You have to break through the uncomfortable…Why? Because mothers are dying from postpartum mood disorders

You have to break through the uncomfortable…..We are losing a silent battle that no one wants to talk about.

Amen!  These are the words Brian Gaydos utters when people ask what happened to his beloved wife, Shelane, and his answer “She died from a disease called postpartum depression” makes them uncomfortable.  Discomfort from stigma is what keeps suffering mothers quiet and getting the treatment they need and deserve.

When I read the August 4, 2017 article by Michael Alison Chandler in the Washington Post titled “Maternal depression is getting more attention – but still not enough” and I saw Brian’s words at the end of  the article, I decided I needed to blog about these words and about the tragic death of his wife.  Shelane Gaydos, a 35-year-old mother with 3 daughters, lost a baby in utero at 12 weeks and within 3 weeks died by suicide.  Family members did not realize until a while after her death that she had suffered from postpartum psychosis.  The article mentions, and as statistics have always indicated, women are more likely to attempt suicide during the first year after childbirth than during any other time in their lives.  It is important to note that a woman doesn’t need to give birth to experience any one of the various postpartum mood disorders, including postpartum depression (PPD), postpartum OCD and postpartum psychosis.  She can suffer from these disorders after having a miscarriage as well.

The article mentions certain things I’ve mentioned all along in my blog and in my book:

  • 1 in 7 new mothers experience a perinatal (during pregnancy and after birth) mood disorder, and yet these disorders continue to be under-diagnosed and under-treated
  • A relatively small percentage seek professional help either because they don’t know what they are experiencing deserves and needs  professional help and/or they don’t know where to go to get help and/or they are ashamed to seek help
  • More obstetricians and pediatricians lack than possess the training needed to diagnose and treat perinatal mood disorders
  • Certain risk factors are the reason why certain mothers develop PPD and others don’t: genetic predisposition to biological factors (some mothers are affected by hormonal fluctuations during/after childbirth and after weaning more than others) versus environmental factors (poverty, poor/abusive relationships, premature birth or miscarriage, inadequate support, inadequate paid leave from work)
  • It’s thanks to advocates with platforms with a broad reach to members of the government and media that there has been progress in recent years.  Brooke Shields is one of the first of the advocates to start the trend of sharing their own experiences, spreading awareness, and trying to effect change.
  • There are still stubborn societal myths (thank you to the patriarchal and quite misogynistic forces and views still in place here in the 21st century) that only serve to put unnecessary, additional stress on women, encouraging the false notion that all mothers can not only care for their babies without any sleep or support, but also be able to breastfeed without any issues and return to their pre-baby bodies and weight quickly.  Unbeknownst to many of us stateside, societies around the world (and in olden days here in the good ol’ USA) have customs in place that provide new mothers with the support they need to recover from childbirth and care for their newborn baby.  Instead, because we are a strictly capitalistic society, more and more mothers now work and have anywhere between 0-13 weeks of paid leave and are expected to recover and jump right back to their jobs before having babies, as if they’d never given birth in the first place!  If only men who think “Women have been giving birth for centuries should just up and go back to the way they were” can experience childbirth firsthand sometime!

Certain states, like Massachusetts, New Jersey, and Illinois have passed laws that mandate screening for PPD, and thanks to recommendations by the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), healthcare providers are screening for PPD more routinely.  What I would like to know is whether these screenings are even happening (I am dubious):

  • In 2015, ACOG recommended that OB/GYNs screen women for PPD at least once during pregnancy and once after childbirth.
  • In 2010, the AAP recommended that pediatricians screen mothers for PPD at well-baby visits during the first 6 months.

Says Adrienne Griffen, founder and executive director of Postpartum Support Virginia, whom I have the honor of knowing through my affiliation with Postpartum Support International:

Postpartum depression is where breast cancer was 30 years ago.

I truly and sincerely hope and pray that it’s NOT going to be ANOTHER 30 years for us to see a significant change in the way we view PPD as a society and reduce the numbers of women suffering–and even dying–from perinatal mood disorders!

 

 

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Why is it still so damn hard for moms to find help for postpartum mood disorders?

