Lauren Hale

Lauren Hale tells it like it is about Perinatal Mood & Anxiety Disorders over at My Postpartum Voice. She is also the founder of #PPDChat, an online Twitter & FB Community dedicated to supporting moms on their journey by harnessing the power of the Internet. You can find her on Twitter @unxpctdblessing.

Research uncovers various classes of PPD

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brainHumans compare themselves to others around them. She has prettier hair. He has a nicer car. Why does she get the corner office when I have worked just as hard? Or the ever popular gym comparisons: I do the SAME exercises as her and yet, nothing. Then we beat ourselves up because we are not achieving the same end results as those around us.

We do the same when we are fighting a Perinatal Mood & Anxiety Disorder. “I’m on Zoloft. It only took so-and-so this many weeks to feel better so I should be feeling better by then too!” Then we hit that milestone and we may not be feeling better. It is so difficult to handle, perhaps even more so than the comparisons in the first paragraph because all we really want is to be better, to be back to ourselves and yet while we are running our own personal marathon toward mental wellness, we compare to those on the same road, forgetting that even on the jogging path, there are those who pass us.

New research out of Chapel Hill, by Dr. Samantha Meltzer-Brody, examined the heterogeneity (that’s a scientific word for diversity) of postpartum depression via a latent class analysis. What she discovered may put some minds at ease when it comes to fighting the battle of postpartum depression.

Turns out, according to Meltzer-Brody, that there are various “classes” of postpartum depression. What does this mean? It means we all are fighting different battles. It’s the same war, but think of it as different levels of skirmishes.

What varies?

“Women in class 1 had the least severe symptoms…., followed by those in class 2…, and those in class 3. The most severe symptoms of postpartum depression were significantly associated with poor mood, increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptoms onset within 4 weeks postpartum and had more pregnancy complications than in the other two classes (69% vs 67% in class 1 and 29% in class 3).

Their conclusion?

“PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations.”

Why does this matter?

It matters because the more in depth our understanding of how PPD behaves is, the more successful we will be in treating it, and possibly even minimizing any severe episodes. In addition to external influences, there are also internal influences and biochemistry at work here. Thanks to Dr. Meltzer-Brody and other researchers like her, the very real possibility looms of truly individualizing PPD treatment.

For now, we continue to propel ourselves forward, going with what works for us, and in addition to fighting our own battles, remember not to judge those who are doing a bit better than we are. We are all on the same road but we are walking to our own struggles.

(photo source:

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Should New ICD-10 Code Reference Puerperal Psychosis?

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Doctors At The General AssemblyA recent blog post at Supercoder exclaims there will be a new code for Postpartum Depression in the ICD-10. What’s the ICD? The ICD ” is the standard diagnostic tool for epidemiology, health management and clinical purposes, according to WHO. This includes the analysis of the general health situation of population groups.” In simple terms, the ICD is where codes for diagnoses and treatment are found and then used by doctors for your charts and for insurance purposes. Of course, it is also used for research and tracking purposes as well (epidemiology).

One would think this is good news as it changes the convolutions from the ICD-9 and simplifies it into one code. But in my personal opinion, this is not a good step for anyone. Why not?

Because, according to the blog post at Supercoder, this new code will reflect a diagnosis of Postpartum Depression as Puerperal Psychosis. What’s the ONE thing we always, always, always cry from the rooftops?



And yet, in the new version of the diagnostic bible for medical professionals, postpartum depression will indeed, become psychosis.

Why the change?

According to Medicaid’s page regarding the switch from ICD-9 to ICD-10, “The ICD-10 code set is much better at describing the current practice of medicine, and has the flexibility to adapt as medicine changes.”

In my humble, non-professional, survivor opinion, this is not a move forward. Instead, this is a step back. We have fought so very hard to differentiate postpartum depression from psychosis. For women, it is an important distinction to make when seeking help. With media sensationalism, the cases the public hears about are rooted in psychosis but often referred to as postpartum depression. This is makes the need to differentiate between psychosis and depression urgent. Women and their loved ones need to be reassured that not all cases of Perinatal Mood Disorders are psychosis. In fact, Psychosis is extremely rare and doesn’t always end in death despite carrying the highest risk for both infanticide and suicide.

In reading the code information page at the ICD-10 website, postpartum depression is mentioned and explained in detail. It’s done quite well, actually. However, the fact remains that the leading words are “puerperal psychosis.”

According to Wikipedia, the definition of “Puerperal Psychosis” is “a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth. A typical example is for a woman to become irritable, have extreme mood swings and hallucinations, and possibly need psychiatric hospitalization.” While this does indeed describe Perinatal Mood & Anxiety Disorders, emphasis must be placed upon the fact that psychotic symptoms are not part of all of those diagnoses found under the Perinatal Mood & Anxiety Disorder umbrella. Only one – Psychosis, involves psychotic symptoms.

