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A Functional Medicine Approach to Perinatal Mental Health – Part Two

February 20th, 2014 by avatar

In a two part post this week, regular contributor Kathy Morelli shares information about and an interview with Kelly Brogan, MD on her nontraditional approach to working with women who are dealing with perinatal mental health issues.  Today in part two, Dr. Brogan shares information on incorporating a whole body Functional Medicine approach alongside traditional Western medicine to help and support women dealing with postpartum mood and anxiety disorders. Part one of this short blog series ran on Tuesday. – Sharon Muza, Community Manager, Science & Sensibility.

Kathy Morelli (KM): In the news, there’s been a lot of information about the negative impact of a dairy-gluten-and- sugar based diet on the body. Can you tell us a bit about the impact of gluten and sugar on thyroid function after childbirth? Can you reference research on this?

Kelly Brogan, MD (KB): Yes, there’s an explosion of research implicating the immune-modulating and inflammatory effects of gluten and sugar (often co-occuring). Many individuals perceive that they are totally “fine” until that day when they’re not. In reality, there has been a long period of “incubation” of their symptoms.

Istock/GoldenKB

Istock/GoldenKB

When it comes to autoimmunity, we know that the postpartum population is very vulnerable to new onset autoimmune disorders, and we know that autoimmunity requires three ingredients: genetic susceptibility, environmental trigger, and intestinal permeability. This has been well-established by Dr. Alessio Fasano of The Center for Celiac Research.

We know that gluten causes an inflammatory response in all people, locally, in the intestine, and that in a subset of about 80% of people, it provokes intestinal wall changes that allow for compounds, food particles, and bacterial molecules called LPS or lipopolysaccharide into the blood stream. In animal models, LPS is used to induce “depression”. There is a large literature, since 1991, establishing the role of inflammation in depression, including in the postpartum depression population.

We also know of a process called molecular mimicry, whereby, immune responses to a food particle or pathogen can lead to attacks on our own body because of common amino acid structures.

We know how to modify inflammation through diet, and we know how to support appropriate immune response through nutrients such as Vitamin A, D, Alpha Lipoic Acid, probiotics and others. I have written about the research supporting these claims on my website if you are interested in the references, but suffice it to say that elimination of gluten, dairy, corn, soy, and sugar is my first step with patients and a primary reason that I no longer need to use medication. It’s quite powerful.

 KM: And can you elaborate on the impact of dairy products on brain health? Can you share a research article on this?

KB: I don’t think that dairy is an issue for every person with mental health symptoms, but I believe it is a compelling variable to control for.

But sure, I can talk about dairy and its impact on health. In schizophrenia and bipolar, in particular, there are papers discussing the role of casein antibodies in clinical presentations. Some of these papers are listed in the references at the end of this article. Some speculation about the reasons that casein, a protein, particularly from Holstein cows which we use in America, is stimulating to the immune system, relates to its being heavily processed – homogenized and pasteurized – so that the fats and nutrients are no longer in their natural state and are provocative to the immune system.

In a paper by Severance et al (2010), they found that new onset and long-term schizophrenics were 8 times more likely to have circulating antibodies to casein than controls and up to 16.5 times more likely in a subgroup of those with psychotic depression.

kelly brogan head shot

© Kelly Brogan MD

In a separate study, this team found similar results in the setting of Bipolar I diagnosis and found that medication treatment did not mitigate this immune response. In a study this year, Li et al (2012) found that new onset schizophrenia was associated with immune activation and a 34% increased risk of developing schizophrenia if their levels of antibody were 2 standard deviations elevated. Casein and gliadin (a component of gluten) interact with opiate receptors in the brain in an unpredictable way.

KM: Based on your research and clinical practice, looking at it as a public health issue, do you believe that the overall public incidence of postpartum depression and anxiety can be reduced by educating women about modifying their diets and lifestyles?

KB: Absolutely and unconditionally, yes. Conventional psychiatry has made no progress with regard to identifying markers for vulnerable populations. We are overly focused on serotonin and examination. Research by Oberland et al (2008) into serotonin transporter polymorphisms has been confusing and inconsistent.

