Postpartum Depression Doesn’t Look the Same Across the Board

I always try to keep up with the multitude of articles that feature Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders.  This particular article from October 4, 2017, titled “Postpartum Depression May Look More Like Anxiety Than Sadness” that appeared on Well and Good, by Annaliese Griffin,  caught my attention.  It caught my attention because it’s because when my doctor told me 13 years ago that I had postpartum depression (PPD), I didn’t believe him.  I thought “How could I be depressed if I’m not even sad?”  He explained that depression could manifest as anxiety, but did I understand that at the time?  Nope. Little did I know that I was about to embark on a journey to discovering what PPD really was….that it’s a catch-all term that encompasses all postpartum mood disorders, which includes postpartum anxiety, postpartum OCD, and postpartum psychosis.  That my PPD caused insomnia, weight loss, loss of appetite, and being a shell of a person unable to enjoy anything, and unable to pretty much do anything.  I was so concerned about my baby’s cradle cap and eczema and her bowel movement/feeding schedules that, by the time her colic came and went at my 6th week postpartum, PPD set in and I had no idea what was happening to me.

This article is very important because the number of women suffering from postpartum mood and anxiety disorders (PMADs) is pretty common.  And I should know because of the number of hits I get on my blog for the symptoms that I experienced.  So, if it’s been over 3-4 weeks since you had your baby and if you are feeling anxious, unable to sleep even when the baby sleeps and unable to function and enjoy things you’re normally able to enjoy (like listening to music), having moments of rage, having panic attacks, and/or having obsessive and even scary thoughts, please go the Postpartum Support International (PSI) website to seek help near you.  You are not alone, there is nothing to feel ashamed of, and you will get better with the right help.  Do not be afraid to ask for and accept help.

Jessica Porten’s story went viral a week ago because she admitted to the nurse at her OB/GYN office that she was experiencing feelings of anger, and that admission was unfortunately not handled correctly.  This, my friends, is why I have been blogging for the past nearly 9 years.  My mission is to help spread awareness and in so doing dissipate the stubborn stigma that refuses to go away because there is still so much ignorance about PPD.  My mission is to also help mothers as much as I can to get the help they need.  Anger/rage is another way that PPD can manifest for some mothers.  Everyone’s PPD experience is unique to that person because we are all complex people that– when emotions, temperaments, hormones, heredity, childbirth experience, and history come together–symptoms manifest differently from one person to the next.  Symptoms can range from feelings of sadness to anxiety, anger and even rage to insomnia, sleeping too much, lack of appetite, eating too much, obsessive/intrusive thoughts, etc.  As such, treatment of these moms will vary from one mother to the next.  Some moms need medication. Some moms need therapy.  Some moms need a combination of medication and therapy.  The duration of treatment will vary as well.  But there is one thing in common among all mothers suffering from PPD:  they need help.  They don’t need to be treated the way Jessica Porten was treated.  They don’t need to be treated like I was treated 13 years ago.

Erica Chidi Cohen, a doula and co-founder and CEO of  Loom in Los Angeles attributes postpartum anxiety to first-time mothers feeling uncertain and anxious about going through childbirth and taking care of a baby for the first time. It is more common than you think for first-time mother to feel anxious but when the anxiety morphs beyond worry to insomnia, lack of appetite, etc. is when medical attention is needed.  A traumatic childbirth experience increases the chances for a new mother to experience PPD.

Click here to visit Kleiman’s The Postpartum Pact. It is an important postpartum toolkit for expectant mothers and their partners and loved ones to review before baby’s arrival.  It truly pays to be prepared, regardless of whether you think you may be at risk for PPD or not.  One never knows, as I have said in prior blog posts and in my book, whether something may happen during pregnancy/childbirth that could lead to PPD.  It can’t hurt to review the pact and prepare to have folks lined up to help once baby arrives to ensure the new mother has adequate practical support, especially if this is her first baby or if she has another little one(s) to take care of already.

Speaking of adequate support, it’s organizations like Loom in Los Angeles and Whole Mother Village  in W. Orange, NJ — two examples of many childbirth, pregnancy, and reproductive wellness communities that have sprouted around the country to provide support, information, referrals and services from preconception to parenthood– that are critical because it takes a village when it comes to a family’s well-being.  Going it alone is not a viable option nowadays, especially when the significant other needs to work to support the family and the new mother is not well and family members are not close by and/or are too busy to provide emotional and practical support.  It really is no wonder there are so many cases of PPD.  Please see my past posts about the importance of mothering the mother and how it takes a village to minimize the occurrence of PPD here and here.

