Dear Military Spouses: Dealing with PPMD as a Military Spouse

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I gave birth to my oldest baby on April 23, 2009 at Wilford Hall Medical Center at Lackland AFB in San Antonio, TX. 3 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 3 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 with 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 PPMD.

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 & 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 spousecan 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 PPMD, 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 PPMD as a military spouse (please note that this is info specific to dependents, servicemembers should of course follow their protocols).

  1. 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 this link (http://www.tricare.mil/mentalhealth) ; 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.
  2. 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 (http://www.tricare.mil/CoveredServices/Mental/GettingMHCare.aspx), 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.
  3. 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.
  4. Another fantastic resource is Postpartum Support International. They have resources specifically for military families, including support coordinators for the different branches of the military. You can access this website at http://www.postpartum.net/get-help/psi-support-for-military-families/.

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.

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Warrior Mom Book Club: Down Came the Rain by Brooke Shields

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BrookeShieldsThe following is a conversation between several members of the Warrior Mom Book Club after reading “Down Came the Rain: My Journey Through Postpartum Depression” by Brooke Shields, the latest in our book club’s maternal mental health-related reads.  You can learn more about the book on Goodreads and purchase it on Amazon.

 

 

Welcome to the Warrior Mom Book Club review of the book Down Came the Rain: My Journey Through Postpartum Depression by Brooke Shields.  We appreciate those who read along with the book club, and especially those who took the time to discuss this book.

CX: : In Chapter 1 “The Little Engine that Could,” Shields writes about her difficulties in conceiving and carrying a pregnancy. It has been said that fertility treatments and miscarriages can possibly increase your risk of experiencing a perinatal mood or anxiety disorder. Do you feel that any of your difficulties or ideals when trying to conceive or carry a pregnancy contributed to your postpartum depression?

SC:  I was fortunate and did not have trouble conceiving but I did have some ideas that set me up for PPD. I thought that babies who cried a lot were crying because the parent was doing something wrong. That thought was so off and so hard to shake when my son cried.

CX: I did not have experience with this but after reading Brooke’s book and having friends experience this, I can absolutely see that those experiences can contribute to PPD.

SK: I thought that conceiving would be much easier than it was in reality. I didn’t have to go through fertility treatments but it took a bit longer than I expected. I feel the reality about trying to conceive is not really talked about and is not expressed well in modern media.

CC: For me, that was the complete opposite – I had infertility with my first, and had a wonderful postpartum. I conceived on the first month with number 2, no complications, dream delivery … and had PPD. I have worked with many new moms though that hide their illness if they struggled to have a baby out of guilt or fear of judgment.

CX: Do you feel that the media’s representation of conceiving makes it more difficult for a woman to share her struggles when undergoing fertility treatment?

SK: I didn’t experience this personally but I have friends who underwent IVF and I didn’t know until much later. They had a difficult time reconciling that they couldn’t conceive the “old fashioned way” and felt it almost made them less of a woman. I think if more people were aware of others’ struggles or if there were more support groups available then maybe these women wouldn’t have as much guilt.

CX: In the chapter titled “ Fasten Your Seatbelts” Shields describes her experience with childbirth and her cesarean section. On page 46 she says, “I had always imagined that birth would be the closest thing to grace I’d ever experience, yet in reality there was nothing graceful about it.” She also describes how she felt as though she had no bond with her daughter when she was born.

What role do you feel your childbirth experience played in bonding with your child? How do you feel doctors and nurses could better assist mothers in reconciling what they imagined childbirth would be and their actual experience?

SC: I felt sad for Brooke when she didn’t feel that she bonded with her daughter after birth. I do think doctors and midwives could help women understand that their idealized birthing scenario might not happen.

SK: Luckily labor and delivery went pretty well for me, I was able to bond fairly quickly with my son. Although I do recall watching other people interact with him and trying to mimic it, because I felt that maybe I wasn’t being “loving enough” with him. I do believe that childbirth is either idealized or made to sound like an absolute horrific process, which is hard to process as a first time mommy. I think doctors and nurses could try to ensure that babies get immediate time with mommy or daddy. Also any wishes of the parents for the baby to get immediate skin to skin contact try to be honored to the best of their ability.

