Blog: Postpartum Matters

New Jersey Location Retires

KONICA MINOLTA DIGITAL CAMERA

After much consideration, we made the decision to retire the New Jersey location of The Postpartum Stress Center.

In 2009, The Postpartum Stress & Family Wellness Center (NJ), LLC. was opened as an adjunct to The Postpartum Stress Center, LLC (Founded in 1988). For almost most seven years we have served the South Jersey area providing general counseling services and support for the perinatal community. Recently, I have found myself dividing my time between obligations with the New Jersey office and my  commitments to our primary Pennsylvania practice.

I have reached a wonderful point in my satisfying career, where I can now choose to consolidate the offices in order to focus on the PPSC post-graduate trainings, which continue to meet the growing needs of therapists from around the world who seek professional training and mentoring, my writing, which is my passion, and of course, my clinical practice, which takes up the majority of almost every day. I look forward to expanding our Pennsylvania offices and services while pursuing writing and teaching.

I would like to take this opportunity to thank each therapist and support staff (especially Heather, who has been indispensable!) who has been devoted to the PSFWC as well as everyone who has trusted us to refer their patients, clients, family member to our therapists.

The office closed 12/15/15.  Anyone currently being seen by one of our therapists can rest assured that we will continue to provide services until that date and at that time, we will make certain you have referral names and contact information to make a smooth transition. There are many wonderful therapists in the South NJ area, many of whom have received training and supervision from The Postpartum Stress Center. We will be happy to provide referral information.

Do not hesitate to contact us at our home office in Pennsylvania (610-525-7527) for any reason.

After years of excellent service and clinical practice, we continue to be available to provide support, education, psychotherapy, psychiatric support and professional training. Let us know how we can help. PPSC-25th-final

    With warmest regards,

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BE HAPPY: (How is that working for you?)

 happy

Seriously.

Does that make you feel better?

Does it help you feel in control of your life?

Does it inspire you to walk down the street grinning at strangers?

Does it fill your heart with unbridled joy?

Does it make you feel grateful and warm your heart?

OR,

Does it make you feel inadequately unhappy.

Does it reinforce the fact that you are doing something wrong?

Does it isolate you from the rest of the world who seem to be better at this happy thing, or at least, better at pretending they have mastered it?

Does it make you feel incapable of meeting the expectations that life puts in front of you? Does it make you feel worse than you did before you read it?

OR,

Does it make you think you should incorporate some new skills?

Does it encourage you to modify your life in healthy ways that might take the edge off of your anxiety?

Does it motivate you to make small changes that might improve your mood?

 

How do you feel when you read the gazillion posts, memes, blogs, advertisements and book titles that promise quick fixes to immediate and lasting happiness? Such as:

9 Tips in Life that Lead to 16 Tips for Living a Happy Life Starting Right Now

Top 7 Tips for How to Be Happy

Cultivating Happiness: Five Tips to Get More Satisfaction

10 Instant Tips to be Happier Now 

15 Tips to Boost Your Well-Being and Happiness 

Is it working for you?

Do you eagerly click, searching for the panacea?

Is it a relief or a burden? Or, both? Does it let you down or inspire you to follow a new path?

Do words like “now”, “instant”, “promise” “immediate” pressure you to remain stagnant or prompt you to move forward?

The marketing of happiness is at an all time high.

I’m wondering how it makes you feel….

 

 

image credit: Mindful Travel

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Symptoms Associated with Positive Response to Medication*

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Ever wonder why some women with postpartum depression take medication and some do not? There may be any number of reasons that vary from woman to woman, but one reason may be that a certain set of symptoms are more responsive to biologic intervention than others.

The following is a list of some symptoms of postpartum depression that may prompt your therapist or doctor to recommend medication. These include symptoms that suggest that medication is likely to help you, and symptoms that are less likely to resolve with therapy alone.

  1. Significant weight loss (beyond that expected after childbirth)
  2. Depression worse in the morning (diurnal variation)
  3. Agitation
  4. Inability to get out of bed or sleeping all day
  5. Extreme indecisiveness (e.g., it takes an hour to decide what to wear in the morning)
  6. Waking often in the middle of the night, even when the baby is asleep
  7. Suicidal thoughts
  8. Medication helped you in the past during a similar episode
  9. Clear-cut change in your personality
  10. Severe irritability, with frequent loss of control over temper or outbursts at loved ones when you previously had good control
  11. A blood relative of yours was helped by medication for depression.

 

 

*Excerpted from This Isn’t  What I Expected by K. Kleiman & V. Raskin
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Postpartum Depression: Whose Problem is it?

Mother with sad expression holding newborn

Postpartum depression and anxiety  are getting tons of attention in the media. From catastrophic accounts of misdiagnosed psychotic episodes, and an increase in state legislative action, to emerging research, as well as an explosion of passion-driven personal narratives from women who have recovered.

All of this translates into greater awareness and activity in research, in clinical practice and in the collective consciousness of women at risk.

This can only be good, right?

Certainly we are moving in a positive direction and the trajectory toward improved outcomes is at an all time high.

Why then, do so many women continue to suffer?

Why is it that postpartum depression and its related conditions continue to be misunderstood by so many healthcare professionals?

Women with postpartum depression and anxiety have been falling through the medical cracks for decades. When my first book, This Isn’t What I Expected was published, back in 1994, few doctors were routinely discussing postpartum depression with their patients, even those at high risk. But many are talking about it now. This is great progress. Some get it right. Others remain stymied by rampant misinformation.

