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Health & Fitness

Workshop Highlights Personal & Professional Perspectives on Pregnancy-Related Mood Disorders

An informed healthcare provider can make all the lifesaving difference to a mom suffering from postpartum depression and other perinatal mood disorders.  On November 15, noted psychologist and author Susan Benjamin Feingold, Psy.D, will share her approach to these challenging, but treatable, sometimes even preventable illnesses.   Her workshop, “Antepartum and Postpartum Mood Disorders” is for all professionals who work with women during the perinatal period (the period before and after giving birth), but anyone who is interested is invited to attend.   

Feingold, a leading practitioner in the field, is the author of Happy Endings, New Beginnings: Navigating Postpartum Disorders (2013) and an adjunct professor in the Clinical Psychology program of the Illinois School of Professional Psychology at Argosy University, Chicago.   She also understands how it feels to be a patient.  She fought her own battle with postpartum depression over twenty years ago.   Her experience with the then poorly understood condition inspired her to become an innovator in the field.

Several years ago, Dr. Feingold began to see patterns in the patients she treated for perinatal mood disorders.  As patients completed therapy, they told her that despite the struggle they were grateful for the experience and were leaving her care transformed.    Dr. Feingold’s approach had turned the potentially most difficult experience of a woman’s life into a catalyst for positive change.    

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One of the highlights of Dr. Feingold’s workshop will be a panel of four women who will discuss their personal experiences with pregnancy-related depression, what it was like for them and how it impacts their lives today.  Other topics will include diagnosis and treatment of the various types of perinatal mood disorders, how to make a referral and handle crisis situations, identifying national and community resources, and risk factors and prevention.  Please follow the links below for more information and to register for the workshop, which is sponsored by the Health Department and Community Health Center of Lake County and by the National Alliance on Mental Illness.

Dr. Feingold kindly spoke with me about the workshop, shared her groundbreaking ideas about “Melanie’s Law” (a recent federal law addressing postpartum disorders), and about helping moms who are at risk or already suffering.

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Q: Please tell us about the workshop.  Who should attend?

A: The workshop is for anyone interested in learning about perinatal mood and anxiety disorders. It’s especially useful for mental health providers and healthcare providers.   But anyone interested in adjustment and emotional problems during pregnancy or the perinatal period is welcome to attend. 

My goal for the seminar is to provide instruction and education and to differentiate between the blues, adjustment disorder, and postpartum depression with its various anxious subtypes.   We’ll also discuss postpartum post-traumatic stress disorder as well as the most rare but most severe, postpartum psychosis.

Q: Is the seminar also for patients, support group leaders and other nonprofessionals?

A: Support group leaders especially might benefit and patients certainly are welcome to attend, although it may be more information than they’re looking for.  So they could certainly decide.   I’ll be discussing the onset, the incidence (how common this is), the risk factors, treatment options and how to distinguish the different subtypes and disorders.  I’ll also discuss positive outcomes and how to transform this difficult experience into a life-changing event.   

Really, one of the most exciting aspects of this seminar is not me.  I’m going to be moderating a panel with four women who have volunteered to share their stories of postpartum depression and to answer questions.   I’ve prepared a bunch of questions, but certainly if the audience has questions, that will be a priority.      

Q: What aspects of the experience will the panel discuss?

A: I didn’t want to tell them what to say, so all I’ve said to them is that they have five to ten minutes to tell their story.  I encouraged them to be open and honest about what the experience was like.   I’ll also ask whether there are any positive outcomes, what they learned and how it changed them. They are all interesting women.  I think they’ll have plenty to say about it.

Q:  Please tell us about “Melanie’s Law.”

A: The Melanie Blocker Stokes MOTHERS* Act is also sometimes called the MOTHERS Act.  It was passed in January 2010 and is an initiative to combat perinatal mood disorders.  It was introduced by Congressman Bobby Rush after he was contacted by Carol Blocker who is Melanie’s mother.  Melanie was a young woman [who suffered from postpartum psychosis] who in 2001 jumped from a Days Inn in Chicago.  It was a real tragedy and her mother has been steadfast in fighting for change so her daughter’s death wouldn’t have been a total waste.  Senator Robert Menendez of New Jersey was another person who was very influential.   The law is a comprehensive federal commitment to combat postpartum depression through research, education initiatives and voluntary support service programs.

We’re still waiting to see how it will make a difference to the women themselves and how it will influence our lives.  Maybe there’s been some difference, but I’m not sure we’re feeling it as much as we will in the upcoming years.  Some of the differences I’ve seen are more funding, so there’s more research, and it feels like there’s more screening going on in many OB offices and hospitals.   But we still haven’t seen the full impact from the consumer standpoint.