We must look at the cumulative burden that pregnancy places on some women and how it exposes the dysfunction of their interrelated neuroendocrine systems resulting in depression, anxiety, and psychosis as non-specific indications that there is lifestyle imbalance and inflammation.

I have a detailed research article about the Neuro-inflammatory Models of Postpartum Depression published here for your further reference.

KM: Based on your research and clinical practice, do you believe that the personal incidence of postpartum depression and anxiety can be reduced for a woman modifying her diet and lifestyle?

KB: Yes. In my clinical practice, with the preventive cases that I work with, I have yet to have an incidence of a woman with postpartum onset symptoms, including those women with previous history.

KM: I’ve heard you lecture about the nutrient deficiencies and dietary factors that could feed into an occurrence of postpartum psychosis. Based on your research and clinical practice, do you believe that the incidence of postpartum psychosis can be reduced by a woman being aware of the risk factors and modifying her diet and lifestyle?

KB: I am very interested in research like that of Bergink et al (2012) that suggests a significant overlap between thyroid autoantibodies and postpartum psychosis.

We know that these antibodies portend endocrine dysfunction and we know that thyroid stimulation can result in psychosis. We also have precedent, in the literature of bipolar and schizophrenia being induced by nutrient deficiencies, even as simple as niacin.

It is myopic to abandon simple and potentially effective interventions in the interest of medicating these patients, particularly because of the established incidence of mania and violence toward self and others with SSRI treatment. I believe these medications, in the postpartum population account for incidences of violence that might have otherwise been avoided. Ssristories.com explores these cases.

KM: In the hierarchy of risk factors for perinatal mental illness, such as an individual’s previous history and family history, where do you think the role of lifestyle management and diet modifications fall?

KB: I think that it trumps all other risk factors, and this is because of what we have learned about the 98% of “junk DNA” that we found after the completion of the Human Genome Project.

This is called “epigenetics” and refers to the role of lifestyle or the “exposome” to modify gene expression within one lifetime.

We outsource much of our bodily function to out bodily microbes, as well, which outnumber our human cells 10:1. This is exciting and empowering because it means that we are not condemned by our family histories or genes. We can change them with each bite off a fork, with each step, and with our home environments.

KM: In your work, you do a thorough assessment and then work carefully to support a woman to taper off their psychotropic medications, if possible. Do you advocate that a woman go off of her medications without supervision?

KB: I do not recommend that women go off their medications without supervision.

My initial consultation is 2 hours and I work intimately with patients during tapers. As I deal with some complicated cases, I require patients to optimize their health and wellness prior to initiating a taper to confer resilience and assure adrenal hormone reserves which are often highly perturbed during a taper (the impact of SSRIs on glucocorticoid functioning is well understood).

Then, we initiate a taper that can take 1-2 years.

This is the most responsible way to do it, and keep in mind it cannot always be done.

This is why I believe that true informed consent prior to beginning a medication must include disclosure of dependency. It is not the original symptoms returning, as I was taught to parrot in my training, it is drug-induced withdrawal and associated “relapse” that often looks like agitation and profound anxiety, often novel symptoms to the patient who has never experienced such autonomic nervous system disruption.

KM: Generally, how do you help a woman who is depressed preserve the breastfeeding relationship, if she states that she wished to do so?

KB: Great question. I believe that lactation support is non-optional and must be daily for the first week and perhaps even the first several weeks. Women need to be supported to nurture this skill and to protect it at all costs. They can’t do it alone (in my observation). Here is a link to more information I’ve published about how to help meet breastfeeding goals.

Once lactation is in place, and supply is established, breastfeeding becomes protective of depression. I will be publishing an article about studies supporting this in the coming weeks. I also encourage pumping early (beginning at 2 weeks) so that there is flexibility around night feedings with partner support.

