Monday, November 24, 2014

Postpartum Depression and Mood Disorders



By Ella Clark

What is Postpartum Depression?

Anyone who has recently been pregnant, experienced miscarriage, stillbirth, recently adopted a child, or are the partner of someone who has recently been pregnant or adopted a child, can experience symptoms of postpartum depression (PPD).  While PPD is known to impact people of all backgrounds, many still experience symptoms without knowing what they are feeling has a name, and can be treated.  Still others may avoid seeking treatment because of negative stereotypes associated with mental health care.  Learning to recognize the symptoms before PPD sets in makes it easier to recognize the difference between the more normal stressors of new parenthood, and something more serious.  

Baby Blues v. PPD

As mentioned by Massachusetts General Hospital’s Center for Women’s Mental Health web page “about 85% of women experience some type of mood disturbance” after birth, including baby blues.   Though both baby blues, and PPD exhibit similar symptoms, PPD is generally considered more severe, and according to Postpartum Support International’s (PSI) website, only about 15% of those who have given birth develop PPD.  While baby blues generally only last for several days, if you notice symptoms that continue for two weeks or more you are likely experiencing PPD.  

Childbirth Connection’s website has provided a list of PPD symptoms to look for in new parents, and those who have recently been pregnant:
Crying easily
Sleep disturbances
Irritability
Anxiety
Lack of energy
Inability to focus
Sad mood
Loss of appetite
Inability to care for yourself
Obsessive or intrusive thoughts
Panic attacks
Thoughts of suicide
Thoughts of killing your baby

Because many of the symptoms of PPD interfere with daily life, and are in some cases potentially life threatening, it is important to seek help sooner rather than later.   

PPD Risk Factors

While anyone could develop PPD, PSI’s site reminds readers that some may be at a higher risk of developing symptoms, depending upon their personal, and family history.  A few of the known risk factors of PPD include:  
History of mental illnesses such as depression or anxiety in yourself, or family members
Lack of social support
Experiencing financial stress
Relationship stress
Difficult or traumatic pregnancy or postpartum period (could be related to difficulty breastfeeding, an unexpected c -section, an ill child, stillbirth, etc.)
Recent changes or major life events (marriage, moving, death of a loved one, change in employment, etc.)
Twin birth
Past difficulty with fertility or loss of a child
Illness in a parent
Post traumatic stress disorder
As described below, those who have survived any form of abuse, especially childhood sexual abuse (CSA), or have experienced and survived war are at an increased risk for developing PPD.  

PPD and Survivors of Childhood Sexual Abuse

Kathy Morelli explains in the Science and Sensibility article “Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 1”  12-20% of women have experienced some form of childhood sexual abuse (CSA), which has been shown to increase a person’s risk of developing PPD.  Survivors of this form of abuse are known to have an increased rate of mental illnesses such as anxiety, and depression, as well as physical symptoms such as painful menstruation, pelvic pain, and pain during sex.  Morelli goes on to explain that experiencing long term stress, and fear during childhood can actually affect the makeup of the brain, especially portions of the brain associated with memories.  In part 2 of Morelli’s exploration of CSA and PPD “Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 2: The Educator’s Role”, the author explains that physical, and emotional feelings of pregnancy, birth, and the extreme focus on the sex organs, may trigger memories of abuse in survivors.  These triggers, along with the increased stress of learning how to parent children, can create  an environment in which PPD is more likely to develop.  

PPD and War Veterans

According to Walker Karraa’s Science & Sensibility blog entry “Giving Birth after Battle: Increased Risk of Postpartum Depression for Women in Military” 16,000 active duty women give birth in the United States of America every year.  Throughout the article, Karraa references research published in the journal Medical Surveillance Monthly Report, which has shown that women who have served, and experience PPD are at greater risk for suicide compared to women who have served but do not develop PPD.  The Journal of Women’s Health, also noted by Karraa, reported that people who gave birth but have never been deployed, experienced PPD 10-11% of the time, while those who have given birth, have been deployed, and went through “combat-like experiences” develop PPD 16-17% of the time.  The risk factor for developing depression was even higher for those who deployed recently after giving birth.

