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Expert Feature: Women's Hormones and Mood

9/7/2019

Hi again! I was featured in Romper talking about a topic I LOVE to nerd out on - monthly mood changes around ovulation and menstruation. Check it out here!

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Expert Feature: Am I Ready to Have Another Baby?

8/28/2019

Interested in questions to ask yourself before having another baby? I weighed in on this, along with other specialists in maternal mental health to generate a list of questions you can ask yourself along the way. Check it out in Romper here!

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Why Maternal Mental Health Is Everyone's Business: A Letter to Clinicians

5/1/2019

(This essay first appeared in the May/June SFCAMFT Newsletter)

Maternal Mental Health is everyone’s business.

Although specialized in nature with a specific clinical focus, maternal and perinatal (the pregnancy through postpartum period) mental health touches all of our work.

Untreated perinatal mood and anxiety disorders (PMADS) negatively impacts a mother’s quality of life and increases her risk for suicide. PMADS are linked to cognitive and behavioral issues in children, the same children with whom you sit eye to eye - talking, playing, and helping them process their worlds.

PMADS intersect with eating disorders, substance abuse, grief and loss, domestic violence, and severe mental illness. Actually we’d be stretched to find a therapeutic area with which it doesn’t collide.

Perinatal mental health can be improved or hindered depending on the level of supportive relationships within couples, families, and communities. And since each of us has a different understanding of what it means to be a ‘mother,’ perinatal mental health will be part of our countertransference experience. Whether our relationship with ‘mother’ is simple or complex, it is still often rife with strong and complicated feelings, and thus therapists must be aware of their responses.

Since knowledge is power and protection, the more we collectively know the better. What follows are a few myths and truths that will improve our understanding and support of our moms.

- Myth: Postpartum depression is the only mental health issue that arises in the perinatal period.

+ Truth: Depression, anxiety, OCD, PTSD, and Psychosis are all perinatal mental health concerns.

The ‘M” in PMAD refers to mood disorders, namely unipolar and bipolar depression. 50% of women with bipolar mood disorder are first diagnosed in the postpartum period.

The ‘A’ refers to a spectrum of anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and post traumatic stress disorder.

Postpartum psychosis is very rare (1-2 in 1000) and must be treated as an emergency.

While defining these disorders is out of the scope of this article, simply knowing there’s a spectrum can be a starting point for clinical considerations.

If you remember one thing only, it’s that each of these disorders is highly treatable.

- Myth: Postpartum Depression is a normal part of the motherhood experience.

+ Truth: Postpartum Depression is a common (estimated at 15%) and (again) highly treatable disorder.

When talking about depression in pregnancy and postpartum, well meaning clinicians will often say that this experience is “normal,’ presumably to help women feel at ease.

Unfortunately, this can lead to moms keeping symptoms private and not getting the help they need. This is an especially problematic message in pregnancy as being depressed or anxious in this phase is predictive of being depressed postpartum.

Overwhelm, ambivalence, fatigue, and transient crying spells are normal. About 80% of postpartum moms have the “baby blues” within the first couple weeks of having a baby, largely connected to sudden and intense hormonal changes.

A pervasive sense of sadness, guilt, irritability, and hopelessness, and even rage - which may show up anytime within the first year postpartum, and peaks around month three - may be signs of something more concerning and should be tended to with therapy and/or medication.

- Myth: You can tell by looking whether someone has postpartum depression or anxiety.

+ Truth: you can tell by screening whether someone has a postpartum depression or anxiety.

We all know that stigma is a huge barrier to mental health treatment overall. But being depressed or anxious during pregnancy or postpartum feels especially taboo for many, thanks to messaging around how glowing, joyful, and happy moms and moms-to-be are supposed to feel.

Women are often using energy they don’t have trying to hide their scary and painful internal experiences. Many women who have a PMAD present as outwardly put together, with bright smiles, not a hair out of place.

All healthcare clinicians can overestimate their ability to informally assess how someone is doing. And since early detection of a PMAD can significantly reduce the severity and duration, we need to deliberately look for depression and anxiety symptoms.

There are accessible and reliable screening tools that can truly help pick up the hidden data. The Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) are two such tools, and both are free and available online.

Resources:

So what do we do when we identify that a PMAD may be at play?