Basically, we have a crisis of failed lactation that I believe relates to environmental toxins called endocrine disruption, undiagnosed thyroid conditions, and insulin resistance from high sugar diet. >Of course, in the end, it’s a woman’s decision to care for and feed her infant as she sees fit. Here’s a link to some very detailed information about finding safe organic formula products.

KM: What do you recommend as readily available methods a woman can do herself to help her heal postpartum depression and anxiety holistically?

KB: I certainly recommend consulting with a holistic provider such as a naturopath, acupuncturist, homeopath, or certified physician. That said, dietary modification, mild exercise, and 20 minutes daily or relaxation response is a great place to start.

KM: What are some of your other projects going on now?

KB: My cup runneth over! I am writing a book that I hope will be a resource to the women I cannot personally see in my busy practice. I maintain an active blog at www.kellybroganmd.com and am also on Huffington Post. I am directing a conference and participating in several in the coming year, and will be providing a course with Aviva Romm, MD to help educate women about holistic health. Fearless Parent will be very active throughout the year with events, blogs, and weekly radio shows to help parents navigate all of the information that comes at them in the realm of thoughtful parenting. Join us!

KM: Thank you for your valuable time & input!

KB: My absolute pleasure. Your interest and support mean a lot to me, as does the mission and educational dedication that Lamaze upholds. I’m an enormous fan!

How do you feel about the information that Dr. Brogan shared?  Have you or your clients had any experience with Functional Medicine?  Would you provide this information to women along with more traditional recommendations, for them to explore when they are being treated for perinatal mood disorders? – SM.

References

Bergink V. et al. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. British Journal of Psychiatry, 2011;198:264-8. Epub February 22, 2011.

Black, M.M. (2008). Effects of B12 and folate deficiency on brain development in children. Food and Nutrition Bulletin, June (29), 126-131.

Brogan K. (2013). Putting theory into preliminary practice: Neuroinflammatory models of postpartum depression. OA Alternative Medicine, May 01;1(2):12.

Dickerson F, Stallings C, Origoni A, Vaughan C, Khushalani S, Alaedini A, Yolken R. Markers of gluten sensitivity and celiac disease in bipolar disorder. Bipolar Disorder. 2011 Feb;13(1):52-8. doi: 10.1111/j.1399-5618.2011.00894.x.

Fasano, A. and colleagues at the Celiac Center, numerous medical research articles.

Jackson, J., Eaton, W., Cascella, N., Fasano, A., Kelly, D. (2012). Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity.Psychiatric Quarterly, 83(1), 91-102, http://dx.doi.org/10.1007/s11126-011-9186-y

Li J, Harris RA, Cheung SW, Coarfa C, Jeong M, et al. (2012) Genomic Hypomethylation in the Human Germline Associates with Selective Structural Mutability in the Human Genome. PLoS Genet 8(5): e1002692. doi:10.1371/journal.pgen.1002692

Niebuhr DW, Li Y, Cowan DN, Weber NS, Fisher JA, Ford GM, Yolken R. Association between casein bovine antibody and new onset schizophrenia among US military personnel. Schizophrenia Research, 2011 May;128(1-3):51-5. doi: 10.1016/j.schres.2011.02.005. Epub 2011 Mar 4.

Oberland, TF, Weinberg, J, Papsdorf, M, Grunau, R, Misri, S, & Devlin, AM (2008). Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses. Epigenetics, Mar-Apr,3(2), 97-106.

Severance EG, Dupont D, Dickerson FB, Stallings CR, Origoni AE, Krivogorsky B, Yang S, Haasnoot W, Yolken RH. Immune activation by casein dietary antigens in bipolar disorder. Bipolar Disorder. 2010 Dec;12(8):834-42. doi: 10.1111/j.1399-5618.2010.00879.x.

