Tag Archive | counselling

Grief and Self-Care

This blog was originally published (by the author) on Reconceiving Loss in July 2015.

It’s the time in your life when the hardest thing to do is to be selfish. Yet, that is how you might feel in terms of your emotions. The sadness, tears, heaving sobs that are unrelenting threaten to unhinge you. You yearn to stop, but you can’t. Those around you try to offer you comforting words or platitudes. Sometimes they help, but often they don’t. This is what grief can look like, particularly the soul-crushing grief of losing a pregnancy or baby.

Through this grief, you often feel alone. Friends and family don’t seem to understand that one month later, you haven’t “snapped out of it” and “moved on.” Your partner is also at a loss for words or actions that might be comforting as he embraces you for the hundredth time. Perhaps he sees the loss differently. Or maybe more time has passed and you even have another baby, yet you still feel some numbness that this new baby hasn’t been able to fully eclipse.

This is the time when you just want everything to disappear. Or you throw yourself back into your life, willing the everyday motions to undo the feelings. You want to be cared for, but all of the attempts of asking aren’t helpful. Perhaps there are a few people that get it, but you don’t want to burden them. The temporary salve they provided in just talking and listening has worn off, and reaching out seems too hard.

A compounded loss in grief is the temporary loss of your sense of self and the idea that you have a semblance of control in your life. Taking this back and reclaiming you can be important and healing through your grief journey. But how? Taking tiny steps to care for yourself. Yes, take care of yourself.

In the throes of grief, it can be difficult to even get out of bed in the morning and go through your hygiene routine. Even past this phase, doing anything pleasurable can seem like plodding through molasses. Often, grieving mothers fear that if they start to engage in life again, that somehow this means that they are forgetting the baby that died. There might be continued focus on trying to achieve a new pregnancy (from yourself or from those around you) as if this is the answer to healing. Ultimately, at the end of the day, you are your own best resource. You are your own best advocate. To do either, you need strength and perhaps the permission that it is OK to matter. It is OK to indulge. It’s OK to ask for a break and to take charge of your needs.

What might self-care look like? It can be as minimal as taking time to journal, take a bath, go on a walk, or sing. Self-care doesn’t have to cost money (as the previous examples suggest) but it’s also fine if it does. Examples might be: a manicure, massage, a weekend retreat, signing up for a class or learning a new skill.) The only limit is you. And you are the only one who is fully able to care for yourself in the way that feels best.

by  Julie Bindeman, Psy-D, Co-Director of Integrative Therapy of Greater Washington

http://www.greaterwashingtontherapy.com/

Love Should Never Hurt

Domestic Violence Awareness Month

Joanne sat bruised and exhausted, hugging her large, pregnant belly. In her mid-30s, blonde and blue-eyed, she was a respected teacher in an elementary school, but tonight she felt like a fugitive. Neither her mother nor her sisters knew how to reach her or where to find her. She was ashamed to say anything to them. But, for the first time in months, she at least felt safe. She would sleep tonight in the shelter. In the morning, she would call the school where she taught and tell them she needed a few days off for a family emergency. If she ever returned to her three-bedroom home, she reminded herself, she needed to change the locks on the front door. Joanne was married to a well-educated man, with a good job. He was also a wife abuser.

Joanne is not alone. One out of every 15 pregnant women in the United States is a victim of domestic violence each year.

WHAT IS DOMESTIC VIOLENCE?
Although even one incident is one too many, domestic abuse is defined as a pattern of behavior of threatened or actual violence committed by a current or former intimate partner. Domestic abuse is not only physical violence. Partners can also be emotionally or psychologically abusive by: failing to show affection or caring for a child; interacting only when necessary; staying emotionally uninvolved and detached. Why? The abusive partner usually seeks to gain power and control in the relationship through fear and intimidation. The abuser tries to control his partner’s behavior by isolating her from friends and family, monitoring her movements, belittling or humiliating her in private or in public or restricting her access to financial resources.

The abuser may force her to have sex or to perform sexual acts that make her feel degraded. He may limit her access to medical care or threaten to hurt himself or take away her children if she does not comply with his wishes. Sometimes women are not aware that they are being abused. They may believe that their partner’s behavior is due to a bad day at work, financial pressures, jealousy, depression or use of alcohol or drugs. Often, the abuser will say he’s sorry, bring her gifts, and promise never to hurt her again. Cultural or religious norms may also play a role in one partner’s response to the other’s controlling or punishing behavior.

WHO IS AT RISK?
According to a report released by the Johns Hopkins School of Public Health and the Center for Health and Gender Equity, “Violence against women is the pervasive yet least recognized human rights abuse in the world…The same acts that would be punished if directed at an employer, a neighbor, or an acquaintance often goes unchallenged when men direct them at women especially within the family.”

