Dutch News| August 19, 2020

​By Hilda Hutcherson| September 4, 2020

"Caroline’s mother was concerned when she turned 15 and hadn’t had her first period. It finally came, but it wasn’t until three months later that she’d get her second. Her gynecologist assured her that irregular periods were common for someone her age, so Caroline’s mother didn’t worry. Then, at 18, her periods disappeared for six months. This time, her college ob-gyn said that the stress of college often causes menstrual periods to wane, and that the best treatment was hormonal therapy to make her periods regular. So she started taking birth control pills.

Thirteen years later, she was ready to have a baby and stopped taking them, assuming that since she was older and not under as much stress, her periods would become more regular. But they didn’t. She also noticed increased acne and facial hair. After six months of trying unsuccessfully to conceive, she started taking her temperature and using an ovulation predictor kit. Both revealed that she was ovulating infrequently and irregularly. The question was why?

Many women with irregular periods are told it’s no big deal. Even her acne and facial hair didn’t throw up a red flag. Fortunately, tests eventually led to an accurate diagnosis: she had polycystic ovary syndrome (PCOS), a hormonal disorder that disrupts women’s fertility and may cause a host of other health issues. As many as 15 percent of women between 18 and 45 have PCOS, making it the most common hormonal disorder among women of childbearing age.

For this guide, I reviewed the current literature and interviewed Beth Rackow, M.D., a reproductive endocrinologist and director of the pediatric and adolescent gynecology program at Columbia University Irving Medical Center.

What to do: 

• Know the signs and symptoms
• Know what’s involved in diagnosing PCOS
• Understand how PCOS may affect your fertility
• Prepare for potential pregnancy complications if you conceive
• Know the other health risks of PCOS
• Consider possible treatments

Know the signs and symptoms
Polycystic ovary syndrome is a common hormonal disorder among women, yet often goes underdiagnosed by health care providers. Some women have few, if any, symptoms. Others have many — irregular or absent periods, excess facial or body hair growth (hirsutism), obesity and infertility — but they may be mistaken as signs of other health conditions.

​Irregular, unpredictable periods are one important symptom. Periods may come twice a month, be infrequent (greater than 35 days apart) or disappear for months at a time. They may be light or they may be heavy enough to cause anemia. You may suspect PCOS if you also have acne that doesn’t respond to treatment or increased growth of facial or body hair. These are signs of excess androgen hormone. Eighty percent of women with hirsutism have PCOS.

PCOS may appear as early as adolescence. “Girls with PCOS typically present when they haven’t had their first period when they should have, their periods are very infrequent or they are having frequent, heavy periods,” said Dr. Rackow.

It’s common for menses to be irregular in girls during the first year or two after the first period. Acne is also common during adolescence. However, if menstrual periods continue to be abnormal after the first two years, or if bleeding is persistently heavy at any time, an evaluation is needed."

By: Ellen S. Glazer, LICSW| February 4, 2020

Most anyone who has struggled with secondary infertility knows that it is an incredibly lonely experience. You may be blessed with one or two children — possibly more — but struggling to expand or complete your family. Surrounded by families with young children, you find yourself alone and in pain.

If you are a veteran of primary infertility, you may remember strategies you developed for shielding yourself from the pregnancies of others. Not so this second time around: pregnant women and moms with babies and toddlers surround you at preschool.
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If you had your first child with ease and are new to infertility, you may feel even less equipped to deal with seemingly limitless fecundity. Primary infertility prepared your fellow travelers for the envy, anger, sadness, isolation, and awkwardness it brings. For you these feelings are new, and along with them comes the guilt of secondary infertility: “Why can’t I be happy with the child I have?” Today we’ll focus on ways you can cope with secondary infertility.

The first few steps to coping with secondary infertility

Seek good medical care. If you went through primary infertility, you know the ropes of the world of reproductive medicine. However, if this is all new to you, do not delay in seeking expert help. There is a lot to learn in reproductive medicine. Beginning to understand it may help you feel that you have some control of your situation. Don’t be reluctant to seek a second and even a third opinion — you will learn from each consult, and talking with a few physicians can help land you in the right place.

