Happy 1st Birthday, STIGMAMA!

I am proud of my friend, Dr. Walker Karraa, for so many reasons.  Today, I would like to acknowledge and congratulate her for the success of her amazing blog, STIGMAMATM. Happy 1st birthday, STIGMAMATM!!!

You have grown soooo quickly! In what feels like less than a year to me–because last year went by so fast–you have had over 70 contributors, garnered over 16,000 followers on Facebook, and been recognized as a leading health blog, and the list goes on. You are the fastest growing blog specifically about mothers (of all ages), mental illness, and accompanying stigma.

I have not had a chance to contribute to you as of yet because I spent half of last year studying for two exams. But I am definitely going to join the ranks of the over 70 contributors that have written for you to date.

If you haven’t followed Dr. Walker and STIGMAMATM by now, please do. They are on a mission to help eradicate stigma. Let’s join them on that mission!

If you are a blogger, please join the blog hop to wish StigmamaTM a very happy 1st birthday, and many, many, many more! Create your blog post, click on the button below, and add your information to the blog hook-up page that comes up via InLinkz.  Not a blogger?  That’s okay.  There are many other ways you can help celebrate. You can spread the word about StigmamaTM to your friends.  On Twitter, you can chat with Dr. Karraa and her contributors and other followers by using @Stigmama1 or #StigmamaBirthday. On Facebook, you can leave Dr. Karraa and her contributors a message(s) on the Stigmama Facebook page.

Beautiful, Troubled Path – A Poem by Stacy M

Stacy M. wrote this poem one year after her first postpartum depression (PPD) meltdown/hospitalization. 

She wrote it as a reflection of the obstacles she hadn’t expected becoming a mom would entail, including a devastating pregnancy loss. 

Despite the deeply wounding obstacles she came across, she never gave up. 

She felt so broken during her  hospitalization, after which she was able to realize that she could heal and move on and still be a great mom.

She wanted to share this poem with other moms who are on a beautiful, troubled path now or have also traveled a similar path.

Just like her, you may not have expected that becoming a mother–a traditionally happy, joyous occasion–could have any pain or darkness associated with it.

Just like her, you will find that the pain and darkness will pass and  beauty will prevail in the end.  Yes, beauty is at the end of the path.

And the difficult experiences are what make you a stronger individual.

Thank you, Stacy, for sharing your touching poem.

 

Path

Photo: Ivy Shih Leung

Beautiful, Troubled Path

have you seen how dark it can get in a grieving mind
have you tried on the shoes that I have walked in oh so many times

have you felt the heavy rain turn to hail upon your shoulders
or have you tried living life moving constant boulders

obstacle after obstacle
how many leaps of faith can one take

wound after wound
how much more heartache

the path to having a family of my own
has set off tears that will never dry

skinned knees from being on the ground
begging the universe please

strength and patience is the hardest to hold onto
when waiting to find inner peace

balancing my mind day in and day out
balancing the pain with a breathe of fresh air
is the only way to heal
to feel

the beauty underneath this troubled path
of becoming a good parent and a better person

= = = = = = = = = = = = = = = = = = = = =

By:  Stacy M.

My Blog’s 5th Birthaversary and Info on PSI Zumbathon Fundraiser

Some people call it a Blogoversary.  Some people call it a Blog Birthday.  The French say “Joyeaux Anniversaire” for Happy Birthday.   I don’t really care much what it’s called.  I just know that both Blogoversary and Blog Birthday hold the same meaning, and my blog has been around for 5 years!  Woohoo!!!  Actually, five years and one day, since the momentous occasion was yesterday.  But I was too tired to blog last night…..anyway, I’ll just compromise and call it a Birthaversary.  🙂

In these past 5 years, I’ve seen an increasing number of personal experiences with postpartum depression (PPD) posted on blogs, on Huffington Post, on online parenting magazines, etc.  Seeing these articles gives me hope that we are reaching more and more people about maternal mental health issues.

At the same time, however, there are still stories in the news of how we–despite being in 2014–are still failing our mothers all over the world.  Sometimes, I think that it’s willful ignorance that keeps people in the dark.  And like the UK  case I wrote about recently, misguided priorities and inadequate training are still leading to mothers falling through the cracks.

I want to implore all PPD survivors, PPD advocates and medical/mental health professionals to make a more concerted effort to:

ISL_020714

Work together
Remember that a healthy baby means a healthy mother
Really focus on the mother’s well-being
Break down silos
Encourage collaborative care
Support mothers and discourage mom-petitions
Embrace the fact that there is no one right way to mother
Ensure there is increased public awareness and research initiatives to improve early detection and treatment
Encourage a culture of sharing and banish stigma

Before I end this post, I would like to share information about an upcoming Postpartum Support International (PSI) zumbathon fundraiser being held in memory of Cynthia Wachtenheim, a mother whose life was tragically cut short last March.  All proceeds from the event will go to maternal mental health public awareness and support.  I am proud to be a member of PSI since 2006.  It is an organization that is very much at the forefront of all of the positive efforts above.

A “How Are You” Would Be Nice….

Can’t believe it’s been 2-1/2 weeks since my last post.   And a lot has happened in this relatively short time period.  Sandy happened.  It happened with a fury here in New Jersey and in New York.  Thousands without power….many STILL without power.  Many in the coastal areas–from Cape May to Staten Island and Long Island and all too many towns in between–no longer have homes to return to.

People generally can’t fathom, understand, comprehend, imagine–or what have you– what it’s like to be in an area that is the unfortunate target of the terrifying forces of Mother Nature.  That is, not until it happens to them.   I would imagine that people who’ve never been impacted by power outage for days, flooding, or loss of home would not know how to adequately express concern.  Understandable.  But, that doesn’t mean you don’t ask how a person you are speaking with–like a colleague whom you know is in the area impacted by, say, Sandy–how they are doing.  Basic etiquette, yanno?   Before hammering away as you normally would in a business-as-usual fashion, start the conversation with “I hope you and your family were not too badly impacted by Sandy.”   I made it a goal to make that either my first statement in emails I sent–or the first words out of my mouth when speaking–to colleagues in the past couple of weeks.

What do I mean by “hammering away?”  I mean people emailing and calling from other parts of the country–in their usual curt, demanding way, expecting someone to immediately provide a response–with no attempt made to ask how you are and if everything is okay.  They just assumed that, if they could reach you by phone/email, then heck….you must be fine.  Well, you know what they say when you assume?   Yep, it makes an a$$ out of u&me.  Do they realize there are still so many people out here with no power…and in freezing temperatures?  Some with flooded homes? Still others with no homes any longer?

Now, I’m going to draw a parallel between people asking about your well being in the wake of Sandy with people asking about your well being after you have a baby.  People just assume that all mothers have smooth, easy and blissful childbirth/postpartum experiences.  Well, no, not everyone has smooth, easy and blissful childbirth/postpartum experiences.  But even if there are childbirth complications, do you ever see an email announcing baby’s birth as anything other than what you traditionally see–i.e., “[Insert baby name] was born at [insert time] on [insert date].  Mom and baby are doing well.”  No, you don’t, do you?  You don’t ever see anything like “Mom had childbirth complications and had to have an emergency surgery to remove her uterus 3 days after giving birth, and mom and baby (and daddy too) had to spend a week in the hospital.”  That, by the way, was MY EXPERIENCE (to get all the details, you’d have to read my book).  That is the email I wanted to send out but didn’t have the nerve to.  The email announcement I had my friend send out for me had the “traditional” language in it.  Here’s an excerpt from my book in the section titled “Hear No, Speak No, See No” as to my theory behind why the traditional language is always used, even when it may not be true:

People only want to hear what they want to hear, which is that your experience was like any other mother’s experience. They don’t even want to hear the details of how the labor and delivery went. They just want to hear these seven words: “Both mom and baby are doing well.” This is what I refer to as the spare me the details effect. Same thing whenever you ask anyone, “How are you?” and you expect the answer to be “Good, thanks.” I always get this strange look from people whenever I provide a response that’s in any way negative.   It’s almost like, how dare I provide a response that isn’t within the socially acceptable “Good, thanks.”

Slowly, the reality of what happened is sinking in with friends and family…and it has been nearly EIGHT years.  To this day, many friends still don’t know the true extent of my childbirth and postpartum experience.   Is it because they are scared of what they will find out?  Perhaps. After all, who likes to talk about negative things if you don’t have to?  Who seeks out awkward situations?  Like I said before, people only want to hear what they want to hear.  HEAR NO, SPEAK NO, SEE NO…..

Even if one does have the nerve to send out a “non-traditional” announcement, what do you think the reaction would be?    Will people leave you alone, not calling or visiting, for fear that they will be a bother or say something that may only make matters worse?  Will they hear the news and scurry away, because it’s human nature to want to avoid hearing bad news, especially when it comes to childbirth?  I’ll tell you this, I will NEVER assume that all is fine with the mom and the baby.  I will always ask how they are, bearing in mind that no matter how much advice I want to pass onto them, I won’t offer any unless they ask me for advice.  I don’t want to hurt any feelings or cause any self-doubt for the new mom.  I don’t want to seem like a know-it-all, all pushy and overbearing.  I will treat others the way that I would want to be treated, keeping in mind what I now know from my own journey to motherhood.

Because people assume (there’s that word again) that everything is fine and dandy just because you appear to be fine and dandy (see my past post on how appearances can be deceiving) and if they themselves have never experienced childbirth or childcare complications or postpartum depression (PPD), they think you should be able to bounce right back as if you’d never given birth before.  At work, that means returning to work immediately (some female executives and employees of small firms) or in 6 weeks (some companies only offer this much in maternity leave) or in 3 months (usual maternity leave duration).   And if you happen to have PPD, they think you should be able to “snap out of it” because “it’s just mind over matter.”  Just like the post-Sandy scenario I describe above, there will unfortunately be those colleagues who will address you as if nothing has changed.  No “How are you feeling?” or “Hope everything went okay.”  Everything is just plain ol’ business as usual.

I’ve said this before and will say it again, one should never assume that just because she’s smiling that everything is fine and blissful.  With one out of eight new mothers suffering from PPD, someone you know–be it a friend, relative, neighbor or co-worker–may at some point experience it.   I wouldn’t want to be in a position where I could’ve asked how a new mom feels but don’t and then later find out that she was suffering from PPD.   All it takes is asking a friend, relative, neighbor or co-worker who has just had a baby “How are you?  How do you REALLY feel?”  You could be saving a life one day, because some mothers do unfortunately struggle with severe postpartum mood disorders….and some unfortunately do not survive.

I could go on and on, but will end with this.  The personal philosophy I choose to live by is to treat others the way I would want to be treated.  How difficult is it to ask these three words “How are you” of someone you know–be it a relative, friend or acquaintance?  Is it that difficult to take the time to show you care about other people in your life?    I sincerely hope the answer to this last question is No.

I’m a Bottle Baby and I Am……a Mother of a Bottle Baby and Proud of It

As I have mentioned quite often on my blog, surviving my postpartum depression (PPD) experience has had a transformational effect on me.

My experience has:
1.  Educated me on the stigma and ignorance that exist with respect to mental health issues (and maternal mental health issues, which are of particular importance to me) in this country….and throughout the world, for that matter.
2.  Educated me on our society’s trend in the wrong direction with respect to ensuring that new mothers get the care and nurturing they need in the first weeks after childbirth.
3.  Opened my eyes to the toxic societal trends in the form of motherhood myths that cause unnecessary anxiety and unnecessary feelings of guilt and shame.
4.  Instilled a desire to help other new moms suffering from PPD (and any moms just seeking non-judgmental emotional support).

