Transformed by Postpartum Depression: A book review

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

 

photo (1)

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.

FFF Friday: “If I was anymore committed, I wouldn’t be here anymore.”

Today, I read through a Facebook debate about whether the pressure to breastfeed is negatively affecting the mental health of new moms, and then stumbled across a great post on the same topic. Kara’s story, below, pretty much sums up my own argument. As someone who has the honor of being “keeper” of these stories of yours – all of your heartbreaks and frustrations and disappointments – I can’t believe the connection between depression/anxiety and breastfeeding pressure isn’t obvious to everyone. But sadly, it’s not. And until our society starts taking responsibility and changes the way it treats new mothers, this is going to keep happening. This isn’t our faults, as moms, for being too sensitive. It isn’t a matter of not getting enough practical support for breastfeeding. The fault lies in how we are overloaded with overly-dramatic information, taught about ideals, and then thrust into a reality that ignores us, berates us, and belittles us. 

No woman should be feeling worthless or suicidal because of her breasts. For any reason. End of story.

Happy Friday, fearless ones,

The FFF

***

Kara’s Story

 

It’s hard for me to share my story, but I have been following this blog for a couple of months now, and I feel like there might be some healing that comes with getting it out, so here it goes.

I became pregnant with my son baby N at 30 years old, after almost 2 years of my husband and I trying to get pregnant.  Just three months before we found out we were pregnant, I lost my dad to a long battle with cancer, and so my joy of finally becoming pregnant, had a shadow of grief tinged in there at the knowledge that my son would never know his grandpa who would have just loved him to pieces!

My pregnancy was pretty normal for the most part in the beginning.  About half way through it I started spilling sugar in my urine tests so I spent the rest of my pregnancy stressed about Gestational Diabetes (not something I was ever actually diagnosed with, but constantly lectured about at every OB appointment from there on in).  During the first part of my third trimester I also started experiencing constant pain in my upper abdomen that increased and lasted throughout the rest of my pregnancy (thought to be caused from a previous abdominal surgery I had).  This pain was so terrible, that I had to be pulled from work 8 weeks early, which caused a lot of guilt on my part.

My due date came and went, and then another week came and went, and finally we were induced 11 days after my due date.  My son was born on day 12 (he must have been very cozy;).  He was a large baby 9lbs. 4 oz, and perfectly beautiful, healthy and just downright perfect!  Finally all of that pain, and the depression I was feeling throughout my pregnancy (which I’ve battled for years), and all the anxieties would fall away now that I had my perfect little man in my arms.  My husband and I felt like our life was complete.

Throughout my pregnancy I was convinced that I was going to breastfeed.  While I was never anti-formula (in fact I and all my siblings were formula fed, as well as my husband and his brother), I just felt that breast feeding was something I wanted to try.  The fact is I never thought it an option not to try really because it’s the “thing to do.”  I could only think of one friend I had who had chosen not to BF from the start, but every other mom I was surrounded by in my immediate life BF, so I guess it must be best, right?!

Once baby N was finally born, and we attempted out first latch, it was noticed immediately that he was not properly latching.  After about 5 minutes of trying, the lactation consultant told me that I had “flat nipples” and immediately handed me a nipple shield.  There was no further talk about how to eventually wean off the shield, or if I was to use it permanently, just “here you go.”  We saw 3 different lactation consultants in the hospital some were more helpful than others.  One (who was the most helpful in the amount of time she actually spent with us), put us on a schedule of breastfeeding every two hours (at least 15 minutes on each side), then pumping for 10 minutes on each side, then hand expressing as much as would come out.  Needless to say after this routine was completed I got about 10-15 minutes of sleep before I had to start all over again.  To say I was exhausted was an understatement.  On top of that I was in a great deal of pain from actually giving birth to my 9lb, 4oz baby (no c-section), which resulted in a 3rd degree tear and still needing an episiotomy.  Not to mention that pushing for two solid hours left me with hemhorroids the size of baseballs, and so the physical act of even sitting to nurse was extremely painful (all I was ever offered was ibuprofen and some useless numbing spray, b/c hey, I was nursing).

We finally left the hospital and went home.  The first couple of times I nursed baby N at home, it actually seemed to be successful.  He would latch on (with the nipple shield of course) and go to town, and he appeared to be satisfied when he was over (at least I thought so, as he would pass out hard afterwards).  Then around 6 pm the night we came home, he started to refuse to nurse at all.  There was nothing we could do to keep him awake long enough to eat, or get him to latch when he was awake.  By the time we had our pediatrician appointment the next day at 10 am, he had gone 16 hours without eating anything.  Needless to say he was lethargic and we were extremely concerned.

