By Pulling Down the Moon co-founder Beth Heller
We’ve said it a thousand times. The fertility process is a marathon not a sprint and the tools in our DIY Essential Fertility Tool Kit are the “energy goo” that can keep you going strong and possibly even cross the finish line faster.
As one of those gals that took seven years and five pregnancies to have two kids, it was the little things that helped me turn the fertility waiting game into a constructive period of time. Most of the little things that helped the most came from the practices of yoga and other traditional teachings where everyday life is treated as sacred and as an opportunity to make changes that can actually improve your health and fertility.
Managing anxiety is probably the one thing that makes the biggest difference in whether someone thrives or suffers on the road to parenthood. Studies show that anxiety levels in women doing IVF are equal to that of a cancer diagnosis. And I can 100% relate. As an already anxious personality, my fertility challenges presented me with a choice. I could struggle, alone and white-knuckled on the path to parenthood, or I could face anxiety head-on and learn how to manage it better. (In fact, that’s how Pulling Down the Moon came into being as Co-Founder Tami Quinn and I created a space for women who were struggling like we were to manage the stress, anxiety and frustration of infertility!)
This week, our Acupuncture Director Christine Davis is offering a Wellness Wednesday class on Natural Ways to Reduce Anxiety. One of the tools she will be sharing from her Traditional Chinese Medicine expertise are Ear Seeds, literally small seeds that can be adhered to different acupressure points in the ear. When massaged gently, the seeds stimulate the point, generating a specific therapeutic effect. At Pulling Down the Moon we offer seed kits specifically geared to fertility, depression, stress, postpartum care, and anxiety.
Ear seeds are great whether or not you are seeing an acupuncturist on a regular basis. If you are in treatment, your practitioner may recommend you wear them between treatments to extend treatment benefits. If you aren’t currently seeing an acupuncturist, seeds are another great tool to help you manage specific conditions – like anxiety.
For me, ear seeds are also another way to practice mindfulness and remember my intention of finding balance and healing. Choosing a event that happens multiple times in my daily life, like starting my car, getting a message notification on my phone or brushing my teeth, as a signal to stop, take a breath and stimulate the ear seed creates a kind of rhythm of mindfulness and healing that helps me feel positive and in greater control of who I am and how I respond to the world around me.
by Alece Demaray, RYT 500 + CPYT
New Year’s goal setting is tough when your goal (BABY!) is not in your control. No matter the timeline you allot yourself or how hard you work to make it happen, it may or may not come to fruition. As a goal driven woman, that is heartbreaking to accept.
I like to work toward things and celebrate when I achieve them. When trying to conceive, I started to do everything that was in my control…see a reputable Reproductive Endocrinologist, adjust lifestyle factors, modify my diet, take proper supplements and get weekly acupuncture. I adopted a mood of empowerment, to make my healthiest self to prepare for conception. I am still upkeeping the changes…and I am still trying to conceive.
I am currently on clomid in prep for IUI #3. As I started a new cycle, it struck me that my emotions have developed a unique cycle of their own:
Cycle Day 1-3: Depressed because I am not pregnant
Cycle Day 3- 7 : Swallowing down clomid with a dose of forced optimism. Emotions run wild.
Cycle Day 8-14: Anxious anticipation to see how I responded to the meds and when the IUI will be scheduled
Cycle Day 14- 24: A mix of hope and positive thinking swells the majority of the two week wait
Cycle Day 24-28: The last few days of the two week wait brew anxiety and negative thinking, as if I already received a negative pregnancy test result
Cycle Day 28 – Upset and mad at the negative result of the pregnancy test.
The yoyo of emotions is real and it is tiring. I want to be hopeful and believe it is possible, but being pulled to the other end of the spectrum becomes more painful, feeling like a positive pregnancy test is the impossible dream. I began to think…How can I learn to ride this fertility roller coaster better? Sure, there are some unexpected twists and turns, highs and lows, but can I learn to EXPECT those challenges and manage my energy BETTER around them?
