By Dr. Sonal Patel
"The 4th trimester is three months after the birth of a baby more commonly referred to as postpartum. By relabeling it as the 4th trimester, society, science, and the medical community can better understand the massive changes mothers are going through while newborns are adjusting to the world outside the womb. The most alarming data in discussing the 4th trimester is the fact that we are losing more moms during this period than the first three trimesters combined. Dr. Sonal Patel explores the economic impact of losing moms during the 4th trimester, a solution that can reduce maternal mortality, and thus positively impact our national economy. Dr. Patel's journey started as a moment of exhaustion in her own 4th trimester courtesy of her 4 sons and now is creating a movement of truly understanding the socioeconomic impact of maternal mortality. Sonal Patel is a board-certified pediatrician, neonatologist, and breastfeeding specialist. Born in Lucknow, India, her family moved to Omaha, Nebraska when she was 9. She attended Emory University, Atlanta, Georgia, from 1995-1999. She studied medicine at the University of Nebraska Medical Center graduating in 2003. She did her pediatric training at LSU in New Orleans, Louisiana. Thereafter, she pursued neonatology starting at LSU and finishing at Tufts University in Boston. She moved to Denver in 2009 and joined Denver Health as a Neonatologist. Through her professional and personal experiences, she noticed the gaps in postpartum care in Colorado. In 2017, she founded NayaCare: Newborn Speciality Clinic at Your Doorstep. She has been a guest on several podcasts and featured on local Denver 7News and 9News. Her articles on the 4th trimester and maternal mortality have been published in many journals. She debuted her first non-fiction book, The Doctor and Her Black Bag. 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"
Book Recommendation #3
Mayo Clinic Guide to Your Baby's First Years
Being a new mom is an overwhelming experience. I often encourage moms to stick to reading books or consulting with their doctors for information to avoid getting misinformed. The Mayo Clinic Guide to Your Baby’s First Years is a great resource because it is comprehensive and discusses common illness, concerns, and developmental changes that parents face during a child’s first few years of life.
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.
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:
10 Ways to Deal with Mom-Shaming
Susan Newman Ph.D. | Posted October 17, 2017
"Who hasn’t had her child-rearing choices questioned—by family, friends, your spouse, or a stranger? Who in your circle is most judgmental?
As a parent, you are subject to comment on a host of parenting decisions: Whether you decide to breastfeed or not; to co-sleep or not, go back to work or stay home with your children, what you let your children eat for breakfast; how you discipline or dress them, the bedtime you set or the time you allow or don’t on “screens”…Often, the “advice” or “suggestion” is completely unsolicited and makes you feel guilty or uncertain.
On social media, even benign parenting practices are subject to criticism. Unlike the rest of us, celebrities are publicly “mom-shamed” more frequently on the Internet. Mariah Carey received a wave of criticism for posting a photo of her 4-year-old son still using a pacifier. Several stars, from Mila Kunis to Chrissy Tiegen to Maggie Gyllenhaal, have been targeted online for breastfeeding in public. Actress Olivia Wilde was berated for posting a picture kissing her young son on the lips.
A new poll finds a majority of American mothers are being judged, some on the Internet, some in person. The University of Michigan’s C.S. Mott Children’s Hospital conducted a national poll surveying 475 mothers of children aged 5 and younger. They were asked if they’ve ever had their parenting questioned.
Sixty-one percent responded that they have been criticized for their child-rearing decisions. The most common topic of criticism: Discipline. Seventy percent of criticized moms reported this. The second-most-cited denunciation concerned diet and nutrition; the third, sleep; the fourth, breast versus bottle-feeding, fifth, child safety, and sixth, childcare decisions.
Although sometimes the criticism is intended to be constructive, 62 percent of those sampled said they believe mothers receive “a lot of unhelpful advice from other people”; 56 percent said mothers “get too much blame and not enough credit for their children’s behavior.”
Family More Likely to Judge
According to the study, family members comprised the top three groups of “mom shamers.” The moms who felt criticized said their own parents (37 percent), co-parent (36 percent) and in-laws (31 percent) were the most frequent to pass judgment. “This may reflect the high volume of interactions with family members, or that mothers may interpret family criticism as an attack by those who should be more supportive,” the researchers noted.
