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Prenatal depression is the most under-diagnosed pregnancy complication in the U.S.

During her second pregnancy, Rebecca Fox Starr knew she wasn't connecting with her baby in the same way she did the first time around. Instead, she was consumed by stress, fear for her upcoming C-section and anxiety that manifested as trouble speaking.


After a debilitating migraine during her seventh month of pregnancy, she made an appointment with a neurologist—who was the first to pick up on the symptoms her other healthcare professionals overlooked: Starr was experiencing prenatal depression, a condition that affects an estimated 14-23% of pregnant women. More than 400,000 babies are born to depressed mothers every year, but the condition is considered the most underdiagnosed obstetric complication in America.

Starr's diagnosis came after her symptoms had been brushed off by other healthcare professionals, and it's not that she made any attempt to hide the way she was feeling. Recalling one discussion with her OB, Starr tells Motherly, "I said, 'I'm not doing well. I'm terrified for this C-section. How can we make it less scary for me because at this point I'm so terrified that I can't function.' And his answer to a lot of my woes was, 'You're pregnant. That's normal. That's what pregnancy is.'"

Failure on the part of healthcare professionals to detect mental health conditions during pregnancy has significant consequences: According to a 2017 study in the Canadian Medical Association Journal, suicide is on par with bleeding and high blood pressure as a leading cause of death during pregnancy and during the first year postpartum. Even for those without suicidal ideations, maternal depression has been shown to alter the experiences of mothers and their babies for years to come.

In her new book, Beyond the Baby Blues: Anxiety and Depression During and After Pregnancy, Starr says there are some fundamental ways in which diagnosing mothers' mental health conditions needs to improve. "To me, a mental health issue is no less serious than a physical health issue," she says. "You just can't measure it with a blood test."

Licensed Master Social Worker Erin Barbossa agrees. "From my perspective, unfortunately, our medical system really lacks putting the mental health lens on unless symptoms are really severe," Barbossa previously told Motherly. "We tend to focus on the physical symptoms related to the health of the baby, and if all of those check out, all is good enough."

By going with an academic publisher for her book, Starr says she hopes healthcare professionals will learn about prenatal depression in the same way they learn about physical experiences associated with pregnancy. "The hope is if they hear a story, then they'll bring that information maybe into their practice and say, 'Just so you guys know, keep a heads up, look out for maybe this or that,'" Starr says. "And this will help to inform the entire process."

It's a process that certainly needs some improvement: A 2003 study found 86% of pregnant women who expressed "significant depressive symptoms" in obstetric appointments were not receiving any form of treatment.

In 2016, the U.S. Preventative Task Force finally recommended healthcare providers screen for depression during pregnancy, as a response to "adequate evidence that programs combining depression screening with adequate support systems in place improve clinical outcomes in adults, including pregnant and postpartum women."

But these prenatal screenings are still not universal and, based on Starr's research on the topic following her own experience, many maternal healthcare professionals don't know how to differentiate depression indicators from other pregnancy symptoms. "There are very, very clear warning signs and I think that the problem is, when you're pregnant, often times you don't feel great," she says, explaining these symptoms are easy for healthcare professionals to confuse if they don't also take the time to listen to the mother. "Bring the humanity back into the healthcare experience and just say, 'So, how are you doing?' And when you ask that question, not just look for the perfunctory answer to your perfunctory question."

And for the mothers—know there is no guilt in feeling distress. If you are struggling to feel joy during pregnancy or the postpartum period, speak up. You aren't alone in this, but you aren't a statistic, either: You are a strong mama who deserves to be heard.

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Unstructured play is play without predetermined rules of the game. There are no organized teams, uniforms, coaches or trainers. It is spontaneous, often made-up on the spot, and changeable as the day goes on. It is the kind of play you see when puppies chase each other around a yard in endless circles or a group of kids play for hours in a fort they created out of old packing boxes.

Unstructured play is fun—no question about it—but research also tells us that it is critically important for the development of children's bodies and brains.

One of the best ways to encourage unstructured play in young children is by providing open-ended toys, or toys that can be used multiple ways. People Toy Company knows all about that. Since 1977, they've created toys and products designed to naturally encourage developmental milestones—but to kids, it all just feels like play.

