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By: Daniel R. George, Ph.D., M.Sc. | July 7, 2022 "This post is authored by Mariam Shalaby, a 4th-year medical student at Penn State College of Medicine"
"It is a tumultuous time in the U.S.—politically and socially—and many of us in the field of mental health are additionally tasked with the responsibility of caring for the emotional needs of others. This can be taxing, even for someone like myself who is a medical student training in psychiatry. What are practical steps we can take to maintain a productive and caring presence amidst national turmoil? A day in the life of a mental health trainee As a fourth-year medical student, I spend a month at a time training in different locations. Recently, I have been training at the local psychiatric hospital, where patients are cared for when their mental illness leads them to be at risk of harm to themselves and/or others, or unable to care for themselves. Waking up on a recent Wednesday morning, the first thing did was check my phone. Texts from loved ones working through personal problems flooded my screen. I sent a quick reply — “Thinking of you” — before switching apps to scroll through cute cat videos interspersed with passionate 30-second video clips about baby formula shortages and another school shooting. I clicked my phone screen off before taking a deep breath and getting ready for the day. Driving to the hospital, I noticed the fluffy clouds and the blue sky above me. It was a pretty June day—a peaceful morning. Merging onto the highway, I noticed the car in front of me. Pink paint emblazoned on its trunk exclaimed: “PAWS OFF ABORTION! STOP CONTROLLING WOMEN.” My chest tightened. I walked into the hospital and sat down for rounds, which is when the team meets with every patient to talk about how they’ve been and discuss their treatment plan. We interviewed eight patients in a row. When I asked one patient what led her to attempt suicide, she looked at me in the eye and said, matter-of-factly, “I was sexually abused by my father as a child, I have struggled with cocaine use for many years, and I am dealing with unresolved grief from the loss of my husband due to overdose.” I gulped, and said, “I’m so sorry to hear that.” Inside, I panicked: What is going on, and how are we going to fix it? Finally, we finished rounds. I took a break for lunch at the neighborhood Italian bakery and noticed an enormous plywood sign in front of one of the houses across the street: “FROM IRELAND TO PALESTINE, OCCUPATION IS A CRIME” it screamed at me in black spray paint. I took a deep breath and tried to notice the taste of my pizza and the sound of the birds. The time passed too quickly, and soon it was time to return to work. When I finally arrived home at the end of the day, I felt drained. I had little energy to do anything at all. And it was only four o’clock; I had gotten home early. I resorted to looking at my phone, and found myself once again watching silly videos that left me feeling just as tired as when I got home. Taking stock I’m grateful that, like many other professional Americans, my basic needs for food, water, and safety are met. And I’m grateful to serve in a role that helps others find stability in their lives. But these days, a sense of vigilance and worry often consumes me. Many of us wake up daily to an overstimulating digital atmosphere, a turbulent sociopolitical landscape, and an emotionally taxing job. I walked through the day on edge, alert for threat. While there are practical ways of responding to outside threats to our senses of security and calm, such as participating in activism about causes we care about and doing our best to care for patients, addressing inner sensations of stress in response to those threats isn’t always so clear. Simply telling myself to “calm down” doesn’t work. Trust me, I’ve tried. That said, here are a few things that I have found to be helpful:
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Tiffiny Hall | TEDxDocklands | March 15, 2019 "Tiffiny Hall is founder of TIFFXO.com and author of nine books. She is passionate about helping women feel confident and strong. Tiffiny explores the pressures placed on women to bounce back and lose weight after they give birth and shares her experiences in dealing with the bounce back culture after she had a baby. Speaking on the importance of mind over matter during the fourth trimester, Tiffiny shares her tips to help women gradually return to fitness after pregnancy and birth. Celebrity trainer, founder of lifestyle program TIFFXO.com, author, podcaster and martial arts expert, Logie nominated Tiffiny Hall has many titles tucked under her 6th Dan Taekwondo black belt.
