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!

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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.

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Celebrating My 6th Blogiversary

Well, ladies (and perhaps some gentlemen), I’ve managed to keep my blog going for SIX years.  If you’ve been following my blog since the beginning, you might’ve noticed the gradual transition of my blog’s focus, tone and frequency.

But through it all, my intent has remained the same….to make sure that those who need the kind of support and reassurance that I couldn’t find and didn’t have access to during my postpartum depression (PPD) experience ten years ago can find my blog and feel a little less alone in their postpartum experience.

For the moms who are going through PPD with insomnia as an initial/primary symptom and are bewildered, like I was, as to why in the world I would not be able to fall asleep when I was so exhausted and recovering from a traumatic childbirth experience, hospital stay and blood loss.

For the moms who develop panic attacks and are bewildered, not understanding what is going on with them because they have never experienced panic attacks before.

For the moms who got pregnant after many years of trying through IVF, thinking all would be blissful once the baby arrives but instead are blindsided by the sudden onset of PPD.

These are the moms who are finding my blog.  Moms who longed to hold their babies in their arms the way they had envisioned they would but could not enjoy their first weeks with the baby because of the darkness of PPD that enveloped them.

I know I am still helping some moms. I know from the comments they leave. I know from the occasions a mom reaches out and asks me to email, text and/or call her.

I want you to be well and to get the right help as quickly as possible so you can.

For those who have been following my blog these past six years, thank you.

I hope to continue to come up with blog posts that people find in searches and that help make a difference in a mother’s (or father’s) life.

I have a few author interviews and other posts coming up.  Please stay tuned.

Seleni Institute – We Need More Comprehensive Women’s Reproductive Health Services Like This!

Something caught my attention today.  An article appearing on my Facebook feed about a workshop offered by Seleni Institute this Wednesday, July 31st, titled: “Preparing for Your Newborn,”  which will assist the expectant mom in knowing what to expect in her first days after childbirth.  When I looked at what the workshop will be covering, I quickly realized that it’s way more than what the standard childbirth and parenting classes at hospitals offer.   It offers many things I complain about in my book that are lacking in standard hospital classes–things that are the source of much anxiety to first-time mothers, like how to choose a pediatrician,warning signs and when to call your pediatrician, soothing techniques, and taking a baby’s temperature.  To find out more and to register, click here.  I will have to inquire whether they also cover the startle reflex (the reason why we swaddle) and what to do if reflex, colic, eczema and/or cradle cap occur.

In Chapter 14 of my book, I talk about the changes needed for progress with respect to ending the ignorance about postpartum depression (PPD), ending the stigma caused by that ignorance, and making sure there are enough support services to help new moms and their families.  In this chapter, I provide my “wish list” of what it would take for such progress to occur, one of which is an increase in peer-led parenting and PPD support groups (one example is MotherWoman, which I have blogged about previously, even on Huffington Post).  The other is the establishment of comprehensive women’s healthcare facilities that are founded on the realization that the emotional well-being of the new mother is absolutely essential to the survival and normal development of her child.  Mental health should absolutely be an integral component of reproductive health, whether it be for issues relating to infertility, miscarriage, still birth, child loss or the postpartum period.

I recently learned of such a facility that I wish I could’ve taken advantage of but couldn’t because it didn’t exist when I was having difficulty conceiving, after my first failed IVF cycle, after childbirth and when I was battling PPD.  It opened its doors earlier this year.  Not sure, however, WHETHER I would’ve taken advantage of such a facility back then, before I came out of my PPD knowing what I know now.  Yes, it’s one of those hindsight is 20/20 kinda situations.  Well, knowing what I know now, I want to encourage women to seek such services early on.  Continuing along the vein of what I wrote in my book’s Chapter 14, knowing the importance of and being able to easily access such services are extremely vital if we want to stop seeing women experiencing the kind of bumpy road to motherhood that I experienced.

This facility is the Seleni Institute in Manhattan.  I hadn’t realized until today that the Advisory Board consists of such esteemed individuals in the field of reproductive mood disorders as Dr. Lee S. Cohen and Karen Kleiman, MSW, LCSW.  Seleni’s services include–but are not limited to–the following.

