Seven mothers share painful journeys

Posted on August 16, 2011 by

Reposting a series of personal essays written by mothers for REDBOOK

The Shadow Side of Motherhood

Becoming a mom is one of life’s greatest joys. But for some of us, the path to motherhood takes a gut-wrenching turn. Seven women share their journeys — and how they made it through.

“I lost my first pregnancy — and almost lost myself”

I’d only known I was pregnant for a matter of weeks when the cramping started. Still, What to Expect When You’re Expecting was already dog-eared, and my copy of Sears and Sears’s The Pregnancy Book looked like it had survived multiple generations of moms-to-be. Miscarriage, however, had been only a footnote in my reading.

I was in bed, and the white sheets beneath me turned red. My husband called the hospital and our obstetrician was paged. My physician, a seasoned veteran, was nonchalant: “Yep, it sounds to me like she’s miscarried. Come on in first thing in the morning.”

The next day, we returned home from the doctor’s office, where they’d confirmed the obvious via ultrasound. The excitement that had hung in the air was replaced by a fuzzy melancholy, and sadness for something lost. My husband tucked me into the couch with a blanket, carefully removing the stack of pregnancy books from the coffee table in front of me. I absently flipped through a catalog, crying when I came across baby clothes I had circled in blue ballpoint. As the intense physical pain faded into lingering depression, this is how I passed my days: I stared into space, lost interest in keeping the house tidy, and sat morosely at the dinner table each night. I felt let down by all the magazines, books, and, worst of all, the other women around me. Why hadn’t anyone told me to fear this? Or how profoundly it would hurt, and how the feelings of grief would overwhelm me?

Many months later, my husband came into our bedroom, where I’d been spending most of my time; I slept 10, 12 hours a night, but was always drowsy. He looked over at me, crying, having lost not only the dream of a child but his wife as well. I opened my eyes to see him staring at me, begging, “Baby, come back.” Though the child we lost was gone forever, I realized then that it was time for me to return. 
—Maggie McGuane

“Did I almost die when I gave birth to my sons?” 
When I was 34-weeks pregnant with my identical twin boys, I started gaining weight at an alarming rate, a classic sign of the high-risk pregnancy condition preeclampsia; a few days later, I was rushed into an emergency C-section. I welcomed that instantaneous sensation of relief as both boys were lifted out of my abdomen. They were doing well despite being seven weeks premature, and were taken to the neonatal intensive care unit (NICU) only as a precaution.

That was the last good news of the night. I was in a drug-induced daze, but I could hear the doctors talking clearly enough to know that things were starting to go wrong: They could not stop the hemorrhaging in my uterus, and I was at risk of bleeding to death on the table.

The next thing I recall is waking up in the intensive care unit with a tube down my throat. I saw my husband, Charles, first, who said the babies were fine. Then I saw that my sister had flown in to see me — and she looked as if she’d been crying. I remembered delivering the babies, and that I had lost my uterus, but what I didn’t yet know is that I had suffered a life-threatening failure of the liver and kidneys. Eleven units of blood had been pumped into my body as well as untold liters of fluid to try to maintain my failing blood pressure, so I weighed almost 100 pounds more than usual, and my body was unloading the excess fluid at an unbelievable rate, draining it through my catheter and from the wound on my belly. It was truly disgusting.

I was still so sick that the fact that I had just given birth was lost on me. The babies waiting for me in the NICU didn’t seem real; I was afraid of what I thought would be their tiny, fragile bodies, especially since I was now in a fragile body myself, utterly dependent on other people. Childbirth, normally a beautiful thing, had become scary and ugly.

After my first son, Nicholas, was born, he spent most of the day in my room with me. When people came to visit, he was the center of attention. This time around, the babies were on another floor and visitors had to choose to see me or them, rarely both. Even my husband’s visits with me lacked focus, and I could tell he was itching to get away. And so I was left alone with my thoughts — and my misshapen body.

In my younger years when I was feeling down, I would sometimes think about who would miss me if I died. And now, faced with a real-life version of the game, I was hungry for this knowledge. Did Charles contemplate living a life without me? Who called my parents, and what were they told? Was there a point when things were truly touch and go for me, or am I just being dramatic?

All I know is that whenever I tell a doctor my story, the look on his face as he hears the details of my ordeal reveals how truly close I came to death. Another time, another place, I would never have held any of my boys again — not my twins, not my 2-year-old, not my husband.

Did I almost die? Even though nearly five years have passed, I still wonder. I’m not sure why it makes such a difference. I just know that it does.
—Jane Randel

“I terminated my pregnancy”
My obstetrician called just as I was preparing a midday snack for my two young girls. I remember feeling sluggish that day. It was August; the air was thick. And sluggish was a considerable triumph, as the wrenching fatigue of my first trimester was slowly loosening its vise. Certainly words — sentences even — were coming through the receiver. But I don’t think I heard any of them. Concepts like “extra chromosome” and “genetic abnormality” wafted around me like bubbles. But I registered Dr. Sara’s unusually clipped tone. Her voice seemed to be trying desperately to regain something of its natural lilt.

After what seemed like hours, I hung up the phone and dialed my husband, relaying the news in the way I’d received it. I did not ask what “we” should do. I already knew.

Tears did not come that day or the day after. But in the hospital a few hours after what my doctor kept referring to as “the procedure,” my eyes were flooded and swollen shut as I lay in recovery. I remember thinking, Recovery? My baby is dead. And I killed her! There won’t be any recovery — not today, not ever.

And I was right. A part of me grieves the loss, even now. Eight months ago, I delivered a perfect baby boy. He is not only proof there is a God. For me, he is also proof that God still loves me. When my son’s tiny fingers grasp mine, the emotions are so strong it’s as though my heart and soul actually spasm with joy and sadness — at once. More than a blessing, his mere existence is a constant, bittersweet reminder of that fateful day. The pain will never go away; I’ve long accepted that it’s as much a part of me as my flat feet. But Cole’s arrival smooths the pointy edges of that pain, making it easier to bear.

I would not do things any differently. I believe that God matches special-needs kids with special moms. I am a patient, giving, and blessed mother. But I am not special — not like that. 
—Y. Gault

“I was overtaken by postpartum psychosis”
Wrapped up like a blue pastel burrito, our baby slept in my arms while the nurse droned on about the warning signs of postpartum depression. I was mesmerized by his silly expressions, his barely audible burps, his tiny fingernails. Who did she think she was talking to? A mental case?

By week two of my son’s life, my elation vanished. I did little more than nurse my son and feed myself. I hated being stuck in the house on sunny days, unable to take even a 15-minute walk. I lashed out at my husband for not doing enough. I was pissed that it took me three days to give myself a pedicure. Sleep-deprived and shocked by how little I could accomplish, I began to panic. I insisted that my husband not take our son to the grocery store (what if something happened?); I obsessed about immunizations, SIDS, leaving him with a sitter, the weird spot on his belly. Giving my baby a bath, I worried he’d catch pneumonia. I listened intently to his every grunt, sniffle, gasp, and whine — was it something I’d done wrong? A diaper left on an hour too long could send me into a spiral of self-hatred and doubt.

I hid all of these worries because I felt like I didn’t have the right to complain — after all, I had a husband at home to help me, a perfect angel of a baby. I convinced myself I was just like any other new mom. But one day, while my husband was out, I got so rattled by my son’s crying jag, I called 911 and told them I didn’t feel safe alone with him.

Later at the hospital, it was determined I was simply sleep-deprived. I left with a stash of tranquilizers, and for three more days I tried my best to appear normal. But then I slipped further. I couldn’t talk, I barely breathed, I didn’t blink. For a month I was hospitalized in a locked ward where I believed I was dead, a saint, God, in cahoots with the Unabomber.

They say time heals all wounds, but it was a psychiatrist specializing in postpartum depression who gave me back my sanity. My doctor knew which drugs to prescribe, but also how much I needed a safe place to talk. When he told me I wasn’t alone, that lots of new mothers end up in a mental hospital, I began to feel less like a freak. As I grew to trust him, I told him my fears, and he listened with compassion and understanding. A confidence that I knew what was best for my son slowly grew in me. Relief washed over me as I began to revel in my son’s new words — bye-bye, baby, bubble. I transitioned from a basket case back to the exuberant, confident, optimistic gal I’d been. And now I had a beautiful child to share the fun with.

It’s been seven years since I wandered around in a hospital gown, sure the guy down the hall was out to get me. Now my life is filled with trips to the playground, homemade cookies, cuddling, and kisses. My friends, family, and coworkers tell me that I’m always smiling, and it’s true. The reason? For six months my life was snatched away from me. And now I have it back.
—Martha Silano

“I gave birth too soon”
Lucy was born almost eight weeks early and had to spend her first three weeks in the NICU. Well-meaning friends would say to us, “That Lucy, she just couldn’t wait to get out in the world and meet her mom and dad.” But I knew the truth: I had failed my daughter. It was my water that had broken inexplicably and landed us in the hospital. And it was my low amniotic fluid that had caused her to be delivered three days later.

I was so angry at myself for failing this monumental first task of motherhood — carrying my daughter to term — that I became incredibly jealous of other mothers who’d accomplished it (which seemed like every mother but me). How did my neighbor, who gave birth and brought her son home while Lucy was in the hospital, have a healthy pregnancy when I did not? Or what about the beaming, nervous mothers I’d see cradling their 48-hour-old babies outside the hospital, waiting for their husbands so they could all go home?

It’s difficult to feel like a mother when you have to ask permission to hold your baby and when, after you hold her for a while, the nurse informs you that you are wearing your daughter out — and don’t you want her to get some rest so she can get strong enough to come home with you? I felt like screaming, “Get away from me! You, my doctor, my husband — everyone out of my life!” My fury made even me want to hide. When my husband suggested grabbing dinner in the neighborhood after a long day at the hospital, I lashed out: “We can’t go there. They know us — what kind of parents will they think we are, eating steak frites while our baby is in the hospital?” In my mind, I deserved nothing.

But then I started to get busy being “Lucy’s mom.” As I sat by her incubator and described for her all the people thinking about her, as I pumped breast milk for her, carefully pouring it into the specimen cups the nurses gave me, and as I shampooed her tuft of hair, my anger took a backseat to love and the responsibility it brings.

I realize now that the anger I felt wasn’t about failing Lucy but about my feeling cheated. When my water broke early, I didn’t get to have the anxious thrill of saying, “Honey, it’s time.” And I certainly didn’t get the birth experience — the pushing, the pain, the holding my seconds-old slimy baby in my arms — that I had foolishly presumed was my right. Instead, I was allowed only a moment with my daughter, a quick kiss before the neonatologist whisked her away.

Later, when Lucy was out of the hospital and thriving, I still clung to her early-birth story as a way to make up for the little shortcomings I felt as a mother. I could weave it into any conversation thread — “Yes, well, Lucy is a late talker, possibly because my water broke at only 32 weeks, blah, blah, blah.” But each time I recounted my experience, the story became less relevant, even bordering on the ridiculous. My resilient, happy daughter had clearly gotten over her premature birth, and I needed to fall in line. About a month ago, Lucy, now 2, and I were at her Tumble Bugs class. She was on the trampoline, bouncing giddily (code for dangerously high), when a mom commented to me, “Wow — your daughter has so much confidence.”

“Thanks,” I said. I didn’t need to say anything else.
—Mindy Berry

“I placed my daughter for adoption”
My foray into motherhood didn’t quite go as expected. When I was 22, I placed my firstborn for adoption. One reason I relinquished her was the fear that I wouldn’t know how to be a mother. No one explained that you learn all the mysterious secrets of motherhood the minute you become a mom. It took the birth of my first parented son two years later for me to realize that you just know how to wake up in the middle of the night, change a diaper with your eyes half shut, and half sleep your way through a feeding. During my unplanned pregnancy, I thought I would never learn to love my child. No one explained that while an unplanned pregnancy brings ambiguous feelings, in the end you will love your child without question.

Of course, I’m lucky. I relinquished my rights during the open-adoption era, so I have continued contact with my daughter and her family. During our first visit, I soothed my 4-month-old daughter’s cries after she was scared by the dog. As I held her to comfort her, it felt so very right. And in that moment, a sadness crept over my soul. My eyes were opening to the many lies that I had believed about my ability to parent. I would have been a fine mom to my daughter. I would have learned the same things that everyone learns in time. The love was always there; I was just scared to open my heart to the possibilities.

Now when we visit, I walk that fine line between being her birth mother and being her mommy. It feels strangely sad to sit idly by while she is parented by people she knows as Mommy and Daddy. I often quietly mother her in my head and think, It’s okay. Come to Mommy, I’ll make it all better. Yet, if I told my daughter to come to Mommy, she would walk to someone else. I’m just beginning to forgive myself for my naïveté about my daughter’s placement. And as I watch her grow, I am finally allowing myself to feel pride amid the sorrow. I’m becoming the amazing mom that I could have been to her, not just for the benefit of the two sons I am raising now but also for her — so that she might be proud of me someday. 
—Jenna Hatfield

“My baby died before he was born”
My water had broken, and I was looking at an ultrasound of my baby turned, bottom up, as if ready to deliver. But it was only week 17. And what I saw on the screen horrified me. The baby’s soft skull was wedged between two huge fibroid tumors growing alongside him. With the amniotic waters draining away, there was no cushion to protect him from their mass. And with no water, there was no way for him to flip and turn away from the danger of the growing tumors. The black-and-white image on the screen pointed out the rigid truth: If he was born now, he wouldn’t survive. But if he didn’t escape my womb, he stood to be crushed inside my own body.

It wasn’t the thought that I would lose this baby that made me keen with grief and rage. I had yearned for a child. I had waited; I had been patient. I’d found a good husband who would be a good father, and created a good life for a child to come into. I’d done everything right.

Hadn’t I? I questioned every candy bar and California roll. Did I forget to take a vitamin? Had the daily commute — two hours each way — been too much? The doctors couldn’t tell me. They ran tests to see if the premature rupture was genetic. It wasn’t. And so they had no answer for why this had happened. That left me with only my own actions, my own body, my own decisions to question. What had I done? What had I done wrong?

