Expert Voices: Dr. Ivy Margulies

Dr. Ivy Margulies

Dr. Ivy Margulies

We are honored to have an expert voice on a very difficult topic to learn and talk about. This is an important addition to our information resources.

Getting Support for Pregnancy after a Stillbirth

No matter what month of pregnancy you were in when your baby died, it is a devastating experience. After experiencing such a loss, you have just as much right to grieve and have a memorial service and/or funeral for your 21-week-old infant as does the woman who birthed her deceased baby full term. Your life has changed forever by this tragedy and you will always be a mother to your baby and you have the right to honor that. 

Pregnancy after a loss, or several losses, makes it more difficult to believe you will actually have a baby one day.

Unfortunately, it also places your body and mind in a constant heightened state of anxiety and worry.  There are things you can do to manage the anxiety during your pregnancy such as having the reassurance that your doctor’s office will see you as often as you need outside the routine prenatal visits.

  • Many women are reassured by hearing their baby’s heartbeat, particularly when they haven’t felt the baby moving too much. I had one patient audiotape the baby’s heartbeat on her phone so that if she were having a moment of worry she could play the soundtrack to calm her down and bridge the gap between appointments. Most doctors who have had a patient with pregnancy loss will offer this to you. 

    But you are your best advocate.

  • Educate yourself on terminology and recent findings surrounding pregnancy loss and stillbirth. Be curious to learn that a woman of advanced maternal age should be receiving antenatal testing beginning at 37 weeks and delivering her baby by 39 weeks thereby reducing the incidence of unexplained term stillbirths. Being your best advocate will allow you to feel more actively engaged in your pregnancy, a feeling that many women are comforted by. The mind/body approach is equally important. So during subsequent pregnancies learn about the influential power of breathing.
  • The breath has the capacity to calm your nervous system down and help you remain present when you start to feel insecure or panicky. • Our in breath is generally shorter than our out breath, so please focus on the breath going into your lungs to the count of 3 and watch the breath go out to the count of 4. Do this for 3-5 minutes and you will feel calmer and more in control and less chaotic.
  • Create a journal. It is a wonderful way to manage the emotional ups and downs of your pregnancy. By doing so, you can help you track your daily emotional state, be aware of any negative triggers in particular; did you have an interesting dream or was there an anniversary date that prompted an intense reaction, etc.
  • Lavender aromatherapy is very helpful in producing a calming effect and it will also help you sleep. There are other aromatherapy oils that produce relaxing, sedating and anti-anxiety benefits. Such as, Bergamot (relaxing), Mandarin (calming), Jasmine (sedating) and Sandalwood (sedating). If you can, pregnancy massage is another useful support to help you get through the last few months. No matter what particular way you have of pampering yourself and/or distracting yourself from anxiety, write those down and look at them when you need ideas.

Some people find Color Therapy a helpful tool; the color green is useful for calming and balancing the heart chakra, it promotes emotional harmony and balance. Green is a healing color to look at, wear and surround yourself with. Another useful color to wear or visualize around you is the color white. Just about everyone has heard of surrounding people with the “White Light of Healing and Protection.” So directing white light around you helps you to facilitate healing yourself and give you the comfort of knowing you are surrounded by a protective light aura. Sometimes no matter what we do we find we cannot relax.

This would a good time to add a psychologist or psychotherapist to your ‘birth team’ to help you with your more complicated thought patterns. A psychologist or psychotherapist can teach you some cognitive behavioral techniques that challenge the thoughts that are causing you distress. This therapy can be very effective at helping you find relief from the unrelenting thoughts, thereby helping you to enjoy your pregnancy more than you would have otherwise. Social support is also critical during this time. It is important to know you have a few close friends besides your partner that you can rely on to support you emotionally. It may also be a good idea to look for a doula or midwife to companion you through the pregnancy and/or a support group with women who because of their similar experiences not only understand and validate what you are feeling, but can ‘hold’ you through what can still be a joyous 40 weeks.

To increase your odds of having a successful pregnancy make sure you optimize your health prior to pregnancy with folic acid, vitamins, maintaining a healthy weight, exercising, having genetic counseling tests performed and reducing any stressors possible. Prepare your body, your mind and your spiritual self to welcome conception and bring your baby through to your waiting arms.

I wish you peace, love and white light,
Ivy Margulies, Psy.D.

Dr. Ivy Margulies is a Clinical Psychologist, Certified Death Midwife and the Founder of Angels Born Still. Her website is www.drivymargulies.com Twitter: @DrIvyMargulies. If you need any advice or have any questions please feel free to email her at ivy@drivymargulies.com.

Words of Wisdom – Excerpts from Christianne Northrup, M.D.’s Work

One of the leading authorities on women’s health is OB/Gyn and author Christianne Northrup was writing about the trend of women becoming mothers for the first time after age 35 back in the 1990s. Her ground breaking book Women’s Bodies, Women’s Wisdom from 1998 gave us a lot to think about.

