Vital Signs: Ignoring postpartum depression and psychosis won’t make them go away

Another horror story. Another mom. Three beautiful girls who will never have another birthday, whose last memory will be terror at the hands of the person they trusted the most.

I don’t know the details. I don’t really want to know the details. I do know that this mother reached out, told her own mom she was “feeling crazy”. I do know that she had three babies in a row, and that the youngest was 2 months. I do know that there’s a strong chance that this was the result of postpartum psychosis.

And I know that this has got to stop.

Can we protect every family, prevent every case? Of course not. But postpartum mental health is taking a backseat when it should be sitting shotgun to every maternal and child health program. That’s a start, at least. We spend so much time worrying about a woman’s breasts, while we dismiss her mind. We worry about how hormones and birth practices affect lactation, while we disregard how they affect our emotions.

After we give birth, we are whisked off to the maternity ward. Our vital signs are monitored, but other vital signs are ignored. A mom who can’t seem to connect with her baby. Who is scared, and asking for help. Who is alone and voiceless. Her pulse may be steady, but her hands shake. Her breasts may leak colostrum, but her eyes may leak silent tears. And we ignore this.

GE-Healthcare-Dash-2500-v4-Vital-Signs-Monitor

OB/GYNs don’t see mothers until 4-6 weeks postpartum. In some cases, that will be too late.

Pediatricians see moms with their newborns several days postpartum, but they are focused on the infant. As they should be. We don’t expect a heart surgeon to be concerned with the diabetic foot of his cardiac patient’s wife.

When I see the role of lactation consultants and breastfeeding counselors growing, gaining more attention, more insurance coverage, I also see an opportunity. What if these professionals could be trained to screen for postpartum mental health issues, if they could recognize red flags and know how to refer families to the proper resources? What if they were trained to support families in their feeding journeys, with the goal being a happy, healthy family and not just a breastfeeding statistic?

With the state of our health care system, I don’t expect that an entirely new support staff can be instilled at every hospital, for the sole purpose of protecting maternal mental health. But when 1 in 7 mothers suffer from postpartum depression or anxiety, I think that constitutes just as much of a public health concern as the supposed risks of “sub-optimal breastfeeding practices” in developed countries. If we are going to focus so heavily on breastfeeding, could we at least give a little simultaneous attention to a mom’s mood while we inspect her breasts?

What happened to the Coronado family is sub-optimal. What passes as “support” for postpartum women is sub-optimal. There is no reason we can’t support breastfeeding while prioritizing maternal mental health. Both are important, but one has been systematically ignored, shoved under piles of paperwork, given lip service. We only seem to worry about postpartum depression in terms of how it affects breastfeeding “success”. There are so many things wrong with that sentence, with that mentality. It’s like worrying about prostate cancer only in terms of how it will affect sex and procreation. Biological norms are important, but support also means protecting those whose biology turns on them.

If we can only speak of maternal needs under the umbrella of lactation support, I can live with that. As long as those needs are met, I can live with that. As long as those needs are being met, maybe we can all live with that.

Survive with that.

Thrive with that.

 

 

“Where is the mother in the discussion?” An interview with Walker Karraa on maternal mental health and infant feeding

Some of you may know Walker Karraa from her comments on our Facebook community page, or from her fantastic posts on Science & Sensibility. But I doubt you’re aware of the full magnitude of her bravery and dedication to issues surrounding maternal mental health. I recently interviewed Walker for a short piece on formula feeding and postpartum adjustment, and was so blown away by her answers – I was only able to use a few of her wise words due to word count constraints, so I’m thrilled she’s agreed to let me post the interview in full here on FFF.

Walker is a doctoral candidate at Sofia University, where she is conducting a study on the transformational dimensions of postpartum depression. She was also the founding President of PATTCh, an organization founded by Penny Simkin dedicated to the prevention and treatment of traumatic childbirth, and is a perinatal mental health contributor for Lamaze International’s Science and Sensibility, Giving Birth With Confidence, and the American College of Nurse-Midwives (ACNM) Midwives Connection. Like that wasn’t enough on her plate, Walker also served as social media manager for the Integral Leadership Review, and has her own social media consulting business, On My High Horse, and is currently working toward co-authoring a book regarding PTSD following childbirth with Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA. 

