On Not Wanting To


I’m tired, y’all.

I’m so damn tired of reading about women splashed across the front page because they’ve done something horrible to themselves or their children.

I’m tired of immediately wondering who let her down. I’m tired of wondering at what point did she fall through the cracks. I’m fed up, to be honest.

It happens way too often, these worst case scenarios splayed across the front page for all to read and shake their heads in disgust or sigh in exasperation because yet another mom has lost her mind.

I’m tired of this bullshit.

I get that drama sells and when it comes to sales or clicks, it’s all about the what will draw people in so OF COURSE LET’S SHARE A STORY ABOUT A MOM WHO FAILED.

Where the hell are the stories about the doctors who failed to screen? Where the hell are the stories about the partners who told these new moms to just suck it up? Where are the stories about their loved ones who didn’t show up to help them when they cried out for help? WHERE THE HELL ARE THESE STORIES?

It takes a damn village, people.

Our village is in peril. Our village? FELL THE FUCK APART AND NO ONE GIVES A DAMN.

In America, we have a pitiful excuse for maternity leave. We are bombarded by stories of celebs who gave birth and look AHMAZING in less than three weeks after giving birth. We are insanely comparing ourselves to women who are a) genetically blessed and b) have crazy access to things like trainers, nutritionists, nannies… and then there are the way we compare ourselves to each other. Stupid idiotic milestones of when we went back to work, how much we manage to get done every day, pushing ourselves to be better than the next mom and still have it all pulled together.

It’s no wonder we are screaming out for help and some of us are doing so through extreme measures.

There was a push for screening but it’s buried in the ACA and we know how well that’s been going with implementation, right?

Then there’s the complication of who will screen. Maternal mental health care crosses so many specialties it’s not even funny. OBGYN, midwives, doulas, Pediatrician, General Practitioner, Lactation Consultants….so who screens? Does the OB? The midwife? The doula? The Pediatrician? The GP? The IBCLC? WHO? Once they screen, what happens? Is the woman informed of her results? Is she successfully referred to the proper care? Is that care knowledgeable about Perinatal Mood Disorders? Will they dismiss her as an exhausted mom instead?

What about the potential physical issues which can masquerade as PPD? Like anemia, thyroid issues, vitamin D deficiencies, etc? Will those be ruled out before she’s put on medication? Or is the doctor just going to toss a script at her and leave her all alone on her skiff in the middle of a hurricane at sea?

Where is this information in childbirth classes? Why are we not informing new moms about this? Why are we not telling them that it can happen, dear caregivers? WHERE ARE YOU? WHY ARE YOU FAILING US? WHY ARE YOU GLOSSING OVER THE DANGER???

Wake up.

Women are dying.

Children are dying.

Families are being destroyed.

And you, you are sitting there claiming “It’s not my place.”

But it is.

Your move.

Get it right.

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Dear Abby downplays potential Antepartum depression


Yesterday, a letter to Dear Abby from a woman seven months pregnant received an alarming response. This mom-to-be states she never wanted to be pregnant. She goes on to share her inability to find any websites for women like her – only websites filled with women cooing over their bellies, etc. Her husband reacted negatively when she shared with him her emotions regarding the pregnancy. Mom-to-be is frustrated, doesn’t want to be pregnant, and flat out asks Dear Abby if there is something wrong with her.

Dear Abby responds:

“No, there’s nothing “wrong” with you. You’re just not particularly maternal.”

Um.

What?

Now, I realize all women are not maternal. It’s okay to not be maternal. However. There’s a difference between non-maternal and a mood disorder. There’s also great potential for this situation to not resolve itself without solid professional help.

To Abby’s credit, she does recommend the mom discuss her emotions with her OB to ensure she’s not suffering from pre-partum depression. But then she goes on to share something very alarming with this new mother. “When your baby arrives, I’m sure you will fall in love with him or her as many other women have.”

Sighs.

Oh Abby.

Not familiar with the research showing Ante-partum depression as a risk factor for Postpartum Mood Disorders?

What about the risk factor of unplanned pregnancies on Ante-partum and Postpartum Mood Disorders?

