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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Women of Color: Will You Tell Us About Your Postpartum Mental Health Experience?

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IMG_1798Attention Warrior Moms of Color: Did you know Postpartum Progress wants to hear from you? We do! We are currently conducting a survey to find out how we can better support and serve women of color who are pregnant and new moms.

Our goal with the survey is to gain insight into what minority mothers experience with their mental health during pregnancy and postpartum, levels of awareness & education on postpartum mood disorders, cultural stigma, and barriers to treatment they face. If you are a Hispanic/Latina, African-American, Native American/American Indian, Asian/Pacific Islander, Indian, or other minority woman we hope that you’ll consider taking some time to participate. Your feedback about your experience will help us determine how we can improve our reach and engagement, and develop programs and initiatives that are inclusive of your specific needs.

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? Response thus far has been very helpful, but we’d love to hear from as many of you as possible.

The survey is open until January 11th. You can access it here: http://fluidsurveys.com/s/minority-engagement/

Questions or comments? You can send them either to myself or Denise, Postpartum Progress’ intern at addyeb@icloud.com or denise.carter02@gmail.com

Thank you in advance for your participation!

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How The VA Healthcare System Can Help Pregnant and Postpartum Veterans pt.2

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Yesterday I wrote part one of my experience with the Department of Veterans Affairs mental healthcare system as a pregnant mother and veteran, giving my initial suggestion as to how they can improve their quality of care. You can read it here, and the rest of my story and suggestions below. 

IMG_4393Invest in Specialists and Training

My initial psychiatrist at the VA was woefully uninformed on the current research on maternal mental health, and medication use during pregnancy. As I said yesterday, once they decided to continue to treat me, the closest they could get to an “expert” on reproductive psychiatry was a psychiatrist on staff with a background in pharmacology.  While she was an improvement, I still had to point her to books and other resources online that contained up to date information. (For example, she had no idea books like Pregnant on Prozac or websites such as MGH Center for Women’s Mental Health existed) Unlike my OB, she was unfamiliar with the work of experts like Dr. Marlene Freeman, Dr. Lee Cohen, Dr. Karen Kleiman, and many others. When I was 8 weeks postpartum my care was transferred to yet another psychiatrist, who was in disbelief that I was actually breastfeeding my son while taking medications. She was also woefully uniformed and readily admitted she knew very little about postpartum mood disorders and methods of treatment, and would be deferring to her supervisor for help in my case. This was not only disheartening, it destroyed my confidence in the VA’s ability to manage my mental health care. Women veterans need mental health care professionals who understand the nuances of maternal mental health, informed on current guidelines and research regarding medication use, and trained on how to address the particular needs of women during pregnancy and the postpartum period. Reproductive psychiatrists should be hired and if it’s not feasible to have at least one on staff at every mental health clinic that sees the female veteran population, then there should at least be a team of these specialized psychiatrists professionals at local clinics can consult with for guidance and input on a case by case basis. Every psychiatrist and therapist employed by the VA should also receive some form of training specific to maternal mental health. I do know that the VA does indeed have a few experts on staff at clinics in places like Chicago and Dallas, but they simply aren’t enough. We need more.

Give Pregnant and Postpartum Veterans Scheduling Priority and Appointment Flexibility

I called the last month to try to speak with my psychiatrist. I was noticing a shift in my mood and was beginning to struggle a bit and wanted to reach out to her for treatment advice and support. I was told she was unavailable and that I should make an appointment. Her next available appointment? December 8th. When I was roughly 4 weeks postpartum, the maternal outreach coordinator called and screened me for postpartum depression, which I was extremely grateful for. However, when she went to put in a consult for me to be seen and have my care transferred to a new psychiatrist, it took another 6 weeks for that consult to go through…and we both had to make several follow-up calls to ensure it was being pushed through the system. I saw my new psychiatrist and talked with her about how I was doing at 8 weeks postpartum. I was then told my next appointment wouldn’t be for another 4 months because of the schedule rotation they had in place. A new mom’s first year postpartum is a critical time. Pregnant and postpartum veterans should have top priority in getting appointments with their providers, because not only does it support and enhance their mental health, but it supports and enhances the health of their newborn as well. Having the right support and access to treatment gives mothers and their new babies the strong starts they need to thrive-they should not be a the mercy of an overcrowded system and providers with heavy case loads.

Flexibility with appointment scheduling would help significantly as well. I was able to convince the therapist I saw very briefly during my pregnancy and my psychiatrist to have our appointments over the phone instead of in office because it was easier to ensure I’d be back home in time to pick my older two children up from school. My schedule was also packed with pediatrician visits and therapy appointments for my older two children, and the VA’s appointment availability wasn’t very accommodating to that either. Also-why not offer daycare services? I have to take my baby (and older kids if they aren’t in school) to every appointment with me, where it can be quite difficult to focus on informing my psychiatrist of how I’m doing, and what I need.

Support Groups and Talk Therapy

Since moving to Austin and enrolling in the VA mental health care system here in Central Texas, it has been nearly impossible for me to acquire talk therapy with a therapist who understands the particular needs and concerns of a woman and mother, as well as a peer-to-peer support group I can attend. After several starts and stops, I finally talked with the head psychologist at the mental health clinic here in Austin last Spring. She was earnest in her desire to offer me some kind of support that worked with my schedule and their available resources but she had to admit that there was very little they could do to help a woman in my situation. “We just don’t have the resources for your particular needs; all of our support groups are co-ed and we currently don’t have a therapist on staff with the right kind of training or experience that would benefit your particular situation. We’re trying to find a way to create it, but unfortunately there isn’t a lot we can do right now.” Mothers need support, especially during their first year postpartum. Either the VA needs to find a way to develop and provide it or agree to outsource it to a civilian provider like they do prenatal care and help the veteran cover the cost, if not cover it fully themselves. Many women’s health clinics currently have breastfeeding support groups for veterans who are nursing. I don’t think it’s out of the realm of possibilities to create a group that supports our mental health as well.

 

This experience has taught me a lot about the ups and downs of having the VA manage my mental healthcare as a pregnant and postpartum veteran. Strides in women’s health have been made over the last decade at the VA, but there is still more work that needs to be done. I’m hoping that sharing my experience exposes a critical gap in care and lends to the demand for change overall at the VA that’s currently taking place. We’ve been warriors for our country, and I hope the VA will honor our service by helping us and our families have the strong starts we deserve.

 

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