Warrior Mom Book Club: A Mother’s Climb Out of Darkness, Part 2

We’re excited to continue our discussion on A Mother’s Climb Out of Darkness by Jennifer Moyer. You can read Part 1 here, and feel free to join our Warrior Mom Book Club!

Warrior Mom Book Club: A Mother's Climb Out of Darkness -postpartumprogress.com

A Mother’s Climb Out of Darkness Discussion, Part 2

Question 1
In Chapter 9, and throughout the entire book, Jennifer discusses risk factors for maternal mental illness and recurrences of mental illness symptoms. Were you aware the risk factors prior to your experience? After you learned about the risk factors were you better able to see how certain things affected your mental health?

CB: I was aware of them because I was already working with pregnant and new moms; but I was in denial for the longest time. It was almost as if I had to ‘check every box’ before I sought help for it.

SK: I had no idea. I did not see any of the warning signs or risk factors until I was well into recovery. Once I saw a list, in my head, I kinda went check, check, check. It’s amazing how a little list of information can mean so much to people, and clarify so much.

LB: I was not aware of my risk factors before my experience. Afterward, I could see it clear as day.

LL: I was aware of my risk factors but still thought it would never happen to me. I think no one ever wants to think it could happen when anticipating what is supposed to be one of the happiest events of life.

ST: I was aware of only one, my prior Depression history. I was just amazed at how soon it hit.

SC: I was aware of my risk factors but I had successfully dealt with anxiety and some depression before so I figured I would be able to handle it if it happened. Like ST said, it hit so soon and I had never experienced such paralyzingly anxiety before.

Question 2
In Chapter 10 Jennifer talks about finding PSI and in Chapter 15 she goes into how helping others has helped her heal. Do you think that advocating for others has helped your recovery? What did you think about Jennifer’s speaking out about her illness and the reactions that other people had to her speaking out?

SK: This was interesting for me because I feel my advocacy has played a large role in my recovery. My family has been very supportive so I haven’t had the fear that some people have of sharing their stories. When I do encounter a bad reaction I try to use it as a teaching moment, and understand that people just need to be more educated and they don’t understand mental health issues.

CB: I definitely found a passion for maternal mental health after my experience. Not only do I lead a support group, but I participate in many other support groups. I really liked hearing her story because as much as she went through, and as many hospitalizations she went through, it shows that you can make it. The face that she had CPS involved, which is most mom’s fears, can show strength in the story too!

SK: CB I couldn’t believe that CPS got involved. Jennifer Moyer, it seems like you were totally blindsided by them calling CPS. Did you end up changing pediatricians after that? I was just shocked by that whole incident.

Jennifer Moyer: No I didn’t change pediatricians but I did ultimately change churches. The ignorance there is what caused the chain of events.

CB: I took it as another example of the ignorance surrounding maternal mental health….I would hope that we, as advocates, are able to dispel the myths by speaking out.

Jennifer Moyer: In fact, my son still has the same doctor, who sees patients as long as they are in school (college included) 🙂

CB: I’m sure it was a learning experience for the doctor; How about the church official?

Jennifer Moyer: I think it was but he ultimately moved to a different church. I made my peace with him after the event.

CB: That’s good to hear

Jennifer Moyer: Anger and bitterness never helps anyone so I had to let go and make peace with the past.

SR: For me, leading a climb was the most cathartic event in my healing.

SK: SR, yes it gave me back some of my confidence and helped me feel like myself again.

CB: Ditto!

LL: I heard of PSI shortly before reading this book and really want to get involved too! Once I had recovered from the acute worst of my ppd I also really wanted to support and love others dealing with it and let them know they are not alone. Her example is awesome!

LB: Advocating has been very cathartic for me. For the most part, I’ve been really amazed at how supportive others have been. My first step was sharing on Facebook about my diagnosis and, later, medication. Many people wrote to give me support, and several moms shared that they had suffered from PPD but never told anyone. I was floored – so sad that they had suffered that way but also very happy that they shared with me and were feeling better. I also wrote several yelp reviews for various doctors, therapist, and psychiatrists who helped (or in some cases) didn’t help me. The first feedback I got was some very mean emails from a mom at my son’s daycare, who called me a psycho and told me that I needed to get over myself. It really hurt, and it took me some time to get over. I still felt that it was well worth it, especially when a husband contacted me about finding some more help for his wife. Being able to reach out to and help them meant so much to me.