Why is there still such a discrepancy between what those of us on the front lines observe and treat and what the public and some professionals presume to be true?

It’s complicated.

It seems to me that when a medical condition intersects with several areas of specialization, the focus becomes diluted, thereby making it impossible for it to be given full attention from any one of the multidisciplinary areas of study or practice. While obstetricians, psychiatrists, primary care physicians, pediatricians, midwives, lactation consultants, doulas and psychotherapists all share, to varying degrees, opportunity, interest and responsibility for the identification of, and ultimately, treatment for, her symptoms, not all are trained to do so.

Unlike conditions that are definable through tangible medical assessments, such as an x-ray, MRI, or laboratory findings, postpartum mood and anxiety disorders are diagnosed by a relatively outdated, albeit reliable and validated screening tool or, by clinical observation and assessment. All too often, essential clinical assessments hinge on the specific training, expertise, and quite frankly, the personality and inclinations of the person doing the evaluation.

There is far too much ambiguity there for my comfort.

This leaves many postpartum women hostage to the readiness, willingness and wherewithal of their healthcare providers.

Women are rebelling against this lack of clarity and fuzzy parameters for detection of such a serious medical condition with their collective outcry for recognition and support. They are joining forces and doing an impressive job educating and enlightening the community at large. There is a constant call to reduce stigma so moms can feel comfortable revealing their symptoms as well as an unwavering plea to healthcare professional to pay attention and ask the right questions.

Even so, misinformation permeates our healthcare system like the fog of depression itself. You cannot always see it, but its impact is undeniable, and those who are in the best position to recognize it are not always able to see it for what it is.

Postpartum women continue to get very sick and remain reticent to ask for help. Women are struggling to get through the day while they, somewhat amazingly, manage to lovingly care for their infants who depend on them. Although coping skills can kick in when survival is threatened, they require energy and reinforcement to be sustained. When women are let down by a medical response too misinformed or too preoccupied to take notice, they settle into their fatigue and absorb the incongruity by way of their fragile self-esteem. It must be me. I am flawed. I am not a good mother.

It seems so clear to those of us who see these women after being dismissed, condescended to, or misunderstood by their healthcare provider.  And so we say, please take heed:

  • This is serious.

Studies suggest that during the first postpartum year, 1 out of every 7 women walking into your office experiences symptoms of depression, (the number is higher when we factor in anxiety, bipolar illness and obsessive compulsive disorder.

  • Ask the right questions.

Screen for postpartum depression and anxiety. Collaborate with a well-trained expert in the treatment of postpartum mood and anxiety disorders and hand their name and number to your patient who is overwhelmed and unable to determine the next step. Take the time to tell her that she needs a comprehensive evaluation with the same authority you would tell her to get a mammogram if you felt a lump.

  • Do your homework.

Baby blues is not postpartum depression.

Postpartum depression is a clinical depression which emerges during the first postpartum year and meets diagnostic criteria for a major mood disorder.

Postpartum depression is not postpartum psychosis.

Every single woman with postpartum depression is at risk for suicide. You cannot always tell by looking.

  • Be accountable.

Do not pass your patient along to the next discipline and make it someone else’s problem.  Refer, do not defer. Do not simply tell her to “call a psychiatrist” or “get more sleep,” even if both would be beneficial.  If she is in your office, she is your responsibility. Provide her with reliable resources and follow up with this action.

A woman with postpartum depression tirelessly weaves in and out of various medical offices, whether or not she is in the mood, has the time, or is able to make her own needs a priority. Even without depression present, between her physiological changes, her baby’s well-being, her sleep deprivation, her exhaustion, and her transition to motherhood – she hardly knows what to do first.

All healthcare practitioners who are dedicated to providing care for women during the first postpartum year should feel compelled to make sure each new mother is receiving optimal care and excellent clinical support and guidance. Be informed. Join forces with interdisciplinary advocates. Do not let her slip through that crack.

Her life may be in danger.

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Put your feet up. Take a break. HMD

Guest post by Alyson Schroeder.
Alyson works for The Postpartum Stress Center in our New Jersey location. She is director of our child and adolescent division.

Alyson_S

“It’s amazing. And terrifying. Yes, I’m amazed and terrified at the same time. Every day.”

This is what a good friend told me when describing what it’s like to be the mother of a middle-school-aged child.

And how true it is…about every aspect of motherhood.

My four-year-old taking off on her bike for the first time without training wheels. Amazed. Terrified.

My two-year-old climbing to the top of the playground structure, lifting his arms wide, and jumping off. Amazed. Terrified….and, to be honest, a little sick to my stomach.

The first night in the hospital watching my newborn baby sleep. Two equal and opposing forces coursing through my body. I didn’t have the words to describe it then but I can feel the sensation still. Motherhood is terrible and wonderful at the same; bitter and sweet; sad and happy; scary and exhilarating.

If you’re a mother and you’re reading this, I know that you completely understand. And I know that it something we also don’t fully understand so we don’t give ourselves enough credit for how truly hard it is. Quite frankly, it’s exhausting. So, enjoy your day tomorrow. Put your feet up. Take a break.

Lord knows we need it.

Happy Mother’s Day!

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I’m not ashamed. I had a miscarriage.

