Fertility massage is a cutting edge field, with far-reaching benefits that are still being explored. At Pulling Down the Moon, we’ve developed specific techniques for working with the body after seeing thousands of fertility clients for nearly two decades. We’ve striven to be pioneers of this emerging healing art, blending the best of ancient modalities with cutting edge massage techniques. Our programs have reached thousands of women across the Chicagoland and the DC area, have been purchased by Shady Grove Fertility, the largest Reproductive Endocrinology Center in the United States, and Pulling Down the Moon has been recognized by the NCBTMB as a provider of continuing education in the field of fertility massage. The American Massage Therapy Association (AMTA) also recognized our Massage Director, Meredith Nathan, with the 2018 Pioneer Award for the development of this protocol.
After struggling with our inability to support people struggling with infertility who lived outside of Chicagoland and the DC area for years, PDM is proud to be launching Continuing Education in Fertility Massage for the first time since it’s inception. Now Massage Therapists across the country with a passion for women’s health and fertility can receive training in our exclusive techniques, and as a result, couples hoping to be parents around the U.S. can receive the benefits.
Moon Massage Level 1 consists of 3 online modules, each ranging 90 minutes to 2 hours in length, a hands-on techniques review video, and a final exam. It will include an overview of reproductive anatomy, both natural and assisted fertility cycles, contraindications for fertility clients, common fertility challenges and ways massage can support these issues, specific fertility massage techniques, and a 30-minute basic fertility massage protocol that can be used with all fertility clients, both male and female (at the appropriate time in their cycle).
This webinar will lay the foundation for a series of hands on courses, ultimately leading to training in our exclusive Fertility Enhancing Massage Protocol™, a training formerly available only to PDtM staff. This level 1 training is your first step toward certification in the FEM Protocol.
“I believe wholeheartedly the FEM Protocol will complement the therapies I treat my patients with and enhance their success, while hopefully decreasing the stress level they are facing as they undergo the difficult and arduous treatments we prescribe.” – Dr. Melissa Ann Esposito MD FACOG
“I thoroughly enjoyed the Moon Massage level 1 Module training series. Meredith is an amazing instructor with an infectious personality. Her enthusiasm for the subject matter, her vast knowledge, and the way she expresses the concepts so clearly make it highly enjoyable to watch as you learn. It is filled with so much practical information, and though it is highly technical, it is presented clearly and with a review section in each segment. All aspects of fertility and IVF are well covered, and the hands on portions really illustrate the techniques clearly. It was one of the best presented and well designed continuing education classes I’ve taken. Thank you so much.” – Deana Burrows, LMT
by Michele Weiss, LMFT
Realistically, I imagine that there were many factors that lead to where I am now 30 weeks pregnant. While I endured over 100 shots in my abdomen and butt, 4 frozen embryo transfers, and countless failures and disappointments, I believe it was something more than the medication and the needles that got me to a healthy pregnancy- or at least kept me going.
I want to share my story because after hearing the stories of many infertility warriors over the years in my private practice, I feel that we need to be open and honest about the real deal. I want to share my story not just so people who have no understanding (or misunderstanding) of infertility’s devastating reach can get a glimpse into our world, but so that those of us in this community of warriors can feel less alone, less damaged and less ashamed.
My husband and I are carriers of a Jewish genetic disorder that lead us to terminate a pregnancy. This is a choice that, I know, evokes intense feelings and convictions in other people. As a woman who longed for, prayed for, and tried mightily for a healthy baby, the choice just felt like a heart string being ripped from my chest. We decided to pursue PGD and IVF after this loss as our route to building a family. However, trying for a child at 38 years old via PGD and IVF proved to be longer and more complicated than we expected.
What helped me through it? There were the practical things like having a doctor and an acupuncturist whom I trusted implicitly and knew were 100% in the trenches with me (Thank you again and again Dr. Eve Feinberg at Northwestern and Kelly Lyons at Pulling Down the Moon). Acupuncture at PDtM was the only place I truly felt I could deeply and fully relax. In the midst of doctor appointments, my medication regimen, diet, meditation, etc., acupuncture helped me slow down and find my center. For me, the holistic approach to treatment helped me feel like I was doing everything within my power to get to a healthy baby.
There were 3 touchstones that kept me going–
1. Stay away from Should’s
2. Small Joys
It was a pretty simple formula, but enormously difficult to implement in the face of failure after failure.
Stay away from Should’s. I decided to keep going until my doctor kicked me out of the clinic. It can feel like insanity to continue treatment in the face of unending loss and trauma. I reminded myself that I still had options if I could just expand the vision of how my journey to baby “should” go. These are not the idyllic narratives recorded in baby books. They are our valid, messy stories of bravery and passion, nonetheless.