At the doctor’s we were told that baby N had lost 12% of his birth weight.  While he was a big baby, we and the doctor were all very concerned.  In that moment in the pediatrician’s office, I broke down and cried tears of shame and guilt for the fact that my son wasn’t getting what he needed, and of course it was all my fault! Our pediatrician was amazing and quickly said that he wanted us to supplement with formula and reiterated to us that I am not a bad mom and that we would get this worked out.  I want to note that our baby N’s doctor is a big breast feeding proponent, since I keep hearing women saying that we should just ignore the doctor when they suggest supplementing with formula b/c that will be the end of breast feeding.  Now I can say “sorry sister, but starving my kid is not an option, and the doctor has our child’s best interest at heart!”

Fast forward, or this will be your longest post in history!  So for the next couple of weeks we tried breast feeding and supplementing with formula.  This took a few different shapes, sometimes it was nursing with the evil nipple shield, and sometimes it was pumping a bottle and doing it that way.  Eventually we did seek the consult of a lactation specialist who came to our house.  She was extremely nice, non-judmental and gave us some helpful hints and advice.  As a result I continued to try to nurse baby N for another week or so using the nipple shield.

As time went on, each nursing session would get increasingly frustrating for both baby N and I.  As a big baby, and impatient feeder, baby N was not getting milk quick enough once we started nursing (not due to let down, mine was pretty good actually, but due to having to use the shield).  So for almost every nursing session we spent at least the first 5-10 minutes (on each side) with him screaming, kicking, and clawing at my breast.  I was extremely sleep deprived, depressed, and frustrated, and a week later I finally said enough is enough, no more nursing. I had tried to reach out to the lactation consultant we met with to discuss getting my son off the shield, but she insisted my son was tongue-tied, to which his pediatrician examined him and said no he was not.  When I further discussed this with her, the only advice she could give was to go have his tongue clipped, which my husband and I were not feeling comfortable with, especially b/c I knew that if we went down that route, then I could never give up on nursing if it wasn’t working b/c I would feel I had to commit after cutting my sons tongue! I decided that I was going to exclusively pump breast milk and just supplement with formula when I needed to.

Well for anyone who has tried exclusive pumping, you know it is not an easy thing to do.  I would pretty much pump for 20 minutes, feed my son what I pumped, supplement another bottle with formula, then desperately get him to try to fall asleep so that I could start pumping again for his next feeding.  Let’s just say mommy and baby bonding was starting to become non-existent and I was becoming a slave to this machine (which felt like some degrading torture device to me, and has anyone else heard their pump talk to them?  Mine definitely did!).

I knew that I had to return to work after 6 weeks b/c I was pulled so early, a longer maternity leave was not an option for us.  I quickly became despaired as to how I was going to continue this crazy pumping schedule, and work full-time, and actually get to spend any quality time with my son, who was spending a lot more time awake as he got older and really wanted my attention (and I desperately wanted to give it).  I knew at this point that I had started to slip down the path of post-partum depression.  I was not surprised as depression and anxiety are something I’ve struggled with since I was a teenager.

At about week 4 of my sons life, I was walking down the basement stairs with a load of laundry in my hands.  Our stairs are kind of steep and narrow, and I lost my footing briefly and almost tumbled down.  I was able to quickly catch myself on the railing, but the very first thought that popped into my head was “stupid, you should have just let yourself fall.”  That moment was a very big wake up call to me in how bad my depression was getting.  Now don’t get me wrong, I have a great life, a wonderful husband, and I am head over heals in love with my son.  I don’t relish the idea of leaving them, however I was at a point where I personally felt like such a failure as a mom (all because I couldn’t make nursing work or give him only breast milk), that I was starting to convince myself that they would both be much better without me.

It was a terrible time, and I knew that something needed to change or the question wouldn’t any longer be how my son was fed, but who was going to be around to feed him.  I started to realize that my “commitment/dedication” to giving him breast milk had become such an obsession and idol in my life, that I was allowing it to not only defeat me, but cause me to doubt whether or not I was the best mother for my son.  I can say now, when people question my “commitment” to breast feeding, that if I was anymore committed, I wouldn’t be here anymore.  I really connected with the post you shared on here, it was a letter from a husband whose wife had committed suicide due to post-partum depression, and she has also had significant struggles with breastfeeding.  She ultimately laid down on the train tracks and took her own life.  My heart broke reading that story, and yet I could completely understand those feelings.

