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Educate Yourself! Read the Pregnancy and Anxiety/Depression Bible

September 5, 2011

Today’s post is a book review with a mission: to promote awareness about anxiety and depression before, during and after pregnancy. I sent a copy of this book to my mother. I will send one to your local library if it doesn’t have a copy. This book is so important. Thankfully, its title is better than “Pregnancy and Anxiety/Depression Bible.” It is my bible, though, and it is actually called:

Pregnant on Prozac: The Essential Guide to Making the Best Decision for You and Your Baby. By Dr. Shoshanna Bennett, Clinical Psychologist.

My Bible for All Things Pregnancy and Medication Related

This is the only comprehensive source about what to do if you already have anxiety, depression, OCD, bipolar disorder, etc. and want to have a baby/are pregnant. I am not exaggerating. Want to read a book about postpartum depression? Everyone and her sister has published a book on it. Take your pick. Lived with this your whole life and want to prepare for pregnancy with that plus an increased risk for postpartum you-name-it disorder? ONE BOOK. One. Many thanks to everyone who has worked to erase the stigma on PPD. Seriously, you have done amazing work. Can we also turn some attention to pre-existing, prenatal & postpartum anxiety? Even the Surgeon General knows that anxiety disorders are more common in women. I can’t help but feel that we don’t have more books about this because people just don’t want to talk about it in general. In my experience, we refuse to talk about something when we are ashamed. In fact, this blog is part of my effort to stamp out my own shame and feelings of failure and inadequacy. Stomp! Stamp! Stomp!

And now, about the book:

Dr. Bennett writes as though her readers were sitting in her office. She has obviously spent a lot of time talking with patients and their families about treatment options and pregnancy. Her extensive experience shows as she relays scientific/medical information in a conversational tone but avoids throwing everything at you at once. Her information is backed by research, but her tone is never cold. Patients’ stories (names changed, of course) sprinkle the text, proving that these decisions are different for everyone. She also calms fears obviously related more to the stigma surrounding mental illness than to reality. This woman is clearly used to talking to real people. The fact that my mother really liked this book says a lot, too, because when she’s worried, she can’t just ask about it at the next therapy session. Relying on me for information can be hard; I used to practice denial like some people practice yoga. This book helped us so much, because it gave us a more neutral place to start talking to each other about the decisions that would come up when I did get pregnant. The more my family knows in advance, the less I have to explain all at once.

You see, there are two distinct parts to any decision I make about my treatment and pregnancy. There’s the medical/psychological part, obviously, where I look at the risks and benefits with my team of professionals, a process I talked about in an earlier post and will talk about again later in this post. Then there’s the part where I explain that decision to close friends and family. My mom, my mother-in-law, my sister, by very closest friends. Don’t get me wrong–not everyone has the right to ask for more information. I don’t mean to imply that women who take antidepressants during pregnancy have to explain themselves. My advice for dealing with self-righteous people who tell you what to do and/or demand that you justify a decision they don’t understand is simple: walk away. My dad likes to say “Don’t argue with an idiot. He’ll drag you down to his level and beat you at his own game.” Most of what my dad says about people in general is unkind and untrue, but I am inclined to agree with his assessment of idiocy. This process I’m talking about, the one that comes after the decision, involves educating the people who love me. They worry. Their hearts are in great places. I want to them to feel included and informed.

There’s a special person in that group: my husband. Dr. Bennett is so eloquent about partners. She has talked to many, because they are necessarily part of her patients’ decisions. Nathan is my everything. I get antsy when he’s away from home. He’ll obviously be the father of any kid I bring into this world. So I gave him a privilege no one else has. I even signed papers to make it legal; he can talk to my therapist and psychiatrist directly. [Time out to say thank GOD these papers exist separately from the marriage contract, so there are no secret phone calls ala Don in Mad Men calling his wife’s psychoanalyst to get a full report on every session. Nathan would never do something like that, but I’m just glad it’s not legal anymore in general.] Nathan has the advantage of being able to come in to the office and ask my therapist or psychiatrist direct questions. He still talks about the time he got to spend alone with Dr. Griffin, my psychiatrist, when they just asked each other questions about how best they can help me. And that conversation is still helpful for me, too, if only because the fact that they know and like one another gives me a great shorthand when talking to them. Nathan’s trust in my “team” has a lot to do with feeling included. But it’s not so easy for all partners. Some of them come into this process for the very first time after one partner is already pregnant and the decision must be made as quickly as possible. Some people don’t even know they have any feelings about medication and pregnancy until they’re staring at an ultrasound. Nathan might experience that. And we have a place to go, an expert to ask, when these heartbreakingly delicate decisions come up. As Dr. Bennett points out, this saves everyone so much heartache. It gives the conversation a safe space and a time limit. No unending circular discussion necessary. I’m not about to invite everyone I’m close to. And I don’t have to, which is great because it sounds exhausting. I can just give them a copy of this book and talk to them after they read it.