I’m exhausted just reporting all of that. And did I mention she has two kids and is a breast cancer survivor? Yeah, she’s all that and a bag of reduced fat potato chips.

I hope you guys will appreciate the revolutionary nature of Walker’s discussion here – her opinions, while brilliant, probably seem uncontroversial to those who follow this blog, but they are quite “rogue” in the birth/maternal-child health community. I can’t thank her enough for being a dissenting voice and speaking up for the benefit of all women. 

FFF: Here on FFF, we see stories almost weekly which discuss how a perceived “failure” to breastfeed can lead to depression, anxiety, and self-esteem issues. Do you think the maternal mental health community has recognized how breastfeeding (or lack thereof) can affect the emotional state of new moms?

Walker Karraa

WK: I think that overall breastfeeding is very well addressed in the health psychology, and developmental psychology fields. What’s lacking is the reframe of the research to integrate more qualitative data, and methods, into the consideration of the full range of implications of breastfeeding from multiple perspectives—including the woman’s perspective.

In a 1985 Lancet article on maternal mortality, Allen Rosenfield asked the famous question, “Where is the ‘M’ in MCH (Maternal Child Health)? In the discussions of MCH, it is commonly assumed that what is good for the child is good for the mother.” (Rosenfield & Maine, 1985, p. 83). In many ways this is relevant in the discussion of breastfeeding and maternal mental health. Where is the mother in the discussion? And in what ways do we still assume what is good for the child is good for the mother? For me, this is all about reproductive rights and a deeper issue about our discomfort with women’s sovereignty over their reproductive, physical, and mental health.

The mental health community has responded to the growth in published data regarding infant health and breastfeeding. This has also been the funding stream for a large part of the last 20 years. But maternal mental health has yet to directly address a woman’s infant feeding choice as a part of her reproductive choice, rather than discrete periods of time that occur with as a continuum of events that are inextricably woven through reproductive events—none of which, taken by themselves, gives either the best data on mental health.

FFF: What do you feel needs to change in order for new mothers to be better supported in terms of mental health in general?

WK: I think one of the first calls to action must be for maternal care providers to get support in knowing that perinatal mood and anxiety disorders are common and create the conditions for morbidity and mortality for mother and children. This is starting to happen, but still very slow. I think new models of medical care such as Dr. Michael C Lu’s life course model, which places the woman at the center of care, not the doctor. And, she is treated across the lifespan, not merely when she is pregnant. This facilitates better reproductive health in preconception and interconception, and uses a reproductive life plan for women and families from an early age. At puberty, to have a conversation with medical, nutritional, mental health providers as to planning one’s reproduction (girls and boys) would be ideal.

FFF: Many women struggle with the decision of whether to treat postpartum or prenatal depression/anxiety with psycho-pharmaceuticals, especially when they are breastfeeding. Why is there such mixed information and messaging about what drugs are safe, and what the relative risks are (ie, breastfeeding without meds vs breastfeeding on meds vs formula feeding and taking the meds)?

WK: Not having good information is a barrier to care for everyone involved. The OB/GYN or midwife, the social worker, the woman, her partner and family—when we don’t have good information, we cannot make informed choices. And for women in poverty, the risk is twofold. Specifically regarding breastfeeding, but also education across the board regarding psychopharmacology, pregnancy, and lactation. With organizations such as OTIS (Organization of Teratology Information Specialists) and Motherisk, there really is no excuse for not having current evidence-based data regarding risk and benefit of untreated depression and anxiety, as well as risks and benefits of medications used to treat them.

Byatt et al. (2012) did a wonderful grounded theory study regarding community mental health provider reluctance to providing psycho-pharmacotherapy. 28 obstetric care providers (nurses, OB/Gyns, etc.) shared how they perceive community mental health practitioners as obstacles to psychopharmacology for perinatal women. The participants felt community mental health providers “99% of the time” discontinued a patients’ medication, and put women at risk of relapse. Secondly, Byatt et al., (2012) reported that participants perceived a lack of collaboration and communication between community mental health care providers and OB/Gyn providers, and that pharmacists also “further impede or delay depression treatment by not filling needed psychotropic prescriptions, often exacerbating women’s mental health symptoms” (p. 3).