A week before I returned to work, I wrote my husband a letter pleading with him to allow me to stop breast feeding.  Please don’t get the wrong impression, he was not in any way shaming, forcing, or guilting me into doing it.  Any encouragement he ever gave was because he truly wanted to be supportive of me being successful, and shared that common “breast is best” feeling that I had had as well.  He really is amazing and only wants the best for our family.  Once I shared what I was feeling with him, he immediately told me to stop, and that I was a good mother and we did not need to keep trying to provide breast milk to baby N.  At this point, his formula to breast milk ratio was tipping higher on the formula side anyways, so really it started to feel like a lost cause.

Since the day I decided to stop pumping and just switched baby N to exclusive formula, there has been a huge weight lifted off of my shoulders.  I will not say that I haven’t struggled with the decision.  Like a lot of other women on here, I have gone, and sometimes continue to go through, feelings of shame when I pull out that bottle of formula in front of other people, especially my breast feeding friends (who have all really been nothing but supportive of me).  I hope to eventually get to a place where I truly feel no regrets, shame or guilt over making the best decision I could have for my son (and I truly did do what was best for him, I decided to give him a mom who will hopefully be around long enough to see him grow up and nurture him in ALL of the ways required by a parent, not just what I feed him).

People have asked me if I am going to try to breast feed with my second child (if we are blessed with one), and right now I really don’t know the answer to that.  I’m still too close to the situation (my son is only 13 weeks), to be able to feel positive about trying again.  But I didn’t smash my pump in the yard with a hammer, or throw it in the creek behind our house like I wanted to so many times, just in case I do want to try again.  I do know, that if I decide not to try it, or even if I do, I will be much more confident in my decisions and know that whatever happens I really do truly have my child’s best interests at heart, and no other person on the planet is qualified to tell me what that is!

My true desire is that someday no woman will have to feel so lost and desperate over what she chooses to feed her child.  There are so many aspects to being a parent, and what you feed you kid is such a small one in the grand scheme of things.  At the end of every visit to the pediatrician, baby N’s doctor always says “love him, grow him, keep him safe.”  What words of wisdom!

 

***

Share your story: Email me at formulafeeders@gmail.com

Why The World is So Screwed Up About Breastfeeding Research, In Several Paragraphs & A Few Headlines

The headlines:

“Study: Breastfeeding can ward off postpartum depression” (Press TV)

“Breastfeeding mothers less likely to get postnatal depression” (The Independent)

“Breastfeeding ‘helps prevent postnatal depression’” (ITV)

“Breastfeeding could help prevent postnatal depression, says Cambridge researchers” (Cambridge News

“Breastfeeding ‘cuts depression risk’, according to study” (BBC

“Failing to breastfeed may double risk of depression in mothers: study” (Telegraph)

“Mothers who breastfeed are 50% less likely to suffer postnatal depression” (The Independent)

“Mothers who choose not to breastfeed are ‘twice as likely to get postnatal depression because they miss out on mood-boosting hormones released by the process’” (Daily Mail, UK)

“Breastfeeding Keep Mothers Happy and Reduces Postnatal Depression” (International Business Times)

“Breastfeeding moms have lower depression risk” (Health Care Professionals Network)

“Breastfeeding protects mothers from postnatal depression, study finds” (The Australian)

 

And the reality:

New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions.

Borra C, Iacovou M, Sevilla A.

Abstract

This study aimed to identify the causal effect of breastfeeding on postpartum depression (PPD), using data on mothers from a British survey, the Avon Longitudinal Study of Parents and Children. Multivariate linear and logistic regressions were performed to investigate the effects of breastfeeding on mothers’ mental health measured at 8 weeks, 8, 21 and 32 months postpartum. The estimated effect of breastfeeding on PPD differed according to whether women had planned to breastfeed their babies, and by whether they had shown signs of depression during pregnancy. For mothers who were not depressed during pregnancy, the lowest risk of PPD was found among women who had planned to breastfeed, and who had actually breastfed their babies, while the highest risk was found among women who had planned to breastfeed and had not gone on to breastfeed. We conclude that the effect of breastfeeding on maternal depression is extremely heterogeneous, being mediated both by breastfeeding intentions during pregnancy and by mothers’ mental health during pregnancy. Our results underline the importance of providing expert breastfeeding support to women who want to breastfeed; but also, of providing compassionate support for women who had intended to breastfeed, but who find themselves unable to.

In other words, women who wanted to breastfeed and did = low risk of PPD. Women who wanted to breastfeed and couldn’t = high risk of PPD. The researchers stress “providing compassionate support for women who had intended to breastfeed but…found themselves unable to”.

This does not prove that breastfeeding cuts depression risk. It proves that women who had a goal and met it tend to have lower rates of depression. It does not prove that there is a biological reason that breastfeeding may be protective against depression. That may indeed be the case, but then the depression risk would have been similarly high in women who never intended to breastfeed.