Small Joys. I decided that I would not let infertility rob me of all moments of joy that still existed- even when those moments of joy were teeny, tiny. I continued going to SoulCycle in between cycles because I felt happy on that bike. I cuddled in my dog’s fur. I went out with my girlfriends for water and wine (guess who drank what?). I spent way too much money on delicious teas. I went to see my favorite bands in concert, my needles in tow, and shot myself up with medication in First Aid bathroom stalls. I knew I needed to create joy where I could and to stay connected to the parts of my life that made me feel like “me” while living in the crazy world of infertility.
Hope. I am deeply Jewish in my beliefs and spiritual practices. To my own surprise, during my infertility struggles I found hope in an Evangelical preacher. I would listen daily to “my Christian Rabbi”, as I affectionately referred to him. And minus the Jesus part which did not fit into my Jewish value system, this preacher’s message helped me tap into hope in the face of hopelessness and strength in the face of vulnerability. I think that God understands that when we are in the eye of the storm, we need to be a little radical.
Then, there was the woman who checked me in for my daily blood work and ultrasound at the infertility clinic. I think she could tell that I was particularly beaten down one morning. After the standard registration procedure, she slipped me a small blue post-it note that read, “Thanks for always coming in with a warm smile. You make my day and I pray for your family to increase with a new baby. TRUST”. Her kindness touched me and reminded me to always cling to hope. I still carry her note with me in my wallet so that I can get a dose of hope if I ever need it.
Even though I am a therapist who specializes in infertility and perinatal challenges, I do not really believe in advice when it comes to these matters. I have heard enough stories to know that each one of us has our own very unique heartache and very personal struggle. All I can share is what helped me. I was fierce and radical as a means to keep going. I expanded my vision of family-building when it wasn’t going the way I thought it would or should. I sought hope in trusted professionals and strangers, alike (even in unexpected places). As I sit here with my 7 month bump, I feel grateful that mine was the messy, painful, beautiful story that it turned out to be. And I will soon be proud and humbled to write that story in my daughter’s baby book.
Michele Weiss LMFT 3166 N. Lincoln Avenue, Suite 202 Chicago, IL 60657 312-213-4690 email@example.com Monday, Wednesday and Friday appointments available www.mweisstherapy.com
by Amie Shimmel Handa, D.C., Dipl. Ac., L.Ac
People talk about stress all the time, and we all know that it is bad for us, but most of us don’t realize the long term consequences of chronic stress. It can impact our fertility, our nervous and immune system and even our gut. But what does that really mean to us?!
I am going to break down what happens during a stress response and hopefully the next time you start to feel stressed you can take some action before the stress starts to control you,When you experience any kind of stress, physical, emotional , or mental, your body processes it the same- through the adrenal glands. When you encounter a perceived threat, (could be a work deadline, something going wrong with your body or life, or even something your body ate that was detrimental, your hypothalamus, a tiny region at your brain’s base, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol.
Adrenaline increases your heart rate, elevates your blood pressure. Cortisol alters immune system responses and suppresses the digestive system, the reproductive system (fertility) and growth processes. Did you know that 70 % of your immune system is in your gut so when cortisol affects the gut it’s also impacting the immune system? Cortisol, long term is highly inflammatory. When inflammation is chronic and it’s been around for a while, it can even trigger an autoimmune disease. As a result of this chronic stress your body continuously cycles through periods of high inflammation, which can damage the gut lining and make vulnerable to pathogens like bacteria, yeast, and parasites and a suppressed immune system.
When the digestive system is compromised and harmful bacteria or yeast multiply and grows, the neurotransmitter “Serotonin “production is lowered and it is your “feel good, well being” hormones so your mood and happiness is reduced from this stress response. We know in holistic medicine the connection between cortisol (stress) and fertility. “We know now that stress hormones such as cortisol disrupt signaling between the brain and the ovaries, which can trip up ovulation,” says Sarah Berga, MD, an infertility specialist and vice chair of women’s health at Wake Forest Medical Center in Winston-Salem, N.C.
The good news is you don’t have to live with chronic stress. There are numerous actions you can start today to reduce your stress. One of the best ways is through regular acupuncture treatments. Each time you receive acupuncture, especially ear acupuncture, you are stimulating the parasympathetic system the “rest and relaxation” system. Other great action steps are massage, yoga and meditation. My best piece of advice for stress is being kind to yourself and knows you are doing a great job!
Try an Initial Acupuncture Consultation in April and get a follow-up session for FREE ($95 value)! Call us to learn more at: 312-321-0004 or book online today with the promo code BOGO19!
Infertility – it affects 7.3 million people…that’s as if infertility took over New York City. That is how big it is!
This is a special post to honor to National Infertility Awareness Month.
It is a time to dedicate a post to all those currently dealing with infertility and for those who have overcome their infertility to reflect back, and remember how that time has forever changed you.