Not familiar with mothers who do NOT connect with their infants at birth or months afterward?

I’m all for providing hope. But to be unrealistic about it is downright irresponsible. Perhaps this mother will fall in love with her infant. But she may not. And now she, along with millions of other mothers in her situation who read this piece, are pinning their hopes on a potential unrealistic outcome which will only cause their guilt and shame to increase when they DON’T fall in love with their infants. No resources were provided. Nothing other than “Talk to your OB.” What if her OB is an idiot? What if he/she dismisses this mother’s concerns just as you have? This mother, and MILLIONS others like her are now left with only your words and those annoying cooing websites for cheery moms.

Postpartum Support International is a great place to turn to for support for Ante-partum depression. There are also several blogs with invaluable posts and insight into ante-partum depression. There’s also #PPDChat on Twitter for instant support regardless of where you’re at in your pregnancy or postpartum.

Thankfully, we’re talking more and more about this. Not nearly as much as we need to but it’s a burgeoning topic. Pregnancy does not always equal a glowing mama. Sometimes it equals a sad/anxious mama. It’s okay. You’re not alone. There is hope. There is help. If only Dear Abby had been responsible enough to provide some for this mom. Instead, she jots off a quick unresearched response which leaves her out in the cold.

Way to go, Abby. Way to go.

There is hope


In a lot of ways, telling the world about your battle with postpartum depression and anxiety or other forms of mental illness is what I’d imagine coming out feels like.

Raw.

Terrifying.

Liberating.

Being honest with the people closest to you (and not so close to you) about who you are on the inside and what you’re thinking?

Takes fortitude. Of the testicular variety.

May, as Katie pointed out, is Mental Health Awareness Month, and May 18th was designated as the day to blog for mental health. While the rally at my blog may be over and the month may be drawing to a close, the mission won’t be complete until the stigma is gone.

I’m humbled to be fighting this fight and championing this cause alongside some of the most courageous women (and the occasional man, too) I’ve had the pleasure of “meeting.”

I know that our work to end the stigma surrounding mental illness is likely an uphill battle. I know that we live in a world where people are quick to judge and slow to accept. I know.

And yet?

I believe in the power of people working together to make things happen. To make CHANGE happen.

I believe, as Mark Twain once said, that “the universal brotherhood of man is our most precious possession.”

That brotherhood, or sisterhood, or humankind-hood, is powerful. It is strong. It is brave. It is hope.

It matters.

You matter.

We are here for you.

If you’re reading this and you find yourself hurting and unsure of what the next step is, reach out. Reach out to your spouse or sibling or parent or friend. Reach out to an e-stranger friend who will listen.

There is hope.

There is always hope.

“Hope is the thing with feathers
That perches in the soul,
And sings the tune–without the words,
And never stops at all,

And sweetest in the gale is heard;
And sore must be the storm
That could abash the little bird
That kept so many warm.

I’ve heard it in the chillest land,
And on the strangest sea;
Yet, never, in extremity,
It asked a crumb of me.”

–Emily Dickinson

Just Talkin’ Tuesday: Unhappily Pregnant


Derniere ligne droite or Pregnancy Last Days

"Derniere ligne droite or Pregnancy Last Days" by f. clerc @ flickr.com

#PPDChat yesterday focused on Pregnancy and Depression. A lot of questions came up and I wanted to continue the conversation today. Welcome to Just Talkin’ Tuesday.

Have you ever tried to find a photo of a pregnant woman in which she is not smiling or glowing?

It’s HARD.

I found one, but it was not easy.

Everywhere you look there are glowing happy pregnant women. Here’s a page from a modeling agency dedicated to providing pregnant models. Every single last one of them is grinning.

Pregnancy, just as postpartum, is supposed to be one of the happiest times of a woman’s life. But what if your mood doesn’t match the one you are supposed to have? The one we are groomed to have? After all, even as young girls, many of us spent hours upon hours playing with baby dolls, fantasizing about having a baby of our own one day. I used to shove stuffed animals under my shirt and “give birth.” Oh, if only it were that easy!

