Saturday Sundries 01.22.11: Stigma, Meds, Relapse, Pregnancy

Saturday Sundries: A Postpartum Q&A Series (Original Graphic created by Lauren Hale for MPV Copyright 2011)

Welcome to Saturday Sundries, A Postpartum Q&A Series. This series will be dedicated to answering questions asked by you, the readers of My Postpartum Voice and Twitter friends of @unxpctdblessing. Ask away. I will answer, to the best of my ability, any question. Sometimes the best answer I will be able to provide will involve discussing the issue with your physician. I am not a doctor, I am not a therapist, I’m just a Mom turned advocate after experiencing Postpartum Mood Disorder twice. I provide peer support and nothing more.

In the interest of furthering discussion about Postpartum Depression and tearing down the walls of Stigma, I hope you will ask questions. Don’t make them easy. Ask the hard questions. If you want to ask a question and stay anonymous, that’s cool too. You can email me at mypostpartumvoice(@)gmail(dot)com with your questions. Just specify you would like it answered anonymously. There’s no shame in not wanting to reveal yourself or your struggles. I get that. But you still deserve to have your questions answered. Someone else out there may need to have that exact question answered but they may not be able to ask it at all.

This week’s questions come straight from Twitter. There are only four this week (the most I’ll take each week is five) but they are excellent questions.

Let’s get to answering them!


First up: @MamaRobinJ asks: How would you recommend making a decision about another pregnancy when still dealing with #PPD & on meds?

Awesome question. The simplest answer I could give to this one can be summed up in one word: Carefully. But you didn’t ask me this question to get an ambiguous one word answer, did you?

There are a two books I  highly recommend to any mother considering this very issue. The first book is Karen Kleiman’s What Am I Thinking? Having a Baby After Postpartum Depression. It proved to be very helpful for me. (That book is why I started this blog!) The second must-have book for any mother considering this issue would be Pregnant on Prozac by Shoshana Bennett.

One of the most important things Karen addresses is the level of fear a mother should have when faced with another pregnancy after PPD. Karen states that a healthy fear of relapse, etc, worries her less than a mother who is convinced she can breeze right through a pregnancy and postpartum after a Postpartum Mood Disorder experience. She’s right. She also talks about reframing the experience in a positive manner. (Hence, my blog.)

If you are already on meds, hopefully you are already in therapy as well. I would strongly recommend discussing this choice with your caregivers, your therapist, etc. Assemble your team, focus on your care, and prepare for the possibility of a relapse after giving birth if you decide to go ahead with getting pregnant. You’ve done the baby care thing before. You’ve done the PPD thing before. Think like a Boy Scout here and Always be Prepared!

It’s important to note here that no one should ever EVER EVER EVER EVER go cold turkey off their meds. Again, I am not a doctor. But if your doctor tries to tell you that you need to immediately drop any psych meds, run, don’t walk, to another caregiver who is willing to work with your own personal beliefs and needs. The issue of medication during pregnancy is very well covered in Pregnant on Prozac. Shosh even covers how to handle uncooperative doctors. Seriously. If you’re on meds and thinking about pregnancy, or you might end up back on meds, GET THIS BOOK. Make your husband/partner read it too. Make him read the Karen Kleiman book too, if he will. Reading both of these books will profoundly influence your experience.

I should mention that some women do relapse no matter what level of prevention they take. But if you assemble your team, have everyone ready to go before hand, even if you relapse, it will be caught quicker and your healing time should be less than if you take no prevention at all. The key here really is to be as pro-active as possible. Halle Berry once said during an interview with Oprah that when you fall back into the valley of depression again, the journey out is quicker than the first visit. Why? Because this time you have a road map. You know yourself, what works, and how to move through that valley better than you did the first time.


Second Question: @WalkerKarraa: Why is there so much stigma re: #PPD?

Wow, Walker. I could write a very long post about just that question.

Since Hippocrates, there has been stigma about PPD. These days, there is a silence around the issue of Postpartum Mood Disorders which infects almost every walk of life.