If you were to have one resource in your back pocket, I would highly recommend Postpartum Support International. You can learn more about all the PMADS on their website and you can find local perinatal trained providers by calling their area coordinators: https://www.postpartum.net/locations/california/

Other great local resources include:

UCSF Pregnancy and Postpartum Mood Clinic
CPMC Perinatal Health and Wellness Program
Homeless Prenatal

Whether through direct service or linking someone with the best resource, together we can weave a web of support for moms.

Yours in wellness, self-care and compassion,

Shana

Are you a mental health or perinatal provider who wants to learn more or consult about perinatal mental health? Or think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Resources For New and Expecting Mamas: Books

5/1/2019

One of the toughest things about perinatal mood and anxiety disorders is that you can’t always tell by looking who has one. Among the many mama superpowers is the uncanny ability to hid a struggle (hey, not all powers are used for good).

And of course, therapy can help. But not everyone is interested in that as a next step, nor is it the only option for wellness whatsever..

Below is a smattering if books that can be helpful in different ways, along with a short-attention-span-honoring one-sentence book review.

From the bottom up.

1. The Pregnancy & Postpartum Anxiety Workbook: Provides basic, CBT-falvored (No, not CBD - Cognitive Behavioral Therapy) easily digestible education about perinatal anxiety, as well as DIY tools and practices.

2. Ina May's Guide to Childbirth: Provides empowered birth stories and childbirth education that can helpful no matter what type of setting you’re planning to give birth.

3. This Isn’t What I Expected: Overcoming Postpartum Depression: Informative, readable, validating information about postpartum depression, and what you can do to help.

4. Dropping The Baby and Other Scary Thoughts: Informative, readable, validating information about postpartum anxiety, and what you can do to help.
5. Expecting Better: Not your average “what to expect book” - illuminates some of the data about what you can and cannot eat and do during pregnancy (spoiler alert: coffee is not evil). 6. Parenting From The Inside Out: A kinda dense, but super important read for parents of kids of all ages sharing one major take home message: When we make meaning of our own experiences, we are less likely to repeat unhealthy patterns with our own children.

Okay, that's it for now. I imagine this list will g r o w! Share with a mom or mom-t0-be in your life. It just may be the exact things she needs (bring her some food while you're at it ;)

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

A Roundup of Resources for New Moms

4/28/2019

One of my favorite observations about being in a helping profession and being a person who taps into all sorts of different healing mediums is that there are SO MANY WAYS TO HELP AND BE HELPED.

This is lucky for all of us, as needs differ form person to person, day to day, sometimes minute to minute.

Below are some new mom resources of different kinds that you can check out, depending you your needs in this moment in time. The list will grow in time.

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Shana Averbach quoted in Washington Post on PPD

4/22/2019

I was honored to be quoted in a recent article in The Washington Post that discussed screening and treatment of Postpartum Depression. You can read the article here!

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Reflections on Becoming (a Certified Perinatal Mental Health Professional)

4/1/2019

Good morning from my kitchen, where there is bright light absorbing, hot tea and pesto pizza consuming, and sweet bits of reflection happening.

Thought I'd share with you. Not the pizza. That's gone. But some thoughts.

This past Saturday I woke up at the crack of dawn and drove across the Bay Bridge to Oakland to sit for an exam. The (positive) outcome (phew!) was being certified as a Perinatal Mental Health Professional (PMH-C, that's me!).

I'm not sure I knew how much this thing mattered to me until I was done. Not passing would have bruised my ego, but work life would have remained the same.

In practical terms it means I've had both fundamental and approved advanced training, at least two years experience, and have passed an exam measuring cumulative and up-to-date knowledge on the subject.

But it's more than that.

As soon as finished and grabbed the quiet space to notice how light my body felt, up floated a montage of memories about this journey.

Sitting at 38 weeks pregnant in an intensive training hearing dozens of voices whispering about the impact of their mothers and thinking, almost as though a commandment: We MUST support the moms. If we are to give them so much power and oftentimes blame, we MUST support the moms.

Hearing the stories of women around me who felt lost, disconnected, traumatized, anxious, disempowered, and sad during their motherhood journey and it not quite making sense to me...yet.