 

 

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Help Her Get the Help She Needs

My first almost wordless blog post, ever. The words in this image say it all. It is an important message that we, as family members, friends, neighbors or even colleagues of new mothers, should take very seriously.  Permission to use this image granted by Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders.

Sign this Petition! Don’t Let Any More Mothers Fall Through the Cracks Any More

REVISED AS OF WEDNESDAY, MARCH 12, 2014, 9:30 PM EST

By now, you’ve probably already heard about the woman who drove her minivan into the ocean at Daytona Beach, Florida.  Her three children–ages 3, 9 and 10–were in the minivan.  And the woman was pregnant with her fourth child.   When I first started reading the article, I was bracing myself to read about the tragic loss of four lives–actually, five lives if you count the unborn child–but thankfully, they did not perish in the ocean.  From the little I could gather from the article, it seemed that the woman was suffering from psychosis, which is how bipolar disorder can manifest in a pregnant or postpartum woman.  The 911 recording of her sister indicated that she was “talking about Jesus and that there’s demons in my house and that I’m trying to control her…..She’s, like, having psychosis or something.”

My friends and I cringed as soon as we heard about this story, just like we cringe when there is ANY news of mothers who attempt to kill their baby/children and themselves.  We cringe because we know that the general population–the majority of people out there who are ignorant about postpartum mood disorders–seem ever so swift to condemn the mother’s actions.

I am sick and tired of the stigma.  Sick and tired of the ignorance about maternal mental health. Sick and tired of women being failed by their doctors and by a medical system laden with holes that let all too many mothers fall through the cracks.

Are you sick and tired too?  Well, join me now in signing a petition to implement universal mental health screening for every pregnant and postpartum woman.  Let’s put an end to the stigma and ignorance, and get mothers the treatment they need before a perinatal mood disorder (PND)–a mood disorder during/after pregnancy which can affect up to 1 out of 7 new mothers–leads to tragic circumstances!

I have participated in/encountered several meaningful discussions on Facebook about screening over the past week.  I know from the past 5 years of blogging and advocacy that, for every bunch of PMD survivors and advocates that voice their support for the implementation of universal mental health screening of pregnant and postpartum mothers, there is at least one individual voicing concern, and even opposing  it.  Why would anyone be opposed to the simple asking of a set of standardized questions to try to see if a mom might be experiencing symptoms of a PND, you ask?  Well, these individuals are concerned that legislating such a screening would cause an already over-medicated society to fall deeper into the arms of Big Pharma and doctors even more reason to simply dole out medication prescriptions.  These individuals fear that, in addition to  inadequate experience with PNDs and an inadequate referral system to therapists who do have experience treating PNDs–both of which are entirely valid points, unfortunately–one too many moms will simply be prescribed medications (and sometimes the wrong ones, to boot) when what many moms do need is therapy as well.  To make it more complicated, many moms will fear taking medications for fear of passing the medications on to their babies through their breast milk.

Whether we get the 100,000 signatures or not, the very least that we hope would come of this petition is to raise greater public awareness of PNDs and reduce stigma. If we were to reach 100,000 signatures, then there would have to be a federal law to INVESTIGATE the subject.  If universal screening were to come about, it would be offered to all mothers, but mothers can opt out.  There would NOT be a mandatory prescription doled out if a mother tested positive.  The desperately sought outcome of the petition would, first and foremost be, EDUCATION of doctors to screen in a non-intrusive fashion, take thyroid levels into consideration, how to provide compassionate and nonjudgmental care, etc., as well as EDUCATION of mothers about PMDs and treatment options available if she were to experience a PND.  It would be up to the mother how/if she would seek treatment.

Did you know that screening is routinely offered by many OB/GYNs already?   I have not heard any negative experiences when it comes to screening that is offered to mothers today.  A big Thank You to Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders for giving me permission to use this image, which I saw pop up on my Facebook feed a few days ago.

screening_Kleiman

I would like to quote fellow Mama’s Comfort Camp member, Anna Tarkov (thank you, Anna, for letting me quote you!), in response to another member’s comments about preferring a cultural overhaul comprised of a national campaign to educate and support for new mothers over the implementation of universal screening…which don’t get me wrong, I absolutely agree with as well (we need all three: SCREENING, PUBLIC AWARENESS/EDUCATION, AND SUPPORT):

