Postpartum Progress

Postpartum Progress' New Research Page Provides Better Access to Studies on Postpartum Depression

Since it is so hard to keep track of the research coming in almost daily on perinatal mood and anxiety disorders, I've decided to add a research page to Postpartum Progress.  You can find it on the right-hand side of your screen underneath "Help Is Here", #5. 

I won't be able to list every single piece of research that comes down the pike, but I will put links on that page to the most current, most interesting, most often cited research.  I've created categories to try and organize it, such as Genetics & Postpartum Depression, Screening for Postpartum Depression, Risk Factors for Postpartum Depression, etc.

Hope this page is helpful to you should you need to find some specific data.  If you know of a study that should be listed there and it isn't, please send me a link at postpartumprogress@gmail.com.  And to my brainy, scientific-type, evidence-based medicine readers, if you see a study on there that you don't think is valid, tell me that too and I'll remove it.

Do You Really Need a Specialist To Treat Your Postpartum Depression?

I was very happy to see that Parents magazine and CNN.com have covered the specialized inpatient unit for women with severe perinatal mood and anxiety disorders at the University of North Carolina.  Go Dr. Elizabeth Bullard, Dr. Samantha Meltzer-Brody and nurse Chris Raines!!!! 

"Immediately, Meehan-Machos's obstetrician referred her to the University of North Carolina at Chapel Hill (UNC). There, doctors had recently debuted a groundbreaking inpatient psychiatric unit, the first in the nation specifically tailored to women suffering perinatal (prenatal and postpartum) mood disorders. Unlike a general psychiatric unit, it offered:

• A core group of doctors specializing in perinatal issues
• Psychiatrists attuned to medications that wouldn't harm a pregnancy or a nursing newborn
• An unusual policy of allowing children, even babies, on the ward during extended visiting hours
• Mom-only counseling focused on anxiety and bonding"

There aren't near enough specialized programs for women with postpartum anxiety, postpartum depression and postpartum psychosis.  These women have a distinct set of issues and deserve treatment from clinicians who have a lot of experience treating them.  Whether its psychiatrists, psychologists, therapists and social workers who specialize in reproductive psychiatry, special inpatient units like the one at UNC or special outpatient units like the one at Women and Infants Hospital in Rhode island, we need more hospital administrators and healthcare systems to recognize that perinatal mental illness is a public health problem and to create the kinds of services that help new moms and moms-to-be get better as quickly as possible.

I can tell you that when I had postpartum OCD I first went to a psychiatrist that I later came to realize had almost no experience with women with postpartum depression.  After dealing with that for ONE YEAR (argh!) and making little headway, I switched to someone who had trained under specialists in perinatal mood and anxiety disorders.  It was like night and day.  Out came the sun!! 

I realize that not everyone has access to specialists.  It is my wish that one day every woman will, no matter in which corner of this country (or any other) she lives.  It is my personal opinion, though, that seeing a specialist in the best case scenario for women trying to get well.  If it's a friend of mine, a relative, a neighbor or my own daughter, I'm going to fight like hell to find a specialist to help her. 

I'm just saying.

Update:

I received the following comment to this post and I'd like to share it so that it isn't missed.

"With reimbursement of mental healthcare as poor as it is, there are not (and may never be) even enough regular psychiatrists to go around, much less psychiatrists who treat only patients with perinatal issues.  If we have special clout and extra connections we may be successful in getting our friend, relative or neighbor in to see a specialist (as long as she lives in a major metropolitan area and has good insurance, of course).  But the vast majority of people aren't so well connected.  We need to make sure not to alienate non-specialists.  OBs, family physicians, midwives etc. can and should be trained well enough to treat straightforward perinatal mood disorders.  And if general psychiatrists are unable to successfully treat the more complicated cases, I don't think the solution is just to hope and wait for more postpartum specialists.  The solution is to insist that general Psychiatric training programs adequately address these common and important conditions."

Thank you for your comment.  I understand what you are saying.  It is true that we are sorely lacking in this country when it comes to having enough psychiatrists to go around, especially in rural areas.  I do not think, though, that you need any particular clout when it comes to seeing a specialist.  Insurance, perhaps, but not clout.  When I was sick I had zero clout.  When I finally got tired of being treated by someone who didn't know what they were doing the only thing I did have was empowerment.  The courage to demand more for myself and my health and to ask around and ask around and not give up until I found someone with more training than the average doc on these illnesses (which doesn't take much actually, because as you rightly point out, the current med school training is inadequate).  There are many healthcare providers from various disciplines who have taken the time to learn more, get CEUs, attend a conference or go to a PSI training.  These are the people I think women should try and see.  

Additionally, I know that many of the specialists in this field do consults and confer with women's personal physicians to discuss care for perinatal mood and anxiety disorders.  They are aware that, because this specialty is so unique, their expertise is needed both inside and outside of their "neighborhoods".  

And finally, I would never suggest women who are suffering wait and hope until we have every specialist we need.  I hope that's not how it came across in my post.  Thankfully, with organizations like Postpartum Support International, women don't have to.  They can connect with one of more than 100 trained volunteers spread out across our country in every state who can offer information on healthcare providers in the vicinity who can help. 

Updated List of Specialized Treatment Programs for Postpartum Depression

This week I have updated the list of specialized treatment programs at hospitals and universities around the country for women with perinatal mood and anxiety disorders, which can be found here.

The University of Louisville Women's Mental Health Program, the University of Michigan Perinatal Mood Disorders Program, the Women's Health Consortium program in NYC, the Columbia University Women's Program, the Penn Center for Women's Behavioral Wellness and UT Southwestern's Women's Mental Health Center have all been added. 

A big thank you to the hospitals and universities who have recognized women's reproductive psychiatry as a mental health issue important enough to deserve a specialized program with trained individuals who can provide some of the best support and treatment around to the women who need it.

If you know of another program that should be on the list, email me at postpartumprogress@gmail.com and I'll take a look.

Wishing for an Open Discussion Between Clinicians & Consumers on Perinatal Psychiatry? Now's Your Chance!

I'm really excited to share with you that the current issue of the Journal of Clinical Psychiatry features a set of commentaries all focused on Perinatal Psychiatry.  Read on, because there is a way that you can be a part of an interesting discussion on the treatment of women with perinatal mood and anxiety disorders, and I really want you to participate.

There are 9 commentaries, plus an introduction by Marlene Freeman, MD.  Each is a short read and not too full of medical jargon, so for those of you who aren't clinicians I'm pretty sure you will be able to understand what they're saying. (No multilayer perceptrons here.) If you're wondering what a commentary is:  Rather than being a paper on the results of a specific piece of research that is published in a medical journal, commentaries are more like op-ed pieces.  The writers provide their observations and opinions, citing the research that forms the basis of these ideas.  Here's one of the titles to whet your appetite:  "Influence of the Media on Women Taking Antidepressants During Pregnancy" by Adrienne Einarson.

Here's the even cooler, interactive part:  The Journal of Clinical Psychiatry has created an online, open forum for you to post comments and ask questions about each of them.   Did you agree with what you read?  Disagree?  Do you have other ideas?  Would you like clarification on something? 

You can start posting your responses today in the forums, and later in the month the authors of the commenataries will offer responses to your comments and questions. 

Anyone can participate; you don't have to be a doctor or in the psychiatric field.  I would encourage all the Warrior Moms out there to read these pieces and share your own opinions or ask questions for clarification.  (Just please be sure to be dignified and constructive if you disagree with something.)  This is an important way to keep the lines of communication open between the medical field and the patient community.  We don't always get to interact in this way so I really encourage you to take advantage of this.  And of course the Journal would love to hear from my clinician readers as well!

It is free to participate but you will need to register for a free account in order to do so.  Just click on the link in the above paragraph.  For each article you can click "full text with forum" and it will allow you to read the piece and comment.  The first time you try to do it, you will be asked to join the Net Society Platinum.  Fill out the form and you'll be on your way.  (Note for the consumers who sign up: for medical school graduation year, I clicked N/A.  For profession I clicked other mental health.  Once you fill out the initial form and submit it, you will then be taken to a page asking you if you want to subscribe to the Journal.  You don't have to.  You can scroll down to the bottom to find your name and login.  It may ask you one more time if you want to update your profile.  Once you're done I'd suggest closing the window and using the link above again, logging in and commenting away.)  

SAMHSA Offers Two New Publications on Women's Mental Health

It seems I may have missed National Women's Health Week back in May.  I didn't notice any big celebrations or news or parades or million women marches -- did you?  And may I ask, IS THAT ALL WE GET?!  A measly week?!!!

Nonetheless, in honor of our health, the US Department of Health & Human Services' Office on Women's Health released two women's mental health publications that are available to you free.  You can either download them or order free copies through the Substance Abuse and Mental Health Services Administration's Health Information Network (SHIN) or call 1-877-SAMHSA-7.

The first is called "Action Steps for Improving Women's Mental Health" and was created for healthcare pros.  This is a report that brings together the most recent research, resources, products and tools on mental health issues in women and explores the role gender plays in diagnosing, treating and coping with mental illness.  It outlines specific action steps for policy-makers, health care providers, researchers and others to take.  The item number for this report is OWH09-PROFESSIONAL.  To view it, click here.