Tiffiny Hall is a one-woman fitness business, with over 20 years’ experience as a personal trainer and coach. Expert in HIIT and HIRT, she rose to prominence on TV in many roles from a Gladiator on Gladiators to a trainer on The Biggest Loser Australia and is now transforming devotees – from athletes to new mums – via her very successful health and fitness app TIFFXO.com. She is a mum, mentor and magnate. One of the most qualified martial artists in the world for her age, she’s a 6th Dan Taekwondo black belt and has mixed martial arts workout plans that will kick your butt in the best possible way. She is the Director of Training for the largest global fitness app in the world. A role that has seen her travel the world & work with the most famous and prestigious experts in the wellness space This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx" 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: Lindsay Dolak | Editor at Aaptiv | August 6, 2020 "No matter how fit you were before and even during pregnancy, postpartum exercise presents a unique set of challenges. Your body is still healing from delivery, and with a newborn in the house, you might be feeling more tired than ever. But finding time to fit in fitness is amazing for both your body and mind—it can be just what you need to get back to feeling like your pre-pregnancy self. No, we’re not talking about “getting your body back.” We’re talking about a boost to your energy, self-confidence and physical strength. Plus, you’re bound to sleep better too. Do we have your attention now? Here, two trainers from Aaptiv—a fitness app offering trainer-led, music-driven audio workouts—break down why you should start a postnatal fitness routine, and how to do it.
Benefits of Postpartum Exercise Postnatal exercise brings a host of positive benefits to your body, but also for your mood and stress levels. Fitness not only helps your body heal but also provides an outlet to recenter and focus on yourself—something that might feel a bit out of reach now that you’re caring for another tiny human. “Postpartum exercise gives moms back that feeling of being in control,” says Aaptiv trainer Candice Cunningham, an ACE-certified personal trainer and Fit For Birth pre- and post-natal corrective exercise specialist. “It’s a huge stress-reliever and also gives new moms something to really focus on for themselves.” Aaptiv trainer and mom Jaime McFaden, an ACE-certified pre- and post-natal fitness specialist and health coach, agrees, adding that consistent exercise post-baby provides a huge boost in not only physical strength, but mental strength as well. “You just went through so many changes—things have shifted. Exercise helps you heal from the inside out,” she says. In addition to the many mental and emotional benefits, postnatal fitness can lead to weight loss, improved strength (carrying around a baby all the time is no joke), better sleep and more balanced hormones—a must after nine months of ups and downs. When to Start Postpartum Exercise First things first: Don’t jump into a postpartum exercise routine without your doctor’s approval. Many doctors recommend waiting six to eight weeks after birth before starting trying any type of exercise, but it often varies. Some women may experience complications during pregnancy or labor that might set them back a few more weeks. For example, a mother who had a vaginal birth will likely have a different timeline than one who had a c-section. And others may even be able to work out sooner than six weeks. According to McFaden, working out during pregnancy may help when it comes time to start exercising again. “Your body’s muscle memory will kick in and you’ll have an easier time getting back into it after birth,” she says. “You still want to give your body time to recover, though. Never push yourself too hard post-baby. Patience is key.” No matter what, it’s crucial to work with your doctor to find out exactly when is right for you and your body. “Every mom is different and it’s important to pay attention to stresses the body may undergo post-pregnancy,” Cunningham says. “A doctor will be able to check for an indication of diastasis recti (the separation of the abdominals) and be able to recommend the appropriate physical work to heal that or any other side effects of childbirth.” There’s no real reason to rush back into exercising early anyways. In fact, it can cause you more harm than good down the line. It might be hard for women used to high intensity workouts or long runs, but taking it slow is key. When you’re ready, start by adding walking and low-impact bodyweight exercises at first. Aaptiv’s fourth trimester program meets new moms where they are and focuses on building back up to regular workouts. It covers core, strength training, outdoor walking and elliptical, and places special emphasis on healing the pelvic floor muscles and not aggravating a diastasis recti—both of which are crucial for new moms with recovering bodies. Don’t worry, you’ll gradually work your way back to sprints and burpees in no time. Best Postpartum Workouts Before you starting working out again, it’s important to temper your expectations. Your body is different now and you won’t immediately be as strong as you once were. Start with simple, functional exercises you can ultimately build on. To get you started, we asked McFaden and Cunningham to share some of their favorite postpartum exercises to work your entire body." 