Let’s Educate Women About Genital Pride: Self-Esteem & Confidence is Sexy!

•February 16, 2015 • Leave a Comment

Although I am all about choice when it comes to a woman having Botox or plastic surgery, or using dye to color her hair, this latest trend is more than upsetting. It’s called “vaginal cosmetic surgery” and I was reminded of the subject most recently via a documentary, entitled, The Perfect Vagina.

It was disturbing to watch this video and the extremes that some women go to in order to feel good about themselves. Instead of encouraging these kinds of drastic transformations, we should be supporting each other to accept our individual differences, including those that make us unique and interesting. This issue also speaks to the damaging effects of the practice used in women’s magazines to airbrush, rather than educate women, about self-esteem. My new mantra is: body acceptance and confidence is sexy!

The documentary film that inspired this post is not easy to take. It made me uncomfortable and curious, but mostly angry. Evidently vaginal cosmetic surgery is growing in popularity, both here and abroad.

Although it has been erroneously called vaginal surgery, it really involves the labia minora, or the inner labia, the external female genitalia that is part of the vulva. It seems as though some women believe that the length of the inner labia should be reduced so it is not longer than the outer labia. Those having the surgery claim the procedure would give them more self-confidence, by improving the appearance of their genitalia.

The medical term for this surgery is Labiaplasty, and the average cost ranges between $5,000-10,000.

Why do women need another thing to stress over or another body part to disparage? If you’re wondering, like I was, where this influence started, some point to pornographic magazines and films. This leads me, and the author of the article who found the documentary, to wonder when did waxing and shaving become popular? According to sex researcher Dr. Debra Herbenick, “young women’s pubic hair has been steadily disappearing over the past decade and that younger women tend to shave it off while older women choose to wax.”

Along with risks of any time of surgery, a query of men’s feelings about the appearance of women’s vaginas brought an overwhelming, “Who cares.” As one respondent put it, “I’d much prefer that she is comfortable with herself versus being neurotically insecure enough to get surgery.”

I agree with this quote: “Perhaps we should stop reading and watching so much porn, stop perusing beauty magazines and comparing our vaginas. A little more self-love couldn’t hurt.”

Motherhood Is An Option, And That’s Okay.

•February 1, 2015 • Leave a Comment

Despite all of the progress in encouraging women to have choices in life, there is still one option that is difficult for many to admit: the decision to not be a mother. I sometimes treat patients who openly discuss the conflict they feel about becoming pregnant. They wonder why they lack the enthusiasm so many others espouse. And despite this very honest and serious doubt, some still proceed with becoming pregnant.

On the one hand, they’ll confess this negative feeling, and then quickly follow up with guilt because they know of so many women who desperately want a baby and can’t conceive. They may also feel shame for denying their partner the possibility of parenthood. And, they wonder if these doubts and negative feelings will grow — like their bodies — and they’ll turn out to be mothers who can’t form an attachment to their babies.

From our first meeting, I let my patients know that my office is a safe haven where any feelings can be discussed and openly explored. There is no judgment or weighing in on one side of the other. My office is actually a sanctuary where women can feel completely free to confess any uncertainties that arise prior to becoming pregnant, during pregnancy, or after delivery.

For that reason, I was pleased to see a post written by Avni Trivedi that showed up in my LinkedIn feed. She says, ” It’s a topic that other people can feel it’s their right to question- implying there’s a level of selfishness about the choice. Various arguments include: Aren’t you letting down your partner and his right to be a dad? Or, What is your purpose in the world if you aren’t going to have a family? They might talk in hushed tones assuming that fertility issues are at play.”

And she brings up some of the reasons women may feel conflicted, “Travel, leisure pursuits, personal development, charity work and social lives can offer a vibrant lifestyle, that can feel at odds with the ‘monotony’ of family. Compared with our grandmothers’ generation, there are so many more options. It’s little surprise that all this choice can lead to overwhelm.”

She concludes her essay with this, “Choose your life, and in my experience, many of my friends who have chosen not to have children are natural nurturers — it’s just that their care is channeled in a different way. Whatever your choice, to be a mother or not, I want you to know that you matter, and you make a difference.”

