Marie Zahorick, MS, APRN, FNP-C, IBCLC became a La Leche League Leader in 1999 and an IBCLC in 2005. After several years of working as a hospital-based bilingual IBCLC, she attended nursing school and eventually became a board-certified Family Nurse Practitioner. In the meantime, she continued working as a hospital-based lactation consultant doing inpatient, outpatient, and Level III NICU lactation support at a variety of hospitals and with a wide variety of patient populations. She also was a substitute school nurse and worked in both school health offices and as a one-on-one school nurse for medically complex and fragile children. She did not get much sleep.
After graduate school, Marie was recruited to work as a nurse practitioner in psychiatry. She was fellowship-trained to manage patients in the acute inpatient setting, partial hospitalization, outpatient office, and OB patients in the general hospital setting. She specializes in women’s psychiatry, especially medical management of women who are pregnant or lactating.
Her expertise includes psychopharmacology in pregnant and lactating women as well as general psychopharmacology. She is experienced at diagnosing and treating mental illnesses such as bipolar disorder, perinatal/postpartum mood and anxiety disorders, postpartum psychosis, obsessive-compulsive disorder, premenstrual and perimenopausal mood disorders, and personality disorders.
She has been a freelance writer focusing on women’s issues and has presented on various topics such as low milk supply, nipple pain from yeast/candida, child development, and quality improvement projects aimed at improving breastpumping frequency for mothers with NICU babies.
She has been involved in several World Breastfeeding Week Celebrations, breastfeeding advocacy programs sponsored by the Department of Human Services and the Center for Disease Control and Prevention, and presentations on the danger of designer drugs to the Hines VA Mental Health staff. She also taught prenatal breastfeeding classes to parents and basic lactation to student nurses for several years.
She lives in the Chicago area with her husband and three adult children in the transient stage of life. Her children all breastfed for at least two years but now just make faces when confronted with that fact.
Marie Zahorick, MS, APRN, FNP-C, IBCLC became a La Leche League Leader in 1999 and an IBCLC in 2005. After several years of working as a hospital-based bilingual IBCLC, she attended nursing school and eventually became a board-certified Family Nurse Practitioner. In the meantime, she continued working as a hospital-based lactation consultant doing inpatient, outpatient, and Level III NICU lactation support at a variety of hospitals and with a wide variety of patient populations. After graduate school, Marie was recruited to work as a nurse practitioner in psychiatry. She was fellowship-trained to manage patients in the acute inpatient setting, partial hospitalization, outpatient office, and OB patients in the general hospital setting. She specializes in women’s psychiatry, especially medical management of women who are pregnant or lactating.
Her expertise includes psychopharmacology in pregnant and lactating women as well as general psychopharmacology. She is experienced at diagnosing and treating mental illnesses such as bipolar disorder, perinatal/postpartum mood and anxiety disorders, postpartum psychosis, obsessive-compulsive disorder, premenstrual and perimenopausal mood disorders, and personality disorders.
She lives in the Chicago area with her husband and three adult children in the transient stage of life. Her children all breastfed for at least two years but now just make faces when confronted with that fact.
As society learns more about trauma and trauma-informed care, we need to consider how trauma can affect our patients and clients during pregnancy, childbirth, and breastfeeding.
According to the U.S. National Center for PTSD (Post-Traumatic Stress Disorder), about half of women are exposed to at least one traumatic event in their lifetime. Unfortunately, women are more likely to be victims of sexual assault and child sexual abuse than men are. Women experience PTSD at 2-3 times the rage of men, with an estimated lifetime occurrence of 9.7%.
Women of childbearing age can have preexisting trauma that often worsens during pregnancy. Although previous pregnancy losses or complicated deliveries can cause PTSD, one study found that as many as 25% of women experience childbirth-related PTSD even after giving birth to a full-term, healthy baby. Postpartum PTSD can cause mothers to avoid starting breastfeeding and also to wean before 12 months. In those women who have a history of abuse as a child, breastfeeding durations are decreased and shorter. Challenges include managing the touch of breastfeeding and coping with trauma symptoms.
This presentation discusses PTSD in women of childbearing age, how it affects pregnancy, birth, and breastfeeding, and how to help. Important skills for those who help mothers include recognizing signs and symptoms of PTSD, bringing it up with clients, and meeting them where they are, such as pumping vs. direct breastfeeding. Resources for PTSD treatment are also discussed.
MARIJUANA AND CBD USE IN LACTATION:
THC for Two?
