Tuesday, November 8, 2011

The Basics

Two of our board members recently drafted an article highlighting the basics of Perinatal Mood and Anxiety Disorders. This is great information or review for everyone.

Perinatal Mental Health: Differentiating Mood and Anxiety Disorders From the Expected Emotions of New Motherhood

Perinatal mood and anxiety disorders (PMADs) are frequently underdiagnosed among health and mental health professionals alike. Too often the symptoms that coincide with these disorders are confused with “expected” emotions during this time. It is important that clinicians know the risk factors and presenting symptoms for PMADs, in order to ensure proper assessment and treatment. Without such treatment, PMADs can impair the developmental trajectory of the baby and family.

Risk Factors

There are numerous risk factors that can increase a woman’s vulnerability to PMADs. Biological risk factors can include a genetic predisposition to anxiety or depression, a family history of PMADs, a history of hormonal sensitivities (i.e. severe PMS), thyroid problems, or infertility issues. Social risk factors include family stressors, unplanned pregnancy, a history of pregnancy loss, or a lack of social support. Psychological risk factors can include perfectionist behavior, worrying, high need for control, or a history of physical or sexual abuse or neglect.

Differentiating Between PMADs and Expected Emotions

Differentiating PMADs from a “normal” reaction to childbirth primarily depends upon the factors of timing and the degree to which functioning is impaired. The DSM IV states a postpartum onset specifier of within 4 weeks postpartum for mood disorders; however, most experts in the field believe the onset to be anytime within the first year postpartum. Below, the four disorders associated with PMADs are described in brief detail.

Postpartum Depression (PPD): 80% of women experience the baby blues within the first 2 weeks after childbirth. Baby blues consists of crying, mild sleep disturbances, moodiness and sadness, but the woman can still function well enough to adequately care for her baby. In contrast, women experiencing PPD may not be able to function well enough to take care of the baby and/or herself, and she will meet the criteria outlined in the DSM IV for major depression.

Postpartum Anxiety (PPA): All new moms worry, but in moms with PPA the worry affects their functioning (e.g., a mom cannot sleep when her baby sleeps because she is watching her baby breathe, or a mom doesn’t want to leave the house for fear of the baby crying.) Generalized anxiety and /or panic disorder may be present.

Postpartum OCD (PPOCD): These women often suffer from intrusive thoughts of harm coming to their baby or of them harming their baby. These thoughts are ego dystonic. Women may change their behavior to avoid the feared image (e.g., avoiding crossing bridges for fear of throwing her baby over the edge).

Postpartum Psychosis (PPP): Research suggests that most women with PPP are those who have not been previously diagnosed with bipolar disorder or who are off their medication postpartum. The onset is usually within the first two weeks postpartum. PPP is a psychiatric emergency. It is important that women with a history of bipolar disorder be followed by a psychiatrist throughout pregnancy and postpartum.

For more detailed information on PMADs or for resources, please visit the following web sites.




Submitted by Gretchen Mallios, LCSW and Yvonne Rothermel, LCSW on behalf of the San Diego Postpartum Health Alliance (PHA). To become a member of PHA and be listed in our provider directory, please visit www.postpartumhealthalliance.org or call 619-254-0023.

Wednesday, August 31, 2011

PHA's Statement Regarding Recent Events

Recent news stories about tragedies involving potentially depressed mothers and their babies have shocked and saddened our communities, especially those among us who have suffered perinatal depression or anxiety ourselves. At PHA, we want to take the opportunity to reassure parents that these reported circumstances are extremely rare. Depression and anxiety are devastating for families, but the vast majority of those who suffer pose no risk of harm to others. However, these stories remind us that perinatal depression and anxiety remain stigmatized, underdiagnosed, and all too often untreated. It is our hope that what arises out of these recent events is increased conversation and understanding about these disorders. They are not uncommon – one in eight mothers will experience one – but they are treatable. For information about perinatal mood and anxiety disorders, please visit our website at www.postpartumhealthalliance.org or any of the following helpful sites:




If you or someone you know needs support in dealing with depression or anxiety during or following pregnancy, please call PHA’s warmline at 619-254-0023.

Tuesday, May 31, 2011

My Journey Through Postpartum Depression and Anxiety

“Tell them I died.”

I spoke calmly. I had clarity. After weeks of panic attacks, hopelessness, and pain, I had a plan.

Ten months earlier, I found out I was pregnant. What should have been cause for celebration was cause for worry. I bled in the early days of my pregnancy and was advised that I might not remain pregnant for long. I was devastated and desperately wanted to gain control over what was happening in my body. My husband and I soon discovered that all was well, but that we were expecting twins. This was exciting and welcomed news, but started us down a stressful road that included countless doctor visits, a cross-country move to be close to family, early winding down at my job, and significant discomfort for many months. I never did manage to feel settled into pregnancy as we had many surprises along the way including fetal heart concerns, my own heart and lung concerns, fetal monitoring every 48 hours, a diagnosis of preeclampsia, and ultimately an emergency c-section. When my boys arrived five weeks early, but healthy, we were extremely grateful and relieved, but I couldn’t shake the uneasiness that had persisted throughout the pregnancy.