Every time you see an infant product commercial, regardless of the product, the Mom and baby are together, smiling, happy. Cuddling, bonding, cooing, grinning, etc. Don’t get me started on Baby Showers, the biggest sham this side of the Atlantic. Instead, we all smile and grin at each other, eat cucumber finger sandwiches, drink tea, all while ooohing and ahhhing over tiny baby clothes and annoying toys you may one day want to heave through the window of your home because Junior won’t stop screaming for the zillionth hour in a row and you’ve not slept in nearly a billion hours. Your eyes are crossed, your hair looks like you stuck your finger in a socket, and you’ve long forgotten what a shower is or even where the shower is in your home. Hot food? Distant memory. You can pee in 1 second flat, change a diaper even faster, and yet still you find yourself trapped on the couch or pacing the floor with a grumpy infant.

No one tells us about the hell we might face. No one opens up until we fall apart. Our society has built up such a high expectation of perfection – at this time the level of perfection is so high it is virtually unattainable. And when moms go to extreme lengths to reach those goals set by society and fall short, they blame themselves. We begin the Mommy guilt game earlier and earlier with each generation. We begin the Judge the Mommy game even earlier. The instant someone finds out another woman is pregnant, they feel they have a right to “inform” her of all her decisions and then expect her to choose to be pregnant and/or give birth THEIR way instead of HER way. So many choices, so much pressure, so many things which can go wrong. When things do go wrong, the mother is judged. She didn’t birth at home. She had a c/s. She had an epidural so… She didn’t breastfeed, she didn’t, she didn’t, she didn’t, she didn’t, she didn’t, she isn’t, she isn’t… she isn’t happy because….

Fact is, any Mom can get a Postpartum Mood Disorder. It’s the most common complication of childbirth. 1 in 8. But we’re not talking about it in the birthing or breastfeeding communities. We’re not talking about it in childbirth classes. We’re not talking about it at prenatal appointments. At 6 week check up appointments. At pediatric appointments. We’re just not talking about it.

Because if we don’t talk about it?

It’s not real.

And that’s why there is so much stigma.

Because if we just shut up about it, it’ll go away and we can pretend it doesn’t exist. It’s a shadow in the corner of the room and if we move just right, it will disappear. It’s the monster under the bed we convince ourselves isn’t really there.

It does exist. It IS an issue. And I refuse to shut up about it. I will get LOUD about Postpartum Mood Disorders until I am physically unable to do so any longer. Why? Because no one got LOUD with me and I nearly lost my life because of them.

If you think I’m going to let that happen to another mom on my watch, you, sir, or madam, are seriously mistaken.


Third question: @thewilsoncrowd asked: Is it possible to relapse in the middle of treatment? Suddenly back to feeling like I’m at square one this week. #PPD

Oh dear, yes. Yes indeed. Especially if something has triggered you.

But it’s so very important to put this in perspective – you say this week. Has this “relapse” feeling lasted all week? Longer than all week? Or has it just been a few days?

Again, not a medical professional, but relapse is usually more than just a few days here and there. For me, relapse would have to be a good solid week or more of just horrible bad days in a row during which I felt no motivation to try and heal through the methods that worked before.

If you feel you are relapsing, definitely get in touch with your doctors. It’s important to note here that any change in med dosage, sleep habits, PMS, or an increase in stress can make it feel like a relapse. Regardless of the root cause, you need to discuss this issue with your physician so the two of you can formulate a plan to help you stay out of this rut and continue on your journey toward recovery. Make it a pot hole instead of a sink hole.  You can do this!


Fourth question: @Preparing4Birth What medications are safe for breastfeeding… why is rapid weaning not a good idea?

I wish I could answer the meds question. I do. I don’t recommend specific medications over other medications. It’s really for a physician to do after discussing a patient’s situation with them. Your doctor should have a copy of Thomas Hale’s Medication & Mother’s milk for reference. If he doesn’t, get them one. Or encourage them to get one for themselves. You can also call your local IBCLC or talk with a La Leche League leader. Another great place for you to get information re: meds during breastfeeding is from OTIS Pregnancy. They even have handy fact sheets available at their website for specific medications. Go check to see if a med you have a question about is there.