I did not struggle with Psychosis but rather with Obsessive Compulsive Disorder. I experienced a near-psychotic break as a result of a negative reaction to medication but it resolved once my medication changed. (This is why it is so important to communicate with your physician about any changes in behavior while on any psychiatric medicine).

While I appreciate the effort to simplify the coding for Perinatal Mood & Anxiety Disorders, the road this starts us down does not seem to clarify much of anything for women, for doctors, or for the media. The results of this change may prove to be a further hindrance to treatment and increase sensationalism with rare cases ending in infanticide and suicide. Imagine a young mother in a room with an untrained physician being informed that she’s just scored positive on the Edinburgh Postnatal Depression Scale and with this diagnosis of Puerperal Psychosis, she’ll need medication, etc. One would hope physicians would be better but there’s always the what if…the what if that I hear all too much from mothers who have experienced the untrained doctors. Perhaps this is what frightens me most.

I would love to hear the opinion of others regarding this change to the coding for Perinatal Mood & Anxiety Disorders. Do you think it’s a step in the right direction? Or do you see it as a hindrance to treatment and outreach? Codes are so rarely discussed publicly so perhaps it won’t matter in the grand scheme and I’m over-reacting. But in a world where labels matter (and they do, in the Perinatal Mood & Anxiety Disorder world), this, in my personal opinion, only ends in a huge leap backward.

Chime in below with thoughts and questions.

(photo credit: “Doctors At General Assembly”, Waldo Jaquith @flickr)

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Thanksgiving Survival Tips

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Thanksgiving Fog

Thanksgiving Fog – Albany Nov 02 by altuwa on @flickr

Before I experienced Postpartum Obsessive Compulsive Disorder and depression, I will admit my self-care during my adult life was nearly non-existent. I still had interests, hobbies, things I loved to do, but I didn’t put any of it into practice on a regular basis. Instead, I allowed myself to give in to what others wanted and needed all too often. This was, of course, no one’s fault but my own. Motherhood and my subsequent fierce battles with Postpartum Obsessive Compulsive Disorder were my great teachers – albeit they taught me through fire and not calm patience.

This morning it hit me just how much I have learned in the nearly 10 years since my first episode. (Side note – I can’t believe it has been nearly TEN YEARS!)

Holidays are difficult for me, Thanksgiving in particular. You see, when I was a pre-teen (I believe they are called tweens nowadays – kids and their slang), I lost my step-grandmother on Thanksgiving Day. She died in the morning and that afternoon, we were at my other grandmother’s house to “celebrate” with a large meal and an even larger family. Some years it bothers me more than others but for the most part, it’s simply part of the day and she’s always with me, even if just in my thoughts.

This year, we invited my parents to come up for Thanksgiving. They accepted and said they’d be here unless there was weather. All looked great until earlier this week when there was talk of a major snow storm due to hit today. I continued to prepare as if they would be arriving. This morning, the final call was made. They won’t be traveling to see us and I am staring at snow-covered ground at the beginning of the threatened storm which is now all too real.

What did I do this morning, you ask?

I relaxed.

Instead of crying or allowing anger to take over, I sat down on the couch, exhaled, drank coffee, and watched a fantastic documentary the TiVo recorded about snow monkeys in Japan. I turned on my HappyLight and snuggled with the cat.

I chose peace. I practiced it without guilt.

When we are in the midst of a battle for our mental health, for our sanity, it isn’t always this simple to choose peace. We cannot choose peace any more than someone who has cancer can choose to be healthy. We have to wait and hope for the best, hope that there is indeed a light at the end of the tunnel. Once we find our light, however, we carry it with us through our lives and it makes us a stronger person. It changes us deep down.

Days like today make me grateful for my experience. Grateful that despite the horrid darkness into which I sank, I rose above it with the help of others (like Katherine). I am grateful for the silence and the magic of the world around me and being able to choose to see it instead of focusing on the what if’s of chaos.

For those who are heading into the holidays and struggling to keep your own anxiety and other issues at bay due to the increased social expectations, please remember to take care of yourselves. Here are a few tips to help keep your holidays (and you) sane:

Know your boundaries and do not be afraid to defend them.

If you are visiting others, scope out the location when you first arrive for a quiet corner to which you can escape if that chest-tightening ball starts to swell in your chest and throat. (Bathrooms are fabulous for this as no one questions it!)

Remember to breathe. Deeply. Breathe is essential and slowing it down helps us soothe anxiety.

Talk with your loved ones, particularly your partner or someone you are close to – develop a strategy for exit if things get too overwhelming.

Remember that you are not required to give an intimate description of how you are doing unless you are up to it. Change the subject. Wikipedia is your friend!

How people choose to react to you is NOT YOUR GIG. Be the best you that you can be at this time in your life. How people choose to react to this says far more about them than it ever will about you.

You can get through this holiday. You can. You’ve come so far, and you are fighting a far fiercer foe than the one which exists on this one day.