A note on building a team: as Dr. Bennett so wisely advises, a team of people who each have expertise in a different area is the best way to go. Therapist and Psychiatrist are, in my case, two members of that team. There’s a whole chapter in Pregnant on Prozac on “The Importance of Therapy” and a subchapter called “Pills Are Not Enough.”  I couldn’t agree more. My psychiatrist says he will refuse to write prescriptions if I don’t stay in therapy. He doesn’t think it’s safe to stop checking in with a professional, nor does he believe that true progress is made by only taking pills. There’s no treatment of the underlying problem in that approach. And one unfortunate truth of psychiatry is that pills eventually stop working. [Your body gets used to that chemical, metabolizes more of it, less of it gets to your brain, and you have to find a new one. This is the same reasons why alcoholics need a lot more liquor to get drunk than those of us who almost never drink–the liver takes out more and more of the stuff that makes you drunk before it can get to your brain.] Dr. Bennett feels the same way about therapy: treat the mind, not just the brain chemistry!

But there’s another chapter called “When Professionals Don’t Agree.” This is more and more likely to happen as my team of professionals expands to include experts on each of the things I want help with: therapist, psychiatrist, nutritionist, general practitioner, neurologist. So far, I already have that going. When we visit the Columbia University Women’s Mental Health Center, I’ll add an expert on mental illness, psychopharmacology and pregnancy. When I do actually find myself pregnant, I’ll add either obstetrician, midwife, or both. Then, I’ll add a doula. At the very end, there may be new nurses and doctors in a hospital who become part of the team. I am going to spend a lot of time in a lot of offices! What if they don’t agree? Who should I listen to? I should listen to the person who has the most expertise in that issue.

As Dr. Bennett points out carefully and forcefully, expertise in a field like psychiatry or obstetrics does not guarantee expertise in treating a pregnant woman who has an anxiety or mood disorder. This book confirmed my opinion that my psychiatrist is a great doctor because he says things like “I’m not an expert in pregnancy and antidepressants.” It also had me primed to accept his referral to the experts at Columbia University who are comfortable giving me advice on that topic.

So, what if my nutritionist doesn’t like the idea of me taking antidepressants during pregnancy? She is an expert on many things brain-related, but not on psychiatric disorders. I will kindly ask her to let me make that decision and to focus on my diet. I will look for a midwife or OB/GYN here in New Haven who has experience with pregnant women who have mood disorders, but even if I find such caregiver, s/he might disagree with the Columbia expert about medication during pregnancy. What then? Well, I will give each team member a list of the other professionals’ phone numbers so that they can argue among themselves, if necessary. I will most likely take the advice of the Columbia expert because I will have asked them for advice specifically about medication during pregnancy; I will be asking the midwife or obstetrician to help me with other maternal/child health issues and to be with me during labor/birth. Can you see why this whole Team of Experts idea is a truly great idea? Read the book for more on how to go about building your team, especially for some great advice about how to identify a true expert.

This is a long book review, I know. But as you can see, it’s not just a book review. It’s a compilation of the advice I have so far found most helpful in the pregnancy/medication decision. The first place I encountered most of that advice in one place, in easy-to-read prose, was Pregnant on Prozac. [By the way, she discusses many possible medications, not just Prozac, but it does make for a pithy title, doesn’t it?]

The book is for everyone who is at risk for every kind of mood disorder before, during or after pregnancy. I recommend it to anyone who is at all worried about this issue. Did you know that obsessive-compulsive disorder is relatively common during pregnancy and postpartum? Checking to make sure the baby is still breathing every five minutes is not normal. You should feel nervous but not having panic attacks about taking a new baby outside. I mention this one in particular, because many, many, many people tell women who suffer from OCD during or after a pregnancy that her worries are normal. Yes, it is normal to worry. No, it is not normal to fear nap-time because the baby could just stop breathing at any moment. But it is so hard to see and happens so easily because moods change all the time when hormones go crazy. Wouldn’t it just be great if every woman knew the warning signs of an actual disorder? Wouldn’t it be great if more women could feel free to ask an expert “is this normal?” Wouldn’t it be nice to know that it is normal? And wouldn’t it be really nice to get help if it isn’t?

Psychological screenings are slowly becoming part of routine prenatal and postpartum care. But it’s not happening fast enough. I believe that the best way to make this happen faster is for women to demand that their doctors take better care of their mental health. Go ahead! If you’re pregnant or just had a baby, on your next doctor’s visit, say “I want a psychological screening, just to make sure.”

Here, I’ll walk you through a psychological screening to make it less scary: you sit with a doctor and answer questions about your daily life. Your habits. How you feel about ordinary things. They take notes. Some of the questions sound weird, but they are just questions. Trust me, they want honest answers. They’re not hard questions, but the tricky part is to stop looking for the meaning behind them. That’s a little hard, especially with all the note-taking. But it doesn’t necessarily mean anything. Focus on being as honest as possible, and focus on the question at hand. If they ask “How often do you check on the baby while she’s napping?” then just tell them. If you freak out and ask “What does that mean? Are you saying I do it too often? Are you saying I don’t love my baby?” then they will try to calm you down and bring you back to answering the question. They won’t tell you what it means, so don’t bother asking. Remember that if you give honest answers, you’ll get an honest answer. And that these people deal with liars for a living.But seriously, you know what’s a lot scarier than a diagnosis? Trying to deal with an undiagnosed mental illness all by yourself. Trust me. That’s harder than anything.