EmptycribThere’s something that women everywhere need to talk about.  It’s time, time to bring it out from its hidden place of shame and solace.  It is time to make this mainstream.

Miscarriage.

A shocking 25% of woman will experience such a loss.  One in four women.  That is a devastating number.  Do you know anyone who has suffered a miscarriage?  Chances are you do… but you may not even know it.  According to the American College of Obstetricians and Gynecologists, studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. That’s only the pregnancies reported and known by doctors.  That number does not include the staggering number of women who miscarry and don’t know, nor does it include women who have not yet sought medical care.

When our loved ones pass; the community rallies.  Flowers are sent, dinners are cooked and brought over, and people offer hugs, love and condolences.  Friends and family step up to let you know you are loved and your loss acknowledged and grieved with you.

When we experience a miscarriage none of that happens.  Why is that? I believe it starts with the culture of secrecy when it comes to pregnancy.  Don’t tell anyone until you pass that first trimester, in case something happens.  From the get go, a sense of shame is instilled in us.  No one wants to know if you lose the baby, is essentially the message.  When we miscarry, there are no flowers.  No dinners cooked.  Very little is done to let you know you are loved and your loss is acknowledged and grieved.  Even if you do choose to share it, most people say they are sorry and then change the subject.

I have been pregnant no less than eight times.  I have had the absolute pleasure of giving birth to three beautiful children.  The youngest is six months old and I enjoy him like babies are going out of style.  I have had more than a few miscarriages.  Each one was painful, filled with sorrow and gone through largely alone.   Each miscarriage was met with an expectation of hush, the brief spark of life unspoken and unremembered by anyone else.

Except for me.  I remember them all.  I remember when they were due and I remember hearing heartbeats and seeing ultrasound photos.  I remember the moments I discovered I was pregnant, and the lump caught in my throat; excitement building but not growing too big, lest I lose this one too.  I remember the pain of going in for countless extra tests, extra blood draws, seeing ‘high risk’ at the top of my files, hearing ‘history of loss’ from my providers and the incredibly casual way my last provider told me “This one isn’t going to be a viable pregnancy” from my last miscarriage a few years ago.

I remember too, the very crass way someone had told me “Oh well, you’ve only had one baby.  Once you’ve had multiple pregnancies, you’ll understand what I mean.”  I don’t even remember what the topic was, but her tone was so dismissive.  I chose not to be silent and I blurted out, “Actually, I’ve been pregnant three times.  I have one child, yes.  I lost the others.  But I have been pregnant three times.”  The silence was deafening.  To say the pause was awkward would be an understatement.  Even amongst other women, I was met with the silent accusation of, ‘OMG.  You SPOKE of it??’

So what should we do when someone miscarries?  The more I speak about my own losses, the more I hear from other women about theirs.  I have no desire to hide, I refuse to be ashamed.  Not talking about my angel babies makes it harder to move on.  So talk.  Talk about your babies.  Share your fears. Express how sad you are.  Let’s break this code of silence that society has imposed on us.

Give permission to grieve.  The ‘what could have been’ is so powerful with a miscarriage.  From the moment we discover or even suspect we are pregnant, our minds start planning.  We imagine a baby in our minds, in our arms and in our lives.  It’s not just a blob of cells.  It doesn’t matter how pregnant a mom is.   Names start popping into our heads, how we will tell people, what will our partner think/say/feel, etc.

Send a card.  Cook them dinner.  If baby items were purchased, ask if they’d like you or someone else to pack them away or hold into those items until they are ready. Offer to help connect them to supports in the community.  Ask how their partner is.

Most importantly, I found for myself, was forgiving my body.  That meant for me, some counseling and time.  There is no timeline for grief.  For some, it’s a few days, and for others, longer.  Both are okay.  In the long run, I am okay too.  I will never forget my angel babies, they each have a special place in my heart.

 

 

photo credit: Claire Petrillo

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Postpartum Psychosis Emergency Room Guidelines|

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Postpartum Psychosis Emergency Room Guidelines

You cannot afford to miss this diagnosis.

Postpartum psychosis occurs in approximately 1-2 out of every 1,000 deliveries. The clinical onset is rapid, with symptoms occurring as early as the first 48 to 72 hours postpartum, although the majority of episodes develop within the first 2 weeks after delivery. Postpartum psychosis is always a psychiatric emergency. A woman with postpartum psychosis may not present with typical psychotic symptoms since she may be urgently trying to cover up her distress and return to the care of her baby.

If she is in the emergency room, it is likely that she is experiencing either 1) acute/severe anxiety symptoms and/or 2) psychotic symptoms. Differentiating between the two is crucial.

Therefore

These questions should be asked of EVERY SINGLE POSTPARTUM WOMAN who comes to the emergency room.

The assessment should include information from family member who may be in a better position to be objective. In addition, family members who accompany a mother to the ER should be directly asked to describe any behaviors they find concerning.

Ask her, AND THOSE WHO ARE WITH HER, the following questions:

• Does she or anyone in her family have a history of bipolar illness or previous psychosis?

• Is she talking or acting in a strange manner that is not characteristic for her?

• Is she unusually quiet and withdrawn, or speaking rapidly with little concentration?

• Does she claim to hear things or see things that others do not?

• Is she suspicious of others or expressing concern that others are out to get her or trying to harm her in

some way?

