Butterfly Confessions: How Writer, Advocate and Mother A’Driane Nieves Gives Birth With Confidence


I am excited to introduce A’Driane Nieves to the Giving Birth with Confidence community. A’Driane is a well-known blogger and maternal mental health advocate. Her artwork inspires, and her chronicle of her pregnancy is a testament to self-advocacy in prenatal care. By sharing her journey through pregnancy and motherhood with bipolar II disorder, A’Driane gives courage to all women to give birth with confidence.


Tell us a little about this pregnancy.

 This pregnancy, my third has been…physically overwhelming. It’s honestly been one for the books! Every symptom the first trimester was far more intense than what I’d experienced previously, especially my morning sickness and the withdrawal symptoms I was experiencing from having to stop my mood stabilizer (Lamictal) until my second trimester. I also struggled with hypotension, migraines, and severe symphysis pubis, which rendered me immobile most days and landed me on bed rest quite often these past 9 months. Since the beginning of my third trimester I’ve had fairly strong contractions daily-ones that are usually 3-4 minutes apart most of the day and force me to stop and breathe through. I ended up in labor and delivery twice and given various medications to try and stop them, often to no avail, which led to stricter bed rest and having to be put on a monitor every appointment. Like I said, this has definitely been one for books…


How do you approach giving birth with confidence with this birth?

This is the first birth that I feel like I actually prepared for mentally in terms of actually learning about the labor process, birthing methods, pain management, etc. With my previous two births, the bulk of my preparation was external, ensuring everything I needed to care for my sons after they were born was purchased and at the ready. I simply didn’t place much value or emphasis on the experience-I solely cared about the end result.

However, with this pregnancy, I took time to really reflect on my previous labor experiences and came to realize that I hated both of them. I found that because external circumstances had me living in survival mode, I went into both of my labors anxious, stressed out, and uneducated about the labor process and mentally unprepared to manage what I was experiencing physically during each one; back labor with my first, and five days of prodromal and early labor with my second. With this pregnancy I decided that while the end result (healthy baby) was still what mattered most to me, I did want to enjoy my labor and delivery as best I could.

To help facilitate this goal, I’ve read several books, articles, and blog posts on various birthing methods, and have pulled different aspects from each to use that I found appealing. I’ve researched & practiced breathing & relaxation techniques I could employ to manage not just the pains of labor but any anxiety I will most likely experience. I explored the idea of hiring a doula, and talked at great length with my husband about what kind of role he felt comfortable fulfilling during my labor and what kind of atmosphere he’d like us to have during the process. This was a first for me, because with my first labor, I was a single mom, and on my own. With my second, my husband and I were together, but we never discussed anything about labor or what “kind” of birth experience we could have. This time I’ve made sure to include him, which has helped us bond in a way we didn’t my last pregnancy.

Taking the time to inform myself of my options, and actually read what happens during labor has definitely helped me approach my upcoming birth with a sense of vigor and enthusiasm I haven’t experienced before. I’ve been able to communicate more with my OB confidently, and feel far more empowered as a patient…


How has taking care of mental health played a role in that?

While being prepared and informed mentally for the birthing process has been important to me this pregnancy, my top priority from the moment I saw the plus sign on the test has been to take care of myself mentally. As a woman with a history of PPD and currently living with rapid cycling bipolar II, anxiety & OCD, I’ve worked hard this pregnancy to ensure I have what I need to do that. From finding an OB with experience treating pregnant women with mood disorders, to finding new psychiatrist who is knowledgeable and up to date with treatment methods, to educating myself on what treatment and medication options are available to me, to attending talk therapy, I’ve fought hard this pregnancy to advocate for my mental health both during pregnancy and in the postpartum period. I’ve asked both my husband and closest friends to help me be aware to any shifts in mood they may notice that I don’t, and to tell me if they notice anything that concerns them during this time or in the days and months to come. I’ve read up on my risk for postpartum psychosis and have talked with other mothers who have experienced it to gain their insight and support. I have also made it a point to ramp up on my self-care, even during periods of depression this pregnancy. Painting, watching a favorite show, listening to music, reading, and even some days just forcing myself to shower-these are all things that have helped me manage my illness aside from medication and therapy these past nine months.

Reflecting on my previous birth experiences and how they impacted me mentally-especially my last where I experienced prodromal and early labor that went nowhere without augmentation-also empowered me this time to talk at great length with my OB about what my options are this time. I’ve expressed how triggering the physical strain of this pregnancy has been on me, and how triggering the end of my last pregnancy and labor was on my mentally. I stressed my desire to not go into this labor exhausted and drained mentally, and my fear that doing so would increase my chances of struggling in the postpartum period. After two weeks of cervical checks that saw no change in my cervix despite having regular, moderate-severe contractions, and other early labor symptoms, we decided last week that scheduling an induction would be best, as I expressed I was already starting to cycle between moods-mostly depressive, and had reached my limit physically. I love my OB because he heard me and took my mental health into account and not just that of the baby’s at this stage. I’m grateful that he was able to look at my maternal health, the baby’s health, and my mental health, and come to a decision that benefitted all three. Very grateful for that.


How has the blogging and online community offer you support?