Postpartum Psychosis

Another, more severe form of PPD, known as postpartum psychosis may also occur in some new parents. It’s important to remember that postpartum psychosis is very rare, and the symptoms that set in are both noticeable, and sudden.  Both Postpartum Progress and Massachusetts General Hospital Center for Women’s Mental Health  have listed symptoms related to Postpartum Psychosis:
Increased energy levels, feeling like you do not need sleep though you are tired
Feeling overly confident, that you’re mentally sharper, that you understand everything
Thinking that yourself or your child has special abilities
You are seeing or hearing things that others cannot
Voices may be telling you secrets or giving you orders
A loss of trust in others, or an extreme suspicion of those who you may have previously trusted
Trouble focusing, or remembering how to do things you used to enjoy
Loss of time, or an inability to track time
Strange physical sensations
A sharp increase in fighting with others
Feeling like someone or something is controlling your behavior
Feeling you have little to no control over your actions
Rapidly changing moods

Treatment and Prevention

It is vital for those working with pregnant, or otherwise expectant parents to focus some of their time on teaching clients, and patients to identify the symptoms of PPD.  Simply discussing PPD, and its effects, not only raise awareness about PPD, but also decreases some of the stigma associated with seeking treatment.  
Some with PPD have found comfort in meeting with, not only their doctors, but other parents who currently face similar difficulties.  Fortunately, the Lamaze Family Center of Ann Arbor offers several options for those seeking this type of support, with a monthly Pregnancy and Postpartum Support Group, weekly Mother’s Group, and monthly Miscarriage & Newborn Loss Support Group.  

Can You Prevent Postpartum Depression?

Though preventative exercises may help guard some people against experiencing PPD, there will still be some who will develop PPD, through no fault of their own, despite taking steps to prevent the development of PPD.  Listed below are some tips Kate Kripke has provided in the article “Can You Prevent Postpartum Depression?” on Postpartum Progress’s website, for those interested in trying to prevent this form of depression.
Take care of yourself through
proper nutrition
keeping hydrated
giving yourself down time every day
Practice good sleep hygiene
getting enough sleep
building a good sleep environment
creating a sleep schedule
Keep moving
Take time to build strong relationships with those around you
Become aware of your thoughts and feelings
Reduce stress through
meditation
mindfulness
deep breathing

Personal Accounts of PPD

While academic articles focusing on clinical descriptions of PPD offer valuable information on diagnosing this form of depression, there is no better way of learning what to look for than from those who have personally experienced PPD.  Below are a few links to blog entries, and interviews with people who have dealt with PPD.   
Lindsay Hunter  

Lebogang

Elizabeth R.

Addye

Rebecca Hawkes


Partners

Postpartum Depression PSI FAQ

Hotlines/Chatlines:

Safe House Sexual Assault Help Line
734-995-5444

Suicide Hotline
1-800-273-8255


Ozone House Crisis Line
734-662-2222
Military Vet Crisis and Family Crisis Line
1-800-273-8255 (1)

Active Military and Family Crisis Line
1-800-342-9647



Other Resources:









References

"Baby Blues or Postpartum Depression?" Childbirth Connection: Information for Women on Pregnancy & Childbirth. Web. 24 Sept. 2014. <http://www.childbirthconnection.org/article.asp?ck=10528>.

Hawkes, Rebecca. "The Day I Couldn't Get Out of Bed: Post-Adoption Depression." Sea Glass & Other Fragments. 1 May 2012. Web. 29 Sept. 2014. <http://www.rebeccahawkes.com/2012/05/day-i-couldnt-get-out-of-bed-post.html>.

Hawkes, Rebecca. "Five for Friday: Five Things I Did to Get Through Post-Adoption Depression." Sea Glass & Other Fragments. 4 May 2012. Web. 29 Sept. 2014. <http://www.rebeccahawkes.com/2012/05/five-for-friday-five-things-i-did-to.html>.

"Postpartum Psychiatric Disorders." Massachusetts Gnereal Hospital Center for Women's Mental Health. Web. 24 Sept. 2014. <http://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/>.

"Postpartum Support International." Web. 24 Sept. 2014. <http://postpartum.net/Default.aspx>.


