Category: Pregnancy

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Losing a Pregnancy Only to Lose One Again

00Fear, Featured news, Grief, Pregnancy, Resilience, Therapy, Trauma July, 17

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Anna R. was having an ultrasound, prepared to see her baby for the first time. When she asked the technician what the sex of the baby was, the tech quickly left the room. The physician then entered to tell Anna there was no heartbeat. This became the first of seven pregnancy losses that she would endure.

Recurrent pregnancy loss (RPL) is typically defined as three consecutive losses prior to 20 weeks from the last menstrual period.

Affecting 1-2% of women, the causes of RPL differ. Advancing maternal age is associated with elevated risks of miscarriages, particularly in women 45 or older. Paternal age can also be a variable, with environmental and genetic factors playing a role as well. The risk of miscarriages further increases with the number of previous miscarriages, reaching approximately 40% after three consecutive losses.

While these causes have been established within the medical community, doctors still struggle to predict what ultimately leads to a couple’s pregnancy loss. Even after numerous tests, Anna’s physicians never found anything wrong, making the loss that much harder to cope with.

After her eighth miscarriage, Tracey Beadle of County Durham, UK told The Northern Echo:

“I think I wanted for them to find something wrong, because that would mean something could either be fixed or give us a reason to stop trying for a baby. We did not know when to stop.”

Janet Jaffe, a clinical psychologist and co-author of the book “Reproductive Trauma: Psychotherapy with Infertility and Pregnancy Loss Clients”, told the American Psychological Association:

“A miscarriage is a traumatic loss, not only of the pregnancy, but of a woman’s sense of self and her hopes and dreams of the future. She has lost her ‘reproductive story’, and it needs to be grieved.”

This grief is unique, in that expectant mothers and fathers mourn a child that never came to be. As Kate Evans, a woman who had six miscarriages said in an article in the Independent:

“If there’s no body, how can I grieve? I feel as though I must be kidding myself, wallowing in a morass of grief over a person who never even lived. Every time my mind trips back to this death, this loss, it strikes on empty, because there’s nothing there to miss.”

While there is no physical body to grieve, the hopes and dreams for a future with the child are ultimately the elements missed the most.

This grief is further complicated by feelings of isolation. When a loved one dies, there is often comfort in collective mourning with other grief-stricken individuals. But grieving the loss of a pregnancy can be an isolating experience for parents, as others haven’t formed the same connection with the unborn child and may struggle to understand why the experience is so painful.

Outsiders may also lack empathy for the mother’s experiences and fault her for the outcome of the pregnancy. Anna explained that people unintentionally implied that she was to blame for her miscarriage through comments like, “Do the doctors know what’s wrong with you?” or “Maybe you weren’t taking good care of yourself.”

RPL has been shown to severely disrupt the parents’ mental health. According to astudy by psychiatrist Michael Craig and colleagues at the Institute of Psychiatry, King’s College London, of 81 women with recurrent miscarriages, 33% were classified as depressed, with 7.4% suffering from severe depression. And 21% of the women also had clinically significant anxiety, while some experienced heightened anger and guilt.

Research documenting fathers’ grieving processes showed that, unlike women, many men do not react with increased depressive symptoms, crying, or feeling the need to talk. But similar to women, a major source of grieving arises from relinquishing their hopes and expectations for their unborn child.

While physical treatments for RPL include surgeries, medications, genetic screening, and lifestyle changes, the emotional and psychological toll must also be addressed.

A report by the Practice Committee of the American Society for Reproductive Medicine indicates that psychological support in early pregnancy results in significant improvement of pregnancy outcomes. Psychotherapy can also help work out anxieties and fears from previous miscarriages.

According to Anna, therapy was what helped her through seven painful miscarriages:

“My therapist became my saving grace. I could comfortably tell her anything and everything—especially things I didn’t want to discuss with my husband, like thoughts of suicide. She was the voice of reason in my confused and isolated world.”

Individuals can find additional help through in-person support groups at local organizations, or through online sites, such as the Baby Center, which offer web-based clubs and blogs. Connecting with these groups allows individuals to interact with others experiencing the same grief, which may reduce feelings of isolation.