Some Highlights of Her Comprehensive Book…

She writes about the field that she knows best and in her Pregnancy chapter she says “Modern obstetrics, however, has changed from natural , patient “standing by” and allowing a woman’s body to respond naturally into a domineering and often invasive practice.” Dr. Northrup discusses how pregnancy is now defined as an illness in American culture for young and older women.

She discusses the term “elderly primigravida” and how she resents that label being given to women having their first baby over age 35 or even age 30 in the 1990s. Of course the term “Advanced Maternal Age” is the label many of us received in the 2000s and today.

  • “Whether or not a woman is more at risk in her thirties must be completely individualized. I’d rather take care of a 40-year-old in excellent health than a twenty-five-year old who smokes two packs and quaffs a gallon of Diet Coke per day. Too often the medical profession “hexes” women in who become pregnant in their thirties or forties by lumping them into statistically high-risk categories that are not necessarily applicable.”
Another term that may or may not be used in the present day is “Premium Pregnancy, meaning that the mother is presumed to be or is more anxious (0r is made more anxious by culture and her doctor!), and we should treat her differently.”  Dr. Northrup sees the bias as well. It’s hard to imagine how we might feel if our doctor made us anxious about this being our only pregnancy – having little idea of what our futures might hold.
Dr. Northrup makes some observations about moms having their first child after age 35 that are very true for many of us:
  • “One of the nicest things about women having their furst babies in their late thirties and early forties is that by then, these women have often established themselves in the outside world of work and career…Many have had the time to get in touch with their bodies over the years and are more comfortable with themselves than they were in their twenties, In my mind, these women are actually low risk,” she wrote.

Expert Voice Iris Waichler, MSW, LCSW

                                    Choices and Tips for Starting a Family After Age 35

 

The number of women who are choosing to have a child after age 35 has been steadily growing for the last 30 years. The Center for Disease Control reported that as of 2006 there were 600,000 babies born to women over the age of 35 in the United States. There are many reasons for this trend:  women want to complete their education, establish their careers, find the right partner, and need to have geographic stability before becoming mothers.  The advances in assisted reproductive technology have also contributed to this trend.

How do you know when you are physically and emotionally ready to begin to build your family? What questions should you ask yourself?  What can you do to prepare yourself for this life-changing journey? Each woman should examine her own reasons for considering becoming a mother after age 35.   

Ask yourself the following questions:

  • Why is now the right time for me to foster, adopt or birth a child?
  • What is my lifestyle and how will having a child impact it?
  • Do you want a biological link to your child or am I comfortable using a donor, surrogate, or adopting?
  • Do I have a stable relationship with a partner or do I feel comfortable about being a single parent?
  • What are my career goals and time demands and how will they fit in with my new role as a mother?
  •  Do I think I will have regrets in the future about not having an opportunity to become a parent?
  • What sacrifices am I willing to make to become a mother?  When I think about this does it raise any doubts or conflicts?

Pregnant by Choice

Choosing to become a parent is different than having an unplanned pregnancy.  When you plan to try to get pregnant, especially over age 35, you should be more assertive about having good prenatal habits.  Many women start taking folic acid 3 months prior to conceiving and continue through the first 3 months of pregnancy. Consult a trusted physician to get information on good prenatal practices and get a complete medical workup.  It is advisable to learn about any potential medical concerns that might affect you or your partner’s success in having a healthy baby.  You might want to consider seeing a reproductive endocrinologist.  They have specialized training combining obstetrics and gynecology with training in hormonal functioning and in treating infertility.  Women over age 35 may experience new health issues like diabetes or hypertension at higher rates than younger women so ongoing prenatal care is important to your ongoing health and the health of your baby.

You want to work with a physician who shares your beliefs about it being all right to become a mother late in life.  I have heard stories from many men and women who felt they were being negatively judged by their medical team for making this choice. Put together a birthing plan with your partner if you have one and discuss it with your physician ahead of time. (Sharon talks about  her challenges around this in her recent post.)

  • It should include your wishes regarding whether or not to have a caesarean section.
  • Do you want to have medications during your labor and delivery?
  • Where do you want to have your baby, at home , a birthing center or a hospital?
  • Do you want to use a doula?
  • Ask your doctor if there are any risks associated with the choices you are making and what his/her philosophy is about pregnancy, labor, and delivery for women over age 35.

Some Fostering and Adoption Choices

The trends for those who are 35 or older and want to adopt are similar. There is an increase in the number of people choosing to adopt (or foster to adopt) who are in this age bracket.  Those parents who are placing their kids up for foster care and adoption are looking for adoptive parents who are more financially stable, in stable relationships, and have the emotional maturity to be good parents. Age may or may not be a factor in selecting adoptive families.

If you are considering an international adoption, be aware that different countries have different policies about the age of their prospective adoptive parents.  For example, countries like Korea, India, China, Africa, and some Latin American countries have been open to allowing parents over the age of 35 to adopt. These policies are subject to change. Consult established adoption agencies that have the latest information on regulations for countries you might be interested in investigating for potential adoption. If you want to do a domestic adoption, you also have options.  You can try to find an adoption agency in your community that works with older parents. If you have trouble finding a program, there are online adoption support sites (see below) that can offer this information.  Remember, that you have the option of adopting from other states. Clarify their agency requirements in terms of whom and how your home study is done.