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! Weight gain 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. Cardiovascular disease “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. Poor libido 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 cancer “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. Insomnia 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. Thinning hair 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: 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: Nourish with Melanie McGrice "So you've just found out you are pregnant, congratulations!! It’s an exciting and happy time. But, it can also be very overwhelming! If you’re wondering which foods to avoid when pregnant, you've come to the right place. In today's episode of Nourish, prenatal dietitian Melanie McGrice reveals her list of the 21 most important foods to avoid when pregnant, and when you can eat them again. Enjoy!" "Pregnancy puts a lot of strain on your body, including at bedtime, which is why finding the best pregnancy pillow is so essential for many women. Find a little relief for those aches and pains by sleeping with a pillow that’s designed to cradle and comfort your pregnant shape. The latest pregnancy pillows come in a wide array of sizes and shapes to fit your particular needs, whether you’re looking to alleviate back pain or to find a positioning solution as a stomach sleeper From full-body styles to wedges, the options are plentiful. Some favorite brands include Boppy and Leachco, but they’re not the only brands to shop for some of the best pregnancy pillows available in 2020. Below are seven pregnancy pillows we recommend for an amazing night of sleep." Moonlight Slumber Comfort-U Total Body Support Pillow "The Comfort-U Pillow by Moonlight Slumber cushions every curve of your aching body with Fusion Foss fiber. It feels soft and stays soft, but it also provides support where you need it most with its classic “U” shape. This is the perfect pregnancy pillow if you want to feel like you’re engulfed in a giant cloud. ($99.95; amazon.com)" Boppy Total Body Pillow in Ringtoss "Need a lift? We love the Boppy Total Body Pillow for moms who need a little extra support to ease those tired muscles and aching joints. Firmly filled and shaped to fit your pregnant curves, this maternity body pillow might just be your new best friend. ($49.99; buybuybaby.com)"
By: Cedars-Sinai Staff| October 21, 2019 "The biggest misconception women have about exercising while pregnant is that they can't do it at all, says Dr. Keren Lerner, OB-GYN at Cedars-Sinai. "It's not uncommon for women to wonder if working out during pregnancy will put the baby at risk," says Dr. Lerner. "I get asked that a lot." Not only is it safe for pregnant women to exercise, but engaging in physical activity while pregnant can be beneficial for the health of a woman and her baby. It can reduce the risk of preeclampsia, gestational diabetes, and hypertensive disorders during pregnancy. It can also minimize discomfort. The American Pregnancy Association recommends at least 30 minutes of physical activity every day for women who have a normal, healthy pregnancy. The best types of workouts for pregnant women It's important to know that not all pregnancy workouts are created equal. Dr. Lerner says workouts like Barre and Pilates are great because they focus on core strength, which can make the delivery and recovery process easier. "Prenatal yoga classes can be great for mind, body, soul, and core," Dr. Lerner says, as long as women are careful not to overextend their backs with deep bends or twists. She also recommends swimming, especially in the third trimester. "When there's more weight being carried, a lot of women end up with back pain," Dr. Lerner says. "Because gravity is less of an issue in the water, women tend to be more comfortable in the pool." No matter what workout they choose, pregnant women should drink plenty of water and take a rest if they start to feel dizzy or lightheaded while exercising. Workouts to avoid when pregnant All pregnant women should avoid contact sports, as well as activities like skiing, snowboarding, rock climbing, horseback riding, and scuba diving. If the pregnancy is high risk, women should talk to their doctor about their workout options. Women should also seek medical advice if they get injured while exercising. While 30 minutes of daily activity during pregnancy is recommended, women who enjoy working out aren't limited to this, Dr. Lerner says. "Certainly those who are used to working out or have active jobs or lifestyles can endure more," Dr. Lerner says. "They just need to be sure they're listening to their bodies." "How can you tell if you're struggling with mental health during pregnancy and postpartum?" By: Women's College Hospital "Women who had Covid while expecting experienced guilt, shame and unhealthy levels of stress." By Katharine Gammon | December 14, 2020 "Kate Glaser had chalked up her exhaustion to being 39 weeks pregnant and having twin toddlers in the house. She also wondered whether her flulike symptoms were a sign that she was about to go into labor. But when she woke up one morning with a 100.4-degree fever, she called her doctor and got a rapid Covid-19 test. Two nurses came to deliver her results to her in the waiting room. They were dressed in full gowns, masks, face shields and gloves. “I knew by the eerie silence and the way they were dressed that I was Covid positive,” she said. “It was an emotional moment; I felt really disappointed and shocked and, as a mom, I felt a lot of guilt. What did I do wrong?” Glaser, who lives in the