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.

 

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.

Maternal Mental Health: Anxiety Disorders in Pregnancy

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 World is Not Flat: Anxiety Disorders in Pregnancy

Imagine you are sitting in your care provider’s office, and next to the scary “universal pain chart” with the not-so-happy faces getting progressively more distressed and discolored, is this chart:

1 in 8 pregnant women will develop an illness that poses these risks:

  • preterm birth (the leading cause of infant mortality and disability in US)1,2,3
  • low birth weight4
  • low APGAR scores5
  • a more difficult labor and delivery with increase of PTSD symptoms related to birth6,7,8,9
  • increased chance of Postpartum Depression/Anxiety Disorders after birth10,11
  • newborn may have increased agitation12,13
  • jittery infants up to 6 months after delivery14
  • breastfeeding difficulties15
  • child may develop learning and attention disorders later in childhood16,17,18

Genetic Disorder? Pre-ecamplsia? STD?

Nope. Perinatal Anxiety Disorder.

Current estimates are that anywhere from 5% to nearly 25% of pregnant women (1 in 8 ) will have a mood or anxiety disorder.19,20,21 And for pregnant women with anxiety disorders, high levels of cortisol cross the placenta and have long-term effects noted long after birth.22

With my first pregnancy, I began developing symptoms of depression and anxiety shortly after my second trimester. I knew something was wrong, and had both physical and emotional symptoms that were getting progressively worse. At the time (10 years ago), my providers didn’t know to ask about depression and anxiety during pregnancy—and I did a darned good job covering it up. My illness went untreated, and I ended up suffering Post-Traumatic Stress Disorder (PTSD) in labor and developing severe postpartum depression and anxiety after the birth. I was three months postpartum before my illness got severe enough, and life threatening, to the point where any of us knew I needed immediate medical treatment.

Anxiety in pregnancy and birth is universal and normal. It is a normal reaction to a physically and emotionally stressful, life-altering event. Secondly, an anxiety disorder in pregnancy is a medical illness, not a character flaw or personality trait. Its etiology is currently traced to an interplay of hormonal, genetic, environmental and immunological systems of the body23,24 – not the half shot of espresso in your latte, your character, or your inability to relax in your [irritating] prenatal yoga class. Newer research is looking at the role of increased oxytocin around the time of birth in influencing the onset of Perinatal Anxiety Disorders (PAD).25 Bottom line: It is not your fault.

 

Symptoms of Anxiety Disorders
Anxiety in pregnancy is normal. But when anxiety in pregnancy is significant enough to cause physical, emotional, and cognitive distress — a perinatal anxiety disorder may be occurring and you need help.26

Pec Indman, EdD, MFT and co-author of the award winning book, Beyond the Blues: Understanding and Treating Prenatal and Postpartum Mood/Anxiety Disorders offered this in a recent interview for this post:

While it’s normal to have some worries during pregnancy (for example, “Will my baby be healthy? or, “ Will I be a good mom”?)–women with anxiety find the worry gets in the way of enjoying the pregnancy and other aspects of life. Women with anxiety may also have appetite changes (often difficulty eating), and find that the worry makes it difficult to fall asleep. Some women experience panic episodes during pregnancy. These are times of extreme anxiety where there may be hot or cold feelings, difficulty breathing or a smothering sensation, numbness or tingling in the fingers or around the mouth, a racing heart, and a feeling of loss of control.

There are several types of anxiety disorders that occur in pregnancy and postpartum, including Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, and PTSD. You can learn more about each type at www.postpartum.net under “Get the Facts.” But generally, symptoms27 of an anxiety disorder include:

  • Excessive, ongoing worry that impacts your day to day activities
  • Thoughts of worry regarding the future, or catastrophic events occurring
  • Insomnia
  • Poor appetite
  • Physical restlessness, inability to sit still
  • Dizziness, hot flashes, nausea
  • Panic attacks

 

Risk Factors
Research shows that there are some risk factors that may predispose some of us to anxiety disorders in pregnancy, and can be discussed with your care provider, partner, family or trained professional. Risk factors28,29 include:

  • Family history of anxiety disorders
  • Personal history of depression or anxiety
  • Thyroid imbalance

 

What do you do if you have symptoms or risk factors for an anxiety disorder in pregnancy?

1. Get help. Talk to a care provider. If you can’t talk yourself, find someone you trust to do so with you. The risks are too great. Pec Indman, EdD, MFT, shares:
If a woman is struggling during pregnancy it is essential to get help. Talk to a trained (many providers have not been trained in this area) and understanding professional. There are lots of kinds of effective treatments including counseling (in particular Cognitive-Behavioral Therapy and Interpersonal Therapy), social support, exercise, Omega-3 fatty acids, acupuncture, and medication.

Regarding women currently on medication, Pec continues:
Women who are on medication for depression, bipolar disorder, or anxiety, should consult with a prenatal (or perinatal) mental health expert before stopping medication. We know that over 50% of women who stop their medication before, or when they are find out they are pregnant, become ill again. Many medications can be taken during pregnancy and will help prevent a relapse.30

2. Ask your care providers (OB/GYN, Midwife, Nurse Practitioner, Family Practitioner) if they are trained in depression and anxiety in pregnancy. One tip I give women is to phrase it this way: “If I develop depression or anxiety during pregnancy or after, how will you be able to help me?” or “How do you help women who develop anxiety or depression in pregnancy?” If it is too difficult to do that, ask a trusted friend, partner, or family member to go with you to your next appointment and help you approach your care provider. Write a list of questions and concerns before you go. Calling ahead to let the front office know you need extra time in your appointment is also a good idea.

What if? If your only option is a care provider who is not trained in this area, go to Postpartum Support International (PSI) for excellent resources to take with you to your appointment, or to find local support systems, or call the warm-line for volunteer support on getting help in your area (1-800-944-4773). If making that call or going online is anxiety producing, ask a trusted friend, partner, or family member to go online for you or with you, to PSI and get the information you need.

3. GET A TRAINED DOULA!!! Birth and postpartum doulas can help you get through birth and postpartum adjustment. I strongly suggest you hire a doula who has training in this area (birth doulas are not required to know this information and postpartum doulas often receive little and/or outdated training on anxiety and depression disorders in pregnancy). Some good questions when interviewing doulas are:

  • What training do you have in anxiety and depression disorders in pregnancy?
  • If I get depressed or anxious, how will you know and how will you help?
  • What local resources do you give to clients?
  • How do you feel about anti-depressant medication during pregnancy and breastfeeding? Any doula who is completely “anti-medication” for any medical illness needs to turn in their birth ball and get with the program (it’s a blog, I can say things like that!). They do not have the skills to help you. Go to PSI and ask therapists in your area for referrals to doulas with experience.

 

Nothing Flat About this World of Anxiety Disorders
Pec Indman notes, “Healthcare professionals used to think pregnant women didn’t experience depression or anxiety. We also used to think the world was flat! Thinking has changed about a lot of things.”

Just as thinking and care regarding birth has changed, health care providers are starting to get it regarding mood and anxiety disorders in pregnancy. But much like our births, women have to raise our voices to raise awareness, and in turn get the care we so desperately deserve and need, for our brains and our reproductive systems.