• Does she have a decreased need for sleep or food and/or exhibit a high degree of confidence or an

exaggerated sense of her capabilities or self-worth?

• Does she feel abnormally hyperactive with racing thoughts and/or behaviors?

Important Points to Keep in Mind

New mothers may be frightened and overwhelmed. HOW the questions are asked is as important as what the questions are. “I know this may be overwhelming right now. Sometimes we see mothers here who tell us they are hearing unusual voices in their head or others are telling them that they aren’t making sense. Are you experiencing anything like this?”

There is a 5% infanticide or suicide rate associated with postpartum psychosis.

During the psychotic state, the delusion may take many forms and may not be destructive. However, there is always a great risk of danger because the delusional and irrational thinking will impair her judgment and ability to care for herself and her baby.

You cannot assume that if she looks good, she is fine. Postpartum women are exceptionally good at holding it together and saying all the right things, in order to maintain control and put forth the illusion that they are fine.

The key to early intervention is to keep the possibility of psychosis in mind when evaluating any woman who has recently given birth.

 

© 2014 The Postpartum Stress Center, LLC

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Tokens of Affection: A Review

Many thanks to Kathleen Kelley, Psychiatric Mental Health Nurse Practitioner in Oregon, for submitting this review of Tokens of Affection. I’m thrilled to get the message out to families who can use the support.

Thank you, Kathleen, for supporting my work and for making such a difference with the work that you do at your end of the world. Some of my very favorite people in the world are right there by your side. 😉

Tokens of Affection

Tokens of Affection: Reclaiming Your Marriage after Postpartum Depression is my new favorite book for couples seeking help with their relationship.

It provides an invaluable set of concepts and tools, using the metaphor of “tokens” that can be given to each other on behalf of the relationship, to help couples reconnect in the wake of postpartum illness. Tokens for essential aspects of the marriage partnership, such as esteem, collaboration, compromise, selflessness, sanctuary, expression, tolerance and loyalty, are described as actions each partner can take on behalf of the relationship. This creates a pathway back to the connection that may have been damaged by the trauma of postpartum depression.

Indeed I find this book so useful, that I would not hesitate to recommend it to couples whose marriage had suffered in the wake of any trauma, as well as couples just starting out on the journey of their lives together, in order to learn how to care for themselves and their relationship when the normal stresses and strains of married life arise. I also recommend this book to couples who are struggling not with the aftermath of postpartum illness, but simply with the disconnection or neglect of the marital relationship that often results from the extreme busyness, fatigue and differing needs that are inevitable when a helpless infant is added to a family.

Thank you once again to Karen Kleiman and Amy Wenzel for this valuable addition to the postpartum and marriage literature.

Kathleen Kelley
Psychiatric Mental Health Nurse Practitioner
Perinatal Mental Health Specialist
kathleenkelleypmhnp.com

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Physical Activity and Depressive Symptoms After Stillbirth

Jarl Stephanie Counselling

Physical Activity and Depressive Symptoms After Stillbirth Informing Future Interventions
Jennifer Huberty, Jenn A Leiferman, Katherine J Gold, Lacey Rowedder, Joanne Cacciatore, Darya Bonds McClain

BMC Pregnancy Childbirth. 2014;14(391)

DISCUSSION

“This was the first study to determine women’s preferences for and experiences with physical activity after stillbirth. As such, it offers information necessary for healthcare providers to design and implement inter-conception interventions that include physical activity to improve the mental and physical health of women after stillbirth, an area which is lacking. Women who have experienced stillbirth are a high-risk population for poor maternal and infant health outcomes because of the negative health implications (i.e., depressive symptoms, weight retention) due to the traumatic event (i.e., stillbirth) and the high rate of conceiving within a year after the stillbirth. The encouragement of positive health behaviors such as physical activity in women who have experienced stillbirth during inter-conception care may positively impact maternal and fetal health outcomes in subsequent pregnancies. Unfortunately, health care providers are not prescribing physical activity for women who have experienced stillbirth. Women who have experienced stillbirth have reported that physicians do not counsel about exercise beyond “returning to normal activity” and that they would have liked information about physical activity and/or advice from their physician about being active for their health after their stillbirth.[22] The promotion of positive health behaviors and the positive implications of this is evident in the literature related to women of live births that are active before, during, and after their pregnancies.[32,33] It is important to understand the specific and unique needs of women who have experienced stillbirth in order to design interventions to help improve their mental, and physical health outcomes.

Despite a decrease in the number of women who reported participating in regular physical activity during their pregnancy (47%) compared to before their pregnancy (60%), 61% of women reported participating in regular physical activity since their stillbirth. This may have been because women who were active knew that exercise might help them feel better.[22] In a study by Huberty and colleagues,[22] women who experienced stillbirth and were active prior to their stillbirth reported using physical activity to cope, feel better, and have time alone.[22] This may also be because despite needing to physically recuperate, low to moderate intensity physical activity (i.e., walking, yoga) offers an outlet in which to feel better and have alone time.[22] This is important, as exercise is a well-known non-pharmacological method to decrease depressive symptoms and reduce episodic recurrences.[16,34] However, in our sample less than half of women who reported being active since stillbirth were currently meeting recommendations for physical activity. This is similar to other studies in non-bereaved women during pregnancy and postpartum.[35] It is well known that pregnant women are less active than non-pregnant women and that pregnancy leads to a decrease in physical activity participation.[26] Additionally, physical activity levels post-partum may not return to what they were pre-pregnancy.[36,37] Strategies are needed to help encourage and guide women who experienced stillbirth to use physical activity as a means to cope and to help them maintain this activity in the long-term. This is especially important because our study suggests that women who have experienced stillbirth and participate in regular physical activity have less depressive symptoms than women who are not regularly active. Similar findings were reported in women who have postpartum depression after a live birth and participate in exercise programs.[19,38] Thus, healthcare providers may consider suggesting exercise after a mother experiences stillbirth as a way to cope with grief and depressive symptoms. Additional research in this area is warranted.

