Letting go...

Yesterday was L.'s first full morning of preschool. He attends a local church-ministry preschool one morning per week this year. Last week, I met his teachers, filled out paperwork and he spent some time getting to know the classroom. We were there about an hour and he seemed perfectly confident and at home there. Wednesday morning, I dropped him off around 8:45am, and he was the first student there in his class of 5 boys. His teachers were thrilled to see him and he seemed content enough. I, on the other hand, was a nervous wreck. I had never before (other than a short time in our church Nursery which is a very familiar environment for me) dropped my child off anywhere. He has had a nanny since he was 3 weeks old and anytime that someone other than family has watched him, it has been in our own home. The whole notion of packing a diaper bag with a bottle that someone else would feed him, a diaper that would be changed by a virtual stranger, and a change of clothes just in case seemed so foreign to me. When we arrived at school, the door (which is split in half horizontally) was closed at the bottom and his teachers greeted us there. I passed over L. along with his diaper bag, and felt myself have to catch my breath. Having previously been a preschool teacher, I knew the right thing to do was to leave quickly and confidently after a brief goodbye. However, I found myself lingering. I couldn't help but blow one more kiss goodbye and mention for the third time that he usually naps by about 9:30am. Rational thinking finally setting in, I left the room and found myself feeling lost on the way to the car. I was still so fuzzy that I made a left, instead of right, and created an extra 5 minute addition to my commute as a result. I realized during yesterday's mom's group that this experience is such a metaphor for what we have to do each day as moms. Some days we don't physically leave our children at all. However, each day we leave behind that child that he/she was that day. Our children are aging and developing each and every day and no two days will create exactly the same experience. We have to let go of today in order to embrace the tomorrow. Do I miss L. snuggling up against me at 3 or 4 months old, unable to move himself into another position because he was not yet mobile? Of course. Now, he lets me know when he is ready for bed by pushing his bottle away, nestling his nose into my arm and arching his back. This is my cue to put him in his crib, give him his lovey, and say goodnight. Sometimes, I am so glad to have an hour or two after bed to catch up on things. However, last night, I really wanted to snuggle longer. Maybe it was the school experience. Maybe it was having been gone to work longer than usual in one day. I am not sure. But, I am certain that in order to treasure today and the todays to come, I have to let go...not of the memories of the yesterdays, but of the experiences themselves. By cherishing the present, I set the stage to enjoy the future even more.

God bless, A.

p.s. Please check out the video link I have added to the sidebar. It's a great 5 minute video about PPMD.

Men Also Get Postpartum Depression

Men Also Get Postpartum Depression

Study Shows 1 in 10 Dads Has Moderate to Severe Postpartum Depression

By Charlene Laino
WebMD Health News

Reviewed By Louise Chang, MD

May 6, 2008 (Washington) — Postpartum depression hits new dads, too.

Moreover, male postpartum depression may have more negative effects on some aspects of a child's development than its female counterpart, says James F. Paulson, PhD, of the Center for Pediatric Research at the Eastern Virginia Medical School in Norfolk, Va.

Paulson and colleagues reviewed data on more than 5,000 two-parent families with children aged 9 months.

They found that one in 10 new dads met standard criteria for moderate to severe postpartum depression.

That's a "striking increase" from the 3% to 5% of men in the general population that have depression, Paulson tells WebMD.

The research, presented here at the annual meeting of the American Psychiatric Association (APA), also showed that the 14% of new moms have postpartum depression. That compares to 7% to 10% of women in the general population.

Depressed Parents Less Likely to Read to Their Kids

The researchers looked to see whether the parents' depression affected their interaction with their children.

"What we found," Paulson says, "is that both moms and dads who were depressed were significantly less likely to engage in interactions such as reading, telling stories, and singing songs to their infants."

But only the dads' behavior significantly affected their child's development at 24 months — "specifically in terms of how many words the child used," Paulson says.

"If their dads were depressed and didn't read to them, the infants had a much smaller vocabulary," he says.

There was no link between the baby-mom interactions and the child's command of words at 2 years.