Speaking of  toxic societal trends, there are quite a number of them, the latest of which has the Breast is ALWAYS the Best fanatics behind it….brings to mind the far-right views on abortion (no exceptions, even for rape or incest), but I won’t go into that here.  This fanatical thinking that breast is ALWAYS the best–despite congenital/neonatal issues, childbirth complications (like mine), needing to take PPD meds to recover in order to BE a mother to your baby (like me), and the list goes on–needs to cease and desist!

Year of the Dragon – 2012

When it comes to the mental well-being of a new mom, I am ever so mindful of the stigmas, ignorance, attitudes, beliefs, myths, etc. that have a toxic impact on a new mom.  The dragon in me comes out (picture me with fire coming out of my mouth) and  I get VERY IRRITATED by the things I come across– whether it be from discussions I overhear (or have with people), articles/posts/comments I read on the Internet, or hear in the news–that have to do with any toxic ways of thinking.  Hence, much of what I post are my reactions to the good and the bad–there is unfortunately more of the latter out there. 😦

In the past few months, I joined these two wonderful Facebook groups for moms:  The Fearless Formula Feeder and Bottle Babies (Brisbane, Australia).    I wish I had such resources when I was having trouble breastfeeding over 7 years ago!    The ladies who make up these two groups are truly amazing, and I respect them so much for their dedication in helping new moms and providing them with non-judgmental emotional support.  Together, they recently released this video titled “I’m a Bottle Baby and I Am…..” that I would like to share with you:

“[How] you fill your [baby’s] tummy is not as important as how you fill their heart, mind and spirit.”
– Bottle Babies

Amen!

I’m such a new member of these two groups that I missed the opportunity to contribute to this video.  Well, anyway, here’s a picture of both me and my daughter as examples of two healthy, bottle-fed individuals with good heads on our shoulders.  🙂

Please Support MotherWoman’s Moms are Worth a Million Mission

Here we are, in the month of May already.  Spring….and Mother’s Day both come to mind.  I know, some of you out there think Hallmark when you hear “Mother’s Day.”  But I have to say it should be way more than that…

Tonight’s post is about….you guessed it…MOTHERS.  Not hard to guess, considering my blog is devoted to maternal mental health.  🙂  Mothers have the toughest, yet most rewarding job…. a job that in this society often gets taken for granted…and is an unpaid one at that.  After all, isn’t being a mother an instinctive, no-brainer kind of thing? <shaking head vigorously>

My post from last night mentioned motherhood myths and societal attitudes that don’t help, but rather make motherhood all the more challenging.  The end result is that the new mother often finds herself isolated both in terms of perception and in reality when it comes to having adequate social support.  The motherhood myths, societal attitudes, and social support are things I actually tackle in depth in my book….and I might add, with great relish.  Because I really LOVE to combat false notions that are detrimental to mothers!

Today’s post is about MotherWoman’s latest mission….and what better time to announce as Mother’s Day approaches!  I can’t agree more with the following, which lies at the very heart of that mission:

When you support a mother, you uplift her family.
When you uplift a family, you strengthen their community.
When you strengthen a community, you change the world.

The theme is the same as what I’ve said before and I’ll be happy to say again:

A healthy and happy mother means a healthy and happy family.

Isn’t that the truth?  Yeah, you know it!!!

MotherWoman’s latest mission, which I think is absolutely critical, is to raise $10,000 for scholarships by July 2nd to enable 25 community leaders and professionals working for nonprofits to take a 3-day MotherWoman Support Group Facilitator Training to learn how to provide peer-led support to moms.  This year, the training is taking place in Massachusetts, New Jersey (in June…I plan to be there), Washington, and Guatemala.  There have been requests for training in other locations, which is a wonderfully encouraging thing to hear, because we so desperately need more support groups for mothers out there!!!!  Coincidentally, I was just saying this in my post last night!

Please take a few minutes to watch this video and hear about the impact this project has had on four mothers and how they are now giving back to other mothers by leading MotherWoman Support Groups in their communities.

 

Please consider helping to support the project by donating and/or spreading the word about this mission to others on Facebook, Twitter, your blog, via email, or even in person!

Click here to donate and see some of the neat perks to donating.  Any amount would be appreciated! 

Also, if you are interested in applying for a scholarship yourself, contact Liz@motherwoman.org.

Motherhood and PPD: Changing Attitudes Takes Open Conversations and Being Supportive

I mentioned in a previous post how Gwyneth Paltrow had “come out of the closet” nearly two years ago regarding her postpartum depression (PPD) experience after the birth of her son Moses.  I am happy to see that she is continuing to talk about her experience, this time in the premiere episode of Lifetime’s The Conversation with Amanda de Cadenet. Check out the Celebrity Baby Scoop article and US Weekly article that I stumbled across, thanks to a Facebook post yesterday from my friend Liz Friedman over at MotherWoman.

What caught my attention was the following quote from Gwyneth:

“We think that it makes us bad mothers or we didn’t do it right, but it’s like, we’re all in this together. I never understand why mothers judge other mothers, like, ‘What do you mean you didn’t breastfeed? What do you mean you didn’t do this?’ It’s like, ‘Can’t we all just be on each other’s side?’ It’s so hard anyway. Can’t we all help each other get through it? There’s a shame attached to it because if you say, ‘I had a baby and I couldn’t connect to the baby,’ it’s like, ‘What is wrong with you?'”

Yes, yes, yes….100% with you on that Gwyneth, as I’m sure many moms would agree as well.  Basically, this is the age-old let’s-judge-other-moms-rather-than-help-each-other thing.  Or let’s-keep-quiet-because-I’m-too-ashamed-to-let-others-know-I’m-not-the-perfect-mom-that-bonds-immediately-and-breastfeeds-instinctively thing.

If we’re so gung ho on breastfeeding, then the goal of breastfeeding advocates should be for every mother who needs help to get it whenever and wherever it’s needed.  Just like my past post on breastfeeding and a section in my book in the chapter on motherhood myths, don’t assume that every mom breastfeeds without any issues.  Don’t make a mom feel bad if she decides not to breastfeed for whatever her reason may be.  One should refrain from judgmental tactics. And don’t assume that every woman has smooth pregnancy, childbirth, and postpartum experiences.  Why do these myths, or attitudes, need to exist, anyway?  What purpose does it serve, other than to crush the self esteem of a new mother?  How about helping out a fellow mother instead of judging, criticizing, isolating, gossiping?    Let’s say we do away with these myths and attitudes?  Let’s come up with solutions in the form of peer-led new mom/postpartum groups, like MotherWoman and Santa Barbara Postpartum Education for Parents (SBPEP), all across the country.  In cities, suburbs, and rural areas.

And Gwyneth also speaks for moms like me who suffered from PPD and understand that it’s awareness that will empower and make a difference for mothers.

“That’s why I talk about it, because even the awareness of it started to diminish it…..Because I didn’t feel like I’m dying or I’m crazy — period. It’s like, ‘Oh, this is a thing. This is a real thing and these are the symptoms and I have them all.'”

As I stated in the introduction to my book reading last Thursday, I wrote my book based on what I was so desperate to find when I was suffering from PPD myself—comfort, hope of recovery, and helpful tips and facts to help validate that PPD is a real illness with physical symptoms and needs treatment, just as any other illness like diabetes has physical symptoms and needs treatment.

Knowledge is power.

Knowledge–which in the case of PPD, is gained by talking to others and reading about it on blogs, in books, and in articles on the Internet and in magazines–has a tremendous normalizing effect.

Knowledge is key in keeping fear at bay, since fear typically rules in the presence of the unknown.

Knowledge about PPD–what it is, what the symptoms are, and whether you’re at risk–will make you less likely to panic over what is happening to you, less likely to feel helpless and hopeless, and more likely to know where and whom to seek help from immediately.

Knowledge of what is causing you to feel the way you feel can help minimize these very negative feelings. Never hearing any other mothers say they’ve experienced any of these negative feelings, you may end up thinking, incorrectly, that you are completely alone in what you’re experiencing. Not knowing that PPD is causing these feelings, you won’t know what’s wrong with you and fear, needlessly, that you will never return to your old self again.  I didn’t know what was happening to me, so I feared needlessly that I would never return to my old self again.

Let’s keep the conversation about PPD going.  By keeping an open dialogue about PPD going–be it via written format on blogs, books or magazines or in day-to-day conversations we have with others or on TV and/or radio if you have access/connections to media outlets–we have a much greater chance at combating the stigma behind perinatal mood disorders and any other challenges a new mom faces.  Let’s come up with ways to support mothers and increase public awareness!

How Has Postpartum Depression Impacted You?

I have a whole bunch of posts pending…more than I have the time to devote to writing.  Lots of ideas….so little time!

Anyway, I picked this article I read in Parenting.com, parts of which really resonated with me.  The article, “When Postpartum Depression Lasts” by Susanna Sonnenberg, reflects the author’s own PPD experience, which seems to have had a long lasting impact on her, so much so that she has residual feelings of loss, sadness and painful reflections on her first months at being a mother.

How well one mom is able to come to terms will differ from the next mom and will depend on a number of factors such as how severe her symptoms were, whether she was quickly and effectively treated, and whether she received some sort of therapy to cope with her feelings of loss (e.g., lost opportunities in bonding), guilt (e.g., for experiencing PPD to begin with), sadness, etc.   Therapy sessions, journaling/blogging, and providing other mothers with support are some of the ways PPD survivors come to terms with their experiences.

There are women who– like Marg Stark, fellow Mount Holyoke College alumna and author of What No One Tells the Mom– are unable to return to their pre-baby emotional selves. For these women, it seems that the biology behind their moods is permanently altered during the childbirth process.

As for me–and I can only speak for myself here–I pretty much returned to my pre-baby emotional self–except, that is, where it concerns my pre-baby body. As I indicated in my previous blog post titled “Just Because I’m Blogging about PPD Doesn’t Mean…”, I’ve managed to come to terms with my experience, finding it very therapeutic to journal my thoughts and feelings into my book and my blog, meet other PPD survivors and subject matter experts, and help some moms along the way. I did return to my pre-pregnancy weight shockingly fast thanks to the rapid, unintentional weight loss caused by my PPD.  But my completely sedentary lifestyle and confinement within my house for over 3 months did a number on my body. It took a while for my legs to not get tired so easily from simply walking at the nearby mall.  My triglycerides level was at an all-time high (nearly 400), probably thanks to the chemical upheaval from my childbirth experience.  With the help of daily jump roping (400 jumps in about 5 min) for a few months, I was thankfully able to drop the levels by 50%. I had back pain and left hand numbness issues (which turned out to be a pinched nerve from misaligned vertebrae), both of which were resolved by a few visits to my chiropractor.  It also took a while for my hair to re-gain its former thickness.

Do I wish I could provide advice and comfort to others I know, and would being able to do so give me a sense of satisfaction?  Yes!

Would I feel less alone in my own PPD and motherhood experience, knowing that others have had similar experiences–thereby, normalizing my own experience?  A resounding Yes!

Do I envy those who have snappy childbirth experiences?  Hell, yeah!

Do I envy the Gillian’s of the world?  I’d be lying if I said No.

But remember, the key difference between the author’s experience and Gillian’s lies in the amount of support they received.  According to Gillian, she had tons, while the author had very little, if any.  The following sounds so much like my own circumstances:

“In my experience, having a new baby was a lonely trial, friendless, sunless, sleepless…..By choice, I lived thousands of miles from a difficult family, and few of my friends had children. I was without a guide, and every demand of the baby’s felt overwhelming…..I didn’t want to leave [the hospital], didn’t know how we’d do the blanket [in reference to swaddling] at home.”

She assumed that Gillian would need her advice because she would need it, just like she would’ve liked to get it but didn’t, as a first-time mother.