No one mentions the natural mood swings. No one mentions that more women may become depressed during pregnancy than after pregnancy. No one tells us the anxiety pregnancy may rain down upon us. No one tells us the immense guilt waiting to consume us as we are overwhelmed and consumed with thoughts of suicide. No one tells us these things. Instead, we are continually bombarded with pictures of perfection, conflicting advice about everything from how to cope with morning sickness to how get rid of those annoying stretch marks to what to buy for our baby’s bedding to what diapers to buy to how to feed our children. Can you say Information Overload? It’s enough to get a mentally healthy mom super stressed at a time when she is supposed to be avoiding stress to begin with!

A pregnant mother’s depression may be triggered by a number of things. It may be an unexpected pregnancy, her partner or family may not be supportive, she may be experiencing unrelated stresses, she may already have children at home and the physical stress of a pregnancy may have her more than worn down, or she may already struggle with depression or another mental illness. Whatever the cause may be, it’s simply not expected for a mom to be anything but happy during a pregnancy.

So who should mom turn to? Where should she go? How can she tell the difference between pregnancy mood swings and something more serious? Mom can start with her doctor. If he dismisses her and she feels in her gut that something more than pregnancy hormones is causing her issues, she can (and should) seek a second opinion. Ask your original doctor or friends for a referral to another physician. She can also contact Postpartum Support International and speak with a Coordinator in her area who will help her locate a knowledgeable doctor or therapist. Telling the difference between mood swings and something more serious involves paying attention to your weeks rather than your days. If you have weeks filled with more down days, anxiety you just can’t kick, and nothing you do seems to bring you out of your funk, then it’s a very real possibility you may need to speak with a professional about how you’re feeling.

I found myself depressed during my second pregnancy. My first episode of postpartum was not treated. I believe this fed into my depression during my second pregnancy. I had not learned any coping methods or of the importance of taking care of myself. I drifted further and further into the darkness, swallowed whole by morning sickness (all-day sickness for me), the lack of desire to eat, take care of our 16 month old daughter, and no desire to take my prenatal vitamins because they triggered nausea. I even thought at one time what would happen if I didn’t  take my prenatal vitamins. Then my daughter was born nearly 5 weeks early with a cleft palate. Turns out there was nothing I could have done to keep her cleft palate from occurring as it forms within the first 4-6 weeks of pregnancy, well before many women are even aware they are pregnant. Still, I beat myself up about not taking my vitamins. I still do every now and then. But I now enjoy spending time with my daughter.

I also found myself depressed during the first 6 months of my third pregnancy. It was an unplanned pregnancy. I would go to every visit and wish they would not find a heartbeat. If the heartbeat wasn’t there, the baby wasn’t there and this pregnancy would just become a figment of my imagination. It hurts me to type that. As I would lie on the table waiting for the nurse to check the heartbeat with the doppler, I closed my eyes and prayed so hard she wouldn’t find it. Many times she had a hard time finding it and I would get excited. But then she would find it, pronounce it healthy and leave the room. I would cry as I stared blankly out the window, disappointed that once again, the baby had survived another month. I know this sounds horrible. I know it’s harsh and I know there are mothers who try very hard to have children or have angel babies. But there I sat, beyond words filled with heartbreak about this growing gift in my belly. I never talked to anyone about either depression. I wish I had. The difference between the two was that with my son, I was already on medication as I had suffered severe and debilitating Postpartum OCD after the birth of our second daughter (fed, I’m sure, by the depression I suffered during my pregnancy with her).  I was also in counseling. I found therapy very helpful in reframing things. And by the time this pregnancy was underway, I was also blogging here and getting started in Postpartum Advocacy. Things were looking very different indeed. I focused more on preparing for myself and caring for myself which then allowed me to take care of my family and the little one inside my belly. With my son, the fog eventually lifted and once I could feel him moving inside me, things began to look up. I realize I am fortunate the fog lifted. It didn’t magically lift though as it took a lot of hard work on my part and the help of professionals.

Please don’t struggle alone if you are pregnant and suspect you may be depressed. There is help. There is hope. Medication while pregnant is one of the biggest concerns for depressed moms. But there are medications you can take during pregnancy that have a minimal risk to mom and baby. Talk with your doctor about your options in this department.

