Antenatal depression and antenatal anxiety: Jen’s story

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antidepressants pregnancyI struggled with undiagnosed antenatal depression and antenatal anxiety.  I felt like such a fraud.  My husband and I had planned for this baby.  I should have been overjoyed and glowing.  Instead I walked around in a fog of self-hatred, irritability, and unrelenting worry.  My internal monologue consisted of, “I should be happy, dammit!” Why couldn’t I enjoy this pregnancy?  It was my final pregnancy, and we were giving our nearly three-year old daughter a sibling.  Where was my pregnancy glow?  Why did I feel like all I did was complain, vent and whine?

Why couldn’t  I relax?  I felt so much pressure to get my oldest potty trained before the new baby arrived.  I felt like all loose ends needed to be tied up.  I had to finish my toddler’s baby book before the new baby arrived.  I had to make sure I was exercising daily.  I had to maintain a tight control on my blood sugar.  I had gestational diabetes with my first pregnancy, so I spent my final pregnancy watching my food intake.  Every time I heard a comment about “eating for two”, I wanted to rage.  I did not have that luxury of eating whatever I wanted.  The meal plan made me miserable.  If my numbers weren’t within the expected range, I immediately panicked.  I was terrified that my daughter would struggle with complications from my gestational diabetes.  Not even the ultrasound showing a healthy twenty week baby girl diminished those fears.  I felt like I had no right to complain or worry.  I knew what to expect.  I needed to just suck it up and deal with it.

Like postpartum depression, antenatal depression looks different for each mama.  My lovely friend Susan describes her antenatal depression like this.  “I just remember feeling a crushing weight and numbness. I wanted to not be pregnant anymore and had thoughts of throwing myself down the stairs. That’s what sent me to a perinatal psychiatrist. All my joy left like I was in a vacuum – and I was suddenly convinced a new baby was the end of everything as I knew it.”

My experience of antenatal depression differed from Susan’s.  My depression manifested itself in extreme irritability, bordering on rage.  I had no patience for anything – traffic, my husband, my daughter, my parents and my sister, my friends, and my co-workers. One of the triggers for my rage was my daughter’s refusal to take naps on the weekends.  I could barely control my reaction.  I would yell and scream at my husband.  I would need to leave the house to give myself an adult timeout.  I still cringe when I remember an epic tantrum that occurred during my seventh month of pregnancy.  I was at a concert at an outdoor venue.  I cut in front of everyone waiting in line for the bathroom and for water, simply because I was pregnant.  I was rude to everyone that day. I took out my rage on anyone in my path.  This irritability and rage manifested itself in full-blown postpartum depression and postpartum anxiety after my youngest was born.  I wish I had recognized these signs sooner.  I could have treated this during my pregnancy when my initial struggle began.

Antenatal depression and antenatal anxiety are not as widely known as the other perinatal mood disorders.  We do moms a disservice when we fail to screen for depression and anxiety during pregnancy.  We need to focus on both the needs of the mother and the needs of the baby.  Mothers are vulnerable during both pregnancy and the postpartum period.  Ask the pregnant mom how she is doing and really listen.  I read this amazing piece that Andrew Solomon wrote regarding depression in pregnancy.  Thank you Andrew for speaking up for both the mothers and the babies.  If you are feeling fragile, do not read Andrew’s piece.

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Pregnancy Anxiety and Family History of Miscarriage

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Pregnant BellyFirst-time mothers can find many things to be anxious about when they become pregnant. What will pregnancy be like? Will my baby be healthy? Did I start taking my prenatal vitamins early enough? Am I really ready for this? But some women may have an additional fear that seems more relevant than it might to other pregnant women: Will I be able to stay pregnant, knowing that my mom had a history of miscarriage?

This anxiety was something that I had to deal with when I discovered I was pregnant with my son shortly after beginning infertility testing. After a year of trying to conceive, I had been getting rather depressed about failing each month, and the beginning of that year of trying may or may not have started with a miscarriage I was too afraid to see my doctor about. I know now that that was a bad decision, not telling my OB/GYN about the three weeks of heavy bleeding that had forced me to reschedule my initial annual exam where I’d intended to ask for a prenatal vitamin prescription, but I didn’t bring it up because I didn’t want to know for sure. My mom had suffered three miscarriages when I was a kid – the reason why there ended up being eight years between the births of my two younger brothers – and I was trying to shield myself from the emotional aftermath of knowing for sure whether it was a miscarriage or just an exceptionally heavy period. My periods were awful and unpredictable when I went off the Pill. I still have plausible deniability.

