Guest Post: The Most Common Complication of Childbirth by Dr. Jessica Zucker, Ph.D.


Perinatal mood disorders have been called the most common complication associated with childbirth. Mood struggles during the postpartum period run rampant but are consistently quieted by our culture’s focus on the overly idealized “glowing” new mother. Though many women gracefully transition into mothering, many others feel they are riding an emotional, hormonal, and physiological roller coaster- with no seat belt and no way to control the speed. With the glaring statistic of 15-20 % of mothers developing postpartum depression (not to mention all of the other perinatal mood disorders), it seems imperative that this public health crisis be addressed systematically and globally.

Perinatal and Postpartum Mood Disorder Statistics

Roughly 10-20% of pregnant women experience depression

One-half to three-quarters of all new mothers are affected by baby blues

Approximately 15-20% of all mothers will develop postnatal depression

Approximately 2-5% of new mothers develop obsessive-compulsive disorder

About 10% of postpartum women are impacted by panic disorder

1-2% of post-delivery women experience postpartum mood disorders with psychotic features (30-50% of women have suffered a postpartum depression or psychotic episode in a prior pregnancy)

Approximately 10% of men are affected by postpartum mood disorders

Postnatal mental disorders can be incredibly detrimental for infant development and attachment formation. “By 6 months, the infant exposed to a mother’s negative affect learns to extrapolate using that behavior with others. By ten months, the emotional responsivity of infants of depressed mothers is already organized differently from that of normal infants.” Determining primary, secondary, and tertiary preventive approaches to perinatal mood disorders will increase the likelihood of generations of healthy baby-mother attachments.

How do we make burgeoning families more of a healthcare priority? Who routinely has the opportunity to discuss maternal psychological and physical transitions with pregnant and parenting mothers? Through the dissemination of maternal mental health information, preventive education, employing diagnostic screenings, and providing additional supportive resources to women and families, the silence and shame that infiltrate postpartum mood disorders may begin to dissipate. Ideally situated, obstetricians and midwives (among other healthcare practitioners) and their unique relationships with pregnant and parenting women, can provide a way to thoughtfully prevent and carefully identify perinatal mood disorders. Here are some initial thoughts on the impact healthcare providers can have on the lives of pregnant and parenting families with the aim of precluding postpartum mood disorders.

Eight Ways the Obstetrician and/or Midwife Can Make Strides Toward Better Serving Pregnant Women and their Burgeoning Families

1. The obstetrician/midwife should be aware of the potential affects of antenatal mood disorders and maternal stress on fetal development and birth outcomes. Getting appropriate training in postpartum mood disorders will allow families to feel safer in their care.

2. Knowledge of the latest research about the efficacy and safety of psychotropic medications during pregnancy and lactation can facilitate authentic discussions about the risks and benefits if medication is indicated.

3. The obstetrician/midwife has countless opportunities throughout pregnancy and at the postpartum visit to talk with patients and their partners about the various risk factors that contribute to postpartum mood disorders, signs to be concerned about, and available local resources. These discussions can be woven seamlessly into routine appointments and allow the patient to feel more deeply understood. Research states that postpartum mood disorder prognoses are best when identified and addressed immediately.

4. Understandably, many women feel confused and conflicted by feelings of maternal ambivalence or outright unhappiness. The obstetrician/midwife can help normalize various feeling states as well as educate patients about perinatal mood issues and possible treatment options. Addressing psychosocial issues increases trust and patient satisfaction.

5. If women with mood disorders are identified at the initial prenatal visit, a consultation with a psychiatrist needs to become part of their care. Women who have experienced previous postpartum mood disorders are at increased risk for reoccurrence.

6. The American College of Obstetricians and Gynecologists (ACOG) recommends a timely screening method- asking the following questions:

(a) Over the past 2 weeks, have you ever felt down, depressed, or hopeless?

(b) Over the past 2 weeks, have you felt little interest or pleasure in doing things?