I was getting my first taste of what I now know to be the primary preoccupation of motherhood: helpless questioning. As mothers, we bend ourselves into knots with the constant weighing of pros and cons, often with no discernible “better” outcome between the two. Every moment with a child is filled with choices — coat or sweater, tea or Tylenol, let it go or let him have it, go to work or stay at home, private school, public school, homeschool. It begins before they’re born and, by all accounts, it doesn’t end until you die. The problem is that no matter what choice you make, you’re afraid it was the wrong one.

In the end, I learned one of the most important lessons in mothering before I had a child to mother: Wait and see. And I waited weeks. Eventually, the labor began, sudden and insistent. Ill-prepared, I pushed. I pushed. I gave birth to a baby who came — and left me — too soon. 
—Tamara Jeffries

http://www.redbookmag.com/kids-family/advice/motherhood-stories

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test self care

Posted on August 15, 2011 by
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Volunteer Grandparent helps mom with postpartum depression

Posted on August 14, 2011 by

AS WE AGE: Volunteer Grandparents making a real impact (reposted from burnaby newsleader blog)

110810-Grandparent2C.jpg

Maureen Hopper has been a volunteer grandparent to Radhika Patel for seven of her 10 years.

Published: August 09, 2011 12:00 PM
Updated: August 09, 2011 1:59 PM

Seema Patel hit a low point in her life after the birth of her daughter, Radhika. Sufferering from severe postpartum depression and coping with the loss of her mother to Lou Gehrig’s disease when Radhika was only two, Patel felt as though she was in a black hole. That’s when her social worker introduced her to an organization called Volunteer Grandparents.

“I thought it would be so nice if my daughter could have a relationship with someone from an older generation,” said Patel.

Two and a half months later, just in time for Radhika’s third birthday, she was matched with Maureen Hopper, a Burnaby nurse whose own daughter had a volunteer grandparent while growing up. Having had a child later in life, Hopper knew she wouldn’t have grandchildren anytime soon, so she decided to become a volunteer.

Hopper knew as soon as she met Radhika that they were a great match.

“I couldn’t have gotten a better kid. She’s very loving and we have many of the same interests,” said Hopper. “We’ve been very compatible right from the beginning.”

Volunteer Grandparents is a Burnaby-based non-profit organization which serves the Lower Mainland. The organization was founded by social worker Marjorie Anderson in 1973 with the goal of bringing together people of grandparenting age with children who don’t have the immediate presence of grandparents in their lives, said Veronica Grossi, program coordinator. The organization offers the family match program, where volunteers over 50 are matched with a child who has no access to natural grandparents and is aged three to 14. Volunteer grandparents can have their own natural grandchildren and must commit to spending two to four hours a week for one year with the new child. The organization also has a school-based program, where volunteers go to elementary schools for one-to-one reading time with children. The organization may be small, with approximately 35 grandparent volunteers, but has had a significant affect on the families it serves.

When Patel met Hopper, she was in an abusive relationship and felt ostracized by her community for wanting to leave her husband. Patel said that Hopper empowered and encouraged her to end the relationship, even when her friends and family told her not to.

“Maureen opened our eyes to female power. She taught us that healthy self esteem frees you from the judgement for others,” said Patel.

“She gave me the courage to leave him.”

The idea of female empowerment has been passed on to Radhika, who wants to be a doctor or veterinarian, said Patel, adding that Hopper has opened Radhika’s eyes to many things she may have not otherwise experienced.

Radhika, who is now 10 years old, says she loves skiing and kayaking with her “Granny.” They live a seven-minute drive from each other and enjoy time together at least once a week. Patel says Hopper is there for all holidays and birthdays, and also goes to watch Radhika perform traditional Hindu dances.

“Radhika is such a sweet girl. I have gotten far more out of this than her, she has been such a joy to be around,” said Hopper. “I have a hard time being out of town a few days because I miss her.”

Hopper encourages those of grandparenting age to become volunteers with the organization, which has a waitlist of families hoping to be matched with a grandparent.

Radhika feels lucky she has Hopper in her life and has only positive things to say about her grannie.

“My Grannie is really special and she’s really kind. I love her.”

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Mom tells her story of postpartum psychosis

Posted on August 14, 2011 by

Posted at 04:46 AM ET, 08/09/2011

From naked on highway to thankful postpartum survivor

 


Heather Coleman and her two children, Lily, then four months old, and Darius, then two years old. This was taken less than two weeks before Coleman’s postpartum breakdown. (Courtesy Heather Coleman)Heather Coleman only remembers bits and pieces of what happened after she climbed out of her car one rush hour afternoon, tore off all her clothes and tried to run down from Interstate 295 to the Potomac River. But she does know it was caused by postpartum psychosis after the birth of her second child, so she wants to find and thank the people who helped save her life by stopping her from jumping into the river.

And she needs your help.

Coleman has gone public with her story to warn both new mothers and their families of the serious dangers of postpartum syndrome. We’ve seen a bizarre postpartum outburst before in Fairfax County. In November 2001, a Fairfax schoolteacher fatally stabbed her husbandwhile he sat watching a college football game, not long after the birth of their child. Friends described their marriage as idyllic and the violence as utterly uncharacteristic.

Postpartum depression affects between 12 and 20 percent of new moms in the U.S., according to the Centers for Disease Control and Prevention, though some mothers’ support groups think the number is higher. The symptoms can range from mild to severe, and can be an indicator of mental illness.

So Coleman has shared her story with a group called Postpartum Progress, and created a Facebook page in hopes of contacting the people who intervened in a weird situation. But she has hit roadblocks in speaking with a District police officer and two people from Richmond.

Here’s a short video interview with Coleman. After the jump, details of her bizarre day, and how you can help locate Coleman’s Good Samaritans:

Coleman is 34 and now lives in King George, Va. In May 2008 she gave birth to her second child, Lily, and five months later she was back at work as a communications specialist for a government contractor in Rockville.

In the days before Oct. 3, 2008, Coleman had been having trouble sleeping, and occasionally had some obsessive thoughts about losing her new baby, but thought little of it. That morning, though, she awoke at 5 a.m. and began distributing flyers in her neighborhood urging residents to register to vote. Which was unusual.

That day, she went to the funeral of a friend’s mother, then to work, where she said she was extremely talkative. She began recognizing a lot of “coincidences.” Her thoughts were racing.

At day’s end, she got in her 2006 Chrysler Pacifica and joined slow-moving Beltway traffic heading south toward Virginia. She recalls phoning her husband, asking him about Adam and Eve, and whether women were evil. She called her parents in Vermont, asking them strange questions, and they realized something was wrong.

Traffic on the Inner Loop trudged along. Coleman said she became convinced the world was coming to an end. She pulled into the breakdown lane and drove a little faster. As she came to the exit for I-295, she took it and headed toward D.C., and the bridge over the Potomac River.

“I was trying to get baptized before the world ended,” which Coleman believed would be coming in some sort of nuclear meltdown at 5:55 p.m.

She stopped her car at the bridge. “I remember getting out,” Coleman said. “I remember taking my shirt up over my head. I remember running, on the right shoulder. I was going to the edge of the bridge, and then walk down and get in the water.”


Do you recognize this man? It’s Keith Coleman, husband of Heather Coleman, who showed up at the scene on I-295 after his wife ran naked down the side of the highway. Heather Coleman hopes someone might recognize her husband from that day and come forward, so she can thank them. (Heather Coleman)Next, she remembers “a woman holding my arm and telling me ‘no.’ She was with a man.” She said a second couple stopped. A police officer came on scene and asked if she’d done any drugs. “I smoked weed,” she lied. Her husband, Keith Coleman, showed up as she was being placed into an ambulance, and Heather Coleman said she screamed and fought the paramedics, and is sorry about that.

She was hospitalized and was unhurt. She was later diagnosed with mild bipolar disorder, and with medication she has everything under control. Still, she wanted people to be aware of the sudden potential that postpartum psychosis can evolve into.

And she wanted to thank the people who saved her, who she believed to be two African-American couples. I tried to help.

Coleman filed a Freedom of Information Act request with the D.C. police, and received both the 911 tapes from that day and the dispatchers’ logs. The logs revealed that it was actually an off-duty police officer named Boone, “Forestville PD,” who was one of the first on the scene. There is no Forestville Police Department.

The 911 tapes revealed that a man named “James” called in from the scene, said he was from Richmond, and that he and his sister were standing with the naked woman. He gave his phone number.

I have called that number days, nights, weekdays and weekends. Without ringing, it goes straight to a recording which says, “The person you have called is unavailable. Please try again later.” And no voice mail.

So James, with a phone number of 240- 216-XXXX, if you’re out there, please call me. My direct line is 703-383-5116.

With the help of the Prince George’s County Police Department, I found Officer Kenneth Boone. He is a member of the Metropolitan Police Department. Unsurprisingly, he remembered the incident. He was very polite, but said he needed permission from his department before he could speak on the record with me, which also is not surprising. He has spoken briefly to Coleman, but they have not fully connected either.

And over the last month, D.C. police spokeswoman Gwendolyn Crump has simply declined to help. Of the six e-mails I have sent her, explaining that Officer Boone did a good thing and Coleman wants to thank him, Crump only responded to the third one. She said on July 15 she would follow up next week. Since then, no response to several more inquiries.

So, D.C. police, if you’re out there, please call me. My direct line is 703-383-5116. Let’s wrap up this postpartum episode with a happy ending.

By   |  04:46 AM ET, 08/09/2011

Source: http://www.washingtonpost.com/blogs/the-state-of-nova/post/from-naked-on-highway-to-thankful-postpartum-survivor/2011/08/08/gIQA4qp03I_blog.html

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An overnight clinic just for postpartum moms

Posted on August 14, 2011 by

Postpartum Depression Clinic The First Of Its Kind

Story by Ann Heppermann / August 14, 2011 (Reposted from NPR blog)

Women suffering from postpartum depression in the United States have not had an overnight clinic to address their specific needs. The new unit at the University of North Carolina, to open Monday, will offer that specialized treatment.
Maria Bruno knew something was really wrong when she put her newborn son, Nicolas, down for a nap and then was too afraid to pick him up.

“I was experiencing anger and rage, and I had suicidal thoughts,” she says.

In her desperation, she called her midwife and said, “‘I don’t know what’s wrong, but I can’t take care of the baby, and I’m miserable all of the time.’”

Her midwife asked what was wrong. Did she have thoughts of hurting herself? “I just laughed,” Bruno says. “I said, ‘All the time.’”

After childbirth, most new moms will experience some form of the “baby blues.” For some women, those feelings persist and turn into postpartum depression – a serious condition that can lead to hospitalization and more.

On Monday, a University of North Carolina hospital in Chapel Hill will open the country’s first free-standing perinatal psychiatry unit. It’s hoped the new clinic and those that follow may prevent Bruno’s experience from happening to other mothers.

Placed With Mental Patients

Bruno’s midwife believed Bruno’s life was in danger, so she called the police. They took Bruno to a University of North Carolina hospital in Chapel Hill, where she was diagnosed with severe postpartum depression.

The hospital had no inpatient program specifically for postpartum women, so the doctors checked Bruno into the same ward that houses schizophrenics, drug addicts and dementia patients. The staff put her on 24-hour high suicide alert.

“When I pumped, I had to have someone outside the door because they didn’t want me to try and strangle myself with the pump parts or something ridiculous,” she says.

Bruno says she never intended to act on her suicidal thoughts. She just felt overwhelmed, unable to be the capable mother she wanted to be.

Just Thoughts

Chris Raines is a therapist at UNC’s Perinatal Mood and Anxiety Disorders Program. She met Bruno after she transferred into outpatient therapy. Each year, Raines sees hundreds of women suffering from postpartum depression.

“I’ve had women come in here for a session and have said, ‘All I want you to do is give me the name of an adoption agency, because there’s got to be a better mother out there for this baby than me,’” she says.

“They will say emphatically, ‘I never thought about hurting my baby, but I would have these thoughts that I would see my babies with knives in it,’” she says. “I’ve had moms that won’t go by the kitchen because they’re afraid that they’re going to pick up a knife — because they’ve had this thought and they don’t know what it means.”

Raines assures the women these thoughts are just that: thoughts. However some health care providers, who aren’t trained in treating postpartum depression, don’t understand this. In Bruno’s case, the hospital staff would not allow her to see her baby at first because they feared she would hurt him.

“I found myself asking the nurses, ‘What is it gonna take for you to let me out?’” she says.

To get released, there were rules. Bruno had to stop crying. She had to take an antidepressant. She had to go to group therapy — even though the session was for alcoholics and drug addicts. After five days, she was finally released.

“I can’t talk about it without crying most of the time,” Bruno says. “It’s in my gut. It will never escape me, that experience.”

A Clinic Just For Postpartum Mothers

Bruno’s story motivated Raines to push for an inpatient clinic — a hospital clinic where the staff understands the needs of women with postpartum depression.

Dr. Samantha Meltzer-Brody, who directs the UNC Center for Women’s Mood Disorders, says everything in the new ward is geared to help women with postpartum depression. There are breast pumps and comfortable rocking chairs, individual therapy and family therapy. Babies will have extended visiting hours so that mom and child can create a routine, even while mom is hospitalized. It’s the kind of treatment, she says, these women should expect.

“Not in the middle of the heart clinic,” Meltzer-Brody says, “not in the middle of a different ward, but in a specialty ward that takes care of women during pregnancy and postpartum.”

“We think that the mental health services for the people that need it also needs to be appropriate.”

Meltzer-Brody says the clinic serves as a model for what should be happening across the country. Calls are already coming in from Michigan, Arizona and other states from women and doctors inquiring about the new clinic’s services.