We can and should push the culture change [campaign to educate and support but with no screening] that needs to happen, but I just don’t know if it’s enough…..I share your concern for medication as a sole solution, but I feel we already have this situation with our medical system. Many conditions don’t require medication and could be treated in another way. Each patient is responsible for making up their own mind and each clinician should present all the options. I thought carefully about whether I should take medication as part of my treatment and I think I made the right call for myself. If someone else chooses another path, that is fine, but if even one life of a mother or child or innocent bystander can be saved if we were to have effective screening during pregnancy and after, I would consider that a victory…….My hope would be that with better screening, clinicians can also be required to provide a lot more beyond a diagnosis. I am cautious about any new proposed policy and often what we end up with is far from perfect. But my feeling is that doing nothing isn’t an option and any step in the right direction is a good idea.

You summed it up so nicely, Anna!

Oh, and do read and encourage others you know to read the facts, and nothing but the facts about bipolar disorder during pregnancy and postpartum.  Here is just one of many places you can read up on it.

Please, please, please…..sign the petition and SHARE WIDELY.  Let’s get as many signatures as possible!  Tweet about it.  Blog about it.  Share about it on Facebook.  Let’s be the change that we so desperately need for our mothers!  Let’s make sure that no more mothers fall through the cracks.  Thank you!

Just Be There For Her

I’m on a roll……4 blog posts in less than 1-1/2 weeks!   Is this a new trend? Not really.  I just have a lot on my mind lately.

I said the last post was probably going to be one of my shortest, but by the time I finished writing it, it wasn’t that short anymore.  Hey, I am the first to admit I’m verbose. I just have a lot to say, s’all.  But then again, being verbose isn’t a great thing when it comes to the working world (people like to see points…they refuse to read anything in paragraph form), for book writing, for blog/article submission requests with a very limited word count restriction, and for the audience that can’t stand blog posts longer than 200 words a pop and whose eyes glaze over if the content isn’t eye-catching, hilarious, dripping with satire or sarcasm, and/or mesmerizingly ingenious.

I’m sure a lot of people look at the length of my book and say “OMG, not for me.”  Hey, perhaps that’s why some people who have indicated they would read and review my book haven’t done so yet…..because when they received my book they realized it was a freaking encyclopedia and haven’t had the heart to tell me they didn’t have the time or interest any longer in writing a review.  :-/  Honestly, you should have seen the manuscript in its earlier stages.  Extremely challenging to manage would be putting it mildly.  What can I tell ya, I had a lot to say about my postpartum depression (PPD) experience, and I wanted to share my experience with as many people as possible.   Every last word I ultimately kept for the book was important, in my opinion.  I simply couldn’t cut any more information out.  I wanted this to be a “one stop shopping” experience of having everything I would’ve wanted to see in a book about a mom’s journey to motherhood that included PPD that I had a very hard time finding anywhere back in 2005, when I first started writing my book.

The Executive Director of Postpartum Support International, Wendy Davis, had written a wonderful review of my book, taking fully into account the length of the tome but in a very positive fashion.  I was going to attempt to sum it up, but in re-reading her words, I couldn’t bear to leave any of it out, it’s that good.  So, thank you again, Wendy, for your glowing words of praise.  I can never thank you enough!

One Mom’s Journey to Motherhood is a wonderfully thorough and accessible treasure trove of research, compelling information, and encouraging advice. It is sure to become a favorite, like a great cookbook that you return to over and over, knowing that you’ll find just what you want and references too! Ivy Shih Leung has written a thoroughly informed book with such a warm approach, it is easy for the reader to take in the solid information and the message of hope and recovery at the same time. Reading that Ivy has overcome her own struggles and written such a wonderful guide is in itself empowering and hopeful.  Every chapter is full of information, written with honesty, clarity, and perceptive suggestions. I am very careful about books to recommend to families and providers who want to learn about pregnancy and postpartum mental health; this is one book that I can recommend without reservation.  Ivy’s background in biology, her careful research, and her strong spirit have worked together to create an insightful author, and we are all the better for it. Thank you Ivy for being such an inspiring advocate and sharing this contribution to the field of perinatal mental health!

I posted this on my Facebook feed earlier today…because I couldn’t keep it bottled up….it was annoying the HECK out of me…and it’s not as if I don’t know that I should try to be more succinct and I haven’t been making any headway in that respect….I’ve been making a HUGE headway in that at work, thank you very much:

Something that just made my day <overflowing with sarcasm>. I was told I am quite verbose and I should learn to be succinct. Please tell me something I didn’t already know!!!