I’m also incredibly grateful this pregnancy for the online support system I have this time around. I found my online tribe and place in the blogging community three years ago while battling PPD, and both my tribe and the blogging community at large have become a lifeline for me. Thanks to the blogging, I’ve met strangers who have become my sisters and confidants, and I’ve found my voice as an advocate. They help me stay informed, encourage me, hold me accountable to taking care of myself, and are there to listen and sit with me when needed. They’ve enabled me to have a strength and confidence this pregnancy that I didn’t previously and even though I know being a mother of 3 with a mental illness such as mine will be a challenge, it’s one I know I’m capable of succeeding at.

I go in for my induction on Tuesday 11/12 at 6am….and I can barely contain my excitement and relief :)



I know I speak for everyone in wishing A’Driane well as she welcomes this beautiful baby into the world!


A’Driane Nieves is a writer, painter, mental health advocate, and speaker. She blogs at butterfly-confessions.com. She also is a contributer at Postpartum Progress. You can follow A’Driane on Twitter @addyeB.


Mental Illness Awareness Week – Postpartum Mood Disorders

Last week, a mother named Miriam Carey was killed after a succession of tragic events. We will never know what compelled Miriam to drive her car into the White House barriers. What we do know, however, is that Miriam suffered from a postpartum mood disorder. And what we can do — to honor Miriam and to support and protect women and babies everywhere — is spread the word:

  • Postpartum mental illness (postpartum mood disorders) is real and it affects as many as 950,000 women annually
  • Postpartum (and perinatal) mood disorders represent more than depression — anxiety, psychosis, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)
  • Postpartum mood disorders are treatable
  • You are NOT ALONE and this is NOT YOUR FAULT

If you think you may be suffering from a postpartum mood disorder, seek help right away. The following two resources provide resources for getting help in your area, as well as support and information:

The Edinburgh Postnatal Depression Scale (EPDS) also is a resource for women wanting to know more about their postpartum depression symptoms. You can easily take this test in the comfort of your own home to learn more about your symptoms and begin the evaluation process. The test is not meant to replace clinical diagnosis or advice, but the results should be shared with your doctor. You can take the test online here: http://psychology-tools.com/epds/.

You can join other women from across the globe in honoring Miriam and mothers everywhere who have and are experiencing postpartum mood disorders by checking out the Facebook page “For Miriam.”




The Human Delivery System: An Interview with Beverly Hills OB/GYN Suzanne Gilberg-Lenz, MD

Dr. Suzanne Gilberg-Lenz is involved in women’s empowerment and public education, and appears frequently as an expert in women’s and integrative health on TV, online and in print. Dr. Suzanne completed her undergraduate education at Wesleyan University and post-baccalaureate pre-medical studies at Mills College. She earned her medical degree in 1996 from the University Of Southern California School Of Medicine, completed her residency in obstetrics and gynecology at Cedars Sinai Medical Center and has been in private practice of obstetrics and gynecology in Beverly Hills, CA since 2000. After many years of a personal yoga and meditation practice, she completed her Clinical Ayurvedic Specialist degree at California College of Ayurveda in 2010 and was board certified in Integrative and Holistic medicine in 2008.



What surprises you most about the work that you do?

Dr. Suzanne: EVERYTHING! I am constantly humbled, reminded of my own requirements for patience. That is a practice- One never gets it perfectly right, and that love really does heal, because it makes us more compassionate and unconditional, less judgmental and more open to a variety of tools.  It doesn’t mean we eschew evidence or science, but rather we wrap it in a human delivery system. I am also frequently surprised at how powerful my advice and words are.  Everything counts and we never know what is affecting other people, so we must be mindful of what we put out there.


You are an OBGYN in a high profile community and practice in Los Angeles; does that present unique challenges for you?

Dr. Suzanne: It actually provides unique opportunities. My patients are highly educated and discerning and not as homogeneous class-wise as people imagine “Beverly Hills” attracts. People who come to our practice are sophisticated and empowered enough to expect the best care possible. They seek and welcome partnership and dialogue but also accept that I have expertise that they do not. They are experts about their own experience of their bodies; I have nearly 20 years of medical experience and training. That is the perfect combination for enlightened high quality healthcare. Before I was completely “out” about my interests, training and participation in integrative and holistic medicine and mind-body practices, I was very concerned about being judged negatively by my community–more my peers and colleagues, not my patients. But that was merely part of my process of learning to own my skills, talents and journey.


What is your top advice to pregnant women approaching birth?

Dr. Suzanne: Know what you know and what you don’t know. Seek advice and counsel of trusted, knowledgeable sources. Don’t use or respond to fear as the basis for educating. Trust your gut instincts but be open to hearing things and information that maybe don’t fit into your fantasy of best case scenario. Trust yourself and your team. Get more than one opinion if necessary. Don’t assume conventional medical providers and institutions are not in support of your journey or not open to your wishes.


How do you integrate screening for mental health into your practice? 

Dr. Suzanne: I try to ask explicit questions about personal and family history of mood disorders, abuse and substance abuse. At this point, I am very lucky to have a practice where the majority of my pregnant patients are not new to me. In other words,  I have known many of them for a while prior to their conceiving — that helps a lot. I also use my instincts and when I encounter anxiety about body changes, the birth and control in general, I see these as red flags to open a dialogue. Anyone whom I suspect may be at risk for a postpartum mood disorder are seen by me at 2-3 weeks postpartum and not the standard 6 weeks.


