Transformed by Postpartum Depression: A book review

“We need both medicine and mothers to create the future of maternal mental health.” – Walker Karrraa, PhD

 

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It’s no secret that I’m a survivor of postpartum depression. It’s something I talk about a lot, and it informs everything I do with FFF.  There is an obvious correlation between breastfeeding and postpartum mental health; whether this connection is positive or negative is a highly subjective, personal, individual matter. I see so many blanket statements, based on problematic data collection, and leaps of logic when it comes to this topic. No one ever stops to listen to the mothers who don’t fit their particular thesis. And while the topic of maternal mental health has slowly been gaining proper attention in both the media and research communities, as usual, the most important voices have been ignored: the voices of the mothers who have lived through PPD, and lived to tell the tale.

Thanks to Walker Karraa, PhD, these voices are now being heard. In her new book, Transformed by Postpartum Depression (Praeclarus Press, 2014) she reports on her own analysis and research as well as that of other pioneers/thought leaders in the maternal mental health field. But throughout, she allows the words of her subjects tell the story. And it’s an important story – one that not only highlights Karraa’s thesis, that PPD can be both traumatic and transformative, but also details how we are failing mothers at every turn. This is something that’s been discussed, even here on this blog, but Karraa’s delivery of the information is profoundly moving and startling because it is so specific, personal, and honest.

Using her interviews with 20 different women, all of whom survived moderate to severe PPD, Karraa examines the experience of postpartum depression. But this isn’t some clinical, cold volume that treats its subjects like research – the care and admiration Karraa has for her subjects is clear throughout the text. It’s a unique book; one that I believe will be just as helpful to moms as it is to mental health professionals and academics.

I think the FFF Friday series is powerful for many reasons, but the one that feels most vital to me is this: for every specific, personal story I share, there are hundreds of moms out there who see themselves in the words. These experiences are individual, but also collective, and sharing them helps both the writer (catharsis) and the reader (relief/camaradarie/normalization). Karraa’s book serves this purpose for the postpartum depression community. That would be enough – but she goes a step farther, pondering complex questions about how we approach the pathology of depression, and even analyzing her own reactions to her research. The result is something entirely unique, engaging, and important.

One section that deserves national attention – like, yesterday – is Karraa’s chapter on the failure of care providers to help these women. Her interviewees report harrowing tales of begging for help, only to be cruelly dismissed, ignored, or ridiculed. Nearly all reported a complete lack of forewarning that PPD was even a possibility, in prenatal classes and OB/GYN appointments – even when they had past histories of mental illness. Lactation consultants failed to see what breastfeeding was doing to a mother’s mental health; pediatricians told mothers their suicidal thoughts were “normal”; therapists refused to help or refer to others who could. These mothers were forced to take matters into their own hands, as Karraa describes:

As I analyzed this data, images of the walking wounded came to mind – as if these women were hemorrhaging – in public – and no one noticed… To walk through daily life dying and being ignored by care providers, and invisible to support systems was crazy-making and cruel. There was almost a punitive sense of the experience of care-provider failure – an additional layer of humiliation, indignity, and negligence…women got pragmatic; if their providers were not going to fix the problem, they would do it themselves.”

Of course, this could be viewed as a silver lining, in the American, pull-yourself-up-by-the-bootstraps sort of way. But that is not what Karraa is advocating. It’s inspiring to see how these women overcame adversity, but infuriating that they had to do it alone. I hope that this book will act as the missing link – a close-up on the face of postpartum depression, a healing volume for those who have been through this particular battle, and a call to action for our society to make immediate changes in how we approach postpartum mental health.

Common Bonds: The challenge of nurturing friendships in the early days of motherhood

When I was first trying to get pregnant, I suffered a few early miscarriages. Going through that particular kind of hell actually had a silver lining: it led me to join an online “support” message board on a popular baby site, something I probably never would’ve done otherwise. But I didn’t have any close friends who’d gone through pregnancy loss, and there was something intensely comforting about turning on the computer at any time of day and finding at least one virtual “friend” at the ready, available to commiserate and connect.

