If it’s Monday, it must be . . .

After my third pregnancy, it felt like I saw every specialist under the sun. Midwife, general practitioner, physical therapist, behavioral therapist, chiropractor, podiatrist. It took a lot of work to put me back together physically and mentally.

My schedule hasn’t changed much this time around, except I’m starting my visits prenatally rather than post. And I haven’t hit everyone on the laundry list yet – which is probably a good thing, given I’m already having continuity of care issues.

Today I saw my general practitioner.

It was to be a followup after my visit to a psychiatrist. Shortly before my pregnancy, I’d started with this GP. When discussing my mental health history and current condition, she suggested I get a specific diagnosis from a psychiatrist since what initially presented as postpartum depression was persisting. I’d been continuing care with a LICSW I’d been seeing. Thanks to hospital systems and network nightmares, I’d need to go through 12 CBT sessions at his facility before even seeing the psychiatrist – even though that’s what I’d been doing for years with my own therapist. Already spooked by the red tape and thought of strong psychotropic drugs, I put it all on hold once I found out I was pregnant. I couldn’t start on new meds anyway and didn’t need any additional stress.

Through the guidance of my LICSW and midwife, I decided the benefits of continuing my low dose of meds were greater than the risk of harm during pregnancy. That’s not to say the decision was made lightly. I cut out mostly everything questionable when pregnant. I’d always felt guilt for taking meds in the first place. But after weighing all my options – and a few bad days of trying to wean – the meds stayed.

Now, my GP didn’t know any of this.

When I tried to verify my protocol and discuss my midwife’s suggestion to possibly wean toward the end of pregnancy so the baby would not suffer any possible ill effects of the drug as a newborn, she wondered whether she would’ve advised taking meds at all had she found out earlier in my pregnancy. She said that’s why she wanted the input of the psychiatrist, especially now with a pregnancy, to know exactly with what we were dealing.

Now, this GP is solid. She did not shy away from discussing different prescription therapies. She wanted me to see the psychiatrist to get to the origin point at the bottom of my pit. She is candid, empathetic. Today, however, I felt the doubt and guilt over taking meds during pregnancy try to push up. The doubt that I’m not getting the best possible prenatal care cropped up when she suggested I see an OB in my group rather than only a midwife; her reasoning being that should my situation become critical I would need someone to assess and intervene immediately.

She is following due process. She is looking out for the best interests of me and my baby. She is talented, trained, and professional.

And yet there are gaps in her knowledge of perinatal mood disorders and their treatment.

My midwife, fully aware there is no definitive research saying meds are 100% risk-free during pregnancy, also knows the research that an anxious and/or depressed mother can also have ill-effects on a developing fetus.

My LICSW knows the mental anguish I put myself through in making this decision and that I can’t hang without the meds.

All three are looking out for the best interests of me and my baby. All three are experts in their fields. And yet, at times, all three have told me something different.

Where is the continuity of care in the perinatal period? Yes, the knowledge base is growing. Yes, awareness is spreading. Yes, some practitioners are training themselves to be experts in this ever-growing area. But there isn’t enough widespread know-how. There are gaps in which women can and will fall through.

I haven’t met any of the OBs in the group I visit, but seeing one doesn’t guarantee me swift and effective intervention in the postpartum period. Not taking meds doesn’t guarantee a perfectly formed baby. Taking meds doesn’t even preclude mood disorders.

There is always some mystery involved in making and growing a baby. Insert mood disorders and mental health issues and the lines are blurred even further. Unfortunately, it still falls primarily to the mother to advocate for her own health amidst all the conflicting care.

Though still haunted by the postpartum experience in my previous pregnancy, I feel that I can advocate for myself this time. Knowing the danger signs, the markers, the despair, I feel equipped to request and access care as soon as it’s needed. I know who to ask and how to get it. However, that doesn’t mean that all of my helpers will be on the same page. One perinatal hand may very well have no idea what the others are doing – just as I don’t know which specialist I’m seeing unless I know which day it is.

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Point of Contact

I entered the world of mental health advocacy kicking and screaming.  Some days, quite literally.

Studying English?  Easy, I loved literature and writing.  Teaching?  A way to purvey that love to another generation while parlaying it into a paycheck.  Motherhood?  An extension of the love my husband and I shared.

Postpartum depression and anxiety?  A most unwelcome and unpleasant recalculation in my life’s journey.

For years, I looked for reasons.  I hadn’t recalibrated my compass, had I?  What had happened to lead to this catastrophic turn of events?