Here are five reasons why unstructured play is crucial for your children—

1. It changes brain structure in important ways

In a recent interview on NPR's Morning Edition, Sergio Pellis, Ph.D., an expert on the neuroscience of play noted that play actually changes the structure of the developing brain in important ways, strengthening the connections of the neurons (nerve cells) in the prefrontal cortex, the area of the brain considered to be the executive control center responsible for solving problems, making plans and regulating emotions.

Because unstructured play involves trying out different strategies without particular goals or serious consequences, children and other animals get to practice different activities during play and see what happens. When Dr. Pellis compared rats who played as pups with rats that did not, he found that although the play-deprived rats could perform the same actions, the play-experienced rats were able to react to their circumstances in a more flexible, fluid and swift fashion.

Their brains seemed more "plastic" and better able to rewire as they encountered new experiences.

Hod Lipson, a computer scientist at Cornell sums it up by saying the gift of play is that it teaches us how to deal with the unexpected—a critically important skill in today's uncertain world.

2. Play activates the entire neocortex

We now know that gene expression (whether a gene is active or not) is affected by many different things in our lives, including our environment and the activities we participate in. Jaak Panksepp, Ph.D., a Professor at the University of Washington studied play in rats earning him the nickname of the "rat tickler."

He found that even a half hour of play affected the activity of many different genes and activated the outer part of the rats' brains known as the neocortex, the area of the brain used in higher functions such as thinking, language and spatial reasoning. We don't know for sure that this happens in humans, but some researchers believe that it probably does.

3. It teaches children to have positive interaction with others

It used to be thought that animal play was simply practice so that they could become more effective hunters. However, Dr. Panksepp's study of play in rats led him to the conclusion that play served an entirely different function: teaching young animals how to interact with others in positive ways. He believed that play helps build pro-social brains.

4. Children who play are often better students

The social skills acquired through play may help children become better students. Research has found that the best predictor of academic performance in the eighth grade was a child's social skills in the third grade. Dr. Pellis notes that "countries where they actually have more recess tend to have higher academic performance than countries where recess is less."

5. Unstructured play gets kids moving

We all worry that our kids are getting too little physical activity as they spend large chunks of their time glued to their electronic devices with only their thumbs getting any exercise. Unstructured play, whether running around in the yard, climbing trees or playing on commercial play structures in schools or public parks, means moving the whole body around.

Physical activity helps children maintain a healthy weight and combats the development of Type 2 diabetes—a condition all too common in American children—by increasing the body's sensitivity to the hormone insulin.

It is tempting in today's busy world for parents and kids to fill every minute of their day with structured activities—ranging from Spanish classes before school to soccer and basketball practice after and a full range of special classes and camps on the weekends and summer vacation. We don't remember to carve out time for unstructured play, time for kids to get together with absolutely nothing planned and no particular goals in mind except having fun.

The growing body of research on the benefits of unstructured play suggests that perhaps we should rethink our priorities.

Not sure where to get started? Here are four People Toy Company products that encourage hours of unstructured play.

1. People Blocks Zoo Animals

These colorful, magnetic building blocks are perfect for encouraging unstructured play in children one year and beyond. The small pieces fit easily in the hands of smaller children, and older children will love creating their own shapes and designs with the magnetic pieces.

People Blocks Zoo Animals 17 Piece Set, People Toy Company, $34.99

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This article was sponsored by People Toy Company. Thank you for supporting the brands that support Motherly and mamas.

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Plenty of modern motherhood paraphernalia was made to be seen—think breastfeeding pillows that seamlessly blend into living room decor or diaper bags that look like stylish purses. The breast pump though, usually isn't on that list.

It's traditionally been used in the privacy of our homes and hotel rooms in the best case scenarios, and in storage closets and restrooms in the worst circumstances. For a product that is very often used by mothers because they need to be in public spaces (like work and school), the breast pump lives a very private life.

Thankfully, some high profile moms are changing that by posting their pump pics on Instagram. These influential mamas aren't gonna hide while they pump, and may change the way the world (and product designers) see this necessary accessory.

