Ivy’s PPD Blog

Once upon a time I was a Kirstie Alley fan…well, what happened, you ask, that would change my mind?  Well, evidently she has decided to go on some kind of anti-MOTHERS Act (or what she refers to as MOTHER F_ _ _ERS Act…real nice) kick, leading all her Twitter followers and fans out there like the Pied Piper led all the mice that were blinded by his music—a perfect analogy in my opinion because these people are blinded by ignorance that breeds fear and conspiracy theories. By the mere mention of the word “screening” these people choose to believe the government is out to get everyone because it couldn’t possibly want to do something to actually help people. They choose to jump to the conclusion that we are moving to a “1984″-like society with Big Brother moving in on us. Wow, that was an amazing leap, cuz nowhere in the bill does it say that screening is mandatory!  And by the mere mention of the word “treatment” these people jump to the conclusion that we are now going to force all mothers out there to swallow pills. Um, okay then.  Again, the bill does not state such a ridiculous notion.  I read some of the exchanges and stopped because it was all a bit much and was giving me indigestion.  I get it, you’re angry.  You hate the government.  You hate meds.  But DO NOT stand in the way of what can make such a positive difference in the lives of so many women who are currently suffering (or will suffer) from postpartum depression…what many people even today don’t even acknowledge as a real illness.    

I see the bill as an opportunity to educate this country on an illness that more women have suffered from than people will ever know. It’s also an opportunity to get increased funding in research to improve medications and discover more alternative treatment options, as well as an increase in postpartum support services. Kirstie, you can accuse me of being naïve all you want, but here this. Screening is having a doctor ask the patient a few questions. The woman has THE RIGHT to decline if she so desires.   We are in a free country, aren’t we?  Personally, I don’t mind answering a few questions. And by the way, what the heck is the harm in that anyway? Oh, yeah, that’s right….those with conspiracy theories think this is an invasion of privacy…another Big Brother ploy by the government. Kirstie, did you even bother to consider that, if a woman is suffering from depression during pregnancy and is diagnosed at that point, it will not only increase her chances of getting some form of treatment and support early on so it doesn’t follow her postpartum?!

Kirstie, if you think you are doing a noble deed and helping other moms out there with respect to perinatal mood disorders, then think again. Instead of blocking progress, do something that will make progress happen. Kirstie, let me ask you. Are you and others like you willing to take the charge and educate the public about perinatal mood disorders? Will you champion this cause? Because that’s the key to banishing the stigma and myths, the major hurdles to women seeking help for a perinatal mood disorder. Kirstie, do you know what the occurrence rate of PPD is in this country? Probably not. All you and others like you choose to focus on is one thing and only one thing. Your conspiracy theories. Just remember that, as long as society remains ignorant about PPD the stigma associated with mental illnesses–particularly around a time that is supposed to be happy (i.e., childbirth)–will continue to keep mothers mouths shut and suffering unnecessarily in silence.

Another hurdle is people not realizing the difference between the blues and PPD. Just in the past week, I spoke to 2 people who didn’t know the difference. Why doesn’t everyone not realize what symptoms to look out for? Because there is a shameful lack of information made available to the public. What we need are: MORE EDUCATION, MORE RESEARCH, MORE SUPPORT SERVICES. This, ladies and gents is what this country needs if we want to stop the silent suffering of mothers! Without a federal mandate, more women are going to continue suffering unnecessarily, families will be torn apart, and deaths will occur…all because there aren’t enough resources and funding out there to make a difference at the rate we are progressing, which is at a snail’s pace. Simply unacceptable!

I am going to preface this post with a quote from Tracy Thompson’s The Ghost in the House: Real Mothers Talk About Maternal Depression, Raising Children, and How They Cope  (pg. 135): “There are two basic ways in which depression is handed down from one generation to another: by the genes parents pass on to their children, and by the behaviors parents model for their children.”  She also goes on to say (on pg 150) “You do not ‘give’ your depression to your children; rather it’s the attitudes they learn from you that provide ‘fertile soil’ for depression to grow.” 

Why do some women get postpartum depression (PPD) and others don’t?  Despite the research that has been performed over the years, no one is 100% sure what causes PPD and why some women get it and some don’t.  What we know is that both genetic and environmental factors come into play.  There is a genetic link, as depression tends to run in families and an individual’s personality will, in large part, determine his/her susceptibility.  Many studies have shown—and it absolutely makes sense—that children of depressed parents are more vulnerable to a wide range of psychiatric disturbances including major depression, anxiety disorders, and alcohol and substance abuse.  There is also an environmental link, as your experiences—in large part those of your childhood—can also play a role in whether you are prone to depression or not.  Socially well-adjusted women with a cheerful outlook, easygoing personality and a large circle of friends will be less likely to develop PPD than someone who has always had difficulty trusting others, establishing close relationships, and are more prone to worrying about things.   I can remember being fascinated during my high school days with the interplay between heredity and environment, just as Darwin’s theory of evolution and the survival of the fittest fascinated me.  Well, now I get to write about it! 

Role of Genetics/Nature

Depression is generally an inherited trait, just like there is a genetic link in terms of alcoholism, diabetes, heart disease and cancer.  I always wondered how alcoholism could be hereditary.  I always assumed people drank a lot by choice to forget their problems, and it gets out of hand.  But what I’ve learned is that there is a correlation between depression and use of alcohol and/or drugs as a form of self medication.  Depression increases the tendency to drink heavily because people want to escape their pain, their thoughts of hopelessness.  For individuals who choose to self-medicate, alcoholism or drug addiction often results when these people rely on these substances to escape their moods on a short-term basis without realizing that, over the long term, they only serve to worsen depression and/or anxiety, impair memory, and not to mention, cause addiction.  Worst case, a person seeking an escape from their depression out of desperation runs the risk of mixing up a dangerous cocktail of drugs (and alcohol) that can kill.  Look at what happened to Heath Ledger.  I’m not saying he was depressed and he was mixing drugs to escape his pain.  No one confirmed (probably because no one really knew) he was depressed at the time of his death.  But his death was ruled as due to an accidental overdose of a mixture of different drugs.  I can remember how much his death hit me.  It affected me for a couple of weeks.  What a shame that such a talented actor’s life ended when his brilliance as an actor was only just taking off.  He should’ve received an Oscar for his role in Brokeback Mountain!  Sorry, didn’t mean to digress…..

I’ll never know if depression runs in my family.  I was never 100% sure whether I suffered from depression as a child.  I often felt unhappy and tended to hide in my bedroom from the world that I felt was so cruel.  It is completely normal to experience sadness and cry in reaction to something negative that happens.  Depression, however, is an illness – experienced by men, women and children – that can be debilitating to the point of no longer being able to carry out normal functions.  Depression is characterized by the following:  inability to appreciate anything that used to bring you pleasure/interest, insomnia or oversleeping, quick appetite/weight loss or gain.  Depression is more than just a feeling of sadness.  And nothing bugs me more than people innocently, and all too liberally, using the word “depressed” to describe how they’re feeling in reaction to something when the words they should really be using are “sad” or “down.”  Since I now know what it’s like to be depressed, I know that all my past periods of unhappiness weren’t episodes of depression.  I was unhappy with my life, but not debilitated and unable to function day-to-day.  I was able to sleep and eat. 

Role of Environment/Nurture

I am going to start off by mentioning some fascinating research findings discovered by researcher Stephen J. Suomi of the National Institutes of Health, which Tracy Thompson mentions in her book (pages 124-125).  His findings, while working with monkeys, showed that experiences occurring early in life can alter the course of genetics. What he learned was that monkeys with the depression-prone gene—as long as they were able to form secure attachments as infants to foster mothers lacking that gene and raised in a caring and secure environment—did not exhibit depressive behavior as adults.  On the other hand, monkeys with the depression-prone gene that were “peer-raised”—or the equivalent to a human child’s experience of growing up in an orphanage—tended to exhibit depressive behaviors as adults. 