When you experience something powerful in your life, like infertility, it leaves a mark with you. You aren’t the same person that you were before.
And that can be a good thing.
I’ll admit, sometimes I can be a bit stubborn, especially when it comes to goals and reaching them. I truly believe that if you put your mind to something you can achieve it. Getting pregnant and the dream to be a mom however is different. It is a goal that you can work at and work at and still never achieve [without needing help, or rewriting what the journey looks like to reach that goal].
I thought I did everything right. Got married, worked to feel stable in my career, lived a healthy lifestyle, and truly waited until I was “ready”. I stopped taking the pill and we tried [and tried and waited and waited] and nothing happened, no period and no pregnancy.
Things weren’t happening according to “plan”, which for me as type A person wasn’t ok.
My husband and I went to go meet with a reproductive endocrinologist to formulate a plan. I had to get my period coming regularly before we could even discuss trying to get pregnant.
Fast forward one year, FINALLY after every hormone drug you could think of, my stubborn period came. It never stayed, I always had to be stimulated to get it, but once I finally got it we could start taking the next step in the plan, trying to get pregnant. At this point I was still strong, pushing forward trying to achieve “the goal”.
After our IUI tries we were starting to feel defeated. I started making back-up plans to our alternative plans, it became obsessive. We decided to move forward with IVF. IVF felt more serious, there were more drugs, more monitoring appointments, more everything.
I was starting to feel the effects of the two-year plus on this journey. My body, my mind, everything, my body didn’t feel like me anymore, I was bloated all the time, stressed out, and frustrated.
But we kept pushing forward, and thank god we did, our first IVF attempt was a success. The moment my doctor called to tell me we were pregnant will be a moment that I will remember forever [vividly, down to the very last detail].
It made all the struggles, all the doubt, all the everything worth it.
So if you are reading this, just starting out on your journey, know that the journey may be hard, it may be stressful on your mind and body, but you will get there, the path may take a couple different turns, but it will end, and you will be stronger than you ever thought possible before you started!
By: Katie O’Connor, Founder of the non-profit Shine: A Light on Fertility: inspiring fertility empowerment by sharing the journey. We provide free support, mentoring and advocacy for fertility health.
*Join Katie on Thurs, April 25th at 6:30pm for Shine Fertility’s NIAW Panel Event!
By Margaret Eich, MS, RDN
Are you getting enough choline in your diet? Most women are not, and most women may not have even heard of choline. Choline plays an important role in fetal development, including brain development. Most people have heard they need to get enough folic acid (or folate) before and during pregnancy to prevent neural tube defects, but did you know that choline may also play a role in preventing neural tube defects, like spina bifida? Research has produced conflicting results in this area, but ensuring adequate choline intake makes sense while the research sorts itself out, especially given choline’s other benefits.
In addition to a potential role in preventing neural tube defects, choline deficiency may also play a role in the development of fatty liver. Choline is also a precursor to the neurotransmitter acetylcholine, which is involved in muscle control and memory. In addition, choline is converted to betaine in your body, which assists in the conversion of homocysteine to methionine, thus preventing homocysteine levels from becoming elevated. Elevated homocysteine is associated with increased risk for cardiovascular disease and miscarriage.
Choline is not technically considered a vitamin, since our bodies make small amounts, but our bodies don’t make enough to meet our daily choline needs. Therefore, we need to get choline in our diet. Non-pregnant women need 425 mg choline daily, and this goes up to 450 mg during pregnancy, and 550 mg while breastfeeding. In the US, average choline intake is well below this recommended level with women on average only taking in 260 mg choline per day!
The best food sources of choline include liver, eggs, meat, seafood, legumes, and cruciferous vegetables like Brussels sprouts, and broccoli. One egg provides almost 150 mg choline, which underscores how helpful eggs are in meeting your choline needs. Not only are eggs rich in choline, but they are also just a very nutrient dense food to support your overall health, fertility, and pregnancy. Because choline is most concentrated in animal foods, vegans or vegetarians who eat limited eggs and dairy products are at highest risk for choline deficiency. Since so many US women struggle with getting enough choline, it’s a good idea to take a prenatal vitamin that contains choline, especially if you are vegan or vegetarian with limited intake of eggs.
Looking for more information about nutrition for fertility and pregnancy? Book a nutrition consult today!
- Linus Pauling Institute at Oregon State University: Choline
- Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Acad Nutr Diet. 2010; 110:1198-1206
By Elizabeth DeAvilla RD
Now that that warmer weather is starting to roll in, (thankfully!) many of us will get the itch to start that good ‘ole spring cleaning! Here at Pulling Down the Moon’s nutrition department, we always suggest a great pantry clean out to help everyone with their nutrition goals for the year.
Up to date?
