The Realities of Postpartum

I just realized I was supposed to blog again in September (my Sept post was meant for Aug), as I’d promised I would blog at least once a month from October 2020-October 2021.  So, this blog post is to make up for September, and I will be posting again for World Mental Health Day 2021.

Today, I’m going to blog about the importance of ALL information relevant to a new mother’s well-being.  I was pleased to see Good Morning America’s piece titled “Moms get real about what it’s like postpartum: ‘I felt like I got hit by a bus.'”  dated September 30, 2021.  I love that there is “real” talk about the realities of postpartum.  That is essentially the motivation and focus of my book, which I’d published back in 2011 because not enough people were talking about the realities of postpartum.  While my book uses the terms “hit from left field with PPD” and “PPD hits you like a ton of bricks” in Chapter 3 (Knowledge is Power), the general idea is the same, and it wouldn’t be so bad if more people talk about the realities of postpartum.  The 2 mothers in the article (Maria Alcoke and Jenny Laroche) share my desire to help educate other women so they can avoid the kind of negative experiences we had.  I mean, with knowledge, we have the the power to minimize fears and anxieties that come with first-time motherhood, as well as to get help EARLY.

Just like my book, the article mentions that there is plenty of information out there about preparing to become a mother, about pregnancy, and about baby care, but there isn’t a whole lot about the realities of the postpartum period, like hair loss, recovery from childbirth, anxiety with caring for a baby for the first time, societal expectation that the postpartum period is just for physical recovery from childbirth, and difficulties with breastfeeding–just to name a few.  For Laroche, who experienced heavy hair loss (“I had no idea that you lose so much hair. No one warned me,” said Laroche, who said she felt “like a passenger in my own body” postpartum) and was concerned about even the most basic of body functions, like bowel movements, these completely normal experiences wouldn’t have been so traumatizing and isolating had she known what to expect by talking about it with other mothers or reading about it.  Why are people so afraid to talk about their real experiences?  Is it fear of being shamed?  Judged by others? Not living up to their dream of being a perfect mother?  Wanting to maintain the notion that pregnancy and motherhood are always blissful experiences?  What I want to know is why people insist on keeping up these false notions.

Alcoke shares:

When talking [in] women’s circles and just talking with your friends and sharing experiences, you never want to scare someone away, right? People don’t necessarily want to hear that, like, ‘Oh did you hear about the vaginal tear that I had?’ but it’s part of the process. It happens. It’s super common.

These are things I touch on in my book in my Chapter 6 (My Postpartum Period – An Exhausting and Uncertain Experience) where I talk about Interrupted Sleep/Sleep Deprivation, Startle/Moro Reflex, Colic, Nasty Eczema and Cradle Cap, My Hair Loss, and Returning to Work.  I also talk about the realities of pregnancy, childbirth and the fact that breastfeeding isn’t always instinctive in Chapter 8.  Here’s an excerpt from my Knowledge is Power chapter:

It’s only natural for you to not want to hear about anything that could go wrong during the postpartum period. You may have enough pregnancy-related concerns as it is, with things like nausea, difficulty sleeping, getting everything ready for the baby’s arrival, spotting, cramping, bloating, preeclampsia, etc. I mean, who wants to look forward to her baby’s birth with anything other than positive thoughts? And who wants to think about something you’re convinced won’t happen to you? It’s natural to deal with concerns as they arise rather than worry about something that more than likely would not happen anyway. But remember that a cross-that-bridge-when-you-get-to-it mentality won’t help you if, once you cross that bridge, PPD hits you like a ton of bricks—suddenly and quite mercilessly.

and

From seeing the happy moms around you to those on the television and in magazines, you look forward to your future with your baby with joyful anticipation, thinking that, with happy thoughts, there will only be happy days ahead. And just because you never hear anyone you know talk about having PPD, it doesn’t mean no one you know has ever suffered from it. A friend, relative, colleague, or neighbor may one day suffer—or at this moment could be suffering—from PPD, and you may never even know it because she doesn’t know what is wrong with her and is ashamed to let anyone know that she is unable to enjoy her baby as she’d dreamed she would. No woman is completely immune from PPD after having a baby. With the right combination of risk factors and stressors, any woman—even you—could end up suffering from it.

The Good Morning America piece also touches on the fact that a woman’s body goes through huge changes that–besides the size of the belly–aren’t necessarily visible to an observer.  These changes are hormonal and even neurochemical.  And yet women are sent home from the hospital a couple days after childbirth to recover and with a newborn to take care of (in addition to possibly other kids)!  Everyone recovers in different ways, lengths of time, etc.  Most mothers experience postpartum blues (not the same thing as postpartum depression – which I talk about in Chapter 8 of my book) due to the huge hormonal changes that come with childbirth.  But a percentage (up to 20%) of new mothers experience postpartum depression (PPD), which is a general term for when there is a postpartum mood disorder.  What the article doesn’t mention is that there is also postpartum anxiety, postpartum obsessive compulsive disorder, and postpartum psychosis.

The piece also touches on the fact that new mothers are setting themselves up for huge disappointment if they assume that, when it comes to pregnancy, childbirth and postpartum, things will turn out the way they plan.  No amount of books/information and staying on top of details is going to fully prepare you for all the variables that include the way a woman’s body responds to childbirth, the huge hormonal swings from pregnancy and childbirth, and the baby’s personality and development…..just to name a few.  When it comes to having a baby, the more you want control of a situation, the greater your struggle will be if the results are not what you expect.

This is an excerpt from my book:

Being a first-time mother, you learn the ropes as you go. Practice makes perfect. But mothers with perfectionist or control-freak tendencies find it particularly hard to adapt to the fact that much of their motherhood experience is one in which mistakes will be made and it isn’t possible to have complete control of your life when you have an infant. Those who set high expectations and have specific thoughts of how their childbirth and motherhood experiences should be are setting themselves up for disappointment when their expectations are not met.

The article also touches on the fact that postpartum care in the U.S. is lacking.  Once the baby is born, all the attention turns to the baby, and it seems everyone forgets about the mother.  The article mentions that, in 2018, the American College of Obstetricians and Gynecologists (ACOG) released new guidelines to help encourage more postpartum care.  Six weeks used to be the standard for the first new mother visit with her OB-GYN.  ACOG now recommends that new mothers contact their OB-GYN within the first 3 weeks after delivery, and that care should continue on an ongoing basis, ending with a “comprehensive postpartum visit no later than 12 weeks after birth.”  I believe the reason for this is for OB-GYN’s to assess if the new mother has any symptoms of a postpartum mood disorder.

Postpartum care for the new mother has been completely lacking in the U.S.  I discuss this in detail in Chapter 9 of my book.  Chapter 9 sections include these sections:
  • First Few Days at Home … Now What?
  • New Moms Need Nurturing Too
  • What Is Social Support?

I’ve blogged about social support in great detail previously here and here.  Hugely ignored is the importance of emotional and practical support during the first four to six weeks postpartum to enable the new mother to get the rest she needs while she is recovering from childbirth and at her most vulnerable, thereby minimizing her risk for PPD. A support network should be set up before the baby arrives. Be prepared to have support with how to soothe a crying baby, how to cope with reflux and colic, how to identify and deal with eczema and cradle cap, and how to deal with food allergies, etc. Not being prepared for these challenges and having to figure out how to deal with them via pure trial and error can cause anxiety levels to skyrocket.

LUNAFEST® Screening on October 15-16, 2021 presented by Postpartum Support International-NJ

Tickets are available now for the 3rd annual LUNAFEST®proudly presented by the New Jersey Chapter of Postpartum Support International (PSI).

This year, the event will be hybrid.  If you are in New Jersey, you can participate  in person.  If you don’t live in the New Jersey and/or would prefer to participate from the comfort of your home, you can participate virtually!  Please consider buying a ticket to support a wonderful cause!

IN-PERSON:
When: Friday, October15, 2021; Meet & Greet Reception @ 7:30 pm; Films begin @ 8:00 pm
Where: The Woodland, 60 Woodland Road, Maplewood, NJ
Tickets:  $40 includes a complimentary cocktail.  To buy, click here.

VIRTUAL:
When
: Log in anytime between Friday, Oct 15 @ 8 PM EST – Saturday, Oct 16 @ 8 PM EST.  The festival of 7 short films has a total running time of 86 minutes.
Where: A Vimeo streaming link and passcode will be emailed to you the morning of October 15, 2021.
Tickets:  Just $20!  What a deal!  To buy, click here.

Proceeds of this particular screening event will benefit the NJ Chapter of PSI.  PSI’s mission is to promote awareness, prevention and treatment of mental health issues related to childbearing.  The long-term goals of the PSI-NJ chapter is to create, throughout the state of New Jersey, a unified voice for the support, education and care of moms and families with perinatal mood disorders, as well as law enforcement and health care professionals.  support mothers (and even fathers) suffering from it.

If you support women’s causes and want to support mothers (and their families) who suffer from postpartum mood and anxiety disorders (e.g, postpartum depression (PPD), postpartum OCD and postpartum psychosis) to get the help they need, please consider coming to Lunafest and sharing with friends, family members, neighbors, and colleagues and even share widely on social media.