With my second pregnancy, I knew before I peed on the stick — based on my first pregnancy — I had significant risks for depression and anxiety, that it was a physical illness, and that the risks to me and my baby were real and needed to be avoided. I was extremely fortunate to have the financial access to good, trained providers — they are forever in my heart. And I went through a mine field of providers who didn’t know current research and made me feel like a bad mother until I found the ones who “got it.” I firmly believe that when given the right information regarding our bodies, and particularly our pregnant bodies, we do a damn good job to learn more, discuss with those who could help us with treatment, and make the best informed choices for our lives. Once we remind ourselves and our care providers that our brain and uterus inhabit the same body and need the same kind of care, we will be part of the move to see that the world is not flat.
.

A special thanks to Pec Indman, EdD, MFT for her contribution to this article, humor, and support.

Pec Indman EdD, MFT, is a mom with over 20 years experience as a perinatal mental health psychotherapist and educator. She is the chair of education and training for Postpartum Support International, and co-author of the award-winning book, Beyond the Blues. An updated edition will be available the end of Oct. 2010. Beyond the Blues, Understanding and Treating Prenatal and Postpartum Depression & Anxiety.

 

References

 

  1. Perkin, M.R., Bland J.M. et al. 1993. The effect of anxiety and depression during pregnancy on obstetrical complications. BrJournal of Obstet Gynaecol 100:629-34.
  2. Wadwa, P.D., Sandman, C.A. et al. 1993. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol 169:858-64.
  3. Orr, S. T., J. P. Reiter, D. G. Blazer, and S. A. James. 2007. Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine 69 (6):566-70.
  4. Ibid.
  5. Ibid.
  6. Beck, C. T., 2004a. Birth trauma: In the eye of the beholder. Nursing Research 53, 28-35.
  7. Beck, C. T., 2004b. Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research 53, 216-224.
  8. Keogh, E., S. Ayers, and H. Francis. 2002. Does anxiety sensitivity predict post-traumatic stress symptoms following childbirth? A preliminary report. Cognitive Behavioral Therapy 31 (4): 145-55.
  9. Kelly, R. H., J. Russo, and W. Katon. 2001. Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptoms amplification revisited? General Hospital Psychiatry 23 (3):107-113.
  10. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  11. Rambelli, C., Montagnani, M.S. et al. 2010. Panic disorder as a risk factor for post-partum depression: results from the perinatal depression-research and screening unit study. Journal of Affect Disord,122(1-2):139-143.
  12. Coplan, R. J., K. O”Neil, and K. A. Arbeau. 2005. Maternal anxiety during and after pregnancy and infant temperament at three months of age. Journal of Prenatal and Perinatal Psychology and Health 19 (3):199-215.
  13. Tagle, N., Neal, C., Glover, V. 2007. Antenatal maternal stress and long term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48, 245-261.
  14. Ibid.
  15. Britton, J.R. 2007. Postpartum anxiety and breastfeeding. Journal of Reproductive Medicine, 52:689-695.
  16. Weinberg, M. Tronic, E.Z. 1998. The impact of maternal illness on infant development. J Clinc. Psychiatry 59(suppl 2):53-61
  17. O’Connor, T. G., J. Heron, and V. Glover. 2002. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child and Adolescent Psychiatry 41 (12): 1470-77.
  18. Ibid.
  19. Onunaku, N. 2005. Improving maternal and infant mental health: Focus on maternal depression. National Center for Infant and Early Childhood Health Policy at UCLA.
  20. Knitzer, J., Theberge, S., Johnson, K. 2008. Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework. National Center for Children in Poverty, Project Five Issue Brief 2.
  21. Gaynes B., Gavin, N., Melter-Brody, S., Lhor, K., Swinson, T., Gartlehner, G., et al. 2005. Perinatal depression prevalence, screening accuracy, and screening outcomes: Summary, evidence report and technology assessment, No 119. AHRQ Publication No. 05-E006-1.
  22. Ibid.
  23. Altemus, M. 2001. Obsessive-compulsive disorder during pregnancy and postpartum. In: Yonkers, K., Little., B. (eds) Management of psychiatric disorder in pregnancy. Oxford University Press, NY, pp 149-163.
  24. Stein, D.J., Hollander, E., Simeon, D., et al. 1993. Pregnancy and obsessive-compulsive disorder. Am J Psychiatry 150:1131-1132.
  25. Bartz, J.A., Hollander, E. 2008. Oxytocin and experimental therapeutics in autism spectrum disorders. Progressive Brain Research, 170:451-462.
  26. American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (4th ed, text revision). Author, Washington, DC.
  27. Ibid.
  28. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  29. Ibid.
  30. Cohen, L.S., Altshuler, L.L. 2006. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA, 295:499-507

A Voice of Strength I Didn’t Know I Possessed: Part II of An Interview with Ivy Shih Leung

A Voice of Strength I Didn’t Know I Possessed: An Interview with Ivy Shih Leung, author of “One Mom’s Journey to Motherhood: Infertility, Childbirth Complications, and Postpartum Depression, Oh My!”

 

In this second part of my interview with Ivy, she shares insight into her Chinese culture and pregnancy and postpartum. Secondly, she delves into her experience with infertility and complications during pregnancy. Finally, Ivy shares wonderful thoughts as to how writing, blogging, and communication can help to end stigma about PPD and create the causes for healing. You can read the first part of our interview here.

 

How has culture affected your writing about your experience?

I don’t feel that my culture really affected my writing about my PPD experience.  Though, I have to say that I am one of the few Asian bloggers I’m aware of.  Unlike most of my Asian friends and acquaintances, I am very outspoken and opinionated.  The Chinese tend to keep their emotions bottled up and thoughts and experiences to themselves.  In general, they are a very proud people.  Everything is pretty much about “saving face,” which means not putting oneself out there when it comes to personal experiences, especially if there is anything in the least bit negative.  As we know from the Western culture, pregnancy and motherhood are supposed to be blissful experiences.  I, on the other hand, have a book that shares ALL my thoughts and experiences while suffering from PPD.  It’s a fairly big deal for any woman to share her PPD story, let alone publish a book about it.  It’s an even bigger deal for a Chinese woman to do either.  

 

What would you like mainstream culture to know about your culture regarding pregnancy and postpartum?

Although I am Chinese and even speak Mandarin fluently, I was born and raised here in the U.S.  As a result, I am very Westernized and do not observe many of the traditions my parents and the generations before them may have observed.  Actually, my mother gave birth here and was not privy to the custom of Zou Yue.  She gave birth in a foreign country with no loved ones around her.  She received less help with taking care of me when I was a newborn than I had when I had my own daughter.  At least when I had my daughter, my husband helped, and my mother and mother-in-law each stayed a week to help. 

