#PPDChat Topic 03.10.2014: Media Sensationalism & PPD


ppdchat-03-10-14

 

Join me tonight as we explore the issue of media sensationalism and PPD. So often, as I stated in my post “On Not Wanting To”, when a mom hurts herself or her children, we get the sensationalized version of it and the details of her journey to that point (and her journey after the event) are dramatized as well. I hope you’ll join me for a passionate and insightful chat into why this needs to change as well as why we owe it to ourselves and to society to reach out to every new mother dyad with care, compassion, and understanding.

We cannot let the village continue to fail.

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How the @BostonGlobe got Postpartum Depression Wrong


With more news stories mentioning Postpartum Depression these days, it is becoming painfully obvious that reporters are scrambling to get their facts straight. Bless them for trying but sometimes, even with the best of intentions, they fall short. Like Karen Weintraub’s article “When the ‘baby blues’ are something more” at the Boston Globe on October 21, 2013.

Karen defends herself in the comments (all two of them at time of writing) about the term “baby blues” by saying that in her researching for this piece, she discovered there is such a thing as baby blues:

Boston Globe Comments

Kudos to Ms. Weintraub for doing enough research to realize that baby blues ARE distinct from depression.

BUT.

There are a multitude of omissions and errors within the article as it stands right now. Let’s go through them:

Ms. Weintraub breaks the Perinatal Mood & Anxiety Disorder experience into only three groups:

  • Baby Blues
  • Postpartum Depression
  • Postpartum Psychosis

Immediately, sirens sound. Particularly because the case study, a Nicole Caligiuri, a first time mother, states she felt “angry and anxious” all the time. While anger/irritability is a sign of depression, anxiety combined with anger is typically (in my non-professional opinion) more closely related to an anxiety disorder. Ms. Caligiuri, however, was diagnosed with Postpartum Depression.

By ignoring the additional facets of the PMAD spectrum, Ms. Weintraub does a severe disservice to those mothers who may be suffering from Postpartum Anxiety, Postpartum Post-traumatic Stress Disorder, or Postpartum OCD.

Weintraub states that 50-85% of new mothers experience baby blues, 14% experience postpartum depression, and a “fraction of 1 percent of new moms” experience Postpartum Psychosis. If you go by those numbers (at the higher levels), nearly 100% of all new mothers experience one of these three phenomena and none experience Postpartum Anxiety, Postpartum Post-traumatic Stress Disorder, or Postpartum OCD.

According to Postpartum Support International’s Get the Facts page:

  • Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. Sometimes they experience anxiety alone, and sometimes they experience it in addition to depression. 
  • Postpartum Obsessive-Compulsive Disorder (OCD) is the most misunderstood and misdiagnosed of the perinatal disorders. It is estimated that as many as 3-5% of new mothers will experience these symptoms.
  • Approximately 1-6% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth.

But in Weintraub’s scenario, there isn’t room for the nearly 20-27% of women who develop these particular Perinatal Mood & Anxiety Disorders. As a survivor of Postpartum OCD, I find this troubling. Particularly because OCD can scare a new mother into thinking she is experiencing a form of Psychosis due to the horrific intrusive thoughts.

As I have mentioned multiple times, it is beyond important to differentiate the varying aspects of a Perinatal Mood & Anxiety Disorder. Why? Because when you lump Postpartum Psychosis sensationalism in with Postpartum Depression, things get murky. You scare new mothers who may be a bit depressed into thinking if they go get help, they will be thought of as potential criminals and have their babes ripped from their arms the instant they admit to feeling anything less than happy.

An additional issue with this article is the strong focus on early motherhood. The logic of this focus is evidenced by the study on which it is centered but a quick mention that PMAD can persist beyond early motherhood would have been a quick fix for this bias.

Why is it important to emphasize that PMAD onset can extend beyond early motherhood?

Often, many mothers do not realize they have issues until they are well into the 6th month or more. I have had mothers contact me at almost a year postpartum to share that they think something has been deeply wrong since the birth of their child but they did not recognize it until now. Many Perinatal Mood & Anxiety Disorders crop up within the first 2-3 months, often immediately after the period of baby blues, but some mothers do not recognize them or even get hit with them until much later. PMAD’s can crop up  within the first 12 months after birth and even then, may not be recognized until much later. But this information is not mentioned anywhere in the article nor are we ever told at what point Ms. Caligiuri sought help.