These simple questions may provide a springboard for exploring mood related concerns and becomes a way to check in about potential psychosocial issues at each prenatal visit.

7. Pregnant and parenting women should feel that all of their physical and psychological concerns are valid and have a place within the patient-doctor/midwife relationship. Fostering an intimate environment through relational sensitivity and candor may increase the likelihood that women will not suffer in silence.

8 . Obstetrician’s and midwives would benefit patients by routinely providing perinatal mood disorder literature as well as local and national therapeutic resources to women and their families.

Sources:

Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (2008) edited by Susan Dowd Stone and Alexis E. Menkins

The Pregnancy and Postpartum Anxiety Workbook (2009) by Pamela Wiegartz

Dr. Jessica Zucker is a psychotherapist in Los Angeles specializing in women’s health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and early parent-child attachment and bonding. Earning a Master’s degree at New York University in Public Health with a focus on international reproductive issues led to working for the Harvard School of Public Health. After years of international public health work, Dr. Zucker pursued a Master’s degree in Psychology and Human Development at Harvard University with the aim of shifting her work from a global perspective to a more interpersonal focus. Dr. Zucker’s research and writing about various aspects of female identity development and women’s health came to fruition in her award-winning dissertation while completing her Ph.D. in Clinical Psychology. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). For more information: http://www.drjessicazucker.com

Just Talking Tuesday: Depression, Super Glue, and Bonding


All too often we are shown over and over and over again those scenes in movies where a mother, who has just given birth, lies in bed in beautiful nightgown complete with a bed jacket. Her hair is perfectly coiffed as she is handed her baby. She instantly knows how to hold this perfectly quiet and peaceful infant. Her face softens as she oooohs and ahhhs as the camera goes all vaseline and fuzzy while sappy music swells in the background.

I don’t know how your births went, but mine were nothing like that. My hair was everything but perfectly coifed, I was wearing a frumpy hospital gown, and I had no clue what to do with this squirming thing now in my arms who was screaming at me like some sort of pissed off Banshee. The second time around, I knew what to do with the little one but she could not cooperate because she was physically unable to do so. The third time around went much much better despite the persistent lack of perfectly coiffed hair and no sappy music.

No one tells new mothers at their baby showers just how hard birth and those first few weeks will be on us. It’s all fun and games, cute frilly or frocky clothes in blue, pink, or some other pastel. Even if we do know what to expect, depression can still slam into us after birth. It is not something we choose. Not something we can turn off at the drop of a hat or just because you want us to be happy again. It takes time to heal.

One of the biggest things depression or a mood disorder affects is a mother’s ability to bond with her infant. The best way to describe this feeling to someone who did not have a problem bonding with their infant is this:

Let’s say you hate cats. You don’t know why but you do. You visit a home with a cat. Said cat decides that YOU are a brand new BFF and relies on you for everything. Meows at you constantly, purrs, wraps itself around your legs, curls up on your lap, and wants you to pet it every second you are there. This interferes with your ability to have an adult conversation with the friend you came to visit. Suddenly your thoughts are sliced in half, then in quarters. You’re distracted, frustrated, your blood pressure rises, you may even begin to itch or manifest physical symptoms as you try to detangle yourself from the cat.

The difference between someone who hates cats and a mom who is depressed and doesn’t bond with her child is that somewhere, deep inside, that woman LOVES her child. She does. Even if she is not showing it, she does. She wants to bond to that child and is desperate to try anything.

Motherhood is something we add to our sense of selves though, not something which should overtake our sense of self. We should not superglue the baby to ourselves and miss out on life because we are a Mother. There needs to be a balance, a sense of old and new. It is a hard line to walk. A hard line to find. An almost invisible line to find if you are a mother with a Postpartum Mood & Anxiety Disorder. But it’s there. You just have to be patient and wait for it to slowly reveal itself.

