By Jean Lee | November 21, 2021
"Shantell Jones gave birth in an ambulance parked on the side of a Connecticut highway. Even though she lived six blocks away from a hospital, the emergency vehicle had to drive to another one about 30 minutes away.
The closer medical center, Windham Hospital, discontinued labor and delivery services last year and is working to permanently cease childbirth services after “years of declining births and recruitment challenges,” its operator, Hartford HealthCare, has said.
But medical and public health experts say the step could potentially put pregnant women at risk if they don't have immediate access to medical attention. Losing obstetrics services, they said, could be associated with increased preterm births, emergency room births and out-of-hospital births without resources nearby, like Jones' childbirth experience.
The dilemma Jones faced is one that thousands of other pregnant women living in rural communities without obstetrics units nearby are encountering as hospitals cut back or close services to reduce costs. Nationwide, 53 rural counties lost obstetrics care from 2014 through 2018, according to a 2020 study in the Journal of the American Medical Association, which also found that out of 1,976 rural counties in the country, 1,045 never had hospitals with obstetrics services to begin with.
The problem is particularly acute in communities of color, like Windham in northeastern Connecticut, where the population is 41 percent Latino, while the statewide Latino population is only 16.9 percent, according to the U.S Census Bureau. The community is 6.2 percent Black. Local activists say they fear low-income residents will bear the brunt of the hospital’s decision because Windham has a 24.6 percent poverty rate compared to 10 percent statewide, according to the census.
The night Jones delivered her son, her mother, Michelle Jones, had called 911 because Jones was going into labor a few weeks early, and after her water broke they knew the baby was coming soon. Both expected the ambulance to drive the short distance to Windham Hospital, where Jones received her prenatal care.
But the ambulance attendant was told Windham wasn't taking labor and delivery patients and was referring people to Backus Hospital in Norwich, Jones said.
In the ambulance, she was without her mother, who was asked to follow in her car.
“I was anxious and scared and traumatized,” Jones said."
By Sarah Griffiths | April 24, 2019
"Giving birth can be one of the most painful experiences in a woman’s life, yet the long-term effects that trauma can have on millions of new mothers are still largely ignored.
It’s 03:00. My pillow is soaked with cold sweat, my body tense and shaking after waking from the same nightmare that haunts me every night. I know I’m safe in bed – that’s a fact. My life is no longer at risk, but I can’t stop replaying the terrifying scene that replayed in my head as I slept, so I remain alert, listening for any sound in the dark.
This is one of the ways I experience post-traumatic stress disorder (PTSD).
PTSD is an anxiety disorder caused by very stressful, frightening or distressing events, which are often relived through flashbacks and nightmares. The condition, formerly known as “shellshock”, first came to prominence when men returned from the trenches of World War One having witnessed unimaginable horrors. More than 100 years after the guns of that conflict fell silent, PTSD is still predominantly associated with war and as something largely experienced by men.
But millions of women worldwide develop PTSD not only from fighting on a foreign battlefield – but also from struggling to give birth, as I did. And the symptoms tend to be similar for people no matter the trauma they experienced.
“Women with trauma may feel fear, helplessness or horror about their experience and suffer recurrent, overwhelming memories, flashbacks, thoughts and nightmares about the birth, feel distressed, anxious or panicky when exposed to things which remind them of the event, and avoid anything that reminds them of the trauma, which can include talking about it," says Patrick O’Brien, a maternal mental health expert at University College Hospital and spokesman for the Royal College of Obstetricians and Gynaecologists in the UK.
Despite these potentially debilitating effects, postnatal PTSD was only formally recognised in the 1990s when the American Psychiatry Association changed its description of what constitutes a traumatic event. The association originally considered PTSD to be “something outside the range of usual human experience”, but then changed the definition to include an event where a person “witnessed or confronted serious physical threat or injury to themselves or others and in which the person responded with feelings of fear, helplessness or horror”.
This effectively implied that before this change, childbirth was deemed too common to be highly traumatic – despite the life-changing injuries, and sometimes deaths, women can suffer as they bring children into the world. According to the World Health Organization, 803 women die from complications related to pregnancy and childbirth every day.
There are few official figures for how many women suffer from postnatal PTSD, and because of the continued lack of recognition of the condition in mothers, it is difficult to say how common the condition really is. Some studies that have attempted to quantify the problem estimate that 4% of births lead to the condition. One study from 2003 found that around a third of mothers who experience a “traumatic delivery”, defined as involving complications, the use of instruments to assist delivery or near death, go on to develop PTSD.
With 130 million babies born around the world every year, that means that a staggering number of women may be trying to cope with the disorder with little or no recognition.
And postnatal PTSD might not only be a problem for mothers. Some research has found evidence that fathers can suffer it too after witnessing their partner go through a traumatic birth.
Regardless of the exact numbers, for those who go through these experiences, there can be a long-lasting impact on their lives. And the symptoms manifest themselves in many different ways.
"I regularly get vivid images of the birth in my head,” says Leonnie Downes, a mother from Lancashire, UK, who developed PTSD after fearing she was going to die when she developed sepsis in labour. “I constantly feel under threat, like I'm in a heightened awareness.”
Lucy Webber, another woman who developed PTSD after giving birth to her son in 2016, says she developed obsessive behaviours and become extremely anxious. “I’m not able to let my baby out of my sight or let anyone touch him,” she says. “I have intrusive thought of bad things happening to all my loved ones.”
Not all women who have difficult births will develop postnatal PTSD. According to Elizabeth Ford of Queen Mary University of London and Susan Ayers of the University of Sussex, it has a lot to do with a woman’s perception of what they went through.
"Women who feel lack of control during birth or who have poor care and support are more at risk of developing PTSD,” the researchers write.
The stories from women who have developed PTSD after giving birth seem to reflect this.
Stephanie, whose name has been changed to protect her identity, says she was poorly cared for during labour and midwives displayed a lack of empathy and compassion. A particularly difficult labour saw her being physically held down by staff as her son was delivered. “He was born completely blue and taken away to be resuscitated and I was given no information on his condition for hours.”
By Stephanie Collier, MD, MPH, Contributor
"Pregnancy is an exciting time. You will soon become a parent to an adorable, tiny human. You may expect to experience the rollercoaster of emotions during pregnancy, or emotions may catch you off guard. Some women feel joy at every flutter or kick, marveling at their changing bodies. For other women, pregnancy is hard, giving no reprieve as it brings severe fatigue, mood changes, and constant worries. You may notice that with every passing month, your thoughts are spiraling out of control, affecting your performance at work and your relationships at home. But how do you manage your anxiety, and should you treat it?
What causes anxiety during pregnancy?
Worries during pregnancy are universal. Hormonal changes of pregnancy, prior heartbreaking miscarriages, and sleep difficulties may all contribute to anxiety for mothers-to-be. You may worry about how a baby will affect your relationships with friends or family members, the health of your future child, the delivery experience, or the financial burden of an additional family member. All of these worries are completely normal. For humans, a certain amount of anxiety is protective; how else could we motivate ourselves to complete our work or run away from a bear?
What are the symptoms of anxiety disorders during pregnancy?
Although it’s normal to be worried about the health of your baby, in some cases this worry becomes debilitating and may require further attention. Thoughts about the health of the baby may become obsessive, even when doctors are reassuring. Worries may also appear as physical symptoms, such as a rapid heartbeat, difficulty breathing, or panic attacks. If this is the first time you experience a high level of anxiety, this may be frightening in itself. When anxiety starts to interfere with your day-to-day functioning, relationships, or job performance, it may be classified as an anxiety disorder — if your doctor picks up on it.
Anxiety can occur at any time during pregnancy, or it may first appear after delivery (perinatal anxiety is the term used for anxiety during pregnancy and after delivery). The rates of generalized anxiety disorder appear to be highest in the first trimester, likely due to hormonal changes. The most common symptoms of anxiety include constant worrying, restlessness, muscle tension, irritability, feeling dread, an inability to concentrate, and difficulties falling asleep due to worries. Some women also experience symptoms as a result of other anxiety disorders, including panic disorder, obsessive-compulsive disorder, or post-traumatic stress disorder.
Unfortunately, two of the most common mental health screening tools in pregnancy (the Edinburgh Postnatal Depression Screen and Generalized Anxiety Disorder 7-item Scale) are not great at detecting anxiety in pregnancy. Although underdiagnosed, anxiety disorders during pregnancy and in the postpartum period are common, and may affect up to one in five women. Many women suffer in silence.
What are the effects of untreated anxiety on the fetus?
When thinking about management of anxiety, it is important to consider both the risks of treatment as well as the harms of untreated anxiety. Although less studied than depression, research suggests that anxiety may negatively affect both the mother and the fetus. Anxiety increases the risk for preterm birth, low birthweight, earlier gestational age, and a smaller head circumference (which is related to brain size).
What are some treatments for anxiety during pregnancy?
Fortunately, there are many treatments that can reduce anxiety during pregnancy and help you feel better. For many women, anti-anxiety medication is not an option during pregnancy, as there is little information on the safety of such medication on the fetus. Some women who had previously taken medications for anxiety may wish to discontinue medications during pregnancy for personal reasons.
Therapies such as cognitive behavior therapy (CBT) demonstrate promise in the peripartum period (the period shortly before, during, and after giving birth). CBT focuses on challenging maladaptive thoughts, emotions, and actions, and it uses anxiety management strategies such as diaphragmatic breathing (adapted to pregnancy).