Day 3?! Come ON.

September 4, 2011

It is only Day 3 of the Lower Klonopin Dose. It feels like it’s been a month. It is only half a milligram less than I was taking, but that’s a 30% decrease. Which means that these things happen:

  • I get so stressed out about choosing an ice cream flavor and then about the ice cream melting in the car that I ask Nathan why it is fun for him to stress me out and decide that we will not get any ice cream at all.
  • I try to ask Nathan for help finding the yogurt-covered raisins and instead stutter something incomprehensible. I have to take a deep breath and a long pause before beginning again and actually succeed in ask the question. I do not have a stutter. Never have. Until today, apparently.
  • I am annoyed because I have finished my soda and the grocery store has no recycling in the parking lot. I am so torn up about what to do with the empty can that I forget to take it out of the cart.
  • I contemplate calling some sort of health department over the mold in the bathroom ceiling.
  • I accuse Nathan of laughing at me at once every hour.
I hate this process. I hate it. I hate it. And I apologize to anyone and everyone if I have bitten your head off recently. BUT. I did go out to Sunday brunch with Nathan. We had a really lovely time.

Yummy! Smoked Salmon!

Rethinking Medication and Pregnancy

September 2, 2011

I want to see what medication-free life is like for a while. –Me.

Psychiatrist: Is that goal separate from having a baby? Do you think you’d still want to “live ‘medication-free'” at this time if you didn’t also want to have

Sorry for the generic photo. But this is what I wake up to every day. This orange bottle that is my savior one day and my albatross the next.

a baby?

WHOA. That is a good question. I did not see that question coming.

It was one of those moments where my brain creaks with effort. Quick! Adjust to an entirely new perspective, right now! Like when you suddenly see the other image in one of those old lady/young lady with a hat optical illusions. It was one of those moments that makes me so proud to have asked for professional help. Because this guy? He knows stuff. Here’s why he asked:

I can’t separate them. I want to get off all medication because pregnant women take vitamins, not prescription drugs. Because there is a warning label on my medication about taking it while pregnant. Because I should. And that information really matters if my doctor is going to do his job properly.

If going off my prescription medication, all of it, were a life goal (a goal separate from anything else), then I could do it with a lot of effort and a lot of time and a lot of patience. I do have a lot of patience. I have the patience to carefully decrease my daily dose of Klonopin, a medication classified as a benzodiazepine–I have been doing this for years. When I met my husband over three years ago, I took two milligrams of this stuff morning, noon and night, for a total of six each day. As of this morning, I take one milligram of Klonopin, once a day. These last few milligrams and half-milligrams are the hardest. The dosage has decreased and increased and decreased again. We’re months from being done. I have patience. But that’s exactly why this is such a great question for the doctor to ask–going off Klonopin was a life goal long before I felt any immediate desire to be pregnant. Which is not true for Effexor, the SNRI I take to help me manage anxiety and depression. Before I wanted a baby, I was just fine with the idea of taking an antidepressant every day for the rest of my life. I have been smart about coming off of Klonopin. I’ve gone slowly and I’ve been patient with myself (mostly) and I’ve been honest with my doctors. Because I don’t feel the same way about the antidepressant–I just want to stop taking it for the sake of a hypothetical fetus–I will not be happy to wait as long as it takes to do so safely. I will be pissed. I will be stomping my feet and hating myself for not being able to do it faster, which will cause more anxiety and slow down the whole process. Not a fun cycle.

And here’s what I knew but did not fully understand until my doctor articulated the idea: it may be safer for the fetus (hypothetical though it is) and for me if I stay take antidepressants during pregnancy. Yes. Taking a prescription drug with a warning label on it might be safer.

How do we figure out if it is safer to take the meds or to not take the meds? A cost-benefit analysis. “Cost-benefit analysis” is an economic term for something we do all the time–weigh the pros and cons and choose the option that costs least. The textbook example (at least in my textbook) was going to college (vs. not going at all). It costs time and money, including the cost of the money you’re not making at a job because you’re in school. You benefit by getting a better job and earning more money in the future. Is anyone else with a fancy college degree and loans to pay wondering about that particular benefit? I liked econ. class. But I also read about applying this concept to life in a great book called Spousonomics: Using Economics to Master Love, Marriage and Dirty Dishes.

It sounds really simple, right? Pros and cons lists are easy! Except that in study after study, we find that human beings are generally bad at being honest about pros and cons. We do things like count “the label is nice” as a “pro” when choosing a brand-name pain-killer over the generic we know has exactly the same ingredients and costs two dollars less. We are famously susceptible to ads featuring beautiful people. We order something at a restaurant because it “looks good” in the picture on the menu even when we know that whatever is in that photograph is probably not even real food. Getting people to do accurate cost-benefit analyses is darn near impossible.