I am not the grand cosmic poomba of all things so I cannot answer those questions with any sort of certainty, but I do know that my struggles awakened a raw, yet steely inner strength I’d never had before.  They fostered an empathy of a whole new level for others’ suffering; for the mantle of motherhood and all its ‘come-withs’.

I had to polish some ragged rock I’d gotten caught up on and dragged along on my journey into at least a burnished gem.  Something positive had to come out of all that suffering.  And perhaps even prevent another woman from travelling the same path.

I started this blog as a way to tell my story, which very few knew.  I thought, with complete disclosure, I might open the dialogue for others.  At least become an ally in an all too commonly silent struggle.  Perhaps I didn’t tackle postpartum directly enough – for many of my discussions and observations were integrated with my life.  However, I still haven’t decided if that was/is a failure, for mental health struggles quickly become an intimate part of one’s life, touching all parts of it.  It also hinted at some version of depression/anxiety becoming part of my ‘new normal’.

And with my ‘new normal’ so different from my old one, I began to develop further plans for burnishing rocks into gems.

I knew what I wanted to do, but with no clinical experience, I had limitations.  I could not mention the word ‘therapeutic’ in any official capacity.  I was petrified that if the programs I had in mind reached the end of my personal experience and empathy, that I wouldn’t be able to help someone in crisis.  

I embarked on a series of webinars offered by Postpartum Support International.  The Social Support Training series, one session every other week, stretched from January to June of last year.  While many of the participants were clinicians in the field of maternal mental health, the course was user-friendly and aimed at individuals interested in starting and supporting groups of mothers in various presentations of mental health.

The Social Support Training was the perfect first step toward a solution.  It offered a wealth of information – statistical and anecdotal, researched and proven – paired with the assurance that social support people are not meant to be clinicians.  They are meant to offer a safe place for mothers to gather and vent, ask questions and talk, discover resources and camaraderie, and just be.

I finished the series a few weeks before I headed to Boston for Postpartum Progress‘ first annual Warrior Mom Conference, the first ever maternal mental health conference for survivors of PMADs.  With my new-found knowledge and training, I looked forward to building on that momentum and connecting with other moms doing the same.  While I did that, I also found parts of me that hadn’t fully healed.  I realized I still had my own work to do and how very complex maternal mental illnesses are.

That fall, my PMAD baby started full-day kindergarten and, though scared as hell, I began formulating plans to kick my ideas into high gear.  I applied for a scholarship offered by Postpartum Progress and the National Council for Behavioral Health to be trained in Mental Health First Aid, which I was awarded a few weeks after discovering I was pregnant with my fourth child.  I faltered, wondering how I would enact my plans with a newborn baby.  But then, they were never my plans anyway.  And now I would have the full-circle experience informing my advocacy.  Up until now, I’d only ever experienced the postpartum piece of mental health; now I could speak to both pre- and postnatal.

I spent two days in New London, Connecticut with two fabulous humans from Child & Family Agency of Southeastern CT learning how to assess and support a person’s mental health status.  Again, the trainers stressed that we were not expected to diagnosis the individuals we come into contact with, but to assess their situation and determine whether they need additional help.  We then must help them feel comfortable and safe until such professional help is acquired.  The trainers helped me gain even more practical ways to help those in need as a civilian, a concerned individual, an advocate.

As I sat in that auditorium, surrounded by empathetic professionals and persons, I flashed back to an article I’d read a week and a half earlier.  “The Community Maternal Mental Health Professional” on The Burnout Cafe (click image for link) discusses the gap between women who need help and the services available to them.  While the central point of contact in this graphic from the article lists a woman’s professional caregivers, and a woman certainly does see these people quite frequently both before and after the baby is born, I would argue another layer of contact needs to be added.  If practitioners aren’t well-informed or comfortable dealing with maternal mental health issues, the assessments, diagnoses, and referrals needed will not occur.  Having been down that dark hole myself, I am well-versed in those discussions.  I can help normalize the feelings a woman may be experiencing, yet not want to admit for fear of retribution to her or her child.  I can point her in the direction of practitioners specializing in the exact type of care she so desperately needs.

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“The Community Maternal Mental Health Professional” as point of contact (via The Burnout Cafe)

With my personal experiences and new-found knowledge via recent trainings, I am a point of contact for mothers.  

My plans may morph and grow as my own life and family does, but the end goal is the same:

Helping Mothers Get the Help They Need.

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