One of the first things I find myself looking for at the start of any clean out is that of expiration dates. May people still think that spices and other dry ingredients can last forever… not true! As a safety precaution, ensure that all your ingredients are not expired. Spices can tend to lose potency after as little as 6 months!
Ditch the processed stuff
You’ll hear this time and time again, the less processed the better, especially during the journey of fertility. The more processed the food is, the more likely it is to contain ingredients that may not be to enticing, especially to our bodies. Additives and preservatives can commonly cause negative effects like inflammation, as well as some intolerances within our systems, and best strategy to avoid? Ditch the processed stuff! This can commonly include things like canned meals, meats, and dried foods as well.
Get it organized
I’m not sure about you but I don’t always have hours upon hours to prepare meals. If I have to spend a large amount of time in the pantry looking for something, I’m almost more likely to run out and replace the item, thus why I always end up with multiple staples! Taking the time to organize, take things out of the boxes if possible, and creating a system can be so beneficial from not only a time perspective, but a food safety aspect as well. Storing whole grain cereals in Tupperware (BPA free of course!) or rice in glass jars not only looks appealing, but is helpful for inventory!
Restock your shelves with the essentials.
If you were to go into your pantry today, could you put together a healthy meal that people would enjoy? This was always a struggle for me in my own pantry, until I started stocking the essentials. Things like dried beans, sauces, spices/seasoning, healthy rice, and usually have the potential to save the day when I just don’t have it in me to venture out to the store…. one more time! Keeping things such as heart healthy (and fertility friendly!) oils such as olive and avocado oil, whole grains such as wild rice and whole grain bread, as well as beans such as Lentils are not only meal staples, but are all supportive to our fertility journey.
The staples to keep/include:
Grains/breads: Whole grains! We can’t stress this enough, adequate fiber is so beneficial to both men and women in health, especially in fertility. Complex carbohydrates will always take more time to digest and won’t spike your blood sugar. Whole grains have also been shown to curb hunger and balance some hormones. Choosing whole grain pastas, breads, cereals, and flour whenever possible is really the goal!
Oils: Healthy fats are your friend, and cooking oils are a great place to start when adding them into your diet. Heart healthy oils such as olive, avocado, as well as coconut oils are great sources of omega 3’s. These oils will have great anti-inflammatory effects, as well as work as absorb all those important nutrients. Decreasing the amount of hydrogenated oils such as canola or palm, will always be beneficial, as they can have the reverse effect, causing inflammation, as well as containing high amounts of saturated fat.
Canned goods: Overall, fresh or frozen foods are always my go-to grabs when it comes to vegetables, however especially during the winter months, I like to have a few cans of vegetables just in case. Always look for reduced sodium, as well as, single ingredients. Many have added preservatives to increase shelf life, avoid those!
by Alison Lautz RYT
Is it over! Winter? Have we made it out of the trenches or is it going to snow again in May? One will never know in this city! Flowers and vegetation will start to grow (we hope), the birds MAY sing, and Chicagoans will start to strip off their boots and puffy coats. Spring is in the air! Now how can we bring spring and a new vibe into our yoga practice? I love spring…. it signifies a time of letting go of our old tired way to make room for the new and another chance to re-start, like a second chance on new year’s resolutions or intentions that we made four months ago. The spring energy is all around us, and these four tips will help you awaken the spirit of spring in your yoga practice.
Awaken new vibrations
Spring is full of spiritual energy and more energy vibrations than any other season. This may be because the earth is working to shed the drab of winter and cultivate a more lively state of being. You may find that this is contagious, like when you see a coworker putting some colors into their outfit, you may want to do the same. Open up your energy to the season by having an open mind to any positive changes or the opportunity to try something new outside of your comfort zone. Try Journaling for the Journey!
Let’s celebrate the fact that we can roll our mats outside of the four walls that we spend most of our days within. It does not matter if it’s in your backyard, on a roof deck, or on a small balcony in a city high rise. Any of these options presents a great chance to connect to nature. Breathe in the fresh air and celebrate the ability to get out of the house. My favorite pose to do outside is Vrkasana (Tree Pose). I truly feel how rooted I am to the earth in this pose from my feet to the crown of my head. Learn more about how to use your breath to reduce stress with this FREE Prana webinar!
Detox your gut
April and May are the perfect time for some big spring cleaning. Most of us hold our old habits, negative emotions, and holiday/winter vacation indulgences in our gut. Try some twists in your yoga practice. Change your diet around a little bit. Drink more water with lemon, try some kombucha…and as always EAT MORE GREENS.
During spring, joy and fun are all around as new life begins. Watch the birds above or lay with your dog or cat in the grass! New life inspires a sense of playfulness that we can embrace in yoga practice as well. Embody playfulness in your practice by going for poses you normally skip and try some laughing instead of cringing whenever you fall out of a pose. Take everything even the TTC journey a little less seriously because we will all get through this. Come check out Yoga for Fertility at Pulling Down the Moon to work on some serious spring awakening. Meet new friends and a whole community of other women working on conceiving! Join the next Yoga for Fertility series on Wednesday, April 24th at 7pm or online starting on Monday, April 29th at 6pm! During National Infertility Awareness in April, try Yoga for Fertility and get 50% off!