Have you struggled through depression during pregnancy? Worried you might end up with depression during pregnancy because you’ve had a Postpartum Mood Disorder? Share your concerns, tips, and success stories here. When you comment, you’ll be entered to win a copy of Pregnant on Prozac by Shoshana Bennett. This is one of the best resources out there for mamas when it comes to pregnancy and mental illness. I happen to have an extra copy of the book here and want to pass it on to someone who could really use the information within it’s pages. This give away is not sponsored or endorsed by Shoshana Bennett, just something I’m wanting to give away to a mama in need. If you win the book and don’t need it for yourself, perhaps you could share it with your OB, Midwife, or Therapist so they could pass it on to someone who would find it helpful. All you have to do to enter is leave a comment by Monday, September 13 at 8pm EST. I’ll be choosing the winner that night via Random.org. For an extra entry, please Tweet about this post and then leave an additional comment with a link to your tweet. You can also receive an additional entry by subscribing to My Postpartum Voice via Email and leaving an additional comment telling me you’re subscribed (and if you’re already subscribed, that counts!)

So let’s get to talking about Pregnancy & Depression. It doesn’t deserve to live in the darkness any longer.

Just Talkin’ Tuesday 05.11.10: Postpartum invoke guilt? You are not alone


I know some of you are sucking air past your teeth through pursed lips right now, nodding your heads in agreement, rolling your eyes and possibly even muttering.

Really? She’s dragging THAT ghost up?

Yup. I sure am.

But why?

Because it’s important to face every facet of Postpartum head on – even the ugly parts.

Why is it so important? So those who are currently struggling KNOW that they’re not alone. So they KNOW that the emotions they’re feeling – while alien to them – are actually quite common among those of us who have struggled before them. The more we talk about our experience, the less victorious the stigma, fear, and guilt will be!

And let’s face it, GUILT is one of the uglier parts of Postpartum. It makes decisions we’re faced with during our Postpartum Mood Disorder even harder. No decision we make is a guilt-free decision.

Breastfeeding and having to medicate? Guilty. What is this doing to my baby? Should I be medicating and breastfeeding?

I had a c-section. Maybe I shouldn’t have had that done. Maybe that’s why I have postpartum. There’s that guilt again, sliding in through the door.

I had a vaginal birth but my c/s friends think I’m holier than thou now (even if I’m not) and won’t talk to me. HELLLLOOOOOO guilt.

I’m bottlefeeding because I can’t breastfeed or breastfeeding grosses me out or I was told to stop by my doc. Oh guilt? Won’t you PLEASE come in? Please?

My daughter/husband/others are judging me for my lack of parenting skills. I don’t know what the hell I’m doing. Fishbowl Guilt: The feeling of judgment from everyone!

I’m thinking about having another baby/I don’t want another baby. Guilty over lack/desire to become/not become a mom again. Especially when pressured by others to become a mom!

I struggled with Fishbowl guilt with my first daughter. I sucked as a mom. My husband told me all the time what a great mom I was and how amazing I was at taking care of our precious daughter. But I never believed him. Even my 7 day old daughter judged me. I had no idea how to relate to a newborn. I’d never done this and just like her, I was brand new at this relationship. I kept the blinds in our house closed all the time. I used the excuse of nursing but it was really to keep all the people outside from peering inside to witness my daily failures as a woman, a mother, and a wife. I had fallen and there was no way I was sharing THAT with the world.

With our second daughter, I pumped exclusively for 7 months so she could get breastmilk as she was born with a cleft palate. It finally came down to my mental health and my relationship with my first daughter and husband or breastmilk for my second daughter. I bought formula. Cried all the way there and all the way home. Managed to keep the tears down in the store but heaven help anyone who had decided to give me a speech about the superiority of breastmilk. I had a whole tirade planned. I even had to fight with WIC to provide Enfamil instead of Similac because they were under contract with Similac but my daughter couldn’t tolerate the stuff. I had to get a doctor’s prescription for plain old Enfamil in order to win that battle. And that meant I had to fight with my then idiot pediatrician because he couldn’t understand what the difference was between the two and almost refused to write the script. Thank goodness for a local IBCLC who gave me the free Enfamil sample she had in her office. She saved them just for me and that meant the world to me.

