Support for Mothers with Postpartum Depression in Nigeria

Last week on Twitter, a tweet flew by me:

A Posptartum Depression Awareness Program for Expectant New Mothers in Nigeria? My curiosity was piqued. I tweeted Kachi and asked for more information.

We had quite the flurry of emails.

Onyedikachi Ekwerike is a First-Class graduate of Psychology from Lagos State University and is currently pursuing a postgraduate degree there in the same field.

Support for Mothers with Postpartum Depression in Nigeria

What made him interested in Postpartum Depression?

“I became hugely interested in postpartum depression after a relative suffered it. She couldn’t name what she was going through and her doctors couldn’t help too. I was however able to detect the problem quickly and helped her get help.”

Kachi said that after he helped his relative, it got him thinking that she couldn’t be the only one experiencing this issue in Nigeria, and he has decided to do something about it.

At the event he held, 150 women attended. They were all screened using the Edinburgh Postnatal Depression Scale. 40 of these women scored above 10 on the scale, putting the rate of positive returns at 26%. Of those 40, 10 of the women admitted to experiencing suicidal thoughts, according to Kachi. The women who tested positive were referred to clinical psychologists for further help.

“There are plans in place to continue this programme as the feedbacks we’ve received so far has been very encouraging. My goal is to take the training Nationwide as less than 1% of Nigerian women know about these problem.  “

Support for Mothers with Postpartum Depression in Nigeria

I asked Kachi if he had experienced any cultural push back to discussing the issue of postpartum depression. (Mental health is very stigmatized in African countries. A recent NY Times article cast some light on just how stigmatized.) He said no, but offered this:

“However among the women many still believe that the problem is spiritual! So they will rather go to pastors than to Clinical Psychologists to get help.

Another challenge is the field of Psychology is in its infant years here. Not many people know psychologists, and there is so much stigma attached to visiting the psychiatric hospital so they will seldom visit one!! Which is something this awareness programme also aims to address.”

The biggest challenges he faces right now aside from raising awareness? Building a network of knowledgeable professionals and cost. Sound familiar?

I am very happy to have connected with Kachi. He’s doing great things and I strongly believe only has even greater things ahead of him. Keep up the great work!

 

Images used with permission.

Postpartum Progress Impact Report 2014

Postpartum Progress Mission 2014

If you’re like me, Postpartum Progress has impacted your life in more ways than one. After having my daughter in 2010, I discovered this powerful community of Warrior Moms at a time when I needed it most. I not only found invaluable information, but also felt the kindness, care and dedication of so many during my own journey through treatment and recovery. I hope you have too, because truly we are none of us alone.

There are many volunteers who work behind the scenes of this passionate organization, and I wanted to take a moment to thank each and every one of you. Your time and talents make the recently released 2014 Postpartum Progress Impact Report possible. Our many programs and campaigns are coordinated by those who strongly believe in our mission, those who offer their time and talents to make these programs a success.

Postpartum Progress IS making an impact in many communities. Below are just a few highlights, but I encourage you to check out the complete report here.

Postpartum Progress 2014 ReachMaternal Mental Health Awareness

Increasing awareness has always been a primary mission. To that end, Postpartum Progress develops and provides materials at not cost to help moms identify PPD and related illnesses, reduce stigma, and encourage mothers to seek professional help. In 2014, 4,250 of our new discreet, pocket-sized “Hugs Cards” were distributed to local peer advocates across the country to share information on where moms can access the free resources and support we provide. Our new Tools page, offers free downloads of our most popular patient resources, including a new 2014 infographic about the negative downstream consequences of untreated PPD.

PostpartumProgress.com and Other Media Reach

Individuals from more than 200 countries visited PostpartumProgress.com in 2014 at a rate of 1.6 million pageviews, with most traffic coming from the US, UK, Canada, Australia, India, Ireland, New Zealand, South Africa, Philippines and Singapore. We continue to reach growing numbers of women and families via our social media channels.

Our reach into other media included a feature on BuzzFeed “Can You Tell a Mom has Postpartum Depression Just by Looking at Her,” which garnered more than 275,000 pageviews in the US alone, and was translated into Spanish and French for global audiences. We were proud to be featured on the national Healthy Mother, Healthy Babies Coalition blog in May during Maternal Mental Health Month, as well as in a full page story in Woman’s World magazine, a supermarket weekly with 1.6 million readers. Also in 2014, we were honored with the Iris Award at the Mom 2.0 Summit in the category of Industry Influence – Philanthropic Work, given for excellence and quality in parent blogging and social media.