Buffalo, N.Y., area, returned home and isolated from her husband and the twins in her bedroom, where she spent hours mentally replaying all her activities leading up to the positive test result. She also made a public post on her Facebook page about her positive status, and what she was feeling — guilt, embarrassment and panic. The post went viral, and Glaser started hearing from women around the world who were pregnant and worried about Covid-19. The majority of the of the 2,300 comments she received were supportive; a few were harshly critical. “I was going down a rabbit hole of guilt and stress,” Glaser said, adding that for her, as much as the physical symptoms were bad, the mental stress of Covid was much worse. Prolonged stress can have real consequences on pregnant people even outside of a pandemic and has been tied to low birthweight, changes in neurological development and other health impacts in children. And the pressure associated with a positive Covid-19 test increases these mental health risks. The anxiety is not without reason. As of November 30, there have been more than 42,000 cases of coronavirus reported in pregnant women in the U.S., resulting in 57 maternal deaths. U.S. health officials have said pregnancy increases the risk of severe disease for mother and child, and being coronavirus-positive in late pregnancy may increase the rate of preterm birth. Prenatal care and birth plans are also disrupted by a positive test result. “Women are expressing so much fear about being infected, but also about going to the hospital, delivering and being separated from their child,” said Laura Jelliffe-Pawlowski, an epidemiologist who is the primary investigator of HOPE COVID-19, a new study that focuses on the well-being of women who are pregnant during the pandemic. The study launched in July and will follow more than 200 women around the world, from pregnancy to 18 months postpartum, to understand how Covid-19 and the pandemic response impacts pregnancy and infant health outcomes. Dr. Jelliffe-Pawlowski and her team have analyzed the data from the first group of women, and they are finding “absolutely incredible” levels of stress and anxiety. “Sixty percent of women are experiencing nervousness and anxiety at levels that impede their everyday functioning,” she said, citing preliminary data. “There are a number of women, particularly lower-income women, expressing how hard it is to choose to stay in a job that puts them at risk versus quitting the job and not having enough food for their baby.” Nearly 70 percent of the participants reported feeling worried about decreasing family income and more than 22 percent worried about food insecurity (though none had experienced it at the time of the survey). Dr. Jelliffe-Pawlowski worried that women were not necessarily getting the psychological care they needed: “If you can’t feed your family, seeking out mental health care is not your top priority.” She also said more than 84 percent of women reported moderate to severe anxiety about giving birth during a pandemic. “Many women do not want to get tested because they will be stigmatized or separated from their baby or not allowed to have people in the room to support them,” she said. She added that similar visiting rules often hold true for babies in the NICU after being born preterm during the pandemic: Only one parent can be present in a 24-hour period. “It’s heart-wrenching to see families go through those choices.” Dr. Jelliffe-Pawlowski is particularly interested in how stress impacts births and long-term outcomes for children as psychological stress is highly associated with preterm birth. After the attacks of September 11, 2001, the risk of preterm births almost doubled for people living near or working at the site of the fallen towers. She’s also concerned about long-term effects of stress and anxiety on maternal bonding during the pandemic. Margaret Howard, a psychologist at Women & Infants Hospital in Providence and postpartum depression researcher at Brown University thinks it is absurd for pregnant women who test positive for an infectious virus to bear any guilt or stress associated with their diagnosis: “Are moms in a special category where they are expected to not get Covid? What about a sinus infection? Hay fever? Cancer? Why is Covid a moral failing for mothers?” When Erica Evert, a pregnant mom in northern Virginia, received her postive Covid-19 test result, it didn’t make sense. She was near the end of her pregnancy, and hadn’t left the house in four and a half months, except for ob-gyn appointments to check on the baby. “My first thought was, is this a false positive? I feel fine. And my second reaction was to start bawling,” said Evert. She was scheduled to have a cesarean section with her second baby and the test was merely a formality — until it was a life-changing event. The hospital gave her a choice: She could deliver the next day and be treated as a Covid-19 patient — separated from her baby with no skin-to-skin contact, per the hospital’s policies. Or she could wait 10 days from the date she received the positive test result and deliver with her regular plan. She had four hours to make a choice she wasn’t expecting. “I kept thinking: am I going to make a decision that results in my child dying?” said Evert." A Dietitian's Guide To Eating During Each Trimester of Pregnancy | You Versus Food | Well+Good3/15/2021
"Registered Dietitian Tracy Lockwood Beckerman gives tips on the most nutritious foods to eat to support your baby in each trimester of your pregnancy."