Some Considerations

Whether you become a new parent later in life through adoption, foster care, pregnancy with or without infertility treatment, there are things to keep in mind: 

  • Do whatever you can to maintain your physical well-being. Healthy diet and lifestyle choices are important.  You want to be a parent and perhaps grandparent for as long as you can.
  • Get as much sleep as possible. Use your child’s naptime for you to take a nap too.
  • Becoming a parent after age 35 requires a lot of energy.  Find creative ways to allow your child to play safely, expend energy, while you participate in a more
    low key way.  Do play dates to give yourself a break.  Find enclosed play areas and classes that the kids can participate in while you watch.
  • Women that become mom’s later in life have greater world experience, have better problem-solving skills.
  • The emotional maturity associated with older age makes you better equipped to handle unexpected problems that may arise.
  • Women that are older generally have a stronger more established network of family and friends.  Use trusted members of your support community
    to offer physical and emotional support as you engage in parenting.
  • Consider joining groups with other families that have been created in similar ways. For example, if you adopted a child from China, find a local group that
    has other families who have adopted kids from China.  I joined a parenting after infertility group with other families who conceived their kids through egg donors.  It helped me feel less isolated and normalized how our kids came into our families which helps us as parents and provides our kids peers with similar backgrounds offering support as they grow up.

Partial List of Resources

National programs like RESOLVE can offer information on local adoption and infertility support programs. You can find your local chapter by going to http://www.resolve.org/about/helpline.html. Another good resource that offers a variety of information on adoption on a national level is http://www.adopt.org/assembled/values.html. (This website is seeking to provide valuable resources of all types to women seeking to be mothers.)

Choosing to become a parent over the age of 35 offers a unique combination of challenges and advantages for each individual.  It will take patience, determination, physical, emotional, and financial sacrifices to find the best route to make your family building dreams a reality.  Identifying local agencies, resources, family, friends and staff that share your vision will make the journey go more smoothly.  Don’t be afraid to advocate for yourself, display your confidence, and be actively involved in the process.  This will help others have confidence in you and your decision to parent.                                                                                                                                                                    

Iris Waichler, MSW, LCSW, has been a licensed clinical social worker for over 30 years.  She has done workshops, individual, and group counseling with people experiencing infertility and authored  the award-winning book Riding the Infertility Roller Coaster: A Guide to Educate and Inspire

Read Iris’ previous post:  The Experience of Being a Mother of Advanced Maternal Age (MAMA)

“Pregnant Woman” and “Happy Mother and Daughter” images courtesy of Image(s): FreeDigitalPhotos.net

Expert Voices: Interview with Natalie Burger, M.D., Reproductive Endocrinologist

Editor Sharon had the opportunity to interview Natalie Burger, M.D. about her work with couples.
Natalie Burger, M.D.

Natalie Burger, M.D.

Sharon: What services do you provide to women?

Dr. Burger: I am a reproductive endocrinologist — most people know us as fertility specialists.  My primary practice is taking care of women and men who wish to become parents.  However, I also have specialized surgical and hormonal training to take care of patients with other kinds of reproductive health problems (e.g. endometriosis, premature ovarian failure, polycystic ovarian syndrome (PCOS)).

 

 

Sharon: Is there some bit of information that you find women tend not to know that you wish they had known prior to coming to see you?

Dr. Burger: Probably the most common misperception that we see is that we have overcome the challenge of ovarian aging.  Because there are more and more women in the news who appear to be having children in their 40s and even 50s, it may appear that we can overcome ‘tired ovaries’.  We can overcome many things (e.g. blocked fallopian tubes, low sperm count, etc.) but we cannot reverse aging of the ovaries.  Many of the older women in the media who seem to be achieving pregnancy are actually using donor eggs (eggs harvested from a young donor in place of their own.).  This certainly is a very private decision — and understandably one that many people may not want to reveal to the general public.  However, it is important to understand that ovarian function continues to decline with time, no matter how healthy or fit an individual is.

Sharon: Do you find yourself giving advice to women experiencing infertility to complement their diagnosis and treatment plan? What are some examples (e.g,. supportive words)?

Dr. Burger: Dealing with infertility can be incredibly challenging.  People often think first about the financial stresses, but even more important are the psychological ones.  Going through infertility (with or without treatment) can place huge emotional pressure on women and their relationships.  Men and women often approach the struggle of infertility differently, and we try to help them understand each others perspective.

After I discuss medical aspects of infertility, I try to also address some of the emotional aspects as well.  

First and foremost, it is important for my patients to understand that they are not alone.  

Fortunately, it is becoming more commonplace for people to talk more openly about their fertility struggles — but there are many, many people who are dealing with infertility who are not necessarily disclosing their challenges.

We are lucky to have many counselors in the area who work with a lot of our patients — and who understand some of the more specific issues our patients are dealing with.  This is especially helpful if someone is not yet ready to talk in a more public forum.  We also have an infertility support group that is run by a nurse at our clinic — it can be very cathartic to talk face-to-face with someone who understands the monthly highs and lows that an infertility patient faces.