Climb Out of the Darkness

Our 2nd Annual Climb Out of the Darkness saw tremendous growth and excitement from 200 participants to 2013 to more than 1,500 last year. Awareness is a major objective of the Climb, and we were thrilled to see the event covered by CNN, The New York Times‘ Motherlode blog, and numerous local newspaper and television news outlets. “It is abundantly clear that Warrior Moms needed an event to call their own, where they could turn their shame upside down and let the world know how important it is to recognize their illnesses,” said Postpartum Progress Executive Director Katherine Stone. Be sure to join us for our 3rd Annual Climb Out of the Darkness on June 20, 2015.

Peer Support & Community

Peer support and community is a vital part of the Postpartum Progress mission. We are truly stronger together. Our Smart Patients private support forum for moms currently struggling with perinatal mood and anxiety disorders grew from 230 members in 2013 to 1,600, many of whom have no access to support groups where they live. And in 2014 we announced we’d be hosting the first patient-centered conference on maternal mental illness, the Warrior Mom Conference, to be held in Boston in July 2015. If you are unable to attend, please join our fellow Homestead Warriors.

Research

Postpartum Progress is interested in collaborating with organizations to not only measure the impact of our own work but to help identify new and better ways to support moms. In 2014, we conducted our first audience impact survey, which revealed that users of Postpartum Progress’ resources are influenced to both seek professional help and speak out about their illnesses with others. For more information about this survey and our first foray into research collaboration, please visit the 2104 Impact Report.

Looking Ahead in 2015

There are many great things to come this year and beyond for Postpartum Progress. “Thank you from the bottom of our hearts for supporting our efforts. We couldn’t do any of this without you,” said Katherine Stone.

I couldn’t agree more. It’s the amazing individuals who volunteer their time and those who raise funds that make these programs possible. I for one am profoundly grateful to all of you.

For more information, read the full 2014 Postpartum Progress Impact Report.

Warrior Mom

 

3 Ways We Can Improve Maternal Mental Health Care For Women of Color

women of color Earlier this week, I shared my growing concern with women of color and their maternal mental health being underserved by professionals and those in the mental health advocacy space. (Note: “Women of color” refers to women who are not considered to be Caucasian: Hispanic/Latina, Black or African-American, Asian/Pacific Islander, Native American, Indian, of biracial heritage, etc) Today, I’d like to offer just a few ways in which I think we can improve our efforts, and make maternal mental health advocacy more inclusive of mothers of color, our experiences, and our needs.

Believe Us

I mentioned in my earlier post that many of the women I’ve spoken with expressed frustration and dismay that they were not taken seriously when they told their doctor, social worker, pastor, or a mental health professional that they were struggling. Their symptoms were minimized, their concerns and lack of awareness about what they were experiencing dismissed, and some even stated they were degraded by the professionals they reached out to. That’s unacceptable, and does more harm to women already suffering. One mother, who is African-American, described her experience to me as this:

“When I FINALLY went to a therapist, after my second child, I was dealing with PPD then. We began talking about my life (two kids under 3, stressful full time job, lack of support from significant other), and her response was to ask me if I was on birth control so I wouldn’t have any more kids.”

Her experience mirrors my own. After the birth of my second child, I knew something was wrong but couldn’t identify what. I was depressed and anxious and my moods were out of control. When I mentioned it to my OB at 8 weeks postpartum, he said I just needed more sleep. When I told him how out of control I felt, he wrote me a prescription for an anti-depressant, said I should discontinue it in a few weeks once I was feeling better, and told me to follow up with my primary care doctor. The medicine didn’t work. I was still a wreck. I went to my primary care doctor and she just told me that again, I was just tired. When I finally realized what I was experiencing was PPD and anxiety (thanks to Postpartum Progress’ Plain Mama English Guides), I called the NJ state PPD hotline. It took two days for a call back, and I was told that because I was on Medicaid, I’d have to see a social worker who was also a therapist from the state’s mental health program. At that appointment, I unloaded everything to him: my swinging moods, rage, intrusive thoughts, depression, fear. He asked me questions about my “living situation” and his next words I remember to this day:

“Well, you know, I mean what you’re experiencing isn’t postpartum depression or anxiety. You’re just experiencing the stress of being an unwed mother to two children who’s in a rocky relationship. Women like you…in your type of situation…in your culture, experience it, you know? Of course you’re stressed. You’re young, with an infant and toddler, going to school and working full-time…there are plenty of other Black women like you who face these kinds of daily challenges, you know what I mean? You just have to shoulder it and keep going the best you can. I think you’re going to be alright once you figure out how to manage it all.” 

