Esther Dale

Esther Dale is a Postpartum Depression, Postpartum OCD, and Postpartum Anxiety survivor, attempted gestational surrogate, full-time college student, Army Wife, mother to three children, and staff to several cats. She loves to read, write, take pictures, and dream about taking naps.

Therapy Isn’t One-Size-Fits-All: Part 2

DSC_6923_editedYesterday, I told you my story of learning through experience that therapy, and mental health care in general, are not a one size fits all type of thing. Today, let’s get down to the practical side of things.

How do you go about trying to find a mental health professional who has at least a working knowledge of PPMD, if not lots of specialized experience?  I’ll give you some tips that helped me, but please realize that this is NOT an exhaustive list, and I would LOVE To hear what has (or has not) worked for other Warrior Moms out there.

  • Use the Postpartum Progress Depression Treatment Programs & Specialists page. Did you know Postpartum Progress has a page specifically for listing postpartum depression treatment programs and specialists who help women with PPMD? We do!!! How awesome is that? Make use of our fantastic resource. Even if you don’t find anyone near you, or anyone near you who is taking new patients, ask them if they can refer you to anyone else.
  • Get specific in your Google search. Throw the word “postpartum” in there, or even a specific PPMD. For example, instead of just doing a basic search for “Atlanta therapist”, try something more specific like “Atlanta therapist postpartum”.
  • See if your insurance has an online in-network provider database. My insurance is through TriCare, so that’s the experience I can speak to/from. TriCare has a website you can go to search for providers who are in network. This gives you contact information and you can then contact the provider directly and ask if they’re still accepting your insurance, taking new patients, and do they have experience with PPMD. Word of caution: make sure they still take TriCare. TriCare’s website has been known to be not entirely accurate/up to date on providers. If you’re with a different insurance company, see if they offer something similar.
  • Use the Psychology Today therapist listings. Psychology Today has listings you can use to look up providers in your area. This can be rather like drinking water from a fire hydrant, but it can give you lots of options to start from and narrow your search field as you go.
  • When you call to set an appointment, ask them directly. Say something like “I’m looking for a therapist who has experience and education dealing with Postpartum Mood and Anxiety Disorders. Is this an area you have worked in before?” If you’re speaking with a person other than the mental health professional themselves, you can always ask if they can call you back directly to discuss it.
  • Ask your OB/GYN, midwife, psychiatrist, family practice doctor, or other medical professional. They may very well have knowledge about what mental health professionals in the area specialize. Doulas can also be very helpful in this area.
  • See if there’s a birth group in your area and ask them. There is a specific birth group on Facebook that has been invaluable to moms in my area for finding all kinds of help, from OB/GYN and midwife to picking hospital to deliver a baby at to recommendations and reviews on therapists and support groups. If you need help finding a group, feel free to shoot me a message and I can try to help you find a group local to you, or if you find a local doula, they should be able to help you find a group if there is one.

Unfortunately, not everyone has access to mental health professionals who specialize in PPMD, and I realize this. If the only therapist you have access to is one who doesn’t have much experience with/education about PPMD, these tips may be helpful. Again, this is not an exhaustive list, it’s just a couple of things that I have learned from past experience.

  • When you make the appointment, make sure they are aware of your situation. This allows them to do some research. Don’t be afraid to recommend Postpartum Progress to them, we even have a page specifically for clinicians.
  • Print off some information to bring with you. Check out the previously mentioned Postpartum Progress page for clinicians and see if there’s anything on there you want to bring with you. Also look around the rest of Postpartum Progress. I am personally a HUGE fan of the Plain Mama English pages that give Plain Mama English descriptions and symptom lists. Print these out and take them with you. Highlight what you feel is applicable, underline stuff, write notes in the margins. I’m actually a huge fan of taking notes like this with me to the doctor in general so I don’t forget my questions or concerns or whatever.
  • Talk to your OB/GYN, midwife, psychiatrist, family practice doctor, or other medical professional. Yes, this is a repeat, but that’s because it’s still applicable. If you are seeing/will be seeing a mental health professional who is not very well versed in PPMD, ask your… let’s say, midwife, for suggestions. Or even your family practice doctor may have some insight on how to prepare for the appointment.

Whatever your situation, I’m glad you’re getting help. And please, don’t be afraid to reach out to the Warrior Moms community. We are here for you. We love you, we see you, we stand with you, we validate you and your experiences. You are not alone.

