november 2012 – monthly theme post – traditions

Traditions.

They are certainly different for everyone. Some people’s traditions are rooted in family – some in their culture – some in their religion…and most people seem to use a combination of any/all of those factors when creating their own traditions for their families.

When my daughter was born, I honestly hadn’t thought much about what traditions I wanted to start with her. I’m a picture fanatic, so I started a “tradition” of doing a weekly and monthly photo shoot with her, but beyond that, I had not (and still have not)  given it much thought.  However, now that she is older and I’ve watched my blog friends talk about experiences ranging from their annual pumpkin patch visit to their kids’ birthday morning meal,  it’s suddenly occurring to me that I had better get on that if I want to start any long-standing traditions in my daughter’s life! How about you? Has the upcoming holiday season spurred you into action regarding traditions?

Suggested Writing Prompts:

  • How do you choose which traditions to create/follow in your family?
  • Are your traditions based on your family history, culture, religion, or some combination of the three?
  • What is your favorite tradition for your kid(s)? Did you also do it as a child?
  • Do you have a set plan of traditions you want to introduce, or do you just “go with the flow?”
  • How do you reconcile differences of opinion between you and your partner or you and your extended family in what the tradition “should” be for your child?

Feel free to write using the prompts above or go off on any tangent you would like. 🙂 Entries for the link up are due by next Wednesday, November 21st at midnight CST.  The full list of links will be posted on Thursday, November 22nd (American Thanksgiving Day!). Please fill out the form below to submit your post.

As always, if you do not have a blog of your own, feel free to leave your thoughts in the comments of this post and we will link to your comment in the final list that goes up next Thursday. Thank you!

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news item: “while you were puking…” (SSRI risky during pregnancy)

Today’s post ended up evolving into something of a guest post from Ms Future PharmD, with an assist from yours truly. It has been really interesting and illuminating getting to know the expertise that is out there on the blogroll this way. Every one of us has something unique to offer, from both personal and professional knowledge. So if you see something interesting in the news, on any relevant topic that interests you, please send it to us with your thoughts here. Similarly, if you have a site suggestion, don’t hesitate to drop us a line here.

In this post, we examine a recent blurb from Babble discussing the risk of SSRI during pregnancy. We recognize that within this community, the incidence of anxiety and depression related to infertility, loss, and pregnancy are likely higher than the general population of similar demographics. PAIL recommends that you always consult with your healthcare professional to choose a treatment path that is right for you, your child, and your circumstances – whatever that path is. Please take care of yourself, and understand that others are trying to do the same.  

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Last week, Ms Future PharmD emailed us about an “article” (it’s a paragraph at best – let’s call it a blurb) about SSRI (selective serotonin re-uptake inhibitor) use during pregnancy, complete with evidence trail leading back to the clinical study. To say this piqued my curiousity both personally and professionally is an understatement. I have mentioned before that I dealt with crippling anxiety during my pregnancy with HGB, but may not have confided that I subsequently went on an SSRI (an agonizing decision made while breastfeeding) to treat severe PPD afterwards. (Please feel free to email me if you would like to know more about this experience and the choices I had to make – I have not blogged about it to date). I have also mentioned that in my professional life, I use clinical drug trials to support brand messaging for pharmaceuticals (albeit for a different audience than the general public, 90% of the time). When I read the Babble blurb on SSRI use during pregnancy, I immediately saw the problem. Ms Future PharmD had this to say when she initially contacted us:

Here’s the trail of discovery: first I read it at a Babble article (yes, I should stop…) This is the article the Babble author references. Here’s the actual study (freely accessible) – via Human Reproduction It seems to have been addressed in a pile of regular newspapers as well as some TV news outlets.  Here’s one from a Boston TV news station.