There will be information about PSI, PSI-NJ and other maternal mental health services in NJ at this event.

Shout Out About Doulas in The Good Doctor….Can We Now Get One for PPD???

A brief post from me today, as it’s almost the end of April and I promised (for Amber) I would post at least once monthly for a year starting last October. Of course, I always start off saying it will be brief, but by the time I’m through, it’s not the short post I thought I was going to write, lol! Once I get my thoughts going, I could go on and on!

I’ve watched The Good Doctor since ep 1, and have absolutely LOVED the show for the way it’s written, cast, and directed. I was thrilled when doulas got a shout-out in a recent episode! I saw this on my Facebook feed a few days ago from a post by Raising Flowers Birth Services in Utah, which gave me the idea to blog about this. I bet more than half the people who watched the ep were like, hmmmm, what are doulas? I’ve mentioned them a bunch of times in my blog, but did blog about doulas specifically here.

I just wish they would do a show on postpartum mood disorders, as we desperately need a primetime TV show brave enough to get the message out that postpartum mood disorders are experienced by mothers (1 out of 7 in this country), and yet how all too often cases are missed, misdiagnosed, mistreated and have potentially fatal consequences for the mother and/or baby. I wish I could get a hold of Daniel Dae Kim on this (I did message him on Facebook yesterday but don’t expect a response), since he is a producer of the show, to see if he can work with Postpartum Support International. I don’t recall a primetime TV show ever having had postpartum mood disorders a focus of an episode. There might have been a shout-out or two or three these past years, but either I missed them or they were not substantive enough for me to recall.

Over the past few years, depression has been getting more attention, since Chicago Med and New Amsterdam have a mental healthcare practitioner on staff and they do have almost weekly examples of someone needing help from them. It’s a tremendous step in the right direction, and I am forever grateful. But…..WE NEED A POSTPARTUM MOOD DISORDER EPISODE!

Please, please, please, producers/directors of Chicago Med, New Amsterdam, Good Doctor….doesn’t matter which show. Please consider the importance of getting the message out because mothers around the country (and world, actually) are suffering and the public needs awareness about it because of the popular belief that, once people hear after a child is born that “mother and baby are doing well,” then all must be hunky dory and let’s all just focus on the baby. But…the baby will not thrive well UNLESS THE NEW MOTHER IS TRULY OKAY. And too many mothers suffer needlessly and painfully when they develop a postpartum mood disorder from out of the blue. Too many mothers feel shame because they don’t want others to know they can’t feel the joy that they “should” be feeling after the birth of their babies. The experience causes unnecessary feelings of despair and hopelessness, as what happened to me back in 2005. I got slammed with PPD from out of the blue. One day I was fine, the next day I wasn’t sleeping or eating, lost all my pregnancy weight and more in a few days, had anxiety attacks morning and night, and I thought I was not going to make it.

I would provide sample links to re-highlight why postpartum mood disorders like postpartum depression (PPD), postpartum anxiety, postpartum obsessive compulsive disorder, and postpartum psychosis are missed, misdiagnosed, mistreated and have potentially fatal consequences for the mother and/or baby, but I would be providing almost every link to every blog post I’ve ever written since 2009. And that’s an awful lot.

How Can I Help If I Can’t Tell If My Friend or Loved One Is Struggling with Postpartum Depression?

That’s a really good question, especially if the new mom doesn’t even know she has postpartum depression (PPD) and many new moms (I am guilty of this) want to hide the fact that they are struggling because they think that that would be a sign that they’re not as good of a mom as they’d imagined themselves to be.

You just have to trust your instincts, be proactive in looking for signs that the new mom is not herself/extra exhausted and/or just ask her how the new mom is feeling. It can also be tricky, as just because she doesn’t look depressed doesn’t mean she’s not depressed. I’d blogged about that previously here and here.

It can be particularly tricky now with COVID and people not seeing each other face to face, and people wanting to take extra precautions to protect a new mom and her baby from exposure to the virus.

Megan Markle’s interview with Oprah and Huffpost article dated March 18, 2021 titled “How to Tell if a Friend is Struggling with Depression or Anxiety During Pregnancy motivated me to write this blog post. It reminded me how even I made it difficult for people to gauge that I needed help.  For those like me who don’t like to be the center of attention/make a big deal over something that causes embarrassment/want to inconvenience anyone and who want to appear a capable and strong woman and mother, we tend to try to shrug things off and shoulder on. Then there’s also the fact that PPD symptoms are different for different women, which makes it all the more tough to tell if something is wrong.  Heck, even medical/mental health practitioners find it challenging to diagnose a perinatal (during pregnancy and postpartum) mood disorder in many situations. 

Megan admitted she experienced suicidal ideation (thoughts of suicide).  According to a study published in 2020, there has been an increase in suicidal ideation among pregnant women in the United States in recent years.  Although I didn’t really experience suicidal ideation, I did get to the point that I felt the urge to disappear to escape the God-awful combination of feelings and fears that I found myself experiencing. That may have been one step shy of suicidal ideation, and I shiver to think of what could’ve happened had I not gotten medical help when I did! Because I was feeling at the end of my rope. It really was beyond awful.

New mothers struggling with a perinatal mood disorder should focus more on getting better and getting help than on feeling bad they even need help or are struggling.  It would help if everyone realized that depression and anxiety in expectant/new mothers is very common, and they should not feel any shortcomings if they do experience it.  They (and you) need to know that they need to get help if they experience any/combination of these symptoms, because it can go from bad to worse suddenly if they do not see a doctor and help:

  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in most of your usual activities; inability to laugh
  • Overall impaired functioning*
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive worrying (e.g., about the baby’s well-being)
  • Difficulty thinking, concentrating or making decisions
  • Feelings of guilt/inadequacy/of being a bad mom
  • Urge to run away/disappear/vanish into thin air
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide

The Huffpost article lists the National Institute of Mental Health website and of course Postpartum Support International (PSI) as helpful resources that list common and unfortunately under-recognized signs.  PSI can also help an expectant/new mother to local support groups/mental health professionals.

It is extremely common for a pregnant/new mom to feel (and look) fatigued.  After all, there are a lot of hormonal changes going on.  But if she is really struggling, seems not her usual self and/or seems much more anxious than they normally are–to the point of not being able to carry out their daily activities and/or are having trouble sleeping—then you should suggest she see someone who works with perinatal (during pregnancy and postpartum) mood disorders.

Here are some ways you can help:

  1. Being aware of perinatal mood disorders (refer to PSI link above).
  2. Frequently check in with her and ask how she is TRULY feeling.
  3. Realize that pregnancy/postpartum is NOT always smooth and happy, so if she is struggling, tell her it’s okay that she doesn’t feel happy and it is of utmost importance that she is doing okay.
  4. Ask her if she needs help (but I would just offer it—for example, just drop off food).  We all know it’s common for neighbors, friends and family to bring over meals for the first few weeks so the new parents don’t have to struggle to put meals together while they are busy caring for the new baby.  I’ve blogged about postpartum help here.  Less common is offering the expectant mom a prepared meal, but doing that especially if you know your loved one is struggling would be a particularly caring thing to do.  Bringing over food/groceries is another way to show you care and during COVID times, these moments of connection (albeit brief and socially distanced) can help stave off loneliness.
  5. Arrange to go on walks regularly with her.  Walking and getting out are extremely important during pregnancy and postpartum weeks.  I wrote about the importance of getting out here.
  6. Last and not least, just be there for her. Give her company so she feels less alone (especially important during COVID times). It doesn’t have to be a long visit. Nor do you have to have a long conversation or do much (which is hard during COVID times anyway). But dropping by a couple times a week (if you’re able), would mean so much. Check out my previous blog post here.

The Huffpost article does mention that “postpartum care in the United States is anemic” but I won’t go into this because this would take up an entire blog post on its own.  I have already written posts about this in the past, such as this one.

A Short Film that Shows the Importance of Having a Maternal Mentor

Last weekend was Postpartum Support International-New Jersey‘s Lunafest fundraiser. The seven short films were diverse and interesting, but the one that happened to have some relevance to maternal mental health was “How to Swim” by Noa Gusakov. It spoke to me the most, which is why I decided to write about it. It made me think about the importance of social support. Having adequate social support from other maternal figures (and doulas when there are no family members or friends as options) is very beneficial, to say the least. Having inadequate social support can increase the risk of postpartum mood disorders, especially if there are other biopsychosocial factors in the mix.

If you haven’t yet watched the short, please do so before reading on, as my review below has tons of spoilers.

“How to Swim” is a 14-1/2 minute short film about Avigail, a young woman pregnant with her first child who is so anxious about being a new mom that she “kidnaps” a maternal stranger one afternoon. There are moments throughout the film that touched me and made me laugh. This is a short that is definitely worth watching. I can see how it has won awards and recognition at numerous movie festivals.