Not Just Baby Blues

Postpartum depression isn't just the "baby blues." It's severe depression marked by feelings of sadness or emptiness, withdrawal from family and friends, a strong sense of failure, and even thoughts of suicide.

These emotions can begin two or three weeks after birth and can last up to a year or longer if untreated.

Paulson says that research suggests that signs and symptoms of postpartum depression differ between the sexes.

Women are often sad or withdrawn, while men may become irritable, aggressive, and even hostile, he says. But there are no hard rules.
The findings don't surprise experts who gathered for Paulson's talk. Elisabeth Kunkel, MD, of Jefferson University in Philadelphia, says, "Postpartum depression in men is a real entity."

She tells WebMD that many men are reluctant to see help "as they are supposed to be providing the support for the new baby and the new mom."

APA President-elect Nada Stotland, MD, of Rush Medical Center in Chicago, says, "The life changes for a new dad are enormous. Just thinking about the costs of raising the kid to 21, maybe for life, can be terrifying. And all the unspoken fears: Will my wife still be as interested in me? Will my baby be as cute as my brother's baby?"

Stotland says that first-time new dads are at greatest risk for developing postpartum depression.

So what should a new dad do? Recognize that the symptoms can interfere with not only your own, but also your child's health, the experts say. Don't dismiss lingering symptoms; instead, go talk to a doctor, counselor, or other health care professional for diagnosis and treatment.

SOURCES: American Psychiatric Association 2008 Annual Meeting, Washington, D.C., May 3-8, 2008. James F. Paulson, PhD, Center for Pediatric Research, Eastern Virginia Medical School, Norfolk, Va. Elisabeth Kunkel, MD, Jefferson University, Philadelphia. Nada Stotland, MD, American Psychiatric Association president-elect; Rush Medical Center, Chicago.

Mechanism for Postpartum Depression Found in Mice

Discovery May Lead to Better Treatments

Researchers have pinpointed a mechanism in the brains of mice that could explain why some human mothers become depressed following childbirth. The discovery could lead to improved treatment for postpartum depression. Supported in part by the National Institute of Mental Health, of the National Institutes of Health, the study used genetically engineered mice lacking a protein critical for adapting to the sex hormone fluctuations of pregnancy and the postpartum period.

"For the first time, we may have a highly useful model of postpartum depression," said NIMH Director Thomas R. Insel, M.D. "The new research also points to a specific potential new target in the brain for medications to treat this disorder that affects 15 percent of women after they give birth."

"After giving birth, female mice deficient in the suspect protein showed depression-like behaviors and neglected their newborn pups," explained Istvan Mody, Ph.D., of the University of California at Los Angeles (UCLA), who led the research. "Giving a drug that restored the protein's function improved maternal behavior and reduced pup mortality."

Mody and Jamie Maguire, Ph.D., UCLA, report on their findings in the July 31, 2008 issue of Neuron.

Researchers had suspected that postpartum depression stemmed from the marked fluctuations in the reproductive hormones estrogen and progesterone that accompany pregnancy and childbirth. Yet manipulating the hormones experimentally triggers depression only in women with a history of the disorder. The roots of their vulnerability remain a mystery.

Evidence suggested that the hormones exert their effects on mood through the brain's major inhibitory chemical messenger system, called GABA, which dampens neural activity, helping to regulate when a neuron fires.

Mody and Maguire discovered that a GABA receptor component, called the delta subunit, subunit fluctuated conspicuously during pregnancy and postpartum in the brains of female mice, hinting that it might have pivotal behavioral effects. To find out, they used mice lacking the gene for this subunit and studied them in situations that can elicit responses similar to human depression and anxiety.

Much like human mothers suffering from postpartum depression, the genetically altered mouse mothers were more lethargic and less pleasure-seeking than normal mice. They also shunned their pups and failed to make proper nests for them.

This abnormal maternal behavior was reversed and pup survival increased after the researchers gave the animals a drug called THIP that acts on the receptor in a way that specifically restores its function in spite of the reduced number of subunits.

"Improper functioning of the delta subunit could impair the GABA system's ability to adapt to hormone fluctuations during the highly vulnerable post partum period," explained Maguire. "Targeting this subunit might be a promising strategy in developing new treatments for postpartum depression."