My new goal is to strive for balance regardless of the cycle phase. Remain present for all that is coming up for me emotionally and physically, but not allowing it to throw me. I will root down and rest into the truth that I WILL BE OKAY, regardless of the outcome. It is a PRACTICE and everyday an opportunity to try the ride again, inviting more ease.
Here are some suggestions and inquiries to support you in remaining cool, calm and collected, regardless of what cycle day it is for you and your emotions:
- Schedule some space directly after your appointments. Use this time to journal and process what things in your life ARE going right. Gratitude journaling can help to reframe your perspective and shift your mood in a positive direction for the rest of your day.
- Take 3 deep, calming breaths before opening the message from your doctor.
- Remain aware and nonjudgmental of your emotions as they fluctuate with medication. Be kind to yourself and thank close ones around you for understanding 🙂
- At the beginning of your two week wait, remain active with safe exercise (yoga!) to keep your mind at ease.
- Prior to your pregnancy test, affirm to yourself (at least) 3 times that you will be okay, regardless of the outcome. You are loved, regardless of the outcome. You are worthy, regardless of the outcome. Try an Unwind the Mind Massage to get through the wait!
- Post pregnancy test, allow yourself to process: do you need to cry, scream, call someone or celebrate? Allow yourself adequate time to digest the information as opposed to rushing off to the rest of your day, without dealing with your feelings.
- Give yourself permission to begin again (mentally) at the start of your new cycle. Reignite the flame of possibility and reaffirm to yourself that YOU ARE CAPABLE AND WHOLE.
If you would like to practice riding the roller coaster together, join me for Yoga For Fertility at Pulling Down The Moon, on Wednesdays evenings. In addition to managing emotions and digesting experiences, YFF will increase blood flow to optimize your fertility. To find more balance on this path, call Pulling Down the Moon to get started in March at: 312.321.0004. I hope to see you on the mat!
Essential oils wonderfully enhance the spa-like experience during your acupuncture treatment. At Pulling Down the Moon we offer this additional option to our acupuncture patients. Different essential oils can be used to treat different ailments. One amazing oil is Bergamot, and I love to use it in the office on my patients. It is helpful in Traditional Chinese Medicine (TCM) to regulate the qi flow, which means it keeps the energy flowing in our bodies and minds smoothly and evenly. It is a great mood balancer for that reason. So, if your anxiety is high and you cannot seem to ground yourself using Bergamot oil will help to calm you down. If you are feeling low and depressed, it also has the ability to bring you up and help lift your spirit when you are down. It works wonders for your emotional state during the holidays and is especially useful during this season!Another oil I use to help alleviate mental tension and has a nice Christmas time scent is Peppermint essential oil. Dabbing a small drop of these oils behind the ears or at certain stress points on the body can help achieve its therapeutic effect. If a patient prefer not to wear the oil, they can take a few deep inhalations of it instead. At Pulling Down the Moon we also use specific essential oils for each phase of the menstrual cycle when trying to conceive, whether naturally or throughout a medicated fertility treatment cycle. The first phase oil is called Activate The Blood & Qi, it is meant to be used during the period. It helps detox the body by riding toxins through the shedding of the uterine lining. The second phase oil is called Nourish the Sea of Blood, it is meant to be used after the period has ended to leading up to ovulation. It helps with building the lining back up and with enhancing the quality of the developing egg/s. The third phase oil is called Lift Spirit and is meant to be used at ovulation time. It helps ensure ovulation occur. The fourth phase oil is Nourish Yin & Blood, it is used after ovulation has occurred up until the period begins (it is one of our oils used during pregnancy). This oil helps strengthen the quality of the luteal phase of the cycle, bettering the chances of implantation of an embryo where conception is the goal. The oils are safe and indicated during trying to conceive and during pregnancy when used in the correct manner as done by our experienced acupuncturists.* Another way of reaping the benefits of the oils without having to wear them is using them in an essential oil diffuser if you are concerned at all about placing them directly on the body. Of course, if our acupuncture patient requests no use of oil we respect that. Any oil used during your treatment can help boost the healing you get from the acupuncture itself.For further information or any questions please feel free to email me at email@example.com and to schedule an appointment for Acupuncture or any or our holistic health services, please call our office 312-321-0004. To purchase any of our fabulous oils please visit our offices in Chicago or Highland Park and/or our online store, including the Fertility Wellness Sampler (including Activate, both Nourish oils, Lift Spirit). Learn more at our FREE in-center Chicago event “Essential Oils for Love and Fertility” on Feb 4th!