Attempting to piece together the story of my grandmother, hospitalized postpartum at age 19, properly diagnosed at age 82, months before her death. Wishing I knew more directly about her lived experience, filling in the gaps with educated guesses.

Joining this community of providers who are the fiercest, most curious, smart, and supportive group of people I've ever encountered en mass. Helping each other hold the heaviest of experiences, forming a net - with clinicians who were strangers just moments before - to help catch those terrifying feelings of free-fall that Our moms are having. Feeling like I had arrived, truly arrived, in the company of this group.

And every. single, mama who has sat on my couch. Her and her and her and her and her. These souls who felt anything but brave and yet showed up anyway, sharing such difficult private experiences and availing themselves to whatever came next.

Relearning the lifelong lesson that even though there are common and predictable manifestations of anxiety, depression, and trauma, that each mama is different and her uniqueness holds healing wisdom. Watching these mamas soar even when they felt they were merely stumbling (a sincere feat in its own right at times).

I could go on.

And I realized then that this exam served as a ritual of sorts, one that honored the meaningful experiences leading up to it, and one that instills more confidence for what's to come.

So anyway, it's now Shana Averbach, LMFT, PMH-C. Thanks for reading :)

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Kindness is Queen: Three Research-Based Reasons to Practice Self-Compassion After Having a Baby

5/31/2018

The postpartum period is challenging by any reasonable standard - long hours, few breaks, a steep learning curve, physical recovery, predictable relationship distress (or that which comes with single parenthood), just to name a few factors. I wish this was compelling enough to get mamas to be gentler on themselves during this short, but oh-so-long-feeling phase.

Then there’s the hormonal rollercoaster, any genetic predisposition toward worry or sadness (on overdrive anxiety and depression), the repercussions of a labor experience that may not have gone as planned, life stressors, and the fact that - if you’re reading this - you’re likely parenting in the United States, which doesn’t have a system in place to support new moms, as many other cultures do. Those seem like enough reasons to be kind to yourself along the way.

And then there’s the part where most of us in the face of distress - due to how our brains work - quite naturally try to will, criticize or even berate ourselves into feeling differently (oh you thought it was just you? Nope). That seems just unfair enough to justify finding ways to balance the scales by steering some compassion inward.

But since these reasons don’t always convince mamas to go the self-compassion route (make no mistake about it, I am aiming to sway you!), I offer you three pieces of research that support the benefits of inclining kindly towards self. All of these come from Kristin Neff, who has a generous spread of research, tools, and meditations on her website. If you're visual, here's an infographic with a couple bonus research points.

1. Self compassion is linked to positive emotions such as happiness, optimism, gratitude, and positive affect.

Let’s go back to the part about life as a new mom being hard. There's nothing wrong with feeling challenged by it, but when we add in the critical white noise that often sounds something like - I should be enjoying every moment of this. I'm not cut out for this job. A better mom would know and do all the things – it adds a layer of suffering.

Finding a way to talk to yourself that includes messaging like – Oh hon, this is so hard right now, you are doubting yourself while trying to learn this new job. That's tough. You are not alone in your doubt or frustration – you will actually have a greater chance at being present for the sweet moments and the not-so-hard parts.

2. Self compassion fosters resilience in the face of adversity.

A sad truth about the journey to motherhood is that it sometimes comes with larger challenges. Some experience loss along the way, others have difficult, if not traumatizing, labors, and still others have devastating life circumstances rolling alongside the transition to motherhood – natural disasters, loss of parent(s), and community violence to name a few.
Finally, about 15% of new moms experience depression and 10% anxiety in the postpartum phase, increasing the difficulty of adjustment and enjoyment.

Enter again this extra layer of hurt with the inner response to these experiences. We have a way of yelling at ourselves to get back up that doesn't exactly, A) work, or B) foster the desire to reach out for a hand.

What if the next words we heard from within were:

You have made it through so much, and it's hard to muster the energy to even slog through the day. You are not alone in your struggle, even on your darkest day. Anyone would be having a hard time in your shoes. This hurts now, but won't last forever.

What the research suggests is that from this place – learning and practicing the skills of self compassion - we are better able to stand back up when pushed around and/or knocked over by adversity.