We are in the 21st century.  It is now 2017.  We have someone leading the country and the GOPs in trying to make it even harder for people to get access to healthcare, and in particular, mental healthcare.  Check out the articles “How Trumpcare Will Affect Moms Fighting Postpartum Depression” and Psychology Today’s “How Trumpcare Will Affect Mental Health Care.”  But we mustn’t let such ignorant, selfish and typically capitalist initiatives impede progress.  We must never stop resisting any initiative to make conditions worse, to stop forward momentum!

It is 2017 and I am asking the question so many of the other attendees of last week’s Postpartum Support International (PSI) conference are asking: Why is it still so damn hard for moms to find help to treat their postpartum mood disorders, like postpartum depression (PPD), postpartum psychosis (PPP) and postpartum OCD?  A common theme across the training sessions offered at the PSI conference, and a common topic of my blog, is the fact that there are mothers seeking help across the country daily, and we may have names of therapists or social workers, but in many cases, these professionals aren’t anywhere near where the mothers are located.  Or there’s the issue of affordability.  Or when the professionals can see a new patient (could be weeks).  Or how about there just aren’t enough professionals who can see new mothers suffering from postpartum mood disorders, period.

A recent article by Crystal Edler Schiller, PhD, assistant professor in the Center for Women’s Mood Disorders and Department of Psychiatry at the University of North Carolina at Chapel Hill, titled “Maternity mental health care should be accessible” highlights the issues.

Although the numbers of professionals is increasing slowly over time, there is just not enough of them to treat the actual numbers of mothers needing care.  Many PSI members are social workers, registered nurses, peer group supporters, psychologists and psychiatrists, which is great.  But the numbers of people in these roles throughout the country fall pitifully short of the help that’s actually needed.   So many mothers suffer in silence, and you only really hear about the ones who openly discuss their experiences via social media (like me) or other articles or in the news.  Or you hear about the mothers in the news who weren’t able to get the right help and their illnesses led to their deaths and/or death of their babies.

I’m fortunate that I’m in New Jersey, a state that mandates screening for PPD and has a state initiative called “Speak Up When You’re Down.”  We also have The Perinatal Mood and Anxiety Disorder Center at Monmouth Medical Center, the very first center dedicated to maternal mental healthcare in the state, which I blogged about previously.  A group of PSI members in New Jersey have come together to form a PSI-New Jersey chapter.  These members meet monthly and we discuss the support they provide mothers via their own practices and/or via the Partnership for Maternal & Child Health of Northern New Jersey, Central Jersey Family Health Consortium, and the Southern New Jersey Perinatal Cooperative. My own experience with PPD pre-dates all of these initiatives, and needless to say, there was a whole lot more ignorance back in 2005.  It’s truly satisfying to see these initiatives take root, with more in the works.  However, this is just New Jersey and as far as I’m aware, only California, Massachusetts and Illinois have similar screening and care initiatives in place and/or in development.  There are 47 other states who are extremely behind when it comes to maternal mental healthcare.

The slow change I’ve seen just in New Jersey alone over the past 12 years since I suffered from PPD is unacceptable.  You would think that all therapists know how to diagnose and treat mothers suffering from a postpartum mood disorder.  Unfortunately, they don’t.

How do we speed up progress?  We need funding to make the printing of pamphlets/flyers available in ALL doctor’s offices that could potentially see new mothers (i.e., OB/GYNs, family doctors, general practitioners, pediatricians).  Medical schools must mandate that all training programs for all healthcare professionals (i.e., doctors, nurses, social workers, therapists) include a minimum of a semester in maternal mental health conditions and are led by PSI educators, and without these programs people cannot obtain their degrees/licenses.  Unless we start putting these measures in place, we are not going to see any significant improvement in addressing the scores of mothers needing help in our lifetime.

I’m going to leave you with the last sentences of Dr. Schiller’s article, which makes the common sense statement that, thanks to ignorance due to stigma, is all too often taken for granted by all too many people, healthcare professionals included:

Let’s dispense with the outdated idea that the body and mind are separate, which is at the foundation of decisions to pay for physical but not mental health care. Mental health is physical health, and our bodies and our babies are only as healthy as our minds.

 

 

 

Happy Mother’s Day 2017

Dear Mama-

If you’re visiting my blog, I just want to let you know that you are not alone in your postpartum experience.

You may feel like you are alone.  But you aren’t.

I am a PPD survivor.  There are MANY PPD survivors.  I am here for you.  There are many PPD survivors out there for you.