The second is called "Women's Mental Health: What it Means to You" and is for consumers.  It is a 22-page booklet addressing the stigma associated with mental health, with information on the signs and symptoms of mental illness.  It also provides suggestions for support and solutions for preventing and coping with mental illness.  The item number for this report is OWH09-CONSUMER.  To view it click here.

Will Texas Be First State With An Infanticide Law?

Two lawmakers in Texas have proposed a bill under which postpartum mental illness would be recognized as a legal defense for women.  According to the Dallas Morning News, which broke the story this weekend:

"If lawmakers approve the measure, Texas would be the first state to have an infanticide law, said George Parnham, the Houston attorney who defended [Andrea] Yates.

'It's something every civilized country has on its books,' said Parnham, a strong proponent of the legislation. 'The only thing that will change public attitude is education about postpartum issues.'

The bill, introduced earlier this month by Rep. Jessica Farrar, D-Houston, applies to women who commit the crime within 12 months of giving birth. If jurors find a defendant guilty of murder, they can take testimony about postpartum issues into consideration during the trial's punishment phase.

If jurors believe that the woman's judgment was impaired as a result of childbirth or lactation, they can find her guilty of infanticide – a state jail felony that would carry a maximum punishment of two years in jail ...

Postpartum depression is recognized as a legal defense in at least 29 nations, including Britain, [as well as Australia and Canada] which has had an infanticide law on the books since 1922."

Of course, there are a lot of people on the internet and talk radio in Texas who are pretty upset about this bill, many concerned that it would give women carte blanche to go around committing infanticide and not having to take responsibility for their actions.  They don't care one whit that most Western countries around the world already have such laws. 

I can see their point.  It's a difficult concept to grasp that some who commit violent crimes may not be responsible, while others are surely responsible.  How do you decide who is and who isn't?  And then there's this: "Isn't anyone who would kill their child crazy?  Does this mean they'll all get away with it now?"  Before I had the unpleasurable opportunity of losing my mind for a brief period, I would have agreed with all of them wholeheartedly, so I understand their perspective.  At the same time, I'm not a fan of some of the more ignorant and even downright mean statements being made -- if you scroll down to the comments on the Dallas Morning News piece, you'll read some pretty uneducated, unbalanced stuff. 

As I've written previously, it is very difficult for people who haven't "lost their minds" to understand how anyone could.  We can choose to pretend it doesn't happen, and watch as more crimes are committed that could have been prevented.  Or we could try to create better programs to help these people, and when we don't help them, we could take a little responsibility on ourselves.  

Fortunately, you can find reasoned discussions of the infanticide bill if you look, like here at Grits for Breakfast, and explanations of why it might make sense, like here at Coping With Life.  As Susan writes on Coping With Life:

Postpartum psychosis is an extremely rare (less than 1 in a thousand) condition in which a mother may be susceptible to “command hallucinations”, i.e. auditory or visual hallucinations which may order her to kill her children in order to save them and her family or prevent evil. This condition presents a true psychological emergency and immediate treatment is required to prevent the possible advancement of the illness that could result in tragedy.

Because such psychotic hallucinations may continue for days at a time and result in the planning of death, it is difficult for a considering jury to believe the mother is truly insane feeling that “insane people are not logical and could not execute a step-by-step plan”. It is this misunderstanding of the course and content of psychotic illness which often brings such outrage and condemnation to the convicted mother during penalty phase of deliberating jurors, resulting in jail terms equivalent to that for intentional murder or manslaughter."

There are actually some sufferers who, in waning moments, are aware they need help, or at least those around them are aware and they try to get that help before the "bad thing" happens.  We can't ignore that a percentage of those people are either misdiagnosed, improperly medicated, poorly cared for by untrained providers, and/or released from the hospital without being well ... it happens more often than you think.  For those who would argue that mothers with postpartum psychosis who kill could have, and should have, chosen to ask for help, some have.  What about them?  What about Andrea Yates, whose psychiatric provider took her off of her antipsychotic medication?!!! 

What about this story from the Palm Beach Post about Amy Kern?  The paper reports that "Acquaintances portrayed Kern, 30, as a bipolar schizophrenic who had been trying in vain to seek help and medication since a recent pregnancy and postpartum depression exacerbated her condition."  Before killing two people, she tried to check into a psychiatric hospital but " ... no one would let her in."  Why not?  What happened? 

As Susan Stone pointed out in the Dallas Morning News piece, "We do not want women who abuse children to use this defense.  There are very clear guidelines for postpartum psychosis."  That part of the story gets missed sometimes I think. 

Do you believe there is a difference between a woman who kills a child with a history of mental illness or evidence of being mentally ill -- for instance she was being treated for a perinatal mood disorder or her family and friends had all shared concern that she was suffering a perinatal mood disorder or her behavior clearly indicated such an illness -- and another woman who kills a child without any such history?  Might we find that there really are some people who have been failed by everyone around them and who were not in control of their thoughts and actions?  If so, should they pay a different price?

Postpartum Progress' "Six Things" Series

If you hadn't noticed it yet, I've created a new series called Six Things.  You can find it on the left of your screen, directly underneath my picture. (Found it?  Good.) 

I decided to develop these documents as a "quick and dirty" way to let people know what I believe are some important things to understand about perinatal mood and anxiety disorders, which include depression and anxiety during pregnancy and in the 12 months postpartum.  These are brief Word documents that you can quickly download. 

If you or someone you know has time to read nothing else, hopefully these Six Things lists will help give you and those who care for you some clarity as you grapple with these illnesses.  These, of course, aren't the only six things you need to know.  You may have another six you'd like to share.  (If so, email me at stonecallis@msn.com). 

So far I've created a Six Things for Moms and Moms-To-Be, and a Six Things for Healthcare Professionals.  There will be more to come ...

Schedule of Spring 2009 Events for PPD Awareness & Training

There are a lot of upcoming events that I've written about before but want to do a quick roundup and remind you of them here:

This Friday, February 27, I'll be at the Depression In the Mother conference held at the Brooklyn Baptist Church Convention Center in West Columbia, South Carolina.  The event goes from 8am to 4pm and contact hours are available for social workers, nurses and counselors/therapists.  To register, click here: http://mha-sc.org/Training/index.php?TRID=25.  Registration costs $40 and includes lunch.  Hope to see you there!

The Lunafest film festival, featuring short films by and about women, will be held on Wednesday, March 5, at the Arlington Draft House in Arlington, Virginia.  Tickets are $15 and the event starts at 7pm with a silent auction.  The event will benefit Postpartum Support Virginia, among other organizations.

Postpartum Support International will sponsor a two-day training, Perinatal Mood Disorders (PMD): Components of Care on March 12-13 in Indianapolis, IN.   The course is evidence-based and is designed for nurses, physicians, social workers, mental health professionals or anyone interested in acquiring formal knowledge about the subject.   It will be held at the Petticrew Auditorium at Methodist Hospital.  For further information, call 317-962-8078.  The same PSI training will be held March 26-27 in Plymouth, Michigan.  Click here to register: http://treeofhopefoundation.org/BrochureReg%20Form.pdf  PSI's training will also be held April 25-26 in Cupertino (San Jose area), California.  For more information, including a complete list of training objectives or to register, go to http://www.perinataltraining.com/Perinatal_Training.html.  AND, as if that wasn't enough, the training will also be held in Washington DC May 7-8 at the National Institutes of Health.  For more info, visit www.postpartumva.org.  I highly recommend these events for anyone who wants to specialize in treating women with perinatal mood and anxiety disorders.

The Sounds of Silence Foundation will host the 2nd annual 5k Run/Walk/Stroller-Walk event on Saturday, May 9th at 9:30am at Jones Beach State Park on Long Island.  Race proceeds will benefit the Posptartum Resource Center of New York.   To register, click here: http://www.soundsofsilencefoundation.org/news/index.php?id=7 

How to Contact the Media About Responsible Mental Health Representation

Several of you have asked me how to contact ABC to share your feelings directly on the "Private Practice" episode.  My dear friend Erin (thanks E-roc!!) sent me this information yesterday and I think it's good to have for everyone who actively promotes more responsible representation of mental illness in the media:

The Parents Television Council website has a page with information on how to contact the broadcast and cable networks.  They suggest you name the show, tell them if you approve or disapprove of it, give your reasons why, say if you will or will not watch the show, and tell them you are contacting the advertisers and your local network affiliates.  They also offer a section on how to contact advertisers. 

Here's the info on Anne Sweeney, who as I've mentioned in earlier posts is in charge of what gets aired on ABC Television.  

Anne Sweeney, President 
ABC Entertainment
500 S. Buena Vista St
Burbank, CA 91521-4551

(818) 560-1000 or

(212) 456-7777
E-Mail ABC

Website

 

Natalie Dombrowski is also asking people to join her in reaching out to ABC at her blog SPEAK.

California Assemblyman Introduces State Legislation on PPD

A couple of weeks ago, California Assemblyman Pedro Nava, in partnership with the Junior Leagues of California, introduced new legislation called the Healthy Mothers' Act of 2009 aimed at raising awareness of perinatal mood and anxiety disorders and creating guidelines for healthcare professionals.  Assembly Bill 159 will ask the California Department of Public Health to establish a statewide perinatal mood and anxiety disorder task force consisting of healthcare professionals and their stakeholders to develop a best practices model for public awareness and standards of care.

I'll let you know about its progress.