What tips, stories, or suggestions do you have that you want to share?

Photo credit: Esther Dale

Therapy Isn’t One-Size-Fits-All: Part 1

Content Warning: This blog post contains mention of miscarriage and links to posts about pregnancy loss.

Once upon a time, I thought that counseling/therapy was a one-size-fits-all thing. Counselors are counselors, and all mental health professionals should be able to help anyone equally, right? It’s ok, you can take a minute to roll around on the floor laughing. I’ll wait.

Much to my chagrin, I learned the hard way that this is not the case. Therapy isn’t one-size-fits-all.

After my middle child was born, I was feeling pretty stressed out. My husband is in the military and we had gotten very short notice that he was the proud recipient of orders to move (PCS, aka Permanent Change of Station) across the country. So, with 1 month’s verbal notice (he didn’t even get the paper orders until 2 weeks out), we moved 2 adults, a 2 year old, a 3 month old, a dog, and 4 cats halfway across the country from Central Texas to the Pacific coast of California in a Ford Explorer with no trailer (we learned at the last minute that nobody rents trailers to Explorers). The move was terrible. The drive was long and stressful and rushed, the vehicle was very crowded, I had to fly back to Texas once our house in California was settled to deal with the movers packing out our stuff from our house there, the movers themselves were a nightmare and a half… the whole thing was a mess. It’s been 4 years and I’m just now recovering, although I still hold a (very deserved) grudge against the moving company.

So there I was with an infant and a toddler, in a brand new place away from my home, with my husband not home a lot because military. I didn’t know anybody in our new home and had left my entire support system back in Texas. I was tired (because new baby and toddler). I was stressed from all the crap from the move (trust me, you’re getting a VERY truncated version). And because of my history with PPMD, I wanted to see a therapist or counselor or some type of mental health professional for a sort of check up to make sure I was really doing ok and figure out some coping strategies with everything that was going on in my life. Makes sense right? Smart move, right? Right. Very smart move. I went online and got information about getting mental health care on TriCare Prime (our insurance), and was happy to learn that it was an easy process. I didn’t have to go to my Primary Care Manager (PCM) for a referral or get any type of pre-authorization, I could just pick a counselor/therapist who was TriCare approved and go see them and as long as I stayed under 8 sessions in the year, I wouldn’t have to get authorizations from insurance. I found a mental health professional who had quite a few years experience as a mental health professional and good reviews and I called and booked my appointment.

Imagine my surprise when I spent most of that appointment explaining Postpartum Depression, Postpartum OCD, Postpartum Anxiety, Postpartum PTSD, what my thyroid had to do with it, and why I was there if I didn’t have a diagnosis and didn’t think I had any type of PPMD again. Not even kidding. I mentioned Postpartum Depression and the response was “Huh? Why don’t you tell me about it, what is Postpartum Mood and Anxiety Disorders?”. It didn’t exactly inspire confidence and I never went back to see her again.

Fast forward a few years. After the whole mess with my missed miscarriage of the twins I was carrying as a Gestational Surrogate and some other crappy stuff, I ended up in a place where I realized I wasn’t dealing well with the trauma and grief I had found myself floundering through. I realized that I needed some professional help resolving everything. This time, I reached out the local birth workers community and did some targeted research on Google and was able to find a fantastic therapist who specialized in grief/loss, postpartum adjustments, and infertility. She had even previously helped lead a support group for postpartum moms. My experience with her was a total 180 from my experience with the other therapist a few years prior. It was such a nice feeling to not have to explain the basics and to be working with someone who had experience and education in dealing with the types of things I was struggling with.

The moral of the story is this: don’t just assume that any and every therapist is going to be able to help you, or that every therapist can help you equally. That’s not going to be the case. It is a huge help to find someone who has at least a basic knowledge of whatever you are dealing with. If you’ve been diagnosed with Postpartum Depression, you’re probably going to get better results with a therapist who specializes in PPMD or something related than you will with a therapist whose area of expertise is with academic underachievement or divorce. If you broke your ankle in a car wreck and needed surgery on said broken bone, who would you prefer to see and have operate on your ankle, given a choice: an Orthopedic Surgeon who’s been operating on broken bones for 20 years or an Obstetrician who has attended hundreds of births? Why should treating our mental health be any different?