Try to avoid self-blame. It is tempting to blame yourself. You are a likely target if you feel you waited too long to have a second child, or perhaps blame yourself for not having your first child sooner. If you have two or more children and are struggling to complete your family, you may accuse yourself of greed. Another form of self-blame comes when parents feel they are being punished for not fully appreciating or enjoying the child they have, or worse still, being “bad” parents.

Take charge of the message. Although many people choose to have one child and feel confident with “one and done,” there is often the assumption that a family means two or more children. As a parent of one child, you are likely to frequently encounter the following questions: “Is she your only child?” or “Are you going to have more?”
It helps to figure out a short, direct, and containable message to give anyone who asks about family size. Something like, “We’re hoping to have a larger family, but it’s not been easy for us.” Or “___ is our first child, but we are hoping he/she will have a sibling before too long.”

Additional ways to cope with secondary infertility
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Try not to focus on age. Many parents think a lot about the spacing of their children. Secondary infertility derails plans for ideal spacing — whatever that may mean to you. My advice to people is blunt: let it go. I remind clients that close or distant relationships with siblings are not defined by spacing. All of us know adults who cherish their sister or brother 10 or 15 years their junior, but argue constantly with the sibling who is within two years of their age.

By Nina Lakhani in New York| Mon 17 Aug 2020 16.47 EDT

"Black babies have a greater chance of survival when the hospital doctor in charge of their care is also black, according to a new study.

In the US, babies of color face starkly worse clinical outcomes than white newborns.

Earlier research from the Centers for Disease Control and Prevention (CDC) published last year shows that black babies are more than twice as likely to die before reaching their first birthday than white babies, regardless of the mother’s income or education level.

While infant mortality has fallen overall in the past century thanks to improvements in hygiene, nutrition and healthcare, the black-white disparity has grown.

Multiple interrelated factors which contribute to these disparities include structural and societal racism, toxic stress and cumulative socioeconomic disadvantages.

The new study published in the Proceedings of the National Academy of Sciences suggests the race of the attending doctor also plays an important role.

Researchers reviewed 1.8m hospital birth records in Florida from 1992 to 2015, and established the race of the doctor in charge of each newborn’s care.

When cared for by white doctors, black babies are about three times more likely to die in the hospital than white newborns.

This disparity halves when black babies are cared for by a black doctor.

Strikingly, the biggest drop in deaths occurred in complex births and in hospitals that deliver relatively more black babies, suggesting institutional factors may play a role.

The study found no statistically significant link between the risk of maternal mortality – which is also much higher for black and brown women – and the race of the mother’s doctor.

Why race concordance is so important in black infant mortality requires further research, but it may enhance trust and communication between doctor and mother, and black doctors may be more attuned to social risk factors and cumulative disadvantages which can impact neonatal care, according to Brad Greenwood, lead author from George Mason University in Virginia.

Unconscious racism among white doctors towards black women and their babies may also be at play.

For white newborns, the race of their doctor makes little difference to their chances of survival.

Despite the stark findings, black women seeking a black doctor to minimize the risk to their babies will struggle as the medical workforce remains disproportionately white. Only 5% of doctors are black, according to the Association of American Medical Colleges."

"It was the end of the world as we knew it, and I felt fine. That’s almost exactly what I told my psychiatrist at my March 16 appointment, a few days after our children’s school district extended spring break because of the coronavirus. I said the same at my April 27 appointment, several weeks after our state’s stay-at-home order.