Perlmutter, D. (2011). Grain brain: The surprising truth about wheat, carbs, and sugar – Your brain’s silent killers. New York: Little, Brown & Company

Depression, Guest Posts, Infant Attachment, Maternal Mental Health, Perinatal Mood Disorders , , , , , , ,

Don’t Ever Give Up! An Interview with Katherine L Wisner, M.D., M.S. American Women In Science Award Recipient

April 30th, 2013 by avatar

“Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem.” – Dr. Katherine L Wisner

Katherine L. Wisner, M.D., M.S., has been involved in clinical work and research since the mid-1980′s. Prior to her medical training, she achieved a Master’s Degree in Nutrition. Dr. Wisner did a pediatrics internship, is board-certified in both adult and child psychiatry, and completed a 3-year postdoctoral training program (NIAAA-funded) in epidemiology. Her major interest area is women’s health across the life cycle with a particular focus on childbearing. In January 2011, Dr. Wisner was chosen as the recipient of AMWA’s Women in Science Award for the year 2011. Dr. Wisner is a Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine.

Most recently, Dr. Wisner and colleagues (2013) published the largest American study to date (N = 10,000) investigating the value of screening for depression in postpartum period (4 to 6 weeks) using the Edinburgh Postnatal Depression Scale (EPDS)1

I know I speak for all in welcoming Dr. Wisner to Science and Sensibility.

_____________

Walker Karraa: Congratulations to you and your colleagues on this most recent JAMA Psychiatry study. The findings have significant implications regarding the value of screening for postpartum mood and anxiety disorders. What role do you think childbirth education has in the area of perinatal mental health?

Dr. Wisner: Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem.  

WK: Should childbirth educators and doulas be trained to screen for PMADs? 

Dr. Wisner: My answer would be yes, but the controversy in the field is about routine screening – that women with depression can be identified, but getting them to mental health treatment if it exists outside the obstetrical care setting is difficult.  So the counterpoint is– why screen if we don’t have on-site, accessible, acceptable services for mental health?  My opinion is that we ought to work toward this model of integrated care rather than decide not to screen!   I certainly think childbirth educators and doulas can increase education and awareness and are often the first professionals that women call for help, so that group of women who want to and can access care can get the help they need.

WK: How could childbirth education organizations use this study to inform their practices and curriculum?

Dr. Wisner:The study provides evidence that the prevalence of depression is high both during and after pregnancy and evidence that screening is effective in identifying women with major mood disorders.  Women with psychiatric episodes certainly can be assured that they are not alone, which is a common belief of pregnant women and new mothers.  

WK: Due to the prevalence of self-harm ideation in postpartum period found in your study and other studies supporting this alarming rate, and the fact that suicide is the second leading cause of maternal death, how might childbirth education organizations and professionals address this critical problem?

Dr. Wisner:Screening with the EPDS, which has the item 10 self-harm assessment questions, and sensitive exploration of self-harm and suicidal ideation is the primary approach to suicide prevention.  It has to be identified before intervention can occur.  

WK: A remarkable finding in your study was the rate of bipolar disorder among women who had screened positive (10 or higher) on the EPDS. Additionally, among those with unipolar depression, there was high comorbidity for anxiety disorders. What are your thoughts as to how childbirth education might begin to help childbearing women unpack and understand the symptoms of anxiety in prenatal education?

Dr. Wisner: In our study we found that women with depression usually had an anxiety disorder that pre-dated the depressive episodes—this observation is true for women who are not childbearing as well.  Having anxiety or depression as a child or adolescent increases the risk for peripartum episodes.  There are excellent pamphlets and websites about perinatal depression (www.womensmentalhealth.org; www.postpartum.net) which can be used to frame a brief discussion and give to the patient for reference.  This also gives the message that talking about mental health before and during childbearing is an important topic, just like surgical births, anesthesia etc.    

WK: The data you have contributed to science are unsurpassed, yet early in your career many questioned whether postpartum depression was real, and doubted if you would be able to pursue a research career in postpartum mood disorders.

Dr. Wisner: Indeed!

WK: How did you persevere–and particularly in a male-dominated field?

Dr. Wisner: I got angry that so few data were available to drive care for pregnant and postpartum women and never let go of the importance of obtaining that information.  That motivation was coupled with a real joy in taking care of perinatal women and their beautiful babies!  