Guest Author Susan Stone: The Self-Defeating Danger of Comparisons

One of the most commonly asked questions I hear from women in my practice suffering from perinatal mood and anxiety disorders (PMADs) -- and even from professionals learning about PMAD treatment -- is "How long does it take to become well?"  This question is inevitably followed by a story of someone who recovered in two weeks or of someone who still appears to be suffering months or years after giving birth.

There is great danger in attempting to compare your own symptoms or treatment to other women you may know who are going through the crushing experience of a PMAD or who have had it in the past.

As with any other medical illness, NO TWO EXPERIENCES ARE THE SAME.  Each woman's illness brings its own unique biological, psychological and social factors.  The intensity, disability and presentation varies as widely as a cut on a knee and a broken leg.

Sometimes there's unity and connection when women talk about what they are feeling.  There is huge relief in knowing you are not the only mother who thought about giving her baby up for adoption, who wished the baby had never been born, or who feel resentment instead of joy at the constant cries for attention.  It can be comforting to know that sleeplessness is its own hell, that partners don't always do the right thing, that no one rises to motherhood without questions and imperfections and that wishing to have your former life back again is perfectly normal.  The horrific guilt that plagues such mothers can be reduced by compassionate and even humorous exchanges with other moms.  The Postpartum Support International weekly Chats are testimony to the relief of ending isolation and lonely despair when you feel there is no one in the world who could possibly understand -- or have compassion for -- what you are feeling or thinking.

But when recovery timeline or treatment comparisons are made, it can lead to women feeling worse if they do NOT bounce back in the number of weeks or months offered as a standard by well meaning friends.  The feelings of associated despair can add further hopelessness as the conclusion becomes: "I must be really crazy if I am not yet well."

This also applies to the form of treatment.  Some women will feel better with sleep and a few good talks with a friend, therapist, pediatrician or neighbor.  That is great, but that is NOT postpartum depression.  Since recovery can't begin until treatment starts, the length of time someone with true PPD has suffered or will suffer depends on accessing that help ... how soon they get to the right professional and the best practice treatment for their own unique symptom presentation.

While all depressions are MEDICAL ILLNESSES (sometimes a biological predisposition increases vulnerability), there are other contributing circumstances as well known as risk factors.  The National Institute of Mental Health is devoting much time and research to further the understanding of how biological predispositions become activated by chemical, psychological or social stressors.  Having a biological predisposition doesn't mean you will definitely develop a PMAD, but as risk factors increase, so does vulnerability to a mood or anxiety disorder.  This wasn't caused by anything you did and you can't compare your circumstances or unique biological makeup to anyone else on the planet.

When social deficits are prominent in a clinical presentation, we can work hard on developing more support and often see great progress.  When certain ways of thinking keep women locked in an endless loop of intrusive thoughts or obsessions, we have Cognitive Behavior Therapy strategies to begin management of unwanted ideas.  And when other behaviors such as addictions or eating disorders complicate the recovery from PMADs, we have therapies like Dialectical Behavior Therapy that help clinicians target all of the symptoms that are impeding a woman's progress.  Finally, medication may be critical in any of the preceding scenarios because when we feel better, we can make new cognitive or behavioral choices that will support the recovery from depression.  Or, medication may not be needed at all.  There is no one formula that works, no one size fits all.

The best course of action is always to seek treatment form an experienced PMAD practitioner who is also credentialed in the form of therapy indicated by your set of symptoms.  This person can assess/identify each component of the disorder, prioritize goals and treatment plans with you and work toward recovery.  The ONLY comparison of any value for a woman recovering from a PMAD is to notice if she feels better than a month ago, a week ago, an hour ago ... and to give herself the patient love and space to fully recover without adding the pressure of someone else's recovery timeline.

Susan Dowd Stone, MSW, LCSW, is the chair of the President's Advisory Council of Postpartum Support International, an NJHSS Certified Perinatal Mood Disorders Instructor, an adjunct lecturer at the Silver School of Social Work at New York University and a public reviewer for NIMH.  Her website is www.perinatalpro.com.  (Note:  Susan Stone and Katherine Stone are not related.)

Senator Menendez Reintroduces Melanie Blocker Stokes MOTHERS Act in U.S. Senate

I wrote about bad news earlier today (it shows up below this post), but now I've received great news from Susan Stone, head of the President's Advisory Council for Postpartum Support International. 

Today, U.S. Senator Robert Menendez (D-NJ) officially kicked off his efforts to secure an increased federal commitment to combating postpartum depression by reintroducing the Melanie Blocker Stokes MOTHERS Act in the Senate.  Thank you for continuing to be so persistent and supportive of new mothers across this country, Senator Menendez.  Thank you, thank you!!

The legislation, which is co-sponsored by Sens. Richard Durbin (D-IL) and Olympia Snowe (R-ME), has support from Senate leadership. It was nearing passage last year, despite being blocked from a vote on the Senate floor by Senator Tom Coburn (R-OK), who has objected to this and other bills targeting specific diseases on ideological grounds.

“We gained significant support for this effort to combat postpartum depression over the last two years, which makes me optimistic that we will be able to deliver this gift to new mothers,” said Senator Menendez. “Increasingly, my colleagues in the Senate are learning about the vicious, debilitating nature of postpartum depression and how it affects families, and they understand why this initiative is so important. We have to attack postpartum depression on all fronts – with education, support, and research – so that new moms can feel supported and safe rather than scared and alone.”

The new legislation would increase federal efforts to combat postpartum depression by:

• Encouraging Health and Human Services (HHS) to coordinate and continue research to expand the understanding of the causes of, and find treatments for, postpartum conditions. 
• Encouraging a National Public Awareness Campaign, to be administered by HHS, to increase awareness and knowledge of postpartum depression and psychosis. 
• Requiring the Secretary of HHS to conduct a study on the benefits of screening for postpartum depression and postpartum psychosis. 
• Creating a grant program to public or nonprofit private entities to deliver or enhance outpatient, inpatient and home-based health and support services, including case management and comprehensive treatment services for individuals with or at risk for postpartum conditions.  Activities may also include providing education about postpartum conditions to new mothers and their families, including symptoms, methods of coping with the illness, and treatment resources, in order to promote earlier diagnosis and treatment.

Arizona State Senator to Introduce Resolution on PPD

The Arizona Guardian reports that Democratic State Senator Linda Lopez of Tucson, Arizona, will introduce a resolution encouraging healthcare providers to do more to inform new mothers on perinatal mood and anxiety disorders like postpartum depression.

"Ideally, she'd want a broader measure that would educate new mothers and their families, healthcare providers and medical school instructors about the disorder and the services available for it.

But, Lopez said, a resolution will have to do. 'We're not asking for anything that would require money this year,' she said."

The Arizona Postpartum Wellness Coalition is involved in this project as well.

PPD News as the New Year Begins ...

Lots of news.  So much in fact that I'm not sure where to start ...

Rep. Bobby Rush (D-IL) has reintroduced the Melanie Blocker Stokes MOTHERS Act (HR 20).  Let's hope the 111th Congress can get this through both houses once and for all!

The Postpartum Dads Project is looking for guest bloggers.  Topics can range from new parenting advice to divorce survival.  They prefer a postpartum mood or anxiety disorder angle in all articles.  Guest bloggers can be male or female.  Please send ideas or completed articles to submissions@postpartumdadsproject.org. 

Shoshanna Bennett has just released her new book, Pregnant on Prozac.  The book covers mental health concerns facing women who are pregnant or thinking about pregnancy.  Safety information regarding medication and alternative treatments in pregnancy for depression, bipolar disorder and other illnesses are discussed.  You can order it through the PSI bookstore by clicking here.

Mary Jo Codey recently appeared on the ABC affiliate in New York to share her story about postpartum depression and promote passage of the MOTHERS Act.  Watch it here!

 

Sleep Deprivation Worsens Postpartum Depression

I don't know.  I think I'd put this in the category of "Did they really need to spend money on research to figure this out??"  I suppose I shouldn't be a pain in the butt about it, but it feels obvious.  Anyway, ignore me and read on:

"A study published in the current issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing shows that depression symptoms worsen in PPD patients when their quality of sleep declines.

Sleep deprivation can hamper a mother's ability to care for her infant, as judgment and concentration decline. Sleep-deprived mothers also may inadvertently compromise their infants' sleep quality because infants often adopt their mothers' circadian sleep rhythms.

All new mothers experience some sleep loss following childbirth, as their estrogen and progesterone hormone levels plunge. They typically spend 20 percent more of the day awake than average during the first six weeks postpartum. Postpartum women wake more frequently and have less dream sleep than non-postpartum women, with women in their first month postpartum spending only 81 percent of their time in bed actually sleeping. Neurotransmitters that influence sleep quality also affect mood, raising sleep-deprived mothers' risk for depression ...

Study author Bobbie Posmontier of Drexel University compared sleep patterns of 46 postpartum women, half with symptoms of PPD and half without. Sleep patterns were monitored for seven consecutive days. Results showed that mothers suffering from PPD took longer to fall asleep and slept for shorter periods. The worse their sleep quality, the worse their depression.

Posmontier recommends clinicians treating women for PPD to address the importance of adequate sleep. 'Mothers can develop a plan to have other family members help care for the baby at night,' she said. 'They also should practice good sleep hygiene. That includes going to bed at the same time every night, avoiding naps and steering clear of caffeine, exercise, nicotine and alcohol within four hours of bedtime.'"