Zou Yue is like some of the other mother-nurturing customs observed by other cultures (la cuarentena in Mexico, sarantisma in Greece, Jaappa in India) in terms of observing a 30 or 40 day period of taking care of the mother, so she can take care of her baby and get adequate sleep to recover from childbirth.  Forty seems to be a magical number, a number that has survived through the centuries and therefore has special significance….no doubt it has something to do with the fact that 40 days is the average length of time for a new mother’s body to recover from childbirth and return to a pre-pregnant state.  It’s also why an OB/GYN will tell the new mother, once she’s given birth, that he will see her in 6 weeks.  Each of these traditions involves female family members and friends of the new mother providing her and her baby with care, so that the new mother’s only focus is on getting rest and bonding with/feeding her baby.  They also help around the house and prepare meals.  Certain rituals are observed in which food is prepared a certain way to help keep her body/system warm. She is protected from feeling overwhelmed; hence, visitors are kept away (or kept at a very minimum) during this time. She is told to avoid bathing for fear of catching cold.  All these rituals have the mother’s well-being in mind.  In terms of breastfeeding, female family members are on hand to teach her how to do it. In these other cultures, there is no expectation that the new mother know how to breastfeed instinctively and easily.  There is a reason behind the phrase “it takes a village.”

I have blogged about the importance of social support and how, through the years, we seem to have lost perspective on things when it comes to the community coming together to help a new mother who has just had a baby.   Getting adequate social support—comprised of both emotional support (e.g., shoulder to cry on, listening non-judgmentally) and practical support (e.g., help with breastfeeding, cleaning, errands, laundry, taking care of the baby for a few hours so mom can take a nap or shower) is critical for new moms. Having enough support during the first 4-6 weeks—until a new mom’s body recovers from childbirth and her hormone levels return to their pre-pregnancy state—can help keep anxiety levels down, help her get the rest she needs from all the changes her body has gone through with childbirth.

 

When you were pregnant, how was your culture addressed by care providers in ways that were helpful? And what about during your recovery from PPD?

I don’t remember if my OB/GYN and hospital staff asked me any questions, either orally or via a written questionnaire, as to whether I had any cultural preferences that needed to be taken into consideration during or after childbirth.  There definitely was no attempt on the part of my OB/GYN to ask me if I had any preferences for the duration of my pregnancy.  Fortunately, I didn’t have any preferences, anyway.  I just wanted to be treated with respect and care, both of which my doctor ended up failing at. Now, in terms of the GP who treated me during my PPD, he was the ultimate example of a doctor with extremely poor bedside manner.  The way I was treated by him and my OB/GYN angered me so much that I wrote them both letters during my recovery from PPD, telling them that their treatment of me aggravated my already extremely painful experience, they should get with the program when it comes to PPD, and I was dropping them and moving on to doctors who didn’t lack bedside manner the way they did.

 

Infertility and Complications

Can you share a little about your experiences with both?

Without getting into the details as covered in my book about my infertility experience and childbirth complications, I’ll just say that, like more and more women these days, I got married late (at age 36 ), had a dermoid cyst removed a year later to increase the likelihood of getting pregnant and not having it get in the way of a developing fetus, tried to conceive naturally for over a year before being referred to an IVF center where we failed our first cycle (it was such less than optimal experience mostly because the staff and environmental overall were cold and disorganized), and got pregnant successfully via my 2nd IVF cycle at a different center.  What started off as 2 fetuses became only one after a car accident I had about 2 months into the pregnancy.  Other than nausea that lasted my entire pregnancy, some spotting, and overall anxiety that I would carry to term, my pregnancy went well.  I delivered vaginally (with an epidural and episiotomy), but ended up having my uterus removed 3 days afterwards due to placenta accreta.  During my entire 7-day stay, I was constantly woken up for blood work and extremely exhausted as a result.  On top of that, I was starved for nearly the whole time I was there.  Due to my surgical procedure, I was kept in an entirely different wing from my daughter for over a day, and whenever I called for a nurse, no one came.  Some nurses were not nice to me at all.  It was like a living hell for me most of the time I was in the hospital.  To get the full details of my infertility, childbirth complications, and PPD experiences, you can read my book. 

 

How can your experience help the readers of Giving Birth with Confidence?

My hope is that those who read about my experience in my book—which covers a lot, including key statistics and information on the biopsychosocial factors behind PPD (infertility and childbirth complications are risk factors)—will become more knowledgeable about perinatal mood disorders.  I hope that they will also read the growing numbers of blogs of mothers who are speaking up about their struggles with perinatal mood disorders.  Why?  Well, knowledge is power.  With more knowledge, there would be less ignorance and stigma, and motherhood myths will have less of a negative impact on mothers than they do today. I want to see fewer mothers being caught off guard and not knowing what is happening to them, should PPD strike.  Being ignorant and unprepared for it causes unnecessary fear, anxiety, guilt, and inability to appreciate one’s baby. For example, insomnia after the third week postpartum is a common first symptom of PPD. 

My blog is hit numerous times each day via Google and other search engines using words like “postpartum insomnia,” “new mom insomnia,” “insomnia four weeks after childbirth,” “can’t sleep when the baby sleeps,” “can’t sleep six weeks postpartum,” and so on, which means that there are many moms out there who are going through what I went through, in terms of insomnia as a symptom of PPD, beginning at around 40 days.  That’s right, there’s that magical number again!  Had I known about PPD before my daughter was born, I would not have been as scared as I was as to why I had insomnia and couldn’t sleep even though I was exhausted beyond words and even during the times she slept. My fear would not have escalated to full-blown anxiety attacks. I would’ve recognized other symptoms like loss of appetite (I lost so much weight so fast that within a couple of weeks I weighed less than I did before I got pregnant!). As soon as I started to have insomnia, instead of merely taking the Ambien prescribed to me by my OB/GYN, I would’ve immediately known to question it as a sign of PPD and gotten the right treatment then.  As they say, hindsight is 20/20….

 

I would like to thank Ivy for her wonderful work and sharing her experiences and knowledge with Giving Birth with Confidence. To learn more about Ivy, visit her blog at http://ivysppdblog.wordpress.com/.

Real Life Is…. An Interview With Mom, Postpartum Depression Survivor, and Photographer Melissa Miller

As happens between women who have experienced postpartum depression (PPD), we find our ways to each other. Out of seemingly nowhere — an email, a conversation — some sort of connection is formed and coincidence creates opportunity to share the extraordinary journey of motherhood with a postpartum mood disorder (PPMD).  In this case, Melissa and I were introduced to each other!  I watched her photo project, “PPMD“ and my heart was so moved. She captures the essence of the beauty and bravery of women who have walked through hell and back — not only recovering from PPD, but growing from it. What Melissa brings to Giving Birth with Confidence is the real story of a real mom realizing her creativity as an essential part of the healing process following postpartum depression.  I am honored to know her, and introduce her to you!

 

When did you realize you had postpartum depression?

This is actually a tough question for me.  Not for emotional reasons but because I think I was in denial or maybe even unaware I had PPD for a long time.  Postpartum depression came about after the birth of my 2nd child.  I am also beginning to realize I may have suffered with depression while I was pregnant with her too.  After she was born I made excuses for my depression and anxiety that it was due to lack of sleep and my daughter being colicky.  It was on a visit to my daughter’s naturopathic pediatrician that my having PPMD came out.  The doctor had been concerned about me when I brought my daughter in and it was during one of the visits that she addressed her concerns with me.  Although I felt there was something wrong with how I was feeling, I was still in denial about admitting I had postpartum depression.  I was scared to admit it.  I tried confiding in a few people and the look on their faces told me they didn’t understand and they were now scared.  Some even suggested taking my kids.  I clammed up.  I didn’t say another word.  Again, I was grateful for my daughter’s doctor.  She is also a midwife.  She was the one person I could speak to without judgment and I owe her so much.     