Our son was a champ nurser from the start. And then we had issues with a bad latch habit. Then there were the back to back to back cases of thrush. I even had to go on an anti-candida diet to finally kick it because our ped and the OB couldn’t get their treatment schedules lined up. I nursed my son for 6 months. During that time, I had some severe emotional trauma unrelated to PPD. It killed my supply. My son was diagnosed as Failure to Thrive at 6 months old. The NEW pediatrician wanted me to pump. HAH! I was so not going back down that road. After a very emotional day of contemplation, we opted for formula. Everyone in the family dove in and donated bottles, a warmer, and we were on our way. Cameron switched completely within the next day and we never looked back.

I did not have Postpartum with my son. Sure, I had issues crop up, but they were not related to the birth of my son. And I weathered them just fine.

I had finally learned to put my guilt up on a shelf and leave it there. I still get it down to dust it off occasionally but it’s never stayed down for very long.

The biggest lesson I learned from my Postpartum was to let go of my guilt. How did I do this? My angel of a therapist once said something to me in relation to a situation with which I was struggling. She told me that how others react to you is THEIR gig, not yours. Wow. HUGE. It really hit home with me and I practice it each and every day. I’m also a huge proponent of believing that as moms, we have to make the decision that’s the best for ourselves and our families. I respect that in others and in myself.

So let’s get to just talking.

Do you deal with guilt? What’s your biggest source of guilt as a mom who’s struggled with Postpartum? Have you put the guilt behind you? How’d you do that? Share your tips for guilt-free living as a mom. Are you still dealing with the guilt and think you shouldn’t be? Try giving yourself permission to be ok with your decision. It’s amazing how far permission will go if you give it a chance.

Breast Cancer, Diabetes screening worth it; Postpartum Depression screening not


Earlier this week, I wrote about UK researchers concluding that Postpartum Depression screening was just not cost effective.

Since then, a couple of other studies regarding screening for other conditions have been released.

It seems that screening for Diabetes in primary care qualifies as cost-effective.

And screening for Breast Cancer saves lives despite the habitual over-diagnosis. For every misdiagnosed case, two lives are saved. In fact, the researchers for this study state that approximately 6 women are misdiagnosed and undergo unnecessary treatment for cancer they may never have developed as a result of a false positive at the screening level. In case you were wondering, these researchers are UK based as well.

Hey. Wait.

The researchers from the UK cited over-diagnosis  as one of the reasons formal screening for Postpartum Depression was not cost effective.

And being misdiagnosed with Postpartum Depression does not lead to expensive radiation treatment or other damaging exposures including surgery. At very worst, you may receive a script for an anti-depressant or a referral to a counselor for some talk therapy.

What the….

So lemme get this straight.

Pumping a woman full of radiation and chemotherapy is hunky dory and cost effective EVEN if she doesn’t need it.

But a quick questionnaire to check on mom’s mental health is NOT?

On what planet does this even BEGIN to make sense??

Let’s also discuss this little nugget. For both the Diabetes and Breast Cancer studies, ACTUAL records were used. The Postpartum Study was compromised of 92 “hypothetical” cases.

When did we stop rating the study of actual records? When did researchers stop including the actual risks and ripples of Postpartum Depression? A woman without Postpartum Depression or who is successfully diagnosed, treated, and recovering is more likely to breastfeed in my opinion. And if she’s nursing, she’s protecting herself and her child from – guess what – Diabetes AND Cancer.

So you really want to practice cost-effective healthcare?

SCREEN women after birth. Ensure their stability, support, and positive outcome with life as a new mom. Encourage them to participate in health practices for themselves and their children. Enabling women to make healthier choices reduces the risk of other issues down the road. Screening saves lives when it comes to Postpartum Mood Disorders. It saves mothers, children, and families. It’s not something you skip over because it’s simply not “cost-effective.” Skip screening and cost will simply shift elsewhere – to diabetes care, cancer care, future mental health care for mom or kids, broken families, etc.