I completely agree with the issue of sleep management for any new mom, but especially those moms who have a perinatal mood or anxiety disorder.  My husband and I had a plan:  I stayed up with the baby two nights in a row, and he stayed up with the baby the next two nights while I slept in a room without the monitor.  And yes, he had a job to go to in the morning.  But he sacrificed so that our whole family could be healthy as soon as possible.  Let me tell you, a full night's sleep does a lot for your ability to cope.  Husbands out there:  You can balk now if you want to, and not stay up to help with the baby.  But if you do, you may pay for it later with a completely incapacitated wife.  Remember, the vow reads "in sickness and in health."

Professional Training in March on Perinatal Mood and Anxiety Disorders

There are some great trainings on perinatal mood and anxiety disorders coming up in March ...

Postpartum Support International's 2-day Certificate of Completion Training "Perinatal Mood Disorders: Components of Care" will be held March 12 and 13 in Indianapolis and March 26 and 27 in Detroit.  The event in Indianapolis is sponsored by Clarian Health.  Contact Sandra Piercy at spiercy@clarian.org for more information.  The event in Michigan is sponsored by the Tree of Hope Foundation.

Karen Kleiman is also hosting a 10-hour postgraduate training program designed to enhance clinical skills and therapeutic effectiveness in the treatment of postpartum illness.  The event will be March 6 and 7.  Register here.  Early registration ends soon.

Calling All Warrior Moms

Hey ladies (and you gents lurking out there)!  2008 has nearly come to an end.  I've accomplished almost NONE of the things I wanted to, as usual, because there's just too much to do and nowhere near enough time.  But that's okay.  I still got a lot of other things done that I'm pleased with.  We just can't do it all, can we? 

Here's what I need to hear from you -- what do you want to see in Postpartum Progress in 2009?  Are there some new features you wish we had here?  Some functionality that you'd like to see improved or added?  Some information that you think is missing?  This site can't exist and remain fresh and helpful without your feedback.  

Are you are reader from another country who wishes there was more information specific to your culture and area?  Are you a sufferer of an illness on the spectrum that you feel doesn't get enough attention and want to see more info?  Are you a family member or friend who has ideas about how to better enlist your help when your loved ones are ill?   Are you a healthcare professional that wants to share best pratices?  Bring it on!

Please, please comment below or send me an email at stonecallis@msn.com.   If you don't share your thoughts and ideas, than I'll never know how I could have made Postpartum Progress more helpful to the people who need support and comfort ...

Nominations Open for Maternal Quality Matters Award

I can't remember if I mentioned this yet or not ... I'm sure some of the postpartum depression programs some of you have created would be eligible ...

Childbirth Connection is seeking applicants to be considered for its inaugural Maternity Quality Matters Award recognizing innovation in maternity care service delivery, systems design and demonstrated quality improvement. Nominations are being accepted from US-based organizations or agencies that can demonstrate significant improvement in maternity care quality through strategies such as performance measurement, incorporation of evidence-based practice, and responsiveness to the needs of childbearing women and families. The deadline for nominations is January 9, 2009. Eligible entities include professional organizations and associations, national and community health systems, hospitals and birth centers, public agencies, quality improvement organizations, and research or consulting organizations. The award recipient will be brought to and honored at a national symposium where all sectors of the maternity care industry will be represented. The symposium, “Transforming Maternity Care: A High Value Proposition,” will be held in Washington DC on April 3, 2009. For more information, or to nominate an organization, go to http://www.childbirthconnection.org/article.asp?ck=10581.

Revised Web Resource on Perinatal Depression

The Maternal and Child Health (MCH) Library has released a new edition of its resource “Depression During and After Pregnancy: Knowledge Path.” This electronic guide includes recent resources about the prevalence and incidence of perinatal depression, identification and treatment, impact on the health and well-being of a new mother and her infant, and implications for service delivery. The knowledge path, produced by the MCH Library, contains information on Web sites, publications, and databases. Separate sections present resources for professionals (health professionals, policymakers, program administrators, and researchers) and for women experiencing perinatal depression and their families. The knowledge path is available at http://mchlibrary.info/KnowledgePaths/kp_postpartum.html.

The MCH Library is a service provided by Georgetown University.  Thanks to both Wendy Davis and Judy Meehan for sending me this info!

 

Where Are All the Women with PPD? Right Here.

The next time one of you tells me you feel like no one else has PPD but you, I'm going to point you toward this posting and remind you that women with perinatal mood and anxiety disorders are EVERYWHERE.  They're just not wearing a big sign around their necks to make it obvious.  But trust me, they're all around you.  You are definitely NOT alone.  Just look at all the Warrior Moms writing about their experiences with postpartum depression and related illnesses in the last few days ...

The mom at Rosy Colored Glasses has a beautifully written 2-part piece on her experience with PPD.  Here's part 1 and here's part 2.  If you've had a baby with food allergies, or been frustrated with breastfeeding, or moved houses, or been surprised at the irritability and anger that can come with PPD, or spent 12 hours a day with a belt sander (ok, maybe not that), then you may see yourself in her story ...

Najma at A Bug's Life writes about her experience with PPD, including being away from her family in Pakistan, infertility, an emergency C-section, a baby with sleep problems, and negative body image ...

Melanie at Soggy Granola Mom talks about Jenny's Light

Hattie at Mommy Musings is reminded of her PPD experience through conversations with others

The Trial of Labor blog has a post about PPD and PTSD after pregnancy loss

The mom at C Shell begins to write her PPD story, including a 16-day hospital stay

Postpartum Depression & Anxiety: The Waiting Is the Hardest Part

I can't tell you how many women I've spoken to lately who are worried and upset by the setbacks they experience while recovering from perinatal mood and anxiety disorders.  They have a string of good days and think they're finally getting better, and then they have a terrible day and feel that all is lost.  It's heartbreaking.

I know exactly how they feel.  I can remember starting to feel better after beginning my treatment.  I'd have a few good days and begin to glimpse peace.  I'd feel like I was turning the corner.  I'd have a sliver of hope, for goodness sake.  And then -- SLAM! -- the sadness, anxiety, misery and guilt would flood back over me.  I'd think to myself, "Of course.  How could I have been so foolish?  I knew I'd never get better.  I'll never be me again."  I'd be crushed with disappointment, and angry for even thinking I could ever get back to my old self.

I did get better, though.  In fact, I'd venture to say that the me who came out of my experience with postpartum OCD is even better than the me who went in.   It took a while, but that's the deal unfortunately.  Recovery from these illnesses is a process.  I wish it was like bronchitis or strep throat:  Call doctor.  Go to appointment.  Get prescription.  Take 1 pill twice a day with food.  10 days later, all better.  It isn't.  It can be scary to hear that, but it's better to know what to expect so that you can be patient with yourself.   

We all start out with more bad days than good, or perhaps even all bad days.  Then you have a few good ones here and there.  Then you start having more good days than bad.  Then one day you realize you've had only good days, for a long time, and you have this slow and cautious realization that maybe the sun has come out for good.

In the meantime, don't let bad days define you or defeat you.  It's okay to have them, and to feel the bad feelings.  Just don't let them convince you that the progress you've made up 'til now is gone.  You're still moving forward, even on bad days.  Just continue to do the things you need to do to take care of yourself.   

There is one thing you can do to help your recovery process along:  Don't take it over as though you are a healthcare provider.  The first time you feel better, don't decide to quit your meds (if you're taking them) cold turkey, or quit seeing your therapist (if you're seeing one) cold turkey, or quit asking for help or taking care of yourself or following whatever method of treatment you and your doctor have decided to follow.  This could impede your progress.  I know lots of people who decide they know better than their healthcare providers, and so they start making decisions as to what they should and shouldn't be doing without the counsel of trained professionals.  I don't think that's a good idea. 

If you feel like the professional you're working with isn't helping you or hearing you, that's different.  It's okay to go out and find another one.  But if you like the one you're with, don't ignore your physician's advice just because you've started feeling better, or because you've bought into the false belief that you should be over this by now, or because you've bought into the false belief that you should be able to get over this all on your own.  There is no set timetable for recovering from perinatal mood and anxiety disorders. And there is no law of nature that states that you're a better person if you can get over it all by yourself.  No one can get through life on their own without help, regardless of whether they're ill or not.  We all need support at some point.  It just happens to be your turn.

In the meantime, try and accept that you're moving in the right direction, even if you have a bad day.  Try and find inspiration and patience in your faith, or in music and literature, or in nature, or in speaking with women who have long since recovered, who know how you're feeling and who know you can get better. 

We know how hard it is to wait for the clouds to lift.  We know that there are ups and downs, and that it can take a while.  We'll wait with you.  You're worth it. 

Study on Women's Attitudes About PPD Meds

A small study in England published in the journal Family Practice finds that women with postnatal (aka postpartum) depression have negative views toward antidepressants.  Only over the course of the illness, through time and contact with others including health professionals did their views change.  The study concluded that doctors should assess women's concerns about meds prior to prescribing them and should provide regular follow-up for women on medication.

To learn more, click here.

