The Silent Struggle after Miscarriage

You are not alone. We hear this phrase in the maternal mental health community so often. But to a mom who who has experienced a miscarriage, it probably doesn’t feel that way. We are missing the mark by not talking about miscarriage and the anxiety, depression or even PTSD that can accompany one. While this post will focus on miscarriage, it’s important to acknowledge moms who have experienced stillbirth or infant loss as well. In my opinion, they each deserve a later post of their own.

According to the March of Dimes, “Miscarriage (also called early pregnancy loss) is when a baby dies in the womb (uterus) before 20 weeks of pregnancy. For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.”*

These stats give a sterile view of an incredibly real and devastating experience. Because miscarriages often occur early in pregnancy, it’s possible that very few people were aware that a mom was expecting and this can, understandably, lead her to feel misunderstood, isolated and hopeless. Furthermore, watching life continue effortlessly for those around her can make those feelings even more intense.

Knowing that these moms are at a higher risk for developing anxiety and/or depression, both after a miscarriage and after subsequent births, we need to be doing more. We need better screening; both immediately after a miscarriage and at regular intervals thereafter. We need to give moms space to feel safe sharing what they need to feel supported. We need to recognize that grief is a process and that it might include a wide rage of shifting and unexpected emotions. We need to let moms know that there is no “right way” to deal with pregnancy loss and she is the only one who can determine what that process looks like for her. We also need to let moms know that while the emergence of grief, anxiety, depression or PTSD after such a harrowing experience is valid and completely understandable, it is also treatable. Depending on the severity of symptoms, support groups (in-person or through social media), therapy or even medication are valid options to help a mom who is struggling.

I almost feel like I don’t have a right to talk about this issue because I have never experienced a miscarriage myself. However, in this mom-tribe, we have to support one another. We need to be reminded to be sensitive and compassionate towards those around us because we might not know the internal battles they might be facing. Maybe I’m able to speak up when someone who is more closely affected cannot. Or, maybe my “you are not alone” is speaking to someone in a different way…a way that she’s been longing to hear. Your pregnancy matters. Your baby matters. Your experience matters. You are allowed to grieve, to be vulnerable, to be cared for by both yourself and others. You deserve to seek and receive help should you need it. You don’t ever have to go through this alone.

Written by Alexis Bruce

I Take Medication for my PPOCD

Let’s talk meds. You’re not alone if the idea of having this conversation makes you uncomfortable. Because for some reason, we are still vehemently fighting the stigma around the need to take psychiatric medications especially while pregnant and/or nursing. It’s a controversial topic and one that many moms feel passionately about no matter which side they fall on.

I have ZERO shame in sharing that medication is a crucial part of my overall treatment plan and an integral component of what keeps me in recovery. Medication, as well as therapy, exercise and good self-care are what keep me feeling like me. My dad is diabetic and no one would ever expect him to stop taking his insulin nor would they expect my mom to stop taking her high-blood pressure medication so why is my need for a prescription any different? I don’t know if I will always need medication but if it proves to be essential to helping me live my best life…then I’m more than okay with that.

When it comes to maternal mental illness, not every mom shares my views on taking medication (and that is OKAY!!!). However, for those of you on the fence, I thought it might be helpful to talk through some of the common objections to adding medication to your treatment arsenal.

I can’t take medication while pregnant.

We all wish for healthy, full-term pregnancies without the need for prescription drugs. But the reality is that it often comes down to assessing the potential risks the psychiatric medication may pose for baby versus the potential risks if mom is left untreated. In some cases, the risk to the unborn child may actually be higher if a mother is taken of off, or declines to start, medication. Consider a mom who is suffering from severe depression. Without her medication, she may be unable to function in her daily life which means she’s unable to care for any existing children, eat sensibly, get an adequate amount of sleep and ensure she receives proper prenatal care. She may also be at a higher risk of engaging in dangerous behaviors including smoking and/or substance abuse.

Data is still limited but there are several psychiatric medications that are now considered to be safe during pregnancy. An informed and trustworthy provider will be able to discuss these options as well as help to perform your individual risk assessment.

I can’t take medication while nursing.

