Month: August 2012

Bringing new mothers’ pain out of the shadows

More needs to be done to raise awareness about the devastation of postpartum depression among the public and medical community and to make effective treatment widely available.

Kimberly Wong

Public defender Kimberly Wong, who suffered severe postpartum depression, founded the Los Angeles County Perinatal Mental Health Task Force to raise awareness about the illness. (Christina House, For The Times / July 29, 2012)

By Kurt StreeterJuly 29, 2012 

Just like for so many others, including my wife, Kimberly Wong didn’t see the darkness coming, and nobody warned her that it could.

Here’s what happened. After years of trying, Wong got pregnant and at first everything went perfectly. The lead-up, the birth, the first week with the new baby, a cute little girl she and her husband named Marley.

Then out of nowhere this tough-minded public defender crumbled. Wong’s skin felt like it was being zapped by a cattle prod. Her resting heart rate was often 100. She could barely eat, sleep, slow down or think cogent thoughts.

Her doctor told her she was simply a high-strung lawyer who needed to relax. So she blamed herself, which made matters worse.

It didn’t help that the doctor’s advice made no sense. Wong had something relaxation can’t cure. She’d been hit by postpartum depression, brought on by, more than anything else, whipsaw hormonal changes that come with giving birth.

This isn’t something we can afford to keep sweeping into the shadows.

Experts say 10% to 20% of new mothers experience it: a steep drop in mood that’s far more devastating and lasts far longer than two or three weeks of the so-called baby blues.

Wong had the worst type. She penned a suicide note. By luck, her husband walked in on her. He took her to a Mid-City mental hospital so she wouldn’t harm herself. Nobody at the hospital had much expertise in what she was battling.

That’s when Wong realized how few options there are for women who need psychological help related specifically to motherhood. She had to drive 50 miles to find a doctor and a support group that really understood.

You should know that time has passed, about eight years since the height of it, and Wong and her family have bounced back. In fact, she has turned her struggles into something good.

“I’m trying to make sure other moms don’t go through what I did,” she says.

When she’s not working at the public defender’s office, she focuses on the nonprofit she started: the Los Angeles County Perinatal Mental Health Task Force. Sure, clunky name, but can there be a more important cause?

Experts say that in L.A. County alone, about 22,000 new mothers suffer from this awful malady every year.That’s 22,000 women — as well as their babies and partners — who need special support and too often aren’t getting it.

The task force — bare bones, operating largely on the energy of volunteers — aims to push us out of the shadows: moms and families who need help but are too embarrassed or just don’t know where to turn; doctors and social workers who are either ill-informed on the nuances of this illness or just don’t look hard enough for the warning signs.

Wong’s doctors didn’t really talk about the possibility she could grow terribly depressed after giving birth, she said. They should have.

She’d suffered childhood trauma: Her mother died when Wong was 11. There was a history of mental illness in her family, and she’d struggled to conceive. Those three facts put her at risk, but no doctors warned her, nobody came up with a plan that could have shielded her from near-fatal darkness.

“There’s just so much stigma that needs to be shattered,” Wong says. “I want people to talk about this like they talk about diabetes or having a bad heart. Not enough has changed since this happened and when it did happen I could barely get help.

“I’m a professional from West L.A. and it was hard enough for me,” she adds. “So think about women in poor communities with little access to good healthcare. Add it up and so many are suffering and the long-term effects for families can be devastating. Yeah, we need to talk.”

I know.

After the birth of our son in 2010, my wife battled postpartum depression. It wasn’t anywhere nearly as serious as what Wong went through and that’s important to know: This malady shows up in different strengths.

My wife’s was a more typical case. She wasn’t close to hurting herself or being put in a hospital. She did everything anyone could ask for our son. But for long, long months she lived in a world of sharp, shattering emotion that could have been avoided if we’d known more or had more aggressive help.

It could have broken my wife. What if she hadn’t had a partner to help? What if she had been poor? We’re insured, and even then it took a while for her doctors to understand how serious this was. But eventually she found a therapist who could talk her through the trouble.

Part of the problem is we live in a world swaddled in golden-hued mythology about parenthood. It’s supposed to be full of nothing but joy. If it isn’t, then moms are told to get more sleep and toughen up. That’s not helpful when depression sinks in its claws.

“A lot of us hide from this issue,” says Wong. “That has to change.”

She’s talking. So am I. So is my wife, who pushed me to write about her ordeal. If you care about mothers and children and families, well, you should be talking too.

Copyright © 2012, Los Angeles Times

Extended Bottlefeeding and Obesity

Does Extended Bottle-Feeding Really Cause Obesity?