“[She] opened the door, beaming wide, the baby propped over her shoulder; [and] I noticed the wood floor, sun shining onto it through the French doors, dust-free, crumb-free. Her hair was clean. Her laptop stood open on the empty dining table……’I don’t want to tell my friends,’ she said, ‘but [the baby’s] sleeping six hours at a stretch.’…..She praised her in-laws, so helpful and available, told me how excited she was for her mother’s next visit, listed the nonstop help of friends and acquaintances. Her story of becoming a mother was about family and support and glorious spring and strength and new pain and two pushes. Two pushes.”

The picture she paints of Gillian–a woman who appeared to take to motherhood like ducks take to water right from the get-go, like they were born to do so without training of any sort–is one of a woman who appears as if she were born to be a mother, all radiant and confident.  She looked perfect, the house looked perfect, her baby was able to sleep early on in enviously long stretches, and she claimed she received tons of help from friends and family.  And all this after a mere two pushes. The perfect pregnancy, childbirth and motherhood experience all rolled up into one.  I devote a chapter of my book to saying that such perfect experiences are not representative of what all women go through, contrary to what societal beliefs and motherhood myths would have you believe.  Though it’s definitely nice to wish for smooth experiences, it really is best to keep your expectations in check.  Trust me.  Hope for the best…you know how the saying goes.

Like the author, I would like to have the opportunity to offer my help and advice to other new moms, thinking they would need and appreciate it, just as I would’ve appreciated it during my first stab at being a mother. Just like the author, I’ve found that not everyone is going to need or even ask for any help and advice.  My friends and relatives all seemed to have no need for my advice/help, even while knowing what I had gone through, with the PPD and all.  Which makes me feel like I’m the only one in my immediate circle of friends and family who has ever experienced PPD.  The lack of PPD may be due to the abundant support they receive from family during the first critical weeks of motherhood and smooth childbirth experiences (after all, lack of adequate emotional/practical support and a traumatic childbirth experience are risk factors for PPD).  In fact, many of my Chinese friends had their mothers stay with them for the first 2-3 months.  Either the mothers flew in from overseas and stayed for that time period, or they happened to live nearby and came over everyday to help out.  I look at and think about those situations with envy, thinking that that is the way it is supposed to be….and yet why didn’t I have such fortune?  Somewhat selfishly, I’ve yearned to find a friend or relative with a similar experience with respect to childbirth complications, uncertainty at being a new mother and taking care of an infant for the first time and/or having to deal with PPD.  After all, it’s natural to feel the need to find someone with similar experiences to try to normalize your own experience…it would help you feel less alone.

“I’d expected her to feel alone and desperate, and she didn’t. I’d expected that she’d need my support, that no matter how many good minutes she had, the bad hours would overwhelm her. I needed her to be like me, so that I could be the wise one now, the healed and the mighty; then my loneliness and depression wouldn’t have been for naught. I wanted to be the one to teach her that it would get better.  Instead, she reminded me …..that motherhood’s first months gouged a terrible pit in my heart. Becoming a mother was nothing like I’d anticipated.”

Now, I would like you to think about how PPD has impacted you. Has it been many years since you’ve had PPD and you find that you are still struggling with certain feelings of loss from having experienced PPD while trying to deal with the fact that there may be others around you who are like Gillian, seemingly filling the shoes of the so-called perfect mother?  Or have you completely come to terms with your experience, feel no regrets, only a sense that your experience with PPD has made you a stronger person, empowered with knowledge that you can use to help others (that’d be me)?  Or somewhere in between?

I think one of the keys lies in how your motherhood experience turned out relative to your expectations.  The larger the gap, the greater the sense of loss.  If you find that you are struggling with feelings of loss, please don’t take it the wrong way if I suggest you talk to a therapist experienced in treating moms with PPD.  It can do you a world of good to have someone help you process and cope with your feelings and experiences.

Let me end this post by saying that, for a good number of moms, their PPD experiences have motivated them to dedicate their lives to helping other mothers get through their PPD experiences, either by 1) becoming psychiatrists, psychologists, registered nurses, social workers, 2) forming PPD support groups or other not-for-profit organizations like Santa Barbara Postpartum Education for Parents, Postpartum Resource Center of NY, and MotherWoman, 3) blogging, like Katherine Stone’s Postpartum Progress, or 4) using other social media means to support mothers, like Yael Saar’s PPD to Joy and Lauren Hale’s #PPDChat on Twitter.

After all, we PPD survivors do share a common bond.  We know what it’s like to have PPD.   We understand.  We care. We are what is referred to on Twitter as the #PPDArmy!

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.”

The Myth That Loving Your Baby Means Never Taking a Break

Okay, so you now have a brand-new, completely helpless infant to take care of.  Loving your baby (and your other children if you have any) means never needing to take breaks from her.  Somehow, new mothers all seem to feel guilty at the mere thought of taking a break, convinced that taking time for themselves makes them selfish and bad moms.  C’mon….how ridiculous is that? 

Sure, your priorities have shifted and you need to take care of your new bundle of joy.  But that doesn’t mean you can’t have any time to yourself or time to rest.  You can’t take care of yourself, let alone your baby when you’re completely drained.  You can’t continue on an empty tank, not allowing your body to restore your energy in the form of sleep and adequate nutrition.  You are, after all a human being, not a super-being or the Energizer® bunny that keeps going and going and going.  No one, not even the Energizer® bunny, can run on empty.  The bunny can’t keep on going and going and going without new batteries. If you deprive your body of the sleep, nutrition and rest it needs, there is only so much time before your body will send up a warning flag and succumb to the stressors with which you are faced.  Sure, you put the needs of your baby before yourself.  You make sure she’s fed, cleaned and comforted.  But at the end of the day (figuratively, not literally), you must also be sure to tend to your own needs.  With energy, you can put more energy into mothering.  Can’t be more logical than that!

Mothers should be allowed/allow themselves to take breaks from the baby at least once a day.  If getting more sleep means having someone watch your baby so you can sleep soundly for 4-5 hour blocks and/or take a nap, then so be it.   This may mean arranging for that person to take the baby out while you nap or have the baby stay with them overnight.  Remember, the more well-rested you are, the better off the baby will be. 

If you cannot manage to find a small block of time to nap each day, then the least you can do is close your eyes for a few minutes every couple of hours.  You know you need help when you start to feel like you can’t manage on your own.  You should not wait until you get to that point, especially women at high risk for PPD.  You need to have a postpartum wellness plan lined up and ready to go upon your baby’s arrival.  The plan should include ensuring you have someone to help you each day for the first couple of months so you can get a 4-5 hour block of uninterrupted sleep each day, as well as take breaks from the baby once a day.  In most cases, you won’t be able to rely on your significant other because they need to go to work.  So perhaps your mother, mother-in-law, housekeeper, or nanny.  Someone.  If you don’t already have a cleaning person, hire one to come by once a week, once every other week or once a month. 

 Importance Of Self Care

 “Taking care of yourself is self respect not selfishness.” – Anonymous

What I learned from my PPD experience is the importance of taking care of yourself.  In fact, taking care of yourself is a necessity, NOT a luxury!  Aside from getting as much rest/sleep as possible, here are some tips that I hope you will seriously consider adopting for yourself!

 You’ll be a lot better off if you lower your expectations for yourself:

  • Don’t feel compelled to go to social gatherings or host any parties, particularly if you’re not feeling up to it.  There will be plenty of opportunities down the road for all that. 
  • Don’t expect to keep up with all your chores in addition to caring for the baby, all on your own.  Don’t expect to keep a perfect household in the first months postpartum, unless of course, you can hire a housekeeper.  Don’t push yourself too hard, and don’t feel bad for not being able to do it all.   No new mother can do it all by herself.  It’s simply unrealistic.  Do what you can manage, get your husband or someone else to help with the rest, or just do it later.  This includes making your bed.  There’s no need to make it everyday.  Doesn’t even matter if the clothes you wear are wrinkled or worn several times already that week.  Remember, your priorities are caring for your baby and making sure you get as much rest as possible.  The key is to minimize your stress as much as possible and avoid overexerting yourself.
  • Don’t feel compelled to pick up the phone every time it rings.  Let the answering machine do its job every now and then, especially when you’re busy with the baby or when you’re trying to get some sleep.  In fact, if and when you do try to sleep, you should try to forward the calls to voicemail so you won’t be disturbed.

Nothing Wrong With Doing Something Nice For Yourself…In Fact You Deserve It

  • Do take the time at least once in the first 3 months to treat yourself to a trip to a beauty salon or massage parlor.  Do something you wouldn’t usually think of doing, like get a makeover, a completely new hairdo, a facial or a massage.  Or do something that you simply haven’t had time to do and is long overdue, like get a perm, highlights, hair coloring, pedicure and/or manicure.  It may be something you can do yourself that you simply haven’t been able to find the time or energy to do since the baby’s arrival, like put on makeup, pluck your brows, or put nail polish on your fingernails and toenails.  However, if you are breastfeeding you may want to put off a perm, highlights and hair coloring, since the chemicals can get into the bloodstream and into your milk.  I’ve been getting highlights since before I got married in 2000 and had to put it off from the time I got pregnant until I changed over to formula feedings.  I was feeling unkempt, not having had a haircut in a while and unsightly, with highlights grown out and long grey roots showing.  I can’t tell you what a relief it was to finally get my hair cut and highlighted again.  I felt rejuvenated, a new person!

Importance of a Healthy, Balanced Diet

  • Do maintain a healthy, balanced diet.  Remember, your body has gone through a series of huge biological changes.  It shouldn’t have to be explained that sleeping, eating and staying hydrated are the 3 minimum and essential requirements for a person to stay alive.  Your body requires adequate amounts of all three to recover from childbirth and recharge each day.  Poor nutrition, sleep deprivation and dehydration will make you more vulnerable to illness and stress, putting you at greater risk for PPD. You must be sure to make time to eat (nutritiously).  Make sure you get enough carbs, fiber and protein.  It is never acceptable to not eat because you can’t seem to find the time to do so because of all the new pressures and responsibilities you now have—not to mention you desperately want to return to your pre-pregnancy weight and figure.  Now’s not the time to cut back on the nutrition your body needs to recover and—if you’re breastfeeding—what your baby needs to get from your milk.  If you’re not healthy, it makes taking care of your baby all the more difficult.  Never mind that your body has just undergone huge changes, blood loss and trauma (some more than others).  If you’re like me and suffer from a loss in appetite and weight, you will cause things like vitamin deficiencies, which in turn, can contribute to fatigue and make your PPD worse.  Yes, another vicious cycle to try to avoid! 
    • To repair your body and bring it back to its former condition, as well as develop enough milk and prevent anemia, be sure to eat enough protein.  Tofu, beans, nuts and of course meat are great sources of protein. 
    • To help with constipation, which is common in the first week as your body recovers from childbirth, not to mention a common side effect of antidepressants—eat foods high in fiber, like fruits, veggies and even beans.  There is no prep work needed for pre-cut veggies (e.g., baby carrots), bagged salads, bananas, and grapes.
    • Rather than eating 2-3 large meals a day, you may be better off with small meals throughout the day.
  • Do avoid sugar, including soda and foods high in carbs, since it can cause rapid swings in your blood sugar level that can cause mood changes.  The key to keeping your mood stable is by maintaining your blood sugar at a constant level.  If you’re experiencing a loss of appetite, try to eat small, nutritious meals throughout the day.  Avoid junk foods that are quick and easy ways to satisfy your hunger but have no nutritional value.  If you want something quick and easy to eat, yogurt is a healthier option than Tasty Cakes, Twinkies or candy bars.  Frozen dinners like Weight Watchers and Lean Cuisine or even Subway sandwiches are healthier options than fast-food meals from McD’s, Burger King, Wendy’s, etc.  Despite my lack of appetite, I made sure to stick with my 3 meals by eating oatmeal (carbs) for breakfast, ramen (carbs) and bok choy or a caesar salad with grilled chicken (protein) for lunch, soup with meat and veggies for dinner and yogurt if I got hungry again later in the night.  Temporarily, my husband hat to eat cooked dinners alone because I didn’t have the appetite to eat more than a couple bites of food at any given time. 
  • Do avoid caffeine since it can cause mood changes, an increase in cortisol levels, and even insomnia.  Coffee, tea and soda all have decaffeinated (reduced caffeine) and caffeine free (no caffeine at all) versions. During my PPD, I abstained completely from caffeine.  If you are a regular coffee, tea or soda drinker, it will be especially tough to abstain during the first weeks when you are completely exhausted and want to get a caffeine boost to start off your day and/or keep you awake during the day and/or night.  It was tough for me, but not impossible, to go completely without coffee during my PPD.  Fortunately, I had already weaned myself during pregnancy to only drinking a small cup of decaffeinated coffee per day, which helped me avoid the usual headaches I get from missing my traditional morning cup o’ joe.
  • Do avoid alcohol, since it is a depressant that can cause sleep disruption.  Contrary to popular belief, alcohol is not a sleep aid.  It may cause drowsiness and help you fall asleep, but it doesn’t help keep you asleep and may in fact keep you up the rest of the night.  It is especially important to avoid drinking alcoholic beverages while you are still breastfeeding—even if you are tempted to relieve your stress with a glass of wine or two or to believe advice you may have received about alcohol’s ability to promote milk supply/milk letdown—since alcohol can be carried through breast milk to the baby.

