say how many pages it was, as I read it on Kindle, but I promise it was an adult book, and wasn't a trashy romance novel either.
• I sat in numerous sessions with Dr. John Cox...the name might not strike a bell, but this man is the developer of the Edinburgh Postpartum Depression Scale; you know the most widely used and validated screening tool for postpartum depression (and related illnesses) in the world.  Love his accent, his humility, and his thoughtful insights when presented with new research!  What a pleasure it was to be in his presence.
• There is still a bit of a discrepancy regarding the preferred terminology when referring to mood disorders in the perinatal period.  However, in my observation, the currently preferred way to reference these illnesses is "Perinatal Mood and Anxiety Disorders" or PMADs.
• There is A LOT of debate over the prevalence and symptoms of postpartum depression.  You can read more at Lauren's blog, My Postpartum Voice, but in a nutshell, there are some physicians who believe that the symptoms of PPD are the same or similar to that of typical major depressive episodes and that the onset of such symptoms is within 4 weeks of giving birth.  Hmmmm...this is something I'd love to hear from you about...cause I'm not sure I can swallow this pill.
• We PPD Bloggers got to hang out as a quartet for the first time ever.  So nice to see Katherine and Lauren there, and pleasure to meet you in person, Ivy!