By Christina Livas L.Ac.
As an acupuncturist working in the fertility field, I am frequently asked if Acupuncture is safe during pregnancy. I am here to answer that question! Acupuncture is a completely safe and effective treatment for minor to moderate pregnancy symptoms. It is important to know that there are many medications that are considered unsafe to take during pregnancy and while breastfeeding. That is why many patients turn to acupuncture (as I did during my own pregnancy) to treat even common symptoms unrelated to pregnancy to avoid taking medication unless it was deemed necessary.
Here is a list of symptoms Acupuncture can treat during your pregnancy journey.
- Nausea and vomiting
- Constipation and/or hemorrhoids
- Urinary discomfort or chronic UTIs
- Headaches and migraines
- Anxiety and depression
- Carpal tunnel/arthritis
- Threatened miscarriage
- Lingering first trimester symptoms
- Sinus congestion
- Emotional Imbalance
- GERD/acid reflux/heartburn
- Neck pain
- Back pain
- Rib pain
- Leg cramps
- Headaches and migraines
- General discomfort
- Sinus congestion
- Preparing the body for labor
- After pains
- Perineal pain
- Incision pain
- Breast discomfort
- Insufficient Lactation
- Baby blues/postnatal depression
While acupuncture can treat a variety of symptoms during your pregnancy there are still areas of the body that should not be needled while you are pregnant. This makes it very important that you choose an acupuncturist that specializes in fertility and/or pregnancy. Pregnancy is an amazing and exciting time in your life and you should make sure your body feels amazing too!!
Book your appointment with Christina in Highland Park or Buffalo Grove! Acupuncture support for fertility, pregnancy, postpartum care, and general wellness is available in Chicago seven days a week, too! Book an Initial Acupuncture Consultation with the $99 Wild Card and save $51 this season!
pubmed/31392990 – low back pain and pelvic painhttps://www.ncbi.nlm.nih.gov/ pubmed/30423471 – anxiety and depression pre/postnatalhttps://www.ncbi.nlm.nih.gov/ pubmed/30261764 – treating nausea and vomitinghttps://www.ncbi.nlm.nih.gov/ pubmed/31483927 – safety of acupuncture during pregnancy
by Kellie Stryker MSW LCSW
According to reproductivefacts.org, “Infertility often creates one of the most distressing life crises that a couple has ever experienced together. The long term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples.”
Kristin L. Rooney, BA and Alice D. Domar, PhD with Boston IVF wrote: “Infertility is often a silent struggle. Patients who are struggling to conceive report feelings of depression, anxiety, isolation, and loss of control. Depression levels in patients with infertility have been compared with patients who have been diagnosed with cancer.1 It is estimated that 1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Despite the prevalence of infertility, the majority of infertile women do not share their story with family or friends, thus increasing their psychological vulnerability. The inability to reproduce naturally can cause feelings of shame, guilt, and low self-esteem. These negative feelings may lead to varying degrees of depression, anxiety, distress, and a poor quality of life.”
It’s normal to experience times of stress throughout the infertility process. However, it becomes a cause of concern when the feelings become persistent or prolonged.
