What is Postpartum Depression?

Postpartum depression is a form of depression that affects women and can occur anytime up to one year after having a baby.  Women with postpartum depression have such strong feelings of sadness, despair, and anxiety. These feelings are so powerful that they make it difficult for the mother to perform normal daily activities such as taking care of themselves or their baby.  Postpartum depression affects about 1 in 10 women after giving birth to their baby.  Some reasons women get postpartum depression can be related to changes in your hormones following childbirth, if you have had depression in the past, fatigue, stressful life events, or other emotional factors.

Signs and symptoms of postpartum depression may include:

• loss of appetite
• insomnia
• irritability or anger
• overwhelming fatigue
• lack of joy in life
• feelings of shame, guilt, or inadequacy
• severe mood swings
• difficulty bonding with your baby
• withdrawal from family and friends
• thoughts of harming yourself or your baby

What are the baby blues?

The postpartum or baby blues begin about 2-3 days after the birth of a newborn and can last up to one to two weeks.  Women with the baby blues can feel depressed, anxious, and upset or angry with their partners, the baby, or other family members.  Some mothers have said, “I was watching a commercial on television and I started crying. What’s wrong with me?”  This is a very normal and typically goes away in a few days.

The signs of the baby blues may include:

• crying for no apparent reason
• anxiety
• mood swings
• sadness
• irritability
• crying
• decreased concentration
•  trouble sleeping

Where can I get help?

At HealthNet, we encourage and schedule all moms who have delivered to follow-up with their certified nurse midwife, women’s health nurse practitioner, or physician around 3-6 weeks following the birth of their baby for a postpartum visit. At this visit we will ask you questions to screen for postpartum depression. Treatment for postpartum depression is available and may include talking with a counselor or use of antidepressant medications (medications that balance the chemicals in the brain and control moods), or both.  HealthNet offers behavioral health counseling and psychiatric care services. For more information, call a HealthNet location near you.

Another excellent resource is Birdie Meyer, who is the Coordinator of the Perinatal Mood Disorders Program at Indiana University Health in Indianapolis, Indiana.  She is an RN with a Master’s Degree in Psychology/Counseling, who offers support groups for women with postpartum depression. She can be reached at 317-962-8191 or by email at bmeyer2@iuhealth.org.

If you are having intense feelings as describe above or any thoughts of harming yourself or anyone else call your provider immediately or go to the emergency room.  I want you to know you are not alone. Don’t be afraid to ask for help, we are here for you and ready to help.

Postpartum Depression Resources:

www.postpartum.net
www.postpartumstress.com
www.ppdsupportpage.com
www.postpartumdads.org

Post by Carrie F. Bonsack, CNM, MS

Pregnancy can be hard on the body.  In order to compensate for the growing baby, a woman’s blood volume increases, her hormones shift and she must compensate for the extra weight she is carrying in her belly.  Our bodies are pretty amazing, and they do a good job of compensating, but sometimes this can cause us to feel more tired, nauseated and sore.  Although we consider these things “normal,” it does not mean that we should accept these things without question.  Below, I’ve listed some tips that could make this time more comfortable and enjoyable.

Body Mechanics
Body mechanics is a term that describes how we use our bodies for daily activities.  We tend to want to move with the least amount of effort whenever possible.  This ability is great most of the time as it helps us to multitask. Without this ability, we would not be able to coordinate breathing, thinking, processing, using muscles, etc.  The problem with this is that we often ignore important muscle groups that need to be used in order to conserve energy.  If we don’t move muscles, they do not get stretched or strengthened.  Over time, the muscles become weak and they are not much good to us.  This can lead to injury too.

My challenge to you is to become aware of your movements. 

During pregnancy, it is especially important to be aware of your movements.  Your growing belly is already prone to putting strain your back and other ligaments that normally you would not be aware of.  Poor body mechanics can lead to muscle strain and while most of the time this is not a harm to the pregnancy, it can make for an uncomfortable mommy.

One of the main complaints I hear from patients is round ligament pain.  The round ligaments hold up the uterus in the front of the body.  As the uterus grows quickly during pregnancy, the round ligaments also stretch quickly.  Preventing injury is key.  Slow position changes and paying attention to your movements can help keep you comfortable.  For example, when you get out of bed in the morning, try rolling to your side, sitting up, putting your feet on the ground and then standing, rather than making this one swift movement.  Good posture will also help by taking some of the weight off of the ligaments and putting it on muscles that are more capable of bearing the weight, if properly strengthened.  This brings me to my next point.