Warrior Mom Asks Why More PPD Treatment Programs Don't Exist

I got this email from Heather and I wanted to share it because it's a sentiment many of us share:

"I have often wondered why there aren't mental health clinics dedicated to women with only [perinatal mood and anxiety disorders]?  Why would they not build places for women facing this, and make more insurance policies cover places like this, and for the uninsured require low income or no income eligibility for these women?  A place where a woman can go and get the care she needed and be around others that face these same problems?  My idea would be to build and staff a mental health clinic dedicated only to women suffering [these illnesses] and a staff of nurses to help care for the baby while mom is in there getting the help she needs.  Then the mother could see the baby and still bond while going through treatment.  This is possible,but will it ever happen?  I hope to see this happen.  I do not think it should be just a far-fetched dream.  I wrote the governor's wife in my home state with this same idea.  I hope to hear good news that this can be possible in the near future."

We do have a couple of programs like that in the U.S., Heather, but we certainly need more.  I'm hoping more and more hospitals will follow the lead of Margaret Howard at the Women and Infants Hospital Day Hospital in Providence, RI.  If they can make it work so that it makes financial sense for the hospital and works for the women and their families, why can't others?

Need Dad Photos for PPD Song Video!!

Download google6ab5c71cc654eab3.htm To help make the Wade Bowen benefit concert for Postpartum Support International even better, country music star Bowen is going to put together a video for his beautiful new song "Turn on the Lights," which he wrote about his experience with his wife's postpartum depression.  The video will feature dads who've been through perinatal mood and anxiety disorders with their wives/partners.  The video will be shown at the concert.  This is a great way to honor the difficult journey dads go through with us when we suffer perinatal mood and anxiety disorders.  If you are a dad or know a dad who'd like to participate, here's what to do:

Send me a jpeg photo (stonecallis@msn.com) by no later than Friday, Oct 24, of any one of the following:

1. Dad with mama while pregnant (if it was antepartum depression) or after delivery
2. Dad holding a piece of paper or a larger sign featuring one of the lines from Wade's song (I've listed them below) -- make sure the type or writing is large enough to be seen on video (48 or 72 pt. font or handwriting with a thick marker) and if you use a computer don't use fancy type that would be hard to read -- just a basic font like Arial, Times New Roman, Verdana or Georgia.
3. Dads with mom and new baby
4. Happy family photos after recovery.

Here are the lyric lines you can use for the signs (just put one line of your choosing on the sign):

• I know it's dark babe
• Please turn on the lights
• Let me see you crying
• Please don't be afraid, girl, it's only me
• I am here to help you

When you send the photo, be sure to include the dad's name and your email so that I can contact you if necessary.

If you haven't heard the song, please check out this YouTube clip of Wade singing "Turn on the Lights".  It's pretty amazing.  And if you'd like to attend the benefit or support it through sponsorship, please click here.

PPD Conference in Chicago Oct. 17

Just a reminder that this Friday is the Jennifer Mudd Houghtaling Postpartum Depression Foundation annual conference in Chicago.  It is presented by Mercy Hospital and Medical Center and will be held at the University Club of Chicago.  I will be speaking, along with Birdie Meyer, Sonia Murdock, Dr. Manny Alvarez and many other fabulous people.  Check it out here: http://www.ppdchicago.org/ or here: http://www.ppdchicago.org/site/files/456/16096/76749/353452/Postpartum_Conference_08.pdf.

Will PPD Be on the Rise Due to Economic Downturn?

According to a study just released by the American Psychological Association, the Wall Street downturn has begun to impact the health of Americans.  As reported by USA Today, "Finances now overshadow the more typical daily stressors of work and relationships; 46% report being worried about providing for their family's basic needs."  What's worse, the poll finds that women are more significantly impacted than men.

We already know that financial troubles are a risk factor for antepartum and postpartum depression and anxiety.  So one has to wonder, given the current economic turmoil, whether we will see an uptick in the number of women with these illnesses.  I imagine that we might, and it would be good for healthcare providers to be aware of this.

National Institute of Mental Health Needs Participants for Two Studies on PPD

Here's a link to an article from the National Institutes of Health on two research studies related to postpartum depression that are currently open to participants:

The first will explore the benefits of treating PPD with estrogen. Women who think they might currently be depressed and have given birth within the last 6 months are encouraged to participate. Women participating in this study may help to advance a treatment that could alleviate their own symptoms and may someday lead to a new standard of care for postpartum depression.

The second study is for women with a history of PPD. Healthy individuals without a history of postpartum depression are also needed to serve as controls. Participants in this study will go through a “simulated” pregnancy by taking a course of hormones that mimic the experience of pregnancy in an abbreviated time frame. Participants will be evaluated and monitored for signs of depression. This will help researchers determine how and to what extent fluctuating levels of hormones during pregnancy can influence mood and behavior.

The women in this study will learn whether they may experience PPD following a future pregnancy. Women who are interested in participating in the trial or who would like more information should contact NIMH at (301) 496-9576.

Urgent News on the Melanie Blocker Stokes MOTHERS ACT

Urgent news from Susan Dowd Stone, LCSW, chair of the President's Advisory Council of Postpartum Support International, after Senator Tom Coburn (R-OK) once again blocked a vote on the Melanie Blocker Stokes MOTHERS Act this week:

"While our Senate heroes, U. S. Senators Robert Menendez (D-NJ) and Richard Durbin (D-IL), co-sponsors of The Melanie Blocker Stokes MOTHERS Act, and their supporters lost a battle in the U.S. Senate this week, we have not lost the war against postpartum depression and services for our nation's mothers. Indeed, this setback is not due to the lack of national support for the legislation, but a defiant blockade by one person, Senator Tom Coburn (R-OK), who has singlehandedly obstructed this and other legislation by using a procedural loophole never meant to overturn the will of the people.

While Senator Coburn himself failed to appear at yesterday's hearing, sparing himself and his conscience further consideration of facts which would have made such action impossible, he sent a surrogate whose mission was to continue his objection to the legislation, thereby "denying relief to hundreds of thousands of mothers who suffer from the condition each year" according to Senator Menendez.

Despite the setback, Senator Menendez reaffirmed his commitment to continue this critical battle. "Hundreds of thousands of women across the country suffer at the hands of postpartum depression every year, and they deserve better than the ideological games being played with legislation intended to bring them relief," he said. "This is a cause I am committed to seeing through, and I will continue to stand up on behalf of mothers suffering from this condition until the blockade is cleared."

Among the MOTHERS Act's champions is former New Jersey First Lady Mary Jo Codey, Carol Blocker, mother of the woman for whom the legislation was named who died from postpartum illness (who prays everyday this bill will pass), Brooke Shields, who spoke passionately in support of the legislation at a Capitol Hill Press Conference, Valerie Plame Wilson, who wrote about her experiences with postpartum depression in her best selling book "Fair Game", Joan Mudd who lost her daugher to postpartum depression and formed the Jennifer Mudd Houghtaling Foundation in Chicago, IL, and many others who remain staunchly committed to this issue.

Congressman Bobby L. Rush who sponsored the bill's counterpart in the U.S. House of Representatives, saw it pass in October 2007 with a nearly unanimous bipartisan vote. It would likely have enjoyed the same fate in the U.S. Senate long before now if legislators were as interested in representing the will of their constituents as they were in continuing current political stalemates that serve no one.

"The effects of pregnancy and postpartum depression and anxiety can be devastating to the mother, the baby, the partner, the family, and society," said Birdie Meyer, President of Postpartum Support International, the bill's lead organizational sponsor.  "Passing the Melanie Blocker Stokes Mother's Act would have provided nationwide education and recognition of this illness. Childbearing women and their families deserve to have this education in every city, every hospital, every clinic, everywhere."

"After years of needless suffering, American women need the relief that would have been provided from increased research into the causes of perinatal mood and anxiety disorders, better education of healthcare professionals to identify and treat these disorders, and grants for programs and services to help women recover," said Katherine Stone, former director of marketing at The Coca-Cola Company and creator of Postpartum Progress, the most widely-read blog in the U.S. on postpartum depression. "It is critical to foster healthy family development by preventing the serious physical and mental health problems affecting both mother and child that stem from undiagnosed or improperly treated postpartum depression."

Dr. Shoshana Bennett, former president of Postpartum Support International, and a survivor of two life-threatening, undiagnosed postpartum depressions, urged the Senate to reconsider this bill.  Sylvia Lasalandra, author of "A Daughter's Touch" and a longtime advocate for the legislation who traveled to Capitol Hill to speak in support of its passage, echoed those sentiments, adding "Shame on you Senator Coburn!"

Susan Dowd Stone, MSW, LCSW, chair President's Advisory Council, Postpartum Support International, said "It seems our Senate has lost its way - this continuing blockade by one Senator offers a troubling analogy to the current financial crisis. Within our federal mortgage agencies, decisions made by a very few deaf to constituent welfare and subject to minimal oversight have brought our country to the brink of bankruptcy. And today, a decision made by one person refusing to defer to his constituents' will and the indisputable science, research and statistics that support the need for this legislation, means thousands of innocents will continue to suffer. More lives will be lost. More families will be irreparably damaged. And more children will suffer the consequences of untreated maternal depression. Only 15% of women suffering with these devastating disorders are ever diagnosed and treated. Billions for the guilty, not a dime for our nation's most critical and innocent social dyad of mother and child."