Similar to a mom’s concern of her prescription drug(s) being passed to her fetus, many moms also worry about potential side effects to baby should their medication be transmitted through breast milk. If together, mom and provider decide that it is best for mom to continue to include medication as a part of her treatment plan, there are several options that doctors now feel comfortable prescribing to breastfeeding moms. Having the discussion with your doctor will likely help ease some of these fears.

Another helpful tool is LactMed which can be accessed online (https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm ) or by using the Lactmed app. LactMed is the U.S. National Library of Medicine’s database containing information on drugs (or other chemicals) to which breastfeeding mothers may be exposed, levels of these substances in breast milk and infant blood as well as the possible adverse effects to the nursing infant. Having some background knowledge can help ensure that you are asking your provider all of the questions that are pertinent to your situation.

I want to try natural or alternative remedies.   

GOOD! Therapy, exercise, fresh air, good nutrition, yoga, mediation, acupuncture, light therapy are just a few of the alternative treatments to take into consideration. There are many options that are available to try prior to seeking medication and there are just as many options available to enhance the benefits of medication should these alternative therapies prove to be ineffective on their own. Personally, I needed to complete Exposure and Response Prevention (ERP) therapy, maintain good exercise habits and work extensively on my self-compassion and mindfulness practice in addition to taking my medication daily. Unfortunately, mental illness does not come with an “easy” button but leading a happy and fulfilling life is absolutely possible!

I should be able to do this on my own.

Ever heard the saying, “it takes a village?” I think this phrase was coined specifically with motherhood in mind. Even more so when motherhood is overshadowed by a perinatal mood or anxiety disorder. WHY should you be able to do this on your own? What is the reward for never asking for or accepting help? WHAT should you be able to do on your own? Change your brain chemistry? When posed this way, the concept seems almost ridiculous! You aren’t alone in any of this. Help is available and you deserve to receive it, whatever that looks like for you.

I don’t want to suffer through the trial and error of finding the right medication and/or dose.

I get this one! Embarking on the journey to find the right medication(s) and the right dose(s) was extremely overwhelming for me. If I’m being honest, the first medication you try might not be the best one for you. Or, the medication that worked for you pre-baby may not be as effective post-baby (speaking from personal experience). To add to the misery, many psychiatric medications do not reach their full, therapeutic benefit until 6 to 8 weeks from the time the medication was started and that wait can be agonizing (again, personal experience). I got to a point in my own personal journey where this obstacle became irrelevant because I was merely trying to survive. I was so desperate to go back to the person I knew I was and to be able to enjoy one of the greatest times in my life, that I probably would have stood on my head and recited the alphabet backwards if I knew that was the fix. So when my provider (who I trust completely) said she thought a medication would be helpful, I was fully on board no matter what the adjustment period looked like. Maybe you’re not there yet, and that is okay.

I don’t want to feel like a zombie.

I had the same concern. I had no idea what Alexis on an antidepressant would look like. Would I be able to function? To laugh? To feel? In my experience, my medication has actually allowed me to feel and achieve to a greater degree. During the throes of postpartum-OCD, I was not functioning, nor was I laughing, loving or enjoying any aspect of my life or my family. I was completely engulfed by my disease. Medication helped to lift the darkness, clear my mind and allowed me to thrive. It helped enable me to be able to do the hard work in therapy and make the necessary efforts to care for myself. Something that I don’t think would have been possible otherwise.

Taking medication means acknowledging I have a shameful disorder.

It pains me that some of us are still afraid to admit that we may struggle with mental illness. Going back to the previous examples I gave about my parents, why are those diseases accepted and yet my mental illness may not be? I have never been ashamed of my illness and I’ll tell anyone about it who will listen. Because mine just might be the story that someone else needs to hear in order to have the courage to ask for help. We are working hard to make strides to end the stigma around mental illness, especially during the perinatal period. We still have far to go. You are not your illness nor did you choose to have your illness; but you can choose how you’re going to tackle it and what you might be able to do with it.