Ruta Nonacs in her book (pg 22) A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years indicates how research has shown that “the seeds of depression are sown early in life,” and mentions how Sigmund Freud was the first to indicate a critical link between childhood events and a predisposition for depression.  Freud argued (supported later by the research findings of Stephen Suomi) that the key to raising a child free of depression is providing a nurturing and loving environment.  Freud believed that exposure to stressful life events (e.g., death of parent, abuse) at an early age, while the brain is still developing, can permanently and significantly affect brain functionality by “[inducing] an oversensitivity to stress that persists into adulthood.  Later, when these individuals are exposed to stress, the HPA axis, which dictates how we react to stress, is too responsive: the body is sent into a flight-or-fight response with little provocation and produces higher than normal levels of stress-related hormones.  When the brain is exposed to high levels of these stress hormones, certain [physiological] changes may occur.….At the time of birth, one possesses certain genes that play an important part in determining predisposition to depression later in life.  Superimposed upon that genetic inheritance are the earliest experiences of childhood.  By adulthood, one’s vulnerability to depression is almost predetermined, a by-product of genes and early experiences.  The missing ingredient is a trigger, some event that uncovers this vulnerability and allows depression to manifest.”  For many women who suffer from PPD, it seems that that event is childbirth and the resulting biological changes (i.e., huge hormone shifts)—not to mention life changes–that come with it.

Genetics plays a role in determining such traits as personality and temperament, which in turn play a role in determining how an individual responds to stressful life events.  It’s safe to say that worrywarts, pessimists and those prone to anxiety or nervousness will probably not deal with stress as well as someone who is easygoing and optimistic.  Add worrywarts, pessimists and anxiety-prone individuals to Type A personalities, perfectionists, and high- or over-achievers—or those who think they should be able and/or want to handle everything themselves the same way they always did before baby came along—to the list of traits with a greater risk for developing PPD.  These individuals will learn, probably the hard way, that this is an unrealistic expectation indeed.  This is why therapy to correct certain attitudes and behaviors in certain situations is recommended.  Though it is, as they say “hard to teach old dogs new tricks,” learned behavior is not completely set in stone.  With practice and help of a professional, negative behaviors and thinking can be adjusted, which helps minimize negative reactions to stressful situations, which cuts down the likelihood for a mood disorder to be triggered. 

Thompson (pg 135)  indicates it’s how that parent handles stressful situations and expresses anger, his/her overall attitude about life, and even the way he/she recovers from when he/she makes mistakes that matters a great deal and ultimately sets an example for the next generation.  Children will observe and mimic, perhaps not intentionally, their parents’ reactions to stress, as well as overall attitudes and behaviors.  When they are young, children look to their parents as role models.  Parents, whether they intend to or not, set the stage for their children’s behavior and outlook on things. Parents cannot serve as role models for optimism, perseverance and resilience if they are unable to keep going when faced with a negative situation. Parents cannot inspire self confidence and self esteem if they put themselves down, blame themselves for things that aren’t their fault, and fail to give themselves credit when they’ve accomplished something for which they should be proud. 

On the other hand, a child whose parents are role models for a positive attitude, optimism, self confidence and ability to deal with issues head on and in an effective and confident manner will more likely adapt a similar outlook, attitudes and behaviors.  The child that is exposed to such positive traits, in addition to nurturing role models who are loving, supportive and encouraging, will more likely develop assertiveness and self-confidence.  Sure, a child may have been born with the depression-prone gene, but if their parent(s) is too overwhelmed with his/her own issues and/or are too depressed to provide positive reinforcement and a nurturing environment, there will be a greater likelihood for the child to develop negative behavior and thought patterns that will open the doors wider for depression to develop. 

Thompson (pg 158) also delves into the behavior referred to as perfectionism, which she refers to as “a sense of failure despite high achievement.”   Usually the roots go deep in childhood when expectations/standards are set so high and positive feedback, acknowledgement, praise, and nurturing are lacking.  What results is a child that, no matter how smart, pretty or talented she is, will never be happy with herself or believe in her own abilities.   For these perfectionist kids, the only thing that matters is being the best—whether it be in sports, school or appearance.  Setting high and unrealistic expectations on themselves ultimately sends them into a vicious cycle of disappointment and other negative behavior and thought patterns that may lead to depressive behaviors.   Along with these behaviors come eating disorders (e.g., bulimia, anorexia) and low self esteem, to name a few.  Thompson goes on to say (pg 159) that “[If] your expectation is perfection, it doesn’t matter how many successes you have, they will never exceed your expectations.”

Assuming the predisposition for depression is passed on to you through your genes, whether those genes are expressed, or turned on, depends on the following:

1)      your experiences during childhood and adolescence

2)      the overall environment in which you live during those years

3)      the severity of stressors with which you are confronted early in your life

4)      how much nurturing (support, positive role modeling and positive reinforcement) you get from your parents

I have no real pleasant memories of my childhood and adolescent years, which were characterized by constant moving and finally settling down in N. Caldwell, NJ only to experience prejudice from being the only Chinese girl in a high school class of over 300 students and with zero friends.  My adolescent years were marked by hatred of everyone in my school class and even my own family.  So many times, I wished I could just blink myself out of my life as if I were a genie.  My parents’ strict discipline of me and my brothers managed to keep us from getting into trouble, managing to raise us to be honest and hard working.  Grant it, I realize now that my life could’ve been so much worse compared to others out there.  But I received very little in the way of nurturing, support (someone to talk to about my feelings/emotions/issues, etc.) and positive reinforcement.  I had no one that could provide comfort when I needed it.  No one to understand or listen to me.  No shoulder to cry on.  No close friends.  I couldn’t even confide in any of my family members.  I felt like whatever I did was never quite good enough for my parents.  That’s not because they kept pushing for A’s.  Rather, it’s because whatever I did never seemed to earn any sort of praise.  That and the fact that the only time I ever really communicated with my parents was through arguments.  All of my negative experiences led to low self-esteem and a self confidence level I’ve been trying all my life to improve.  My family life was characterized by anger that got out of hand way too many times and loads of misunderstandings and fights.  Sure, all this made me into a survivor, if in fact I was able to survive at that point in time.  I’m surprised I survived my high school years, I really am.   Looking back, I’m amazed that I never once touched a cigarette or any drugs.  Heck, I didn’t even have a beer until I was in college (didn’t like the taste anyway).  So, I obviously didn’t self medicate to escape my issues.  I definitely could’ve used an understanding and non-judgmental therapist, though.

This is why it is important we provide consistently positive feedback/interaction, love, and nurturing to our children.   If we want to keep our children free of depression, nurture them, love them, encourage them, and spend quality time with them.  Minimize the stressors that they face within reason, especially as they go through adolescence.  Be aware and supportive of your children’s school experiences and activities, and help them with any challenges they face.  If you want your children to grow up with self confidence, a positive outlook, honesty, being hard working and well-grounded overall, then serve as their role model for all these traits.  Lead by example.  Be there for them.  Listen to them.

Role of Reproductive Events

Every woman is unique in terms of her genetic make-up, as well as any traumatic events she may have experienced.  It is entirely feasible for someone vulnerable to depression to live most of their life without ever exhibiting any signs of depression, only to succumb to it with a certain combination of physical (i.e., drastic hormonal fluctuations, prolonged sleep deprivation) and psychological (i.e., high anxiety) factors.  The huge shifts in hormone levels and accompanying emotional/mood changes inherent for those who are genetically predisposed—coupled with the fact that the postpartum period is particularly stressful (remember, even positive change leads to stress)—may be the reason why cases of depression surface during the postpartum period. 