 

How did your photography and creativity help your recovery?

Photography became my voice.  I remember days when I would be crying, anxious and filled with so much emotion that I didn’t know what to do. I could pick up my camera and in a way, detach myself from it all.  All of a sudden I was looking through my viewfinder and looking at life around me in a different way.  It is difficult for me to express but at that moment it helped me, it helped lift the anxiety and depression for just a minute.  It broke the cycle.  At other times I couldn’t express to people how I was feeling so I used my photography to express emotions in other ways.  Not specifically just my emotions and voice, but others too.  I couldn’t talk about what I was feeling because I didn’t feel anyone would understand.   As I poured myself into my photography I found myself wanting to do more, to learn more, so I went back to school.  It is funny how, in life, there are really no accidents.  If it hadn’t been for my picking up the camera as a way to stay creative being at home with my kids I wouldn’t have had this incredible gift to use while dealing with my PPMD.  And, if it hadn’t been for my having PPMD I wouldn’t have gone back to school and if I didn’t go back to school I wouldn’t have done my project, “PPMD.”

 

Walker: Tell us about your current photo project, “PPMD.”

 My project. Well, as I mentioned about no accidents in life, I was sitting in my Assignment and Editorial class and the topic of our final assignment came up.  We had weekly assignments throughout the 10 weeks of class while also working on a final assignment to be presented at the last class.  The instructor mentioned the best projects are those we can connect with.  I don’t know how it came out but all of a sudden postpartum mood disorder (PPMD) popped into my head.  I also immediately questioned how I was going to present a photo essay on postpartum mood disorder.  I had no idea but presented my idea anyhow.  My instructor loved the idea and encouraged me to include audio.  So, I decided I was going to take photos of women who had or were currently struggling with postpartum mood disorder.  I was going to pose them in their homes and then ask them to provide me with an experience, memory or something else of significance that related to their own experience with PPMD.  I was encouraged to have 10 images for my final and this meant 10 women.  I had no idea how I was going to find that many.  

I should also point out that my main goal was to create a project that would not only empower women who had experienced PPMD but to also educate people about PPMD in hopes of eliminating the judgment and stigma associated with it.  I didn’t want women to be scared, like me, to share their experiences and I wanted all women to get help and to not be ashamed.  I want women to look at these photos and hear the voices and say “hey, I am not alone,” and “these women don’t look crazy; I am not crazy either.”  I used my resources and emailed my local parents community yahoo group and the staff at the non-profit I volunteered for.  I was overwhelmed at the responses I got.  I had over 15 people respond.  It also awakened me to how many women suffer PPMD.  I scheduled time to meet with each woman without my camera.  I wanted to connect and hear their stories.  This was the most amazing experience.  I cried with these women, I laughed with these women.  I heard their stories, I shared mine.  We were not alone.  It was amazingly cathartic for me and for them.  I have received many thank yous, because for most of us, it was the first time we were able to share our stories without judgment.  The horrible things in our heads we were able to laugh about.  We knew they were not reality and we just needed to be heard.  My project shares the voices of the women and their portraits capture them in a way that is reflective of me and my experience.  This project has only just begun.  My dream is to share this project worldwide. To travel and meet with women and then photograph and audio record them.  At this time I am unsure how the project will continue to grow but am still going to school and this project is an active part of my education.  

 

 

 

Melissa Miller is a photographer, student, wife and mother of two living in Seattle, WA.  Photography came about as a way to explore her creative voice.  She’s done work for Open Arms Perinatal Services, PALS Doulas and Thrive by Five’s “Love.Talk.Play.” campaign.  She is currently enrolled at Photographic Center NW where she is taking classes and continuing her personal project, “PPMD“ on the subject of postpartum mood disorders.

Transforming Depression, Increasing Awareness: An Interview with Liz Friedman

Liz Friedman is the Program Director at MotherWoman, Inc. and the Founder of the Postpartum Support Initiative.

What do you remember from your experience of postpartum depression?

Liz: When I became a mother almost 9 years ago I experienced a severe perinatal emotional crisis.  My pregnancy was complex, my birth was traumatic, my postpartum period was disastrous. I did everything right and everything went wrong.What I recall most distinctly from that period was the fear that I was losing my mind. I was terrified that I had made a terrible mistake and that I would never be an adequate mother for my beautiful son. I thought I would never recover. The isolation of that time was deeply damaging and my loneliness in the face of that crisis still brings me to tears. Yet step by step I found a path and began to recover with the help of a few excellent resources in my community.

 

How did that experience influence your work with MotherWoman?

Liz:  With every step forward that I took, I became angrier about what no one told me. How could I not

have known there was the possibility of this happening? Why didn’t I know that isolation, difficult pregnancy and traumatic birth are some of the key risk factors for perinatal emotional complications?  Why didn’t I know that there are ways to prevent and prepare for the risks of postpartum depression?  Most importantly, why didn’t I know that postpartum depression is the leading complication of childbirth? Why didn’t I know that 1 in 8 mothers experience perinatal emotional complications?

By the time my baby was 6 months old, I began to gather mothers together to share our experiences of pregnancy, birth and the postpartum period.  MotherWoman was born from the same desire to create a place for women to share their REAL stories of motherhood. Annette Cycon, LICSW founded the organization in 1998 and I joined in 2005 with the explicit goal of bringing a focus to perinatal mothers. We founded the Perinatal Support Initiative and developed the MotherWoman Support Group Model to address this issue. We believe in mothers’ ability to heal and lead powerful lives as the mothers and women they are meant to be.

 

Before you had children, what was your awareness of depression and anxiety in pregnancy and postpartum?

Liz: Awareness? What awareness? Not until after having lived through the experience did I gain any real awareness. And it wasn’t until I became an advocate and educator that I received a true education. This is the one thing that mothers say again and again as they walk into our perinatal support groups: “Why didn’t anyone tell me??”

I strongly believe it is our responsibility as educators and advocates ensuring that all mothers have accurate information regarding depression/anxiety disorders so they can be informed, and thoughtful about how to best approach the childbearing period of their lives. We need to do this in a way that doesn’t frighten them but rather empowers them. If we do not do this as part of our prenatal education we have done mothers a huge disservice.
What would you suggest to childbirth educators and doulas?

Liz: Pregnant women trust you because you are their childbirth educators and doulas. They will listen to you. Have courage and tell them the facts of the postpartum depression and anxiety mood disorders.

Every childbirth educator and doula must make it an essential part of their curriculum to cover the basics regarding PPMAD (perinatal and postpartum mood/anxiety disorders). This means telling mothers and their partners what symptoms, prevalence, and risk factors, and treatment options may be, and referrals in the area.  Partners need to know what to look for because often they are the ones who first notice a mother struggling.  Childbirth educators and doulas need to insist that pregnant women put attention on what emotional life is like postpartum and prepare for it.   Mothers and partners need to be encouraged to create a Postpartum Plans that is evidence-based and addresses some of the most common challenges in the postpartum time.   Partners need to be made aware of how much support they will be expected to give and how much physical and emotional support a new mother actually needs for the entire postpartum year!

