Showing posts with label pregnancy. Show all posts
Showing posts with label pregnancy. Show all posts

May 17, 2008

Insurance company wants to push meds on depressed woman due to cost effectiveness

A mental health provider was kind enough to leave the below comment on my blog. I found it so unsettling that I want to put it front and center as a post. I personally feel that this mental health provider is an absolute hero for standing up for her patient the way she did. If only every woman with depression or PPD had a patient advocate like her!!! Please read and let me know what you think. (I just wish I knew what insurance company this was.....)

Anonymous said:
I am a mental health provider and very interested in the topic of postpartum depression/perinatal mood disorders - I have two children and struggled w/ postpartum anxiety after my first child.

This topic struck me today specifically because I "had it out" with an insurance company and their "clinical review counselor" today....

I have a client who is a 35-year-old woman who is moderately depressed, and trying to get pregnant. She is responding nicely to psychotherapy and wishes not to start medications because of her desire to become pregnant, and I support this as do her physicians. The "clinical review counselor" from her insurance company disagreed with me because meds would make her treatment progress faster and therefore cost the insurance company less -- he cited this new literature that you cite here in your blog -- I hadn't read it yet but told him that it was ridiculous to medicate someone who is responding to psychotherapy and who wants to become pregnant just to speed things up. It's not worth the risk, no matter how small. His only response was that it was afterall the patient's decision.

What annoys me is that if I were not one to advocate for my clients or one who was up on the research, I may have been swayed by this and felt pressured to lead the patient in that direction. In this case, I totally feel like I won though, especially when he asked me for the expected length of treatment; I said "6 months and if she gets pregnant she'll need to be monitored throughout the pregnancy and the postpartum period because her risk of postpartum depression is increased." He said "ok" -- NEVER do they say "ok." Their job is to limit benefits to save money - he clearly had no clue about perinatal mood disorders.

January 14, 2008

A mom shares her PPD experience with me

I received an e-mail from a mom named Peggy who shared her PPD experience with me. I was so touched by her story that I asked her if I could share it on my blog, and she said sure. I'm always so grateful when other moms share their stories because it not only helps build our growing PPD Prevention community, but it also helps other women who are suffering realize they're not alone.

Here's Peggy's message:

"Hi, I think you're doing great talking about your experience. I was so emotionally impressed with your site. I have also suffered from PPD after my second child, and I must say it was a nighmare. Five months i was running around like a zombie. I couldnt sleep i was so anxious that when it came to go to bed, i was convinced that i wouldn't sleep. I only sweated thru the night. I dont know why but i worried over every silly thing. In the morning I had no appetite to eat, and i was a frequent visitor to the toilet with diarrhea. I lost ten pounds and had ups/downs every second. I don't have to tell you how terrible this is. I kept running from doctor to nutritionist and I was almost a vitamin cabinet. Until one day i went to a chiropracter and he told me that his wife had the same thing and she went to a physiciatrist. I THOUGHT HE WAS INSANE. Me to a physiciatrist -- I'm not mentally ill. I felt physically ill. I felt like I was having the flu since my baby was born. After all, my supportive husband made me go, and I must say that that day changed my life. When i found out about PPD i was so relieved that it was only this! He put me on zoloft. I was on it for 18 months and I had an easy weaning. Thank god that I'm over with this and I definitely became stronger in nature and confidence. One thing that still bothers me is that I have a phobia of getting pregnant again. My baby is almost 3 years now, I would eventually want another baby. Besides that I still have times that i can't sleep and my anxiety, mood, eating disorder, returns, and it takes me time to bounce back, which makes me happy to see that i can do it on my own, But will this ever fade away? i hate when the down days come. My mind keeps nudging and racing that i'm falling back and maybe i'll need medication again. I feel sick of it. Again thanks for your support and keep up your good work." PEGGY

I wrote Peggy back and let her know how great I think she's doing with handling her "down" times. I imagine that much of that comes just from the natural stress of having kids to raise and all of the daily physical, mental and emotional work that it involves nearly every minute.

I remember all too well the times after I had recovered from PPD when I still would feel occasional feelings of sinking down. They weren't that bad, compared to when I had full-blown depression, and I was always able to "get back up," but it was still troubling and made me nervous and a little scared, just like how Peggy describes. When I had those times, I tried to remember what my psychologist at the time would tell me: to be gentle on myself, not to panic or beat myself up over not feeling good, and to know that I would get through those stressful moments and that that's all they were -- a response to stress.

And, like Peggy, I also had such a fear about a future pregnancy and was terrified when I became pregnant with my fourth child. But I knew what to expect -- I'd already been through the worst, and was careful to educate myself on how to prevent PPD. And it worked! It's amazing and empowering to know that you can actually choose to avoid the PPD hell that you've experienced before.

Anyway, many kudos to Peggy for sharing her story!!! Peggy, you're an incredibly strong woman!

August 7, 2007

Pregnant and on meds

I just love this conversation that's evolved from my post (a couple of posts back) on taking anti-depressants when breastfeeding! I set out simply to give my personal opinion on the risks involved and now feel way more enlightened on this "hot button" topic. In the midst of the mixed messages we get from drug test results and the medical community, we're left to wade our way through the murkiness of this issue while feeling guilty about whichever decision we choose.