Rapid weaning is not a good idea as it can cause several issue with both you and your infant. If you are talking about rapid weaning from nursing, that alone can cause severe issues with both the mother and infant dyad. The mother may experience engorged breasts as her system is absorbing the shock of no longer nursing the way to which it had become accustomed. Engorgement can lead to mastitis and infection. Mastitis is very painful and is considered an urgent medical condition. The infant is suddenly switched over to formula and his/her young and immature digestive situation is flung to the wind as those in “charge” wait to see what will happen. You may end up with a mother who may want to nurse, despite the risks of whatever med she is on. It is of the utmost importance for a physician to be sensitive to the nursing desires of a new mom. Nursing is either not working out at all or it is the ONE thing she is doing right. To take nursing away from the latter mom is to remove a positive left in her very dark world which is a bad idea.

Rapid weaning of any psychiatry medication is strongly advised against as it can cause some severe and even worse issues than being on the meds. Not only will you go through withdrawal, but your infant may go through this as well. And that’s just not good for anyone. If you are nursing and on medication, it is important to let your child’s pediatrician know what medication you are on and at what dosage so they can monitor your infant for any possible side-effects. Primary side effects with psychiatric medications with infants are sleepiness and weight gain. If your infant seems to sleep a lot or is struggling to gain weight, it’s important for your pediatrician to know you are on medication that might be causing these issues. Again, Thomas Hale’s Medication & Mother’s Milk is a very solid resource for this information.

Another important thing to note here is that, as with question one, preparation here really is key. Find out what meds you can take. Let your doctor know what your issues are, honestly. Also know what the risks are to both you and to your infant. It is also important to know the characteristics of the medicine you are prescribed, if you are prescribed one. Some meds may dry up your breastfeeding supply. Others make make you more annoyed than ever. It’s important to work with your doctors to find the approach which fits your philosophy the best. You are advocating for yourself AND for your infant here. Don’t be afraid to question things. Ask why. There is no line when you are protecting yourself and your infant. Question everything.

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Whatever Wednesday: Questions from Twitter

I decided to take questions from Twitter today. Only the first 5 responses though so as not to overwhelm myself. In no particular order, here are the questions and their answers.

1) @ksluiter asked: I want to know about succesfully weening to get pregnant or staying on meds while pregnant.

Staying on meds while pregnant was a decision I struggled with when I became pregnant with our son. The pregnancy was not planned so I skipped over the whole “weaning to get pregnant” concern and skipped straight into the “should I stay on my meds while pregnant” arena. This is most definitely a decision which should be made with the help of a medical professional. There were a few things which helped me make my decision a little easier:

a) Moms on meds when pregnant and then go off their meds during pregnancy face a higher relapse rate for mental health issues (specifically Postpartum) after delivering.

b) Baby has already been exposed to medication for 4-6 weeks by the time you realize you are still pregnant (unless you weaned beforehand) Going off meds cold turkey will affect baby as well as you.

c) High levels of stress/depression cross the placenta as well and can inhibit fetal growth and spur premature delivery. Given that my 2nd daughter had indeed been born nearly 5 weeks early, I was not interested in going that route again.

Bottom line here: This decision is an intensely personal decision. Talk with your doctor. Research. Know what you are comfortable with doing.

Couple of great resources for this are: Pregnant on Prozac by Shoshana Bennett and also Otis Pregnancy (also has a Twitter presence: @OtisPregnancy) Check them out.

2) @invisibledaddy asked: what’s the closest experience you’ve had to ppd besides ppd itself, to help us get a sense?

Wow. I had to really think for this question. I think the closest experience I have had to PPD happened my junior year of college. Within 19 days between February and March, I lost both of my grandfathers. This left me with no grandparents. The subsequent grieving process I went through was extremely similar emotionally to how I felt during Postpartum Depression. My grief was a very physical grief and that’s where it differed from my Postpartum. It also differed in that I wailed. A lot. Quite often I would wail and scream myself to sleep. I struggled with anxiety attacks as well, something I did not experience during Postpartum. I also thrashed and hit. It took me a very long time to recover.

The most important difference here is that people expect you to grieve when you lose a close family member or friend. When you have Postpartum, there is an element of guilt and shame accompany the disorder with which you struggle. Why? Because you have a baby. You SHOULD be happy. Even those who experience the grief of miscarriage or losing an infant within the first months of life experience this as many around them will tell them awful things such as “Well, it was never a REAL baby” (miscarriage) or “He/she wasn’t here very long so the pain will fade quickly because you didn’t have a lot of time to bond.” Acerbic comments such as this are extremely unhelpful and only serve to expose the ignorance of those offering them. (FYI, for a great website about miscarriage and infant loss, I highly recommend the folks over at Grieve Out Loud.)