July 20, 2012
With research you have to remember that it’s not every single person that will have the outcome that they predict. What the researchers are saying is that for those babies that drank out of a bottle longer, more of the babies were likely to be obese later on. This not a direct cause and effect, meaning that it does not mean your baby will be obese if she is still using the bottle at 36 months. I have a child who is a perfect example of that. Three years, two months old, loves the bottle, skinny as a rail. But there is something to the research and the underlying reasons are what need to be examined. Are the babies who drink from a bottle as an older child also getting sugary cereals and breakfast bars instead of fruits and vegetables? This are things to examine and look at.


The following is reposted from:

Even though she’s now 23 months old, my daughter Maya still really likes hitting the bottle. It’s a ritual—the first bottle of the morning, and a request when I get home from work. She sits on my lap, we cuddle, and she relaxes, her body growing less tense. In the evenings, I don’t give her much because it will ruin her dinner. We both know it’s the pose that matters, and that little time for reconnection.

So of course I was immediately concerned when my pediatrician abruptly told me to stop using bottles “cold turkey” because they are linked to obesity. She was right that a new study from last year connected bottle usage to obesity, and it sure made for some frightening headlines when published, like this one: “To Avoid Adult Obesity Stop Bottle-Feeding at 18 Months,” from Medical News Today. The article began by intoning darkly:

If you want to reduce your baby’s chances of becoming an obese adult you should not continue bottle-feeding him/her beyond 12 to 18 months.

Who wants a fat kid, really? Or this one, from U.S. News, “Prolonged Bottle Feeding Boosts Kids’ Obesity Risk,” which began:

Nearly one-quarter of 2-year-old bottle feeders were obese at age 5, researchers say.

Well, I suppose that seems clear enough. But what did the research really say? Here’s more detail:
The prevalence of obesity at 5.5 years was 17.6, and 22.3 of children were using a bottle at 24 months. The prevalence of obesity at 5.5 years was 22.9% (95% CI, 19.4% to 26.4) in children who at 24 months were using a bottle and was 16.1 (95% CI, 14.9% to 17.3%) in children who were not.

Prolonged bottle use was associated with an increased risk of obesity at 5.5 after controlling for potential confounding variables (sociodemographic characteristics, maternal obesity, maternal smoking, breastfeeding, age of introduction of solid foods, screen-viewing time, and the child’s weight status at birth and at 9 months of age).

I was struck by several things here. First, although nearly 23 percent of bottle-feeders were obese at the age of 5 1/2, 16 percent of the rest of the population (i.e., not bottle users) also were, which is only a 7-point difference.

Second, the sample size is on the small side — i.e., 22 percent of the sample used a bottle, 23 percent of whom ended up overweight. That’s a total of 341 kids. If we subtract the 16 percent that represents the background obesity rate, there are only 55 kids whose habits are driving the conclusions (because they make up that 7-percent spread). The authors say that is a statistically significant number, though, so I also took a gander at their assumptions.

They used a data set with limited inputs, certainly. First, the study did not account for what was actually in the bottles. Yet it seems to me that this could matter a lot. Apple juice, for example, is high in calories and does not fill you up, yet creates a taste for sugary drinks, making it easy to consume to excess. While whole milk may be higher in calories, it offers a host of essential fats, vitamins and calcium, and is denser and harder to over-consume. Water, obviously, has no calories. Formula, which is loaded with sugars that stimulate appetite, unsurprisingly is also linked in previous studies to obesity.

As children are frequently given juices (or even worse, Kool-Aid), given the small number of families driving the conclusions, this seems like an important caveat, and one notably missing from the official conclusion or coverage. Instead, the authors publicly suggest the opposite, where one of them claims that the study accounted for “feeding practices during infancy.” But this is misleading. After all, what a child is actually consuming has just got to be more important than whether it’s being delivered by bottle or cup.

Second, the study did not measure the kind of bottle being used, whether glass or plastic. Before you think I’ve gone off the deep-end on this one, consider that studies have shown that Bisphenol-A (BPA) likely plays a significant role in obesity, both by making our bodies produce insulin as though we are consuming twice the calories we actually are, and by helping to flip a genetic switch that predisposes us to be fat.

The study’s data-set spans 2001 to 2006, when most parents were unaware of the BPA issue and most bottles still had BPA in them, and in which plastic bottles were typical, as they are today. But the analysis simply ignores the possibility of harmful chemical influences.

Third, the authors’ don’t recognize any benefit at all from using a bottle:

Rachel Gooze notes that weaning children from the bottle by the time they are 1 year of age is unlikely to cause harm and may prevent obesity.

I beg to differ. Research shows that strong bonding is essential to healthy brain development, particularly in children ages 0 to 3 years. While extended use of a bottle is not an essential part of creating these bonds, the act of feeding a child is intrinsically a nurturing moment, and so it may not be irrelevant either. The researchers should have at least considered the possible emotional downsides.