LB: Also I think forgiveness is so important, even though it can be very difficult. Jennifer Moyer, I’m also inspired by how you moved past the actions of the pediatrician and the pastor!!!

ST: I definitely think it’s helpful to myself and others. The reactions….For me 95% of reactions I’ve gotten have been very positive. The others are just ignorant and refuse to believe it is real. In the beginning it was hurtful, now I blow them off.

SC: I supposed someone could just recover and close the door on PPD without looking back, but Jennifer Moyer turned so much awful stuff into learning experiences and advocacy for herself and others. I definitely feel compelled to do this. I just wish I had more time to devote to this cause.

Jennifer Moyer: SC, I learned to focus on family first as advocacy will always be there. Taking that time helped me be a better advocate now. I still believe advocating as a wife and mother comes first. 🙂

Question 3
In Chapter 11 Jennifer discusses her advocacy and her efforts for changing policy. I found this to be interesting and made me think more about how to get involved and let the government know that there needs to be change. How did Jennifer’s discussion of governmental policy affect you? Do you have any experience with this or were you inspired by her work?

SK: I really want to try to get more involved in my local and state government. Not sure how to go about that, but I know that if the opportunity arises I will jump at it. For now I am becoming more involved with a local perinatal mental health coalition to help raise awareness and increase resources locally.

CB: I admired her work. I definitely think tha tmore has to be done on the government side; but my social anxiety gets in the way of me taking an active effort in it.

Jennifer Moyer: Meeting with your local representatives is a starting point. They want and need to hear about the issues that matter.

SK: CB, I think if we all do as much as we are comfortable with then things will begin to change little by little. There are a few moms in our community that help with events but don’t want to be out in public talking about it, and I totally respect and understand their decision.

SK: Jennifer Moyer, do we just email or call them to try to meet with them? What information do they want to hear?

Jennifer Moyer: You can email and/or call requesting an appointment to talk about maternal mental health. They schedule appointments while in their district offices so calling to find out their availability is always good. You can take fact sheets, share your story, etc.

CB: Hey one on one doesn’t sound as scary then!

Jennifer Moyer: No, remember they want to get re-elected so they are usually pretty nice LOL

SK: Jennifer Moyer, we would probably have to have some practical examples of what changes could be made or what we would like to see. Is there any current legislation that we could encourage?

Jennifer Moyer: There are some recent developments even at federal level but each state is different so you would need to research on how the state handles mental health such as what state department oversees mental health. Mental health issues can be handled by different committees in each state. I have a friend in TN that couldn’t even find on the state website what department handled mental health so you may have to make do a little research.

SK: Jennifer Moyer, thanks, that gives everyone a good starting point. 🙂

LB: I honestly had only thought of reaching out to other moms through Facebook and Postpartum Progress, but this is another really important thing I can do to help. I’ll definitely do some research into the California laws.

Question 4
Chapter 12 held a few important topics for me. Jennifer spoke about how traumatic a perinatal mental health issue can be to not only other mother, but also the family. Also how the media’s portrayal of PMADs can make this trauma worse by making a mother scared to seek help. What topic affected you the most in this chapter? Did the stigma surrounding mental health issues hinder you from seeking help or receiving the help you deserved?

CB: I totally agree about trauma to the family; but media portrayal spoke most to me. I struggle because my mom loves entertainment stories and she still brings up cases like Andrea Yates to me — it’s hard to get through. I did an article for our local climb and the headline they wrote was postpartum blues: they didn’t hear anything I said.

SK: The media can be so difficult to deal with because they can portray women with maternal mental health issues in such a bad light. I hope that the more information that is made available and the more advocates get out there, the more people understand that we do not want to have these issues. We cannot control these issues without proper treatment and care. the sad part is most people cannot afford the proper care or are too scared to seek it out.

CB: I know when I hear stories — I’m able to sympathize with the mother and a lot of people I know have trouble with that.

SK: Yes! Getting people to not equate PPD to Baby Blues is a huge struggle! I had one of my co-workers tells me that his wife had the baby blues (his son was 8 months old) and that he was not happy with her reactions around the other children. eventually he asked me for more info and I believe she got help, but it is so hard when people don’t understand.

