The expert resource for women, families and healthcare providers offering the information you need to combat the effects of pregnancy related mood disorders
February 16th, 2009
Researching Perinatal Mood Disorders: Science must trump the politics of fear
The last decade has brought a great deal of attention to the affective disorders that can occur during pregnancy or the postpartum. Many brave women have come forward to share their stories, exposing their struggles so others might hopefully escape a similar fate. Initially, postpartum depression was associated primarily with the period after pregnancy (thus postpartum), but we have since learned that many of these disorders may occur during pregnancy (antepartum). The entire period of pregnancy and the postpartum has come to be described as the perinatal period.
We now know that the approximately 800,000 women who will experience a diagnosable postpartum mood disorder this year after live births are the statistical majority, but not the whole story. Women who miscarry, whose babies are stillborn or who lose their infant shortly after birth are also at risk. Those numbers are in the thousands further raising the population of vulnerable women who are susceptible to such disorders well into the millions.
It can be easily understood that the psychosocial stressors of loss, combined with the biological shifts of pregnancy, could heighten affective risk following these tragedies, which often result in a disenfranchised grief for these mothers. Well meaning loved ones may attempt to soothe with statements that she can soon become pregnant again, that she will have another child. Such predictions tend to have the opposite effect further invalidating and isolating the mother's experience. Her womb was infused with the biology of creation, her breasts were preparing to nurse a child, her arms preparing to receive a baby. Her heart and soul were thus attuned and the loss can be grieved forever. Perinatal research is appropriately identifying and including this group in postpartum studies and treatment. We know we need to follow these mothers carefully. After all, they are united with their live birth sisters by the uniquely personal biological and psychosocial influences of pregnancy.
But there is another group of women who have lacked representation in such studies or who are sometimes presumed to need no such services at all. Women who elect to terminate a pregnancy seem to be missing from the collective statistical data we have gathered on who experiences a perinatal mood disorder.
This commentary is not about a Pro-Life or Pro-Choice stance. It's not about Roe v. Wade and it's not about judgment. It's not politically or socially or religiously motivated. It's about science and sisterhood and the need to fact gather from every pregnant woman who suffers an affective disorder during or after pregnancy. Women in the difficult position of having to terminate a pregnancy, be it for financial and economic problems, social factors, age, impending divorce, illness of mother, health of the fetus, traumatic impregnation; deportation, impending incarceration, birth control that didn't work - are not exempt from postpartum mood disorders but often silenced by judgment.
Suspend opinion for a moment if you can and simply consider this: These women have become pregnant, their bodies are experiencing the hormonal fluctuations and biological changes of pregnancy which begin at conception. But these women are not yet represented in our studies, perhaps for fear the discussion might be too charged, the research subject selection too scrutinized by funders and too easily politicized by those awaiting the outcome. To not include every woman who becomes pregnant in our understanding of these illnesses is to narrow our perspective and blind science to reality.
Those who fear the possible overturn of Roe v. Wade may worry about giving the Pro Life message fuel for fire if it is acknowledged that there are vulnerabilities associated with every choice a pregnant woman makes. But Pro Choice positions do a great disserve to the very women they are trying to protect when pretending that elected termination is without emotional risk - the fact of becoming pregnant is the major vulnerability that all women who develop a perinatal mood disorder have in common.
But so much is in this label that seeks to categorize and define an outcome for one group of women. The term post abortion depression reeks of judgment and separation from compassion. It serves no purpose except to politicize an illness. By implying this is a special form of depression reserved for women who terminate pregnancies, we are adding to stigma and failing to scientifically identify all those who may suffer from these devastating disorders.
The language in The Melanie Blocker Stokes MOTHERS Act has been amended to include a sense of Congress and pledges to study postpartum depression regardless of how the pregnancy is resolved. This is how it should be. But let's lose the label of post abortion depression. It's postpartum depression (i.e. following pregnancy). Unless we want to begin saying post C Section depression or post vaginal delivery depression or post fertility treatment depression. Do we say post smoking lung cancer as opposed to post environmentally caused lung cancer implying the smoker is less worthy of our compassion?
Since when does an action word full of controversy and judgment qualify as an onset specifier for a medical illness?