Me? I’m gonna head into the kitchen now and wrap things up so I can binge on Netflix for the remainder of the day.

You? Have a fabulous holiday season and don’t forget to be the awesomeness that is hidden deep inside.

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Authenticity Instead of Perfection

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decoy momAuthenticity is defined as real, not false or imitation. Original. Genuine. This is what we should strive for as women, as mothers, as people. To be that which we are deep down instead of cookie cutter copies of those around us. It’s only when we dare to step out of our comfort zone that we will boldly begin to live our lives. Strive for authenticity instead of perfection. Dare to be you, even if that means walking around with spit up on your shoulder and gummy bears stuck to your shirt. Motherhood isn’t glamourous but it’s one of the best jobs in the whole world.

Colorful jars sit atop a shelf in a misty and humid room. Running water slides down her skin as she lathers up with the latest in moisturizing body wash which promises to make her skin glow with youth. She washes her hair with shampoo and conditioner to make it thick, silky, and soft.

As she exits the shower, the drying process begins – softly – so as not to leave any red marks or heaven forbid, pull skin in the wrong direction. Pat the face dry then move down to her toes. She folds the towel in thirds and places it neatly back on the rod before she wraps her hair in a smaller towel.

Grabbing a toothbrush, she measures out the whitening toothpaste and gets to work. Rinses, then gargles with mouthwash to ensure bad breath stays at bay. Then, moisturizer. While that soaks in, she puts on her undergarments. A bra with an underwire and underwear that promises to hold in her stomach which has nurtured the lives of her children close for the past few years. She frowns. Back to the bathroom.

She reaches for the first layer of glow, then dots on concealer. Waits for it to dry before applying an overall foundation and gently blending it together to hide the exhaustion and stress marching across her face. Next up, eye liner and eye shadow. They make the eyes more open and energetic. Mascara goes on next, gently, the kind that lengthens the lashes because again, more awake and conscious. Less tired.

Then she puts on blush to cheer her cheeks up, smiling as she carefully brushes up, not down – happy, not sad, she whispers to herself.

She takes down her hair and gives it a tousle. Plugs in the hair dryer and gives her hair a once over, then pulls it into a messy bun and pokes a pretty bobby pin with a gorgeous flower on it into the base of the bun. Walks into the closet and chooses whatever isn’t wrinkled or covered in baby food stains. Grabs a pretty pair of heels then over to the jewelry box to select accessories.

A small hand tugs on her silk skirt and she looks down.

“Mama? You look beee-yooo-tea-fahllll. Hug?” her middle daughter asks, covered in chocolate from whatever snack she just finished devouring.

So the mother leans down and gives the child a hug, knowing she will have to change her clothes. She sends her daughter on her way, and walks back into the closet, stripping as she goes. A new outfit selected, she makes it to the car with no child-induced stains on her pretty clothes.

She turns the key, unlocks the door, and slides into the driver’s seat, throwing her miniature purse on the passenger seat beside her. Exhaling, she checks her makeup one last time to be sure she looks human and not like some exhausted creature just waking up from hibernation. She doesn’t. She turns the key, starts the music, and backs out of the driveway.

Transformation into Decoy Mom complete.

Decoy Mom is a mom who goes through great lengths to hide how her life is really going, to hide the authenticity of her fight. Every stitch must be perfect, every thing in it’s place, nothing negative to be found anywhere. And yet, inside, everything is falling apart. Her heart, her life, her soul – it’s all cracked and crumbling.

I’m not saying that a Mom who has it all pulled together is definitively falling apart. Nor am I saying that a Mom who doesn’t have it all pulled together is authentically herself. What I am saying is that we are all “covers” when we are with people and some of us are even “covers” when we are alone. As the previous post by Katherine pointed out, you can’t tell when a mom has a Perinatal Mood & Anxiety Disorder just by looking. We are good at hiding it.

We choose what pieces of ourselves to share and what pieces of ourselves to hide. We are not expected to be fully authentic with anyone unless WE choose to do so. But we should absolutely be at least fully sharing ourselves with ourselves. In order to be authentic with anyone at all, you have to first be authentic with yourself. Being authentic with yourself is a difficult practice but a necessary one. As Brene Brown says,

“Authenticity is a daily practice.”

Stop hiding behind a mask, telling yourself lies about who or what you are inside and outside. Take a hard look inside. Explore. Make a list of everything that is there whether it is good or bad. Work to improve or re-frame the bad (sometimes, negative traits can be utilized for positive things – are you firm & harsh? Figure out how to rein that in by using compassion and understanding). Expand the good, let go of the negative. Focus on flipping the script.

Figure out what you want out of life this year, make a list, then break it down into smaller goals. Don’t let the big things overwhelm you and don’t let yourself become Decoy Mom.

Be the authentic Mom, wife, sister, cousin, aunt, and YOU that you were meant to be. Stop hiding her under layers of crap. You might find that you have more time (and energy) to BE you if you give up all the hiding.

(photo sourced from:

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