Reference

Maguire J, Mody I. GABAAR plasticity during pregnancy: relevance to postpartum depression. Neuron. 2008 Jul 31; 59

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The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

Let's educate America

Good morning, everyone! Yesterday I attended a workshop at the Carter Center on Maternal Depression. While the information presented (research on incidence, impact, etc.) was not new to me, the discussion shared sparked something in me that led me to feel on fire with passion about educating the people of the United States about Postpartum Reactions, resources, support services, best practices, ways to get help regardless of income or insurance status, etc. While the numbers clearly state how being low-income is a huge risk factor for maternal depression, there is little offered, even in a large city like Atlanta, to help these women. I think back to my dire situation at 5-6 weeks postpartum when I hit rock bottom and felt absolutely helpless and hopeless and I can't imagine how I would have reacted if I had not had the $325 to pay for my initial psychiatric evaluation and therapy session or if I had not had the $100 per month to pay the co-pays for my prescriptions (let alone if I had not had insurance at all and had to pay full price for the meds). I sat there feeling enormously blessed and almost embarrassed that my recovery truly is credited to the financial and social situation I found myself in when crisis hit. Had I not had a supportive and loving network of family and friends and had I not had the ability to pay for the services I received I would not be better today. In fact, I am not sure where I would be today. My guess is that I would have had to be hospitalized, which actually may have made my condition worse instead of better, even if it had been the only option. I thank God that this scenario was not my reality, but I mourn for those for whom it is.

Today, I ask those of you who read my blog to brainstorm ways that we can get education, advocacy, and support to those who are suffering in silence or those who are suffering but do not have the resources to get the assistance they need. Think outside of the box with me...how can we "make the news" or do the legwork ourselves to find women and families in need and connect them with the people who can help them? Please send your thoughts to me, either via email or as a comment to this post. All ideas are welcome, and even if you can do no more than make a suggestion, you are making a difference...thanks in advance!

Blessings, A

Sailing by...

Time really does have a way of doing this. One minute I was in the midst of PPD and feeling as if the "newborn stage" would never end and now I find myself anticipating the Meet the Director night at L.'s new preschool. He's nearly 11 months old and almost 26 lbs. He certainly is not a newborn anymore. It's hard to believe that I ever wished he would age more quickly. While I realize that it was related to his sleep patterns and independence, which are directly related to my general mood and health, it still seems so sad that I was not able to experience much joy in those early days. Don't get me wrong, the joy that I find in each day with him now more than makes up for any loss, but it has made me think.

I read a post on a blog the other day about the redemptive value of a healthy birth and postpartum period for a PPD sufferer. It seemed to me previously that experiencing a horrible postpartum reaction would make anyone convinced not to have another child, and that has been my experience with the women I have been supporting through their PPMD, but I must say that it intrigued me. Would that be possible for someone who had such a severe reaction, like me? Today I spoke with Dr. Arnold about this very topic. We chatted about the possibilities and the health that my being able to discuss such a topic exemplified. We discussed strategies, both psychological and practical, and of course determined that the whole conversation was just theoretical. But, I must say that if I could guarantee a new, larger home, a baby nurse for at least 3 months, and no postpartum reaction, I would probably consider having any child naturally. Even with a planned C-section and recovery, I believe that I would be able to swallow (in a few years) the idea. It is still my preference to adopt, partially because of PPD, partially because I think it's a wonderful gift to give a needy child, and mostly because I secretly (or maybe now not-so secretly) want a little girl.

Today I bought L.'s birthday invites. Ordering them seemed almost surreal and then my colleague, whose father died on Wednesday, walked into the office to use the folding machine to fold the programs for his Dad's funeral. The absolute dichotomy of these situations resonated with me. While helping D. fold the programs, I realized that I couldn't possibly honestly mourn for my "loss" of my son's first year while honoring the death of beloved man. Life truly does parallel and separate at the same time. I thank God today for L.'s life and realize that no matter how many birthdays we celebrate, I will both mourn his age and be grateful for the amazing gift God has provided me in his life.

Blessings, A.

