March 2017
PMAD Recurrence
This month our newsletter theme is recurrence of perinatal mood and anxiety disorders. Many families worry about becoming pregnant after a prior experience with a PMAD. This month we have a number of personal stories that deal with what this might look like: about making the decision to become pregnant after a prior PMAD; about how PMADs can differ for each perinatal period; and also how one might tell (older) kids about their mama's experience with a PMAD.  And our research corner this month focuses on a recent student on postpartum depression and consecutive pregnancies. 

As always, we appreciate your feedback about our newsletters.
In This Issue
Parent Corner
Do we HAVE to tell the kids?

It was a beautiful Pacific Northwest Day. My family--me, my husband, 6-year-old son and 4-year-old daughter--were enjoying the day at one our gorgeous parks on the lake, proudly walking for awareness of Perinatal Mood and Anxiety Disorders. I had been drawn to the walk and Perinatal Support Washington, its sponsor, because of my own history with depression and anxiety after my son was born. I was able to get through that period of my life gritting my teeth, leaning on my superhero lactation consultant and my husband, and hoping a move back to be closer to family and more support would help. It did. Now, 6 years and another kid later, I was with my family raising awareness and supporting other families struggling.

I had never really talked to my son about that first year of his life. He knew he cried a lot and didn't like to sleep, but we usually just laughed about it and I never mentioned that it made me a nervous wreck and a recluse for the first 6 months. That day, after walking, I took him for a bathroom break in the park. From the stall he asked, "Why are we walking today?" I told him sometimes moms get very sad after their babies are born and that PS-WA is an organization that helps these moms and we want to help them, too. Flush. And then he hit me with it: "Mama, were you sad when I was born?" Gulp. I told him. "Yes. I was very sad and nervous. You cried a lot, and didn't like to eat. Neither of us slept very much. I was worried about you. But I loved you so much and wanted you to feel better and be happy. I was glad to be your mom. My body and mind had a hard time dealing with it, though. But I feel much better now. And I still love you very much" His response?  A smile and an "okay." Phew! I think I did okay on the spot, but it would have been nice to be prepared.

If you're a mama who experienced or is experiencing postpartum depression or anxiety, chances are you are dreading this conversation with your child/children. But it doesn't have to be scary. My son caught me off guard, but I'm glad he asked. If it hasn't come up yet, you have a chance to really think about what you want your kids to know about your mental health. What is important to you that they understand? You know your kids and you know what they are likely to be able to digest. Keep it very simple for the little ones to be continued when they're older. And for the older kids, you may be able to go a little deeper about how you felt, why you felt that way, and how you got yourself to feel better. Most kids want to know that you're going to be okay. Some kids will ask tons of questions. It's okay if you don't have all the answers. Be honest. And be prepared for their feelings, so they are comfortable telling you how they feel. It might be easier to have this conversation with a little support from a partner, friend, or family member who gave you support during the hard times. If so, get that person on board for this discussion.

You may be a mama still in the throes of depression and anxiety. If you're not ready, if you're still getting better, then of course you don't have to talk to your kids about your mental health struggles right now. Take care of you first. Sometimes it's helpful for little ones to know why you are feeling the way you are, though. In these instances, you don't have to get deep, but an acknowledgment of your changing feelings and reassurance that it's not your child's fault might help put to rest any fears or uneasiness kids might experience when they see their parents going through these mood changes.

Even though my second pregnancy and postpartum period was much mellower than my first (although I did have a therapist on speed dial just in case!), I still plan to talk to my daughter about my experience with my firstborn. I like the idea of ending the stigma of mental illness early on in my kids' lives and keeping that conversation ongoing so they (fingers crossed) don't feel ashamed or alone if they need help. I want them to know they can always express their feelings; I will. My daughter is 6 now and as I write this I'm thinking it's about time to have the conversation her.

Amy Boelter is a part-time work from home, stay-at-home mom who is currently a Program Coordinator for PS-WA. She lives in Seattle with her husband and two kids.
Emily Tatum, on her experience with PMAD recurrence
Can you tell us a little about yourself?

Hi! My name is Emily and I am the mother of Dillon (9), Fitz (3), and Hannah Jane (2), and I am expecting my fourth baby this April. I live in Lake Stevens, which is about 35 minutes from Seattle. We homeschool my 9 year old, and my 3 year old is in developmental preschool in Lake Stevens. I spend my time crafting and doing what I can to smash the patriarchy. 
What was your experience with perinatal mood or anxiety disorders?

I had some postpartum depression with my oldest back in 2007 that involved some intrusive thoughts of hurting my baby. I enrolled in therapy to work through those issues but was anxious with my next baby about how bad the depression might be. With Fitz I had my placenta encapsulated and I felt like it helped me a ton and I did n ot have the same issues with depression I had with Dillon. Hannah Jane and Fitz are only 16 months apart, and I suffered from some perinatal depression that included intrusive thoughts and suicidal ideations. We had just moved to the Seattle area from Atlanta, GA,  and the stress of moving and lack of support system here for me were huge contributing factors. I was seen by a provider and successfully made it through my pregnancy. In the postpartum of my 3rd baby, my depression became increasingly worse (even with the placenta encapsulation), so I sought out help from a therapist and went on medication. We have found a medication that works well for me and I continued that throughout my current pregnancy. As of now, my perinatal depression is under control and I am looking forward to having our last baby and closing this chapter of our parenting journey.