I especially love psychologist and nationally-renowned PPD expert Ann Dunnewold's comment that "we need more honesty among women that this decision is hard" and that "women need to stop judging each other. Society as a whole is hard enough on us, setting up perfectionist, unreachable standards for mothers. We need to keep in mind the absolute truth, for the majority of women: that we are all doing the best we can do."

Several women have commented on my previous posts on this topic, openly sharing their experiences. One is now in the sixth month of her pregnancy with her second child. Not only did she suffer from PPD with her first baby, she has also dealt with severe depression since she was 13 years old. She is currently taking Zoloft and plans to stay on the anti-depressant during her postpartum while breastfeeding. She brought up an extremely valid concern that I hadn't touched on .... although we've been talking about the risks that anti-depressants pose to an infant, what about the risks involved when a mom's depression is left untreated? Studies show that the occurrence of untreated postpartum depressive episodes in a mother is linked to poorer cognitive test scores in their children. And way more tragic -- aside from the potential cognitive and development delays and possible psychological damage -- there is also the risk of a child losing a mother to suicide.

I want to thank this very strong and empowered woman for sharing her story -- openly letting us in on her decision that she's made to be on Zoloft while pregnant -- and bringing up this very important point that weighs heavily in this excruciating decision that so many of us have to face head on. I wish her all the best with the rest of her pregnancy and hope she keeps in touch so we can all celebrate with her when she experiences a joyful, calm PPD-free postpartum!

August 2, 2007

More on meds and breastfeeding

Well, I've been e-mailing with a woman who wasn't at all happy with me after reading my previous blog on anti-depressants and breastfeeding. (She gave me permission to write about our communication on this blog.) She shared with me her experience of suffering from bipolar disorder and being on medication for it since she was a teen. When she and her husband were trying to get pregnant, she went off her meds. But by the end of her first trimester, she was having an absolutely horrible time so her doctor advised her to go back on her medication. She did so and went on to have a symptom-free, wonderful full-term pregnancy. Her baby is now nearly six months old and she's breastfeeding her baby and doing just fine. She feels very good about her decision to remain on medication and knows that she needed to do this in order to function and to be able to take care of her baby. She said she felt like she needed to defend her decision after reading my last post and make it clear that other moms shouldn't feel guilty about the decisions they make.

I absolutely agree with her. I applaud her for handling her illness so incredibly well and being so strong to know her options and then to choose the best one for her and her baby. Taking charge of our own health care is what each of us needs to do. The big stumbling block here, that I was trying to express in my previous post, is knowing our options. Often we're given information by the medical community (via pharmaceutical companies), without realizing we have other options. Or we're given just part of the information, or worse, complete misinformation.

I do feel fortunate that I didn't need to take an anti-depressant while I was pregnant, so I never faced that excruciating choice. I do know plenty of other moms who have and who felt like they wouldn't have made it through their pregnancies without medication. I totally respect and support their decision. I remain skeptical, however, about the safety of taking anti-depressants while pregnant or breastfeeding and think we need to demand more and better testing on these drugs. We shouldn't have to settle for an anti-depressant that is shown to cause birth defects, even if it is only a small percentage. We shouldn't have to settle period, but as women, that's historically what we've had to do when it comes to our health care.

I'm starting to ramble, but I guess what I really want to express here is that I think it's always good to discuss how we all need to respect each other's differences in opinion and different choices. Motherhood is tough enough as it is, but it's certainly way tougher if we don't pull together and support each other.

Just like the mom I've been e-mailing with felt attacked by my statement in my previous post that it's common sense to avoid anti-depressants during pregnancy and breastfeeding, I went through a similar experience when I made my decision not to breastfeed my fourth baby. I had really thought it out and made this decision because I knew it would be in my and my baby's (and my other children's) best interest for me to avoid postpartum depression so that I could be a functioning mother. For me, that meant not breastfeeding so that my hormones would become normalized faster and so that I could immediately go on an anti-depressant and not worry about it being in my breastmilk. It was a good decision for me, but I had a heck of a time expressing that to the nurses on the maternity wing of the hospital where I delivered. Although they didn't come right out and say it, they practically accused me of being a bad mom.

Twice a lactation consultant was sent to my hospital room to try to encourage me to breastfeed. I was given all kinds of "breast is best" cues and whenever I asked for formula for my hungry baby, it took forever for it to be delivered to my room. It was all I could do not to feel guilty for my decision, when I knew deep down, below the crashing hormones, exhaustion and pain from the C-section, that I had made the best decision for me.

These decisions are never easy, are they??

July 2, 2007

When you have a subsequent pregnancy

When I was pregnant with my fourth baby, I was pretty nervous about possibly going through another bout of PPD. I'd had such a horrible crash after my third and I'd heard all of the dismal statistics on how common it is to have a repeat PPD experience. But I was determined to beat it. The difference between my third postpartum and my fourth was knowledge. I was empowered by knowing what to expect, being aware of my PPD symptoms and preventive measures that I could take to avoid them.