Jennifer Moyer: So many moms are afraid of losing their child(ren) that they don’t reach out. Sadly, this is still happening way too often and the ignorance out there can cause the families to make it worse.

CB: My close friend was hospitalized and unmedicated for a week–at the end they told her she was fine and Italian that liked to talk a lot–she left there unmedicated — she’s still struggling two years postpartum and she’s just now doing better.

SK: Also, like Jennifer Moyer, it caused some major difficulties in my relationship. We had to rebuild after I sought treatment and learn how to communicate better.

Jennifer Moyer; I cannot say enough about the benefits of the right professional therapy. It helped save my family.

SK: Mine too, I cannot imagine where my relationship would be without it.

CB: Yes SK — I was there too and divorce was brought up — I am happy we were able to make it through and learn to communicate on a new level.

Jennifer Moyer: CB I hope your friend is getting peer support as well as professional support. There is still so much stigma and ignorance out there.

CB: Yes, Jennifer Moyer — she runs the peer support group with me 🙂

SK: Also Jennifer Moyer, I like how you discussed your son going to therapy. One thing I have gained from all this, is the knowledge that if my son needs help with any mental health issues, I will hopefully be able to better spot them and help him get treatment.

LB: Stigma definitely prevented me from getting help at first – not because I was afraid of what would happen to me or my child, but because of my family’s initial reaction. They didn’t understand and kept telling me to get ahold of myself, and that I could handle this. They talked about all the amazing things I had done in my life, and tried to reassure me. They told me to stop crying and worrying. they said having a baby is just hard. So I thought all moms went through what I experienced. I was too embarrassed to seek help for a long time. I remember the Andrea Yates case but had never heard of postpartum depression (yes, I Know, I’m one of those weird people who doesn’t match much tv or care about celebrities and didn’t know about Brooke Shields and Tom Cruise ducking it out 🙂 ) so I guess I was inversely affected by media coverage. It never was on my radar at all.

ST: the stigma prevented me from disclosing my illness to friends. I worried they would shun me. Silly now, all of them were very receptive. the “what next” paragraph on page 172 hit me hard. learning how to live with my new body and mind was scary after PPD. It’s scary now with this most recent bout of depression.

Question 5
Chapter 13 discusses Jennifer’s research into alternate forms of healing and not understanding that PMADs can develop into lifetime mental health issues. Did you attempt to use any homeopathic or alternative forms of treatment? Did your health providers ever inform you that you may need to consider that your PMAD could lead to needing lifetime treatment?

SK: I did not understand that this could turn into a lifetime of mental health issues, but now I do and am at peace with that. I will handle things as they come and if that means I stay on medication then that’s okay. I didn’t try any homeopathic forms of treatment, however, I do try to stay aware of my body and keep better control of my anxiety through mindfulness and CBT.

CB: I’m with SK! Though, I did have a doctor tell me about my issues and PMDD is my diagnosis–so I’m mindful of how I’m feeling. I would like to try oils one day; but for now I medicate and use exercise; and I’m okay with that.

LB: During the thick of my battle with PPD/PPA, my acupuncturist treated me a couple of times. It was helpful and she was very supportive. She suggested weekly visits but shortly after that, after that, I became so overwhelmed that I only left the house to go to work (so I could pretend I was fine) and take walks because I was so restless. It was too intimidating to go anywhere else for quite a while. Later she suggested an excellent naturopath, who is monitoring my hormones, adrenal gland and thyroid functions. She is also helping me wean off of antidepressants and sleeping pills by replacing them with supplements and helping me make some great lifestyle changes It’s been amazing, I’m not sure whether this is in the right category as an answer to this question, but I also did a lot of therapy on letting go of my past. I was sexually and mentally abused as a child and during PPD I somehow felt like the roles were reversed and my baby was abusing me. I don’t know whether this crosses the line into psychosis. But in any case, one of the therapists and I used a technique called EMDR to go back into my memories and let the trauma out. It made a huge difference. I’m so grateful for the help I was able to receive! Oh, and yes, my caregivers did let me know that this could be a long term issue.

ST: I didn’t look into any homeopathic remedies, except St. John’s Wort, and I nixed it. AS for the lifetime of mental illness, I was already a three time sufferer of depression prior to PPD. It was kinda a given.