I also saw it pop in my Twitter feed via Postpartum Progress here and again at Babble here (both pieces by Katherine Stone @ Postpartum Progress and both worthwhile reads in my opinion). So, what is causing all the stir? Here is the original blurb from Babble, in its entirity:

SSRI Risky During Pregnancy

According to a new study, “there is clear and concerning evidence of risk with the use of the SSRI antidepressants by pregnant women, [and] that these drugs lead to worsened pregnancy outcomes.” Additionally, there is no evidence at all of any benefits of using these antidepressants during pregnancy — not for the mother or the baby. Source; Medical Xpress
I have written here before about the actual importance and validity of  “a new study” and the perceived importance and validity of ” a new study” by the general public as reported to them in the mass media. To say that it is watered down, with the “key messages” distilled into a single soundbite i s putting it mildly, but right above this paragraph is a shining example (e.g. what are the definitions for “outcomes” and “benefits?”). Alarmism, with a dash of no actual imformation makes for a one-sided, and frankly potentially damaging blurb. To find out exactly what “the study” measured, one would have to click on the source (which is again, a study summary, and not the actual study). How many readers are likely to do this? (Which, to be clear, is not a statement on the intelligence of the average reader, but simply the amount of time available to flesh out the message that was just consumed.) As it turns out, the study is actually a meta-analysis of existing literature chosen by the researchers and examined for common themes. In other words, nothing was actually empirically measured in a clinical setting.  At this point, I begin to see red and have a hard time separating my professional distate from my personal outrage and experiences.

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Ms Future Pharm D dissected the summary AND the clinical paper for us, adding in her thoughts:
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Preface: I’m not your doctor, or a doctor at all, so this doesn’t count as medical advice.  See your own doctor or get a referral to a specialist if you have questions about your own health.  SSRIs are a group of medications used to treat depression and anxiety that might do something to serotonin levels in your brain but we aren’t sure yet exactly how they work.  Popular ones are Proz.ac (fluoxetine) and Zo.loft (sertraline) although there are a whole bunch of diverse drugs in the class.

One of the things that makes me really mad about this article is the things it isn’t telling you.  It doesn’t really have anything new to say.  All of science says that SSRI antidepressants are helpful for some people and not for others (publication bias or not).  This isn’t new, yet this article gets all excited about it as if this is something new.  (Sidenote: publication bias means that if your study doesn’t find your drug beneficial, you don’t publish it, but it gets reported to the FDA. This article reviews all the studies, not just the published ones.  Having no access to unpublished articles, we don’t know if the only reason they weren’t published was that the findings weren’t positive.  There could be other problems too.)  All of our research says that CBT (cognitive behavioral therapy a.k.a. talk therapy) is as beneficial as or more beneficial than SSRIs alone.  That’s not new either.

The big things that are missing from the (second, summary) article are an explanation of the magnitude of effects seen, or how big a deal it is that the SSRI changes pregnancy outcomes.  There’s a higher risk of cardiac defects, yes.  The difference is 0.09% with no SSRI or 0.1% with it.  Is that fundamentally different? Probably not.  How much shorter are pregnancies when the mom takes an SSRI?  The article makes a big fuss about how gestation is shorter but never admits how much shorter (it’s less than a week shorter).  They mention an increased risk of miscarriage, but again skip mentioning how much higher.  In one of the studies they cite, the SSRI-taking women had a 13% miscarriage rate and those without had a rate of 8%.  The usually accepted miscarriage rate is 12-15% in the population, so that isn’t actually evidence that the SSRIs had a thing to do with it.

When we get to the section specifically on SSRIs and infertility, the authors conclude that we should study it more because the evidence is sparse and that sperm counts might be affected by SSRI usage.  Yes, there’s one study that showed that couples treated for depression while undergoing infertility treatment got pregnant at much higher rates, but it was published in a not-so-reputable journal (not a good sign of its credibility) and it only sampled 140 couples (hardly enough to conclude anything about every infertility patient everywhere, other than to say treating mental health is important).  All this fuss and the real conclusion is that we should study it more?  News media, read the article.

This article also spends a lot of time talking about how SSRI use is associated with negative outcomes in pregnancy (hypertension for example).  That tells us not much about whether the SSRI is being used because the pregnant person is otherwise at increased risk of hypertension (say due to anxiety or obesity or something else) or if the SSRI causes the hypertension, and since most studies are done after the pregnancy ends (retrospectively), there’s no way to really know.  Likewise, perhaps someone with a history of loss gets depressed and then an SSRI.  Does the next miscarriage really have to do with the SSRI?  It’s hard to know without a whole lot more study.