What are the difficulties you experience in screening in pregnancy and postpartum?

Dr. Suzanne: Some people resist discussing matters that they themselves haven’t already recognized or addressed and I am not a trained psychotherapist, but people are mostly open to the discussion and appreciate that I am interested and have a ready arsenal or referrals who are experienced and trained. Honestly, time is the biggest constraint — but I’m a bit notorious for running late and this is one of the reasons why: I strive to be present for every patient encounter- some require more time and attention than others.


What do you think the difficulties for women are in communicating mental health needs to practitioners?

Dr. Suzanne:  Shame, guilt, and fear, confusion lack of support or understanding that help is available. If we don’t ask, we may not ever know — most patients won’t reveal unless asked directly. Some patients’ family members don’t get it and that can be a barrier. The Supermom Syndrome and unrealistic expectations of doing it all themselves can also be barriers.


If a woman does not feel her mental health concerns, or symptoms were addressed by her OBGYN, what should she do?

Dr. Suzanne: There are so many great resources online today– Postpartum Support International, the social media platforms, etc. I’d go there and get local resources — maybe anonymity helps some people to approach the topic too.


Do you see a lot of postpartum depression or anxiety in your practice?

Dr. Suzanne: Of course I don’t document stats but I’d say it runs at about 10-15% — that is a wild guess BTW! What is really interesting is that I have a number of patients who had a postpartum mood disorder in first pregnancy and we anticipated the second time with a plan and prevented a recurrence — that is really satisfying to me and also indicates that if we can recognize the risk, we can mitigate the occurrence — just like any other medical issue. If someone has an elevated GLUCOLA challenge (standard gestational diabetes screening tool), the GET Diagnostic testing and then dietary counseling to prevent the untoward effects of untreated carbohydrate intolerance and insulin resistance. We wouldn’t think of ignoring that!


What would your top advice be for a woman who thinks she may be experiencing postpartum depression or anxiety?

Dr. Suzanne: Don’t be afraid to say it out loud to someone who can help — ask for help — if you don’t get it at first ask again — talk to your provider, your partner, your friends — treatment is available and it works. Parenthood requires humility and surrender, not the façade of perfection.


Thank you, Dr. Suzanne for sharing your advice with Giving Birth With Confidence!


Dr. Suzanne’ s diverse background includes research experience combining Ayurveda and conventional medicine, an exploration of the relationship between psychosocial risk factors in pregnant urban teens and participation on a MacArthur Foundation funded team at University of California at San Francisco. She has worked at San Francisco’s famed Haight Ashbury Free Clinic and supervised midwives and residents at an inner city hospital in Los Angeles, California. Dr. Suzanne has taught at Cedars Sinai Medical Center, The National Ayurvedic Medical Association, Yoga Studios and Childbirth conferences and appeared TV shows such as Dr. Drew’s Lifechangers, The Tyra Banks Show, The Today Show, Headline News and Bill O’Reilly’s No Spin Zone.Find out more about Dr. Suzanne Gilberg-LenzPractice: www.womencareofbeverlyhills.com

Website: www.thedrsuzanne.com

Twitter: @askdrsuzanne

Facebook:  https://www.facebook.com/pages/Dr-Suzanne-Gilberg-lenz/


A special thanks to article transcriber, Miles Moon Karraa.



Pregnancy and Postpartum Mental Health: Safety in the Storm

By Wendy Davis, PhD


The proper support of new mothers, babies, and their families requires a whole chain of care that goes from the earliest prenatal care all the way through the first early years of a child’s life. We are all links in that chain — families, providers, and communities:  we work best when we are collaborating, working together, creating nurturing environments for infants and their families.  The most important message about mental health and self-care for new parents is that it is a natural need to receive support during pregnancy and postpartum, and that includes emotional as well as physical and practical support.

How can families help when a mom has postpartum depression or anxiety? How do we learn about signs and symptoms in a way that feels empowering and not shaming? Sometimes it seems that our heaviest burden is our own self-criticism and judgment, our own expectations that a “good mom” would never feel any emotional distress.  Women who are depressed or anxious during or after pregnancy tell us that friends, family, and perfect strangers directly influence how they feel, whether they reach out, and even how they communicate with their partners. How a family responds to a new mother’s emotional and mental health can affect her through pregnancy, pregnancy loss, postpartum, and her developing self-image as a mother.

Here’s a good illustration.

I am standing in line at the grocery store and overhear a conversation between the two women in front of me. One is there with two children – a baby in the cart and an older child who calls her grandma. She is taking care of the little ones and talking to the silver-haired woman behind her, comparing notes about grandchildren. I hear the woman with the children mention that she’s helping because her daughter-in-law has “Postpartum Depression.” They pause and look at the kids. I wait…I wait for the inevitable: the rolling of the eyes, the talk about how women these days just want the easy way out, how everyone and her sister seems to have “Postpartum Depression.”  I ready myself, getting ready to tell them that it is real, it is rough, and that we are lucky to have real resources, volunteers who can help her connect, find resources, not feel alone. I want them to understand, to know that they should not judge. I want to tell them that it actually is almost true that “everyone and her sister” has it, and that we need to listen to them, not judge, and help them. I’m ready. I take a breath.