According to reproductivefacts.org, if you experience the following symptoms for a prolonged of time, you may benefit from meeting with a mental health professional.
- Loss of interest in usual activities
- Depression that doesn’t lift
- Strained relationships
- Social isolation
- Thoughts that are consumed by infertility
- High levels of anxiety
- Diminished ability to concentrate or accomplish tasks
- Change in your sleep patterns, appetite or weight
- Increased use of drugs or alcohol
- Persistent feelings of pessimism, guilt, bitterness, anger or worthlessness
- Thoughts about death or suicide
Help Is Out There
The following resources are dedicated to helping you improve your Reproductive Mental Health:
- RESOLVE: The National Infertility Association – RESOLVE provides free support groups in more than 200 communities; is the leading patient advocacy voice; and serves as the go-to organization for anyone challenged in their family building.
- ASRM : American Society for Reproductive Medicine – ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers. The Society is committed to facilitating and sponsoring educational activities for the lay public and continuing medical education activities for professionals who are engaged in the practice of and research in reproductive medicine.
- Pulling Down The Moon – Holistic care for family health and fertility should be highly personal, compassionate, and customized to meet the unique needs and complex challenges of each patient. Founded in 2002, Pulling Down the Moon recognizes the stress and emotional turmoil and fatigue that can come with infertility as well as your day to day health.
- Shine Fertility – Shine supports women through mentorship, community and education. We empower women by encouraging a proactive approach to fertility health and fertility preservation.
Taking Care of You
It’s ok to be sad, frustrated, angry, resentful, bitter and whatever emotions you may be feeling at this very moment. You are allowed to feel all of the above and more. Sit with it. Don’t force yourself to put on a brave face when you are going through unimaginable pain. However, when you are ready, allow yourself to work through the emotions you are experiencing.
Georgia Witkin, Ph.D with Progyny wrote: “You may not have control over the physical effects of fertility treatment, but you can take control over many of the psychological effects. What you think and what you do shapes what you feel, so choose thoughts and behaviors that reinforce your sense of control.”
Kellie Stryker is a Licensed Clinical Social Worker and owner of Rain to Rainbow Counseling. Kellie has over 10 years of experience in the mental health field. Kellie currently lives in Crystal Lake, IL with her husband and 1 yr old daughter who was conceived through infertility treatments. Kellie’s mission as a Reproductive Mental Health Counselor is to provide support to others as they navigate through their infertility journey.
Rain to Rainbow Counseling offers supportive services which are focused on all aspects of Reproductive Mental Health which include infertility, grief, loss, miscarriage, stress management, adoption and pregnancy counseling. Rain to Rainbow Counseling is currently in network with Blue Cross Blue Shield of IL and Optum United Health Care. In Person and Online Telehealth Sessions are available.
Benefits of Online Telehealth:
- Confidential: Rain to Rainbow Counseling uses Simple Practice, a secure and HIPAA compliant program.
- Online Client Portal: No software to download. Private login and password for each client.
- Same benefits and techniques: Only difference is we see each other on screen instead of in person.
- Convenience: Can literally be done from when and wherever you are comfortable.
The anticipation, anxiety, the loss of control and not knowing what to expect can be especially difficult during the “two-week wait.” The two-week wait – between ovulation and when your next cycle is due to start – can feel as if you are in limbo as there is no way to tell if you’re pregnant.
You may find yourself watching for signs and symptoms of pregnancy. Each twinge in your belly, tenderness in your breasts and feeling of fatigue, asking yourself, “Does this mean I’m pregnant? Or am I getting my period?”
The questions, the “what if’s,” the TIME all feels endless and one seems to build upon the other until what you’re left with is a gigantic ball of anxiety and feeling a loss of control.
What if instead of “getting through” the two-week wait, we were intentional and mindful of nurturing ourselves by creating a plan? This holistic guide to self-care will provide you with a plan for nurturing yourself in four areas: physical, social, emotional and spiritual.
