"On Constant Watch": Trauma and Postpartum Anxiety

Sure, motherhood is a 24-7 job.  I mean, you ask any mother of any number of children and she'll say she's tired, she has or is still getting up in the middle of the night with kids, getting calls at work about sick children, canceling appointments with doctors, friends, and pedicurists because something going on with her child takes precedence.  All that is true, but that isn't what I am going to talk about today.

When I was a child, I lived in a a completely unstable and unpredictable atmosphere.  My mom's drunken rages would come out of nowhere and take place at anytime of the day (because she drank until she passed out and then as soon as she woke she began drinking again).  I couldn't count on the basics like clean clothes, a well-stocked refrigerator or even being able to get to places I needed to go, like school, let alone on time.  Most years I missed 29 days of school (since 30 was the maximum before child services would be called) and I couldn't ever be counted on by my friends to participate in activities or get together because my mom's alcoholism and the amount that she drank each day varied between consistent tipsiness (a condition under which she drove constantly) or a coma-like stupor (which resulted in being passed out on the couch and unresponsive).  My Junior year of High School, my teacher sat in front of the school with me until after midnight waiting for my mom to pick me up after a ski trip.  The bus and all the kids had arrived at 11pm to rows of parents waiting in warm cars for their kids and had long since left, but mine never showed.  And, even in those days of pay telephone and landlines with cords the phone was never going to ring loud enough to wake my inebriated mom.  So you aren't left hanging, I'll tell you that I eventually called my best friend's mom and she came to pick me up and I stayed at their house that night.  That was the way I lived childhood.  Never knowing what was next or whether I'd have what I needed.

Fast forward fifteen years to my thirty-first birthday when after 46 hours of labor and an emergency c-section my little boy came screaming into the world, already making a statement at 9 lbs.  The last ten years or so had been pretty predictable and stable...I'd made them that way.  By then, I had a great Senior year of High School with my Gram, four awesome years of college, two years at my first job and living with my sister and baby niece, two years of living in NY and working a great job and enjoying the city, and three years of living in Atlanta, finding renewed faith, a great community, learning how to be married and making friends all under my belt.  I had created a predictable and stable life for myself.  I had control of my own destiny and felt confident that I was living the life I wanted and needed.  Then L1 arrived.

The labor and delivery going awry and breastfeeding nightmare probably would have been enough to take me back to that place of uncertainty and lack of control that causes general anxiety and discomfort.  But, add in a couple of perinatal mood disorders and we had a full recipe for disaster on our hands.  And there is only so long that your body can live under those sleep-deprived conditions of constant duress before something gives.  It was my mind that gave in that time.

If a typical expectant mom asked me about new motherhood today, I would have two priorities.  One would be to alert her to the risk factors, symptoms of and resources for PMADs.  The other would be to be sure that she clearly understood that there is almost nothing predictable, reliable or stable about being a mother to a newborn.  And, if it's your first time?  Prepare to have your world rocked.  Can you survive it?  Sure, gratefully most people do and even go on to do it again.  But, will it be a challenge?  Absolutely.

If you are a woman who has a history of trauma or anxiety, I believe that your brain is already trained to go into overdrive in times of stress.  You've been there too many times before and for your mind, anxiety is almost like a default mode.  For a new mom, that fight or flight switch that was flipped on repeatedly in your past due to traumatic experiences or an anxiety disorder may feel like it's been permanently flipped when you have a baby.  I mean, already you are responsible day in and day out for this human life (could there be any greater of an assignment than that?).  But on top of that, your brain reacts to those sorts of situations like they are life and death.  Just like getting in the car with my drunk mom, or engaging in an argument with your abusive boyfriend, or whatever our trauma or triggers were in the past, simply having this baby and caring for it seems like an overwhelming, anxiety-producing and never-ending proposition.  And?  This baby?  It will be months before anything he/she does will be reliable.  In fact?  You may not even know what he or she needs at any given moment and the itty bitty responsibility may spend most of the day (or night, for that matter) wailing and fidgeting, further exacerbating your anxiety.

