Hanging on By a Thread: What flossing taught me about postpartum depression and intrusive thoughts

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I am honored to introduce my friend Susan Goldberg who is courageously sharing her story of postpartum depression for the first time.  Susan’s discussion of how parenting books exacerbated her struggle resonated with me in a way I hadn’t anticipated.  That’s the power in sharing our stories here isn’t it?  No matter how long I’ve been reading or writing about PPD, a new “me too” always leaves me feeling just a bit more healed.  Thank you, Susan, for trusting Postpartum Progress with your story.

Susan GoldbergI keep coming back to dental floss.

This is a problem. The writer in me knows that I need to open with a strong image, and, ideally, that I should close with that image, making — no pun intended — a tidy loop of a narrative, tidying up (forgive me) all the loose ends.

But what I keep returning to is the nightly ritual of flossing. I’ve been a model flosser for decades, a dentist’s dream, scraping away at the grit between my teeth even on nights when I’d had a few drinks, even when I was exhausted, even when the tedium of dental hygiene was the only thing between me and my bed and my bed was so, so attractive. I flossed out of a sense of obligation, because it felt good, but most of all because I had long taken it as a bellwether of my own mental health: no matter how bad things are, I’d always figured, if I was still managing to floss, things couldn’t be dire. There was still hope. I mean, no one on the brink of madness, of utter collapse, says to the guys in the white suits, “I’ll be with you in a second — I just need to floss my teeth.”

Or do they?

Probably you knew I was going to say this, but for the record: in retrospect, I’m not sure that flossing was such a good bellwether.

I’m pretty sure didn’t floss for the first few nights after my first son, Rowan, was born, a little over 10 years ago. I’d had a C-section (he was breech) and that first week in the hospital, with its midnight shift changes and baby weigh-ins, 2 AM lactation consultations, was a blur of day and night, pain medication and sweet exhaustion. But by the time we got home, I was ready for routine, a clear demarcation between day and night, rest and wakefulness.

The problem was, there was very little routine, very little demarcation between day and night. There was very little rest. There was lots of wakefulness, though: hours and hours of it, those hours punctuated by increasingly fitful moments of sleep and, eventually, no sleep at all, even when the baby slept. Months passed, with my partner, Rachel, and I juggling the nights in which our son woke as often as every 45 minutes, soothed back to sleep only by breast-feeding or, if we were lucky, with a pacifier. We slept in shifts — Rachel going to bed by nine to take over at 2 AM with bottles of pumped milk, me shuffling about the house with the baby sleeping against my chest in the sling, hoping to ease him into bed and catch a couple of hours of sleep (after flossing) before I could surrender responsibility.

It wasn’t just sleep, obviously. It was so many things that to list them here quickly, in one paragraph, is almost laughable, but for the sake of narrative and expediency I will: my mother had died six months earlier. We’d just moved to a new city and I knew practically no one. Rowan had been born at the end of November and the weather had turned bitterly cold — getting out of the house involved shoveling, warming up the plugged-in car and scraping the frost off the inside windows with my credit card. And I had nowhere to go, anyway, so I didn’t leave the house. Instead, I read books about infant sleep and paced the house, day and night, with my baby.

Those books: Marc Weissbluth and Dr. Richard Ferber and baby whisperer Tracy Hogg and the Searses and Katie Allison Granju with her tome on attachment parenting. They nearly killed me. There’s a picture of me, in the early days, sitting on the sofa with my laptop on my lap, the baby sleeping next to me on the couch. It’s a simple enough shot of modern life with baby while mom catches up on e-mail. But if you could read the thought bubble above my head, it would have been filled with warring impulses: What kind of mother are you, letting your baby sleep on the couch — on his stomach, no less? He could die. In my head, Hogg hissed at me to Start as I meant to continue: if I wanted my baby to sleep regularly, in his crib, through the night, then what kind of asshole was I being by letting him sleep on the couch? And then Granju would chime in: What kind of monster are you for staring at your computer instead of staring lovingly your child? Why is he sleeping on the cold, unloving couch cushion when he could be nestled against your chest, the rhythm of your beating heart in sync with his? You’ll break him, you know. You already have.