I think that’s beautifully said and I hope that I can convey this sentiment to my patients and that they truly feel safe in my presence to divulge any feelings that are robbing them of a happy, fulfilling, self-designed life with motherhood or without.

Collaboration leads to Study Identifying Three Subtypes of Postpartum Depression

•January 26, 2015 • Leave a Comment

A recent article about international collaboration on Postpartum Depression (PPD) caught my eye for two reasons. It describes a study from the University of North Carolina School of Medicine, and it includes quotes by Samantha Meltzer-Brody, MD, MPH.

Dr. Meltzer-Brody is director of the Perinatal Psychiatry Program at the UNC Center for Women’s Mood Disorders, and I had the privilege of meeting her in June when I was the banquet keynote speaker at the Postpartum Support International conference.

The study, which was published in the January 2015 issue of The Lancet Psychiatry, concluded that in treating PPD, “one size does not fit all,” and that this understanding could affect the diagnosis, treatment and importantly, the unraveling of the underlying biology of the illness.

Data from more than 10,000 women were considered and helped to identify three subtypes of PPD. They are: the timing of symptom onset (beginning during pregnancy or after birth), the severity of symptoms (including thoughts of suicide), a history of a previous mood disorder and whether or not a woman had medical complications during pregnancy or at childbirth.

One finding according to researchers is that “women who experienced symptoms during pregnancy may be at risk for more severe postpartum depression than those whose symptoms begin after birth.”

Along with my esteem for Dr. Melzer-Brody, I found the study especially compelling because it involved international collaboration by well-trained researchers. These experts were unified in their dedication to gaining more understanding about perinatal disorders and to unlocking some of the mysteries that make treating the illness so challenging.

This new international consortium is called PACT (Postpartum Depression: Action Towards Causes and Treatment), and it includes more than 25 investigators in seven countries. This diversity of its membership — including the departments of psychiatry and genetics — have likely helped to expand the focus to not only the symptoms of PPD, but also to it’s underlying biological and genetic components.

This type of collaboration of experts and different fields is impressive and exactly what may help to unlock the puzzle of perinatal depression and anxiety disorders. Now, I am eager to see how PACT’s findings will enable PPD specialists to improve our diagnosis and treatment of women who suffer from the disorder.

Fetal Surgery May Put Mom At Risk For Postpartum Depression

•January 3, 2015 • Leave a Comment

A recent article describing a pregnant woman’s decision to proceed with surgery to improve the odds of her unborn son prompted this week’s blog post. Because it’s a topic not usually associated with postpartum depression (PPD), I thought it worthy of exploring it further.

In this case, eight weeks prior to delivery, doctors partially removed the unborn boy from the mother’s womb so surgeons could extract a tumor the size of an orange from his left lung. Instead of bringing joy, the occasion of the child’s premature birth — and knowing that he had indeed made it through the surgery and delivery — left the mom depressed and overwhelmed. “I definitely had postpartum depression,” she is quoted as saying. “It was very hard. I was at the lowest point in my life after he was born.”

According to the article, “experts refer to the mother in this experience as the ‘innocent bystander’ because she is subjected to a hip-to-hip wound of her abdomen from two surgeries (the fetal surgery and cesarean delivery), a lifetime of scarring, months of bed rest and lost work — and an expectation that she cope with it all.”

Dr. Julie Moldenhauer, the medical director of the special delivery unit at the Children’s Hospital of Philadelphia, said, “It’s a very fine weighing of the balances between maternal risk and fetal risk, because clearly for the fetus this is a life-or-death situation. And for mom this is a very large commitment.”

Moldenhauer, who is doing research on the incidence of PPD with mothers who carry babies with birth defects, says, “We found that moms with these difficult pregnancies are at higher risk for developing postpartum depression, high anxiety and post traumatic stress disorder. Thankfully, the case study has a happy ending because today, the 2-year-old boy is healthy — and alive.

I think it important to note that many women are at risk for PPD due to hormone sensitivity, relationship issues, and biological vulnerability to depression or anxiety. So, couple that with facing the trauma of fetal surgery and the uncertainty of the outcome. It’s a life and death decision, but there are also the far-reaching implications, such as the developmental struggles of the baby that survives, and how this will impact the mom’s life.