 

Join our Warrior Mom Book Club to read and discuss books about maternal mental health with other Warrior Moms. See you next time!

The Truth About Postpartum Psychosis

emergency-stop-buttonThese are the kind of posts we don’t like to write. But they are also the posts we must write because these situations carry the most potential for stigma and misunderstanding as they relate to the Perinatal Mood & Anxiety realm.

A recent situation in Cincinnati is the reason for this post. I won’t link for safety reasons, and if you are fragile, I would recommend you NOT Google for the story. (If, however, you do, and you need someone to talk to about it during the day, find me on Twitter here: @unxpctdblessing. I will be happy to chat with you.)

Media sensationalism along with misunderstanding by society at large can turn a singular incident into a large scale stigma fest. THIS is why we write posts like this. To educate and prevent misunderstandings in the future. It is a delicate balance to write these posts without triggering our audience, hence the emergency stop picture. While I have tried to keep this post as non-triggering as possible, again, if you are fragile, you may want to skip this post.

When a mother with Postpartum Psychosis follows through with behavior which is limited to a very small percentage of mothers who do experience psychosis, it is splashed across the front pages and often combined with the term “postpartum depression” or “baby blues,” leading readers to believe a depressed mother is capable of this act.

Let’s get a few things straight here.

Postpartum Psychosis only occurs in 1-2 of every 1000 births, or .1% of births.

Of those .1%, only 4% may commit infanticide, and 5% may commit suicide.

Postpartum Psychosis is NOT Postpartum Depression.

Postpartum Psychosis is defined by hallucinations, delusions, rapid mood swings, decreased sleep, and increased paranoia.

Postpartum Depression is defined by increased sadness, irritability, increased sleep, feelings of guilt, and loss of interest in usual things. It also carries the risk of thoughts of harming your child or yourself, but mothers with Postpartum Depression are highly unlikely to follow through.

Baby Blues is experienced by up to 80% of all new mothers and is NOT a disorder found on the Perinatal Mood & Anxiety spectrum.

It’s important to note here that I know more than a few mothers who have successfully fought back against psychosis and won. They (and their children) are still with us. Psychosis also does not always equal the death of a mother or a child. It is, however, the one disorder on the spectrum which carries the highest risk for loss of life.

I want to add that Postpartum OCD is the other disorder on the spectrum closest to the signs and symptoms of Postpartum Psychosis. How do you tell the two apart? OCD moms are typically disgusted by the thoughts which flit through their heads while moms with Psychosis believe the thoughts they are experiencing, no matter how delusional, are real and rational. They are driven to follow through with them, while moms with OCD fight against them and do everything to make them go away. Am I saying moms with Psychosis WANT to follow through with their delusions? No. I’m saying that because of the nature of the disorder, they are unable to fight back without help.

From the Postpartum Support International Website:

It is also important to know that many survivors of postpartum psychosis never had delusions containing violent commands. Delusions take many forms, and not all of them are destructive. Most women who experience postpartum psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment, and this is why women with this illness must be treated and carefully monitored by a trained healthcare professional.

So what should you do if you or a mother you know and love shows signs and symptoms of Postpartum Psychosis?

She should immediately be seen by a physician. She should not be left by herself, or alone with her infant at any time. It is possible she may need to be hospitalized for a short (or longer) time until she begins to respond to any prescription medications to balance her psychosis. Unfortunately, we do not live in a perfect world and mothers often fall through the cracks. Compliance with medications outside of the hospital setting (which is the alleged case in Cincinnati), is something no one can monitor. What we can do, however, is continue to educate the population at large about the signs and symptoms, encourage them to not leave the mother alone, and encourage compliance with any treatments set forth by a medical professional.

Healing from a Perinatal Mood & Anxiety Disorder is not a solo journey, nor is it an easy journey. We need a village to wrap their arms around us as we learn how to walk again. Be a part of that village. Please.

Here are some resources to get you started:

Signs & Symptoms of Postpartum Psychosis

Suicide Hotlines

Know that above all, you are not alone and you will get through this.

 

Should New ICD-10 Code Reference Puerperal Psychosis?

Doctors At The General AssemblyAre postpartum depression and puerperal psychosis, also called postpartum psychosis, the same thing? A 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?