  • Support groups for, miscarriage/stillbirth/child loss, perinatal mood and anxiety disorders, pregnancy, new moms, unexpected childbirth outcomes, parenting support/mindful parenting, and body image.
  • A certified lactation counselor providing clinics, classes, workshops, and one-on-one sessions to help the expectant mother know what to expect and the new mother on how to improve her breastfeeding experience.
  • Experienced psychotherapists and social workers on staff to provide counseling on infertility, coping with physical changes during and after pregnancy, infant bonding and attachment, life and career transitions, relationship/marital/partner difficulties, parenting concerns, and body image anxiety.
  • A website offering valuable insight into all things relating to reproduction.  It is filled with an amazing amount of information that, once again, I only wish I had had access to during my IVF cycles, pregnancy, and postpartum period.

The origin of the name Seleni is in and of itself extremely creative and a lot of thought was put into an appropriate reflection of the organization’s mission. In combing through everything on the site, I’m filled with wonder at the promise this organization holds for women, and I really hope to see more organizations like this open throughout the country.  Even better, I would like to see this organization become national!

If Only I Had Known…..

So, if you haven’t noticed, I’ve been somewhat absent from the blogging scene…it’s been 3 weeks since my last post, the longest break from blogging I’ve taken in a long time. I have to admit I’ve been dry on ideas lately, not to mention the fact that I’m finding it tough to be back on the Twitter scene AND keeping up with my blog AND working full-time AND all the other stuff that needs to be done like spending time with my daughter, helping her with daily homework, etc.

I finally came across a tweet today from Mindy Berkson (@infertilityhope on Twitter) that said:

Did you know that adhesions can lead to #infertility or increase the chance of an ectopic #pregnancy? goo.gl/PmDdA

This tweet IMMEDIATELY grabbed my attention.  Why? Well, as some of you already know, I had had a dermoid cyst that was growing on one of my ovaries removed back in 2001, I had an ectopic pregnancy less than 2 years later, and I had to undergo two IVF cycles.

The link takes you to an article posted on the Resolve website, a great resource for those who are struggling with infertility.  Titled “Pelvic Adhesions: Impact on Your Fertility,” the article provides an overview of what adhesions are, what causes them, how they can be removed, as well as a reminder to stay well informed by asking questions prior to surgery, like whether the doctor will be employing such procedures as microsurgery or adhesion barriers to minimize the risk of adhesion formation.

Adhesions are basically scar tissue that typically forms as a result of surgical procedures. Pelvic adhesions is scar tissue that typically develops after pelvic surgery (to remove fibroids in the uterus, cysts on the ovary, ectopic pregnancies in the fallopian tube, or endometriosis).

Had I known all this (and that there were procedures that could minimize risk of adhesions), you bet I would’ve requested my OB/GYN employ one of the procedures to minimize the risk of adhesion formation, which may have or may not have led to IVF.  Or I may not even have gone through with the dermoid cyst removal altogether.  I will never know which was the lesser of two evils–leaving the dermoid cyst on the ovary or the adhesions from removing the dermoid cyst. I will never know whether leaving the dermoid cyst on the ovary would’ve led to infertility. I will never know whether adhesions from the surgery led to my infertility. I will never know whether I was inherently infertile at that point in my life–with or without the dermoid cyst, with or without the surgery.

I just know that I did have a helluva journey to motherhood, one that was paved with infertility issues, childbirth complications, and postpartum depression–and hence the title of my book.  But let me tell you….I came out of it much stronger and smarter than before!  And now I am going to do as much as I can to bring awareness to others.  The awareness I never had and which could’ve made a huge difference for me.

Words Are Not Always Necessary…..Comforting Those Struggling With Infertility

Today is Day 2 of National Infertility Awareness Week, and I wanted to share a great article I came across today on Resolve’s Facebook page.  The title of the LA Times article is “My Turn: What to Expect When We’re Not Yet Expecting” by Carrie Friedman, author of “Pregnant Pause: My Journey Through Obnoxious Questions, Baby Lust, Meddling Relatives, and Pre-Partum Depression.”  

The article is short and sweet…providing helpful tips to well-meaning friends and family members of those who are struggling with infertility.  Ms. Friedman recommends 5 things NOT to say.  It boils down to words not necessarily being necessary because–unless you’ve been through infertility yourself–you will more than likely say something that will only sadden/upset/strike a nerve (you get the picture, right?) the couple that is undergoing fertility treatments.   