FFF: Why do you think so many women express grief, guilt, and feelings of failure around the subject of infant feeding?

WK: Because that is their experience! And I attribute all of it to social constructs that are completely ingrained in medical, social, and mental health systems that have been made for and by men. The intentions of those men is not necessarily nefarious, and not really the point. It is that the constructs we have to measure ourselves (abilities and weaknesses) are made by men. We tell women from the get-go that they need us to be good mothers. They need our insight, knowledge, treatment, book, video, technique, services, product to be taught how to mother. This is so ironic, because so many of the birth movements have evolved from a call to empower women. But to empower, we have just made more systems of knowledge that mimic the ones we refute. That is not very popular to say, but it is true. The messages still given to women is that if they “know” something analytically, they are devoid of femininity, and if they “know” something inter-subjectively, they are devoid of ration.

Shame is a powerful force for women. And at no time in her life is a woman more susceptible to shame than early motherhood. If they are lucky enough to find a safe space to share their feelings without judgment, such as your blog, they are given the gift of voice. They can speak their truths.

FFF: Any tips for a mom who is having a tough time reconciling her use of formula?

WK: You know, when I was a doula, I had clients ask me to go buy formula for them so they wouldn’t be seen in public. When I was diagnosed with breast cancer shortly after the birth of my second, I underwent two mastectomies before she had turned one. I learned that my body parts have nothing to do with my inherent ability to love her. My breasts were gone—off of my body, one in one hospital and another at a hospital down the road. I fed, nurtured, attached with, loved, and parented without them…and still do! So my advice is to write down on a piece of paper: My breasts have nothing to do with my love for my child. And keep it where you can see it. Memorize it, know it.

FFF Friday: “The last people who should be against you are your fellow moms.”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.

I haven’t posted this week, because it has been a rough one for me and my family. A few days ago, we had to say an unexpected goodbye to our beloved dog. I don’t usually bring up my personal life on this blog, unless it has to do directly with infant feeding, but in a weird way I do associate Fearless Pup with my struggle to breastfeed. While in the midst of my postpartum depression, and trying desperately to feed FC, my only refuge was when I retreated to the bedroom to pump every 90 minutes. Fearless Pup would trail after me, jump up on the bed alongside my hospital-grade Medela, and lick my tears away as I cried. He was the only creature that was able to reach me when I was so entrenched in the hell that is PPD. He was there through those dark days with his soulful brown eyes looking up at me, willing me to get through this, to heal, to do whatever it would take to swim back to shore. He was my furry lifejacket, and I honestly don’t know how I would have made it through those first few months without him.

Anyway – this has nothing to do with the following post by Erin, but I wanted to share this memory with you because to me, it is the iconic image of my postpartum depression. Erin’s story is wonderful on many levels – I love her positive response to the “mommy wars”. But I think the most important aspect of her submission is that she associates her postpartum mood disorder with breastfeeding. I’ve said it before and I will say it as many times as I have to: breastfeeding is a different experience for different women. While studies may show that for some women, breastfeeding keeps the PPD and postpartum anxiety demons at bay, for others of us it can be a major trigger. And unfortunately, not everyone has a furry lifejacket to help them crawl back to safety.

Happy Friday, fearless ones…

The FFF

*****

Erin’s Story

I am 30 years old and just had my 2nd child, a boy 2 months ago.  I have a daughter who will be 3 in August.  When I was pregnant with her, I was one of those people who thought I would breastfeed with no problem.  I didn’t buy a single bottle.  I talked endlessly about breastfeeding with my friends and even found myself tempted to belittle someone on a website who said they didn’t plan to breastfeed at all.  How could they?  Didn’t they KNOW how much better it is for their baby?  Well I knew and I had every intention of feeding her for one solid year.