But I can get a lot of help making my list from people who know more about this than I do and have a tiny bit more perspective on the issue. Here’s what I know so far:

  • There is evidence that links benzodiazepines to birth defects. There’s a link, but it’s not fate. If I take Klonopin while pregnant, it is more likely that the fetus will have a birth defect. (To the friend who could not stop taking her Klonopin when she found herself pregnant–you are brave and doing so well, even though things get really hard. Your girls are lucky to have a mom like you!)
  • The research we have has not found a link between most antidepressants and birth defects.
  • Some antidepressants do show an increased risk of birth defects.
  • There is a giant body of research that links untreated/unsuccessfully treated depression in pregnant women with harm to the baby. These babies cry more and sleep less than babies born to women without depression or whose depression has been treated successfully. This is true in the first 48 hours and, as a matter of fact, even after many months, the children whose mothers were depressed during pregnancy tend to be more sensitive and less resilient than other kids. Bottom line: out-of-control depression and anxiety during pregnancy is bad for a fetus.
  • Both Effexor and Klonopin are habit-forming. (The baby could go through withdrawal after birth if enough of the drugs get through the placenta and into the fetus’s blood stream. I have no idea how likely this is, but I’m throwing it in here because I freaking hate what my body does if I don’t take my meds.)
  •  SSRIs and SNRIs have been around for a long time, and many women have safely taken them while pregnant.
  • No cognitive technique I could possibly use to stop an anxiety attack would counteract the effects of a high “baseline” level of anxiety. This could have already done serious damage by the time I recognized the problem and got help. In other words, going off the SNRI only to go back on it while pregnant is not a pretty scenario. And my “baseline” is high. If you knew me before I was medicated/in therapy, you might remember that I was, well, on edge and a bit moody.

Sometimes, the chemicals our bodies make are worse for a fetus than something artificial. If I can safely stop taking Klonopin, that’s really a good idea. But I do not know if it’s a good idea to try going off of everything, altogether. In this case, “natural” is not necessarily the best.

I might feel overwhelmed by this if I didn’t have an ace up my sleeve. Ready? Drumroll please

The Columbia University Center for Women’s Mental Health Center

My psychiatrist recommends these people very highly. He says that both Nathan and I can go together for a consultation in which people who specialize in the mental health of pregnant women give us information and advice to help us make decisions. He says that he doesn’t know enough about treating a pregnant woman to comfortably give me the advice I want; so he’s sending me to people who do know.

No matter what I choose, I’m going to be giving up something I have grown really attached to: either I wait to get pregnant or I give up the idea of a prescription drug-free pregnancy. I don’t want to wait. I don’t feel comfortable exposing a fetus to antidepressants. Remember what I said about people being bad a cost-benefit analysis? Here’s another example. A big part of me whispers that if I just threw out the drugs, I’d be fine. Eventually. That part of me is stupid. I feel like utter crap if I skip Effexor for just one day. Toughing it out is not an option.

A therapist once told me that I draw too many “lines in the sand,” meaning that I give myself rules and deadlines that are impossible to follow/meet and then beat myself up for failing. Our current plan is to make a decision about trying for a baby next spring. Which means that I want to start trying for a baby next spring, dammit, and have gotten my hopes up! This is not a line in the sand, though, it’s a safe space. We decided to set a date (March 1, 2012) for making this decision so that we didn’t have to talk about it constantly or wonder what the other person was thinking. But it could easily become a line in the sand if I start thinking that I must come off my medication by March. I have already said things like “I’ll be off Klonopin by December, and then we’ll immediately decrease the dose of Effexor!” I see it now–that’s absurdly difficult. Nathan’s concern about that plan? Valid. Holding myself to a schedule like that could put my health in serious danger.

Another stupid part of me is whispering you are already a bad mother, too impatient to make the healthiest choice. (For the record, this is not an actual voice.) It’s important to articulate that thought. Because you know what? If I decide to wait until my un-medicated baseline level of anxiety is comparable to what I feel now, I might wait forever. So here’s my new world: I might never be comfortable without medication. That is a possibility. I am trying my very hardest to accept that without throwing around the word “Failure.” Like a diabetic who takes insulin during her pregnancy, I might have to take medicine that helps me fight anxiety and depression during my pregnancy. I’d be doing it for me and for the baby.

One picture has been stuck in my mind since last night’s session–it’s a printout from a monitor recording mirror image heart-rates for fetus and mother. It comes from a woman who is suffering from depression and her unborn baby. In a study done at Columbia University, fetal heart rates stayed relatively constant, even when the mother was under stress. When a woman with untreated depression experienced anxiety, her heart rate rose, and her baby’s rose with her. We know that babies born to these women are highly sensitive to their environments; this could be one clue about why that is. But let me tell you–the idea of that tiny, new heart beating too fast and a fetus feeling anxiety keeps my mind open. Whatever the cost of taking medication, it’s hard to imagine that cost outweighing the benefit of keeping our fetus safe from that awful stress.