Sleep is not only necessary and restorative for our bodies, it also allows us to cope with our feelings of anxiety and overwhelm in a more manageable way. If you find yourself having difficulty falling asleep, here are a few helpful tips:
- Keep a journal or notepad next to your bed and write down the thoughts, worries or items on your ‘to-do’ list. Say to yourself, “This will be here for me if/when I need it.” Sometimes the act of writing something down allows for a cathartic release of whatever we’re feeling preoccupied with.
- Listen to a guided meditation app before bed to relax into sleep and take your mind off of the two-week wait. Bonus: the more you practice, the more this cues your body and mind that it’s time to sleep.
Gentle exercise such as planning a walk to a scenic place, a lake or forest preserve. Getting outside can have a calming, centering effect while you are present in nature. Try Yoga for Fertility poses on your own or building community through practice with others. Schedule an Unwind the Mind Massage, “This session was created to be a safe oasis from post-ovulation stress, boosting immune and endocrine function, while supporting a potential pregnancy.” (Pulling Down the Moon, Fertility Enhancing Massage (FEM)
- Plan a social outing with your partner or friends. Socializing provides an outlet for connection as well as a distraction from the thoughts and feelings you maybe preoccupied with. And, it’s fun! What activities do you enjoy doing? Want to try something new? Try being intentional about planning enjoyable activities, especially during the two-week wait.
- Create a list of friends, family members or supports you can reach out to check in with during the two-week wait. Is there a fellow member of your support group, a friend or family member who has an understanding of what you’re going through? Who acts as a sounding board, offers encouragement or provides a fun distraction? Write these supports down so that when you’re feeling especially alone or overwhelmed during your journey you have a few go-to people you feel safe reaching out to.
- Mantras can have a powerful and empowering impact. Choose a word or short phrase you would like to be the focus during your two-week wait. How would you like to feel and respond to yourself and others? Write the mantra on a post-it note or schedule it as a daily event on your phone to be reminded of your intention.
Nurture ~ Empower ~ Peace ~ Joy ~ Warrior
- Practicing meditation & mindfulness “Mindfulness is the energy of being aware and awake to the present moment… Being present is the most powerful place to be.” Thich Nhat Hanh. Bringing your attention back to the present moment can help decrease feelings of anxiety and increase self-awareness. New to meditation? Try a guided meditation app. There are guided meditations specific to fertility, sleep, anxiety and grief that you may find especially helpful in starting or ending your day.
In summary, while creating a plan doesn’t take away the uncertainty, it may allow you to feel a sense of control with how you choose to meet this part of your fertility journey. Creating a plan for the two-week can be a nurturing way to care for yourself during a time when your thoughts and feelings may be overwhelming. Take this time to connect with yourself, your partner and those you enjoy spending time with who play a supportive role in your journey.