 

What questions should pregnant women ask potential doula about depression/anxiety?

Liz:

  • Do you have experience supporting mothers who have had depression/anxiety?
  • Are you philosophically opposed to your clients using medications to assist with depression/anxiety?
  • How can you help me prepare for the possibility of experiencing depression/anxiety?
  • What resources do you have to help me if I develop depression/anxiety?

 

What advice would you offer pregnant women today?

Liz: Many mothers make a birth plan to prepare for their birth.  I recommend that every women make a postpartum plan!  If mothers had a real idea of what the postpartum period would be like, they would PLAN! In order to make a plan, you need to understand the risk factors, the likelihood of different outcomes and path for prevention that works for you. Could you imagine what our postpartum experiences would have been like if we had real support set up for us after we gave birth to our babies?

 

What was it like doing TEDtalks?

Liz: I won the TEDWomen’s contest in Dec 2010 and it was the first time in the history of TED that a postpartum mother’s story was highlighted and given international attention.  At TED you have to be bold so I told them the truth.  I spoke about the incredible despair and isolation I experienced during my postpartum time.  I told them my dream: I will do everything in my power to ensure that no other mother has to go through what I went through; alone
, terrified and not knowing if she will ever be ok again.  And then I showed them the path: through the MotherWoman Support Group Model we will bring women together to transform our lives and build solid foundations beneath our feet.

 

Where do you hope to see MotherWoman 10 years from now?

Liz: MotherWoman is going international! Our Support Group Model (SGM) is transforming the way professionals approach the issue of depression and anxiety mood disorders in pregnancy and postpartum.  Our Support Group Model is innovative, ground-breaking and provides the missing link in caring for perinatal mothers. Our model not only educates mothers about PPMADs and provides structured safety for diverse mothers to share their stories and to heal but it is also an empowerment model which believes in each woman’s inherent wisdom and ability to take positive steps that benefit her and her family. Our goal is to have one Support Group for every 2000 births nationally.  In communities utilizing our model, awareness about depression and anxiety disorders in pregnancy and postpartum is growing and the number of mothers who are seeking help and care is increasing– and that means that mothers are recovering and their families are thriving.

 

Book Review: Dropping the Baby and Other Scary Thoughts

Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood (Kleiman & Wenzel, 2010) is a courageous and compassionate examination of the scary thoughts that may accompany anxiety in pregnancy and postpartum. Recently, author and perinatal mental health expert Karen Kleiman, MSW shared valuable insight into the topic, and how every mother and care provider can benefit from this book.

Can you describe the term “scary thoughts”?

Scary thoughts” is the expression we use in the book to incorporate any and all categories of faulty thinking that can interfere with feelings of well-being of a new mother. This term refers to thoughts, urges or impulses that are intrusive and bombard a new mother at any time with no notice. They can take the form of worry (anxiety), obsessive thinking (OCD), rumination (depression), catastrophic misinterpretation of bodily sensations (panic), and intrusive memories (PTSD). Whatever form the scary thoughts present in, they are always unwanted and the degree of distress can range from mildly annoying to severely disturbing.

How common are scary thoughts in motherhood? And what are helpful signs needing help?

Research by John Abramowitz has shown that 91% of all new mothers (and 88% of fathers) experience unwanted thoughts after childbirth (Abramowitz, Schwartz, & Moore, 2003.) That’s a very high number! That means almost every new mother experiences some degree of obsessive thinking.

Keep in mind that it is not the thought itself or the content of the thought that is worrisome it is the level of suffering it causes. The level of suffering refers to the amount, frequency, and how time-consuming the distress is. Not surprisingly, if a mother perceives the thought as threatening, her anxiety will be greater. In this way, it is actually her interpretation, or misinterpretation, of the thought, rather than the thought itself, which makes her so anxious about them.

Women who have a history of an anxiety disorder or depression, or who tend to be a worriers, or describe themselves as perfectionist, have an increased risk of experiencing scary thoughts. (Though having no such history does not exempt a woman from experiencing them). The presence of any anxiety during pregnancy and the postpartum period is typically associated with scary thoughts.

What advice would you give to pregnant and postpartum women today who may be experiencing scary thoughts, anxiety, or symptoms of mood disorders?

Intrusive thoughts are almost always unwanted and scary. One of the best things they can do is to understand that these thoughts are extremely common and occur all the time. Almost all mothers will admit they have had distressing thoughts that bombard them out of nowhere from time to time. The important thing to remember is that having the thoughts is not, in and of itself, problematic. Rather, how the women reacts or deals with her troublesome thoughts is what determines whether she needs treatment or not. In other words, we know that the thoughts are triggered by anxiety. The more anxiety a woman has, the harder it may be for her to deal with it, and the more it may interfere with her ability to function and get through her day.

How do you think the book would be best used by pregnant women?

Pregnant women are also vulnerable to having scary thoughts. Will my baby be okay? What if I do something that hurts my baby? What if I don’t want my baby? Why did I get pregnant in the first place? Pregnant women also need to know that these thoughts are common and if they persist or are particularly troublesome for a woman, she can get treatment, such as Cognitive-Behavioral Therapy, which will help her learn how to adapt her thinking in response to these thoughts and better manage the anxiety. This way, she will develop skills that will help reduce her risk for postpartum depression and anxiety after her baby is born.

How could a pregnant or newly postpartum mom use this with her care provider (OB/GYN, midwife)?

Perhaps the best way to use this book is to either let her care provider understand what she has learned or by sharing the book directly with her provider. The book is geared toward both the consumer and the provider since it has been our experience that excellent healthcare practitioners do not always have up-to-date information, and unfortunately, many still do not understand the nature of scary thoughts. Providers who are misinformed can inadvertently agitate a situation by over-reacting, thus, reinforcing a woman’s greatest fear – that if she discloses what she is thinking, someone will judge her or think she is crazy.

How can new mothers help each other de-mystify mental health and deconstruct the happy mother = good mother myth you discuss?

The stigma attached to new mothers who are anxious or depressed has been around for ages. The best things women and healthcare providers can do is to help educate others and speak about the issues that surround this vulnerable time in a woman’s life so accurate information can be disseminated. Though much headway has been made in the areas of research and public awareness, we still have far to go as a society who is learning to accept and embrace a mother who doesn’t always feel so good.

_________________________________________________________________________

I encourage all moms, family members, childbirth educators, doulas, and care providers to add this book to their ‘must have’ library. Further information about this book and topic are available at www.postpartumstress.com. There is a wonderful video on the topic at http://postpartumstress.blogspot.com.