Yup.

POSTPARTUM DEPRESSION IS NOT PSYCHOSIS.

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)

Triggers and How They Affect Recovery

Triggers and Recovery from mental illness

Knowing is half the battle. I found this to ring true in my experience with managing my mental illness during my pregnancies and postpartum.

I was diagnosed with Bipolar Type 1 in 2006. It took over a year for me to find the right psychiatrist, the right combination of medications, and the right techniques through therapy to allow me to begin to manage an illness which had taken me and my family completely by surprise. After months of anguish over what was working and what wasn’t, we finally found a medication that stabilized me and I started to feel pieces of my old self emerging from the darkness.

Once I had been stable for about a year, my husband and I decided we were ready to start a family. I was scared of a recurrence of my illness, but wanted to be a mom more than anything, so we started trying and I was able to get pregnant rather quickly. Unfortunately, our joy was fleeting as I experienced an early miscarriage and had to have a D&C. I was afraid that the medication I had been taking for my bipolar disorder caused the miscarriage, so I convinced my psychiatrist to allow me to taper off the med so that we could try again after I healed from the surgery.

We became pregnant again fairly soon after, and since I was doing so well off the medication and had no recurrance of symptoms, my doctor continued to see me as a patient but allowed me to stay off my medication for the duration of the pregnancy.

This was a terrible decision on both our parts, but I didn’t realize this at the time. Four weeks after delivering my son I experienced a severe episode of postpartum psychosis and had to be hospitalized for a week. It was arguably the worst week of my life, having been ripped from my child, having to abruptly stop nursing, and it took an incredible toll on me both physically and emotionally.

I was stabilized quickly by the team of doctors at the hospital by resuming my course of medication I had been on before my pregnancy. The recovery from the trauma of being taken away from my newborn for a week would take much longer.

I learned through my postpartum psychosis episode that my triggers are: lack of sleep and lack of medication in my bloodstream. These two facts would prove essential to me creating a much more positive postpartum experience with my second child. But not without another lesson first.

Once stable again after my PPP hospitalization, my husband and I began to talk about completing our family with one more baby. Even with my three hospitalizations (two before our first child and the PPP episode), I still didn’t know enough about my illness to know that the benefits of me staying on my medication during the pregnancy and exposing the fetus to the medication, although not the most ideal situation, far outweighed the risks of not being on medication at all given this was one of my top two triggers.

Doctors can advise patients, but it’s up to the patient to follow through with the prescribed recommendations. My doctor had agreed to let me stay off medication during the first trimester due to a heart defect risk, but after week 12 we decided I would go back on my medication for the duration of the pregnancy.

Tapering off my medication in just week 5 of the pregnancy, combined with my excitement and mounting loss of sleep over how excited I was to see those two pink lines on the pregnancy test, landed me in the psych ward again. My baby was barely the size of an orange seed and I had to be hospitalized for almost a week and put on antipsychotic medication to bring me down from the mania I had been struck with.

Because of lack of sleep and lack of medication. Two things I learned I could control.

Recovery from that episode took months; experts say that each subsequent episode is more difficult and takes longer to recover from, and I’ve found this to be true. But I emerged from that setback a much more informed and capable mother, ready to truly manage my illness so that it did not cause me and my family any further pain.

My husband and I talked about how we could handle my postpartum period differently with our second child, and we made plans to take charge over my triggers so that I could stay in recovery long-term. I stayed on my medication for the entire rest of the pregnancy and beyond because my medication kept me stable. We made plans that I would bottle-feed and my husband would take over the middle-of-the-night feedings between 2am – 5am so that I could get a long stretch of sleep at night, keeping my nocturnal clock in check.

I’m not saying it was easy. But my postpartum period with my second child was so much more enjoyable and relaxed compared to my first because I took the upper hand over my triggers. With my family’s support, I made it through. And I continue to keep a firm grip on my dedication to the medication that keeps me stable and getting the appropriate amount of quality sleep each night so that I can stay steady on my recovery path.

Bipolar disorder is a condition I’ll live with for the rest of my life. Learning my triggers and techniques which allow me to stay on top of them so they don’t throw me into a manic episode has been a learning process, but it is one which has empowered me to live well even with a mental health disorder.