Past Experiences – Missing Mom

A woman lost her firstborn child to Child Protective Services when she was 17, after having been abandoned by her abusive father. Part of the reason for losing the child then was poverty – no crib or medical insurance. She also had untreated mental issues. She has been in therapy since she was 18 and her therapist will support her now – 6 years later. She is now 3 1/2 months pregnant with her second child and understandably afraid of losing this child as well or that they’ll bring up her mental health issues from the past. This child’s father is not the same one as her first child’s father and is supportive of her. She gets SSI income and her boyfriend is a line cook. Because they are on a tight budget, she is buying what she can in preparation for her baby, as she can. How can she avoid a repeat experience ?

A response came from a woman who works in primary care settings. She has seen cases where if the parent previously lost a child to the Div of Health Services, that parent comes under heightened scrutiny. Suggestions – If you are going a regular OB clinic or community clinic, show up for every single prenatal appointment, stay on top of scheduling. Make them aware of the regularity/consistency of your therapy appointments. I personally would not meet with or trust their social or behavioral health person – keep them at arm’s length until you get a good read as to whether they seem genuinely interested in helping with you. It seems you have good support already, so don’t even go there. If you feel you have to appease them and must meet with one, just be prepared to say all the areas you have covered already. Don’t express vulnerability or what you don’t have. Better to go through trusted community organizations if you need physical items, housing resources, etc. Expect to have to do a Urine Analysis at some point. Avoid using any substances including marijuana that might get you flagged.

I am a big fan of midwives and so I liked this suggestion – seek out a birth center or better yet a home birth midwife. You can meet them for a consultation (no pressure to pick that one). Wait until you find one you think you could have a trusting relationship with. They won’t have access to all your medical records. They are more focused on supporting you as an individual. The less contact with nosy/intervention happy medical people, the better in your case. If you end up needing to birth in a hospital, a good midwife ought to be a good advocate for you in that setting, even though it is also a high risk setting for Div of Health Services involvement/hospital staff scrutiny.

If she is in a conventional medical care setting, the woman suggests be one step ahead with all the baby item planning. Having the car seat well in advance, like by 30 weeks, and schedule a car seat installation safety check (you can find them by searching “car seat safety clinic” they are often done at fire departments). If she signs up for WIC (which pays for formula), she needs to be aware that they are another scrutinizing entity that could represent a threat.

The biggest poverty factor to control for is housing stability. If you rent, is your lease month to month or year long? Being on good terms with your landlord can smooth inspections. Best have a Plan B. Make certain savings could cover a move, if needed. Or have a support network, one that would allow you stay with a stable family that is considered “safe”.

Additional suggestions from another with behavioral health work within a primary healthcare setting – No one can report a thing until the child is born. Be careful about what releases you sign. No one can talk to anyone about you without your release – unless it becomes a mandated report. If you sign releases, you are at risk. Therefore, any releases need to be very specific. Don’t sign blanket things like “service coordination.” Instead say what services you want coordinated.

This woman disagreed with some of the previous advice – I don’t agree with universally declining behavioral health services, because those services can be helpful for connecting with community based programs for things like car seats, help with food insecurity, clothing, etc. If your ongoing therapist is well connected, and knows what programs are available within your community, they may be able to serve in that role. In that case, it is appropriate to explain that you are in regular behavioral health care already.

There will likely be complete screenings as a routine part of your care to look at maternal stress/perinatal mental health concerns. They may also be helpful in holding the balance of psychotropic medication/medication choices, while you are pregnant, if that is part of your typical mental health treatment plan. You can consider signing a very specific and narrow release with your therapist, but generally, I would limit it only to things like medication, pregnancy health, dates of service. I would not allow your therapist to release your progress notes, progress summaries, treatment plans unless there is a compelling reason to do so.

I came across the letters DBT in an adoption discussion group and as I had no idea what it stood for, I do what I often do in such cases, google it. It started with this comment by an adoptive parent –

“I just had it click in a deeper way yesterday that I put a lot of thought and effort and will into trying to heal my kids. As if I’m a savior. As if I can. But in DBT, it talks about creating a change ready environment for your kids. By the way, if you can find a child DBT therapist, do it! Its expensive and it involves individual and parent and group sessions, and its work and learning, but its SUPER effective. All kinds of stuff prove its effective. Back to my point, if I’m trying to create a change ready environment, a calm and consistent environment where mean words can roll off my back, and I’m working on me setting the example that self care is important and I’m working on me so that I can hold all the pain they send my way, that’s where I make the most beneficial impact for all of the family and that’s where I love my kids the best.”

DBT stands for Dialectical Behavior Therapy. Dialectical behavior therapy is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder. There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm and substance abuse. Many of these issues are aspects experienced by adoptees due to the trauma of separation from their original mothers.

One woman commented – “DBT absolutely SAVED MY LIFE. The skills helped me stop with SI and I then went on to lose 140 pounds.” I had to google SI too. Introverted sensing (or Si for short) is one of the most misunderstood cognitive functions in the personality community. Introverted sensing is a perceiving (information-gathering) function. It focuses on the subjective, internal world of personal experience and compares and contrasts new experiences to past experiences and memories. Si-users tend to notice patterns repeating themselves and are quick to spot changes or inconsistencies in their environment. They trust personal experience and subjectively explore the impact of current events, choices, and consequences.

So back to DBT . . . .

Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others. DBT can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (eating disorders and substance use disorders). DBT is sometimes used to treat post-traumatic stress disorder (PTSD).

DBT incorporates a philosophical process called dialectics. Dialectics is based on the concept that everything is composed of opposites and that change occurs when there is a “dialogue” between opposing forces. The process makes three basic assumptions:

All things are interconnected.
Change is constant and inevitable.
Opposites can be integrated to form a closer approximation.

Mindfulness skills help you slow down and focus on using healthy coping skills when you are in the midst of emotional pain. The strategy can also help you stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior. BTW, I am a BIG believer in mindfulness.

Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook. There are 4 techniques – distraction, improving the moment, self-soothing and thinking of the pros and cons of not tolerating distress.

Emotion regulation lets you navigate powerful feelings in a more effective way. The skills you learn will help you to identify, name, and change your emotions. When you are able to recognize and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and helps you have more positive emotional experiences.

Interpersonal effectiveness helps you to become more assertive in a relationship (for example, expressing your needs and be able to say “no”) while still keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.