In our study, 38% of women reported using activity as a means to cope with depressive symptoms, anxiety, and/or grief associated with the death of their baby. Others reported engaging with family/friends, and support groups to cope with their symptoms. Medical and mental health providers may consider offering group-based exercise programs for women who have experienced stillbirth that incorporate both a social support and exercise component. For example, support groups’ session times could be shortened (30 minutes as opposed to 60 minutes) and 30 minutes of yoga or walking could be incorporated. Similar approaches were used in chronic conditions and social support (i.e., group-based) was a known facilitator to improving physical activity participation.[39–41] More research is warranted.

Yoga has burgeoned as an exercise trend in Western society because it positively affects psychological conditions, pain, cardiovascular, autoimmune and immune conditions, and pregnancy outcomes. Based on findings in studies in pregnant and postpartum women and other chronic conditions, yoga represents a potential means of care that may help women build their capacity to be resilient and cope with depressive symptoms both immediately after their stillbirth and in the months and years that follow.[41–43] Even though less than 20% of women in this study used yoga to cope, 50% were interested in yoga and of those, most preferred yoga in their home. Studies that examine the feasibility of in-home versus in-studio yoga settings may further inform the design of interventions and help guide low-cost, sustainable strategies for coping after stillbirth.”

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My Breast Was Not Best

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In 2001 when I had my first baby, breastfeeding was just becoming more focused on. Breast is Best was everywhere and I was looking forward to nourishing my baby from my body.

When my baby arrived, I kept waiting for my milk to come in. Nurses told me since I had a traumatic delivery, it was probably delayed a few days. I was encouraged to sleep, give her a bottle and send her to the nursery. Thirteen years ago, a baby rooming in was not common. When I insisted she stay with me so I could cuddle her and nurse her as often as possible, I was met with resistance. I’d fall asleep, only to wake and find she’d been taken to the nursery and given a bottle.

I was sent home with a stack of pre-mixed two ounce baby bottles that I was determined not to use. I latched her as often as she wanted and smiled down at her beautiful little face nestled against me. I was filled with maternal love and cherished the moments. The hours ticked by, she grew hungrier and I could not figure out why she was so upset. She’d pull off me and scream, her arms and legs would kick in frustration. I’d sit there and cry, not understanding where my milk was.

I went and got a breast pump. Then I called lactation consultants and visited them. It was declared that my milk had not come in yet. That could be the only answer. I was to use a pump as often as I could to stimulate milk production, offer the breast first always, and then give her a bottle. She gave me a tracking sheet to keep track of how much she ate and when. Those tracking sheets became my new obsession. Everything was detailed immediately and precisely.

And so began the agony of sitting at a pump as often as I could, feeling like a dairy cow… minus the milk. Dribbles came out and I collected them as carefully as I could. It would take me days to collect an ounce and when I had that ounce I fed it to her as if it were liquid gold. Weeks went by and my milk still continued to only dribble. She’d only nurse for a few seconds and then would eat her bottle, although even those were not well. I went back to see a lactation consultant. It was decided that she was a lazy eater, her mouth was too small and she was not able to provide the suck that was needed to stimulate milk production.

I went back to my routine of nursing, bottle feeding, pumping, crying each time I had to give her a bottle of formula and then dismally stare at the empty collection bottles that were at my breast as the pump tried to do its job. I became more and more depressed, sometimes not getting dressed for days. Why bother? I felt defunct as a mother already. If I was a horrible and unworthy mother, there was no point to getting dressed and going out. I felt terrible about my postpartum body, additionally, having put on seventy pounds during pregnancy. I didn’t even want to try to squeeze any clothing over my sausage like appendages. Attempting to get dressed was another foray into depression and self hatred. My body looked nothing like it did pre-pregnancy. Why didn’t anyone tell me about this? How come my other two friends seemed to already be wearing their pre-pregnancy clothes but I was not? The answer in my head was that they were clearly better mothers than I was. They had plenty of milk, pumping and nursing. I sank like a stone into depression.

But still I continued on, trying to pump milk for my baby, taking supplements, tracking everything that went in her and came out. Then came the day that it happened, when she was about 6 weeks old; she refused to latch. She cried when I tried and stopped when I offered her a bottle. I began to hate my broken body even more. I sat there, rocking my baby who was happily sucking lazily away on a bottle and silently cried, wish I had known the last time I had nursed her would have been my last. I would have cherished it more. I would have taken in every moment.

I got a bit better when I stopped trying to nurse and pump. I didn’t plaster my thoughts with negative remarks about my broken body as often. My baby was happier, quickly getting the bottle and sustenance she wanted when she was hungry. Visual cues were packed away, nursing bras, the pump, supplies, etc.
My daughter was still a horrible eater. I told myself that was most of the reason I failed at breast feeding. She really was a lazy eater as the lactation consultant told me. Most babies her age were eating 4-5 oz and she was still only eating 2 oz. It would go better next time, I told myself. The next baby will have a better suck, and that will fix my breast feeding woes.