I struggled with bonding with our first two daughters. Our first because I had not a clue what to do with her, even apologized to her at 7 days old because I did not know how to talk to her. Our second because she was physically separated from me at less than 24 hours old and sent to a NICU in another city over an hour away. I would later find myself wailing that I wanted to leave her at the hospital. We did not bond until she was nearly three years old and back at the same hospital in which she spent time in the NICU.

I bonded well with my third though but I did not struggle with Postpartum OCD or Depression that time around. We had all the warm fuzzies and after a few weeks if you listened closely enough, you could hear sappy music in the background.

I know my issues with depression and OCD interfered in my ability to bond with my babies. But today, I try so hard not too look back and be sad. Instead I try my best to bond in the here and now because that’s what matters. I cannot change the past. I can only work to improve the present and make the future even better. (Believe me, it’s taken me almost 6 years to be able to say that!)

Did your PMAD affect your bonding? How? What was your experience?

Let’s get to just talking.

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Is PPD a series of mini-episodes or thoughts vs. something major: A reader makes an important point


Yesterday, I posted this piece regarding a DM I received at Twitter. Tonight I received this response which includes some excellent points. I wanted it to have more than just an afternoon meandering about. So here it is- in all it’s bloggy goodness. Thanks for commenting!

I so much appreciate your honesty here, Lauren. And, of course, am always so glad to know that you are out there sharing your important journey with other moms who are struggling or who have struggled.

I am going to make a point that, please know, comes with a huge amount of respect. It is more of an observation and a request to look at this question with another perspective than anything else.

The title to this post is “Is PPD a series of mini-episodes or thoughts vs. something major?”- I imagine that the woman who wrote this might be wondering if she could possibly have PPD- because for her, this is characterized by a series of on again off again thoughts or feelings that come and go and come back again, You know the situation I am sure: mom feels awful and confused by her thoughts and then for a day or two feels better. So she doesn’t reach out And then, again, WHAM, she feels awful again.. for a few days, and so she thinks she will seek out help. But then, ahhh.. a few days of feeling much better so, again, she holds back. And on and on. This mom thinks she must not have PPD because hers is not a knock-down -lights out situation. And so it takes her months and months to get the help that she actually needs.
I see this over and over in my psychotherapy practice when moms come in, finally and exhausted, at about 8 months postpartum when they have been feeling this way for a longer time than they needed to.

I appreciate your last few paragraphs about how everyone’s experience is unique, and so I think this is what I am trying to highlight in my comments. PPMDs come in all shapes and sizes and on a spectrum from mild to severe.
Your last paragraph is a set of questions to moms out there and it reads “is your PPMD JUST a series of thoughts?”

I would ask that we all make sure that we acknowledge that no PPMD is a “just” anything… No matter what someone’s challenge is, it can be pretty darn ugly for them.

with respect and admiration,
Kate Kripke, LCSW

Dear Kate,

Thank you so very much for commenting and bringing to light such invaluable points regarding Postpartum Mood Disorders. They are indeed unique to each woman. It is true that just because a woman hasn’t been knocked flat off her feet she can’t struggle with a PMD. Just as clothes, PMD’s really do come in all shapes and sizes and they come in every season too – no mom deserves to have her experience with Postpartum Mood Disorders dismissed as you’re completely right – no one deserves to have their experience termed as “just” something. The word “just” is dismissive for me.

I chose to blog about this question because it legitimately intrigues me. The writer was asking a question about PMD’s in a way I had never considered them before. Honestly, I think it was the word “just” that drew me in to the question at hand. No mother should ever have to decide if her experience is “just” this or “just” that. It IS what it IS and that is what she will heal from as the days go on and the sun continues to rise on the new days ahead for her. No mother should ever have to worry about someone pointing the finger at her and telling her that it’s “just” a series of thoughts or “just” a series of episodes. And even if it is thoughts or episodes for her – they should ALWAYS be considered and handled as if they were a serious knock-down case of PMD’s. Each and every mother deserves our support regardless of where she may be on the “spectrum.” In fact, regardless of where she is on the spectrum, our compassion for her should remain in the same place. High.