So there I was with a positive pregnancy test around Christmastime 2004, overjoyed that I was finally pregnant, but haunted by the shadow of a possible miscarriage. Some of these things are genetic. Some are due to environmental factors. Some don’t seem to have any reason whatsoever. Were those genes passed on to me?

These fears led to a tearful call to my OB/GYN just after New Year’s. I was spotting. They tried to reassure me over the phone as they set up the appointment for me to come in. Spotting can happen in a normal pregnancy. It doesn’t mean anything is wrong. But predisposed as I was to anxiety, this was no consolation. I saw the CNM I liked at my OB/GYN’s office for a pelvic exam and a urine test. The blood was brown, though, old blood, and my pregnancy test was positive. My cervix was inflamed, though, so they sent me to the local women’s hospital for an internal ultrasound because they didn’t have any ultrasound techs in the office. I was only five weeks along, so all they could see what the egg sac and yolk sac, which was good enough for them to reassure me my pregnancy was fine. Only if I started seeing red blood along with cramping should I worry and give them a call.

I didn’t have to make another call like that, but my anxiety didn’t go away.

My inflamed cervix ended up needing to be treated, and I was prescribed MetroGel for it. MetroGel is considered Category B for pregnancy risk, but I was still in my first trimester, and I was terrified that something bad would happen if I introduced this foreign substance so close to where my baby was developing at such a crucial period. I ended up waiting until the first day of my second trimester to actually use the MetroGel. That decision in itself was risky, as an untreated infection can also potentially harm a developing fetus, but it was what I considered the safest route at the time.

Thankfully, my anxiety levels decreased appreciably once I reached 24 weeks. That was the magic number in my head where I felt I could stop worrying about a miscarriage, because about 50% of babies born prematurely at that fetal age survive. And with each passing day, I knew my son’s chances of surviving and being born relatively healthy were just getting better and better.

Unfortunately, my anxiety came back with a vengeance after my son was born, alongside my undiagnosed postpartum depression. If I’d known then what I know now, 10 years later, I would have talked to my doctor. I would have tried to get help. I know I would have avoided taken any medication during my first trimester, but I might have considered some of the lowest-risk medications during my second and third trimesters according to the best available information at the time. I certainly wouldn’t have waited until my son was three before finally seeking treatment from a psychiatrist.

I know I couldn’t have stopped worrying about losing my son, but I could have had someone to talk to about it if I’d looked into therapy. But that’s why I think Postpartum Progress is so important – so people like me can encourage other women to get the support we never had.

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Mental Illness Didn’t Crush My Dream of a Family

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3347120739_0d840078faPhoto Credit: carf via Compfight cc

I was diagnosed with Bipolar Disorder after experiencing two manic episodes in the same month, each requiring hospitalization. At the time I was devastated and felt as though my dream of having a family had been shattered.

I knew I wanted to be a mom from a young age. I adored babysitting and loved being in charge. In my mind I’d meet the man of my dreams in college, we’d get married soon after, and when the time was right, we’d start a family.

In reality, that all did happen, with one exception.

I met the love of my life while in college. We dated for four years before he proposed. At 24, we said our vows in front of family and friends, promising to love each other in sickness and in health. Little did we know sickness wasn’t far off. We’d have just over two years of health before mental illness knocked the wind out of our nearly perfect love story.

Madness struck me before I’d even had the chance to decide that I was ready to try for a baby. My diagnosis of bipolar disorder left me wondering if I’d ever be healthy enough to be a mother. A year went by as I struggled to keep my chin above water, my depression pulling me deeper and deeper into the ocean of despair. I felt like I had nothing to live for.

My husband and parents fought hard for me. I saw countless psychiatrists, and even a noted doctor from NIMH (National Institute for Mental Health) who told me, as I sobbed in his office with my husband by my side, that I could still have children if I wanted. It was possible, he said. And staying on medication under doctor’s supervision would be a good idea.