Grandparents were happy they were able to feed her now and my breastfeeding mom friends never said one word to shame me about not being able to breastfeed. When I’d get undressed I’d hate my breasts for a moment, but not nearly to the extent I had before. When my libido returned I became able to appreciate them a bit more and slowly began to accept that, in my case, breast is not always best.

A sweet friend asked me one day… if you took a Harvard graduating class, would you be able to pick out which were breastfeed and which were bottle fed? No, I replied. The same friend asked me how I bottle fed my daughter. I demonstrated. Hold her closer, she suggested. Don’t be afraid to look at her and smile at her and cherish this feeding time, even without nursing her.

Admittedly, cherishing bottle feeding seemed a foreign concept to me. It was reiterated to me that my job as a mom was to feed my baby. My daughter had no idea the difference between formula and breast milk. I pulled her in a little closer and she smiled up at me, a trail of formula running out of her mouth. I wiped it away and slowly began to forgive my body for betraying me, or at least, that was how I had perceived it. Forgiving myself was exactly what I needed to do in order to move passed my grief.

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A Personal Tribute to Our PPD Leaders.

PPSC-25th-finalDuring a recent training class, I mentioned the name of colleague of mine, and soon realized that the therapists in the room were not familiar with her and her work.  I was surprised since she had been a pioneer in the PPD community for so many years, but it dawned on me that some of the clinicians who are now interested in specializing in this area, have had little experience with some of us “older” folks.

Therefore, as part of our 25th year celebration of The Postpartum Stress Center, I thought I would offer my own personal tribute to honor the long standing commitment of a few of my esteemed comrades so all PPD therapists are sure to know who they are and what they have accomplished along the way.

I am not going to list everyone’s achievements, because, well, there are far too many. They are gifted authors, teachers, advocates, innovators, scholars, healers, and creative thinkers. This is simply an unsophisticated attempt to make sure that therapists who are passionate about this work, familiarize themselves with the names and faces of those who have blazed the trail in preparation for this extraordinary work. You can read more about each one and her achievements on the individual websites. Suffice it to say that none of us would be doing the work we are doing without their leadership in this field. I urge you to check out their websites and see who they are.

Some thirty years ago this amazing team of women broke new ground in the field of postpartum mood and anxiety disorders and literally changed the way people viewed the transition to motherhood.  I am honored to be a part of this group and to call them my friends. Most of us worked independent of each other at first, then, without the help of the Internet and social media, found our way to each other and became a force to be reckoned with!

There are many many others that belong to this grand assembly of PPD leaders, and my apologies to those I inadvertently left out.  But the ones on this page have meant the most to me in my work and so, well, this is personal. It’s a very special thank you. In no particular order, let me introduce you to my colleagues who have paved the way and continue to inspire us with their wisdom… Thank you one and all. xo  

Signature

 

Ilyene2

Ilyene Barsky, LCSW 
(October 16, 1953 – January 18, 2011)
The Center For Postpartum Adjustment

 

Diana Lynn Barnes, PhD
The Center for Postpartum Health

 

Pec2

Pec Indman EdD, MFT
Women’s Mental Health Counseling, Consultation & Training

 

Susan2

Susan Dowd Stone, MSW, LCSW
Perinatal Pro

 

Wendy Davis, PhD
Executive Director, PSI

 

 

 

Jane2

Jane Honikman
Founder of Postpartum Support International

 

Shoshana Bennett, PhD
Clinical Psychologist, lecturer and keynote speaker

 

Birdie Gunyon Meyer, RN, MA, CLC
PSI Education & Training Chair, Past President, PSI

 

Sonia2

Sonia Murdock
The Postpartum Resource Center of New York, inc

 

Diane2

Diane Sanford, PhD
Women’s Self-Care, Mind/Body and Postpartum Expert

 

 

 

 

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What does PPD look like?

scarythoughts

Once upon a time, I had a terrible secret.  I didn’t want anyone to know.

Not even myself.

I did my best to ensure that no one would find out, lest I then face judgment.  So I did my hair, I did my nails.  I made sure what I put on to wear looked nice.  I did my make-up and plastered on a smile.  Once at the doctor’s office, I was standing in line with another new mom.  We stood there and held our babies and the receptionist looked at me and then looked at her.  “Honey, for someone who just had a baby, you look awfully put together!”  I smiled and then turned to the other new mom who looked much more how I actually felt.  Hair disheveled, her shirt had spit up on it, her pants wrinkled.  “It’s all a façade.  Trust me.” I said to her.

Friends and neighbors would comment and compliment me.  “You look great for someone who just had a baby!”  or, “Wow, I love your new hair!”  Little did they know my new, shorter haircut was a product of hating what I looked like so much, I needed a drastic change.  I was also pulling my hair out.  I needed it short enough to make it harder for me to sit there and go through the strands, picking out hairs that ‘didn’t belong’ and yanking them out.  I camouflaged that by donating 15 inches to a charity.  That was why I cut my hair off.  Not because I was trying to look chic.