They surprise me.

The woman in front of me shakes her head. “Oh, I only wish we had help back in my day. I wish… She’s a lucky girl, your daughter-in-law. If I had been able to ask for help and have someone take the kids to the store….You know, she’s lucky to have you.” They smile at each other, and look down at the children. I feel like crying, with relief. If the grandmothers at the store understand, then we might just have a chance.

Times have changed, and they will continue to change. Although another day could have brought an insensitive conversation about depressed new moms, this day in this store reminded me that our families and communities are beginning to understand. New moms do get depressed and they get anxious. Pregnant women have as much chance of becoming depressed or anxious as their postpartum moms, and teenage moms have a greater chance than any. Even adoptive moms and dads can become depressed and anxious after a new baby arrives. We have been ignoring it and as a result families have suffered. Fortunately, communities around the world (and the internet)  are working together to create a safety net that includes raising awareness, connecting families with resources, educating providers, and forging partnerships to help families.

The earliest references to depression, fears, or psychosis around childbearing were recorded in the 4th century BCE!  In modern times, we stopped talking about them. Acknowledgement of despair seems to have been replaced by pretty media pictures of mommies and babies and shallow reassurances by families and doctors who tell mom to get a haircut, buy a new dress, or wean the baby. Traditional rituals to support new mothers and fathers were replaced by baby-shower games, and built-in help for new parents gave way to expectations that one parent will go to work and the other stay home to keep up with housework, her appearance, and the bliss of new motherhood. In this modern world, where is the language to describe mornings filled with anxious fears, dinner that remains uncooked,  and nights disrupted by mommy crying as much as the baby?

Organizations like Postpartum Support International believe that we can prevent a crisis if new parents receive reliable information, resources, and adequate support before the baby arrives. If families learn that symptoms of emotional and mental distress during pregnancy and postpartum are common, treatable, and temporary, then they will not be consumed by fear or shame if it occurs. They might find ways to rest more, reach out sooner, and engage with informed providers and support services to prevent their distress and facilitate their recovery. Most importantly, by finding resources, they can make contact with real mothers, fathers, and grandparents who have gone through their own difficulties around childbearing, and they will learn that they are not alone and not to blame. Women should know that they can contact support organizations like PSI for support around any stress, adjustment, or distress related to childbearing; they don’t need a diagnosis and they won’t be pushed into any particular treatment.

Although we most often hear about “Postpartum Depression” when we talk about mental health around childbearing, there are in fact several ways that emotional distress commonly arises – not only depression, but anxiety, bipolar cycles, grief, trauma, and psychosis. The most recent research shows that more than 1 out of 8 pregnant and postpartum women develop significant depression or anxiety, and up to 1 out of 10 fathers also have depression after a new baby arrives.  Postpartum Psychosis, the most serious postpartum psychological disorder, occurs in 1 to 2 per 1000 births.

This means that one in eight women has enough disruption in her moods, sleep, appetite, confidence, and ability to function that she could be diagnosed with a clinical mood disorder. You can’t tell who it is by looking: moms will smile on the outside while they are feeling lost, scared, and emotionally numb. Our cultural taboo against maternal depression has thwarted us from talking compassionately about our emotional lives as mothers.

There are identifiable risk factors such as a history of PMS, depression, anxiety, or bipolar mood disorders, recent loss, or life stressors. Symptoms might include feeling overwhelmed, inadequate, anxious, or detached, and in some cases the difficult anxiety symptom of repetitive, intrusive thoughts that include unwanted images of harm to their babies. If the family and their caregivers do not have reliable information to help them distinguish between anxieties that are not dangerous and delusional thinking that is, anxious mothers live in fear and their symptoms increase.

If a mom is fortunate, people around her will remind her that she is worthy of care, treatment, and help. If she has emotional difficulties, they will tell her that these are symptoms of distress, not a sign of her inadequacy. Having negative feelings about becoming a mother is a symptom of depression; it is not a cause. We can be open to the truth about the difficult adjustment of becoming a parent. Can we accept that depression, fear, anger, and loss might exist side by side with love and attentive parenting? If we can become a culture of truth-tellers and fair listeners, we will make our families stronger and healthier, and change the environment into which children and their parents emerge.

So, let’s hear it for the grandmothers in line at the store. Thank you for listening, providing safety in the storm, telling the truth.

 Contact Postpartum Support International for support, information, resources, and volunteer opportunities at www.postpartum.net or 1-800-944-4PPD  (1-800-944-4773).


Wendy Davis, PhD, provides counseling, training, and consultation for mental health related to pregnancy, birth, loss, postpartum recovery. She was the founding director of Oregon’s Baby Blues Connection and is the Executive Director of Postpartum Support International.