What all women who want to have children should know is that no woman is completely immune from PPD, and what would be of tremendous benefit at a time when you’re transitioning to motherhood is plenty of practical and emotional support.  To determine whether you are at risk for PPD, consider your past history and family history carefully.  You should also keep the following in mind:

 Genetics + Life Events + Reproductive Events = Increased Risk for PPD

Was I genetically predisposed to depression and/or anxiety?  I will probably never know the answer to this question.   As I mentioned earlier, I am not aware of experiencing depression while growing up.  I firmly believe my PPD was triggered by the following chain of events:  childbirth complications + 7-day stay in hospital + concern for baby’s health + possibility of SIDS + baby’s bad case of eczema and cradle cap + my hair loss + my daily hive outbreaks on legs, arms, butt and mouth (some up to 2” welts) + baby’s one-week colic.   The huge shift in hormones probably tipped the scale in favor of PPD.   Given the tough life I had while growing up and how I survived all those years, I felt I could handle the challenge of taking care of my brand-new, helpless and completely dependent baby despite the non-stop series of events I faced.  But that series of events put my body in such a heightened state of anxiety at a time that my body was at its most physically vulnerable (i.e., loss of 4 units of blood during surgery to remove my uterus, huge drop in hormones, lack of sleep), that my body couldn’t find a way to turn off that anxiety switch.   Hence, the insomnia that started me down my PPD journey.  I will write more on the topic of Risk Factors in my next post.

Me, Senator Menendez

Yesterday morning, I was invited to attend a press conference at Valley Hospital in Ridgewood, NJ, with U.S. Senator Robert Menendez (D-NJ), Former New Jersey First Lady Mary Jo Codey, Audrey Meyers, President of Valley Hospital, Dr. Fred Rezvani, Chair of Obstetrics and Gynecology, Sylvia Lasalandra, author of A Daughter’s Touch, and Susan Dowd Stone, Chair of the President’s Advisory Council for Postpartum Support International.  

The press conference was held to discuss how passage of the Melanie Blocker Stokes MOTHERS Act (S324) would benefit thousands of mothers in this country each year through an increase in public awareness, education and support services, as well as clarify misconceptions about this legislation–for example, the bill does NOT mandate screening; what it will do is increase research to ensure early detection and treatment of perinatal mood disorders.   He indicated his mission to pass the MOTHERS Act was inspired, in part, by Mary Jo Codey’s personal brush with a postpartum mood disorder and her resolve that contributed to the establishment of the New Jersey Postpartum Depression Law that took effect back in April 2006, which includes the Speak Up When You’re Down literature, website, and 24/7 hotline.   Senator Menendez emphasized that postpartum depression is not just a disease that affects the mother…..the whole family is affected.

Mary Jo Codey and Sylvia Lasalandra spoke about their serious and life-changing experiences with postpartum depression.  I’ve heard their stories several times now, but they still succeed in bringing tears to my eyes, as they brought tears to several others in the audience today.  Both of these brave women stated their full support of the legislation that would provide information made available nationally to help educate the public about perinatal mood disorders to hopefully, once and for all, overcome the myths and stigma that have worked to keep mothers from getting help when they need it.  It’s time for mothers to stop suffering in silence. 

Susan Stone, Sylvia Lasalandra, Senator Menendez, Mary Jo Codey, Audrey Meyers, Dr. Fred Rezvani

Dr. Fred Rezvani, Chair of the Department of Obstetrics and Gynecology at Valley Hospital in Ridgewood NJ, started his excellent speech with the history of PPD that begins with the first written account dating back to Hippocrates, the centuries that elapsed before scientists performed any research on perinatal mood disorders in the 1800’s, and the momentum that has picked up over the past few years.   Dr. Resvani provided a slew of statistics that included PPD occurrence in 10-20% of new mothers, but he tended to believe those figures are understated, with 25% being closer to reality because women tend to suffer in silence due to stigma and fear of what would happen if they spoke up.    He mentions how other countries practice social support customs that help the new mother get through the first weeks postpartum–what this country is so lacking and undoubtedly a contributing factor to the high rates of PPD here.   While other countries have paid maternity leaves of several months in duration–not to mention paid paternity leaves–many companies in this country still require the woman to return to work 6 weeks after giving birth, and there is no paid paternity leave.  What our society needs to do is  adapt an attitude that is more supportive of the mother as she transitions into motherhood.  He expressed his heartfelt desire to help mothers but he–along with all the other OB/GYNs, GPs, pediatricians, psychiatrists, psychologists, etc. throughout the country–can only do so much right now with the limited resources available to them to ensure early detection, proper diagnosis and improved treatment options that include alternative treatments.  He is in full support of this bill because it will not only provide opportunities to improve on existing screening methodologies  such as the Edinburgh Postpartum Depression Scale, it will also provide funding/grants for various forms of support services to be provided to mothers by private, not-for-profit  or public entities in the first months postpartum.

During the press conference, several references were made with respect to how Senator Coburn (R-OK) has been stubbornly opposed to the bill–even despite the fact that he is an OB/GYN– and it should be interesting given how Rachel Roberts, who was just crowned Mrs. Oklahoma International, is a postpartum depression survivor and will continue her postpartum depression awareness mission that she started during her Mrs. Tulsa days.   Please visit her website.

The press conference concluded with Susan Dowd Stone presenting to Senator Menendez the list of national organizations and individuals who have signed the petition in support of the legislation.

For more information, please visit:

• Susan Dowd Stone’s blog
• WCBSTV article

It’s not too late to sign the petition in support of this long overdue legislation!  Please click here to sign the online petition and show your support for this critical federal legislation!

Hope all you moms out there had a very Happy Mother’s Day!  If you haven’t gone over to Postpartum Progress to check out all 24 letters written by book authors and bloggers, please do so now!   To be part of such an effort and to be among so many fantastic authors was such an honor. And it all would not have been possible had it not been for the dedication of Katherine Stone who spent her entire Mother’s Day making sure each one of these letters was posted on the hour, every hour, all day long.   These letters are written in all different styles and by women of all different backgrounds but with one thing in common…we want to help support, encourage and educate new moms out there, and help them get through one of the most challenging and exciting times of their lives.

To see my letter to new moms, click here.  In my letter, I provide the brand-new mom with advice on 3 key areas I wish I had known more about going into motherhood:  Sleep, Support, Breastfeeding. 

Please do other moms you know a favor and tell them about all these letters written to support and educate the new mom.  If I had had access to this wealth of information BEFORE I had my baby, my own postpartum experience would most likely have been better.  It’s unfortunate that I don’t get a second shot at this.

To all new moms out there, get ready for Katherine Stone’s Mother’s Day Rally over at Postpartum Progress on Mother’s Day!  

She has assembled 24 women–book authors, therapists, mommy bloggers, PPD bloggers– who will each be writing a letter addressed to you, the new mom.  Every hour on the hour for 24 hours, a different letter will be posted to provide you with advice, inspiration and encouragement.   Whether you are currently suffering from a perinatal mood disorder, feeling anxious from being a first-time mom and needing support, or about to have a baby and reading up on what to expect as a new mom, you should expect to receive a wealth of information that will help you. 

I am thrilled and honored to be part of this effort to provide new mothers support on a day that is dedicated to celebrating mothers in this country.    If only I had had this kind of information made available to me when I was expecting my daughter!   Katherine Stone will be bringing this virtual community of women dedicated to helping mothers right to you, wherever you may be, with just a few keystrokes…..this is what the country needs more of (in addition to groups within your local communities).   My hope is that, over time, there will be more mother-focused support groups and women’s reproductive mental health services in each of our communities all over the country, so that there will be fewer moms out there suffering at a time that should be happy.

This is National Infertility Awareness Week, a movement to raise awareness about the disease of infertility affecting 7.3 million Americans.  RESOLVE is a community for women and men with infertility and provides information, support and opportunities to take action.  Check out the RESOLVE website for more information on infertility and how you can make a difference for you and others experiencing infertility.   You can also find a listing of support groups and mental health professionals that specialize in infertility, as well as a calendar of events around the country.   