To look at me would mean you’d never know how much I was suffering.  How badly I felt about myself and my abilities as a mother.  You’d never even for one second think that the most horrible, intrusive scary images and thoughts daily invaded my head, making me feel as if I were the lowest of the low.  How could a good mother think those things, anyhow?  For me, the answer was simple.  A good mother would and could not and therefore, I was not a good mother.  That was my secret.

You would never know by looking at me or talking to me that I was suffering from horrible PPD and OCD.  You would never know how hard it was for me to leave my own house, to walk out that front door was positively terrifying.  You would never know to look at me that I would just sit there and cry.  You would never know the horrible things I thought.  You’d never know I felt sad, alone and horribly depressed.  You’d never know how irritable I felt, the rage that boiled or that I screamed into my pillow to relieve the stress until I was hoarse.  You’d never know the crushing anxiety or the extreme numbness I could feel.

So what does postpartum anxiety look like?  It looks like your friends, your neighbors, the perfectly put together mom at play group and the moms that runs into the dentist office 15 minutes late with a baby on her hip and a toddler in her grip.  It looks like my friend who could not leave her house and it looks like the lady who whispered to me once that she knew how I felt.  It looks like me, right there in the mirror, on my best days and my worst days.  It looks like the new mom who quit her job to be home alone with her baby and it looks like the mom who just handed her 6 week old infant to strangers while she goes to work. We have a misnomer that a postpartum mother doesn’t dress well, doesn’t put on any make up, forgot how to do her hair and sits in a dark room and cries.  Postpartum depression can look like just about anyone.  That’s what makes it so dangerous and that’s why it goes untreated and undiagnosed too often.

I had the misunderstanding that admitting I had an illness was to admit I was weak.  That I had failed at taking care of myself and therefore, my baby.  By admitting my secret, by getting out how horrible I felt, that was when I opened the door to getting well.

photo credit: Vanessa Vander Eeckt

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My Story

claire1

Like many moms, when I received the news that I was pregnant with my first baby, I was elated. I spent the next ten months… yes, ten, she was very late… preparing in all the ways that baby and pregnancy magazines tell you to. I cleaned everything with toothpicks, I painted rooms, (well ventilated, of course), I bought brand new furniture and accessories, I got a bunch of bottles ready, nursing supplies ready, crocheted a blanket, dug out my lamp from when I was a little girl and sang songs to my tummy so the baby would know my voice. Took infant first aid and cpr classes, parenting classes and birthing classes. I did everything I was supposed to do to prepare for a new baby.

But what I was not prepared for were the horrible thoughts that plagued me. Having had dealt with terrible thoughts for years, it troubled me why they seemed to get worse with my pregnancy. I had trouble preparing meals. Being around knives and stoves made me think things I was deeply ashamed of. The beautiful nursery I crafted with love, painted myself, put up a gender neutral border, and arranged just so with furniture… I didn’t want to go up the stairs to see. More specifically, I didn’t want to have to go down the stairs. I’d stand at the top of the stairs, knuckles turning white as I gripped the rail, staring at the staircase going down. This was the happiest time of my life! So how come it didn’t feel like it? Don’t worry, it’ll get better, I told myself. As soon as you hold that gorgeous baby in your arms, it’ll be better.

Except it wasn’t. It got worse.

When I finally had my baby girl, I was so happy. It was a difficult delivery; she was already two weeks late when they finally induced me. I kept telling them I felt like something was wrong, but I was reassured everything looked great and not to worry, “you’re a first time mom.” But I had a gut feeling that would turn out to be right. After thirteen hours of back labor and absolutely no progression, the doctor on call made the unilateral decision to break my water. I had terrible back labor and I didn’t want to lie down. It took 5 nurses to hold me down and there was meconium in the fluid, I passed out and both me and my baby’s heart rates started to drop. When I came to, I was told that I was being rushed in for emergency surgery and I felt my heart sink. I had already failed at being a mother, my own body refusing to do what I was created to do.

Just as I started going into crisis, my regular OB arrived home from her vacation and came straight from the airport to the OR and she delivered my baby. My baby had been face down, but not facing the right way, the wrong part of her head was presenting and the cord was wrapped around her neck three or four times. As I came to from time to time in the recovery room, I had to keep asking the nurse on duty if I had had a baby yet and what it was. My husband at the time and I had decided not to find out the gender. She told me I had had a girl. I couldn’t wait to see her. But wait I would, as I would wake back up and ask the same questions three more times before I was really recovering. It would be hours before I saw her.

When I did, she was everything I had hoped. Beautiful. Bright blue eyes. She had porcelain skin and a healthy set of lungs. She was crying inconsolably as they wheeled me in, but the moment she was placed in my arms she stopped, looked up at me and just smiled at me. Peace. I fell in love with this tiny, beautiful person with my entire being in that one lone moment.

When I got home, I waited for the thoughts to go away. I waited to stop being afraid and I waited to start enjoying my baby more. Breastfeeding was failing and I didn’t know why. All I knew is that not even a week into motherhood, I had already failed twice as a mother. The guilt was so heavy. I had friends who had just had babies and complained about leaking boobs and how gross yellow, seedy newborn poops were. My baby cried and cried and finally as I sat in the darkness of the bedroom, I offered her one of those two ounce premixed baby formula bottles. She began to gulp it down with a fever… and that’s when it hit me. She was so hungry. And as she ate I cried silently so no one would hear me and told her how sorry I was as I rocked her consolingly.