Just listening and being there (present, but not necessarily trying to figure out what to say that will comfort) are enough to show that you care.  As I mentioned in prior posts, staying away because you are uncomfortable with the circumstances due to your uncertainty of what to say or do will only serve to make the couple feel further removed from ones they love and/or isolated from others in their experience.   Feelings of isolation is one of many risk factors that can lead to perinatal depression if your fertility treatment succeeds and you find yourself an expectant parent (which I hope will be the case for you, I truly do).  Refer to my previous post on infertility and correlation with PPD.

National Infertility Awareness Week – April 24-30, 2011

The 22nd National Infertility Awareness Week (NIAW) will be taking place from April 24th to 30th this year.  NIAW is a movement to raise awareness about the disease of infertility that affects 1 out of 8 couples.  Click here for the calendar of events taking place all over the country.

RESOLVE is a community for women and men with infertility and provides information, support and opportunities to take action.  Check out the RESOLVE website for more information on infertility and how you can make a difference for you and others experiencing infertility.    There is a wealth of information on this website–a lot more than even a year ago! 

You can find the following:

Infertility is a major cause of anxiety and depression.  With the number of individuals faced with infertility today, it is no wonder that antenatal and postpartum depression rates are as high as they are today.  As such, it is very important that you seek support in getting through this difficult and highly stressful time of your life.   Support can be in the form of family and/or friends that you feel are empathetic (i.e., have gone through this themselves) and/or non-judgmental.   

If you’re not sure whom to talk to among your circle of family/friends, visit the RESOLVE website and look up mental health professionals in your area that have experience with helping couples get through infertility and infertility treatments.  Getting this kind of support can help prevent your anxiety levels from reaching a point that– should you (and I really hope you do) get pregnant– you could be heading into pregnancy with a great risk of developing perinatal depression

The absolute worst thing you can do is keep your feelings of grief and anxiety to yourself, and in fact, doing so can put you at greater risk for developing a perinatal mood disorder!

MY ONE AND ONLY

When I spotted the July 19, 2010 edition of TIME magazine sitting on the coffee table at my in-laws’ house this past Saturday, I was instantly drawn to the cover and the title of the feature article “The Only Child: Debunking the Myths.”    The intro lines of the article really grabbed my attention, with the typical setting that for some reason seems to be a common setting that kicks off many articles, both printed and on the web.  The setting is a supermarket.  Sometimes the exchange is between two women standing on line.  Sometimes it’s between the cashier and a customer.  In this case it was the latter….a mom, minding her own business, with her adorable, pink-cheeked baby seated in a grocery cart and the cashier.   Usually, questions asked at the supermarket pertaining to babies usually have something to do with the age of the baby, and if there are no other children present, whether that is the first baby.  Well, in this article, the cashier starts off the conversation with the latter.  If the answer to that question is “Yes” as it was in this case, then sometimes, the conversation steers toward comments suggesting that she ought to work on the next baby real soon, so that this one isn’t lonely and has a little brother or sister to play with, and to avoid the “single child syndrome” — the belief that single children end up spoiled rotten because their parents lavish all their attention on the one child, lacking social skills and selfish because they don’t have any siblings with whom to interact (and therefore no “sibling rivalry” experiences) and with whom to share their toys.

In all honesty, I didn’t finish the article because I already got what I needed from it, which is inspiration to write a post and share my experience with others who care to listen.   Then, I was inspired even more to make this post a priority when, on Sunday, I saw a tweet from @ArmsOpenGrace where she was saying that she was at a BBQ and couldn’t help but to compare herself with everyone else who all had 2+children, and she’d just had her first child not that long ago.   I tweeted to her: “I can’t help but wonder what it’d be like to have 2 instead of 1. I don’t even compare myself with others anymore. No point.”  So I proceeded to tell her that the TIME article inspired me to write my next post.  And here we are.

For strangers to be prying for this kind of information is a bit much, I have to say.  And it’s all based on this societal pressure to have more than one child, all thanks to Granville Stanley Hall about 120 years ago.   But I’ve learned to come right out with the truth just to cut the exchange short.   That really stops the conversation from getting further than it really has to.

I can’t tell you how many times I’ve had to experience the following exchange, similar to the one in the TIME article, from the time my daughter was an infant til now (and she is now 5-1/2).

Acquaintance/Colleague/Stranger  (A/C/S):  “What a beautiful little girl!  How old is she?”

Me:  [I would tell them my daughter’s age at the time]

A/C/S:  “Do you have any more children?”

Me:  “No”

A/C/S:  “So, when are you going to have another?”

Me:  “I’m too old.”

A/C/S:   “Nah, you’re not that old.”