If your anxiety is severe, medications may be an option for you. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety during pregnancy and after delivery. It does not appear that SSRIs are associated with an increased risk of major congenital malformations. However, SSRIs may be associated with transient neonatal symptoms such as jitteriness, tremor, crying, and trouble feeding, which resolve on their own in a few days.
The use of benzodiazepines such as lorazepam (Ativan) and alprazolam (Xanax) during pregnancy has long been a controversial topic. Although older studies showed an association between their use and an increased risk for cleft lip and palate, a more recent study looking at benzodiazepine use during pregnancy did not show this link when these medications were used alone (although there may be an increased risk when combined with antidepressants)."
By: Cindy & James Mindful Relaxation
"Meditation For Pregnancy is a comforting and relaxing meditation that can be done at any time but works best before sleep. It's a super-effective way to reduce anxiety and connect with your baby."
By Melissa Willets | Updated August 22, 2021
"The term rainbow baby may not be familiar to people who haven't experienced a loss. But to those of us who have, it has a very deep and even life-changing significance.
So what is a rainbow baby? It's "a baby born after a miscarriage, stillborn, or neonatal death," says Jennifer Kulp-Makarov, M.D., FACOG. "It's called a rainbow baby because it's like a rainbow after a storm: something beautiful after something scary and dark."
She adds, "It's an extremely emotional and devastating experience to lose a pregnancy [or baby]. To create a life or bring a baby into the world after such a loss is amazing like a miracle for these parents."
I'm currently seven months pregnant with a rainbow baby, and indeed, I feel like I'm walking around with a miracle in my belly. There was a time when I never thought I could feel hopeful again. Just last year, we lost our beloved baby Cara at 23 weeks of pregnancy. The days, weeks, and months after she became our angel baby were the darkest of my life. But soon a dim hope flickered inside my heart, and eventually ignited a flame, that became my desire to try again, in part to honor Cara, and to find meaning in her loss.
Rainbow Babies Can Honor an Angel Baby
Moline Prak Pandiyan, a previous ambassador for March for Babies, March of Dimes Eastern North Carolina, knows this feeling well. She lost her son Niko when he was five months old due to complications related to his premature birth. "Although Niko lost his fight, his spirit lives on, and he continues to inspire many," she explains. Not only is this mama involved in fighting prematurity, but she was also inspired to conceive a rainbow baby.
Not that she previously knew the meaning of the term "rainbow baby." "I remember the feeling that I had when I first heard [it]," says Pandiyan. "It was perfect. I so much wanted to make sure that Niko wasn't forgotten, and the term so eloquently acknowledges the babies who we've lost, while also celebrating the joy of our babies who do survive."
Prak Pandiyan is now a proud mom of a little girl, her rainbow, who truly informs her parenting philosophy. "My husband and I always wondered what life would have been like if our son could be discharged and come home with us," she says. "When we welcomed our rainbow baby into this world, our perspective as parents shifted. Whenever things get hard—feeding challenges, sleeping challenges, mild illnesses—we always make it a point to step back and remember that things could be so much worse."
Parenting a Rainbow Baby May Feel Different
Mama Stephanie Sherrill Huerta, who has one daughter, is also expecting a rainbow baby, via adoption, after several miscarriages and failed adoption attempts. She too acknowledges that parenting her rainbow baby will be different, telling Parents.com, "We will love him a little differently than our daughter because we went through so much grief and pain before meeting him. He will truly be the light at the end of the tunnel, the pot of gold under the rainbow, and the rainbow after our storm."
That same spirit has encouraged me to enjoy my current pregnancy more than before. Morning sickness and heartburn can't take away my gratitude for the chance to carry a healthy baby.
Elizabeth Lorde-Rollins, M.D., MSc, OB-GYN at CareMount Medical says this is normal. "For parents who have experienced the loss of a child, whether that loss occurs before or after birth, the life adjustments associated with pregnancy are accompanied with an acute sense of gratitude even when they are uncomfortable," she notes. "And although most of us have the great fortune of being wanted babies, parents tend to have a special, and in many cases incredibly sharp, sense of being blessed when they are expecting and then giving birth to a baby that follows loss."
By Loren Kleinman | May 12, 2021
"The day Lily was born, my husband, Joe, took pictures, murmured soft words, and held her every moment he could. "I want to stay home with her for her first year," he said. "I read it's important for their development."
Luckily, he was able to as he was honorably discharged from the Navy. But despite my three-month maternity leave, I wanted to go back to work.
But when we returned home from the hospital, I unraveled. No time to shower, eat, or pay a bill. Our lives revolved around Lily. Everything I imagined about motherhood exploded. Dreams of gardening with my daughter in a Snugli on my chest were replaced with her unrelenting cries and endless diaper changes.
Yet to Joe, she was just a baby. "What did you think having a baby would be like?" he asked.
"Not like this," I snapped, taking off my spit-up covered shirt and replacing it with a clean one.
It wasn't just the dirty shirt. I had thoughts of hurting myself and my baby, an alarming desire to drive us both off the road. I hated myself for these thoughts, but I hated her more. I hated that she never slept, and resented that I couldn't, either. I hated breastfeeding, which was not magical as I'd pictured, but painful and lonely.
I missed our date nights, coming and going as I pleased, and clean clothes.
Darkness settled over me, unlike any depression I'd experienced. I began experimenting with cutting myself just to feel something other than exhaustion, spending long minutes in the bathroom, my only escape. With each cut came relief from the burden of this new, agonizing life.
"You were in there a long time," Joe teased me.
Low spirited, I replied, "I wish I never had to come out."
He reached out to console me and saw the cuts on my arm. I didn't hide them. I didn't care. But Joe called his therapist, who told him about a clinic for women with postpartum depression.
"He doesn't even know me," I argued.
"You're going," a frazzled Joe said. "Today."
My First Dose of Postpartum Depression Treatment
We arrived to find a room filled with infants, dads, and moms, many of the latter red-faced and crying, while their husbands stood by, holding babies. I was amazed to see so many men like my husband, cradling their little ones, in solidarity with their wives, as the women went one by one to meet with a psychiatrist.
When it was my turn, I looked back at Joe and Lily. A concerned smile dusted his face. "We'll be right here when you're done."
During my intake, I asked flatly, "Will I ever love her?"
"This is a classic postpartum depression question. You will love her," the psychiatrist assured me. "But I have to ask, do you have any plans to kill yourself?"
Without hesitation, I said, "I want to drive off the road." Then I wept.
I wasn't allowed to drive until further notice, and if I didn't abide, the psychiatrist warned, "We'd have to consider hospitalization."
Joe ferried me to and from the clinic every day, no matter how many times he'd been up with Lily the night before. On weekends, Joe tended to me and to Lily, making sure we both ate and slept, as his parents flew out from Washington State to lend a hand, a relief to both of us.
For the first time, I felt some hope.
Every week, I attended weekly dialectical behavior therapy sessions (DBT), learning skills for coping with my anxiety and insomnia like radical acceptance and positive self-talk.
Things Only Got Worse
Then, one night, after Joe put Lily to bed, we sat on our back porch, me with my usual glass of wine, him with his Coke and ice.
"Are you OK?" he asked, as I stared, glassy-eyed, into the trees.
Before coming outside, I'd already washed down a handful of Tylenols, along with sedatives and a few glasses of wine.
"I can't live like this anymore." I paused. "Lily deserves a mom, not me."
Joe sighed and said, "I'm calling the clinic's emergency line."
The therapist on duty advised Joe to bring me to the hospital immediately, even though I protested. But I had no choice. I confessed my desire to kill myself, so I could go voluntarily or in an ambulance.
Joe stayed with me for nine hours in the emergency room, until there was a bed ready in the psychiatric unit. His parents watched Lily at home.
"Please don't let them take me away," I called out to Joe, as a nurse led me to the unit.
"I'll see you in the morning," Joe answered back. "You will be OK."
When he arrived the next day, I pleaded with him to get me out.
"Someone tried to kill themselves last night," I cried. "I don't belong here."
"Can you give it a chance?" he begged.
I sat back in my chair and folded my arms. I resented Joe for bringing me here. At the beginning of our relationship, I'd been the strong one, helping him through his own hardships. But Lily changed everything.
"I have to get back," he said. "Focus on getting better, not getting out."
When Joe leaned in to give me a kiss goodbye, I stopped him. "I want a divorce when this is over," I whispered.
He teared up and said, "You've said some of the meanest things anyone has ever said to me."
I felt no remorse. Before the baby, we never went to bed angry. Now, I loathed him for keeping me here. I was determined to punish him, and I did, lashing out constantly, but he kept visiting and taking my phone calls. He never stopped trying.
I was discharged after five days. Joe and I argued for the entire ride home. When we arrived at the house, I imploded: "I can't take this anymore!"
I threw chairs and baby toys, wailing, and punching the wall. Joe couldn't calm me, so he took Lily and his parents to the farthest part of the house.
The next morning, Joe gave me a choice: "You either go to your parents' house and take a break, or you go back to the hospital."
I chose the first option.
A few days later, Joe called me. "I told my therapist what happened. He called Child Protective Services," he said matter-of-factly.
"They're going to take Lily away?" I asked.
Shocked, I suddenly realized how much I wanted her."
