My Postpartum Story: Then and Now

I am so happy to volunteer for the PHA Warmline.  I just wish there had been this kind of support for me when my babies were born.

Thirty-two years ago my son was a happy breastfeeding baby, but in order to return to my job as a flight attendant I needed to wean him, rather abruptly. As a result my hormones went crazy, and coupled with the stress of getting back to work, I found myself spiraling out of control. I couldn’t sleep or eat and eventually became delusional and was hospitalized.  Fortunately, a week in the hospital with medication helped me get the deep sleep I desperately needed and I was able to bounce back to normal… juggling a new baby and busy work schedule.

When my daughter was born three and a half years later I decided to hang up my “wings” and quit flying.  She nursed until about 15 months and everything seemed perfect.  We even built our first home.  No postpartum.

A miscarriage and five years later my third baby was born. I figured I had all kinds of help, having done this twice already. It never occurred to me that everyone needed me! My baby was jaundice and needed monitoring in one of those portable bilirubin beds.  My husband almost missed her birth due to food poisoning, so he wasn’t much help.  By the time Lauren was a week old I was physically exhausted, but never saw the signs of postpartum – fortunately my husband did.  Again I was hospitalized, while a friend cared for my baby, and once again the deep sleep I needed helped to restore my mind and body.

Surviving postpartum and not just becoming a statistic has given me a passion to share what I’ve learned and experienced with new moms. Perhaps I can help them avoid the some of the consequences of “untreated” postpartum by sharing my story and the resources now available. Postpartum Health Alliance is such an awesome support network, and just knowing they are there is a huge comfort. 

Submitted by Donna Kole

A Powerful New Tool for Reaching Moms

We are pleased to announce the release of a video created for PHA that provides information on symptoms of PMADs, shares the story of one mother who suffered, and encourages mothers to find help.  We will soon be featuring this video on our website, but you can get a sneak preview here!

A Mother's Journey Through PPD/A

Fourteen years ago I gave birth to a beautiful, healthy baby boy, at 7 lbs. 9 ounces, and named him Owen (not his real name). I’d been waiting for Owen for a few years. I’d had two miscarriages before him: one in my 10th week of pregnancy and one in my 14th week of pregnancy. Right after the second miscarriage, I needed a D&C and lost 1.5 liters of blood during the procedure, which was quite scary. The medical staff in Europe, where I was living at the time, told me, however, that the blood loss was a fluke. As I found out after delivering Owen, it really had not been a fluke because after he was born, I lost 3 liters of blood due to the uterus not contracting, and it took medical staff 6 hours, from 1PM until 7PM, to get the blood loss under control. It was a life-threatening situation; thank goodness for blood transfusions! I don’t really remember much of this because I was mostly out of it, but my husband will never forget… to this day he says those 6 hours were the longest hours of his life. A doctor had talked to him twice during this time to tell him they were trying to do everything they could, but were not sure if I was going to make it. Obviously I did.

I was in the ICU for 2 nights and then was wheeled into a room with 2 other mothers who had just delivered their baby. Between the 3 of us, we always had one baby that was up and needed to be fed. So, needless to say, I got very little sleep; so little that I broke down crying on my 5^th day at the hospital and begged my husband to take me home. He supported my decision, and I checked myself out of the hospital. That first night at home, I experienced my first panic attack ever. I asked my husband to call 911 because I thought I was dying. I could feel extreme tingling in my whole entire body from head to toe, so much so that I felt I was leaving my body, which I thought meant that I was about to die. My husband called the doula that had helped us deliver Owen and, over the phone she explained that I was experiencing anxiety. She recommended my husband normalize the experience, turn on some calming music and make me a warm drink. He did all of that while I experienced one panic attack after another and had yet another night of no sleep. And so our journey to hell (as we refer back to it) had begun.

