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 by @ksluiter: and now my depression is affecting those not yet born…


Hi.

It’s me, Katie, from Sluiter Nation.

I have a problem.

I’m not pregnant.

Sigh.  Yes, this is a problem.

Let me back up the truck for those of you who don’t know my back story.

I have an almost-two-year-old son, Eddie. Three months before Eddie turned a year, I was diagnosed with postpartum depression and anxiety.

I have been fighting this damn disease ever since March of 2010.

The therapist I see and my general practitioner both agree that at this point?  Because I had a pre-existing anxiety disorder?  I can likely drop the “postpartum” part of the label.

I suffer from depression and anxiety.

And I am trying to get pregnant.

Also?  My husband suffers from extremely mild depression.

up until very recently we were both medicated.

Do you know how hard it is to conceive when both players are on drugs?  The med that my hubs was on?  Decreased sperm count and made it difficult to…um…finish.

You can’t get a baby without the finish, people.

My meds kill libido.

So let’s recap.  One of us doesn’t want it and the other can’t complete the task anyway.

And here we are…three months later…no baby.

Not surprising, but still frustrating.

So now the hubs is off his meds.  And he is all raring to go…all the time.

Yay for lots of baby making, right?

Wrong.

It’s still hard for me to want to.  I mean, I so want to.  I want another baby so bad it’s hard to be excited when others are blessed with little lives.  And I want to be close with my husband.

But…stupid medication.  stupid depression sucking the joy out of my sex life.  stupid anxiety about what my body looks like.

People keep telling me to relax.

How do I do that?    How do I enjoy sexy time more than only a couple times…a  month?  Because it’s going to take more than that for us to make a human.

I am so tired of this stupid depression and anxiety taking over every aspect of my life.

It stole so much precious time away from my son and my husband.  And now I feel like it’s taking time away from my not-yet-created baby.

Then & Now: Why I blog turns three


Three years ago and thirty nine or so weeks ago, I was driving home from my therapy appointment for the Postpartum Mood Disorder I struggled with after the birth of our second daughter. It was THE DAY. The trees were greener. The rain drops sparkled. The sun breaking through the grey clouds summed up my mood perfectly. My heart soared. My oldest daughter would soon be three years old. Our youngest had just turned one. I was heading out to a relative’s house for the weekend with my mom, my first weekend away from the kids in a very long… well, ever. The Sunday after that weekend, I would discover I was pregnant with our son. And would totally freak out.

I did not want to go back to that dark place. So I read. Intensely advocated and prepared. Began to blog as an outlet for myself and to help other women.

Little did I have any clue that my first post would lead me here.

To three years and thirty nine or so weeks later. Never did I have a clue that I would interview Karen Kleiman, the author of What Am I Thinking: Having a baby after Postpartum Depression, here on my blog. Her book was what inspired me to begin to blog in the first place as it urged moms facing subsequent pregnancies to reframe them. So I did.

I haven’t stopped yet a nor do I plan on stopping any time soon.

I am ever so grateful for my positive Postpartum experience after the birth of my son. After struggling so hard with the first two, I finally got to immerse myself in the bliss of motherhood. I smeared Vaseline on the lens of my life and it totally rocked. Having been through hell it was certainly even more cherished and certainly not taken for granted.

I remember losing myself in the sweet scent of new baby. I remember holding him close and feeling our hearts beat in sync with each other. I remember him nuzzling my neck as he cuddled closely after nursing. I also remember curling my toes in pain because nursing was rough with him. I remember Thrush. I remember cracked nipples. But mostly I remember all the good stuff.

And these days, he is the light of our lives. Our little boy is a joker, a prankster, a caring and concerned three year old who loves to kiss, hug, and watch Cars. He doesn’t snuggle nearly as much but that’s okay. He will sit down on the couch with his toy laptop and blog right along with Mommy & (now) Daddy.

I am ever so thankful for his presence in our lives. Ever so thankful for his laughter, his camaraderie, his energy, and his caring spirit. Even when things get challenging with him, it is hard for me to keep a straight face. Damn his adorable infectious cuteness.

Who knew that when God decided to bless us with our son, it would also birth in me such a strong advocate for women with Postpartum Mood Disorders?

Thank you, little buddy, for motivating Mommy to put herself out there for so many women. You have no idea how many lives you have helped touch. None.

C-Sections and Postpartum Depression: Is there a link?


When Theresa over at The Healthy Baby Network asked me to write an article about the potential link between Postpartum Mood Disorders and Cesarean Sections, I was excited as it was a new area of research for me. I started out with the expectation of finding a definitive link. However, I failed to locate just such a link. Many of the research studies swing toward or away from a link. And one review study lacks a conclusive result in either direction.

Why is this? Why is there no proven link when repeatedly I have heard from mother after mother who had a cesarean section of the emotional struggles she has faced after the birth of her child? Of the trauma, the disappointment, the disbelief that birth did not go quite the way it should have?

Go read the article I wrote for Theresa over at The Healthy Baby Network and chime in with your thoughts. We would love to hear them!

Six years ago


Six years ago today I began a journey at 1:15p.m.

I had no idea where I was going. No clue regarding the difficulty of the tasks ahead.

I could say it was the beginning of the fall. But I won’t. I don’t see it that way.

Six years ago, not only did I give birth to my first child, I unknowingly gave birth to a new me. I gave birth to a strong new woman who was about to be tested in ways she never thought possible. Ways that allowed me to grow in directions I never thought possible.

I am constantly amazed at my daughter’s intelligence, her impeccable sense of humor, and her compassion toward everyone around her. The girl would give you the shirt off her back if she thought it would help you. (I have NO idea where she gets all this compassion from. None! *wink*)

I’m thrilled to celebrate her birthday today. And truly the ultimate Survivor Mama Day for me. Because six years ago today is when the me today was born. And I am madly in love with both of us!