By Paige Glidden | May 07, 2021
"During TheBlueDotProject's Maternal Mental Health Awareness Week, it's time to focus on the mental health of mothers—especially during a life-changing pandemic. The most recognized maternal mental health disorder is postpartum depression, but there are other common mental health concerns to look out for.
Juggling societal and familial expectations is a heavy burden for anyone. But when you add a new baby into the mix (during a pandemic!), it can become overwhelming. Sleepless nights, hormones, and new emotions all feed into overwhelm after the birth of a baby, not to mention that maternal anxiety and depression are the most common complications of childbirth, impacting up to 1 in 5 women.
The first week of May serves as Maternal Mental Health Awareness Week, bringing to light the challenges that moms face and the reality of postpartum depression and anxiety. Maternal Mental Health Disorders (MMHDs) include a range of disorders and symptoms, including depression, anxiety, and psychosis. Although often referred to more commonly as "postpartum depression," there are several different types of postpartum mental health disorders that affect new moms.
Symptoms can occur during pregnancy and/or the postpartum period (together often referred to as the perinatal period). These illnesses can affect anyone—and they are far more common than you'd think. Although an estimated one in five women have a maternal mental health disorder, most cases go undiagnosed, leading experts to believe that the number should be much higher. New parents also experience the baby blues, which is not formally considered an MMHD—up to 80 percent of women suffer from this in the initial two to three days postpartum, according to Bridget Frese Hutchens, Ph.D., CNM, RN, CNL, PHN.
What's worse is that only 30 percent of women who screen positive for depression or anxiety seek or receive treatment. When left untreated these disorders can cause devastating consequences for moms, babies, families and communities. The good news is that risk for both depression and anxiety can be reduced (and sometimes even prevented), and with treatment, women can recover.
It can be hard to identify some of the symptoms of postpartum mental health challenges, but it's worth paying attention to. Here are five types of maternal mental health conditions to look out for:
Common Maternal Mental Health Disorders
1. Postpartum Depression
Pregnancy and Postpartum Depression (PPD) is a mood disorder that can begin during pregnancy or in the first three weeks after having a baby, according to ACOG, the American College of Obstetricians and Gynecologists. Symptoms can range from mild sadness, trouble concentrating, or difficulty finding joy in once-loved activities to severe depression, and mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression, according to The Blue Dot Project. While there is no single cause for PPD, experts attribute it to the drop in hormones estrogen and progesterone following childbirth and general stressors which increase during pregnancy and the postpartum period. With proper mental health care, PPD is treatable and the risk of severe depression can also be prevented.
2. Dysthymia, Persistent Depressive Disorder
Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression. According to the Mayo Clinic, people with dysthymia may lose interest in normal daily activities, feel hopeless, or have overall feelings of inadequacy. Women with pre-existing dysthymia may be at a higher risk for severe symptoms/depression during the perinatal period, according to The Blue Dot Project.
3. Pregnancy and Postpartum General Anxiety
It might seem normal to worry before or after having a baby, but if your anxiety is more than just the baby blues and you can't get these worries out of your brain, you might be suffering from pregnancy or postpartum related generalized anxiety . Around 10 percent of women will develop anxiety during pregnancy or after childbirth, according to the American Pregnancy Association. Anxiety is treatable during pregnancy and postpartum.
Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the "what if's"—questions like "what if my baby experiences SIDS" or "what if my baby has autism," and extreme worry about not being a good parent or being able to provide for her family, according to The Blue Dot Project."
"COVID-19 has caused a spike in post-traumatic stress among pregnant and postpartum women, internet-delivered cognitive behavioral therapy may help make treatment more accessible and less expensive for kids with social anxiety disorder, and other mental health news from spring 2021.
Pregnant Women Are More Vulnerable to Mental Health Problems Due to the COVID-19 Pandemic
What’s New Pregnant and postpartum women in 64 countries, including the United States, have been experiencing a higher level of symptoms of post-traumatic stress, depression, anxiety, and loneliness as a result of the ongoing COVID-19 pandemic, according to a study published in April 2021 in PLOS One. Factors that put women at the greatest risk were worrying about their children and medical care, as well as seeking information about the pandemic at least five times a day from any source, whether online searches or talking to others.
Research Details Nearly 6,900 pregnant and postpartum women from around the world participated in an online survey advertised on social media and online parenting forums. The survey found that 43 percent of women demonstrated higher levels of post-traumatic stress, 31 percent of women experienced more symptoms of depression and anxiety, and 53 percent of women had high levels of loneliness. Other key findings:
Why It Matters Psychological distress during pregnancy and after birth can negatively impact both mothers’ and their children’s health. “We know that maternal mental health has adverse effects on a range of outcomes for the offspring — for example, infant outcomes, mother-infant bonding, and later offspring physical and behavioral health,” says study author Karestan Koenen, PhD, a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health in Boston, adding that helpful ways to care for mental health could include:
Mental health screening among pregnant and postpartum women is also key, but efforts shouldn’t stop there, says study author Archana Basu, PhD, a research scientist at the Harvard T.H. Chan School of Public Health.
“In addition to screening and monitoring mental health symptoms, addressing potentially modifiable factors such as excessive information seeking and women’s worries about access to medical care and their children’s well-being, and developing strategies to target loneliness such as online support groups, should be part of intervention efforts for perinatal women,” says Dr. Basu."
"Infertility is difficult to live with. That said, sometimes, we make things harder on ourselves. Not intentionally or consciously, of course. We may not know it can be any other way. Or we just don't realize we're self-sabotaging ourselves.
Here are some things you should stop doing if you are fertility challenged, so you can start living a better, fuller life.
1. Stop Blaming Yourself
Maybe you waited "too long" to start a family. Maybe something foolish you did as a college student has wreaked havoc with your fertility. Maybe you wonder if that year you decided to live on only fast food wasn't the brightest idea.
Or, perhaps you have no idea what could possibly have led to your current fertility woes. But you're sure it's something you could have stopped had you only known better.
You need to stop blaming yourself. Even if you can find a way to somehow make it "your fault," you should still stop blaming yourself. It doesn't help. It just depresses you.
Plus, most cases of infertility are either not preventable or not predictable. You really can't know if you had done something different whether you'd be a Fertile Myrtle or not. Drop the blame, and focus on what's most important now--moving forward and tackling the problem.
2. Stop Waiting for a Miracle
If you have been trying to conceive for more than a year (or more than six months, if you're over 35), and you have not succeeded, it's time to see a doctor. Some couples decide this advice isn't really for them, though. It's for those other people. You know, the infertile ones. They decide to keep trying on their own and pray for a miracle.
Here's the problem with that thinking: There are some causes of infertility that worsen with time. While you pray for your miracle, your chances may be quickly disappearing.
There's nothing wrong with deciding to keep trying and wait on treatment, or even deciding not to pursue fertility treatment in the end. But you shouldn't avoid fertility testing. At least find out what is wrong and what your options may be.
Get checked out, both you and your partner, and confirm that whatever is wrong can wait. Then, if you want, set a "miracle waiting" period. Speak to your doctor about how long they think you can try without losing valuable time.
3. Stop Feeling Hopeless
A diagnosis of infertility can hit a person hard. Sometimes, it's difficult to see past the next couple of days or weeks. You may feel hopeless, certain that you will never conceive or that your life will never be happy.
If you can't conceive a biological child, maybe you can use an embryo donor, egg donor, or sperm donor. If you can't use donor gametes, maybe you can adopt. If you can't adopt, remember that people can live childfree and have happy, normal lives.
To be clear, these other possibilities don't magically make the pain go away. You will need time for grieving and healing from the trauma of infertility.
However, when you start to wonder if you will never have a child, or when you start to think your life is ruined, try as best as you can to hold onto at least a sliver of hope. There is life after infertility. Please remember that.
While it's possible you won't conceive, you'll feel better if you can keep your thoughts focused on the positive possibilities. Low-tech treatments work for many couples. Your chances for success may be better than you think. Speak to your doctor about your particular prognosis.
4. Stop Acting Helpless
Most couples are extremely pro-active in their care. But not everyone realizes they are the decision makers.
To the couples whose doctors tell them they are "too young," despite trying for over a year...
To the couples whose fertility clinics refused to try IVF with their own eggs because their chances aren't great, not realizing that the clinic probably doesn't want to "ruin" their track record with a risk...
To the women whose doctors won't test or treat them until they lose weight, but leave it to them to figure out how exactly to do so...
You are not as helpless as it seems. If the doctor you're seeing refuses to run an evaluation, go find a new doctor. If a clinic turns you down because your chances are "too low," seek out a second opinion.
If your doctor tells you to lose weight, be sure they evaluate and treat any hormonal imbalances that may make losing weight difficult, and ask for a referral to a nutritionist.
Maybe go get a second opinion on whether you really need to lose weight first.
You have so much more power than you realize. Don't be afraid to stand up for yourself.
4. Stop Living in Two-Week Increments
This is a basic one but so common it deserves special mention. When you're trying to conceive, your life can easily fall into two-week increments: the two weeks you wait for ovulation, followed by the two weeks you wait to take a pregnancy test.
The worst part about this is there are no breaks; there's no anxiety-free time when you're anxious about ovulating or anxious about feeling pregnant.
While it's unrealistic to think you'd be able to just drop all the fretting, you should at least try to live beyond the two-week wait craziness. You may need the support of friends, a support group, or a counselor to learn how. But it's possible.