I deeply appreciate Ms. Weintraub’s effort to reach out to Dr. Katherine Wisner and Dr. Michael O’Hara, respected experts in the research field of Perinatal Mood & Anxiety Disorders, however, I wish she (or her editor) had taken the time to allow this article to be a bit more clear regarding the wide scope of Perinatal Mood & Anxiety Disorders. I also wish a side bar had been included to resources for women and families who are struggling with these issues, particularly given that Ms. Weintraub included this quote from Dr. O’Hara:

Social support is probably the most important thing to provide a new mother, who is at a particularly fragile point in life, said Michael O’Hara, a professor of psychology at the University of Iowa, who has been researching and treating postpartum depression for three decades.

 

Postpartum Support International will connect new mothers with social support. Also, specifically in Hadley, Massachusetts, there is Mother Woman, a fabulous organization who is making fantastic strides toward improving access to support and care for struggling women & families. Advocates in the trenches, such as the volunteers with PSI and Mother Woman, recognize how important it is to have peers support each other so they do not feel all alone in the dark. It is an oversight that neither of these organizations are mentioned anywhere in Ms. Weintraub’s piece.

Overall, Ms. Weintraub, despite making a few blunders, seems to handle the issue at hand with a respectable grace. The study at the heart of the article focuses on the development of depression in children born to mothers who struggled with depression but Ms. Weintraub is fabulous in her handling of this issue, particularly with this paragraph:

But parents shouldn’t feel like they’ve ruined their child’s life if they go through a period of depression, Pearson said. The increased risk of depression in their children is small. Overall, 7 percent of teens are depressed, compared with 11 percent of teens whose mothers were depressed early in their children’s lives.

She side-steps the potential onslaught of guilt and gracefully allows parents to breathe a sigh of relief by including this information from the study’s co-author.

As I stated in the opening, coverage of Perinatal Mood & Anxiety Disorders is greatly improving. But we still have a long way to go to get to fully informed reporting. For the most part, Ms. Weintraub’s article is generally free of sensationalism, includes quotes from respected experts, and manages to allay any potential guilt a new mother with a PMAD may feel in reading it. However, it is still just a few small adjustments away from being truly spectacular and informative.

Dear Sting, Postpartum Depression is No Joking Matter


Sting played a small venue in Chicago last night to promote ‘Last Ship’, according to this article written by Scott C. Morgan.

The article discusses the process Sting went through to bring ‘Last Ship’, a Broadway musical, to life.

Then at the end, is the kicker.

Though Sting is writing the score for “The Last Ship,” he won’t be appearing in the show. So Seller asked the singer how it will be for him to see other people performing his songs onstage.

 

“I imagine I’m going to have postpartum depression,” Sting joked.

 

Oh, Sting.

I have been a fan since I was a pre-teen and had to sneak off at my grandmother’s house to watch videos on MTV. Yanno, back when MTV actually showed videos.

You’ve been a source of solace for me in my dark times. I used one of your songs in a playlist of mine as I healed from my own bout of severe Postpartum OCD. The rhythm was just right and I liked the emotion it evoked within me.

But now?

I can’t do that.

Because you’ve said this.

In eight words, you have managed to completely undermine the seriousness of what I experienced. What millions of women experience every year. In eight words.

Do you see how easy it is to marginalize someone else’s experience? How easy it is to compare the hell that is a Perinatal Mood Disorder by saying you’ll go through the same thing as you watch other people perform your songs? While it may not be easy to see other people perform your art, I guarantee you that it is a hell of a lot easier than the depths of hell I and millions of other women witness as survivors and warriors in the trenches against PMADs.

We fight, Sting, for our fields of gold, fragile as we are. We fight because maybe, just maybe, tomorrow we’ll see a brand new day filled with hope. We don’t want to be the shadows in the rain, never coming home.

Please, think about what you are saying before you say it. Because when you do not think before you speak, you end up hurting people, minimizing their experiences, and comparing their hell to something which is not even close to their experience.