- Yoga for Fertility – https://www.pullingdownthemoon.com/services/yoga-classes/
- Fertility Enhancing Massage (FEM) – https://www.pullingdownthemoon.com/services/therapeutic-massage/
- Meditation Apps:
- Calm – https://apps.apple.com/us/app/calm-com/id571800810?ls=1
- Insight Timer – https://apps.apple.com/us/app/zen-timer-meditation-timer/id337472899
- Meditation Studio: Fertility Collection – https://www.meditationstudioapp.com/fertility
- Fertility Mantras & Positive Affirmations – https://fertility-news.rmact.com/path-to-fertility-blog/infertility-mantras-fertility-mantras-your-choice
Emily Heilman is the founder of Flourish Counseling & Wellness. As a Licensed Clinical Social Worker (LCSW) and Certified Perinatal Mental Health specialist (PMH-C), she specializes in perinatal mental health and wellness, supporting women and their families navigate their fertility journey, the pregnancy and postpartum period, and throughout motherhood. Her experience in the field of women’s and perinatal mental health spans the past 13 years where she has worked in community mental health, hospital settings and private practice. Emily offices are located in the Chicago Loop & Oak Park. To learn more, visit: https://flourishcounselingltd.com/
by Rickie Kostiner RYT, Clinical Intern
I took a good hard look one morning at the piles of stuff that had accumulated between my jeans and sweaters. It was a misshapen pile that had peculiar characteristics including big dark spots and glimpses of shimmer, it was hard and jagged around the edges but soft and mushy inside. No, it wasn’t loose socks, empty boxes, or unopened mail, it was me. I wasn’t dreaming, but I swore that I could see myself in physical and metaphysical form in my closet that day. My heart sank and slouched to the ground. Knees to chin I rocked back and forth for what seemed like an entire day wondering how I got there. How did I end up on that shelf and how could I find my way back into my own body. My body, I shrieked. What. Is. A. Body and why can’t I feel any part of mine? I touched my toes, not painted calloused soles. I licked my lips, cracked, and broken. I ran my fingers through my hair, rough and thin. I closed my eyes and tried to breathe but every breath stopped short in my chest. What was happening? How did I get this way? I somehow managed to pull myself off the dirty carpet that day and I continued to move through the rest of my day. That’s all I did, I moved through places, interactions, workouts, meals. There were no feelings, because I wasn’t there. I was still on that shelf.
How do I get off the shelf? Am I ever going to feel anything ever again. I walked past a yoga studio everyday to get on the train. One day a sign out front of the studio read, “come inside and feel your body! Baby, it’s cold outside.” Okay, I thought, this is it, I’ll try it. That first yoga class was weird, I couldn’t explain how it made me feel but I went back. I went back three more times and then five more times after that and pretty soon I was practicing six times a week, but I still couldn’t tell you why. I practiced for two years, completed my first 200 hour teacher training, and had started teaching and I still couldn’t tell you why.
It was a Sunday, I had been teaching yoga for about four months. A dear friend and fellow yoga instructor told me she was going to take my class. Immediately, I felt shocks of nerves zooming through my body. “I’m nervous!” I said to her. She replied, “Rickie, I am here for whatever you have to give.” Wow. Right? Think about it, I am here for whatever you have to give. That level of flexibility is something I could only dream about achieving. For the first time since I started practicing yoga I felt something other than those adjectives that I was “supposed” to be feeling (tired, strong, healthy etc.) I felt safe. I went home that day and opened my closet to see that the pile of stuff was smaller. The parts that were black began to fade and the parts that were shimmering glistened a little more. As I continued to take in what my friend had said, ideas began to click in my head. In teacher training our leaders told us that yoga was much more than the physical practice, it is a much deeper and broader philosophy that encourages and encompasses a way to live, a way to treat one another, and most importantly, a way to treat the self.
I started to listen, and I started to observe. I took a step back from the rigid expectations I had of myself as a teacher and student and allowed the philosophy to manifest within. The true intention behind the practice and philosophy of yoga is to find stillness, both in the mind and body. The physical, asana, practice of yoga is done in order to help the body sit still. Handstand means nothing if the body cannot rest. Slowly, yoga finally began to make sense. The reason I came to yoga each day was because I was allowed simply to be.
Everyone has their unique reasons for finding and pursuing yoga. If you approach your practice with intention that is truth and that is real. Yoga changed my life by giving me a safe space to uncover layers of myself and were buried beneath many years of neglect. Today, as I continue my studies and research further into the dimensions of counseling and psychology, I am reminded every time I step on my mat that I have everything I already need within to heal. A perspective that took me a long time to actualize, but once I did, other pieces of my life fell into place. The piles of stuff in my closet slowly transformed into significant pieces of my life that I began to recognize as relationship, family, self. I was there all along, buried beneath the layers of stuff, patiently waiting to be uncovered. As you begin to uncover layers of self that have been buried remember to trust in the process that the practice of yoga can bring. Now, I practice both on and off my mat with the intention of, I am just a voice, the yoga does the work.