I love analogies, and I’m going to use one here.  I have pansies outside on the deck that I never expected to make it all winter with the cold, snow and ice, but it DID make it.  I covered the plant with a plastic food container to prevent it from getting crushed by snow/ice and to protect it from the below-freezing temps and wind.  I visited it, touched the one or 2 flowers that endured during the winter, and spoke to them (never thought I’d ever be a flower whisperer, but here I am) as much as I could.

Here are the persistent pansies that failed to let the elements prevent them from standing tall.

And here are the pansies today!  

You will get through the sleepless nights due to your anxiety, insomnia, feelings of helplessness.  Just like the pansies surviving was doubtful, they were able to persist because they received care and support.

I made it, without even knowing that what I had was PPD.

I made it through with crappy bedside manner from both my OB and doctor.

I made it with no support from anyone else around me except for my husband. I’d never heard of anyone having PPD before.

I didn’t know about Postpartum Support International (PSI).

I wasn’t on the Internet much back then.  It was 2005. I wasn’t on Facebook or Twitter.

I wasn’t referred to any therapists who specialize in PPD.  I didn’t have a support group, either.

But I made it.  And YOU WILL TOO.

If you are reading this and you are suffering and don’t have any idea how to get help, please leave me a comment.  I will respond and try to help you find resources to help you get through this.  You can also go to the PSI website for phone and local resources.

There was a blog post from fellow PPD survivor, Andrea Bates, author of the blog “Good Girl Gone Redneck” featured on the PSI website on World Maternal Mental Health Day this past week that I want you to visit if you haven’t seen it already.  Please check it out.  She’s a wonderful writer.  I wish I could write like her.  She also wrote 3 blog posts leading up to Mother’s Day this past week that you should also check out.

Happy Mother’s Day, Mama!

Love,
Ivy
❤ ❤ ❤

Maternal Mental Health Awareness Month – 2017

Just like this time last year, I’ve come across so many things on my Facebook feed in the past few days–all in anticipation of Maternal Mental Health Awareness Month– that I’m just going to highlight all the exciting work, developments, other mothers’ experiences, and upcoming events all in one post.  It’s just a shame that these exciting developments, including articles to boost awareness, don’t happen all year round!  Think about how much more progress there would be if that were to happen!

As I stumble across more articles this month, I will add them to this blog post.

 

House Bill 1764 in Illinois

I saw an exciting announcement today on my Facebook feed from my friend Dr. Susan Benjamin Feingold, a nationally renowned expert on perinatal (pregnancy and postpartum) disorders and the author of Happy Endings, New Beginnings: Navigating Postpartum Disorders.  She testified yesterday in the Illinois Senate Criminal Committee.  HB 1764 just passed the Senate Committee and must next pass the full Senate.  Once the Governor signs off on it, it becomes Illinois law, making Illinois the first state to pass such a law!  Such a law has existed in the UK since 1922 when the Infanticide Act was put in place to ensure mothers receive psychiatric treatment and rehabilitation, rather than a death sentence or life in prison. Canada and several other European countries have also adopted similar laws.  It’s about time the US did too!

It’s due in large part to the following individuals that HB 1764 has made it thus far:  Dr. Feingold and Lita Simanis, LCSW who provided critical testimony, Bill Ryan (retired Assistant Deputy Director at the Illinois Department of Family and Child Services who regularly visited the Lincoln Correctional Center in Logan County, IL and heard the stories of numerous women serving long or lifetime prison sentences for crimes committed while sick with a postpartum disorder) who proposed the law and brought it to State Representative Linda Chapa LaVia (83rd District) who sponsored it, and Barry Lewis (Chicago Criminal Defense Attorney) who provided a written brief and expert testimony as to why this law is constitutional (in response to opposition from the State Attorney).

Click here for more information about postpartum psychosis and why this news is of such significance and a major stepping stone to what will hopefully be the passing of similar legislation throughout the U.S.   Cases of postpartum psychosis are rare and cases of ones leading to infanticide are even rarer.  But as the article states, all cases of postpartum psychosis are neurochemically caused.  Usually, women who are sick with postpartum psychosis don’t even know that’s what was wrong with them and their conditions go untreated, undiagnosed or diagnosed but not properly treated.  During trial, these women are not allowed to talk about their conditions or have them considered as mitigating factors in sentencing.  Although the idea of infanticide is truly tragic and unfathomable, try donning your empathy hat and imagine what it would be like if it were you (be sure to read up on what postpartum psychosis is and what it does to a person first) that was being controlled by  neurochemistry gone completely out of whack until tragedy strikes with an act you commit–one that you could not prevent or control due to your illness–that you will pay for dearly for the rest of your life enduring painful, unrelenting regret, many years or life in jail (or even face the death sentence), and with your illness never addressed or treated.