This group of ours became inseparable, and over the course of a year, we bonded through fertility treatments, pregnancy scares, and subsequent, unfair, heartbreaking multiple losses.

And then, we started having babies.

And this group, which had been so strong despite our geographical, religious, political, ethnic and socioeconomic differences, did begin to splinter, but just a tiny bit. Comments tinged in tentative judgment about birthing choices, small digs about things someone would “never” do or questions met with not-so-hidden sanctimony. Things were changing, and it was hard to watch, but  overall, we were still miles above the typical mommy-chatroom behavior norm.

When I started having trouble breastfeeding, I immediately turned to this crew for help. I expected some judgment, especially as I’d started seeing so much friction in the group. But oddly, magically, there was NONE. There was only support. These friends of mine – women whose voices I’d never even heard, or whose eyes I’d only seen in photographs – reassured me, counseled me, implored me to do what was best not only for my child, but also for myself.

Meanwhile, I couldn’t find the same degree of support in real life. Wasn’t it supposed to be the other way around? Wasn’t the World Wild Web supposed to be the cesspool, teeming with anonymous, heartless trolls, whereas the “IRL” people were grounded in the humanity forced on us by feeling someone’s breath on our skin, having their eyes meet ours?

I’ve thought a lot about this over the years… why our group was immune to the usual mommy war bullshit. I don’t think it was because we were better or kinder or more highly evolved – I’ve seen the same group disintegrate over political arguments and anti-vaccination threads on Facebook, 6 years after our merry band of miscarrying misfits had formed. No, I think our immunity had more to do with us starting out so different from one another. Unlike most friendships, we didn’t have a lot of common ground. For the most part, we only had one thing in common: grief. The rest of it never mattered. We had perspective.

Perspective, in my opinion, is what destroys friendships. Or rather, the lack of perspective is what destroys friendships. Especially when your friendship faces the hurdle of parenthood. As new mothers, we are all floundering, trying to find our way through thickets of thorny branches. Go to far to the right, you get pricked. Lean too far to the left, you get pricked. Either way, you’re going to bleed. Our friends should be there, but often they aren’t in the woods with us at all, and from their vantage point, the forest looks picturesque and cheery. If there’s someone by your side, swaying in the same direction into the same thorns, you can hold each other steady. But someone who leans in a different direction might pull you too far, topple you over. It’s easier to let go of her hand and find your way through the woods alone.

When I was struggling with breastfeeding, my friends who didn’t have kids yet couldn’t understand why I was so obsessed with what did (or didn’t) go into my baby’s mouth. Others, child-free friends who thought they “knew” how important breastfeeding was, understood why I was thinking about these things, but acted confused when I grew sensitive at their intellectual discussions about human milk. (For them, it wasn’t visceral, it wasn’t personal, it was just what they’d read in Time magazine. For me, it was my nipples, my body, my baby.) My breastfeeding friends couldn’t understand what I was going through, assuming my struggles paralleled theirs, and if they could push through, why couldn’t I?

They couldn’t understand.

But here’s the secret: they didn’t have to.

Friendship isn’t about commiseration. It’s about empathy. You don’t have to have walked through the same thorny thicket, you just have to show up with band-aids and beer.

There are many friendship theories about how like-attracts-like, and I worry that this is never more true than during the mothering period of a woman’s life. Not only do we find it hard to connect with friends who don’t have kids, but we find it hard to connect with women who have kids but parent them differently. That’s normal, I suppose; there’s a human tendency to want to validate ourselves through other people’s choices, and an innate desire to see ourselves reflected in our friends’ eyes. When we seek out new mom-friends, of course we will gravitate towards women who can relate to our everyday experience, and whose discipline, feeding, and parenting styles are close to our own.