​Yes, it was exhausting having a kindergartener and fourth grader doing impromptu distance learning while I was barely keeping up with work. And it was frustrating to be stuck home nonstop, scrambling to get in grocery delivery orders before slots filled up, and tracking down toilet paper. But I was still doing well because I thrive in high-stress emergency situations. It’s exhilarating for my ADHD brain. As just one example, when my husband and I were stranded in Peru during an 8.0-magnitude earthquake that killed thousands, we walked around with a first aid kit helping who we could and tracking down water and food. Then I went out with my camera to document the devastation as a photojournalist and interview Peruvians in my broken Spanish for my hometown paper.

Now we were in a pandemic, and I’m a science journalist who has written about infectious disease and medical research for nearly a decade. I was on fire, cranking out stories, explaining epidemiological concepts in my social networks, trying to help everyone around me make sense of the frightening circumstances of a pandemic and the anxiety surrounding the virus.

I knew it wouldn’t last. It never does. But even knowing I would eventually crash, I didn’t appreciate how hard the crash would be, or how long it would last, or how hard it would be to try to get back up over and over again, or what getting up even looked like.

In those early months, I, along with most of the rest of the country, was using “surge capacity” to operate, as Ann Masten, PhD, a psychologist and professor of child development at the University of Minnesota, calls it. Surge capacity is a collection of adaptive systems — mental and physical — that humans draw on for short-term survival in acutely stressful situations, such as natural disasters. But natural disasters occur over a short period, even if recovery is long. Pandemics are different — the disaster itself stretches out indefinitely.

“The pandemic has demonstrated both what we can do with surge capacity and the limits of surge capacity,” says Masten. When it’s depleted, it has to be renewed. But what happens when you struggle to renew it because the emergency phase has now become chronic?"

"What is COVID-19?
COVID-19 is a new illness that affects the lungs and breathing. It is caused by a new coronavirus. Symptoms include fever, cough, and trouble breathing. It also may cause stomach problems, such as nausea and diarrhea, and a loss of your sense of smell or taste. Symptoms may appear 2 to 14 days after you are exposed to the virus. Some people with COVID-19 may have no symptoms or only mild symptoms. 

How does COVID-19 affect pregnant women?
Researchers are still learning how COVID-19 affects pregnant women. A report released in June 2020 looked at whether pregnant women might be at increased risk of getting very sick from COVID-19. This report from the Centers for Disease Control and Prevention (CDC) notes that:

• Pregnant women with COVID-19 may be more likely than nonpregnant women with COVID-19 to need care in an intensive care unit (ICU) or need a ventilator (for breathing support).
• Pregnant women who are Black, Hispanic, or Asian may have a higher risk of severe illness or need ICU care more often than other pregnant women. This is likely caused by social and economic inequity, not biological differences.

Although the risk of needing more care in the hospital and having more severe illness may be increased, the overall risk of these outcomes is still low for pregnant women. Also, it’s important to know that the report suggests the risk of death is not higher for pregnant women with COVID-19 than for nonpregnant women with COVID-19. 

How can COVID-19 affect a fetus?
Remember that researchers are learning more about COVID-19 all the time. Some researchers are looking specifically at COVID-19 and its possible effects on a fetus. Here’s what they know now:

• Some pregnant women with COVID-19 have had preterm births, but it is not clear whether the preterm births were because of COVID-19. 
• Researchers have found a few cases of COVID-19 that may have passed to a fetus during pregnancy, but this seems to be rare.

More research is needed to understand the effects of COVID-19 before birth. After birth, a newborn can get the virus if they are exposed to it. 

 What should pregnant women do to avoid the coronavirus?
Pregnant women should take steps to stay healthy, including:

• keeping your prenatal care visits 
• limiting contact with other people as much as possible
• staying home as much as possible
• staying at least 6 feet away from other people if you need to go out 
• wearing a mask or cloth face covering in public and any other needed protection while at work 
• washing hands often with soap and water for at least 20 seconds
• cleaning hands with a hand sanitizer that contains at least 60 percent alcohol if you can’t wash them (rub until your hands feel dry)
• avoiding touching your eyes, nose, and mouth 
• having a good stock of essential supplies, including at least 30 days of any medications (so you don’t have to go out as often)

Should pregnant women wear a mask or face covering?
As of April 3, the CDC says all people, including pregnant women, can wear a cloth face covering when they are in public to slow the spread of COVID-19. Face coverings are recommended because studies have shown that people can spread the virus before showing any symptoms. See the CDC’s tips on making and wearing a face covering.