Infertility is a major cause of anxiety and depression.  With the number of individuals faced with infertility today, it is no wonder that antenatal and postpartum depression rates are as high as they are today.  As such, it is very important that you seek support in getting through this difficult and highly stressful time of your life.   Support can be in the form of family and/or friends that you feel are empathetic (i.e., have gone through this themselves) and/or non-judgmental.   If you’re not sure whom to talk to among your circle of family/friends, visit the RESOLVE website and look up mental health professionals in your area that have experience with helping couples get through infertility and infertility treatments.  Getting this kind of support can help prevent your anxiety levels from reaching a point that– should you (and I really hope you do) get pregnant– you could be heading into pregnancy with a great risk of developing perinatal depression.  The absolute worst thing you can do is keep your feelings of grief and anxiety to yourself, and in fact, doing so can put you at greater risk for developing a perinatal mood disorder!

Refer to my earlier post for more info on this topic.

Just a real quickie from me today.  Please visit great post by Dr. John Grohol over at Psych Central who writes about PPD and why the Melanie Blocker Stokes MOTHERS Act is so critical.   Check it out!

Evidently, strong opposition to this bill continues to come from Senator Tom Coburn (R-OK) of Oklahoma who refuses to pass any of what he calls “disease-specific” legislation.   What, is he afraid that by doing so, he may appear to have a conflict of interest?  Is this another example of someone who knows the truth and wants to protect his own reputation more than he wants to help the very people he had taken an oath to help as an MD?  Or worse yet, did the anti-pharma extremists get to him?

What vicious irony….the one major senatorial opponent is an OB.  Huh?  Are you as confused (and angered) as I am?   For a person whose career and education have been based on helping women, there is no excuse for his blocking a bill that will help mothers. It’s simply inexcusable. This behavior only serves to reinforce my belief that OB/GYNs need just as much to be educated as the public–which is why this legislation is SO CRITICAL!  There are still OB/GYNs out there that still need to learn to forget about the mythical “Oh it’s just the blues, you’ll snap out of it” and correctly detect, diagnose, and provide information about treatment options to our mothers so they can make an informed decision on what’s right for them.

Just so you are aware–because I wasn’t aware before–the bill that was just passed through Congress now has to be moved by the Senate H.E.L.P. (Health, Education, Labor & Pensions) Committee to a vote on the floor of the Senate.    I was also made aware by Katherine Stone’s post yesterday that there is no Democratic opposition in the Senate, just a lack of Republican support.  HELP….what an appropriate name for a committee that can make it or break it for this bill that can help mothers, and how ironic that Senator Coburn is standing in the way of mothers getting help. 

So, the major hurdles are 1) ensure the bill is moved through HELP by calling/emailing Senator Coburn’s office, and 2) call/email your Republican Senators.  What I did upon reading Katherine Stone’s post yesterday about Senator Coburn (and PLEASE DO THE SAME):

• Sent an email via his website asking why he’s so intent on blocking legislation that will benefit mothers, the very people he was educated and spent his career thus far trying to help.
• Called and left a message at one of these numbers: Dr. Coburn’s office in Washington: 202-224-5754, Tulsa: 918-581-7651 and Oklahoma City: 405-231-4941.

Senator Menendez has to be commended and thanked for working so hard on this bill for so many years, and not giving up.  He is committed to seeing that this bill passes once and for all, even changing the language in the bill to address the concerns of Republicans as other parties such as the American College of Obstetricians and Gynecologists–specifically, with respect to the concerns about mandatory screening, there is NOTHING in the bill that mandates it!    

What the Republicans, including Senator Coburn, need to realize is that postpartum mood disorders is a silent epidemic, that they don’t hear much about it due to 1) stigma that comes with mental health particularly around childbirth and motherhood, and 2) not enough women knowing how to even recognize what they’ve got (or had) is (or was) a postpartum mood disorder.  Just because they don’t hear about these illnesses doesn’t mean they don’t exist.  

I’m going to repeat my earlier post here, because I feel it is so important:

Without a federal mandate, improvements in 1) public perception toward moms with PPD, 2) research efforts to improve existing treatment options and ability to detect PPD earlier and thus minimize the impact on mothers, 3) availability of support services, and 4) quality of care by medical/mental health practitioners will continue to crawl at a snail’s pace like it’s done for centuries…..and at what cost?  

How many more mothers (and families) must suffer before people realize that something must be done to help mothers (and families) in this country?

 The following Press Release is posted with permission….

FOR IMMEDIATE RELEASE April 20, 2009
CONTACTS:
Menendez Press Office 202-224-4744

Attention fellow bloggers, mothers, PPD survivors and other concerned citizens…..today is the big day, the 2nd official BLOG DAY to let your voice be heard in support of this much-needed legislation to help mothers in this country.   This year’s event is being led by fellow PPD blogger, Lauren Hale. 

I don’t need to encourage my fellow PPD bloggers, but if you see this and don’t already blog and have been thinking about doing so, today wouldn’t be a bad time to start.   It took some encouragement from fellow PPD blogger, Kristin  Davis, for me to start blogging 2-1/2 months ago.  She told me it would be easy, and she was right!  

If you do have a blog, please use the tag “Melanie Blocker Stokes MOTHERS Act“ and leave a comment here so that Lauren knows you’ve joined in.  Other options would be to join on Facebook and/or Twitter about it.    There is also the option to simply pick up the phone and call your US Senator.

The more people blogging about this important legislation between now and Mother’s Day, the more people will become aware and add their names to the list of national endorsers.  If you’re reading this post now and haven’t already added your name to the list, PLEASE do so right now!  This list will be presented to the Senate during the week of Mother’s Day.

This list of national endorsers includes PPD survivors (like myself), friends and family members of PPD survivors, national non-profit organizations, concerned citizens, medical practitioners, mental health practitioners, and major family foundations formed by those who have lost loved ones to untreated or improperly treated birth or postpartum mood disorders.  Click here for more information on these foundations.  

Check this blog post that is questioning, once again, the Melanie Blocker Stokes MOTHERS Act.  And this is coming from a well-established blogger who has won awards for his reporting on mental illness, has been voted as a top ten mental health blogger, and has a large following in the mental health arena.   Frightening, very frightening……

His last paragraph irked me so much that it had me red in the face and shaking with anger, so much that I submitted the following comment addressed to him and doubters of the bill:

“I’m baffled why you would make the statement you make in your last paragraph, which gives the impression that you know very little about PPD.  Here are my 2 cents and food for thought for you and your blog followers:  

Unless you’ve been through it yourself, you can’t possibly know what having PPD is like (scratch your head all you want).  One of the best things about this country is that we are all, each one of us, allowed to think whatever we want.  However, don’t do so in ignorance.  READ THE BILL before anyone should spout their anti pharma claims.  Nowhere in the bill does it say all mothers will be drugged.  Nowhere in the bill does it say that all mothers must be put through screening.  Part of the issue today surrounding perinatal mood disorders is the lack of research, education and public awareness on these very serious AND VERY REAL illnesses.  That includes adequate training of medical health care providers on the proper diagnosis and offering the correct treatment options (and patients being properly informed so the decision THAT’S RIGHT FOR THEM can be made).  Without the Melanie Blocker Stokes Mothers Act, how many more centuries are we going to remain ignorant about perinatal mood disorders with mothers paying the price?!   There has been more progress made in the past 8 years than from the first documented cases in the days of Hippocrates until the turn of the century–thanks to Brooke’s book, Tom’s rantings, passing of the NJ postpartum depression law in 2006 and last but certainly not least media focus on the Andrea Yates case (that’s unfortunately one of many cases of a doctor prescribing an antidepressant without a mood stabilizer for postpartum psychosis, which can lead to disastrous consequences…this is what I’ve read in many books written by subject matter experts).”

I don’t know how many times I’m going to have to sing the same song over and over again.  I’m never going to change my tune, though.  This is where I stand…moms out there currently suffering from PPD or PPD survivors, please join me!  If you are irked by his post–be prepared, though, for the comment thread, as it’s frightening to see the comments from the anti-pharma extremists–definitely speak your mind and submit your own comments!  If you are currently suffering from a postpartum mood disorder, don’t let those anti-pharma comments scare you away from any protocol you may currently be following.  Remember, how you want to be treated–whether it be through medication, therapy or a combination of the two– and how quickly you want to be well again is YOUR decision to make in consultation with your medical/mental healthcare professional.