Strengthening emotional health can give patients the stamina they need to get through the infertility journey successfully.

Sharon: Is there any advise that you routinely share with your patient’s partners?

Dr. Burger: Men and women commonly deal with infertility differently.  I think it’s important to recognize that even though your partner is not dealing with the situation the same way you are, it doesn’t mean that they don’t care.  They may just not understand your perspective.  If a couple is really struggling, I would highly recommend talking to a counselor or other third party.  It can prevent or at least mitigate some of the hurt and anger that can occur when it seems like your partner doesn’t understand.

Sharon: Approximately, how many of the women who come see you (%) have been older than age 35 and trying to conceive their first child?

Dr. Burger: As it is more common these days for women to defer childbearing to focus on career, it is very common for us to see women in their later 30s and 40s.  I would estimate that about 25% of the patients I see are women over the age of 35 who are trying for their first child.

Sharon: How often do you see women experiencing secondary infertility, even if they have conceived successfully after age 35?

Dr. Burger: Secondary infertility is very common.  As ovarian function continues to decline with time, what might have been easy a few years ago can turn into a real struggle with time.  In addition to the ovaries getting older, other medical issues can become more common with age (e.g., fibroids) and these things can also thwart fertility.

Sharon: What, if anything do you see as different about the older mothers? This could be about their health or attitudes toward health and pregnancy.

Dr. Burger: Older mothers have the benefit of life experience.  Mature women tend to be especially motivated and committed to the success of the process.  They are prepared to do what it takes to get to the end goal. 

 I would say that there is also a certain strength and resilience that I see in this group of (AMA) women.


Sharon: Thinking about the questions that they ask you in person (or by phone or e-mail), what if anything is unique or thoughtful about their questions? Is there any wisdom in advanced maternal age?

Dr. Burger: I think that many of the questions are similar no matter what age of patient I am working with.  Oftentimes more mature patients have already done their homework so to speak — and come especially prepared to discuss infertility evaluation and treatment.


Sharon: What else can you share about your observations and interactions with women of age 35 or better?

Dr. Burger: I would tell my current and future patients that their journey to motherhood may not happen in the way that they initially felt it would — however it will happen the way it was meant to be.  Be open to the different paths that can lead to you becoming a parent.

Natalie and Sons

Dr. Burger is married with 2 kids and a Board Certified Reproductive Endocrinologist with Texas Fertility Center in Austin.  

Expert Voices: Christina G. Hibbert, Psy.D. on Pregnancy & Postpartum Mood & Anxiety Disorders: Are Women of Advanced Maternal Age at higher risk?

Dr. Christina Hibbert

Dr. Christina Hibbert

As mentioned in my previous contributions to The Advanced Maternal Age Project, Perinatal Mood and Anxiety Disorders (PMADs) are caused by a combination of biological and psychological factors:

  • Hormone changes in pregnancy and postpartum, coupled with sleep deprivation and the physical and psychological demands of becoming a parent can lead to depression or anxiety.
  • Genetics is also key, including previous sensitivity to hormone changes, and a personal or family history of mental illness. In fact, the most documented risk factors for postpartum depression include: a history of depression, depression or anxiety in pregnancy, poor social support, and stressful life events during pregnancy or just after the baby is born.

Are women of advanced maternal age at an increased risk for developing a perinatal mood or anxiety disorder? The short answer is “No,” at least not because of their age.

PMAD’s affect women the same regardless of age, culture, or socioeconomic status. Some research, in fact, has found that women of advanced maternal age may have more protective factors than younger mothers, including psychological advantages like greater resilience and more stable interpersonal relationships#.

 

However, a history of infertility does increase the risk of a Perinatal Mood or Anxiety Disorder. Since women of advanced maternal age tend to have a greater incidence of infertility, this puts them at a higher risk.

It is however well-documented that women struggling with infertility and undergoing Assisted Reproductive Technologies like In Vitro Fertilization have rates of depression almost twice the norm. 

Considering the extreme shifts in hormones, the cycle of rising and falling hopes and expectations, and the experience of multiple pregnancy loss, physically and psychologically these women have been “put through the ringer” (for more on the psychological impact of these experiences, read “Women’s Emotions: The Emotional Earthquake” article). This means that, once they finally do conceive, many  are entering pregnancy with depression or anxiety, increasing their risk for PMADs.

Once the baby is safely delivered, women who have previously struggled with infertility may also feel tremendous pressure for everything to be “great,” to feel like the “perfect mother” with a “perfect love” for their baby.

These pressures can actually lead to increased levels of depression or anxiety, which can lead to increased guilt about that depression. “I’ve always dreamed of having this baby. Now I’m not even happy. What is wrong with me?” many women tell themselves, and shame themselves over feelings that are beyond their control.