It’s so easy to forget, in those poop-stained, exhausting, dizzy days of baby and toddlerhood, that we are more than mothers. We are sisters, aunts, daughters, employees, poets, musicians, writers, readers, dancers, athletes. We are multifaceted. Yet the part of ourselves that takes utmost priority when it comes to nurturing and developing friendships is the part that gave birth. Why can’t we connect with a woman who feeds and diapers her child differently, when three years ago we would’ve bonded quickly and powerfully over a mutual love of Ani DiFranco? Maybe it’s hard to feel close with a former friend who is formula feeding, when you’re struggling so hard to breastfeed because you feel it’s the most important thing you can do for your child – but why can’t you step back and celebrate what you do have in common?

This potent mix of hormones, hopes, fear and ambivalence – this thing we call motherhood – can create amazing friendships. It can also destroy amazing friendships.

I’m pondering all of this, because I am honored to have an essay in a new collection of stories about female friendships, which is available for purchase now. It’s called “My Other Ex: Women’s True Stories of Loving and Losing Friends”, and it’s part of the phenomenal HerStories Project, spearheaded by Jessica Smock and Stephanie Sprenger. Not all the stories in it are about motherhood, but many are, and nearly all focus on times of transition. Each and every story is heartbreaking in its own way, but for me, the ones about motherhood provoked a powerful sense of frustration and sadness. Because it doesn’t have to be this way. These things that divide us don’t need to do so, but they do. They almost always do. Fear, judgment, resentment, pain – emotions that should be mitigated by friendship, but are instead exacerbated by it.

 

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So tell me, FFFs – did you lose friends during your transition to motherhood? Did you patch them up later? Do you have “another ex”?

 

Elisabeth Badinter steps into the breastfeeding minefield

There’s an interesting discussion going on right now on Slate.com between two major players on the breastfeeding landscape. Hannah Rosin (whom, in the interest of self-disclosure, I personally worship as a writer and social critic) and Katie Allison Granju, one of the world’s leading lactivist voices, are in a heated debate over Elisabeth Badinter’s new book, “The Conflict.” And it is one hell of a conversation, from two very smart, and very different women.

For those of you not familiar with Badinter, she’s a French feminist who claims that “modern motherhood undermines the status of women”. She argues that we have become slaves to our infants; that we are all obsessively striving to be perfect mothers, which has come to mean “natural” mothers. She does not take too kindly to attachment parenting practices like co-sleeping, med-free birth, and mandatory, exclusive breastfeeding.

I haven’t read the book yet (because that would require several hours of free time, which if I were lucky enough to have, I would rather spend watching Teen Mom and yelling at the television) but I have read practically every interview Badinter has given since her book was announced. I understand her point of view. I do not agree with all of what she says; I think she’s rather extreme and judgmental in ways which only serve to put down other people’s choices, when the goal should be ending society’s free-for-all on mother blaming. But I do agree with what she says about breastfeeding in this recent interview with the Washington Post:

“I am not criticizing breast-feeding, only the duty to breast-feed. Even if there were more substantial “public and institutional support” to help women breast-feed, that wouldn’t change the fact that not all women necessarily want to breast-feed. And those women must be free to bottle-feed without being bullied with the idea that they are bad mothers.”

Anyway, love her or hate her, she’s certainly causing a stir. Unfortunately, any truths that she is revealing are being obscured by her too-heavy hand; she’s putting people on the defensive, and as we all know on this blog, that tends to lead to a big fat FAIL. I’m not sure Badinter cares, and I envy this about her; she isn’t trying to make friends, but rather present her theories and, let’s face it, sell books. More power to her – we need more opposing voices to counter the current trends in parenting culture. I don’t need to agree with her to appreciate that she is taking on the myths of motherhood which torment so many of us.