Y’see….I started off wanting this blog post to be short and sweet, and I’ve gone off topic from the intent of this post which is, as the title indicates, to just be there for the new mother.

Be there

I was going through some emails this evening and stumbled across one from Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders, giving me permission to use this image, which I saw pop up on my Facebook feed a day or two before Thanksgiving, for a blog post.  This image sums up the fact that what a new mom needs is non-judgmental company from loved ones…no words necessary.  This especially holds true for those who have never experienced a mood disorder like PPD, and are unsure of how to behave or what to say around a loved one who is suffering from it.  Although my book repeatedly mentions the importance of providing emotional and practical support to the new mother–whether she is suffering from PPD or not–the key to it all, should you be uncertain of what to say or do to help  her, is to JUST BE THERE FOR HER.  It is so important because the feeling of loneliness and isolation with respect to her experience of being home alone with the baby is one that is shared by many a mom with PPD.

Moms with PPD tend to be more sensitive, their feelings will hurt more readily, and they will be more prone to feeling unimportant. She will tend to lack self confidence especially with respect to her new mothering responsibilities. Certain well-intended comments or advice can end up hurting her feelings. In my book, I offer suggestions for the ways friends and family members can be more supportive without being judgmental.  I wrote these suggestions, remembering how alone I felt in my PPD experience.  

So, there you have it….another post that I had every intention of keeping to a couple sentences but has easily exceeded 1,000 words!  Ironic that for a post that supports the notion that words are unnecessary, I am wordy as can be.

xoxo

Cognitive Behavioral Therapy for Women with PPD

Real quick post tonight, as I am feeling very exhausted, having had about 20 hours of sleep since Sunday, simply due to the fact that I can’t seem to get everything done in the time I have each day, so I end up staying up until after 1:00 am each day.Speaking of sleep, something that caught my attention on my Facebook news feed this morning was a post from Karen Kleiman over at her Postpartum Stress Center Facebook page.  Her post provided a link to a brief article titled “An Open Pilot of Cognitive-Behavioral Therapy for Insomnia in Women with Postpartum Depression.”  Karen Kleiman is the author of a number of books on the topic of PPD.

The article touches on the fact that Cognitive Behavioral Therapy, or CBT, has been shown to improve sleep for women experiencing insomnia as a symptom of postpartum depression (PPD).  CBT is something that I mentioned in prior posts that I had not tried, because I was not referred to anyone who specializes in CBT for women with PPD.  I mention in my book and in prior posts that I might have benefited from CBT.  Now I will never know whether CBT would’ve made a difference during my darkest days of PPD.

I encourage you to email Karen directly at kkleiman@postpartumstress.com (and put CBT in the subject line) if you have participated in any CBT program/therapy for PPD, as she is in the process of gathering information for another book, this time a CBT book for the perinatal population.  Your personal experience will be invaluable to her.  Please check out her blog post for more information about CBT and PPD.

Breast-feeding Is A Mother’s Choice…Don’t Let Anyone Tell You Otherwise!

My first day really back on Twitter (I decided to finally try to get back in the swing of things), and I saw all these tweets about an article on Psychology Today about breastfeeding[WARNING:  I realize that there are moms out there suffering from postpartum depression (PPD) and/or having a difficult time breast-feeding that should not be reading articles that will only cause them further distress and feelings of guilt and inadequacy.  So, if you are currently suffering from a postpartum mood disorder, you should probably wait until you are feeling more strong before reading what I call crap that is being shoveled out in a feeble attempt to remind people that breast-feeding is best, no exceptions…which is what this article is trying to lead people to believe, which is dead WRONG.]

As I read the article by Dr. Darcia Narvaez, my mouth dropped farther and farther til it felt like it was going to hit the floor, it was that unbelievable.  It’s unbelievable that Psychology Today would allow such an unbalanced piece to be written, let alone be published for all the world to see.  The irony is that she’s posting this under the heading of “Moral Landscapes.”  I think it’s absolutely immoral what she’s doing in pulling such bullying tactics, trying to guilt mothers into breastfeeding irregardless of circumstances that they may find themselves in.  This Dr. Narvaez needs to walk the shoes of a mother who has suffered from childbirth complications and PPD.  It is obvious she has no experience or knowledge whatsoever of maternal mental health issues, PPD being a serious one, with one out of eight new mothers suffering from it.