In addition, it can be overwhelming to have a special needs baby to take care of at home, without the assistance of nurses. Other factors, such as the lack of time for self-care and the needs of siblings, exacerbate the mother’s stress.

It seems there a critical piece being overlooked in these fetal surgery situations. Imagine if the specialized physician team that is coordinating fetal surgery also recommending to the mom and couple that they consider the benefits of psychotherapy for support, tools for coping, and interventions for anxiety.
This would also allow the therapist to evaluate the mother for predisposition to postpartum depression and put a timely treatment plan in place.

U.S. Needs To Follow Other Countries By Granting Paid Maternity Leave

•December 30, 2014 • Leave a Comment

If working women were granted paid maternity leave, let’s say four and a half months worth, would that lower their risk of postpartum depression and anxiety?

Count me in as one raising my hand to say “I think it’s likely” that it would lower their stress level and that’s why I was pleased to see a recent op-ed piece in the Wall Street Journal written by a Google CEO, Susan Wojcicki, which promotes this theory.

Many of my peers, and others concerned with women’s employment and health issues, are puzzled by our country’s inability to emulate every other country in the developed world that offers new mothers paid maternity-leave benefits.

Although the U.S. Family and Medical Leave Act of 1993 mandated maternity leave, most American women, particularly those in low-wage jobs, cannot afford to take the unpaid time off they are entitled to.

Thus, they return to work too early, often jeopardizing their own health and well-being, and possibly the attachment with their newborn children. Wojcicki is quoted as saying, “A quarter of all women in the U.S. return to work fewer than 10 days after giving birth, leaving them less time to bond with their children, making breast-feeding more difficult and increasing their risk of postpartum depression.”

Before someone jumps on this quest as giving preference to mothers in the workplace, studies have shown that paid maternity leave not only benefits this group, but is also a plus for families and business. Consider Wojcicki’s employer’s experience: when Google increased its leave time from 12 weeks to 18 in 2007, turnover among new moms decreased by 50%.

If more companies would become as enlightened as Google, and other enterprises who offer sufficient paid maternity leave, women wouldn’t have to put their careers on hold — or even jeopardize their jobs — to take care of their very young children. With the support of their enlightened employers and federal government policies, new moms could be at home during children’s time of greatest need, and then return to the workplace mentally and physically prepared to do their best job.

Study Looks at Lowering Depression Worldwide

•December 20, 2014 • Leave a Comment

While those of us in therapeutic practice consider it important that depression sufferers receive help from a trained mental health professional, we also recognize that these services are not easily available in many parts of the world.

In my mind, it’s doubtful that those without our years of study and experience can offer the same level of care that can lead to personal transformation. But, when there is no alternative, the method explained in a recent New York Times article is worth our interest.

The author, Tina Rosenberg, describes a program underway in rural Rawalpindi, Pakistan. It’s called the Thinking Healthy Program where basic cognitive behavioral therapy is taught for only two days to female community health workers with a high school education. The trainees, called Lady Health Workers integrate what they have learned into their regular visits with pregnant women and new mothers. (I was pleased to see this focus as it can address the number of women suffering from Postpartum Depression.)

In Rawalpindi and Goa, Rosenberg reports that researchers are shifting the Thinking Healthy Program –financed by the N.I.M.H. –from community health workers to minimally trained peers.

In both places, mental health professionals are recruiting and training local women with levels of education similar to those of the depressed mothers they will work with. So far, results are impressive: one week after the sessions ended, 94 percent of the women no longer had depression.

Interestingly, villagers didn’t have a clinical diagnosis for their depression, instead calling it witchcraft or laziness. “Stress, of course, is overwhelming for these women,” the study reported, “but they have little sense they should or could seek relief. Women in Africa and South Asia care for others. They do not spend valuable time taking care of themselves.”

The researchers also point out that peers can’t do everything in mental health. “They are valuable, but must complement professionals, who are needed to diagnose and treat more serious illnesses and, in many cases, depression.

“But peers can do a lot. The therapy groups offer confidential social support — a place for women to understand they have a disease shared by many others, and to talk about their problems without fear of gossip.”