 

PPD Screening in NYC and Texas:
On May 18th, First Lady of NYC, Chirlane McCray, announced that NYC Health + Hospitals will screen EVERY new mother for maternal depression.  NYC Health & Hospitals provides healthcare services to more than 1.4 million New Yorkers in more than 70 patient care locations and in their homes throughout New York City.  Click here for the link to her Facebook page announcement.  Click here for more about NYC Health & Hospitals.

On my Facebook feed on May 23rd, I saw a link to an article that made my eyes pop wide open!  How exciting was it for me to read that, over in Texas, House Bill 2466 was passed for new mothers participating in federally-backed health care programs (for low-income families) like Medicaid to be screened for PPD when they bring their babies to see their pediatricians.  Yes, mothers who bring their babies in for their checkups can get screened for PPD by their babies’ pediatricians, and the screening would be covered under their children’s plan, like the Children’s Health Insurance Program. Research has shown that PPD is less likely to be identified and treated among low-income mothers, and this bill seeks to detect PPD through newborn checkups.  The rationale is–which I’ve blogged about previously and even wrote about it in my book–since mothers are not required to see their OB/GYN after childbirth unless there’s a medical issue that needs treatment, there is the opportunity at their babies’ 1-month checkup for the pediatrician to screen the mother.

 

Alexis Joy D’Achille Center for Women’s Behavioral Health:
In my Facebook feed today, I spotted an article about a new center like The Perinatal Mood and Anxiety Disorder Center at Monmouth Medical Center, which celebrated its grand opening on May 5th.  Click here for my blog post about this first of a kind center in New Jersey.  Due to open this fall, the the Alexis Joy D’Achille Center for Women’s Behavioral Health will offer comprehensive maternal mental health care at West Penn Hospital in Bloomfield, PA, in partnership between Allegheny Health Network and the Alexis Joy D’Achille Foundation.  This new facility will offer a wide range of treatment, including weekly therapy, an intensive outpatient program and partial hospitalization for women with more severe forms of PPD.  The Alexis Joy D’Achille Foundation was founded by Steven D’Achille in memory of his late wife who at the age of 30 lost her battle against the severe PPD that hit her after she had her daughter in August 2013.  The article about this new center talks about the work it has done to benefit new mothers since 2015, and the work it plans to do once the facility is completed.

 

Personal Success Story: If You Only Ask – by Jordan Reid
Being your own advocate by being informed about postpartum mood disorders, knowing your risk, and being prepared for the possibility – unfortunately, you have to for self-preservation purposes because there aren’t enough resources to catch the moms who fall through the cracks of doctors failing to diagnose, treat or even refer maternal mood disorders. The post reflects the main steps I suggest in chapter 5 of my book, which delves into risk factors and coming up with a prevention plan.  I also touch on being prepared in a previous blog post by having a therapist lined up, just in case, if you think you are at high risk for postpartum depression (PPD).  I’ve also blogged about risk factors for PPD.

 

Postpartum Support International (PSI):
The annual PSI conference is coming up in Philadelphia!  Register by May 8th to take advantage of early bird rates for its PMD certificate course from 7/12-13, as well as for the regular 2-day conference from 7/14-15).

Additionally, PSI has just announced its partnership with the University of North Carolina-Chapel Hill (UNC-Chapel Hill) School of Medicine to expand the PPD ACT.  The PPD ACT is an iPhone app previously released in the U.S. and Australia to study PPD, which is now expanding its reach to iPhones in Canada and to Android phones in the U.S. and Australia.  The app was designed to help understand why some women suffer from PPD and others don’t, in the hope of improving the ability to minimize risk and find more effective treatments.  Women with the app can participate in surveys and DNA testing to study the genes of those suffering from PPD.  This study is the first of its kind.  Last year, approximately 14,000 women enrolled in the study.  Many women who participated were successfully treated for PPD. Ultimately, the hope is to be able to expand the study across the globe.  To download the app or learn more about the study or PPD, click here. For more information about the PPD ACT, click here to access the UNC-Chapel Hill announcemen, here for a HuffPost Canada post announcement, and here for a Mom.me post titled “Find Out If You Have Postpartum Depression Without Leaving Home” by Claudiya Martinez on May 15, 2017.