Marijuana is now legal for recreational use in eleven states and legal for medicinal use in 33 states. CBD oil, a hemp derivative, is legalized in 47 states. Due to popularity of these substances, lactating mothers often assume legality equals safety.
This presentation discusses the psychoactive potential of both these substances, their similarities, and their differences. It also discusses the large gap in knowledge and lack of research on both. Finally, it discusses educational, harm-reduction approaches the IBCLC can take with mothers to give information while maintaining a trusted partnership.
PERINATAL MOOD AND ANXIETY DISORDERS (PMADs):
Postpartum depression is just the tip of a Titanic-sized iceberg
This presentation will assist the IBCLC in supporting mothers with perinatal mood and anxiety disorders (PMADs.) PMADs include a spectrum of commonly-occuring mental health disorders. About 20% of postpartum mothers experience depression, with rates climbing to 60% in some low social-economic status women and adolescent mothers.
However, lesser-known PMADs include perinatal panic disorder (up to 11% prevalence), perinatal obsessive-compulsive disorder (OCD) (also up to 11% prevalence), and perinatal post-traumatic stress disorder (PTSD) (up to 9% prevalence). These often include very distressing intrusive or bizarre thoughts, behaviors, or flashbacks.
Perinatal bipolar disorder and postpartum psychosis are particularly dangerous due to severe depression, and reckless or bizarre behavior that can endanger mother and baby. Women with bipolar disorder may have stopped medications during pregnancy and are experiencing mood instability. They may also not realize they have bipolar disorder and require careful diagnosis, since twenty-two percent of depressed women postpartum have bipolar depression. Postpartum psychosis is an emergency and occurs in 1 to 2 of every 1,000 deliveries. This requires immediate hospitalization for safety, due to a 5% suicide rate and 4% infanticide rate.
The lactation consultant can be part of the safety net for postpartum mothers. Although the IBCLC is not expected to diagnose psychiatric disorders, s/he can screen mothers, refer for services and act as an expert resource for the mother’s lactation journey.
MEDICATIONS FOR MOTHERS’ MINDS:
Psychopharmacology for lactating mothers
If you have worked with mothers for more than a few weeks, you have encountered a mother with mental illness. You may not have recognized the symptoms while talking with your patient. Or, you may get a phone call from a mother or a medical professional asking if a certain psychiatric medication is “safe” during lactation.
Perinatal mood and anxiety disorders (PMAD) include a spectrum of common mental health disorders: postpartum depression, perinatal panic disorder, perinatal obsessive-compulsive disorder, postpartum posttraumatic stress disorder, postpartum bipolar disorder (which can include depression, hypomania and mania,) and postpartum psychosis.
These disorders often ruin enjoyment of the postpartum experience and bonding with the baby. Perinatal bipolar disorder and postpartum psychosis are particularly dangerous due to severe depression, and reckless or bizarre behavior that can endanger mother and baby.
Medicating the lactating mother is a careful balancing act between the health and safety of the mother and the health and safety of the baby. But failing to medicate a mother with PMAD can lead to misery, dysfunction, poor infant outcomes and in the worst situations, injury and death.
This presentation will give an overview of the different classes of antidepressants, antianxiety medications, antipsychotics, and mood stabilizers commonly used in breastfeeding mothers. Electroconvulsive therapy and transcranial magnetic stimulation will also be discussed as non-pharmacologic treatments.
Co-presenter on medical staff continuing education program. Discussed background on manufacturing, economics and biochemistry of CBD . Also discussed legality, problems with THC content and loss of licensure and arrest when unwitting consumers test positive for THC. Talking with patients about use of CBD reviewed in great detail.
A video presentation for my Family Nurse Practitioner degree on culturally-consistent and effective healthcare for expectant Hispanic mothers.
Quality improvement project involving six months of chart audits, which revealed a monthly average gap of 5.5-10.9 hours between the first and second breastpumping sessions immediately after birth. Examined different levels of research identifying importance of staff support for pumping and what mothers find helpful in their endeavors. Discussed changing pumping logs, working on improved tracking/charting by RN staff, and improving communication between Mother-Baby RNs and NICU RNs.
Co-author of quality improvement project focusing on supporting mothers with NICU babies to establish early, optimal and long-lasting breastmilk supply. Audited electronic charts of all mother’s with babies admitted directly to NICU from L&D from September 2014-February 2015 in a suburban Chicago Level III NICU to see how much time elapsed from time of delivery to time of first breastpumping session. Focused on improving hand-off communication between L&D RN and Mother-Baby RN. Also focused on shortening interval between first pumping session in L&D and second pumping session, usually in Mother-Baby.