After a year of intense suffering, I couldn’t take it any longer and finally agreed to try a medication my doctor had been recommending. It took several months for me to feel the full effects, and for my old, up-beat personality to begin to reemerge. My husband and I took things one day at a time, and when the weeks added up to a full year of stability, the year of hell began to fade into the shadows of our minds. Thoughts of pregnancy began to fill my head, and all of a sudden I was pleasantly distracted from my illness.

I’d accomplish my dream of having a family; it was so close I could taste it.

Looking back now, with two healthy kids and six years of parenting behind me, sure, I’d do things a little differently.

I was medication-free for my first pregnancy and although I did fine and had no symptoms of my bipolar disorder during the 40-weeks, the same can’t be said for the four weeks after my son was born. Postpartum psychosis ripped me from my newborn but I was fortunate it only took a week in the psych ward to return me to my family. In hindsight, part of the problem was the pressure I put on myself to be a “perfect” mom to my new baby. Maybe if I wouldn’t have been so insistent on breastfeeding, I wouldn’t have gotten sick. Maybe if I would have let family help more with the night feedings, my mind wouldn’t have lost control of itself.

Lessons learned, I agreed to do things differently the second time around. I thought I had all the proper precautions in place. I did my research and decided that since the medication I took had the greatest risk to the fetus during the first trimester, I’d work with my doctor to taper off the med once I got a positive pregnancy test. The plan was to go back on the med in the second trimester and remain on it for the duration of the pregnancy.

Unfortunately, the exciting news of the two little pink lines sent me into a manic episode after a week-long battle with elated insomnia. I spent five days in the psych ward at five weeks pregnant battling the most severe mania I’d ever endured. The doctors brought me back from my break in reality with powerful anti-psychotic drugs and I feared I might lose my baby.

Recovery from that most recent hospitalization in April of 2010 was the most difficult. I worked closely with my doctors and my baby girl was thankfully born completely healthy. My postpartum period with her was drastically different than that of my first child, due to the plan I had put in place before she was born. We formula-fed from the start, since breastfeeding wasn’t an option anyway due to my meds. Knowing she’d be a bottle-fed baby from the moment I became pregnant made it easier to get past the sadness over not being able to breastfeed.

Since my husband and I knew that lack of sleep was my number one trigger, he did the middle-of-the-night feedings in her first few months which allowed me to get a solid chunk of quality sleep. We even had my sister-in-law stay with us for the first two weeks since she was home on a break from her job at the time, and she took the night shift. Sleep was still a challenge in those first few months, but luckily she was a great sleeper and we made it through.

One thing is certain: I didn’t let mental illness rob me of my dream of a family. My family is everything to me.

Parenting is no easy task. Throw in mental illness to manage, and it can get intense. Intense, but not impossible. There are resources out there, there is support out there. My kids are worth it all, no doubt about it. I share my story – our story, really – so that other women out there can find hope.

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How Women of Color Can Manage The Impact of Acculturative Stress and Discrimination During Pregnancy

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dr sumner acculturative stress and discrimination during pregnancyToday I’m thrilled to have Dr. Lekeisha Sumner with us to share insight on two very common types of stress women of color may experience during pregnancy and tips on how we can manage both. Dr. Lekeisha Sumner, PhD, ABPP is a board-certified clinical psychologist with specialization in both clinical psychology and medical psychology. She is currently an Associate Professor in the Department of Psychology at Alliant International University and Assistant Clinical Professor in the Department of Psychiatry & Biobehavioral Sciences at UCLA. A frequent commentator on psychological science, she has written extensively on trauma and the intersection of culture and gender in health and well-being. Dr. Sumner maintains an independent practice in West Los Angeles where she was recently commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment to serve on the Strategies for Improving Outcomes for Peripartum Women committee.

With so many changes in one’s body, daily routine, and responsibilities, it’s typical for many women to feel overwhelmed at times both during pregnancy and after the birth of baby. And yet, for some women, these feelings can be compounded by stressful experiences related to their cultural backgrounds or ethnicities, which increases their vulnerability for emotional distress.

