May is Maternal Mental Health Awareness Month...

May is Maternal Mental Health Awareness Month. Though we don't often hear a lot about mental health during pregnancy and the early postpartum period,  perinatal mental health issues (including postpartum depression, anxiety,  and other mood and thought disorders) are considered the most common complication of childbirth. Up to 20% of new moms will experience a significant mental health issue during pregnancy or in the first year postpartum. In honor of Maternal Mental Health Awareness Month, and all the moms and families out there who have experienced perinatal mental health issues, here is some information that could help you, or someone you know.

• Mental health issues don't always start after baby is born. Many women first experience mental health issues during pregnancy. Moms with a history of mental health issues are more likely to experience a perinatal mood disorder, but even moms with no history are at increased risk during the childbearing year.

• Postpartum Depression is not the only mood disorder affecting new moms. While up to 15% of new moms experience postpartum depression, 6-10% experience pregnancy and postpartum anxiety disorders, and some moms experience postpartum OCD, PTSD, or bipolar mood disorders. Postpartum anxiety can look very different from postpartum depression. Instead of exhibiting low mood or sadness, moms with anxiety may seem very alert, worried, and panicked.

• Postpartum psychosis, a rare, but very serious illness, affects less than 1% of new moms. Despite what you may see on TV, postpartum psychosis, in which moms experience delusions or hallucinations, is very rare. It is however, always an emergency if a mom is experiencing these symptoms and immediate treatment is important.

• There are a wide variety of treatment options that can help mood and anxiety disorders get better.   For some women increased self-care and social support may be enough to see a reduction in symptoms. For others talk therapy may be the best option. Some women may to use medication to see a reduction of symptoms. Luckily, there are many safe medication options for women who may be breastfeeding.

• Postpartum mood disorders don't only affect new moms. Having a baby is an important adjustment for everyone in the family. It is estimated that up to 10% of new dads may experience postpartum mood or anxiety disorders as well. It is important that anyone experiencing symptoms  for more than two weeks gets help, since it won't just go away on its own.

• Some great online resources to learn more or to find help:
• Postpartum Support International: www.postpartum.net
• Postpartum Progress: www.postpartumprogress.com

2014 Annual Report is Now Available!

Lamaze Family Center Ann Arbor's 2014 Annual Report is now available. Click here to read the full report. Thanks to all of the families, businesses, and friends who made 2014 such a great year for us. We feel honored to work with so many families and their little ones!

Doulas are awesome, but not magic...

By Elizabeth Satterley, LCCE, CD(DONA)

There has been a ton of good press about doulas in recent months.  Bastions of baby info like Parenting and Baby Center, as well as more mainstream news sources such as The Huffington Post and  New York Times are all touting the benefits of having a doula at your birth.  What is a birth doula, you ask? A birth doula is a professional labor support person who provide physical, emotional and informative support throughout labor.  They are extra hands and calm hearts in the labor room.  They do not provide any clinical care like OBs, midwives or nurses.  They help with positions and comfort measures to cope with pain, they provide a cheering section and commiseration when needed and they help families get the information they need to be empowered to make informed decisions for their birth. They are possibly the one face you recognize continuously throughout your labor experience. They are awesome, but they are not magic.


I love doulas.  Let me just say that up front.  I had doulas (yes, multiple) at both of my own births.  I work closely with doulas in many capacities of my multiple jobs.  And, oh yeah, I'm a certified birth doula with DONA International. I have been blessed to attend 40 births over that last 8 years and I could not be more proud of the work I have done.  By and large, I have received thanks and praise from the families I have worked with and it touches me deeply to hear that these families value my support in their journey to parenthood. That said,  I am not magic.

Let me explain.  There is tons of great research coming out these days that shows the value of having a doula attend your birth.  There are very credible research studies that show the value of the type of support doulas provide.  In one particular study in the Cochrane Review doula support shows fewer inductions, less use of pain medications, shorter labors, less cesarean births, fewer instrumental vaginal deliveries and healthier babies.  This study goes on to state that there are no risks to doula support and that all women should have continuous support throughout labor and birth.  In another, newer study in the American Journal of Managed Care shows a 60-80% reduction in likelihood of a cesarean birth if a doula is there for support.  Finally, even the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) in an Obstetric Care Consensus named doula support as "one of the most effective tools to improve labor and delivery outcomes."  This is amazing press and evidence-based back up for what doulas do.  Support in labor helps.  It helps health outcomes and, it stands to reason, helps emotional outcomes as well.  Women and families have the opportunity to improve their birth experience with a doula present.  But, they are not magic.

