The Cost of Not Helping Moms

Photo Chris Ryan, Getty Images

171092762

Postpartum Depression is thought to affect at least 10-15% of mothers in Canada, according to a major national study from 2011.

Please take a moment to consider how many women that is. That is nearly one out of every 6 mothers.

But those are only the occurrences we know about. Because even a gold standard study of postpartum mood disorders supported by the Public Health Agency of Canada has some major flaws.

For example, lets look at how information was gathered for this study:

In the provinces, women were cold-called for computer-assisted telephone interveiws that lasted on average 45 minutes. In the territories, a paper survey was distributed in areas where a phone was not available in the household.

The Edinburgh Postnatal Depression Scale was used. This tool was developed in 1987 in Scotland. It is valued for its efficiency because it is only 10 questions long. Furthermore, it is concerned only with experiences of the mother in the previous seven days, so if you recovered from a perinatal mood disorder a month ago, no one is asking.

Stats Canada selected a group of 8, 542 women ages 15 and over who had had live singleton births.

IT EXCLUDED:

  • Mothers of twins and multiples
  • Mothers of stillborn babies
  • Mothers younger than 15

Who is more at risk for a postpartum mood disorder than a mother of multiples, a stillborn baby, or a mother under the age of 15? Why are these women excluded from the data? Why are they not being represented?

This study was a cross-section taking place over a matter of a few months, it was not longitudinal. This is problematic. Women in Canada have on average 2 living children. So obviously, a study that only collects data from one pregnancy at a time, is forgetting that the same woman will likely have more children, or has already. We want to know how many women will have been affected by postpartum mood disorder in their life, NOT just who had it the week of the phone-survey.

Very concerning is that out of the 8,542 women, only 6,421 mothers responded to the survey.

HERE ARE SOME REASONS WHY A MOTHER IS LESS LIKELY TO RESPOND TO A GOVERNMENT-ISSUED SURVEY:

  • You have postpartum depression. And feeding and diapering your child is your only priority right now.
  • You’re terribly ashamed and don’t want to tell anybody what you’re going through, let alone admit it to yourself. A symptom of postpartum mood disorder is thinking that you are the worst mother in the world. A woman can be an excellent mom and still think that, if she is suffering from this illness. A common fear is that if they disclose their illness, they will have their kids taken away.
  • Postpartum mood disorder is enormously stigmatized. What if someone in your family reads your survey responses? Or hears your responses while you’re talking on the phone? Imagine if there was a similar phone survey to collect answers from victims of domestic violence or sexual assault? Would that not be hugely inappropriate? It’s absurd.
  • “Is this person on the phone for real? I can’t see their face; they’re asking such personal questions, and they want me to talk about my mental health? While my in-laws are here??”
  • You have poor literacy skills (which also can increase your PPMD risk).
  • You come from a first nations/rural/remote community, where there is a history of strained relations with the government.
  • The person on the phone is English-as-a-second-language and you struggle with non-English accents.
  • You have a child hanging off one breast or you’re trying to heat a bottle, and the dog is barking at the door.
  • You saw the unfamiliar number on the phone and yelled, “Kids, don’t answer it!” because you definitely don’t have 45 minutes to answer questions like how much money your husband makes.
  • You have to pick up your older kids from hockey, there are bills to pay, the fridge is empty, it’s 8pm, and the stove is cold

I Think You Get the Picture.

“…Why, in the hospital, could I [receive] the services of a lactation consultant but not of a mental health professional to discuss PPD? Why did my OB/GYN stop by my room every day to check my Cesarean stitches but not my state of mind? During my pregnancy, my husband and I had to take six birthing and parenting classes in which we practiced putting on diapers and installing car seats but did not discuss maternal care options.

Angela Pandolfo Roy, My Voice Didn’t Soothe Him, My Touch Didn’t Comfort, 2007

The true statistic is obviously a lot higher than we can imagine. And that number can include women like your sister, your best friend, your wife, your daughter, or it could have been your own mom at one point.

And the bottom line is – mothers are not getting help.

The consequences of UNTREATED perinatal mood disorders on children are serious and cannot be overlooked , .