GA Supports Women with PPMDs

Hello everyone! I am sorry that my writing has been infrequent lately. You would think that being PT would allow me more time, but so far it seems like it just allows me more time with L., but not yet more personal time. Either way, while I continue to be a coupon clipping queen for the benefit of my family now that my income has been halved, I still think that God's plans, while not necessarily consistent with ours, always overrule us, and it's for our benefit. The blessing of these two full days per week with my son will be treasured. As we approach his first birthday, with each bottle I feed him I realize how soon we will be no longer feeding him via bottle and how soon he truly will be a toddler. When we took him to get his first professional haircut about 10 days ago, I realized how much he had changed in his appearance and that he has gotten closer to becoming a little boy and further from being an infant. While my newborn experience was filled with terror, I still recognize that it was also blessed with moments of joy, of rocking my little (alright, almost little) bundle to sleep with his dark brown (now light brown) hair gently brushing against my cheek. Now he still enjoys being rocked, but in order for him to calm down enough to lay and go to sleep, I need to sing and shush him. No longer is he immobile and at the will of my interests or place in the house. He can move about as he wants; and he does.

Last evening, I met with 11 other passionate women, all of whom are connected to PPMDs in varying ways and who share the desire to respond to a woman in need, especially in the time before and after she has a baby. This new organization, for which I am so thankful to have been asked to be a part of, is called the GA Postpartum Support Network. This non-profit seeks to support women in various and comprehensive ways: volunteer training, practitioner training, website with lists of people and written resources, fund-raising to increase awareness, movements to create legislation to protect and care for women, etc. Once the GPSN website is up and running I will post a link immediately from my blog and will update you on the status of things.

Also, to note, the first Support Group for Moms experiencing or who have experienced Postpartum reactions will be held in the next month. This group serves Midtown and areas North of Atlanta. It will be the only existing Support Group in the metro Atlanta area at this time. The meetings will be on the 1st and 3rd Mondays of the month 6-7:30pm to start. Once the group has met, we can decide as a collective entity the way that we would like to move forward. If you are interested in participating in this group or would like to suggest it to someone who might benefit from it, please contact me. You may leave a comment at the bottom of this post or you may email me at atlantamom930@gmail.com.

Just breathe

The past weeks have been filled with emotion. My position at work was recently reduced from Full to Part time with a change in responsibilities. Our Milanese friends whom we have not seen since 2005 were supposed to arrive on July 22 and we learned on the 21st that Davide's mother had suddenly passed and that they would not be traveling to the U.S. to visit. Our beloved nanny since L. was just 3 weeks old celebrated her last day with our family. We made last minute arrangements to do a low-cost, low-stress vacation to Florida to see friends. We spent 6 days away from home and enjoyed the company of old and good friends, shared memories, made new ones, relaxed, stayed up too late, and ate well! I even FINALLY got to go see Sex and the City...hooray for me!

We arrived home on Tuesday evening and Wednesday I spent a full day alone with L. I realized mid-afternoon that it had been the first time in forever that I had done that. I went from thoughts in the morning of the potential niceties of being s Stay at Home Mom to that afternoon realizing why it is important for me to do some work outside the home. Thursday, we welcomed L., our new nanny, to our home and into L.'s life. While much different from B., she is a loving and well-educated woman who seems to possess many of the same values that we do in our family. B. stopped by yesterday to say goodbye to us with her husband and brought us the coolest Little Tykes car for L. It is meant for ages 1.5-5 years, but she wanted to give him this great toy before she moved. We hugged after postponing the goodbye as long as we could. Tears were shed by her and me. I took a shower right after she left and equated the water slowly trickling down my body and into the drain with the sense of grief and loss I have recently experienced. I can't quite explain the pain that a change in area of ministry work or the loss of stability that comes when a nanny who has been with your child almost since he was born brings. I ache for both, but at the same time know that our God never changes and realize the importance of Him in my life and that truly He is all I need.

A few months ago a colleague placed little notes in each of our mailboxes at church. The quote on the note stated, "If nothing ever changed, there'd be no butterflies." How true, dear friends, how true.

May each of you embrace change as you are able and find good in each day.

Best, A.