For now, I am gonna have to do the opposite of Rick Astley and give you up because you let me down.

Sticks and Stones Will Break My Bones But Words….


I started this post the other day after a comment was left on a post I promoted on Facebook. Then I had to walk away because I started down a path I did not want to go down. This was a difficult post for me to write as it forces me to revisit a meeting which left me both enraged and shaken. I’ve calmed down quite a bit and the following is a much more polite response than the one I started the other day.

The post is a wonderful interview of Dr. Katherine Wisner by Walker Karraa. The interview, found here, focuses on Postpartum Mood Disorders, of course, but also addresses the challenge and controversy of screening mothers for the presence of Postpartum Mood Disorders.

Screening is a hot topic and has been for quite awhile. There are a lot of unknowns regarding when to screen, how to screen, what happens after a positive screen, liability for care of the patient, when to refer, etc. Bottom line, I feel, is that we need to screen in order to start the dialogue about Postpartum Mood Disorders with care providers in every field that comes in contact with both expecting and new mamas. We also need to work more diligently to create supportive nets of care for women in our communities – coalitions of OB’s, Midwives, Pediatricians, IBCLC’s, Psychiatrists, Psychologists, therapists, doulas, and other various caregivers for pregnant women and young children. It needs to be comprehensive.

Those of us who advocate for the care and support of families battling Postpartum Mood Disorders must be well-versed in all things relating to pregnancy and postpartum. Our scope of knowledge must include a basic grasp on the rights of the expectant woman and as a new mothers. This is in addition to the psychiatric knowledge we also hold and are constantly researching in order to better arm new and expectant mothers.

It is exhausting sometimes, to read all of this information. I myself have suffered from information overload. But, empowering new and expectant mothers to make healthy and better decisions for their care and therefore for their families, is what I have been called to do so read I must.

In the past couple of years I haven’t been reading as much, I’ll admit, but prior to that, I read voraciously. I dove into all things birth related. So when there was a chance to go see Henci Goer at a local get together on August 26, 2010, I went.

Henci, a well-known author and advocate for Lamaze birth and healthier women-empowered births, was someone I admired.

Until the night I met her and discussed my experiences which led to my own advocacy with her.

Henci, after discussing at length, her new project, completely shot down my experience with a very dismissive sentence, the gist of which was left in a comment at Karraa’s interview with Dr. Katherine Wisner I referenced above.

Here was a woman, who seemingly was all about empowering women and improving their birth experiences, failing to even acknowledge the difficulties I experienced after my own. I didn’t experience Postpartum Depression, according to Goer, my experiences were directly related to my birthing experience and therefore weren’t my fault but that of the system’s.

While I agree there are far too many interventions in the modern birthing realm for many mothers and it’s sad that organizations like Solace for Mothers even have to exist, to shoot down the experience of another and how she has worked through it in one dismissive sentence is almost as bad as what my first OB did to me.

PTSD QuoteTrauma is about perception. It’s not about what happened to you, it’s about how you perceive what happened to you. This perception is shaded by our own personal experiences and baggage. These experiences and this baggage also directly affects how we process our experience after our brush with trauma.

No one has the right to question a woman’s perception of her birth experience.

No one has the right to re-frame her experience FOR her. It is hers and hers alone to process. It is hers to share as she feels necessary, with whatever details she deems necessary.

The comment Henci left on Karraa’s interview with Dr. Wisner reads as follows:

I am extremely concerned that the focus on screening for postpartum depression using an instrument solely designed for this purpose will miss diagnosis of childbirth-related post-traumatic stress symptoms and full-blown PTSD altogether or will mislabel women experiencing post-traumatic distress as depressed. PTSD symptoms are fairly common–as New Mothers Speak Out found, 18% of women were experiencing symptoms and 9% met the diagnostic criteria for PTSD–and while some symptoms overlap with depression, the treatment differs.

Furthermore, on-site mental health services would be of little use to women suffering from childbirth-related emotional trauma because one of the prime protective responses is avoidance of environments and personnel that re-trigger traumatic memories.