My Rant About Giving Birth In America

September 1, 2011

I learned a few things this morning when I woke up at about 3:00 am. And never went back to sleep. First, my family is adorable in the middle of the night. My cat’s idea of “nocturnal” involves snoring loudly, my dog, well he’s just plain adorable all the time. My husband reacts to restless motion from me by wrapping his arms around me in a vice grip so tight I have to sort of push out to make room for circulation. This morning, I felt like if I could just give in to the trio of breathing, I would drift back off… But it never happened.

Lewis the Dog, asleep, with "Abominable Snowman Toy," on his big dog bed. (RIP, Abominable Snowman. Sorry you got torn limb from limb. You were well-loved.)

When I gave up on sleep and came out to the living room, the cat decided to follow me and fall asleep on my feet. (It’s really hard to be annoyed when there’s a very soft cat sleeping on your feet.) I decided to give in to Baby Fever and catch up on The Baby Project at NPR.org. Of all the things I have been doing to deal with Baby Fever, this activity is definitely one of the healthiest. A bunch of women have been blogging about their experience with pregnancy, childbirth and motherhood for the past couple months. The project is almost over, so catching up meant reading a lot of birth stories. These are always full of suspense, despite the fact that all the highlights are pretty obvious going in. But aside from the obvious evolutionary fascination with the propagation of my species, what fills me with suspense is the fact that each story is so very different, despite the fact that most of the events are exactly the same. The personality of everyone involved in the birth of a child changes the story. That is part of what really gets me about your run-of-the-mill media coverage of pregnancy. Magazines don’t tell you this stuff. [Yes, I am one of those people who finds NPR completely fascinating, often noble and frequently comforting.] Why is it a healthy outlet for me? I get to read all about pregnancy and babies and even see pictures of teeny tiny babies and I still leave the blog going “Whoa. I better slow the f*** down and be careful about this decision.”

We all know that when US Weekly covers Beyonce’s pregnancy, they’re not going to tell us that she has acne for the first time in her life, that her feet have grown three sizes or that the personal trainer specializing in pregnant famous people is on call 24/7 to make sure her face never looks fat. (For the record, I made all of that up, in case that wasn’t obvious, but I just love the idea of exercises for the fat face problem.) Here’s another thing they’re not going to tell us: giving birth is dangerous.

Women get really sick and sometimes die growing babies and giving birth. All the time. In the United States. In fact, women in the US are more likely to die giving birth than women in 49 OTHER COUNTRIES. Here’s what Amnesty International has to say about those stats from the United Nations:

“Women in the US face a greater risk of maternal death than nearly all European countries, as well as Canada and several countries in Asia and the Middle East. Despite the 34% decrease in global maternal mortality between 1990 and 2008, with 147 countries experiencing a decline in maternal death rates, the US was among just 23 countries to see an increase in maternal mortality.”

Yes, that’s right, I might be safer giving birth in the middle east. Did you see that one coming? The middle east is dangerous, right?! Well, apparently they’re better at handling the dangers of childbirth than we are. And did you read that last sentence? We are one of only 23 countries in the world to experience more maternal deaths. When I mention home birth, some people look at me like I’m nuts. But you know what? Hospitals are not doing so well. “Between 2003 and 2007, the average maternal mortality has been 13 deaths per 100,000 live births, approximately double the low of 6.6 deaths per 100,000 live births recorded in 1987.” You know what the goal is? 4.3%. Know how many states accomplished that in 2010? FIVE. It is about TWO TIMES more dangerous to give birth now than it was for my mom. (I was born in 1984. At home. Zero complications.)

Here’s the brutal truth: I am not as worried as I could be, because that 13 per 100,000 number is an average skewed by the jaw-droppingly high statistics among women living in poverty, Native American women, Hispanic women and women in other minority groups. The next time someone calls this country “post-racial America” just because we elected a black man to the White House, you can bet I’m bringing up that little tidbit. I am a middle-class, well-educated white woman. I know how to look for and how to pay for quality health care. I have no problem yelling at doctors, and I have no problem demanding that I be involved in every decision. I will yell, kick and scream, if necessary, until I get something resembling the care I want. If I spoke poor English, how do you think I’d fare when a doctor asked me if it was ok to do an intervention like administering petocyn or oxytocin (drugs means to speed up contractions)? If this incredibly strong, brave woman felt alone and afraid when she woke up from her emergency C-section, what do you think it feels like for a single mother who is also an immigrant still learning English? My literacy skills are good enough to figure out how to fill out the massive amount of paperwork I would need to file in case my family required financial assistance for medical bills. My mother, mother-in-law, sister, husband, step-father-in-law, mom-in-law’s best friend the maternity ward nurse, [insert friend or relative here], would all have the know-how and the guts to stand up for my rights and my wishes in case I was, oh, distracted by giving birth or, maybe unconscious from pain or blood loss or both.