Stone, Katherine. "Postpartum Psychosis Symptoms (in Plain Mama English)." Postpartum Progress. Web. 24 Sept. 2014. <http://www.postpartumprogress.com/the-symptoms-of-postpartum-psychosis-in-plain-mama-english>.

Morelli, Kathy. "Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 2: The Educator's Role." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 5 June 2014. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=8374>.

Morelli, Kathy. "Childhood Sexual Abuse as a Risk Factor for Postpartum Depression – Part 1." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 3 June 2014. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=8370>.

Karraa, Walker. "Giving Birth after Battle: Increased Risk of Postpartum Depression for Women in Military." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 11 Nov. 2013. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=7555>.

Monday, October 27, 2014

In Honor of Pregnancy and Infant Loss Awareness Month...



By Ella Clark
In honor of National Pregnancy and Infant Loss Awareness Month, Lamaze is dedicating this blog to the difficult subject of perinatal loss.  Perinatal loss refers to the time soon before or after birth during which a newborn dies or a pregnancy is lost.  Some of the content of this blog is especially difficult, and may be potentially triggering for those who have experienced the loss of a wanted pregnancy or death of a child.

When planning to bring a new life into the world, preparing for the loss of a child is the last thing new parents usually consider.  While the number of parents who experience the loss of a wanted pregnancy or newborn is relatively high, people often keep the their grief private.  Wanted pregnancies that result in the death of a fetus, or the unexpected death of an infant, leave parents who have already begun a bonding process with that child or fetus, grieving.  After the bond breaks as a result of a death, parents express their sadness in similar ways to those who have lost an older child.  The emotional aspects of miscarriage are discussed further in Postpartum Progress’s article “13 Things You Should Know About Grief After Miscarriage or Baby Loss”, by Kate Kripke.  Kripke reminds readers of the normalcy, and validity of the complicated emotions faced after the loss of a pregnancy or new baby.  

Unfortunately, many people may not understand what suffering parents may feel in the wake of an ended pregnancy or child’s death, which is why connecting with other people who have also gone through this unique kind of loss may help parents heal.  For those living in the Ann Arbor area the Lamaze Family Center of Ann Arbor offers a free monthly support group facilitated by those experienced in dealing with infant and fetal loss.  The remainder of this blog will be used to define, and briefly explore loss related to miscarriages, stillbirths, infant death, Sudden Infant Death Syndrome, and late term abortion.  

Miscarriage (spontaneous abortion)- The loss of a pregnancy before 20 weeks in the womb.

The Our Bodies Ourselves article “Miscarriage in the First Trimester” points out that “15-20% of known pregnancies end in miscarriage”.  These numbers include only known pregnancies, meaning many other pregnancies which parents were unaware of have also ended in miscarriage.  “Miscarriage in the First Trimester” focuses on describing how most people experience the physical process of a miscarriage, letting readers know when to seek health care and the variety of miscarriage related medical choices parents must make.  

Blogger Lauren Wayne shares her miscarriage story with readers in the blog “On a First Miscarriage”.  Wayne describes, without graphic detail, the process of becoming pregnant, physically losing the pregnancy, and the emotions she experienced in the time after the loss.  Throughout the story, Wayne also discusses her interactions with others also touched by loss, keeping in mind a broader range of lived experiences.
Stillbirth- According to March of Dimes stillbirth is described as a fetal death after 20 weeks in the womb.
The March of Dimes, is a non profit devoted to helping families carry wanted pregnancies to term, while offering support for those whose pregnancies end in loss.  Their informational webpage “Pregnancy Loss” lets visitors know that 1 in 160 pregnancies ends in stillbirth.  In depth explanations of what can happen after a stillbirth diagnosis are included on the page, including what to expect from medical staff including necessary tests, the possible causes of miscarriage, and possible risk factors to keep in mind for future pregnancies.  

If you’re interested in learning more from others who have experienced stillbirth the website Still Birthday provides a wealth of information about stillbirths including, first hand accounts, what to expect, information about stillbirth support, and how to heal.

Infant death- Defined as the death of a newborn from birth through the first year.