The film starts in the waiting area of the hospital where Avigail and her husband are waiting for their visit with the doctor. She observes the interactions of another pregnant woman and her mother (Tammy) with envy, wishing her own mother could be with her. When the other pregnant woman leaves the waiting room, Avigail goes over to talk to Tammy who, as it turns out, was leaving the hospital. Wanting to spend more time interacting with Tammy, Avigail pretends to be a childhood friend of Tammy’s daughter. Avigail tells Tammy she happens to be going in the same direction and offers her a ride. Tammy needs to go to the mall, and Avigail says she also needs to get something from there…..and they end up shopping & chatting away the afternoon. They seem to bond, but all due to the pretense that their lives intersected with Tammy’s daughter.

Of course, the truth does come out and Tammy reacts with shock/fear that Avigail “kidnapped” her, but she becomes somewhat understanding once Avigail explained why she did what she did. One gathers from watching the way Avigail talks about her mother that she isn’t simply too far away to be with her. My reaction was immediate sympathy for Avigail. I don’t believe Avigail planned to “kidnap” Tammy, but just wanted to have a conversation with her that led to their spending the afternoon together. It really is sort of a creepy thing to do, but at the same time, I could imagine myself in Avigail’s shoes. I could imagine feeling scared of going into motherhood for the first time without my own mother by my side to guide me. I could imagine wanting a maternal mentor so badly that I would try to become friends with one that I have a good feeling about. I don’t know if Avigail has any other maternal figures in her life, like other relatives or friends that are mothers. Assuming she doesn’t, then it makes first-time motherhood all the more frightening. This is why I had all the feels and was drawn into this film.

The film ends with Tammy walking away from Avigail. It made me sad to think that the bond they formed–even though it was under false pretenses–vanished and they may not see each other again….and it was back to Avigail having no one to help her after the baby arrives. Although the film ends on somewhat of a positive note–with Avigail learning that the bra that Tammy had suggested she leave on and not pay for was actually paid for by Tammy when Avigail went back to pay for it– I still couldn’t help thinking it would’ve been nice if they exchanged contact info so Tammy could stay in Avigail’s life.

LUNAFEST® Virtual Screening on November 13-14, 2020 presented by Postpartum Support International-NJ

Last year, I had to start my post, “If you live in New Jersey.”  Well, this year, you can participate from the comfort of your home, wherever you live!  Please consider buying a ticket to attend LUNAFEST®, which is proudly presented by the New Jersey Chapter of Postpartum Support International (PSI).

When: Log in anytime between Friday, Nov 13 @ 7 PM EST – Saturday, Nov 14 @ 7 PM EST.  The festival of 7 short films has a total running time of 97 minutes.

Where: Virtual  via streaming link that will be sent along with passcode to all attendees the morning of Friday, Nov 13.

Tickets:  Just $25!  What a deal!  To buy, click here.  I bought my ticket, and can’t wait!  Last year’s event was a huge success, and I was so glad to be a part of it!

About:  Since 2000, LUNAFEST® has showcased a collection of short films by, for, and about women. LUNAFEST® is dedicated to promoting awareness about women’s issues and highlighting female directors. Discover the ground-breaking work of female filmmakers who are changing the industry with this year’s lineup of seven short films.

Proceeds of this particular screening event will benefit the NJ Chapter of PSI.  PSI’s mission is to promote awareness, prevention and treatment of mental health issues related to childbearing.  The long-term goals of the PSI-NJ chapter is to create, throughout the state of New Jersey, a unified voice for the support, education and care of moms and families with perinatal mood disorders, as well as law enforcement and health care professionals.  support mothers (and even fathers) suffering from it.

If you support women’s causes and want to support mothers (and their families) who suffer from postpartum mood and anxiety disorders (e.g, postpartum depression (PPD), postpartum OCD and postpartum psychosis) to get the help they need, please consider coming to LUNAFEST® and sharing with friends, family members, neighbors, and colleagues and even share widely on social media.

Lunafest in West Orange, NJ on September 13, 2019 Benefit for Postpartum Support International

If you live in New Jersey, please consider attending LUNAFEST proudly presented by the New Jersey Chapter of Postpartum Support International (PSI).

When: Friday, September 13, 2019 at 7:00-10:00 pm

Where: Luna Stage at 555 Valley Rd, West Orange, NJ

Tickets:  $25 includes a complimentary cocktail.  To buy, click here.

About:  Since 2000, LUNAFEST has showcased a collection of short films by, for, and about women. Discover the ground-breaking work of female filmmakers who are changing the industry with this year’s lineup of eight short films.  Your support of Lunafest will not only help flip the script of the 2.13 : 1 ratio of male to female short-film directors in this country, but help raise money for local women’s causes.

Proceeds of this particular screening event will benefit the NJ Chapter of PSI.  PSI’s mission is to promote awareness, prevention and treatment of mental health issues related to childbearing.  The long-term goals of the PSI-NJ chapter is to create, throughout the state of New Jersey, a unified voice for the support, education and care of moms and families with perinatal mood disorders, as well as law enforcement and health care professionals.  support mothers (and even fathers) suffering from it.

If you support women’s causes and want to support mothers (and their families) who suffer from postpartum mood and anxiety disorders (e.g, postpartum depression (PPD), postpartum OCD and postpartum psychosis) to get the help they need, please consider coming to Lunafest and sharing with friends, family members, neighbors, and colleagues and even share widely on social media.

There will be information about PSI, PSI-NJ and other maternal mental health services in NJ at this event.

 

 

 

 

 

A Letter to My Mother on Mother’s Day

Dear Mom,

You brought me into this world.
You raised me.
You taught me to be a caring, polite, honest and hard-working individual.
I have much to thank you for.

You were always a very caring mother.
Even though you always worried so much…..
Too much, in fact.
You worried so much that you drove me and my brothers bonkers.
Your incessant worrying made for a very tough time growing up as your daughter.

You always did tell me, wait until you have your own child(ren), and
Then you will know what it’s like to be a mother.
Looking back, I do realize you were just trying to be the best mother you can be,
Just as I now want to be the best mother I can be too.

I remember how we used to fight a lot.
Much of it was due to no one being able to see things from the perspective of the other.
And dad was a catalyst to our fights.
My unhappy teenage years didn’t help matters.
Things were tough for me growing up.
I hated school and where we lived so much.

But I know things were tough for you too.
You lived far away from your own parents….
So far away that you only saw them a couple times since you came here in the 1950s,
Seeking a better life for yourself and future family.
You always just grinned and trod on,
Focused on ensuring your children did well in life.

Life has not been that fair for you, I know
And I wish I could have changed your experiences and circumstances
So you could’ve had a better life
That you didn’t have to spend so many lonely days at home alone
After my brothers and I moved out and
While dad worked all day, 7 days a week.

I wish I knew then what I know now.
That your heightened anxiety and obsessive behaviors,
Your worst enemies,
Should have been treated so that
After you had your surgery in 2012,
Your anxiety and obsessive behaviors wouldn’t compromise your health.
Your soon-to-be-84-year-old self
Still doesn’t look your age
Despite all the medical issues you’ve faced.
Had it not been for your anxiety and obsessive behaviors,
I could see you living up to 100 years old,
Full of the energy and youthfulness I remember seeing
As a child while you sang and danced in the kitchen.

I will never forget your sadness that you couldn’t spend more time with your family.
It pains me to remember.
I wish I could’ve done more for you earlier….
Like send you back to see your family more,
But money was always an issue.

This regret will hang over my head for the rest of my life.
This regret has taught me that
It’s not about material wealth, size of home, or appearance of wealth that matters
So much as the fact that time goes by and people age too quickly
Moments are all too fleeting,
And before you know it, there are so many lost opportunities
To do things you wanted/meant to do
That are now too late to carry out.
I may now have the means to send you home to visit your family.
But you are now too old and frail to travel.

I don’t want any more regrets.
I don’t want to later look back with regret that I didn’t see you as much as I could.
I don’t want to later look back with regret that I didn’t cook for you.
I don’t want any more regrets.

I want to be there for you as much as I can,
Within my abilities and despite my shortcomings,
As I am far from a perfect daughter.

Today, on Mother’s Day, a dreary, rainy, chilly day,
I reflect on my shortcomings as a daughter.
I could’ve spent more time with you.
I could’ve cooked more for you.

But things are not too late.
I can still see you every week.
I can still cook a little for you,
Even though I suck at cooking.

You inspire me to be a better mother.
And a better daughter too.

Happy Mother’s Day, Mom.

Love always,
Ivy

Parenting is hard

As a follow-up to my July 2018 post about my friend Elly Taylor’s US tour, I would like to help spread the word that PARENTING IS HARD.

 

* * * * * * * *

That’s right, parenting is NOT necessarily instinctive.

Don’t let anyone tell you otherwise.

Parenting is a journey that is traveled by the new mom who learns as she goes.

And one in which the new father (or partner) learns as he goes.

Or as per Elly’s training mantra and title of her book, it’s a journey to Becoming Us.

And you, parents, need to and should take as much help as you can get along the way.

There should be no shame with that.