Take for example, Olivia, a bright and compassionate 28-year old woman who was in the second trimester of her first pregnancy when we met. She had moved to the United States several years ago from her native country and was elated to finally have the opportunity to be with the man of her dreams and start a family. Her husband, a US native, was supportive of her adjustment to life in a new country and particularly attentive to her needs during pregnancy. She was especially grateful for the comfort he provided now that she lived without her extended family.

Despite all the wonderful changes that were happening in her life, Olivia felt chronically overwhelmed and was stunned by the recent discovery that she had developed hypertension during her pregnancy. She had already unsuccessfully tried the home remedies her mother suggested which included taking a walk around the block and listening to relaxing music. But, at the urging of her husband who observed her increasingly distressed mood, she decided to enter psychotherapy.

Olivia began experiencing stress on her job long before she became pregnant but things only intensified once she disclosed her pregnancy to her boss. Since that time, she began to experience difficulty sleeping, little appetite, constant worrying, and difficulty concentrating and had even begun to grind her teeth during sleep. Given the severity of the symptoms, Olivia was concerned that they would negatively impact her pregnancy. As she began to delve into the underlying sources of her stressors and the contexts in which they occurred, it became clear that many of the experiences she described are common among women from some ethnic and cultural groups (especially women of color, refugees, immigrants, etc.) yet rarely discussed: acculturative stress and discrimination.

Acculturative stress typically refers to the emotional strain of having to alter one’s cultural attitudes, beliefs or behaviors to adapt to and navigate a distinctly different culture. For Olivia, acculturative stress presented as the strong social pressure she felt to quickly learn English and lose the accent of her native language. She also experienced discrimination on her job as her boss would often humiliate her by making snide comments about immigrants within earshot. He would keep constant tabs on her, would make embarrassing “jokes” about people of color and her accent, and routinely give her lower performance evaluations than her colleagues even though her productivity was equal too or greater than theirs. After disclosing her pregnancy, these incidents worsened. Although working in a hostile climate resulted in her having performance anxiety, ruminative thoughts and nightmares, she was too intimidated to report this behavior to human resources and believed she would have been labeled as being “too sensitive,” “playing the race card” and perhaps worse, risk further alienation and stigmatization.

Over a period of time, intense and chronic stressors like the ones Olivia experienced can wear on a person and leave them feeling emotionally drained and depleted. The stress brought on by discrimination and acculturative strain during pregnancy can quickly erode one of the most sacred and enjoyable periods of a woman’s life and render women at risk for symptoms of depression and anxiety, and poorer lifestyle choices (e.g. eating habits, nicotine use) as they attempt to cope. For some groups, these stressors may alter the release of bodily hormones that may affect the outcomes of pregnancy. For example, African American women across the economic and educational strata have the highest rates of preterm birth in the United States. Studies confirm that these findings are in part due to the high levels of chronic stress and ethnic discrimination they are exposed to throughout the lifespan. While research shows that these stressors do not affect everyone or every group of pregnant women exactly the same, they can certainly diminish mood mood, energy, and confidence in caring for baby.

There are some ways to help lessen the impact of acculturative stress and discrimination. For instance, women who use healthy coping strategies (e.g meditation, walking, journaling, asking for help), those with a strong belief in their ability to overcome obstacles and those who have pride in and a connection with their cultural heritage and cultural values all seem to have better emotional responses in the face of these types of stressors than those without. Also, women who feel a sense of belonging and receive support from their partners throughout pregnancy and post-partum also tend to respond better. For Olivia, getting involved in an on-line support group, a local church that appreciated congregants from diverse backgrounds and engaging in psychotherapy were all beneficial in helping to restore her well-being and equipping her to improve her ability to cope.

For all women, the pregnancy experience is shaped not only by biology but also by psychological and cultural influences. While you may be limited in eradicating all stressors during pregnancy, given the suffering that severe culture-specific stress during pregnancy can cause for you and baby, it’s a good idea to discuss with your doctor as soon as possible any concerns in your life.   You will also want to monitor your stress levels not only during pregnancy but also in the many months after your bundle of joy is delivered. Taking a few extra steps can help you better prepare to be the best warrior mom you can be.

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