Whatever you believe, regardless of your stance on this issue - all women stand together as vulnerable targets of these disorders - disorders that do not discriminate based on the length, outcome, disposition or political leaning of the mother. Being female and becoming pregnant initiates the risk. From there it's a confluence of biological predispositions and psychosocial stressors that determine affective outcomes. All women who find themselves on the sinking ship of perinatal mood disorders need a hitch to land. Let's not tell some of these mothers to get to the back of the boat based on how their pregnancy resolved.
February 13, 2009
ABC’s Private (Mal) Practice fails to present the facts
in botched opportunity to raise PPD Awareness
Caving to the sensationalism that fuels stigma (and perhaps ratings) rather than supports understanding, last night's ABC’s Private Practice episode presented an outrageous and unsympathetic caricature of a woman suffering from postpartum depression… or was it postpartum psychosis? The show’s producers apparently passed on any professional consultation, so the new mother presented an unlikely combination of severe symptoms which were poorly interpreted and never professionally assessed. The result? A botched opportunity to raise awareness while fanning the flames of fear that keep women and families suffering in silence.
The image of the suffering mother - with acupuncture needles sticking out of her head (!) - experiencing a psychotic episode was more akin to Friday the 13th than the public awareness campaign promised by ABC. Postpartum psychosis is extremely rare with incidence less then .2% and was not accurately presented in this three ring circus. The implication that postpartum depression and postpartum psychosis are interchangeable labels is incredibly irresponsible.
But the show’s mothers weren’t the only target of ignorance and blatant indifference to client care.The show managed to insult the integrity of every health care professional associated with the mother’s illness. The therapist came off as a clueless, self absorbed nut case who failed to advocate for her client, the acupuncturist acknowledged that his client was having a psychotic episode (yet left her alone in a room), and the two docs charged with the care of the other pregnant mother were engaged in their own emotional and professional battle failing to prioritize the welfare of their anxious client.
The Public Service Announcement that was supposed to air immediately following the show- to inform women and families where they might find the CORRECT information and help for such disorders - went missing. Therefore the thousands of new or pregnant mothers who might have watched the show (let’s pray they went to bed early instead) were not given any resources unless they went to the website itself. And there, further insult awaited.
The Private Practice Homepage is now offering a poll. You can answer YES or NO only to the question:
"Should a woman undergoing psychiatric treatment who nearly drowned her baby be allowed to see it?"
It can be imagined that this additional witchhunt will generate a tsunami of negative responses furthering the misunderstanding of perinatal mood disorders and associated stigma.
The show had approached Postpartum Support International for consultation on the Public Service Announcement – perhaps attempting to legitimize their story line by association with the world’s number one resource for PPD - but PSI was not shown the episode prior to airing. Hopefully, those set on their teeth by this horror show may have googled postpartum depression and found PSI’s website where they can find the information and help they need to navigate pregnancy related mood disorders.
Or let’s hope they found Katherine Stone’s Postpartum Progress Blog – an award winning website authored by an amazing woman who devotes herself to presenting the FACTS about these illnesses and encouraging women to seek treatment and each other. On Katherine’s website you can find listings of the U.S.’s most stellar PPD facilities and providers where best practices and renown professionals successfully treat the mothers who come to them with appropriate care and respect.
Or perhaps googling PPD brought them to a beautifully authored and compelling PSA on Postpartum Depression presented by CBS CARES. This Public Service Announcement was developed in conjunction with a sensitive PPD storyline on their award winning series Cold Case last year. It has been seen by thousands, probably millions of people across the country who were positively moved by its prosocial message of outreach and hope.
Finally dear women - whether you are pregnant, new moms, or contemplating pregnancy - if you watched that show and wondered... "Could this be me?"The answer is NO!! Those on the forefront of PPD research, education and treatment are among the most devoted and passionate practitioners you can find (see list above). If you aren’t feeling like yourself and new motherhood isn’t what you expected or you want to know the FACTS about PPD - get those questions answered now by experienced specialists who will guide you to the right help.
Perhaps we can take the perspective that any media spotlight focused on these disorders might heighten awareness and get people talking. But what a missed opportunity for a major network to offer quality primetime educational outreach to help prevent or end the suffering of the 800,000 women who will experience a perinatal mood disorder this year.
To calm down listen to this beautiful song, composed by Wade Bowen, about his wife's experience with postpartum depression. Here's the link to it on U-Tube