Remarking on the stress and overwhelming choices of new parenthood, the study points out that 42 percent of the criticized mothers said the judgment “made them feel unsure about their parenting choices.” As a parent, you have the ultimate say—even if you’re conflicted about your choices.
10 Tips for Standing Up To Mom-Shaming
When it comes to standing up to those who judge you, it can be tricky to assert your parenting authority and keep conflicts at bay. Here are 10 insights and suggestions to help bolster you against those who believe they know what you should be doing and how to do it.
By: Auburn Harrison | TEDxUniversity of Nevada
"It's the most common complication of childbirth, yet PPD is a condition clouded with stigma, shame and guilt for mothers who experience it. According to Postpartum Support International, 15% of women suffer from postpartum depression, yet women are forced to suffer in silence and shame. Based on a personal experience with an extremely severe case of postpartum depression, anxiety and psychosis, Nevada-based nonprofit executive, Auburn Harrison, paints a heartbreaking and harrowing picture of why our society's silence on the topic is hurting mothers. Auburn Harrison serves as a nonprofit executive director for nonprofit dropout prevention program for at-risk youth, Communities In Schools of Western Nevada. Her organization provides basic needs and case management to local students living in poverty, including wraparound student support services such as mentoring, tutoring and resources to help students stay in school, graduate and achieve life success. Auburn has been involved in the Northern Nevada non-profit and philanthropic and nonprofit community for over a decade. Auburn spent five years as an on-air television reporter at at KOLO 8 News Now, and five more years as an enlisted journalist in the US Navy. She holds a master's degree in Writing from University of Nevada, Reno. In 2019, Auburn was named one of the Top Twenty Young Professionals Under 40 by the Reno Tahoe Young Professionals Network. Auburn lives in Reno with her husband and three little boys. 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: CityLine | January 9, 2019
"There is science behind prioritizing your happiness, moms! Dr. Karyn Gordon proves that silencing mommy guilt is important to your family's well-being."
BY KIRA M. NEWMAN | AUGUST 17, 2016
"Mothers-to-be don’t spend their entire 40 weeks of pregnancy glowing radiantly; there are also midnight worries, endless shopping lists, and swollen feet. Somewhere around 18 percent of women are depressed during pregnancy, and 21 percent have serious anxiety.
Research is starting to suggest that mindfulness could help. Not only does cultivating moment-to-moment awareness of thoughts and surroundings seem to help pregnant women keep their stress down and their spirits up—benefits that are well-documented among other groups of people—it may also lead to healthier newborns with fewer developmental problems down the line.
The research is still in its infancy (pun intended), but researchers are hopeful that this low-cost, accessible, and positive practice could have transformational effects. Here are four benefits for pregnant women.
1. Mindfulness reduces stress
Jen, an entrepreneur friend of mine who recently had her first child, was put on bed rest and couldn’t even exercise to keep her stress down. “I had so much anxiety,” she recalls. “Meditation really helped me stay calm and sane.”
She isn’t alone. In a small pilot study in 2008, 31 women in the second half of their pregnancy participated in an eight-week mindfulness program called Mindful Motherhood, which included breathing meditation, body scan meditation, and hatha yoga. In two hours of class per week, participants also learned how to cultivate attention and awareness, particularly in relation to aspects of their pregnancy: the feeling of their belly, the aches and pains, and their anxiety about labor.
Compared with women waiting to enter the program, participants saw reductions in their reports of anxiety and negative feelings like distress, hostility, and shame. These were all women who had sought therapy or counseling for mood issues in the past, but the program seemed to be helping them avoid similar difficulties during a chaotic and transformative time of their lives.
A 2012 study of another eight-week mindfulness program found similar reductions in depression, stress, and anxiety compared with a control group, though only 19 pregnant women participated. In interviews, participants talked about learning to stop struggling and accept things as they are; they remembered to stop and breathe, and then take conscious action rather than acting out of anger or frustration.
“I’ve learned to take a step back and just breathe and think about what I’m going to say before I open my mouth,” one participant said.