The Benefits of Knowing You’re At Risk

But just because a mother is at risk doesn’t mean she needs to panic. In fact, knowing you are at risk for a Perinatal Mood or Anxiety Disorder can be a huge benefit: It can motivate you to do the following:

  1. Get prepared for the possibility of a PMAD (see Part 1 of this series), and
  2. To seek support and treatment early (see Part 2).

The most important thing you can remember is this: You are not alone. You are not to blame. With help, you will be well. As a 4-time postpartum survivor myself, trust me as I repeat: You will be well.

For information on PMAD Treatment, visit my site.

Dr. Christina Hibbert is a Clinical Psychologist, Founder of the AZ Postpartum Wellness Coalition and Producer of the DVD Postpartum Couples. A 4-time Postpartum Depression survivor, Christina had her most trying experience in 2007, when her sister and brother-in-law died, she and her husband inherited their two children, and she gave birth to their fourth baby, going from 3 to 6 kids practically overnight (an experience she shares in her forthcoming book, This Is How We Grow) A speaker, blogger, and singer-songwriter, Dr. Hibbert keeps her practice, her family, and her heart in Flagstaff, AZ. Visit Dr. Hibbert at www.drchristinahibbert.com or www.postpartumcouples.com.
.

Expert Voices: Christina G. Hibbert, Psy.D. on Perinatal Mood & Anxiety Disorders

Dr. Christina Hibbert

Dr. Christina Hibbert

In Part 1 of my contribution to The Advanced Maternal Age Project we discussed the emotional changes that typically accompany pregnancy and postpartum. But what happens when those “typical” emotional changes intensify?

Perinatal Mood & Anxiety Disorders

Though many families have heard about Postpartum Depression, most do not understand that there is actually a spectrum of emotional disorders that can occur in pregnancy and postpartum. The term “Perinatal Mood and Anxiety Disorders” (PMADs) describes this spectrum. At the mild end is the “Baby Blues,” a temporary condition that affects most new mothers (see Part 1); at the severe end is the more rare Postpartum Psychosis. But there are many other disorders in the middle of the spectrum that most families know next to nothing about.

This brief overview will hopefully put Perinatal Mood & Anxiety Disorders on your radar, helping you identify when your “Blues” have gone beyond normal postpartum adjustment and when you may need professional treatment.

Pregnancy Depression affects an estimated 10% of women while Postpartum Depression affects 15-20%. Symptoms vary but may include: sadness, worry, sleeplessness, appetite changes, feelings of guilt, hopelessness, and even suicidal thinking. Symptoms can start anytime during pregnancy or the first year postpartum.

 

Pregnancy & Postpartum Anxiety

  • Anxiety in Pregnancy affects an estimated 6% of new mothers while Postpartum Anxiety affects at least 10%. With symptoms like worry, racing thoughts, sleep and appetite disturbances, and physical symptoms like nausea or dizziness, Perinatal Anxiety can feel debilitating and overwhelming.
  • Postpartum Obsessive Compulsive Disorder (OCD) is a specific type of anxiety disorder that affects approximately 3-5% of women. These women experience obsessions (usually in the form of intense thoughts or images related to the baby), a sense of horror about these obsessions, and compulsions, or behaviors aimed at reducing their anxiety. Postpartum OCD is the most misunderstood and misdiagnosed perinatal disorder.
  • Other forms of Postpartum Anxiety include: Postpartum Post-traumatic Stress Disorder (6% of women), which is usually the result of a traumatic childbirth experience, and Postpartum Panic Disorder (10%) with predominant symptoms of panic attacks and intense fears.

Postpartum Psychosis is the most rare disorder, affecting approximately 1 of every 1000 mothers. The symptoms of Postpartum Psychosis are extreme, including hallucinations (hearing and seeing things), delusions (or false beliefs), irritability, and rapid mood shifts. Unlike the other disorders, the onset of Postpartum Psychosis is typically sudden and it requires immediate medical intervention to protect the safety of the mother and the baby. Hospitalization is the recommended treatment for Postpartum Psychosis.

The Good News

Though Perinatal Mood & Anxiety Disorders are common and can be overwhelming and challenging, the good news is that all of these disorders are highly treatable. Treatment generally includes social and practical support, psychotherapy, and medication; a combination of these is considered “best practice”. Research is also discovering more alternative treatment methods, like massage, light therapy, and nutritional supplements. (For more on Postpartum Depression Treatment visit  my site.) 

The point is that there are options for everyone and you are not alone. You can overcome Perinatal Mood & Anxiety Disorders; the more you understand about them, the smoother the recovery.

Dr. Christina Hibbert is a Clinical Psychologist, Founder of the AZ Postpartum Wellness Coalition and Producer of the DVD Postpartum Couples. A 4-time Postpartum Depression survivor, Christina had her most trying experience in 2007, when her sister and brother-in-law died, she and her husband inherited their two children, and she gave birth to their fourth baby, going from 3 to 6 kids practically overnight (an experience she shares in her forthcoming book, This Is How We Grow) A speaker, blogger, and singer-songwriter, Dr. Hibbert keeps her practice, her family, and her heart in Flagstaff, AZ. Visit Dr. Hibbert at www.drchristinahibbert.com or www.postpartumcouples.com.