I have as well a philosophical issue with making depression the preeminent postpartum mood disorder. Depression centers the problem in the woman, and therefore the cure is centered in her as well. PTSD, however, is centered in the system, and therefore its cure depends on systemic reforms. The incidence of emotional trauma can be minimized by reducing the overuse of cesarean surgery and other painful and invasive treatments, by implementing shared decision-making, and by providing physically and emotionally supportive care. So long as postpartum mood disorders are primarily seen as an issue of depression, little or no attention will be paid to the all too common glaring deficiencies of medical model management in this respect.

I have several issues with Henci’s comment.

She seemingly assumes that the Postpartum Mood Disorder community is unaware of the difference between Postpartum Depression and Postpartum Post-traumatic Traumatic Stress Disorder. I can assure her that we are indeed not unaware. Most providers and advocates I know work diligently to go beyond the EPDS to dig deeper for possible birth trauma. The EPDS, while yes, not designed to pick up specifically on PTSD, is a starting point for a conversation about emotional issues during the perinatal period. Henci’s issue with this illustrates exactly why we work to educate providers about the many aspects of Postpartum Mood and Anxiety Disorders.

The discussion with a mother who had a traumatic birth experience is wildly different than with one who did not. Not all mothers who experience a Postpartum Mood Disorder necessarily experience PPTSD. Nor are their issues rooted in an issue with the so-called system. May I remind you, Henci, that PMD’s have existed since the time of Hippocrates. It is not some new fangled “too-many interventions” kind of disorder.

Not all of us are not “victims” at the hand of the system as you would have us believe, Ms. Goer. I’ve held discussions with mothers who had home births or natural births in a birthing center and still gone on to experience a Postpartum Mood Disorder. While it’s certainly not as common and there is a seeming correlation to interventions during the birth experience, there simply isn’t enough evidence to claim interventions (particularly cesarean sections) are the definitive root of all Postpartum Mood & Anxiety Disorders as Henci claims in her comment. (See article “Is there a link between C-sections and Postpartum Mood Disorders?)

We, the advocates for care and empowerment of women who do experience emotional trauma during and after birth, are working diligently to bring to light the additional issues on the Postpartum Spectrum such as Postpartum Post-Traumatic Stress Disorder, Postpartum Obsessive Compulsive Disorder, Postpartum Anxiety, and others. We no longer focus solely on depression. If we do, it is only because Postpartum Depression has been used as a catch-all phrase for so very long.

In the past six years I have been blogging, the term has graduated from Postpartum Depression to Postpartum Mood Disorders to Perinatal Mood Disorders to Postpartum Mood and Anxiety Disorders. In fact, I’m often at a loss as to which one to use. Postpartum Mood and Anxiety Disorders covers it most thoroughly, I believe.

There are researchers who focus on nothing but birth trauma and Post-Traumatic Stress Disorders – such as Cheryl Tatano Beck. I had the pleasure of meeting Cheryl at the 2010 PSI Conference in Pittsburgh. That meeting was so much different than my meeting with Henci. Cheryl was warm, accepting, and thanked me for my work in bringing my experience to light and fighting for others who had been through the same thing.

I do not hide that my first birth was a rough one. I know there are other mothers out there who had even more horrific experiences. But I talk about it because negative birth experiences do happen. I talk about it so that other women will read it, and know that it’s okay to talk about their experiences. If I simply dismissed the experiences of all the women who reached out to me, well, I’d be doing a huge disservice to the community around me. To women in general. In essence, I’d be traumatizing them even further.

With wisdom and knowledge comes power. With that power, comes great responsibility. I hold that responsibility as if it were a fragile ball of glass. My goal is to keep it from shattering. My goal is to create a safe and soft space for it as it grows stronger.

If only Henci Goer saw the birthing world the same way.

Guest Post for Mental Illness Awareness Week – @MotherUnadorned – You are NOT a Bad Mom


I cannot simply tell you how much I adore and admire Cristi’s drive to speak up about mental illness. The woman is fearless and is always speaking up or doing something to bring awareness to mental health, suicide awareness in particular. I’m honoured to have her posting here at the blog for Mental Illness Awareness Week. Without further ado, I present Cristi’s amazing post. Read. Take to heart. Share. You are not alone.

