By Robin Miller RDN
Studies suggest that infertility affects approximately 15% of all couples, and although conventional wisdom suggests that infertility is a female issue, the reality is approximately 40% to 50% of fertility issues are due to male factors. Much research suggests that a healthy diet rich in certain nutrients, such as omega-3 fatty acids, antioxidants, other vitamins, specifically, vitamin D and folate, and low in saturated fat and trans–fat is associated with good semen quality. Fish, shellfish, other seafood, poultry, cereals, vegetables, fruits, low-fat dairy, and skim milk have been found to be positively associated with several semen parameters as well. Fish and fish liver oil in particular also contain other essential nutrients, that have been associated with better semen quality. With that said, there is now new research and data focused on the intake of fish oil supplements and testicular function as measured by semen quality and reproductive hormone levels.
After examining data from nearly 1,700 young men, researchers determined that fish oil supplementation was associated with a higher sperm count and improved levels of hormones, specifically lower FSH and LH levels; higher free testosterone to LH ratio that contribute to male fertility, according to the report published in JAMA Network Open.
However, the amount of fish oil the men in the study took was wide-ranging, so there is no specific quantity that can be suggested from this study. Furthermore, because it’s an observational study, we can’t assume a causal or contributing relationship between fish oil supplements and positive outcomes; a double-blind, randomized, placebo-controlled study is the preferred method of research to support a positive correlation.
In the meantime, most everyone can benefit from more fish in our diets! Incorporate wild, organic, preferably low-mercury fish, such as wild salmon, shrimp, tilapia and whitefish to name a few, into your diet 1-2 a week. Try swapping out a deli meat sandwich with a tuna sandwich or a steak for a piece of wild salmon during the week and you will be naturally getting in some healthy fish oil along with tons of other nutrients, like vitamin D, iron, zinc and magnesium that support fertility. If fish is not your jam, try supplementing a high-quality fish oil supplement to achieve optimal benefits.
To learn more about ways to increase fish in your diet as well as find a fish oil supplement right for you, schedule a nutrition consult today and work with one of our Registered Dietitians!
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!
by Cathy McCauley, LMT
Whether getting pregnant naturally or using some form of assisted reproductive technology (ART) like IVF, fertility clients come to Pulling Down the Moon because they want to increase their chances of fertility success. I often see clients have better success after a 90-day prep.
Because the cycle of an egg is about 90 days, it’s helpful for you to prepare and optimize the health of your ovaries, uterus and your whole body at least three months before trying to conceive. In that time, you can monitor your nutrition, increase your vitamin intake, become intentional about improving blood flow and lowering stress levels. All of this can help enhance fertility and create a healthy environment for a pregnancy.
Want to create a 90-day prep plan for enhanced fertility? Start here!
Preconception nutrition research shows that what you eat can impact the health of your ovaries and eggs either negatively or positively. Yet trying to navigate all the information out there can be overwhelming. The ART Prep/Recovery Program is unique to Pulling Down the Moon and exactly what it says: A science-based nutrition program (with some teachings and techniques from Traditional Chinese Medicine and yoga added) especially created to help you prep for your upcoming treatments.
With this program, our nutritionists will help you set goals, regulate blood sugar levels, support the liver, assist in getting your gut and thyroid to function properly, discuss sensitivities, look at possible food eliminations, decrease inflammation and safely cleanse. Your nutritionist will also be an accountability partner and will provide support, encouragement, ideas, and recipes to help you meet your goals while simultaneously working to improve your egg quality.
Vitamins and Supplements
Pulling Down the Moon has been working with medical doctors for over more than a decade, as well as, keeping up with the latest research and literature in the emerging field of supplements. We can provide recommendations on specific supplements for your unique situation and also help you streamline an overwhelming supplement regimen to include the supplements with the most research behind them for fertility. From finding the right prenatal vitamin to taking a probiotic to getting on a supplement of CoQ10, we can help you make the right choices as you work on enhancing your fertility during your prep.
Blood Flow and Stress Reduction
Studies show that embryos with the highest implantation potential are from follicles that have sufficient blood and oxygen. If you want optimum egg health, promoting oxygen-rich blood flow to the ovaries is essential.
No doubt, stress influences your body in many ways and your fertility is not spared. High levels of stress can create an abundance of hormones, which in turn, can disrupt ovulation. By reducing your stress levels, you can have a positive affect on your fertility and your overall well-being.