What I’ve quickly realized in reading some of these disturbing forums, is that there is unfortunately no convincing people who are set in their hatred of anything that has a hint to do with medications.   It’s astonishing to realize how Tom Cruise’s rantings back in 2005 truly pale in comparison to some of these people’s words of pure hatred.  They see the words MOTHERS ACT and they think MEDS, and only MEDS.  C’mon!  That’s ridiculous.

People are losing site of what the bill is truly about.  These anti-pharma people have their own agenda and it’s not really about helping mothers survive postpartum mood disorders.  They are so blinded by hatred of medications that they cannot even see what the bill is truly saying.   Some comments are from people–men AND women–who’ve never had a baby and/or suffered from a postpartum mood disorder and have no concept of what it’s like to suffer, and be so completely in the dark while doing so, from one.   These people should have no business booing the bill whatsoever!  Take your anti-pharma agendas elsewhere because– and I’m going to say it one last time–THIS IS NOT ABOUT MEDS, IT’S ABOUT HELPING MOTHERS THROUGH EDUCATION, PUBLIC AWARENESS & RESEARCH!!!

With public awareness, the public will hopefully one day understand the scope of this illness–how common it really is and what it can do to a new mom–and the hope is that there will be more women-centered health initiatives, including postpartum centers, that focus on the needs of mothers and ensuring there is adequate social/practical support in the first 1-3 months after childbirth (that’s when most women are the most vulnerable to postpartum mood disorders).  Establishing a support network before you have your baby should be up there in priority with picking out the baby’s names, buying baby products and preparing the baby’s room.  Hiring that doula and/or housekeeper just for those weeks, if you can afford to do so.  If you can’t afford to hire help, gather your family members, friends and others in the community to help you.  Refer to previous post on social support.

It’s about helping mothers, pure and simple.

The “baby blues” is a passing episode of mood instability that affects up to 80% –or 8 out of 10–of new mothers and is usually characterized by tearfulness, sadness, irritability, mood swings and anxiety-all normal and expected behavior due to the huge hormonal shifts. The blues, which can begin as early as immediately after delivery and up to one week postpartum, generally subsides on its own, with no medical/therapeutic intervention, within 2 weeks.  

You would think that obstetricians would be the experts on identifying PPD, but the sad truth is that even today, most of them still buy into the myth that any mood disorder experienced by the mother after delivery is merely a state of mind and a normal part of adjusting to motherhood. They will wave off your symptoms at the 6-week checkup and claim it’s just the blues and you’ll get over it.  It’s frustrating whenever I read about mothers who do seek treatment and get the ol’ “Oh, it’s just the blues. Everyone gets the blues. You’ll be fine before you know it.” Then, when you aren’t fine before you know it, you then end up with this despair that you don’t know what’s wrong with you. It makes me so angry when I read about these stories.  How many more doctors are going to wave off a woman–saying they have the blues, all is normal, it’ll go away by itself–who is claiming she has insomnia, appetite disturbance, inability to smile, laugh or feel happy  3 weeks or longer after childbirth?  

A New Mom Needs to be Evaluated for PPD if….

Practically every book I’ve read indicates that a new mom needs to be evaluated if she experiences 5 or more of these primary symptoms of PPD for most of each day for two or more consecutive weeks:

• Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
• Loss of interest/pleasure in most of your usual activities; inability to laugh
• Overall impaired functioning*
• Sleep difficulties (either insomnia or sleeping too much)
• Weight loss (usually fairly quick) associated with a decrease in appetite
• Weight gain associated with an increase in appetite
• Excessive worrying (e.g., about the baby’s well-being)
• Difficulty thinking, concentrating or making decisions
• Feelings of guilt/inadequacy/of being a bad mom
• Urge to run away/disappear/vanish into thin air
• Onset of panic attacks
• Sense of despair and/or hopelessness leading to thoughts of death/suicide

*What I mean by overall impaired functioning is feeling unable to do anything.  I prefer to use the ”debilitating”  to describe my experience.  Debilitating meant the following for me: I would find myself frozen in one spot (either standing or sitting) not knowing what to do next and feeling helpless, useless and unable to function properly. All I could do was sit there, but even sitting there, I was deluged with feelings of hopelessness, in large part due to my not having a clue what was wrong with me. I couldn’t feel or think positively. I couldn’t smile. I couldn’t enjoy anything that I used to enjoy. If your symptoms are debilitating to the point that they interfere with your day-to-day functioning and prevent you from enjoying that which used to bring you interest/pleasure, you should be evaluated by a medical or mental health practitioner right away (don’t wait).

A sign for an OB/GYN that what you’re experiencing is PPD and not just the blues is if your symptoms are continuous, debilitating, and last beyond 2 weeks postpartum. The first question an OB/GYN should ask the patient to rule out PPD is whether or not the symptoms interfere with her everyday functioning. Usually, with the blues, you will feel weepy every once in a while, but the symptoms are not debilitating. In fact, they usually subside within 2 weeks with no medical intervention. My insomnia at 6 weeks should have been a clear indication to my OB/GYN (and his staff) that I had PPD at that point.  Instead of merely prescribing me Ambien to help me sleep, they should have screened for PPD.  Their insistence that I didn’t have the “classic” symptoms of PPD is founded on the minimal number of times I was willing to call the doctor’s office with a question or concern.  They never once bothered to ask me if I had certain common symptoms of PPD. If I had a medical practice that was concerned about women’s health before, during and after pregnancy, I would ensure I was trained on PPD detection and treatment since it has such a high occurrence rate, and make sure I took steps necessary to detect and treat PPD in my postpartum patients. In fact, I would even screen pregnant moms too, since so many cases of PPD arise during pregnancy.

Remember, if your doctor tells you that what you have is the blues, and you are 3+ weeks postpartum and are experiencing 5 or more of the symptoms listed above, you will need to make a decision on what to do to help yourself get better. 

If you’re comfortable with this doctor and prefer to stick with him/her, tell him/her he/she needs to screen you for PPD and reach out to Postpartum Support International (PSI) for information/resources.  

Even better (since time is of the essence), ask him/her if he/she can refer you to a medical or mental healthcare practitioner who has experience treating PPD.  You always have the option to find a psychiatrist who can screen you for PPD, provide you with a listening ear and advice, and prescribe any medications as necessary.  If this is your first time experiencing a mood disorder, don’t be afraid to seek therapy.  What matters is you must do what it takes to get well.  Certain PPD patients do well with a combination of medication–especially if they are very symptomatic and need treatment for their symptoms before therapy can be beneficial–and therapy.

If he/she doesn’t have any referrals, go to the PSI website to look up your state coordinator who can refer you to local medical/mental healthcare providers.

Never assume….never take for granted that everyone always has smooth deliveries and postpartum experiences…..never think that just because she’s smiling that everything is fine and blissful, as it always has to be after the birth of a baby.

I just got through reading a touching letter on Susan Stone’s blog written by a father who lost his daughter to postpartum depression (PPD) and is encouraging people to petition for the Melanie Blocker Stokes MOTHERS Act.   His daughter seemed fine though people realized too late that she appeared to be more consumed with worry in the days leading up to her suicide.    Touched and with tears in my eyes, I started to write this post.

Something has to be done to stop the silent suffering of so many new mothers, bring more public awareness on PPD, and more healthcare professionals (GPs, OB/GYNs) up to speed on detecting PPD before it spirals out of control and leads to sometimes disastrous consequences.  What we need to do is prevent these situations from happening in the first place.  The only way we can make progress is through public awareness, which includes dispelling the myths of motherhood.  Now, if you happen to be one of the proponents of those ridiculous myths because you feel threatened or whatever the reason might be, then take a reality pill and get with the program.  Jump off that la-la train that you’ve been riding.  You cannot possibly ignore the fact that PPD is the #1 complication of childbirth, with 1 out of 8 women suffering from it.  If you still want to ignore it, then that’s YOUR problem.  Don’t make it anyone else’s. 