Q: So it’s a good step?

A: Yes.  It is an important first step.  It legitimizes that this really is an actual illness.    

Q: What do healthcare professionals most wish patients knew about this illness?

A:  I think they wish that patients knew how common this disorder is.  It affects 800,000 to 900,000 women in the U.S. each year.    I’m sort of talking for all healthcare professionals, which is hard to do, but I think they wish patients would be more forthcoming and talk about what they are going through.  If [healthcare professionals] don’t know what’s going on with their patients, they’re really at a disadvantage.  So maybe they wish patients would be more willing to admit that they’re not feeling like themselves.  

I think they want patients to realize that this is an illness and that they aren’t flawed and they’re not bad moms which might be one of the reasons, because of the stigma, that women don’t want to tell their healthcare professionals what’s going on.   Patients don’t always realize how common this is and they think their healthcare professionals will think badly of them.  Women may not want to admit that they’re having this difficulty or that they don’t feel connected to their baby.  They feel like they will be judged.  I think healthcare professionals wish patients knew that this is an illness that needs treatment.  Take it seriously.  Early intervention is important in terms of getting well as soon as possible.

Q: What do patients most want their healthcare professionals to know?

I think women themselves want their healthcare professionals to know how common this is and that it’s not a character flaw, that it’s an illness, so not to judge them.   I think some patients also worry, and I’ve heard this over and over, that “if I told my doctor, they might try to take the baby away.  They might think I’m a bad mom.” 

I think patients wish that their healthcare professionals knew the importance of early identification and screening, of prompt treatment.   I think they wish [more healthcare professionals] had a basic knowledge of the signs of postpartum mood disorders.   And maybe I’m talking for myself, but I think they wish that their providers knew the risk factors and could have referral resources at the tips of their fingers so that patients could get information and treatment quickly.

If we were more advanced in this area, OBs, family practitioners, doulas, lactation consultants, childbirth educators and midwives would know the risk factors and could somehow red-flag who might be at risk.  This is not to stigmatize, but so you could educate the woman that yes, this happens.  “You have depression in your family.”  Or, “You’ve struggled with this before and it’s a possibility.  It’s a common disorder, so please come to me.”  Set it up before.  Give her resources.   Once in a while I do have that kind of situation where a patient who is pregnant calls saying, “I know I’m at risk.  My doctor gave me your name.  I haven’t delivered yet and I’m feeling okay now, but I’d like to meet with you and maybe we would work together if I do have trouble.” 

Q: That’s a great proactive thing to do.

A: It is.  And proactive is exactly what it is and a great way of putting it.  And that approach can be so amazing.  In the best of all worlds, I meet with her [during the pregnancy].  She has my name and already feels more comfortable.  She has a plan in place and that alone can really help in terms of prevention.  Of course, I can’t guarantee it.  But if someone does have trouble, then they have the steps they need to take.  They’re not caught unaware.  It’s very difficult when a woman delivers and [a postpartum disorder] blindsides her.  Then she doesn’t know where to go, who to call, where to start.

Q: That has to be so hard.

A: Yes.  Very difficult.  I realize that this can happen in other illnesses.  Things like cancer.  You don’t have the name of an oncologist before anyone tells you that you need it.   People are in shock and they have to pull together resources and muster the energy at a time when the floor has dropped out from under them.  That’s what can happen with this.   So when a proactive approach works, it’s amazing.  That’s where I would love to see things go. That’s sort of the new world approach to perinatal disorders.

Q: Knowing help is there if you need it can be very reassuring.  So if somebody is at risk, can a proactive approach during pregnancy actually lower the risk for a postpartum disorder later?

A:  Yes.  There are things we can do if someone is at risk; make sure they have good coping strategies, get a support network in place, maybe get some extra help with a postpartum doula.  Having this sort of team in place in a preventative way can make such a difference.

I’ve also found with preventative care that patients I’ve treated who plan another pregnancy and want to avoid another “postpartum,” that if we have one or two appointments and set up a plan, many of those women don’t even have a second occurrence.  If they do have another occurrence, more often than not, it’s less severe. 

Getting back to “Melanie’s Law,” something I would change is for health insurance companies to pay for preventative [mental health] care.  This is not currently the situation.   If you could have someone come in for one or two sessions during their pregnancy, it could make all the difference.  It could save so much money because if I don’t need to treat later, look how much cost is prevented.  