The biggest thing left out of this article is what happens in depressed women who get pregnant and aren’t treated at all for depression.  The outcomes are worse than those in women taking SSRIs and include more miscarriages and preterm births.

The thing that makes me the most upset reading this article is the focus on the fetus.  Yep, fetuses are important if you’re trying to have a baby (duh) but so are mothers.  Nowhere does the article talk about the incidence of postpartum depression or psychosis in mothers treated with SSRIs or CBT (it’s lower based on the research we have).  Nowhere does it talk about quality of life for depressed pregnant mothers who are untreated, or her support people.  Nowhere does it talk about the long-term consequences to relationships of women being untreated or possibly undertreated for depression/anxiety during pregnancy.  Untreated depression is not a pretty thing and that’s why we treat it.  Treatment of some sort is probably a really good idea if it was in place before pregnancy and stopping suddenly is not a great idea either (brains are slow to adapt to changing medications that alter their functioning so you have to taper down, and this doesn’t mean the medicine is horrible for you, it means your brain is good at adapting).

Overall I’d say that this article is sensational and doesn’t include literature that is important to the decision on how to treat a woman who’s depressed and is/may become pregnant.  The guidance from the leading medical folks is still “consider the risks and benefits carefully before treating or changing treatment.”  This article doesn’t change that at all, so if this might be you, be sure you get the treatment you need to be healthy and have a doctor you know is an expert in depression treatment during pregnancy supervising your care.  The article does make a good point that it’s important to have a qualified specialist treating pregnant women, especially those with infertility to cope with.

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Did/do you struggle with anxiety/depression related to your ALI journey? Pregnancy? Postpartum period?

Have you previously written about these experiences, and would you be willing to share them again by linking in the comments?

What is your impression of the Babble blurb? Would you have clicked the “source” link to find out more?

Have you taken (or decided not to take) an SSRI during pregnancy or while breastfeeding? What factors went into your decision?

Do you feel that there is enough accessible information about these issues made easily available to the average woman?

What questions would you ask your doctor (or have asked) if faced with this decision?

**Please be mindful of your comments in this discussion. The choice to take medication or not is extremely personal and sometimes difficult. Thank you.**

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adoption blogger interview project – interviews are up!!!!!!

It’s finally here!!!

Adoption Bloggers Interview Project 2012

I’ve been so excited to participate in the blogging event put on by Heather at Production Not Reproduction, mostly because I got paired with someone who I respect so much and have followed for so long.

I know everyone has their *favourite* blog. Lisa’s blog is mine. Her story as a birthmother moves me to tears, is so relatable, and her adoption situation it is everything I hope never happens in our family.

Sound kinda odd? Yup. Lisa, literally motivates me want to be a better mom and better adoptive mom.

When reading her words, I try my hardest to remember them and apply them or her situation to the relationship we have with our birth family. Mostly, I am so thankful that blogs like Lisa’s exist, because her words inspire and make me work outside my comfort zone in the Open Adoption we have with our birth family.

We both got to send questions to each other and I think both of us hope that people will see just how important family really is when adopting domestically. You can find my interview of Lisa here and her interview of me at her blog.

Make sure you head over to Heather’s blog to check out the 2012 Adoption Blogger Interview Project and the hundred + participants who got involved!!

Comments here are closed to encourage you to visit the blogs on Heather’s site 🙂

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featured post – “hungry? try the lasagna.” by Jules

We’re featuring our very own Jules for our feature post today!

Jules wrote an extremely honest and candid piece about body image, post-baby body and body image issues post-baby. We’ve all been there.  Even if we’re the ideal of fit and healthy, a personal trainer, or Nicole Kidman, we all pick apart our body and perceived imperfections.  And then pregnancy, wow talk about a game changer.  I am within the weight range of what is “normal” for me, yet can’t fit into my pre-pregnancy jeans, pregnancy seriously shifted some stuff around on my body. Like, where did this extra stuff on my hips come from? Jules takes us on an honest look at the changes pregnancy can cause to our body and our feelings about our bodies:

“I loved my belly when I was pregnant. I felt like some sort of female goddess warrior princess. But after my c-section, when I finally was allowed out of bed and took that first shower? Oh, man. I cried with a mixture of relief and despair. “I’m finally clean!” / “My body is RUINED FOREVER; I AM DISGUSTING.””