How many more lives should be torn apart from an illness most people still think is a make-believe illness?  Some marriages do not survive.  Children of women with untreated PPD may end up with cognitive, social, emotional and behavioral delays and potentially anti-social issues down the road.  For God’s sake, some women whose illnesses spiral out of control don’t even make it through alive. 

Sure, mothers have been giving birth for thousands and thousands of years. Just because most women with PPD don’t speak up doesn’t mean it doesn’t exist. And you mothers out there….if you don’t speak up, people will continue to go on scoffing at the idea that PPD does exist.

Why the fear?  Why the secrecy?  Why not speak up?

You may be wondering why the heck, then, doesn’t a mother who’s not feeling herself get help in the first place, then think about this.  

• Many (like me) don’t even know what is happening to them in the first place. 
• Many go see their doctor about why they’re feeling the way they’re feeling, but are told that what they’re feeling (baby blues) is normal and should go away by itself; yes, doctors still misdiagnose even today (more on this in my next post – stay tuned). 
• Many are afraid of what their family/friends may think. 
• Many are afraid others will look down at them and call them weak/bad mothers. 
• Many may even fear that if they speak up, their children will be taken away.  After all, media is doing a great job in painting the wrong picture about PPD  (see earlier post on ABC’s Private Practice) and the public seems to think, ever since the Andrea Yates case, that everyone who has PPD is at minimum a bad mother or will turn into an Andrea Yates.    Well, Andrea Yates had postpartum psychosis (PPP)–which occurs in 1 in 500 to 1,000 mothers– and was never successfully diagnosed and treated, and look at the disastrous consequences that resulted.   The healthcare system failed her and those around her didn’t help her.  Instead, the public chooses to put the blame squarely on her shoulders. This is why public awareness and education are CRITICAL!

Basically, with the exception that the birth of a child is a life-changing experience for all women, though in different ways and to different degrees, no one woman’s motherhood experience is the same as any other. The only experiences you will hear are the mothers who have positive experiences gushing to everyone they know and run across “I love being a mother. Being a mother is such a fulfilling, wonderful experience that I wouldn’t trade it for the world. I couldn’t ask for anything more. It’s all I ever dreamed motherhood to be.” Since you only ever hear about the positive experiences, women whose experiences aren’t as positive will tend to keep their feelings to themselves.  It takes courage and a desire to empower other women to speak up.  Slowly, the numbers of women who speak up are growing until hopefully, one day, this suffering in silence nonsense will finally come to an end.  I’m hoping this momentum continues to the point until the motherhood myths disappear and mother-centered programs (mental/physical health and practical/social support) during the postpartum period become the norm rather than the exception.

Don’t compare yourself to other mothers that appear to be coping extremely well with motherhood–those who never look tired, always look happy and seem to do it all without needing any help at all. I know how tempting and almost second nature it is, but you must resist doing so.  Don’t assume that, just because other new mothers around you seem to have a picture-perfect motherhood experience, they’re natural mothers because they seem to know what to do and do everything right, and even look great  even immediately after having given birth. It could also be that some of these women have hired help in the form of a doula/nanny/housekeeper, which does in fact help new mothers get the rest they need to recover (see previous post on social support).  Unfortunately, however, not everyone has the ability to hire such help. 

You don’t know what truly goes on behind closed doors.   Just like others won’t know something’s wrong unless you open up, you’ll never know whether these seemingly perfect mothers are just putting up a façade. It’s scary how common it is for a woman to disguise how she’s truly feeling–it’s called make-up and good acting–all so others won’t know she’s not coping as well as she thinks she should.  She wants to give the impression that she’s handling it like the supermom that other mothers give the impression they are and how she wants to be viewed as.  This is one of the reasons why even today people are surprised to hear that PPD is the #1 complication of childbirth.  

No one’s life is perfect, despite appearances.

Please see a doctor if you don’t feel yourself even after 2-3 weeks postpartum, and you’re feeling down, unable to smile, unable to enjoy anything and/or unable to sleep even when the baby sleeps.

A big thank you to Susan Stone for your continuous efforts to help pass the Melanie Blocker Stokes MOTHERS Act and for today’s brilliantly-crafted blog post regarding the illogical, way-out-of-left-field anti-pharma agendas of the bill’s opponents. 

Here’s the meat of her brilliant blog post for you to digest and guide you to do what’s right–which is to not be swayed by the anti-pharma and anti-Mothers Act blogs, videos, etc. but to read Susan’s blog in entirety and read the bill for yourself.  Realize that what Susan is saying makes a lot of sense, and the anti-pharma fanatical claims do not hold a lot of water.  Add your name to the growing list of supporters and petition today (if you haven’t done so already) to show your legislators that you support this important bill!

“The detractors are crafty. Notice they don’t offer a link to the actual language of the bill on their websites, because if they did…. readers would quickly discover that The Melanie Blocker Stokes MOTHERS Act does not promote [or fund] medication….. Nor does [it] mandate screening…..[Their] false arguments are easily refuted by simply reading the bill [which is thankfully what] Legislators and organizations….do…..But in the murky waters of the internet – where those lacking healthcare expertise and appropriate education can operate as covert authorities – such misinformation can feel true….. So for those of you wondering what to believe when confronted by the minority who oppose this bill through video, blog and ideological distortion, here’s what you can do. ….. READ THE BILL Then go back and take a look at these misguided arguments which fail to associate a single allegation with anything that is actually in the bill. …..[Attempting] to deny others access to the lifesaving maternal healthcare offered by this bill speaks to a far more sinister perspective …….. [They] want to deny you access to the full range of choices that can lead to your recovery…….. When we pass The Melanie Blocker Stokes MOTHERS Act, women in all economic and social strata in every state across the union will be able to find the help they need to return to health. How can one possibly distort this transparent and noble intent?……Truth has always been the most powerful advocate.”

I have read in several forums that it is believed that the reason why so many New Jerseyans are supportive of the Melanie Blocker Stokes MOTHERS Act is due to the fact that New Jersey happens to be the pharma capital of the country, with the largest concentration of pharma companies located in this state. Can you honestly say that everyone who has thus far signed their names in support of this bill (click here to see latest list) is a pharma-related person? I’m certainly not. I am simply a PPD survivor. My PPD so debilitated me that I could not function on a day-to-day basis, period. With panic attacks I couldn’t control and a feeling that I would not physically be able to survive my experience, I needed medication to return my brain chemistry back to its normal levels. As soon as that occurred—which was 4 weeks after I started taking it—I was fine and happily able to enjoy motherhood, my baby and my life once again. I would think that there is wide support in New Jersey because its citizens have seen the benefits to a law that was passed nearly 3 years ago to benefit mothers through early detection and education.

What I learned from my experience was that the way in which my doctor treated me could have been different. I probably would have been better off seeing a psychiatrist who could provide the comfort and reassurance that I needed, due to my doctor’s lack in bedside manner. Either way, I’m confident that the psychiatrist would have prescribed an SSRI anyway, given my level of functioning—or lack thereof—plus insomnia, quick weight loss and inability to smile and enjoy all that I used to before PPD hit me.  And this is coming from someone who–if you’ve read my previous posts–has avoided taking medication since I was a toddler and able to run away from mom and that spoonful of yucky stuff!

I do not blame mothers out there who feel the way they do about being misdiagnosed and prescribed the wrong medication. It’s unfortunate, but true, that many healthcare providers still need to learn to properly recognize the symptoms of a postpartum mood disorder (PPMD), including PPD, postpartum OCD (PP OCD) and postpartum psychosis (PPP). If a mother has PPP but is improperly diagnosed as having PPD and is prescribed an SSRI, the symptoms can worsen terribly. You can find more information about all these differences and why it is critical for early and proper detection and treatment of these postpartum mood disorders in the wonderfully informative books that I’ve had the pleasure of reading:  “Postpartum Depression Demystified“ by Joyce Venis, RNC and Suzanne McCloskey, and “Postpartum Depression for Dummies“ by Shoshana S. Bennett.