As was the case during pregnancy, our early days with the boys looked nothing like what I had anticipated. I was advised not to breastfeed because they were too small. All of the cute newborn clothes and tiny diapers we had excitedly collected were too big for them and I had to search for anything small enough for them to wear. Everyone who visited commented on how tiny they were, and I felt offended and hurt. No one meant any harm, but after months of obsessing over having healthy babies, I was shook up by each reminder that we didn’t quite make it to the end. I am someone who rarely fails to achieve what I set my mind to, but for many months now, I had been fighting circumstances that were out of my control.

Despite these initial difficulties, we enjoyed our first few weeks with the babies. They were quiet and soft and very sweet. We cuddled and sang and swaddled. I was increasingly exhausted, however, as I could never manage more than a couple of hours of sleep between feedings. Attempts to breastfeed were unsuccessful, but I was determined to provide them with breastmilk. So when I wasn’t feeding or sleeping, I was pumping. I began to feel stuck. I was hooked up to this machine during the only times I might have been able to do something that even remotely reminded me of who I was. The need for breastmilk became obsessive and I misguidedly felt that I could successfully manage at least one part of this process if I could just make enough milk. Ironically, this stress was likely the cause of my inability to make enough milk, and I was deflated each time I had to supplement with formula.

In the midst of my feelings of inadequacy and my obsessive need to gain control over situations, the babies developed colic. I’ll never forget April 29th. They cried for eight hours straight. I attended a wedding that evening and was in a daze, absolutely distraught at the fact that I couldn’t console my babies that day. As I drove home, I experienced what I believe was my first panic attack at the thought of returning home. The next month was torture. Each day the babies seemed to cry more, unresponsive to my attempts to comfort them. They wouldn’t eat without crying and they seemed to be screaming at me all day. I had never encountered a problem that I couldn’t solve just by working harder at it, but no matter how hard I pushed myself, I couldn’t gain control over this situation. Every new formula or medication we tried, every book I read, every person I talked to, every technique I applied resulted in nothing but disappointment. I then went from a manic need to resolve this issue to completely shutting down. I became numb and despondent, unable to motivate myself to do just about anything. My stomach turned at the sight of the breast pump and I couldn’t bring myself to look at the bottles as I filled them and fed my babies. The sound of their cries made me shake and stopped my breathing. Everywhere I looked I saw evidence of my failure as a mother.

I decided, with the help of my family and friends, that I needed help. I saw my primary care physician to talk about medication. Although she was willing to prescribe it and talked to me about how I was feeling, her attempt to reassure me that what I was going through was just normal adjustment made me feel worse. What I was going though was NOT normal. If that didn’t register with her, then I must really be a more terrible mother than even she had ever encountered. I chose not to start the medication, as I was too afraid to give my boys breastmilk while taking it. And Lord help me, I was going to give them breastmilk if it was the last thing I did. I also went to see a therapist who also assured me that everyone goes through a tough time adjusting to motherhood. This was absurd. She didn’t even suggest postpartum depression, and I again felt like no one could ever understand the depths of my pain. What an abnormality I was, truly a never-before-seen case of weakness and incompetence. Even professionals didn’t recognize this. I had never felt more alone and scared in my life.

On Memorial Day, 2006, I found myself unable to look at my babies. They were sleeping in their swings, and I was terrified about them waking up. I knew I couldn’t go to them. I was physically unable to pick them up anymore, as the dread and pain were too overwhelming. I hid myself under the dining room table like a frightened animal and called my husband, my mother, and my father. I was done. It was going to end here.

While waiting for my parents to arrive, I shared with my husband that I was completely unable to function as a mother and that it was time for me to give up. I was going to leave that day and not return. It sounds melodramatic now, but I was clear at the time that I had no other choice. I thankfully was not suicidal, but I was definitely not sticking around. When my parents arrived, I told them that I was leaving and that it was up to all of them to decide what to do with the babies. I wasn’t coming back and I wouldn’t be in touch. I calmly shared that I was finally clear on the fact that I was not only a terrible mother, but I was a terrible person and needed to start over where no one knew of my failures. I was incapable, useless, and selfish, unable to be the wife or mother my family deserved.

The only thing I asked was that they tell my boys that I had died. I never wanted them knowing that they were abandoned and thinking it was their fault. It was mine. I had failed.

My family was clearly rattled by this, and my parents packed up the boys and began to leave with them. It was only at that moment, as my boys were being taken from my home, that I began to feel again. I suddenly cried out for them. I wailed and fought to grab them, and my husband held me back. I reached for them and screamed as they were taken away. As much as it hurt, this deep surge of pain was a sign of hope. I wasn’t totally ready to give up yet.