Here are some approaches:
In very simple terms, acupuncture is believed to clear blockages in the body in order to allow energy, greater health, and the feeling of emotional well-being to flow freely within the body. And more and more, acupuncture is becoming a widely accepted and sought after natural treatment for restoring fertility.
Some research shows acupuncture may improve ovarian functioning, balance the endocrine system and hormones, increase circulation to the uterus and improve egg quality.
Additionally, the treatments are balancing, relaxing and offer clients an opportunity to unplug and feel grounded. Many clients fall asleep during their sessions.
Pulling Down the Moon acupuncturists are well-trained in working specifically with fertility clients. They are knowledgeable in treating your whole body and can provide you up-to-date information on fertility health and wellness.
Pulling Down the Moon’s Yoga for Fertility (YFF) offers you another way to prep for enhanced fertility.
At each class, you will learn a series of yoga postures designed to improve fertility by increasing blood flow into the pelvis, releasing stress and anxiety and balancing life energy flow in the body.
In addition to this physical practice we explore concepts from yoga philosophy that frame the fertility journey in a way that reveals our personal strengths, reinforces the joy of everyday life and empowers us to create the family we are meant to have. Through this class you will also join the wonderful, positive healing community of Pulling Down the Moon and enjoy the energy of all the amazing women who have shared their journey with us.
The last treatment service we offer is dear to my heart. I’ve been a massage therapist at Pulling Down the Moon for several years and have seen women experience much success after receiving massage as part of a fertility prep plan.
What we offer is unique. Our FEM Protocol™ is a five-part series using massage and related techniques to enhance the health and functioning of the pelvic and abdominal organs, and to promote the client’s mental, emotional, and physical well-being.The five parts of the protocol focus on cleansing and detoxification, enhancing reproductive circulation, oxygenating the pelvic organs, and combating stress. Benefits may include:
- promoting egg quality by improving the follicular environment and increasing its supply of oxygen-rich blood
- lowering hormone disruption through stress management and clearing lymphatic congestion (a common storehouse for excess hormones and toxins)
- supporting uterine lining and alignment through melting abdominal scar tissue, clearing circulatory pathways, and releasing structural tension patterns
- encouraging relaxation and an overall sense of well-being during your fertility journey
We offer a massage treatment schedule to keep you on track during your 90-day prep. And once you’ve actively started trying to conceive, whether naturally or through ART, we encourage you to continue to receive the FEM Protocol. It is safe any time in a cycle and we are trained in helping you determine what will be the best treatment for you no matter where you are on your fertility journey.
Get started with a 90 day prep and save with one of our New Year, New You Passports to Wellness! Have questions about how Pulling Down the Moon’s unique services can support your journey? Call us at: 312-321-0004 for us personalized support today!
Kelly Lyons, L.Ac, MSOM
The value of your practitioner
Why do I need to come in to the office?
One of the beautiful aspects of acupuncture is that your body is seen and understood as the complete instrument that it is. Your acupuncture point system is endlessly evolving. If you have graduated out of weekly or twice weekly acupuncture sessions, or have fallen out of the habit of coming in to the office, this post if for you. It is also for those who are at the end of their fertility focus, may be on a break, or are wondering if they can use acupuncture for different reasons.
What is important about coming to see your acupuncturist is that they will assess the current state of your health and choose point combinations that will tune your instrument, or all out repair it. It needs to be done in the office every now and then, even though we send you home more educated, with homework, or with goals accomplished.
There are ways to make this easier and less stressful. Pull out your calendar! As you assess your healthcare plan for the next year, look at the entire year ahead. Break it down into quarters, seasons, and peak stress times. Book a sequence of appointments for at least 2 weeks before an event like a holiday, a change in season, or as the quarter winds down. Book 2 appointments the week before tax season or school starts. It is great to touch base with your wellness team to be reminded of how to stay on track. This will help you be at your best.
Women have the opportunity to use their menstrual cycle, also, for scheduling structure. The frequency of office visits depends on what is going on for you, and what your cycle or the year is like. Talk to your acupuncturist to find out what fits best for you. For some, it could be coming during your period, to help keeps things moving. For others, it could be better to come in before you ovulate. Reach out and ask us how we can help recharge your wellness routine.
Come in and see us then have a great Fall! Book and save in October with our BOO-GO special that includes a FREE follow-up session ($95 value)!
by Christine Davis, LAc MSOM
With each passing year, things seem to get busier. More appointments, more work requirements, more life events, more things to do. Then there’s the well meaning family members and friends: why aren’t you pregnant yet? My friend tried This Thing and it worked for her, so you you should try it, too! Then there’s social media and the internet: EVERYONE seems to be happier and more successful than you – here’s what you SHOULD be doing to do to be happy ALL THE TIME. It’s all a never ending stream of NOISE. Where does it stop? How can you simmer down and quiet the stream of mental debris that constantly stimulates worry, fear, anxiety, and frustration?