  • Impaired infant bonding
  • Difficulty establishing breastfeeding, which is also associated with depression
  • decreased performance in school-age children
  • Delay of developmental milestones
  • Decreased weight gain and thriving in infants
  • Increased risk of SIDS
  • Behaviour problems
  • Difficulty in making secure relationships throughout life
  • A greatly increased chance of children having a mental health disorder like depression, anxiety, ADHD, or autism
  • Increased chance that children participate in crime or drugs
  • Stressful marriages and family environment

In 2012, as reported by the Globe and Mail,

“…more than 49,000 Canadian mothers experienced depression within the first 12 months after giving birth, putting at least 80,000 children at risk for poor development.”

Furthermore the downstream effect of UNTREATED perinatal mood disorders on our healthcare system is just enormous:

  • A national Canadian figure is not available, but lack of maternal mental health care costs the UK £8 billion a year, the US $1 billion and Australia $433 million.
  • When moms don’t get help right away, their first point of entry with the health care system is usually with acute inpatient services
  • Increased pressure on an outpatient care stream that cannot adapt to the individual needs of moms vs. other members of the public
  • Unnecessary trips to the ER, for mothers and children in crisis, or unknowingly suffering symptoms of anxiety or depression (ever heard, “oh, she’s just a nervous/new mom”?)
  • Increased doctor visits and repeated contact with the health care system, while a resolution is not found
  • Mental illness of any kind is associated with chronic diseases such as heart disease, stroke, dementia, obesity, diabetes, and hypertension
  • Increased risk of self-medication with drugs and alcohol, and during successive pregnancies
  • Increased sick days and sick leave time from work
  • Less likely to follow up with adequate prenatal care, which leads to problems such as early termination of pregnancy or complications at delivery time
  • Increased usage of social work or police in a crisis situation
  • In the case of very severe mental illness, such as postpartum psychosis, there is a risk of infanticide, although rare
  • suicide

Referring to Canada’s embarrassing lack of information on maternal suicide, also from the Globe and Mail:

“In contrast to Canada, Britain has rigorously analyzed maternal deaths for more than 50 years to sift out contributing factors. The findings are astonishing. When maternal deaths between 2000 and 2002 were examined, for example, psychiatric illness accounted for the majority of those deaths. Put bluntly, more mothers died by committing suicide than by succumbing to any other medical complication, such as hemorrhage or heart disease.”

Mothers are the bedrock that shape our families and our communities, both local and beyond. So it’s no wonder that when moms are sick, it affects everybody.

Postpartum mood disorders are not somebody else’s problem. They are not something that expecting women or moms alone should watch out for. We are greatly underestimating both incidence and impact of these illnesses.

 

We’ve heard of things like postpartum depression before. So why should we do anything differently? In the words of our new Prime Minister in response to why he appointed a 50% female cabinet,

“Because it’s 2015.”

And we are failing moms. We have been, and we still are.

Why is this? Despite the fact that so many women are ill, we have a really hard time talking about postpartum mood disorder.

Mothers are supposed to be happy and glowing after the birth of their child, right? They just have to be. Any challenging of that view creates enormous cognitive dissonance, and we quickly sweep it under the rug.

And by sweep it under the rug, I mean we give out a pamphlet with ten questions, spend more time going over proper fit of the car seat, wave them off, and hope for the best.

We need to do more in our communities for moms, and the time to start is now.

We need to improve access to information on perinatal mood disorders for both healthcare providers and the public.

We need to improve screening, such as at regular paediatric doctor visits throughout the first year and beyond.

We need to improve our screening tools, so that we don’t miss any of the warning signs and symptoms (there are more than ten).

We need to improve follow up.

We need to improve the doorways to the healthcare system so that moms can be connected with people who can help.

We need improved access and response time so that moms don’t have to wait months for a therapist who specializes in perinatal mood disorders.

We need more support groups of other moms going through the same thing.

We need more teams of health care warriors, ready to stand up for moms and fight perinatal illness.

If you are in health care, your presence here, reading this, is a great start. I hope you share this call for action with other health care providers – nurses, doctors, paramedics, social workers, counsellors, anyone who will listen.