How to Screen Yourself for Postpartum Depression

May is Mental Health Month. As childbirth education advocates, Lamaze believes that mental health during and after pregnancy is critical to the health and safety of moms and their babies. If you are experiencing depression, anxiety, psychosis, or any other mental health issues, contact your care provider and seek support and resources from Postpartum Progress and Postpartum Support International. You don’t have to suffer alone — and you don’t have to suffer. There is support and treatment available for mental health disorders. Also know that you are not alone — it has been found that 1 in 7 women will experience postpartum depression, though that rate is thought to be higher for all postpartum disorders.

So how do you know if you are experiencing a postpartum disorder? Many moms downplay or dismiss their feelings, chalking them up to “hormones,” but it’s important to take notice and check in with yourself. A postpartum disorder is more than just a “bad day,” and even if you feel as though you are coping, a postpartum disorder ultimately affects your quality of life. If you feel as though something is “off” or if your partner expresses concern about your state of well-being, you can take a free, quick, confidential, online screening quiz to determine whether you may be suffering from postpartum depression.

The Edinburgh Postnatal Depression Scale (EDPS) was developed in 1987 to help doctors determine whether a mother may be suffering from postpartum depression. The scale has since been validated, and evidence from a number of research studies has confirmed the tool to be both reliable and sensitive in detecting depression. The EPDS Score is designed to assist — not replace — clinical judgment. If you feel you may be at risk or suffering from post natal depression, please share the results with your care provider.

Interview with Wendy Isnardi, Author of “Nobody Told Me… My Battle with Postpartum Depression and OCD

If you’re just tuning in piece, be sure to check out the first piece in this two-part post, Kathy’s review of Wendy’s book, “Nobody Told Me… My Battle with Postpartum Depression and Obsessive Compulsive Disorder.”

By Kathy Morelli, LPC

Meet Wendy

Wendy Isnardi lives in Suffolk County, New York, along with her husband and two young daughters. Since the birth of her first daughter, she has been a staunch supporter and volunteer for the Postpartum Resource Center of New York. This is a non-profit agency dedicated to helping women and their families survive their ordeals with depression during pregnancy and depression following the birth of their children. She has dedicated countless time and energy to assure that the center continues to exist and provide the support that women need in order to beat serious mental diseases. She has put fighting women’s depression on the forefront of her life with great personal sacrifice.


Q: First off, I am honored that you agreed to let me interview you! Tell me briefly about your current volunteer work at the Postpartum Resource Center of NY.  

I am currently the resource coordinator and phone support.  In addition, I speak at “Family Night”  for the Circle of Caring Support Groups and I have facilitated support groups as well.


Q:  Tell me what motivated you to write your book?

Being  a volunteer at the Resource Center doing phone support I saw how important it was for me to get my story out.  So many women were afraid and embarrassed to discuss their PPD issue with anyone.  They were so afraid that they would be judged and branded a bad mother.

There is such a stigma with mental health issues that no one wants to talk about it. 

There was nothing wrong with me; I was a great mother that loved my daughter more than anything.  I became extremely ill after her birth and I got the help that I needed and got better.  There is no shame in that so I figured “why not write a story about my situation” and try to normalize it. I also wanted to show moms that you can go on and have other children and not be affected by the disorder again.  If I could help at least one mother then it was all worth it.


Q: Do you find writing to be a healing experience?

Absolutely! I wouldn’t change one thing about my experience because it changed me.

I feel that it made me a better, more understanding person.  As I wrote the book it took my back to that place and helped me come to terms with what happened. I will never forget that dark time, but I will also never forget the rewards that I got from that experience, especially the undying love I have for my daughters and husband. I did it all for them.


Q: I was especially riveted by your descriptions of harm befalling you and your baby.  You were so brave to expose these thoughts.  In fact I used these in a presentation, and it was quite powerful for the audience to hear these thoughts. 

How do you feel about these scenes in your book? (shark feeding scene, escalator scene, gun fears, etc). Why did you include such detail?

The escalator scene for me is what really changed everything.  That’s when I decided I wanted to go back into the hospital.  The thoughts were so graphic that I got physically ill.  I was scared to death.  I thought the safest place for me and everyone else was in the hospital.

The shark incident was probably the first time that I ever seriously contemplated suicide.  Walking into the aquarium I was already extremely anxious and severely depressed.  I hadn’t really been out in public too many times and the aquarium was packed.  Besides the fact that I really wasn’t comprehending the whole OCD concept, so I was really believing in all of the crazy thoughts that were going on in my head.

Once we came upon the huge shark tank I started to panic.  As I looked over into this tremendous tank I saw sharks in all different sizes swimming about, looking for food.  The image of my babies body falling into the tank flooded my head and it was all I could think about.  The more I tried to stop the thoughts the stronger and more graphic they became.

That was where the focus of my thoughts started to surround me and my own mortality.  That’s when I was afraid that I was going to take my own life.  And was when the reality that my husband had loaded guns in a safe right in our bedroom.  I never attempted suicide, nor did I have a plan, but the thoughts were there and they sickened me.


Q: Have you gotten negative feedback on this?

So far, I have only gotten positive feed back, but I know that there will be critics that don’t truly understand the disease that would think of my story negatively and wonder why I wasn’t arrested or committed.


Q: I was interested in your experiences with OCD before your birth.  Do you look back on your behaviors before the pregnancy and wonder why this was not previously addressed ?