No one says that you need to go it all alone.

The more help you get, the better your parenting experience will be.

Trust me.

And trust Elly and everyone else that is trying to spread this truth and resources to get you that help.

The more we realize this going into parenthood, the less we are blindsided.

The more we are prepared for the twists in the parenting journey that life throws our way.

For 1 out of 7 new moms, postpartum depression (PPD) is one of the twists that they will come across on their journey.

Minimizing surprises leads to a better parenting experience and less risk of PPD.

We should want this for everyone, no?

So, please help spread the word.

PARENTING IS HARD.

 

* * * * * * * *

Check out Elly’s brand new video.
It is a very important video for all expectant and new mothers and their partners.
I just adore listening to her lovely Australian accent.

Stay tuned to a follow-up post on Elly’s 2019 tour to the United States.

 

Keys to Empowering New/Expectant Moms and Maternal Mental Health

I was talking to someone 2 days ago who mentioned that for millenials, images are the way to go to attract attention to important messages.  In this day and age of limited-word media like Twitter and other social media forums, sound bytes and visuals tend to grab people’s attentions more.  Print media — like magazines and books (like mine) and all the other books I devoured in my quest for knowledge on why postpartum depression (PPD) occurs in certain women — are going more and more by the wayside.  Just today, I stumbled across an email from Karen Kleiman, MSW, LCSW, (founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders)1 yr and 9 months ago giving me permission to use the below image on my blog.  This image grabbed my attention and I want to help circulate it.   You should too if you care about mothers.  We need images and information like this to reach more expectant mothers.  We need to ensure they are informed before they even give birth so they aren’t blindsided with PPD.

Why do I feel this information is important? My experience with PPD happened back in 2005, and I blogged about the ignorance of my OB/GYN in February 2009, just shy of 10 years ago.  It was one of my first blog posts. Unfortunately, not much has changed between then and now except for the advent of Facebook and other social media to spread the word via organizations such as Postpartum Support International (PSI), PPD survivors/advocates, social workers, therapists and others who treat perinatal mood disorders (PMDs).  I know this from the stories that come across my feed on Facebook.  I know this from talking to others whose job is to care for mothers who struggle with PMDs.  The general population doesn’t know the difference between postpartum blues and PPD because all too many doctors don’t even know the difference.  Karen Kleiman would not have needed to create the above image if she didn’t see the problem still existing with doctors misinforming PPD moms.

The care model for OB/GYNs should be mandated to include:

  1. adequate training in medical schools/residency programs to ensure doctors know how to recognize symptoms of and treat perinatal mood disorders and know the difference between the baby blues versus PPD
  2.  a 15-minute time slot in every hospital baby care/childbirth training session to go over the basics of perinatal mood disorders (PPD, postpartum anxiety, postpartum OCD, and postpartum psychosis), difference between the postpartum blues and PPD, breastfeeding realities, risk factors, importance of lining up practical/social support before baby’s arrival, insomnia as a common first symptom, etc.)
  3. being prepared to offer referrals to organizations like PSI (which has coordinators in every state that can try to help the mother find local help), maternal mental health facilities and mother/baby units (which are starting to pop up more & more around the country), PPD support groups, therapists/social workers who specialize in helping PPD moms, and even websites / blogs / Facebook groups that can provide online support
  4. screening patients for risk of perinatal mood disorders
    • prior to pregnancy – to establish a baseline of hormone levels before pregnancy and determine if the woman has a history of PMDD  or other risk factors for PPD
    • during pregnancy – consultation comprised of questions to try to detect pre-natal depression and review of a standard small booklet with images and bullet points covering the basics of perinatal mood disorders (PPD, postpartum anxiety, postpartum OCD, and postpartum psychosis), difference between the postpartum blues and PPD, breastfeeding realities, risk factors, importance of lining up practical/social support before baby’s arrival, insomnia as a common first symptom, etc.)
    • during 6-week postpartum visit – including blood work to detect iron/thyroid deficiencies and measure hormone/neurotransmitter levels, thyroid panel, Adrenal Stress Index

Click here to see my Onboarding Questionnaire, Pregnancy Questionnaire, and Postpartum Questionnaire.

As you can see, I am continuing to use my PPD experience to come up with ideas to effect change in the reproductive health care arena.  I will continue to find ways to contribute toward public awareness campaigns, as well as resource development and distribution.

New mothers with babies in the NICU are at increased risk of PPD – Part 2

Continuing on the topic I started on January 13th titled “New mothers with babies in the NICU are at increased risk of PPD,” I wanted to add a few points I missed earlier, inspired by a post that came across my feed recently from the Emerald Doulas website titled Preemies Parents and PMADs.  The post was authored by Carrie Banks, an Emerald Doula and one of the North Carolina state coordinators for Postpartum Support International.

Finally home from the NICU with the baby, it is natural for parents to feel anxious, now that they are responsible for their baby’s care and there are no nurses, doctors and machines tending to their baby’s care any longer.  The feeling of being fully responsible and the fear that something may go wrong can cause the parents to feel overwhelmed, especially if there are still medications, feeding and weight gain challenges, as well as physical (e.g., vision, hearing, motor skills) and cognitive development concerns.

I can recall feeling overwhelmed with having to deal with colic, cradle cap and eczema all at once.  My baby was not even a preemie, and my postpartum depression (PPD) starting once the one-week colic period ended.  So, yes, factors that cause stress during the first postpartum weeks while a new mom is still healing from childbirth can indeed lead to PPD.

The Emerald Doulas article contains great tips on addressing:

  • impaired/delayed bonding due to inability to hold the baby/feelings of fear/awkwardness of holding the baby in the NICU
  • transitioning to life at home after the NICU
  • feelings of isolation, guilt and shame
  • why getting help is important

Parents of preemies may also feel ungrateful or even guilty for seeking help for themselves, since everyone’s focus has been on the preemie baby for days, weeks or even months.  While these parents may feel like the only thing that matters is their baby to be okay, they need to remember that they need to stay strong and healthy, both mentally and physically, in order to be there for their baby!  Weeks if not months of having to stay strong for their NICU baby and for other children they may have can chip away until suddenly they find themselves unable to keep it together any longer.  Being anxious and sleep-deprived over an extended period can lead to a postpartum mood and anxiety disorder (PMAD) to set in.

Another contributing factor to the development of a PMAD is the feeling of isolation that occurs from staying home with the baby and keeping visitors away to protect the baby against germs, especially during the winter when colds and the flu abound.  The disappointment that comes from not having friends and family around like they would’ve wanted to have can also contribute toward the development of a PMAD.  Finding a community and support in the form of a NICU support group in-person and/or online can be invaluable, as it can help them feel less alone and more hopeful knowing they are not along in their experience both inside and outside of the NICU having to deal with physical/cognitive development concerns/challenges in addition to the seemingly endless visits with doctors, speech therapists, occupational therapists and/or physical therapists.

There should be no doubt as to whether seeking help is an option.  If you need help, do not hesitate to get it.  Reach out to friends and relatives.  See if you can get a friend and/or relative to help coordinate the search for specific kinds of help.  I’ve seen many situations where a friend sets up a Meal Train account and shares it on social media or email to get friends/relatives/neighbors/colleagues to pitch in money or orders from local restaurants/delis to be sent directly to the family.  If you need help with overnight care and you can afford to hire a postpartum doula, then see if you can locate one through referral from a friend/relative or by searching for one on the Doulas of North America (DONA) website.

You, my dear mother (and father), need to remember self care!

New mothers with babies in the NICU are at increased risk of PPD

The motivation for this blog post is a Huffpost article that popped up in my Facebook feed yesterday titled “NICU Moms Are Struggling With Mental Health Problems–And They Aren’t Getting Help” by Catherine Pearson.  It happens to be from 4/13/2018, but I’m only seeing it now for the first time.

I have blogged about the many risk factors for PPD before.  One of the risk factors happens to be premature births.  Last time I blogged about premature births being one of the risk factors for PPD was 9 years ago.  So, I’m way overdue blogging about this topic again!

A new mother who was pregnant one minute–and expecting several more weeks of pregnancy–and suddenly giving birth and seeing your baby hooked up to machines is an overwhelmingly anxiety-provoking experience.  All new mothers are not only hormonal, exhausted and trying to recover from childbirth, but NICU mothers are also anxious about their babies, unwilling to leave their babies’ sides, and find it hard to eat, sleep or even talk to friends and family members who don’t fully understand what it’s like to have a baby in the NICU. Unable to touch, hold and feed her baby and instead seeing her tiny, precious baby hooked up to so many wires, it is natural for a NICU mother to be consumed with feelings of helplessness, distress and fear.  Each day, the NICU mother spends many hours each day at their baby’s side, pumping every few hours, and on high alert with respect to her baby’s breathing and the noises of the machines keeping her baby alive.

In the daily hustle and bustle of the nurses and doctors in the NICU, having them stop and ask the mother (and/or father) how they are holding up and making sure they are taking care of themselves and getting enough rest are not going to be at the forefront of their priorities, though you’d think it should be second nature for them to do so.  In fact, they are seldom trained to know what to ask.  Even if they did ask, there is an inadequate referral system in place to get help for a mother with a postpartum mood disorder.