So, I made a list of everything I needed to have in place so that I could experience the kind of postpartum that every mom envisions -- you know, where you're glowing and healthy, constantly cooing over your baby and relaxing pristinely in your designer maternity loungewear and talking to your friends about how to lose those extra ten pounds.

Okay, so maybe no postpartum is close to that vision, but still, it is possible to have a relatively peaceful and happy postpartum, even with your fourth baby, and even when you've previous suffered from PPD, because I did it.

The key to my last, successful postpartum was having a strong support system in place. Since our extended family is so spread out geographically and I didn't have the luxury of having relatives to lean on, I brought in a postpartum doula to help me for three weeks after our baby was born. Doula is a Greek word and means "woman who serves." A postpartum doula can help in so many ways, basically being a post-birth helper. My doula helped with the baby at night, watched over my C-section incision as it healed, helped identify any symptoms of PPD, handled the laundry, cooking, watched the baby when I needed to spend time with my older children, but most importantly, she listened to me and helped me gradually get back on my feet. She and I were a team and that support was priceless. She stressed that I need to take of myself and recover so that I could take care of my new baby and the rest of my family. Paying for a postpartum doula was the best money that my husband and I have ever spent.

One of my dreams for all new moms in the future is that they all can have the choice of having a postpartum doula.

If you're looking for a doula in your area, feel free to e-mail me and I'll help you find out your options; kdavispark@gmail.com.

May 28, 2007

Does PPD end?

I was just reading some blogs written by women who are suffering from PPD and one of them asked if PPD ever goes away. Just that one statement brought a rush of memories. I remember that feeling so well -- like you're in this tunnel that keeps getting smaller and darker, with no light in sight. When I was in the throes of PPD, I couldn't even remember what it was like to feel good. I couldn't remember what "normal" was. And I couldn't imagine being that way ever again.

But PPD does end. You do reach light and leave the tunnel. Some women crawl out of the tunnel on their own. Others are lifted up and carried out by their family or friends. But it does end.

In my situation, it was a little of both. I crawled and at the same time leaned on those around me who offered their unconditional love and support. The thing that began to shatter the darkness was knowledge. I was so horribly ill and yet had no idea what was wrong with me. Beginning on the day I came home from the hospital with my beautiful baby daughter, my world started disintegrating. I was hit with intense nausea, worse than any morning sickness ever was. I experienced seemingly endless vomiting and diarrhea and quickly lost my "baby" fat and any reserves I had. I was dizzy the second I tried to lift my head off my pillow. When I did make it out of bed, I often fainted. I gave up breastfeeding my daughter after a week because every time I brought her to my breast, I had to run for the toilet. By the second week I was in complete dispair. Not only did I have my newborn daughter to care for, I also had a 13-month-old son! I was an instant and utter failure, not being able to even get out of bed.

My obstetrician was on maternity leave, so the doctor filling in for her sent me to a gastroenterologist since my symptoms were mainly G.I.-related. This particular doctor was supposedly the best G.I. specialist in Dallas. He checked me over thoroughly (colonoscopy, endoscopy, etc., etc.) for cancer ---- countless tests and two 3-day hospitalizations later, he was done with me. He could find nothing wrong with me and literally threw his hands up and shrugged at me.

By this time, my daughter was 3 months old. I was unable to be a mom, a wife, much less a healthy person. I couldn't drive anywhere. I couldn't keep food down. I couldn't do anything but lay in bed. I wanted to die.

During my last hospital stay, a nurse quietly suggested that I read a book called "Postpartum Survival Guide" by Anne Dunnewold. I didn't know much at all about PPD and was stunned to think that I might have it. I didn't realize I was depressed.

My parents had responded to my situation by cutting me off -- they chose a "tough love" stance because they thought being sick was all my choice.... that I was lazy or simply unwilling to function as a mom. Even though they told relatives not to help me, an aunt wasn't willing to let me suffer without help. I told her about the book recommended by the nurse and she agreed that PPD could be a possibility. I read every page of the book and saw my story in its pages. I couldn't believe it. My aunt encouraged me to get into therapy and offered to help me with child care so that I could get out of the house. I called the book's author, Anne Dunnewold, a psychologist who happened to have an office in Dallas. Although she was completely booked six months out, when she heard my story she agreed to see me within the week. That meeting changed my life. Anne not only suggested medication to help me get out of the tunnel, she also suggested yoga. I started taking Prozac, signed up for a weekly yoga class, and remained in therapy for a year, although my PPD symptoms magically disappeared within a couple of weeks of seeing Anne that first time.

It was the knowledge of PPD that empowered me. I finally had a name for what was wrong with me. At that point I knew my life wasn't over. It was the support of my aunt that helped me get to therapy. It was the combination of therapy, medication and yoga that saved my life.

For anyone who is suffering from PPD, I promise you that you can get better. Don't lose hope. You will get your life back. I did, and not only that, I had a subsequent pregnancy and never experienced PPD again. Knowledge is everything ---- PPD is absolutely preventable.