Saturday Sundries 01.22.11: Stigma, Meds, Relapse, Pregnancy


Saturday Sundries: A Postpartum Q&A Series (Original Graphic created by Lauren Hale for MPV Copyright 2011)

Welcome to Saturday Sundries, A Postpartum Q&A Series. This series will be dedicated to answering questions asked by you, the readers of My Postpartum Voice and Twitter friends of @unxpctdblessing. Ask away. I will answer, to the best of my ability, any question. Sometimes the best answer I will be able to provide will involve discussing the issue with your physician. I am not a doctor, I am not a therapist, I’m just a Mom turned advocate after experiencing Postpartum Mood Disorder twice. I provide peer support and nothing more.

In the interest of furthering discussion about Postpartum Depression and tearing down the walls of Stigma, I hope you will ask questions. Don’t make them easy. Ask the hard questions. If you want to ask a question and stay anonymous, that’s cool too. You can email me at mypostpartumvoice(@)gmail(dot)com with your questions. Just specify you would like it answered anonymously. There’s no shame in not wanting to reveal yourself or your struggles. I get that. But you still deserve to have your questions answered. Someone else out there may need to have that exact question answered but they may not be able to ask it at all.

This week’s questions come straight from Twitter. There are only four this week (the most I’ll take each week is five) but they are excellent questions.

Let’s get to answering them!

 

First up: @MamaRobinJ asks: How would you recommend making a decision about another pregnancy when still dealing with #PPD & on meds?

Awesome question. The simplest answer I could give to this one can be summed up in one word: Carefully. But you didn’t ask me this question to get an ambiguous one word answer, did you?

There are a two books I  highly recommend to any mother considering this very issue. The first book is Karen Kleiman’s What Am I Thinking? Having a Baby After Postpartum Depression. It proved to be very helpful for me. (That book is why I started this blog!) The second must-have book for any mother considering this issue would be Pregnant on Prozac by Shoshana Bennett.

One of the most important things Karen addresses is the level of fear a mother should have when faced with another pregnancy after PPD. Karen states that a healthy fear of relapse, etc, worries her less than a mother who is convinced she can breeze right through a pregnancy and postpartum after a Postpartum Mood Disorder experience. She’s right. She also talks about reframing the experience in a positive manner. (Hence, my blog.)

If you are already on meds, hopefully you are already in therapy as well. I would strongly recommend discussing this choice with your caregivers, your therapist, etc. Assemble your team, focus on your care, and prepare for the possibility of a relapse after giving birth if you decide to go ahead with getting pregnant. You’ve done the baby care thing before. You’ve done the PPD thing before. Think like a Boy Scout here and Always be Prepared!

It’s important to note here that no one should ever EVER EVER EVER EVER go cold turkey off their meds. Again, I am not a doctor. But if your doctor tries to tell you that you need to immediately drop any psych meds, run, don’t walk, to another caregiver who is willing to work with your own personal beliefs and needs. The issue of medication during pregnancy is very well covered in Pregnant on Prozac. Shosh even covers how to handle uncooperative doctors. Seriously. If you’re on meds and thinking about pregnancy, or you might end up back on meds, GET THIS BOOK. Make your husband/partner read it too. Make him read the Karen Kleiman book too, if he will. Reading both of these books will profoundly influence your experience.

I should mention that some women do relapse no matter what level of prevention they take. But if you assemble your team, have everyone ready to go before hand, even if you relapse, it will be caught quicker and your healing time should be less than if you take no prevention at all. The key here really is to be as pro-active as possible. Halle Berry once said during an interview with Oprah that when you fall back into the valley of depression again, the journey out is quicker than the first visit. Why? Because this time you have a road map. You know yourself, what works, and how to move through that valley better than you did the first time.

 

Second Question: @WalkerKarraa: Why is there so much stigma re: #PPD?

Wow, Walker. I could write a very long post about just that question.

Since Hippocrates, there has been stigma about PPD. These days, there is a silence around the issue of Postpartum Mood Disorders which infects almost every walk of life.

Every time you see an infant product commercial, regardless of the product, the Mom and baby are together, smiling, happy. Cuddling, bonding, cooing, grinning, etc. Don’t get me started on Baby Showers, the biggest sham this side of the Atlantic. Instead, we all smile and grin at each other, eat cucumber finger sandwiches, drink tea, all while ooohing and ahhhing over tiny baby clothes and annoying toys you may one day want to heave through the window of your home because Junior won’t stop screaming for the zillionth hour in a row and you’ve not slept in nearly a billion hours. Your eyes are crossed, your hair looks like you stuck your finger in a socket, and you’ve long forgotten what a shower is or even where the shower is in your home. Hot food? Distant memory. You can pee in 1 second flat, change a diaper even faster, and yet still you find yourself trapped on the couch or pacing the floor with a grumpy infant.

No one tells us about the hell we might face. No one opens up until we fall apart. Our society has built up such a high expectation of perfection – at this time the level of perfection is so high it is virtually unattainable. And when moms go to extreme lengths to reach those goals set by society and fall short, they blame themselves. We begin the Mommy guilt game earlier and earlier with each generation. We begin the Judge the Mommy game even earlier. The instant someone finds out another woman is pregnant, they feel they have a right to “inform” her of all her decisions and then expect her to choose to be pregnant and/or give birth THEIR way instead of HER way. So many choices, so much pressure, so many things which can go wrong. When things do go wrong, the mother is judged. She didn’t birth at home. She had a c/s. She had an epidural so… She didn’t breastfeed, she didn’t, she didn’t, she didn’t, she didn’t, she didn’t, she isn’t, she isn’t… she isn’t happy because….