A U.S. Bureau of Justice study reports that women of any age and from any racial, ethnic, religious or socioeconomic background may experience physical or psychological abuse from an intimate partner, but that women between the ages of 19 and 29 reported more violence by intimate partners than any other group. In the United States, domestic abuse is also a crime. Although partner abuse exists among same-sex relationships, violence against women is most often perpetrated by a male partner they know and love. Many, like Joanne, are afraid or ashamed to talk about or report it.

VIOLENCE DURING PREGNANCY
Domestic violence tends to begin or escalate during pregnancy. In fact, one in six women reports their first incidence of partner abuse during pregnancy. One study concludes that a woman is more likely to be abused by her partner than suffer from pre-eclampsia, gestational diabetes or placenta previa, conditions for which women are routinely checked. The abuser sees his partner’s pregnancy as a threat; he believes she will care more about the baby than about him. Pregnant women in abusive relationships are at higher risk for medical complications that include bleeding problems, miscarriage, vaginal and cervical infections, high blood pressure and premature labor and fetal distress. Abuse in pregnancy also increases the risk for low-weight gain and low birth weight infants. Once the baby is born, domestic abuse may escalate.

WHAT ABOUT THE CHILDREN?
Young children are often silent witnesses to domestic violence, and many are also the targets of their fathers’ physical, emotional or sexual abuse. Each year an estimated 3.3 million children in the United States are exposed to violence by family members against their mothers or female caretakers. Children exposed to violence at home are likely to suffer from chronic depression and anxiety and may express their sadness and anger through acting out, defying people in authority and through other behavioral problems. Children may become too traumatized to learn or develop normally and may be unable to reach their full potentials as adults. Children who witness domestic violence at home are more likely to repeat the cycle as adults. Experts say young girls are more likely to tolerate abusive behavior from their own intimate partners, and young boys are more likely to become abusers themselves.

One in every five women who seeks medical care in emergency rooms is there as a result of injuries inflicted in a domestic violence dispute

U.S. businesses spend an estimated $5 billion dollars a year on medical expenses related to domestic violence and another $100 million per year for lost wages, time away from work, and employee turnover directly related to family violence.

More than 1 million women a year seek medical assistance for potentially lethal injuries caused by battering.

Approximately 2,000 to 4,000 women in the United States are killed each year by abusive partners or ex-partners.

Making a Safety Plan
When you feel ready to leave your home, it will be helpful to have put aside some things that you will need. It may be safer to keep those items at a neighbor’s or a friend’s house:

Extra set of car keys
Cash, checkbook or credit cards
Driver’s license and social security cards (for you and your children), green card, passport or work permit
Clothes for yourself and your children
Birth certificates
Children’s school records
Health insurance cards
Court papers or court orders
Lease agreements or mortgage payment book

Taking the First Step
Making a decision to end a relationship with an abusive partner is often difficult. For some women, it is the desire to protect their children that brings them to the point of asking for help. Taking action is hard because domestic abuse usually takes place over a long period of time and a woman’s self-esteem and confidence are slowly eroded. She becomes isolated from her community, friends and family. A woman may also remain in an abusive relationship because she is afraid of what family members may say or because she lacks financial resources. She may worry about compromising her partner’s professional status in the community. Often, she still has hope that the abuse will stop and that her partner will come to his senses. Each woman knows when she is ready to leave an abusive relationship. When she does, she can take the first step toward ending the abuse by asking her midwife, other healthcare provider, the police or her employer-assistance program for help.

BREAKING THE SILENCE
Help is available. Call the toll-free National Domestic Violence Hotline: (800) 799-SAFE (7233). From all 50 states, the District of Columbia, Puerto Rico and the U.S.Virgin Islands, victims of domestic violence, their families and friends receive crisis intervention, referrals to shelters, medical care, legal assistance and social-service programs. Trained counselors who speak more than 125 languages are available.

Are You in a Dangerous Relationship?
Your partner may be a good provider, a successful and respected member of his profession, even a caring father of your children. You may still love your partner and he may be sorry for hurting you and may promise never to do it again. However, he may also behave in ways that are considered abusive and illegal.

How can you tell?

Have you ever been afraid of, or felt threatened by your partner?
Do you worry that things you do may cause your partner to get angry, emotionally abusive or physically violent?
Has your partner ever attempted to injure you physically by grabbing, punching, kicking, arm twisting,choking or pulling your hair?
Has your partner ever hurt your pets or destroyed your clothing or other things you care about?
Has he threatened to destroy or take away your home or personal property?
Has your partner prevented you from taking medication, seeking medical care, or insisted on being present at all medical appointments?
Does your partner control your access to financial resources? Decide what and how much you can buy? Control the bank accounts? Refuse to pay bills?
Does he hide deeds to your home, wills, financial savings, and passports?
Has your partner threatened to harm himself or other people you care about? Has he ever threatened to harm or take away your children?
Does he prevent you from communicating with other people by withholding phone calls, keeping you from speaking with or visiting co-workers, friends or family? Prevent you from going to work or school?
Do you feel as though he is constantly checking up on you?
Does your partner often put you down, devalue your abilities, and make you feel guilty,or embarrass you in front of others?
Does your partner demand to have sex when you don’t want to or when you are ill? Force you to perform sexual acts that make you uncomfortable or hurt you? Hurt sexual parts of your body? Insist on unprotected sex or use of pornography?