Thank you again for your comment and for taking the time to point out some very invaluable information.

Warmest,

Lauren Hale


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Postpartum Voice of the week: Sue of @SueandFadra at Lives Less Ordinary


As I was clicking through all the Postpartum blog posts from this past week, one stood out.

The sheer honesty, power, intensity, and raw emotion of the writing leapt off the screen at me. I found myself nodding my head several times, connecting with her story. It is a rare thing to find a writer who not only opens up about her experience with mental illness but does so in such a way that she captivates you, drawing you in until it is just you and her words.

You can find her story here.

Sue’s story really started to speak to me when she mentioned her issues with her pelvis. I had similar issues with all three of my pregnancies. It was never as severe as hers but lemme tell you, when your body produces entirely too much relaxin and your hips can barely keep themselves together to keep the baby in, the pain is excruciating. During my first pregnancy, I could barely put on underwear or shoes without weeping from the intense pain. Turning over in bed? Out of the question. I prayed I wouldn’t have to pee in the middle of the night. We had to get a tempurpedic mattress topper just to make it tolerable. And sleeping on my side (ie, on my HIPS/Pelvis) made things worse. My first OB, classic knowledgeable God that he was, simply told me “Welcome to pregnancy.” Sorry dude, but normal pregnancy should not have you in tears as you get dressed. I ended up on self-commanded bed rest the last two months of my first pregnancy because walking around hurt too much. I stayed propped up on the couch with a vibrating heating pad most days and watched TV. It sucked.

My second pregnancy began to head the same way at four months along. New OB this time – I got PT, which helped. Third pregnancy, symptoms showed up at three months. I got water therapy and it? Was a lifesaver. I ended up agreeing to getting induced at 38 weeks because by that time, baby was so low and weighing so heavily on my weary pelvis that I could again barely walk.

Often times, doctors here in the US are misguidedly unaware of this rare pelvic disorder and brush it off as “normal” pregnancy pain/adjustment. But it’s not. And it can disable you for life if handled incorrectly, especially if you have a vaginal delivery and are suffering from a severe case of it as Sue found herself. For most, the pelvic pain does fade after birth but many women struggle with pelvis issues for life. I could feel my pelvis shift in and out of joint after my second pregnancy, especially when driving my car. It was worse after my second delivery. I can still pop it in and out of joint. But lemme tell you, it hurts like the dickens if it’s out. Oh, the burning, the aching… it’s enough to make me want to take a tranquilizer. I am doing much better these days as I’ve been faithful with doing yoga each and every morning. But the issues caused by pregnancy and relaxin will haunt my pelvis for life, I fear. It’s a large part of why I will never get pregnant again. I don’t think my pelvis could handle another pregnancy. Physically and mentally, I am done.

Enough about me though, let’s get back to Sue. This is, after all, her award post! (I apologize for the digression, it’s just so rare to read about someone else who went through similar pelvic issues during pregnancy!)

Sue’s post is entitled “My Voice, My Depression” and with those words, she owns her Depression instead of the other way around. Sue takes back the power which Depression can hold over so many of us.

My favorite passage:

I am desperately trying to get past this time in my life, but I know it will take some time. I have acquired the amazing talent of hiding all of what I have said above from the rest of the word. If you see me on the street you would think nothing but, there goes funny, upbeat Sue. While underneath I an working, fighting and choosing a happier path than I have had the last few years.

These days are hard because I am trying my best to work though them. Emotional work is extremely difficult. It consumes you and can bring your life to a screeching halt.

Sue is in the middle of her Postpartum experience, still struggling, still fighting to escape the fog and the darkness. And yet she has written with such clarity about the journey she is currently experiencing. For that, she is The Postpartum Voice of the Week.

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