How racism can impact your pre- and postnatal care — and advice for speaking to your Ob-Gyn about it. By Erica Chidi and Erica P. Cahill, M.D. | October 22, 2020 "The data is heartbreakingly clear: Black women in America have more than a three times higher risk of death related to pregnancy and childbirth than their white peers. This is regardless of factors like higher education and financial means, and for women over 30, the risk is as much as five times higher.
While the recent national dialogue created in response to the data has been a critical leap forward, it has also brought up a lot of fear and questions from Black women about how we can prevent these outcomes. Last year, we sought out resources to help Black women navigate their prenatal and postpartum care in light of this knowledge, but came up empty when looking for a resource that explicitly called out encountering racism during this time and how to tackle it. As a result, we partnered to create an education guide that would offer pregnant Black women agency when planning their care (which, in most cases, would be with white care providers). We felt it required an allied, intersectional perspective that acknowledged the importance of care providers and health educators working together on behalf of patients. We aimed to have a discussion with medical racism and antiracism at the center, especially since increasing evidence points to the effects of structural racism as the reason for this mortality inequity. Medical racism is present whenever health care professionals or institutions alter the diagnostic or therapeutic care provided because of a patient’s race, particularly if the decision puts the patient at an increased risk of poor outcomes. We wanted to inform Black women of the unique risks they could encounter during their pregnancy, birth and the postpartum period, as well as what they could do to prepare for them. This guide is meant to help Black women feel safer, and to provide a modern framework for medical providers to actively address their own racism." By Hilda Hutcherson| September 4, 2020 "Often misunderstood and misdiagnosed, PCOS can play havoc with your fertility. Here’s how to recognize the symptoms and take action to protect your reproductive health." "Caroline’s mother was concerned when she turned 15 and hadn’t had her first period. It finally came, but it wasn’t until three months later that she’d get her second. Her gynecologist assured her that irregular periods were common for someone her age, so Caroline’s mother didn’t worry. Then, at 18, her periods disappeared for six months. This time, her college ob-gyn said that the stress of college often causes menstrual periods to wane, and that the best treatment was hormonal therapy to make her periods regular. So she started taking birth control pills.
Thirteen years later, she was ready to have a baby and stopped taking them, assuming that since she was older and not under as much stress, her periods would become more regular. But they didn’t. She also noticed increased acne and facial hair. After six months of trying unsuccessfully to conceive, she started taking her temperature and using an ovulation predictor kit. Both revealed that she was ovulating infrequently and irregularly. The question was why? Many women with irregular periods are told it’s no big deal. Even her acne and facial hair didn’t throw up a red flag. Fortunately, tests eventually led to an accurate diagnosis: she had polycystic ovary syndrome (PCOS), a hormonal disorder that disrupts women’s fertility and may cause a host of other health issues. As many as 15 percent of women between 18 and 45 have PCOS, making it the most common hormonal disorder among women of childbearing age. For this guide, I reviewed the current literature and interviewed Beth Rackow, M.D., a reproductive endocrinologist and director of the pediatric and adolescent gynecology program at Columbia University Irving Medical Center. What to do:
Know the signs and symptoms Polycystic ovary syndrome is a common hormonal disorder among women, yet often goes underdiagnosed by health care providers. Some women have few, if any, symptoms. Others have many — irregular or absent periods, excess facial or body hair growth (hirsutism), obesity and infertility — but they may be mistaken as signs of other health conditions. Irregular, unpredictable periods are one important symptom. Periods may come twice a month, be infrequent (greater than 35 days apart) or disappear for months at a time. They may be light or they may be heavy enough to cause anemia. You may suspect PCOS if you also have acne that doesn’t respond to treatment or increased growth of facial or body hair. These are signs of excess androgen hormone. Eighty percent of women with hirsutism have PCOS. PCOS may appear as early as adolescence. “Girls with PCOS typically present when they haven’t had their first period when they should have, their periods are very infrequent or they are having frequent, heavy periods,” said Dr. Rackow. It’s common for menses to be irregular in girls during the first year or two after the first period. Acne is also common during adolescence. However, if menstrual periods continue to be abnormal after the first two years, or if bleeding is persistently heavy at any time, an evaluation is needed." By Sneha Kohli Mathur, CNN| August 28, 2020 "Nima Bhakta was that college friend who everyone knew would be a great mother.