Now that you’ve learned about pregnancy and postpartum emotional health, you may be wondering, “Am I at Risk?” Join me for Part 3 where I will discuss the risk factors and causes of Perinatal Mood & Anxiety Disorders, and specifically those related to women of advanced maternal age.

Interview with Holistic Health & Fertility Writer, Jess Pedersen

Recently, Co-editor Sharon posed some questions to Jess Pedersen of Be Mama Be Well to learn more about her work and support of women.

Sharon: What services do you provide to women?

Jess: I am currently studying Holistic Health Coaching at the Institute for Integrative Nutrition (IIN). I recently received my pre-certification to provide nutrition and health counseling and will receive my final certification in December 2012 from the American Association of Drugless Practitioners. With that being said, the focus of my health coaching practice is infertility and women’s health. I will be providing one-on-one health coaching services and group workshops in and around the Pittsburgh area starting in September. I am actively sharing my knowledge about nutrition and fertility by blogging about holistic health on my own website, www.BeMamaBeWell.com, as well as serving as a contributor to other fertility focused sites, such as www.WithoutChild.com.

Holistic Health & Fertility Writer, Jess Pedersen

 

Sharon: Why did you choose this as your work?

Jess: I rode the “infertility roller coaster” for several years in my mid-thirties and wore the Advanced Maternal Age label during my two pregnancies. I was diagnosed with Polycystic Ovarian Syndrome (PCOS) in my twenties.

When I married my husband at the age of 33 I knew it wasn’t going to be easy to conceive. I made my rounds through the local fertility specialists, injected fertility drug cocktails into my abdomen, and eventually gave up on traditional medicine just before going down the IVF route. I found a Naturopath in my neighborhood that specialized in infertility. 

With changes to my diet and several other holistic protocols, I was pregnant within five weeks. It was miraculous.

That pregnancy ended at ten weeks and within eight months I was pregnant again. Sadly, that pregnancy ended at 26 weeks due to a condition called Preterm Premature Rupture of the Membranes (PPROM). I won’t go into detail about my history, but my story can be found on this blog.  Although my husband and I chose not to attempt to conceive again, I was amazed that my body responded so well to the natural fertility methods and treatments. 

The ability to change my fertility and improve my health through nutrition was something that I felt compelled to share with other women dealing with the heartbreak of infertility. That experience led me to find IIN and start a new career in my forties as a holistic health coach.


Sharon:  What percentage of the women you are helping are age 35+ and seeking to conceive their their first child?


Jess:
Although I am not actively practicing yet, I am connecting with a lot of women regarding the topic of fertility nutrition. The majority of these women are over 35 and either struggling to conceive their first child or are experiencing secondary infertility while attempting to have a second child.


Sharon: Are many experiencing secondary infertility after successfully conceiving at age 35+? How are their experiences and attitudes different, if at all?


Jess:
Yes, secondary infertility is often an issue with women over 35. I know from personal experience that infertility is emotionally and physically challenging no matter why or when you experience it. But I have seen that this population of women has a unique frustration in that they don’t understand why they are struggling when they conceived easily the first time. They typically ask, “What is different now? What am I doing wrong?” No one likes being labeled by their doctor as infertile. But having this label after easily conceiving in the past is shocking to most women. 

Secondary infertility can also cause a lot of emotional pain because people tend to be less sympathetic toward couples who already have a child. These women often suffer privately and seek support only from their closest friends, family, and health practitioners.

Sharon: What, if anything do you see as different about the older mothers? This could be about their health or attitudes toward health and pregnancy.


Jess:
Older mothers are excellent at taking charge of their health and their pregnancies. They seek out practitioners that will help them reach their fertility and pregnancy goals. From my own personal experience, I had a “whatever it takes” attitude regarding my hope to become pregnant and was willing to make sacrifices, eliminate allergens from my diet, and follow strict protocols to reduce the symptoms of my PCOS and improve my chances of conception. This type of persistence exists in this community of women as well. [Read more…]

Expert Voices: Christina G. Hibbert, Psy.D.

Pregnancy & Postpartum Emotional Health: What Every New Parent Should Know

 

Dr. Christina Hibbert

Dr. Christina Hibbert

Most families excitedly prepare for this “beginning of all things” expecting the “wonder, hope, and…dream” of bringing a new life into the world. For women of advanced maternal age and their partners, these “possibilities” may be even more “hoped” for. Yet while deciding to have a baby a little later in life can certainly be a joyful event, it can also bring many unexpected emotional changes, and mothers may find themselves wondering, “Why didn’t anyone warn me it could be so hard?”

“A new baby is like the beginning of all things—wonder, hope, a dream of possibilities” (Eda J. Le Shan).

Emotional Changes in Pregnancy
We’ve all seen the cartoons and heard the jokes of the “emotional” pregnant woman, and let’s face it—they can be pretty accurate! Pregnancy is known for its ups and downs, and despite a woman’s age, changes in emotional health are usually part of the pregnancy process.