During Mental Health Awareness, we encourage finding support in whatever format works best for you-whether yoga, acupuncture, visiting a support group specific to your needs for infertility support, trying again after loss, or single parenthood), meditation, and/or speaking with your doctor. Resources, such as, Resolve (866-NOT-ALONE), Star Legacy Foundation, and the Women’s Professional Health Networking Group of clinicians supporting patients going through fertility treatments, pregnancy after loss, struggling in their relationships on the journey, perinatal anxiety, depression, and more (consult with your practitioner at PDtM for more information about these trusted contacts including Alison Lautz below).
Join Pulling Down the Moon for the FREE Webinar Hope & Healing: Simple, Practical Techniques for Coping with Disappointment & Loss on June 3rd at 6pm CST.
Author: Rickie Kostiner RYT, Clinical Intern Supervisor: Alison Lautz, LCSW Therapist & Life Coach www.alisonlautz.com 815-341-9244 firstname.lastname@example.org
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.
by Marie Davidson, Ph.D.
As I write this it is actually the Feast of the Epiphany, celebrated in Christian tradition as the day the Wise Men arrived from the East after the birth of Christ, led to their destination by a star. The Merriam Webster Dictionary also offers these definitions of epiphany: “A sudden perception of the essential meaning of something;” an intuitive grasp of reality through something simple or striking;” and “an illuminating realization.”
Many years ago, as measured in ordinary time, but not all that long ago as measured in emotional impact, I experienced an epiphany that made all the difference to me as a suffering fertility patient. I dwelled in distress much of the time, my thoughts haunted by the many challenges of treatment, the succession of disappointments, and, worst of all, the complete absence of any certainty about how this fertility drama would turn out.
One morning, my moment of epiphany arrived quite suddenly. No wise men or wise women arrived, and no guiding star appeared, just a swiftly dawning realization of what I was really going through—right now—in my life. To this day I cannot say for sure what brought on this intuitive grasp of reality at that particular moment. I suppose it was the result of many, many months of efforts to not embrace my situation. My distress had served to only highlight my sadness and anger and to keep me from moving past that. It was just no longer a reasonable option to keep this exhausting process going. So, I had a serious, mildly humorous chat with myself.
This is what I said:
“OK, Marie, this is what’s going on in your life right now—you and your husband have been in a battle against infertility (and against each other, truthfully.) Infertility sucks, but it’s what you’ve got. You didn’t cause it, and you may or may not overcome it in the way you hope. You don’t know the end of this drama you are in because the screenplay isn’t finished. But there is something you can do, and that is to accept the role you’ve been assigned and act it out as skillfully and graciously as you can. Inhabit the script! Be the star in your own drama, dammit!”
Or something like that, it’s pretty close to the internal conversation I had. I definitely know I made a conscious decision to star in my own story. I would be the guiding star leading me to my unknown destination.
My life improved after that. Far from wonderful and still plenty of stress and anxiety, but I had a peace of mind that had eluded me for a long time. I rather think I excelled in playing myself—the woman who happened to be an infertility patient; the woman who accepted her inability to control the next act in the play I was starring in; the woman who was now able to experience the other parts of her life without the dark film of infertility blocking the view.
I did not know then that my life’s work would be a career counseling fertility patients. What a privilege it has been. A number of years ago, I met a woman who had come to talk about family-building options. She’d been through a lot of treatment with no success. I noticed how even-keeled she was as she spoke of her history and I commented, “You seem to be handling all of this pretty well.” She said, “Well, you should have seen me a year ago, when I was a complete basket-case.” I asked, “So, what happened?” Her answer was, “One day I decided to accept the basic background reality of my life.” I smiled. “You had an epiphany.”