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Breastfeeding problems tied to moms’ depression

Posted on August 11, 2011 by

Wed, Jul 27 2011, By Amy Norton

NEW YORK (Reuters Health) – New moms who have particular difficulty breastfeeding may be at greater risk of postpartum depression, a new study suggests.
The findings, reported in the journal Obstetrics & Gynecology, do not prove that breastfeeding problems are the cause of depression symptoms. But researchers say that new mothers and their doctors should be aware that the two can go hand-in-hand.
The study found that of nearly 2,600 mothers who had ever breastfed, just less than eight percent screened positive for major depression two months after giving birth.
And that risk was higher among women who either had severe breast pain or generally “disliked” breastfeeding during their baby’s first weeks of life.
Whether the breastfeeding difficulties are to blame is not clear, according to lead researcher Stephanie Watkins, an epidemiologist at the University of North Carolina, Chapel Hill.
A limit of the study, she told Reuters Health, is that there was no information on whether mothers had suffered depression during pregnancy.
So it could be that women who were already depressed had a tougher time with breastfeeding.
“Everything is harder when you’re depressed,” said Dr. Alison Stuebe, an obstetrician/gynecologist at UNC who also worked on the study. “It may be that some women were depressed during pregnancy, and that made breastfeeding harder.”
On the other hand, she said in an interview, it’s possible that underlying hormonal factors contribute to both breastfeeding issues and depression. Stuebe and her colleagues are doing further studies to look into that question.
Whatever the reasons for the connection, the researchers said the main message is that early breastfeeding problems could serve as a warning sign of postpartum depression in some women.
Both Watkins and Stuebe suggested that new moms talk with their doctor about any breastfeeding problems they are having. And doctors, they said, might think about screening those women for postpartum depression.
The American College of Obstetricians and Gynecologists (ACOG) says there is not enough evidence to support routinely screening all new mothers for postpartum depression. (The major downside of any medical screening is that it can lead to over-diagnosis, and treatment of people who do not need it.)
On the other hand, ACOG also says that depression screening can benefit new mothers and their families, and “should be strongly considered.”
Focusing screening on women with risk factors for postpartum depression could be the best route, Stuebe noted. “And our study suggests that this (breastfeeding difficulties) may be a risk factor,” she said.
The findings are based on 2,586 U.S. women who took part in a larger study of infant feeding practices. All had breastfed and answered questions on their experiences with it in the first few weeks.
The women were then screened for depression when their babies were two months old.
Overall, women who screened positive were more likely to have had severe breast pain in the early weeks of breastfeeding. During week one, 35 percent did, versus 22 percent of women who did not screen positive for depression.
When the researchers accounted for other factors — like women’s age, education and race — severe breast pain was linked to a doubling in the odds of postpartum depression.
Similarly, mothers who “disliked” breastfeeding in the first week were 42 percent more likely to later screen positive for postpartum depression, compared with women who said they liked it.
None of that means that women who dislike breastfeeding are destined for depression, Stuebe stressed.
But, she said, women and doctors should be aware that the two things can “run together” — and that some women who feel breastfeeding is painful or too difficult may actually have depression.
According to ACOG, the so-called “baby blues” — where mothers feel anxious, sad or irritable in the days after delivery — are very common. True postpartum depression is less frequent, affecting about 10 percent of new mothers.
Some symptoms include strong feelings of sadness, anxiety or helplessness that do not improve after about a week and start to interfere with daily life.
As for treatment, some doctors might recommend an antidepressant medication (which is generally considered safe during breastfeeding). But support groups or other non-drug options may also help, according to ACOG.
SOURCE: bit.ly/p1EV6I Obstetrics & Gynecology, August 2011.

Reposted from: http://www.reuters.com/article/2011/07/27/us-breastfeeding-depression-idUSTRE76Q66420110727

Posted in PPD Causes | Tagged , , , , , , , | 2 Comments

Ithaca mothers turn placentas into post-natal supplement

Posted on August 11, 2011 by

Ithaca mothers turn placentas into post-natal supplement

Polly Wood of Ithaca shows a container of empty receptables for placenta encapsulation. Wood transforms mothers' placentas into capsules to be taken during a mother's post-partum period. / AARON MUNZER / Photo PROVIDED


Written by Aaron Munzer Correspondent

5:25 PM, Aug. 10, 2011|

Within 24 hours of the baby’s birth, Polly
Wood had her gloved hands on its
placenta.

Using traditional Chinese medicinal
techniques in the family’s home, Wood
steamed the mother’s cast-aside organ in
a blend of warming herbs, dehydrated it,
and then poured it into 120 small capsules
that new mothers call their “happy pills,”
she said.

When the new mother and her baby came
home from the hospital, she found an
extremely clean kitchen, and a jar full of
light-brown capsules that she was to take
for several weeks during the postpartum
period. Wood, a trained encapsulation
specialist, said ingesting the vitamin,
hormone and nutrient-rich placenta can
relieve symptoms of depression, mood
swings and “the baby blues” that affect up
to 80 percent of new moms.

“It’s the only time humans make an organ
when they need it,” she said. “It’s another
aspect of our body’s natural wisdom that’s
just tossed out. If you don’t decide to take
your placenta home at the hospital, it’s
tossed out as toxic waste.”

After working as a doula, or labor coach,
for years, Wood decided to change her
focus while maintaining her work with
mothers by delving into placenta
encapsulation as a way to help them cope
with the rocky road of postpartum life.

Last fall, she received training from a
network of encapsulation professionals
called Placenta Benefits, and abides by a
host of federal Food and Drug
Administration food safetystandards and
Occupational Safety and Health
Administration guidelines while in mothers’
homes. There are now encapsulation
professionals in most states, according to
the organization’s website. For her service
Wood charges $225 to $300 based on the
mother’s income.

“So it’s not just some unusual idea; it’s
available to the mainstream,” she said.
“One of the main benefits is its ability to

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nourish the mother and reduce the
potential for postpartum depression.”

Wood said that’s because the placenta is
incredibly rich in protein, minerals, B
vitamins and female hormones the woman
produces during pregnancy — a perfect
tonic for a new mother. Several scientific
studies have shown placental ingestion
increases milk production, increases pain
dulling hormones, and prevents iron
deficiencies in mothers, and there is an
ongoing study at the University of Las
Vegas on a connection between
placentophagy and postpartum
depression.

Kimberly O’Brien, a professor of nutritional
studies at Cornell University, said that while
placentophagy isn’t harmful to a new
mother, there’s little scientific evidence so
far proving its effectiveness for postpartum
depression.

She said that the placenta is a natural
source of nutrients for a new mother,
including heme iron, which is a form of the
mineral more easily absorbed by the body,
but she noted that the minerals in the
placenta can also be obtained with a
prenatal vitamin.

“I think that the placenta is a truly amazing
organ that hasn’t been sufficiently studied,”
she said. “It is really a truly miraculous
organ, but there isn’t sufficient data to
show that is causing a biochemical change
in women who ingest it.”

O’Brien said she’d love to see more
research on placentophagy, but until now,
says there’s not enough evidence to
recommend it from a scientific standpoint,
given the modern woman’s access to
nutritional foods and vitamins.

McKenzie Jones-Rounds of Ithaca, who
used and recommends Wood’s service,
said the idea is new here culturally, but s
aid in many cultures placentas are sacred,
and can be eaten, planted under trees or
honored in other ways.

“Some people I wouldn’t suggest it to
because they’re living a different life and
think it’s too wacky, but even so I know a
woman who thought it sounded crazy but
she was also intrigued by it,” Jones-Rounds
said. “I feel like at least she knows it exists
now. It’s just a new idea.”

Sarah Kager, a labor and delivery nurse at
Cayuga Medical Center, said she
recommends Wood’s service in the natural
child birthing classes she teaches, even
though she said many women find the
notion odd at first, even though other land
mammals — with the exception of camels

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— consume their placentas after birth.

“It’s seen as a little strange,” she said. “But I
had a two-minute conversation with Polly,
and I consider myself sold. If you compare
us to mammals, like we are, it makes a lot
of sense, but as humans, it’s hard for us to
wrap our head around eating our own
organ.”

In addition to the encapsulation, Wood
often talks with her clients multiple times
after she has prepared the placenta to
check in on their lives and their mental
state. More often than not, that’s on the
phone, because as the only trained
professional operating in central NewYork
since she started in September, Wood has
had clients as far away as Buffalo, Syracuse
and Elmira.

In those cases, she’ll have clients freeze
their placentas until she can arrive, to keep
the hormones in the placenta viable. But
Wood said checking in with mothers is an
important aspect of postpartum mental
health.

That’s the experience Courtney Sullivan
had. Sullivan, who was already a mom of
four and a farmer before she gave birth to
twins recently, ingested her placental pills
after being prepared by Wood, and said
she found they gave her more energy than
she is used to having after childbirth.

“I always had a hard time postpartum, with
energy, emotional stuff, just trying to keep
up,” she said. “I was really, really happy
with the results. I had a good amount of
energy, and I feel like the only way I was
able to keep up with everything I had to do
with the babies at night and the family in
the day was taking those capsules. I felt
like it also sustained me.”

Sullivan also noted that just the time spent
with Wood in her home was helpful to her.

“The really nice bonus about it is you get to
see Polly Wood, she’s so nice and sweet,”
Sullivan said. “People help you for sure, but
there isn’t always a supportive woman in
your life who shows up and is super jazzed
to share this time with you and help
complete the journey. She was the final leg
of this really intense journey.”

Wood wants the service to be affordable
for all new moms, and charges a fee based
on a sliding scale of $225 to $300, based
on what the client can afford. She said she
can also work out payment plans if
necessary.

Although she acknowledges there’s very
little published research on the benefits of
placentophagy, Wood said common sense

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— natural wisdom, she calls it — is clear
on the issue.

“All land mammals except humans and
camels eat their placenta immediately after
birth in its entirety,” she said. “It’s another
aspect to a natural, healthy birth that
nourishes the mom, and if she’s well taken
care of, she’s better able to take care of
the new baby in her family.”

Wood said an opposing line of thinking is
that other mammals eat their placentas to
clean their nesting site to avoid predators.
Still, she said she thinks there’s more to it
than that.

“I see the point, but that’s not enough,” she
said.

When she’s not cleaning, steaming and
drying out placentas, Wood homeschools
her daughter Pearl, plays music and
creates art that focuses on aspects of “the
sacred feminine.” She also works at the
popular vendor Macro Mamas at the Ithaca
Farmers’ Market.

Placentas feature prominently in her artistic
thinking, which she said helped to propel
her into this new line of work.

“I saw a placenta as the soul twin of a
child,” she said. And now, “I see placenta
ingestion as another intelligent step
towards creating sustainability in our
world.”

Source: http://www.theithacajournal.com/article/20110810/NEWS01/108100360/Ithaca-mothers-turn-placentas-into-post-natal-supplement?odyssey=mod|newswell|text|FRONTPAGE|p

Posted in PPD Recovery | Tagged , , , , , | Leave a comment

Case Study Examining Postpartum Depression Symptoms and Treatment

Posted on August 10, 2011 by

Case Study Examining Postpartum Depression Symptoms and Treatment

August 05, 2011
by Aza Nedhari

Postpartum Mood Disorders
The criterion as specified by the DSM-IV-TR for Postpartum Onset Specifier is with Postpartum Onset (can be applied to the current or most recent Major Deprressive, Manic, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder or Bipolar II Disorder or to Brief Psychotic Disorder) and must have an onset within 4 weeks postpartum (APA, 2000, p 423).

Postpartum Depression also referred to as Postpartum Major Depression (PMD), “occurs in approximately 10 percent of childbearing women and may begin anywhere between 14 hours to several months after delivery” (Epperson, 1999). PPD exhibits all the typical symptoms of depression, but is distinguished by its manifestation after the childbirth. There are three degrees of PPD that can be experienced by a woman after childbirth: 1) “baby blues” which the DSM classifies as Adjustment Disorder with Depressed Mood (309.0) or with Mixed Anxiety and Depressed Mood (309.28) and which resolves without significant consequences; 2) postpartum depression or Major Depressive Disorder, and; 3) postpartum psychosis, Mood Disorder with Psychotic features (296.x4) or Psychotic disorder not otherwise specified (298.9).

As the focus of this paper is Postpartum Depression, it is vital to differentiate the degrees of PPD. “Seventy to eighty percent of U.S. women who give birth experience postpartum blues” (American College of Obstetrics and Gynecologist, 1999). The ‘baby blues’ is characterized by mild and transient mood disturbances with an onset of 1-7 days postpartum with a peak between day 5-6 postpartum. Symptoms include low mood, anxiety, crying, irritability, insomnia, and mood lability. Because of its commonality, it is viewed as a ‘normal’ phenomenon. It can last for a few hours or a few days. At the other end of the spectrum is Postpartum psychosis, a rare illness only affecting 2 out of every 1000 women who give birth (APA, 2000). Onset can be dramatic and abrupt and can begin within 2 to 4 weeks postpartum or as early as 2 to 3 days. Early symptoms include restlessness, irritability and insomnia. Typical features included rapidly evolving or shifting depressed or elated mood, disorganized, confused and disoriented behavior, and the presence of hallucination or delusions typically focus on the infant (Jellineck, Patel, & Froehele, 2002). Psychosis of any kind is considered a psychiatric emergency, however, with postpartum psychosis, potential harm to the infant necessitates immediate attention and evaluation. In between these to extremes lie Postpartum major ,depression (PMD/PPD). PMD/PPD ranges in severity and onset can be insidious, but typically begins within the first 2-3 months postpartum. “More than 60% of women have an onset of symptoms within the first 6 weeks postpartum, providing primary care physicians with the perfect opportunity for diagnosis” (Leopold & Zoschnick, 1995, n.p. ).

Etiology of Postpartum Mood Disorders
“Multiple investigations into the etiology of postpartum depression have not reached a consensus” (Leopold & Zoschnick, 1995), hence the inclusion of it in the DSM-IV as separate category diagnostically different from Major Depression. Biological theories suggest that deregulation of the neurotransmitters serotonin and norepinephrine, epinephrine, and dopamine serve as the origin of PPD. Other biological factors included prolactin levels are rise throughout pregnancy and fall during delivery, and have been considered to be a factor in the onset of PPD. O’Hara, Schlechte, Lewis, & Varner (1991) presented conflicted results showing higher levels of prolactin on postpartum days 2, 4, and 6, while lower levels in by week 6 postpartum. Other hormonal factors such as estrogen levels which decrease significantly in the postpartum period and regulate mood, memory, and cognition and brain function has been thought to play a major role in the onset of PPD. “The specific effects are best characterized in the dopamine system where estrogen increases dopamine turnover through the regulation of tyrosine hydroxylase, degradative enzymes, and turnover dopaminergic receptors” (Leopold & Zoschnick, 1995, n.p.).