During pregnancy, hormone levels are at an all-time high—30 times greater than normal. Hormones such as estrogen are actually precursers to the neurotransmitters in the brain that make us feel “normal”. Thus, when our hormones shift, the neurotransmitters shift, and our emotions shift too. For some women, pregnancy hormones can be protective, improving emotional stability and mood. But for many other women the shifts in hormones make them weepy one moment, elated the next, feeling frustrated and wondering, “What is going on with me?” (For more on hormones and the brain, read the “Women’s Emotions” series,

Postpartum Emotional Changes: The Baby Blues
Once the baby is born hormone levels drop below “normal” and then slowly begin to regulate again. These extreme shifts can trigger what many women describe as an “emotional roller-coaster” in the first days or weeks postpartum. Called “The Baby Blues,” these shifts in mood are a normal consequence of fluctuating hormones, lack of sleep, and the many physical and psychological demands faced by a new mother.

Up to 80% of new mothers will experience the “Baby Blues”. Symptoms include fatigue, sadness, irritability, anxiety, or feeling overwhelmed, but for most women these symptoms should improve in a few days or weeks. (For more on The Baby Blues, read “The Baby Blues & You”.)

Preparing for Emotional Changes
We tend to spend most of our time preparing for the physical aspects of pregnancy and childbirth, but it’s just as important to prepare for our emotional well-being. The following suggestions can help:

  • Learn all you can: Educating yourself and your partner on the emotional changes of pregnancy and postpartum is one of the best ways to be prepared.
  • Create a Plan: A “plan” for emotional well-being is a great way to decrease external pressure and remind yourself that “this is normal”. Your plan should include a solid system for emotional and practical support, and discussing your emotional health with your doctor.
  • Set up your support system: Research shows that moms who have good social support have better emotional adjustment. Your partner or spouse can be part of your “support team,” along with friends and family. Allow others to help with the baby, household duties, or help you get a little extra sleep. A postpartum adjustment group is another great resource for new moms. (Visit www.postpartum.net to search for a group near you).
  • Talk to your doctor about your emotional health: Start during  pregnancy and continue the discussion postpartum. Ask questions, and if your doctor doesn’t know the answers keep looking until you find them.
  • Seek professional help if your symptoms persist or intensify. If it’s been longer than two weeks or if your symptoms intensify you may be experiencing a Perinatal Mood Disorder like Pregnancy or Postpartum Depression. Seek help from a mental health or medical provider who is trained in these disorders in order to reduce symptom severity and duration.

Resources:

Dr. Christina Hibbert is a Clinical Psychologist, Founder of the AZ Postpartum Wellness Coalition and Producer of the DVD Postpartum Couples. A 4-time Postpartum Depression survivor, Christina had her most trying experience in 2007, when her sister and brother-in-law died, she and her husband inherited their two children, and she gave birth to their fourth baby, going from 3 to 6 kids practically overnight (an experience she shares in her forthcoming book, This Is How We Grow) A speaker, blogger, and singer-songwriter, Dr. Hibbert keeps her practice, her family, and her heart in Flagstaff, AZ. Visit Dr. Hibbert at www.drchristinahibbert.com or www.postpartumcouples.com.

Be sure to join me for Part 2 of this series as we discuss Perinatal Mood Disorders and treatment options. In the meantime, remember: Having a baby really can be a “dream of possibilities,” especially when you’re emotionally prepared.

Expert Voices: Dr. Shahryar Kavoussi

The stress that couples with subfertility undergo in their journey towards becoming parents can be immense.  It is obviously an emotional endeavor with ups and downs due to the difficulty that they may have experienced in conceiving; the hopes that each month’s attempt brings, and the disappointment if the result is negative after the two week post-ovulatory wait, are potential highs and lows that add to stress.

Women over age 35 should seek a fertility evaluation if they have not conceived after six months of unprotected intercourse — if a woman over 35 has a known factor (for example, infrequent or absent periods, endometriosis, male partner with a known history of low sperm parameters), then an earlier evaluation is warranted. Fertility evaluations and treatments can amplify stress to varying degrees in couples and I have found that the initial consultation is so important in terms of addressing stress.  The patients should be aware that they are not alone – approximately one out of seven couples in the United States experiences infertility.  That is over seven million people.  A comprehensive overview of fertility factors and treatment options helps to inform and empower women who are trying to conceive, and answering their questions helps address the concerns they have about their own fertility.

As patients subsequently have tests done and pursue fertility treatment, some may achieve a successful pregnancy within a shorter time span and others may have a longer, more difficult journey towards parenthood.  The intensity of emotions can change over time; therefore, it is vital to check on how every patient is doing emotionally and to make sure they are doing relatively well, considering the circumstances.

Sometimes, my patients ask what they can do to reduce their stress levels.  Stress has been shown to affect fertility; most studies have shown that stress has an adverse effect on fertility although some have shown no effect.  It is difficult to measure stress, and we all do experience some degree of stress at work and/or home.  It is a tall order sometimes, but I ask my patients to not stress about being stressed.  Exercise, acupuncture, support groups, and activities that patients personally feel have reduced their stress in the past can be very helpful.   It is impossible to determine whether patients who achieve successful pregnancies via fertility treatment are able to do so because of or in spite of decreased stress levels.  Either way, at that point, the fact that the inner transition from “trying to conceive” to “Mom” has occurred is all that matters.