Sit up!
I know I probably sound like your grandmother, but I’m sorry to say, she was right.  For some reason, we like to slouch.  Like I mentioned before, we don’t like to engage a lot of muscle groups so we hold ourselves up with the least amount of effort.  Good posture helps engage the muscle groups throughout your torso.  It might not be comfortable in the beginning but once the core is strengthened, it will help you hold up your growing belly without as much strain.  As the pregnancy goes on, this practice might also help you to breathe with more ease.  Good posture opens up the chest and gives your lungs more room to expand and baby more room to do her thing.  Try sitting on the floor whenever possible or on a chair without a back.  This will encourage you to sit up and use your core muscles as opposed to sitting on a fluffy chair or couch that does all of the work.  You can also try sitting on an exercise/birthing ball.  This will encourage good posture and help you as you train for your labor day!

Try squatting
Have you ever watched little kids that have recently learned to walk?  Their ability to squat is amazing.  Once again, this is an activity that we have replaced with a seemingly easier activity we call bending. Somewhere between 12 months and 12 years old, we seem to lose this important movement.  I’m sure the majority of us have been told to lift with our legs and not with our backs, which of course requires squatting, so we know this is an important movement, but alas, we bend…and strain.

Squatting is especially beneficial in pregnancy as it stretches the muscle groups that facilitate delivery of the baby.  Your pelvic floor muscles are about to be stretched more than they ever have before.  These muscles were made to do this, but healthy muscles stretch easier.  Think about a rubber band. A rubber band with good elasticity is going to go back to its original size and shape much easier than a rubber band that has lost its elasticity.

Join a prenatal yoga class
A yoga class is a great way to stretch and practice moving your body in healthy ways.  These poses can also help to strengthen your muscles.  Yoga is great for super athletes as well as beginners.  Group classes are also good for people who need a little extra motivation and support.   A structured class is also a good place to practice new movements in the correct way to avoid injury.

For more information on HealthNet’s Women’s Services, visit www.indyhealthnet.org.

As a certified nurse midwife and a mom of two, I can attest to the misery of morning sickness. I was lucky or shall I say, very unlucky to have it with both of my pregnancies.  I still have a strong sensory aversion to the scent of cucumber melon! I had a car deodorizer in this scent and every time I would drive to work I would throw up. I even had to keep gallon size Ziploc bags in my car for emergencies!

You may be feeling like you are hugging the toilet more than your loved ones, but don’t worry it will eventually go away so that you may experience the joy of pregnancy! Let’s go over a few facts about morning sickness.

What is it?

Nausea and vomiting is a common condition in pregnancy also known as “morning sickness”.   This condition is so common that is has been shown to affect 70-85% of pregnant women[1].  Morning sickness can occur at any time during the day. Some women may have nausea only, while others have both nausea and vomiting.

In most cases, morning sickness will not harm you or your baby.  A severe form of morning sickness, Hyperemesis, is where the woman can’t stop vomiting, lose at least 5% of pre-pregnancy weight, and presence of ketones in the urine. Women with hyperemesis need medical attention.

Why am I sick and how long will this last?

Hormones are thought to be a cause of morning sickness, although the true reason is unknown. Women, who are pregnant with twins, have had it with a previous pregnancy, or who have a history of migraines or motion sickness are more likely to have nausea and vomiting.

Symptoms usually start between the 4^th and 9^th week of pregnancy, and typically last until between the 12^th and 16^th week of pregnancy[2] .  There is no magic cure, but here are some helpful hints.

What can I do that helps me feel better?

Taking a multivitamin before getting pregnant can reduce the severity of morning sickness symptoms.

• Rest as much as possible
• Powdered Ginger capsules (250mg) one capsule during the day and one at bedtime may help[3].
• Eat small, frequent meals (5-6 times/day rather than 3 big meals)
• Eat high protein snacks (milk, yogurt, peanut butter)
• Eating crackers or dry cereal before getting out of bed in the morning may help
• Taking folic acid and a multivitamin vitamin or chewable/gummy children’s vitamin without iron for the first trimester may help.
•  Acupressure wrist bands (Sea Bands) may help[4]
•   “Preggy Pops” are lolly pops made of brown rice syrup, sugar and essential oils, that come in several different flavors created to help relieve morning sickness.
• Slices of lemon with salt are used by some women
• Your medical provider may decide to place you on a medication such as Vitamin B6 (Pyridoxine) and/or Doxylamine (an antihistamine), or other antiemetics such as Phenergan or Zofran if these measures don’t help.