Another thing I experienced with Postpartum that not many associate with it was intense anger and increased irritability. Many associate crying as one of the major symptoms. While it is a symptom, it is not one that every mom will experience. Many moms instead become very overwhelmed and as a result, develop what I term “explosive” personalities, blowing up over the smallest perceived injustice or high expectation.

3) @MamaRobinJ asked: How about blogging about PPD. How much detail do you think people should offer? What’s too personal?

I have a few personal rules I stick to when blogging about PPD. The primary goal is to keep from endorsing specific medications as I feel that is a discussion best left between physician and patient and to keep from triggering others.

Sharing details is good to an extent. That said, if you have a piece you are posting to your blog that a new mom may visit, always ALWAYS warn at the very beginning of the piece that if someone is in a fragile state, they should probably skip the post and come back when they’re feeling a bit healthier. I’ve taken to posting music videos via YouTube at the beginning of posts I think may trigger someone. Katherine Stone, author over at Postpartum Progress, has a symbol she posts at the beginning of potentially triggering posts. We all have our own methods but we all keep in mind the fact that the people reading our blog may not be in the same mindframe we are now.

Another thing aspect of sharing details is that in writing your own story, you may feel drained. It may drag up some of the same emotions you had when you experienced while in the depths of PPD. Be prepared to deal with this. Sharing is therapeutic. But it can also be exhausting. Share at a pace which is healthy for you. Your mental health is far more important than indulging the curiosity of your readers.

Too personal for me is:

  • Naming the Psych Hospital I spent time in
  • Naming any of my Physicians
  • Naming any of my medications

Even with HIPAA, for me this is a privacy issue and one that I will not disclose under most circumstances.

If I do disclose my medication, I am very careful to say that it is what worked (or didn’t work) for me. All treatments/therapies work differently for different people. It is important for us to respect the journey of others toward wellness.

4) The good folks over at @bandbacktogether asked: “why did you start to blog?”

The best answer to this question is back at my very first post in May 2007. But, for the sake of posterity and saving you a click and a ton of reading (and the horrificness of my first ever blog post), my husband and I found ourselves quite unexpectedly pregnant after a very nasty episode of Postpartum OCD (and probably PTSD due to my daughter’s NICU stay). Once the pregnancy test lines turned pink and I dug myself out of bed after reading Karen Kleiman’s “What Am I Thinking: Having a Baby After Postpartum Depression,” I decided to start a blog in order to “reframe” my pregnancy as Karen suggested. Little did I know something I started for just for me would still be around nearly four years later and evolved into what it has today – including #PPDChat at Twitter every Monday at 1p & 830p ET.

5) @TouchstoneAZ asked: “Have you seen any correlation between when period returns pp even while bfing and PPD?

When I asked for further clarification, she stated she was asking about mood and period. If I’ve understood her question correctly, I think she’s asking about increased issues with mood during PMS after an episode of Postpartum. SO many mothers (including myself) struggle for a long time with increased mood issues during PMS after a Postpartum episode. I get increasingly irritable, cranky, and just all around grumpy. I was on medication for PMS prior to pregnancy for my PMS. In fact, I remember reading research stating that women with PMDD (or severe emotional issues during PMS) are at a slightly higher risk for developing PPD. I can’t find the link at the moment though as my kids are on day 3 home from school for snow and frankly, my brain is fried. I’m also defending my laptop from my three year old as I type this so .. when I find the link, I’ll update this answer with it, I promise.


This was fun! I may have to do this again next week! If you liked this feature and have a question about my experience or anything Postpartum related, please either @ me on Twitter (I’m @unxpctdblessing) or email it to me at mypostpartumvoice(@)gmail(dot)com with “Q&A submission” as the subject line. I look forward to hearing from you!

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Just Talking Tuesday Giveaway winners: @momgosomething & @OMyFamily


Given you were the only two to comment on last week’s giveaway, I’ve decided to send both of you a copy of Pregnant on Prozac by Shoshana Bennett.