When did such legislators decide that in the world's greatest democracy, individual opinion trumps society's need, consistent research findings and responsibility to constituents? Coburn is a doctor who participates in funding decisions for NIH and NIMH yet apparently remains unmoved by their perilous findings indicating that untreated maternal depression is a public health crisis. When one legislator can overturn the will of a country, we are no longer living in a democracy.

We will again await its inevitable passage at the next Congressional session when reason may more strongly prevail. Below is an outline of the bill's urgent and noble purpose:

The legislation would increase federal efforts to combat postpartum depression by:

• Coordinating and continuing research to better understand the causes of, and treatment for, postpartum conditions. Also, supports a National Public Awareness Campaign to increase awareness and knowledge of postpartum depression and psychosis.
• Creating a grant program for the delivery of essential services to individuals with postpartum depression.
• Conducting a study on the benefits of screening for postpartum depression and postpartum psychosis.

It is estimated that postpartum depression (PPD) affects from 10 to 20 percent of new mothers. In the United States, there may be as many as 800,000 new cases of postpartum conditions each year. The cause of PPD isn't known but changes in hormone levels, a difficult pregnancy or birth, and a family history of depression are considered possible factors."

Groups supporting the legislation:

• Postpartum Support International
• Association of Women's Health, Obstetric and Neonatal Nurses
• American Psychological Association
• American Psychiatric Association
• Children's Defense Fund
• American College of Obstetricians and Gynecologists
• March of Dimes
• Mental Health America
• American College of Nurse Midwives
• National Council for Community Behavioral Healthcare
• Depression and Bipolar Support Alliance
• Suicide Prevention Action Network USA
• National Alliance on Mental Illness
• Association of Maternal and Child Health Programs
• National Partnership for Women & Families
• OWL- The Voice of Midlife and Older Women
• National Women's Law Center

Samantha's Story

Warrior Mom Samantha F. shares her story:

"Emily Adaline is the name we gave her when she was born.  But to us she will always be our Bean.  My daughter was very much wanted, planned for and beautiful.  She is the perfect combination of my husband's cute nose and my sleepy eyes.  When I pushed her out, I felt then as if I had just pushed out my spirit.  My heart was still there, but now it existed on the outside of my body.  That is when the feelings and questions started to wander around in my head.  Why was I so afraid of her? Why did I feel like my world had just ended?  How could I not want her?

The first night she came home, I stared at her like she was a time bomb.  I stayed awake for 36 hours straight just waiting for her to scream.  She never did, of course.  My husband and our daughter lay there sound asleep while I felt as if I was going to crawl out of my skin.  All I wanted to do was hide.  I knew something was wrong and I needed to get help before it got out of hand.  My head ached from the constant crying.  The anxiety had its angry hold on me and would not let go. 

I contacted my doctor and they diagnosed me with postpartum depression.  Little did I know that this was the most common complication of childbirth.  I was started on an antidepressant right away.  It was troubling that I would have to take a pill to cope, but I did it.  I was no use to my daughter in this condition.  It took a few weeks for the medication to kick in, and in the meantime my friends and family made a huge fuss over me.  Even my daughter's pediatrician called to check on me.  I felt as if I needed to leave, so they could move on with their lives.  I would call my husband and ask him why he stayed with us.  I would tell him that I had ruined his life.  He would tell me over and over again that I was his life.  Our daughter was his life.  He would never leave us and I had only made his life better by giving him a perfect baby girl.  He would beg me to get better and say that he missed his wife so much.  I didn't know then, but the only thing that would truly make me better was time.

I took the days literally minute by minute.  Baby steps I call it.  I know that a lot of this will never make sense to anyone.  It still breaks my heart that I was not able to enjoy the first months of my daughter's life because of my depression.  I am happy to say, though, that I am much better.

I am thankful that I had a support system to lend a hand when I needed it most.  My neighbors, family and friends did not allow me to be alone.  They picked up the slack while I recovered.  My husband made sure I was getting sleep.  He was actually the primary caregiver for the first month of our daughter's life.  I would call him at work and sob on the phone.  Not once did he complain.  He just listened to me.  That's what I needed most.  Our Bean is now 9 months old and is perfect.  I look back on those first couple months after we brought our daughter home not with a sense of shame but one of achievement.  I went to battle with postpartum depression and I won."

Indiawest: South Asian Women Suffer PPD In Silence

Thanks to PSI Board Member and fabulous Warrior Mom Kimberly Wong for letting me know about this article from Indiawest Online about South Asian women and their experience with postpartum depression.  This is an excellent story about how cultural differences can impact postpartum depression, and about how immigrant status is a significant risk factor, which has been borne out by recent research.  I encourage you to check it out!

New Public Radio Piece "BORN" Looks at the Postpartum Experience in America

Earlier this year, I had the opportunity to sit down with one of the award-winning producers of the public radio documentary "BIRTH" to discuss the postpartum period and motherhood in America for their new radio production called "BORN".  The piece has now been completed, and I'm really excited about it.  I was able to listen to it last week, and I think it is just fabulous.  They have done a beautiful job of helping to normalize the difficult experiences all new mothers have. 

"BORN" is an hour-long public radio journey created by Thin Air Media about the postpartum experience in contemporary American life, looking at how our society supports new mothers and families after a child is born.  It is nationally distributed by Public Radio International (PRI) and available to public radio stations from September 2008 to September 2009 at Content Depot. 

Even though they aren't identified on the program, some of the voices you'll hear, in addition to mine, are Dr. Louanne Brizendine, author of "The Female Brain", Dr. James Leckman, director of Research at Yale University's Child Study Center, Joan Blades, founder of MomsRising.org, psychotherapist Carol-Merle Fishman and Sarah Blaffer Hrdy, author of "Mother Nature: A History of Mothers, Infants and Natural Selection". 

If you would like to purchase a copy of the program for $20, click here. 

Finding Places Where the Referral System Works for Women with Perinatal Mood Disorders

Last week I spoke at the annual conference of the Georgia Perinatal Association.  What a great group of RNs, social workers, OBs and others!!  I really enjoyed sharing with them as much information as possible about the spectrum of perinatal mood and anxiety disorders, and appreciated how interested they were in the topic.  So many of them came up to me afterwards to say that they had implemented screening and education -- they are really doing their best to share the latest information with their patients, look for risk factors and utilize screening tools to identify sufferers. 

Their chief concerns?  Foremost is the issue of what to do next once a woman is identified as someone who may be suffering PPD or another perinatal mental illness.  Our nation is suffering from a shortage of mental health providers, and we certainly don't have very many people specifically trained on treating perinatal mental illness.  Are the few that are trained taking patients?  What if the woman has too long of a wait to get in to see the psychiatrist?  It seems to me that everyone's biggest concern at the conference was where to send their patients and how to make sure they are cared for effectively.  Secondly, what about reimbursement for screening?  Many states' Medicaid programs don't offer reimbursement, including Georgia.  (Kudos to the few that do, like Illinois!)  And then there's insurance -- what about women who don't have psychiatric coverage and can't afford therapy or meds?  What about the women who don't have transportation to get to the doctor?  How can they ensure that these women will be cared for properly?

I thought I'd bring their questions to you, across the country, and ask what innovative programs you have seen that complete the second half of the treatment picture -- education and identification comes first, but then we must have referrral and treatment to complete the circle.  If you have seen this done well in your state, let me know at stonecallis@msn.com and I will share your knowledge of best practices with the readers of Postpartum Progress.

Advanced Training on PPD Treatment in NJ This Fall

The Southern New Jersey Perinatal Cooperative is hosting an event called "Breaking Down Walls: New Options in Postpartum Depression Treatment" on October 10 in Princeton.  This conference is aimed at clinicians who have a basic understanding of postpartum depression and want to enhance this knowledge with some advanced expertise.  Speakers include Susan Stone, Karen Kleiman, Shoshanna Bennett and Margaret Howard.  The event fee is $65 and includes breakfast, lunch, contact hours and course materials.  Pre-registration is required by Friday, September 26.

Come See Me in Chicago at the Jennifer Mudd Houghtaling Perinatal Depression Conference!

Mercy Hospital & Medical Center is presenting the Jennifer Mudd Houghtaling Perinatal Depression Conference at the University Club of Chicago on October 17, 2008.  Continuing education credits are being provided by the University of Illinois at Chicago and the St. Xavier School of Nursing.  Speakers include lots of fabulous people I am big fans of, including:

• Sonia Murdock, Executive Director of the Postpartum Resource Center of NY
• Dr. Manny Alvarez, Chairman of the Dept. of Obstetrics at Hackensack University Medical School and Chief Health Editor for FOX News
• Birdie Meyer, President of PSI and coordinator of the Clarian Health Perinatal Mood Disorders Program
• Dr. Lee Cohen, Director of the Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital
• Dr. Laura Miller, Director of Clinical Services at the Dept. of Psychiatry of the University of Illinois at Chicago
• George Parnham, whom you may recognize as Andrea Yates' lawyer

There will be other speakers as well, including me, which I'm very excited about.  It's an honor to be invited to speak among all these people who know a whole lot more than I do.  I hope to see some of you there!

You can register online for this event at www.mercy-chicago.org/ppd/.