4. Stop Basing Self-Worth on Fertility
Infertility can make you feel worthless. Broken. Ashamed. These are all very common feelings, experienced by men and women who live with infertility.
Before you started trying to conceive, before you ever realized you faced infertility, you probably felt different about yourself—hopefully more positive. You need to remember that the old you is still there. You don't become someone else when you're diagnosed with infertility.
If you were awesome and lovable before infertility, then you're just as awesome and lovable after. If you doubt this, think about what you'd say to a friend who told you they felt ashamed and worthless because of their infertility. You probably wouldn't say to them, "Yep, you're right. You're worthless!" No way.
You know it's not true of a friend, and you need to understand it's also not true of yourself. You are so much more than your fertility."
"After the birth, there are oh-so-many ways your body will ache. We asked midwife Tracy Hydeman and other experienced parents for their soothing suggestions.
1. When you’re breastfeeding, massage your breasts to ward off mastitis. You can also use warm compresses or take a hot shower.
2. Get hydrated with natural electrolytes (which help regulate nerves and muscles) by mixing water, sea salt and freshly squeezed orange or lemon juice.
3. Soak your bottom in an Epsom salt bath at least two times a day. Add herbs like comfrey leaf and witch hazel to help tears heal and reduce inflammation.
4. Cabbage leaves are a “fantastic thing for engorged breasts,” says Hydeman. They cup the breasts naturally and relieve inflammation.
5. Eat a beef and barley stew—the beef is good for replenishing your iron, and the barley will help your milk come in.
6. If necessary, book an appointment to see a physiotherapist for pelvic-floor and diastasis recti physio ASAP.
7. That little peri bottle you got from your hospital nurse or midwife? It’s a new mom’s best friend when it comes to keeping things clean down there postpartum. (Any tearing or incisions will make it difficult to wipe after delivery.) Simply fill it with warm water and squirt to cleanse yourself after using the toilet or squirt while peeing to dilute the urine if you have any burning or discomfort.
8. Homemade “padsicles”
– Spritz sanitary pads with water or top with witch hazel. Many moms also swear by adding aloe vera gel and lavender oil.
– Fold up the pad and insert it into a zip-top bag or seal with plastic wrap. Freeze. Place on the perineum for cold comfort.
9. If you have a supportive partner or help at home, take advantage of that by embracing the “babymoon” period. Try to stay in bed for at least 72 hours after the birth.
10. Organize (or ask a friend or family member to organize) a meal train, which is a system in which people can sign up to bring you meals. Don’t be shy about mentioning any food preferences or allergies."
BY ANNE LORA SCAGLIUSI | May 25, 2021
"Jen Schwartz, mental health advocate and CEO of Motherhood Understood, first experienced perinatal depression a day after giving birth. “The biggest red flag was that I was having scary thoughts about wanting to get hurt or sick so I could go back to the hospital and not have to take care of my baby,” she says. “I had no interest in my son. I thought I had made a huge mistake becoming a mother and I couldn’t understand why I was failing at something that I believed was supposed to come naturally and that all other women were so good at.”
According to the World Health Organization, about 10 percent of pregnant women and 13 percent of new mothers will experience a mental disorder, the main one being depression. Without appropriate intervention, poor maternal mental health can have long term and adverse implications for not just these women, but their children and families, too. In most cases, however, women may not be aware of the help available or even that they might need it.
“Most of the time, they mistakenly think they are failing at parenting,” says Wendy Davis, executive director of Postpartum Support International (PSI). “They don't realize they are going through a temporary, treatable experience that many others have gone through.”
To find out more during World Mental Health Awareness Month, Vogue speaks to a range of global mental health experts and women who have experienced perinatal depression.
What is perinatal depression?
"Perinatal depression is the experience of depression that begins during pregnancy [prenatal depression] or after the baby is born [postpartum depression]. Most people have heard of perinatal depression, but what’s equally common for mums to experience is perinatal anxiety either separately, or with depression,” explains Canadian therapist Kate Borsato. Perinatal depression does not discriminate. “Some people are surprised when I tell them that I experienced postpartum anxiety, because of my job as a therapist for mums. But mental illness doesn’t really care who you are or what you know.”
While anyone can experience it, there are some known risk factors that increase women’s chances of developing mental health difficulties in the perinatal period. According to Australia-based social worker and founder of Mama Matters, Fiona Weaver, these include a “previous history of depression or anxiety, those who have limited support networks, have experienced birth or pregnancy trauma, infertility or who may be genetically predisposed to it.”
What are the signs and symptoms to look out for?
Symptoms differ for everyone, and may include feelings of anger, anxiety, fatigue, neglecting personal hygiene and health or surroundings, fear and/or guilt, lack of interest in the baby, change in appetite and sleep disturbance, difficulty concentrating/making decisions, loss of enjoyment or enthusiasm for anything, and possible thoughts of harming the baby or oneself.
Women can also develop postpartum obsessive-compulsive disorder, and postpartum psychosis. Copenhagen-based content creator Clara Aatoft was diagnosed with severe postpartum depression and psychosis months after becoming a new mum. “For the first three months, I didn't sleep at all. I was constantly aware of my daughter’s needs. She was later diagnosed with colic. When I gave up breastfeeding and switched to the bottle, my depression and psychosis went full-blown.” She continues, “I started thinking that my daughter was a robot that someone placed a chip inside at the hospital. I attempted suicide and ended up in the psychiatric ward. I’m very well now, still medicated on antidepressants. But my daughter and I have the best relationship.”
BY SARA SHULMAN | JUL 24, 2021
"With stars like Debra Messing and Halle Berry looking decades younger than their actual age, 40 is definitely the new 30! Woman are no longer dreading reaching middle age and are feeling healthier than ever, thanks to the latest fitness and wellness trends. But aging comes with a lot of changes, too. It's usually around 40 when some women start to form deeper fine lines and wrinkles. The big 4-0 also signals the importance of doing health screenings regularly. For example, at age 40, women should have their first mammogram.
“Women must always remain proactive about their health at every age,” says Taz Bhatia, MD, a board-certified integrative medicine physician, women’s health expert and author of The Super Women RX. The good news is there are ways to anticipate where your health is headed as you age through preventative screenings and an active lifestyle. Remember, age is just a number so keep it that way!
Losing weight in your 20s was as easy as cutting out soda for a week, but as women age, it gets harder to lose weight and easier to gain it. “Age, inactivity, stress levels, and poor dietary choices are the biggest precluding factors to weight gain,” says Kecia Gaither, MD, a New York City-based OB/GYN and director of perinatal services at Lincoln Medical and Mental Health Center in the Bronx. “Staying active is key,” she explains.
Fatigue and low energy
Feeling tired may not seem like something new to a woman in her 40s. After all, you’re probably working full-time, raising children, and managing a home, but as women age, they tend to get more tired, quicker. This is due mainly to hormonal changes happening from menopause. “Consistent sleep is a key factor in rejuvenating and replenishing the body,” Dr. Bhatia says. Dr. Bhatia recommends seven hours of consistent sleep for five nights a week.
“This is the most common cause of death in American women,” Dr. Gaither says. Over time, plaque builds up in the arteries, causing them to narrow and harden. "This prevents the normal flow of blood and oxygen that the heart needs. A clot may develop over the plaque, blocking the flow to the heart leading to a heart attack.” This is just another reason diet and exercise are so important.
There are numerous reasons women in their 40s experience a low sex drive. Everything from hormonal changes to vaginal dryness could be the cause. Sometimes the solution can be as simple as using an estrogen cream, but in other cases, it may mean something more serious. Always talk to your doctor no matter how serious or not you think the issue is.
“Breast and cervical cancer are the two most common cancers affecting women,” Dr. Gaither says. Breast cancer can occur at any age, but the risk increases with age. "Cervical cancer can affect any woman who is or has been sexually active, but it primarily occurs in women who have had HPV, are immune compromised, have poor nutrition, and don’t get pap smears,” she adds. Routine mammograms are key once you hit 40.
As if fatigue and low energy weren’t issue enough, insomnia plagues many middle-aged women as well. In fact, a U.S. Centers for Disease Control and Prevention (CDC) study found that close to 20 percent of women age 40 to 59 said they had trouble falling asleep on four or more nights a week. The study explains that for many this is due to the onset of menopause. Night sweats, skyrocketing body temperatures, and mood swings can all affect sleep patterns.
Although hair loss for both men and women is mainly hereditary, hormones during menopause can play a roll as well. But there are supplements and treatments you can take in order to help prevent hair loss, so if you’re worried, ask your doctor."
By: Pregnancy & Postpartum TV | March 6, 2019
"Prenatal Yoga Bedtime or Prenatal Yoga Before Bed. Help get to sleep with this prenatal bedtime yoga or prenatal bedtime stretch. Prenatal yoga bedtime as a pregnancy insomnia remedies."
"What Is Prenatal Depression?
Prenatal depression, also called perinatal depression, is depression experienced by women during pregnancy. Like postpartum depression, prenatal (or perinatal) depression isn’t just a feeling of sadness—mothers who experience this mental health disorder may also feel anxious and angry.
You've likely heard of postpartum depression—and that's a good thing. The more that postpartum depression is talked about and understood, the more mothers will seek the help they need so that they can feel better and live full and healthy lives as new moms.
But prenatal depression is a maternal mood disorder that hasn’t gotten nearly as much attention as it should. While prenatal depression can be treated, many expecting mothers don’t even know that it’s a “thing” and therefore don’t seek treatment for it.