If you’re not in health care, then you are still one of two: someone who knows a mom, or someone who is a mom. And you have two choices: to pretend this problem is not as big as it is, or to raise your voice.

Because when moms get better, everybody gets better.

– Jessica C., RN, BN

 

 

Advertisements

Antidepressants Are Options

woman-and-waterfall-1579269-1599x2382

There is a constellation of facts and emotions swirling around antidepressants, always. And the big feelings around antidepressants are of suspicion, anger, judgement, pressure, guilt, and shame. And a lot of times, facts get misused or distorted, or completely invented.

I am pro-pharmaceutical.

I am also pro-meditation/mindfulness, pro-cognitive behaviour therapy, pro-eating right and exercising, pro-sunshine, and pro-vitamin B6. I am pro-GETTING BETTER.

A mood disorder (like anxiety or depression or bipolar) is a physical illness. Why? It takes place in a PHYSICAL body (where else?) and it is hurtful; it’s not conducive to thriving or living your life. It is body stress. And just like other kinds of stress or inflammation, it is accompanied by biochemical markers like increased cortisol and cytokines in your bloodstream [source].

Anxiety and depression disorders are excruciating. They are agonizing to go through and create alienation and isolation around a person. They create chaos in families. NO ONE chooses to be anxious or depressed any more than they want to hold their hand against a hot stove burner. In a culture of shame and judgement, most symptoms are covered up, hidden, and disguised as much as possible. What you see, if you see any signs at all, is usually just the tip of the iceberg.

The decision to treat your mood disorder is a painful one and it requires a lot of courage. More difficult, is when people battling their anxiety and depression get caught in a larger battle – Treat With Drugs vs. Without Drugs.

I roll my eyes when mental illness is called an ‘invisible illness’ – it is no more invisible than any other kind of injury on the inside of the body, as opposed to the outside. By that definition – a physical illness somewhere that isn’t on the skin’s surface – a knee injury is an ‘invisible’ illness. Heck, most soft tissue injuries are invisible. A GI disease like a hernia or ulcer that isn’t seen by the naked eye is an invisible illness. Just like with other physical illnesses that can’t be seen on the outside of the body, mental illness is initially diagnosed based on the patient’s reported symptoms, such as pain and impaired functioning. But are conditions like carpal tunnel or a pulled muscle as de-legitimized and stigmatized to the level that mental illnesses are?

Illnesses that happen in our most vulnerable organ – the brain – are the hardest to examine by doctors. So in the absence of information, comes a lot of opinion and judgement. Sadly, most of it is negative because the signs and symptoms of mental illness can resemble extremes of normal emotions in healthier people. And therein lies the key to understanding the stigma. Because we can’t open up the brain’s minute circuitry to look inside as easily as we can view somebody’s GI tract with a scope, people create assumptions about WHY people with mental illness are suffering. They make the mistake in thinking that victims of mental illness are not doing enough to cope on their own, when in reality their brain is creating a situation that is overriding their capacity to cope.

The brain is not inherently mysterious; we just don’t understand it well, and perhaps we won’t for a long long time. When something is beyond understanding, it is human nature to fall back on familiar points of reference – such as ourselves. In ancient times we thought lightning was caused by a human-like god throwing spears of fire. So when someone can’t come to grips with a loved one’s depression, their solution to the problem is like pouring a cup of water on an inferno. What works for them, won’t work for someone with depression.

This all seems pretty obvious, but it brings me to my next point.

If you have never needed a psychiatric medication, you cannot possibly begin to condemn someone for taking one.

Mental health medication gets a lot of bad press. It’s not surprising why. Psychiatry and medicine has a sad history of over-prescribing, chemical abuse and oversedation, calling normal human experiences ‘disorders’ that require pills when they don’t, making considerable profit by exploiting desperate people, creating addiction and causing permanent damage, and the list goes on.

BUT that doesn’t mean under the guidance of an ethical health care provider you cannot find a SAFE option for you and take it responsibly. It doesn’t mean that you should be judged or shamed for needing medication, or that medication is a bad thing when prescribed and taken responsibly. It doesn’t mean that you are copping out. Or taking a shortcut. Or not trying hard enough. Or have a weak or addictive personality. It doesn’t mean you are a pill-popper. Or a junkie. Or a bad mom or a bad husband.