So, what should we do with this?  First, I believe that women who have a history of trauma should be educated about postpartum anxiety disorders before or during their pregnancies.  Then, those at risk should be offered a plan for how their support system will help them identify and treat if they do indeed suffer from a perinatal mood or anxiety disorder.  Having this discussion ahead of time and creating a plan while the mom is well will help her to feel more in control of the situation, even if she is really ill at the time.  Secondly, I think we need to acknowledge that motherhood not only isn't a bowl of cherries and we might feel sad sometimes, but that sometimes moms don't necessarily feel sad, but rather feel like they are on a plane that is about to crash or in a car that's lost its brakes.  And that feeling sometimes doesn't go away on its own.  And sometimes that anxiety when left to continue for days, weeks, or months can actually change our brain chemistry and damage our ability to cope, even under otherwise non-stressful circumstances.

Postpartum Anxiety Disorders can be overcome.  And, with good resources and support and a treatment plan can even be mostly avoided in the future if you have more children.  But, it takes time, patience, and a lot of letting go, in addition to treatment and support to be able to be able to relax enough to find joy and peace in mothering.

An Anniversary of Sorts

Today is a significant day.  L2 will be six weeks old on Thursday.  You see, in 2007, at 5 weeks and 5 days postpartum, I officially "crashed".  After yet another sleepless night of bottlefeeding breastmilk, followed by endless futile and obsessive burping, followed by 45 minutes of pumping during every three hours, I snapped at my husband for the last time that day.  After giving him a verbal lashing so severe that even my nearly psychotic mind was able to tell I was in the wrong I simply slumped over the kitchen counter and whispered, "I think I'm going crazy".

THAT was the turning point.  I called a psychiatrist.  She got me in two days later and diagnosed me with severe postpartum depression.  Turns out I actually had postpartum anxiety and panic disorder, as well as postpartum PTSD which all eventually caused depression, but the exact diagnosis isn't important.

What is important  is what happened over the next few weeks and months.  Initially, we discovered that a simple SSRI wasn't addressing the real issues of sleep deprivation, anxiety, racing thoughts, panic and obsessing about the trauma of my birth and inability to nurse.  Once we added another medication, I found a therapist in addition to my physician, I began sharing about my experience and found out that indeed others HAD survived this severe of a PMAD before (can you believe that technology was so different just four years ago that I wasn't on Facebook or Twitter and Postpartum Progress was the only blog I could find...and Katherine the only "person" I could seem to manage to email with questions and concerns at that time?).

The time, sleep, medication, therapy, support from family and friends finally led me to find myself again.  The horror of the experience led me to be initially adamant about not and then simply scared to death about having another child.  But, the resources I had found since those awful days in 2007, like the awesome new doc, new therapist, amazing network of support, both in person and virtually via social media, knowledge that I had survived once and would again, if I had to, eventually allowed me to warm to the idea of another child.  Wanting a sibling for my older son pushed that warming into action and in just a couple of months of trying we became pregnant again the month before L1 turned 3.

Today?  It's been 5 weeks and 5 days since I had L2.  And? I am super tired from getting only 5 hours of totally unconnected sleep last night.  But?  I am well.  It's only noon, but I pray, hope and believe that this day will come and go with challenges but won't be any more memorable in the long-term than yesterday or tomorrow.

Have hope, Survivor Mamas.  You can and will get well if you are currently suffering.  And, it is possible to be well during pregnancy and postpartum if you choose to have more children.  I am living proof.

A Father's Day Reflection and Dedication to my Dad and Husband

As I sat feeding L2 this morning, I thought about all the reasons I appreciate my father and husband, yet fail to take the time to thank them throughout the year.  In response to my thoughts and reflections on Father's Day, I've written each of them letters that I would like to share here.

Dear Dad,
I rarely have the opportunity or take the time to tell you how much gratitude I have for your love and support.  You never gave up on spending time with me as a child, no matter how difficult my mother made it for you.  You drove hours just for a 36 hour visit with me.  You came immediately when I was left traumatized after being the victim of a violent crime as a middle-schooler.  When you learned of the abuse and neglect I had suffered under my mother's care, you made a plan and came to take me away, even as a Senior in High School.  When I could only manage to bring a few personal belongings with me that day, you took me shopping for new clothes so I could feel better about myself.  When you realized that switching schools my Senior year would cause even more trauma for me, you sacrificed your only opportunity for me to live with you permanently that last year of High School and asked your parents to care for me so I could remain with my friends and teachers.  You'll never know how that one choice impacted the rest of my life.  That year with Gram was the greatest gift you could have ever given me.