These stress-busting and mood-lifting effects mirror those found in mindfulness programs for the general public, but can mindfulness help with the specific anxieties and fears that go along with pregnancy? Many pregnant women have a loop of worries that easily gets triggered: Will my baby be healthy? I’m scared of labor. Something doesn’t feel right—do I need to go to the doctor?
A 2014 study looked specifically at these feelings, called pregnancy anxiety. Forty-seven pregnant women in their first or second trimesters, who had particularly high stress or pregnancy anxiety, took a mindfulness class at UCLA’s Mindful Awareness Research Center. For six weeks, they learned how to work with pain, negative emotions, and difficult social situations. Compared with a control group who read a pregnancy book, participants who took the class saw bigger decreases in their reports of pregnancy anxiety during the duration of the experiment.
Mindfulness, perhaps, gave them the tools to navigate complex emotions that wouldn’t budge, even in the face of the most reassuring reading material.
“It is inspiring to witness a mother with extreme fear of childbirth cancel an elective caesarian because she now feels confident enough in her own strength to go through the birthing process,” said one mindfulness teacher. “It is humbling to hear how the couple whose first baby died during labour were able to stay present during the birth of their second, observing their fear without getting lost in it.”
2. Mindfulness boosts positive feelings
Not all mindfulness involves meditation; you can also become more mindful by noticing the way moods and bodily sensations fluctuate throughout the day. This type of mindfulness can counter our tendency to be “mindless,” when we assume things will be the way we expect them to be—the way they were in the past—and we don’t notice new experiences. For example, pregnant women might expect pregnancy to be exhausting and painful, so they pay less attention to the happy and peaceful moments.
In a 2016 study, a small group of Israeli women in their second and third trimesters received a half-hour training in this type of mindfulness. Then, for two weeks, they wrote diary entries twice daily about how they felt physically and mentally, a way of helping them realize how much things change.
Compared with groups of women who simply read about other women’s positive and negative experiences during pregnancy, or did nothing specific at all, women in the mindfulness group saw greater increases in their reports of well-being and positive feelings like enthusiasm and determination across the duration of the exercise. Also, the more mindful they were after the experiment (as measured by questionnaire), the higher their well-being, life satisfaction, self-esteem, and positive feelings one month after the birth—a time when women need all the resources they can get.
Nurse-midwife Nancy Bardacke developed the Mindfulness-Based Childbirth and Parenting (MBCP) program after training in and teaching Mindfulness-Based Stress Reduction (MBSR), a widely researched program developed by Jon Kabat-Zinn. MBCP takes principles from MBSR and applies them to pregnancy, teaching mindfulness practices alongside insights about labor and breastfeeding. It includes three hours of class per week for nine weeks, as well as a daylong silent retreat.
In a small 2010 pilot study, 27 women in their third trimester of pregnancy participated in the MBCP program with their partners. In addition to improvements in pregnancy anxiety and stress, participants also reported experiencing stronger and more frequent positive feelings—such as enjoyment, gratitude, and hope—after the program.
“I definitely am aware of trying to be in the moment and that each moment, good or bad, will pass,” said one participant. “When I got really worried about the birth, I would just breathe to stop my mind from going all sorts of bad places.”
3. Mindfulness may help prevent premature birth
Among pregnant women’s worries, the possibility of a premature birth looms large. “Preemies” (babies born before 37 weeks) are at risk of breathing problems, vision and hearing issues, and developmental delays. And mothers of preemies have high rates of anxiety, depression, and stress, which often go unacknowledged in the face of the baby’s needs.
Here, too, mindfulness may have a role to play. In a 2005 study of 335 pregnant women in Bangalore, India, half were assigned to practice yoga and meditation while the other half walked for an hour per day, starting in their second trimester and continuing until delivery. The yoga group, who took yoga classes for a week and then practiced at home, had fewer premature births and fewer babies with low birthweight.
Another indicator of newborn health is the Apgar score, usually measured minutes after birth, which takes into account the newborn’s complexion, pulse, reflexes, activity level, and respiration. In the 2016 Israeli study mentioned above, women’s reported levels of mindfulness after the experiment were linked to their babies’ Apgar scores, even after controlling for socioeconomic status.