ALSO:  On November 6, the Jennifer Mudd Houghtaling Postpartum Depression Foundation Benefit will be held at the Chicago History Museum.  (I got married at the Chicago Historical Society, FYI.  Great place.)  The event will be held from 5:30 to 9pm and will raise money to support the foundation's programs.  This year it will feature an interview with celebrated photographer Victor Skrebneski by Chicago Tribune columnist Rick Kogan.  Tickets are $150 per person.  To reserve tickets or get more info, please visit www.ppdchicago.org or call 773-477-2252.  Please reserve your tickets by October 31.  This is a wonderful organization that deserves your support. 

 

National Library of Medicine Creates One-Stop Shop for Women's Health Research

A new site was launched earlier this year by the National Library of Medicine to provide consumers with the latest information on significant topics in women's health research.  I didn't even know there was a National Library of Medicine.  These nice people have created a one-stop resource so that you won't have to visit a variety of websites, including PubMed, MedlinePlus and ClinicalTrials.gov, to get the research info you're looking for.  The Women's Health Resources site can be found at http://sis.nlm.nih.gov/outreach/womenshealthoverview.html.  Here's the specific women's mental health section: http://sis.nlm.nih.gov/outreach/womenshealthtopicsnlm.html#b011.

News & Observer Covers NC PPD Support

Here's a nice story in the Raleigh News & Observer (NC) about Ann Wimer and her MomsSupportingMoms group for women with perinatal mood and anxiety disorders.  "For more information, visitwww.momssupportingmoms.net or call (919) 454-6946. For information about other services, including how to receive brochures for medical practices and educational outreach opportunities, please contact Postpartum Education and Support at 919-889-3221 or visit www.postpartumeducationandsupport.com.

UNC Hosting Women's Mood Disorders Symposium in November

The University of North Carolina Center for Women's Mood Disorders will be hosting an informational symposium called "Depression Across the Reproductive Life Cycle: Pregnancy, Postpartum, the Menstrual Cycle and Menopause" on November 1, 2008 from 1-3pm.  The event is open to the public and the registration fee is $25.  For more information, visit www.womensmooddisorders.org or call 919-966-9640.

Moms All Over the Blogosphere Write About Perinatal Mood & Anxiety Disorders

Here's a roundup of what's going on out there in the world of perinatal mood and anxiety disorders this week ...

Cate at 18 Years and Counting is suffering from postpartum depression and anxiety and needs a Warrior Moms Virtual Hug.  Here's a post she just wrote about her obsessions and fears.

Jodi Kluchar has just created the PTSD After Childbirth blog.  I'm am sure that those of you with postpartum post-traumatic stress disorder will want to follow along for information and comfort.  The blog offers info on conferences, birth stories, research and more.

Miranda has just created a blog called Postpartum Help to share her experiences with postpartum depression and try and help others.  Give her a shout out!

Laura at Depressed (but not unhappy) Mormon Mommy has written about the helpful things people said to her when going through postpartum depression, and what she would say to others.

Lisa at the Lis & D blog writes about the recent loss of a friend of hers to postpartum psychosis.  (This breaks my heart.) She also shares her own experience with postpartum depression.

Diane at The Mommy Diaries writes about postpartum depression vs. stress.

Upcoming PPD Screening Event in Massachussetts

Shrewsbury Youth & Family Services in Shrewsbury, MA, will be holding a special event on Tuesday, September 2nd from 9am to 6pm offering free PPD screenings, the opportunity to speak to clinicians and information on perinatal mood disorders.  For more information, call 508-845-6932.

New Research Relates Crosstalk to Postpartum Depression

A week or so ago we learned that researchers at UCLA uncovered that mice lacking a certain protein (remember GABA?) were depressed and neglected their babies.  When the protein was reintroduced it restored the mama mice to normal maternal behavior. 

This week, a different study out of the Medical College of Georgia finds that something called "crosstalk" may help identify the cause of baby blues and postpartum depression.  Crosstalk is the term used to define the exchange of nutrition and oxygen from mother to child during pregnancy in blood traveling through the placenta. 

Platelets that enable blood clotting secrete serotonin.  Apparently the serotonin prompts the clotting.  This leads the placenta to try and get rid of the serotonin so that blood vessels don't constrict and prevent the fetus from getting all that it needs.  A serotonin transporter gene prevents clotting until after birth. 

Once the fetus and placenta are delivered, platelets then move in to stop unterine bleeding.  Serotonin released by those platelets leads serotonin levels to rise, which stimulates production of interleukin-1 beta, another type of protein.  Interleukin-1 beta gets in the mother’s bloodstream, crosses the blood brain barrier, and creates more serotonin transporters on the neurons when they are not needed.  Why is that a problem?  Because serotonin transporters reuptake serotonin and terminate its function.  That's not what we need, because serotonin helps regulate mood, sleep and appetite.   

Until interleukin-1 beta levels normalize, there’s too little communication between serotonergic neurons and moms get the blues, says researcher Dr. Puttur Prasad.

In more serious postpartum depression, variations of the serotonin transporter gene – which already have been linked to non-pregnancy related depression – appear to make bad matters worse because they are even better at taking up serotonin, he says.  Which means we have even less.  Yikes. 

Dr. Prasad now plans to analyze DNA to see if women identified with postpartum depression have some of the same variations of the serotonin transporter gene already identified with non-pregnancy related depression.

Americanized Latinas Have Higher Rates of Perinatal Depression

Researchers at the University of Texas' School of Public Health and Health Science Center have published a study in the Maternal and Child Health Journal finding that "Americanized" U.S. and Mexican-born pregnant and postpartum Latinas have higher levels of depression.  They describe “Americanization” as the process by which immigrants adopt the lifestyle and customs of their host nation, lead author Marivel Davila said. 

"Elevated levels of depression were reported by the women born in the United States, as well as those who asked to conduct their interviews in English. Two non-acculturation variables were associated with elevated depression - being single and being pregnant.

'Screening for depression during pregnancy is important for this population group, given Latinas’ high rates of fertility and births to single women, particularly among more acculturated U.S.- born Latinas,' Davila and her colleagues wrote in the article ..."

To read more, click here.

PSI Hosts 2-Day Training in Tampa in October

University Community Hospital in Tampa, Florida, will be hosting Postpartum Support International's 2-day training program entitled "Perinatal Mood Disorders: Components of Care" on October 24 and 25.  The conference will be held at Pepin, the hospital's heart institute.  Attendance is limited to the first 100 registrations.  For further information, please contact June Vinyard at 813-615-7907 or jvinyard@mail.uch.org.  This is a class very much worth taking, especially if you're considering in specializing in the treatment of perinatal mood disorders. 

Matria Healthcare Launches MaternaLink PPD Screening Program

Matria Healthcare, LLC, a subsidiary of Inverness Medical Innovations, Inc., announced today that it has launched its MaternaLink Postpartum Depression (PPD) Screening Program, a service to help identify new moms at risk for PPD. The program's focus is to provide earlier clinical evaluation and support, better mental health and improved clinical and financial outcomes.

Matria will partner with health plans, Medicaid and employers to confidentially screen new moms. Matria's trained staff will use a validated screening tool to assess a new mom's potential risk factors for postpartum depression. Depending on the results, new moms are then referred to behavioral health providers for additional evaluation and treatment.

The new MaternaLink PPD program is an expansion of Matria's Total Maternal-Newborn Solution (TMNS), which comprises services that cover the entire continuum of maternal-newborn care from risk screening, education and case management to home-based OB services and NeoLink, a comprehensive NICU case management program. All participants receive 24/7 access to highly-experienced OB and NICU trained nurses who work in tandem with patients' physicians' plans of care.

"As more health plans and employers begin offering Matria's new PPD screening services to their members and employees, we look forward to the opportunity to positively impact the lives of moms suffering from this treatable but often ignored, medical condition," said Gary Stanziano, M.D., executive vice president of Matria Women's and Children's Health.  Matria Healthcare is a leading provider of integrated comprehensive health enhancement programs to health plans, employers and government agencies.

Note:  From the news release below I am unable to tell what type of screening tool they plan to use or exactly how the process works.  It will be interesting to find out.

Class on PPD in Valencia, CA on September 30

Diana Lynn Barnes will be leading a class on the emotional and psychological issues that can develop into PPD after delivery.  The class is scheduled for September 30 from 6:30 P.M. to 9:30 P.M. in the Greeley Education Center at Henry Mayo Newhall Memorial Hospital in Valencia, CA.  The fee to attend is $35. To register, call (661) 253-8607

Pennsylvania Launches Project to Create Depression & Pregnancy Info Network

The Pennsylvania Perinatal Partnership (PPP), a coalition of maternal and child health care professionals, is launching a 15-month initiative on pregnancy and depression. 

"Depression is the number one complication of pregnancy," declared Joanne D. Craig, co-chair, Pennsylvania Perinatal Partnership.  "Pennsylvania will harness the good ideas and tremendous resources of states around the nation to create a depression and pregnancy information network. This is going to change the lives of millions of women and their families," Craig added. 

The funding for this effort is a public-private venture with support from the Thomas Scattergood Behavioral Health Foundation and the Pennsylvania Department of Public Welfare.  "This clearinghouse will link people with model programs with those who are searching for program ideas. It will highlight the struggles and successes that other states have experienced when launching their programs to combat perinatal depression," said Joe Pyle, President of the Scattergood Foundation.

Secretary of Public Welfare B. Estelle Richman, Secretary, Pennsylvania Department of Public Welfare said, "We believe that Pennsylvania can lead the nation in promoting improved behavioral health programs for pregnant women and their families. We are pleased to be part of this partnership." 