“…[Studies have suggested that up to 70 percent of women whose babies spend time in the NICU experience some degree of postpartum depression, while up to one-quarter may experience symptoms of post-traumatic stress disorder.”  Simply put, a new mother’s risk of experiencing a postpartum mood disorder is very high.  And that is not surprising in the least.”

What should the screening entail?

I’ve previously blogged about and will repeat here that mothers should be assessed for postpartum depression (PPD) between 4-12 weeks postpartum.   She should be encouraged to have her six-week follow-up visit with her OB/GYN, provided she doesn’t complain about symptoms up to that point.  If she is symptomatic before the six-week visit, she should be screened right then.  If the 6-week screen doesn’t indicate PPD, she should be assessed once more at the 12-week point and also when she weans and when her period returns, since these events can trigger PPD in some women.

The following—in addition to screening tools like the Edinburgh Postnatal Depression Scale or Cheryl Beck’s Postpartum Depression Screening Scale—should be asked at the six-week follow-up visit with the OB/GYN, which can help diagnose PPD:

1. Have you been feeling any of the following for the past 2 weeks:

  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in hobbies/activities you once enjoyed; inability to laugh
  • Overall impaired functioning
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive worrying/anxiety/concern about the baby
  • Restlessness/irritability
  • Difficulty thinking, concentrating or making decisions
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide

2. How have you been feeling physically and emotionally?

3.  How is your appetite?

4.  How are you sleeping?  Have you been able to get at least 4, if not 5, hours of sleep a night?

5.  Have you had any recurring thoughts/images that are disturbing?

 

If local resources for PPD are not readily available (though all hospitals around the country should have a list of local psychologists, psychiatrists, social workers, registered nurses, PPD support groups on hand), the least they can do is provide a pamphlet for Postpartum Support International. Its website lists resources in every state.  And many states have already formed, or are in the process of forming, chapters to focus on state-specific efforts at advocacy, training, and other improvements.

If you are a new mom with a baby in the NICU, please, please, please remember that, though your attention is preoccupied with your baby, if you let your own strength and health go by the wayside, it is possible to succumb to a postpartum mood disorder.  Not everyone will succumb, but just remember the increased risk and higher occurrence among NICU moms.  Don’t forget to take care of yourself.  When your baby comes out of the NICU, you need to be strong and healthy to care for your baby.

 

 

Be the One Person Who Makes a Difference for Someone Else

My first blog post in over 4 months was only 2 days ago.  As you can see, I meant it when I said I would focus more on blogging!

Today’s post is inspired by a Scary Mommy article that appeared in my feed yesterday. The title of the article is “Am I Invisible? One Mom’s Pain-Relieving Response to Being Excluded” by Rachel Macy Stafford.  The title itself triggered my mind to flash back to many experiences of trying to befriend other mothers, only to have my attempts stopped dead in their tracks with the same kind of cold reaction mentioned in the first few paragraphs of this article.   I’ve hated–no, DESPISED– the feeling of being excluded since I was repeatedly excluded as a teen by these 3 C’s:  cliques, classmates and even fellow churchgoers.  Exclusions by teens is one thing.  But exclusions by adults?  Totally unacceptable, unnecessary, immature, inexcusable …..and quite simply, crappy.

As an adult, I have never had any problems striking up conversations with strangers I’ve never met before.  I have done that fairly often during the past 29 years of commuting into the city.  Usually, we are able to have these conversations due to our shared commuting woes.  That is our common bond.

In 2018, I made more new friends in my area in the one year than I have in the past 17 years combined.  As I’ve said in prior posts, I’ve found it challenging making friends in my area.  The friends I made last year arose from shared objectives of ensuring a #BlueWave this past November.  That was our common bond.

In 2016, I made more friends with classmates at my college reunion than when I was in college!  Being alums (without the stress of getting passing grades) was our common bond.

In 2006, I became a member of Postpartum Support International (PSI).  I blogged about our common bond previously in this blog post.

These are just some examples of how a common bond encourages friendships to form and conversations to be had even between strangers.  But that leads me to ask why a common bond of motherhood does not encourage friendships to form and conversations to be had even between strangers?  Why did the author of the Scary Mommy article experience the cold and mean exclusion that she experienced?  Why did I experience numerous cold and mean exclusions of countless mothers, even ADULT mothers of newborns, when we share a common bond of wading through unfamiliar territory together?

Doesn’t matter what the reason is, now does it?  Regardless of the reason–whether it be insecurity, pride or just plain nastiness–I would never do this to someone else.  It’s taken me a long time to piece it all together….the realization that such nasty behavior was actually a favor, as it instantly warned me not to waste any time.  In keeping with my philosophy “Life is too short for BS,” when I see people who–whether they know me or don’t know me yet–behave in a manner that is suggesting exclusion, I won’t waste my valuable time or energy on them.

In keeping with my philosophy of “Love, laugh and live a life with no regrets” I will take my experiences of people turning their backs on me and make sure I DO NOT treat others the way I DO NOT want to be treated myself.   I would NOT turn my back on someone who needed help, a listening ear and/or support.  I am not in the business of being on this earth to earn negative points in the karma area, TYVM.

I would:

  1. Help others who need help because, if the situation were reversed, I would want someone to offer me help
  2. Listen and provide comfort to others who need comforting because, if the situation were reversed, I would want someone to comfort me
  3. Support others who need support because, if the situation were reversed, I would want someone to support me

You know what they say about motherhood?  IT TAKES A VILLAGE.  Do what the Scary Mommy article suggests, which is to be the one person that makes a difference for someone else.  Imagine if everyone did that?  We would truly have a village!

The article urges us to each be the one that makes a difference for another, because all it takes is one person to help, listen/provide comfort to, and support someone else and help them realize they aren’t totally alone in this very-populated-and-yet-quite-lonely-at-times world.  How do we know the other person who’s coming to you for help, comfort or support isn’t in a dire situation?  How would you feel if you found out you could have made a difference by helping them, but was cold to them and there was a tragic outcome?

New mothers who are experiencing, or have experienced, a postpartum mood disorder share a common bond of loneliness, of feeling alone in our experience.  All it takes is one person to help another to not feel alone.  This is why so many new mothers have dedicated their lives to providing help/listening to/providing comfort to/supporting mothers suffering from postpartum mood disorders.  They want to give to someone what they did not receive while they were sick themselves.  Many, like me, did not get help, comfort or support.  Too many new mothers feel alone and for no reason at all.  There is no reason for a new mother to feel alone and at the end of their rope.

I will end with this beautifully-written poem in the Scary Mommy article:

With one invitation, we can take someone
From outsider to insider
From outcast to beloved member
From unknown neighbor to coffee companion
From wallflower to life-of-the-party
From shortened life expectancy to 80 years of joy.

I DO NOT want to have any regrets for not doing something when I had the opportunity.  Do you?

Why Screening of Postpartum Moms is Important and Who Can and Should Do the Screening

Today’s post was inspired by a March 19, 2018 NPR article by April Dembosky titled “Lawmakers Weigh Pros and Cons of Mandatory Screening for Postpartum Depression,” as well as a June 2018 Romper article by Karen Fratti titled “Moms Should be Screened for Postpartum Depression in the ER, New Study Suggests, & It Makes Perfect Sense,” a June 30, 2018 News Medical article titled “Screening mothers for PPD in emergency setting,” and a June 29, 2018 Austin360 article by Nicole Villalpando titled “Who should be screening moms for postpartum depression? More doctors now can.

Screening moms for postpartum depression (PPD) serves multiple purposes.  Screening will help ensure moms get the help they need and avoid suffering unnecessarily.  In case you weren’t aware, screening educates women on what PPD is, why it happens and just how common it is (1 in 7 new moms experience it), and helps them avoid what I and so many other mothers have gone through (PPD makes you feel alone, like you’re losing your mind and will never return to your previous self).  It will ensure fewer moms will ultimately fall through the cracks.  It will ensure fewer tragedies involving mothers and their babies.  And I’ve said this many times before, but a mother who is not well cannot care for her baby the way a healthy mother can.  This is pure logic.  Unfortunately, logic takes a back seat because our capitalist society places more priority on what benefits the pocket over what benefits the people’s well-being.

So…..question is WHO should screen new moms for PPD?

Her OB/GYN?  This should be a given, period, hands down, no questions asked!  In May 2018 the American College of Obstetricians and Gynecologists recommended that, in addition to the standard 6-week postpartum visit, OB/GYNs perform a follow-up visit within the first three weeks postpartum.  This new recommendation is due to the fact that symptoms of PPD often begin before the 6-week appointment.   See second half of my blog post on the issues many OB/GYNs are faced with in terms of screening.