1. Gail Simmons 

Top Chef's Gail Simmons looked amazing on the red carpet at the 2018 Emmys, but a few days after the award show the cookbook author, television host and new mama gave the world a sneak peek into her backstage experience. It wasn't all glam for Gail, who brought her pump and hands-free bra along on the big night.

We're thankful to these women for showing that breast pumps belong in public and in our Instagram feeds.

[Update, September 21, 2018: This post was originally published on May 31, 2018, but has been updated to include a recent Instagram post by Gail Simmons.]

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Dana Dewedoff-Carney has a beautiful family. On paper, she's a mom of three. But in her heart, she has five children. She's had two miscarriages, one last year at five weeks, and another this past summer.

"I lost our son in June. I was 14 weeks pregnant, but he had passed away at 12," she tells Motherly, explaining that she and her husband had already named their boy Benjamin.

He never got a chance to live in this world, but he is changing it. His mama is the force behind Project Benjamin, a photo series that is going viral and changing the way people talk about pregnancy and infant loss.


Dewedoff-Carney started Rise for Women, a New Jersey-based organization dedicated to empowering women and connecting them with the resources they need to thrive. Rise for Women was born out of a painful time for Dewedoff-Carney. She was a single mom of three, and she was struggling, although from the outside she looked fine.

After launching Rise for Women Dewedoff-Carney created the hashtag #StruggleDoesNotHaveALook, which took on a whole new meaning this year after she and her now husband lost their babies. She came up with another hashtag, #TheyMatterToo, to remember them, and invited other moms to join in a photo session.

Each mother had her portrait taken with a chalkboard bearing a phase that someone told her after her miscarriage.

In Dewedoff-Carney's case, a doctor who perhaps meant to be kind told her the baby she lost "was the wrong baby." Other women in the photo series were told they could always adopt, or that they should be happy with the children they already have. Dewedoff-Carney says sometimes people don't realize how much their words cut those suffering a loss.

"I know people are not saying these things to be malicious and hurt us, but if they could just be a support and say, 'I am so sorry for your loss, I'm here for you,' that is so helpful," she explains.

Experts agree. Jessica McCormack is a licensed marriage and family therapist in private practice at The Self Care Path in Burr Ridge, Illinois. She says parents who've suffered a pregnancy loss don't need people to try to offer solutions or minimize their grief, but just to validate it.

"You aren't trying to fix their emotions, you are simply stating, 'I hear you, that was so hard for you, this really sucks right now.' No need to fix, no need to tell someone it will be okay. It's a time to just give a hug and tell them it's okay to feel how they feel. This often creates comfort just by knowing someone is there for you," she tells Motherly, adding that it is totally normal for parents to struggle after a loss.

"It's a completely normal experience to have a bunch of grief, sadness, depression, anxiety, shame, guilt and jealousy of others with healthy successful pregnancies," McCormack explains.


For Dewedoff-Carney, that's exactly what Project Benjamin is all about. She says too often conversations about the feelings one has after a miscarriage or infant death are happening behind closed doors or in private Facebook groups. She hopes her photo series will help people realize they're not alone, and that the woman down the street (or on Instagram) who seems to have it all may be suffering herself.

By having a very public conversation about pregnancy loss, Dewedoff-Carney and her fellow moms are hoping more people will understand what they're going through, and not try to minimize it.

Ashlyn Biedebach is a Registered Nurse and founder of By The Brook Birth Doula. She says "when a woman suffers a loss, at any gestational age, it is truly a loss, not just of a baby, but of hope and an idea of the future."

Biedebach suggests if parents who've suffered a loss encounter loved ones who don't seem to be recognizing their baby, they try to give them some grace, but that doesn't mean you have to pretend it didn't happen.

"Well-meaning family members may intentionally choose to move past painful experiences, even if you are still deep in the grief of the loss of your baby. Bringing up your loss in a gentle way, or having an intentional conversation with those who are moving on can help, but also talking with a counselor, too."