For our family, my daughter never breastfed, and so our bonding over a bottle has replaced a rather fundamental missing piece. I’m not eager to let this go based on one study showing she could, maybe, have a slightly greater chance of being obese four years from now, especially given the care I take with her overall diet. For example, she almost never has juice, or really concentrated sugar of any kind.

If using a bottle appeared to be causing cavities or hampering her speech development, that would be another issue, and is a legitimate concern raised by dentists (those sugary beverages again!) and speech pathologists. My daughter now uses (I would guess) about 600 words and more every day. She’s also never been very interested in a pacifier or thumb-sucking, either of which can also be a speech development blocker.

Moreover, she eats a wide variety of fruits, proteins and vegetables, uses both sippy cups and regular cups, and is learning to use a straw, as speech experts advise. The bottle is just a break, and I assume will drop away sometime when she’s no longer needs that daily form of checking in. If not, we’ll ease it out of use and replace it with some other bonding ritual we invent.

In the end, I’m not convinced at all by this study, and disappointed that both my pediatrician and the press apparently take its conclusions as gospel. Advice from doctors rarely seems to take account of the havoc that would be wreaked on families’ lives by following their rigid approach. The costs of this in terms of both family peace and pediatric credibility are high. And the concerns around obesity have now reached such a fever pitch that it seems we’re able to be bossed around on “slim” evidence indeed.

In the end, it seems to me, we all would benefit from trusting our instincts about what’s right for our child–for others besides my daughter, taking the bottle out of circulation may be no big deal. For the rest of us, we probably just need a moment or two to relax in a day, and so do our kids.

How does your family come down on this issue? Am I just making up excuses because I don’t want to face the music (or really, screaming)?

Did I miss something important about the study or its implications? Or do you agree with me that this is just another in a too-long line of simplistic anti-obesity messages that fail to grapple with the real issues?

Laura MacCleery is a non-profit lawyer, mom and squeaky wheel in search of a spoke. Read more of Laura’s writing on her blog, Laura’s ‘Rules’.

Kissing Kids on the Lips!

So lately there’s been a flurry of on-line activity on an attachment parenting forum that I follow around the issue of children kissing on their parents on the lips as a sign of affection. Most people are of the opinion that this is a personal choice that each family has the right to make and that the family should act according to its family rules, values, traditions and beliefs. To me this is the obvious response given that no one family is in a position to tell another family how to act or behave, or what is right or wrong.

One mother’s answer, however, resonated with me quite strongly. She stated the following:

“I have been thinking about this for 3-4 days now before I responded, trying to be sensitive to other cultures and other ideas. I have thought it over, but in the end, I am just plain sad. I can’t say it any other way. I am sad and disappointed that other kids can’t kiss their parents on the lips if they really want to. This seems VERY awkward to me. WHY is this not ok? How is this so different than the cheek? Really analyze that…cheek vs. lips…why does it matter?

What I worry about is that the kid gets to see you freely kissing your partner/spouse on the lips, but they are forbidden from doing so. Thus, for me, this translates into “You, young child are something different, you must NOT kiss me on the lips, you don’t deserve it, you are not worthy, it is some kind of special something reserved for ______. Reserved for WHAT??? For me, this feels essentially that this kissing on the lips action (in a child’s mind) is BAD.

So, kids can’t achieve this worthiness until they are mature…dare I day “sexually ready”? What kind of signal does THAT send? I don’t want to equate romantic kissing with sexual readiness. I think exploring is good and healthy…if my girls can’t be comfortable here with us, where CAN they be comfortable to explore?

I get that this is a culturally relevant issue. I live in a white, American culture that is rather stuffy and we work hard to overcome that. Maybe too much so. I don’t know. What I do know is that we kiss our kids freely on the lips every day and they do so to us without hesitation and we don’t want that to change that at all.”

I thought that this was a balanced perspective which brings in the idea that the EuroAmerican culture traditionally eschews physical affection and physical touch creating a forbidden fruit type of culture. The idea of the naked body in the U.S. is much more taboo compared to other cultures to the point that we cover our children up long before children in other countries are expected to wear bathing suits in public. Isn’t it healthy for children to be able to run around without clothes and to normalize the naked body? By covering our children up so young, the naked body is over sexualized and glimpsing a naked breast is equated to the consumption of pornography. (This ties in, of course, with the current issue of women breastfeeding in public.)

As a woman who grew up without ever seeing her parents kiss in public and showing very little physical affection, I find it comforting to know that other families are also trying to change the generational taboo of physical affection and touch. Granted, I realize that in certain cultures, such as the Muslim culture, this may not be an acceptable practice; however, I am not raising my child in a Muslim culture. I am raising her here, in the U.S., in a different country with its own level of conservative beliefs and I will continue to foster a sense of comfort with love, touch, affection and kissing on the lips, as long as she is comfortable with this act.

Many thanks to the mom from the forum who granted me permission to quote her post. It takes a village to educate a nation.

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