Her baby’s pediatrician (but here the patient is the baby, not the mother)?  The American Academy of Pediatrics (click here and here) recommends doctors screen mothers for PPD when they bring their newborns in for wellness visits, since they occur numerous times in the baby’s first year; whereas, the mother only gets the one wellness check at postpartum week six.  Pediatricians who realize that the baby’s development can be negatively impacted when the mother is ill with PPD will try to screen the mom for PPD.  Problem is, most pediatricians as far as I’m aware are not prepared to screen and refer mothers since the mother is not a patient.

An ER physician?  While you will no doubt raise your eyebrows, doctors like Dr. Lenore Jarvis, an emergency medicine specialist with the Children’s National Emergency Department at United Medical Center in Washington, DC, have been seeing moms bring their babies to the ER, and it turns out the baby is fine but it’s the mother who is highly anxious and feeling overwhelmed.  In these cases, it’s logical to try to determine if it’s the mother who needs help.  In fact, Dr. Jarvis and several colleagues conducted a research study with several colleagues on screening moms for PPD in an ER setting.  A Eureka Alert release dated June 29, 2018 explains the results of the research study. Moms who participated were screened using the Edinburgh Postnatal Depression Scale supplemented by other questions.  The great thing about the research study is that, when moms scored positive for PPD, they received information about PPD and were offered–or if they had a strong positive score from screening, they were required to have–a consultation with a social worker.  Additionally, the researchers followed up with mothers who screened positive one month later to see how they were doing.  This is akin to case management programs we have in place when patients check out of hospitals (I explain all this in my post below). Now THIS is the way it SHOULD be!

Dr. Jarvis refers to the ER as a “safety net  for people who are not routinely accessing regular checkups for themselves and their children. If a mother is having an acute crisis in the middle of the night and feeling anxious and depressed, they often come to the emergency department for help.”  Because American policymakers have been so resistant to instituting policies that would require insurance companies to work with doctors to ensure PPD is caught early through screening and subsequent referrals–researchers/subject matter experts on PPD are left to make recommendations for what Dr. Jarvis referred to as a “safety net” approach of having emergency rooms screen for PPD when moms come in either for their babies (for colic, fevers, etc.) or even for themselves (symptoms of a postpartum mood disorder).

While I agree we need to cover all bases and try to screen a new mother wherever and whenever possible, why do we even need to resort to waiting until a mom comes into the ER to screen them?  Why do we have to have such a safety-net, fall-back, beats-nothing-at-all, better-late-than-never approach in the first place?  Answer:  our society continues to place too much priority on conception and childbirth but once the baby is born, everyone forgets the mother.  Once the baby is born, the mother’s health falls by the wayside.  I’ve blogged about this before, but the attention from that point on will be on the baby from visitors who coo at the baby and treat the mother as invisible.  Same thing with doctor visits; the mother only gets one postpartum wellness check at 6 weeks.  That’s it.  It’s like the mother ceases to exist.  Whereas, other cultures have customs to honor and mother the mother (click here and here for past posts).  The birth of the baby is synonymous in these cultures with the birth of the new mother and they are honored for bringing new life into the world.  This, my friends, is why maternal mental health advocacy is so important.  Until American policymakers institute policies to demonstrate the importance of mothers and their health, we advocates must continue to act as “squeaky wheels to get the grease.”

The following section is an excerpt from my book.

New mothers, especially the ones at high risk for PPD, should be screened during their six-week postpartum visit, provided she doesn’t complain about symptoms up to that point. If she is symptomatic before the six-week visit, she should be screened right then. If the six-week screen doesn’t indicate PPD, she should be assessed once more at the twelve-week point—or when she weans or when her period returns, whichever comes first, since these events can trigger PPD in some women.

The following—in addition to screening tools like the Edinburgh Postnatal Depression Scale or Cheryl Beck’s Postpartum Depression Screening Scale—should be asked at the six-week follow-up visit with the OB/GYN, which can help diagnose PPD:

  1. Have you been feeling any of the following for the past two weeks?
  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in hobbies/activities you once enjoyed; inability to laugh
  • Overall impaired functioning
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive anxiety about the baby
  • Restlessness/irritability
  • Detachment from and inability to bond with the baby
  • Difficulty thinking, concentrating or making decisions
  • Feelings of guilt, inadequacy, failure and/or worthlessness
  • Urge to run away
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide
  1. How have you been feeling physically and emotionally?
  2. Are you feeling particularly stressed, and, if so, is it due to a major change you are experiencing, such as marital problems, death of a loved one, financial problems, a recent move, or a job change?
  3. How do you feel about the baby? Are your feelings in line with your expectations of how you’d feel about the baby?
  4. Do you feel you have adequate emotional and practical support from your partner? Do you have any relatives or any other help, like a doula, to help you with the baby during the day?
  5. Are you breast-feeding and, if so, how is it going?
  6. How do you feel the labor and delivery went? Do you feel you experienced any sort of trauma during the delivery?
  7. Do you feel your childbirth and motherhood experience are meeting your expectations?
  8. Do you feel particularly anxious about your baby’s health (colic, SIDS)?
  9. How is your appetite?
  10. How are you sleeping? Have you been able to get at least four, if not five, hours of sleep a night?
  11. Have you had any recurring thoughts/images that are disturbing?
  12. How have you been adapting to motherhood, in general?
  13. Have you returned, or will you return, to work?

I believe these types of questions should be incorporated by all OB/GYNs throughout the country. This all theoretically sounds good and fine, but in most cases, OB/GYNs are not prepared to implement. Why not? At the very least, it would require training on perinatal mood disorders (recognition of symptoms and treatment), as well as ability to provide the right referrals as needed.

This last paragraph from my book excerpt remains true to this day.  Sad because I published my book in 2011.  Seven years later, things have not really changed.

California’s screening bill, AB 2193, has yet to pass the Senate and get signed into law.  Once passed, it would be an exciting development for mothers, as it doesn’t just require screening for PPD.  It requires health insurance companies to set up case management programs (same way my mother was assigned a case manager each time she had to stay overnight at a hospital to ensure she had a plan in place to address the issues that landed her in the hospital–i.e., physical therapy in a rehab center, visiting nurse to change her bandaging, etc.) to help connect moms who screen positive for PPD with a mental health practitioner.

Case management is set up to ensure there is a treatment/referral plan in place.  I sincerely hope that this means health insurance companies are prepared and able to carry out the new requirements.   And I sincerely hope that California will lead the way for other states to follow suit in setting up similar screening bills that will actually require health insurance companies to set up case management programs.

It goes without saying that screening moms for PPD serves no purpose if you can’t help those who test positive for PPD.  So far, as the first state that put mandatory screening in place, New Jersey has not had any reason to be excited ever since its initial groundbreaking “first-state-to-mandate-screening” announcement.  New Jersey, as well as 3 other states— Illinois, Massachusetts, and West Virginia — have tried mandated screening, and it did not result in more women getting treatment, according to a study published in Psychiatric Services in 2015.

A whopping 78% of those who screen positive don’t end up getting mental health treatment per a 2015 research review published in the journal Obstetrics & Gynecology.  Why have women in these states with mandatory screening not been getting treatment?  Well, for starters:

  1. Some obstetricians and pediatricians are afraid to screen for PPD because they are not equipped to refer.  But why is that?   Why is it hard for them to all rely on the resources available via Postpartum Support International?  Its website lists resources in every state.  And many states have already formed, or are in the process of forming, chapters to focus on state-specific efforts at advocacy, training, and other improvements.
  2. The resources to whom doctors (obstetricians, pediatricians, general practitioners, etc.) can refer mothers are limited, especially in more rural areas.  And in more rural areas, it’s harder to find mental health practitioners trained in prescribing meds to pregnant/breastfeeding women, let alone trained in treating moms with PPD.
  3. All too many mental health practitioners don’t take the woman’s insurance or there are significant limitations from an insurance coverage perspective.
  4. There’s a very long wait (several months) to see most mental health practitioners, especially for the first time….a woman in the throes of PPD can’t afford to–both literally (from a cost perspective) and figuratively (from a life & death perspective).
  5. There’s little incentive financially, thanks to insurance companies’ lack of adequate coverage for doctors who do such screening…..in my opinion, screening should be done at the standard 6-week postpartum checkup and therefore covered as part of that checkup.

Attention, American policymakers….our mothers are worth it.  I mean, we make such a big stink about fetuses and unborn babies in this country, let’s start thinking bigger picture, shall we?  Without mothers, there would be no babies to conceive and bring into this world.  Let’s start treating mothers less like second-class citizens and more like human beings who deserve to be able to give birth to and care for their babies without getting sick with PPD and possibly dying in the process!

 

Please Throw Me a Postpartum Party Instead of a Baby Shower, Thanks

and

A truly useful baby shower gift after the baby’s arrival is having relatives, friends, neighbors, etc. chip in funds for hired help [like a postpartum doula] for the first one to two months.

Additionally, as this article suggests, the shower that is thrown should entail a list of family/friends who will help (with watching the baby so the new mom can get some much-needed alone time/rest/shower, picking up groceries, cooking, dishes, laundry, cleaning, etc.) during the first 6 weeks postpartum.  This could include a meal plan via http://www.mealtrain.com deliveries or doing take-out and dropping the food off.