WK: Do you think there is still an underlying doubt as to whether postpartum depression (or perinatal mood/anxiety disorders) is real?

Dr. Wisner: Not in academic medicine, and I have not heard anyone say this in about a decade (thankfully!). 

WK: What is your favorite part of the research? Data collection, analysis, or interpretation?

Dr. Wisner: Publishing findings that make a difference in women’s lives, and holding the babies. 

WK: What new trends do you see in research as hopeful signs of progress?  

Dr. Wisner:  The incredible number of young clinicians and investigators who are interested in perinatal mental health.  Also,  our field has been so accepting of interdisciplinary enrichment of research questions.  

WK: What advice would you share with women in research today? 

Dr. Wisner: Network with  your colleagues inside and outside your organization frequently, attend perinatal mental health meetings and don’t ever give up!  

___________

What are your thoughts regarding Dr. Wisner’s expert opinion?   How do you currently address postpartum depression and anxiety in your childbirth classes?  After reading this interview and taking at look at Dr. Wisner’s just published research, might you reconsider how you teach about this important topic or change your approach?  Let us know in the comments section below- Sharon Muza, Community Manager

More about Dr. Wisner

Dr. Wisner’s research has been NIMH funded since she completed her post-doctoral training in 1988. She served on NIMH grant review sections continuously from 1994 to the present. Dr. Wisner completed was a founding member of the NIMH Data Safety and Monitoring Board, and is only the second American to be elected President of the Marce International Society for the study of Childbearing Related Disorders.

Her major interest area is women’s health across the life cycle with a particular focus on childbearing. She is a pioneer in the development of strategies to distinguish the effects (during pregnancy) of mental illness from medications used to treat it (Wisner et al,JAMA 282:1264-1269, 1999; MHR01-60335, Antidepressant Use During Pregnancy).

In recognition of her work, she was a participant in activities related to the FDA Committee to Revise Drug Labeling in Pregnancy and Lactation, a committee member for the National Children’s Study (Stress in Pregnancy), a consultant to the CDC Safe Motherhood Initiative and the Agency for Healthcare Research and Quality Report Perinatal Depression: Prevalence, Screening Accuracy and Screening Outcomes.

Dr. Wisner was elected to membership in the American College of Neuropsychopharmacology in 2005. She received the Dr. Robert L. Thompson Award for Community Service from Healthy Start, Inc., of Pittsburgh in 2006 and the Pennsylvania Perinatal Partnership Service Award in 2007 from the State of Pennsylvania. 

Dr. Wisner was the first American psychiatrist to collect serum from mothers and their breastfed infants for antidepressant quantitation as a technique to monitor possible infant toxicity. She published the only two placebo-controlled randomized drug trials for the prevention of recurrent postpartum depression and showed that a serotonin selective reuptake inhibitor was efficacious.

References 

1.Wisner, K.L., Sit, D., McShea, M. C., Rizzo, D.M., Zoretich, R.A., Hughes, C.L., Eng, H.F., Luther, J.F., Wisneiweski, S. R., Costantino, M.L., Confer, A.L., Moses-Kolko, E.L., Famy, C. S., & Hanusa, B.H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, Published online March 13, 2013. Doi: 10.1001/jamapsychiatry.2013.87

 

Childbirth Education, Depression, Evidence Based Medicine, Guest Posts, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression, PTSD, Research , , , , , , , , ,

Beyond Downton Abbey: The True Life Trauma of Pre-eclampsia, Eclampsia, and Its Psychological Aftermath—An Interview with Jennifer Carney of The Unexpected Project

February 5th, 2013 by avatar

By Walker Karraa

Regular contributor Walker Karraa interviews Jennifer Carney, a mother of two, who suffered from eclampsia at the beginning of her third trimester.  Jennifer shares her real life story, on the heels of a favorite character’s similar experience on the popular TV show “Downton Abbey.”  Today, we learn about Jennifer’s experience and on Thursday we learn more about resources and organizations working hard to make this potentially deadly disease less harmful to pregnant and postpartum women.  - Sharon Muza, Community Manager