Here are my suggestions. They aren’t a complete list, but these are the important ones. It may take time to incorporate them all:
- Say it with me: “No.” “I’m sorry, I’m not available.” It’s ok to put yourself first and say “no” when what is being asked of you will compromise your wellness. Clear a path for your ability to think clearly, breathe, and do the things you need to do to feel balanced. Much like Marie Kondo’s method for clearing physical clutter, you need to decide what’s important in your life mentally and emotionally. Say YES to the things that create the life you want (even though they may be difficult, too, sometimes) and NO to the things that are holding you back from that life.
- Disconnect. Social media has been fun over the past couple of decades, right? There are some good and some (really) bad parts, but study after study emerges showing the negative impact that it can have on your mental and emotional state. If you are having trouble completely disconnecting – especially if work or other interests require you to connect with SM – limit your interactions with these apps/websites. Give yourself a specific time frame in which you allow yourself to use them in a positive, uplifting manner.
- Get help. There is no shame in reaching out to a professional if you need help with mental wellness. This could be a mental health professional, a religious guide, etc. Someone who you trust, who is impartial, who has training in helping to guide you is ideal. This doesn’t mean you are signing up forever – sometimes a few sessions can really help to clarify and ground you. I feel like the best therapists are the ones who hold a “mirror” up, so to speak, so that you can see things as they are, then help you to appreciate the beauty that you see.
- Center yourself. This could be with meditation, prayer, yoga, journaling, long walks by the lake – whatever helps you to focus on one, two, or ten things–instead of the thousands of thoughts that are constantly flooding in otherwise. I like to think of Georgia O’Keefe’s “Sky Above Clouds” painting – the thoughts are just clouds floating past. Try not to hang on to them and instead just observe them and let them float past. There are some amazing smartphone apps: FertiCalm and FertiStrong, Insight Timer, MindfulIVF, Headspace, etc. that have tons of guided meditations for everything from general anxiety to trouble sleeping to going through an IVF cycle.
- Find gratitude. Keeping a Gratitude Journal helps with this. Write just a line or two each day about something you are grateful for. It could be the delicious muffin you had for breakfast, the painless phlebotomist experience, your favorite song coming on the radio, the friend who went out of her way to give you the support you needed. Many studies have shown that focusing on the positive aspects of life actively literally rewires the brain to feel happier and more positive.
- Try Acupuncture. A modality of Traditional Chinese Medicine (TCM), acupuncture is a therapy for the mind, body, and spirit. With regular (once or twice per week, usually) treatment, you will see many aspects of your physical, mental, and emotional self come into balance. Acupuncture is known to be helpful for everything from pain to allergies to digestive stuff to fertility, but it can also be helpful for balancing the mental state and emotions.
Firstly, an acupuncture visit is usually very relaxing! Most who haven’t tried it don’t believe me when I say that, but when else do you take 30 min to just lie still, no phone, not going to sleep (although it’s ok if you do!), not talking or listening (except to quiet music)? This is a deeply restorative time to be quiet, soft, grounded.
Acupuncture has mounting scientific evidence showing that regular treatment can help with reducing anxiety, depression, and other emotional disorders. In TCM, there is a strong connection between the physical state and the emotional state. By creating a state of harmony throughout the physical body, balanced mental/emotional wellness is the natural outcome.
In TCM, fertility is associated with the element of Water. When water is too abundant or too scarce, the earth and all forms of life suffer, including our own bodies. The element of Water shows its emotional imbalance in the form of Fear/Anxiety. When we are in a constant state of stress (life, work, family, infertility, etc), we put ourselves into a constant state of “fight or flight.” This creates a situation in which our bodies focus only on staying alive for the moment rather than long cycles like those required for fertility. By using acupuncture, we are able to break that constant loop of stress, find grounding, and reconnect with our natural cycles which can lead to improved fertility.
Choosing to find serenity in this life takes effort. Just think about when someone says, “Calm down!” or “Relax!” Has anyone ever calmed down or relaxed just by hearing that? I don’t think so. By regularly making the choice to build the space for quiet, for reflection, for balance, you are creating a foundation for the life you are searching for.