Perhaps if we focused more on ensuring new mothers have the support they need after the new baby arrives, there would be fewer instances of postpartum mood disorders!

 

Join Elly Taylor of Becoming Us on her U.S. tour of training sessions for parents and professionals!

My friend, Elly Taylor, is an Australian relationship counselor, author of the book Becoming Us, and founder of an organization of the same name, which she created to teach professionals and support mothers and their partners.  Both the book and organization’s mission is to help the mother and partner navigate the peaks and valleys of the parenting journey via 8 essential steps that Becoming Us as “map, compass and travel guide all in one.”

Elly is here in the states for her “Seed Planting” workshop tour in Chicago, Beverly (MA), Providence (RI), New York City, Houston and Los Angeles.  For the complete schedule and how to register, click here.

At Darling Harbour, Sydney (2014)

Elly and I have a bunch of things in common.  We are both postpartum depression (PPD) survivors and book authors (though hers is award winning).  We were both blindsided by PPD and the challenges of parenting.  We are both members of Postpartum Support International.  Elly loves NYC (where I’ve spent the last 29 years working) as much as if not more than I love Sydney (where she lives).  She is fortunate enough to be out here in NYC each year for the past 3 years on Becoming Us-related reasons; whereas, I’ve been back to Sydney 3x in the past 21 years (I so wish I could return more often!).  I look forward to seeing Elly during her stay in NYC!

Professionals:

Sign up for Elly’s 2-hour interactive workshop that will teach you key tools to prepare/support expectant/new parent couples to anticipate/cope with the changes–and stay connected through the challenges that come with–early parenthood. You’ll come away with ways for parents to nurture themselves and their partners so the whole family can thrive.  This workshop is designed for couple and family therapists, birth professionals, infant or child mental health professionals, and any others who work with expecting, new or not so new parents.

The transition to parenthood is a major one that consists of numerous transitions.  The training will teach you what the transitions are and how they can negatively impact mothers and their families. You’ll learn how to plant Becoming Us “seeds” that reduce risk for the most common parenthood problems including perinatal mental health issues and relationship distress. Finally, you’ll discover the groundbreaking Becoming Us approach to parenthood and how you can apply the model to your work with parents at any stage of their family life cycle.

Parents:

Sign up for Elly’s 1-hour interactive workshop that will teach you about the transitions that parents normally go through in their first years of family, the steps to navigate each of these transitions and staying connected through the challenges that come with early parenthood. You’ll come away knowing how to nurture yourselves while growing a family that thrives.

 

 

The Robin Study is Looking for New Mothers to Participate in a Research Study

The Robin Study is a research study evaluating an investigational oral medication in women with postpartum depression (PPD).  An investigational medication is a study drug that will be tested during a study to see if it is safe and effective for a specific condition and/or group of people.

To be eligible for the study, you must:
  • Be 18 to 45 years of age
  • Have given birth within the last 6 months
  • Feel any of these symptoms associated with PPD for 2 weeks or longer:  insomnia, crying/sadness, lack of appetite, sudden weight loss, hopelessness, lack of interest in baby, loss of interest in things you used to enjoy, intrusive/disturbing thoughts
  • Have symptoms that began no earlier than the third trimester and no later than the first four weeks following delivery (I know that many mothers don’t develop PPD until 6 weeks or later, but this is a specific requirement for this particular research study)

If you qualify and decide to participate:

  • Your PPD symptoms will be continually monitored by qualified study staff (nurses and clinicians), under the guidance of the study doctor.
  • You will receive study-related medical care and the assigned study drug at no cost.
  • You will be required to take the assigned study drug at home every night for 14 days. You’ll have nightly phone calls with the study coordinator and will come into the study site three times while on the medication and two times as follow-up. Your total participation will last about 76 days.
  • Transportation may be provided for those who require assistance.

To learn more about the study, review frequently asked questions, and see if/how you may qualify, please visit www.TheRobinStudy.com, call (844) 901-0101 to speak with a study representative, or fill out the contact form and a study representative will follow up with you.

Recent PPD Successes and Failures in the Media

I went from blogging once in two months to 8 times so far this month!  With Maternal Mental Health Month a little less than a week away, a lot of fundraising, training and public awareness events are being prepped to happen throughout May.  Another reason to love this time of year….hello spring!

Okay, so the title of my post is “Recent PPD Successes and Failures in the Media.”  There were 2 things in the media that caught my attention on my Facebook feed today that motivated me to blog once again. One is a success and one is a failure.  If you’ve been following my blog for some time, you would know that one of my favorite things to blog about are successful and failed attempts at depicting new mothers suffering from a mood disorder in the media, like my recent post about “Black-ish.”

Let’s start with the SUCCESS……
On this morning’s Megyn Kelly TODAY a postpartum mood and anxiety disorder (PMAD) survivor, Ashley Abeles, shared her experience.  The segment also included brief appearances by Dr. Catherine Birndorf and Paige Bellembaum who are the Medical Director and Program Director, respectively, of The Motherhood Center of New York. The Motherhood Center provides support services for new/expectant moms and treatment for PMADs. I met these ladies from the Motherhood Center at previous Postpartum Support International conferences.  If you missed the show, you can watch it here.  We need more moms sharing their PMAD experiences on shows like this!  Experiences kind of like my own that, as her husband explains, isn’t “headline-grabbing” material involving the tragic death of the mother and/or baby.  Because guess what, the vast majority of PMADs experienced by new mothers are NOT headline-grabbing material.  They’re mothers suffering from anxiety, panic attacks, insomnia, weight loss and/or intrusive/obsessive thoughts who need medication and/or therapy to recover.  Yes, severe postpartum depression (PPD) can cause a mother to feel so depressed that she just wants to disappear or her baby would be better off without her since she can’t feel joyous like a new mother should, but postpartum psychosis is too-often confused with and lumped under PPD (as a catch-all term) by both the general public and doctors alike.  Yes, doctors!  Also, PPD is not the same as the baby blues and even today, doctors still mix up the two!  We’ve come a long way since I had PPD when it comes to information in the news, in publications, on the Internet and in social media.  But we still have a LONG way to go.

And here’s the FAILURE……
The movie “Tully” starring Charlize Theron.  A Motherly post by Diana Spalding titled “We’ve seen Tully– and we’ve got some real concerns” it seems yet another movie director/producer has failed to do their homework about PPD before coming up with the screenplay and releasing it.  What every movie director/producer or TV show director/producer needs to do before even contemplating a movie or TV show about PPD is consult with Postpartum Support International.  This organization is the leading authority on maternal mental health matters and should ALWAYS be consulted to ensure the right information is incorporated into the movie/show plot.  “Tully” attributes the bizarre experiences of Tully (i.e., hallucinations she has of Marlo, frantic baking and cleaning late into the night, impulsive behavior that leads to her car crash, suicidal ideation) to PPD.  However, her behavior is actually attributable to postpartum psychosis, hence this movie spreads misinformation about what PPD really is.  Her talk of suicide is brushed off by her husband, which I can see happening in the real world when loved ones fail to “get it” and ignore the mother’s serious need for help.  While this is a movie and movies don’t necessarily have to educate–after all, this is not a documentary–it should at least get terms right (postpartum psychosis, NOT PPD!)  and it should try to mention at some point that yes, the new mother who’s obviously not well and diagnosed, albeit incorrectly, with PPD needs help!  Maybe put some kind of disclaimer at the beginning or end of the movie like you sometimes see at the beginning or end of a TV show.  Something along the lines of:

“Approximately one out of seven new mothers suffers from a postpartum mood disorder.  If you are a new mother that is experiencing any of the following symptoms: insomnia, crying/sadness for more than 2 weeks, lack of appetite, sudden weight loss, rage, hopelessness, lack of interest in the baby, loss of interest in things you used to enjoy, thoughts of harming the baby or yourself, please know that you are not alone, what you are experiencing is not your fault, and you will recover if you get the right treatment.  Contact Postpartum Support International at 800-944-4773 or visit http://www.postpartum.net

“Mother May I?” – An Important Documentary About Childbirth Trauma

A couple of days ago, a link to the Kickstarter project for the documentary “Mother May I” popped up on my Facebook feed, and it instantly caught my eye (and yes, I am one of the many backers and sincerely hope they meet their financial goal in 30 days, so please consider backing too….even $10 would help!).  Why did it catch my eye?  Because I had a traumatic childbirth experience that was the beginning of an agonizing postpartum depression (PPD) journey.  I didn’t have the awareness needed for me to advocate for myself.  There were no patient advocates anywhere along my PPD journey.  I didn’t have anyone to talk to about my experience.  I didn’t have a means of validating what I experienced.  I was in the dark.  I had to learn the hard way.  This is why I blog, why I wrote my book, and why I look for ways to help others and to try to get the word out and raise awareness so fewer mothers will be blindsided the way I was.