Despite taking down my family and personal history where I detailed several things that placed me at risk for PPD (family history of mental illness, personal history of depression and anxiety, single, unexpected pregnancy, early childhood trauma, minimal support from family and friends), this therapist ignored all of it and said what I was experiencing was expected because of my cultural experience. This (White) man was not helpful nor was he culturally competent and a good match for my particular needs. I struggled to find adequate help for two more months.

Tell Us, Talk to Us, Become Culturally Competent

During my first and second pregnancies, I wasn’t screened for PPD or told anything about it, despite being at risk for developing it.  I didn’t even know PPD was A Thing. Other mothers of color have told me they’ve had similar experiences:

“I wish my doctor had told me anything. I had no information whatsoever.”

“When I had my daughter I was 20 and unwed (but my boyfriend was present). I got lectured from a social worker about my elevated risk for shaken baby syndrome. But no one asked about my mental health, either at discharge or at my follow up appointments.”

” I was upfront about my bipolar disorder with staff at the birth center. In the office, they even said, “You know you’re at increased risk for postpartum depression, right?” Then after the birth, the midwife attending just went about her business doing paperwork and asked me to sign to accept financial responsibility. Another midwife came in to check on me and asked me how I was feeling in front of family and friends. I was NOT about to say that I was having intrusive thoughts (I didn’t even know what to call it then). A lady who wasn’t a midwife (I think she was in billing) called to ask how I was doing. I broke down in tears on the phone. She called me weekly for several weeks. She gave me more care and concern postpartum than any of the midwives did.”

“She (my doctor) mentioned it, I just wish maybe she talked about it more in depth with me- signs/symptoms, etc.”

We need those in charge of our pregnancy and postpartum care to do a better job of informing us about what the signs and symptoms of postpartum mood disorders are. We need to be made aware of how they can manifest in our lives, and what places us at particular risk for occurrence. Providers need to become more culturally competent on how issues such as racial and gender discrimination, racial profiling and harassment, the high rate of domestic violence in our communities, our high rates for chronic illness, violence, poverty, and other sociopolitical aspects of our lives impact our mental health. Treatment plans then need to stem from an understanding that takes all of these factors into consideration.

Advocate for Better Access, Better Quality of Care, More Awareness

Reports have shown that there are disparities in mental health treatment, quality of care, and access to services when it comes to minority mental health, especially for women of color. Aside from cultural stigma, barriers to treatment include lack of insurance coverage post pregnancy, the costs of mental health services, and very little community resources in neighborhoods with significant minority populations. Educational literature and books on maternal mental health are hardly written with our experiences and needs in mind. Research on women of color and maternal mental health does exist but it is not extensive. Many awareness campaigns lack a multi-cultural focus, despite pregnant mothers of color facing significant and unique physical and mental health risks .

How can we do better? I’d like to see more literature featuring women of color distributed in doctors offices and where social services are located. It would alleviate a huge burden if mental health offices had childcare so we could safely leave our children in the care of others while we are seeing a therapist. We should create more spaces for mothers of color to gather and discuss their struggles and experiences with each other to gain support. More mental health professionals should offer reduced rates or at least accept Medicaid. There should be collaboration between cultural institutions our neighborhoods trust and national mental health organizations to raise awareness and eradicate cultural stigma on an ongoing basis. I’d like to see the expansion of Medicaid so more mothers can have comprehensive and longer coverage that enables them to access mental health services.

I think while some strides have been made, we still have much further to go to help women like myself. I’d like to see a more concentrated effort made in advocating for better care, easier access, and more awareness that empowers mothers of color. Doing so will help us give our families and ourselves the strong starts we deserve.

Misdiagnosis and Missed Diagnosis: Part 1

Trigger Warning: This is part 1 of a 2 part story of my misdiagnosis and missed diagnosis after giving birth in 2009. This post contains some references and details about Postpartum OCD and Intrusive Thoughts. If you are feeling particularly vulnerable and prone to triggers, you may want to avoid this post until a later time. 