I would love a nice, calm home birth. There are far fewer drug-resistant bacteria in the home. I also just have really terrible memories of hospitals. The sliding doors at the entrance to a hospital raise my heart rate. But if I end up in a hospital with an epidural, that anesthesiology bill alone might cause more sleeplessness than the newborn. And we have insurance. It’s crappy insurance, but it covers maternal/child health care. An emergency C-section is not something anyone can prepare for, fully. But this just bugs me: the very facts of my whiteness, my education and my background give me confidence in my family’s ability to figure out how to pay for the medical care we deserve.

There is a lot going on here besides issues of class, race and gender (if men gave birth, I have a strong feeling that mortality rates would drop like a rock); this is about the rise of the non-emergency C-section which, in case you did not know this, involves cutting a woman open from her stomach, pulling a baby out of a uterus the surgeon has just cut open, and stitching it all back together. If this is right for you–go for it. Just look at a photo first, because I really don’t think it’s possible that 30% of American pregnant women plan C-sections and fully understand what’s going to happen. I think they’re smart enough to understand, let me be clear on that. I don’t think hospitals explain it.

I get to hear a lot of birth stories, because I get to hang out with a lot of kids and moms. I cannot tell you how many times I have heard bitterness and anger in descriptions of doctors who said nothing but “We’re going to give you a little something.” I am scared for myself, honestly, but I just know I’ll be ok. I’m mad, really really mad, that childbirth is, on the one hand, an illness that must be carefully monitored by doctors in hospitals, instead of a natural, healthy process and also no big deal when a woman in labor tries to tell someone that something is wrong. I am angry that we are still treated as overly-emotional, hysterical, untrustworthy patients.

Go Team!

August 31, 2011
Traditional shrimp curry as prepared in Benagl...

If you haven't tried shrimp curry, you are missing out. And yes, I thank God and Nathan daily for my husband's culinary skills, which include Indian food that is better than takeout.

I have “met” with Jan The Amazing Nutritionist twice now, and after both Skype video chats, the flood of hope and relief I have felt has brought tears to my eyes. These emotions come after I begin to absorb the wealth of new information each conversation affords. While a visit to a doctor, even a good doctor, finds me struggling to get a word in, visiting with Jan means answering questions about every aspect of my life, not just about her area of specialization. I have lost count of how many darn times rushed to stop a doctor with a hand on the door handle, saying “Wait! I think this other piece matters!” only to see Doc turn around, sit down again, and reconsider a medication or other piece of advice. Even the neurologist I raved about had no idea which questions to ask. The visit went well because she listened to me, but I have had to learn to make them stop and listen to my speeches about how migraines are connected to anxiety which is connected to you name it. Jan asks me questions and then tells me why she’s asking. Best example? She asked a bunch of questions about Frova, my new migraine medication. I figured she just wanted to know what else I was putting in my body in addition to the foods I reported in my food diary entries.

I felt discouraged this morning, when I woke up with pain all through the right side of my upper body, from my shoulder blades to my eyeball and realized I was going to have to take Frova if I wanted to make it to babysit this afternoon. Then came the beta blocker. Then, I forgot to take my anti-anxiety meds until 11:30 am, and only remembered because I suddenly thought “Why in the hell do I feel so jumpy?” So I added a Xanax to the mix, to make sure that I’d get dressed and leave in time to make it to my 1:00 pm gig at the big house down the block. A baby just felt so far away as I swallowed that handful of blue, red and gray pills, all with warnings on their bottles against consumption during pregnancy.

But then, I read this in an email from Jan:

“Frova is a serotonin receptor agonist. It mimics serotonin production. This is the feel good, calming neurotransmitter. Tryptophan is the precursor to serotonin.
 Have a look at the foods high in tryptophan..  shrimp is #1!!!!!
 http://www.whfoods.com/genpage.php?tname=nutrient&dbid=103
That link revealed this list of “events” that indicate a need for foods high in tryptophan:
  • Depression
  • Anxiety
  • Irritability
  • Impatience
  • Impulsiveness
  • Inability to concentrate
  • Weight gain or unexplained weight loss
  • Slow growth in children
  • Overeating and/or carbohydrate cravings
  • Poor dream recall
  • Insomnia
Yes, Yes, Yes, Yes, No, Yes, No, No, Yes?, No, No. That’s fully HALF of things I most definitely need help with. And FOOD can help! Because the chemicals in my brain are also in food… which makes total and complete sense. “Hey!” I thought, “I eat lots of shrimp! Shrimp is great!” (Nathan makes the best sauce you’ve ever tasted.) But we had just talked about how I’m not eating enough of any of the animal proteins in eggs, cheese, grass-fed beef, organic chicken and other obvious foods. I am eating more shrimp. Connection? Who cares! Let’s pile on the shrimp and see what happens!

Some of these are on the high-in-mercury or over-fished categories, but lots are in the Wonderland-style "Eat Me!" category even for pregnant ladies. (PS Jan says "shrimp is #1!!!" in her email because it was high on our co-created list of foods to eat more of on a budget.)