Under the auspices of this information network, professionals, consumers, elected officials and advocates will share information about model programs, successful legislative initiatives and research findings.  The project will culminate in nationwide summit on pregnancy and depression. 

The Pennsylvania Perinatal Partnership (PPP) is the first statewide group of its kind in the nation.  Created in 2002, the Partnership brings together maternal and child health organizations from across Pennsylvania. PPP members work jointly on such issues as improving managed care services for pregnant women, creating a best practices model for the early detection and prevention of perinatal depression, and advocacy for improved state funding of pre-natal care programs.  There are 17 member organizations of the PPP.  The Family Planning Council serves as the fiscal and administrative agent for the PPP.

John Walsh and Others Speak Out in Support of the Advancing America's Priorities Act

This afternoon I participated in a press conference call hosted by Americans United for Change, featuring a group of people all supporting bills within the Advancing America's Priorities Act.  Speakers included:

• John Walsh of America's Most Wanted supporting the Combating Child Exploitation Act which will increase resources in the fight against child pornography and other internet crimes against children;
• Bruce Morgan of the Christopher & Dana Reeve Foundation promoting passage of the Christopher & Dana Reeve Paralysis Act which supports and enhances cooperation in paralysis research, rehabilitation and quality of life programs for people with paralysis;
• Lee Page of Paralyzed Veterans of America, also supporting the Christopher & Dana Reeve Paralysis Act;
• Alvin Sykes of the Emmitt Till Justice Campaign supporting the Emmitt Till Unsolved Civil Rights Crime Act, which will strengthen the ability of the federal government to investigate and prosecute unsolved murders from the civil rights era; and
• me, Katherine Stone, speaking on behalf of Postpartum Support International in support of the Melanie Blocker Stokes MOTHERS Act, which as you know will help provide more education about and research into perinatal mood disorders and services for the women who suffer.

In a sad way, it was comforting to me to learn that so many other people are as frustrated as we are in trying to get bills passed to provide assistance to everyday Americans who need real help.  Some of these organizations, including PSI, have been waiting for many years to get the Senate to take action.  Mr. Walsh talked about how frustrating it is to watch the government spend "$5 billion to photograph ice crystals on Mars" while Congress continues to delay taking action on bills that would change the lives of people here in the US on day one.  As he said so eloquently, "This is not about a bridge to nowhere.  This is about Americans -- the sacrifices they make and the obstacles they face."

To Blog or Not to Blog? Writing About Tragedy on Postpartum Progress

I want to highlight an interesting comment on Postpartum Progress this weekend from a reader responding to a news story I posted a while back about a woman in Iowa who killed her baby and then herself:

"How can these stories not cripple and terrify the many women on this site currently experiencing perinatal mood disorders?  This is probably the most difficult part of the illness ... hearing these stories and believing you are insane and have no control over your actions.  Why doesn't anyone make any posts about dealing with these feelings??  How can you ever start to bond with your baby while getting treatment if you hear these stories and believe they are about you???"

What an excellent comment.  I tried to email the reader back but my response was undeliverable, which really bums me out, because I wanted to be able to talk to her in person and offer my support.   

I struggle with this as well.  I don't want to upset the readers of Postpartum Progress.  I know exactly how it feels to be so vulnerable and confused and afraid of yourself.  And it is true that stories of infanticide can make you feel worse because you're so worried that you're capable of doing the same.  What women need to do in this case is reach out.  Talk to your doctor about your concerns and your fears.  Listen to what they say.  Treatment at the hands of professionals is the answer.  If your trained therapist and/or psychiatrist is concerned that you are at risk of harming yourself or someone else, they will hospitalize you and help you stabilize.  If they aren't concerned, they'll tell you.  You'll still be afraid, of course, because that is part of our illness.  The truth is, even if you didn't read or hear scary stories in the media, you'd still be afraid of what you might do.   

I feel that we're victimized by the fact that people gloss over perinatal mood disorders as though women can't handle the truth.  As if it's just too touchy a subject.  I'd rather err on the side of being completely truthful than pretending bad things don't happen.

I made the decision to tell the stories, although I try to leave out the scary details.  I tell them because they are the truth, though thankfully just a small part of the truth.  Such tragedy is among the consequences of our illnesses.  People need to know that so they will take us seriously and educate themselves about perinatal mood disorders and take action to make sure women have the services they need. If society can convince itself that postpartum depression is just a temporary setback and no real strategic plan of attack is necessary, than it will take that path of least resistance.  We can't afford that.

I want to hear from the Warrior Moms on this.  What do you think?  Do you think I should leave out such stories, or that it is an important part of the whole story?  Please let me know. 

Fighting Perinatal Mood Disorders in the United Kingdom

In the United Kingdom (UK), an organization called Post Natal Illness ORG UK is fighting for the same kind of support we want here in the U.S. for women with perinatal mood disorders, which are called postnatal illness (PNI) or postnatal depression (PND) across the pond. 

The National Health Service (NHS) in the UK, which includes England, Northern Ireland, Scotland and Wales, is nationalized and thus has basic standards of care available to all.  PNI ORG UK is campaigning for the NHS to establish a "perinatal pathway of care" that would ensure all mothers with PNI get the care they need from all related health agencies from day one.

One step toward getting that done has already happened.  The UK's National Institute for Health & Clinical Excellence (NICE) is an independent organization responsible for "providing national guidance on the promotion of good health and the prevention and treatment of ill health".  They make recommendations that the NHS is expected to accept and implement.  NICE has now created guidelines for antenatal and postnatal mental health which state that the NHS in all areas of the UK should have a multidisciplinary approach to providing services to women with PNI.  (You can read the antenatal and postnatal mental health guidelines here.)

The issue at this point is that PNI ORG UK doesn't think NHS is following through on NICE's recommendations, which include requiring all people in contact with women in the antenatal and postnatal periods (including midwives, obstetricians, health visitors and primary care practitioners) to take a history of any mental illness in the patient or family and to ask questions to identify possible depression. 

PNI ORG UK founder Veritee Reed Hall, who is also one of the PSI coordinators for the UK, says her organization is working to see that these recommendations are truly implemented across the UK.  To that end, one of her group's members has started an online petition to the Prime Minister of Great Britian, which you can find here: http://petitions.pm.gov.uk/Post-Natal/.  They urge anyone reading Postpartum Progress who is a UK citizen to join in signing the petition.

P.S.  Here are other organizations in the UK that provides support to women with PNI: The Association for Post-Natal Illness and Mother's Voice.

The Melanie Blocker Stokes MOTHERS Act Moves Forward!

Send your letters:  http://capwiz.com/ndmda/issues/alert/?alertid=11668371 Let those Senators know how you feel!

Here's a message from Susan Stone, past president of PSI on this weekend's potential work in the Senate:

Today, America's mothers, infants and families have reason to be encouraged and to reach out to their state senators to again request their support of The Melanie Blocker Stokes MOTHERS Act in its final push to passage.YOU HAVE BEEN HEARD and this morning, Majority Leader Reid introduced a package of bills called Advance America's Priorities Act which now includes The Melanie Blocker Stokes MOTHERS Act. Senators Robert Menendez (NJ) and Richard Durbin (IL) have been working very hard with Majority Leader Harry Reid and Chairman Edward Kennedy to pass this legislation. 

These initiatives will be considered over the next week.

Your renewed advocacy and attention is especially welcome RIGHT NOW!  We need to continue make it deafeningly clear how important this bill is to women and families all across America.  The online petition in support of The Melanie Blocker Stokes MOTHERS Act has been reintroduced and we invite your signature and call to your state senators office. If you wish to write a personal letter, this would also offer welcome support. By clicking on this link you will be connected to the petition and information on how you can reach your senator and sign the petition.  http://capwiz.com/ndmda/issues/alert/?alertid=11668371

We are almost there!! After years of unfathomable and needless suffering, American women may finally get the relief offered through increased research into the causes of perinatal mood disorders, better education of healthcare professionals to identify and treat these disorders, and grants for programs and services to help women to recovery. Thanks for the tremendous efforts which have brought us to this point and your steadfast participation in this final effort.

My Letter to the U.S. Senate

Go here.  Send a letter now.  Here's mine:

Dear Senators:

I represent tens of thousands of readers of Postpartum Progress, the most widely-read blog in the United States on perinatal mood disorders.  I hear from these women every day about the suffering and isolation they're experiencing while going through the devastation of postpartum depression and related illnesses.  They want to know why they weren't warned and what could have been done to prevent it.  They want to know why there aren't more services available to help them recover, from local support groups and trained healthcare professionals to better information into the causes of perinatal mood disorders and the impact of various treatments.  We know from research that untreated perinatal mood disorders are a serious public health threat --they can lead to chronic depression in the mother, behavioral problems in the child and stress-related health problems in both -- yet 90% of all women who suffer are never treated.  This serves as an enormous financial cost to our health system and even bigger social cost to our communities now and into the future, and it will continue on perpetually until we break the cycle and take the lead to proactively educate pregnant mothers, support increased research and train our healthcare providers.  I know this as a child of a mother who went through PPD, whose mother had it as well, and as a woman who had postpartum OCD herself.  Please pass the Melanie Blocker Stokes MOTHERS Act.  By doing this, you will immediately begin to create healthier families all across America.

Sincerely,

Katherine Stone