Some people are not so appreciative of Badinter, though. Granju has gone back and forth with Hannah Rosin (who thought the book had valid points, many of which she has made in her own writing) in a series of published exchanges, the last of which included this paragraph:

As for Badinter’s views on breast-feeding, I think that it’s important to note that her position on this issue is ethically suspect from the get-go. Elisabeth Badinter isn’t simply an incendiary and stylish French feminist theorist. She also personally holds controlling interest in Publicis, one of the world’s most powerful and profitable PR and advertising firms. As it happens, Publicis is the agency of record for Nestlé , the huge multinational corporation that makes and sells a wide variety of infant formula products all over the globe, and which is arguably best known for its lengthy and ongoing history of flagrant violations of the World Health Organization’s International Code of Marketing of Breastmilk Substitutes. Considering that Badinter styles herself as an honest-to-God academic—a serious one with serious credentials—it’s troubling, to say the least, that she doesn’t seem to feel the need to proactively disclose the obvious conflicts posed by her millions in income from Nestlé ’s PR firm.

And there it is. The ubiquitous and inevitable Big Formula accusation. Hannah’s no stranger to it. Mitt Romney’s gotten it. Add to that list Rebecca Goldin, Joan Wolf, Dr. Alan Greene. Basically anyone who has ever dared to question the “breastfeeding at all costs” mentality. Now, in this case, Badinter probably does hold an interest in Publicis. And they probably do deal with Nestle. But for all we know, this could mean that her agency represents Nestle Chocolate. I don’t know how much Granju knows about advertising and PR, but from my cursory knowledge having been the “talent” (and being married to someone who works with a lot of these companies) it is very common for one agency to have one segment of a large corporation as a client, but not another. So for example, P&G might use J. Walter Thompson for Pampers commercials, but another company for cleaning supplies. 
I’m not going to go into a long schpiel defending Badinter’s corporate affiliations, though, because even if she were actively working on the Nestle account, unless the sales revenue from her book was going to fund Nestle formula advertising directly, it shouldn’t be relevant. Someone who is a big fan of WHO Code is not going to work with formula companies, so it stands to reason that someone with her viewpoints wouldn’t think twice about taking money from Nestle. One thing has absolutely nothing to do with the other. She is an academic who wrote a book; she also happens to have some sort of financial involvement with a PR firm who works in some capacity with a company which has a formula division (albeit one that has done some horrible things to sell formula). She’s got a diversified portfolio, if you will. Why does this make her position “ethically suspect”? Is Granju’s opinion ethically suspect because she wrote a book on Attachment Parenting? Doesn’t the trend to favor attachment parenting as the “best” way serve her financial interests? 
Do we all see how ridiculous this is? 
Dismissing people’s opinions on breastfeeding as part of some capitalist conspiracy only serves to cheapen your argument. Granju makes some excellent points in her dialogue with Rosin, but this one passage makes her look like she’s grasping at straws. She also goes on to say that if breastfeeding pressure were so intense, then our breastfeeding rates would be higher:

…if American women are, in fact, being subjected to crushing, guilt-inducing nursing shame, it doesn’t appear to be working too well. While breast-feeding rates in the U.S. have edged up overall in recent years, and are indeed crazy high in certain highly specific subpopulations of American women (Park Slope-dwellers, residents of Portlandia), the overall breast-feeding numbers in the United States tell a quite different story…Given that, by the numbers, not very many American women at all seem to be “enslaved” by breast-feeding in the way Badinter claims, how is it that breast-feeding is “undermining our status”?

… which is another common argument against the breastfeeding pressure backlash which Rosin herself inspired. This response lacks nuance: women can feel pressured and still fail at breastfeeding. In fact, I’d say that the pressure, the “all or nothing” attitude, is exactly what contributes to our high initiation/ low continuation problem. This blog is proof – if women who formula fed didn’t desperately want to breastfeed, and didn’t feel that breastfeeding was tied up with their own ideas of “perfect motherhood’, then Badinter wouldn’t be selling books, Hannah Rosin wouldn’t be a folk hero, and this blog wouldn’t need to exist. 
What do you think, fearless ones? Do Badinter’s views on breastfeeding resonate with you? Do you relate more to what Rosin is saying, or Granju? And humor me – do you live somewhere other than Park Slope or Portlandia? 