Many feel ashamed to even share how they are feeling. After all, you are supposed to be overjoyed and excited when you are expecting a baby, right? It’s easy to feel guilt and shame when you are feeling the exact opposite.
Here’s what you should know about prenatal depression, including how common it is, what to look for in terms of symptoms, and most importantly, how to get help.
How Common Is Prenatal Depression?
Like postpartum depression, which impacts as many as 1 in 7 new moms, prenatal depression is actually quite common.
According to a journal article by Maria Muzik, MD, and Stefana Borovska, published in Mental Health in Family Medicine, 13% of pregnant moms experience depression.
As the authors note, perinatal depression (both prenatal and postpartum) is even more common among mothers facing adverse experiences, such as a history of depression or economic hardship.
“The prevalence of perinatal depression is even higher in vulnerable groups with certain risk factors,” the authors explain. “Young, single mothers, experiencing complications, with a history of stress, loss or trauma are far more likely to succumb to depression. Furthermore, one study found that up to 51% of women who experience socioeconomic disadvantage also report depressive symptoms during pregnancy.”
It's important to note prenatal depression doesn’t discriminate: You can experience it whether or not you have pre-existing risk factors. Always remember there is no shame in experiencing a serious bout of depression during pregnancy, and you are not alone.
Similar to postpartum depression, experts can’t pinpoint one particular cause of prenatal depression, but have hypothesized that it’s likely caused by a confluence of factors—a “perfect storm” of triggers that come to a head for some mothers during their pregnancies.
Either way, it’s important to note that whatever caused your prenatal depression, it most certainly wasn’t your fault. There was nothing you did wrong, and you are not a bad mom (or going to be a bad mom).
“Depression and anxiety during pregnancy or after birth don't happen because of something you do or don't do—they are medical conditions,” notes the Academy of American Pediatrics (AAP).
“Although we don't fully understand the causes of these conditions, researchers think depression and anxiety during this time may result from a mix of physical, emotional, and environmental factors,” they add.
Prenatal depression manifests differently for every mom—you may even experience it differently from one pregnancy to another. It’s important to understand that anytime you feel overwhelmed by your emotions, unable to function in your day-to-day life, or just “off,” you should reach out to discuss your feelings with a trusted loved one or medical provider.
Here are some of the most common symptoms of prenatal depression:
For more mental health resources, see our National Helpline Database."
By: Robin Elise Weiss, PhD, MPH | June 14, 2021
"Affirmations are statements that you use intentionally to instill a sense of positivity and purpose in your mind about a particular subject. You can use these short phrases and sentences to help yourself focus on and accept a positive message that you wish to remember.Affirmations are an example of using positive thinking to set an intention and increase the likelihood of positive results. Even better, they are simple to do, free, and accessible to all.
Why They Work
While there is no guarantee that affirmations will actually change the outcome of your pregnancy, some studies suggest that affirmations can reduce stress and anxiety—which can make it easier to rest, eat, and avoid issues such as headaches and fatigue. Plus, positive thoughts tend to cultivate positive feelings, which may help to make your pregnancy experience more enjoyable and relaxed.
Studies show that using positive affirmations impacts brain pathways, increasing activity in the areas of the mind responsible for self-worth, self-regulation, and core values. Researchers believe that making a regular practice of saying affirming statements can effectively shift your focus from negative emotions or stressors to your own expansive capacity to cope, bolstering your confidence and bringing you new ideas, strategies, energy, and hope for the future.
Write Your Own
The beauty of positive affirmations is that you can write your own to use whenever you like. They can be said out loud or silently in your head, quietly whispered to yourself, or written down. In lieu of writing your own, you can also use one you have read or heard elsewhere. If it makes you feel strong, positive, and hopeful, then you're on the right track.
Remember, your affirmation should be in the present tense, as if what you wish to happen is already occurring. For example, someone who is worried about coping with childbirth might say, "I am strong." A person who is trying to get pregnant and having difficulty might say, "I am a good parent to my child."
This person might decide to repeat the affirmation every morning as a reminder of their goal and to foster their hope for this desired outcome. During infertility treatments, they might visualize this affirmation while undergoing procedures and tests, as well. During pregnancy, daily pregnancy affirmations may serve to enhance the mother's bond to their growing baby while also alleviating the worry that something might go wrong.
How to Do It
Anything that speaks to you can work as an affirmation. If you're unsure, brainstorm statements that connect to the feelings, values, and intentions you want to affirm. If you have a specific worry or negative thought that keeps coming to mind, try flipping it around to a positive one.
If you catch yourself thinking, "I can't do this," counter that with, "I can do this." "Childbirth is scary" becomes "childbirth is beautiful." Simple is good. Setting your positive intention can literally change your mind.
To help you get started writing your own affirmations, consider beginning with phrases like the following:
"For a new mom-to-be, experiencing sleep deprivation after the baby is born is a given. But you probably didn’t realize that it could also occur during the first trimester of pregnancy.
Most women experience sleep problems during pregnancy. Pregnant women tend to get more sleep during their first trimesters (hello, early bedtime) but experience a big drop in the quality of their sleep. It turns out that pregnancy can make you feel exhausted all day long. It can also cause insomnia at night.
Here are some of the most common culprits for insomnia during early pregnancy, plus a few tips to help you get a better night’s sleep.
What is insomnia?
Insomnia means you have difficulty falling asleep, staying asleep, or both. Women can experience insomnia during all stages of pregnancy, but it tends to be more common in the first and third trimesters. Between midnight bathroom breaks, out-of-control hormones, and pregnancy woes such as congestion and heartburn, you might be spending more time out of your bed than in it. The good news: While insomnia might be miserable, it’s not harmful to your baby.
Sheer logistics play a role as well. By the end of a pregnancy, many women have a hard time just getting comfortable enough to sleep well. During the first trimester, you might not have much of a baby belly to accommodate, but there are other issues that can prevent a good night’s sleep.
What causes insomnia during pregnancy?
Expecting? There are many reasons you might be wide awake in the wee hours. These can include:
It can be difficult to distract yourself from these thoughts, but try to remember that worrying isn’t productive. Instead, try writing down all of your concerns on paper. This will give you a chance to consider possible solutions. If there are no solutions, or there is nothing you can do, turn the page in your journal and focus on another worry. This can help empty your mind so you can rest.
Being up front with your partner about your feelings and worries can also help you feel better.
Develop a bedtime routine
One of the best things you can do to manage insomnia while you’re pregnant is to set up good sleep habits.
Begin by trying to go to bed at the same time every night. Start your routine with something relaxing to help you unwind.
Avoid screen time at least an hour before bed. Blue light from the TV, your mobile phone, or tablet can have an impact on your body’s circadian rhythm. Try reading a book instead.
Taking a soothing bath might also make you sleepy. Just be careful that the temperature isn’t too hot — that can be dangerous for your developing baby. This is especially true during early pregnancy.
To be safe, avoid hot tubs.
Diet and exercise
Diet and exercise can have an impact on your sleep.
Drink plenty of water throughout the day, but minimize drinking after 7 p.m. Try to avoid caffeine starting in the late afternoon.
Eat to sleep
Eat a healthy dinner, but try to enjoy it slowly to reduce your chances of heartburn. Eating an early dinner can also help, but don’t go to bed hungry. Eat a light snack if you need to eat something late in the evening. Something high in protein can keep your blood sugar levels steady through the night. A warm glass of milk can help you feel sleepy, too."
"Seaneen Molloy was excited to discover she was expecting her second baby during lockdown. With a history of mental illness, she carefully planned the pregnancy, but when her baby arrived she experienced the "terrifyingly rapid" onset of a crisis which left her unable to hold baby Jack."
"Having a baby is supposed to be a joyful experience, and for lots of women it is. However, up to 20% experience mental ill health during pregnancy and the year after birth. Tragically, suicide is the leading cause of death in new mothers.
Women who already have a mental illness are at a high risk of relapse during pregnancy - that's women like me.
I have a diagnosis of bipolar disorder and an anxiety disorder. This meant that pretty much from the moment I became pregnant, the perinatal mental health team were involved.
This includes specialist midwives, psychiatrists, nurses and social workers whose goal is to support women to stay well, and intervene quickly if they don't.
Normally, I manage my mental health by being careful with my sleep and leading a pretty boring life away from overwork and alcohol, but pregnancy chucks in a host of factors you have no control over.
Hormones rage through your body, wreaking havoc upon your mood, your energy levels and your ability to keep your lunch down. You either can't stay awake or are awake for hours - peeing a thousand times and being hoofed by tiny feet.
I had managed to stay well, and off medication, for years, but in the run-up to birth antipsychotic medication was introduced to prevent postpartum psychosis. This can cause women to develop delusions and lose touch with reality.
It's the one I was most at risk of developing due to my history of bipolar disorder, but in the end, I experienced postnatal anxiety.
My mental health had been largely OK during my pregnancy and my labour and after-care were carefully planned.
I had a calm elective Caesarean section due to a traumatic first birth, a room of my own and the baby was whisked away on his inaugural night so that I could get some all-important sleep (this bit was hard - it went against every natural instinct). A procession of midwives, doctors and social workers visited to see how I was doing.
Although I found it intrusive, it helped me feel safe. When I was discharged from hospital with my baby, Jack, I felt swaddled in care and confident everything would be OK.