Wearing a cloth face covering is most important in places where you may not be able to stay 6 feet away from other people, like a grocery store or pharmacy. It also is important in parts of the country where COVID-19 is spreading quickly. But you should still try to stay at least 6 feet away from others whenever you leave home.

If you have COVID-19 or think you may have it, you should wear a mask while you are around other people. You also should wear a mask if you are taking care of someone who has COVID-19 or has symptoms. You do not need to wear a surgical mask or medical-grade mask (N95 mask). 

How will COVID-19 affect prenatal and postpartum care visits?
It is important to keep your prenatal and postpartum care visits. Call your obstetrician–gynecologist (ob-gyn) or other health care professional to ask how your visits may be changed. Some women may have fewer or more spaced out in-person visits. You also may talk more with your health care team over the phone or through an online video call. This is called telemedicine or telehealth. It is a good way for you to get the care you need while preventing the spread of disease. 
If you have a visit scheduled, your care team’s office may call you ahead of time. They may tell you about telemedicine or make sure you do not have symptoms of COVID-19 if you are going in to the office. You also can call them before your visits if you do not hear from them."

By Cassie Shortsleeve| July 14, 2020

"Six weeks after I gave birth to my first daughter, I found myself in my OB/GYN’s office for my postpartum checkup. After a quick conversation and a physical exam, my doctor told me that I was “cleared.” I could resume all regular pre-pregnancy activity.

I went home, fed my baby and went on a run — and had to stop after a half-mile. My pelvic floor felt like it was going to give out and — although once an avid runner — I felt clumsy. That night, I lay awake, milk-stained and sweaty. Nothing about me felt “cleared.”

Despite the fact that in 2018, the American College of Obstetricians and Gynecologists recommended that, to optimize women’s health, postpartum care should become more of a rolling process rather than a single encounter, for many new moms, the six-week postpartum appointment remains the only touch point with the health-care system that birthed her baby.

If Latin America has la cuarentena — a 40-day period when women take care of a new mom while she rests — and the ancient Indian medical system of ayurveda teaches us that we must nurture women for 42 days postpartum for the health of her next 42 years, the United States, traditionally, has this: one lone appointment that, in many senses, gives a message of closure to the fragile and monumental postpartum period.

"The four- to six-week time frame has historically been thought to be enough time for women to be able to go back to do more physically demanding jobs, like farming, without having any serious medical issues,” explains Heather Irobunda, a board-certified OB/GYN in New York. Your uterus has usually shrunk back to a pre-pregnancy size, lacerations have healed, soreness from birth has resolved.

But physical changes persist for longer — probably six months or so, says Kecia Gaither, director of perinatal services at NYC Health+Hospitals/Lincoln. Around then, pelvic floor and abdominal musculature tone returns, changes in hair normalize, and the menstrual cycle might become more regular (if it’s returned).

Some research even suggests women wait 12 months to conceive again. But how long does it take for the body to recover? It depends on where you look.

The Centers for Disease Control and Prevention, for one, says that a “pregnancy-related” death is a death of a woman while pregnant or within one year of the end of pregnancy, but “maternal mortality” is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of the end of pregnancy.

The Diagnostic and Statistical Manual of Mental Disorders, often called the “bible” of psychiatric health conditions, defines postpartum depression as depression “with postpartum onset: defined as within four weeks of delivering a child.” But, says Cindy-Lee Dennis, a professor at the University of Toronto who studies the postpartum period, “it’s fairly standard in the research literature to consider postpartum depression up to one year postpartum.” (Take a landmark 2013 study published in JAMA Psychiatry of 10,000 mothers: It found that 1 in 7 women develop PPD within the first year postpartum.)