The Myth That All Mothers Bond Instantly and at First Sight

All mothers fall instantly in love and bond with their babies.  If bonding isn’t automatic and doesn’t happen right away or it’s not intense, then that must mean you’re a bad mother.  Wrong!  This is yet another societal myth that serves to screw with the minds of new mothers. 

Be Realistic, Not Idealistic

Before I proceed any further with this post, I want to be clear that I didn’t know and understand enough about bonding to worry about this much in the weeks following the birth of my daughter.  One of my ongoing themes is to caution people against setting high expectations.  The higher your expectations, the more there is at stake; thus, the greater your worries and stress are, the greater the chances you fill fall short of them, and the greater the chances are that disappointment  will be the outcome.  As through much of life and on the job, you need to learn how to manage expectations.  Actually, you need to maintain a realistic attitude.  It’s not really “Hope for the best, and expect the worst.”  It’s realizing that hardly anything in this world and throughout life works out 100% the way you would like. 

Expectations of having a natural, vaginal birth without pain relief; of immediate bonding with your baby; of immediate success with breastfeeding—if you set such high expectations, when things don’t turn out the way you envisioned, the feelings of disappointment at a time when you are both emotionally and physically vulnerable can lead to postpartum depression (PPD).  Why do we set ourselves up to have such letdowns?  Again, if you go in with certain expectations, you’re at greater risk for disappointment if your experience doesn’t match your expectations.  It’s to your advantage not to have any expectations at all, but instead take things one step at a time.  That way, there will be less chances of setting yourself up for disappointment if your experience doesn’t match that of others around you. 

The Myth That All Mothers Have to Bond Instantly and at First Sight

Something else that society has you believe is that all mothers feel an immediately overwhelming sensation of love and joy—an immediate connection—with the baby at first sight.  Does feeling anything other than that make you a bad mother?   No. Does feeling unmoved, unemotional or disappointed at the baby’s appearance when they first see their newborns signify detachment and lack of maternal behavior and signs of depression?  No.  A woman may have certain expectations of how her baby would look at birth, or of how she would feel looking at her baby for the first time.  She may have certain expectations of how she should feel at birth due to what they hear from other mothers and/or seeing photos of blissfully happy mothers holding their newborns immediately after delivery.  It’s not unusual or bad to feel exhausted and numb after having gone through X hours of intense and painful labor.  I remember feeling disappointed that I didn’t feel ecstatic the way some of my friends—not to mention women on television—felt after they saw their babies for the first time.  She is merely setting herself up for a letdown if she doesn’t feel exactly the way she’d imagined she would feel upon seeing her baby for the first time.  She might even be a little disconcerted about the baby’s scrawny, bloody appearance or head that might be a bit misshapen from being squeezed for the last X hours through her narrow birth canal or maybe a “stork bite” on the face. 

Speaking of stork bites, they are a fairly common occurrence.  In fact, per Medline Plus, they occur in up to one third of all newborns.  A stork bite is a temporary birthmark that a baby is either born with or develops within the first months.  Stork bites are usually pink, since they are due to the stretching (dilation) of certain blood vessels.  Stork bites are usually located on the back of the neck, eyelids, forehead, nose, or upper lip.  My daughter had one on one of her eyelids as well as on the back of her neck—hence the term “stork bite.” 

You prepare and long for the moment, picturing it all in your mind in the months leading up to your baby’s birth, in which you will fall instantly in love with your baby the moment she is placed in your arms.  Don’t let the one mother you know or delivery scene on television convince you into thinking that that is a given occurrence with every childbirth.  Not all mothers fall instantly in love and bond with their babies.  Not instantly falling in love with and bonding with your baby doesn’t mean you are a bad mother. Per “Postpartum Depression Demystified” by Joyce Venis, RNC and Suzanne McCloskey (pg 47) “[It] takes time for that special bond to develop.  You and your baby need to get to know each other a bit in order for those strong feelings of attachment to take root.”  If after a few weeks you still feel detached from your baby, you should review my previous post on the symptoms of PPD to determine whether you are experiencing any other symptoms of PPD.  

Without a doubt, there is greater likelihood for a woman to experience “instant maternal rapture” if her childbirth experience goes well (in her opinion), but Susan Maushart (pg 87) in her book The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It states:  “A woman who has been ravaged by hours or even days of excruciating pain and anxiety, or one who has been so thoroughly anesthetized that (depending on the drug of choice) either her body or her mind is numb, is hardly a likely candidate for ecstasy.”   Maushaurt continues (pg 86) as follows: “[Recent] studies suggest that bonding with one’s newborn is a good deal more complex than achieving a magic postpartum moment.  The fabled surge of maternal feeling which women have learned to expect in the immediate postpartum period is highly variable, even among women who have experienced the most ‘natural’ of natural births….[and] there is no evidence that an immediate bonding experience is a precondition for the growth of maternal feeling over time.”  Since magazines and books seem to focus so much on bonding, it’s no wonder there is such disappointment when what you read is not what you get—when you don’t experience that same “surge of maternal feeling” that other mothers have reported experiencing. 

Let’s take a step back now to ask the question “What is bonding, really?”  Does bonding occur only with breastfeeding?  No! If this were true, then does it mean that everyone who doesn’t breastfeed doesn’t successfully bond with their babies?  No!  Does bonding immediately occur upon first sight of the baby, and as you take him/her into your arms after delivery?  No!  Then what is it?  Bonding is close interaction with your baby which includes holding, infant massage, singing/reading/talking to and playing with him/her.  All these important types of interaction stimulate the baby’s cognitive/emotional/social development. 

I can’t say it any better than Shoshana Bennett in her book “Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression” (pg 53):  “There is no one magic moment of opportunity when bonding must happen….Even if your depression or anxiety has made it difficult for you to care for your baby, it’s never too late.  Bonding is a process of familiarity, closeness, and comfort that continues for years.”  It’s this connection that you have to focus on, not whether or not you breastfeed or were not yourself when you had PPD for several weeks.  Don’t let books, magazines or other moms tell you that your baby will bond better if breastfed.  Keep in mind that there are plenty of children all over the world who drink formula and are perfectly happy and develop close and loving bonds with their mothers.  Bottom line is, if you love your child and show affection to that child, you will bond.   If you are like me and missed a period of bonding opportunity while depressed, once you are out of that PPD fog, let go of what’s already past and make the most of your time with your baby going forward. 

Missing out on the opportunity to bond with—in other words, responding to the baby’s cry through comforting, holding, feeding and communicating—your baby immediately after birth for whatever reason, due to complications from birth for the mother (as with happened to me) and/or baby (jaundice, physical defect), does not mean you will fail to bond properly.  Don’t let the image of bonding at birth become an obsessive thought.  I mean, think about it…what about adopted children?  They don’t stand a chance with bonding with their adoptive parents? 

I’d like to end with this.  PPD that is not treated can prevent attachment and bonding, which can only reinforce feelings of failure—a vicious cycle, of which there are many when it comes to PPD!

Forget the Myths, Here are the Realities of Pregnancy, Childbirth and Postpartum Experiences

Pregnancy is NOT always a smooth, easy and blissful experience

Pregnancy is always a smooth, easy and blissful experience.  Not only that but  you (and your skin) are supposed to “glow.”   Nah, don’t you believe that for one instant!  Grant it, there are those who experience one or more births that most women can only dream of having.  You will occasionally hear about births that progressed so quickly and easily that no pain relief, episiotomies, or stitches even, were needed.  I have a friend who said that labor started so suddenly while still at home that she just gave birth there.  Where all it took were some intense contractions and a few pushes, and it was all over.  Within minutes, baby was contentedly breastfeeding. They couldn’t even wait for help to arrive.  Now, that’s a childbirth experience that can’t be beat! 

In terms of pregnancy and its associated physical challenges—like nausea, vomiting, water retention, difficulty sleeping in the later months—Susan Maushaurt (pg 50) in her book The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It says:  “We fight off our symptoms with a grim determination…..and get on with it, to show the world….that pregnancy is no big deal, really.”  Maushart describes how her nausea, which was triggered by practically every smell and so severe and debilitating, and yet she was “as likely to publicize it as [she] would a bout of bed-wetting.”  Like Maushart, I experienced nausea a lot.  In fact, I was nauseated by every little smell for the entire duration of my pregnancy.  Unlike Maushart, I wasn’t afraid to tell people.  I told people at work, I told my friends, I told my family.  Why would I want to hide this information from others?  It seems that Maushart, along with countless other women, choose to keep quiet due to fear of being judged as not taking it like a woman.  It seems that if we were to dare complain about any aspect of pregnancy and postpartum, we would be branded a failure.  Deep down, we compare ourselves with those women who glow and love every minute of being pregnant.  What we all need to realize is every woman is unique and so every woman’s pregnancy, circumstances and therefore childbirth experiences will be different.  Some experiences will be great, while others won’t be.  That’s just reality.

The reality is that—and you seldom see any of this unless you’re deliberately on the lookout for such information—about 15-20% of pregnancies fail to carry to term, per Ruta Nonacs in her book A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years (pg 84).  Many women suffer from repeated miscarriages.  With each miscarriage, there is grieving and the more a woman grieves and the longer the period of grieving, she becomes increasingly more vulnerable to depression.  Studies show that women with recurrent miscarriages (and/or infertility) experience clinically significant depression. Needless to say, it is very difficult to cope with a loss at any point, whether it’s a loss during the first trimester, later in the pregnancy, at childbirth (stillbirth or death from preterm birth), or up through a few weeks postpartum (neonatal death).  You wouldn’t think that it would be possible to feel an emotional connection within the first few weeks of pregnancy, since there is nothing about an embryo that resembles a baby yet.  For me, even the few weeks during my first pregnancy was more than enough time to become emotionally invested.  When I found out it had to be terminated due to what they referred to as an ectopic pregnancy, I was devastated.  I can’t even imagine carrying a baby to term only to have the baby die.  That has got to be one of the most devastating experiences any woman could ever have to endure.