Book Review: “Milkshake” serves up a sweet, frothy satire of the breast/bottle battle

For the past two years, I’ve spent a lot of time reading about breastfeeding. A lot of time. And while I (obviously) find the subject infinitely interesting, I’ve started missing my guiltiest of guilty pleasures: reading “chick-lit”.

Luckily for me, a book has come along that merges my professional interests with my penchant for witty, engaging stories with female protagonists. A book – wait for it – about the breastfeeding “wars”. One that pokes fun, equally, at La Leche League regulars and bloggers like me.

Milkshake, a new book by Boston Globe columnist Joanna Weiss, is a satirical take on the extreme sport of motherhood. We meet its heroine, Lauren, when she’s a day or two post-partum, still at the hospital, and taking the requisite “baby care” class (where the prominent message is that formula is comparable to crack).


….Lauren looked down at her own breasts…and thought about what breastfeeding was going to entail. She was dreading the moments when she had to provide love in a liquid form, but her fear was no match for the power of guilt. She had read the pamphlets listing the vast health benefits of breastmilk. She had watched her friend Mia shake her head and murmur, “That poor child,” when she saw mothers bottle-feeding on the banks of Jamaica Pond. She had seen the government-sponsored pro-breastfeeding ads: a dirty factory labeled “INFANT FORMULA INC.”; a baby crying in a metal bassinet; the tagline, “Breastmilk. For mommies who care.”

Lauren is committed to breastfeeding, and luckily doesn’t face any major roadblocks. But like any new mom, it takes time for her and her daughter Rory to get a rhythm going, and public breastfeeding proves challenging. When Lauren accidentally flashes a group of high school boys while attempting to nurse in the middle of the art museum, she finds herself the unwitting symbol of the breastfeeding-in-public debate; a pawn of a power-hungry politician, and the poster child for BOOB (Boston Organization for the Oversight of Breastfeeding).

On the other side of the ensuing media circus is Claire Langoon, who runs the blog “www.hurtslikeabitch.com.” I’m not sure if Weiss was at all aware of this blog when she wrote the book, but I definitely related to Claire as a far hipper version of myself, with a different slant to her message – she sounds more like a younger, American version of Elizabeth Badinter – but the same bottom-line intent: to bring moderation to the discussion. Claire argues that switching from breast to formula allowed her to feel truly free; that the pressure to breastfeed is just another way to bring women down.

Lauren is struggling with the transition to motherhood, and isn’t quite sure where she fits in. Although she’s being paraded around town as a breastfeeding role model, she finds herself questioning the more extremist views of those surrounding her. When her best frenemy Mia, a Type-A sanctimommy, aggressively confronts a woman buying formula in the grocery store, Lauren balks. She asks Mia how she could do such a thing:

“All that is necessary for evil to prevail is for good people to do nothing,” Mia replied.

“That woman isn’t evil,” Lauren said. “Maybe she has a problem with her breasts, or—I don’t know. What does it matter to you?”

“It matters because it’s a slippery slope,” Mia said. “You really need to talk to Sheila about this. One of the things we have to do is stigmatize formula, so that it becomes socially unacceptable. So people are ashamed. Smoking used to look cool, you know, but now it just makes you look like a skank.”

“Smoking actually kills you,” Lauren said.

“That just gave me an idea,” Mia said, suddenly sounding less agitated. “They should put a warning label on this stuff. ‘Surgeon General’s Warning: This product makes you a bad mother.’”

