Dear Friends of PSI,
I was recently lucky enough to present a short talk about Postpartum PTSD at the Marcé Society meeting in Paris. Yes, you read that right…..the city of extremely sophisticated women in beautiful scarves and lovely little boots…..slender, dark haired young men (also in scarves), and food, GLORIOUS food. Need I say that I had a fabulous time?
My trip began in the small town of Tain l’Hermitage, located two hours southeast of Paris on the Rhone river. Here, La Teppe Medical Center sponsored a two day pre-conference on Interpersonal Psychotherapy. Since I did my graduate work with the psychologist who literally revolutionized psychotherapy with this approach, I felt as if I were returning home. IPT focuses on utilizing the therapist’s self as an instrument of relationship and “cure.” In this approach, the therapist is actually encouraged to participate emotionally (albeit in a disciplined manner) with the client, rather than utilizing analytic commentary. The therapist also aids the client in forming and/or repairing interpersonal communication approaches with those who are important to them. It is easy to see how such an approach would be useful when working with pregnant or postpartum families, particularly around identifying the need for assistance and then actually approaching people for that help.
We had some extracurricular fun in this location – visiting the famous Valrhona chocolate factory shop. Exquisite chocolates. I got some chocolate balls that included curry, cinnamon, and chili powder. They were awesome, and didn’t last long. We were unable to visit any of the local wineries (among the best in the world) due to the fact that it was harvest time and people had to focus on bringing in the grapes. No time for tours. Nevertheless, it was wonderful to simply look up to the hills and see the names of wineries looming above us. They were quite lovely to look at.
The attendees of the preconference came from around the world, but were particularly strongly represented by Australia, Turkey, and France. They were an exceptionally lovely group of people, and much emotion and excitement was shared. It was nice to have made these connections before heading off to the Marce, which was attended by over 700 people and would have been a bit lonely without prior attachments.
The Marcé was held in an area of Paris quite near the Eiffel Tower, which towered over us each day as we walked to the conference building. (It turned out to be farther away than I thought. It seemed so close, but when Birdie and I walked to it, it turned out to be about a 40 minute walk!) Birdie Gunyon Meyer (past president of Postpartum Support International) was my roommate for this whole trip, and what a time we had. I don’t think we ever got to bed before 2:00 a.m. There was just so much to talk about every single night, and so many adventures to be had…..we saw a funny show called “How to Become Parisian in One Night” (basically, be arrogant in as many ways as possible) and a terrible show at the Moulin Rouge. Oh, I mean, that one was BAAAAD. Also, of course, we were busy eating lovely meals at every opportunity. Birdie taught me to love sea bass (of course, one of the most expensive fishes to purchase…..sigh) and I added it to my culinary repertoire. We went twice to the same restaurant because their fish was so delicious. (Also because of the cute waiter with his adorable mustache and gallant manner.)
Anyway, the talks at the Marcé focused on prevention, identification, and treatment of postpartum mood and anxiety disorders. Presenters spoke from a variety of backgrounds and countries. For example, a physician from Indiataught us that postpartum psychosis in that country is often the result of a specific brain disease, which, if not treated promptly, may be lethal to the patient. Thus, certain types of testing and assessment are of the utmost importance – things that we would hardly even think of here in the U.S. Something to be aware of if you are treating a woman who has actually lived a significant portion of her life in India prior to giving birth here in the United States.
Speakers from Turkey described the very early state of development of postpartum programs in their country, and of their work to help more mothers receive educated treatment about PMADS in the midst of stigma and overall cultural denial. Researchers from Sweden presented their protocols for the use of lithium in postpartum moms with bipolar disorder, and noted the high percentage of bipolar women represented in their hospital programs for postpartum psychosis. And French speakers and poster presenters spoke at length about the many (I do mean MANY)mother-baby hospitals that are available in that country. They sound just fabulous, and I really don’t understand why we don’t have them all over America.
Here’s another thing that they have in Europe and the British Isles that we could use more of……home health visitors. Many speakers discussed the programs they train home visitors to do. For example, some home visitors are trained in applications of cognitive behavioral therapy, which they then utilize on routine home visits to new parents in order to help them successfully adjust to the challenges of parenthood. A few such programs are currently being researched to note the degree to which they are successful in preventin or ameliorating symptoms of PMADS.
There is a program being looked at in America which nurses act as “visitors” to parents who have babies in the NICU. They rotate around the unit, having talks with the moms and dads who are there – providing education and support in an ongoing manner but without the formal requirements of leaving the hospital to get therapy. Considering the extremely high percentage of NICU parents who develop depression and/or PTSD, this is a fabulous idea and definitely needed. Another program being researched is one in which midwives are trained in the application of cognitive behavioral therapeutic skills to use with their patients.
Several presentations focused on the development and usage of online programs for the prevention and treatment of PMADS. Maura O’Keefe from Canada discussed the program Mother Matters- an online intervention program for postpartum women, and Sandra Scherer presented on an internet-based stress management program for anxious women with preterm labor. Jeanette Milgrom (Australia) discussed a webbased CBT program for postpartum moms. There several other programs in development, and they seem to be going well, although the research is in early stages.
Finally, the biological contingent spoke at length about things such as phenotyping and genetic signature of PPMD in Swedish twins, monocyte gene expression in first-onset postpartum psychosis, and the epigenetic basis for depression. Vivette Glover, who has a website of her own (Begin Before Birth), presided at many of the biologically focused panels. I attended some of these talks, but they were incredibly detailed and really best suited for those who already have a strong knowledge base in the field.
There was some focus on PTSD – both in postpartum moms and in the nurses who care for moms when things go wrong on the Labor and Delivery Units. Jenny Gamble presented some specific ways to promote women’s mental health following births they perceive as traumatic. On her list were the following: (a) help fill in the missing pieces of the woman’s experience in order to help her create a cohesive narrative; (b) connect specific emotions to specific events; (c) review labor management without denigrating the care, but do provide a listening ear; (d) enhance woman’s social support systems; (e) reinforce positive coping strategies that are already in place; (f) explore solutions. She also spoke briefly on the suffering experienced by nurses who care for bereaved parents. Similarly, Cheryl Beck, DNSc, CNM, FAAN referenced her new study about the secondary traumatization suffered by nurses who work on L&D. (Cheryl Beck will be speaking at the PSI Conference in Minneapolis on June 21.) And my own short presentation focused on the percentages of women who view their births as traumatic, the risk factors that predominate in such cases, and the importance of interviewing women to understand their perceptions of the birth experience in order to prevent and/or treat childbirth related PTSD.
So…there is much for us to know, and investigate, and much for us to do to help those women who suffer with any type of PMAD, and to educate and help those who care for them. I am so grateful that I was able to attend both the preconference and the MARCE, andI highly recommend that people who have the opportunity attend the next MARCE Conference (2014) in Wales.
Leslie Butterfield, PhD
PSI of Washington Chair