WNYMoms-P.P.D.

Unexpected Expectations

2008-02-08T09:58:00.000-05:00

I took the test one night. It was positive. I stared at the two pink lines on the Find Out If You Are Pregnant in 90 Seconds stick in shock, amazement, disbelief, and excitement. We are expecting, I told my husband, who proceeded to stare blankly at the T.V. for the next three hours, speechless. The moment that you realize you are expecting a baby is beyond comprehension.

In a flash, a woman is expecting. But, after baby is born, there are expectations. Many women find themselves in the position of being expected to be mom, expected to be wife, expected to be homemaker, expected to be full time employee, and for some, expected to be caregiver for aging parents. Suddenly, dreams of expecting have become expectations to be all, for all, at all times. Where do these expectations come from? And more importantly, how do you manage them?

Although men are now blessed with the freedom to be stay-at-home dads, the overwhelming trend in society continue to find women in the expected role of taking extended time off from her career to care for little ones. While some moms find this to be extremely rewarding and can not imagine any other purpose in life, other moms find this to be isolating and depressing, leading to guilt feelings because she would prefer to work rather than stay at home. But, even if she goes back to work, her paycheck would wind up going toward daycare expenses anyway, so isn’t it better to just tough it out and stay at home with baby?

For many families, the luxury of having a stay-at-home parent is not an option as two incomes are needed to make ends meet. Women in these situations may find pressure from family members, her partner, and from herself to maintain high standards as homemaker, child care provider and full-time employee. Working moms may feel guilt for not spending as much time with her children as she would like because of work- related expectations.

With both parents working, both parents return home, with children in tote, exhausted. Now, the daunting marathon of 20-minute well-balanced meal preparation, quick play baths, bedtime stories, tucking in, oh, and quality playtime to band-aid the guilt of leaving the children in daycare all day, occurs within a two-hour time frame. When the whirlwind finally dies down, many women are expected to then do the dishes and laundry, prepare book bags and lunches, and other household chores. Commonly, the husband or other partner is reading or watching TV. For some families, no thought goes into this. It is tradition, it is the female role. It is just what happens. Now, it is true that men of younger generations tend to be more inclined than older generations to contribute to household management, but for many families, it is still expected for the mom to take care of these activities.

A common theme in each of these situations is the feeling of guilt. Guilt that somehow we have not been available to our children so they will now need counseling later, guilt that we have not been available to our husbands or partners, guilt that we have only produced five outstanding projects at work this year instead of the customary ten, guilt that our parents are aging and we have not spent enough time with them or giving back to them they way that we would like to. This guilt is the product of not being able to meet expectations that no human being could possibly meet.

So, how do moms change these patterns? Improving this situation is three-fold: redefine unrealistic expectations into realistic and achievable expectations; setting appropriate boundaries with family, friends, and work; and expecting and requesting assistance from those around us.

First, each mom needs to evaluate her personal values and expectations as a mom and other life-roles. You may even want to write them down. What does it mean to be a good mom? What do I want to achieve as a mom? As a wife? As an employee? Am I the type of person who can be a stay-at-home mom, or am I more work-oriented. Try to avoid all judgment related to your responses. There is no right or wrong. Each woman has been created with different preferences, perspectives, experiences, talents, personalities, etc. The problems arise when you try to be something that you are not because you think that is what you are supposed to be.

Consider your personal values and expectations list. Try to redefine your values and expectations as behaviors. Identify behaviors that need to be done daily, those that need to be done weekly, monthly, or annually. Are your daily behaviors achievable? Do you feel overwhelmed by looking at your list? Are there some things that are more important than others? Keep working on your list until you feel comfortable with what you are expecting of yourself daily.

Next, review your list with your significant other. Discuss the pressures that you have, and explain why you have prioritized some values on your list over others. Ask your partner to discuss with you the expectations he places on himself as a father, in his other life-roles, and the expectations that he relies on you to meet. Through your conversation, work on the list so that you are both clear on what you are realistically able to accomplish, what you will be expecting your partner to do, and the importance of respecting each others roles. Try not to get discouraged if your partner does not understand why you are doing this or is not supportive. Explain what you are doing and why it is important for you to do.

Then do it. Set your boundaries and stick to them. If you are able to take care of yourself, you tend to be better able to take care of your children and partners needs. An excellent book that may assist you is, Boundaries: When To Say Yes, When To Say No, To Take Control of Your Life, by Drs. Henry Cloud and John Townsend.

Postpartum Depression Treatments

2008-01-18T13:30:00.000-05:00

Over the past twenty years, PPD treatment options have been studied medically and psychosocially. Several different types of counseling strategies have been implemented to improve PPD symptoms for women including short-term/long-term individual counseling, group counseling and support groups. Each type of counseling has been shown to improve women’s experience of postpartum depression. It is up to each woman to determine the best care for her as well as the care that is available in her area.