Practically every single point she makes is filled with inaccuracies and lack of research to back them up due to a pure bias toward breast-feeding.  It’s almost like she deliberately set out to target mothers and try to bully them into following her preachings, but with no research/statistics to back any of her assertions up. Well, this preachy article should be pulled, in my honest opinion.  Thankfully, many comments opposing this article immediately started to appear on the site, and Karen Kleiman wrote a post on Psychology Today, which I applaud wholeheartedly.   Please check it out.  I wasn’t going to post a comment because what I would’ve wanted to say has been said in the numerous comments and this Dr. Narvaez wasn’t going to listen anyway.  Usually, I love to pull out my favorite lines to criticize here in my blog, but with this article, I would’ve had to quote the ENTIRE thing, it was THAT BAD.   I would like to take her first eight points and throw them out with tomorrow’s trash, especially the one where she tries to have you believe that “99% of moms can breastfeed successfully.”  Yeah, right.  Most women rarely succeed on the first try. Many don’t succeed until several days later. Some never succeed at all. Not succeeding at breast-feeding does not automatically make you a failure at being a mom.

But isn’t breast-feeding as easy as putting a baby’s mouth to your breast and having it suck? Aren’t we like other mammals that possess mammalian glands that produce milk for our offspring? We’ve all seen new piglets, puppies, and kittens lined up in a row doing their thing, all naturally knowing how to suckle after birth.  No, for HUMANS breast-feeding is no more instinctive than all other aspects of baby care that are learned from doing or learned by the in-person guidance of experienced individuals.  If breast-feeding were instinctive, why would there even be the need for lactation consultants? Why would one of the minimum qualifications of doulas be experience with breast-feeding? For every woman who feels that breast-feeding is natural, fulfilling, a source of contentment, and a great way to bond with the baby, there is a mother who feels that breast-feeding is difficult, painful and physically and mentally exhausting. Getting the baby to latch isn’t as easy as you’d think, and one would never know that a tiny little mouth can cause so much pain while sucking, especially if your nipples are already sore and cracking. And that’s in addition to the round-the-clock feeding schedule (e.g., one hour at a time, every two hours), sleep deprivation, and possibly even mastitis.

There’s this whole to-do about breast-feeding nowadays and how breast is best. Consequently, all too many moms choose to breast-feed with the best of intentions—knowing the benefits to the baby—but with very little concept of what it really entails, faced with a steep learning curve, and not expecting to have to learn or get help from anyone else for something as seemingly simple as putting the baby to breast to let the baby do its thing. As a result, all too many moms end up setting themselves up for a big letdown when they have difficulty breastfeeding and are unable to breastfeed for as many months as they were hoping to be able to do.

What new moms should keep in mind is that breast-feeding is a matter of personal preference. It is not for everyone. It is not a prerequisite to being a good mother. It’s a personal decision that must be made and should not be influenced by what other people say, think, or do. A mother who breast-feeds doesn’t mean she’s a better mother or loves her baby more than a mother who does not breast-feed. Breast-feeding is one method of feeding your baby. Your baby will grow up just fine with one of the formulas available today. There are plenty of people who were fed formula that are healthy and extremely successful in their careers.

A common misconception out there is that you must nurse your baby if you expect to bond properly. Let’s think about this for a moment. What about everyone who’s been bottle-fed? I doubt everyone who’s ever been bottle-fed failed to bond properly with his or her mother. You don’t have to breast-feed to bond. If you do breast-feed without any problems, that’s great. But you can also bond while formula feeding. Not everyone chooses to and/or is able to breast-feed. Dads and adoptive parents can’t breast-feed and are still able to bond successfully with their babies.

If you want to breast-feed, giving it your best shot is all you can ask of yourself.   Don’t let anyone else influence you into believing you must breast-feed. You and your significant other are the only ones who should have any say in the manner in which you feed your baby. It’s no one else’s business. You will be making the decision based on what you feel comfortable with and what you think is best for your baby. Feeding your baby formula doesn’t mean you’re a bad mom.

Don’t feel guilty or deficient about not being able to breast-feed, and don’t feel guilty for having to stop breast-feeding if you need to take medication to recover from your PPD. The priority is for you to be well again so you can care for and establish a warm and loving relationship with your baby.

If you haven’t already done so, go on over to these blog posts that have also been written in response to the Dr. Narvaez’s article:   My Postpartum Voice’s “My Breasts, My Sanity, My Choice” and Fearless Formula Feeder’s “Good versus ‘Evil’: How ignorance can bring out the best in the breastfeeding/formula debate.”