All the time.  I worried about everything, all day every day, since I was a little girl.  I remember reacting to certain situations and wondered why other people didn’t feel the same way I did.

Everyone around me knew how much of a worrier I was and always accused me of being a hypochondriac.  I just thought I worried more than most.

Not until after I gave birth to Madison did the worrying take on a life of its own and literally knocked me off my feet.


Q: Does OCD still rear its unwelcome symptoms? 

Yes it does.  I think it’s always there.  Now I know how to handle it.

I’m not nearly as anxious as I was in the past.  The thoughts are about everyday nonsense and pass as soon as they come.  I do find my OCD peaks a bit when I ovulate and right before my period, but it’s no big deal. 


Q: Do you have any particular information you’d like to impart to persons suffering from OCD about their healing work to do before pregnancy and OCD postpartum? 

Most important is not to buy into the crazy thoughts.  A thought is just a thought.  A change in mood and becoming depressed and anxious is temporary and will get better when treated properly. You are not alone and you are a good mother.  Education is key and taking care of yourself is also extremely important.


Q: Do you feel your confusing relationship with your father contributed to your particular mental health difficulties?  Or have you considered it is more genetic? Or a combination?

I guess my relationship with my father made me very insecure and there was a need for me to feel accepted.  There is a tremendous connection genetically; my father and his siblings all suffered from  mental illness (untreated).  I definitely think it is a combination.


Q: What type of self-care do you engage in now to help yourself maintain good mental health?

I eat very healthy and drink lots of water.  I try very hard to keep active and exercise whenever I can, which isn’t often. I try to avoid stressful situations and when I feel anxious I realize it will pass. Stress and aggravation can bring on mood changes. In my opinion a good sense of humor goes a long way too.


Q: How are you continuing your advocacy work?

I am currently the Resource Coordinator for The Postpartum Resource Center of New York. I also provide phone support there as well, talking to moms and families in need.  I speak at seminars regarding PPD and mood disorders, and co-facilitate support groups.  I will do media work for the resource center.  I will basically do whatever it takes to make a difference.


Q: What are some of your future projects?

Being the best advocate for PPD! And  helping the Postpartum Resource Center of New York, Inc.’s VISION for 
a Perinatal Depression Parent Support Network in every New York State community. I have dedicated myself to the cause.  As I said before — whatever it takes.


Q: What do you do to relax on beautiful Long Island?

I spend time with my beautiful family.  We love going to Montauk and especially love The East End in the fall.  We have four dogs and take them for walks.  We just love being together.  I am blessed!!!


Kathy Morelli, LPC, has a professional marriage and family counseling practice with a focus on pregnancy, birth, postpartum and trauma in Wayne, NJ. Kathy also offers phone consultations and web-based courses. She has a long-term interest in mindbody therapies and is trained in shiatsu, acupressure and Reiki. She writes and speaks on birth comfort measures and perinatal mental health and has appeared at various universities and conferences across the country. She writes on perinatal mental health for Lamaze’s Science & Sensibility, is a board member of Prevention and Treatment of Traumatic Childbirth (PATTCh) and is one of Postpartum Support International’s (PSI) Virtual Volunteers. Visit her at birthtouch.com and kathymorelli.com.

Book Review: Nobody Told Me…My Battle with Postpartum Depression and OCD by Wendy Isnardi

When Wendy Isnardi published her book, I had to read it. I love reading books in this genre: books written by real women in the perinatal mental health advocacy community. I love the real life stories about women putting themselves out there kicking the perinatal mental illness stigma! (You can read my review of  Ivy Shih Leung’s book here and Walker Karraa’s interview with Ivy here.)

Wendy’s story is unique in this genre as she suffered from both postpartum depression and postpartum obsessive-compulsive disorder (OCD). Her story is especially relevant as she shows us the birth world and the maternal mental health world are truly related. The first woman-to-woman contact in her community who had the appropriate resources for her situation was her Lamaze instructor.  Her story illustrates how childbirth educators might very well be the first contact with the right referrals for perinatal mood disorders. It was fortunate her Lamaze instructor had the appropriate contacts for Wendy when she needed them.

Today, Wendy still successfully manages OCD.  OCD can be difficult to treat as it requires a great deal of strength, diligence and commitment to successfully manage. It’s tough and you gotta be tough to beat it.

Her storytelling is the in-your-face, no-holds-barred style of her native Brooklyn and her current residence, Long Island (where I was born and raised, so I can relate!).  She calls her absent, estranged biological father “the sperm donor” and her ever-present, ever-strong mother her “hero, ” and her step-father her “true father.”  She lived through several moves until she credits her mother and her real father with giving her the gift of a stable home life.

Wendy lived through stressful years of a dating and marriage to a person who abused substances and cleared out their back accounts.  She tells of her painful feelings of failure as she divorced and then filed for bankruptcy.

Wendy then met her true love, Joey, her husband. She tells us that all her life, she was labeled a “worrier.”  But, no one really identified her peculiarities, such as a need to line up lipsticks by the correct color, and her need to collect lots of types of things, like makeup brushes, as symptomatic of OCD.  In general, her life and the OCD symptoms she manifested were manageable before childbirth.