According to the CDC website article “Infant Mortality” about “24,000 infants died in the United States in 2011”.  A majority of these deaths, the website states, are a result of birth defects, premature birth, SIDS, injuries, and complications that arose during pregnancy.  The CDC also reminds readers that the rate of infant death indicates the general health of populations as a whole.  For example, if a specific group of people experience high rates of infant death, the rest of the people in this group are also likely to experience poor general health.  

Unfortunately, In Michigan there are several areas with relatively high rates of infant death, including the city of Detroit.  The large number of infant deaths in the area has been attributed to high rates of poverty, in both the city and its residents, and structural racism, which leaves many people of color without the adequate support necessary to new parents.  As pointed out by Esmé E. Deprez and Chris Christoff in “Babies Pay for Detroit’s 60-Year Slide With Mortality Above Mexico’s” most of the country has experienced a decrease in infant mortality, while Detroit’s rates have stayed relatively high.  In fact,  Detroit has the highest rates of infant death in the country, higher even than the average rates of infant death in China, Mexico, or Thailand.  Deprez and Christoff let readers know that “non-whites made up 21 percent of Michigan’s population but 43 percent of infant deaths”, meaning even though whites make up the majority of the population in Michigan almost half of all infant deaths occur in families of color.  Fortunately, there are birth professionals who devote their lives to changing this reality.  One such birth expert is Sherry L. Payne MSN RN CNE IBCLC CD(DONA) BSN,  writer of the Science and Sensibility article “Black Infant Mortality and the Role of the Childbirth Educator and Doula”.  Payne encourages birth educators and support people to keep in mind the impact of racism when working with clients, also stressing the importance of people of color working in the birth industry themselves.  In addition to concerned birth workers, the city of Detroit has also implemented the Make Your Date program designed to put soon to be parents in contact with the education, and resources they need to ensure healthy pregnancy and birth outcomes.   

Sudden Infant Death Syndrome (SIDS) or Crib Death- The unexplained, unexpected death of a child under a year old, who otherwise appeared healthy.  

According to Postpartum Progress 5,000-7,000 infants in the United States die from SIDS each year.  While the cause of SIDS is unknown it is one of the leading causes of infant death.

Risk factors for SIDS outlined by the March of Dimes page “Sudden Infant Death Syndrome” include:
The infant sleeping on the stomach or side
Soft bedding, pillows or stuffed toys in the child’s sleeping area
A hot room or too many layers of clothing on the infant
Older people sharing a sleeping space with the infant
Being a baby boy
Being Black or Native American
Being born Premature or low weight
Infants living with people who smoke, drink or use recreational drugs

Late Term Abortion- An abortion is generally considered late term once a pregnancy has reached 24 weeks or longer.  Jodi Jacobson explains in the article “Late Abortions: Facts, Stories, and Ways to Help” featured on RH Reality Check, that people who elect for late term abortions usually do so because of genetic abnormalities, which are not usually detectable until 24 weeks or later.  These parents usually experience a similar sort of grief as those who have gone through fetal or infant loss, despite the fact that late term abortions are voluntary.  In many cases, parents elect for late term abortions, for otherwise wanted pregnancies, when complications with the fetus would place an undue burden on parents or family members, severely restrict the quality of life on the child, or place the parent’s or child’s life at risk.  

As explained by the online magazine article “The Truth Behind Late-Term Abortions”, featured on the site Everyday Feminism, abortions after 20 weeks make up only about 1% of all abortions performed in the United States.  In most cases the parents who have late term abortions expected to carry their pregnancy to term, but due to unforeseen complications with the pregnancy, or physical development of the fetus, parents are faced with the difficult decision of whether or not to abort their pregnancy.  Though these pregnancies are ended voluntarily, as explained above, parents do not always view the abortion as such and will feel the effects of loss similar to parents who go through miscarriage or stillbirth.

Gretchen Voss describes her own late term abortion in the article “My Late Term Abortion” featured on the Our Bodies Ourselves website.  For those interested in connecting with others who have also had a late term abortion the online forum A Heartbreaking Choice offers support, information about the decision making process, message boards, and related medical information.