It will take a federal mandate in the form of the Melanie Blocker Stokes MOTHERS Act for progress to be made in the improvement in public perception– not to mention accurate diagnoses and treatment–of postpartum mood disorders.  Research and education are the two core elements of the Melanie Blocker Stokes MOTHERS Act that can enable us to make any kind of significant progress in helping to reduce the rates of occurrence, misdiagnosis, and incidences where cases go untreated.

Increase in Research Efforts: To determine the factors (e.g., hereditary, environmental) that predispose women to PPMDs, as well as new ways to screen for and treat PPMDs.   Speaking of screening, unlike what opponents of the bill are claiming (and complaining loudly about), no mother is ever forced to do anything they don’t want to do.  The option of screening would be offered, but it’s ultimately the mother’s decision whether to be screened or not.  Unlike what opponents of the bill claim, it’s NOT just about prescribing meds to the unsuspecting mother. It’s about early detection and treatment of a PPMD, so the new mother’s postpartum experience–and motherhood experience overall–is as happy a period as possible. After all, a happy mother means a happy baby. A PPMD that goes untreated is detrimental not just for the mother but for her relationship with her partner and the baby’s cognitive, speech and behavioral development. Whenever a PPMD is detected, the healthcare professional should offer treatment options (e.g.,  medication, therapy, alternative remedies, support groups, etc.). It should ultimately be up to the patient to decide what treatment option is right for them. Early detection (plus education) would help prevent a PPMD from spiraling into a situation that renders a new mother utterly debilitated, helpless and unable to enjoy her time as a new mother. Had I been screened for PPD right at the moment my insomnia started, I could have been spared the frightening panic attacks I experienced, and having to take Xanax to help me get through those moments until the Paxil could kick in 4 weeks later (and then I was stuck taking Paxil for a year).Had I known about PPD, its risk factors and symptoms, I may not have had moments where I thought I would never return to my old self again. I would not have felt so utterly hopeless and miserable.

Public Awareness Campaigns (for the layperson as well as healthcare professional) would help address the following issues prevalent today: 

1.  PPMDs continue to be misunderstood, under-treated and misdiagnosed today, and new mothers pay the price of the ignorance of the very healthcare professionals to whom they entrust their care.  Even today,  medical professionals still have the tendency to confuse PPD with the baby blues.

Solution: There must be a push for all healthcare professionals who come in contact with postpartum mothers to be able to detect, properly diagnose (i.e., being able to discern the differences between PPD, PP OCD and PPP), and properly treat these disorders. It would help if people realized baby blues typically ends by the second week postpartum.  Symptoms like insomnia, loss of appetite, and inability to smile and find enjoyment in anything beyond the first two weeks should be indicators that she needs to be examined for a PPMD.  If she already knows all this by receiving literature about PPMDs before she has her baby, she will more likely question the doctor if her gut is telling her she might have a PPMD.  The minimum that should happen–and is very feasible and not difficult to accomplish in the near-term–is for medical professionals who aren’t that knowledgeable about PPMDs to build an extensive network of referrals for those who specialize in the treatment of these disorders (e.g., certain doctors, psychiatrists, psychologists, etc.).  It should be mandatory for all OB/GYNs and hospitals to be able to refer patients to Postpartum Support International’s warmline for support and local referrals and resources.

2.  Most new mothers have certain expectations of what childbirth and motherhood will be like. When a new mother goes into childbirth not knowing what PPMDs are, what her risk factors are (if any), and what to do if she does become ill, she will basically– let’s face it– be blindsided if she does succumb to a PPMD. She will feel alone, ashamed, helpless, and frightened that she will never return to her old self again.

Solution: She wouldn’t feel this way if she had gone into childbirth already knowing that PPD is the #1 complication of childbirth. She wouldn’t feel ashamed that she isn’t glowing with blissful happiness day in and day out in the days and weeks following childbirth. She wouldn’t have to hide her suffering behind smiles and a well-groomed appearance, so that even the doctors who specialize in PPMD care won’t be able to diagnose her with a PPMD. All mothers-to-be should know that: 1) No woman who has just given birth is completely immune from developing a PPMD; with the right combination of risk factors–from genetic to environmental–any mother can develop a PPMD; 2) you can and should consult with your OB/GYN (if they’re not knowledgeable, ask for a referral and/or call your PSI state coordinator for a referral to someone who specializes in PPMDs) on your risk factors; and 3) measures to minimize the likelihood of developing a PPMD would include setting up a support network before you have your baby to allow you to get 5 hours of uninterrupted sleep a night. See my previous post on social support.

3.  Mothers suffering from a PPMD tend to feel ashamed for not being able to cope like all other mothers around them (not realizing that many around them may also be suffering in silence). As long as women continue to suffer in silence, there will continue to be a large number of untreated and misdiagnosed cases. They must realize that by doing so, not only do they suffer unnecessarily, they increase their recovery time as well (and perhaps even jeopardize their lives and their babies’ lives).

Solution: With consistent education and information made available to the public–not to mention brave PPD survivors telling their stories–mothers suffering from PPMDs will realize there is absolutely nothing to be ashamed of, they are not alone in their experience, PPD occurs in as many as one out of eight mothers, they shouldn’t wait to get the treatment they need to be well again, and not getting any treatment at all can have negative consequences for her, her baby and her partner.

4.  Literature about PPMDs isn’t consistently given/made available to all new mothers.

Solution: Information should be provided to all new mothers to educate them on PPMDs, so they can make informed decisions about their treatment options. Information should be made readily available through websites, books, magazines, media campaigns, television commercials, public service announcements, the Postpartum Support International (PSI) poster posted in OB/GYN offices/exam rooms and hospitals.  GPs, OB/GYNs and pediatricians should have material about PPMDs readily available for patients to take, like the PSI pamphlet “Postpartum Mood Disorders: What Every New Parent Should Know” or New Jersey’s pamphlet “Speak Up When You’re Down.”  All OB/GYNs should hand out info on PPMDs, including a list of symptoms and local and online resources, to all pregnant women. All hospitals where babies are born should provide departing new parents with information about PPMDs including symptoms, resources, and treatment options.  What needs to catch the attention and make people realize that PPD can happen to them are such eye-catching phrases like “The #1 complication of childbirth is depression” and “You may not think you can ever be depressed after having a baby, but the reality is ONE OUT OF EIGHT new moms has postpartum depression.”

5.  It is still not standard practice for all childbirth education classes offered through hospitals around the country to inform first-time parents of PPMDs.

Solution: All first-time parents should receive a “first-time parents primer” as a segment of the childbirth preparation and/or childcare classes to educate them about: 1) the wide range of physical and emotional changes that occurs during pregnancy and immediately after childbirth, including the differences between the baby blues and PPD, how to recognize their symptoms, and know when/how to get help; 2) how the brain (neurotransmitters), hormones, mood, stress and family history that are unique to each woman can cause PPMDs; 3) emphasis on the importance of emotional and practical support during the first 4-6 weeks postpartum to enable the new mother to get the rest she needs while she is recovering from childbirth and at her most vulnerable; and 4) keeping a real perspective on and managing expectations with regard to childbirth and motherhood. What I mean by keeping a real perspective on things is basically dropping all notions that you will be some kind of supermom. It is key for first-time parents to be aware that, as with anything else, the higher their expectations are–in this case, with respect to childbirth and childcare–the more they are setting themselves up for disappointment. For example, don’t set yourself up for a huge let-down by thinking that 1) taking care of a baby is a cinch since all a baby does is sleep, eat, pee and poop, 2) motherhood is instinctive, and 3) breastfeeding will come naturally (it’s not as simple as it may appear to be, at least for most first-time mothers it’s not). They should focus more on the variety of bumps in the road that have a tendency to pop up but were never really covered in any great detail in the typical childcare class, magazines or books. Real-life training on how to soothe a crying baby, how to cope with reflux and colic, how to identify and deal with eczema and cradle cap, how to deal with food allergies, and how and why moms should get 4-5 hours of uninterrupted sleep at night. A basic explanation of why newborns only sleep in short spurts for the first three months–i.e., due to neurological development–wouldn’t hurt. Some sources state that the infant’s immature neurological development may be behind colic as well. Knowing more about the why’s in infant development will leave less room for surprises and, ultimately, feelings of guilt when a mother can’t soothe her child.