But Wendy’s OCD worsened when she became pregnant with her first daughter, Madison. It is well known that a woman with a history of mental illness (diagnosed or undiagnosed) is at risk for a perinatal mental illness.

Emotionally, she says she was a “bundle of nerves.” She tells us she obsessively searched the web for pregnancy information and obsessed about all the health messages. The messages were everywhere! Don’t eat tuna, don’t eat cold cuts, don’t wear high heels, don’t stand in front of a microwave, don’t eat maraschino cherries, the baby will get brain damage, etc. And, as Wendy says, everyone has an (unsolicited) opinion for a pregnant woman!

Wendy experienced a tough pregnancy physically, too.  She  suffered from excruciating constipation during pregnancy.

And Wendy’s birth experience was traumatic. She had a very frightening emergency cesarean section. Wendy actually saw her own “insides” all pulled out of her in a mirror during the surgery.   Her husband told her he was afraid he was going to lose her.

Then, we segue to her being at home with her baby daughter, Madison. And the worsening of the terrible unrelenting anxiety and depression so debilitating that she became unable to care for her baby. She was afraid to be alone. Her obsessive fears and scary thoughts took over her life. She had  paralyzing obsessive thoughts about bacteria in the baby bottles, about medication accidentally being dumped into the baby bottles. She quickly became afraid to be left alone with her baby. Her  emotional state impacted the whole family; her husband and mother had to take shifts, so she wouldn’t be alone.

What makes Wendy’s story so unique and riveting is her willingness to describe in excruciating detail her unrelenting “scary thoughts;” the debilitating thoughts that women with postpartum anxiety and OCD experience.

She now knows, and shares with us, that those scary thoughts were just thoughts, and were not precursors to harmful action. She says she knows she would never actually have harmed her baby, but the thoughts she was having terrified her. She couldn’t stop them and they were dark thoughts. She didn’t understand what they were all about. Her distress and fear were real.

During all of this, Wendy is feeling depressed and lost. But, by a happy coincidence, she meets her Lamaze instructor at a craft fair.  Her Lamaze instructor recognizes she needs help and gives her a referral to a professional licensed therapist. Wendy calls her immediately and starts to see her that week. She begins therapy, and gets set up with a psychiatrist who prescribes medication.

But Wendy still had a long and scary road.  Her healing process began, but it was a long fight, not for the faint of heart.

Wendy found professional help and then she also found peer support at the Postpartum Resource Center of New York, which is a non-profit agency dedicated to helping women and their families survive their ordeals with depression during pregnancy and depression following the birth of their children. She began to immediately get involved at the center, volunteering there, along with her husband and her mother.

Wendy shares with us that her scary thoughts and obsessions included bloody thoughts and fears about her husband’s gun (even thought Joey is a police officer who knows gun safety and appropriately locks it up). Other obsessive thoughts were frightening bloody thoughts about escalators and her all-consuming bloody terrors of the shark tanks when she visited the Seaquarium.

It is important to note here that her scary thoughts were just that — terrifying thoughts — not precursors to action, not full-blown delusions. She never lost touch with reality and right and wrong.  Wendy had frightening thoughts but she knew she would not hurt her baby.

Wendy’s story is riveting as she sought help and  never stopped fighting. She was able to fight through to a successful healing process. She moved on to help others, have another child and a fulfilled, successful life.

Come back next week to read my interview with author Wendy Isnardi.

Kathy Morelli, LPC, has a professional marriage and family counseling practice with a focus on pregnancy, birth, postpartum and trauma in Wayne, NJ. Kathy also offers phone consultations and web-based courses. She has a long-term interest in mindbody therapies and is trained in shiatsu, acupressure and Reiki. She writes and speaks on birth comfort measures and perinatal mental health and has appeared at various universities and conferences across the country. She writes on perinatal mental health for Lamaze’s Science & Sensibility, is a board member of Prevention and Treatment of Traumatic Childbirth (PATTCh) and is one of Postpartum Support International’s (PSI) Virtual Volunteers. Visit her at birthtouch.com and kathymorelli.com


Pregnancy, Birth & Postpartum Resolutions

New Year’s resolutions may take on more meaning if you’re preparing for the birth of a child in 2013. This year, perhaps for the first time, “join the gym and lose 10 pounds” isn’t on the list. At the same time, many of the resolutions you make for a healthy pregnancy look a lot like those you would make for a healthy lifestyle, pregnant or not. For example:

  • eat fruit and vegetables daily
  • get 8 hours of sleep
  • exercise 30 minutes a day
  • carve out time for yourself
  • ask for help when you need it

For a healthy pregnancy, birth, and postpartum period, we’ve compiled a few significant resolutions for you to consider adding to your list this year.



Listen to your body. If it’s telling you to slow down, do all that you can to make it happen. Cereal for dinner? Why not. Nap at 6 p.m.? Yep. On the other hand, if you’re feeling great, don’t let pregnancy slow you down — continue your exercise regimen, meet up with friends for dinner, enjoy life!

Learn about evidence-based maternity care. You can’t always count on your care provider to give you the best, most up-t0-date care. How will you know if you’re not receiving the best care? Learn how to navigate the maternity care system and how you can get the best care.