It was a complete shock that I did get ill.
In the chaos of newborn-life I forgot a dose of my anti-clotting medication which is given to mothers after C-sections.
And this one tiny event broke my brain.
I went from mildly chiding the home treatment team for their postnatal visits, because I was fine, to a full-blown mental health crisis within about 12 hours. It was terrifyingly rapid - which is why perinatal mental illness can be so deadly.
My mild anxiety exploded into an all-consuming panic that I was going to die imminently from a blood clot in my lung. I couldn't think of anything else but the black terror of certain death that was coming for me - how I was going to leave my children, how I'd brought a new child into the world never to know me.
I called out-of-hours GPs describing symptoms I was convinced I had, sobbed, screamed and couldn't breathe. I terrified my husband and myself.
Then we hit the emergency button.
The psychiatrist came over with the home treatment team. They took my fears seriously, which I appreciated, and gave me a physical examination and the missed dose of medication. My antipsychotic medication was increased to the maximum dose and benzodiazepines - a type of sedative - prescribed, to try and calm me down.
I wasn't allowed to be left alone and the mental health team were to visit me every day where I tried to articulate my terror to their masked faces.
At first I resented their visits, but they became a 30-minute space where I could let down the exhausting facade and share how I was really feeling.
My anxiety then transformed into an obsession that Jack was going to die. I was afraid to leave the room and rested my hand on his chest all night.
If my husband took him out to the shops with his brother, I cried and paced about, imagining they had all been hit by a car. I texted him incessantly.
Everyone was saying I needed "rest", so he tried to give me space. But after the second or third breakdown, he agreed to keep his phone on loud and to answer quickly. The home treatment team also advised he give me clear timescales so I knew when to expect them home.
But the medication also caused intense restlessness. I couldn't sit still. I couldn't get comfortable enough to hold my baby for more than a minute."
By MGH Center for Women's Mental Health | May 19th, 2021
"This is a question we often hear. One of the challenges in answering this question is the interpretation of the word “best”. On one hand, the best antidepressant is the one that is the most likely to be effective. On the other hand, the best antidepressant is the one that carries the least risk when used during pregnancy. What this means is that there is no single answer. Each situation is different, and our recommendations are based on a careful assessment of the patient’s course of illness, treatment history, past medication trials, and the most up-to-date information on reproductive safety. Added to this calculation is the understanding that untreated depression also carries some risk in terms of maternal well-being and has been associated with worse pregnancy outcomes.
Stay with the Same Treatment or Switch?
We often meet with women who have switched to a different antidepressant medication in preparation for pregnancy. Other women make a switch when they discover they are pregnant. These switches are motivated by the belief that there is a “safer” medication to be used during pregnancy. The reality is that most of the antidepressants taken by women today are relatively safe and carry a very low risk to the developing fetus. What separates one antidepressant from another is that some medications have more data to support their reproductive safety than others. But even this distinction is disappearing; we have data to support the use of most SSRIs (with less data on fluvoxamine or Luvox), the SNRIs duloxetine (Cymbalta) and venlafaxine (Effexor), and bupropion (Wellbutrin). Tricyclic antidepressants, although not commonly used today, also have data to support their reproductive safety.
We have very little data on the reproductive safety of the MAO inhibitors. In addition, MAO inhibitors may have serious interactions with other medications frequency used during pregnancy and labor and delivery, specifically medications used to manage pain, such as nalbuphine (Nubain) and meperidine (Demerol). In women taking these medications, we are likely to suggest switching to another antidepressant with a better reproductive safety profile.
At this point, we have less data on the use of the newer antidepressants. There is some data on mirtazapine, with the most recent study including 334 cases of neonates with prenatal exposure to mirtazapine. While these data are reassuring and there is no indication that mirtazapine carries significant teratogenic risk, the number of mirtazapine exposures remains small. Ideally we would like to have data from 600-700 exposures to get a better estimate of risk. Making decisions regarding safety on studies with small sample sizes can lead to miscalculations of risk in either direction.
The data is even more limited with regard to the use of vortioxetine (Trintellix), vilazodone (Viibryd), levomilnacipran (Fetzima). If there are effective alternatives, we typically recommend switching to another antidepressant.
In settings where we have limited data regarding the reproductive safety of a particular antidepressant, we may consider switching to an antidepressant with a better characterized reproductive safety profile. It is important, however, to carefully consider the benefits and risks of making this switch. With any switch, there is the risk of relapse when making a change in the maintenance treatment. Thus, there are situations where we recommend continuing an antidepressant with limited reproductive safety information because there are no effective alternatives and the risk of relapse is significant.
What About Zoloft? Isn’t Zoloft the Safest?
At some point in the early 2000s, there emerged the belief that sertraline (Zoloft) was the safest antidepressant to use during pregnancy, and many women taking other antidepressants were encouraged to switch to sertraline during pregnancy. It is somewhat unclear where this opinion came from — maybe one paper suggesting lower placental passage of sertraline compared to other antidepressants; however, there is and never was any solid data to support the assertion that sertraline is safer or the safest antidepressant. Reflexively switching women to sertraline puts women at risk for recurrent illness.
While sertraline is effective for the treatment of depression and anxiety and is a reasonable choice for many women, one problem with sertraline is that it tends to be under-dosed. The typical starting dose is 50 mg; however, many individuals will need 150 mg to 200 mg to effectively manage their symptoms. Especially when sertraline treatment is initiated in the primary care setting, we often see women whose dose is too low to effectively manage their symptoms.
What About Paxil? Doesn’t It Cause Heart Defects?
The most current data regarding the use of paroxetine (Paxil) during pregnancy does not indicate an association between the use of paroxetine during pregnancy and risk for cardiovascular malformations. However, in 2006, GlaxoSmithKline (GSK) elected to change product label warnings for the antidepressant paroxetine (Paxil), advising against the use of this drug by women who are pregnant. This decision was based on two preliminary studies which suggested a small increase in the risk of cardiovascular malformations among infants exposed to paroxetine in utero. For many years, this concern regarding risk of heart defects resulted in recommendations that women taking paroxetine should either stop paroxetine or to switch to a different antidepressant during pregnancy.
However, in 2008, a study from the Motherisk Program in Toronto reported on the outcomes of over 3000 paroxetine-exposed infants and found no association between the use of paroxetine during pregnancy and increased risk of cardiovascular malformations. Nonetheless, some women and their treaters continue to feel uncomfortable with the use of paroxetine during pregnancy. Furthermore, many websites (including reputable sites like the Mayo Clinic) continue to urge women to avoid paroxetine during pregnancy because of the risk of malformations.
At this point, we typically do not recommend switching from paroxetine to another antidepressant for pregnancy. Although paroxetine is an SSRI, there are definitely situations where an individual may respond better to paroxetine than to other SSRIs. Thus, switching to a different antidepressant may increase risk for relapse.
What About Lexapro? And Pristiq?
There are some newer antidepressants that are derived from older parent antidepressants. For example, citalopram (Celexa) is a racemic mixture, composed of R- and S-enantiomers (or mirror images) of citalopram. While the S-enantiomer is clinically active, the R-enantiomer is not. Escitalopram or Lexapro contains only the active S-enantiomer. Because the S-enantiomer is contained in the original citalopram formulation, we can infer that the reproductive safety of escitalopram (Lexapro) is the same as that of citalopram (Celexa).
Another example is desvenlafaxine or Pristiq. For venlafaxine to be effective as an antidepressant, it must first be metabolized by the body to desvenlafaxine. Pristiq contains only the active metabolite desvenlafaxine. Because desvenlafaxine is a metabolic byproduct of the original venlafaxine formulation, we can infer that the reproductive safety of desvenlafaxine (Pristiq) is the same as that of venlafaxine (Effexor).
The Bottom Line
No two situations are identical; thus, we must carefully consider each woman’s clinical history and preferences in order to select a treatment plan that makes sense. Ideally this discussion should occur long before a woman is pregnant, so that there is ample time to consider the various options and to make changes, if necessary.
When we meet with women to discuss the use of antidepressant medications during pregnancy, we typically consider a number of issues:
The perinatal psychiatry consultation should be viewed as a collaborative venture, where provider and patient decide together what is the best option for treatment during pregnancy."
-Ruta Nonacs, MD PhD
By: Love Amy Michelle | October 28, 2017
"Love Amy Michelle is a space for you to reconnect with yourself + to find some peace amidst the chaos."
Depression During the COVID-19 Lockdown Highlights the Importance of Social Connections for New Moms
By MGH Center for Women's Mental Health | May 18th, 2021
"Because pregnant and postpartum women face unique challenges in the context of the COVID-19 pandemic, they may be at increased risk for mental health problems in this setting. In a recent study, researchers from the University College of London surveyed 162 new mothers in London between May and June 2020 using a social network survey designed to assess the impact of the COVID-19 lockdown.
Almost half (47.5 percent) of women with babies less than six months of age had depressive symptoms suggestive of postpartum depression assessed using the Edinburgh Postnatal Depression Scale. This is a huge increase in the expected prevalence of postpartum depression; studies carried out prior to the pandemic have shown that about 10% to 15% of women report depressive symptoms during the postpartum period.
