What Do Pregnancy Loss and PPD Have in Common?

On Facebook yesterday, I stumbled across a link to an article on Babble.com titled “Suffering in Silence — How One Woman Coped With the Loss of Her Baby.”  It is truly one of the best written articles on pregnancy loss–in this case, miscarriage–I have ever read.  In reading the article I couldn’t help but be reminded of how I felt after my ectopic pregnancy and when I found out the twin to my daughter didn’t make it past the second month of pregnancy.

UNNECESSARY TABOOS

So, what do pregnancy loss and PPD have in common?  Well, to start with, both seem to have become through the years taboo topics that you rarely hear others bring up on conversation….least of all by those who are in the process of grieving their pregnancy loss and those who are suffering from PPD.   The only people you would be willing to share such a private matter with are certain family members and close friends.   Ironically, it’s at times like this that you need support the most.   Grieving in private, which is what I did when I suffered both my losses, only increases your risk for depression.

THE NUMBERS…YOU WOULD NEVER KNOW

Second, because people don’t talk about their experiences, society as a whole really has no concept of how frequently pregnancy losses and PPD occur.   The author, Jody Pratt, points out:

“An estimated one in seven pregnancies ends in miscarriage. Each year in the U.S. alone, over 700,000 babies don’t survive to be born. Millions of people must be mourning them. So, where are they?  ‘The only tradition our society does have regarding miscarriage is that you’re not supposed to talk about it.'”

As for PPD, an estimated one in eight new mothers experience it.  So, where are they all?  Before I had PPD myself, I hadn’t heard squat about it from anyone I knew.  After I had PPD, I’ve only come across a handful of those I personally know that mentioned their own experiences to me.  Believe me, they are out there.  Thanks to the stigma of mental health and lack of awareness, all too many moms suffering from PPD continue to keep their experiences to themselves, not knowing that what they have is a true illness and there should be no shame associated with feeling the way they do.

ANOTHER CONSEQUENCE OF THE TABOOS

Another consequence of people not talking about their experiences is that people have no real concept–not unless they, of course, have firsthand experience themselves–of what it’s like to lose a baby during pregnancy, regardless of how early in the pregnancy the loss occurred.   Comments that either I or others receive in reaction to the news of pregnancy loss lean in the direction of “Just keep trying….you’ll succeed.”  “At least this happened now rather than later on in the pregnancy, after seeing your belly growing and feeling the baby kicking and moving and feeling your love for the baby growing daily.”  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.   Then, when I lost the twin to my daughter at two months, I cried on and off for a few days but forced myself to move on because I couldn’t risk having my grief jeopardize my pregnancy. 

When it comes to PPD, unless you’ve been through it yourself, it’s hard to really know what the PPD mom is really going through.  All people know is that having a baby is supposed to be a happy time and you only really see happy moms.  So, when a mom who is suffering from PPD isn’t glowingly happy but instead is suffering from PPD, comments she receives may tend to send like the following:  “You have the healthy, beautiful baby that you’ve always wanted.  What more could you want?  How could you not be happy?  Pull yourself together…your baby needs you.  All new moms go through this after having a baby.  It will pass on its own.  You’ll be fine in no time.”

BREAKING THE CYCLE

Parents who grieve should speak up more.  Though, with the reactions they get from even the most well-meaning of family and friends, it’s no wonder people want to keep their grieving to themselves.  It’s also no wonder that most expectant parents do not tell anyone about their pregnancies until the end of the first trimester, because there is a greater likelihood for pregnancy losses to occur during that time.  As a consequence, if you do (God forbid) experience pregnancy loss, you automatically end up suffering in silence because people didn’t even know you were pregnant to begin with.  Being as risk-averse as I am and prone to believing in “jinxes,” you better believe my husband and I didn’t tell anyone at all about my pregnancy until the first trimester was over and I didn’t tell colleagues until I could no longer hide it from them at around 6 months!   I grieved in silence after both of my losses because they occurred before the first trimester was over.

At the same time, family members and friends should learn how to support grieving parents better.  Maybe take some sensitivity training or something.  Learn that keeping what you say to a minimum–in this case, LESS IS MOST DEFINITELY MORE–just your being there for the grieving parents and offering a listening ear (if they ask you) and avoid offering advice especially if you’ve never suffered a loss like this yourself.  Read up on articles such as the one Katherine Stone had previously written up that provide suggestions on how to support someone who is grieving.  Follow the blogs I list under Pregnancy Loss/Infertility Websites & Blogs.  It would also help tremendously for people to know that there are many others who are going through–or have gone through–pregnancy loss (or PPD).  I mean, look at the numbers!   Articles like this one written by Jody Pratt should be accessible via pregnancy books, magazines, and newspapers.  In all forms of media that expectant parents would have easy access to.  As I mention in prior posts, the best place to obtain non-judgmental emotional support is a therapist that specializes in pregnancy loss (or PPD).   Doing so is an investment in your mental health down the road as you embark on future pregnancies that will one day, hopefully, be successful.

PREGNANCY LOSS – A RISK FACTOR FOR PPD

Finally, negative life events related to childbearing–e.g., history of and unresolved grief associated with pregnancy loss (previous stillbirth, abortion, miscarriage) and  multiple failed IVF cycles are a significant risk factor for PPD.  There is a lot at stake emotionally with the baby that is conceived after years of trying, possibly with the help of IVF and after failed attempts/cycles and perhaps even miscarriages.  Click here and here for more info.

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.