See my article in Motherhood – Pakistan’s First Parenting Magazine (http://motherhood.com.pk/motherhood)

A New Study: Postpartum Depression and the Medication, Citalopram (Celexa)

•December 6, 2014 • Leave a Comment

While postpartum depression (PPD) refers to the period after the birth of a baby and the symptoms experienced by the mother, relief for the condition is similar to that prescribed for anyone suffering from the debilitating effects of depression.

For a number of patients, psychotherapy is sufficient to bring relief and to help the patient learn new strategies, gain insight, transform, and grow. For others, this remedy alone is not enough, and requires a combination of therapy and medication.
In those cases, I am an enthusiastic supporter of whatever tools will help to get a woman well, medication included.

While determining the most effective medication that will have the fewest side effects, which is important for all who will be taking any drug, it is especially crucial for a mom who may be breastfeeding her newborn.

This introduction comes because of my interest in a new study recently published in Medical News Today, which appears to trumpet the drug Citalopram (Celexa) as top choice for postpartum depression. The research was conducted by scientists from Ohio State University and presented at Neuroscience 2014. It comprised of examining the brain cells of rats that were chronically stressed during pregnancy.

The research focused on an area within the brain that controls the reward system — the nucleus accumbens. This site was chosen because the scientists suspected that stress during pregnancy altered the reward system in the brain producing an inability to feel pleasure (anhedonia), “making depressed mothers less rewarded by their offspring and less motivated to take care of them.”

Citalopram is an SSRI — selective serotonin reuptake inhibitor — that promotes the amount of serotonin in the brain and results in better and more stable moods. When the researchers prescribed the drug for stressed mothers, they found that mood was improved and the effects of stress reversed.

While this is encouraging, I’m not cheerleading because drugs can have side effects. If you were to check those for Citalopram, this is what you’d find:

“Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.”

And then there’s this: “FDA pregnancy category C. Taking an SSRI antidepressant during pregnancy may cause serious lung problems in the baby.”

Plus, “Citalopram can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using citalopram.”

Needless to say, pregnancy and postpartum depression also pose significant risks to baby and mother. Although psychotherapy is safe for both, when medication is needed there is always need to do a risk-benefit analysis.

So, we have a conundrum: what’s a woman to do when suffering from PPD? My suggestion is to first turn to a therapist who specializes in the condition.

If you both determine the PMAD is so severe that medication is needed, add to your team a psychiatrist with specialization in perinatal issues. Then, determine which of the various medications available, are the most effective and the safest for that individual patient and her baby.

Exercise Is A Good Coping Strategy, But Not Enough To Quell Perinatal Depression

•November 26, 2014 • Leave a Comment

A recent article that described activities taking place at a playground in Daytona Beach, Florida brought up a subject that I believe worthy of discussion. With strollers and babes in tow, a group of new mothers stretched, jumped, and jogged as if they were school kids at recess.

I applaud exercise for a variety of reasons, but mainly because it is a good coping strategy to help with mood symptoms that can occur with postpartum depression and anxiety disorders (PMAD).

The group exercise can also provide other benefits in decreasing the isolation that many new moms experience. However in cases of perinatal illness, while this recreation is certainly helpful, it’s not enough. To speed recovery, women experiencing symptoms of PMAD must still receive treatment from a mental health specialist.

Having said that, I’d like to repeat some of the health benefits that postpartum exercise can bring. The list below has been provided by the Mayo Clinic, and is repeated in the Florida article. Additionally, I regularly suggest these advantages in my therapy practice.

Regular exercise can help:
-Relieve stress,
-Promote healthy weight loss,
-Improve cardiovascular fitness,
-Restore muscle strength and tone,
-Condition abdominal muscles,
-Boost energy levels, and
-Improve mood.

Jenny Wischmeier is the aerobic instructor cited in the online article. She uses Fit4Mom as a form of training, and as an isolation breaker for moms.
The benefits are for the “body, mind and soul,” said Bonnie Wittman, who is the service line administrator for Halifax Health Center for Women and Infant Health.

Wittman said that along with exercising together, the group shares frustrations and finds solutions to common questions, such as breastfeeding or fussy babies. The group meets for an hour of exercising at a public space like a park or shopping mall. Fit4Mom recommends moms wait at least six weeks after childbirth before joining.