Introduction: 

http://flic.kr/p/dJBJhW

The recent episode of “Downton Abbey” brought much needed attention to the maternal health issue of pre-eclampsia. Why is it we rely on fiction for permission to get real? Where is the line between evidence-based research and fictional representations of the lack of it? How do we encourage each other and the next generation of maternal health advocates to harness the undeniable power of media but not become part of a social construction of maternal mortality as not real? As a qualitative researcher, I believe that some of our best evidence stems from researching real experiences from real women. It is my pleasure to introduce a real woman who experienced the full range of eclampsia and its psychological aftermath: Jennifer Carney.

Note: Consultation with Science and Sensibility contributor, Christine Morton, PhD was conducted to insure accurate and current statistical data regarding pre-eclampsia and eclampsia. 

Walker: Jennifer, can you tell us your story?

JC: My second pregnancy was easier than my first. Up until it wasn’t. I conceived as soon as we started trying. We had no soft markers on the ultrasounds, no need for an amnio, and no borderline gestational diabetes. I was only 34 and with a successful full-term first pregnancy; I was considered “safe” from preeclampsia. The only risk factor I had was my weight, but even with that, statistically my risks were much lower than for a healthy first time mom. There was something about it that seemed too easy. I felt like the other shoe was going to drop – but I never imagined that it would fall with such force.

In my 32nd week, I began to feel ill – like I had the flu. I took a day off from work to rest and recover. I thought I was getting better, but that night I began feeling worse. I called in sick to work again – it was a Friday – and my husband and son went off to work and daycare. I was alone. I laid down and slept for about 4 hours. When I awoke, I felt much, much worse. The headache radiated out from behind my eyes. I was seeing spots. I was incapable of thinking clearly. The phone rang several times, but the receiver was not on the base. I couldn’t locate it before the answering machine picked up. By this point I was aware that something was very wrong, but I wasn’t able to do anything about it. I stayed on the couch, barely moving for as long as I could.

Signs and Symptoms of Pre-eclampsia

  •  High blood pressure. 140/90 or higher. A rise in the systolic (higher number) of 30 or more, or the diastolic (lower number) of 15 or more over your baseline might be cause for concern.
  • Protein in your urine. 300 milligrams in a 24 hour collection or 1+ on the dipstick.
  • Swelling in the hands, feet or face, especially around the eyes, if an indentation is left when applying thumb pressure, or if it has occurred rather suddenly.
  • Headaches that just won’t go away, even after taking medications for them.
  • Changes in vision, double vision, blurriness, flashing lights or auras.
  • Nausea late in pregnancy is not normal and could be cause for concern.
  • Upper abdominal pain (epigastric) or chest pain, some- times mistaken for indigestion, gall bladder pain or the flu.
  • Sudden weight gain of 2 pounds or more in one week.
  • Breathlessness. Breathing with difficulty, gasping or panting.

If you have one or more of these signs and symptoms, you should see your doctor or go to an emergency room immediately. 
Source: Preeclampsia Foundation

Sometime after 5:00, I realized that I was going to have to call someone else to pick up my son at daycare by the 6:00 closing time. I managed to get to my feet and stagger toward the kitchen. I reached out to steady myself on the counter and missed. I fell to my left, onto the hard tile floor in front of the stove. I knew this was bad, but all I could think was that I had to hold on and that someone would be coming. I told myself that I couldn’t let this happen. Shortly thereafter, I tried to scream and felt the beginning of what I later learned was a tonic-clonic or grand mal seizure.  

This was eclampsia – full blown seizures caused by extremely high blood pressure. Somehow, I held on. Somehow, I held on in this state for something like 3 full hours. I have no way of knowing how many seizures I had in that time. When my friend arrived after 8:00, she found me on the floor. I came to long enough to answer her question – “yes, I know where I am. I’m fine.” I tried to get up – and immediately started seizing again. She called 911 and within minutes the paramedics arrived. 