They never stopped, those voices. They kept me company in the day, kept me awake in the middle of the night. (Somewhat ironically, I was ghostwriting a parenting book of my own during my son’s first few months, pretending on paper to know exactly what I was doing. And I’m ashamed to admit it here, but here’s just how far gone I was: when Hogg later died of cancer, and when Granju’s son died of a drug overdose, my bitterness toward these two utter strangers overshadowed any empathy I felt for them. My apologies to them both.)

These were the pre-Facebook days, and I longed for something like Facebook — like this website — to replace them, some kind of beacon in the night where I could commune with other parents as I rocked and paced with my baby: Who’s awake? Who’s scared? Who’s lost in grieving? Who else can no longer recognize herself? Who else is desperately looking for someone to help her feel less alone, to make sense of these feelings, to tell her that it’s going to be okay — or, more to the point, to say, You’re not okay. What you’re going through is real, and even common, but you’re not okay. You need help.

No one did. Friends nodded and clucked sympathetically, offered to come over for an hour or two so that I could nap, but of course I couldn’t nap, so what was the point? My doctor never asked. “I’m having a hard time,” I finally said one day on the phone to my father. “I know,” he said. “I know.” But the conversation never went further. No one mentioned postpartum depression, suggested that maybe I should see someone. At one point, I phoned the District Health Unit to ask if they had any services that would help us sleep-train the baby, because I was so tired. They phoned back and berated me for even considering letting him cry it out. What kind of asshole are you?

Eventually, the baby slept: first in five-hour chunks and then, after marathons of sleep training that nearly killed me and Rachel (and during which we nearly killed each other), through the night. Eventually, I took a Mindfulness-Based Stress Reduction course, got some perspective. Eventually, spring came, and then summer. Eventually, things got a bit better, then a lot better. We had a second baby.

“What sleep philosophy will we use?” I asked Rachel, justifiably terrified.

“Whatever gets everyone the most sleep,” she answered, and we threw out all the books and went with what worked for us.

Through it all, I flossed. And I survived.

But I’m scarred. I talked about those times with a good friend a few weeks ago, one of those no-holds-barred conversations that goes immediately — no small talk — to the painful core of things. “No one said anything,” I said, and was suddenly racked with tears I didn’t know were still there. We talked about the respectful, uncomfortable silences each of us had maintained at different points in our friendship, when both of us knew something was wrong, but didn’t want to overstep, didn’t want to intrude, even though the hurt and the pain and the damage were obvious. And we made a vow to each other to speak up, to be the friend who says, “I think something’s wrong.”

On so many levels, we need to learn how to have these conversations with each other, to find ways to speak up about our own pain and acknowledge each other’s. New parents need education about postpartum mood disorders well before their babies are born — and not just light references to the “baby blues.” Our midwives and obstetricians and family doctors need to check in regularly. We need to establish circles of safe friends and family members who can intervene, gently, to say, “I think something’s wrong. Can I help you get some help?” We need conversations — not just with the warring voices in our heads, but with each other and with the people who can help. We need websites like Postpartum Progress, and ways to make sure people know about it and resources like it.

I still floss regularly, but every so often, even just a few times a year, I skip a night. I skip it for all the usual reasons: too tired, up until 2 AM dancing, just don’t feel like it. But I also skip it to remind myself that sometimes, it’s okay to take a break. I skip to remind myself that my sanity, my well-being, are much too complex and complicated to be reduced to a single, arbitrary ritual of self-care. In other words, sometimes, flossing is just flossing — not the single, tenuous thread holding me together, keeping me from falling into the brink.

photo credit: Susan Goldberg

Susan Goldberg is a writer, editor, essayist and blogger, and coeditor of the award-winning anthology And Baby Makes More: Known Donors, Queer Parents and Our Unexpected Families (Insomniac Press, 2009). Her personal essays have been featured in Ms.Lilith, Today’s Parent and Stealing Time magazinesas well as in several anthologies and collections. She is a contributing blogger for VillageQ.com and Today’s Parent, where she blogs regularly as The Other MotherIn 2012, Susan was chosen as one of BlogHer’s Voices of the Year community keynote speakers, and has twice been a VOTY honouree. She is one of approximately 30 Jews in Thunder Bay, Ontario, where she lives with her partner and their two sons. Read more at www.susanlgoldberg.com and www.mamanongrata.com.