 

Karen Kleiman, MSW, licensed, clinical social worker, is founder and director of The Postpartum Stress Center of Pennsylvania and The Postpartum Stress & Family Wellness Center in New Jersey. She is author of several books on postpartum depression, including This Isn’t What I Expected , and an internationally recognized postpartum depression expert. In 1988 she founded The Postpartum Stress Center, a treatment facility for prenatal and postpartum depression and a training center for therapists. Her work has been featured in local and national magazines, numerous radio shows, local and national television shows, including Inside Edition, The Oprah Winfrey Show and NBC Nightly News with Tom Brokaw. Karen lives with her family outside of Philadelphia, Pennsylvania. In addition to her clinical practice, Karen teaches a specialized post-graduate course for clinicians, provides training programs for healthcare professionals and mentoring opportunities for therapists who wish to specialize in the treatment of perinatal mood and anxiety disorders.

Amy Wenzel received her Ph.D. in clinical psychology from the University of Iowa, followed by her clinical psychology internship at the University of Wisconsin Medical School. She has served on the faculties of the University of Pennsylvania School of Medicine, the American College of Norway, and the University of North Dakota. Her research has been funded by the National Institute of Mental Health, the American Foundation for Suicide Prevention, and the National Alliance for Research on Schizophrenia and Depression. She is author of Anxiety Disorders in Childbearing Women: Diagnosis and Treatment and editor of the forthcoming: Handbook of Perinatal Psychology (Oxford University Press), as well as author or editor of books on topics such as cognitive therapy, cognitive research methods, and close relationships. She is founder of the Hope & Resiliency Clinic, a treatment, research, and training clinic focused on suicide prevention and support for survivors of suicide.

The “Perfect Mom,” Jerry Springer, and Postpartum Depression

A Survivor’s Story of Transformation and Growth

Vanessa is an amazing example of not only surviving Postpartum Depression (PPD), but of being able to speak to the gifts such a difficult experience can bring:

Going through postpartum depression completely blind-sided me.  I didn’t know what was happening to me and when I tried to tell people, they would say “Yeah, motherhood is so tiring; it will get better.”  I wanted to believe them, but I felt like I was unraveling. I had a postpartum with an anxiety/panic component that left me practically sleepless for 11 days. I would sleep maybe 30-45 minutes in a 24 hr. period. I would wake up with my heart racing. Trying to get back to sleep was nightmare.  I was beyond exhausted to the point that I felt like I was starting to hallucinate.  I wasn’t sure what these “intrusive” thoughts were, but they really scared me. I was scared to tell my husband, but I was not sure I could trust myself not to hurt myself.  I was beyond terrified, certain I was off the deep end and beyond hope of ever getting out of this dark hole. 

With the help of her husband, Vanessa sought help from a psychotherapist, and reproductive psychiatrist who helped her with medication.  The treatment prevented her from harm, and hospitalization—but not before it had taken a heavy toll on her body and spirit.  At the same time, Vanessa speaks to the transformational gifts she has experienced as a result.

Relationship with husband

Having PPD gave me a new found appreciation and love for my husband, even more than I already did.  When I took my vows for better or worse I never imagined that how bad worse could be.  The way my husband adored me throughout the whole process and loved me for the person he knew I was and not the shell of a person I had become… was amazing. He was by my side every step of the way, calling Drs. for me when I couldn’t,  just fighting for the best for me when I felt like I couldn’t fight anymore. It was very humbling for me to go from caretaker of my husband and boys to needing full time help. I feel like it opened another dimension and depth to our relationship for which I am very thankful.

New strength

I also feel like I have become more assertive and more intentional.  A silly example, I took my two boys for a haircut the other day and there was a TV that had Jerry Springer on, not a huge deal but that show doesn’t align with how I want my kids to speak or behave and I asked the lady if she could please turn it off, in the past I would have been more shy and just try to ignore it but it would have bothered me.

New insights

You mentioned the word, “intentional”, what does it mean for you?
I have realized that I can’t make everyone happy with my choices or decisions. So when I do need to make a choice or decision I weigh it against if it is in best interest of my family and myself.  Before I probably would have accepted responsibilities or done things out of obligation. Now I know now more clearly what I am passionate about. Sometimes that means saying no to the Valentine’s Day party at my son’s school, and not feeling guilty about it. I think learning to balance out mommy guilt though is going to be a life-long process or at least 18 years. But I definitely have more perspective now and have given myself so more slack. I feel so much more confident and able to voice my opinions. I think I have a new understanding for the preciousness and brevity of life. 

How would you say your experience of ppd helped you in that?
I never expected or anticipated this illness and it made me realize that we are indeed human and although this didn’t take me out, it could have and I am going to spend every day I have here making it count.

Growth and Compassion for Others

I felt like I saw myself growing in my compassion for others, especially people experiencing depression. It opened my heart to a whole new dimension of empathy.  I didn’t realize before how physically debilitating and paralyzed depression can make a person feel. I was shocked to learn that depression is a very physical illness. The body aches I experienced were unreal.  I told my husband it felt like my bones were cold and achy. I felt also more numb than sad.  Which in my mind before I thought depression meant people just cry all the time, although that was a significant symptom I felt more numb than sad.  I remember looking at my baby and wanting deeply to connect and I would literally force myself to smile at him because I had remembered something I had read before about the negative impacts of depression on babies, that made my resolve all the stronger.  And I have to say my almost 1year old is the happiest little guy I know!

Freedom from being “perfect mom”—the biggest blessing

I have freed myself from trying to be a “perfect” mom. This is the hugest blessing, and despite the suffering I endured, I am so thankful that post-partum depression “happened” to me.  I NEVER thought I would ever say that in a million years but it took me to a depth that I had never known and now I feel like I am walking in a higher place then I was before.  I never would have given myself permission to receive help, because as a stay at home mom I “should”

be able to do everything.  Getting help and having someone clean my house and do the laundry has freed me to play more with my kids and be more engaged instead of running around trying to get it all done to be the perfect mom. I came to a point in my postpartum depression where

I pretty much stopped functioning, for our family it was not a choice whether to get help or not. My husband had just started a new job and had already taken lots of time off, for the birth of the baby and trying to take care of me, the baby and my 2.5 year old. I experienced a lot of guilt at first having someone else do the laundry and cleaning, and watching my kids so I could nap. I realized that cleaning was not as important to my identity as being present for my children. Allowing myself that luxury and freedom has been one of the best things I have done for our family and it took me getting to such a low point to reach out and get that help.

Where do you think your beliefs about the perfect mom came from?

That is a really good question, I am not sure where this fictitious woman came from. Probably bits and pieces here and there. I think when I accepted my job as a stay at home mom, I think comes with it certain connotations like if you are home you “should” be able to do it all alone. Where I feel like looking back in history or in other cultures families are raised by multiple generations and one person is not expected to do “it” all alone. 

Recovering

The best thing that I heard in the depths of the depression, was that it is treatable and you will get better.  Even though I absolutely didn’t believe it, I thought I have to be the exception and that is
something the doctors have to say. I kept thinking what if it doesn’t work for me. But here I am a year later my baby’s first birthday next week.

Is there anything else you would like to share?

I would like to say, don’t try and figure out what next week is going to be like just be here today and get through hour by hour, sometimes moment by moment. Try and listen to your body, something really strange for me was that I was drawn like a magnet to go sit in the sun every day.  That is the only place that felt comfortable to me; I am NOT a nature girl at all. As soon as I would watch the sunrise I would go out all day until the sun set. Later I told my doctor that, he said that my body was trying to heal itself, that’s pretty amazing.