Thanks for reading Therapy Isn’t One-Size-Fits-All: Part 1. Check back here tomorrow for part 2, in which I’ll give some tips (and links!) for finding a mental health professional who fits your need and tips for when you don’t have access to a mental health professional who specializes in what you need. And in the meantime, what has been your experience with trying to get therapy for PPMD?


Photo credit: Esther Dale

Dealing with Postpartum Depression as a Military Spouse

Dealing with Postpartum Depression as a Military Spouse

I gave birth to my oldest baby on April 23, 2009 at Wilford Hall Medical Center at Lackland AFB in San Antonio, TX. Three months after giving birth, I was back at Wilford Hall, this time at the ER, terrified that I might act on the terrible thoughts and images that were in my head although I didn’t want them there. For three long months I had ignored the symptoms and tried to pretend that nothing was wrong, tried to hide my agony from the world, from my friends and family.

Why did I hide it? Why didn’t I ask for help sooner?

Because military.

My husband is in the military and on top of the typical stigma and myths faced in general by those Postpartum Mood and Anxiety Disorders, there’s another set of challenges and stigma and myths that I was fighting, even though I didn’t recognize it. These are issues that I have heard from other families dealing with or who have survived postpartum mood and anxiety disorders.

One issue is, as I stated, the stigma, fear, and myth. It’s so easy to think “If I am having problems, they might take away my spouse’s security clearance/job/weapons qualification and access/kick them out of the military. As a general rule, this is not the case. The military is not going to pull your spouse’s security clearance because you spend some time in therapy or admitted to the hospital with Postpartum Depression.

Actually, the military wants you to get the help you need, and many command teams will try their best to work with your spouse on adjusting their schedule. If you are struggling and you need to seek help, help them find some educational material to take with them to go speak with the Commander, 1SG, whoever. If it helps, speak with the chaplain first. They may have suggestions on how you/your spouse can approach this with the command team to achieve the best results for both your family and your spouse’s unit. But they can and should work things out and help your spouse get things squared away… all without giving them UCMJ action.

One of the other issues that faced me, and also faces many other women needing to seek help for PPD and other postpartum mood and anxiety disorders, is with TriCare and/or the doctor(s)/clinic(s). Not only can it be a huge run around and pain in the butt to find a provider you can see, get your referral approved, and then actually get an appointment, it can be daunting and slightly terrifying, not to mention confusing. You may or may not be seen by military health providers, and you may or may not have to deal with paperwork for referrals, etc. I’d like to offer some suggestions on how to deal with the TriCare/etc. side of postpartum mood and anxiety disorders as a military spouse (please note that this is info specific to dependents; service members should of course follow their protocols).

Know your coverage.

TriCare is not a one-size-fits-all insurance. Your benefits may vary depending on, for example, whether you’re with TriCare Prime or TriCare Standard. You will first need to know which type of TriCare you have. (Don’t laugh. I have known dependents who didn’t know this information.) Once you know that, I would recommend trying to learn generally speaking what TriCare covers and how they work when it comes to mental health care. I suggest starting at TriCare Mental Health); it has a lot of really good information as well as contact info for the 24/7 TriCare Nurse Advice Line and a crisis hotline.

If you are having an emergency, CALL 911 or GO STRAIGHT TO THE EMERGENCY ROOM.

You do NOT have to call TriCare or your PCM, get a referral//authorization ahead of time, etc. If you are admitted, as per the TriCare website on getting mental health care, you will need to call your regional contractor within 24 hours or the next business day, and admissions must be reported within 72 hours. Please note that it does not have to be you doing the calling, so please don’t stress about that. Let your spouse or another trusted family member or friend have all the information they need and take care of the paperwork. You focus on getting better.

Again, get to know your coverage.

In many cases, you might not need a referral/authorization before starting outpatient care. And once you do, your provider can take care of that paperwork for you.

Another fantastic resource is Postpartum Support International.

They have resources specifically for military families, including support coordinators for the different branches of the military.

As military spouses, it’s easy to get caught up in the culture of being brave and strong and carrying on, of supporting our spouse and not taking care of ourselves. It’s easy to buy into the fears and misinformation such as “Will Family Advocacy come investigate me and try to take my baby? Will the MPs get involved? Will my spouse get in trouble? Will my spouse lose their clearance?” But these are all things that should not keep you from seeking the help that you need.