3. Self compassionate people feel less emotional upheaval when faced with relationship conflicts

Research shows that two out of three couples experience relationship distress in the first few years of parenting. Said another way, you can expect to have some degree of relationship conflicts after having a baby (and that's not even to speak of parental and in-law ones!).

Considering that fact that, as mentioned above, most people in this culture are parenting largely in isolation, having conflict with a partner is really tough – you are each other's third and fourth hands!

I don't know about you, but when I'm in a heated conflict I kind of emotionally spin out far away from my kind and reasonable parts. But when I can soothe myself through compassionate words (You're feeling misunderstood, you just wanted to enjoy this rare time together, oof. It's okay, it happens to most of us) and warm touch (hand on heart, hand on belly) I am able to come back to myself quicker, and then back to my partner.

My experience aligns with the research that says if you can find a way through with self-compassion, you will be able to find your footing more easily when swept up by conflict.

There is a simple and profound Buddhist concept that says Suffering = Pain x Resistance. When we are in the middle of the pain points that come in the postpartum phase and beyond, one way we resist is by listening to our inner critic, believing the tough parts will last forever, and, most concerning, thinking we are alone in our experience. Compassion is like a salve for the pain, thus lessening the suffering. And mama, you deserve to be soothed.

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Resources For New Mamas, San Francisco: Yoga, Pilates, and Beyond

5/21/2018

Take care of your body. It’s the only place you have to live.-Jim Rohn

From headaches to toe cramps, it would be a gross understatement to say that through pregnancy, childbirth, and postpartum, your body goes through a lot of changes. Some are barely noticeable, some excruciating, and everything in between.

One way to tend to your body during these times - and to prep for or heal from certain physical aspects of childbirth - is to practice yoga, pilates or another fitness method to the degree that you are cleared to do so by your doctor.

Considering the unique circumstances that come with the perinatal territory (from being extra stretchy to being especially sore in certain areas to actually having a baby with you!), it’s wise to practice with someone who knows about your needs.

Enter pre- and post-natal classes. These serve to get your body moving in the ways right for you (which can have amazing benefits for your mental state too). A not so small bonus? The opportunity to connect with other women in your same phase of life. You of course are also welcome to talk to no one, because both are appropriate in these kinds of classes.

Below is a list of local providers that, like the emotional support groups shared before, are stickin’ around for a while.

Yoga Tree offers both prenatal and mom-and-baby yoga at a couple of their locations. There are a few day/time options to choose from, as well as teachers. I imagine all teachers who specialize in mom support are special, but I’d be neglecting a San Francisco fact of life if I didn’t mention that Jane Austin is the queen of prenatal and postpartum yoga - a special lady with a huge passion for her work. (multiple locations, most commonly Mission and Potrero Hill)

The JCC is another place where you can find both prenatal yoga and baby-and-me classes. The facility is beautiful and of course you can check out any number of other classes and offerings (there are many). Members can also utilize up to two hours of childcare for littles 6 weeks to 10 years old. (Presidio Heights)

Preggo Pilates offers a wide spectrum of perinatal support, whether you’re simply preparing your body or healing from having your baby(s). Via classes and individual instruction (and sometimes retreats!), they specialize in prenatal and postnatal pilates, safe core Work, diastasis recti (abdominal separation), pelvic floor/incontinence/prolapse, postural and breath awareness, and cesarean healing. If the offerings aren’t enough to get you in the door I’ll add that the owner Stephanie Forster is a joyful presence. Read her "about" page and you'll feel held already: (Mission and Potrero Hill)

PRACTICE SF offers a variety of classes all with mindfulness in mind - among them pre- and postnatal yoga, with babies welcome. The space is tucked away like a mini oasis in the middle of the Marina and these classes - along with various workshops and series - serve to slow down and/or observe the natural busy-ness of the mind during this time of anticipation or full throttle parenting. One unique PRACTICE offering is their postnatal class for babies who are already crawling (typically you get the boot once baby is on the go). (Marina)