You've never raised your voice or hand to me.  No matter how angry I must have made you, you always listened and respected me enough to figure out how to do the right thing on my own.  Even when I disappointed you with one of the "Big Five" (gratefully the least of the offenses in wrecking my new car), instead of holding a grudge and lecturing me about how much of a bad choice I had made to drive down an icy hill just to take a trip to the mall, you allowed me to take responsibility and learn how to deal with insurance companies, auto repair shops and repayment of the loan towards my deductible.

When I was sick after having L1, not once did you question the validity of what I was experiencing or tell me to "get over it".  Instead, you left a luxurious resort and rushed to be by my side.  When I was having a panic attack, you held me and told me you understood, instead of telling me to suck it up or trying to distract me or minimize it.  When I couldn't care for myself you made extra trips to Atlanta so I wouldn't have to spend my days alone, racked with anxiety.  When I got better you celebrated with me.

Thank you for being the kind of Dad that always tells others how proud you are of me, that always wants to take the time to talk with me, and that won't ever give up on me.  I love you.

Dear M,

From the day we had our first date...a casual lunch at a local college restaurant...I knew I would marry you.  I wouldn't admit it to others or myself, but I came home from that meal completely surprised myself at the certainty in my head and heart about that.  We didn't marry until 6 years later, but I always knew that despite the ups and downs and "togethers and aparts", God had made us for each other.

As I reflect on this particular Father's Day, I want to thank you for becoming the kind of father that I am proud to be married to.  When our children are in your care I never worry or question that they are safe and healthy.  When you are away from us, I can always be certain that you are doing whatever it is not only for yourself, but for us.  If you are working, I know it's so we can have financial security and insure that our children have the best possible future ahead by saving for tuition at good schools, being able to buy healthy foods, having the opportunity to travel and experience cultural and educational experiences, and setting a good example of the work ethic that was passed down to you by your own father.  If you are exercising, I know that you are taking the time to care for your body so you are best able to care for us, both by having released your stress and by staying healthy so you can be with us and provide for us as long as God allows.  If you are spending time with friends, taking up a hobby, enjoying watching sports or even getting a massage, I know that even then you are caring for yourself so that you can come home to us refreshed and able to enjoy your family time even more.

As a husband, you balance me, which balances our family and provides a healthy home for our children.  Your flexibility for my rigidity.  Your goofiness for my seriousness.  Your frugality for my whimsy.  Your practicality for my romanticism.  Your aloofness for my over-analyzing.  Your big thinking for my getting stuck in the details.  Your fortitude during my times of anxiety or weakness.

Thank you for being you.  I love you.

Maybe the best post I have ever read on PPD & Breastfeeding...

This post*, written by Allison Robicelli, someone who writes about food, not mommyhood or PPD, is probably one of the most poignant pieces I have read to date.  I HAD to share the link.  Here's a snippet to wet your palate, but please, pretty please with sugar on top, go read the entire thing.  And then share it.

The part that I was fully expecting, the part that would change me for the better and heal all the pain inside me I had been living with to bear this child, was the moment that my son was born.  You know that scene on TV, don’t you?  Where the baby comes out, and everyone has the biggest smiles on their faces, and they hand the child to their beaming mother who looks as if she’s so happy she might explode?  Where the bitchiness, discomfort and depression immediately end, and your endorphins thrust you into the ultimate high of total unconditional love?

Yeah, that part didn’t happen.  After an extremely rough birth, I laid there in semi-consciousness looking at my son, and didn’t see the love of my life, but rather a complete and utter stranger.

Thank you Nona Brooklyn for posting this.  THANK YOU, again and again.

*Please note that this post does include language intended for adults. 