I became an insomniac (even though I used to fall asleep at the drop of a hat) and had absolutely no appetite, even had an aversion to food (even though I had been a total foodie my whole life). I lost about 30 lbs. in a little over 2 weeks (pregnancy weight included) and became thinner than I’d ever been. I experienced many more panic attacks and started having intrusive thoughts, which were very graphic and therefore very disturbing. I saw danger everywhere, literally everywhere! I would look at things and worry about how those things could potentially hurt my baby. For example a window: he could fall out, a bath: he could drown, a knife: he could get cut, a belt: he could get strangled, a washer/dryer/ oven: he could end up in there and would never make it out alive. I had stopped nursing Owen about 2 weeks after he was born – very heart-breaking decision, but I’d come to realize that as long as I kept breastfeeding, my body would be unable to catch a break - and had started bottle-feeding. Every time I mixed up the bottles I thought for sure I was using the wrong water or not the right amount of formula, and that would eventually kill him. Owen’s level of dependency on me seemed to be a responsibility I could not handle; he just seemed too vulnerable to be put in my incapable hands. I had thoughts of disappearing, of no longer having to be a part of Owen’s life or my husband’s life, not just for their own good, but also for my own survival. Owen felt like a leech, sucking the life right out of me. Because of his existence, I felt myself just withering away… slowly, but surely. My thinking scared me tremendously because I thought I had gone completely crazy. I did not know what the thoughts meant: did they mean I wanted to hurt my baby? Or maybe they meant I became “bad” overnight and was turning into a criminal? As I was trying to make sense of it all, I knew one thing with certainty: I no longer trusted myself. So, I told my husband (who I thought, without a doubt, was going to leave me and take the baby with him, but at that point, I had already come to terms with that). When I told my husband that I no longer wanted to be left alone with Owen and why, he immediately went down the stairs to talk to our neighbor, a psychiatrist. The psychiatrist came to see me that same day and listened to my story as well as he could because I was sobbing the whole time. He wrote me a prescription for an anti-depressant - one that also helped with sleep and appetite -, which I started taking that day. I slept well that same night for the first time in almost 2 months! I also started seeing someone for therapy, just a handful of times, but it helped. I also stopped spending time alone with the baby. We were expats, so we flew family and friends out to help us. Once my thoughts were back to normal and I trusted myself again, which was about 2 months later when Owen was around 4 months old, I started taking care of him by myself again. And so our journey back from hell had begun.

Being diagnosed with Post Partum Depression & Anxiety was such a relief to me! It showed me that psychiatrists had heard of this illness before and that I was not the only one suffering from it. I was so happy about the diagnosis that I told everyone about it: family, friends, and neighbors. My guilt about being the most ungrateful and undeserving mother on this entire planet started to subside little by little. I would say, all in all, it took about a year for me to feel completely like myself again, but I did get consistently better once I reached out for help. In hindsight, I guess I had a few things going against me: giving birth in a foreign country with no - to a very low - support system, changing from having a full-time job to becoming a stay-at-home mom and the isolation that comes with this, a traumatic birth, prior miscarriages, an extremely colicky baby who could cry for 7 hours straight, and finally, a genetic pre-disposition to depression and anxiety. This temporary “soul loss,” as I call it, and permanent loss of a large part of my innocence and naiveté luckily did end up serving a much greater purpose.

I became a Marriage and Family Therapist treating new mothers who suffer from depression and anxiety. Also, eight years ago, my husband and I adopted an adorable baby girl at birth, so Owen has a younger sister. Both kids are doing great and I’m confident I am a “good enough mother.” And last but not least, my husband and I are celebrating our 20^th wedding anniversary next year, and I can honestly say that most of our two decades together consist of fun times with memories that put a smile on my face J

The Basics

Two of our board members recently drafted an article highlighting the basics of Perinatal Mood and Anxiety Disorders. This is great information or review for everyone.