My baby was born and it was the best day of my life.  I couldn’t wait to feed her!  She tried to latch on and couldn’t without a shield.  This began the downfall of my breastfeeding experience.  By the time I left the hospital, not only my nipples, but every part of my breast that was sucked into the shield was cracked and bleeding.  My daughter cried at every feeding and never seemed full.  I kept at it, determined that I would make it work.  At her first check up she was 5 oz under weight her birth weight.  At her two week check up she was still 4 oz under her birth weight.  My nipples hurt so badly that I would sob when I fed her.  I dreaded each and every feeding.  That’s about when the postpartum depression/anxiety set in.  I have never experienced anything so intense in my life.  I felt like I was going insane.  I couldn’t concentrate, worried about everything, couldn’t sleep, lost interest in my baby and my family and my entire life.  I cried all the time.  I wished I could go check myself into the hospital.  And it all centered around the fact that I did NOT want to breastfeed but was too ashamed and stubborn to admit it.  After her 2 week check up, the doctor told me to pump my fore milk out and start her out with the hind milk, then feed her the bottle of fore milk.  So I did.  And that was the last time my daughter EVER latched onto me.  She got a bottle in her mouth and never went back.  She loved drinking from a bottle because she could actually drink!  And she wasn’t drinking my blood.  I started pumping and thought I would just try pumping as long as I could.  But my postpartum issues were taking over my life.  I would pump one feeding and couldn’t at the next.  I was a mess.  I went on an anti-depressant/anti-anxiety pill and it helped tremendously.  I remember reading recently that breastfeeding helps with postpartum depression.  For me, it was the cause of it.  And I don’t buy that information because when I was having so many issues and called my OB doctor, the first question out of her mouth was “are you breastfeeding?”  Apparently she’s seen this before!

I remember calling a Le Leche League representative that someone gave me a phone number for.  I told her my problems and her first question was “did you HAVE to have an epidural?”  I said “Um, I gladly received one!”  She said, “Well epidurals cause babies to stay drowsy and not very alert for weeks and makes it hard to breastfeed.”  At that point I dismissed her as a complete idiot and said “thanks for your time.”  That night my husband and mom sat with me while I cried and both advised me to just quit.  My husband did a lot of research on breastfeeding and determined that the risks did not outweigh the benefits in our case.  I went to formula that night and NEVER went back.  I felt horrible guilt and judgement, mostly self inflicted, but deep inside I felt relief.  I finally bonded with my baby girl.  I started to fall in love with her and started to love motherhood.  I put the pump away and let my breasts return to their normal selves :)

With my son, I attempted breastfeeding again but went into it with a totally different attitude.  I didn’t assume it would work, I just thought I would see how I felt and if it worked it worked, if it didn’t, it didn’t.  He latched on like a champ and I fed him solid for 2 weeks.  Unfortunately I dealt with the same postpartum anxiety again.  I apparently am very sensitive to hormonal changes in my body.  After a near kidney infection, a back injury, and my anxiety at an all time high, I made the same decision to not breastfeed.  And I immediately began to heal once I made that choice.  My mind started to ease, I was able to take the medication I needed for my infection, my back, and my anxiety that I couldn’t take while nursing.  I felt better.

For me, breastfeeding is directly in correlation with my anxiety and both times I have not felt better until I totally quit.  I can let myself feel like a failure, or I can realize that this is so small in the scheme of things.  It is a tiny insignificant part of what makes me a good Mama.  I adore my children.  I stay home with them, I spend all of my time with them, and I love motherhood.  I take hundreds of pictures every week of my kids.  When they go to bed at night, I watch the videos that I took of them that day and cry because they are growing up too fast.  I miss them while they nap.  They are beautiful, healthy, smart, perfect.  No part of me thinks I did them a disservice by not breastfeeding them for longer.  I do not regret it.

My husband who was not breastfed an ounce and is 6ft 6 inches and a college athlete likes to make the joke that if only he had been breastfed maybe he wouldn’t be so small and weak :)   I think about all the moms in my life that I love.  Whether or not they breastfed isn’t something that comes to mind when I consider how they are as a mother.  My own mother who I truly believe is one of the most selfless people on earth did not breastfeed any of her kids for much time, or at all. It does not matter.  What matters is your heart, your love for your kids, and your commitment to family. There is a lot more to this life than whether your babies drank out of your boobs.  I have so many friends who breastfeed and I support them wholeheartedly.  And they support me.  The only thing I ever ask of them is not to pity me because it didn’t work out.  I adore feeding my baby a bottle, it’s wonderful!