And joining a support group was very helpful to me, my friends who wanted to help but had never gone through it before were sweet and well-intentioned but talking to someone going through the same thing brings strength.  You are not alone by being open and vulnerable you will literally be shocked by the women you know who have suffered. There is a 1 in 8 chance that you know someone who has been in a similar circumstance.  By breaking the silence and destroying the stigma of this frightening illness more people can heal.

I extend my deepest gratitude to Vanessa for sharing her story. Increasing our awareness about postpartum depression is an essential tool to healing and helping.  If you have questions or concerns about postpartum depression, please visit www.postpartum.net. For information regarding medication during pregnancy and postpartum, please visit www.otispregnancy.org.

Blossom in the Desert, Part II: Postpartum Progress, an Interview with Katherine Stone

In this second part of my interview, Katherine Stone of Postpartum Progress offers her unique insight into the growing prevalence of depression/anxiety in pregnancy and postpartum, and the role of childbirth professionals in addressing perinatal mental health concerns. Katherine also speaks to the amazing potential for personal growth through the experience of postpartum depression/anxiety.

____________________________________________________________________________

Can you share how you have experienced personal growth through your experience of postpartum obsessive compulsive disorder (OCD)?

The personal growth has been amazing.  I really think getting through a dark time in your life or tough experience, no matter what it is, helps you to learn more about who you are.  It also gives many people a purpose that, until then, they didn’t know they had.  That has been the case for me.  While I loved working in corporate marketing, my life has been enriched in countless ways by the work I do now.  I love that technology allows me to reach women anywhere they are and give them the kind of information they need to get help and get better.  While postpartum depression is not something that I’d wish on anyone, I think it’s possible, once you’ve given yourself enough time to fully recover, to find some gifts in it, even if that’s just knowing that you have much more strength and courage than you ever thought.

Why do you think we have such high prevalence of postpartum depression and anxiety disorders (PPD)?

PPD exists everywhere, not just in the US, or in Western nations.  I wrote a story a few years ago on my blog, for instance, about some research that found that PPD is highly prevalent in Negev Bedouins. 

I don’t believe there’s a single reason as to why it exists or is so prevalent.  There are many things that can play a part in whether a woman will have PPD, from her family history of mental illness, to her current financial situation, to whether she has diabetes, to what her childbirth experience is like and on and on.  Perhaps we’re just recognizing it more, I don’t know.  Plus, I imagine that the way in which we now live plays a part.  Most of us are no longer in the proverbial village that it takes to raise a child.  We have the baby, we’re out of the hospital lickety-split, we have fewer social supports and many of us are back to work in short order.   I doubt any of that helps with our emotional wellbeing.

As you know, I focus a lot on the area of stigma for mothers with mental health challenges. Have you had a personal experience of stigma?

I don’t think I’ve personally experienced much stigma, other than what I put on myself in the form of shame and isolation when I was going through postpartum OCD. 

I see it quite a bit, though, with the women I speak to all around the world.  People have no idea how poorly women with PPD are still being treated.  Women are dismissed by doctors, told they can’t be helped, told they can’t possibly have PPD if they seek treatment past 3 or 4 months postpartum.  They lose jobs.  Some are told by their faith communities that their PPD is a spiritual failing.  If they later divorce, their PPD experiences are sometimes brought up in custody battles.  Some lose the ability to get life insurance after being treated for PPD. 

I think the treatment that gets to me the most though is the poor treatment by health care professionals.  I’ve had desperate women told they should just take a hot bath or eat more meat and they’d feel better.  Women told they should just wait it out and call back in several weeks if things don’t get better.  Women told by OBs that the OB can’t help because he or she is not in the mental health business.  Women who finally get the courage to seek help and are told they’ll have to wait months to get in to see someone.  Those things really make me mad.

How can women with history, risks, or diagnosed depression or anxiety give birth with confidence today? What would your advice be regarding their birth, and after?

I can’t say I’m much of an expert on the giving birth part, but at least in terms of the potential for antenatal or postpartum depression or anxiety, my advice would be to know your risk factors and know the symptoms, and make sure your loved ones know them as well.  Know that if the symptoms should arise, there are great resources to help you.  PPD and related illnesses are temporary and treatable with professional help.  Reach out to advocates like myself or the people at Postpartum Support International www.postpartumsupport.net who understand what you are going through and will connect you to that help.  You can be confident that you will get well.  You will get back to the old you.  You will be a good mother.  Really.

Where could birth professionals play a bigger role?

I think birth professionals could play a bigger role by being as up-to-date and informed as possible on perinatal mood and anxiety disorders.  Know the psychiatric resources in your area.  Know that women can get a perinatal mood and anxiety disorder any time in the first year.  Know where the support groups are. 

I’d also love to see them doing in-depth social histories on women to identify their risk factors for these illnesses from the start, before they ever have the baby.  Those with high risk could receive special education and resources in advance, so they’d be more prepared for what might happen and how to deal with it quickly.  Imagine the suffering that could help prevent.

Additionally, it seems like I’m hearing from a lot of women who’ve experienced birth trauma.  It is so important for birth professionals to realize that events in the delivery room that they perceive as fairly routine are never routine and often very scary for someone who has never had a baby.

For more information regarding birth trauma, please refer to http://postpartum.net/Get-the-Facts/Postpartum-Post-Traumatic-Stress-Disorder.aspx.

One of the biggest fears I hear from women, is that we will somehow harm our children, either with medication, breastfeeding choices, or depression. How can women transform this fear into confidence in birthing and mothering?

That’s a great question.  I’m not sure if we can ever fully eliminate the fears or worry over how we might hurt our children, whether related to PPD or anything else we do as mothers.  Raising little people is such a monumental job, and most of us take it so seriously that there are always going to be worries about whether we are doing it right and making the right decisions.  That being said, we still have to make those decisions.  We can’t put our heads in the sand.  And the truth is that our own mental illness has the very serious potential to harm our children in the long run, so something must be done about it.  Women have got to get help.  They deserve to be healthy, and their children deserve healthy mothers. 

I have learned to focus on making the best decisions that I can, based on all of the information available to me at the time, and then I try to let go and move on to the next thing.  That’s the very best I can do, and I’ve become confident that that is good enough.

Katherine Stone is the author of Postpartum Progress (http://www.postpartumprogress.com), the most widely-read blog on postpartum depression and other mental illnesses related to pregnancy and childbirth.  Postpartum Progress has been named among the top ten depression sites on the web by PsychCentral, won a 2010 Fit Pregnancy Best of the Web Award, and is a Parenting magazine Must-Read Mom Runner-Up.  Katherine is also the founder and executive director of Postpartum Progress Inc., a non-profit dedicated to vastly improving the support and services available to women with perinatal mood and anxiety disorders.  Additionally, she writes the weekly column “If Mama Ain’t Happy” on ParentDish, and is a guest contributor for the topic of PPD at BlogHer.  She was the winner of the 2010 Bloganthropy Award, given for using social media to make a difference, and was named a WebMD Health Hero in 2008.  Follow her on Twitter at @postpartumprogr.