Over the years, I have found it very useful to apply the same kind of epiphany to other life situations—the ones you can’t control but must live in and through. Whatever it is I struggle with, I try my best to be as skilled and gracious as I can be, even if I won’t win any Golden Globes. Strangely, the experience of an infertility journey can give you a valuable perspective on how to deal with the inevitable brick-bats of life.
Marie Davidson, Ph.D.
Fertility Centers of Illinois
Dr. Marie Davidson is a licensed clinical psychologist and patient educator. She specializes in counseling individuals and couples who are coping with infertility, and has provided counseling services to patients, donors, and surrogates since 1992. Dr. Davidson earned her doctoral degree at the University of Illinois in 1988. She facilitates patient education seminars on numerous topics such as considering egg donation and cracking the door to adoption, leads several women and couples support groups, and is widely published in the fertility field. She has been an invited speaker at many professional meetings.
Her personalized care and detailed understanding of the treatment process have been a welcome and supportive resource to many couples and individuals as they seek to grow a family.
by Melissa Hinshaw LMTIt’s that time of year when everyone is moving and shaking and buying and baking and trying to make all the parties and give families equal time. Whether you are single, married, divorced, or in between, you know what I am referring to. During this festive, yet chaotic time of year, how do we hold on to ourselves and what we deem important? What do each of us hope for the holidays and what traditions do we want to hold fast to our hearts when the pace is so fast and we are trying to please so many?The pressure of the holiday season can be both exhilarating and stressful. In my younger years, two small children at my hip, one with Autism and not interested at all in Christmas, presents, Santa, or family gatherings, by the end of the season I used to feel completely wiped out, angry, resentful, and grateful that it was all over with. I realized I had no boundaries during this time of year and I went with the flow and did what was expected socially and and within my own family even though it was, at times, not good for me or my family at all. I wanted my younger son, who was ecstatic about Christmas, and presents, and Santa to experience the magic that I had growing up. My childhood home was a wonderland of smells, and tastes, and decorations and presents and nervous excitement while my four brothers and sisters and I awaited Santa’s visit. Looking back, we rarely traveled around from this house to that house or attended gatherings that my parents felt pressured to attend or did much anything stressful except for getting the lights on the damn Christmas tree. My mom was a pro…I think because she loved this time of year and you knew it when you were at my house. I longed for this feeling again. The feeling of holiday joy and giving and singing and snow. I wanted it to be simple. I wanted to love Christmas again and I wanted my children to love it too.After many stressful and disappointing holidays with depression looming each and every year beginning with Thanksgiving. After many tearful conversations on the phone with my mom, having a glass of wine when the whole thing was finally over, and asking her, “How do I do this mom? I used to love this time of year. How do I make it special like you did, for my boys, one who could care a less and often falls apart over the holiday break, and one who couldn’t get enough?” “Melissa my dear, create your own traditions. Do what works for your family. Say, No, when you need to.” She was right. I needed to create Melissa traditions, Melissa style, and engage both of my children at their individual levels yet do holiday things we could enjoy as a family. I took her advice. I created a few simple traditions that we have stuck with over the years. My youngest loves it while my older son complains and requires lots of cheerleading, but we do our activities together and it makes us feel like we are a part of the holidays. We have pictures to remind us that we have done this before and we will do it again this year. This is a big deal for me and I cannot completely explain my reasons. I just know that being swallowed up by others’ rituals and rules and schedules doesn’t bring me joy. It brings me sadness and stress. Of course I enjoy celebrating with other people and sharing what makes the holidays special for them, but that is reserved for a very few. It is ok to have quiet during this time of year. It is ok to find peace and joy in the simple.I encourage everyone to find one special thing to do with your partner, your kid or kids, or your best friend that brings you to a special place. Something that you can do each and every year…something to look forward to. Something that you decide feels good and brings joy. Something you can share a photo of to remind you what you’ve done and to remind you that you you will do it again.If you need to break that is okay, too. We are here for you, take time for a massage before or after the holidays or start the New Year off with a cleanse!
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