Here’s what just makes me insane: not one of the many, many doctors I have asked about migraines and triptans has ever explained to me what they actually do. I have asked. They have been vague. Discouraged and already having taken twice as long as I’m “supposed” to take in the doctor’s office, I give up. Time and again, I give up trying to get doctors to explain to me what exactly these chemicals are doing. I have mutely accepted “help with the pain” and “help keep blood vessels open,” too exhausted to repeat “But HOW?!” I’m smart. I’m well-educated. I even understand a good amount of medical jargon. Hit me. I can take it. But they refuse. The notable exception is my neurologist, but I see him four times a year, and we usually have a whole lot else to talk about. I am now encouraged to email him to ask more questions, though, because he’s just such a nice guy and so good at explaining stuff.
My therapist is right (shocker!)–I feel less anxious when I learn more. The more information I have, the more empowered I feel and the less anxiety I experience. Right now, I am pretty excited about that huge bag of frozen shrimp Nathan found on sale. (I never get sick of it.) As Jan pointed out, preparing for pregnancy by eating more and more often. She tells me that I’m already eating lots of the foods she recommends during pregnancy. And, one of my favorite quotes from her is this one: “You need tons of this stuff when you’re building a human fetus, but you need them to rebuild your own cells, too!”
Maybe the Xanax has kicked in. Maybe I’m excited about my ability to do more every day to help me fill my brain with the happy chemicals the pills are currently helping me produce/use effectively. Information is power.

Apprehensive, Excited and Back in Therapy: Good-bye August

August 30, 2011

My therapist has returned, ladies and gentlemen! And I am so glad. She was in Vermont, but came back before Irene. As I gushed about how much I LOVE the babies I’ll be caring for this fall in my attempt to earn a living, she said, “It sounds like you’re ready to have your own.” Well, that was really good to hear! But I have to get off of these meds before I can justify trying to get pregnant. Tomorrow, I’m heading to NYC to meet with my psychiatrist (a different person, one with an M.D./Ph.D. and a prescription pad) to discussing shaving a little bit more off of my daily dose of Klonopin.

I am excited about the idea of going off the anti-anxiety medication Klonopin and, after that, my SNRI, Effexor, because after I stop taking those pills, we can start trying to get pregnant. We will have that option. I am apprehensive about even just this next step because, as I have said before, I can feel the Klonopin kick in, calm me down and help me start my day. I want this so badly it hurts. I hate that the pharmacist knows our faces. I wish that this process simply involved throwing all the dangerous pills away and not looking back. I sometimes wonder if I am somehow missing whatever basic information other humans have that allows them to get through a day without feeling panicky. They must know something I don’t know! I’m told that this is not true. That there is no key. It’s just hard. And that sucks.

Example of an American grocery store aisle.

Why doesn't this freak you out, too? Seriously! Grocery stores are crazy places!

You know what else was hard? August. And August did not suck, at least not every day. I took my “as needed” Xanax a few more times than I do when I’m in regular therapy. I did a lot of talking to Nathan about why I felt scared of [insert mundane, not dangerous object or activity]. I also went out to dinner with people I hardly know (a really big deal for me) and had a good time. I left a job I loved (my summer gig at the child care center) and then went out and got a new job. Two jobs. I went to the doctor. Two different doctors, in two different locations. I went grocery shopping by myself, voluntarily. I do not go to grocery stores alone, people! This morning, I took public transportation to work and home from work and did not panic. The mere thought of getting on a train used to trigger hyperventilation and lead to many skipped classes. And I like trains. Today, I took the bus. And I hate the bus. I haven’t had a migraine in ten whole days [and I am now knocking on wood].

In sum, I did it. I got through August. Not only did I get through it, but I kicked butt. I was happy–am happy. I am also quite proud of myself. September is going to bring new adjustments at work and in my medication. I am scared. I don’t want to take the bus. I don’t want to feel more anxiety. I don’t want to deal with Nathan being gone a lot, as school starts up again. But you know what I have to say to you, September?

BRING IT ON. I can take it. I am one tough lady.

See? Happy! And yes, that is the chubbiest baby you have ever seen.

Placenta Encapsulation: Why not?

August 29, 2011

(A note of caution: this post is not for the faint of heart or stomach.)

I am glad that I have a long time before I have to make any actual decisions about Baby. If, when, how (birth plan) and what (stuff, stuff and more stuff) can all be decided much later. Including a good year to decide how I feel about little suggestion that shocked the heck out of me:

Eat the placenta. Or, rather, swallow it in pill form. It could prevent postpartum depression.

WHAT? Oh, wait, don’t most mammals actually do this? Where did I learn that? I don’t know. But I don’t remember hearing about human women doing this until yesterday, and it’s already cropped up in about four places since then. So I thought I’d post it here and see what you all think. (The placenta, by the way, is basically what feeds and protects the fetus during gestation. In some cases, it can even protect a fetus from contracting things like HIV from an infected mom. It’s a seriously awe-inspiring organ. And it is “birthed” a few minutes after the baby is born. It’s considered biohazardous waste in the US and hospitals dispose of it as such.) New York Magazine talked about monkeys and other mammals eating the “after birth” and described the process of “placenta encapsulation” in this pretty fantastic article. They also describe burying it and planting a tree over it, which sounds kind of awesome, actually. The “encapsulation” part is the only resin, I’m even considering ingesting a bodily organ that *I* will produce, by the way. I am soooo not brave enough to do what woman in the article says she did–make it into a smoothie and drink it down with some banana mixed in.