What should I avoid doing?

• Certain smells can trigger nausea or vomiting, so try avoid bad smells.
• Avoiding fatty and spicy foods may help

When should I seek help from a medical provider?

If you have tried the above recommendations for nausea and vomiting and are still feeling sick you may need to seek medical treatment from your HealthNet midwife, nurse-practitioner, or physician. At the health center, your provider will find out if you are having morning sickness or if something else is causing your nausea and vomiting.  Your provider will work with you to determine if you need medications to help relieve the sickness. If you are dehydrated, you may need to have fluids placed in your body through an intravenous line (IV).

Call for these symptoms of dehydration (not enough fluids in your body):

• You cannot keep down food or fluids for 24 hours
• Your urine is dark and you are not urinating very much
• You are dizzy or feel like you might faint
• You are vomiting blood

Meet – Better Indy Babies/Healthy Families

Better Indy Babies (BIBs) is a free home visitation program for expecting mothers. BIBs is designed to promote a healthier you for a healthy pregnancy. Our efforts assist in healthy fetal development and help reduce infant immortality rates, SIDS, and foreseen childhood health problems. Since 1989, the program has been providing prenatal care coordination services and served as one of two pilot projects funded by the Marion County Divisions of Family and Children Services.

Healthy Families – Marion I (HF) is a voluntary home visitation program that works with parents and children from the age of 0-3 for healthy growth and development for the child through a variety of services including access to health care and parent education.

So here are the four things you should know about Better Indy Babies & Healthy Families.

1.  Separate names, but they work together to make one great program!

   As you may have noticed from reading above, both programs basically serve the same purpose — only in two different stages of a child’s life.  Both work toward proper care and development for all Indianapolis children through home visitation.

2. Together they provided more than 12,364 home visits last year.

   The result of a home visitation program such as BIBs/HF is a researched success.  A Healthy Families program in New York with a similar sister program like Better Indy Babies was featured in a research study published in the American Journal of Preventive Medicine where ‘pregnant women and adolescents were randomized to either an intervention group that received bi-weekly home-visitation services or to a control group’.  And the conclusion was this:

   

   photo by paparutzi

   “A prenatal home-visitation program with focus on social support, health education, and access to services holds promise for reducing low-birth-weight deliveries among at-risk women and adolescents.”
   
   

3. BIBs/HF is filled with tireless staff who not only visit these families, but also become an integral PART in their lives.

   This is true and can be seen in an earlier blog post that gave a recap of the BIBs/HF Picnic & Graduation Ceremony.  Read that post!

4. Assistance to help sustain this great program is always a need!

   There are plenty of ways to get involved with this great group of people!

   • Donate new or gently used baby items to the BIBs Pantry at University Heights United Methodist Church.
   • Consider a small gift. We can’t understate the significance of even a $5 donation to the BIBs/HF programs.  Raise awareness and tell your friends that you donated to this great program!  Together, we can help all children in Indianapolis get a GREAT start to LIFE.

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Interested in BIBs/HF?  Want to learn more?
Questions about Low birth weight and infant mortality in Indianapolis?
Comment below!
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Clients of the BIBs/HF program get a sense of community at the picnic. We all have had situations where we felt alone and as if we are the only person in the world going through a particular experience.  The BIBs/HF staff take pride in supporting clients, connecting them to community resources, and letting them know that they are NOT alone.

Both home-visitation programs are dedicated to meeting the needs of culturally diverse families in our community. They encourage self-sufficiency and healthy parent-child relationships. I had a chance to talk with three different families who attended the picnic. Support was the repeated and underlying feeling that shined through in every answer to my questions.

Carrie Tahat was a mother who was completely by herself when she found out about BIBs/HF in the hospital.

HealthNet: What services have been the most useful for you and your daughter?
Tahat: Receiving referrals and information to community resources.  When I was homeless they connected me with the program that helped me find an affordable place to stay.  BIBs/HF staff would even drive me to my doctor appointments when I really needed to get to the doctor.