I am SICK up to HERE with the subtle and not-so-subtle message towards people who take mental health medication. If you can take some vitamin B12 and a sniff of lavender essential oil before bed to manage your depression and anxiety, that’s awesome. But don’t go writing an unsourced airy fairy blog post about how the pharmaceutical industry is just trying to kill everybody and you should feel nothing but shame and guilt for relying on some sketchy chemical from a lab, that is little better than a placebo. Just ask anyone lucky to find an SSRI that worked for them – the effect is the complete opposite of placebo.

And for every industry worker for Big Pharma I swear is some alternative asshole trying to make money by selling you holistic oils and crystals, but I digress.

We need to remember that mental health should be treated the same way all other issues in the body are – with titration, and appropriateness. If someone comes to the ER with a hangnail you don’t just throw some hydromorphone on it. Or just as bad – if someone comes with their foot cut off you don’t ask if they tried icing it first.

So yes some things like meditation and sunshine and essential oils and vitamins and good nutrition and a sweaty workout and cognitive behaviour therapy  and a big old handful of cashews daily will manage some mood disorders. But not others. That is why antidepressant options remain just that, options. And non-invasive non-medical things should be continued as supportive therapy.

So are you failing if you need it? No way. You are trying your best. Haters can hate. You just keep on keepin’ on your healthy way. With your head up. And a middle finger in the air. If you need it.

– Jessica C., RN, BN

 

I Wear Climbing Boots

img_4773

You just had a baby. There’s smiles and congratulations. Balloons and flowers. Visitors at your door. Matching hospital bands and a little one snuggled into your arm.

But something is wrong. You don’t know what it is yet, so you smile and push through as best you can. You pull your hair up into a quick knot and smooth your gown, or the first shirt you’ve put on in days, and get ready to receive the next group of family and friends. When the well-wishers are gone, your spouse, and perhaps close family, sense there’s a change. But these early days are so crazy and your partner is adjusting too. There’s no time and no words to describe what’s going on inside you, meanwhile the storm just keeps building.

The days blur by sleeplessly and you realize: somewhere in your mind something just broke. You think you might be losing it. And you’re scared.

Most moms who have emotional struggles after birth are diagnosed as having Postpartum Depression. But Postpartum Mood Disorder is a many-headed hydra that includes postpartum depression, and also illnesses like postpartum anxiety. Treatments such as counselling and medication are similar in treating PPMDs in all their forms. But as long as ‘experts’ blanket-diagnose all mood disturbances after giving birth as Postpartum Depression, the screening tools and awareness among healthcare providers remains narrowed to a subset of symptoms – that of depression. A mom suffering from Postpartum OCD, for example, might not get help because her symptoms aren’t recognized, or even worse, misunderstood.

If a mom is not showing typical signs of depression, and saying that she “just can’t sleep” (or relax or stop cleaning and sterilizing or checking on the baby at night, or avoiding sharp objects in the house), she might be seen as just another ‘nervous’ or ‘first-time’ mom. The truth is, Postpartum Mood Disorders can manifest, not only as depression, but also anxiety, panic disorder, OCD, mania, or psychosis.

Insomnia is a VERY common early sign of a postpartum mood disorder. It is also horribly isolating. Reaching out to friends and family can be met with raised eyebrows. You might hear statements like, “You’re a new parent! How could you have trouble sleeping? When I was a new mom I fell asleep, blah blah blah.” or my favourite crappiest advice of all time, “Just put your feet up and sleep when the baby sleeps”. When helping hands come to offer to relieve you for naps or nighttime duty, the agony of ‘Momsomnia’ ramps up several gears. The chance of sleeping at night or even for naps during the day is made more impossible under the crippling weight of performance pressure, when someone finally offers you a break. And nothing fills you with more guilt than seeing the confusion (or worse, annoyance) on your helpers’ faces when they ask you if you got some rest, and you reply sadly “no” after coming out of a quiet room hours later.