CX: For 24 weeks, I suffered from hyperemesis gravidarum and then ended up with pruritic urticarial papules and plaques of pregnancy (an itchy rash) shortly thereafter. I had no ability to ask the right questions about the birthing experience due to being so ill for most of my pregnancy. My expectations weren’t exactly for a butterfly and rainbow birthing experience, but I did not expect nearly as many complications and difficulties as I had. When I did speak up about pain, concerns, crying, etc, it was often excused as baby blues and completely normal. The pain and onset of PPD was very early and this made bonding very difficult. I clearly remember thinking that she was not my child and was better off with someone else because I felt like she didn’t love me. If I had known that complications can happen and that bonding doesn’t always happen immediately it may have helped. I felt like my MD appointments were often rushed, education was the least of their concerns, it was mostly to do weigh-ins, urine analysis, and a quick check in. Those appointments are vital for education and assessment of pregnant moms.

CX: In the chapter titled, “Why am I Crying More Than my Baby?” Shields describes her emotions in the midst of her PPD without knowing that it was postpartum depression. She talks about trying to describe her emotions while also trying to convince herself that she wasn’t too bad off and maybe she could muscle through.

What would you have wanted someone to say to you to help you seek and accept help? Is there a way to better educate family and partners so that they will better be able to recognize signs of Perinatal Mood and Anxiety Disorders in new mothers?

SK: I think that PPD was discussed more at prenatal visits and maybe if mom’s and families were given a list of possible PMAD symptoms upon being discharged from the hospital it would be so helpful. I got a lot of info on what to expect physically and for the baby but very little about possible mental issues.

CC: I think partner involvement is so important. If obstetricians would recommend the partner being present at one of the late pregnancy appointments and plan to discuss maternal mental illness, that would be a great step. If pediatricians screened would also be helpful, as I was just told last week when I met with staff at a pediatric clinic that both partners are often present at the two week appointment.

CX: Throughout chapters 4 and 5, Shields discusses her difficulties with taking an antidepressant and ceasing her dosage after she begins to feel better. Soon after, she experienced a flood of emotions and, after contacting her doctor, she restarted medication.

For anyone who has been prescribed medications for PPD, have any of you stopped medication after starting to feel better? Were you told by your prescribing physician that even if you begin to start feeling better not to stop your medications, especially without consulting your physician? What type of advice were you given when prescribed medication?

CX: I was lucky enough that my MD was very clear about not stopping medication when I started to feel better. I did feel at several points in my recovery that I could stop taking the medication, that I was back in control of my life, but I did not. My MD did a wonderful job making a plan with me for coming off the medications slowly and assessing how I was doing at each step of the way.

SK: I never stopped my medication without first discussing it with my therapist, but the first time I tried to wean off of it it did not go well. I had to go up to my original dose and try again in a much slower gradual way.

CX: On page 141 Shields states, ”When my baby was only a week old, I knew something wasn’t right because of the severity of my emotions, but I never dreamed they were due to postpartum depression. She goes on to describe how she knew it just wasn’t baby blues anymore. Shields comes to a realization that she is no longer experiencing baby blues, and was now experiencing postpartum depression. For many of us, this conclusion came at different times and in different forms.

Can you describe when you first realized you were experiencing postpartum depression or anxiety, and not the “baby blues”? Did you come to this conclusion, or did a family member, friend or physician?

BB: I feel day three postpartum but my dad noticed a change the day my baby was born. Love this book!

SK: I realized it once my medication started to work. I didn’t want to admit it to myself, even after starting to see a therapist and going on medication. Once I began to feel like myself and realize what motherhood could really be (my son was 10months old at the time) I knew what I had experienced was not just baby blues. Also reading Postpartum Depression in Plain Mama English gave me a swift kick into the realization that what I was experiencing was not normal.