And then Jules gets to what, for me, is the most important point of this post.  It’s no longer about us.  It’s no longer about us and whatever insecurities we have about our bodies:

“…motherhood has reshaped my reality, and that includes my body, which to be honest I’ve never particularly appreciated or treated properly. I’m learning how to do both these days for my own sake, but also for my girls– they’ll never be able to love themselves if the people they love most, like their mother, don’t show them how.”

Because now, we’re Moms.  Our reactions towards our bodies, our attitudes towards food, exercise, body image, etc, are now not just ours alone. Because now we have little eyes taking in and absorbing everything we do and say.  If I’m constantly picking apart my body and stressing over not being “perfect” (whatever that is) my little girl is going to see that. And I’d sooner walk over hot coals then have her inherit body insecurity issues from me. She is going to be exposed to enough of that from our culture as it is.  Even if you are the Mom to boys, this is still important.  Boys learn from their Moms just as much about body image, and they learn what to expect and how to treat the future women in their life, and if you constantly disparage yourself for your son to see, he learns that it’s ok to do that.

As Jules points out, it’s not like we have to be all sunshine and rainbows about our bodies, we can be honest and admit to the things we need to work on, or even things that are fine, but just bother us about our body:

“We will all have moments of trying on that dress for a wedding and we just hate it so hard because it clings to all the wrong places.”

But we have to make a choice. A choice to love ourselves as we are right now, even if “right now” isn’t exactly where we want to be.  We can still love ourselves and project healthy image for our kids.  Because our bodies, transformed by pregnancy, are a testament to the miracles our bodies have wrought.  And those miracles are so worth it.  Please read and comment on Jules’ very thoughtful post, “Hungry? Try the Lasagna.” As always, comments here are closed to encourage you to visit Jules’ blog and share some love.

the monday snapshot – mandski

This week, Mandski of Full Bed is going to open up the week for us with her contribution to the 10th edition of The Monday Snapshot – an evolution of the MMM feature, meant to bring the PAIL blogroll to life by giving its members a chance to feature themselves and make new connections. If you would like to be featured on The Monday Snapshot, please sign-up here!

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Mira seems to have her first bad illness. It was just a cold with a runny nose through the weekend, but overnight her temperature shot up. Thanks to Tylenol and TLC, she finally fell asleep at 7 am, just in time for me to email my boss to tell him I can’t come in. My husband was already planning to be at home with her, but sometimes a baby just needs her mama.

Now, get to know a little more about Mandski with her answers to the Monday Snapshot “5 Questions”:

1) How long have you been blogging and how did you get started?

I started my blog recently, in January of this year. I’d been reading infertility and loss blogs for awhile, but didn’t have a blog of my own. After Mira arrived, I felt like I really needed an outlet and a community, so I started my own blog and was lucky enough to do so just before PAIL got going.

2) Tell us a little about your ALI journey and your family (3-4 sentences):

My husband and I started TTC in July 2009. We realized there was a problem very quickly, but it took awhile to identify and treat my main medical issues (Hashimoto’s and PCOS). After the problems were identified, we were lucky enough to be able to conceive with the help of medications. I miscarried in November 2010 and we conceived Mira in February 2011. She was born in November 2011, and will probably be our only child. My husband and I had dramatically different ideas of the lengths we wanted to go to have a child, which was a major emotional issue for me and our marriage, but we’re both happy to be a family of three.

3) What makes you unique in the blogging world? (e.g. special talent, rare diagnosis, life experience)?

Something that has really shaped my life is the loss of my brother. Sadly, this isn’t unique. Having a baby and being in school was also something unusual in my story, though that chapter of my life is now complete. Probably the only reasonably unique thing about me is that I’ve experienced, and have family who are in, drastically different economic circumstances.

4) One word to describe yourself: 

Determined

5) What blog or website (IF or not) would you recommend to others? Why?

This is terrible, but I love STFU, Parents. It’s always good for a laugh.

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As always, we want to see your Monday Snapshot as well, so please comment below with a link to your post– and of course, go visit Mandski at Full Bed!

If you would like to be featured on The Monday Snapshot, please sign-up here!

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