Know Science No Stigma: Antidepressants During Pregnancy and Risk of Autism

Coming out of a blogging break to step onto my soapbox for one of my favorite reasons….to point out inaccurate information being published, in this case by JAMA Pediatrics in its report titled “Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children.”  Now, mind you, JAMA is a publication on which pediatricians from all over the world depend for the latest research.

Over the past few days, several responses were published, including ones from Postpartum Support International (PSI), Slate, and Huffington Post.

The sub-title or header to the PSI article says “Less Fear, More Science.”  That’s what EVERYONE needs to focus more on.  It’s one of my main mantras.  In fact, one of my most popular Pinterest pins (pinned 629 times as of 2/11/18) says KNOW SCIENCE. NO STIGMA.  Four words with significant meaning.  It’s posted on the Brain & Behaviour Research Foundation website.

JAMA needs to acknowledge this and pull the study, and if they can’t pull it, then they need to read the response from PSI, discuss it with other subject matter experts and decide how to handle it properly so the pediatricians all over the world can know the truth.  So that pediatricians don’t feed the flames of ignorance and fear among the public unnecessarily!

Free Copies of “Baby Basics: Your Month by Month Guide to a Healthy Pregnancy”

Psssst…OFFERING FOR FREE!  Note: This offer is for folks living in the continental U.S. only.  As of 12/23/16, they are still available!  I’m one of those folks who hates throwing things out and would rather give away or sell things via local resell/re-use groups or garage sales or eBay.

I have 2 copies of “Baby Basics: Your Month by Month Guide to a Healthy Pregnancy”…this book is available for $8 via the What to Expect Foundation and $13 via the march of Dimes and $5 or so via Amazon.  These copies are unused, so are as good as new.

Baby Basics

I am offering for just the cost of shipping (approximately $4). Please leave me a comment below and I will email you for your address to ship a copy (or both copies) to you. I won’t publish the comment so no one will see your address, promise.

This would make a fabulous gift for someone you care about that is expecting a baby.  The earlier on the expectant mom gets a copy of this book, the better prepared she will be in terms of what to expect during pregnancy and what to prepare for when baby arrives.  The info in it is VERY helpful/important that I wish I had received when I was pregnant back in 2004.  For more details on what the book provides, please click here.

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

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

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

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

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

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

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

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

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

screening_Kleiman

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

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

You summed it up so nicely, Anna!

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

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

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

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

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

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

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

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

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

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.