If all that comes back normal, doublecheck your birth control!  Yes, your birth control. (hormones…)

Perhaps you’ve given birth and have decided not to rely on breastfeeding as your birth control, or you’re not nursing, or you’re done.  You start birth control.  Soon after (days later, or maybe longer), you start to feel moody, angry and other things that might be seen as “PPD”.

Or maybe you already were diagnosed with postpartum something, already on medication and were feeling okay, but recently? ….not so much.  Did you just start birth control?  One of my cyber axe-murderer ppd friends started the bc patch.  A few days later she felt like she was wigging out.  She thought it might be her patch, so she removed it.  …just as quickly as she started feeling ”off”, she was as quickly back to where she’d been.  Feeling pretty good again.  “On” again.

The usual suspects are apparently the progesterone-only types of birth control.  The mini-pill, the patch (Ortho Evra), Implanon, the Mirena IUD, Depo-Provera (“the shot”).

At least with the patch you can take it off.  The mini-pill you can stop taking.  But “the shot” has to wear off, in 12 to 14 potentially miserable weeks.  Removing the Implanon or Mirena is something your doctor would do. 

Some of these don’t mention depression as a potential side effect.  “Your mileage may vary,” meaning, just because depression is listed as a potential side effect doesn’t mean it will effect you.  Or if depression isn’t listed, it doesn’t mean the birth control isn’t doing something that has you feeling depressed.  It might be doing it anyway, regardless of what the patient information sheet says.

Bottom line is, you know yourself and your body best.  Listen closely.  Then talk with your doctor.

Chances are, when someone mentions postpartum depression, images of antidepressant television ads come to mind, with a woman talking about how she can’t get out of bed, how she feels sad and that depression hurts.  Or perhaps horrible news stories flash to mind.  It’s understandable that it’s the rare mother who would want to be associated with that stigma.

Fortunately, the variety of pregnancy and postpartum disorders are more and more recognized, and with that, the stigma diminishes.  Here’s the quick list:

• Pregnancy and/or Postpartum Depression
• Pregnancy and/or Postpartum Anxiety
• Pregnancy and/or Postpartum Panic
• Pregnancy and/or Postpartum Obsessive Compulsive Disorder (OCD) (scary thoughts)
• Postpartum Post Traumatic Stress Disorder (PTSD)
• Postpartum Psychosis (rare [1 or 2 per 1000 births], but serious)

As someone who experienced postpartum anxiety with OCD, I didn’t find the proper name for that difficult time until about 5 years afterwards.  Oprah had Marie Osmond on her show, and they were talking about some book Marie wrote, “Behind the Smile; My Journey out of Postpartum Depression.”  Five minutes later I was on the internet in a discussion forum reading stuff from women who said things about their experiences that resonated with mine.  Oprah “diagnosed” me. I was thrilled!  It had a name!

So far here in Hawaii, women are usually diagnosed with “PPD”.  At the PPD Support Hawaii support group though, women identify with the other flavors too–anxiety, panic, OCD and PTSD.  Actually, the majority seems to have one of the anxiety types, and/or PTSD versus the cant’-get-out-of-bed depression.  In fact, the name, “PPD” makes it harder to find help when one doesn’t feel down or depressed.

One of the latest varieties under the umbrella to finally be recognized officially is postpartum PTSD.  PTSD is most-often associated with war and the trauma of facing battle.  But anytime a person perceives a threat to their own life or that of a loved one, PTSD can be an appropriate fit.

Many women who end up with an emergency Caesarian section get PTSD.  It may be all the rush-rush-rush and hush-hush-hush of a white-faced medical team racing down the hallway with mom-to-be on a gurney or a stern-sounding statement from the doctor saying something about the cord being around baby’s neck and “we could lose him/her” that pushes mom’s brain over the edge into a nightmare.  Maybe during the c-section she lost a ton of blood and the doctors scared her about her own life and survival (who will raise my baby!!!).  Or even, something about baby seems drastically wrong.  The cord.  Being blue. Not responding and breathing right away.  There are so many things that can sound horrendously scary when one is so vulnerably stuck on a rolling bed with white coat-wearing professionals all around.  Perhaps the woman opted to bypass an epidural, gets an emergency c-section but has no memory of the actual birth—just the rush down the hall and flurry of stressed out doctors.  Did she actually have the baby yet?  Is that really her baby?  How can she know?  What happened?  WHY?