Biological factors do not create as much as a susceptibility to Postpartum mood disorders as psychological and social factors. In a controlled re-test study of psychological, environmental, and hormonal variables of Postpartum Mood Disorders, O’Hara et al. (1991) found that “stress interactions accounted for very significant proportions of the variance in the depression outcome. There was very little association between hormonal variables and postpartum depression. Vulnerability coupled with life stress predicated the diagnosis of depression” (p. 68). Vulnerability speaks to the psychological theories of PPD which according to the cognitive model, “a patients negative view of the world and herself leads to depression and low self-esteem and disturb relationships” (Leopold & Zoschnick, 1995). “Three correlates of PPD are consistently found by researchers: marriage problems and lack of social support, particularly the father’s, infant problems, including pregnancy and delivery problems, and a prior history of depression or other emotional problems (Hagen, 1996). “Of the 13 studies addressing the role of socioeconomic factors in PMD/PPD, only two found that low socioeconomic status is predictive of PMD/PPD” (Epperson, 1999). Women who have a prior history of depression or mood disorders displayed a significant influence on the occurrence of PMD/PPD during postpartum. “At least one-third of the women who have PPD/PMD have a recurrence of symptoms while as many as 60 percent with bipolar disorder have a relapse after childbirth” (Epperson, 1999). Adequate screening by healthcare professionals can identify women who are at-risk and provide her with adequate information and resources to reduce the likelihood of occurrence or relapse.

Social, Historical, and Political Impact of DSM Inclusion
The connection between childbirth and psychological instability has been historically validated. Hippocrates describes “puerperal fever” in 460 B.C. “theorizing that suppressed lochial discharged was transported to the branin, where it produced agitation, delirium, and attacks of mania” (Leopold & Zoschnick, 1995). In 1858, Marce’ in his Treatise on Insanity of Pregnant and Lactation Women, “linked negative emotional reactions with childbirth (Griffin Hospital, 2004). It was not until 1958 with the publishing of the DSM II that “Psychosis with Childbirth” was even included. Prior to this, no gender discussion had been included in the DSM, however, “with each edition, of the DSM, there has been greater attention paid to gender issues” (Kornstein, 2010, p. 11). The DSM III eliminated this diagnosis due to lack of evidence that PPS was a distinct entity. With the media attention being given to women who carried out infanticide and/or suicide during the postpartum period the necessity of inclusion of a disorder during the postpartum period became vital. The DSM-IV added “the modifier “With Postpartum Onset” to describe episodes of Major Depressive Disorder, Bipolar I or II Disorder and Brief Psychotic Disorder with onset within 4 weeks after childbirth” (Korstein, 2010, p. 11). The upcoming edition of the DSM-V proposed an extension of the postpartum onset specifier to 6 months. “If included, this would help increase access to insurance coverage to mental health services in pregnancy and postpartum. Additionally, it will encourage funding for researchers investigating perinatal mood disorders incidence and initiation” (Stone, 2010).

Client History
Sudi, 29, is a married caucasian mother of two girls living in an affluent community in Maryland. Her and her husband Yao, who is Chinese-American both worked full-time until Sudi became pregnant with their second child, Emma. Sudi first pregnancy went smoothly and she experienced no complications. She returned to work after 6 months and was able to balance her new role as a mother and as a business executive. Sudi decided after Zoe, the first child to wait at least 3-4 years until she would get pregnant again. However, despite her use of contraceptives, she became pregnant when Zoe was 18 months old. Sudi experienced a great deal of internal conflict, about her decision to continue the pregnancy. She was just getting back to her old self, had been promoted to a Director position at her job, and was not ready to start over again with another baby and even contemplated termination of the pregnancy well into the first trimester. Yao, did not believe in abortion, and her decision to proceed with the pregnancy created a strain on the relationship.

Early in the pregnancy Sudi experienced severe morning sickness and was diagnosed with Hyperemesis an hospitalized for 1 month as well as given medication. During the 6 month of pregnancy, Sudi had to be put on bed-rest due to bleeding and frequent fainting spells. Initially, she was relieved as she was much bigger than her first pregnancy and was very tired during the day. But a few weeks later, Sudi began to experience panic attacks, frequent crying, and avoided speaking to family and friends. Yao, became very worried, but Sudi and others ensured him that this was normal pregnant behavior. Emma was born via cesarean 3 months later and initially Sudi was overjoyed, despite her initial feelings and difficult birth. She was visited frequently by her close friends and family who took turns assisting her with adjustment. However, two weeks later, Sudi could not muster any feelings for her Emma. She would often go through the day not speaking to her, only touching her to change her and feed her. She cried frequently, had difficulty sleeping, was unable to concentrate, and began to have disturbing thoughts. Sudi reports “feeling guilt and shame for not being connected to Emma” and was convinced that she was not a good mother, that she was failing Emma and Zoe, and that she was unable to produce enough milk for her.

Sudi, was raised in a middle-class neighborhood by her grandparents who died when she was 16. Her mother birthed her when she was 19, and decided that she was unable to care for her. After the death of her grandparents, Sudi lived with her mother and her brother. Because of the lack of established relationship between Sudi and her mother, there was on going conflict and she was eventually dismissed from her mothers home. She lived with various people before going to college. During that time, she experienced sexual abuse, witnessed crime, and poverty. During her first year of college, Sudi became very anxious, began smoking marijuana and entered a state of depression. She engaged in fights with her roommates and was referred to the school therapists. In her last year of school, she found her father and began establishing a relationship with him and her sisters. She vowed, to never depend on anyone and to never do to her children what was done to her.

Most recently, Sudi expressed to that Yao that “everyone would be better off without her”. She remains in her room most of the day, rocking back and forth in her chair. Zoe has exhibited oppositional behavior because of her lack of attention from her mother, Emma is often inconsolable and colicky, and Yao is been operating off 3 hours of sleep for the past 2 months as Sudi, has had difficulty managing the domestic duties such as cooking, cleaning, and attending to both children. Concerned for her well-being and the well-being of the children, he suggested therapy. Sudi was initially reluctant, telling Yao that she would never harm herself or the children, but after being convinced by her family and friends, she decided to attend.

Sociocultural Factors
Unlike other cultures, the postpartum period in Western culture is more relative to the newborn-infant than lavished attention given to the mothers. In an anthropological observation of Chinese culture, extra attention given to the mother from family and social networks, “precluded Chinese women from experiencing PPD as understood by Western culture” (Boyle, 1994, p. 54). Even though Sudi has family and social support, her presentation of symptoms are consistent with Western cultures perceptions of birth and motherhood. The media projection of motherhood creates a fictitious standard by which women such as Sudi who experience Postpartum Depression, become “afraid to speak out about their feelings in case they are judged a ‘bad’ or not a ‘good enough’ mother” (Fraser & Cooper, 2009, p. 683). Sudi unplanned pregnancy “placed her under emotional strain, which can lead to feelings of depression (Wheatley, 2005, p. 18). Research has shown that “unintended pregnancy has been linked to a variety of negative outcomes for both the mothers and the children…particularly depression. Complications during pregnancy is more common in women with postpartum depression” (Iranfar, Shakeri, Ranjbar, Nazhadjafar, & Razaie, 2005, p. 619).

Sudi’s complications during her pregnancy that culminated into a difficulty delivery and traumatic birth experience sets the preface for both depression and a stress-related disorder. Son et. Al (2005), found that “pain as well as intrusiveness of delivery procedure were associated with perinatal dissociation” (p. 307). Additionally, they found that an earlier history of depression and sexual abuse, serves as pathways to postpartum depression and traumatic stress related disorders. Due to more recent media reports of women and postpartum depression, a myth has surrounded that depression in more common in certain populations, particularly white middle-upper class women. This however is not the case. Studies have shown that there is a slightly higher rate of depression among low-income women, even though most are not depressed, and that single women without a co-habiting partner were at the highest risk and rates, without regard to race (Hobfoll et al., 1995).

Being cognizant of one’s strengths, weakness, values, beliefs, and prejudices is one of the most important aspects in the determination of effectiveness as a helper (Corey & Corey, 2007). In assessing and diagnosing Sudi, it is important that the therapist be cognizant of her capacity to handle both socio-cultural factors and situations that challenge values and morals. What we presuppose as being right or wrong is variable upon individual definitions and individual realities. However, it is these definitions of right or wrong that lay the foundation for one’s value system (Okun & Kantrowitz, 2008). The reality of the therapist as a mother, a survivor of sexual abuse, and depression, and an Black women of a different socio-economic class, would have to aware of her judgments. The therapist has an ethical duty as provided by the ACA (2005) to be “aware of their own values, attitude, beliefs, and behaviors, and avoid imposing values that are inconsistent with counseling goals” (A.4.b.).

Sudi has family and social support, resources, and basic needs met, all which are typically risk-factors for increased susceptibility to Postpartum Depression or Postpartum Traumatic Stress Disorder. The therapist must also not assume that Sudi has the same coping mechanisms to be able to handle great stress and adjustment. Additionally, the therapist must not be dismissive of her symptoms, writing them off to normal postpartum experiences. What must be the focal point for the therapist is an establishment of an effective client-centered relationship premised upon the essentials of Carl Rogers’ which postulates that empathic understanding, including respect and positive regard, genuiness and congruence, concreteness, warmth, and immediacy, are vital components to the process of therapeutic change and the establishment of rapport with clients. Rogers (1980), asserts the more real the therapist in putting up no professional or personal facades, the greater the likelihood the client will change and grow in a constructive manner. Similarly, the way in which the therapist joins with the client accurately sensing their feelings and personal meaning and communicating this understanding to the client, the likelihood of change increases. He refers to this type of empathetic understanding “ one of the most potent forces for change” (p.116). Sudi’s presentation of symptoms must be taken seriously, without regard to the therapists personal history of overcoming similar challenges. “Practitioners have the abilty to decrease the impact and devastation of postpartum depression by following guidelines for treatment” (Leopald & Zoschnick, 1997). The therapist, could potentially disclose to Sudi her experience with similar situations as a way to foster trust and empathy and to not further the feeling of Sudi feeing “judge or a bad mother” for exhibiting the symptoms she has.

Ethical Considerations
Melchert & Patterson (1999) state “the ethical principle of beneficence underlies mental health professionals duty to warn…this principle obligates health care professionals to attempt to prevent harm to clients and third parties as long as doing so does not present the professional with significant risks or cost and the benefits that clients or other would receive are not outweighed by the risks or costs incurred by the professional” (p. 180). Confidentiality within the counseling relationship has been generally regarded as a key aspect to building rapport with clients. “Mental health professionals generally agree that effective treatment may necessitate full disclosure and that confidentiality is important for the maintenance of the therapeutic relationship” (Chenneville, 2000, p.661). The American Association of Marriage and Family Therapist Code of Ethics (2001) 2.1 requires that therapist review with the client possible limitations of their rights to confidentiality. As Sudi presents probable signs of psychosis, it would be discussed with the client that disclosure to medical professionals and/or her partner would be necessary if she presents a harm to herself or others, in this case her child. After conducting assessment with Sudi, if it is reveal that she is high risk for suicidal idealization, a breech of confidentiality would necessary. The ACA (2000) B.2.a. States that “the general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious or foreseeable harm…if in doubt, the counselor should consult with other professionals” (p. 7).

Diagnosis
Axis I
296.3×4 Major Depressive Disorder, Recurrent, with Postpartum Onset Severe with Psychotic Feature, Mood Congruent

Axis II
V71.09 No diagnosis

Axis III
Hyperemesis gravidarum, mild

Axis IV
Victim of sexual abuse and child abandonment
unwanted pregnancy,
adjustment to lifecycle transition,
V61.10 Partner-Relational Problems
V61.20 Parent-Child Relational Problems
V61.9 Relational problems due to Mental Illness

Axis V
GAF=40 (current)

Rationale
Sudi, exhibits all the signs and symptoms of Major Depressive Disorder. She is given the Postpartum specifier as she is still within the range of the four week postpartum period. The inclusion of psychotic features with congruent mood was given as Sudi is delusional regarding her inability to care for her children and her disturbing thoughts. Her delusions are “consistent with typical depressive themes of personal inadequacy and guilt” (APA, 2000, p. 413). As she experienced a period of depression during college, and symptoms of depression during the prenatal period, she was provided an additional specifier of Recurrent as opposed to Single Episode. In order for a diagnosis of Major Depressive Episode with a Postpartum specifier to be given, “five or more of the following symptoms have to be present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interests or pleasure” (APA, 2000, p. 356) Additionally, these symptoms have to occur with four weeks postpartum.

1. Depressed mood most of the day, nearly everyday, as indicated by either subjective report or observation made by others.

A. Sudi has displayed depressed mood for over 1 month everyday and it has impacted her relationship with her husband and her children.

2. Marked diminished interests or pleasure in all, or almost all activities most of the day, nearly everyday.

Sudi depression has caused her to show little to no interests in caring for her children, her home, or engaging with her friends or family.

3. Insomnia or hypersomnia nearly everyday

Sudi reports having difficulty sleeping, frequency and duration of insomnia would have to be determined during assessment.

4. Psychomotor agitation or retardation everyday

Sudi rocks in her chair most the day, everyday, remaining disconnected from her new baby,

5. Feeling of worthlessness or excessive or inappropriate guilt (which maybe delusional) nearly everyday.

Sudi expresses feeling “guilt and shame for not being connected to Emma” and has convinced herself that she is not a good mother and is unable to produce enough milk for her.

6. Diminished ability to think or concentrate, or indecisiveness nearly everyday

Sudi reports difficulty concentrating. Frequency would have to be determined during assessment.

7. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Sudi has recently expressed to her husband that everyone would be better off without her. Given her other symptoms, suicidal ideation would be assumed, however, assessment would be needed to positively grant criterion.

B. Her symptoms do not meet the criteria for Mixed Episode.

C. Her symptoms have caused clinically significant distress or impairment in her social and family life. She has withdrawn from both family and friends and is neglecting her infant as well as her toddler.