On deciding if you should have another baby after surviving a PMAD

Yesterday at Postpartum Progress Katherine Stone asked readers what they think about Gwyneth Paltrow's recent statement that she doesn't plan to have any more children as a result of her postpartum depression experience.  The comments that post generated showed me that there is so much more to this and that this question elicits conversation that goes well beyond a celebrity and her family size.

After I read the post, I quickly rattled off this comment and hit "post".

I believe that my experience this second time is evidence that with a good plan, treatment during pregnancy (whether it be meds or not), good social support, and proactivity at the earliest sign of things going down that path again, that a recurrence, should it occur, can be very short-lived and manageable. Even with the severity of my first experience and the sudden onset of panic/anxiety/depression day three postpartum this time, I was able to put my treatment/contingency plan into place immediately and be back to functioning well in my family a week later.

While everyone's experience and chemistry are different, I do believe that should you decide to have more children after surviving a perinatal mood disorder, there are many things that can be done to either prevent it happening again, to limit it's severity this time or to recover very quickly without it impacting your long-term health and family life.

I also COMPLETELY respect anyone's decision not to have more children after experiencing the hell that PMADs are. It took me three years and lots of prayerful consideration to come to this conclusion. I wouldn't have been at all surprised, however, if the answer had been "one and done". And? I would have been totally okay with that, too. While I love L2 with all my heart and have bonded with him immediately, I couldn't have known that happy ending would be the outcome.

Regarding Gwyneth, I think that Survivor Mamas will use her statement, if they choose to give it any weight in the first place, to bolster them and feel good about whatever decision they, themselves are leaning towards/have made regarding more kids. From the comments above, I already see that happening in this community.

But then, as I savored a shower and one of the rare few moments of quiet time in my home recently for obvious reasons, I thought to myself...hmm...I do believe all of what I wrote above, but I left out THE MOST IMPORTANT component of preparation for having a child as a Survivor Mama.  And, therefore, I felt compelled to share my thoughts, of course, my humble opinion only, on the matter.  I truly believe that being completely recovered from and having reconciled your pregnancy and postpartum experience are probably the best ways to begin preparation for having another child as a Survivor.  Going into another pregnancy haphazardly, accidentally or before you have not only completed treatment for your PMAD, but then done the work necessary to reconcile that experience are recipes for possible disaster.

I wasn't thrilled to be nearly 35 with a child well out of diapers and finally to the point of fair independence only to start all over at square one with my second child.  However, I knew that I needed to complete my treatment, continue working on the issues that arose as a result of my PMAD, and to move past the guilt, anger and other ugly remnants that PPD had dispersed in my life before I could even consider another child.  I also knew that I needed to be totally okay with seeing those pink lines on the stick, because once I did there was no going back.  So, for six months before I removed my birth control device I prayed about and made sure that I was very clear and honest with myself that I was truly "ready".  I talked with other Survivors and my doctors and therapist.  I asked friends to pray for me and with me.  And, then finally, after what seemed like an eternity, the answer that was right for me became clear and we "pulled the trigger".

So, here I am darkening the door of 35 with an almost four year old and a newborn, but well.  Not perfect.  Not free from anxiety.  Not able to do this without the help of treatment again.  But, well.  Well enough to care for my family, function in my life, interact with my friends, and even take a shower once in a while. ;)

On why bonding can happen anytime...and why it will be okay...

It was months before I bonded with L1.  Sure, I took care of him when I was well enough to.  And, somewhere deep down I knew that I loved him.  But, I remember in those early weeks confessing that I loved him like and wished that he could be my nephew instead of my son.  That I knew how to be an aunt and that I  was obviously unworthy of being a mother if I couldn't even bond with my own son.  My flesh and blood.  The child whom I had longed and cried just one glimpse of in the weeks preceding his birth.

In this photo, taken when L1 was around 7 weeks or so old, I can tell, and maybe you can, too, not only how sick I am, but also how far removed I was from being the kind of mother I desperately wanted to be.  I was a shell of a person and was far from being connected to my own child in the way that you anticipate you will be when you dream of motherhood.