 

You are NOT a Bad Mom.

The other day I posted on Twitter:
“Sometimes I wonder what others think of me because of my #mentalillness and then I remember I really don’t care. #stigma is stupid.”

Truth is, most of the time I honestly don’t care if others have an unfair opinion of me because of my mental illness. But that is a truth for me born from living with and learning to accept that my mental illness is just that, a REAL illness like any other medical condition. Others’ opinions and stigma are born from ignorance.

It’s not my fault.
It’s not a weakness.
And it needs real medical treatment.

But I know that for many who are blindsided with postpartum depression, OCD, anxiety or psychosis, it’s not that easy to brush off the stigma. Especially when you’ve never experienced mental health issues.

You probably don’t understand what’s happening.
Maybe right now, today, you’re feeling like a bad mother.
Maybe you even feel like a bad person because you’re having “intrusive thoughts” of running away from your family or hurting yourself or your child*.

I want to tell you.
You are NOT a bad mother.
Your thoughts and feelings DON’T make you a bad person.
And, you are NOT alone.
You just need a doctor to treat your medical condition.

I’ve been there myself after the birth of my 2nd child. I felt hopeless and wanted to run away as my 2 year old’s relentless jealousy surfaced. I felt like I couldn’t handle my life, my kids, my home or myself.

It was all falling apart.
I was falling apart.

But I asked for help because I knew I needed professional treatment.

And so do you, right now, if you’re struggling.

You need REAL medical treatment for this often temporary, but very real illness that affects so many women (and even men on occasion.)

I am going to say it again.
You are NOT a bad mother.
You are NOT a bad person.
You are NOT alone.

So many moms have been where you are right now and WE are here with open hearts and open arms to help you find your way. There’s no stigma with us. Just love and support and help.

If you’re here reading Lauren’s blog you probably already know about the beautiful gift of #PPDChat on Twitter and #PPDChat Support on Facebook. If you don’t, I encourage you to check them out. Social media can offer such an amazing support when we feel alone, at home, and haven’t yet been able ask for help in person.

I also encourage you to visit Postpartum Progress for loads of information and resources for perinatal and postpartum mood disorders.

If you’re struggling or in crisis, the Lifeline hotline number 800-273-TALK is always available to you. And Befrienders.org offers a list of hotline numbers worldwide.

There are so many women who have been where you are today and have made it through.

There IS a happy ending with the right help. I promise you.

This is your health, your child, your family, your life. You all deserve the happy ending. And stigma really truly is stupid. Please don’t let it hold you back from finding yourself again.

You are NOT a bad mom.
You are NOT a bad person.

You are LOVED.
You are BEAUTIFUL.
And, you are NOT alone.

Cristi Comes
Wife. Mom. Me. Advocate for mental health & suicide prevention. Attachment parent. Survivor of mental illness & PPD. Jewelry designer. Motherhood Unadorned Blog is motherhood naked, plain & uncensored. On Twitter @MotherUnadorned, on Facebook at Motherhood Unadorned

*If you are having such intrusive thoughts, please contact your doctor immediately.

 

Postpartum Health Activist Writer’s Monthly Challenge 2012


Hey y’all!

Over at WEGO Health, April is their Health Activist Writer’s Month. They host a 30 day writer’s challenge to go along with this month. When you sign up, you’ll get prompts via email for 30 days. If I remember correctly from last year, they do send them out in advance so you’re not scrambling to write posts at the last minute.

I will be writing a post a day for all 30 days. I hope you’ll join me in writing every day about health. It’s going to be a lot of fun and I’d love to see what you have to say about each of the topics, too. Of course, I’ll be spinning the topics to relate to Postpartum Mood Disorders. I really hope you’ll jump in here with me!

All you have to do to join is click the banner below to sign up and you’ll be able to start posting once April rolls around.

Looking forward to writing with you! Let’s make sure Postpartum Mood Disorders are well-represented!

Giving up BACON for Mothers & Babies


Bacon Sacrifice Campaign for Postpartum Progress

To donate via credit card:

DonateNow

To donate via paypal, click on over to Postpartum Progress.