D. Her symptoms are not due to due to the direct physiological effects of a substance or hyperthyroidism.

E. Symptoms are not better accounted for by another disorder

Limitations of Diagnostic Criteria
Postpartum major depression is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being diagnostically distinct from its nonpuerperal counterpart, although the DSM-IV does allow the addition of a postpartum-onset specifier for patients with an onset within four weeks of delivery (Epperson, 1999). Presenting symptoms of depression such as weight loss, loss of energy, and sleep disturbances are more difficult to detect in postpartum women there is a range of normality for which these exists due to adjustment of having a new baby. These limitations of the DSM-IV-TR in providing clinicians with clear guidelines for diagnosis, allows for PPD to remain largely underdiagnosed and undertreated as the risk factors are not reliably identified. Additionally, “obvious limitation of the temporal criteria used within the DSM-IV is that it excludes all cases which have an onset later than 4 weeks postpartum” (Stewart, Robertson, Phil, Dennis, Grace, & Wallington, 2003, p. 22). “Before a definitive diagnosis of PMD/PPD can be made, depression caused by a medical condition such as thyroid dysfunction or anemia must be ruled out” (Epperson, 1999).

Treatment Plan
During the treatment phase with Sudi, the therapist would gather information regarding the frequency and duration of her depressive symptoms. Family history of mental illness would inquired upon through the use of a Genogram which would also help the therapist gain insight into relationship dynamics between family members as well as her circle of support which will be an important aspect in treatment planning. There will be an additional inquiry about Sudi’s prior sexual trauma and if this played a role in her initial onset of depression. Subsequent questions surround her initial depression episode would included whether or not a diagnosis was given, the duration of the episode and her symptoms. Also, the duration of treatment and what method(s) were utilized would be of importance. The therapist would also inquire about her feelings regarding her pregnancy and birth of her child to determine whether trauma existed. She would be asked if she is feeling overwhelmed, stressed, anxious or depressed. The therapist should inquire about how she is feeling physically and how her energy level is. Lastly, her feelings about the baby would be inquired about.

In addition to the Genogram, the Edinburgh Postnatal Depression Scale, The Self-Control Questionnaire and The Pilkonis Life Events Schedule. The Postnatal Depression Scale is a 10-item, self-rated instrument that is “useful because a threshold score higher than 12 has been 100 percent sensitive and 95.5 percent specific in detecting major depression” (Epperson, 1999). The Self-Control Questionnaire is a 41-item instrument designed to assess women’s attitudes and beliefs about their own self-control behaviors. “The SCQ had correlated significantly with both prepartum and postpartum depression levels” (O’ Hara, et al., 1991, p. 65). The Pilknois Life Events Schedule is used for indexing stressful life events that occur during pregnancy and postpartum. “In earlier work, the number of life events that occur during pregnancy and the first 9 weeks postpartum has been found to be associated with diagnosis of postpartum depression” (O’Hara, et al., 1991, p. 65). Determining the cause and contributing factors to Sudi’s depression as well as cultural factors will dictate which form of therapy will be utilized.

Postpartum Depression is “considered a major public health problem and has been associated with adverse outcomes for the infants’ cognitive, emotional, and social development” (Reay, Robertson, & Owen, 2002, p. 211). “Until recently, the treatment of PMD has not been a subject of research because most investigators and clinicians have considered PMD too similar to its nonpuerperal counterpart to warrant such investigation” (Epperson, 1999). For Sudi, the focus of therapy would be assessing how she is viewing her current situation, confronting her negative thoughts regarding her pregnancy, her child and her role transition as mother of two children, focusing on her marital strain, and helping her to focus her attention on positive thoughts and actions. Treatment goals involve: 1) reducing her depressive symptoms 2) alter her negative thoughts regarding her role as a mother 3) increasing congruent communication between her and Yao 4) developing a plan to help her adjust to her having two children and continuing her career 5) improving social adjustment. As Sudi exhibits more severe symptoms than supported by psychotherapy alone, she would potentially benefit from a combination of medication and Interpersonal Therapy (IPT) is a “time-limited, interpersonally oriented therapy that has been empirically demonstrated to be effective in the treatment of depression. It is readily available as a cost-effective intervention and can be delivered in a variety of clinical settings” (Reay, et al, 2002, p. 212). “Interpersonal psychotherapy helps patients with PPD to understand their associated life experiences within 3 problem areas: interpersonal disputes; role transitions; and bereavement. IPT recognizes the role of biological and psychological factors in the cause and vulnerability to depression, it focuses on social factors and working through interpersonal problems to alleviate depression” (Grigoriadis & Ravitz, 2007, p. 1471-1472). The beginning phase of therapy would involve educating Sudi about Postpartum Depression and its functional and interpersonal effects. Sudi would be encouraged to to reach out to family, friends, and her local new mother and breastfeeding support groups. The middle phase and focal problem areas of treatment “guide therapeutic interventions and link symptoms of depression to interpersonal events, losses, or changes” (Grigoriadis & Ravitz, 2007, p. 1472). To address the interpersonal role disputes, primarily the incongruent communication between Sudi and Yao, IPT utilizes communication analysis to “reveal ways in which patients interact with others that might inadvertently exacerbate conflicts” (Grigoriadis & Ravitz, 2007, p. 1472). Regarding Sudi’s role changes and adjustments as mother of two children, a Director, and wife, she a variety of role s to integrate, each having their own set of responsibilities and demands. IPT will aid Sudi in establishing balance in her perception of her roles while evaluating and modifying expectations that may have been unrealistic, and set new priorities that would give her a sense of control and stability. The therapist will provide Sudi with homework assignment to aid her developing a schedule that helps her to adapt to new time, emotional, and physical demands, while balancing her needs and desires as well. Once Sudi has developed a healthier balance of time and renegotiated her priorities, the relationship with Emma and Zoe would be of primary focus. “Attachment between mother and infant is crucial in the development of the infant’s sense of security and safety” (Grigoriadis & Ravitz, 2007, p. 1473) and it would be the goal of the therapist to aid Sudi in developing a healthy relationship with Emma, giving attention to Zoe to alleviate her physical symptoms, and be more attuned and responsive to both her children as she transitions through recovery.

Due to the degree of dysfunction Sudi is experiencing according to GAF score, Sudi would be recommended for Antidepressant Therapy coupled with IPT. As Sudi is breastfeeding Emma, it is of importance the type of antidepressant used to avoid contamination of breastmilk. Research has found that selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants “should be seriously considered in lactating and non-lactating women who have moderate to severe PMD, suicidal thoughts or difficulty functioning” (Epperson, 1999).

Pregnancy, childbirth, and motherhood is one of the most significant and stressful times in the life of woman. Societal pressures to wear the mask of a “joyful motherhood” forces many women to suffer in silence, in the confines of their own minds. The media projection of motherhood as euphoric phase, is far from the initial reality of sleep deprivation, hormonal fluctuations, adjustment to various roles, and the responsibility for another life. Interpersonal psychotherapy proves effective in helping women experiencing interpersonal disruptions in this phase of life as it is short-term, problem focused, and specific.

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References

American Association of Marriage and Family Therapist. (AAMFT, 2001). AAMFT Code of Ethics. Retrieved from http://www.aamft.org/resources/LRM_Plan/Ethics/ ethicscode2001.asp.

American Counseling Association. (2005). Code of Ethics. Alexandria, VA: Author.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) (DSM-IV-TR). Washington, DC: Author.

Boyle, D. (1993, July-August). Postpartum Depression. LEAVEN, 29(4), 53-54, 58.

Chenneville, T. (2000). HIV, Confidentiality, and Duty to Protect: A Decision Making Model. Professional Psychology: Research and Practice, 31(6), 661-670. doi: 10.1037/70735-7028.31.6.661.

Corey, G., Corey, M.S. & Callanan, P. (2007). Issues and ethic in the helping profession (7th ed.). Belmont, CA: Brooks/Cole.

Epperson, C.N. (1999). Postpartum major depression: Detection and treatment. American Family Physician, 59(8), 2247-2254, 2259-2260. Retrieved from http://www.aafp.org/afp/ 990415ap/2247.html

Fraser, D. & Cooper, M. (2009). Myles textbook for Midwives (15th ed.). London, England: Churchill Livingstone Elsevier.

Griffin Hospital. (2004). Postpartum Depression. Retrieved from http://www.vwhcc.org/ whcc_html/docs/postpartum.pdf.

Grigoriadis, S. & Ravitz, P. (2007). An approach to interpersonal psychotherapy for postpartum : focusing on interpersonal changes. Canadian Family Physician, 53, 1469-1475. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234626/pdf/ 0531469.pdf.

Hagen, E.H. (1996). The functions of Postpartum Depression. Santa Barbara, CA: University of California. Retrieved from http://cogprints.org/1720/3/ppd_for_cogprints.pdf.

Hobfoll, S., Ritter, C., Lavin, J., Hulsizer, M., & Cameron, R. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63(3), 445-453. doi:10.1037/0022-006X.63.3.445.

Iranfar, S., Shakeri, J., Ranjbar, M., Nazhadjafar, P., & Razaie, M. (2005). Is unintended pregnancy a risk for depression in Iranian women?. Eastern Mediterranean Health Journal, 11(4), 618-624). Retrieved from http://www.emro.who.int/publications/ emhj1104/PDF/10.pdf.

Jellinek, M.J., Patel, B.P., Froehle, M.C. (Eds). (202). Bright Futures in Practice: Mental Health-Volume 1. Practice Guide. Arlington, VA: National Center for Education in Maternal and Child Health. Retrieved from http://www.brightfutures.org/ mentalhealth/pdf/bridges/postpartum.pdf.

Kornstein, S.G. (2010). Gender issues and DSM-V. Archives of Women’s Mental Health, 13(1), 11-13. doi:10.1007/s00737-009-0113-2.

Leopald, K. & Zoschnick, L. (1997). Postpartum Depression. The Female Patient, 25(8). Retrieved from http://www.obgyn.net/femalepatient/femalepatient.asp?page=leopold.

Melchert, T., & Patterson, M. (1999). Duty to warn and intervention with HIV-positive clients. Professional Psychology: Research and Practice, 30(2), 180-186. doi: 10.1037/0735-7028.30.2.180.

O’Hara, M., Schlechte, J., Lewis, D., & Varner, M. (1991). Controlled prospective study of postpartum mood disorders: Psychological, environmental, and hormonal variables. Journal of Abnormal Psychology, 100(1), 63-73. doi:10.1037/0021-843X.100.1.63

Okun, B. F., & Kantrowitz, R. E. (2008). Issues Affecting Helping. In M. Flemming, S. Shook & M. Banks (Eds.), Effective Helping: Interviewing and Counseling Techniques (7th ed.). Belmont, CA: Thomson Higher Education.

Reay, R., Robertson, M., & Owen, C. (2002). Interpersonal psychotherapy for postnatal depression: A quality improvement approach. Australasian Psychiatry, 10(3), 211-213. doi:10.1046/j.1440-1665.2002.00449.x.

Rogers, C. R. (1980). Way of Being. New York, NY: Houghton Mifflin Company.

Stewart, D.E., Robertson, E., Phil, M., Dennis, C.L., Grace, S.L., Wallington, T. (2003). Postpartum Depression: Literature review of risk factors and interventions. Toronto Canada: University Health Network Women’s Health Program. Retrieved from http:// www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf

Stone, S. (2010, February 13). How DSM-V Language on Postpartum Depression May Affect Insurance Coverage & Research Funding. Message posted to http:// postpartumprogress.typepad.com/weblog/2010/02/how-dsmv-language-on- postpartum-depression-may-affect-insurance-coverage-research-funding.html.

Van Son, M., Verkerk, G., Van der Hart, O., Komproe, I., & Pop, V. (2005). Prenatal depression, mode of delivery and perinatal dissociation as predictors of postpartum posttraumatic stress: an empirical study. Clinical Psychology & Psychotherapy, 12(4), 297-312. Retrieved from Academic Search Premier database.

Wheatley, S.L. (2005). Coping with postnatal depression. London, England: Sheldon Press.

Source: http://www.studentpulse.com/articles/558/case-study-examining-postpartum-depression-symptoms-and-treatment

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A mother’s grief

Posted on August 10, 2011 by

 

 Today I am sharing a very moving blogpost I came across while searching for images of mothers. This was written by a photographer, Kalamu ya Salaam,  who interviewed a mom whose son had come home from Iraq with severe PTSD.  Her photos are shared with her permission.

The Inspiration of Listening

Eugene Richards has always been an inspiration.It’s not just his pictures that inspire me, but it’s
his access to intimacy.His work is a beacon – it’s a symbol of what I strive to achieve.I’ve read his book, Cocaine True, Cocaine Blue dozens of times, but only recently did I pay acute attention to the writing.It looks as if he’s interviewing the people he photographs, and I wondered if there was a tie between the act of
interviewing and access.I decided to try something similar with a subject the next time the appropriate opportunity arose.When I met this woman, I thought I would try. 
One of our military reporters was working on a story about this woman, whose son served in Iraq. Her son
suffers from PTSD as a result of his combat experience, and he tried to kill his wife.He’s now in jail.His mother asserts his time in Iraq caused his breakdown.”The Army broke my son. They broke him, and then they
threw him away,” she said.Instead of taking the ubiquitous picture of her standing by a window holding a picture of her son, I wanted to make an image that reflected her pain.I asked her if it would be OK to interview her and have her talk about her son, while I photographed her.We both knew it would be emotionally tough for her, but she trusted me. I emphasized that my goal was to show the pain she was suffering, and she agreed.You can see her pain in this progression of images. I hope it touches people deeper than a traditional superficial image.
1
We started talking about her feelings.We probed deeper into her emotional state, and while it
was difficult, it’s important to remember this was an agreed action by both of us.
2
The more we talked about her son, the more she opened up.She began to trust me more, and I could feel I was beginning to make an image that was a more honest portrayal of her experience.It was intense, and profoundly sad.As she cried, so did I. I couldn’t prevent myself.It was all just too damn sad.
3
During the interview, I reminded her that though I was holding up a camera between us, I was still listening.I think it helped her in trusting me, even though we didn’t have constant eye contact.
4
After almost an hour, we came to this point in the interview. It
seemed a release for her, this moment in time.
main
I’m very grateful for her in trusting me, and for her being open to sharing her emotion with me
and our readers. We don’t always get such an opportunity.Afterwards she was exhausted, and very emotional. I think it’s worth mentioning though, that she thanked me for listening, and for asking her
the questions that led to that moment.She told me no one had listened to her to this extent.I think the lesson learned is to give the people you photograph space. Give them the chance to reveal their emotions.Don’t only depend on writers to interview - you may miss out on a chance to better understand someone.
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For Dads: What To Do, What Not To Do When Your Wife Has Postpartum Depression

Posted on August 9, 2011 by

What you think might help, might not.