Birdie Gunyon Meyer, a registered nurse and director of certification for Postpartum Support International, a nonprofit group that lobbied to extend the period following delivery in the definition of PPD, says: “I don’t think anybody really believes that the postpartum period is over at four or so weeks, but we give that impression when you come in for your four- or six-week checkup."
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The truth is, the adjustment to parenthood takes time. It takes more than a couple of weeks and more than a couple of months. Researchers say Year 1 is critical for children and parents alike. “For the child, the brain is growing rapidly and the experiences that happen and the neurological pathways that are developed stay with the child for a lifetime,” says Dennis."

By Charles Feng| July 22, 2020

"Three years ago, my wife, daughter and I took a photo shivering on a beach amid the howling autumnal wind. Last year, for 11 glorious, anticipatory weeks, while my wife was pregnant, I planned to update the picture at the same location with a new baby in tow.

But that plan was abruptly upended when we had a miscarriage. Now that picture that sits on our mantel would still be just the three of us, squinting into the camera, buttressing one another against the cold.
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The miscarriage itself lasted only a few hours. But the self-recrimination lingered long afterward because I wasn’t sure how to grieve when my wife’s emotional response seemed more important. When I searched online, women’s perspectives abounded on websites, in YouTube videos and in news articles, but men’s perspectives were scarce. Academic research was little better. A pattern emerged: Although there is a spotlight on Mom’s emotions and well-being during a miscarriage, Dad’s experiences are rarely discussed.
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The pregnancy for our first daughter went smoothly. So, when my wife found out about our second pregnancy, we told family members and friends immediately after finding out, around the two-month mark. This meant that when the miscarriage occurred, we had to backtrack and explain to everyone what had happened, in painful conversations.

My wife’s friends, mostly women, showered her with messages and flowers. On the other hand, for the few friends, all men, I contacted, the comments ranged from the trite (“Sorry, that sucks”) to the callous (“Gotta try again!”) to, well, silence. My best friend, with the best of intentions, emailed my wife his condolences but excluded me.

Eventually, another friend who had recently experienced two miscarriages carved out some time to chat over dinner.
“How are you feeling, buddy?” he asked.

​“Okay,” I said.

“Tough as it seems right now, it does get better with time.”

“Good to know.” I felt like a sullen teenager.

“You know, while discussing miscarriages is in general taboo, for men it seems especially so,” he said.

He’s right.

The entire arc of the miscarriage, from conception to loss, occurs within the female body. Aside from contributing sperm, I felt like a bystander. I was traveling when my wife watched the double pink lines appear on the pregnancy test. She occasionally saw the obstetrician on her own and started organizing the baby’s room without my input. I had an ancillary role in the pregnancy, so I wasn’t sure I even had a right to feel devastated.

The event itself is permanently etched in my psyche. Throughout the night, my wife had unremitting abdominal pain. I was asleep when she barged through the door from the bathroom.

​“The baby’s gone,” she said through tears.

“I’m so sorry,” I said. I got up and hugged her. “What should we do now?”

“I don’t know.”

My wife went to the obstetrician, while I stayed home with our 2-year-old daughter.

After a sushi lunch — no longer pregnant, my wife could eat raw fish again — we dropped our daughter off at my parents’ house. To distract ourselves, we caught an animated movie. That evening, we drove to a deserted parking lot at the local elementary school. I shut off the car ignition and let the jazz radio buzz in the background. I held my wife’s hand as we stared into the darkness. We talked about the movie but little else.

The next day I was back at work.

The best thing I could do was to just be with her. I felt like I didn’t have a right to express my despair, so I actively suppressed my emotions. My wife needed to lean on me, so I became a stoic, unperturbable oak tree for her. According to a study published this year, after a miscarriage, men have described themselves, in supporting their wives, as “rocks, guards and repair men.” We adhere to traditional notions of masculinity, of being steady and capable, and never, ever succumbing to emotions."