By Brooke Laufer, Psy.D.
Motherhood, Not What You Thought
Mental health issues are among the most common complications related to childbearing, and yet it is still a topic that is largely misunderstood. A conversation I had with my dentist recently reminded me how little the general public knows about perinatal mental health issues. “Oh,” she said, “I just thought women cried a little bit, but you know, they’re usually just so happy to be mothers, right?!” We want to believe becoming a mother is an absolute joy. Motherhood is expected to be a fulfilling time for a woman, when a woman is in her most natural role–the role she was meant to play as suggested by film and other media–when her true purpose is determined. In reality, having a child is a profound, frightening, and exhilarating experience at the boundary of life, from which one comes back a transformed person. Most women bear this monumental transition to motherhood with some hardship. Experiences range from tearfulness, exasperation, and nervousness to more extreme feelings of obsessiveness, helplessness, and even murderous fantasies. While many women will have what is labeled the Baby Blues, 20% of women will have a Perinatal Mood and Anxiety Disorder, a debilitating psychological experience that interrupts their lives. With a growing amount of research and education, we begin to clearly see what distinguishes a true Perinatal Mood and Anxiety Disorder from the non-clinical experience of the Baby Blues.
10 years ago I was as unaware as my dentist of what could happen to a woman’s state of mind when she was faced with childrearing, so after my daughter was born I learned in a shocking and destabilizing way–the way most women learn–what a Perinatal Anxiety Disorder was. For me, it started with anxiety attacks while in my third trimester. I shook uncontrollably in the evenings and experienced an overwhelming sensation of claustrophobia during the day. I found a good psychiatrist who helped me understand that taking an SSRI (the one I’d gone off when I got pregnant) would relieve my anxiety and would not hurt my baby. Then after a fairly uncomplicated birth, I was supposed to be thrilled, but I had a new baby who didn’t sleep well. I loved her, but I wasn’t completely attached to her; I was also ragged and jumpy. When she was 4 months old, I started having intrusive thoughts that deeply disturbed me. At first they were like small blips on a radar, like thoughts from the periphery of my mind that I could barely hear. But then the blips grew larger and included images. I could clearly hear thoughts telling me that harm would come to the baby. I could see my baby being sexually violated. I had thoughts that my husband and I would be the ones to sexually harm our baby daughter. I could barely tolerate these thoughts as they began popping in with greater frequency. Luckily, my psychiatrist answered his phone the day I called beside myself in tears. He calmly told me that what I was experiencing was Postpartum OCD, he told me about Karen Kleiman’s book This Isn’t What I Expected, and he raised the dosage of my Sertraline. I was a therapist, a clinical psychologist, and I was learning for the first time what a Perinatal Mood and Anxiety Disorder was; this was not the Baby Blues. I recovered from my Postpartum OCD, but my life was changed forever. Since that time I have done what I can to research perinatal mental health, to immerse myself in the literature and new information we have on this condition, and to talk about it. Talk to women, to friends, to family, and especially to my clients, letting them know they are not alone, they are not crazy, and they can still be the mothers they want to be.
The term ‘Baby Blues,’ first used in Nicholson J. Eastman’s 1940 best-selling baby care book Expectant Motherhood, is an umbrella term referring to any emotional experience a woman has in the period after bringing home the baby. It is no surprise this massive life transition, along with sleep disturbance, disruption of routine, and emotions from the childbirth experience itself will contribute to how a mom feels. Her experience is also affected by the hormone changes that occur first during pregnancy, and again after a baby is born. The levels of progesterone and allopregnanolone rise during pregnancy and plummet after childbirth, and this drop is thought to contribute to emotional dysregulation. These short-term postpartum symptoms include weepiness or crying for no apparent reason, impatience, irritability, restlessness, anxiety, fatigue, sadness, mood changes, and poor concentration.The informal diagnosis of Baby Blues requires that these symptoms last no more than 2-4 weeks, occurring for a few minutes up to a few hours each day, and typically going away with rest, support, and time. Baby Blues rarely get in the way of daily life or need intervention from a medical provider.
