Postpartum Voice of the Week: Meds, Placentophagia, and Mamas! Oh My!

To take meds or not to take meds. THAT is the question so many moms with a Perinatal Mood Disorder face with a heavy heart. I hope it is a decision you take seriously, educating yourself about the risks, the benefits, talking with your doctor before changing a dosage level if you do decide to take medicine, and involving your pediatrician as well if you are nursing and decide to take medicine. Pharmacological treatment of a Postpartum Mood Disorder should involve a team of professionals – and the most important person on that team is YOU.

Stacey over at Maternal Ramblings wrote a wonderful post simply entitled “PPD” in which she opens up from a mom’s point of view about a severe case of PPD that led her to take medicine. She didn’t want to take medicine at first as she feared it would control her life. Stacey came to realize that a good day on meds was better than a bad day without. She’s enjoying feeling normal again and looks forward to the day when she won’t need the medicine anymore.

Kate Kripke, a fellow Postpartum Support International Coordinator in Colorado, wrote a great post from a professional standpoint entitled “What if I have PPD and I don’t want to take meds?” It’s well worth the read as she offers some invaluable insight when it comes to alternative or complementary approaches.

Ruta Nonacs, MD, Ph.D over at the Massachusetts General Hospital Center for Women’s Health offers a Quick Review of Non-Pharmacologic Options  for the Treatment of Antenatal Depression. Understandably, a pregnant mother may want to avoid meds on a personal level even more so than a postpartum mother. Ruta quickly sums up several options but does caution that all of the studies associated with these methods only reviewed their effectiveness with mild to moderate depression. If you have severe depression, these options may not work for you. Remember, your health and mood is paramount. Depression crosses that placenta too.

Finally, Kate Kripke also offers a great piece on Placentophagia. If you are not quite sure what that is, it’s the ingestion of the placenta after birth. Many mothers have begun to encapsulate this after birth. To read more about a mom who did just that and how she did it, a great post is offered up by Emma Kwasnica, a passionate natural birth advocate in Canada. (There ARE pictures.) If a mom wants to ingest her placenta after birth, I feel she has the right to do so. Where I run into a problem is with the promotion of Placentophagia as a prevention for PPD. As laid out by Pec Indman as part of Kate’s post, much of the research quoted by those who practice Placentophagia is outdated and much of it does not focus on actual placenta ingestion but instead on the depletion of iron after birth. To date, no known human study has been completed which specifically focuses on Maternal Mental Health and the practice of Placentophagia. If you happen to know of one, please share it with me. I, and other PSI Coordinators, would love to read it.

In the end though, we are all on our own paths and so must our journey to wellness reflect our own hearts. I believe whole-heartedly in supporting a mama in whatever decision she may make as long as it is a well-informed decision reflecting her true sense of self and her family philosophy. No mother should ever be judged for her decisions when it comes to her mental health or the well-being of her family.


Nadya Suleman: A Mother of Multiples

Research out this past week from Johns Hopkins indicates that Mothers of Multiples are at a 43% higher risk than Mothers of singletons to experience “moderate to severe depressive” symptoms nine months after giving birth. The interesting kicker? Regardless of multiple birth status, few mothers reported talking with a Health Care professional about depression.

So what on earth does this have to do with Nadya Suleman?

For starters, unless you’ve been living under a rock, you’ve probably heard about the eight babies Ms. Suleman recently gave birth to. She’s also the proud mama of twins. What does this mean? It means that Ms. Suleman has twice put herself at a higher risk of developing moderate to severe depressive symptoms after giving birth.

What does this mean for her kids?

If Ms. Suleman has developed depression and has not sought help, her mental state could potentially have a negative effect on her kids. According to an article by Ruta Nonacs at Medscape, Postpartum Depression may affect maternal-infant bonding, cause the mother to be either extremely withdrawn or more intrusive, and use negative facial expressions. All of this may lead to children who, according to Nonacs, “exhibit behavioral problems (eg, sleep and eating difficulties, temper tantrums, hyperactivity), delays in cognitive development, emotional and social dysregulation, and early onset of depressive illness.”

Sometimes I can’t help but wonder if my untreated PP OCD led to the behavior issues we had with our first born. There is always a “what if” question at the back of my mind. I get angry with my doctor. I get angry with myself for not pushing for better care and help. I get angry. Then I remind myself that I cannot change the past – only change the future. So far, I’m doing my best. It’ll have to do.

I sincerely hope Ms. Suleman does not experience a Postpartum Mood Disorder. They are a dark and treacherous crew indeed and I would not wish them on my worst enemy. But I do urge women who are not bonding with their children or have a gut feeling that something is a little off to seek help. You deserve it, your children deserve it. You are not alone, you are not to blame, and you will be well.

Sharing the Journey with Ruta Nonacs, M.D.

Dr. Ruta Nonacs M.D., author of A Deeper Shade of Blue, also serves as Associate Director of the Center for Women’s Health at Massachusetts General Hospital and an Instructor in Psychiatry at Harvard Medical School. She received her MD from Cornell University Medical School and her Ph.D from Rockefeller University in New York.