In July of 2009, 3 months after having my first baby, I finally admitted that all was not well in my world. For 3 months, I had been falling deeper and deeper into a spiral of awful. Sometimes I felt indescribably angry. Sometimes I felt a deep sense of sadness and despair and would just cry and cry and cry, or maybe I’d be about to get out of the car in the parking lot at the store and suddenly burst into tears and not even know why. Sometimes I felt completely numb; I would just sit in my rocking chair holding my beautiful little girl, staring off into space, not really thinking or feeling anything at all other than blankness and emptiness. The worst of all was pictures and thoughts that flashed unbidden into my mind. Thoughts and pictures of dropping or throwing my daughter down the stairs. It terrified me and I would actually cancel appointments if I was upstairs because I didn’t want to carry my child on or near the stairs and those pictures and thoughts become reality. As soon as they entered my mind I would chase them away and hug my baby a little closer and pray “God, what’s happening? Please forgive me and make this go away”. I had no idea what was wrong with me.

At my 6 week Postpartum check up at the Wilford Hall Medical Center OB/GYN clinic, I filled out the  Edinburgh Postnatal Depression Scale questionnaire that I was handed. My answers clearly indicated that I needed further screening but the Nurse Practitioner who saw me just put it to the side without saying anything and never really asked how I was feeling, so I figured that what I was experiencing must be normal (news flash: it wasn’t). Things kept getting worse until eventually, one night in July, I found myself standing at the top of the stairs while everyone else was asleep thinking that everyone else would be so much better off without me if I threw myself down the stairs. I walked away and started to go to bed and then thought that it would be easy to take a massive amount of the painkillers my husband had left over from ankle surgery and just go to sleep and not wake up. I called the chaplain and he met me at the Emergency Room.

I was diagnosed with Postpartum Depression and transferred to a psychiatric facility in San Antonio, since WHMC (the military hospital on Lackland Air Force Base) only admitted service members for inpatient treatment of mental health issues, dependents automatically got referred out. I was breastfeeding my baby and didn’t want to have to stop, so we tried going the medication-free route first with talk therapy, both individual and group. We quickly realized that it wasn’t making enough of a difference, so on to medication it was.

During this time, one of the biggest questions asked of me was “Do you have thoughts of harming or killing yourself or others?”. I answered yes. Partly because I had found myself on the brink of attempting to commit suicide, but also partly because of the thoughts I had been experiencing. I later found out that the thoughts and images that shoved their way uninvited into my mind were Intrusive Thoughts, one of the classic and tell-tale symptoms of Postpartum Obsessive-Compulsive Disorder. I didn’t know, at the time, that there was a difference between suicidal/homicidal ideations and intrusive thoughts, or that there was a whole spectrum of Postpartum Mod and Anxiety Disorders, I thought it was just all part of Postpartum Depression. Unfortunately, it seems that none of the staff caring for me at either of the hospitals knew this either, and I was diagnosed as simply Postpartum Depression. This is one of the things that I eventually hope to see changed: to see better education for medical professionals making them aware of the differences between types of symptoms and the various PPMD.

It only took a few days after starting medication (Lexapro) before I started to feel better. Before starting medication, my mom and my husband had come to visit me at the hospital and when my daughter started to cry, it was a noticeable trigger. My mom and husband had to keep the baby up front and switch off who had her and who was visiting with me. After starting meds, I was able to cope better when she started to fuss, I started to open up a little in therapy instead of sitting huddled up in the corner unable to speak without crying. After a little over a week in the hospital, I was sent home with prescriptions for Lexapro to manage my symptoms on a daily basis, Ativan for sudden anxiety attacks, and Ambien to help me sleep at night. I was also given an appointment to see a psychiatrist outside of the hospital.

When I went to my first appointment it was a total disaster. I ended up having to reschedule after I had been there for a couple of hours and still not been seen, because I had to get home since my babysitter had to leave. They weren’t able to reschedule me for another month or so out. I ended up back in the hospital a month after being discharged due to a recurrence of my symptoms (again, the intrusive thoughts that I didn’t know much about and didn’t know how to manage), and had my medication dosage adjusted. Thankfully, I only had to stay for about a week again and was able to go back home.

To be continued tomorrow…