One 2011 study found that a mindfulness program reduced premature births, but not birthweight or Apgar scores. Here, a group of 199 second-trimester pregnant women in Northern Thailand either got typical prenatal care or participated in a mindfulness program. Two hours a week for five weeks, the mindfulness group learned different meditations and how to cultivate awareness and acceptance of their thoughts and emotions. During and afterward, they were encouraged to meditate for over an hour daily across several different sessions. In the end, only six percent of women in the meditation group delivered their babies prematurely, compared with 16 percent in the care-as-usual group.
Could mindfulness help reduce premature births in women who are most at risk for them, including low-income and older women? That’s a question for future research to address."
By: Kaiser Permanente | 2021
"Time is valuable for any busy mom. There never seems to be enough of it. And when you think about your priorities, making time for self-care probably falls near the bottom of your list —below work, kids, home, and family.
But if you don’t take time for yourself, you could be doing more harm than good. Stress, exhaustion, burnout, and even illness can take more of a toll when you aren’t getting what you need. So whether you carve out a few minutes for yourself, or a whole day, here are some ideas to get you started:
1. Focus on the physical
2. Give your brain a boost
3. Pamper yourself
4. Find time for your friends
5. Take a leap
Do something big that you’ve never done before, like:
6. Hone your skills
7. Get silly
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."
By: Elizabeth Scott, MS | Fact checked by Sean Blackburn on June 24, 2020
"From giving an important presentation at work to attending a party by yourself, there are countless situations that can be impacted by negative thoughts. Whether or not you have a diagnosed panic disorder, it's easy to get distracted by negativity and fears that can lead to a downward spiral of emotions.
In order to move forward, it's important to swap negativity with rational, positive thoughts.1 This shift can come to you more easily and automatically with practice, eventually shaping new thinking habits and strides toward recovery.
How to Ease Stress With Affirmations
Here are some ways to use positive affirmations to manage stress, particularly when dealing with anxiety at the same time.
Identify and Stop Negative Thoughts
First, learn to identify negative thoughts so you can nix the negativity as soon as it enters your mind. For example, if you found yourself thinking, "I'm going to look stupid if I go to that party alone," identify the negative thought and correct yourself in the moment.
Consciously decide to reframe and move your thoughts into a more positive direction.2 Remind yourself that others will likely be arriving alone, that people are looking forward to seeing you, and that you will probably have a good time. These thoughts can help put you in a better frame of mind.
Use Positive Affirmations
You may find it helpful to learn positive affirmations ahead of time so you're prepared when triggering situations occur. Consider the following options for common scenarios.
When faced with a situation that generates fear, such as traveling or meeting new people, try repeating positive affirmations that acknowledge your negative thoughts or emotions and let them go:
Managing your anxiety or panic disorder can be particularly difficult in times of stress, such as when you need to give a presentation in public or will be going to a networking event at work. While you may be tempted to call out sick or avoid the situation altogether, that can be harmful to you and your career. Instead, remind yourself of these affirmations:
Sometimes positive thinking can be taken too far, so it's important to remain grounded. When positive affirmations become unrealistic, they can actually trigger more anxiety as your subconscious mind notes that the ideas aren't realistic.3 You can find yourself more stressed if you start convincing yourself that you can do things you're not prepared for, and the reality of failure hits hard.
Notice that the examples given above focus on realistic and true statements that are also positive. These include what you will gain, what you have accomplished in the past, and what you will realistically achieve."
By: Rachel Gurevich, RN |Medically reviewed by Meredith Shur, MD on April 20, 2020
"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."
"This 10 minute mindful meditation will give you the mental clarity and space necessary to ground yourself with beautiful focus and set your day on the perfect track for success and fulfillment."
"Over 1 billion women around the world will have experienced perimenopause by 2025. But a culture that has spent years dismissing the process might explain why we don’t know more about it.
By: Jessica Grose | April 29, 2021
"Angie McKaig calls it “peri brain” out loud, in meetings. That’s when the 49-year-old has moments of perimenopause-related brain fog so intense that she will forget the point she is trying to make in the middle of a sentence. Sometimes it will happen when she’s presenting to her colleagues in digital marketing at Canada’s largest bank in Toronto. But it can happen anywhere — she has forgotten her own address. Twice.