My son was born, not breathing, about an hour later. The doctors were able to revive him, thankfully. He went off to the NICU and I was sent to the ICU. Two days later, I regained consciousness. I was on a respirator and completely disoriented. I was later diagnosed with HELLP syndrome, eclampsia, pneumonia, acute respiratory distress syndrome (ARDS), and sepsis – any of which can be fatal on their own. My son was moved to another hospital with a larger NICU, and I spent 8 days in the hospital where he was born. I saw him briefly before they transferred him – but was unable to hold him until after I was discharged – more than a week after he was born. For the next 20 days, I was only able to see him and hold him during daily visits to the NICU. It would be 4 full weeks from his birth before we could take him home to meet his 4 ½  year old brother for the first time. This was definitely not what we had envisioned.

This experience changed my entire perspective on life. It was the first significant health crisis that I had ever faced and it shook my sense of security and safety. It took a long time to recover physically from the trauma and emotionally I was just a wreck. I was aware that Post-traumatic Stress Disorder (PTSD) was a possibility, but I think the picture I had in my mind of what PTSD was turned out to be very different from the ways in which I experienced it. I had envisioned a quick, big breakdown – but the reality was much subtler. At first, I experienced an aversion to seeing pregnant women. I wanted to warn them, but I also could barely look at them. It manifested in other ways, too – dreams about seizures, muscle spasms, intrusive thoughts. But it felt manageable and the antidepressants helped control the runaway anxiety that had hampered my first postpartum experience 4 years earlier.

Photo: J. Carney 

The mental health issues were helped by the antidepressants, but I wish that I had tried therapy much sooner. It’s doing wonders for me now – but I waited over 6 years to try it. Today, my preemie is in kindergarten and doing well. Aside from my son, getting involved with the March of Dimes and Preeclampsia Foundation has been by far the best part of the whole experience. I wouldn’t change that part, at all.

Walker: How is mental health neglected in the overall understanding of the topic, treatment, and recovery?

JC: This is a huge problem. I got great care while I was in the hospital. I saw social workers, chaplains, and a wide variety of people who inquired after my pain levels and my coping skills. The problem with this is that I was on massive pain killers the whole time. Percocet and morphine can mask emotional pain as well as physical pain. I’m sure I came off as reasonably well adjusted to the whole experience, despite the mental confusion left over from the seizures and the serious health issues that remained. And I was relatively okay. Even during the month-long NICU stay, I was doing all right. I was sleeping well, eating, taking care of myself – but I was also still on Percocet. It smoothed over the rough edges.

It wasn’t until the help dried up, the prescriptions ran out, and the reality of being at home by alone with an infant to care for that the walls started to come down again. Here I was at the scene of the initial trauma, cooking at the same stove that I had seized in front of for hours, responsible for a premature infant who needed drugs to remind him to breathe. This is when I needed the help. This is when I needed information on PTSD and postpartum depression (PPD). This is when I needed support. And as I began the long process of understanding what had happened and why, I found I needed even more support to help me wrap my head around it all.

As I noted while talking about myths, there is a pervasive culture of blame in the overall birth discussion regarding preeclampsia. It can be hard to find information that doesn’t make you feel that you somehow brought this condition on yourself. I looked at the risk factors and the arguments about lifestyle, obesity, and diet – and found a lot of things that sounded like they made sense. But they only made sense if I internalized them and blamed myself for the shortcomings. Maybe it was my fault. This, as you can imagine, does not help the feelings of depression and trauma. It took a LONG time for me to come to the conclusion that there was no way for me to have known that this would happen or to have prevented it. Statistically speaking, I had a very low chance of developing eclampsia even with the risks factored in. Statistically speaking, my son and I should not have survived, either. But we did – and now I want to make sure that I use that in a meaningful way. 

Walker: Did your childbirth education prepare you for your experience?