Each woman is different in terms of their ability to cope with and move beyond a loss.  Some are able to cope and move on relatively quickly.  For others, the experience is so devastating that they may not be fully able (or willing) to let go of the pain and memory of their loss, and fall into depression.  These women should seek professional help to help cope with their loss and move on with their lives.  It really helps to share your feelings with therapists who, unlike friends, family, colleagues and neighbors who—despite good intentions may unintentionally say something that hurts your feelings—make for non-judgmental and supportive listeners.  It isn’t good to keep all your feelings bottled up inside.  Grieving and getting a certain amount of emotional support from others are components of the healing process.  It’s best to deal with grief as it occurs rather than letting those negative feelings accumulate and stay unresolved over time.  At some point, your body and psyche may get to a point that they can no longer hold back depression.

Women who have had previous experience(s) with miscarriage and/or traumatic birth experience—including, but not limited to, having a stillborn baby—will tend to experience high anxiety levels, due to great fear of yet another pregnancy loss, during a subsequent pregnancy.  High anxiety levels make it difficult for a woman to enjoy her pregnancy.  Women who have had to endure IVF cycles and/or repeated pregnancy loss—e.g., miscarriage(s), stillbirth(s)—have experienced much psychological trauma to get to this point and are considered high risk for a perinatal mood disorder.  There is a correlation between feelings of loss and the age of the mother, how long she has been trying to conceive, and whether there were previous pregnancy losses, which in turn lead to feelings of failure and inadequacy, not to mention higher anxiety levels and stress, which can cause a woman whose body and brain are already challenged by hormonal fluctuations to become depressed. 

Let’s not forget that pregnant women can become depressed—this is referred to as antenatal depression.   In fact, approximately 1 out of 10 women experience antenatal depression, though many cases are undiagnosed.  Per Postpartum Depression Demystified“by Joyce Venis, RNC and Suzanne McCloskey (pg 59), untreated cases of depression during pregnancy have a 50% chance of worsening after childbirth.   Depression during pregnancy generally does not go away once the baby is born.

So, in short, while it’s true that mothers who are fortunate enough to have smooth pregnancies each and every time they have a baby more than likely feel that this is a true statement, pregnancy is NOT always a smooth and blissful experience. 

A smooth pregnancy does NOT mean a smooth postpartum period

I had a relatively smooth pregnancy so the thought never occurred to me that I could possibly develop PPD.  Unfortunately, a smooth pregnancy does not always guarantee a smooth postpartum experience.  You could totally love being pregnant and loving every minute of the pregnancy but still end up with PPD.  If you find that a number of the risk factors in my post “Risk Factors for PPD” apply to you, you could still fall prey to PPD despite how well your pregnancy went.

The childbirth experience is subjective and unique to each woman.  What one woman deems as a good childbirth experience may be completely different from another woman.  What is satisfying to one woman may be disappointing for another.  Some women may view a good birth as one in which the baby came out fine, despite the long and painful process.  Some may view a good birth as one that is completely “au natural,” in which no pain relief is administered and the baby is delivered vaginally.  Yet others may view a good birth as one where there is very little pain, or pain that they can deal with, thanks to the invention of the epidural.   Increasing numbers of women are even opting to have caesarians despite the lack of medical necessity and out of preference for being in control and able to decide what day to have the baby and minimize the chance of any complications.  Ultimately, it’s the woman’s perception and satisfaction of her childbirth experience that matters and key to starting off her postpartum experience on a positive note. 

For some, unfortunately, a disappointing childbirth experience increases a woman’s risk factor toward postpartum depression—particularly if there are any complications like an emergency caesarian, pre-term birth and any medical problems of the baby resulting with a stay in the NICU.   Many women long, hope and prepare for a natural childbirth experience.  In other words, no medical intervention of any sort.  A vaginal delivery with no epidural, no forceps, nothing.  Just plain endurance, willpower and heavy-duty breathing exercises.   What they don’t plan for—baby in breach position or other unforeseen medical emergency for the mother and/or baby—are the times an emergency caesarian or other medical intervention may be required.  For these women, not being able to have the birth experience they had hoped for can cause a tremendous sense of loss, disappointment and grief.   It’s situations like this that it’s best to adopt a realistic attitude of hoping for the best but realizing that anything, really, can happen. 

If you read my recent post about my childbirth experience, you’d know that I had to lose my uterus due to a rare complication called placenta accreta (where the placenta grew into my uterine wall) only 3 days after having my baby.  I would say, without a doubt,  that that experience paved the way to my PPD.  I wouldn’t say that that experience alone is what triggered my PPD, since my PPD didn’t start until the 6th week postpartum.  Needless to say, when you experience a complication like that, which not only takes a lot out of a person physically since it’s a major surgery with 4 units of blood loss—this being only 3 days after childbirth, another big deal physically—on top of the hormonal fluctuations, sleep deprivation, and daily procedures in the hospital, your body is not in prime physical condition, is it?  I was planning to treat all this in a practical and matter-of-fact sort of way and move on.  Put this all behind me.  There was no way for me to even know that in just 6 weeks’ time, I was going to get blindsided with PPD.   Something I could not just snap out of all by myself, without medical intervention. 

The following are just examples of obstetrical complications leading to a traumatic birth experience…. the types of experiences we hope never to have but in reality do happen to some women: 

  • Emergency caesarian (especially after having had no pain relief and enduring many hours of labor)
  • Baby going into distress during or after delivery
  • Inability to see or hold the baby immediately upon birth
  • Extremely difficult and long labor
  • Baby requiring surgery to correct a serious congenital defect
  • Husband not being there with you
  • Last-minute change in OB/GYN delivering your baby 

The disappointment of falling short of your birth plans, frustration of this unexpected turn of events, inability to do more for your baby, and/or lack of control can be too overwhelming, too much to bear for a new mom whose hormones are already topsy-turvy and “playing tricks” on her emotions. 

Hear No, Speak No, See No….

Those who’ve been fortunate enough to have smooth and stress-free experiences lack empathy for those who don’t have such experiences.  After all, empathy comes from personal experience.  On the one hand, without going through a difficult pregnancy, childbirth and postpartum experience yourself, there is no way for that person to know what any of that’s like.   On the other hand, women who have had negative experiences with pregnancy and childbirth, such as ectopic pregnancies, miscarriages, and infertility, generally do not talk about these experiences with others for several reasons.  After all, who wants to hear bad news?  Even if you think that someone else would be understanding, chances are you are reluctant to burden someone else with heavy news and/or you don’t feel they can empathize or know what to say to you.  People are generally inclined to stay away from awkward situations.  Because people don’t openly discuss their difficult pregnancy, childbirth and postpartum experiences, the public is only aware of the smooth, easy and blissful pregnancy, childbirth, and postpartum experiences.  It’s natural to feel you’re an imperfect mom when things don’t go smoothly because you only hear good things from other moms.  Or you simply want to hide the fact that your birth experience was not as good as you’d hoped it would be.  Unfortunately, this only supports the notion that all pregnancies are smooth, easy and blissful experiences.  Not to mention, it also makes women like me who have infertility issues, as well as pregnancy, delivery and postpartum complications ask themselves the question “Why me?” and feel worse that they are being deprived of positive experiences every other mother seems to be enjoying.  This only makes them feel more alone in their experience than ever.

Unfortunately, it’s human nature to avoid wanting to hear about problems you have during delivery and/or the postpartum period—as I unfortunately experienced firsthand. People only want to hear what they want to hear, which is that your experience was like any other mother’s experience.  They don’t even want to hear the details of how the labor and delivery went.  They just want to hear these 6 words:  “Mom and baby are doing fine.”  This is what I refer to as the “spare me the details” effect.  Same thing whenever you ask anyone the question “How are you” and you expect the answer to be “Good, thanks.”  People don’t want you to go into details, especially if they’re negative in any way.  I always get this strange look from people whenever I provide a response that’s in any way negative.  It’s almost like, how dare I provide a response that isn’t within the socially acceptable “Good, thanks.”

Empathy seems to be the key that gives people the understanding and realization that others need help and support, that all is not always peachy keen.   You learn from life’s experiences, which motivate people to do certain things.  Why do you think I do what I do?  To help other women, so they can be empowered with knowledge.  Ignorance is NOT bliss when it comes to things like pregnancy, childbirth, and postpartum experiences.  Be in the know.  Also, it’s best going into labor and delivery not having high or certain expectations, since you won’t be setting yourself up for disappointment.  All you should and can do, really, is to hope for the best and be as knowledgeable as you can about the REALITIES of pregnancy, childbirth, and postpartum experiences—including PPD!  After all, PPD is the #1 complication of childbirth.

Here’s to Public Awareness about PPD…More of This Kind of Accurate Reporting is Needed!

A real quickie from me today……Check out this recent piece on CNN.com.  It’s a great example of the kind of information that should be more frequently made available to the public about postpartum depression (PPD)….not like those misleading articles in magazines (the most recent one I can think of was in Vanity Fair) that add to the misconceptions about PPD.  It’s chockfull of very important and useful information about PPD, including the following:

  1. One mom’s experience with it, plus links to 2 other moms who talk about their experiences on Parenting.com (in my opinion, very well written);
  2. why many women are afraid to speak up about/seek treatment for it;
  3. the Melanie Blocker Stokes MOTHERS Act and how it, once passed, can help fund related research and education, provide training to medical professionals, and increase treatment options and support services;
  4. difference between the blues and PPD;
  5. the hormonal/neurochemical/psychological/social factors that can lead a woman at risk to get PPD (and for some the depression begins during pregnancy);
  6. how moms with PPD can–and should–get help (and how they should NOT wait or try to tough it out and suffer silently); and
  7. last but definitely not least….importance of the new mother taking care of herself and getting the help (emotional, practical) she needs.

Other newspapers, magazines, etc. should follow this wonderful example of accurate reporting that provides helpful links to PPD stories and other resources.  We need more of this kind of reporting to help banish misconceptions, or myths, about motherhood–PPD included!  The public needs to be aware how prevalent PPD really is, it shouldn’t be confused with the blues (which about 80% of new mothers get), and that it should be taken seriously. 

Happy mothers mean happy babies.  Mothers deserve and need rest and support!  

Knowlege is power, folks….and don’t you forget it!

Sharing My Less Than Perfect Birth Experience

At about 4:30 AM on Friday, December 10, 2004, my water broke.  The first thing that came to my mind was “Oh no!  I’m not ready for this!  This can’t be happening already! ”  I woke my husband up and told him what had happened.  I thought maybe, by some chance, this was all just a false alarm.  But we paged the doctor anyway.  When he called back, we informed him that my water had apparently broken.  Much to my dismay, he told us to meet him at the hospital.  I hadn’t even packed the hospital bag yet, which my husband had warned me many times to do.  Somehow, and I don’t remember any of this, we threw a hospital bag together in a big rush and off we went to the hospital.  I experienced mild trepidation about getting the epidural, but I was not obsessed about it.  So when the time came to get it, I just told myself it had to be done to spare me the intense pain from which I wanted to be spared.  The labor and delivery went fine, but immediately after my doctor delivered my baby girl into my arms, he had a look on his face that I’ll never forget……………………………

My placenta would not come out. 

After waiting an hour, the doctor proceeded to try to manually manipulate it out.  Even the epidural couldn’t help with the pain from what he was doing.  So they moved me to the OR where they proceeded to administer painkillers through my IV drip, all the while trying to manipulate the placenta out by hand (yes, a hand all the way up you know what) and then by a long suction device similar to the procedure for a dilatation and curettage (D&C).  I was trying not to scream, but a few times couldn’t help it.  The doctor finally gave up.  He told me he’d schedule an MRI for me the next day, before doing anything further to determine the exact problem.  He explained that one of two things was the problem.  Either my large fibroids (and I had quite a few) were preventing the placenta’s movement out or this was a case of placenta accreta, which is a rare complication where the placenta attaches to the wall of the uterus.  I had a sinking feeling it was the latter and way more serious of the 2 possibilities.