Though nothing can stem the hurt of the loss of a wanted pregnancy, a combination of healthy coping mechanisms, and an understanding of the physical and emotional stages of loss may keep your grief from becoming all consuming.  Keeping in mind that the grieving process looks different for everyone, the distinction between grief and full blown depression is fine.  By keeping track of the length and severity of your feelings associated with this difficult time may help you detect and treat any depression symptoms before they become a serious concern.  However a person chooses to express their emotions, it is important to know that you are not alone in your feelings, and that services do exist for those in need of additional support.   





Works Cited

"Baby Care 101." March of Dimes. 1 Mar. 2012. Web. 13 Oct. 2014. <http://www.marchofdimes.org/baby/sudden-infant-death-syndrome.aspx>.

Casper, Monica J. "The Color of Infant Mortality." Truthout. 4 Sept. 2014. Web. 13 Oct. 2014. <http://www.truth-out.org/opinion/item/25975-the-color-of-infant-mortality>.

Deprez, Esmé E., and Chris Christoff. "Babies Pay for Detroit's 60-Year Slide With Mortality Above Mexico's." Bloomberg. Bloomberg, 11 June 2014. Web. 13 Oct. 2014. <http://www.bloomberg.com/news/2014-06-11/babies-pay-for-detroit-s-fall-with-mortality-above-mexico.html>.

"A Heartbreaking Choice." A Heartbreaking Choice. Web. 13 Oct. 2014. <http://aheartbreakingchoice.net/>.

"Infant Mortality." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 12 Aug. 2014. Web. 13 Oct. 2014. <http://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm>.

Kripke, Kate. "13 Things You Should Know About Grief After Miscarriage or Baby Loss."Postpartum Progress. WordPress, 16 May 2013. Web. 13 Oct. 2014. <http://www.postpartumprogress.com/13-things-you-should-know-about-grief-after-miscarriage-or-baby-loss>.

Kacere, Laura. "The Truth Behind Late-Term Abortions." Everyday Feminism. 6 June 2014. Web. 13 Oct. 2014. <http://everydayfeminism.com/2014/06/truth-late-term-abortions/>.

"Late Abortions: Facts, Stories, and Ways to Help." RH Reality Check. Web. 13 Oct. 2014. <http://rhrealitycheck.org/article/2009/06/02/lateterm-abortions-facts-stories-and-ways-help/>.

"Make Your Date." Make Your Date. See Quinn. Web. 13 Oct. 2014. <https://makeyourdate.org/>.

"The Mary G. Schuman Miscarriage & Newborn Loss Support Group." Lamaze Family Center Ann Arbor. Design Hub. Web. 13 Oct. 2014. <http://www.lamazefamilycenter.org/?module=Class&class=Group&groupID=4>.

"Miscarriage in the First Trimester - Our Bodies Ourselves." Our Bodies Ourselves. Cornershop Creative, 9 Apr. 2014. Web. 13 Oct. 2014. <http://www.ourbodiesourselves.org/health-info/miscarriage-in-the-first-trimester/>.

Muza, Sharom. "Black Infant Mortality and the Role of the Childbirth Educator and Doula."Science and Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 16 Sept. 2014. Web. 13 Oct. 2014. <http://www.scienceandsensibility.org/?p=8682>.

"Pregnancy Loss." March of Dimes. 1 Feb. 2010. Web. 13 Oct. 2014. <http://www.marchofdimes.org/loss/stillbirth.aspx>.

Stone, Katherine. "What Is the Difference Between Grief & Depression After Pregnancy Loss?" Postpartum Progress. 2 Sept. 2009. Web. 13 Oct. 2014. <http://www.postpartumprogress.com/what-is-the-difference-between-grief-depression-after-pregnancy-loss>.

Voss, Gretchen. "My Late-term Abortion - Our Bodies Ourselves." Our Bodies Ourselves. 11 Jan. 2011. Web. 13 Oct. 2014. <http://www.ourbodiesourselves.org/stories/my-late-term-abortion/>.

Wayne, Lauren. "On a First Miscarriage." Hobo Mama. 4 May 2010. Web. 15 Oct. 2014. <http://www.hobomama.com/2010/05/on-first-miscarriage.html>.