The researchers also observed that the more contact new mothers had with other people — whether remotely or face-to-face — the less likely they were to report depressive symptoms. While this finding suggests that social isolation incurred as a result of the COVID-19 lockdown may have increased risk for depression, another interpretation is that women with greater social networks are less vulnerable to depression (whether or not there is a lockdown). However you interpret the data, multiple studies have demonstrated that social isolation is a risk factor for depression, in general, and having adequate social support reduces the risk for postpartum depression.
We often encourage new mothers to bolster their support networks and often recommend new moms groups. While this is a reasonable approach to managing the social isolation of new parenthood, many new mothers struggle to get out of the house and are unable to establish new social networks. One of the silver linings of the pandemic has been increased access to support groups on virtual platforms. For example, Postpartum Support International or PSI now offers a wide array of online group meetings for women who are pregnant or postpartum. Whether or not a lockdown is in effect, these social networks are so important to a new mother’s emotional well-being and may potentially decrease risk for psotatum illness."
-Ruta Nonacs, MD PhD
By MGH Center for Women's Mental Health | May 6th, 2021
"While we have relatively limited information regarding the prevalence of obsessive-compulsive disorder (OC) during pregnancy and the postpartum period. Previous studies have indicated that women may be more vulnerable to the onset of OCD during the postpartum period. Other studies indicate that women with OCD may experience worsening of OCD symptoms during pregnancy and the postpartum period.
A recent study published in the Journal of Clinical Psychiatry looks at the prevalence of OCD symptoms during pregnancy and the postpartum period. They speculate that using standardized instruments for the diagnosis of OCD may fail to capture perinatal OCD, and their study incorporates a detailed assessment of obsessions of infant-related harm and corresponding compulsions.
In this study, 763 English-speaking women living in the Canadian province of British Columbia were recruited into this longitudinal study following women from the third trimester of pregnancy until 9 months postpartum. The Structured Clinical Interview for DSM-5 (SCID-5) was used to confirm DSM-5 diagnoses of OCD.
The weighted prevalence of OCD during pregnancy was 7.8%, and the weighted prevalence increased to 16.9% across the postpartum period. The estimated point prevalence of OCD diagnosis was 2.6% during pregnancy (6 weeks prior to delivery) and increased to 8.7% at 8 weeks postpartum. The point prevalence of OCD remained high (6.1%) at 20 weeks postpartum.
The incidence of new OCD cases was estimated to be 4.7 new cases per 1000 women each week during the postpartum period. By six months postpartum, the cumulative incidence of new cases of OCD was 9.0%. Most cases emerged during the first 10 weeks postpartum.
In total, the researchers observed that 100 women reported symptoms consistent with a diagnosis of OCD at some point during pregnancy or the postpartum period. In this group, 60 of the women reported onset of OCD symptoms during pregnancy or the postpartum period. The remaining 40 women reported that their OCD symptoms preceded the pregnancy.
High Prevalence of OCD During Pregnancy and the Postpartum Period
The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population in the United States. The current study indicates that the weighted prevalence of OCD during pregnancy was 7.8% and increased to 16.9% across the postpartum period. Consistent with previous studies, Fairbrother and colleagues conclude that pregnancy and the postpartum period is a time of increased vulnerability to OCD. In addition, new onset of OCD is relatively common during pregnancy and the postpartum period, with 9% of women reporting postpartum onset of OCD in this study.
These estimates of prevalence are higher than those reported in previous studies, a finding that the researchers attribute to using a more comprehensive evaluation of perinatal-specific OC symptoms, including intrusive thoughts of infant-related harm. However, the authors note that some women joined the study after childbirth and may have been attracted to the study because of their experience of postpartum intrusive thoughts. Nonetheless, this is one of the largest studies we have regarding the incidence of OCD during pregnancy and the postpartum period and is noteworthy in that it used the SCID to confirm OCD diagnoses.
Current guidelines for screening perinatal women do not specifically recommend screening for OCD. This study indicates that perinatal OCD is relatively common and the authors recommend more careful screening for perinatal-specific OC symptoms. They note that standardized assessments for OCD include questions about obsessions involving dirt, germs, arranging and ordering; however, perinatal OCD is more often characterized by intrusive thoughts related to harming the infant (e.g., unwanted thoughts or images of harming the infant on purpose, harm to the infant stemming from parental distraction or neglect, being sexually inappropriate with the infant). Furthermore, given the shameful and horrifying nature of these thoughts, many women are hesitant to share these thoughts with others."
-Ruta Nonacs, MD PhD
By MGH Center for Women's Mental Health | May 5, 2021
"At this point, nine states and Washington, DC have legalized the use of recreational marijuana. Another 30 states have legalized medical marijuana. The downstream effect of these changes has been a significant uptick in the use of cannabis among women of childbearing age. According to data collected from the National Survey on Drug Use and Health, the use of cannabis in pregnant women rose from 2.37% in 2002 to 3.85% in 2014 in the United States, noting that 21.1% of pregnant women who used cannabis reported doing so on a daily basis.
While we have data to indicate that the use of cannabis during pregnancy may negatively affect fetal growth and brain development, we have less information on how the cannabis and its byproducts, which are secreted into the breast milk, may affect the nursing infant. Here are some important things we do know:
Can cannabis be found in the breast milk?
No matter how marijuana/cannabis is consumed (smoking, vaping, or ingesting), its byproducts can be found in the breast milk. Figuring out how much is passed into the breast milk is complicated because how women use cannabis varies considerably. For example, the kinetics of smoking vary considerably from ingesting. Both cannabidiol (CBD) and the psychoactive component, delta-9-tetrahydrocannabinol or THC, have been detected in breast milk.
In the largest study to date, which included eight breastfeeding women, the amount of THC detected in pumped breast milk ranged from 0.4%-8.7% of the maternal dose, with an estimated mean of 2.5%. Using these data, the average absolute infant dose was estimated to be 8 micrograms per kilogram per day.
If cannabis is consumed, how long does it persist in the breast milk?
Cannabis concentrations in the breast milk are variable and are related to maternal dose and the frequency of dosing. However, there are some things that make cannabis a little different than alcohol or other recreational drugs. Cannabis and its byproducts are very fat-soluble or lipophilic. Because in women the percentage of body fat is 25-30%, there is a large reservoir for the storage of cannabis. What this means is that it takes much longer for cannabis to leave one’s system, compared to substances like alcohol. Furthermore, there is an especially long washout period in those who have been daily users. Long after the psychoactive effects have faded, THC and its metabolites can be detected in blood, urine, and breast milk.
Studies focusing on the detection of THC in milk have yielded variable results, with duration of detection ranging from 6 days to greater than 6 weeks in various studies. The most recent study from Wymore and colleagues In a recent study, Wymore and colleagues collected data on self-reported marijuana usage and measured levels of THC in maternal plasma and breast milk samples several times a week. In all 25 participants, THC was detectable in breast milk throughout the six week duration of the study.
The researchers estimated the mean half-life of THC in breast milk to be 17 days (SD 3.3). Based on this estimate, they calculated that it would be possible to detect THC in breast milk for longer than 6 weeks. In addition, the researchers were able to calculate a milk:plasma partition coefficient for THC which was approximately 6:1 (IQR, 3.8:1 – 8.1:1). Milk:plasma ratios give us a sense of how easily a compound passes from the mother’s bloodstream into the breast milk and can be used to estimate the amount of exposure through breast milk. Most M:P ratios for drugs commonly used in breastfeeding women are around 1 or less than 1; thus, an M:P ratio for THC of 6 is high and suggests that levels of THC in the breast milk may be higher than in the mother’s bloodstream.
The findings of the Wymore study are consistent with previous studies measuring THC in breast milk which observed a duration of detection ranging from 6 days to greater than 6 weeks after using cannabis. The longevity of THC in the breast milk may be related, in part, to the extremely high fat content of breast milk and the lipophilic nature of THC, so that the breast milk “traps” the THC, in a sense acting like a reservoir for THC storage.
What are the effects of exposure to cannabis in the nursing infant?
The bioavailability of cannabis and its metabolites ingested by neonates in the breast milk has not been well-characterized. There are conflicting data regarding the outcomes of infants exposed to cannabis during breastfeeding and very few studies assessing outcomes in this population. These studies are not easy to conduct. First of all, recreational use of cannabis continues to be illegal in many states. Furthermore, it is difficult to disentangle the direct effects of cannabis delivered in the breast milk from the indirect effects of cannabis on the quality of childcare and parenting, especially in heavy, chronic users or when cannabis is combined with other substances.
In one study, 136 breastfeeding infants were assessed at one year of age. In the 68 infants exposed to cannabis during the first month of life, there was evidence of decreased motor development at one year, when compared with matched infants who were not exposed to cannabis. Specifically, there was a 1465-point decrease in the Bayley index of infant motor development. However, the authors of this study cannot conclude that these findings were entirely due to exposure via breastfeeding, as many of the women also used marijuana during pregnancy.
In another study, 27 breastfed infants exposed to cannabis were compared to 35 unexposed breastfed infants. At one year, no differences were noted for motor and mental development using the Bayley Scales of Infant Development. However, the small size of this study limited statistical analysis.
So the jury is still out regarding the effects of cannabis on the nursing infant.
All women should be screened for drug use as a component of standard prenatal care. Screening for substance use should occur during the course of pregnancy with the goal of providing information regarding the potential adverse effects of cannabis and to ensure referral to appropriate resources for treatment as needed. Because many women are able to abstain from substances during pregnancy but resume use after delivery, screening must be repeated during the postpartum period.
Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics recommend that women refrain from using cannabis during pregnancy and while breastfeeding. Because of the persistence of cannabis and its byproducts in the breast milk for days to weeks, using cannabis and waiting for it to clear out of the breast milk is not a viable option. For women who use cannabis for medical indications, alternative therapies with more safety data during breastfeeding should be considered."
-Ruta Nonacs, MD PhD
By: Becky Vieira
"Dear Husband-I see you. Then and now. You might not think I did.
I try to imagine what you endured. The pain, fear. While the primary focus was on me, my health and recovery, I know you were suffering also. Silently. Never saying a word of complaint.
I recognize all you did to get me where I am today. To get us here.
We thought we’d just be tired. That exhaustion would be the biggest of our problems once our son was born. Neither of us expected that I’d be gripped – no, controlled – by my postpartum depression. It was supposed to be the happiest time of our lives, not the living nightmare it soon became.
It started slowly, do you remember? We thought I was tired. That my hormones were adjusting yet again. But before we knew it I was underwater. The progression from healthy to dangerous transpired within days once that beast took hold of me.
How did you do it? We had a newborn. No idea what to do with him. You carried that aspirator in your back pocket at all times “just in case.” And while we watched him sleep for fear something would happen if one of us closed our eyes, I began losing my fight.
Yet you continued on.
I started to slip away. I wanted to leave, convinced you both would be better off without me. You held me when I needed it. Let me run into the street to scream, then greeted me at the door with a warm blanket and tea when I returned. Researched treatment. Medications. Called my doctor and hid my car keys when things got dark.
You also got up every morning and went to work. Held things together for us financially. All while receiving frantic calls from me. Coming home between meetings, at lunch. To check on us.
There was no guidebook for you. No one you could call to ask questions on how to handle the situation. I was wrapped in the support I found online from other mom’s with postpartum depression. But what did you have? No men on social media were presenting themselves as the husbands of women with PPD. You had nowhere to turn.
There are resources for PPD. Help. But no one can really tell you how to live through it. It felt as if we were thrust into a new universe, one that spoke an entirely different language. My mind started lying to me and my will to live was faltering. Our coping skills were stripped away and we had to find a way to survive. I needed to be healthy again.
You kept going, for all of us. Trusted your instincts and did the best you could. Yes, there were moments when I was angry over the things you said or did. But today I see that it was in my best interest. You always tried to help.
Even when I screamed at you and said horrible things. Threatened to walk out of your life because I was convinced you deserved better than a sick wife. You never gave up.
You should be proud of yourself and recognize all you did. I’m proud of you. And grateful you stayed by my side. I’ll never forget sitting on the kitchen floor, crying to you as I said, “I’m crazy.” You kissed me and said, “then I guess I’m crazy, too.” Our tears turned to laughter and I knew I’d never be alone.
We survived and our marriage is actually stronger today because of all we endured. You held it together so that I could fall apart safely. And then build myself back up again.
Yes, I spoke up. Got help. Worked on myself, started taking medication. But it would have been much harder without you by my side.
I know you suffered. Were scared. And probably angry, frustrated and hopeless at times. But I never saw that. I only felt loved and supported.
Thank you for everything. I see you and what you did for me and our family. And I’ll never forget."
"If you think you may be suffering from postpartum depression, don’t wonder. Speak up. Talk to you doctor, partner, family and friends. If you are scared or worried about the stigma (I get it… we shouldn’t be concerned about that but of course we often are) and would rather talk to someone outside of your circle, you can call Postpartum Support International at 1.800.944.4773. If you just need a fellow mom to validate you and listen to your fears, find me on Instagram and reach out.
Anxious, overwhelmed, unhappy, or scared by how you feel? If you’re struggling emotionally, you could be depressed. Take this 10-question quiz to find out."
By: Melissa Willets
"If you're like me, your answer to the question: "Should I have another baby?" changes by the hour. I gaze at my sleeping, angelic children, snug in their beds at night, and think, YES! Definitely, the sooner the better, NOW. Then my kids are screaming, fighting over a single, blue crayon, and it's, NO! NO! NO! No more kids, ever.So how do you cut through those everyday moments of indecision, to get to the real answer of whether you should have another baby? Try asking yourself these six things:
1. How do you feel when you get your period?
Is it, relief or sadness? Last month my period was a welcome relief. I have a 10-month-old baby, a three-year-old, and an almost six-year-old. We've got enough going on! But this month it was different. I felt a little sad, and began to think, what if? What if our family is not quite complete yet? What if we had another baby?
2. How do you feel when you see a newborn?
Do you feel love sick, or just sick? I see an infant, and my heart swells. An involuntary, "aww," escapes my lips. I can't help it! I love how a newborn smells, I love her soft, delicious skin. Babies are heaven, pure and simple. And having another one is starting to feel like the greatest idea ever!
3. What do you picture your life to be like with another child?
Is life overwhelmingly hectic or charmingly challenging? I don't picture a scenario replete with loud crashes, screaming children, me trembling, gripping a too-full glass of wine, crying in frustration, as little people slowly take over my house, and my life. Instead, I see happiness. I picture smiles, hugs, cuddles, love and giggles. Oh, there's craziness too, believe you me. But mainly I hear The Beatles' song "All You Need Is Love," playing in my head when I imagine being a mom to four kids.
4. What would life be like if you didn't have another baby?
Arrow straight through the heart. Ouch. No, the truth is I've felt conflicted about having another baby for a while. Life is great the way it is. Life is full. We are parents to three, beautiful, funny, silly, smart, wonderful girls. Why mess with what is working pretty darn well for us? When I think this way, another baby seems like a bad idea...
5. What is your biggest reason for wanting another baby?
Is something still missing? Or, is it just hard to imagine closing that door yet? There are so many reasons I want another baby. I still long to feel a baby kick inside of me. I yearn to hold a newborn in my arms, knowing that I did that; I made that. I have also loved, loved seeing how my children love, and care about each other. Being witness to their sisterly bond has been the greatest privilege of my life. I know that adding to our family would just bring more love, and joy.
6. What is your biggest fear about having another baby?
I worry about tempting fate if we have another baby. Can I really be lucky enough to bring four healthy babies into the world? No one could be that lucky; it just isn't fair. Right? Sigh. I don't know."
By Uma Naidoo | December 07, 2018 | Updated March 27, 2019
"The human microbiome, or gut environment, is a community of different bacteria that has co-evolved with humans to be beneficial to both a person and the bacteria. Researchers agree that a person’s unique microbiome is created within the first 1,000 days of life, but there are things you can do to alter your gut environment throughout your life.
Ultra-processed foods and gut health
What we eat, especially foods that contain chemical additives and ultra-processed foods, affects our gut environment and increases our risk of diseases. Ultra-processed foods contain substances extracted from food (such as sugar and starch), added from food constituents (hydrogenated fats), or made in a laboratory (flavor enhancers, food colorings). It’s important to know that ultra-processed foods such as fast foods are manufactured to be extra tasty by the use of such ingredients or additives, and are cost effective to the consumer. These foods are very common in the typical Western diet. Some examples of processed foods are canned foods, sugar-coated dried fruits, and salted meat products. Some examples of ultra-processed foods are soda, sugary or savory packaged snack foods, packaged breads, buns and pastries, fish or chicken nuggets, and instant noodle soups.
Researchers recommend “fixing the food first” (in other words, what we eat) before trying gut modifying-therapies (probiotics, prebiotics) to improve how we feel. They suggest eating whole foods and avoiding processed and ultra-processed foods that we know cause inflammation and disease.
But what does my gut have to do with my mood?
When we consider the connection between the brain and the gut, it’s important to know that 90% of serotonin receptors are located in the gut. In the relatively new field of nutritional psychiatry we help patients understand how gut health and diet can positively or negatively affect their mood. When someone is prescribed an antidepressant such as a selective serotonin reuptake inhibitor (SSRI), the most common side effects are gut-related, and many people temporarily experience nausea, diarrhea, or gastrointestinal problems. There is anatomical and physiologic two-way communication between the gut and brain via the vagus nerve. The gut-brain axis offers us a greater understanding of the connection between diet and disease, including depression and anxiety.
When the balance between the good and bad bacteria is disrupted, diseases may occur. Examples of such diseases include: inflammatory bowel disease (IBD), asthma, obesity, metabolic syndrome, diabetes, and cognitive and mood problems. For example, IBD is caused by dysfunction in the interactions between microbes (bacteria), the gut lining, and the immune system.
Diet and depressionA recent study suggests that eating a healthy, balanced diet such as the Mediterranean diet and avoiding inflammation-producing foods may be protective against depression. Another study outlines an Antidepressant Food Scale, which lists 12 antidepressant nutrients related to the prevention and treatment of depression. Some of the foods containing these nutrients are oysters, mussels, salmon, watercress, spinach, romaine lettuce, cauliflower, and strawberries.
A better diet can help, but it’s only one part of treatment. It’s important to note that just like you cannot exercise out of a bad diet, you also cannot eat your way out of feeling depressed or anxious.
We should be careful about using food as the only treatment for mood, and when we talk about mood problems we are referring to mild and moderate forms of depression and anxiety. In other words, food is not going to impact serious forms of depression and thoughts of suicide, and it is important to seek treatment in an emergency room or contact your doctor if you are experiencing thoughts about harming yourself.
Suggestions for a healthier gut and improved mood