If you are worried, talk to a military chaplain. I started with the on-call chaplain for my husband’s battalion. He talked to me and met me at the ER, and stayed as long as I wanted/needed. It doesn’t matter whether you’re religious or not, or if you’re the same denomination as the chaplain. They are there to support you and your family, without judgment. You can talk to them without fear of reprisal; they are confidential. I went to an Army chaplain with some concerns about a friend of mine, and the chaplain assured me that he is not a mandated reporter. A chaplain is about as safe a person as you can go to to seek help in figuring out what steps to take.

Take care of yourself. You don’t have to be brave and strong. It’s okay to be whatever you need to be, to feel whatever you are feeling. If you feel alone, there are other spouses who are there or have been there, who are willing to walk with you through this dark valley. Let us help you.

Not All Situations Are the Same: My Four Stories

postpartum depression storiesTrigger warning: This post contains some references to miscarriage.

Often, I find myself telling my story of life with and after postpartum depression (and postpartum OCD, and postpartum anxiety, and postpartum PTSD… darned comorbidity). I love to tell my story. I also love to listen to the stories of other people. Over time, I have come to realize that it’s easy to fall into a trap of saying or insinuating that [this] is what worked for me and so you should do what I did; it worked for me and it will work for you.But one of the things I have come to realize is that no two stories are the same. And it’s not just that no two people’s stories are the same, no two stories are the same even for an individual person. Even if there are similarities, there will still be differences. This certainly holds true for treatment options and strategies.

I have had four pregnancies. Three of those ended with live births, one ended in miscarriage. They also all had different mental health situations, outcomes, and treatments. I have one story, in the sense that it is the story of my life, but that one story contains smaller individual stories, and they don’t all follow the same template.

The first story

My first story is that of my oldest child. In April 2009, after a very long and difficult labor, I gave birth to a beautiful little baby girl. Unfortunately, life was not the idyllic fairy tale of storybooks and I found myself suffering a nasty case of postpartum mood and anxiety disorders. I was officially diagnosed with postpartum depression and anxiety, and had missed diagnoses of postpartum OCD, postpartum PTSD, and hypothyroidism. I believe I also had some antenatal depression that went undetected. (I didn’t even know that was a thing until a while down the road). That story involved 2 inpatient hospital stays, 9-ish months of Celexa, Ativan, and Ambien, and seeing a therapist. That was what was necessary and what worked for that story. Ultimately, an overdue diagnosis of hypothyroidism resulted in me starting on Levthyroxine (thyroid medication), which resolved my PPMD about as promptly as you could hope for, almost literally overnight.

The second story

In April 2011, I gave birth again, to another beautiful little baby girl. This time, in consideration of my history, I had started on Zoloft at 38 weeks pregnant as a prophylactic measure, and also had my thyroid levels (TSH and T-4) checked pretty much monthly during the pregnancy and again after giving birth. This second time, there were no problems and life was pretty rosy.

The third story

In September 2012, I gave birth to a very unexpected beautiful baby boy (let’s just say that it’s important to keep in mind that a 99% effectiveness rate for birth control still leaves 1% for whom it is not effective). This time, I had a number of things going on during pregnancy that were extremely stressful, and ended up starting Zoloft at about 35 weeks instead of the planned-for 38 weeks. However, I still didn’t really have major issues afterwards and everything resolved itself fairly quickly without further intervention.

The fourth story

The fourth story is my ongoing one, which I wrote about yesterday. In April 2014, I miscarried the twins I was carrying as a gestational surrogate. It’s been a tough road. The emotional aftermath of pregnancy loss is no joke. I haven’t had a need for medication this time; therapy alone has been very useful in helping me deal with postpartum adjustment and the grief and trauma that 2014 brought me.

Four different stories. Four different treatment plans. Four different outcomes. And that’s all for the same one person: me. If my situations don’t even follow a predictable formula, why would I expect that anyone else would have the exact same situation/needs as me or even the exact same situations for their own individual different situations and stories? I can’t. We can’t.

It is so vital to remember this. My story isn’t yours and your story isn’t mine. Our brains, bodies, and situations are different. It’s okay if and when we react differently to similar circumstances and situations; it’s even to be expected. The danger is when we start to insist that someone should follow our advice and not consider any other method because it worked for us. There is no guaranteed cure or prevention for PPMD (dear GOD do I wish there were). We must all keep this in mind and be gentle in dealing with ourselves and with other people. We must remember that we are all unique individuals with unique brains, situations, needs, and stories. We must love each other and ourselves to remember that not all situations are the same.