Ms. McKaig’s symptoms were a rude surprise when she first started experiencing them in 2018, right around when her mother died. She had an irregular period, hot flashes, insomnia and massive hair loss along with memory issues she describes as “like somebody had taken my brain and done the Etch A Sketch thing,” which is to say, shaken it until it was blank.
She thought she might have early-onset Alzheimer’s, or that these changes were a physical response to her grief, until her therapist told her that her symptoms were typical signs of perimenopause, which is defined as the final years of a woman’s reproductive life leading up to the cessation of her period, or menopause. It usually begins in a woman’s 40s, and is marked by fluctuating hormones and a raft of mental and physical symptoms that are “sufficiently bothersome” to send almost 90 percent of women to their doctors for advice about how to cope.
Ms. McKaig is aggressively transparent about her “peri brain” at work, because she “realized how few people actually talk about this, and how little information we are given. So I have tried to normalize it,” she said.
An oft-cited statistic from the North American Menopause Society is that by 2025, more than 1 billion women around the world will be post-menopausal. The scientific study of perimenopause has been going on for decades, and the cultural discussion of this mind and body shift has reached something of a new fever pitch, with several books on the subject coming out this spring and a gaggle of “femtech” companies vowing to disrupt perimenopause.
If the experience of perimenopause is this universal, why did almost every single layperson interviewed for this article say something along the lines of: No one told me it would be like this?
“You’re hearing what I’m hearing, ‘Nobody ever told me this, my mother never told me this,’ and I had the same experiences many years ago with my mother,” said Dr. Lila Nachtigall, a professor of obstetrics and gynecology at N.Y.U. Grossman School of Medicine who has been treating perimenopausal women for 50 years, and is an adviser to Elektra Health, a telemedicine start-up.
Dr. Nachtigall said her mother had the worst hot flashes, and even though they were living in the same house when her mother was experiencing perimenopausal symptoms, they never discussed it. “That was part of the taboo. You were supposed to suffer in silence.”
The shroud of secrecy around women’s intimate bodily functions is among the many reasons experts cite for the lack of public knowledge about women’s health in midlife. But looking at the medical and cultural understanding of perimenopause through history reveals how this rite of passage, sometimes compared to a second puberty, has been overlooked and under discussed.
From ‘Women’s Hell’ to ‘Age of Renewal’
Though the ancient Greeks and Romans knew a woman’s fertility ended in midlife, there are few references to menopause in their texts, according to Susan Mattern, a professor of history at the University of Georgia, in her book “The Slow Moon Climbs: The Science, History, and Meaning of Menopause.”
The term “menopause” wasn’t used until around 1820, when it was coined by Charles de Gardanne, a French physician. Before then, it was colloquially referred to as “women’s hell,” “green old age” and “death of sex,” Dr. Mattern notes. Dr. de Gardanne cited 50 menopause-related conditions that sound somewhat absurd to modern ears, including “epilepsy, nymphomania, gout, hysterical fits and cancer.”
By: Jessica Grose | February 4th, 2021
"In early September, as the school year inched closer, a group of mothers in New Jersey decided they would gather in a park, at a safe social distance, and scream their lungs out. For months, as the pandemic disrupted work and home life, these moms, like so many parents, had been stretched thin — acting as caregivers, teachers and earners at once. They were breaking.
As are mothers all over the United States.
By now, you have read the headlines, repeating like a depressing drum beat:
“Working moms are not okay.” “Pandemic Triples Anxiety And Depression Symptoms In New Mothers.” “Working Moms Are Reaching The Breaking Point.”
You can also see the problem in numbers: Almost 1 million mothers have left the workforce — with Black mothers, Hispanic mothers and single mothers among the hardest hit. Almost one in four children experienced food insecurity in 2020, which is intimately related to the loss of maternal income. And more than three quarters of parents with children ages 8 to 12 say the uncertainty around the current school year is causing them stress.
Despite these alarm bells clanging, signaling a financial and emotional disaster among America’s mothers, who are doing most of the increased amount of child care and domestic work during this pandemic, the cultural and policy response enacted at this point has been nearly nonexistent.