I don’t think in terms of monetary costs, but health insurance companies do.  I think in terms of the cost to the woman, to her family, of all the suffering, and it’s certainly well worth the price of a session or two. Health insurance companies would be smart to invest in that kind of preventative care and to allow practitioners to do that and save themselves money.  And then for the patients, to save them suffering.

We know that the incidence in general of postpartum disorders is a 10% - 20% risk.   For women who have had it before, in a subsequent pregnancy the risk goes up to a 30% - 50% risk and according to the literature it will be more severe each time.

I think that preventative care is really the wave of the future.  I don’t know when that future will be, to be perfectly honest.  But that is where I would like to see “Melanie’s Law” going:  opening the door to preventative care of perinatal disorders.  

Q: When does a postpartum mood disorder become postpartum psychosis?

A:   Postpartum depression and postpartum psychosis are different disorders.    There are differences in terms of time of onset, symptoms and treatment.  Postpartum psychosis often comes on quickly.   Postpartum psychosis is really very rare, but it’s very severe.   It affects one to two out of a thousand new moms and is considered a medical emergency.  It requires hospitalization.    

Q: What are the symptoms that distinguish postpartum depression from postpartum psychosis?

A: With postpartum psychosis, a woman has impaired judgment.  She can have delusions which are false beliefs.  Her reality testing is compromised.  It’s considered a thought disorder so she might feel like someone is inserting thoughts into her head.  Being psychotic is unique in that this woman is no longer responsible for her actions.  That’s why it’s a medical emergency.  Not that every woman with postpartum psychosis takes her own life or takes the life of her child, but she is more capable of that because she might be having hallucinations.  She might be hearing things – auditory hallucinations are more common.  There is sometimes religiosity in terms of “God told me that my role was to kill this baby in order to save the world,” or “this baby is damaged and it’s the devil.” It’s really off the charts.  It’s very different than your difficult postpartum depression or anxiety.  It’s very rare, but it’s very severe and scary.

Q: Can preventative care lower the incidence of postpartum psychosis as it can with postpartum depression and anxiety?

A: In terms of prevention with postpartum psychosis, I'm not sure if we could prevent it, but we certainly can be more prepared, thus treat it earlier and perhaps even lessen the severity of the illness. If we know that our pregnant patient has bipolar disorder, which is a risk factor, we would want to monitor her mood and have her on medication to help her to remain stable. I would definitely want a psychiatrist to be involved. I think where it could be tricky, is if this is the first episode or the onset of bipolar illness.

Q: I know your book has done so much good.  Have you heard personally from the women who have benefited?

I’ve received very favorable feedback from patients and practitioners.  People have told me what helped and what they found inspirational.  They found that the book validated their experience, especially reading the women’s stories.  The coping strategies were helpful and the resources helped them find support.  Also, one thing I’ve heard and that’s part of my purpose, is that the book helped people to look at postpartum depression differently and to search for the meaning in their own experience.   

Q: So what projects are next?

A:  I am working on a new book and it’s a little different.  I have an idea for another book in the perinatal area, but that one is just in the hopper right now because I’d like to get finished with the book I’m working on.  So I’m currently working on a book to help women with relationships:  how to find the right one and quit picking the wrong men.   I talk honestly about my own history and my own personal path to finding who I think is the right man.  So that’s the next project.  I’m about a third of the way done.   

Q: How can people contact you?

They can email me: susanbf@sbcglobal.net, but they should put something in the subject line about the workshop or perinatal disorder because I get so many emails and wouldn’t want to miss it. Or they can call my office: (847) 831-7731. 

*MOTHERS is an acronym for Mom’s Opportunity To Access Health, Education, Research, and Support for Postpartum Depression

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The workshop “Antepartum and Postpartum Mood Disorders” is on Friday, November 15, 2013 at the Greenbelt Cultural Center, 1215 Green Bay Road, North Chicago, Ilinois. 

Registration and networking: 12:30 p.m. – 1:00 p.m.

Workshop: 1:00 p.m. – 4:00 p.m.

Register by contacting Mary Jouppi :  Call (708) 951-6872 or email Serz01@comcast.net

2.75 CEU’s available for LSW/LCSWs and LPC/LPCPs if registration is received by November 12. 

All other registrations must be received by November 13.

A registration form is also available at: http://www.melmetts.com/NAMI/www/flyer_support_group.pdf

Dr. Feingold is online at:

Web: drsusanfeingold.com
Blog: post-postpartumdepressionblog.com

Additional resources:

Postpartum Support International 1-(800) 944-4773 and

 The MOM'S HOTLINE (866) 364-6667

 

   

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