CX: I was sitting in a weekly mom’s group one evening and it just hit me. Those women loved their children and their significant others, even though we all were experiencing significant sleep deprivation, stressors at home and work, and new mom worries constantly. I on the other hand, hated my life and I regretted being a mom. I actually thought about giving my child to my parents and running away. I still remember the chair I was sitting in and the moment I broke down and realized I needed help. My daughter was 5.5 months old when this realization finally occurred.

 

We hope you’ve found our conversation helpful. Feel free to weigh in! Have you read this book? Could you relate to Brooke’s experiences? If you’d like to join us for the next book, you can find the Warrior Mom Book Club here and request to join: https://www.facebook.com/groups/warriormombc/

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Warrior Mom Wall Announcement

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pencil-432613_640We all have stories to tell.

Stories filled with victories, with curve balls, and stories filled with heart.

We want YOUR stories on our Warrior Wall at Postpartum Progress’ first Warrior Mom Conference, the first EVER patient-centered maternal mental health conference.

How do you participate, you wonder?

Easy:

Grab some paper. One page only, no larger than 8.5×11 inches.

Write a note of inspiration or a few lines of your story. Draw. Whatever will fit on your chosen paper that you’re inspired to share with us.

Then slap a stamp on that bad boy and mail it to the following address before June 15:

Lauren Hale

P.O. Box 20791

Lehigh Valley, PA 18002-0791

What will happen to it once it’s received?

We’ll be snapping pictures of the artwork/stories and sharing them on the Postpartum Progress Instagram account as they come in*, then all of this lovely Warrior Mail will be organized into a piece of art to be displayed in Boston at the Warrior Mom Conference.

We cannot wait to see what you have to share with us!

 

*Sending in a postcard implies an agreement to allow Postpartum Progress to share and disseminate your submission as we see fit in association with the promotion of the project for which it was submitted as well as for the Warrior Mom Conference, for which the project is a component.

*If your piece incorporates or promotes a website, it will not be included in the Warrior Wall display unless the referral is easily removed from the submission. If you wish to advertise/sponsor the Warrior Mom Conference, please reach out to Susan Petcher at wmc(@)postpartumprogress.org.

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Sprinkles of Self-Care

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tea cup David MaoI push self-care a lot in the #PPDChat world. Why? Because it was one of the biggest things that helped me and also because as mothers, we often forget to mother the most important person in our lives -ourselves.

This week’s #PPDChat focused on self-care, angling toward finding the positive, even in the dark.

There is a misconception held by many that self-care has to be something massive and complicated. Wanna know the truth?

Self-care is actually pretty simple. If done right, you can sprinkle it throughout your daily life.

Here are three ways you can incorporate some sprinkles of self-care into your life, starting today:

#listof3List three things for which you are grateful every morning, before your feet hit the floor. Tweet it, keep a journal by your bed, do it in your head. Although I would recommend keeping a physical copy of it so you can look back at it. Then, in the evening, before you go to sleep, list three things which made you happy, smile, or laugh. The purpose? To refocus your energy toward a positive end instead of a frustrated or negative energy. Keeping a physical copy gives you something to read through on the tough days.

Five Senses: Get a pen and a piece of paper. Yep, no computer or digital for this one. Write a list of all five senses, leaving five spaces under each. Then, in each of those spaces under your senses, list five of your favourite things. Keep at least one of those five things in your home at all times. Boom. Emergency self-care kit you can sprinkle throughout your day or grab to take into your blanket fort on the REALLY tough days.

10 minutes/day rule: Dedicate a minimum of 10 minutes to yourself and only to yourself every day. If you can manage more, great. But 10 minutes is a realistic short period of time that will make a difference. Plan to do something for yourself during these 10 minutes – make it as elaborate or as simple as you want. Make a nice cup of tea. Sit outside and drink it. Go to a coffee shop and get your favourite drink and go to the park. Go for a 10 minute power walk. Whatever fills your pitcher – do it for 10 minutes every day. You’re worth it.

Will these make a difference overnight? Probably not. But after time, you’ll realize they are making a difference and these things will be part of your daily routine.

We can’t fill the pitcher of those around us if our own is woefully empty. Go forth and fill yours.

What will you do for yourself today?

 

photo source: Unsplash

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