 

National Coalition of Maternal Mental Health (NCMMH):
And last and most definitely not least, please have a look at how you can participate in Maternal Mental Health Awareness Week (May 1-7) led by the National Coalition of Maternal Mental Health (NCMMH).  Click here to see how you can partner along with other organizations, blogs, authors, mental healthcare providers, etc. in the awareness initiative by becoming a social media partner (like me) to NCMMH.  Help spread the word about the #1 complication of childbirth on Facebook and Twitter by changing your profile pictures and cover pictures, as well as re-tweeeting/re-posting digital messages from the NCMMH’s Twitter and Facebook accounts from May 1-7.

 

The Perinatal Mood and Anxiety Disorder Center at Monmouth Medical Center – Grand Opening on May 4, 2017

Announcing the Grand Opening of The Perinatal Mood and Anxiety Disorder Center at Monmouth Medical Center (MMC)!  This is such an exciting development for New Jersey that I’m taking the day off from work to attend this grand opening to meet the program’s multi-disciplinary team of experts and clinicians certified by Postpartum Support International.

When:  Thursday, May 4 at 1:00 p.m. (ribbon cutting starts then)
Where:  Maysie Stroock Pavilion (Pavilion & Second Avenue, Long Branch)
RSVP:  Email teamlink@rwjbh.org or call 888.724.7123
Agenda:  Speakers will include Mary Jo Codey (former NJ First Lady who will share her personal experience with postpartum depression (PPD), Lisa Tremayne, Robert Graebe, MD (Chairman of the OB/GYN Dept), and several PPD survivors who are former patients of the center.

Thank you to Lisa Tremayne, RN, CPPD, CBC, CCE — maternal child health nurse at MMC — for graciously providing the details of how New Jersey’s VERY FIRST perinatal mood and anxiety center of its kind has evolved under her persistent efforts.

After the birth of her triplets (after 6 years of not being able to conceive naturally and one round of IVF) in 1998, Lisa suffered from what she later learned was postpartum anxiety/postpartum OCD, which greatly affected her life as a new mom.  She experienced racing thoughts and living in a constant state of anxiety.  She never received help, no one ever questioned if she was okay, and it took years for her to fully recover.

It wasn’t until 2007 when she was at a mandated lunch and learn with the Central Jersey Family Health Consortium that she learned she had what they referred to as postpartum depression (PPD).  Not telling anyone about her experience, she started volunteering for the consortium, and helped patients find resources and help. In 2011 she became the MMC Childbirth Education Manager. As facilitator for a new moms support group she quickly realized many mothers were suffering from PPD.  She then received permission to start a PPD support group, which was instantly well received and attended by large numbers of mothers.  It was at that point she broke her silence and shared her experience with others. She presented her plan to start a PPD program to new business development, but it wasn’t until April 2015 that the plan was accepted and the program was started with the support of the chairperson of OB.  The program consisted of Lisa, a therapist and a psychiatric nurse practitioner on a part-time basis. Since then, the program has grown.  It is now a mother/baby program in which babies are not only allowed but encouraged to attend with their mothers so the staff can assess mother/baby attachment at all times.  Many classes/workshops are designed specifically for the mother/baby.

Lisa and the other dedicated members of the program are excited about the grand opening that is finally going to take place on May 4th!  To date there have been intakes of over 800 women, and 500 women have received medical evaluation, treatment and referrals to appropriate services through the program.  On average, there are 30 new patients a month.  Lisa hopes the program will evolve into a partial day stay program by 2018.  The program is interdisciplinary and every member is completely passionate about helping moms/babies, normalizing this temporary and treatable illness and educating the public that this is the #1 complication of childbirth.