Fact is, any Mom can get a Postpartum Mood Disorder. It’s the most common complication of childbirth. 1 in 8. But we’re not talking about it in the birthing or breastfeeding communities. We’re not talking about it in childbirth classes. We’re not talking about it at prenatal appointments. At 6 week check up appointments. At pediatric appointments. We’re just not talking about it.

Because if we don’t talk about it?

It’s not real.

And that’s why there is so much stigma.

Because if we just shut up about it, it’ll go away and we can pretend it doesn’t exist. It’s a shadow in the corner of the room and if we move just right, it will disappear. It’s the monster under the bed we convince ourselves isn’t really there.

It does exist. It IS an issue. And I refuse to shut up about it. I will get LOUD about Postpartum Mood Disorders until I am physically unable to do so any longer. Why? Because no one got LOUD with me and I nearly lost my life because of them.

If you think I’m going to let that happen to another mom on my watch, you, sir, or madam, are seriously mistaken.

 

Third question: @thewilsoncrowd asked: Is it possible to relapse in the middle of treatment? Suddenly back to feeling like I’m at square one this week. #PPD

Oh dear, yes. Yes indeed. Especially if something has triggered you.

But it’s so very important to put this in perspective – you say this week. Has this “relapse” feeling lasted all week? Longer than all week? Or has it just been a few days?

Again, not a medical professional, but relapse is usually more than just a few days here and there. For me, relapse would have to be a good solid week or more of just horrible bad days in a row during which I felt no motivation to try and heal through the methods that worked before.

If you feel you are relapsing, definitely get in touch with your doctors. It’s important to note here that any change in med dosage, sleep habits, PMS, or an increase in stress can make it feel like a relapse. Regardless of the root cause, you need to discuss this issue with your physician so the two of you can formulate a plan to help you stay out of this rut and continue on your journey toward recovery. Make it a pot hole instead of a sink hole.  You can do this!

 

Fourth question: @Preparing4Birth What medications are safe for breastfeeding… why is rapid weaning not a good idea?

I wish I could answer the meds question. I do. I don’t recommend specific medications over other medications. It’s really for a physician to do after discussing a patient’s situation with them. Your doctor should have a copy of Thomas Hale’s Medication & Mother’s milk for reference. If he doesn’t, get them one. Or encourage them to get one for themselves. You can also call your local IBCLC or talk with a La Leche League leader. Another great place for you to get information re: meds during breastfeeding is from OTIS Pregnancy. They even have handy fact sheets available at their website for specific medications. Go check to see if a med you have a question about is there.

Rapid weaning is not a good idea as it can cause several issue with both you and your infant. If you are talking about rapid weaning from nursing, that alone can cause severe issues with both the mother and infant dyad. The mother may experience engorged breasts as her system is absorbing the shock of no longer nursing the way to which it had become accustomed. Engorgement can lead to mastitis and infection. Mastitis is very painful and is considered an urgent medical condition. The infant is suddenly switched over to formula and his/her young and immature digestive situation is flung to the wind as those in “charge” wait to see what will happen. You may end up with a mother who may want to nurse, despite the risks of whatever med she is on. It is of the utmost importance for a physician to be sensitive to the nursing desires of a new mom. Nursing is either not working out at all or it is the ONE thing she is doing right. To take nursing away from the latter mom is to remove a positive left in her very dark world which is a bad idea.

Rapid weaning of any psychiatry medication is strongly advised against as it can cause some severe and even worse issues than being on the meds. Not only will you go through withdrawal, but your infant may go through this as well. And that’s just not good for anyone. If you are nursing and on medication, it is important to let your child’s pediatrician know what medication you are on and at what dosage so they can monitor your infant for any possible side-effects. Primary side effects with psychiatric medications with infants are sleepiness and weight gain. If your infant seems to sleep a lot or is struggling to gain weight, it’s important for your pediatrician to know you are on medication that might be causing these issues. Again, Thomas Hale’s Medication & Mother’s Milk is a very solid resource for this information.

Another important thing to note here is that, as with question one, preparation here really is key. Find out what meds you can take. Let your doctor know what your issues are, honestly. Also know what the risks are to both you and to your infant. It is also important to know the characteristics of the medicine you are prescribed, if you are prescribed one. Some meds may dry up your breastfeeding supply. Others make make you more annoyed than ever. It’s important to work with your doctors to find the approach which fits your philosophy the best. You are advocating for yourself AND for your infant here. Don’t be afraid to question things. Ask why. There is no line when you are protecting yourself and your infant. Question everything.

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2 thoughts on “Saturday Sundries 01.22.11: Stigma, Meds, Relapse, Pregnancy

  1. As always, you never cease to amaze me. Your never-ending ability to support and offer strength to others is overwhelming. I’m so glad to *know* you.

    On the BFing question, I would say the same re: talking to a doctor, but would also suggest Kellymom.com, which is a fantastic BFing resource website, this way the mom can have some info to bring TO her doctor when she brings up the topic of safe meds, weaning, etc. Also talking to an LC is a great idea, as well. Here’s a specific link: http://kellymom.com/health/index.html

    Personally – I have a copy of Karen Kleiman’s book and need to get into reading it. I got it some time ago and remember the first time I saw you suggest it, I was so thrilled that I had it and had your seal of approval! :) You rock, Mama.

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