One night when my daughter was about six months old, I saw a special on a news program about Postpartum OCD. As I sat there I began to understand why I felt so terrible. I watched the woman on the screen explain everything that I had been going through. The terrible thoughts, the anxiety, the compulsions I didn’t even fully realize I had. As I sat there watching, my husband at the time asked me if that was anything I could relate to. I never replied. I think the tears running down my face were answer enough.

The next morning I did some research and made phone calls that resulted in my first therapy session that would begin a journey of healing and acceptance. I would resist medication something fierce, but when I did start it, that was when I really began to pick myself back up. It’s a journey in some ways I’m still making, since I am recently postpartum once again, blessed with a baby boy this past September, to join his big sister who is now thirteen and his older brother who just turned three.

Postpartum issues are why I am here. Having been through them myself, I’ve always shared with friends and family about what was going on, what I was going through. It was nothing to be ashamed of, and gosh darn it, I was not going to be ashamed. Sharing my story lead to other moms pulling me aside and telling me their stories. Some people said I was brave to be so bold and open and others said I should keep such matters private. Some said that they could not understand or relate to how I could be having such a hard time when I had such a beautiful baby girl. How could I be so sad? I bet they didn’t know I asked myself that same question over and over.

While support for postpartum issues has grown and become much more prolific since I first saw that news program thirteen years ago; there is still much work to be done. I hope contribute to that effort, in sharing my stories, journeys and lessons here with you.

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Welcome Claire!

claire2014bw2

I am so thrilled to welcome Claire Petrillo as a senior writer for our PPSC Blog. I’ve known Claire a long time and she has always had her finger on the pulse of current issues that impact new moms and has expressed herself with both clarity and fire. She speaks her mind. And she often speaks on behalf of many women who share similar sentiments.

Let me introduce you to her:

Claire is a writer, photographer, hiker and book lover who has worked within the human services sector and is currently a stay at home mom.  She lives in New England with her husband, a teenage daughter, her twelve year old step-son, a special needs three year old son, new baby boy and two teenage step-daughters who visit.   She and her husband work together to raise their blended family and help their kids understand the value of being a family.  She has written for the Patch previously and is hoping to go back to school for her Master’s degree in all her copious spare time.

Yes, she is currently a postpartum mommy, so be kind to her, always. She certainly has her hands full at home but when she can find the time, she will share her thoughts on our blog for our readers. Feel free to let her know how you feel about anything she writes. Claire has strong opinions, which is why I love her, so be forewarned. But she knows that as long as she makes me look good, she is fine. 😉 She is sweet, she is smart, she is passionate about things that are important to her. She is a wonderful mother and she knows how to turn her personal vulnerabilities into areas of strength and expertise.

Welcome my dear Claire. Speak to us.

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Keeping it Real for the Holidays

So we’ve all read the top ten lists of how to survive the holidays. Even the PPSC came up with a list of how to find your holiday brave. It’s all over the Internet. Everyone has their own suggestions for what to do, what not to do, and how to do it.

Sometimes these common admonitions do help.

But sometimes they simply add more words and pressure to the list of things women already feel they cannot do.

To women who are severely depressed right now and finding it hard to get through the day, the holidays can truly feel oppressive. To those of you who are consumed by paralyzing guilt and the sense that who you are simply does not matter, this is for you:

You DO matter. It just doesn’t feel that way right now. When you get relief from your symptoms (Therapy? Meds? Time?) you will no longer think and feel this way.

Remember that what you are thinking and how you are feeling right now are SYMPTOMS, they are not who you are.

For some, the holidays can be a brilliant blessing surrounded by loved ones and an abundance of joyful exchanges. For others, it can feel like a contrived expedition into family secrets and phony relationships. For most of us, it is somewhere nice and cozy in between.

When you are sick with depressive symptoms, it’s hard to see anything for what it is. Hopelessness feels pervasive. Gratitude feels elusive. Joy feels unobtainable.

Sometimes, the best you can hope for is simply to get through the day.

Here’s your list:

  • Wash your face. Brush your teeth. Brush your hair. Put some blush on your cheeks.
  • Take a walk. Bring music to distract your brain. Breathe deeply. Stand up straight. Move your body to the rhythm of the music.
  • Your mantra for the day is: I’m doing the best I can. I’m doing the best I can. It’s okay.
  • Ask for help. Let your partner know how you are doing. Let your partner know what you need.
  • If you do not feel up to the festivities and are unable to push yourself through the motions, then give yourself permission to assess whether you need to participate or not. Discuss this with your partner. If it’s an overwhelming gathering of 100 family members at a restaurant an hour away, perhaps you can find an excuse to leave early or not attend at all. If, on the other hand, it is a small get together with close family members or friends, it might feel better than you think to push yourself to be there and soak up positive energy around you. It might be helpful to let one or two people with whom you are close, know how you are feeling so you don’t isolate yourself further.
  • Reduce ALL expectations. Give yourself an excuse to do less and let that be okay. You will make up for it next year when you feel stronger.
  • How you feel right now is temporary. If you are getting treatment, you need to give it time and remind yourself that although the timing of this might suck right now, you are under no obligation to contribute to the holiday events beyond that which you feel capable of doing.
  • Do not feel guilty about what you are able or not able to do right now.
  • Take care of yourself by resting, eating well, avoiding things and people that make you feel bad.
  • Indulge in self-compassion.
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