It is simply not acceptable to allow new mothers to continue to suffer. Not acceptable at all.

Adrienne Einarson responds to Vogue’s “Pregnant Pause”


On April 29, I posted a piece entitled Thoughts on exploring a “Pregnant PauseFocused on an article appearing in this month’s Vogue magazine, I methodically refuted and balanced the article’s bias against medicating with anti-depressants during pregnancy.

Yesterday morning I woke up to find an email notification regarding a new comment on the piece. The author? None other than Adrienne Einarson, one of the most dedicated researchers in the field of SSRI usage during the prenatal period. Adrienne currently serves as Coordinator for the International Reproductive Psychiatry group at Motherisk in Toronto. She has published several studies in her areas of interest which include psychiatry, nausea and vomiting of pregnancy, and alternative medicine. Her RN specialities include psychiatry and midwifery.

Adrienne’s comment deserves its own post. Her voice deserves to be heard. She states up front that she does not often comment or blog but that the bias of the Vogue article upset her so greatly she felt the need to speak out. This letter has been sent to Vogue but has not received any response as of yet. (I have also submitted my piece directly to Vogue but also have not received a response.) She has granted permission for me to share her letter directly with you.

“I do this because I care about women who have to go through this and if my research can help, I will continue doing it.” ~Adrienne Einarson~

Without further ado, I give you Adrienne Einarson’s response to Vogue’s “Pregnant Pause”:

I am writing to you on behalf of an international group of individuals who are involved with reproductive mental health, as either clinicians, researchers and in some cases both. We would like to voice our concerns regarding your recent piece entitled “Pregnant Pause,” which we felt, did not achieve a balanced perspective on this issue, which was surprising to us, coming as it did from such a highly esteemed publication as Vogue.

We appreciate that you decided to do a piece on this often controversial issue, which can make deciding whether or not to take an antidepressant when pregnant, an extremely complicated decision for both the patient and her health care provider. However, we were very disappointed by the extremely biased approach that you took when writing this article. First of all, the data that you quoted is not as recent as you stated, these studies were published in 2005/2006, they were preliminary and the results have not been confirmed in more recent published papers, which you brushed off as not being important.

It is unfortunate that the women you quoted in your piece, thought that they had a baby with a heart defect because they took Paxil® and are suffering unnecessary guilt because of it, as if women don’t have enough to feel guilty about already in these complicated times. You acknowledged that there are probably 250,000 pregnant women taking antidepressants in the US, and you must understand before you can make any conclusions, that 1-3% of all pregnancies involve a baby with a birth defect of some kind, whether a woman takes any medications or not and 1/100 babies are born with a heart defect. That is why, researchers who conduct the best quality studies, use a group of exposed women (taking an antidepressant) with a group of unexposed woman (not taking an antidepressant) and compare the rates of adverse events in both groups. The studies that were conducted in this fashion, did not find a difference in the rates of malformations between the groups, including heart defects with Paxil®. Bottom line, if you do the simple math, it is evident that a large number of women would have had a baby with a defect whether they took an antidepressant or not, including the women in your article.

Another disturbing theme that came up several times in the article, is that physicians hand out antidepressants like candy, and physicians in our group were most offended by this statement as they are very careful about prescribing antidepressants and would not give them to someone who not does not require treatment. Every decision is made with great care, all the while weighing the risks/benefits of antidepressant treatment, and especially with pregnant women, ultimately to ensure the best possible outcome for both the baby and the mother.

Finally, and I am sure this was not your intention, several of our group members who are psychiatrists have reported that their pregnant patients have decided to stop taking their antidepressant since they read your article and I will leave you with one example of the damage you may have caused by this highly biased and often inaccurate article.

After reading this article, a woman called her psychiatrist and informed her that she was not going to take her Prozac anymore. She had had no less than seven consultations with psychologists and psychiatrists and all had agreed that she needed to be on medication because of her severe depression and possibility of suicide and concern in the post-partum period. She had finally agreed to go on the medication and at 34 weeks she was doing very well and looking forward to the birth of her baby and then read your article…………

Adrienne Einarson, Coordinator, The International Reproductive Psychiatry group