They have been really helpful with all things for clothing, food, and shelter. I have been with the program for 8 months, and they have helped me with EVERYTHING that I have needed.

Melanie Smith was referred to BIBs/HF when she was 3 months pregnant and attending her appointment at HealthNet’s own Barrington Health Center.

HealthNet: If you met someone in a similar situation as yourself, what would you say to get them to seek out the services provided by BIBs/HF?
Smith: I have referred A LOT of people.  A lot of people come up to me and ask me HOW I am doing such a good job raising my children and make sure they are hitting their milestones.  I tell them that BIBs/HF is a great way to find support from people OTHER than your family.

They do a really good job of letting you know that you are not alone. They do a really good job of supporting YOU.

Cliff and Serena Williams have a 3-year-old son who is a GRADUATE of the program.  Serena had no idea about the support system available from BIBs/HF until she was referred by the doctor, and now she tells EVERY pregnant woman she meets that it is essential for them to get into this program.

HealthNet: What is the best part of the BIBs/HF program?
The Williams: The home visits are interactive and personal.  Our son has been a handful, and our home visitor has presented a wide variety of activities and strategies to help him reach his milestones and goals. 

There are so many more success stories like these! Together, HealthNet’s Better Indy Babies and Healthy Families programs provided more than 12,634 visits to at-risk homes in Marion County last year. With your help, they can do even more.

Every parent and parent-to-be needs support and encouragement. Know someone who might benefit from BIBs/HF’s programs? Email info@indyhealthnet.org to learn more!

BUT!! Don’t forget FOUR great things about our Health Promotions team!

1. Nutrition & Diet – Our Clinical Dietician is here to help people learn how eat healthy, lose weight, control their cholesterol and SO MUCH MORE!  It is hard for anyone to eat healthy but even HARDER when you don’t have many choices.  Eating healthy on a budget is Karen’s strong suit. She will make sure you get on the road to success.
2. Tobacco Cessation – QUIT SMOKING!! We have a VERY persistent Tobacco Cessation Counselor who will exhaust every strategy in the book to find a way for her patients to stop smoking.  (Read a success story in a previous post).  It really all boils down to the individual’s commitment to quit, but Stacey will make sure that you have every tool possible to keep from lighting up again!
3. Pregnancy & Childbirth – Newly pregnant?  Whether it is a patient’s first pregnancy or FOURTH, all who participate in our childbirth or breastfeeding classes will benefit in some way. Our 5-week childbirth classes surround patients with others who are sharing the same experience.  Expectant moms learn helpful tips during their pregnancy and take a tour of the Methodist Hospital Labor and Delivery unit. Carlene makes it her job to help our patients be prepared for this new stage in their life.
4. Community Outreach – Whether it is a Health Fair or piloting a new walking program (more to come), our Health Promotions team is always thinking of great ways to engage our patients in preventive care.  It is our job to help patients take ownership of their own health, because their lives are busy and at times VERY stressful. Illness can only increase stress and cause greater difficulty in treatment.

In the middle of all of this “MADNESS,” we want to recognize the great work done by our Health Promotions team.  Who also needs YOUR help! All pregnancy classes, smoking counseling, and nutrition help are free to our community.  A quick donation can go a long way in order for our team to continue and INCREASE their success in the most underserved areas of our community.

Consider a $25 gift to Health Promotions to keep them in our centers and increasing the health of our neighborhoods!

The Indiana Youth Institute sent out an issue alert entitled “Kids Raising Kids“, and another surprising fact to accompany the increasing teen birth rates is that one in five of these births is to a teenage girl who already is a mother.

“Children born to teen mothers are more likely than children of older parents to grow up in a poor and mother-only family, to live in a poor or underclass neighborhood, and to experience high risks to both their health status and potential school achievement.”- Issue Alert from Indiana Youth Institute

These children are 50% more likely to be born at a low birth weight and do not perform as well as children of older mothers on measures of child development and school readiness.  With these numbers increasing in Indianapolis, it is important to know what resources are out there for teen mothers in order to help them out.  In a study done by the FSU Center for Prevention & Early Intervention Policy, children born to teen mothers are more likely to experience abuse, neglect, and abandonment.

By raising awareness for HealthNet’s Better Indy Babies (BIBs) and Healthy Families (HF) Programs, we can change the wording of that last sentence.  Learn more about the resources available for teen mothers, or donate directly to BIBs/HF here.