Whatever you’re story may be, the last people who should be against you are your fellow moms.  It is our own insecurities that cause these “mommy wars” to begin with.  I support moms who love their babies.  Whatever your methods or reasons for each little decision, if those choices are made in love, they are the right ones.

 *****

You know what would really cheer me up? A great FFF Friday submission. Send one over to formulafeeders@gmail.com. 

FFF Friday: “Losing my sanity was not something I could afford…”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.




Wow. After my plea for entries last week, I got a slew of incredible stories delivered to my inbox. (In related news: You guys ROCK.) One of these amazing submissions was Chelsea Allen’s. I always appreciate hearing stories about the psychological impediments to breastfeeding, because these are as real and valid as the physical ones – and seldom understood. Body-image issues, anxiety disorders, PPD… all of these things can be that proverbial straw that breaks the breastfeeding camel’s back (a breastfeeding camel. Now THAT would be a cool sight…). The more these stories are shared, the less alone the next mother who is suffering through something similar will feel. I’m humbled by Chelsea’s willingness to share her very raw feelings with me, and with all of us.

Happy Friday, fearless ones.

- The FFF

***

I have two little boys. With my oldest, I never tried to breastfeed him because I had huge fears of nursing him in public because of my weight and breast size. I had some major self esteem issues going on with my body and just didn’t want to torture myself. When I got pregnant with my second born, I decided I would try to get over those fears and breastfeed him because well…breast is best right? I educated myself very thoroughly. Went to classes about breastfeeding, read and read about it, how to latch the baby properly etc etc. When it finally came time to nurse my baby, I demanded he be brought to me immediately so I could have the skin to skin contact that was so important and try to latch him. He flat out refused! So I tried again a little bit later and finally I got him on with the help of the nurses. He nursed for a good 20 minutes, which the nurses said was wonderful. However, I was a nervous wreck! I suffer from extreme anxiety anyways but when he was nursing I was having a hard time breathing, I became covered in sweat, my heart started racing and I just…I dunno I was shaking very badly. I pushed it aside though and tried to continue nursing him. While I was in the hospital, I had the nurses in there every time it was feeding time to help support and encourage me because I literally had these anxiety attacks every time it was horrible!

When we got home the anxiety attacks only got stronger. I was by myself without the nurses and had an older child the required attention at well. My anxiety was through the roof, even when I wasn’t nursing him. What didn’t help was that he was literally wanting to nurse every half hour, for a good 25 minutes each time. Getting comfortable was also impossible, which stressed me out even more and because I was stressed, my son was too. He cried and screamed and would get so upset he wouldn’t latch for the longest time. I went through five days of this and it was turning me into a monster, towards my significant other and other little one. I began to resent my baby, didn’t feel like I was bonding with him at all. My significant other finally was like, Chelsea, you need to just give him the bottle. Put him on formula, he said. I felt like the biggest failure. Yet, the moment when I gave him that bottle it was like…a whole new world for us. It felt like the sun was finally shining. After having anxiety attacks like I was, I was finally able to relax and just enjoy my baby. I suffered from a bad case of PPD though and it was a struggle for me to get back on my feet, and still to this day I struggle with it (although its under control).

If I ever have baby number three, I will never ever try to breastfeed again. It was one of the worst experiences of my life and I will never put myself or my baby through that again. When I tell people my story, they have a hard time believing it. Saying awful things like “You should have just dealt with it instead of giving up.” Yea maybe I should but I had another child to worry about and losing my sanity was not something I could afford to lose. And resenting my baby was also the worse feeling ever. I wanted to love and bond with him, not look at him with disgust and resentment.

It’s taken me several months to get over my failure and now I don’t let those people get me down. I made the best choice for my baby and myself.

***


Inspired to share your story? Good, then. Send it along to formulafeeders@gmail.com.

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