“A baby opens you up, is the problem. No way around it unless you want to pay someone else to have it for you. There’s before and there’s after. To live in your body before is one thing. To live in your body after is another. Some deal by attempting to micromanage; some go crazy; some zone right the hell on out. Or all of the above. A blessed few resist any of these, and when you meet her, you’ll know her immediately by the look in her eyes: weary, humbled, wobbly but still standing. Present, if faintly.” Elisa Albert, After Birth (2015)
Perinatal Mood and Anxiety Disorders
When a disturbing emotional state lasts beyond 2-4 weeks, clinicians should start to assess for a perinatal mood and anxiety disorder (PMAD). Formerly referred to as Postpartum Depression, or simply “postpartum,” we now use the term “Perinatal” because the symptoms can occur not only one year postpartum, but also during pregnancy, or after a pregnancy loss. We say “Mood and Anxiety Disorders” instead of “depression” because it more accurately covers the range of experiences women have. These include major depression, generalized anxiety, OCD, PTSD, and postpartum psychosis.
Although there is no clear indicator of who will experience a PMAD, previous mental health issues, trauma, and lack of resources are some of the risk factors. Important to note: PMADs do not affect just biological mothers. Growing research shows us that men experience postpartum anxiety and depression. In fact a client of mine came in a few weeks after her baby was born and reported that her husband was acting strangely: yelling a lot, throwing pillows at the wall when the baby cried, uncontrollably crying, and openly fantasizing about leaving the baby out in the snow. We were able to get him in for a session with her and help him understand that he needed help. The couple was surprised that he was having postpartum rage, while she was adapting well. He actively resented his child for destroying their former life, while she’d become protective of the child. Eventually, with months of treatment, he was able to love and attach to his daughter.
Similarly, adoptive parents may report symptoms of PMADs: it can be particularly confusing to resent or feel disconnected to an adopted baby whom you wanted and planned for and possibly spent much or most of your savings on. Likewise, LGBTQ families who may have worked for years on fertility treatments or with a surrogate to finally bring home a baby are also vulnerable to PMADs and should not be ignored as a population worth assessing.
Perinatal depression mimics that of a major depressive disorder but with certain symptoms specific to mothering. A woman may be withdrawn from the baby and her family, not want to hold the baby or have difficulty bonding, have a flatness of facial expression and voice, exhibit excessive tearfulness, or severe self loathing. She may have a belief that she can’t handle motherhood or be a good mother, she may be unable to enjoy most of her life, or she may believe her family would be better off without her.
A client of mine described feeling like she couldn’t see herself in the family picture. She vacillated between dissociation and depression. This mom had twin baby girls with whom she was not bonding. She felt like a machine part going through the mechanical motions of caretaking. After her first session of unburdening herself of the sadness and shame she carried, she was able to start to locate herself. Her experience points to the invisibility some women feel as mothers. The erasure of self to motherhood is well noted by the poet Alice Notley:
“For two years, there’s no me here….
Two years later I obliterate myself again
having another child” (1972)
Perinatal Anxiety and PTSD
Perinatal anxiety, or anxiety during and after pregnancy, has received little attention compared to its well-known cousin, postpartum depression, yet anxiety symptoms are more frequently reported. Worrying, of course, is a normal part of new motherhood–checking that the car seat is secure or that the baby is still breathing, for example–but if it interferes with a woman’s life so that she cannot think about other things or take care of herself or her baby, then it verges on mental illness.
For women who are prone to anxiety, the information-saturated era we live in is loaded with potential stressors about conceiving, being pregnant, and parenting, requiring women to be vigilant about what information she is exposed to. An anxiety disorder can be spotted in the repetitive fears and questions moms have, in extreme over-protectiveness such as not letting anyone hold the new baby, or in the too well put-together mask some moms wear, hiding an internal world out of control.
Post-Traumatic Stress Disorder (PTSD) in the perinatal period refers to past trauma resurfacing during the perinatal period, including flashbacks and nervous system responses (freeze, flee, fight) that can interrupt caring for a new baby. What many doctors do not realize is that women who have experienced sexual trauma may have fear of a baby coming out of the vaginal canal, a fear of male providers, and/or a fear of being alone with baby.
Perinatal Obsessive-Compulsive Disorder
Obsessive compulsive disorders are possibly the most insidious of the postpartum conditions because they include the intrusive thoughts that haunt many mothers. Intrusive thoughts are thoughts that happen frequently and randomly, feel uncontrollable, and are often disturbing. These disturbing thoughts, or obsessions, can lead moms to engage in repetitive behaviors, or compulsions, to try to ease their anxiety. Many moms with OCD are plagued by repetitive fears of harm coming to their babies, possibly due to the extreme helplessness of a newborn baby. It is horrifying for mothers to have uncontrollable thoughts and images of their baby tumbling down the stairs or falling out a window, or images of themselves smothering the baby or sexually abusing their own child. Because of the disturbing nature of these thoughts, it can be the most difficult disorder to admit, yet, as was my experience, by breaking the silence women can find tremendous relief in the normalization of Perinatal OCD.