Our societal confirmation bias is so damn strong, that we blatantly overlook the finding that suggests something potentially negative about breastfeeding promotion. But here’s something to ponder: while we can’t force insufficient glandular tissue to produce adequate milk, or force women to breastfeed who don’t want to, we CAN ensure that every mother gets support in her feeding journey. We CAN listen to research that suggests the pressure to breastfeed is contributing to feelings of guilt, shame, and judgment – a potent trifecta of emotions for those prone to depression – and do something about it. If we are going to take this one study as “truth”, as so many parenting-related studies are mistakenly interpreted, something good might as well come out of it.

At this point, there is a pretty clear correlation between not breastfeeding and PPD. Instead of using this as ammunition against formula use, we could be asking the tougher questions: Why are women who don’t breastfeed more depressed? If it is something biological, wouldn’t the rates of PPD have been skyrocketing in past generation where breastfeeding was rare? If we stop making breastfeeding seem like the only-best-right choice to raise a happy, healthy child, would it mitigate this risk?

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

One of my favorite quotes about research comes from the Nobel-prize winning scientist who discovered the importance of vitamin C, Albert Szent-Gyorgyi: “Research is to see what everybody else has seen, and to think what nobody else has thought.” These days, the reverse seems to be true – research is to confirm what everybody else has seen, and everybody has already thought. This needs to change, and it won’t, as long as our society and media turns even the most interesting findings into self-confirming soundbytes.

 

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.

 

 

An open letter to Chris Bingley: Your wife deserved better.

This is an open letter to Chris Bingley in honor of his wife, Joe Bingley, whom he lost to severe postpartum depression. 

Dear Chris,

I read about your beautiful wife Joe’s battle with postpartum depression, and I wanted to say… oh hell, I don’t know what to say. Because I’m afraid my anger about what happened to your wife will just feed your grief, and that is the last thing I’d ever want to do.

I write about the pressure to breastfeed, and what it is doing to women, and I hear stories every day that mirror what Joe went through. Women who suffer from a growing desperation, an inner knowledge that something isn’t right, even when everyone around them is willing it to be so; even when everyone around them is telling them it will all be okay if they just get some sleep, get some help around the house, or get over the “hump” of the baby blues.

And these women – more often than not – are seen by an array of healthcare professionals as they try to dig themselves out of this tunnel. The stories I hear have a common refrain – all they cared about was if the baby was breastfeeding. I came second. And all I heard was that breastfeeding was the most important thing a mother can do for her child and I was failing at that. This was my refrain, 5 years ago. I sang it and sang it until someone listened, until thousands of other women answered it with a song of their own. And our collective voices are rising, growing stronger by the day, shouting our song, screaming that we deserve more, that Joe deserved more, and that we will. Not. Let. This. Happen. Again.

PPD is a strange and mysterious beast; it’s not always tamed easily, and it feeds on different aspects of different people. For some, breastfeeding is a lifeline, the one thing they can do “right”. For others, it is the sandbag strapped to them as they are already sinking. But the problem is not breastfeeding. The problems is that we are so focused on breastfeeding that all of resources and energy are going to this one aspect of postnatal care – that we have forgotten that the mother’s mental and physical health should come first. I know most people will think that is a terrible thing to say – because doesn’t the baby’s physical and emotional health matter? But what they are forgetting is that a mother’s mental and physical health can afford to be a priority because there are other options to ensure the physical and emotional needs of the baby. Formula or donor milk can suffice. A father’s loving embrace, or a grandmother’s or aunt’s or uncle’s, can fulfill all needs until a mother is well. We are lucky to live in a time where moms can get well without sacrificing their babies’ well being.

But we are unlucky to live in a time where people are unwilling to see things this way.

Joe should have been helped. The professionals who she encountered should have looked at her face rather than her breasts. They should have seen she was sinking; they should have insisted that either a lifeline be thrown or a sandbag removed. There should have been protocols in place for her prenatal, delivery and postnatal care so that she was   screened for and treated for PPD. There should not have been so much pressure put on her to breastfeed; she should have been told that all that mattered was her health and happiness, and that her breastmilk or lack thereof had nothing to do with her worth as a person or as a mother.

I didn’t know Joe. I wish I’d had a chance to. I wish she could be one of the voices in our choir of healing and hope. That she could yell with us and demand better of our governments, our healthcare providers, and our society, so that no woman would be left to drown; so that no woman would ever have to sing that stupid refrain again.

Because I’m sick of the same old song. And I’m sure Joe would be, too.

Sending love from across the pond,

Suzanne Barston, aka The Fearless Formula Feeder

Related Posts Plugin for WordPress, Blogger...