In the midst of hopelessness, people may feel safer bracing themselves for more heartache. But it is important to remember that, even after four consecutive losses, a patient has a greater than 60% to 65% chance of carrying the next pregnancy to term. In the meantime, seeking psychological support to work through the anxiety and grief may be beneficial.

–Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Postpartum Depression Underdiagnosed in Men

00Depression, Featured news, Parenting, Post-Partum, Pregnancy June, 16

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After his son Jaden was born, Jason Maharaj felt depressed, exhausted, and stressed. Following complications during the pregnancy, Jason’s wife was diagnosed with postpartum depression, and he had to look after both his son and his wife while continuing to work.

But Jason soon realized that his mood was unusual and he spoke to a clinician about his feelings. The clinician responded: “Now is not the time for you. Now is the time to take care of your wife.” Only after he reached his tipping point—snapping at his son and bursting into tears—did Jason receive a diagnosis of his own.

Postpartum depression is most commonly diagnosed in new mothers within 12 months of childbirth. However, 1 in 4 new fathers also experience symptoms of the disorder during this period.

The symptoms include depressed mood, little interest in regular activities, feelings of worthlessness, and loss of energy.

Fearing that an open discussion of their feelings would result in dismissal or stigmatization, many men experience symptoms but resist seeking help.

In a study conducted by Jane Iles, Pauline Slade, and Helen Spiby at the University of Sheffield in the UK, couples completed questionnaires about their stress levels at different times following childbirth—after 7 days, 6 weeks, and 3 months. Results showed that symptoms of postpartum depression were similar among men and women. Men’s acute symptoms often followed their partner’s or occurred simultaneously. In both men and women, higher levels of postpartum depression and posttraumatic stress were related to inadequate partner support.

Sherri Melrose, assistant professor at the Centre for Nursing and Health Studies at Alberta’s Athabasca University, believes that healthcare professionals could help families best by addressing the needs of both parents. She explains that men often respond to their depression by socially isolating themselves or by expressing aggressive and pessimistic mood patterns.

Jason Maharaj showed frustration toward his son, who was craving attention. “I jumped up and turned around and yelled at him,” he recalls.

Unlike many women who are more comfortable expressing sadness, men often react to their depression with anxiety and anger. Melrose notes that some men may turn to substance abuse, avoidance of familial responsibilities, or extra-marital affairs to cope.

But like women suffering with postpartum depression, a father’s reaction to the disorder depends heavily on the social support they receive, especially from partners. In the same study by Iles, Slade, and Spiby, the authors found that men who feel attached to their partners and receive support are less likely to withdraw, react violently, or cheat.

Melrose recommends that healthcare practitioners be taught to recognize not only the existence of postpartum depression in men as well as women, but also the different ways it can manifest.

Commonly, women are administered the 10-question Edinburgh Postnatal Depression Scale to determine signs of postpartum depression. But Melrose questions the validity of this scale for use with men, as it cites frequent crying as a major symptom, which is far less common in men.

The more recent Gotland Scale for Assessing Male Depression uses 10 questions specifically designed to assess masculine expression of depression, using phrases such as “stressed out” or “burned out” rather than “I have been so unhappy that I have been crying.” Melrose believes the Gotland Male Depression Scale may be more suitable to test postpartum depression in new fathers, but suggests further testing to confirm the scale’s reliability and validity.

Because postpartum depression in men is highly stigmatized, hospitals, outpatient clinics, daycares and other organizations serving parents and children should consider their role in educating new parents about its possible manifestation in men. Psychologists and physicians should also ensure they take the feelings of both parents seriously.

Until they do, it is unlikely the stigma surrounding the condition will dissipate.

– Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Pregnancy Centers

Crisis Pregnancy Centers Traumatize Women Through Deception

10Deception, Featured news, Gender, Politics, Pregnancy, Religion, Trauma February, 16

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In 2002, U.S. President George W. Bush enacted a policy allowing faith-based organizations to receive government grants to provide social services. America’s Crisis Pregnancy Centers (CPCs) were a major beneficiary, receiving an estimated $60 million in federal grants for abstinence promotion between 2001 and 2006.