By Robin Miller, RDN
Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women, affecting up to 10% of women of childbearing age. Despite what the name suggests, it is actually a disorder of the endocrine system–think hormones! You can even be diagnosed with PCOS even without having ovarian cysts.
PCOS is characterized by high levels of androgens (“male” hormones), including testosterone, androstenedione, dihydrotestosterone (DHT), dehydroepiandrosteron (DHEA) and DHEA sulfate (DHEA-S). Higher than normal levels of insulin are also common due to to insulin resistance (much like that seen in type 2 diabetes) over time. When you have insulin resistance, your insulin isn’t working as well as it should to signal for glucose to be transported out of the blood and into the cells of the body to be used for energy. To compensate, the pancreas produces more insulin leading to high insulin levels, which seem to drive the higher testosterone levels in PCOS.
A recent study suggests that supplementation of Coenzyme Q10 (CoQ10), has beneficial effects on glucose metabolism as well as serum total and LDL cholesterol levels in people with PCOS. In this study subjects took 100 mg of CoQ10 daily for a 12-week period at the conclusion of the study a notable improvement in overall fasting glucose, insulin resistance, and total and LDL cholesterol was observed in subjects.
So, what is Coezyme Q10? Coenzyme Q10 (CoQ10) is a nutrient that occurs naturally in the body. CoQ10 is also in many foods we eat. CoQ10 is involved in energy production and acts as an antioxidant, which protects cells from damage and plays an important part in the metabolism.
Unfortunately, as we age, naturally occurring levels of CoQ10 in our body decline. Evidence suggests that supplementing CoQ10 may help many different conditions such as high blood pressure and heart failure and most recently PCOS.
Want to learn more about how supplements can help you? Schedule a nutrition consult and work with one of our Registered Dietitians to develop an individualized supplement and treatment plan specifically designed for you!
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 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 Margaret Eich, MS, RDN
Vitamin A is a fat-soluble vitamin that is essential for reproduction, vision, immune system function, and embryo and fetal development. There are two main types of vitamin A: preformed vitamin A known as retinoids, which are found in animal products, and are converted to retinoic acid, which regulates transcription of a number of genes. The second type of vitamin A is called carotenoids, which includes beta-carotene and hundreds of others. Only about 10% of carotenoids are capable of being converted to retinol and further to retinoic acid. Beta-carotene, alpha-carotene, and beta-cryptoxanthin are all capable of being converted to retinoic acid, though only small amounts are converted.
Most women hear about vitamin A in terms of toxicity – that you shouldn’t take too much vitamin A prior to and during pregnancy, as it may cause birth defects, which is true. We recommend limiting the amount of preformed vitamin A from supplements to no more than 5000 IU (which is equivalent to 1500 mcg RAE). RAE stands for Retinol Activity Equivalents and is the standard way of expressing vitamin A requirements and amounts in food, as it accounts for the differential bioavailability of preformed vitamin A and carotenoids. Supplement labels usually use International Units (IU) to list vitamin A doses, which can sometimes make sorting out your vitamin A intake confusing! There is no limit for carotenoids like beta-carotene, as they haven’t been shown to be capable of causing vitamin A toxicity or birth defects. Some prenatal vitamins do contain preformed vitamin A, such as retinal palmitate, which is fine and maybe helpful if you struggle to meet your vitamin A needs, as long as the preformed vitamin A is less than 5000 IU. Make sure to check all of your supplements for vitamin A, as other combination formulas aside from your prenatal vitamin may contain vitamin A.
The daily recommendation for vitamin A is 700 mcg RAE and increases to 770 mcg RAE in pregnancy. In the US, women are getting on average only 580 mcg per day – in other words, US women are not getting enough vitamin A. So while it’s important to make sure you’re not taking in excess vitamin A from supplements, it’s also important to make sure you’re getting enough vitamin A due to its essential role in reproduction, embryo development, and organ formation during fetal development.
Your best sources of preformed vitamin A include liver, fish, dairy, kidneys, eggs, poultry skin, butter, and dark meat chicken. Your best (plant) sources of carotenoids include: sweet potato, pumpkin, carrots, cantaloupe, spinach, kale, collards, and butternut squash. Absorption and conversion of carotenoids to active vitamin A is variable based on the food it’s contained in, and an individual’s ability to digest and absorb it. Because of the variable in absorption, it makes sense to include a mix of preformed vitamin A and carotenoids to meet your vitamin A needs.
Need some help sorting out your vitamin A intake. Book a nutrition consult today!
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