From the women I’ve talked with, who have endured birth-related PTSD, many seem to have a stuck moment in time that they cannot easily get away from.  It’s a glaring, frozen time period, so bright that it’s hard to look at closely, at all really, especially for any length of time.

Tiny peeks back at what happened, over time, in a safe and validating environment can help alleviate the “charge” that some unexpected reminder, or trigger, can elicit.  A trigger could be something as simple as driving past the hospital where the birth took place.  It could be the smells experienced at the birth, the noise, or any number of things somehow tied to the event that triggers flashes of the violent or traumatic memory.  As long as it was perceived as such, that is the woman’s truth.

Recognition of the condition as a birth-related event can help, and can help for finding appropriate treatment.  While postpartum PTSD is under the umbrella of PPD, finding a PTSD therapist who understands birth trauma can be yet another challenge.  Sometimes talking to peers with similar feelings can be a good option, or “as good as it gets.”  A prescription for an antidepressant, while appropriate in many other situations, isn’t necessarily the treatment for PTSD related to child-birth.

To find out more about any of the mentioned conditions or talk with someone who understands, see the links below.  PPD Support Hawaii offers a warm line (call you back within 24 hours), as does Postpartum Support International (PSI).  PSI also has a free Wednesday “Chat with an Expert” for women every week.  There’s also men’s chat on Mondays—the first Monday of the month.  http://www.postpartum.net/Get-Help/PSI-Chat-with-an-Expert.aspx

There is just no reason to suffer.  All of the varieties under the PPD umbrella are very treatable.  You’re not alone, you didn’t cause your condition, and with help you will be well again.

Resources:

www.PPDsupportHI.wordpress.com PPD Support Hawaii

www.Postpartum.net Postpartum Support International

www.PostpartumProgress.com Most widely read blog on postpartum mood issues.

www.tabs.org.nz Trauma and Birth Stress

…so you can easily find out when and where we’ll be having the support group.  You’ll know where we’ll be attending events, giving presentations, holding Family & Friends Nights.

Follow the links on the right, under “Social Media.”  –>

Whether you’re having a rough pregnancy or the baby has arrived, things just aren’t going as expected… join other new/expecting moms for support, understanding, information and resources.

De-stress your distress. The topic (PPD) isn’t happy, but we do have some laughter and enjoyment, along with relief and hope.

Infants (in car seats/strollers) welcome. We also have Family Nights quarterly, to lend support, understanding, information and resources to spouses/partners and family.

A mom called me recently and said she’d been diagnosed with PP ocd.  I was surprised, to say the least.  “Really?  PPD w/ocd?  Were you diagnosed in Hawaii?” Well, no, it turns out she had talked to someone on the mainland.

I know what it is.  I lived it.  I’d learned about PPD w/ocd (PP ocd) on national discussion boards, when I logged on to a Postpartum Depression board in 2001.  It was all very hush hush at the time.  Shameful even.  –the nature of the obsessions (thoughts) from ocd is generally harmful/scary. It’s as if one’s mama bear protection instinct is on overdrive, and throwing up these thoughts/images of all the things a new mom has to look out for, to protect their little one.  The “what if’s” playing out in worst case scenario. …you’re prepping dinner, cutting up chicken… “What if….?”

Not generally something you want to talk about over lunch with your new mommy friends, or even bring up with your own doctor.

The awareness of PPD w/ocd has gotten better, but still isn’t well-known in Hawaii.  To find out more, Get the Facts here.  Print out some information and take it with you to your doctor.  The condition is very treatable, and it doesn’t mean you want to hurt anyone.

She is probably not alone in her thinking.  At first glance, it makes sense, right?  Babies make you depressed, so stop having them.  Like…, eating shrimp makes you break out in hives, so stop eating shrimp.  Even if you love eating shrimp, you break out in hives.  So stop.

Oh wait.  You love your children?  Even though you tend to get depressed (that’s Depression, not “depressed”) during the perinatal period, you love your children.  …so..stop having them???

Fortunately, it’s not that simple, and there are things you can do if you do find yourself experiencing depression (or anxious, or having scary thoughts, or panicking, etc.).  But that’s another post. (It’s all the other on topic posts here, and the very reason we exist.)