Published on March 20, 2011 by Karen Kleiman, MSW, LCSW in This Isn’t What I Expected

 

It can be extremely frustrating to live with someone’s who’s depressed, especially when you have a new baby and it seems like the house is crowded with things that need to get done right now. What you think might help, might not. Or, could even make things worse. Remember, you cannot fix this. You cannot make this go away.  No matter how hard you try or how much you love your wife, recovery takes longer than you want it to. You must be willing to wait this out with her. 

I’m hoping these suggestions will help the two of you.

Keep these important points in mind:

  • Research has shown us that a woman’s depression will improve markedly with the consistent support of a significant other.
  • The longer you pretend that the depression will go away by itself and deny it is really happening, the longer her recovery will take.
  • The more you expect of her, the greater your demands, the more difficult her recovery will be.
  • The harder you are on yourself, the less resources you will have to carry you through each day.
  • You must take this very seriously.
  • You have much more power to affect the outcome of how you both feel, than you might think you do.
  • Your wife will get better. Things will settle at home, in time. You will have your wife and your life, back.

What to say

Her moods and emotional vulnerability will get in the way of good communication for now.

Here’s what you’re up against:

  • If you tell her you love her… she won’t believe you.
  • If you tell her she’s a good mother…she’ll think you’re just saying that to make her feel better.
  • If you tell her she’s beautiful… she’ll assume you’re lying.
  • If you tell her not to worry about anything… she’ll think you have no idea how bad she feels.
  • If you tell her you’ll come home early to help her… she’ll feel guilty.
  • If you tell her you have to work late… she’ll think you don’t care.

But you can:

  • Tell her you know she feels terrible.
  • Tell her she will get better.
  • Tell her she is doing all the right things to get better (therapy,medication, etc.).
  • Tell her she can still be a good mother and feel terrible.
  • Tell her it’s okay to make mistakes; she doesn’t have to do everything perfectly.
  • Tell her you know how hard she’s working at this right now.
  • Tell her to let you know what she needs you to do to help.
  • Tell her you know she’s doing the best she can.
  • Tell her you love her.
  • Tell her your baby will be fine.

What NOT to say

  • Do not tell her she should get over this.
  • Do not tell her you are tired of her feeling this way.
  • Do not tell her this should be the happiest time of her life.
  • Do not tell her you liked her better the way she was before.
  • Do not tell her she’ll snap out of this.
  • Do not tell her she would feel better if only: she were working, she were not working, she got out of the house more, stayed home more, etc.
  • Do not tell her she should lose weight, color her hair, buy new clothes, etc.
  • Do not tell her all new mothers feel this way.
  • Do not tell her this is just a phase.
  • Do not tell her if she wanted a baby, this is what she has to go through.
  • Do not tell her you know she’s strong enough to get through this on her own and she doesn’t need help.

Practical things you can do

  1. Help around the house
  2. Set limits with friends and family
  3. Answer the phone. Take a message.
  4. Throw in a load of laundry. Order take-out for dinner.
  5. Accompany her to doctor’s appointments
  6. Educate yourself about PPD, read the books your wife gives you
  7. Write down the concerns and questions you have and taking them to her doctor or therapist.
  8. Make a list, together, of the things that may provide an outlet for her so you can both refer to it when she needs a break.
  9. The single most important thing for you to do to help is to just be with her. Sit with her. No TV, no kids, no dog, no bills, no newspaper. Just you and her. Let her know you’re there.This isn’t easy to do, especially with someone who seems so sad or so distant. Five minutes a day is a good place to start.

Other things you can (should) do

  1. Call her from work to check in. Call her again if she’s having a bad day.
  2. Ask her if there is anything you can do to help.
  3. Look her in the eyes when she talks to you.
  4. Encourage her to get as much rest as possible.
  5. Intervene so she can get some uninterrupted sleep.
  6. Try to find some “you and me” time with no other distractions.
  7. Call a friend and solicit support.
  8. Listen to her.
  9. Be patient.

REMEMBER:

  • Try to postpone any important decision until after she is feeling better.
  • Decisions that cannot wait should be made together, whenever possible.
  • Decisions about childcare, work, breastfeeding, etc. will feel enormous to her now. Help her sort this out by discussing the pros and cons of each decision.
  • Some of the things you think she should do right now to feel better, may not work.
  • Some of the things that previously made her feel good, may feel like too much effort at this time.

© Copyright 2011 Karen Kleiman, MSW www.postpartumstress.com

Adapted from The Postpartum Husband: Practical Solutions for Living withPostpartum Depression by Karen Kleiman, MSW

photo: Getty images

Source: http://www.psychologytoday.com/blog/isnt-what-i-expected/201103/dads-what-do-what-not-do-when-your-wife-has-postpartum-depression

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The baby boost – how babies are helping their moms recover from depression.

Posted on August 9, 2011 by

The baby boost

Reveals how babies are helping their moms recover from depression. The ten percent of new mothers who suffer major depression within weeks or months of giving birth; The Postpartum Well-Being Program directed by Stephanie von Ammon Cavanaugh at Rush-Presbyterian-St. Luke’s Medical Center (Chicago); How mothers benefit from interaction with their babies; The program’s success.
By PT Staff, published on January 01, 1994

Postpartum Depression

For 10 percent of new mothers the joy of childbirth gives way to major depression within weeks or months. If not treated, these women not only suffer from the usual symptoms of the disorder–anxiety, hopelessness, and loss of self-worth–but also may have trouble forming a bond with their baby. And that can stunt a child’s emotional and mental development.

Now, a team of Chicago doctors has enlisted some very special people to hell depressed new moms: their own babies.

“We try to preserve the mother-baby bond as well as promote the integration of the entire family during the course of the mental illness,” reports psychiatrist Stephanie von Ammon Cavanaugh, M.D., who the Postpartum Well-Being Program at Rush-Presbyterian-St. Luke’s Medical Center.

Unlike traditional therapy, which relies on individual counseling, the program encourages mothers to bring in and interact with their babies as much as possible. The baby acts as a “powerful stimulus,” helping depressed moms combat the intrusive thoughts they often have about intentionally harming their child, while building up their confidence as nurturers. Husbands and kids also get counseling to confront feelings of resentment and guilt that can overwhelm families coping with a depressed parent

So far, the program has been quite successful, says Cavanaugh. With treatment, more than 80 percent of women with postpartum depression can recover completely within one year. Without help, only 25 to 30 percent improve and those who don’t may have babies who grow up wetting the bed, having a lower I.Q., and crying more often.

Source: http://www.psychologytoday.com/articles/199401/the-baby-boost

 

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Insufficient sleep linked to increased incidence of postpartum depression

Posted on August 9, 2011 by

Postpartum depression higher in sleep deprived moms

Published on July 21, 2009 by Dennis Rosen, M.D. in Sleeping Angels

Depression after childbirth, or postpartum depression, occurs in between 13-20% of women. Its onset is usually a few weeks after childbirth, and many risk factors for it have been identified, including a history of depression preceding childbirth, poor support networks in caring for the newborn, and what has been termed “difficult child temperament” (though it is not always clear whether the mother’s mood colors her perception of the infant’s temperament, or if the infant’s temperament does in fact influence the mother’s mood).

A study published in the August 2009 issue of the Archives of Women’s Mental Health looking at the effect of sleep fragmentation on the development of postpartum depression found that new mothers who were awake for more than two hours between midnight and 6 am on a regular basis, and new mothers who napped less than one hour during the day on a regular basis, were at increased risk for depression three months after delivery. Their sleep was measured with a motion sensor (an actigraph) which can give a more accurate indication of sleep patterns than diaries, particularly if they are not filled out in “real time”, as can happen when one is chronically sleep deprived and trying to deal with all the extra work accompanying a newborn.

This study’s findings demonstrate the very important role sleep plays in the health and well being of a new mother, sleep which is all too often very lacking. It also points to a very simple way that partners, older children, extended family, and/or friends can help a new mother adjust to and cope with the hardships and responsibilities of caring for a newborn: taking care of the baby for portions of the day and night so that she can simply get more sleep. A less sleep deprived mother is a happier and healthier mother (and wife, partner, friend).

Many of the infants seen at the sleep center at Children’s Hospital Boston are referred because of irregular sleeping patterns, and difficulties initiating and maintaining sleep. These almost never have a negative effect on the child, but do wreak havoc on the parents’ (especially the mother’s), ability to get a decent amount of sleep. The children are usually bright eyed, smiling and playful, often in stark contrast to the exhausted mother with dark circles under her eyes who looks like she hasn’t slept in half a year (and in many cases, she indeed has not).

Postpartum depression is a serious, and unfortunately, all too common disorder. Perhaps by making sure new mothers have a chance to sleep properly, its incidence can be mitigated.

Source: http://www.psychologytoday.com/blog/sleeping-angels/200907/insufficient-sleep-linked-increased-incidence-postpartum-depression

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Going Through a Crisis

Posted on August 9, 2011 by

Will you ever feel happy again?

Published on May 27, 2011 by Shoshana Bennett, Ph.D. in Mommy Mental Health

When we’re experiencing a challenging event or time in our life, it can feel absolutely devastating. In the moment, it can seem difficult to impossible even imagining surviving, let alone ever feeling happy again. To maintain a healthy perspective in the middle of a rough period takes practice. Saying things like, “this is so difficult and painful but I know the worst of it is temporary,” can help. The emotional pain can easily distract and trick us into believing it will never leave. If you hear yourself thinking or saying the words “never” and “always” (For instance, “I’ll never get over this” or, “I’ll always feel this way”) you can be sure you’ve lost your healthy perspective. It’s so important for us to remember that indeed we can and will get through it, with proper support. From my personal and professional experience, I can say with conviction that we can actually emerge from the crisis better and stronger than before.

Dr. Shosh
www.DrShosh.com

Source: http://www.psychologytoday.com/blog/mommy-mental-health/201105/going-through-crisis

Shoshana Bennett, Ph.D.

Dr. Shoshana Bennett

Shoshana Bennett, Ph.D. (“Dr. Shosh”) from the popular DrShosh.com Radio Show is the author of Pregnant on Prozac, Postpartum Depression For Dummies, and co-author of Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression & Anxiety.  National TV shows including  “20/20” and “The Doctors” feature Dr. Shosh as the postpartum expert and news stations consult her.  Several publications including the San Francisco Chronicle and the San Jose Mercury News have written articles on Dr. Shosh’s work.  She’s interviewed regularly on national radio and has been quoted in dozens of newspapers and magazines such as The Wall Street Journal, WebMD, Boston Globe, Fit Pregnancy, Glamour, Parenting, Psychology Today, New York Post, Self, Cosmopolitan, and the Chicago Tribune.

Dr. Shosh is a pioneer in the field.  She is a survivor of two life-threatening, undiagnosed postpartum depressions. She founded Postpartum Assistance for Mothers in 1987, and is a former president of Postpartum Support International. She has helped over 19,000 women worldwide through individual consultations, support groups and wellness seminars.  As a noted guest lecturer and keynote speaker, she travels throughout the US and abroad, training medical and mental health professionals to assess and treat postpartum depression and related mood and anxiety disorders. She earned three teaching credentials, two masters degrees, a Ph.D. and is licensed as a clinical psychologist. She can be contacted through DrShosh.com.

 

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PPD? Questions & Tips for Postpartum Women

Posted on August 9, 2011 by

Do we really know how postpartum women are feeling?

Published on July 26, 2011 by Karen Kleiman, MSW, LCSW in This Isn’t What I Expected

To physicians and other healthcare practitioners:  If you are not asking these questions of each postpartum woman, you do not know how she is feeling:

To postpartum women: If your healthcare provider is not asking you these questions, take this list with you and be sure they know how you are feeling:

  • Have you had PPD before?
  • Do you have a history of depression?
  • Are you sleeping okay when your baby sleeps?
  • Any changes in your appetite?
  • Are you experiencing anxiety or panic?
  • Are you afraid to be alone with your baby?
  • Do you feel more irritable or angry than usual?
  • Are you worried about the way you feel right now?
  • What worries you the most about the way you feel?
  • Are you afraid you might lose control?
  • Are you afraid of the thoughts you are having?
  • Do you wonder if you’re a bad mother?
  • If you are breastfeeding, how important is that to you?
  • Do you ever have thoughts about hurting yourself?
  • Do you find it hard to make decisions?
  • Does your husband know how you are feeling?
  • How do you feel about taking medication if it helps you feel better?
  • Are there other stressful events that are impacting the way you feel?
  • Is there anything you are afraid to tell me, but think I should know?

Tips for professional and family support:

  • Do not assume that if she looks good, she is fine.
  • Do not tell her it’s normal to feel this way after having a baby.
  • Do not assume this will get better on its own.
  • Do encourage her to get a comprehensive evaluation.
  • Do take her concerns seriously.
  • Do let her know you are there if she needs you

source: http://www.psychologytoday.com/blog/isnt-what-i-expected/201107/ppd-questions-tips-postpartum-women

copyright 2011 Karen Kleiman  postpartumstress.com

 

 

 

 

 

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Postpartum Depression Shouldn’t Make Moms Feel Ashamed

Posted on August 9, 2011 by

Image via Bryan Gosline/Flickr

Originally Posted by Jacqueline Burt on August 6, 2011 at 6:00 AM

It doesn’t surprise me that there’s still enough of astigma associated with postpartum depressionthat many moms don’t seek help.

Postpartum depression is an illness, but we treat it as a character flaw, a personal failure. I know the shame women with PPD feel, because I’ve been there myself.

I’ll never forget the despair and self-loathingthat marked the postpartum depression I went through after my daughter was born. I knew it was “normal.” All the baby books listed it as a postnatal symptom right alongside engorged breasts and fatigue.