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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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BabyCenter Finds PPD Moms Don’t Seek Help Due To Guilt & Shame

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BABYCENTERBabyCenter®, the number one pregnancy and parenting digital resource, recently asked 1,400 moms about their experience with postpartum depression and found that 40% said they didn’t seek medical help for their illness. Their reasons for avoiding reaching out for help included feeling like they should or did have the strength to get over the feelings without a doctor’s help (30 percent), believing their symptoms weren’t serious enough (25 percent), or feeling too much embarrassment (24 percent) and guilt (23 percent).

 “This study revealed serious findings that need to be addressed,” says Linda Murray, BabyCenter Global Editor in Chief. “Depression is dangerous for women and their babies, and untreated depression can become worse and lead to other complications. Depression affects people from all walks of life, but new moms are particularly susceptible given the stress of becoming a parent, lack of sleep, and hormonal changes. We want moms to understand that seeking help for PPD isn’t something to be embarrassed or ashamed about; in fact, it’s one of the most important things they can do for the well-being of their babies.”

Postpartum Progress is thrilled that BabyCenter put its resources behind taking a deeper look at postpartum depression and how it affects women. It’s so important to understand the barriers that prevent moms from seeking treatment to get the help they need. It stands out to me that the results of the survey found in particular that women felt they should be able to get over PPD themselves or that their symptoms weren’t serious enough to need professional help — those are beliefs we can effectively change by raising awareness about this illness and how it can affect both mom and baby when untreated.

In response to the findings of their study and to lend support to the cause of maternal mental health, BabyCenter is now graciously allowing me to blog regularly on their site to shed additional light on PPD and remind new and expecting moms that there is no shame in feelings of anxiety or depression. If you are experiencing PPD, please know that getting treated as soon as possible is important. Please go check out my very first post on BabyCenter: Asking for Help for PPD: Failure or Fierceness?

“I can’t stress enough that PPD is treatable, but only if moms ask for help,” says psychologist Susan Bartell. “It can be hard, but moms don’t need to be afraid to seek support during this difficult time. And it’s important for moms to remember that help comes in many forms ranging from friends who simply fold your laundry to therapy.”

About BabyCenter

BabyCenter® is the voice of the 21st Century Mom® and modern motherhood. It’s the number one pregnancy and parenting digital destination worldwide, reaching more than 40 million moms monthly in 11 languages across 14 owned and operated properties from Australia to India to China. In the United States, 7 in 10 babies born last year were BabyCenter babies. BabyCenter is the world’s partner in parenting, providing moms everywhere with trusted advice from hundreds of experts around the globe, friendship with other moms like them, and support that’s remarkably right at every stage of their child’s development. BabyCenter is a member of the Johnson & Johnson family of companies.


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Minority Engagement, Diversity and Inclusion Survey

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postpartum depressionPostpartum Progress is hard at work behind the scenes to improve our support and inclusion of minority and underserved women in our community outreach and engagement. While we often feature stories on the blog from mothers of color and offering Spanish versions of the blog and nonprofit’s website are in the works, we want to go above  our current efforts to develop programs and initiatives that will reach and engage minority women both online and off, all across the country.

However, in order to do that, we first need to know what your experiences have been, and what we can do better to help you. We’ve spent the last month developing a survey that we hope will help us gain some insight into what women of color experience with their mental health during pregnancy and postpartum, levels of awareness & education on postpartum mood disorders, cultural stigma, and barriers to treatment you’ve faced.

It will help us determine what kind of support you desire and how Postpartum Progress can improve on building a community that’s inclusive.

The survey was created by our new intern Denise Carter from Emory University’s Rolllin’s School of Public Health, with input from myself based on my personal experience with PPD and anxiety. Denise is currently getting her Master of Public Health in Behavioral Sciences and Health Education. She also has a Bachelor’s in social work, with minors in non-profit management and African-American studies. She has extensive experience and a passion for helping women of color care for and improve their mental health-we are thrilled to have her helping us!

The survey is 100% confidential and anonymous-your identity will not be tracked. Please feel free to answer honestly and with as much detail as possible. The more we know about your experience with perinatal mood and anxiety disorders, and what kind of support you need, the better we can help be an effective and valuable organization: changing the landscape of maternal healthcare locally and globally. Will you join us in this mission?

You can access the survey here: http://fluidsurveys.com/s/minority-engagement/

Questions, comments? Send them to us: addyeb@icloud.com or denise.carter02@gmail.com

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