The pandemic has touched every group of Americans, and millions are suffering, hungry and grieving. But many mothers in particular get no space or time to recover.
The impact is not just about mothers’ fate as workers, though the economic fallout of these pandemic years might have lifelong consequences. The pandemic is also a mental health crisis for mothers that fervently needs to be addressed, or at the very least acknowledged.
“Just before the pandemic hit, for the first time ever, for a couple months, we had more women employed than men,” said Michael Madowitz, an economist at the Center for American Progress. “And now we are back to late 1980s levels of women in the labor force.” The long-term ramifications for mothers leaving work entirely or cutting back on work during this time include: a broken pipeline for higher-level jobs and a loss of Social Security and other potential retirement income.
“Covid took a crowbar into gender gaps and pried them open,” said Betsey Stevenson, an economist at the University of Michigan. Her long-term concerns are even more fundamental: Will watching a generation of mothers go through this difficult time with little support turn the next generation of women off from parenthood altogether?
The economic disaster of the pandemic is directly related to maternal stress levels, and by extension, the stress levels of American children. Philip Fisher, a professor of psychology at the University of Oregon who runs an ongoing nationally representative survey on the impact of the pandemic on families with young children, points out that the stressors on mothers are magnified by a number of intersecting issues, including poverty, race, having special needs children and being a single parent.
“People are having a hard time making ends meet, that’s making parents stressed out, and that’s causing kids to be stressed out,” Dr. Fisher said. This buildup can lead to toxic stress, “And we know from all the science, that level of stress has a lasting impact on brain development, learning and physical health.” Almost 70 percent of mothers say that worry and stress from the pandemic have damaged their health.
The statistics on stress levels are shocking, but they are sterile; they don’t begin to expose the frayed lives of American mothers and their children during this pandemic. A young mother who self-identified as American Indian/Alaska Native summed up her situation in response to Dr. Fisher’s survey: “We are requesting government help for food. Relationship between partner and I are tense. I am personally struggling more now with depression and anxiety. My toddler has become more anxious as well and shown aggressive behavior. She seems overwhelmed most of the time.”
Times editor-at-large Jessica Bennett spent months communicating with three women, who kept detailed diaries of their days, for a look at just how much American mothers are doing every waking second."
Sleep and Pregnancy
By familydoctor.org editorial staff.
"The amount of sleep you get while you’re pregnant not only affects you and your baby, but could impact your labor and delivery as well. Lack of sleep during pregnancy has been tied to a number of complications, including preeclampsia (a serious condition that affects your blood pressure and kidneys). This condition could result in pre-mature birth. Now is the time to take sleep seriously.When you become pregnant, one of the first symptoms you may notice is being overwhelmingly tired, even exhausted. Sleep will be irresistible to you. You can most likely blame your changing hormones for this, especially the extra progesterone that comes with being pregnant. In the beginning, pregnancy also lowers your blood pressure and blood sugar, which can make you feel tired.
Shortly after the first trimester, your energy should return. Sometime during the third trimester, you’ll begin to feel tired again. Some of this feeling can be blamed on the sheer physical exhaustion that comes from growing a baby and the stress that it puts on your body. However, your weariness during this time is in direct relation to your inability to get a good night’s sleep.
Even if you’ve never had trouble sleeping before, you may find it much more difficult while you’re pregnant.
Path to improved health
Sleep should never be seen as a luxury. It’s a necessity — especially when you’re pregnant.
In fact, women who are pregnant need a few more hours of sleep each night or should supplement nighttime sleep with naps during the day, according to the National Institutes of Health.
For many pregnant women, getting 8 to 10 hours of sleep each night becomes more difficult the farther along they are in their pregnancy. There are many physical and emotional obstacles to sleep in this stage. Anxiety about being a mom or about adding to your family can keep you awake. Fear of the unknown or about the delivery can cause insomnia. Plus, there is the getting up every few hours to go to the bathroom. It also can be difficult to find a comfortable position in bed, especially if you are a former stomach sleeper.
If any of the following is keeping you awake at night, try these strategies for getting a good night’s sleep.