About one-third of new mothers describe their childbirth experiences as traumatic, but you hardly ever hear about negative experiences because everyone wants to be like “everyone else” and happily announce that “mother and baby are doing well.”  No one wants to admit to having a negative childbirth experience, just like no one wants to hear about a negative childbirth experience.  And that is why everyone thinks childbirth experiences aren’t that big a deal.

I had previously blogged about negative childbirth experiences via my blog post titled “Forget the Myths, Here are the Realities of Pregnancy, Childbirth and Postpartum Experiences.” It was one of my first blog posts.   The difference between my traumatic childbirth experience and the ones that are the focus of this film is that the ones in the film, like the one experienced by Caroline Malatesta, involve obstetric assault that resulted in both physical and emotional harm to the mother.  That is much, much worse than what I experienced.

What has been completed thus far is 20 hours of footage of interviews of more than 15 experts (including a birth doula, a labor & delivery nurse and psychologist who specializes in posttraumatic stress disorder (PTSD) and survivors of birth trauma.  My plan is to reach out to the Birth Monopoly Foundation folks behind this documentary–including Caroline Malatesta, President, whose own birth trauma story is the impetus behind and featured in this film–and make sure they include the connection between negative childbirth experiences and maternal mental health disorders like PPD.

If you’ve been following my blog for some time, you know that passion for public awareness is one of my focal points.  I am particularly excited to see that funds from the Kickstarter project will help fund online campaigns to provide free information about birth trauma, resources, and legal rights. It will also help fund college outreach initiatives to help get the film (plus guided discussion) into 1,000 college classrooms around the country.  I believe there is no better time to present such information to teens than in colleges.   Colleges are a great way to reach numerous young people at once.  Speaking of which, I had envisioned doing a book reading of my book at my alma mater when it first came out, but I didn’t get very far.  My school is an all-women’s school and what better place to reach so many women at once about PPD!  But my idea didn’t get much interest.  Perhaps I wasn’t reaching out to the right people.   Perhaps I will try again there….and in other colleges as well.

To follow Birth Monopoly on Facebook: http://www.facebook.com/birthmonopoly 

 

Journey of a PPD Survivor – Q/A Series – #2

Welcome to the second of my Journey of a PPD Survivor Series!

Laura Winters, LCSW, whom I’ve had the pleasure of knowing since we met at this year’s Postpartum Support International conference in Philadelphia, is a therapist specializing in infertility and prenatal/postpartum stress.  We are both members of the recently-established PSI-New Jersey chapter.  Laura is passionate about helping women on their journeys through motherhood, offering individual and group support.  Her practice, Postpartum Health & Harmony, is located in Chatham and Mountain Lakes, NJ.  For more information or to contact Laura, please visit www.postpartumhh.com.

Thank you, Laura, for taking the time to provide my blog readers some insight into your journey as a PPD survivor!

*  *  *  *  *  *  *  *  *  *  *  * *  *  *  *  *  *  *  *  *  *  *  * *  *  *  *  *  *  *  *  *  *  *  * *  *  *  *  *  *

Question 1:
Can you please describe your journey to becoming a Licensed Clinical Social Worker and what motivated your passion to help women with infertility issues (which I experienced) and mothers suffering from a perinatal mood disorder? How long have you been helping women experiencing infertility and perinatal mood disorder?

 When I was considering careers, I wasn’t totally sure what I wanted to do, but I knew that I wanted a career that would enable me to make a difference in people’s lives.   Social work was suggested to me and it was a perfect fit!  I started out my career working with children and teens and I really enjoyed helping them through various challenges.  In 2007, I started working in private practice, primarily focusing on families.  It wasn’t until about 2011 that I first started seeing some women who were struggling with perinatal mood disorders.  At that time, it wasn’t a specialty of mine, so I only saw a few new mothers.

In 2013, I became a mother and had an entirely new appreciation for parenthood.  It was incredibly difficult in ways I never imagined.  Breastfeeding was not going well, which caused me a lot of anxiety, sadness, and added to my exhaustion.  My husband and I both felt more like roommates and our relationship was strained.  This experience inspired me to make some career changes, most notably acquiring more advanced training in perinatal mood disorders and developing this specialty in my practice.

As I began to work with more pregnant and postpartum moms, I also started getting referrals for women experiencing infertility and postpartum moms who had gone through fertility treatments.  Once again, I felt a need to learn more and was interested in adding this focus to my practice.  I see these times in women’s lives, when you’re trying to conceive or newly postpartum, as being so precious and yet such a vulnerable period.  For the most part, everyone assumes that they will get pregnant easily and that motherhood will be challenging but amazing.  When things don’t go as planned, it can completely turn your world upside down and have you questioning everything about your life.  My personal experience definitely fueled my passion for supporting moms as well as couples trying to conceive.

 

Question 2:
In your practice, have you seen a correlation between infertility and a perinatal mood disorder? Do you treat mothers who you’d also seen while they were struggling with infertility issues and ended up suffering from a perinatal mood disorder?  Have you treated women suffering from infertility issues who ended up not suffering from a perinatal mood disorder?

 Infertility treatment is a risk factor for a perinatal mood disorder and I do see this correlation in my practice, though not across the board.  There are so many factors that influence whether a mother will develop a perinatal mood disorder.  I’ve seen women who have been through infertility treatment and did not end up experiencing any perinatal mood disorders.  Support and early intervention are very helpful in protecting a mom’s mental health.

  

Question 3:
Can you provide an overview of the services you provide? I see that you help patients in person, online, and even in a support group setting. Do you find one way of seeing your patients is more helpful? 

 I offer individual, couples, and group counseling.  I see almost all of my clients in person.  I offer online and phone sessions for times when clients may not be able to come to the office, such as not having child care available or in the first few weeks after childbirth.  Online and phone sessions are a great way of continuing sessions when life gets in the way.  The support group is open, meaning that you don’t have to register and can come as often as you need.  The moms that come to the group tend to be looking for different support than those who come for individual counseling.  The group moms are often looking to connect more with other moms going through similar experiences.

  

Question 4:
In your practice, what kinds of treatments for postpartum depression do you recommend?

In addition to therapy, I will recommend medication for those that are open to it or who have tried other things and are still struggling.  I also encourage my clients to try to incorporate exercise and a healthy diet into their routine.  For clients that are interested, I may recommend meditation or teach them an acupressure technique called Emotional Freedom Technique (EFT).

 

Question 5:
Have any medical healthcare practitioners–like IVF doctors, general practitioners, OB/GYNs or pediatricians–ever refer their patients to you?

 Yes, medical healthcare practitioners are great referral sources.  I definitely get more referrals from those healthcare professionals who take the time to talk to their patients about mental health.

 

Question 6:
What do you think medical health practitioners who come in contact with new mothers, like OB/GYNs, GPs and pediatricians, can do to help prevent, detect and treat perinatal mood disorders?

I would encourage medical health practitioners to take time to talk to moms about mental health.  Ask them about their mood and stress level.  Look their patients in the eyes and ask them how they are really doing.  Normalize how challenging being a mother is.  Making comments such as “motherhood is tough” or “you have a lot on your plate now” can go a long way in helping a mother feel comfortable to open up to you.  And having referral sources on hand when their patients need more support is extremely important.  Don’t leave it up to a new mom to have to find help herself.

 

Question 7:
Is there one key piece of advice you would offer to an expecting or new mom?

For expecting moms, I would tell them to make a postpartum plan that outlines things such as who they can count on for specific types of support (baby/childcare, cooking, advice, etc), how they will protect their sleep, and where they can turn if they need support.  For new moms, I would advise them to take breaks, ask for and accept help, and know that challenges come in phases but do eventually end.

 

Question 8:
What would you want to say to women currently suffering with a postpartum mood disorder?

This is the most common complication of childbirth and not an indication of who you are as a mother.  There is a lot of support available out there including counseling, support groups, and other moms who have been there and are happy to offer encouraging words.  You will feel better once you get the support that’s right for you.  Other moms have recovered and you will too.

 

Question 9:
What advice would you offer to friends/family members of a woman who is currently suffering with a postpartum mood disorder?

Reach out to her often – call, text, stop over.  Be there for her when she’s ready to talk.  Try to listen and validate her feelings.  Consider what support you can offer her—including cooked meals, childcare, cleaning, keeping her company—and rather than asking if she wants that help, tell her that this is how you’d like to help.  Tell her when you’re available to provide that support and then let her decide when you can come over.  Most moms will turn down help initially, but when you are very specific with what you can do and when you can do it, it’s harder to turn that down.  Also, it may help you better understand what she’s going through by researching information on perinatal mood and anxiety disorders.

 

Question 10:
What do you see as the biggest challenge in helping a mother recover from a postpartum mood disorder?

Lack of support and lack of insurance coverage are big obstacles.  It’s hard enough finding a therapist or psychiatrist, let alone when you have an infant and aren’t feeling like yourself.  Whether you have insurance coverage or not can help or hinder the process.   I find that the more support a mother has around her (people who can help with certain tasks and give her breaks), the easier recovery is.  It’s really challenging when you don’t have enough support at home and are expected to do a lot of the childcare and household tasks.  It doesn’t allow enough time for moms to tend to their needs.