JC: Heck no. I only took classes with my husband before our first child. We weren’t planning to take the classes again with the second, but since he was born at 7 months, we probably would have missed most of them even if we had planned to. I distinctly remember the childbirth educator talking about her own response to sleeplessness, which was a sort of slap happy, giddy reaction. She mentioned PPD, but not in any real way that conveyed the depths or potential seriousness of the condition. We also received almost no information on pregnancy complications. To me, preeclampsia meant high blood pressure – and I had never had problems with that before. It was totally off my radar. Plus, Preeclampsia very rarely happens in a second pregnancy if it didn’t happen in the first. So, no one prepared me for it. Not my doctor, not my classes, not my books.

Walker: What recommendations do you have for childbirth educators and doulas regarding this issue?

JC: Really, I think it comes down to trusting that the moms you are helping can handle the information that they NEED to know. I was alone. If I had known that these symptoms could mean eclampsia or preeclampsia, I might have been able to save myself from the seizures – which would have also likely saved me from the ARDS and pneumonia. My ICU stay might have not happened. My son was going to be born early – but if I had gone to my doctor or called an ambulance myself, it might not have been so close a call. It’s not my fault that I didn’t know – but it could have been tragic.  

Know the signs and symptoms. Know that a woman with severe PE might be having cognitive issues – confusion, and vision problems. Don’t ask her to drive. Don’t downplay distress. And take complaints of headaches, upper quadrant pain, nausea, diarrhea, shoulder pain, visual disturbances, and a general feeling that something is “off” seriously. And if you have a client or patient that experiences something like this, please follow up and ask about mental health issues. Be careful not to ask questions that can be answered with the words: “I’m fine”. Dig deeper.

Closing Thoughts

How might we increase our understanding of this issue through Jennifer’s story? Is it possible to begin a dialogue here–one in which we agree to change paradigms of learning and knowing women’s experiences beyond an episode of a fictional television show?  Jennifer presents an exemplar synthesis of the fullest range of insight possible when empirical and phenomenological considerations are employed.. Her lived experience combined with and through her knowledge of the evidence creates an exemplar of how knowing and knowledge cannot be divided if the pursuit of knowledge is truly desired.

In the next installment, scheduled for February 7th,  Jennifer reflects on common myths about PE, and her work with the Unexpected Project and the Preeclampsia Foundation.   

Birth Trauma, Childbirth Education, Depression, Guest Posts, Maternal Mental Health, NICU, Postpartum Depression, Pre-eclampsia, Pre-term Birth, Pregnancy Complications, PTSD , , , , , , , , , , , , ,

New Traumatic Birth Prevention & Resource Guide Now On Giving Birth With Confidence

June 7th, 2012 by avatar

Giving Birth with Confidence, Lamaze International’s blog and go-to resource for expecting and new parents has joined with a new organization, PATTCh, (Prevention and Treatment of Traumatic Childbirth) to share the new “Traumatic Birth Prevention & Resource Guide” with GBWC readers and all of us. The guide is a collection or resources and stories surrounding traumatic birth and PTSD written by PATTCh board members.

Traumatic birth and post-traumatic stress symptoms are estimated to affect almost 20% of birthing women and being able to refer birth professionals, women and their families to this resource can provide valuable information and support during this vulnerable time.

PATTCh is dedicated to the prevention and treatment of traumatic childbirth. Penny Simkin, Phyllis Klaus, and other leaders in birth and birth/postpartum counseling have joined together to help women who have experienced a traumatic birth experience or may be at risk for such an event.

Thank you to PATTCh and Giving Birth with Confidence, for recognizing the necessity of such a resource and for making it so available to all of us.  Please explore the Traumatic Birth Prevention & Resource Guide on Giving Birth with Confidence today and share with your classes, colleagues and others. To learn more about PATTCh, its mission, and members please visit the PATTCh website.

All of us working together to recognize, offer assistance and make referrals to women at risk will help improve the experience and prevent or minimize suffering during the tender childbearing year.

 

 

Depression, Giving Birth with Confidence, Infant Attachment, Maternal Mental Health, Postpartum Depression, PTSD, Survivors of Sexual Abuse, Uncategorized , , , , , , , ,