Perinatal Mental Health: Differentiating Mood and Anxiety Disorders From the Expected Emotions of New Motherhood

Perinatal mood and anxiety disorders (PMADs) are frequently underdiagnosed among health and mental health professionals alike. Too often the symptoms that coincide with these disorders are confused with “expected” emotions during this time. It is important that clinicians know the risk factors and presenting symptoms for PMADs, in order to ensure proper assessment and treatment. Without such treatment, PMADs can impair the developmental trajectory of the baby and family.

Risk Factors

There are numerous risk factors that can increase a woman’s vulnerability to PMADs. Biological risk factors can include a genetic predisposition to anxiety or depression, a family history of PMADs, a history of hormonal sensitivities (i.e. severe PMS), thyroid problems, or infertility issues. Social risk factors include family stressors, unplanned pregnancy, a history of pregnancy loss, or a lack of social support. Psychological risk factors can include perfectionist behavior, worrying, high need for control, or a history of physical or sexual abuse or neglect.

Differentiating Between PMADs and Expected Emotions

Differentiating PMADs from a “normal” reaction to childbirth primarily depends upon the factors of timing and the degree to which functioning is impaired. The DSM IV states a postpartum onset specifier of within 4 weeks postpartum for mood disorders; however, most experts in the field believe the onset to be anytime within the first year postpartum. Below, the four disorders associated with PMADs are described in brief detail.

Postpartum Depression (PPD): 80% of women experience the baby blues within the first 2 weeks after childbirth. Baby blues consists of crying, mild sleep disturbances, moodiness and sadness, but the woman can still function well enough to adequately care for her baby. In contrast, women experiencing PPD may not be able to function well enough to take care of the baby and/or herself, and she will meet the criteria outlined in the DSM IV for major depression.

Postpartum Anxiety (PPA): All new moms worry, but in moms with PPA the worry affects their functioning (e.g., a mom cannot sleep when her baby sleeps because she is watching her baby breathe, or a mom doesn’t want to leave the house for fear of the baby crying.) Generalized anxiety and /or panic disorder may be present.

Postpartum OCD (PPOCD): These women often suffer from intrusive thoughts of harm coming to their baby or of them harming their baby. These thoughts are ego dystonic. Women may change their behavior to avoid the feared image (e.g., avoiding crossing bridges for fear of throwing her baby over the edge).

Postpartum Psychosis (PPP): Research suggests that most women with PPP are those who have not been previously diagnosed with bipolar disorder or who are off their medication postpartum. The onset is usually within the first two weeks postpartum. PPP is a psychiatric emergency. It is important that women with a history of bipolar disorder be followed by a psychiatrist throughout pregnancy and postpartum.

For more detailed information on PMADs or for resources, please visit the following web sites.

www.mededppd.org

www.postpartum.net

www.postpartumhealthalliance.org

Submitted by Gretchen Mallios, LCSW and Yvonne Rothermel, LCSW on behalf of the San Diego Postpartum Health Alliance (PHA). To become a member of PHA and be listed in our provider directory, please visit www.postpartumhealthalliance.org or call 619-254-0023.

PHA's Statement Regarding Recent Events

Recent news stories about tragedies involving potentially depressed mothers and their babies have shocked and saddened our communities, especially those among us who have suffered perinatal depression or anxiety ourselves. At PHA, we want to take the opportunity to reassure parents that these reported circumstances are extremely rare. Depression and anxiety are devastating for families, but the vast majority of those who suffer pose no risk of harm to others. However, these stories remind us that perinatal depression and anxiety remain stigmatized, underdiagnosed, and all too often untreated. It is our hope that what arises out of these recent events is increased conversation and understanding about these disorders. They are not uncommon – one in eight mothers will experience one – but they are treatable. For information about perinatal mood and anxiety disorders, please visit our website at www.postpartumhealthalliance.org or any of the following helpful sites:

www.postpartum.net

www.mededppd.org

www.postpartumprogress.org

If you or someone you know needs support in dealing with depression or anxiety during or following pregnancy, please call PHA’s warmline at 619-254-0023.