So what is flawed with this woman’s line of thinking?

Part of it is that the women she is talking about (the ones with postpartum depression) aren’t having a moment of “I wish I didn’t have this child” or “I’m having a crappy day with the kids” kind of depression.  Maybe it’s hard to explain to someone who hasn’t had the experience.  All the women I know who have had “PPD” and have talked to over the past decade have loved their children immensely.  Some tried for years to have them, and yet when they finally did have that long anticipated baby, they became (D)epressed and/or Anxious.

Anyway, I hope she has a nice Mother’s Day tomorrow.

Shrimp, anyone?

“OB doctors/nurses should tell women that they may become depressed after they give birth.  Then they should tell them what to do if this should happen.”

Hawaii DoH–PPD Facts Sheet (2008) **see updated publication below.

We couldn’t agree more!

Sadly, the result showing the highest shared characteristic of the women participating in the study percentage was for intimate partner violence during pregnancy, at 37.8%.  More than a third of all pregnant women were hit, beaten, pushed, slapped.  This is shocking.  The American Psychiatric Association says that 25% of women have been physically assaulted or raped by their partners, during their lifetimes. So 13% more, during the short nine months of pregnancy?  Another big surprise is that 26.8% said they had used illicit drugs during their pregnancy,  24.5% had smoked during their last trimester.  More use of drugs than smoking?

At any rate, there’s the information for Hawaii, including that ~3000 new mothers a year likely experience a Perinatal Mood/Anxiety Disorder (aka PPD) here.

Are you surprised too?  Share your thoughts.

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11/12/10

No sooner did I post this (well, plus about 24 hours) than I see an StarAdvertiser article posted by Healthy Mothers Healthy Babies Coalition of Hawaii, on their Facebook Page with a new publication regarding Hawaii’s mothers and their birth circumstance statistics.  Turns out that 37% thing with domestic violence is a waaaaaay different figure.  In this publication, covering some of the same years as the above linked one, the rate is a lowly 6% overall, and about 14% for the mothers < age 20.

Here is the publication. Maybe one of you can explain the differences in stats between the two.  Or I could email them and ask about it.  I’ll share if I do.

Exercise by itself has been proven to prevent 75% of PPD. Vitamin D has proven more efficient than any antidepressant – without the side effects of premature delivery, preeclampsia, or having a child with obesity..

Oh, yes, she did.  She has no clue that most everyone there will have tried a gazillion things to get over “this” before they showed up on a PPD board.  A gazillion things that didn’t work.

Not only did she not provide any research links backing her statements (oh…because there aren’t any), her whole tone came across as “you could have prevented this if only you had exercised or taken Vitamin D.”  And, miracle of miracles, Vitamin D (taken by mom) will prevent childhood obesity.  Wow!!  Really?

In all fairness, it’s been rare that this kind of post has shown up.  But, rare or not, it’s a bit like throwing a skunk into the middle of a dog show.  Dog show?  Yeah, other four-legged creatures.  But only one of the creatures in the crowd stinks.  In real life though?  People offer this kind of “advice”…regularly.

To find out more regarding PPD and its treatment just click on About PPD up top.

Phew!  Got that off my chest.  If you haven’t had the pleasure of the PPD experience directly yourself, it’s best to keep your comments to yourself.  But if you’re a PPD survivor, please share!  What kind of comments have you heard?

“I think I may have postpartum depression, but I don’t want to hurt my baby.”

Okay.  No worries.  You absolutely can have postpartum (or during pregnancy) depression or anxiety without having thoughts of hurting yourself or your baby.

Somehow, in getting the message out about the existence of “PPD” or perinatal mood/anxiety disorders out, the waters have been muddied by the few high profile cases that usually involve postpartum psychosis.  Or by bad portrayals of “PPD” on popular television shows, where a mother is shown as dangerous and unpredictable (possibly psychotic) yet labeled as having “postpartum depression.”  Well, who in their right mind wants to be identified as being like …that!!? [9/12/10 "that!!?" meaning the tv version, well over the top, and generally inaccurate.]

There are many symptoms of antenatal and postpartum mood and anxiety disorders.  You can have a couple of symptoms, or a bunch of them, and they don’t have to include thoughts of harm coming to your loved one.  Check our “About PPD” tab for more information.

Where do you think this idea comes from?