The following photo was taken a few weeks later, once my treatment had begun to take effect and I had begun doing things to improve our bonding.  You can tell that things were progressing, but I know as I look carefully and remember this tenuous time that they were far from perfect and that my relationship with my son, but more importantly with myself as a mother, left much to be desired.

A couple of weeks after that photo, at Christmastime, this photo was taken.  I remember feeling joy for the first time in months that Christmas.  It was fleeting.  It was temporary.  But it was real.  It was genuine and heartfelt and the smile I wore was not an attempt at a decent photo of my child and me, but rather a moment in time captured.

In mid-February of the following year, when L1 was 5 1/2 months old, he was baptized.  For the first time since I had become a mother I recall that I felt like me again this weekend.  I hosted our dear friends for the Baptism festivities, had a luncheon in honor of the occasion, enjoyed a casual glass of wine, and did all of the things that had been previously missing from life post-baby.  I finally realized that while the "me" I had known had gone MIA for a while, that deep down she was not lost and was still in there and capable of reconciling this new role as a mother and being the same person I had been and wanted to continue being.  And?  As a result my heart and mind, healed and open, allowed my son and I to connect and to create an unbreakable bond that has continued to deepen and thicken to this day.

Have hope dear Survivor (and Surviving) Mamas, that regardless of when you bond with your child that with effort and healing it WILL happen.  And it will be so worth it!

If someone's gonna call me in the middle of the night...

they had BETTER be this cute:

Can you believe it's been a month already?  Neither can I!  It seems like L2 is so brand new and these four weeks have passed so quickly, and yet?  Somewhere in my heart he always existed.  Maybe as a tiny little missing L2 shaped piece.

While I am far from having everything figured out, at the one month point I do feel like I have a bit of perspective on pregnancy and the early postpartum weeks as a survivor of postpartum depression and anxiety.  So...what questions do you have for me?  Ask away!

When you want to cry...laugh.

Today is one of those days. One of those my three week old slept better than my husband and three year old did and therefore I barely slept last night days.  And now?  L1 will not keep his hands off of L2 long enough for the poor wee one to get 5 winks.  So today...when I want to pull out my hair and crawl into my closet and cry?  Instead?  I am going to look at this photo...

Three Week Update: Two's More Than Company

As you've probably gathered if you've been following me on Twitter or reading between the lines in the short posts I've done since L2 was born, at least for now I am SO much better off this time around postpartum.

Physically?  My c-section recovery was a cinch compared to with L1.  I was up and around within a week of surgery and was able to participate (carefully) in everyday life.  I didn't take a single pain pill (not even an Advil) once home, so while I was a little uncomfortable if I lifted something I shouldn't have or moved about too much one day, it was nothing I couldn't handle.

Emotionally?  We had a blissful start after an amazing birth experience (more on that later) and then at hour 47 I crashed.  Days 3-6 postpartum resembled a slightly milder version of the hell I lived in for weeks and months postpartum with L1.  Honestly?  It both scared the crap out of me and was a huge wake-up call.  I knew we needed to do something and fast.  And?  I knew that while all the emotional work I had done in preparation for this experience was helpful and worth it, that for me postpartum depression, anxiety and panic are about physical changes that happen in my body completely outside of my control.  Gratefully, there are things one can do about that and we immediately began to put the contingency plan into place.  I went back on the meds I had been on previously postpartum, albeit on much lower doses.  After more struggles breastfeeding (despite L2 latching perfectly- imagine that?!?!), weight issues with him, and the anxiety that taking multiple meds that were seeping into my breastmilk, I made the tough decision to stop nursing.  This time, though, it was completely my decision and I felt good about it.  Turns out, the kid has horrible reflux and a milk protein allergy just like his brother and is on hypoallergenic formula anyway.  So, ironically, even if I had "toughed it out" and continued nursing we probably would have had to stop because of his health issues.

Managing two kids, even with lots of help, is a huge adjustment, for those without any PPD, too, I imagine, and so I won't say we are even close to figuring it all out.  But, I am trying to take it day by day and pray my way through the challenges and physical demands that it creates.  Two?  It's a whole new ball game, but I must say I am still so glad we decided to play.