Tri-State Area Resources for New Mothers and Professionals Who Care for Them

I will be adding to this post as I think of other resources…

Postpartum Support International (PSI)

I’ve been a member of PSI since 2006 and have met many wonderful, dedicated and caring social workers, therapists, peer-to-peer support group leaders, etc. at its conferences over the years.  The PSI website, as I’ve mentioned in numerous previous posts, provides a listing of resources by state. There is also a warm line for those who need telephone support.

I’m happy to mention that more and more PSI chapters are forming. For example, in the tri-state area the PSI-CT chapter just recently formed https://psictchapter.com/ and NJ is in the process of forming a PSI-NJ chapter.  Click here for the article  published on February 20th that highlights the purpose of the PSI-CT chapter.  The PSI-NJ chapter is in the early stages of development, but the officers are now in place and ramping up plans with monthly calls to establish committees. The chapter has a Facebook page and a website is in the works as well.

If you would like to get involved with either chapter, please let me know and I can put you in touch with them.

Maternal Mental Healthcare Centers

When it comes to mothers’ centers, there are 2 on my mind in New York City:

Seleni Institute
The Motherhood Center of New York

I will be adding NJ and CT ones in the next few days.

Workshops for Professionals, Peer Support Group Leaders, and Advocates

The Partnership for Maternal & Child Health of Northern New Jersey will be hosting training events featuring Cheryl Tatano Beck, DNSc, CNM, FAAN, Distinguished Professor at the University of Connecticut, School of Nursing.

Click here for more information about the workshop scheduled for April 26th in New Providence.
Click here for information about the workshop scheduled for April 27th in Englewood.

The target audience for these workshops includes physicians, nurses, social workers and others (like peer-to-peer support group leaders) working with perinatal women.  Advocates and others concerned about maternal mental health (like me) are also welcome to sign up.

I will be sure to post information about events intended for new mothers and for those who are dedicating their lives in helping new mothers.

 

 

15%-21% of Moms Suffer from a Perinatal Mood Disorder

For the longest time they were saying between 1 out of 8 women suffer from a perinatal (before, during or after childbirth) mood disorder.  Then, they said between 1 out of 7.  And more recently, literature indicates it’s now approximately 15%-21%, which is anywhere between 1 out of 5 and 1 out of 6, with 21% experiencing a postpartum mood disorder.

If you are suffering from a perinatal mood disorder, you can see from these numbers and in many places online–from a multitude of Facebook support pages, blogs and on Twitter–and in newspapers that you are not alone.  For example, in today’s Upworthy, my friend Heidi Koss shares her experience after the birth of her daughters.  She is a PPD survivor and now helps other moms suffering from perinatal mood disorders.  Her story was also mentioned in an NPR article a week ago today.

You need to know when you need to get help from a doctor and/or therapist.  Get it early.  Know the facts.  Know the difference between postpartum blues and postpartum depression (PPD).  Know the difference between PPD, postpartum anxietypostpartum OCD and postpartum psychosis.  Click here for helpful information that can help you.

You need help for you.
You need help for your baby(ies).
You need help for your family as a whole, including your significant other.

I just found out tonight about the fate of Carol Coronado about whom I blogged in May 2014.  She suffered from postpartum psychosis (not PPD as some newspapers allude to), didn’t get the right help and was just sentenced to life in jail.  Carol, her babies, and her husband were failed by the system.  The same system that failed to ensure she got help is punishing her for their failure.  Sound fair to you?  No!  Her case sounds similar to Andrea Yates case nearly 15 years ago.  I pray for Carol and her family.  She has suffered enough and does not need to spend the rest of her life in jail.  I saw a Facebook comment about Carol that triggered me to write this post.  The coldness and lack of understanding are a reflection of just how close-minded people can be.  It amazes me, really.  It’s really hard to beat down stigma when you have such barriers in the way.  But don’t let any of that deter you from getting help.  YOU are important.  Forget these clueless people.  Get the help you need.  Don’t delay!

Whenever you read about these stories in the news, please remember the facts.  Get information from the right resources (links above would be great place to start).  And don’t let stigma and ignorance steer you away from understanding and compassion.  Don’t let stigma, ignorance, and the close-mindedness of people (those who choose not to understand and would rather continue their misogynistic, super hokey, religious extremist mindset in which women are second class citizens) steer you away from getting the help you need to be well again!  Stay strong!  There is help out there!  Reach out to me.  Reach out to the Postpartum Support International Facebook page (closed group) for support.