If you have answered yes to one or more of these questions, know that none of this behavior is acceptable; you don’t deserve it. You may want to seek counseling. If you feel you are in danger, help is available to you 24 hours a day when you are ready to seek it. You can call the National Domestic Violence Hotline toll-free, (800) 799-SAVE (7233) or (800) 787-3224 (TDD). You don’t have to give your name, and your wishes will be respected. Trained counselors who speak several languages are available immediately. They can provide crisis assistance and information about shelters and health care centers, as well as free legal assistance and counseling. If you are in immediate danger, you should call 911.

Domestic violence is not biased, it crosses all socioeconomic backgrounds. Stop it now. IT may save you and your family’s life.

Other Resources:
National Coalition Against Domestic Violence: http://www.ncadv.org
The National Domestic Violence Hotline: http://www.ndvh.org

Article by Nicette Jukelevics, Childbirth Educator certified by the International Childbirth Education Association
Presented by Angel J. Miller, MSN, CNM, CEO, WomanPlace, Inc.

Preconceptional Counseling and Care

Becoming a parent is a major commitment in life. It can be met with challenges, rewards and informed choices. Before you conceive, be sure to incorporate a healthy life-style to ensure optimal health for mom and baby. Receiving pre-conceptional counseling and care can lay the ground work for a healthy lifestyle and healthy pregnancy. Good health before pregnancy can help you cope with the stress of pregnancy, labor and birth. Obtaining good health care before you conceive will help you throughout your pregnancy. It also provides you with the opportunity to find out your risks, treat any medical problems that may affect the outcome of your pregnancy and adopt or continue a healthy lifestyle.

If you are planning to conceive, schedule a pre-conceptional visit with your healthcare provider. Included in your visit is a comprehensive history of your health including: Family history and risk factors, your medical history, surgical history, medications that you are presently taking including vitamins, supplements, OTC (over-the-counter) meds; your diet and lifetstyle and any past pregnancies.

Your preconception visit is a time for you to ask questions. Do not hesitate to seek advice, discuss your concerns and your options. Your healthcare provider is there to provide information and guidance to help you make informed choices in your healthcare to help you obtain and maintain a healthy pregnancy.

Women who are planning to conceive should stop their form of birth control several months in advance. Even though methods vary in use, it may affect when your menses resumes and becomes regular. During this time you may also want to start taking a prenatal vitamin daily to ensure you are getting added vitamins and increased folic acid.

Your lifestyle includes diet, exercise, weight, substance use, living/working environment and infection history. Current immunizations are important to prevent any infections during your pregnancy that can harm you and your baby, even if you were vaccinated as a child (measles, mumps, rubella, polio, tetanus), you may not be immune now. If you are vaccinated prior to conceiving, you will be protected. The vaccine for mumps, measles and especially rubella should be given at least 3 months
prior to conceiving. During this period of time, you should use a reliable method birth control.

Optimal health at any time during your lifetime involves a healthy diet and the proper amount of exercise. Ideally, you should be in good physical shape and follow a regular exercise regimen before your conceive. If you are not used to being active, you should start an exercise program gradually.

Tobacco, alcohol and recreational (illegal) drug use is addictive and can harm you and your baby that can last a lifetime or even result in death. They can have detrimental affects on the organ formation, causing damage. The misuse of prescription medication can also harm the fetus. For the sake of your own health and that of your baby, now is a good time to cut back on smoking and alcohol and quit all recreational drugs. It takes time and patience to quit a habit, especially if you have had that particular habit for a long time. Ask your healthcare provider to suggest ways to get through the withdrawal state or quitting and to refer you to support groups. Your decision to quit may be one of the hardest things you have ever done, but it will be one of the most worthwhile.

Does your work environment impose any hazards? If you are trying to conceive, it is a good idea to look closely at your work place and surroundings. Are you exposed to toxic substances, chemicals, or radiation? Discuss your level of exposure to specific substances with your employee health division, personnel office or union representative.

Exposure to lead or certain solvents, pesticides or other chemicals can reduce your partner’s fertility by killing or damaging sperm. Unlike women, who are born with a complete supply of eggs for their entire lifespan, men make new sperm on a daily basis for most of their lives. Unless the damage to a man’s reproductive system is very serious, he will probably be able to make healthy sperm against a short time span after his exposure to the harmful material stops.

Questions to Consider…
• Do I or a member of my family have a disorder that could be inherited?
• Do I need to gain or lose weight to prepare for pregnancy?
• Should I make any changes in my lifestyle?
• Could any medications I am taking cause problems during my pregnancy?
• Can I continue my present exercise program?
• Does my work expose me to things that could be harmful during pregnancy?
• Do I need to be vaccinated for any infectious diseases before I try to conceive?