Postpartum Psychosis is the most rare of perinatal conditions, occurring in .1% of moms, but it is the most dangerous. Psychosis is a break from reality that can happen over time but can also become a medical emergency very quickly. As with Postpartum OCD, a mom may experience intrusive and paranoid thoughts, but instead of being disturbed by them, she may begin to identify with them. For example, a new mother may have the thought that someone is going to steal her baby, so she acts on it by hiding the baby or running away with the baby. Unfortunately, it is typically after a postpartum psychotic episode has ended badly that the media gives it attention. Just a few years ago a woman who I know from my hometown was arrested for the death of her 14 month old boy. After months of working full time, bad day care experiences for her baby, an unstable partner, and increasing symptoms of OCD and paranoia, she came to believe she and her son would be better off dead. After she suffocated her baby she attempted to overdose on medications, but she survived. Even though the she had an expert forensic psychiatrist diagnosed her with Altruistic Filicide, deeming her Not Guilty By Mental Defect, she was sentenced to 25 years in prison. Unfortunately, there is still little understanding or mitigation done for mothers convicted of infanticide, resulting in excruciating treatment and excessive sentencing.
Women may find it difficult to reach out for help, as it is taboo to admit you are unhappy or unnatural at motherhood. To the extent that women in our society are still seen as playing their most natural role as mothers, to acknowledge unhappiness or discomfort may have high stakes relating to women’s own identities and how others may see them. A mom may fear being seen as a “bad mother,” which would ostracize her from mainstream society. With more education and awareness around the frequency and epidemiology of perinatal mental health issues, much of this silencing can be alleviated. What is essential to understand is that a woman herself should not be blamed–not by her providers, her family, or herself–for a perinatal condition. We often have little control over the occurrence of a Perinatal Mood and Anxiety Disorder, but we can do much about its treatment.
Psychotherapy and Medication
With a proper diagnosis of a Perinatal Mood and Anxiety Disorder, good treatment can support a full recovery. The best form of treatment is individual psychotherapy that reduces stigma and shame and normalizes the client’s experience. Besides reassuring women that it’s normal to feel ambivalent during pregnancy and motherhood, I also educate each woman about her particular diagnosis. Women often feel desperately alone and deeply ashamed when they experience PMAD symptoms, especially ones that are less talked about like rage or intrusive thoughts. I reassure my clients that these inner experiences don’t indicate their worthiness as mothers but are instead treatable symptoms of common disorders. Women express tremendous relief when they realize that their scariest and most shameful symptom is something others also experience–and something we know how to treat. Helping women accept all the parts of themselves will reduce symptoms of anxiety and depression. One important goal I look to when working with PMADs is helping women regain a sense of self. It may not be the self they knew before the baby but a new self that emerges in the transformation. Questions we consider: How does having a baby disrupt a mother’s sense of who she is, of her body, her understanding of life and death, her relation to the world and to her sense of independence, her experience of fear and hope and time, and the structure of her experience altogether?
Therapy may include the new baby, so that I can support a secure attachment and help the mom experience the infant’s behavior without insecure projection and negative interpretation. I may recommend infant massage or, inversely, setting the baby down for an extended period. Therapy may also include the partner or other family members. Marital disharmony is the most commonly cited non-biological cause and consequence of PMADs, so by bringing in and educating the partner on PMADs, a mom is more able to be understood and get her needs met at home. Group therapy, such as a moms support group, can be an excellent way to reduce shame and isolation, as it can provide universality, catharsis, socialization, and good information.
Additionally, psychopharmacology is an effective form of treatment for Perinatal Mood and Anxiety Disorders. Current research and an updated classification system (no longer the A, B, C labels for medications that were often misleading) suggest many medications are safe during pregnancy and breastfeeding. There is still damaging stigma around medication and pregnancy that needs to be fought with accurate information. Reducing a previously prescribed medication for pregnancy or changing a medication during breastfeeding are potentially misguided recommendations that can put a women at risk of relapse. The American College of Obstetricians and Gynecologists and the American Medical Association agree that treating the mother’s health is the priority; the trace amounts of medication that a fetus or nursing baby will receive should not keep a mother from the medical treatment she needs.
Although public awareness of postpartum depression has increased in recent years thanks to celebrities like Brooke Shields and Serena Williams, many people–including therapists–are still learning that PMADs are serious and pervasive experiences. When I started talking about my Postpartum OCD experience one of my aunts told me the story of my grandmother, who had three children in four years. The day after they brought home the third baby my grandfather got in his car to go to work, as he started to pull out of the driveway my grandmother came running outside and threw herself on the hood of his car. She spent the next 7 months in a sanitarium, a nicer version of an asylum in a neighboring state, and came home to her children who were being cared for by a strict German nanny. It’s possible my grandmother was experiencing depression or anxiety or even psychosis, they sent her away and no one discussed it. Although awareness and treatment have improved since the harsh days of my dear grandmother, perinatal mental health is still overdue for the attention it deserves, considering women are doing some of the most laborious and important work of our world.