 

Dr. Kavoussi is a Reproductive Endocrinologist with Austin Fertility and Reproductive Medicine-Westlake IVF in Austin, Tx.

Expert Voices: Iris Waichler, MSW, LCSW

 The Experience of Being a Mother of Advanced Maternal Age (MAMA)

Sharon Munroe, one of the founding mothers of The Advanced Maternal Age Project, asked that I write on my observations of women over the age of 35 who become moms. I should tell you that my writing comes from a blend of personal experience becoming a mother at age 45 through an egg donor and my professional work as a licensed clinical social worker for the last 30 years.

The technological gains in infertility treatment have increased success rates and parenting options like surrogacy, foster care, and adoption, offer more opportunities for women over 35 to become parents for the first time.   Many women are getting divorced, starting to have 2nd families, or choosing to become single mothers.

Becoming a first time over age 35 mom offers several advantages.  Many people have more financial stability at an older age.  People often have had the chance to fulfill their career goals later in life and may feel less of a pull between career and parenting at this stage of their lives.  In my experience as a social worker, women that enter parenthood at a later age are more certain about their choice to become parents and this may result in a stronger commitment to the parenting experience.
I believe that we have more to offer our children as an older parent because we bring our life experiences, knowledge, coping skills, and life lessons to our new role as parents.  All of us must face life challenges as we grow into adulthood.  The obstacles you encounter during your parenting journey may feel less like a crisis when you bring this experience, organizational and problem solving skills, and wisdom.  Many people I have known have expressed stronger feelings of self confidence and greater patience as they grow older.  These are important skills in a parenting toolkit.

Another advantage to having a child later in life that many people overlook is that you may have a more established community network of friends and family that are an important of your life.  This additional support when you become a new parent is invaluable and offers a lot of comfort. In my experience working with older parents I know they often have made many sacrifices to become parents.  As a result of this they are especially committed to giving time and attention to their children.

One issue that frequently arises with older moms is an increased awareness of your mortality.  Many times parents that start later in life can end up having one child.  I  hear these parents express fear about becoming ill or disabled as they grow older.  They are fearful about being a burden to their children.  There are no guarantees about the onset of an illness or an accident regardless of your age.  One thing  MAMA’s can do is become proactive about health and lifestyle choices.  Eat well and exercise.  Schedule appropriate medical visits and preventative tests like mammograms and pap smears. Take an active part in taking care of yourself because this ultimately helps you take care of your child.

Older parents often express a concern about their physical ability to keep up with their children.  As you age you may find that your energy level does diminish.  The lack of sleep that goes in conjunction with being a new parent contributes to stamina concerns. Mothers with young children need to use the nap time as a time to help you rest and recharge.  Women often use this time as a time to rush around and do chores.  Find ways to play with your child that gives them a chance to run around and get tired.  Make play dates to give yourself a break.  Find places that may be more confined where your child can play and you can safely watch like a fenced in playground.  We had a wonderful place that was indoors and was like a “fantasy kingdom” with dress up areas and places for imaginary play.  My daughter loved it.  She would run and play changing costumes, going into castles, and I could sit closely by and watch her.

One tough challenge for older moms is to find other older moms.  When I initially had my daughter I was desperate to find other women around my age to talk with.  I initially felt I was the only mother in the world who was going through menopause and had a child going through the terrible two’s simultaneously.   I contacted my local RESOLVE chapter. RESOLVE is a national organization devoted to supporting people experiencing infertility. They referred me to a woman who had started a parenting after infertility group who lived 2 blocks away.  That group had women in it who were all MAMA’s.  They have become dear friends.  We still get together over 10 years later.  Having a trusted peer group where members speak the same language, openly talk about questions like disclosure, or what to do with frozen embryos, has brought me comfort, friendships, resources, and a sense that I am not alone.  Another aspect of this group is the kids in it have become a part of their families due to infertility treatment or adoption.  They are growing up with other kids that were conceived or brought into families in similar ways.  This normalizes their experience and they will have friends they can talk to as they grow older and may struggle with questions about their biological origins.  Websites like the Advanced Maternal Age Project may be a place to find others geographically close to you to link up with.

We have all heard the expressions “you are only as old as you feel” or “age is just a number.”  Remember to view yourself as a parent and not attach an age to it. The best any parent can do regardless of age is to be an active participant in your child’s life offering comfort, stability and guidance as you all grow together.  Parenting is one of the most satisfying and challenging  jobs anyone can take on. It is on the job training regardless of your age.  Take comfort in knowing you are not alone. Good luck on your parenting journey.

Iris Waichler, MSW, LCSW, has been a licensed clinical social worker for over 30 years.  She has done workshops, individual, and group counseling with people experiencing infertility and authored  the award-winning book Riding the Infertility Roller Coaster: A Guide to Educate and Inspire.