Labor & Birth

Plan for the best support. Who will attend your birth? Do they support your wishes? Will they provide positive energy? Think carefully about your birth support team. Look into hiring a doula. Share your birth plan with everyone well before labor begins.

Take labor one step at a time. Humans seem to be hardwired to think about what’s going to happen next. With labor, it helps to only think about what’s happening now. If you can take each contraction, each stage, each moment as it’s happening, you’ll be better able to put complete focus on the task at hand instead of worrying about what’s to come.



Speak up. It’s wonderful to have friends and family ooo and ahh at your new little joy. But a house full of visitors can be overwhelming during a time when you’re trying to understand a brand new world. Feel free to ask for some time and space alone with your baby. Post visiting hours on your front door or update your Facebook status to let friends know when you’re accepting visitors.

Know the signs of postpartum depression/disorders. Postpartum mood disorders (anxiety, depression, OCD, psychosis) affect hundreds of thousands of women every year. With knowledge of the warning signs and access to resources, women who suffer from postpartum mood disorders can and do recover.

Maternal Mental Health: Pre-Existing Risk Factors for PTSD and Childbirth

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.



This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Heidi Koss, MA, LMHC

Health care providers aren’t exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Your inherited mental health risks, such as an increased risk of anxiety and depression
  • Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
  • The inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

  • Being female — women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD and depression
  • History of abuse (such as childhood abuse, sexual abuse, rape)
  • Combat exposure
  • Physical attack
  • Being threatened with a weapon
  • Car accident, plane or train crash
  • Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

  • Flashbacks of the event — vivid and sudden memories
  • Nightmares
  • Insomnia
  • Fears of recurrence
  • Emotional numbing
  • Panic attacks
  • Inability to recall important aspects of the event — psychogenic amnesia
  • Exaggerated startle response, hyper-arousal, always on guard
  • Hyper-vigilance, constantly looking around for trouble or stressors
  • Avoidance of reminders of the traumatic event
  • Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it’s hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Recommended Books:

  • Postpartum Mood and Anxiety Disorders, A Clinician’s Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
  • Beyond the Birth, A Family’s Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.




PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.


Maternal Mental Health: Daily Support Service for Mothers Who Suffer from Postpartum Disorders

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

Postpartum Progress (www.postpartumprogress.com), the most widely-read blog in the United States on postpartum depression, hosts a service to help pregnant and new mothers get through the difficulty of perinatal mood and anxiety disorders.

Daily Hope is the nation’s first support service featuring once-daily e-mails to mothers with postpartum depression, postpartum anxiety, postpartum OCD and antenatal depression or anxiety. This free service provides encouragement from survivors, the country’s top perinatal mental health specialists and authors of the leading books on perinatal mood and anxiety disorders and parenting.

Many of the nearly one million women who suffer each year do not have access to perinatal mental health specialists or PPD support groups where they live. “I hear from thousands of mothers across the country and around the world who say that having someone to lean on who deeply understands can contribute a great deal to their recovery process,” said Katherine Stone, founder of Postpartum Progress and survivor of postpartum OCD. “I felt Daily Hope would be a great way to use technology to offer mothers encouragement from the nation’s most trusted experts on their illnesses, regardless of where they live or what type of health insurance they have. The more support we can provide to women with postpartum depression, the better, because the quicker the recovery, the less likely the illness will have a long-term impact on mom and baby.”

Contributors to Daily Hope include, among many:

  • Karen Kleiman, MSW, author of “This Isn’t What I Expected: Overcoming Postpartum Depression”
  • Ann Dunnewold, PhD, author of “Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide” and “Even June Cleaver Would Forget the Juice Box”
  • Marlene Freeman, MD, MGH Center for Women’s Mental Health and Harvard University
  • Pamela Weigartz, author of “The Pregnancy & Postpartum Anxiety Workbook”
  • Susan Stone, LCSW, former president of Postpartum Support International
  • Janice Croze, co-founder of 5MinutesforMom.com and survivor of PPD
  • “Aunt Becky,” author of the blog Mommy Wants Vodka, founder of Band Back Together and survivor of antenatal depression
  • Adrienne Griffen, founder of Postpartum Support Virginia

To sign up (for free) and subscribe to Daily Hope, click here.

Postpartum Progress, founded in 2004, provides the most comprehensive, in-depth and accessible information available on perinatal mental illness for pregnant women and new mothers. Having already helped more than 350,000 women and healthcare providers, Postpartum Progress offers an unflinching look at getting through postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis, and antenatal depression & anxiety. Postpartum Progress has been named one of the top 10 depression blogs on the web by Psych Central, the winner of Fit Pregnancy’s Best of the Web Awards in the Advice category, and was a runner-up in Parenting’s Must-Read Moms and Scholastic Parent & Child’s Best Parenting Blogs Awards. It has been featured on Babble, ParentDish, Café Mom, Health.com and many other parenting websites. Postpartum Progress was founded by Katherine Stone, who was named a WebMD Health Hero in 2008 and won the Bloganthropy Award in 2010 for her advocacy work for pregnant and new mothers with maternal mental illness.

Postpartum Progress the blog and Daily Hope are both offered by Postpartum Progress Inc., a non-profit organization dedicated to vastly improving the amount of services and support available to women with perinatal mood and anxiety disorders.