Turns out, they couldn’t squeeze me in on Saturday, so they put me down for Sunday.  In the meantime, I was only allowed to eat ice cubes.  I had to get a blood test at least a couple times a day for the next five days.  Evidently, the technician on duty on Sunday was not the one who usually handles abdominal MRIs.  Basically, he was not familiar with the appropriate protocol, so the entire 45 minutes of my being in the MRI — hooked up to the IV drip and morphine, bleeding from the episiotomy and peeing uncontrollably every time I stood up — was for nothing.  I couldn’t believe I had to go through the same exercise the following day.  The doctor told me that I may have to undergo surgery to get my uterus removed if the MRI proves my doctor’s fears of placenta accreta.  In this situation, the placenta cannot just be cut off, the entire uterus would have to go too.  In preparation for the possibility of surgery, the doctor was not comfortable with my low blood count, so he insisted I receive 2 units of blood.  That sent me into a panic because that would mean I’d get someone else’s blood.  Because I feared I could get AIDS from a blood transfusion, before going into any surgery, I would’ve preferred to store my own blood.  That is what I’d done for my dermoid cyst removal back in 2001.  But this time, I wasn’t prepared.  I refused the blood, which only angered the doctor.  I finally gave in, but only after several crying episodes where not only was I afraid I wouldn’t make it through all this, but that I’d lose my uterus.  A part of me would be gone forever.  I would never be able to have kids again. 

That night, the nurse came in to attach a catheter to my other arm for the blood transfusion.  She wasn’t as good as the nurse who inserted the other catheter.  Because my left arm already had a catheter for the IV drip and antibiotics, they had to find a way to insert one into my right arm.  The clearly visible vein was way over-used by the nurses taking my blood daily.  So the nurse went for my wrist…..and missed.  Then she went for my hand……. and missed.  By that time, I was delirious.  They had to get someone else to try, and luckily, she succeeded in inserting it into a vein that you can barely see at all.   Fortunately, I have no fear of needles or I never would’ve survived all this (and my IVF cycles, for that matter).

Next morning came.  Inside, I was a wreck.  I was starving.  I was still on a diet of ice cubes.  But I maintained my composure the best I could.  This time, the regular MRI technician was on duty.  With difficulty, I slowly got out of my wheelchair and onto the MRI platform.  I was in the MRI for about 90 minutes this time, trying to stay as still and as calm as possible throughout the entire procedure, following the technician’s instructions on when to breathe and when to hold my breath.  Fortunately, I am not a claustrophobic or they probably would’ve had to knock me out just to get me into the MRI.  It was nothing like the CT Scan that was performed on me years ago, which uncovered the fact that I had a dermoid cyst rather than cancer. 

That afternoon, the doctor performed the surgery on me to try again, this time with the aid of general anesthesia, to remove the placenta.  The doctor warned that I could hemorrhage on the table, and if that occurs, I would need additional units of blood and an emergency hysterectomy would need to be performed.  At that point, I was tired of being upset, tired of all the procedures – the MRIs, the catheters, the bleeding, the inadvertent peeing, the daily blood work, the temperature readings, and my lousy diet of ice cubes.  I was numb.  I went into the operation trying not to think about anything but surviving so I can go back home with my husband and daughter.  I was praying I would come out alive.  The anesthesiologist administered the anesthesia and by the time I counted to 3, I passed out.  When I came to, it was 2-3 hours later and I was in the recovery room.  The surgery itself took 2-3 hours.  I was extremely groggy and experiencing throbbing pain in my abdomen.  Not sure if the hysterectomy had occurred or not, the first thing I did was feel for stitches.  And there they were.  They had had to remove my uterus.  I felt so, so sad at that point.  The doctor then appeared and explained what had happened.  I had hemorrhaged and needed 4 units of blood.  At that point, fear of getting someone else’s blood was no longer that big a deal.  What was done, was done.  The fact of the matter was I could no longer have another child. 

Though I can’t say what living in hell is like (and I hope I NEVER do), I don’t know any other way of expressing how I felt during that miserable week.  I lost track of how many rooms I had to stay in….there was the delivery room, a few hours in a recovery room, followed by a room in the maternity ward, then one night that felt like an eternity in what to me was like hell (that’s where I nearly cracked) in the recovery wing of regular surgery patients (where the nurse in charge was — pardon me for saying this, but – a bitch), and I was finally moved to another room in the maternity ward where I stayed the last 3 nights.  For the most part, the nurses in the Maternity section were truly sympathetic and helpful.  These nurses were definitely a step higher than the nurses in the recovery wing with respect to sensitivity to the new mother.  I can recall the first nurse that helped me was like Florence Nightingale….an exemplary nurse.  And the last nurse was truly sympathetic for me and helped me as best she could.  I regret not writing down their names at the time so I could thank them after I went home.  All the nurses in-between, however, were not particularly sympathetic, kind or caring, despite the evidence written all over my face at how miserable I was feeling.  They appeared to be all about just doing their job, callous probably from dealing with patients day in and day out.  No one was particularly pro-active about stopping for even a minute to ask me how I was feeling that day, lend an ear, see if I needed anything.  My stay in the recovery wing was hellish not only because I couldn’t see my baby while I was there but also because it was nearly impossible to get a nurse whenever I needed one.  What was the call button for, if no one ever responded to it?  I had to get my husband to search for one each time I needed something.    Needless to say, but I’m going to say it anyway, it makes all the difference in the world when nurses are warm and caring both during and after delivery, checking on you frequently and anticipating your needs during your stay at the hospital.

Mind you, my diet was restricted to delicious ice cubes for most of my time at the hospital.  I think it was during my last 3 days that I graduated to fluids (e.g., juice, tea, salty beef or chicken broth and jello) and on the last day, I was allowed to eat a couple of delicious hospital meals! All this time, I was trying not to “shoot myself” with morphine.  I was rigged up to the morphine drip and all I had to do was push the button to get some.  If it weren’t for the moments where the gas movements hurt so much it felt like sulfuric acid was burning a hole slowly through my abdominal wall (it was such a searing pain), I never would’ve needed the morphine past the first night.  I hate having to depend on medicine!  Antibiotics, though, are different.  They’re needed to ward off infection.  The nurses gave me a bunch of Percocet to take for pain, but I never touched a single one.  To this day, I’m not even sure if the searing pain that felt like a hole was being burned into my abdomen was caused by gas.  The whole experience made me all the more anxious because I didn’t know what was causing this pain and how long this would go on for. 

To this day I cannot understand why they always had to come in during the middle of the night to take my temperature and sometimes blood.  I’d be sleeping and they’d come and wake me up.  Didn’t they understand how important sleep is to a new mother?  I was never able to get a block of 5 hours of sleep during that dreadful week in the hospital.  At that time, I had no idea the lack of adequate deep sleep and constant interruptions by hospital staff would set me up for PPD.  Hospital staff should be instructed to allow a new mother to get at least 5 hours of sleep at a time.

All this time, I had to keep my chin up the best I could, knowing that I had a newborn to try and breastfeed.  Despite my brave attempts, I wasn’t very successful.  With the help of the lactation consultant that would come by once a day, I was able to successfully get the baby to latch on and suckle for a little bit.  I was surprised that I was so willing to let a stranger come to the room, grab my boob and manage to get my daughter to latch on.  It felt great to be successful those couple of times, but it was to be short lived.  I couldn’t keep this up with all the procedures I had to undergo.  I definitely couldn’t do any breastfeeding the time I was not even in the maternity ward.  By the time we left the hospital, my daughter was already suffering from what they called “nipple confusion.”  I’d already lost precious bonding opportunity with everything I had to go through at the hospital.  Failing at breastfeeding would be a second failure of my one and only childbirth experience.  And I hadn’t even left the hospital at that point.  After leaving the hospital, I gave breastfeeding my best shot for as long as I could manage it, despite my weakness, sleep deprivation and iron deficiency from all the blood I had lost in the surgery.  

I will never forget how, during the seven long, tortuous days at the hospital, my husband was by my side the entire time, sitting/sleeping in a chair next to me. He barely took care of himself during this time, all grimy, unchanged and unshaved.  Though, he did venture to go home to check on the house, not to mention make sure Bunny had enough hay and water, once every other day.  Along the way, some nurses felt so bad for him that they tried to accommodate him the best they could.  When I was stuck in the room from hell in the Recovery Wing, he wasn’t allowed to stay in my room, but the maternity ward was kind enough to find a room for him to stay in. 

It’s interesting how the pain from labor does not keep most women from having more children.  It seems that women have selective memory with regard to their childbirth experiences.  I would say that it’s our desire to have, and love of, children far outweighing the dread one fears of labor pains.  Despite my PPD experience, if I still had my uterus, I’d want to have one more child.  If the placenta accreta hadn’t occurred, I would’ve proceeded with another IVF cycle, regardless of the fact that I’d be at least 42 years old when having the baby.

– – – – – – – –

Now that you have an actual story from someone who survived a not-so-pleasant–to say the least–birth experience (not to mention how tough it was for me to get pregnant), my next blog post will be my gripe on why there seems to be the prevailing notion that pregnancy, childbirth and postpartum are all smooth, easy and blissful experiences.

How anyone could think that PPD isn’t real is beyond me

Postpartum depression (PPD), and depression for that matter, is an imaginary, or make-believe illness, a state of mind that can be changed at will, a means to get attention, an excuse to take medication to escape from reality, a sign of weakness or self indulgence, an excuse to avoid the reality of motherhood.

Yeah, get a grip on reality–and get educated while you’re at it–for crying out loud.  These statements couldn’t be further away from the truth.  In this day and age, how anyone can believe any of this BS (especially other women) is beyond me.   Why can’t women be supportive of each other instead of being so critical and competitive with each other?!   That includes being supportive of and contributing toward efforts that will help mothers experiencing PPD rather than impeding those efforts (those people, by the way, should be ashamed of themselves).  Why women have to be so feline (note:  my #2 anger trigger is feline behavior, after my #1 anger trigger of behavior & remarks made out of ignorance/racism/condescension) is beyond me!

Skeptics will claim that, since PPD isn’t necessarily detectable via blood work nor a growth or wound or handicap that is visible to the naked eye, that it must not be real.   And please don’t say this is a recent phenomenon or that women have been giving birth thousands of years and we’ve only seen a rise in PPD awareness–and thank goodness for that–in the past decade, so it must be a new invention made up by women in today’s generation because they can’t cut it like the tougher women of previous generations.  Right.    Anyway, this “recent phenomenon” is thanks to the women out there (you go girls!)–plus celebrities who are finally gaining the courage to speak up more about a condition that has been documented as far back as the days of Hippocrates.  Scientists have not been spending years on research on treatments, detection, determination of risk factors, etc. for lack of anything better to do.

People out there scoff at the idea of PPD and claim to know all about it, when in fact they don’t.  Why?  Because they never suffered it themselves…duh.  They’ll claim that all new mothers experience mood shifts after childbirth.  Hello, you’re thinking of the blues, which happen within the first couple of weeks postpartum and resolve on its own.  They’ll claim that there is no scientific evidence that PPD exists.   They’ll claim that insomnia, a classic symptom of PPD, is merely sleep deprivation and fatigue that all new moms experience.  They’ll also claim that having a panic attack is the same thing as anxiety that comes from difficulties in transitioning to motherhood and being a first-time mom.  Now, had these people actually experienced real PPD, including real insomnia and real panic attacks, they would understand what it’s like to have PPD,  insomnia and panic attacks.   Until then, they should keep their ridiculous claims to themselves.  I’m not going to tell these skeptics to do their reading because no amount of facts will change these peoples’ minds…unless perhaps they experience any of these conditions for themselves.   It’s really a shame, isn’t it, that people insist on maintaining their stubborn beliefs, regardless of how ridiculous they are.