We met in 2006, and I could see that she was always at ease when she interacted with children. Kind and confident, she was also the friend who talked about how excited she was to have children of her own. That's why it was such a devastating loss to her family, friends and to me, when she lost her battle with postpartum depression and died by suicide on July 24. Suicide is one of the leading causes of death in women with postpartum depression. In a letter to her family before she died, Nima wrote that she tried to tell her loved ones about her struggle with postpartum depression but she hadn't been able to find the words to explain the depth of her suffering. She wrote that she had a loving and supportive husband and that no one was at fault for her pain. It started, she wrote, after her son was born in 2019. She felt completely changed as an individual, wife, sister, daughter and aunt, and she didn't understand how she couldn't even attempt cooking or other things that she once enjoyed. Her constant worry about the future and self-blame for any difficulties with her son overwhelmed her. She got to the point that she believed that she was a complete failure as a mother and was scared that she would cause him harm in the future. Throughout her letter was a sense of shame for needing help taking care of her son, and guilt that she wasn't feeling better despite having an incredibly supportive husband, Deven Bhakta, and her sisters and family. In her text messages to me she expressed she was experiencing postpartum depression. "Everything I do for Keshav just seems like a task for me, it's been hard to have that bond between me and him. Really didn't expect all this since I love kids but with Keshav I've been struggling. I haven't been out of the house either unless it's for a doctor appointment, it's pretty bad. Deven's been such a big help it's ridiculous." She couldn't see what a wonderful mother she was to her beautiful baby boy. I saw her as a devoted mother diligently attending to all of his daily needs. I could see she loved him so much. How did a mother who didn't have any of the risk factors for PPD -- factors that include a personal or family history of depression and lack of social support -- still succumb to it? It can be harder for Indian women like us to ask for psychological help because these issues are not always discussed in our community, but there are other reasons women suffer from this misunderstood condition. What is postpartum depression? During pregnancy and in the hours after childbirth, women experience a dramatic drop in their estrogen and progesterone hormone levels, and that fluctuation is thought to contribute to postpartum mental health problems, according to the American College of Obstetricians and Gynecologists. In addition to the changes in hormones, emotional factors, fatigue and general life stressors may contribute to PPD, experts say. Postpartum depression may begin in the days or weeks following childbirth, or it may begin months later, and it can last weeks, months or years if untreated. While the experience of PPD can look different for each woman, common symptoms include a loss of pleasure or interest in doing things she once enjoyed; eating and sleeping much more or much less than usual; experiencing panic attacks or anxiety most or all of the time; feelings of guilt, worthlessness and self-blame; sadness or crying uncontrollably; fear of not being a good mom; fear of being alone with the baby or disinterest in the baby; difficulty making decisions; and thoughts of hurting oneself or the baby. Postpartum depression is not the so-called "baby blues," which 70% to 80% of all moms experience, according to the American Pregnancy Association. While baby blues may begin soon after birth, its symptoms -- which can include crying for no apparent reason, anxiety, insomnia and mood changes -- should dissipate two weeks after childbirth. If they continue past two weeks, mothers should be examined for postpartum depression." |
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