Brooke Laufer is a Clinical Psychologist who has been practicing psychotherapy since 2005. Brooke began her clinical work in psychiatric wards and then in schools with adolescents and their families. After having her first child Brooke had a disturbing Postpartum OCD experience, which inspired her to begin researching, understanding, and specializing in the treatment of perinatal mental illness. She has a private practice in Evanston, where she continues to treat adolescents and adults, specializing in perinatal mental health issues.Brooke Laufer, Psy.D.
Diana Zic, RPYT, CHC
I am extremely empathetic to those women with endometriosis as I used to suffer from pelvic pain, heavy menstrual flow, and at times vomiting and constipation dating back to the age of 12. Although I haven’t been diagnosed with the disease, I’m pretty sure the rupture of my appendix when I was in 3rd grade paved the way for my discomfort around my menstrual cycle.
For those reading this and are unsure of what endometriosis is exactly, according to Mayo Clinic, “it is often a painful disorder in which tissue that normally lines the inside of your uterus – the endometrium – grows outside your uterus. Often times it spreads to the Fallopian tubes, ovaries and the ligaments that hold the organs in place which may cause trouble when trying to conceive and cause pain.
Many women do not realize that they have it until they are trying to conceive. As it’s hard to diagnose without laparoscopic surgery (which I’ve done and it’s not the greatest experience as you can imagine) though it can help clean up scar tissue temporarily which can relieve discomfort and offer a window to try to conceive, but it’s likely to come back if the root cause isn’t found.
Also, I believe because so many women are suffering from pelvic pain and PMS symptoms it’s become seen as a cliché to have these symptoms so they are brushed off as “normal”.
The symptoms of endometriosis are typically associated with the menstrual cycle and unique to each woman and may include: Pain during sex, extreme cramps that don’t go away with anti-inflammatory support or that impede daily life, bowel and urinary disorders, periods that last longer than seven days, heavy cycle (changing pad or tampon every hour) and nausea or vomiting. YUCK!
Good news! There are ways to decrease symptoms in a non-invasive way FIRST!
- Be mindful. Start to track your symptoms daily: mood, stress levels, diet and exercise to see if there’s a pattern to your pain.
- Try an elimination diet. Certain foods may be triggering inflammation in your body. Read about some recommendations here from our nutrition team.
- Balancing your hormones. High levels of estrogen is connected to endometriosis. Studies show when estrogen is dominant over progesterone, or progesterone is too low, it can set a woman up for pelvic pain. Yoga can ease menstrual pain, improve fertility, and aid in hormonal balance.
- Seek out a pelvic physical therapist with expertise in women’s health and a massage therapist specializing in fertility. This can alleviate pain, symptoms, and aid in hormone balance.
Do you have or think you have endometriosis and are trying to conceive? Do you want support to help guide you to the root cause of your pain and heal your body? Join Diana for Yoga for Fertility with rolling enrollment on Wednesdays in Chicago (through April 10th) and the NEXT SERIES will start on Monday, March 25th at 7pm at Pulling Down the Moon or learn about our March fertility health coaching special with Diana at: 312-321-0004 today!
By Cathy McCauley, LMT
Spring arrives this month, and with it, more cold days (perhaps even snow)! But March also brings the promise of new life. I love this time of year. The ground starts to smell fresh and ripe. Small green buds begin to swell from the earth reaching up, up, up. Birds chatter in the trees. The sun stays in the sky a little longer each day. After a long, cold winter of hibernation, spring restores nature’s beauty.
Spring inspires us to restore ourselves, too and these self-care techniques will lead you to restoration of mind, body and spirit.
—Hydrate. Drink a glass or two of water first thing in the morning. Keeping yourself hydrated helps boost your mood, improves brain power and protects you against disease.
—Make a gratitude list. Spending just a few minutes a day writing down what you are grateful for can dramatically shift your day. The more gratitude you have, the more open to abundance you become.
—Breathe. Set aside a few minutes each day to practice breathing. There are so many benefits! Among them, diaphragmatic breathing alleviates stress, reduces pain, strengthens internal muscles and moves blood to organs and tissues. If you’re not sure how to get started, schedule an Open the Breath (™) massage to receive some hands-on breath work coaching.
—Stretch. Five to 10 minutes of stretching in the morning increases energy levels, enhances circulation, reduces injury and centers your mind. Even better is a regular yoga practice. Pulling Down the Moon’s yoga classes can give you a jump start!
—Eliminate something from your diet that isn’t serving you. Instead of overhauling your entire diet, start by taking out one food that doesn’t nourish your body. Replace it with a different item that supports your desire for restoration. Learn even more by working with a nutritionist!
Do you have ideas on how to restore yourself or tips for others? Please share them! I look forward to seeing you in the center. Many wishes for a beautiful spring!
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