Ok, grossed out yet? I am! But if you choose the encapsulation, you don’t do it yourself. You find someone, usually through a midwife, doula or an organization called Placenta Benefits, to take away the after-birth in a safe container. That person then gives it back in pill form. You can read the NYMag article if you want more details. According to that same article, scientists aren’t sure why mammals do this, but they have a few theories. Giving birth is hard. Pregnancy is tough on the female body. The placenta, it turns out, has a lot of the same nutrients that get depleted during pregnancy and childbirth.

But here’s the piece from Bamboo Family Magazine that really convinced me to take this seriously:

“Powdered placenta has been used in traditional Chinese medicine for centuries.  In the postpartum period, placenta capsules can be used to

  • Balance hormones
  • Increase energy
  • Increase and enrich breast milk.
  • Decrease the baby blues and postpartum depression.
  • Decrease in lochia, postpartum bleeding.
  • Decrease iron deficiency.
  • Decrease insomnia or sleep disorders.”

And here is what my nutritionist, Jan Katzen-Luchenta, had to say about it when I emailed her:

“Fe, Cu and Zn [Iron, Copper and Zinc] elements appear to have interactive connections in human placenta. The primary essential fatty acid in the placenta is Arachidonic Acid – brain growth. So with Mom being a bit depleted from childbirth – not a bad thing to eat the placenta for extra nutrients. All trace minerals are essential.”

Placenta Benefits.info (PBi) sells this a little too hard, in my opinion, and it’s a bit off-putting. But if this claim is true, I’m listening anyway:

Eighty percent of women experience some sort of postnatal mood disorder, the mildest of which is called the “baby blues”. Symptoms of the baby blues include weepiness, sadness and anxiety, and these negative emotions can last for the first several weeks of the new baby’s life. With proper preparation, the majority of women can avoid the baby blues.”

How do they know this? Why, they have research. Scientific research, of course. Here are just some of the articles their site links to:

  Placenta Increases Milk Production
  Placenta ingestion for pain relief
  Placentophagy alters hormone levels
  Postpartum Depression attributed to low levels of CRH
  Maternal iron deficiency affects postpartum emotions
  Fatigue linked to Postpartum Depression
  Iron supplementation helps fatigue
  The significance of postpartum iron deficiency

Low milk production, pain (yes, it hurts after you give birth, sometimes, a lot, and breast-feeding can hurt, too), the crazy drop in pregnancy hormones and fatigue might all contribute to a low mood. It makes sense that if taking placenta capsules can increase the minerals my nutritionist mentioned and increase milk while decreasing pain, it would help with PPD. And in case it’s not super obvious, I am at REALLY high risk for PPD, PPOCD and quite a few other acronyms.

According to the NYMag article the science out there is pretty small-scale and inconclusive. Ask any woman who has done this, however, and her anecdotal evidence might convince you. And you know what? “It’s just a placebo effect” is not a convincing argument against doing this, because if it’s all in my head, who cares? My mood changes drastically because of what’s in my head all the time! I got stressed out because I put my underwear on inside-out one day last week. The knowledge that no one could possibly know this did not keep me from feeling anxious about what they might think if they did know that I was paying no attention that morning. That is the kind of thing that can throw off my whole day. If taking a happy pill only makes me happy because I think it will, then sign me up anyway. Seriously, though, thinking happy thoughts is an over-simplified way of stating it, but positivity has some serious benefits when it comes to treating mood disorders. I have seen it. Optimistic people overcome serious mental illness a lot better than pessimistic people.

In fact, there is no convincing argument against placenta encapsulation at all. The people who take your money to do it are performing a service I certainly don’t want to do myself, and they tend to be really passionate believers. So I don’t feel like that’s a scam at all. And despite sounding really gross and “akin to cannibalism” it’s something that’s just going to get thrown out if you don’t want to use it. So here’s the analogy I’ve come up with:

If I were in the desert and dying of dehydration, would I drink my own urine to survive? You bet. (Doesn’t the British survival show guy do that in like every other episode?) If I’m dying inside and feeling hopeless and these pills can be taken safely, help me breastfeed AND help with hormone changes, two major factors for new moms at risk for PPD… why wouldn’t I? It’s an odor-less, tasteless pill no bigger than a vitamin supplement. The Pill (the kind that’s meant to prevent pregnancy) used to contain hormones from the urine of pregnant horses. Do you know what’s in your medicine cabinet? I’m just saying.

The question that keeps banging around inside my head is this: do I have a good reason not to do this? If there is any small chance it could help?

Now do you understand why I’m glad I’ve got plenty of time to get used to the idea?