The goal of this post is not to preach that medication is the right choice for everyone, because it isn’t. However, it is the right choice for some. Sometimes, it’s as simple as having a conversation with your doctor and other times it means truly reflecting and taking ALL risks into account. If anything, I hope this post has made you reflect on your own perspective (whatever that may be) and has helped you be better able to a approach the topic from a place of non-judgement, self-directed or otherwise. Imagine how we could shift the paradigm if we started to empower ourselves, as well as those around us, to do whatever is needed to live our healthiest and happiest lives? That sounds pretty good to me!

–Written by Alexis Bruce

What is a PMAD?

For too long, the media has used postpartum depression as a blanket term used to encompass all perinatal mood and anxiety disorders (PMADs). We are pleased to see the increased use of the term “PMAD” rather than using one maternal mental illness to define a whole category. However, for many, there is still a great lack of understanding regarding the different types of perinatal mood and anxiety disorders as well as their symptoms. Failure to identify, define and share information about these different disorders perpetuates the stigma around maternal mental health and may also make a mom who is suffering feel isolated, alone and afraid to share or ask for help. The fact is that 1 in 7 women get postpartum depression (or another perinatal mood or anxiety disorder); in low socioeconomic communities, that number rises to 1 in 4. For these reasons, we wanted to dedicate a post to explaining the different perinatal mood and anxiety disorders and their symptoms. Please note that symptoms can start anytime during pregnancy or within the first year postpartum.

WHAT IS POSTPARTUM DEPRESSION?

Depression during pregnancy (antepartum or prenatal depression) as well as postpartum depression are more common than many realize. While postpartum depression often becomes the scapegoat for nearly all postpartum mental health issues, there are some hallmark symptoms that are used to identify this illness including the following:

  • Feelings of anger, irritability or rage
  • Regret of becoming a mother or feeling as though you’ve made the wrong decision to have a baby
  • Lack of interest in the baby
  • Loss of interest, joy or pleasure in things you used to enjoy
  • Feeling disconnected or numb
  • Crying and sadness
  • Eating too much or too little
  • Insomnia
  • Feelings of guilt, shame or hopelessness
  • Fear that you will never be yourself again and things will never get better
  • Possible thoughts of harming the baby or yourself.

It is important to recognize that postpartum depression is NOT the “baby blues” which is typically a few days to two weeks of mild ups and downs and weepiness. The key is to ask yourself how often have you been feeling this way, for how long and to what extent are these symptoms affecting your ability to function in your daily life?

WHAT IS POSTPARTUM ANXIETY?

Pregnancy or postpartum anxiety can be present on its own or in addition to postpartum depression. While most moms experience some anxiousness or worry during pregnancy or after giving birth, postpartum anxiety is more severe and impacts a mom’s ability to function and/or bond with her baby. Some symptoms of postpartum anxiety include:

  • Constant worry
  • Feeling as though something bad is going to happen
  • Racing thoughts that are difficult to slow down
  • Feeling like your to-do list is never done or that your work is never good enough
  • Sleep and/or appetite disturbances
  • Feeling as though you can’t sit still, restlessness
  • Physical symptoms such as dizziness, nausea or diarrhea

In addition to generalized anxiety, a mom may also suffer from postpartum panic disorder with which she will likely experience extreme nervousness and recurring panic attacks. These attacks may include dizziness, shortness of breath, chest pain, heart palpitations and numbness or tingling in the extremities. These symptoms are not life threatening and will subside after the attack passes.

WHAT IS POSTPARTUM-OCD?

Anxiety may also present as pregnancy or postpartum obsessive compulsive disorder or postpartum-OCD. This disorder is known for causing intrusive thoughts that are unwanted and terrifying to the mom who is experiencing them. You might be suffering from postpartum-OCD if you are experiencing some of the following:

  • Worried constantly no matter what others might say to reassure you
  • Disturbed by dark, unwanted thoughts – possibly about harm coming to your baby
  • Afraid to be alone with your baby
  • Spending hours Googling or researching in an attempt to decrease your anxiety
  • Avoiding potentially harmful things such as the stove, stairs, knives or bathtub
  • Obsessed with checking things such as locked doors or your baby’s breathing
  • Sleep and/or appetite disturbances
  • Afraid that if you share what you’re experiencing with loved ones or a doctor, that your baby will be taken from you

A professional who has not been properly trained in perinatal mood and anxiety disorders may confuse postpartum-OCD with postpartum psychosis. Therefore, many moms experiencing intrusive thoughts are afraid to be honest with family, friends or providers. The key differentiating factor is that a mom with postpartum-OCD experiences thoughts that are ego-dystonic or thoughts and/or impulses that are distressing and inconsistent with the person she identifies herself to be.