Many of these skeptics of PPD are also skeptical of depression, in general.  They’ll claim that depression is a matter of mind over matter.  They’ll claim that anyone can snap out of depression on their own accord.  Well, wake up!  The ability to will or wish away depression is a myth.  You can’t overcome it by just putting your mind to it.  PPD is a real illness with a biological cause, just like diabetes and heart disease.  You can’t just “snap out of it” any more than you could if you had an ulcer, diabetes or heart disease.  Until I experienced PPD, I thought depression is just a state of mind.  I used to say things like “I’m depressed” whenever I felt sad.  Now, I’m careful to not use the word “depressed” in the context of sadness.  I believe the majority of folks out there mistakenly think that being depressed is the same thing as being sad, feeling down or feeling blue.   People, particularly OB/GYNs,  need to stop getting these two very distinctly different conditions confused with each other because by doing so, they are preventing women with PPD from getting the help they need right at the beginning.  Not to mention, perpetuate the misconceptions about PPD.

With PPD, the longer you wait to seek help, the harder it is to recover from.  But why wouldn’t you get the help that you need to get better and enjoy motherhood sooner?  Why suffer longer than you have to?   There are many possible reasons, though high up at the top of the list would be 1) mistakenly thinking that this is just the way it is with being a first-time mother who is trying to cope but just going through a rough patch (because they don’t know any better due to lack of education about PPD and their doctors’ misdiagnosis as blues) and 2) fear from the stigma associated with mental illnesses and what others would think/say and.    All too many women will unnecessarily struggle with toughing it out or self medicating with alcohol or other substances.

My best piece of advice to you moms out there is to not give a damn what other people think.  Now, if I could take a dose of my own medicine, that would solve one of the biggest habits—or weaknesses, that is—I’ve had so much trouble kicking over the course of my lifetime!  Your priority should be the wellbeing of you and your family.  The best thing you can do for yourself and for your baby—in fact, for your whole family—is to seek help as soon as you experience three of more of the symptoms described in my post “Baby Blues is NOT the Same as PPD!”  Don’t wait until you are crippled by the effects of PPD like I was.    Prolonged and untreated depression can not only negatively affect your marriage and your baby’s cognitive and social development, it can unnecessarily strain your relationship with your partner.  Worse yet, untreated PPD can lead to such feelings of hopelessness that ending your life may seem like the only way out of the pain.  Don’t try to tough it out, thinking what you’re experiencing will pass on its own just as quickly as it developed.  Don’t try to tough it out because others around you are trying to convince you that this is all part of the process of transitioning to motherhood, that every new mom experiences sleep deprivation and anxiety (see previous post on the difference between that and true insomnia, a very common PPD symptom if it is experienced 3 weeks or later after childbirth).

Though the symptoms and their severity may be unique to every woman, PPD is debilitating to all those who suffer from it.  Depression–and there are thousands in this country today that are afflicted with it– affects people physically, not just mentally.  It is a physical illness that is the result of a chemical imbalance.   Hormonal changes are responsible for perinantal (during pregnancy and postpartum)—and even premenstrual dysphoric disorder (PMDD)—mood disorders and an imbalance in brain chemicals called neurotransmitters.  Serotonin is one such neurotransmitter.  Research shows that serotonin dysregulation is a primary cause of PMDD and PPD.  A sudden and huge drop in estrogen levels immediately after childbirth contributes to a decrease in serotonin availability in the brain.  Since serotonin promotes normal mood, a decrease in serotonin availability in the brain is associated with anxiety/depression.  This is why medications such as selective serotonin reuptake inhibitors (SSRIs), which increase serotonin availability in the brain, have in many cases been effective in the treatment of PPD.   An SSRI was effective for me.

Let me explain something here, lest the words “medications” and “SSRIs” trigger a violent reaction among the anti-pharma faction out there.  I am not advocating medication for everyone.  Different treatments will work for different women.  A woman must be informed enough to be able to make a decision that she feels is right for herself.   Being informed means having ready access to information about PPD, its symptoms, where to go for help, what treatments are available, what medications are usually prescribed and their side effects and risk of being passed to the baby via breastfeeding, etc.   It also means having a doctor that is adequately trained to detect, diagnose and treat perinatal mood disorders.  But many doctors are still not adequately qualified to do any of that, plus lack adequate tools and resources.  This is why awareness about PPD and preventive measures (like lining up adequate social support and getting 5 hours of interrupted sleep as much as possible in the first 6-8 weeks postpartum) are so, so critical to everyone who plans on having a baby. 

I’d like to close with this piece of advice to the skeptics.  Without knowing the full story (or without ever experiencing PPD or any other illness directly) one should NEVER pass judgment on the situation of others.   Women with PPD do not need to be scoffed at, doubted and criticized.  They need support and understanding.  If you were in their shoes, would you want to be on the receiving end of these negative or–shall I say–tasteless behaviors?

Pain, Sadness Hiding Behind Smiles…Never Assume and Think That All is Blissful for the New Mom

Never assume….never take for granted that everyone always has smooth deliveries and postpartum experiences…..never think that just because she’s smiling that everything is fine and blissful, as it always has to be after the birth of a baby.

I just got through reading a touching letter on Susan Stone’s blog written by a father who lost his daughter to postpartum depression (PPD) and is encouraging people to petition for the Melanie Blocker Stokes MOTHERS Act.   His daughter seemed fine though people realized too late that she appeared to be more consumed with worry in the days leading up to her suicide.    Touched and with tears in my eyes, I started to write this post.

Something has to be done to stop the silent suffering of so many new mothers, bring more public awareness on PPD, and more healthcare professionals (GPs, OB/GYNs) up to speed on detecting PPD before it spirals out of control and leads to sometimes disastrous consequences.  What we need to do is prevent these situations from happening in the first place.  The only way we can make progress is through public awareness, which includes dispelling the myths of motherhood.  Now, if you happen to be one of the proponents of those ridiculous myths because you feel threatened or whatever the reason might be, then take a reality pill and get with the program.  Jump off that la-la train that you’ve been riding.  You cannot possibly ignore the fact that PPD is the #1 complication of childbirth, with 1 out of 8 women suffering from it.  If you still want to ignore it, then that’s YOUR problem.  Don’t make it anyone else’s. 

How many more lives should be torn apart from an illness most people still think is a make-believe illness?  Some marriages do not survive.  Children of women with untreated PPD may end up with cognitive, social, emotional and behavioral delays and potentially anti-social issues down the road.  For God’s sake, some women whose illnesses spiral out of control don’t even make it through alive. 

Sure, mothers have been giving birth for thousands and thousands of years. Just because most women with PPD don’t speak up doesn’t mean it doesn’t exist. And you mothers out there….if you don’t speak up, people will continue to go on scoffing at the idea that PPD does exist.

Why the fear?  Why the secrecy?  Why not speak up?

You may be wondering why the heck, then, doesn’t a mother who’s not feeling herself get help in the first place, then think about this.  

  • Many (like me) don’t even know what is happening to them in the first place. 
  • Many go see their doctor about why they’re feeling the way they’re feeling, but are told that what they’re feeling (baby blues) is normal and should go away by itself; yes, doctors still misdiagnose even today (more on this in my next post – stay tuned). 
  • Many are afraid of what their family/friends may think. 
  • Many are afraid others will look down at them and call them weak/bad mothers. 
  • Many may even fear that if they speak up, their children will be taken away.  After all, media is doing a great job in painting the wrong picture about PPD  (see earlier post on ABC’s Private Practice) and the public seems to think, ever since the Andrea Yates case, that everyone who has PPD is at minimum a bad mother or will turn into an Andrea Yates.    Well, Andrea Yates had postpartum psychosis (PPP)–which occurs in 1 in 500 to 1,000 mothers– and was never successfully diagnosed and treated, and look at the disastrous consequences that resulted.   The healthcare system failed her and those around her didn’t help her.  Instead, the public chooses to put the blame squarely on her shoulders. This is why public awareness and education are CRITICAL!

Basically, with the exception that the birth of a child is a life-changing experience for all women, though in different ways and to different degrees, no one woman’s motherhood experience is the same as any other. The only experiences you will hear are the mothers who have positive experiences gushing to everyone they know and run across “I love being a mother. Being a mother is such a fulfilling, wonderful experience that I wouldn’t trade it for the world. I couldn’t ask for anything more. It’s all I ever dreamed motherhood to be.” Since you only ever hear about the positive experiences, women whose experiences aren’t as positive will tend to keep their feelings to themselves.  It takes courage and a desire to empower other women to speak up.  Slowly, the numbers of women who speak up are growing until hopefully, one day, this suffering in silence nonsense will finally come to an end.  I’m hoping this momentum continues to the point until the motherhood myths disappear and mother-centered programs (mental/physical health and practical/social support) during the postpartum period become the norm rather than the exception.

Don’t compare yourself to other mothers that appear to be coping extremely well with motherhood–those who never look tired, always look happy and seem to do it all without needing any help at all. I know how tempting and almost second nature it is, but you must resist doing so.  Don’t assume that, just because other new mothers around you seem to have a picture-perfect motherhood experience, they’re natural mothers because they seem to know what to do and do everything right, and even look great  even immediately after having given birth. It could also be that some of these women have hired help in the form of a doula/nanny/housekeeper, which does in fact help new mothers get the rest they need to recover (see previous post on social support).  Unfortunately, however, not everyone has the ability to hire such help. 

You don’t know what truly goes on behind closed doors.   Just like others won’t know something’s wrong unless you open up, you’ll never know whether these seemingly perfect mothers are just putting up a façade. It’s scary how common it is for a woman to disguise how she’s truly feeling–it’s called make-up and good acting–all so others won’t know she’s not coping as well as she thinks she should.  She wants to give the impression that she’s handling it like the supermom that other mothers give the impression they are and how she wants to be viewed as.  This is one of the reasons why even today people are surprised to hear that PPD is the #1 complication of childbirth.  

No one’s life is perfect, despite appearances.

Please see a doctor if you don’t feel yourself even after 2-3 weeks postpartum, and you’re feeling down, unable to smile, unable to enjoy anything and/or unable to sleep even when the baby sleeps.

How Public Awareness, Screening Can Help Moms

I have read in several forums that it is believed that the reason why so many New Jerseyans are supportive of the Melanie Blocker Stokes MOTHERS Act is due to the fact that New Jersey happens to be the pharma capital of the country, with the largest concentration of pharma companies located in this state. Can you honestly say that everyone who has thus far signed their names in support of this bill (click here to see latest list) is a pharma-related person? I’m certainly not. I am simply a PPD survivor. My PPD so debilitated me that I could not function on a day-to-day basis, period. With panic attacks I couldn’t control and a feeling that I would not physically be able to survive my experience, I needed medication to return my brain chemistry back to its normal levels. As soon as that occurred—which was 4 weeks after I started taking it—I was fine and happily able to enjoy motherhood, my baby and my life once again. I would think that there is wide support in New Jersey because its citizens have seen the benefits to a law that was passed nearly 3 years ago to benefit mothers through early detection and education.

What I learned from my experience was that the way in which my doctor treated me could have been different. I probably would have been better off seeing a psychiatrist who could provide the comfort and reassurance that I needed, due to my doctor’s lack in bedside manner. Either way, I’m confident that the psychiatrist would have prescribed an SSRI anyway, given my level of functioning—or lack thereof—plus insomnia, quick weight loss and inability to smile and enjoy all that I used to before PPD hit me.  And this is coming from someone who–if you’ve read my previous posts–has avoided taking medication since I was a toddler and able to run away from mom and that spoonful of yucky stuff!