My Journey Through Postpartum Depression and Anxiety

“Tell them I died.”

I spoke calmly. I had clarity. After weeks of panic attacks, hopelessness, and pain, I had a plan.

Ten months earlier, I found out I was pregnant. What should have been cause for celebration was cause for worry. I bled in the early days of my pregnancy and was advised that I might not remain pregnant for long. I was devastated and desperately wanted to gain control over what was happening in my body. My husband and I soon discovered that all was well, but that we were expecting twins. This was exciting and welcomed news, but started us down a stressful road that included countless doctor visits, a cross-country move to be close to family, early winding down at my job, and significant discomfort for many months. I never did manage to feel settled into pregnancy as we had many surprises along the way including fetal heart concerns, my own heart and lung concerns, fetal monitoring every 48 hours, a diagnosis of preeclampsia, and ultimately an emergency c-section. When my boys arrived five weeks early, but healthy, we were extremely grateful and relieved, but I couldn’t shake the uneasiness that had persisted throughout the pregnancy.

As was the case during pregnancy, our early days with the boys looked nothing like what I had anticipated. I was advised not to breastfeed because they were too small. All of the cute newborn clothes and tiny diapers we had excitedly collected were too big for them and I had to search for anything small enough for them to wear. Everyone who visited commented on how tiny they were, and I felt offended and hurt. No one meant any harm, but after months of obsessing over having healthy babies, I was shook up by each reminder that we didn’t quite make it to the end. I am someone who rarely fails to achieve what I set my mind to, but for many months now, I had been fighting circumstances that were out of my control.

Despite these initial difficulties, we enjoyed our first few weeks with the babies. They were quiet and soft and very sweet. We cuddled and sang and swaddled. I was increasingly exhausted, however, as I could never manage more than a couple of hours of sleep between feedings. Attempts to breastfeed were unsuccessful, but I was determined to provide them with breastmilk. So when I wasn’t feeding or sleeping, I was pumping. I began to feel stuck. I was hooked up to this machine during the only times I might have been able to do something that even remotely reminded me of who I was. The need for breastmilk became obsessive and I misguidedly felt that I could successfully manage at least one part of this process if I could just make enough milk. Ironically, this stress was likely the cause of my inability to make enough milk, and I was deflated each time I had to supplement with formula.

In the midst of my feelings of inadequacy and my obsessive need to gain control over situations, the babies developed colic. I’ll never forget April 29^th. They cried for eight hours straight. I attended a wedding that evening and was in a daze, absolutely distraught at the fact that I couldn’t console my babies that day. As I drove home, I experienced what I believe was my first panic attack at the thought of returning home. The next month was torture. Each day the babies seemed to cry more, unresponsive to my attempts to comfort them. They wouldn’t eat without crying and they seemed to be screaming at me all day. I had never encountered a problem that I couldn’t solve just by working harder at it, but no matter how hard I pushed myself, I couldn’t gain control over this situation. Every new formula or medication we tried, every book I read, every person I talked to, every technique I applied resulted in nothing but disappointment. I then went from a manic need to resolve this issue to completely shutting down. I became numb and despondent, unable to motivate myself to do just about anything. My stomach turned at the sight of the breast pump and I couldn’t bring myself to look at the bottles as I filled them and fed my babies. The sound of their cries made me shake and stopped my breathing. Everywhere I looked I saw evidence of my failure as a mother.

I decided, with the help of my family and friends, that I needed help. I saw my primary care physician to talk about medication. Although she was willing to prescribe it and talked to me about how I was feeling, her attempt to reassure me that what I was going through was just normal adjustment made me feel worse. What I was going though was NOT normal. If that didn’t register with her, then I must really be a more terrible mother than even she had ever encountered. I chose not to start the medication, as I was too afraid to give my boys breastmilk while taking it. And Lord help me, I was going to give them breastmilk if it was the last thing I did. I also went to see a therapist who also assured me that everyone goes through a tough time adjusting to motherhood. This was absurd. She didn’t even suggest postpartum depression, and I again felt like no one could ever understand the depths of my pain. What an abnormality I was, truly a never-before-seen case of weakness and incompetence. Even professionals didn’t recognize this. I had never felt more alone and scared in my life.