As a therapist, McCormack agrees. "Since it's roughly 1 in 4 women that have a pregnancy that ends in miscarriage, women need support," she tells Motherly, recommending that women who've had a loss talk to their OB-GYN or family physician and ask if there are any support groups in their community.

If your doctor doesn't refer you to a support group you can find a therapist yourself. McCormack suggests women simply search the psychologytoday.com therapist directory by entering their zip code along with the keywords "miscarriage" and "fertility." The therapy doesn't have to be just for mom, either. Sometimes dads need to talk, too.

"I also encourage couples to go to therapy after something like this, as men tend to feel lost and uncertain as to how to process their own feelings while supporting their partner," says McCormack.

Both McCormack and Biedebach agree that talking about this kind of loss, whether in person or over social media, is important. Biedebach says, for some parents, honoring their baby through a social media post is their way of remembering and recognizing their importance. McCormack notes that a social media post can also be a good way to invite a larger quantity of people to support you in your time of need.

"It also reduces the stigma by bringing to light that it is completely normal for women to experience something like this," she explains.

That's Dewedoff-Carney's goal, and while she can't travel the county photographing mothers herself, she's inviting anyone to join the conversation by taking their own photo, sharing their story and using the hashtags #StruggleDoesNotHaveALook and #TheyMatterToo. Since her photos went viral, women have been commenting and sharing their stories publicly, and it's brought Dewedoff-Carney to tears.

"They're naming the children that they lost," she explains. "They're doing that, they're speaking their truth, and they're letting it out."

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Chrissy Teigen has been very open about the ways pregnancy has changed her body. Mom to 2-year-old Luna and 4-month-old Miles, Teigen—a former swimsuit model—has famously embraced her postpartum body (stretchies and all), while noting that she's still, at times, insecure about it, but she's not ashamed.

That's why, when a man on Twitter commented on a photo of Teigen's red carpet look for the Emmy's to ask the whole wide world (and Teigen herself, he tagged her) if she was pregnant again, Teigen was quick to shut down the shamer.

"I'm asking this with the utmost respectful [sic], but is @chrissyteigen pregnant again?" The man wrote.

"I just had a baby but thank you for being soooo respectful," Teigen replied (from the Emmys).


Fellow moms were quick to jump to Teigen's defense. Many pointed out that Teigen actually looks incredible for any human, let alone one who is four months postpartum. Other mamas were quick to chime in with stories about their own lingering baby bumps.

For a lot of women, our bodies are different after having a baby. Sometimes that means we're a little rounder in the middle than we used to be. It happens to almost everyone, even red carpet-walking A-listers, like Teigen and actress Jennifer Garner, who once told Ellen Degeneres that she would have a bump forever.

"I am not pregnant, but I have had three kids and there is a bump," Garner explained in 2014, after paparazzi photographs fueled speculation that she and Ben Affleck were expecting a fourth child. "Forever and ever, not another baby. Just a bump like a camel. But just in reverse," Garner jokes.

Like Garner, Teigen dealt with the pregnancy question with a sense of humor, but she shouldn't have had to defend her body from the Emmys. As many, many Twitter users pointed out to the man who asked, it's never cool to ask a woman if she is pregnant.

It's not polite to ask, and it's no one's business whether a woman's bump is a pregnancy, some fabric, a burrito, a weird shadow or (as in Teigen's case) basically a figment of someone's imagination.

A lot of mamas online last night chimed in to say that while Teigen's stomach doesn't look like it did in her Sports Illustrated days, it still looks pretty freaking amazing.

Yes, after two kids, Chrissy Teigen doesn't look like a swimsuit model. But she shouldn't have to. She's not a swimsuit model anymore. She is a cookbook author with her own Target line and she hosts a hilarious TV show. She's also a mother. She is so much more than her midsection.

"Honestly, I don't ever have to be in a swimsuit again," she recently told Women's Health. "Since I was 20 years old, I had this weight in my mind that I am, or that I'm supposed to be. I've been so used to that number for 10 years now. And then I started realizing it was a swimsuit-model weight. There's a very big difference between wanting to be that kind of fit and wanting to be happy-fit."

Teigen is happy with her body, and we're happy she spent Emmy night educating the internet about respecting women.

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