More recently, access to abortion clinics has become a great concern in the United States, with 70 laws cutting abortion funding passed in 2013. It is estimated that as of 2014, CPCs outnumber abortion clinics five to one.

Founded on Christian ideology, CPCs are at the forefront of the pro-life movement and are gaining popularity among American conservatives. Often presenting themselves as abortion clinics, they claim to offer free pregnancy tests, sonograms and abortions to attract women facing unwanted pregnancies.

But these centres are not medical clinics and do not offer abortions. Women who walk into CPCs seeking guidance are often bombarded with images of aborted fetuses and religious propaganda to dissuade them from aborting unwanted pregnancies. Often located near actual abortion clinics, CPCs attempt to confuse visitors, induce guilt, and pathologize abortion through misinformation.

Misconception is a short documentary from Vice News that exposes unethical practices occurring in crisis centers. The film features hidden camera footage of lies told to women designed to scare them out of terminating their pregnancies.

The documentary shines light on the psychological distress women experience in these centers. CPC counsellors are seen telling women that abortion causes long-term psychological damage, infertility and can lead to complications for future pregnancies.

“If people die due to an abortion, later on they’re finding parts of the fetus in the lungs or the heart,” one counsellor told a client.

Donna, featured in the documentary, recounted a disturbing experience at a CPC in Texas. Thinking that the White Rose was an abortion clinic, she went in to receive a free sonogram and counselling. When she told her story to Vice, Donna was emotionally distraught: “It didn’t occur to me that there was a catch. It’s an awful feeling, being in that place, and I can’t explain why. You go in asking for help, but they’re not giving you the kind of help that you’re asking for. I feel like I was lied to. I feel like I was tricked.”

While some lie outright, other CPCs use controversial studies to dissuade women from aborting. Care Net, one of the largest American CPC networks, distributes a national brochure that purports a significant correlation between abortion and breast cancer, citing a single study that has since been called into question. Multiple other sources have demonstrated that abortion does not affect a woman’s risk of developing breast cancer.

Allison Yarrow’s August 2014 report, The Abortion War’s Special Ops, documents the emotional trauma that women experience from this ongoing deception. The report speaks of counsellors repeatedly warning clients that abortion can lead to ‘post-abortion syndrome’, a supposed condition that includes a combination of suicidal thoughts and depression. Unsurprisingly, an American Psychological Association report found no significant increase in negative emotions or psychiatric illness as a result of having an abortion.

At a pro-life conference in 2012, Abby Johnson, a supporter of CPCs, explained their main strategy. “We want to appear neutral from the outside. The best call, the best client you ever get, is one who thinks they’re walking into an abortion clinic. The one that thinks you provide abortions.”

In an effort to reveal the deceptive tactics of CPCs, some women are fighting back. Pro-choice activist Katie Stack campaigns against anti-abortion legislation after her own disturbing experience at a local crisis center.

In 2011, she started The Crisis Project which exposes the “medical misinformation, emotional manipulation, and religious doctrine” within these clinics across the United States. As an undercover reporter, Stack frequents CPCs in an effort to reveal the harmful inaccuracies they spread.

The fight to end CPC deception comes with its challenges. Earlier this year, Missouri Bill HB 1848, which would have required clinics to notify patrons that they do not perform abortions or give referrals for abortion services, failed to pass. Many states have faced similar roadblocks in establishing pro-choice legislation.

While anti-CPC activists have a long way to go to acquire legislative change in the United States, they are making some headway on an international scale. Global organizations like Google have agreed to remove CPCs’ deceptive advertisements from search results.

On September 18, 2014, Yarrow told the Huffington Post: “We are all entitled to our own positions on abortion, but I bet many people disagree with taxpayer-funded deception.”