At some point in their pregnancy, most pregnant women suffer from heartburn, which is a form of indigestion that feels like burning in your chest and throat. Heartburn can wake you up in the middle of the night and ruin a good sleep. Minimize the chance for this by avoiding spicy foods. Also, cut down on rich foods for dinner.
Restless leg syndrome
Few things are more distracting than restless legs syndrome (RLS), especially when you are trying to go to sleep. While you can’t take traditional RLS medicines when you are pregnant, you can try to reduce the feelings of RLS with a good prenatal vitamin that includes folate and iron.
Morning sickness — at bedtime
Despite the name, morning sickness can occur any time and is often worse later in the day. Try eating a few crackers at bedtime and keep a stash in your nightstand in case a wave of nausea hits as you are trying to go to sleep.
There are many ways insomnia can creep in and compromise your sleep time. Often, it’s just about being able to shut down your brain. Most medicines for insomnia should not be taken while you are pregnant. Instead, try journaling some of the things you are anxious about. Write down what is stressing you and try to let it go as you go to sleep. Also, stop drinking caffeine by early afternoon. Try not to take long naps during the day. Doing any — or all — of these things can help ease you back into sleep at a reasonable bedtime.
Not many things can wake you as quickly and painfully as a leg cramp. Sometimes called a charley horse, these cramps are usually a contraction of your calf muscle. Less frequently, they can occur in your thigh or your foot. These can plague you in pregnancy because of a lack of minerals, especially calcium and magnesium. They also are more common if you are dehydrated. To guard against leg cramps, make sure that you continue to take your prenatal vitamin and drink plenty of water and other fluids during the day.
Finding a comfortable position
As your body grows, sleep becomes a little harder to come by, especially in the third trimester. It’s difficult to get comfortable. It’s harder to move around and shift positions in bed. If you’ve been a stomach or back sleeper, it can be hard to adjust to sleeping on your side. The best position to sleep in when you’re pregnant is on your left side. This improves blood flow and, therefore, nutrient flow to your baby. Try lying on your left side, knees bent with a pillow between your knees. It also helps to tuck a pillow under your stomach, as well, for extra support.
Frequent bathroom breaks
With the baby pushing down on your bladder, you likely can’t make it all night without waking at least once to go to the bathroom. You can help minimize nighttime bathroom trips by cutting down on how much you drink in the evenings. Just be sure to get adequate hydration during the day. Bright lights can make it harder for you to fall back asleep, so use nightlights so that you will not need to turn on the lights when you get up to go to the bathroom.
In addition to minimizing the common obstacles to getting a good night’s sleep, there are also ways to encourage good sleep habits. This is called good sleep hygiene.
Things to consider
Sleep is essential to health. Lack of sleep is associated with many chronic diseases, including type 2 diabetes, obesity, depression, and even heart disease. If you’re pregnant, not getting an adequate amount of sleep can put you at risk for some serious conditions. Lack of sleep can also complicate your delivery.
In one research study, pregnant women who slept less than six hours at night late in pregnancy had longer labors and were more likely to have cesarean deliveries.
Another study reports that the sleep you get in your first trimester can affect your health in the third trimester. Women who don’t get enough sleep (less than five hours per night) in the first trimester are nearly 10 times more likely to develop preeclampsia late in pregnancy. Preeclampsia is a condition associated with pregnancy-related high blood pressure, swelling of hands and feet, and protein in urine.
If you’ve ever had a sleep disorder, it could be made worse by pregnancy. If you’ve had sleep apnea in the past, your snoring may get worse during pregnancy. This is especially true if you were already overweight when you became pregnant. Expect that RLS will worsen during this time. Heartburn will intensify, 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."
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 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
By: Bethany Braun-Silva
"Expecting parents have multiple checklists of everything they need to get ready for their baby’s arrival. Cribs, bottles, car seats, and strollers are just a few of the essentials you need to consider before welcoming a new baby. But even before any of that, there’s the hospital bag checklist. A robe, a nightgown, slippers, and a few blankets are sure to make the list, but oftentimes, a postpartum recovery kit gets overlooked.
A postpartum recovery kit has what moms need to help with bleeding, soreness, and overall discomfort. You can create your own kit by buying things like disposable underwear, ice packs, and perineal spray separately, but there are also ready-made kits for moms that include all these things and more.