What was your road to recovery like? What helped the most?

For me the things that help the most are:
  • SLEEP: If I don't get enough sleep, my mental health plummets
  • Self Care: I need time away from my kids to decompress. Sometimes I find this in social gatherings like crafting but over the last year I have realized working a part-time job helps a ton with this too!! Also, the extra income isn't bad either.
  • Socialization: Motherhood is SO lonely. Even when you are with your kids alllllll day it can feel so isolating. I joined a Meetup group and Facebook group of moms and make a concerted effort to get myself and my kids out there and participate in activities to get that adult interaction.
  • Therapy and medication: Talk therapy for me is super beneficial and we have found a medication that works well for me. 
Are you preparing in any special way when it comes to your postpartum period? What does your "safety net" look like?

For my postpartum period I am planning on having my husband take off an entire week to spend time with the baby and me. With my previous births, he did not do this and I think it will be very helpful this time. Additionally, like my last two births, my sister will be coming to stay for a week after that to help me with the other 3 kids. She is always super helpful when she comes and I am looking forward to spending time with her. 
In the past there have been brief moments of crisis I had to get through where going to an outpatient program or inpatient facility might have benefited me greatly but with factors of both no child care and lack of funds to do so I had to get through those moments without. We intentionally chose the best healthcare through my husband's job this year so that if I need that kind of help, I can get (afford) it. My sister is also on standby to come in case that is necessary. This gives me much comfort.
How are you feeling lately? What are your wellness/self-care practices?

I am feeling really good mentally lately. There are days that are not so great and they are almost always attributed to a lack of sleep, usually because one of my kids was sick. I really try to focus on getting as much rest as possible even if it means a mid-day rest on the couch while the kids watch Frozen. My husband focuses on letting me sleep in on the weekends because he knows I need the rest and that is when he has the ability to help. 
What do you want other families to know about expecting a baby after a prior experience with a PMAD?

Not all postpartum periods are the same. Every single one of my experiences was completely different than the other. I think that it is important to be prepared throughout pregnancy with a therapist you like and to have an action plan in place if you develop a PMAD. Additionally, it is SUPER important that you take care of yourself during this time; when your cup is empty you have nothing to give anyone else and it can be very draining.  
First Person
Kaela Koepke, on having a baby after a PMAD

I'd like to dedicate this second pregnancy to Prozac. I'm 3.5 months pregnant with number two and already the difference in my mood between pregnancies is night and day; the contrast is astounding. At eight weeks into my first pregnancy three years ago, I was sobbing at my midwife appointment, petrified of a miscarriage, despite having no personal or family history of miscarriages or health issues that might make me more at risk for a miscarriage. Unfortunately, my midwife looked at me like I was crazy; neither of us caught on to the fact that I was having severe Perinatal Anxiety and Depression that continued throughout the pregnancy. I was in tears every day with intrusive thoughts and worry that something bad would happen to the baby. This time around, I basically slept through the whole first trimester, but it was calm and peaceful in my mind--thank you Prozac.

I debated for a long time if I would go off medication in preparation for another pregnancy. A perinatal psychiatrist at Swedish Hospital's Lytle Center for Pregnancy and Newborns in Seattle gave me ample research about SSRIs and pregnancy and advised me to stay on the medication. While the risks are very low, there is some risk, but there is also very real risk with untreated mood and anxiety disorders, which I was all too familiar with, and that risk felt greater for me. A healthy baby is of course important, and my health also matters, my 2.5-year-old son's wellbeing matters, and I'd like to maintain a marriage. Babies don't develop in a vacuum; if I'm not well, the baby, my son, and my family won't be well, and I refuse to suffer like that again.

I struggled for a long time with the decision, finally chose to go off the medication, and made a plan with my prescriber to wean off, but when the day came, I just couldn't do it. Every fiber in my being was screaming, NO do not do this; my gut had never felt so strong. So I stayed on it and I am so incredibly happy I did. It was the right decision for me. I cannot believe the difference in my mind and emotions and am so grateful I get to have a pregnancy free from this illness. It's helping me understand and grieve more fully what wasn't normal hardship the first time.

I surprised myself when I wanted another baby. The illness lasted almost my whole pregnancy, then 14 months postpartum, for a total of almost two years, before I finally decided to go on medication.  As I climbed out of the darkness, I slowly but surely saw glimmers of my old self, and a new even better self came back. My friend said I was more me again than before I was pregnant. The illness robbed me of that sacred transition into motherhood.