She is very dedicated to ensuring women, families, and professionals have accurate information regarding depression during a woman’s childbearing years. In fact, her inspiration for her book, A Deeper Shade of Blue, lies within a strong desire to provide a carefully researched resource for women and their families that lays bare the myths and facts of symptoms, treatment, and recovery. Thank you Dr. Nonacs for your pioneering efforts in this area and I look forward to your continued work!

I sincerely appreciate her willingness to share her journey here and hope you enjoy her words!

Who IS Ruta Nonacs? What do you do when you’re not teaching or doing research?

I am trained as a psychiatrist and have spent my professional life doing a combination of research and clinical practice, working mostly with women during their reproductive years. I have recently been devoting more time to Postpartum Support International; it is one of my most important professional goals to increase awareness of postpartum depression. To this end, I spend a fair amount of time writing for both medical and lay audiences. Since having kids, I started working part-time and that has worked well for me. I have two daughters, ages 3 and 8, and I feel fortunate to be able to spend a lot of time with them.

How did you come to be interested in Postpartum Mood Disorders? Was there a particular experience or situation that drew you into the topic?

During my residency, the first patient I took care of was a young woman who was in the first trimester of her pregnancy, and I had the privilege of following her for the next three years. As a single mother, it was a difficult time in her life, and I felt that I was really able to help her a great deal. I can’t help feeling that this experience had something to do with my choices later on. I also had the good fortune of doing my residency at Massachusetts General Hospital, where they have a phenomenal perinatal psychiatry program.

As we both know, motherhood is a life-changing experience. How has motherhood changed you?

It has changed me in so many ways. For one, it has permitted me to slow down and enjoy all the little small pleasures in life.

Postpartum Mood Disorder recognition and treatment options have come quite a long way, even since my first episode a little over four years ago. How much further do we have to go and in your opinion, what can we do to facilitate the furthering of positive change regarding these conditions?

Depression in all shapes and forms carries a real stigma, and I think we still have a long way to go here. I think one of the things that has helped women with postpartum depression to get treatment is hearing about other women’s experiences with the disorder.

Moms need to take time for themselves in order to recharge their batteries. What is it that you do to relax and recharge?

I wish I could say that I am good at following the advice I give to my patients. I probably don’t relax as much as I should, but I do love bicycling, being outdoors, and photography.

Of all the research you have done in the Postpartum Depression area, were there any results you were particularly surprised to obtain? If so, what were they and why were you surprised? If not, would you mind sharing a brief overview of one of your favorite research projects with us?

I think one of the things I have enjoyed about my research (and my clinical work) has been the chance to make things better. Let me clarify this a bit. We have done a great deal of research on identifying risk factors for postpartum depression. Probably the strongest risk factor is having a history of depression or anxiety before pregnancy. By identifying women at highest risk for postpartum depression, we have been able to implement certain interventions that decrease the risk of postpartum illness. That means we can actually prevent postpartum depression, and that is a truly wonderful thing.

Tell us a bit about your book, A Deeper Shade of Blue and the related blog. What inspired these projects?

A Deeper Shade of Blue is a book for the lay public that provides reliable information on the spectrum of mood and anxiety disorders that affect women during their childbearing years. In this book there is information about postpartum depression and also about mood disorders that occur during pregnancy, as well as the psychological issues surrounding infertility and pregnancy loss.

I wrote the book because there is so little accurate information out there on these topics. While there has been increasing awareness of postpartum mood disorders, most women knew very little about mood and anxiety disorders that occur during pregnancy. There is also so much misinformation in this area; for example, many women assume that they can’t take medications during pregnancy or while they are breastfeeding, and that simply isn’t true. I wanted to give women a carefully researched resource, a guide that would help them to be better informed and to get the help they need.

What is your philosophy regarding your approach to Postpartum Depression? How did you develop this philosophy?

My general philosophy is that we can never afford to ignore postpartum depression. Even when it is relatively mild, depression takes a toll on a mother and on her family. This philosophy derives from my clinical experience — seeing way to many women who have not been able to enjoy or participate in important aspects of their lives because they were depressed and did not receive any treatment.

What advice would you give to medical professionals who may come in contact with a mother who is depressed? What are some of the best things they could do for this mom? What should they not do?

I think the first thing to do is to educate the mother. Many women don’t know a lot about depression; they do not know that this is a biological illness. They don’t know what treatments are effective. Depression still carries a significant stigma, and so many women are horribly ashamed about being depressed. Medical professionals need to help to enlighten women and help them to see depression as any other type of illness that requires attention. Medical professionals need to help women access the help they need, whether it is support from the family, talk therapy, or treatment with medications. These resources are sometimes difficult to find, and we need to make sure that women get the help they need.

And last but not least, if you had a chance to give an expectant mother (new or experienced) one piece of advice, what would you tell her?

As hard as it may be, you need to take care of yourself first. If you aren’t taking care of yourself, you can’t be the mother you want to be.