WHAT IS POSTPARTUM PTSD?

Several events can contribute to a mom experiencing postpartum PTSD. These may include prolapsed cord, an unplanned c-section, alternative means to deliver the baby, feelings of powerlessness or lack of support during delivery or a baby who needs to spend time in the NICU. Symptoms of postpartum PTSD may include, but are not limited to the following:

  • Flashbacks
  • Nightmares
  • Avoidance of stimuli associated with the perceived traumatic event
  • Difficulty sleeping
  • Anxiety and/or panic attacks

We want to stress that trauma is subjective. Your labor, delivery or postpartum period may not be deemed traumatic from a medical perspective. However, if you are experiencing symptoms of postpartum-PTSD, know that your feelings are valid and you deserve to be taken seriously. Please reach out to a provider you can trust.

WHAT IS POSTPARTUM PSYCHOSIS?

Postpartum psychosis is a rare but extremely serious condition that requires immediate medical attention. Approximately 1 or 2 out of 1,000 moms will experience postpartum psychosis. Hyperbolic media depictions have greatly contributed to the inaccurate assumptions about the disorder. While you may have been lead to believe that all moms experiencing postpartum psychosis harm themselves or their children, the reality is that 5% of moms with postpartum psychosis commit suicide and 4% commit infanticide. Those statistics are still far too great for a condition that is treatable.

A mom who is suffering from postpartum psychosis experiences a break from reality. In her psychotic state, her hallucinations, delusions and beliefs make perfect sense to her. As opposed to postpartum-OCD, a mom with postpartum psychosis experiences thoughts that are ego-systonic or thoughts that are acceptable to her sense of self.

It’s important to note that many survivors of postpartum psychosis never harm themselves or anyone else, nor do they experience delusions that give them violent commands. However, because a mom with postpartum psychosis is experiencing irrational thinking and judgement, it is imperative that she be evaluated, treated and carefully monitored by a perinatal mental health professional. Please seek immediate medical attention if you or someone you know is experiencing any of the following:

  • Feeling paranoid or suspecting that others are out to get you
  • Seeing and/or hearing things that no one else does
  • Experiencing thoughts of harming yourself or others that you want to act on
  • You are unable to sleep and have more energy than you’ve ever had before
  • You are irritated by the fact that those around you don’t seem to understand you

In conclusion, the message we’d like to give regarding ALL perinatal mood and anxiety disorders is that they are temporary and treatable with the right, professional help. In no way are you at fault for the symptoms you are experiencing nor do they make you a bad person or a bad mother. Help is available and recovery is possible.

There is no one size fits all when it comes to perinatal mood and anxiety disorders. However if you find that you, or someone you know, is experiencing symptoms of a PMAD, please reach out to a healthcare provider you can trust. If local to the milwaukee area, you can contact Moms Mental Health Initiative by email at mmhimke@gmail.com. You may also contact us via Facebook or learn more by visiting our website, www.momsmentalhealthmke.org. You can also learn more about additional resources near you by visiting Postpartum Support International’s website at http://www.postpartum.net/  or by calling their warm-line at 800-944-4773. Finally, if you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 800-273-8255, or dialing 911. You are not alone.

-Written by Alexis Bruce

A Post of Hope: Alexis’ Story

Trigger Warning: Intrusive Thoughts, Pre-Term Labor

It was a beautiful fall day, one that felt more like summer. 33 weeks pregnant with my second boy, I was doing my best to get as much done as possible while my oldest napped. This pregnancy had been so different from my first. Leo was such an active baby (a fact that remains true today). Little did I know that this day would be the beginning of a very terrifying chapter in my life.