But nothing prepared me for the reality …

I loved my new baby more than I’d ever loved anything on the face of the earth. I was beyond lucky, and I knew that. That’s why I couldn’t forgive myself for feeling like I was emotionally at the bottom of a deep, dark well, fighting to keep myself afloat. That’s really the best way to describe it … for me, postpartum depression was like falling. And falling, and falling, and having no idea how to climb my way back up.

I was terrified that I wouldn’t be able to take care of my daughter, but I was even more terrified to admit that to myself. I was less afraid of what other people would think, which is why I didn’t wait very long to make an appointment with a therapist once I realized that I needed to see one. In my case, the “stigma” was self-imposed. I can’t help but wonder if it’s not the same for other women … we expect so much of ourselves, we want, more than anything, to be the ”perfect” mothers to our new babies.

But we’re not perfect, and that’s okay. The first step in getting over postpartum depression, for me, was accepting that fact, and realizing that I could be a good momin spite of my own personal limitations.

My heart goes out to moms who are going through this incredibly difficult time. I can promise you that it won’t last forever. The sooner you get help, the sooner you’ll start to feel better. You deserve to feel better.

Did you go through postpartum depression?

Image via Bryan Gosline/Flickr

Originally Posted by Jacqueline Burt on August 6, 2011 at 6:00 AM

Jacqueline Burt

ABOUT THE AUTHOR  Jacqueline Burt has written for numerous magazines, newspapers and websites. She is easily bored and often tired, so she requires constant entertainment to keep her awake. Dance, Monkey! Dance!

Source: http://thestir.cafemom.com/baby/124181/postpartum_depression_shouldnt_make_moms

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Asking for Help: What Gets in the Way and Why?

Posted on August 9, 2011 by 
It takes strength to ask for help, it is not a sign of weakness.
Published on August 4, 2011 by Karen Kleiman, MSW, LCSW in This Isn’t What I Expected

 Women tend to take better care of everyone else than themselves. Most women readily confess that self-care is on the bottom of their “to-do” lists. Mothers, in particular, are inclined to sacrifice their own needs while maintaining intense focus on the needs of their children. Often, mothers are motivated by the belief that complete and singular attention to ones’ child is the very hallmark of a devoted, loving mother. Compromise in this area does not feel like an option to many women.This prevailing notion that motherhood is synonymous with sacrifice, if not complete abandonment of ones’ own needs, can quickly translate into a loss of self. Somewhere along the way, mothers have incorporated the misperception that taking care of themselves is selfish and incompatible with the fierce demands of motherhood.

It’s hard to ask for help. Asking for help is often perceived as a character weakness, If I were only strong enough, I could do this by myself or worse, a mothering flaw, If I were a good mother, I wouldn’t need help. Giving help is simply easier than asking for it, and accepting it is even harder altogether! However, it is important to recognize that these perceptions are just that-perceptions, rather than facts. In early chapters, we learned that mothers with scary thoughts are understandably reluctant to let others know how they are feeling and what they are thinking. Even though one might understand that it is in her best interest to talk about it, it makes sense that she might hesitate to do so. Nevertheless, asking for help around the house, or help with the kids, or companionship to ease the strain is essential to a woman’s well being and should surpass the reflex not to ask for it.

One of the most powerful contributing factors to a woman’s reluctance to ask for help during the postpartum period is her need for control when everything around her is feeling so out of control. During this time when unpredictability triumphs over order, postpartum women are often forced to relinquish their desire for harmony and settle for the illusion of control. What does an illusion of control look like? It looks perfect. If a woman is inclined toward perfectionism, this tendency will promptly supersede the chaos. In this way, everything that feels out of place miraculously falls in line. At least that’s how it looks. One new mother described it this way:

I tried so hard to make sure everyone saw me as a mother who was totally in control; after all, I’ve done this before. No big deal. Women have been having babies for centuries. I knew what I needed to do to look good so no one would think anything was wrong. On the surface, it looked exactly the way I wanted it to. I was calm and perfectly in control. I made sure to put my make up on right before an appointment with my doctor or my kid’s doctor or my therapist. I even put on lipstick, which I never wear, so I would look fresh and ready for the world. But it was like my body was stuck in high idle with my engine revving but going nowhere. At any moment, I felt my insides would rupture. Still, I wouldn’t dare let anyone know I was feeling that way.

The energy it takes to maintain this illusion is enormous and, ironically, makes it harder to ask for help. The experience of feeling completely out of control, while simultaneously longing for it, is not unfamiliar to mothers. This is why it is so important for women to give themselves permission to ask for help. Remember, the objective is to reduce the external stress, thereby reduce the distress, and in so doing, reduce the frequency or intensity of feelings of distress.

Asking for help is not a luxury. It is essential.

Excerpted and adapted from “Dropping the Baby and Other Scary Thoughts” Kleiman & Wenzel (2010) Routledge

Source: http://www.psychologytoday.com/blog/isnt-what-i-expected/201108/asking-help-what-gets-in-the-way-and-why

Karen Kleiman, MSW, LCSW

Karen Kleiman, MSW, LCSW

Karen Kleiman, MSW, LCSW, is Founder and Executive Director of The Postpartum Stress Center, LLC.  She is the author of several books on postpartum depression, and has been working with women and their families for over 25 years. A native of Saint Louis, MO., Karen has lived in the Philadelphia area since 1982 with her two children and her husband. After graduating in 1980 from the University of Illinois at Chicago with her Masters in Social Work, she began her practice as a psychotherapist, specializing in women’s issues. In 1988 she founded The Postpartum Stress Center, LLC where she provides treatment for prenatal and postpartum depression and anxiety.

In addition to her clinical practice, Karen provides advanced training classes for clinicians from around the world to hope to specialize in the treatment of perinatal mood and anxiety disorders. She and her staff also conduct inservices for healthcare professionals as well as consultation and supervision to therapists. She frequently lectures and continues to write on the topic of postpartum adjustment. Her work has been featured in local and national magazines, numerous radio shows, local and national television shows, “Inside Edition”, The Oprah Winfrey Show and NBC Nightly News with Tom Brokaw.

Currently, Karen is affiliated with a number of on-line sites, where she writes articles, facilitates support chats and addresses concerns of postpartum and pregnant women. In addition to her work at The Postpartum Stress Center, Karen maintains a general private practice where she treats individuals, couples and families.



		
	    

	
	    

		
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	Blues or Depression – how do you know?



	            

Posted on July 29, 2011 by 
        


		    

		
Is this the ‘blues’ or am I struggling with depression?


Human Services, Inc.


We all have times when we feel blue, are overwhelmed by everyday tasks, have difficulty sleeping, lack joy in life, or find it difficult to concentrate. However, if any or all of these feelings become frequent and persistent, they may be symptoms of depression, and should be taken seriously. Depression is a common and serious medical illness that negatively impacts feelings, thoughts, and actions. It affects men and women of all ages, cultures, races, and income levels.


However, the very word “depression” can be confusing, as it is used both in a general and a clinical sense. We often say that we are “depressed” when we are blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, however, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.


Depression is a common but serious medical illness that involves changes in the brain. If you are one of the more than 20 million people in the United States who have depression, your feelings of being “down in the dumps” or “blue” do not go away. They persist and interfere with your everyday life. Such symptoms can include sadness, loss of interest or pleasure in activities you used to enjoy, change in weight, difficulty sleeping or oversleeping, energy loss, feelings of worthlessness, and even thoughts of death or suicide.


Depression can run in families, and usually starts between the ages of 15 and 30. It is much more common in women, who can also get postpartum depression after the birth of a baby. Some people suffer “seasonal affective disorder” in the winter, which involves depression. Depression is also one part of bipolar disorder. Depression often co-exists with other illnesses. Such illnesses may precede the depression, cause it, and may be a consequence of it.


Although depression can affect anyone, there are a few groups that are particularly vulnerable. These include the elderly; suicide rates are highest among people aged 65 years and older, with men in that age group having the highest rates of all. The next most vulnerable group is adolescents; suicide is the third leading cause of death for young people aged 15-24 years. When depression is combined with substance abuse, the risk for self-harm goes up dramatically for any age group.


Left untreated, depression wreaks havoc on a person’s quality of life. It may worsen symptoms of other diseases, and even can be fatal. People who have a stroke or heart attack, for example, are more likely to die if they have depression.


The good news is that depression is treatable, even in severe cases. Between 80 percent and 90 percent of people respond well to treatment, and most gain at least some relief from their symptoms. The first step is to visit a doctor. Your family doctor or a health clinic is a good place to start. A doctor can make sure that the symptoms of depression are not being caused by another medical condition. A doctor may refer you to a mental health professional.


Most insurance plans cover treatment for depression. Check with your own insurance company to find out what type of treatment is covered. If you don’t have insurance, local city or county governments may offer treatment at a clinic or health center, where the cost is based on income. Medicaid plans also may pay for depression treatment.


People who are depressed often need those who care about them to lead the way. If you are concerned about depression in yourself or someone else, it is important to seek help. Discuss your concerns with a health care or mental health professional and request a complete evaluation. Remember that depression is treatable, and the proper diagnosis and treatment can restore the sufferer to enjoyment of life.


- HSI, a nonprofit organization with seven offices located throughout Washington County, annually serves more than 8,600 people, offering a variety of services to adults, children, adolescents, and families.


Source: http://www.review-news.com/main.asp?SectionID=60&SubSectionID=126&ArticleID=5341


Is this the ‘blues’ or am I struggling with depression?


From Human Services, Inc.


We all have times when we feel blue, are overwhelmed by everyday tasks, have difficulty sleeping, lack joy in life, or find it difficult to concentrate. However, if any or all of these feelings become frequent and persistent, they may be symptoms of depression, and should be taken seriously. Depression is a common and serious medical illness that negatively impacts feelings, thoughts, and actions. It affects men and women of all ages, cultures, races, and income levels.


However, the very word “depression” can be confusing, as it is used both in a general and a clinical sense. We often say that we are “depressed” when we are blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, however, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.


Depression is a common but serious medical illness that involves changes in the brain. If you are one of the more than 20 million people in the United States who have depression, your feelings of being “down in the dumps” or “blue” do not go away. They persist and interfere with your everyday life. Such symptoms can include sadness, loss of interest or pleasure in activities you used to enjoy, change in weight, difficulty sleeping or oversleeping, energy loss, feelings of worthlessness, and even thoughts of death or suicide.


Depression can run in families, and usually starts between the ages of 15 and 30. It is much more common in women, who can also get postpartum depression after the birth of a baby. Some people suffer “seasonal affective disorder” in the winter, which involves depression. Depression is also one part of bipolar disorder. Depression often co-exists with other illnesses. Such illnesses may precede the depression, cause it, and may be a consequence of it.


Although depression can affect anyone, there are a few groups that are particularly vulnerable. These include the elderly; suicide rates are highest among people aged 65 years and older, with men in that age group having the highest rates of all. The next most vulnerable group is adolescents; suicide is the third leading cause of death for young people aged 15-24 years. When depression is combined with substance abuse, the risk for self-harm goes up dramatically for any age group.


Left untreated, depression wreaks havoc on a person’s quality of life. It may worsen symptoms of other diseases, and even can be fatal. People who have a stroke or heart attack, for example, are more likely to die if they have depression.


The good news is that depression is treatable, even in severe cases. Between 80 percent and 90 percent of people respond well to treatment, and most gain at least some relief from their symptoms. The first step is to visit a doctor. Your family doctor or a health clinic is a good place to start. A doctor can make sure that the symptoms of depression are not being caused by another medical condition. A doctor may refer you to a mental health professional.


Most insurance plans cover treatment for depression. Check with your own insurance company to find out what type of treatment is covered. If you don’t have insurance, local city or county governments may offer treatment at a clinic or health center, where the cost is based on income. Medicaid plans also may pay for depression treatment.


People who are depressed often need those who care about them to lead the way. If you are concerned about depression in yourself or someone else, it is important to seek help. Discuss your concerns with a health care or mental health professional and request a complete evaluation. Remember that depression is treatable, and the proper diagnosis and treatment can restore the sufferer to enjoyment of life.


- HSI, a nonprofit organization with seven offices located throughout Washington County, annually serves more than 8,600 people, offering a variety of services to adults, children, adolescents, and families.


Source: http://www.review-news.com/main.asp?SectionID=60&SubSectionID=126&ArticleID=5341


		
	    

	
	    

		
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	How can stay-at-home moms avoid depression?



	            

Posted on July 29, 2011 by 
        


		    

		
Reposting this blog entry:


http://www.momstalknetwork.com/resources/stay-at-home-mom-depression-ways-to-avoid-it/




Written on April 26th, 2007 at 8:28 pm by Kelly


 






Depression can strike anyone at any time in their lives. When we think of depression and mothers, what comes to mind is postpartum depression. But, stay-at-home moms can suffer from depression as well. Learn how to keep depression from becoming an issue in your home.


Most mothers who decide to stay at home with their children will tell you that they have made no greater decision in their lives. Being present for the formative years is a once in a lifetime experience. The children benefit from having a parental presence throughout the day and the family saves money on daycare services.


Still, there are challenges that each mother has to face as a stay-at-home parent. The interaction with other adults is limited now that there is no job outside of the home. At first it may not seem like a big deal, but every woman needs a little girl talk now and again.


Stay-at-home mothers perform a job that never ends. At the end of the day your kids do not leave for elsewhere. They are already home.


Household duties still need to get done. The best times to clean is when the children are asleep and don’t need constant supervision. Then you have to clean, cook, wash clothes, and tidy up before they wake up. Moms can feel like a prisoner in their own homes.


When the days become overwhelming, depression can set in. At first, you may feel like sleeping every time the kids lay down. Then you may get easily irritated with them when they want you to play with them or if they break something. Moms could chalk these symptoms up to fatigue. Then your emotions may begin to have their way with you.


If this happens, stop and take a deep breath. Depression is a serious issue that needs to be dealt with. If your kids are getting to you, be honest about it and don’t feel guilty. We all have our breaking point without an outlet. The solution may be as simple as a bit of “mommy time”.