Please email me @ mypostpartumvoice (@) gmail dot com with your addresses. The books will ship by the end of this week!


Discovery Health Postpartum Nightmares airs March 2, 2010 as part of “Baby Week”

This past weekend I had an opportunity to view the entire program ahead of airing schedule at the invitation of Discovery Communications. And no, I’m not being paid to post about this. (Happy, FTC?)

Discovery Health is airing “Baby Week” this week. The second program is entitled “Postpartum Nightmares” and airs on March 2nd, 2010. Check your local listings for the time.

I will admit that I had my hesitations about this documentary at the outset. First, I was not aware of the program. Second, the first description I saw promised “experts’ and well, we know from the past how well that can go.

After a few emails, I discovered the experts they were able to get involved were none other than Shoshana Bennett and Pec Indman. Cool. Two amazing women who know precisely what they are talking about and are filled with compassion for the families fighting Postpartum Mood Disorders. Now – what about the re-enactments? What are THEY going to be like?

The re-enactments are not for the faint of heart. Just 90 seconds in and I was ready to throw in the towel – ready to write off the whole thing. I questioned if I was watching a documentary or a horror film. But I took a deep breath and continued to watch, shooing my children back to nap every five minutes.

Based on what I saw and managed to hear (in between shooing the kids back to nap), the overall narration was impressive. The three women in the documentary were treated with quite a bit of respect. They told their stories with amazing detail and explained the treatment through which they found recovery very well. Do note that their birth experiences were somewhat on the extreme side and I don’t remember hearing one I would term a “normal” birth experience (ie, no complications/surgery). At the end of the program, I was glad I hung tough. I am glad Discovery Health has put this out there despite the graphic dramatization of the re-enactments. Although, thinking back on my own experience, a lot of what was described eerily similar to what I experienced. The intrusive thoughts, the overwhelming anxiety, the desire to just not have to deal with it anymore – all of that is there. I just wish it hadn’t looked so much like a horror film.

If you are currently struggling with Postpartum Depression, have recently recovered or are emotionally fragile and haunted by images, etc, I would not recommend you watch this program as it may cause more harm than good.

Some of the important topics touched on during the program are:

Ultimately, I was happiest that there was a clear distinction drawn between Postpartum Depression and Postpartum Psychosis. And I was beyond thrilled that Postpartum OCD was discussed. It’s very rare for OCD to be discussed as it is quite often mistaken for Psychosis. I also thought it was really cool the way PSI was mentioned in the third story. (You’ll just have to see that for yourself should you choose to watch!)

I really liked that Dads were interviewed for all three stories in addition to the Moms. The dad’s give an additional depth to the story that just would not have been there had we only heard the story from the Moms. It is truly important to remember that a Postpartum Mood Disorder affects more than just mom. It ripples out and hits the entire family.

Discovery has a couple of pages set up for resources. You can find them here:

Postpartum Resources

Postpartum Family Info

If you choose to watch this program and want to vent and/or discuss it afterward, please catch up with me on Twitter. My username there is unxpctdblessing. I’ll be available to talk and answer (to the best of my ability) any questions you may have. Use the “hashtag” #discoveryPPD or @ me so I can find you.

You are not alone.

If you are watching the program and begin to have issues and need to talk with someone, you can call the PSI Warmline @ 1.800-944-4PPD. There is a Coordinator checking messages daily. Your call should be returned within 24 hours. If it is not, email PSI to let them know you have not had a call back. You can also locate a coordinator in your area via by clicking here and finding your state or international location.

Understanding Postpartum Psychosis: A Temporary Madness

understanding-postpartum-depressionA new book by Teresa Twomey with Shoshana Bennett became available today. This book is not for the faint of heart.

This much needed volume is broken into three parts.

The first section addresses Legal, Psychological, Historical and Media-based views of Postpartum Psychosis.

The second section includes stories from women who have experienced Postpartum Psychosis and recovered.

The third part addresses the stories of two women whose PPP experience had “Tragic Conclusions.”

You can order the book by clicking here.

And if you’d like to get to know the author, Teresa, check here. I’ve scooped her up for an interview!