When the bleeding started, I went into shock. I called my husband who told me to call 911 immediately. Surely, my baby was gone. After an ambulance ride and hours without answers, my sweet Leo entered the world at 2:29 AM. At 33 weeks, I was told his lungs wouldn’t be ready for the world so hearing his brief cry was as sweet as hearing his heartbeat for the first time. But it didn’t last. Leo was whisked away to the NICU where he would call home for the next 21 days. I’ll never forget my husband and I sitting alone in the hospital room just minutes after his birth wondering if all this was real. When a nurse finally came in, she tossed me some parts and said “start pumping”. This was the start of my journey through postpartum.

I was, without a doubt, in survival mode. I didn’t have a single second to think about what I’d gone through or to begin to process because my babies and my husband needed me. I went through the motions of balancing hospital and home-life like a champ. Family and friends were surprised to see how well I was doing and honestly, I was too. But as soon as Leo’s health improved, I crumbled. I started to experience dark thoughts that terrified me so much that I was afraid to be alone with my kids. Imagine holding this beautiful miracle, who you wanted so badly, and suddenly having violent images of how you might go crazy and harm him. Your worst fears playing out in your mind on a constant loop. Sure, I’d heard of postpartum depression but no one ever told me anything like this could happen! The thoughts became so frequent and the fear so intense that I started to avoid objects that could be potentially dangerous, wouldn’t give my babies baths and, on particularly bad days, would make my husband stay home from work. I was living each moment with a horrible sense of dread that something terrible was about to happen.

Soon, I was overwhelmed by feelings of helplessness and shame. I thought that if I told anyone about the scary thoughts I was having that they would surely take my children from me. So, I remained a prisoner in my mind. I would wake up each morning praying that my brain wouldn’t already be playing the horror movie that had become my existence. But it was always still there. The pit in my stomach, the terrifying images, the “what-if’s”…I was in agony and a shell of the me I used to be. These feelings were coupled with intense guilt. Guilt for the extra burden I was putting on my husband, guilt for avoiding my children and guilt for ever having the thoughts at all. My unwanted thoughts started to convince me that I must be some sort of evil monster and that my sons deserved a much better mother. There were many days where the hopelessness I felt was so deep and heavy that it made me question if I would ever get better and even how much longer I could go on this way.

But this was the face of Postpartum OCD. Somehow, by the grace of God, I found the courage to ask for help. However, like many moms, I immediately felt defeated by the number of weeks I’d have to wait to get an appointment with either a therapist or a psychiatrist. I desperately started searching Google for a local support group or anything that could help me make it through. I stumbled upon Postpartum Support International’s website and saw where they had a warm line for moms to call. On Friday night, before a holiday weekend, I called and left a message with my contact information. By the next morning, a local PSI rep had already contacted me. She quickly put me in touch with Sarah from Moms Mental Health Initiative, a local group I’d never heard of. Here is where my story begins to change.

Within hours of my first conversation with Sarah, I was sitting in a therapist’s office! Not just any therapist but one who was educated on Perinatal Mood and Anxiety Disorders and who was sensitive to the unique symptoms and vulnerability that moms like me can face. The amount of relief I felt after that first appointment is indescribable. Sarah also added me to Circle of Hope, MMHI’s online peer support group. The amazing women I connected with in Circle of Hope openly shared their experiences and offered an outpouring of advice and encouragement.

I’d like to end this post with “and she lived happily ever after”. And while that’s true, my days aren’t without struggle. The reality is that recovery from this disease is not linear. Just when you’re basking in the light, a dark day (or few days) slaps you upside the head. But the difference is that I’m no longer walking through the darkness alone. I have a safety net of amazing people, resources and love around me. And some days, just knowing I’m not alone is enough. So, I see you mama. You’re tired, you’re beaten and you are terrified. But stay strong. Keep fighting and know that through this you will learn that you are capable of more than you ever thought possible. That this trial will show you strength you never knew you possessed. What you’re experiencing is real but it is also treatable. If this sounds like you, I hope that by sharing my story you’ve been inspired to ask for help. Or, if you already have, I hope it’s given you the courage to keep going. You will get through this and you will get better. And someday it might be your story that gives another mom hope.

-Written by Alexis Bruce