Who is blamed for childhood abuse? – Adults/caretakers in that child’s life.
Who is blamed for addiction? – The individual who can’t help themselves.

But before you click away, what if I posed an answer that said we as a community and society can also be blamed for this?

In reading an article outlining an interview with Canadian physician and best-selling author Dr. Gabor Maté, it made me think about how policies and outreach can help create a better environment for children to live and develop.

Dr. Maté’s response to whether or not genetics is linked to behaviors and dysfunctions in humans is very intriguing.  In part, genetics HAS to play a role in tendencies, but Dr. Maté poses that if we place blame on genetics for behavior and dysfunction, then it takes people off the hook.

“Well, if people’s behaviors and dysfunctions are regulated, controlled and determined by genes, we don’t have to look at child welfare policies, we don’t have to look at the kind of support that we give to pregnant women, we don’t have to look at the kind of non-support that we give to families…” – Dr. Gabor Maté

If we are taken “off the hook” so to speak, then we don’t have to worry about not providing prenatal care for at-risk mothers or support services for young families on the brink of poverty.

Children who grow up in low-income families are more likely to be abused, more likely to be neglected, and more likely to end up as addicts.  The environment that a child grows up in creates the person that child will become, and parents in these situations are subject “not [to] bad parenting, [just] extremely stressed parenting”. And, this stress affects the child.

To read the full interview of Dr. Gabor Maté, click here.  To help directly, visit HealthNet’s website and learn about our Better Indy Babies Program, or donate directly to help a low-income family in Indianapolis create a better environment for their child.

According to PregnantTeenHelp.org, around 750,000 teenagers will get pregnant this year.  Breaking this down further, it comes out to about one-third of all girls in the United States will get pregnant while they are a teenager.  Additionally, more than two-thirds of these teenagers will not graduate from high school.

The bright side – the teen birth rate has dropped about one-third since the early ’90s.

Better but still surprising! The effect that teen births can have on an individual are a cause for concern.  Whether it is because of the lack of education on the subject or wanting to hide the pregnancy, teenagers are at greater risk of having little to no prenatal care, which could be harmful both to the mother-to-be and the child.  A lack of prenatal care is a great cause for concern considering that teenage mothers also have a higher risk of premature births and lower birth weights. Both of these consequences can lead to greater short-term and long-term health problems for both the mother and child.

Shedding a light on teen pregnancy is important.  It is comforting to know that teen pregnancies are declining.  But when teen pregnancies do occur, support should be first on the list.  Reminding girls of the importance of prenatal care, offering help in any way, and just talking with a pregnant teen can make a WORLD of difference.

HealthNet’s Better Indy Babies (BIBs) and Healthy Families (HF) programs help at-risk and young families by offering a support team.  This team includes social workers, registered nurses and community health workers, and they provide prenatal health education, support and linkage to community resources.

• Learn more by visiting HealthNet’s program page, here.
• Or donate to BIBs/HF directly by clicking here.

• smoking during pregnancy
• infant having two or more siblings
• Medicaid enrollee
• unmarried
• infant low-birth weight
• less than high school education
• teen mother
• short spacing (under 15 months) between pregnancy
• poor pre-natal care
• adverse outcomes in prior pregnancy

Most of these factors are situations that occur BEFORE the child is born and even before pregnancy.

“Children younger than three years of age are the most likely of all children to become involved with Child Welfare Services, and they have the highest rate of victimization of maltreatment among all age groups.”

Services for at-risk households are crucial to prevent these young children from being neglected and abused.  This report was mainly done to research the possibilities of taking care of these children after they enter Child Welfare Services.  However, there are organizations out there that provide support for families, mothers, and siblings of newborns.

Whenever I hear the word “risk factor” when talking about child abuse and neglect, I become wary.  I think that parents, families, and siblings are in tough situations where stress levels are increased, family history has taught parents in a certain way, and other factors are present.  Having the knowledge of where to find support services and resources is crucial to decreasing stress, breaking family history cycles, and helping in other ways.

Better Indy Babies and Healthy Families America are two resources provided by HealthNet throughout the Indianapolis community.  The staff here provide knowledge and support to families and parents who are pregnant or have children from age birth to 5.  You can help these two resources be of greater service to families in need.  Learn more about what tools are out there or donate directly by clicking here.