I do not blame mothers out there who feel the way they do about being misdiagnosed and prescribed the wrong medication. It’s unfortunate, but true, that many healthcare providers still need to learn to properly recognize the symptoms of a postpartum mood disorder (PPMD), including PPD, postpartum OCD (PP OCD) and postpartum psychosis (PPP). If a mother has PPP but is improperly diagnosed as having PPD and is prescribed an SSRI, the symptoms can worsen terribly. You can find more information about all these differences and why it is critical for early and proper detection and treatment of these postpartum mood disorders in the wonderfully informative books that I’ve had the pleasure of reading:  “Postpartum Depression Demystified” by Joyce Venis, RNC and Suzanne McCloskey, and “Postpartum Depression for Dummies” by Shoshana S. Bennett.

It will take a federal mandate in the form of the Melanie Blocker Stokes MOTHERS Act for progress to be made in the improvement in public perception– not to mention accurate diagnoses and treatment–of postpartum mood disorders.  Research and education are the two core elements of the Melanie Blocker Stokes MOTHERS Act that can enable us to make any kind of significant progress in helping to reduce the rates of occurrence, misdiagnosis, and incidences where cases go untreated.

Increase in Research Efforts: To determine the factors (e.g., hereditary, environmental) that predispose women to PPMDs, as well as new ways to screen for and treat PPMDs.   Speaking of screening, unlike what opponents of the bill are claiming (and complaining loudly about), no mother is ever forced to do anything they don’t want to do.  The option of screening would be offered, but it’s ultimately the mother’s decision whether to be screened or not.  Unlike what opponents of the bill claim, it’s NOT just about prescribing meds to the unsuspecting mother. It’s about early detection and treatment of a PPMD, so the new mother’s postpartum experience–and motherhood experience overall–is as happy a period as possible. After all, a happy mother means a happy baby. A PPMD that goes untreated is detrimental not just for the mother but for her relationship with her partner and the baby’s cognitive, speech and behavioral development. Whenever a PPMD is detected, the healthcare professional should offer treatment options (e.g.,  medication, therapy, alternative remedies, support groups, etc.). It should ultimately be up to the patient to decide what treatment option is right for them. Early detection (plus education) would help prevent a PPMD from spiraling into a situation that renders a new mother utterly debilitated, helpless and unable to enjoy her time as a new mother. Had I been screened for PPD right at the moment my insomnia started, I could have been spared the frightening panic attacks I experienced, and having to take Xanax to help me get through those moments until the Paxil could kick in 4 weeks later (and then I was stuck taking Paxil for a year).Had I known about PPD, its risk factors and symptoms, I may not have had moments where I thought I would never return to my old self again. I would not have felt so utterly hopeless and miserable.

Public Awareness Campaigns (for the layperson as well as healthcare professional) would help address the following issues prevalent today: 

1.  PPMDs continue to be misunderstood, under-treated and misdiagnosed today, and new mothers pay the price of the ignorance of the very healthcare professionals to whom they entrust their care.  Even today,  medical professionals still have the tendency to confuse PPD with the baby blues.

Solution: There must be a push for all healthcare professionals who come in contact with postpartum mothers to be able to detect, properly diagnose (i.e., being able to discern the differences between PPD, PP OCD and PPP), and properly treat these disorders. It would help if people realized baby blues typically ends by the second week postpartum.  Symptoms like insomnia, loss of appetite, and inability to smile and find enjoyment in anything beyond the first two weeks should be indicators that she needs to be examined for a PPMD.  If she already knows all this by receiving literature about PPMDs before she has her baby, she will more likely question the doctor if her gut is telling her she might have a PPMD.  The minimum that should happen–and is very feasible and not difficult to accomplish in the near-term–is for medical professionals who aren’t that knowledgeable about PPMDs to build an extensive network of referrals for those who specialize in the treatment of these disorders (e.g., certain doctors, psychiatrists, psychologists, etc.).  It should be mandatory for all OB/GYNs and hospitals to be able to refer patients to Postpartum Support International’s warmline for support and local referrals and resources.

 

2.  Most new mothers have certain expectations of what childbirth and motherhood will be like. When a new mother goes into childbirth not knowing what PPMDs are, what her risk factors are (if any), and what to do if she does become ill, she will basically– let’s face it– be blindsided if she does succumb to a PPMD. She will feel alone, ashamed, helpless, and frightened that she will never return to her old self again.

Solution: She wouldn’t feel this way if she had gone into childbirth already knowing that PPD is the #1 complication of childbirth. She wouldn’t feel ashamed that she isn’t glowing with blissful happiness day in and day out in the days and weeks following childbirth. She wouldn’t have to hide her suffering behind smiles and a well-groomed appearance, so that even the doctors who specialize in PPMD care won’t be able to diagnose her with a PPMD. All mothers-to-be should know that: 1) No woman who has just given birth is completely immune from developing a PPMD; with the right combination of risk factors–from genetic to environmental–any mother can develop a PPMD; 2) you can and should consult with your OB/GYN (if they’re not knowledgeable, ask for a referral and/or call your PSI state coordinator for a referral to someone who specializes in PPMDs) on your risk factors; and 3) measures to minimize the likelihood of developing a PPMD would include setting up a support network before you have your baby to allow you to get 5 hours of uninterrupted sleep a night. See my previous post on social support.

 

3.  Mothers suffering from a PPMD tend to feel ashamed for not being able to cope like all other mothers around them (not realizing that many around them may also be suffering in silence). As long as women continue to suffer in silence, there will continue to be a large number of untreated and misdiagnosed cases. They must realize that by doing so, not only do they suffer unnecessarily, they increase their recovery time as well (and perhaps even jeopardize their lives and their babies’ lives).

Solution: With consistent education and information made available to the public–not to mention brave PPD survivors telling their stories–mothers suffering from PPMDs will realize there is absolutely nothing to be ashamed of, they are not alone in their experience, PPD occurs in as many as one out of eight mothers, they shouldn’t wait to get the treatment they need to be well again, and not getting any treatment at all can have negative consequences for her, her baby and her partner.

 

4.  Literature about PPMDs isn’t consistently given/made available to all new mothers.

Solution: Information should be provided to all new mothers to educate them on PPMDs, so they can make informed decisions about their treatment options. Information should be made readily available through websites, books, magazines, media campaigns, television commercials, public service announcements, the Postpartum Support International (PSI) poster posted in OB/GYN offices/exam rooms and hospitals.  GPs, OB/GYNs and pediatricians should have material about PPMDs readily available for patients to take, like the PSI pamphlet “Postpartum Mood Disorders: What Every New Parent Should Know” or New Jersey’s pamphlet “Speak Up When You’re Down.”  All OB/GYNs should hand out info on PPMDs, including a list of symptoms and local and online resources, to all pregnant women. All hospitals where babies are born should provide departing new parents with information about PPMDs including symptoms, resources, and treatment options.  What needs to catch the attention and make people realize that PPD can happen to them are such eye-catching phrases like “The #1 complication of childbirth is depression” and “You may not think you can ever be depressed after having a baby, but the reality is ONE OUT OF EIGHT new moms has postpartum depression.”

 

5.  It is still not standard practice for all childbirth education classes offered through hospitals around the country to inform first-time parents of PPMDs.

Solution: All first-time parents should receive a “first-time parents primer” as a segment of the childbirth preparation and/or childcare classes to educate them about: 1) the wide range of physical and emotional changes that occurs during pregnancy and immediately after childbirth, including the differences between the baby blues and PPD, how to recognize their symptoms, and know when/how to get help; 2) how the brain (neurotransmitters), hormones, mood, stress and family history that are unique to each woman can cause PPMDs; 3) emphasis on the importance of emotional and practical support during the first 4-6 weeks postpartum to enable the new mother to get the rest she needs while she is recovering from childbirth and at her most vulnerable; and 4) keeping a real perspective on and managing expectations with regard to childbirth and motherhood. What I mean by keeping a real perspective on things is basically dropping all notions that you will be some kind of supermom. It is key for first-time parents to be aware that, as with anything else, the higher their expectations are–in this case, with respect to childbirth and childcare–the more they are setting themselves up for disappointment. For example, don’t set yourself up for a huge let-down by thinking that 1) taking care of a baby is a cinch since all a baby does is sleep, eat, pee and poop, 2) motherhood is instinctive, and 3) breastfeeding will come naturally (it’s not as simple as it may appear to be, at least for most first-time mothers it’s not). They should focus more on the variety of bumps in the road that have a tendency to pop up but were never really covered in any great detail in the typical childcare class, magazines or books. Real-life training on how to soothe a crying baby, how to cope with reflux and colic, how to identify and deal with eczema and cradle cap, how to deal with food allergies, and how and why moms should get 4-5 hours of uninterrupted sleep at night. A basic explanation of why newborns only sleep in short spurts for the first three months–i.e., due to neurological development–wouldn’t hurt. Some sources state that the infant’s immature neurological development may be behind colic as well. Knowing more about the why’s in infant development will leave less room for surprises and, ultimately, feelings of guilt when a mother can’t soothe her child.

The importance of social support…..a historical perspective

It seems the main root behind the belief or “myth” that all mothers can and should be able to instinctively take care of a newborn lays deep in the historical trend away from social childbirth, where experienced mothers in the community used to help prepare the mother-to-be for motherhood, be there for her at childbirth, and provide emotional and practical support to her in the first month or so postpartum. These women in the community (extended family, friends, neighbors) used to educate the woman on what to expect, helping to ease that transition to motherhood. They used to provide breastfeeding support and be there to address questions and concerns as they came up. They took care of everything around the house, allowing the new mother to recover from childbirth, get the rest that she needed and focus on taking care of and bonding with her baby.

From what I’ve learned while reading all the books I’ve been reading, women started to have hospital births in the 1920s with hospital staff taking care of the baby and allowing her to rest in the first couple of weeks. By the 1960s women started wanting to have control of where and how they had their babies. Since then, the husband has become the main support team. But it was a lot to expect from someone who was becoming a parent for the first time while having to work at the same time. With more and more women having careers and extended family members moving farther away, the kind of support the new mother needed was often not feasible, which is why all too many mothers today have no choice but to do it all themselves. Many mothers today have never had any prior experience with caring for babies, even. With lack of guidance, emotional/practical support and role models, it’s no wonder first-time mothers are anxious, not sure what to do, and are exhausted. Not having had the opportunity to recover and rest up from childbirth, and in most cases with the partner off at work all day, she finds herself alone with the baby during the day, lacking self confidence, exhausted and overwhelmed.   During the first few weeks postpartum, the new mom is at her most vulnerable.   If she doesn’t get the rest she needs and let her body recover, the woman with high risk for mood disorders may fall prey to PPD.  It’s no wonder the rates of PPD are so high nowadays. I just received information yesterday from Postpartum Support International with a blurb that I briefly read over that shows a high correlation of social support and lower PPD rates from a study recently performed in Australia.

Starting from the 1980s, doulas have become more and more popular to provide the kind of support women in the community used to provide. Unfortunately, not everyone can afford a doula. My hope is that one day doulas–or even organizations like the Santa Barbara Postpartum Education for Parents founded by a group of mothers– will become standard for everyone, since it’s unlikely we will unwind the changes that have occurred in this society–e.g., women with careers, unavailability of extended families.   Had my husband and I known what a doula was and how one would’ve benefited us, we would have hired one.  As they say, hindsight is 20/20.  That’s why I’m sharing this with you.

It’s definitely a long road ahead of us in terms of lowering those PPD rates. If we can get the word out to everyone on what PPD really is and who is at greater risk and making sure they get appropriate emotional/practical support, we can help lower those rates…and the stigma associated with PPD.