Over the next week I took my medication, found a new therapist, visited a support group and made sure I was never alone with the babies. I talked and was supported. My husband was a rock, never judging me and never showing how scared he must have been. I had help and I tried to rest. I cried as my breastmilk dried up and as I returned the pump to the hospital. Things still didn’t look as I had expected, and I wasn’t going to gain that control I desperately wanted, but I was going to learn to accept what was. It took a lot of work, a number of professionals, and medication for me to slowly make my way back to myself. Within weeks, the dark cloud lifted. Within months, I began to feel joy.

Five years later, I am a truly happy mother. I love my children deeply and my family is in-tact and thriving. I am sure that I am a good mother and know that my early impressions of myself were clouded by depression, a filter through which your worth is disguised and your hope is destroyed. I have learned to let myself be human, working to accept the things I cannot control and to forgive myself for the mistakes I have made and continue to make. I still grieve the loss of those early months. They are a hazy, dark time for me and my heart hurts to think that I began motherhood under that fog. I worry about what my depression and anxiety might have done to my children while I was pregnant and when they were newborns. I experience pangs of envy when I hear of happy babies who don’t cry and mothers who easily breastfeed their babies. I was robbed of these precious moments. Yet, others have had it worse, and each day that I look at my beautiful boys and feel the joy that we experience together in this life, I am grateful for where my journey has brought me.

Today I work for the Postpartum Health Alliance, trying to prevent depression and anxiety in mothers and support them if they are suffering. We work hard to share with mothers the message that they are not alone, that how they feel is not their fault, and that they will get better. I have the privilege of talking to women who call seeking help. I have the opportunity to teach doctors how to identify and help women like me. I have a platform on which to affect the conversation about perinatal anxiety and depression. All of the obsessive energy that went into judging myself is now a powerful drive to help others. I hope this story creates understanding and a sense of responsibility among all of us to seek out ways to support one another. Without those who knew, those who cared, I truly would have left. But I am here, and I have so much to teach and share and tell my boys.

Instead of telling them I died, I will tell them I survived.

Thursday, May 26, 2011

Mamafest Success!

A wonderful evening was shared by guests, vendors, and the PHA board and volunteers. Last Friday more than 250 mamas enjoyed a night out with a fabulous view from the La Jolla Country Club, wonderful food, informative speakers, and tons of prizes and exciting auction items. And all for a great cause - supporting PHA!

Thank you to our amazing sponsor, Stroller Strides, and our talented event coordinator Corina Dubois of Celebrate Mama. Please visit their sites at www.strollerstrides.com and www.celebratemama.com. We are grateful for all you did to ensure that the evening was a success.

Wednesday, May 18, 2011

Mamafest is Here!

Please join us at MAMAFEST

May 20, 2011


La Jolla Country Club

Mamafest is an ultimate evening event for moms in the San Diego County area, presented by Stroller Strides. The annual event brings together a variety of different entertainment and shopping options for moms, and gives 100% of the proceeds to the Postpartum Health Alliance. Mamafest is the official San Diego promotional event in support of Pregnancy Awareness Month.

Mamafest features everything a mom could want for her night out! Elements include:
-- a lively shopping marketplace
-- speaker panels
-- silent auction
-- swag bags & FREE giveaways
-- food, socializing, and a cash bar
-- Mamafest magazine
-- local connections
-- and more!

For information and to purchase your tickets, visit
http://celebratemama.com/index .php/locations/mamafest-san-di ego

Monday, May 2, 2011

PPD and PHA in the News

10 News San Diego aired a story on April 17th about a PHA Advisory Board member, Michael Spangler, the suicide of his wife Annie and the UCSD Maternal Mental Health Clinic. PHA''s Educational Chair, Katie Hirst, MD, was also interviewed in the piece to discuss the issue of PMADs. PHA was pleased to be mentioned as a resource. The video and transcript of the piece can be viewed at http://www.10news.com/news/27696805/detail.html.

Tuesday, April 19, 2011

Just Announced!

Join Us for the Next Postpartum Health Alliance Educational Luncheon...

Women's Experience of Childbirth:

What To Do When It's Traumatic

Speaker: Janet Jaffe, PhD

May 13th, 12:00 - 1:30
Elijah's La Jolla
8861 Villa La Jolla Drive,
La Jolla, California 92037

Phone: (858) 455-1461

Cost is free for PHA members and $10 for non-members. Attendees will order and pay for lunch individually off the Elijah's menu. Unfortunately, we are not able to provide CEU's.

Please RSVP to Katie Hirst by email: khirst@ucsd.edu

Janet Jaffe, PhD, clinical psychologist, is the co-founder and co-director of the Center for Reproductive Psychology and co-author of two books, Reproductive Trauma: Psychotherapy with Infertility and Pregnancy Loss Clients (APA, 2011) and Unsung Lullabies: Understanding and Coping with Infertility (St. Martin’s Press, 2005). She is currently in private practice in San Diego.