One of the things I’ve noticed about the large-scale conversation about breastfeeding is that there is a shocking absence of humor, pathos, and humility on the part of most of those involved. It’s a shame, because we could probably get farther in discussions on the subject if we realized how ridiculous we all sound some of the time. Milkshake highlights some of the very real, very serious issues pertaining to the breast versus bottle debate, but in a way that feels more like a sitcom than a sociology class.

Weiss has chosen to e-publish her book, so right now it’s only available for download through Amazon and Barnes and Noble. For the sake of those of us without Kindles or Nooks (I know, I know, I’m a luddite… but I love the smell of a book. Sue me…), I hope some smart publisher will pick this up and make it a trade paperback. It’s far better than most of the mommy-centric chicklit out there, and while I worry that saying this will belittle the entertainment factor of the book, it is also an insightful take on the breast/bottle issue; one that urges moderation and understanding.

Read this book while you’re in the middle of nursing a cluster-feeding 6-week old; read it while you pump; read it while you formula feed. Just read it, because no matter how you’re feeding your baby, you’ll laugh at yourself. And god knows, we could all stand to do a little more of that.

Why statistics are like sexy bad boys

I’ve been thinking a lot about statistics and studies lately. I can thank Rebecca Goldin and Polly Palumbo for this, since reading their work has taught me to look at numbers and research with a more critical eye.

Case in point: a good friend texted me early in the week about the latest study linking sunscreen use to cancer. There were many exclamation points and frowny-faces in the text, as well as a link to a foreboding article about the study. This one had scared her. Granted, she literally bathes her toddler in SPF 50, but what can you do? We live in sunny LA. It’s practically child abuse not to carry California Baby Sunscreen with you at all times. Anyway, before I even glanced at the article which had spooked her so, I knew what the real story would be. Correlation. Here’s two immediate theories:

1. People who wear high-level sunscreen might have a false sense of security about their time in the sun. Maybe they don’t reapply as often as they should.

2. Very possibly, these are same people who have a higher risk of skin cancer due to family history. Why else would you spend the money (and forgo that guilt-free “breakthrough tan” possible with the lower SPFs) on SPF 50 or higher?

I wasn’t completely correct in my assumptions; there was talk of the Vitamin A in the sunscreen speeding up UV exposure, and some concern that other chemicals used in these lotion could actually cause cancer (one report I heard from our local Fox affiliate suggested that the only people who might want to heed this warning is parents of kids under 2; their skin might be more susceptible to these chemicals). But many of the doctors interviewed in the media fallout from this study did refer to similar correlation theories. Like so many of these media-touted studies, it’s imperative for us to think critically about what we hear, and not jump to the same doomsday conclusions as our media brethren.

What does all of this have to do with formula feeding? A lot, I think. When I read breastfeeding/formula studies, I don’t go into it wanting to disprove the superiority of breastmilk; to the contrary, I think that anytime Mother Nature kicks technology’s ass, it’s pretty darn cool. But I do want to separate truth from overblown claims; to see the reality in the science, the human face behind the statistics.

Statistics are like sexy bad boys. They can be thrillingly dangerous, and look so promising – if you can just tweak them a bit to make them into a better version of themselves. They make an impression. But they mislead; they can be all gloss and no substance. Sometimes, there’s a wonderful heart under a rough exterior; not all bad boys are truly bad. You just need to go into the relationship with your eyes open, and realize that there might be more than they are showing you at first.

Like I said: it’s about reading the studies critically.

Which is why I was so thrilled to find Joel Best’s book, Damned Lies and Statistics: Untangling Numbers from the Media, Politicans, and Activists (University of California Press, 2001). It’s a few years old, but remains as topical as ever. Consider it required reading for all FFFs. I promise you, it’s not your father’s statistics book. It’s funny, acerbic, and easy enough for someone who dropped out of math junior year in high school (ahem, moi) to understand. Don’t believe me? You can read the introduction here. If you don’t love it, you can write me and tell me to shove it. Pinky swear.

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