On Memorial Day, 2006, I found myself unable to look at my babies. They were sleeping in their swings, and I was terrified about them waking up. I knew I couldn’t go to them. I was physically unable to pick them up anymore, as the dread and pain were too overwhelming. I hid myself under the dining room table like a frightened animal and called my husband, my mother, and my father. I was done. It was going to end here.

While waiting for my parents to arrive, I shared with my husband that I was completely unable to function as a mother and that it was time for me to give up. I was going to leave that day and not return. It sounds melodramatic now, but I was clear at the time that I had no other choice. I thankfully was not suicidal, but I was definitely not sticking around. When my parents arrived, I told them that I was leaving and that it was up to all of them to decide what to do with the babies. I wasn’t coming back and I wouldn’t be in touch. I calmly shared that I was finally clear on the fact that I was not only a terrible mother, but I was a terrible person and needed to start over where no one knew of my failures. I was incapable, useless, and selfish, unable to be the wife or mother my family deserved.

The only thing I asked was that they tell my boys that I had died. I never wanted them knowing that they were abandoned and thinking it was their fault. It was mine. I had failed.

My family was clearly rattled by this, and my parents packed up the boys and began to leave with them. It was only at that moment, as my boys were being taken from my home, that I began to feel again. I suddenly cried out for them. I wailed and fought to grab them, and my husband held me back. I reached for them and screamed as they were taken away. As much as it hurt, this deep surge of pain was a sign of hope. I wasn’t totally ready to give up yet.

Over the next week I took my medication, found a new therapist, visited a support group and made sure I was never alone with the babies. I talked and was supported. My husband was a rock, never judging me and never showing how scared he must have been. I had help and I tried to rest. I cried as my breastmilk dried up and as I returned the pump to the hospital. Things still didn’t look as I had expected, and I wasn’t going to gain that control I desperately wanted, but I was going to learn to accept what was. It took a lot of work, a number of professionals, and medication for me to slowly make my way back to myself. Within weeks, the dark cloud lifted. Within months, I began to feel joy.

Five years later, I am a truly happy mother. I love my children deeply and my family is in-tact and thriving. I am sure that I am a good mother and know that my early impressions of myself were clouded by depression, a filter through which your worth is disguised and your hope is destroyed. I have learned to let myself be human, working to accept the things I cannot control and to forgive myself for the mistakes I have made and continue to make. I still grieve the loss of those early months. They are a hazy, dark time for me and my heart hurts to think that I began motherhood under that fog. I worry about what my depression and anxiety might have done to my children while I was pregnant and when they were newborns. I experience pangs of envy when I hear of happy babies who don’t cry and mothers who easily breastfeed their babies. I was robbed of these precious moments. Yet, others have had it worse, and each day that I look at my beautiful boys and feel the joy that we experience together in this life, I am grateful for where my journey has brought me.

Today I work for the Postpartum Health Alliance, trying to prevent depression and anxiety in mothers and support them if they are suffering. We work hard to share with mothers the message that they are not alone, that how they feel is not their fault, and that they will get better. I have the privilege of talking to women who call seeking help. I have the opportunity to teach doctors how to identify and help women like me. I have a platform on which to affect the conversation about perinatal anxiety and depression. All of the obsessive energy that went into judging myself is now a powerful drive to help others. I hope this story creates understanding and a sense of responsibility among all of us to seek out ways to support one another. Without those who knew, those who cared, I truly would have left. But I am here, and I have so much to teach and share and tell my boys.

Instead of telling them I died, I will tell them I survived.