– Lauren Goldberg, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Womb Wounds: Fetal Alcohol Spectrum Disorder

00ADHD, Alcohol, Child Development, Education, Empathy, Featured news, Guilt, Health, Neuroscience, Parenting, Pregnancy, Psychiatry, Stress, Trauma November, 14

“Fifteen years ago there were very few people who knew about FASD. If you were to go to court and say, ‘My son or daughter has FASD,’ a judge wouldn’t even know if it was a real thing.” – Jonathan Rudin, Justice Committee Co-Chair at the FASD Ontario Network of Expertise

Recently referred to as an “invisible condition” by the popular Canadian newspaper, The Globe And Mail, Fetal Alcohol Syndrome Disorder (FASD) often goes undiagnosed.

A supervisor at the Toronto Children’s Aid Society described to the Trauma & Mental Health Report the stream of FASD cases that have recently found their way into youth care and justice systems.

“You often don’t know a child has FASD because the mother is not around to confirm alcohol exposure during pregnancy. With one case, we suspected it, and did some digging. The grandparents of the child confirmed that the mother did consume alcohol during pregnancy. It was the grandparent’s report that changed everything. Nobody would have known.”

Characterized by growth deficiencies and central nervous system damage, FASD is an incurable condition. According to Ernest Abel, Professor of Obstetrics and Gynaecology at Wayne State University and Ronald Sokol, Professor of Paediatrics at the University of Colorado, FASD is the leading cause of mental retardation.

The Canadian Academy of Child and Adolescent Psychiatry explains that mothers often feel intense guilt and are typically blamed for damage to the child. For this reason, they are not always forthright about drinking habits. Stigma also plays a powerful role in motivating mothers to withhold information. And often, mothers consumed alcohol before they knew they were pregnant and are therefore unable to recall precise quantities and timing of drinks.

Adelaide Muswagon, a single mom, was featured in the Winnipeg Free Press in an article on FASD. “It took a lot of courage for me to get help. I know behind my back I was called an alcoholic and druggie. I can’t change what I have done; I already harmed my child. But I want expecting mothers to know my story, realize the consequences, and not make the same mistakes I did.”

The diagnosis of FASD is only given at birth for the most extreme cases. More often than not, symptoms are mild and fall within the normal range of development. For a firm diagnosis, confirmation of alcohol use during pregnancy is required. Because FASD can look like other medical, psychosocial and psychiatric conditions, children can be mistakenly labelled with Attention Deficit Hyperactivity Disorder (ADHD) or a behavioural disorder.

Fortunately, the behavioural symptoms associated with FASD are becoming better known. As we learn more about the hardships associated with the condition, mothers may question their decision to be vague or dishonest about drinking.

Liz Kulp, award winning author, advocate, and person living with FASD speaks candidly about her experiences in her book, The Best I Can Be: Living with Fetal Alcohol Syndrome-Effects.

“Finding out [why life was so hard for me] didn’t change how hard life is, but it did make me believe I was not a bad person. When I ask a question, it is because I don’t understand, not because I have not been listening, sometimes there is a blank space and I can’t get across it. I may look really normal and I work really hard to maintain. That is really stressful and sometimes I get frustrated. Sometimes the stress just builds up, especially when different people put different expectations on me all at the same time.”

For students, FASD manifests with attention problems and difficulties understanding instructions and rules. Common sense can be lacking, along with a tendency to take things literally. Learning issues lead to high drop-out rates. Youth with FASD often become involved in criminal justice systems, and many such individuals are overrepresented in prison populations. Jonathan Rudin, an Ontario lawyer and chair of the FASD Justice Committee says people with FASD are “usually not the mastermind behind the crime” but they are “easily convinced to take the rap.”

Catching the condition early in life and understanding its effects can help with education, parenting strategies, and legal provisions.

Moving through life without knowing why things are harder for you and why everyone else seems to be able to function with ease can be devastating. Sadly, people with undiagnosed FASD often grow up using alcohol to cope, possibly giving birth to a child with FASD.

Alleviating stigma around FASD by providing mothers with a non-judgemental space to speak about their drinking may help with diagnosis and treatment.

– Contributing Writer: Anjani Kapoor, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today