The most ideal treatment is called dyadic group counseling. In this setting, women receive group counseling while her baby enjoys contact with other babies in a group setting. Then, the women are paired with her child for group counseling together. In this way, the interaction between mom and baby are observed and treatment can focus on mom’s ability to pick up on baby’s cues.

Although counseling is the best first option for care, the most popular treatment is anti-depressant medication. Although long-term effects on the baby are undetermined at this time, it is generally supported to continue antidepressant treatment when a woman has been taking medication prior to pregnancy in order to prevent in increase in symptoms during and following pregnancy. Once the baby has been born, the woman may continue on the same antidepressant while breastfeeding as babies have already been exposed to the anti-depressant.

Other options for care are inpatient hospitalization or psychiatric day treatment programs. In these settings women are closely observed, given medications to decrease her symptoms and may or may not be permitted to spend time with her baby, depending on the severity of symptoms.

Some women would prefer to stay at home, but due need additional assistance. For these women, home care may be an option. The benefits of home care visitation from nurses, midwives, and healthy visitors has been extensively researched in Australia and European countries where home visits are a government service provided to all women postpartum. Home visits have been successful in assessing, diagnosing and intervening when women show symptoms of PPD.

Several non-traditional methods to treat PPD have been researched with success in reducing symptoms. These include omega-3 fatty acid supplementation, xion-gui-tiao-yin herbal supplementation, massage therapy, exercise, and light exposure therapy. As with any treatment, only try these methods under the direction of a trained professional.

For information on services in your area, contact the Postpartum Depression Resource Center of New York at www.postpartumny.org or call (631) 422-2255.

Request NYS Senators to Support New Postpartum Depression Bill

2007-11-05T12:42:00.000-05:00

A couple of weeks ago the full US House of Representatives passed HR 20, the Melanie Blocker Stokes Depression Research and Care Act, with support from a coalition of elected officials, nonprofit organizations and grassroots community activists.

The Bill now goes to the US Senate for approval. Please write to New York State Senators to request their support of this Bill.

Senator Charles Schumer
http://schumer.senate.gov/SchumerWebsit/contact/webform.cfm

Senator Hillary Clinton
http://clinton.senate.gov/contact/webform.cfm?subj=issue

Introduced in the House by Congressman Bobby Rush [D-IL] and strongly backed by organizations including the American Psychological Association (APA) www.psych.org/, Postpartum Support International (PSI) www.postpartum.net/ and the Suicide Prevention Action Network www.spanusa.org/, the bill was first introduced in 2001 after the tragic death of Chicago mother Melanie Blocker Stokes www.melaniesbattle.org/.

By passing HR 20, Congress, and our nation, will finally put significant money and attention into research, screening, treatment, and education for mothers suffering and surviving this serious, debilitating, and often life-threatening disease.

For more on the Passage of th Bill passage from PSI and Rep. Rushs office, go to http://www.postpartum.net/legislative-updates.html

What are postpartum mood disorders?

2007-10-18T10:44:00.000-04:00

There is much inconsistency pertaining to an actual diagnostic definition of postpartum depression (PPD). However, there tends to be consensus about the following symptoms: depressed mood, exhaustion, irritability, tearfulness, diminished energy/motivation, feeling helpless/hopeless, decreased desire to have sex, appetite and sleep disturbances (WHO, 2003). Physical symptoms have also been cited such as headache, asthma, backache, and abdominal pain (WHO, 2003). The Diagnostic Statistical Manual of Mental Disorders-IV (DSM-IV-TR) requires that Major Depressive Disorder criteria must be met within four weeks after delivery (APA, 2000).
Types of PPD

Many times, PPD is used as an umbrella term to describe any mental health symptoms during or following pregnancy. Professionals are beginning to recognize a spectrum of depression and anxiety that is experienced during pregnancy and up to one year postpartum (Austin, 2004). Within this spectrum are several mental health conditions, one of which is classic postpartum depression. Below is a list of the spectrum of recognized postpartum mental health conditions and their symptoms.

Postpartum Mental Health Conditions
Baby Blues: Sadness/crying. mood swings. decreased sleep. anxiety lack of independence and attentiveness, and feeling vulnerable. 50%-80% of women experience these symptoms up to to ten days post delivery.
(AMP, 1999; Seyfried & Marcus, 2003)

Postpartum Depression: Anxiety, short temper, hopelessness, lack of interest in baby or in general, decreased appetite, lessened level of concentration/focus, felling of guilt, depressed mood, lack of or too much sleep. 10%-22% of women experience these symtpoms two weeks or longer after delivery. 50%-80% of women who had PPD before will have it again with future pregnancies.
5%-14% of women with PPD will have thoughts to harm herself
(AFP, 1999; Josefsson, Berg, Nordin, & Sydsjo, 2001; Lindahl, Pearson, & Colpe, 2005; OHara, Neunaber, & Zekoski, 1984; Seyfried & Marcus, 2003)