Resolve to make time for yourself everyday. On a beautiful day, take the kids to the park, where you can relax and they can have some free time. Invite a girlfriend you haven’t seen in a while and use the time to catch up. If she works, offer to bring a picnic lunch to accommodate her lunch hour.


Regardless of what you do, time apart for one’s self is important for everybody. Rising early in the morning for a period of meditation can change the perspective of your whole day. Paying attention to your own needs can keep the specter of depression at bay.


 




		
	    

	
	    

		
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	Well done, Kim Clijsters



	            

Posted on July 29, 2011 by 
        


		    

		
Kim Clijsters became the first mom to win a major since 1980, defeating Caroline Wozniacki 7-5, 6-3 in the U.S. Open final on Sunday.




Kim Clijsters


Julian Finney/Getty Images








The mother of all comebacks: Kim Clijsters celebrates unlikely U.S. Open triumph with daughter Jada


By NICOLA BODEN


Last updated at 12:18 PM on 15th September 2009


Appearing in her first grand slam tournament since retiring more than two years ago, Kim Clijsters would probably have been quite happy to make it into the second week.


Instead, she stormed all the way through to the final and took the title – repeating her success at Flushing Meadows four years ago.


The delighted 26-year-old was able to celebrate with her young daughter, Jada – who was the very reason she gave up tennis in the first place.


The toddler, who at 18 months is the spitting image of her Belgian mother, lapped up the limelight at the Arthur Ashe stadium as her mother showed off her trophy.


‘We tried to plan her naptime a little bit later so she could be here today. It’s the greatest feeling in the world, being a mother,’ an over-whelmed Clijsters told the cheering crowds.


Kim and JadaFamily affair: Kim Clijsters with daughter Jada after winning the U.S. Open in New York




Clijsters kisses her husband Brian Lynch


Kim, Jada and Brian


Delight: Clijsters kisses husband Brian Lynch in the stands and, right, celebrates with him and Jada




Clijsters is the first mother in 29 years to take a grand slam crown after Evonne Goolagon won Wimbledon in 1980. She is also the first ever wild card entrant to win the U.S. Open.


Her triumph against Caroline Wozniacki was all the more remarkable because she gave up tennis in 2007 to start a family with husband Brian Lynch, a basketball player.



The U.S. Open was only her third tournament since she announced her return to the courts in March this year. As Clijsters said herself this morning: ‘Winning was not really our plan’.


A hugely popular player, the Belgian was welcomed back onto the tour with open arms and swept aside both Venus and Serena Williams on her journey to the U.S. title.


Serena handed her a place in the final on Saturday night after arguing with a line judge who called a foot fault as she was 15-30 and serving to stay in the match.


ClijstersI can’t look Mummy: Clijsters and her 18-month-old daughter lap up the limelight at the Arthur Ashe Stadium


ClijstersHistoric: Clijsters is the first mother to win a grand slam in almost 30 years


After a warning earlier in the game when she smashed her racket, Serena was given an automatic point penalty for a second violation and the match was over.


In truth, Clijsters had already been comfortable and took it 6-4, 7-5 but a message she posted on Twitter later revealed she was still struggling to absorb quite how far she had already come.


‘The fairy tale goes on – some how, I’m in the US Open final on Sunday beating both Venus and Serena along the way… am i dreaming???,’ she wrote.


Less than 24 hours later, when a final delayed by rain eventually took place, she duly overcame ninth seed Wozniacki of Denmark 7-5 6-3 to complete the fairy story.


Clijsters clinched the 93-minute match – and its $1.6m pay cheque – with a forehand winner and sank to her knees in celebration, visibly sobbing.


She immediately climbed up to her family’s box to give Brian – her husband of two years – a kiss and to hug her friends.


JadaIsn’t Mummy clever? Jada was fascinated by the silver trophy, which comes with a $1.6m pay cheque




Clijsters


Kim and Jada


Playful: Jada, who is the spitting image of her mother, runs around the court at Flushing Meadows




‘I don’t have words for this,’ she said during the trophy presentation ceremony. ‘I’m just glad I got to come back and defend my title from 2005. It’s so exciting for me.’


Clijsters, who was unranked because of her time out from the game, was offered a wild card for the tournament earlier this year.


She had not competed in the event since her first grand slam triumph there in 2005 – missing out in 2006 because of injury and then because she had already retired.


‘I just wanted to start these three tournaments to get back into the rhythm of playing tennis and get used to the surroundings again. So I have to thank the USTA for giving me the wild card to come back here,’ she said.


It took a while for Clijsters to find the range with her groundstrokes against Wozniacki, who was appearing in her first grand slam championship match.


But by the end of the final at a windy Arthur Ashe Stadium, she was cracking winners from both sides and registered 36 in all compared to her opponent’s 10.


Wozniacki had been a break up in the first set at 5-4 but Clijsters closed it out by winning the last three games and then dominated in the second set to win.


ClijstersChampion: Clijsters, husband Brian and daughter Jada posing for pictures in Times Square


The Dane was magnanimous in defeat, saying: ’She’s such a great girl. Unfortunately she beat me today. She played a great match and deserved this trophy.’


Clijsters’ victory will spur on Roger Federer, who will be out to prove tonight that new fathers can also win grand slams.


Now the father of twins, the World Number One takes on an in-form Juan Martin del Potro in the men’s final and is aiming to win a record 16th grand slam title.


Of Clijsters’ win, he said: ‘Amazing. For her to have this incredible run is fantastic. This is a great story for women’s tennis, that’s for sure.’


The Belgian was previously engaged to Australian tennis star Lleyton Hewitt.


She is not now expected to make a full return to the tour but is likely to play in major competitions, including Wimbledon.


Clijsters and Wozniaki


Hard-fought: Clijsters overcame ninth seed Caroline Wozniacki in two sets to clinch the grand slam title


GoolagongWinner: Evonne Goolagong with her daughter Kelly in 1978, two years prior to her second Wimbledon triumph


Read more: http://www.dailymail.co.uk/news/article-1213326/Kim-Clijsters-celebrates-U-S-Open-win-daughter-Jada.html#ixzz1TWkgmhyp




		
	    

	
	    

		
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	The Anatomy of Depression



	            

Posted on July 29, 2011 by 
        


		    

		
Here is some interesting information from Robert J. Hedaya, author of the book “The Antidepressant Survival Guide: The Clinically Proven Program to Enhance the Benefits and Beat the Side Effects of Your Medication”






Posted by By Robert J. Hedaya, M.D., D.F.A.P.A. on January 28, 2009 – 12:00pm






The Anatomy of Depression: Part I


GOAL: The person with depression is in a complex homeostatic state, albeit a disturbed, negative, painful one. The task of the clinician is to develop an understanding of the homeostatic processes (social, biological, etc) involved, and the nodal points that require intervention. The clinician must then intervene at as many of these points as possible, at the same time, to re-establish a new more functional equilibrium.


THE PARADIGM: Neurotransmitters are built from a number of essential nutrients. The process, not too different from making a ‘big mac with special sauce’, requires that certain ingredients (e.g., tryptophan, tyrosine, B vitamins, folic acid, B12, magnesium, etc.) be available in adequate supply. High demand (i.e., stress, certain medications such as stimulants and prilosec) requires a greater supply of the essential ingredients. If any of these is in short supply production and maintenance of a steady state is impaired. In addition, the breakdown and or recirculating of the neurotransmitters requires other nutrient dependent processes (e.g.folic acid, methionine). The task of the clinician is to assess the adequacy of diet, nutritional value of the food sources, digestion, and absorption of the key ingredients used to make the neurotransmitters.


BEN’S STORY: In June of 1985, Benjamin sat in the corner seat of my waiting room, feeling distraught and humiliated. Recently released after three weeks on “the psych ward” at McLean Hospital, this rejection-sensitive young man was still highly anxious, experiencing panic, hopelessness and suicidal ideation. His pain was poorly disguised by a thin veneer of quick humor. Using a combination of individual and group therapies, and phenelzine (an MAO inhibitor), gradually, over 5 years, he came to live a full life, and his visits to me were reduced to a biannual event, when I would catch up with his life, and enjoy some of his excellent sense of humor. In 1989, I switched Benjamin over to fluoxetine (Prozac) which lacked the risk of a hypertensive crisis. Benjamin did quite well, and eventually, he married and had three children. His wife, stressed by the maternal role which her own mother had abdicated, developed fibromyalgia. Benjamin’s parent’s health and finances deteriorated. As the breadwinner of his own family, and only child to his parents, his stress level rose significantly. In August of 1999, Benjamin came for an early visit. Fourteen years after his first panic and depression, he was now having a recurrence of the panic attacks. He was terrified that he would end up back in the hospital. He was convinced that he needed to change his medication to Zoloft. “I think it’s ‘Prozac Poop out’, he said.


THE PARADIGM: In general, when one is depressed regardless of the causes (i.e. metabolic, nutritional, social) distortions in one’s thinking become part and parcel of the depression. Selective attention to these distorted thoughts (usually catastrophic thinking, all or nothing, etc-for a full description of this read Aaron Beck’s Cognitive Therapy of Depression or “Feeling Good” by David Burns) is the norm for depressed patients. One aspect of the treatment of the depressed person is identifying these thoughts, the nature of the distortion, testing the logic behind the ‘automatic assumption’.


BEN’S STORY: I asked Benjamin what basis he had for thinking this, and explored his logic. I asked him if there were any other ways of looking at the situation. Finally I reassured him that hospitalization would not happen, and explained the reasons why (e.g., panic could easily be treated with a short acting benzodiazepine while we were searching for the cause, we could increase the frequency of contact as needed rather than use the hospital, he had a relationship with a psychiatrist he trusted, and who cared about him, whereas that was not the case 15 years earlier), knowing that it was important to deal directly with this negative thought and preoccupation.


THE PARADIGM: Untended, this “catastrophic fear” was causing anticipatory anxiety (activating his dorsal raphe nucleus), priming his limbic system for panic (locus coeruleus), and feeding-forward via the amygdala and locus coeruleus into full fledged panic, and the ‘hypothalamic-pituitary-adrenal gland (HPA) axis-activation-positive-feedback’ loop. It would become a self-fulfilling prophecy.

Having addressed this thought, I explained to Benjamin that ‘Prozac poop-out’, (the commonly held idea that the antidepressants often stop working after a while) was not a concept that makes sense. If a person with unipolar depression is fully responding to an antidepressant in an essentially stable manner for several months or more, and then relapses, it is incumbent on the practitioner to search for other factors that are now over-riding the medication (assuming adherence to the medication), such as psychosocial changes and stressors, as well as any aspect of metabolism.


At this point I decided that in order to approach the situation with ‘fresh eyes’, I would evaluate Benjamin as if he were a new patient. I would do my best to leave no stone unturned, no assumption of mine unchallenged.


Tomorrow, I will detail the surprising domino-like events that nearly brought Ben to his knees.






By Robert J. Hedaya, M.D., D.F.A.P.A. on January 29, 2009 – 9:12am






BEN’S STORY (Continued): I decided to start with the psychosocial stressors – (being a parent, having an ill wife and parents) and delve into the nature of how these stressors changed his life, and how he adapted to them. Apparently, Benjamin had to take a detour from his own career in order to manage his parents finances, control his mothers spending, and deal with his fathers business. When the day was done, he would come home to his ill wife and do most of the house work. Having little support, Benjamin began to cope by stress-eating. He gained weight, began to experience indigestion, and excessive belching. His family doctor, concerned about gastro-esophageal reflux, placed him on Prilosec. Benjamin noticed a significant improvement in his indigestion and remained on the drug for three years before his present panic attacks and depression recurred. However, now the recurrence of panic shook his confidence and he felt that he was losing control of his life and his mind, once again.


THE PARADIGM: Knowing that Prilosec could inhibit B12 absorption, (it inhibits the very cells that produce intrinsic factor, which is necessary for B12 absorption), I eventually convinced Benjamin that he should be worked up for a B12 deficiency secondary to the Prilosec. Despite his distress, he was quite resistant to this idea. The detection of B12 deficiency is difficult. One can look for a macrocytic anemia (large red blood cells also called high MCV), low serum B12 levels, or high levels of methylmalonic acid. However, a number of studies indicate that these tests are often falsely normal when tested against the gold standard Schillings test (no longer available).


Martin Seligman’s learned helplessness model of depression demonstrates that despite their pain, some depressed individuals actively resist help. The neurophysiology of mood disorders suggests that a certain part of the prefrontal cortex (the ventromedial prefrontal cortex) whose function is to accurately predict or anticipate rewarding experiences and pleasure, or painful consequences, has reduced activity.


Because Benjamin complained of indigestion, bloating, constipation, and gassiness, I also evaluated him for bacterial overgrowth of the small intestine which can impair nutrient absorption. An IgG panel for delayed food sensitivities, a comprehensive digestive stool analysis, and an adrenal saliva test rounded out the work up.


BEN’S STORY: When he finally agreed to the workup (one year later), he indeed turned out to have a B12 deficiency. His methylmalonic acid and CBC were within normal limits, although his MCV was trending to the upper limit of normal, and his red blood cell count was trending toward anemia. These trends indicated that a macrocytic anemia was developing, but that the effects of the B12 deficiency manifested themselves first in Benjamin’s weakest system-his nervous system. The only test that was abnormal was a functional intracellular assay of B12 function. With the introduction of B12 injections Benjamin’s panic and depression cleared completely.


The next two tasks were to help Benjamin address the stressors in his life, and his stress-eating response. Based on the test results a number of dietary changes, a program to rebalnce his gastrointestinal milieu, nutritional support, as well as meditation and a regular exercise program were instituted. Benjamin lost weight, discontinued the Prilosec, and felt more in control of his life. He has been without panic or depression since then (8+ year follow up).


I saw Ben last week, and he told me “I am at a high point in my life.” Many of his career aspirations were coming to fruition, and family stresses were becoming more manageable as his attitude was maturing. Is this just a nice, sugar coated story with a happy ending, or are there lessons to be learned from Ben’s difficult passage? You decide.


(Adapted with modification from: Depression: Advancing the Treatment Paradigm, Robert J. Hedaya, MD, FAPA, 2008. IFM.ORG)










		
	    

	
	    

		
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