Many moms agree that postpartum recovery kits are a great choice. The Frida Mom Hospital Packing Kit for Labor, Delivery, Postpartum, for example, has over 1,000 five-star reviews on Amazon and a near-perfect 4.8-star rating. “I would 100% say that every postpartum experience needs this kit,” writes one customer. “I think it’s well worth the price for the comfort you’re getting.”
The Miloo Mom Hospital Labor and Delivery Gift Packing Kit for Delivery, Postpartum is also a great choice available on Amazon. One reviewer writes, “I was very impressed with my kit, and I used all of it when I was in the hospital.”
Convenience is so important when you have a new baby, especially when it comes to your healing. The first six weeks after giving birth are a critical time in the healing process, and having the right tools handy can make all the difference in your physical (and mental) health. If you’re pregnant or know someone who is, check out the postpartum recovery kits below."
"Lifestyle changes to improve and prevent symptoms of depression and anxiety."
I knew he’d run the other way if I jumped too quickly into a medical referral or diagnosis, so we started with the most human approaches — connecting about what was really going on for him, and exploring readily available lifestyle changes that aligned with his interest, motivation, and values. Within weeks, his spark started to come back, and within months he felt he had a new lease on life. He wasn’t suddenly happy all the time. But he felt a new sense of his capacity to take charge of his mental health.
Will everyone have an outcome like Roy from lifestyle changes? Definitely not — anxiety and depression are complex conditions with tremendous individual variation, varied underlying causes, and varied levels of severity. But can everyone benefit from learning the foundation for how to care for their mind either separately or as an adjunct to professional treatment? I believe so.
The following seven health behaviors are key ones linked to prevention or symptom improvement of anxiety and depression.
While everything on this list is simple, it’s far from easy. Change is hard. And if you currently have depression or anxiety, it can be especially challenging. That’s why one of the key behaviors is being kind to yourself.
If moved to do so, choose one area to work on at a time, perhaps an area you feel especially motivated or confident to address, or an area that feels aligned with your most important values. Then take it one step at a time. The funny thing about change is we often don’t know it’s happening, we just keep rowing in the right direction, and usually after a few, or a few thousand, twists and turns, we look back in awe at how far we’ve come.
While 10-18% of adults in the U.S. experience chronic sleep issues, this number jumps to 65-90% of those with depression, and over 50% of those with generalized anxiety disorder. Of those with depression, 65% had sleep issues first. Addressing sleep issues can alleviate symptoms of mental health conditions, and given sleep problems are a risk factor for mental health conditions, can also help protect your mental health.
There are many resources to help improve your sleep, such as this free app.
A disposition that tends towards self-critical, or perfectionistic, can be a risk factor for anxiety and depression. This can include feeling like you must be perfect to be accepted, an inability to accept flaws within yourself, intense self-scrutiny, or an unrealistic sense of others’ expectations and your capacity to meet them.
Despite the fear of many who have this characteristic, the antidote to perfectionism isn’t letting it all go, or saying goodbye to standards – it’s self-compassion. According to researcher Kristen Neff, self-compassion has three components: self-kindness vs. self-judgment, common humanity vs. isolation, mindfulness vs. overidentification. How we treat ourselves through the ups and downs of life can have a tremendous impact on health and mental health.
3. Social Connection
From the time we are born, we need social connection in order to thrive.
A recent study lead by researchers at Harvard sought to understand what could most protect us from depression that is within our control. After analyzing over 100 potential factors, they found that social connection was by far the most important protective factor.
It’s been a lonely year for many. And many are anxious at the prospect of going back to normal. But connection doesn’t mean a big party or bustling office. It can be confiding in one trusted person about how you’re really doing, listening to how someone else is really doing, giving a meaningful thank you, or having a (safe) visit with any family member or friend. If this feels out of reach, try making a short list of people who at any point have given you a sense of belonging. Other studies have shown that just calling positive relationships to mind can have a positive impact on our capacity to tolerate stress."
"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+Good
"Registered Dietitian Tracy Lockwood Beckerman gives tips on the most nutritious foods to eat to support your baby in each trimester of your pregnancy."