Postpartum Panic: Severe anxiety, hot/cold flashes, impatience, shortness of breath, increased worrying/fears, heart palpitations, sweating, and trembling. In one study, 11% of women experienced panic attacks postpartum. 35% of women how have a diagnosis of panic disorder prior to pregnancy will experience and increase in panic symptoms postpartum.
(Cohen, Sichel, Dimmock, & Rosenbaum, 1994; Wenzel, Gorman, O’Hara, & Stuart, 2001)

Postpartum Obsessive-Compulsive Disorder: Intrusive thoughts of hurting baby, repetitive behaviors (ie: checking on the baby, counting, cleaning). thoughts of hurting self and fear of imminent disaster. 3%-5% of women will experienc postpartum obsessive-compulsive disorder. Women have an increased risk of developing obsessive-compulsive disorder during the postpartum period more than any other time in womens lives.
(Brandes, Soares, & Cohen, 2004; Neziroglu, Anemone, & Yaryaura-Tobias, 1992; Wenzel, Gorman, OHara, & Stuart, 2001).

Postpartum Psychosis: Hallucinations, thoughts of killing the baby, disorientation, denial, loss of touch with reality, paranoia and hyperactivity. One to two in every 1,000 women will experience postpartum psychosis. These women have a 5% chance of committing suicide and a 4% chance of infanticide. There is some evidence that links postpartum psychosis to pre-existing manic episode(s).
(Brockington, Cernick, Schofield, Downing, et al., 1981; Kendell, Chalmers, & Platz, 1987; Seyfried & Marcus, 2003)

As the list above indicates, 50% to 80% of women will experience the Baby Blues which is often the result of dramatic hormonal changes immediately following birth of the baby (George & Sandler, 1982; Hamilton & Sichel, 1992). Between 10% - 15% of women will have the Baby Blues for longer than ten days and her symptoms will become more intense, more frequent and begin to include other symptoms such as short temper, feeling hopeless, and lack of interest in the baby among others. This is more characteristic of PPD.

Just as there is a myriad of mood disorders in general, there is a range of mood disorders postpartum including postpartum obsessive-compulsive disorder, and postpartum psychosis. While the occurrence of these disorders postpartum is rarer than the Baby Blues and PPD, the risks to the baby as a result of these conditions tend to become more severe, with the highest percentage of infanticide occurring when the woman is suffering with postpartum psychosis.

Often overlooked, postpartum anxiety disorders may occur more often than PPD (Wenzel, Haugen, Jackson, & Brendle, 2005). The frequency of postpartum generalized anxiety disorder (GAD) is more prevalent than GAD rates in the general population (Wenzel et al., 2005) and may also occur concomitantly to depression symptoms with 10%-50% of women who with PPD also experiencing anxiety (Perfetti, Clark, & Fillmore, 2004).

If you or a loved one suspect that you are experiencing a postpartum mood disorder it is important that you seek out professional assistance as soon as possible. If you are not sure where to go or who to contact for assistance, you can try the Postpartum Resource Center of New York at http://www.postpartumny.org/ or email me.

This information was obtained from Zittel-Palamara, K., Needle, T., & Rockmaker, J. R. (2007). Postpartum training manual. Funded by a CDHS Training Grant.

2007-10-03T09:15:00.000-04:00

Did you know?

Up to 80% of moms feel sad, anxious, vulnerable, cry more frequently and experience mood swings up to ten days after having a baby?
About one in eight moms will continue to feel this way two weeks or longer after delivery?
Additional symptoms may surface including a short temper, feelings of hopelessness, lack of interest in or overly concerned with the baby, changes in appetite, and difficulty concentrating?
When moms do not seek help for these experiences there is a 50% chance that she will continue to feel this way one year after giving birth?

Approximately 2,000 moms in Western New York will experience postpartum depression each year. These moms do not need to suffer in silence. However, most moms will not discuss her thoughts or feelings with professionals, family members or friends. Sometimes this is due to moms not knowing that what she has been experiencing is postpartum depression, other times it is because she does not know what to do or is afraid to tell someone.

To address these issues, I will be writing a four part series discussing postpartum depression as well as other postpartum mood conditions. The first part in this series will help moms to identify symptoms of postpartum mood changes. The second part will provide information on how to address symptoms with medical and mental health professionals, spiritual directors/counselors, and with family members. Part three will suggest different self-help strategies and a family plan, and part four will suggest ways to advocate for moms postpartum needs in the community.

If there are other postpartum mood-related questions or areas that you would like more information about, please feel free to write in and ask.

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2007-10-02T15:20:00.001-04:00

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