Me:  “I’m a lot older than you think.  Did you know I was lucky to have her on my 2nd IVF cycle?”

A/C/S:  “I didn’t know that!  Well, why don’t you give it another try?”

Me:  “I can’t.”

A/C/S:  “Well, you succeeded before….”

Me: “I mean, I really can’t.”

A/C/S: [not wanting to give up]: “But you’re not that old.  Why not?”

Me [just so I can stop this exchange before I start to get nasty]: “Because I’m missing a critical body part.”

A/C/S: [not getting it but curiosity has gotten the better of them]:  “Um, not sure what you mean.”

Me:  “I. Have. No. UTERUS.”

A/C/S: [face falls after a few seconds, realizing finally what I’ve been trying to say]:  “Oh, I see.  I’m sorry.”

A/C/S: [conversation taking a sudden turn]: “Well, you are blessed with this beautiful girl.  You are really lucky to have her.”

Me:  “Yes, I know.  She’s my one and only.”

A/C/S: “You can always adopt, you know.”

Me:  “Yes, I know. But I am happy with just the one.”

And then, depending on who this person is and how comfortable I am with sharing my postpartum depression (PPD) experience with him/her, I may go on to tell him/her about my childbirth complications that resulted in my lengthened hospital stay, followed by PPD that started 6 weeks later.    A couple of people asked me if they thought that it was the realization that I could no longer have children that led to PPD.  I told them it was one factor, but definitely not the only factor.

Would I have wanted another child?  Absolutely!  When I was younger, I dreamed I would have four children…one more than me and my two brothers.   As I got older, I would have settled for three.    That was, after all, more than two…and two at the time just didn’t seem enough.   But then I got married late because it took me a long time to find “the right one” (and he was worth the wait!).  Not long after we got married,  I had to get surgery to remove a dermoid cyst, which my OB/GYN recommended to prevent pregnancy issues.   We got pregnant after months of trying, but only to have it result in an ectopic pregnancy that had to be terminated.  Then, after many more months of trying to conceive, we were encouraged to undergo IVF treatments.   After our 2nd IVF cycle, which thankfully succeeded, and we were well on our way with the pregnancy, I was praying deep down inside that I would be fortunate enough to succeed just one more time.  I was willing to endure one more, just so I could provide one sibling for my child.

When I woke up from my emergency partial hysterectomy, I felt so incredibly sad.   I was sad that I could not have another child.  I was sad I couldn’t provide my daughter a sibling.  I felt unwhole.  I was essentially missing an important piece of me.  A piece of me that would enable me to bear children.  It was so final.   Before, I had all my parts but they just weren’t working quite right.  There was a breakdown somewhere in the complex process that occurs behind the scenes–starting with the sperm swimming and finding a good egg to hook up with all the way through the time that there is a viable pregnancy.  And all I needed was some help (in the form of IVF) to prime up the process and improve my chances for a viable pregnancy that would carry to term.

In the hospital, after hearing the terrible news, I couldn’t help but cry.  But I couldn’t just wallow in my grief.  I now had a baby to take care of.  Since she was my only chance at having a baby, despite my pain and exhaustion, I was determined to do the best I could at breastfeeding her, changing her and holding her.  I was fine until my first PPD symptom, insomnia, appeared during the 6th week.  But in between childbirth and that 6th week, my body and my psyche had to endure so much fatigue and anxiety.  Six weeks of non-stop fatigue and anxiety finally caused my body to shut down.  I’ve endured a lot of challenges and anxiety in the past, but nothing that could compare to such a life-altering experience as childbirth and the weeks of adjustment that go with it.  And I was already starting in the negative, after having gone through what was referred to as a life-threatening procedure in which I hemorraged and lost 4 units of blood, on top of the following chain of events:

  •  traumatic delivery experience that resulted in a partial hysterectomy resulting in loss of ability to have any more children
  • negative experience in the hospital–e.g., constant sleep interruptions in the hospital, constant moving from one room to another and changes in hospital staff, multiple attempts to replace IVs in my arms/hands, food deprivation (I only had about 2 meals the whole week I was there….otherwise what I had were ice cubes for the most part, plus an occasional broth or jello), below-par treatment of certain hospital staff, searing pain (felt like someone was burning me) in my abdomen that came & went for 2 days after the surgery
  • constant sleep interruptions from the noises the baby made throughout the night, plus night feedings
  • baby’s bad case of eczema and cradle cap
  • baby’s one week colic