On Monday, March 30, 2009 our Congressional leaders voted on behalf of America’s mothers by passing H. R. 20 the Melanie Blocker Stokes Mom’s Opportunity to Access Health, Education, Research and Support for Postpartum Depression Act of 2009.  Thank you, Congressman Rush for your years of dedication and support in the passage of this legislation! 

Click here to view the full statement read by Congressman Rush on the House floor.   Following is an excerpt:

“After eight long years, today marks an important step forward in the journey for Congress to fully recognize postpartum depression as a national women’s health priority…..No longer will postpartum depression be dismissed as mere ‘baby blues.’  There is no denying the fact that the need for resources to combat postpartum depression grows more and more each and every year……Of the new postpartum cases this year, less than 15 percent of mothers will receive treatment and even fewer will receive adequate treatment; however, with treatment over 90 percent of these mothers could overcome their depression.”

Now let’s keep our fingers crossed that the Senate will pass this bill!  Susan Stone is busy collecting the quickly growing list of names of individuals and organizations supporting this bill.   If you haven’t done so already, ask her to add you to the list by emailing her at susanstonelcsw@aol.com.  Please be sure to provide your Name, State, credentials (i.e., MD, PhD, LCSW, RN, etc.) and/or whether you are an advocate, a survivor, a mother, a concerned citizen, etc. 

I’m proud to see such a great show of support from my home state, New Jersey–the first state to pass legislation to require healthcare providers to screen new mothers for postpartum depression (in 2006).

Carol Stokes, mother of Melanie Blocker Stokes who took her own life eight years ago while suffering from postpartum psychosis, wrote a letter that appeared in the Chicago Sun Times on Monday, March 30th.   In it, she asks the question as to why legislators in the state of Illinois are so willing to turn a blind eye to mothers that suffer from postpartum mood disorders.  New Jersey passed its law in 2006 (one year after my own PPD experience) requiring healthcare providers to screen new mothers and provide information about postpartum mood disorders so they can recognize symptoms and know the risk factors.   In her letter, Carol asks what legislators in Illinois (and other states for that matter) have against passing a law  for healthcare providers to screen mothers for these disorders.   What do they have against educating the public?  Why do they want to see mothers continue to suffer, sometimes tragically, from these very real and very serious illnesses?

Knowing that legislators are standing in the way of such critical improvements to the treatment and understanding of very real illnesses such as PPD, postpartum psychosis and postpartum OCD should anger every woman in this country into action and sign the petition to urge legislators to once and for all pass the Melanie Blocker Stokes MOTHERS Act.  The bill requests funding for education, research, public awareness campaigns and programs supportive to mothers struggling with these disorders. It requests research into the potential benefits of screening.

An excerpt from Susan Dowd Stone’s blog (because I couldn’t say it any better):

“After 8 long years of a tireless battle that has yet to become federal law, Carol is angry. Hundreds of thousands of women and their families join her in the disbelief that our nation has not yet been moved to action. Our nation and most states are still without mandated strategies to combat these common illnesses. When one considers that some countries have recognized the devastation of these disorders legally since 1922 (England), how did the world’s most powerful and wealthy country allow these lethal disorders to stay under the radar for decades? Only New Jersey currently has a state law in place, thanks to the efforts of PPD survivor, advocate and Former NJ First Lady Mary Jo Codey.

The statistics are there and they are frightening. Up to 20% of mothers will experience a diagnosable pregnancy related mood disorder…that translates into 800,000 women this year if you use national stats on live births. But if you take the condition of pregnancy as the initiating vulnerability to these disorders, then it may be that the thousands of mothers who miscarry or whose babies are stillborn are also susceptible to these disorders.

For the mother, the effects of untreated postpartum mood disorders range from chronic disability to death. For the child, behavioral and learning disabilities can result when mothers cannot bond effectively with their infant.”

What can you do to help stop this ignorance and ludicrousness from continuing on for yet another year?  Show your support of the Melanie Blocker Stockes MOTHERS Act by doing the following:

1.   Sign the online petition (scroll down and enter your zip code in the bottom right of the screen), and

2.  Add your name to the list of those in your state who support the legislation

Join me and others on the Sounds of Silence Foundation’s 2nd annual run/walk to help raise funds in the effort to increase awareness of perinatal mood disorders, such as postpartum depression (PPD), postpartum OCD, and postpartum psychosis.   Not only is this for an excellent cause, it will be a nice opportunity to race (or walk) along the Atlantic Ocean.  And might I add that it’s meaningful, indeed, to have such an event on Mother’s Day weekend!

Date:  May 9, 2009

Time :  Registration from 8:30-9:15; race/walk begins at 9:30 AM

Place:  Jones Beach State Park, Wantagh, Long Island (Field 5)

Registration:  $25 Fee – you may either register for my team by clicking here, or clicking on the link above to register as an individual.

Donation:  If you can’t participate in person but would like to make a tax-deductible donation (and encourage others to do so as well), please feel free to do so by entering an amount in the Make a Contribution box in the center of my team page.  Proceeds from donations will benefit the Postpartum Resource Center of New York.

Lauren Hale interviewed me for her blog Unexpected Blessing.  You should really check out her blog, as it has a ton of great stuff.   In answer to her ten interview questions, I shed more light on who I am, what my PPD experience was like, why I am blogging, and why I’ve been writing a book (that I hope will be completed in the next few months).

Thanks, as always, for visiting my blog!

A state by state registry of all organizations, facilities, healthcare or mental health care practices, blogs, media, newsletters, consortia, women’s groups or community groups that support The Melanie Blocker Stokes MOTHERS Act is being maintained by former Postpartum Support International president, Susan Dowd Stone.   Click here to view the list. 

Thus far, the listing of national, non-profit supporters include such organizations as the American College of Nurse Midwives, American College of Obstetricians and Gynecologists, American Psychological Association,  American Psychiatric Association, Association of Maternal and Child Health Programs, Association of Women’s Health, Obstetric and Neonatal Nurses, Association of Women’s Health, Childbirth Connection, Children’s Defense Fund, March of Dimes, Melanie Blocker Stokes Foundation, National Organization for Women, National Partnership for Women and Families, and Suicide Prevention Action Network USA. 

To be added to this list, please send an email to susanstonelcsw@aol.com with the name of your entity and/or blog name and contact person.  The week of Mother’s Day, this listing will be sent to every legislator and maintained until the legislation is passed!  Needless to say, I am on this list as an advocate for fellow mothers.

Please, please….we must join together and make our voices be heard on behalf of mothers!  Don’t let certain misguided organizations or individuals try to scare you from signing the petition by insisting that the Melanie Blocker Stokes MOTHERS Act is merely a plot to force mothers to undergo screening, give up their rights to privacy, and take medications that would harm them and their babies.  Read what the legislation is about before you form any negative opinions.  Screening is critical–though it’s entirely up to the mother whether she wants to undergo it or not– as the earlier on a perinatal mood disorder is caught, the shorter the road to recovery, and the sooner the mother can enjoy and take care of her baby.  

Remember, knowledge is power.  Ignorance is NOT acceptable.   By helping mothers, we help their families as well.   A sick mother cannot take care of a baby.  A happy and healthy mother means a happy and healthy baby.  Perinatal mood disorders such as postpartum depression (PPD), postpartum OCD and postpartum psychosis don’t just affect mothers.  If left untreated, these disorders can have negative consequences on the whole family.  They can destroy marital relationships.  They can have a negative impact on the child’s cognitive and social development.

To sign the online petition, click here, scroll down and enter your zip code in the bottom right of the screen to automatically generate emails (or letters) of support for the MOTHERS Act to your Congressman, Senators and committee chairs.   It only takes a few seconds of your time, but it will be so well worth it!