 Ok, doulas do sound magic.  I get it.  All this research shows how helpful they can be.  It sounds like they can make the potentially scary hospital a more welcoming place.  It also sounds like they can make that labor pain you've been hearing so much about (or possibly dreading on this, your second or third time around) disappear.  It sounds like they are your ticket out of the OR.  The truth is, you are and can do those things.  The doula cannot make you choose the right care provider, they cannot make you ask questions of your doctors, midwives and nurses so you understand what they are recommending.  They cannot magically eliminate labor pain with a smile and wave of a cold pack.  They cannot force you into a position that will help move this labor along when you are so tired you just want to quit. You and your partner do those things.  We can suggest, we can present options, we can massage, we can cheer for you, we can cry with you but YOU make all the calls. The doula is just an extension of your choices and wants for your birth.  We are there to help boost all those things to the next level, but if you change your mind, we move with that and support your new choices.


I sometimes worry that some women and families see us as the panacea for all things scary in labor.  I know that every mom I've worked with was capable of having a good birth without my help.  I also know that I could have had my babies my way without those doulas present.  I also know that the doulas present at my births made it easier to do it.  I hope that I did that for my clients too.  It is not to the doula's credit that a family avoided a cesarean or pain medication, it is to that family's credit.  Sometimes mom needs an induction. Sometimes I can't make all the pain go away (thank you, back labor ) and mom really needs pain meds. Sometimes my families still have a cesarean birth after hours of work.  Birth is crazy and cool and a miracle every time, but we never know what we are going to get and sometimes, despite all efforts on everyone's part, we don't get what we planned.  A doula is there to help cope with these little twists and turns in the road, not to keep you on the one straight path.  You choose the path, your doula will do her best to make that path smoother. 


So, we are not magic.  We can't wave a wand and make your birth happen how you are picturing it. We will do everything we can to support your decisions and choices and ease your pain and relax you so that you can make the best decisions for you and your baby. We can't do it for you but we can do it with you.  Mom, you are magic.  You can do this!  But we would love to be there to help.

Welcome 2015 and a Recap of 2014!

As we welcome 2015, here's a link to a great summary of advances made in the world of maternal care
in 2014.
Some highlights include:

• A focus on the high rate of primary C-sections and some rethinking about "normal" labor patterns and progress. New guidelines for the stages of labor have been incorporated into all of our childbirth classes.

• For those families who do undergo cesarean sections, there has been increasing focus on "family centered" cesareans. Hospitals that offer family centered cesareans try to make cesarean births more respectful of families physical and emotional needs. This can include things like immediate skin to skin contact in the operating room when appropriate, involving partners in traditional birth rituals like cutting the cord, and having music of the mother's choice playing during surgery.

• A research study in the journal Birth, which found that use of non-pharmacologic pain management (i.e. the comfort measures and labor positions taught in our childbirth classes) reduces the need for medical interventions during labor and delivery. 

• Increased focus on the importance of the human microbiome and the impact that the increase in cesarean births may have on infant gut bacteria colonization.

We can't wait to see what 2015 brings!

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  

“Post-Partum Regression”

Lebogang

“Black with Postnatal Depression: My Therapist Had Never Treated a Black Woman”

Elizabeth R.

“Same Sex Parents Get Postpartum Depression Too”

Addye

“Postpartum Depression: It Doesn’t Just ‘Happen’ to White Women”

Rebecca Hawkes

“The Day I Couldn’t Get Out of Bed: Post-Adoption Depression”

“Five for Friday: Five Things I Did to Get Through Post-Adoption Depression”

Partners

“Postpartum Depression: When Dads & Partners Don’t Seem To Get It”  

Postpartum Depression PSI FAQ

Hotlines/Chatlines:

Safe House Sexual Assault Help Line

734-995-5444

Suicide Hotline

1-800-273-8255

Suicide Chatline

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

Veterans Crisis Chat Service

Other Resources:

Safe House of Ann Arbor Sexual Assault Support Services

Lamaze support groups

Teens and Young Adults Classes

Postpartum Support International (PSI)

PSI Tools For New Moms

PSI Michigan resources

Cochrane Library Research on Postpartum Depression

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>.

"PSI Michigan Resource Guide." PSI Michigan. Web. 24 Sept. 2014. <http://postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators/PSI-Locations-United-States/PSI-Michigan.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>.