Trying to get help for postpartum insomnia is very very hard, and clear information is sparse. Many people confuse insomnia with the interrupted sleep that comes with caring for a little baby. But there is one HUGE distinction: not being able to sleep EVEN WHEN THE BABY IS ASLEEP and you have time to sleep. That is insomnia, NOT sleep deprivation.

Insomnia can be accompanied by sleep panic (panic attacks while trying to get to sleep or upon waking up in the morning, for example) and sleep dread (watching the clock until nighttime and holding negative associations about your bed and bedroom). One of the most frustrating things you can encounter when looking for answers is the notion of ‘sleep hygiene’, as if problems with getting to sleep or nighttime waking are, by contrast, somehow dirty. Postpartum insomnia is a monster of its own – and limiting screen time at night and sticking to a regular bedtime (you wish you could) may not help.

Medication is much-needed in many cases of postpartum mood disorder, such as to help with anxiety and insomnia. Furthermore, moms already have enough guilt on their plate without the added stigma that medication carries – like the rhetoric that it is just a Western World Numbing Agent (and you can tough it out with exercise and positive thinking). Medication is a common treatment in combination with counselling, and it saves lives. Period. But it can be difficult to know when and if to start it. 

Not all symptoms are visible on the outside, and have different degrees of impact on a mom’s ability to look after her baby. Some people with anxiety can be on hyperdrive, or fueled by hyperarousal. They may not have trouble getting out of bed in the morning. They may not forget to shower or get dressed when opportunity is provided. And sometimes they can even get a lot of stuff done – sterilizing bottles, folding the laundry, and cleaning the kitchen until it’s spotless – until 4:00 in the morning. And that’s when the rubber starts to come off the tires. More attention needs to be given to these moms who just can’t stop worrying. Who need to get up and check to see if the baby’s breathing just one more time. Who can’t stop counting and recounting how many times the baby has fed, pooped, spit up, cried. It is these moms who fear the sky falling, and then end up crumbling inside.

OCD is a common experience among new moms, but is severely underdiagnosed. Reaching out for help with this disorder is terrifying. A lot of moms with OCD are paralyzed with fear that they are experiencing postpartum psychosis. OCD is NOT psychosis. OCD is another expression of anxiety. A book that addresses this topic entirely is called Dropping the Baby & Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood, written by Karen Kleiman and Amy Wenzel. This Huffpost article describes very well what the agony of perinatal OCD is like.

The truth is, postpartum anxiety and insomnia are hell. Please, if you need help, reach out. No matter how hopeless you feel, you CAN and WILL get better. Tell someone – your doctor, your partner, your mom. These recommended resources below are a good start – you can print them to show others what experience you are going through.

And someday think about joining your nearest Climb Out of the Darkness walk to raise awareness for perinatal and postpartum mood disorders. Watch this video by the Postpartum Progress team and be inspired to connect with moms in your community and beyond.

I’m still wearing my climbing boots.

Postpartum Progress: The Symptoms of Postpartum Depression & Anxiety in Plain Mama English

Ivy’s PPD Blog

Babycenter.com

Pumpkin Coconut Mug Cake

This mug cake is perfect for a fall or winter treat. Warm, spice-y, moist, and just the right amount of sweetness. Curl up and enjoy!

pumpkin coconut mug cake.
pumpkin coconut mug cake.

1/2 cup whole wheat all-purpose flour

1 tsp. pumpkin pie spice

1/2 tsp. baking powder

1/4 tsp. baking soda

1/4 tsp. salt

1/4 cup + 2 tbsp. canned pumpkin

3 tbsp. canned full fat coconut milk, well shaken

2 tbsp. maple syrup

2 tbsp canola oil

1 large egg

  • toss everything in a large coffee mug and whisk with fork to combine
  • cover with small dessert plate (or similar) to keep batter from overflowing
  • throw in the microwave for about 2 minutes on high, or until a butter knife comes out clean
  • Top with some more coconut milk combined with sweetener of your choice (or ice cream)
  • TIP: it may be easier to just pour out the coconut milk into a bowl and whisk, before using

This recipe was adapted from ‘Pumpkin Cake with Coconut and Lime’ in Dina Cheney’s Mug Meals: Delicious Microwave Recipes.