Wischmeier said the emphasis of the exercise is not about getting the body to conform to a certain ideal or body image. The group is more about camaraderie then competition. “I call it ‘Our Village,’” she added. “It’s a place where there’s no judgment. We’re all going through the same thing.”

Exploring Links Between Depression and Infertility

•November 17, 2014 • Leave a Comment

A recent article about the relationship between depression and infertility has encouraged me to explore the subject for this blog. According to the writer, “people who experience depression are more likely to have fertility problems.” So, it’s not surprising that once pregnancy is achieved, the depression might continue during pregnancy and after pregnancy (postpartum depression).

Let’s first look at infertility. Who wouldn’t feel sad if you’re trying to conceive and treatments fail, or when an invitation to a baby shower arrives in the mail? Imagine your own blue mood if a close friend or relative announces a fourth pregnancy.

In addition to those experiences, infertility can impact a couple’s sex life, and a woman’s sense of self-worth. She may feel like a failure, as well as that her life is no longer her own, but instead is governed by doctor appointments and disappointments.

And although no one knows whether depression itself can cause infertility, some studies suggest that hormonal imbalance is a culprit in both conditions.

Along with all of these factors, being depressed can cause someone to adopt lifestyle habits that can negatively impact fertility, like overeating or lack of appetite. Smoking or drinking — which people often turn to when depressed — can also lower fertility.

While we might expect that a positive outcome after fertility treatments would lift depression, unfortunately this isn’t always true. In fact, those who have experienced infertility before conceiving are at an increased risk for postpartum depression.

So, after reading all of this, your question may remain: What comes first? Does depression cause infertility, or does infertility lead to depression? It certainly is difficult to have unrealized goals (pregnancy and parenthood) and the realization that we are often unable to control our destiny (infertility).

Add into this mix, hormones — often prescribed by fertility doctors — which can add to distress. Many women are given Lupron, a drug that could initiate menopause. To counter this, patients are then treated with high doses of hormones. This roller coaster ride can often destabilize mood and mental health.

As you can see it’s a complicated issue. The one thing for certain is that
Infertility patients who have depression can often be treated successfully with therapy alone or sometimes in combination with medication. This combination can often increase pregnancy success, as well as decrease risk of perinatal depression.

Postpartum Support Groups Are Beneficial to Women Experiencing Perinatal Illness

•November 11, 2014 • Leave a Comment

A recent article in the Yakima Herald about the effectiveness of support groups for women with postpartum depression supported my belief that these types of groups are particularly valuable.

The story describes the journey of a public health nurse at the Yakima Valley Farm Workers Clinic who conducts home visits with new moms and their babies. Although her work provided Jennifer Sumner with information about the signs of postpartum depression, after giving birth to her second child, “she started begging her husband to take her somewhere and leave her there, to start his life with someone else and let her just run away.”

Sumner is quoted as saying, “If I could’ve snapped my fingers and made myself disappear from this life, I would have. It was ‘the deepest, deepest sense of complete self-loathing and worthlessness, of hopelessness for the future.’”

In spite of her being shattered when the illness struck, Sumner says she still delayed seeking treatment “out of denial, guilt and shame.” Due to the stigma of mental illness, Sumner, as with so many other mothers, resisted getting the prompt treatment that is so desperately needed. This unfortunately delays recovery.

Yet fortunately, the public health nurse took her experience and devised a way to help assure that no other new mothers would endure a similar trial. She launched a support group — bolstered by a state grant — for women struggling with postpartum mood disorders and those adjusting to life after childbirth. The funds will provide more training and resources for local health care providers.

Ms. Sumner’s story resonated with me because I’ve facilitated support groups for over fifteen years. I’ve learned that these groups are a wonderful way for women to meet others who are suffering similar symptoms, and to help them feel less lonely, isolated, and alone.

Because of the intimate conversations and sharing that occurs in support groups, the women who participate often form close bonds and make lifelong friends. Typically, these types of meetings are free or low cost, so they can help women who aren’t able to afford individual treatment.

In my view, while support groups are indeed valuable — and can be part of an overall treatment plan — they are not a replacement or alternative to individual therapy from a specialist in perinatal disorders. (Those interested in finding a group can check the Postpartum Support International website.)

Readers of this blog should be aware that after the first of the year, I plan to start another session of my perinatal support group. Stay tuned to this page for details.


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