The Lotus Method is a departure from yoga/pilates zone, but is another way to get at the unique physical needs of this time period. They describe what they do best: "At The Lotus Method, we focus exclusively on Pre/Postnatal women. Using a strength training and functional movement approach, The Lotus Method incorporates breathing techniques and postural alignment and integrates your core and pelvic floor. We strive to diminish pregnancy pains and discomforts, prepare mothers for the demands of pregnancy and labor and help women recover and return to fitness safely postpartum.” This is a great option for those who know that commitment is crucial to actually doing the thing you want to do as they have different membership levels, with a three-month minimum. One piece of feedback I've heard numerous times about this place is that their assessment process is very thorough. They really get to know your unique needs. (SOMA, Marina/Cow Hollow, Noe Valley)

Last, but (based on so many local mamas raving about it) not least, another specialty program is Every Mother, formally known as The Dia Method. Every Mother offers online classes and community in addition to real life ones. This is just a piece of their manifesto: "Every Mother unlocks a scientifically proven method to strengthen the body during pregnancy and rebuild it after birth, regardless of how long it has been since you became a mother. We're a knowledge circle, a community, and a celebration of the mother you've become, and the woman you've been all along.” (online and various SF locations, check website to for up-to-date offerings)

Hopefully one of these options with be a great fit for you. A friendly public service announcement to go with the recs: You don't have to be as strong and flexible as you think to go to these classes. That's WHY you're going. You don't have to have the perfect outfit, nor a cute new water bottle. Your baby doesn't have to be fuss-free to be welcomed to a class, and you don't have to be either. Give it a try Mama. You got this.

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

Resources for New Mamas: Podcasts

5/15/2018

“There is divine beauty in learning.... To learn means to accept the postulate that life did not begin at my birth. Others have been here before me, and I walk in their footsteps.” - Elie Wiesel

Anyone else temporarily lose their ability to read while pregnant and/or postpartum? We know there are some significant brain changes that start in pregnancy and continue up to two years postpartum. These changes are shown to enhance the parts of our brains that will help us attune to our children (evolution, she is a beauty!), and perhaps the reading parts are not part of that system (that part is not tied to the solid studies linked, just my theory).

Lucky for us, podcasts are more popular than ever, and are an excellent way to gain knowledge in a more conversational way...well, more like an eavesdropping on an informative, interesting conversation way, but you catch my drift.

Below are some excellent options, for your new mama listening pleasure:

Mom and Mind is Maternal Mental Health-focused podcast hosted by Dr. Katayuni "Kat" Kaeni. Having listened to several episodes and shared in many maternal mental health cyber spaces with Kat, I want to say this: Kat is not f&%king around when it comes to MMH. She takes it seriously, and has dedicated so much time to getting great information out there. This is the end of my editorial for this hole post (thanks for humoring me).

The actual description of Mom and Mind says this:
"This podcast focuses on the Maternal Mental Health struggles related to becoming pregnant, being pregnant, birth and early parenthood. We talk about all of the stuff that you wish someone would have told you BEFORE you tried to be pregnant or have a baby. Postpartum depression is only part of the story. The goal of this podcast to put all of this info out in the open. There’s no need to hide these very human experiences…so many people deal with these struggles. So, the podcast provides real life stories of moms, dads and family AND we will talk with experts, leaders and advocates in the field of maternal mental health and maternal health. You deserve to be informed!!!!"

Honest Mamas - "supporting women emotionally & spiritually on the motherhood journey. Three psychotherapists, moms, and friends share stories & interviews about pregnancy, fertility, parenting, motherhood and much more" - is another great option, with dialogue about everything from birth planning to anger to coparenting and beyond.

For those experiencing high risk pregnancy and/or postpartum life, there is Delivering Miracles, which is "a podcast on the real, raw side of family-building including infertility, loss, high-risk pregnancy, bed rest, prematurity and healing after baby comes home.

For all things birthing related, there's Motherbirth, which seeks to provide "vivid, inspiring birth stories . . . meaningful advice from guest experts . . [and] honest exploration of what it means to become a mother.

Last, but certainly not least, is The Longest Shortest Time, which features "stories about the surprises and absurdities of raising other humans—and being raised by them. The Longest Shortest Time is a bold, daring podcast about parenthood in all of its forms." I can't recommend this podcast without noting the episode I think all new parents or parents-to-be must hear: The Weird History of Judgy Parenting. You're welcome.

So there's a start! Hopefully at least one of these speaks to YOU!

Yours in wellness, self-care and compassion,

Shana

Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call.

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