Blossom in the Desert: Postpartum Progress, an Interview with Katherine Stone

At a recent mental health conference, I sat in a ballroom filled with the leading experts in the field of perinatal and postpartum depression and anxiety.  A heated topic emerged.  A tall woman with vibrant red hair stood in line and waited her turn at the comment microphone.  With utter clarity and striking confidence, she spoke truth to power for all women experiencing depression or anxiety around the time of childbirth. She stood amidst every expert and spoke for all of us.  That woman was Katherine Stone, the author of Postpartum Progress, the most widely-read blog on postpartum depression and other maternal mental health issues. 

I nabbed her in the hallway at the break and asked if she would do an interview for Giving Birth With Confidence. She said yes, and handed me her business card….a photo of the desert with one brilliant flower blossoming in the middle. That photo captures Katherine–her steadfast commitment to represent potential, and to encourage women to stay bright and bold in the middle of dry times.

It is my pleasure to offer the first of a two-part interview with Katherine. In part one Katherine reflects on pregnancy, birth and the postpartum period sharing her own journey through postpartum obsessive compulsive disorder (OCD) and her recovery.  In Part II we will learn about Katherine’s advocacy, and tireless effort to help all women give birth with confidence.

__________________________________________________________________________

Tell us a little about your work and blog.  

I am a full-time advocate for women with perinatal mood and anxiety disorders, and the mother of two children, ages 4 and 9. 

I started my blog Postpartum Progress in 2004 so that women wouldn’t feel as alone, ashamed and uninformed as I did when I had postpartum OCD with the birth of my first child in 2001.  It has since become the most widely-read blog on perinatal mood and anxiety disorders.  I am extremely proud of it, and the community that has been created through it. 

What were your births like?

My first birth was a bit of a nightmare. My water broke first thing in the morning and off we went to the hospital.  I then spent hours and hours and hours in labor, and actually pushed for 4 hours. Four hours! I was completely emotionally and physically spent, beyond spent, by the time my son was finally delivered via forceps.  I already felt like a failure for not having been able to “properly” birth my own child.  Afterwards, he had jaundice, and unbeknownst to me the nurses in the nursery were giving him a bottle to prevent dehydration so after the first or second day he started refusing the breast. Oh, and the day we went home from the hospital was September 11.   All around, not the best experience.

How, if at all, did your births affect your OCD?

I do think it had an influence, although truth be told I can see now that I was already headed toward postpartum OCD anyway.  Still, perhaps it wouldn’t have been so severe.

What would you like to share about your personal experience of Postpartum OCD?

It was a nightmare. I’ve never been so scared in all my life.  I was sure my life was over and that I’d never be the same again. I felt completely disconnected to my baby and was convinced he would never love me.  I had intrusive thoughts, like “what if I drown him in the bathtub?”  (I didn’t know at the time of course, that they were intrusive thoughts.  I just thought I had become a monster.) I couldn’t eat. I couldn’t sleep. I was filled with anxiety and dread all the time.  Postpartum OCD is just an awful illness. 

It’s hard to put into words how terrifying it is and how it can become so easy to be convinced that you are such a horrible and worthless person.

How did you get through it?

After several weeks of complete terror, I reached out for help.  I figured my life was over anyway so I might as well tell someone and get help.  I couldn’t stand the pain anymore.  I was sure when I told the first therapist I saw what my thoughts were that she’d call the police.  Thankfully she knew what was wrong with me, and explained it to me in the calmest and most supportive terms.  She told me I would be okay.  That was the first step in my recovery.  I took medication and went to therapy as my treatment.

What did you learn?

I learned a lot about the human mind and how we don’t have as much control over it as we think.  I learned to have great empathy for anyone suffering a mental illness.  I also learned that I’m a survivor and a strong and loving mother.  It was a hard path to take to learn all of that, but I’m grateful for it now.

How did you make meaning out of the experience?

I suppose the way I made meaning was to commit myself to helping all of the women who come after me.  Hundreds of thousands of people have gotten help from my blog Postpartum Progress, and I’ve recently started a nonprofit to try to do even more good.  It’s given me my life’s work, so I don’t regret having had postpartum OCD.

Did you have a birth or postpartum doula?

We did hire a baby nurse to help us after my son was born, but I sent her home after a couple of days.  I was so riddled with anxiety that I couldn’t stand to have her around.  She did nothing wrong, of course.  I just felt at the time that it should be me taking care of the baby, and that I shouldn’t need to have a nurse.  I already felt like I had failed the birth, and failed breastfeeding, and so I didn’t want to feel like a needed a nurse to help me do what I thought were basic mothering things like diapering and bathing. 

What did you learn in your childbirth education class about postpartum mental health?

PPD was glossed over.  In fact, I clearly recall the teacher of the class saying that none of her students ever got PPD so we shouldn’t worry about it.  What a travesty that was.

What did you know about your risk factors for depression before you had your baby?

I didn’t know anything about risk factors for perinatal mood and anxiety disorders before having my son.  I was never asked a single question.  I was never screened.  Had I known, I think I would at least have been prepared for the possibility that it would happen.

How does your experience influence your parenting? 

I’m not sure it influences my parenting any longer, but I think for the first couple of years I had a lot of guilt about it and I worked extra hard to make sure my son and I had a good bond.

Last year, I launched a new non-profit organization, called Postpartum Progress Inc., which is focused on improving the kinds of services and support that women receive.  I want to see more professionals who specialize in perinatal mood and anxiety disorders.  I want to give women help who don’t have access to it based on where they live or their resources.  I want to see improved public awareness.  I want more specialized treatment programs.  There is SO much work to be done, and I’m excited about contributing to it.

I’ve also recently launched a new service called Daily Hope, which is a first-of-its-kind project to help women who are currently suffering.  They can opt in to receive a daily email of encouragement on getting through these illnesses.  The messages of hope are written by me, as well as the nation’s top experts and authors on maternal mental illness, as well as survivors.  Because most women do not have access to PPD support groups and specialists where they live, we are bringing the experts and support to them.  This is one of the first projects of my non-profit, so it’s very exciting.  A lot of work, but very exciting.  Women who’d like to sign up can click here:  http://postpartumprogress.us2.list-manage.com/subscribe?u=49e8e6d424badbb0285da7485&id=6f51f854b1

If you would like more information regarding postpartum progress, or postpartum depression and anxiety, visit www.postpartumprogress.com for links to excellent information, resources and support.

Katherine Stone is the author of Postpartum Progress (http://www.postpartumprogress.com), the most widely-read blog on postpartum depression and other mental illnesses related to pregnancy and childbirth.  Postpartum Progress has been named among the top 10 depression sites on the web by PsychCentral, won a 2010 Fit Pregnancy Best of the Web Award, and is a Parenting magazine Must-Read Mom Runner-Up.  Katherine is also the founder and executive director of Postpartum Progress Inc., a non-profit dedicated to vastly improving the support and services available to women with perinatal mood and anxiety disorders.  Additionally, she writes the weekly column “If Mama Ain’t Happy” on ParentDish, and is a guest contributor for the topic of PPD at BlogHer.  She was the winner of the 2010 Bloganthropy Award, given for using social media to make a difference, and was named a WebMD Health Hero in 2008.  Follow her on Twitter at @postpartumprogr.