"Nima Bhakta was that college friend who everyone knew would be a great mother.

We met in 2006, and I could see that she was always at ease when she interacted with children.

Kind and confident, she was also the friend who talked about how excited she was to have children of her own.

That's why it was such a devastating loss to her family, friends and to me, when she lost her battle with postpartum depression and died by suicide on July 24. Suicide is one of the leading causes of death in women with postpartum depression.

In a letter to her family before she died, Nima wrote that she tried to tell her loved ones about her struggle with postpartum depression but she hadn't been able to find the words to explain the depth of her suffering. She wrote that she had a loving and supportive husband and that no one was at fault for her pain.

It started, she wrote, after her son was born in 2019. She felt completely changed as an individual, wife, sister, daughter and aunt, and she didn't understand how she couldn't even attempt cooking or other things that she once enjoyed.

Her constant worry about the future and self-blame for any difficulties with her son overwhelmed her. She got to the point that she believed that she was a complete failure as a mother and was scared that she would cause him harm in the future. Throughout her letter was a sense of shame for needing help taking care of her son, and guilt that she wasn't feeling better despite having an incredibly supportive husband, Deven Bhakta, and her sisters and family.

In her text messages to me she expressed she was experiencing postpartum depression. "Everything I do for Keshav just seems like a task for me, it's been hard to have that bond between me and him. Really didn't expect all this since I love kids but with Keshav I've been struggling. I haven't been out of the house either unless it's for a doctor appointment, it's pretty bad. Deven's been such a big help it's ridiculous."

She couldn't see what a wonderful mother she was to her beautiful baby boy. I saw her as a devoted mother diligently attending to all of his daily needs. I could see she loved him so much.

How did a mother who didn't have any of the risk factors for PPD -- factors that include a personal or family history of depression and lack of social support -- still succumb to it? It can be harder for Indian women like us to ask for psychological help because these issues are not always discussed in our community, but there are other reasons women suffer from this misunderstood condition.

​What is postpartum depression?

During pregnancy and in the hours after childbirth, women experience a dramatic drop in their estrogen and progesterone hormone levels, and that fluctuation is thought to contribute to postpartum mental health problems, according to the American College of Obstetricians and Gynecologists.

In addition to the changes in hormones, emotional factors, fatigue and general life stressors may contribute to PPD, experts say. Postpartum depression may begin in the days or weeks following childbirth, or it may begin months later, and it can last weeks, months or years if untreated.

While the experience of PPD can look different for each woman, common symptoms include a loss of pleasure or interest in doing things she once enjoyed; eating and sleeping much more or much less than usual; experiencing panic attacks or anxiety most or all of the time; feelings of guilt, worthlessness and self-blame; sadness or crying uncontrollably; fear of not being a good mom; fear of being alone with the baby or disinterest in the baby; difficulty making decisions; and thoughts of hurting oneself or the baby.

Postpartum depression is not the so-called "baby blues," which 70% to 80% of all moms experience, according to the American Pregnancy Association.
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While baby blues may begin soon after birth, its symptoms -- which can include crying for no apparent reason, anxiety, insomnia and mood changes -- should dissipate two weeks after childbirth. If they continue past two weeks, mothers should be examined for postpartum depression."

"Do you ever feel like you’re not doing enough as a parent? Like you might be totally screwing this up and maybe even making things worse for your kids? We’re right there with you. Parenting was already hard, and now we're navigating a pandemic on top of it.

In this webinar, we’ll talk about the self-doubt, anxiety, and uncertainty that has come with pandemic parenting. We’ll also share what the research says about “good enough’ parenting, especially in times of crisis. We’ll be joined by guest, Dr. Sharon Lamb, psychologist and author of The Not Good Enough Mother. Agata Freedle will serve as moderator to guide our conversation and pose questions that you submit.
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Join us on Zoom at 9 p.m. Eastern Time for this free webinar."