The memory of the darkness is sometimes piercingly painful, so I've been in therapy for the last year, unpacking the trauma of that time, healing layer by layer, coming to terms with what was and what wasn't, unraveling old family issues that contributed to the suffering of that time, and dealing with fears of it possibility happening again. I read Karen Kleiman's books, What Am I Thinking: Having a Baby after Postpartum Depression and Tokens of Affection: Reclaiming Your Marriage After Postpartum Depression. My husband and I are starting couples counseling to fortify our marriage before the next baby comes.
The other day when I talked about preparing mentally for the challenges of having a newborn again, my friend said to me, "Wow, are you going to war or having a baby?" Both, was my answer. This time around, I am well equipped with multiple professional and personal supports, knowledge and training from volunteering for Perinatal Support  Washington, coping skills and experience I didn't have the first time, and my dear friend Prozac. But I know that even all that doesn't guarantee I'll dodge another bullet. So I am nervous, but trying to stay present in the moment and trust that I will handle whatever comes when it comes more quickly and more effectively than the first time around. Because I am a warrior mom.

Kaela is a stay-at-home mom of one bright shining 2.5-year-old and lives near Seattle, WA. Her pre-mom career was being a Master's level mental health therapist and chemical dependency counselor. She unashamedly says, "Yes, counselors get PMADs, too. It is an illness that does not discriminate."
Postpartum Depression, Life Stressors, and Consecutive Pregnancies
A 2016 study by psychology professors at UCLA and USC investigated stability and change in women's symptoms of postpartum depression after two consecutive pregnancies. The study specifically accounted for variables such as interval between pregnancies; perceived stress; parenting stress; significant life events; and interpersonal violence.
A sample of 228 ethnically and racially diverse women participated in the study, which evaluated them at one, six, 12, 18 and 24 months after the first pregnancy; during the second and third trimester of the second pregnancy, and then from six to 20 weeks after their second delivery.
Researchers found that most women showed relative stability in depressive symptoms from one postpartum period to the next, with a slight trend toward decreased symptoms. Twenty-four percent of the sample had clinically significant symptoms after at least one of the two pregnancies; 28% of that group had a recurrence of clinical postpartum depression.
Perceived stress and parenting stress had the greatest indirect effect on recurrence of postpartum depression, while life event count had the weakest. "We found that
women who reported more depressive symptoms following the birth of one child were at risk of experiencing more stress thereafter, such as parenting and interpersonal difficulties, and these interpregnancy-interval stressors, in turn, exacerbated risk of depressive symptoms following a subsequent pregnancy."
New Moms Connect Study: Nurturing Emotional Wellbeing. Are you expecting your first baby? You could be part of a study that aims to help soon-to-be moms manage stress, enjoy your baby, and increase your sense of well-being. The 8-week program includes: Practical skills for managing the joys and challenges of becoming a parent; Mindfulness-based stress management that can be applied to birth or parenting; Self-care tools that support calm and connected parenting; Six classes plus two individual consultation sessions to address your concerns one-on-one. The classes and individual sessions will be held in South/Central Seattle. You also will be asked to meet with research staff at the University of Washington for four assessment meetings, where you will complete surveys and participate in activities with your baby. You will be paid at least $90 for each assessment meeting you attend. You will receive a total of $420 if you attend all four meetings. Parking or transportation costs will also be covered. To be eligible: You need to be expecting your first baby, be less than 33 weeks pregnant, and have household income of less than $45,000. For more information: Contact Anna at 206.221.7049 or

Who Will Catch Me: A Perinatal Mental Health Safety Net.  Tuesday, May 9, 9am-4pm.  This one-day intensive explores an innovative, multidisciplinary coalition-building model to address perinatal mental health on the community level. Research shows that screening for Perinatal Mood and Anxiety Disorders (PMADs) is not enough.  Interconnectedness between silos of care is needed, and includes professional training for providers across sectors, multi-cultural public education to break down stigma, culturally appropriate, diverse and accessible resources, and universal screening allows a community to ensure that perinatal women, especially those most vulnerable, receive the care and treatment they need. The Community-based Perinatal Support Model (CPSM) has demonstrated early success in diverse communities across Massachusetts. There will be a demonstration of a community readiness focus group, representing various sectors of the Seattle provider community.  Audience: Anyone who works with pregnant, birthing, and postpartum families will benefit from this workshop.  CEUs: Bastyr University 5.5 continuing education contact hours. InstructorsAnnette Cycon, LICSW , is founder and former Director of Training at MotherWoman, a support and advocacy organization in Massachusetts, leading innovative training and policy initiatives nationwide. Peggy O'Neill, PhD, LCSW, is Associate Dean of Academic Affairs and Assistant Professor at Smith College School for Social Work. Click here for more information and to register.
Giving to Perinatal Support Washington
Employee Giving
Are you a Microsoft or King County employee or spouse of one?  
Please consider supporting us through your respective workplace giving programs. For King County employees, our code is 9187. Our tax ID is 91-1448669. If you are looking for us, be sure to check our old and new name (Postpartum Support International of Washington) if you don't see us--we are there.

Warm Line: 1-888-404-7763 (PPMD)

Support Education, Referral
(formerly Postpartum Support International of Washington)