childbirth, Mental Health, motherhood, perinatal mood and anxiety disorders, postpartum depression, pregnancy, Uncategorized

When does a perinatal mood disorder start?

Please read on to pinpoint when you or a woman close to you will begin to see signs of a perinatal mood and/or anxiety disorder.

When two lines appear on the pregnancy test
When pregnancy is unexpected
When pregnancy is finally achieved
When pregnancy is not achieved
When the mother loses the baby
When the mother chooses not to have the baby
When the adoption falls through
When the drastic changes in lifestyle that having a baby will induce begin to occur:
- nausea
- extreme exhaustion
- no more wine with dinner or beer after a rough day
- limited mobility

When the hormones at flux in the pregnant body affect thought processes
- heightened anxiety at the amazing responsibility of growing and then caring for a baby
- fear of the unknown or varied outcomes of gestation, labor, delivery, and aftercare
- ambivalence over the new self the mother must create or become
- mourning the loss of the former self

When medication regimens must be altered due to unknown effects of routine prescriptions on the fetus
When mother worries and feels guilty about continuing medication and its effects on fetus
When mother suffers a loss during pregnancy
postpartumpathways.com
- death of a loved one
- separation from partner

When the mother has no partner or support person

When a drastic transition occurs during pregnancy
- moving homes and/or locations
- away from support network
- loss of own or partner’s employment

When labor and/or delivery does not go as planned or expected
Traumatic labor and/or delivery
- physical trauma
- emotional or psychological trauma

Complicated recovery from labor and/or delivery
- infection
- injury

When adoption is complete

Unexpected medical condition in infant
Loss of infant

Difficulty feeding infant
- breastfeeding
- colic
- reflux
- allergies
- tongue tied

Extreme fatigue recovering from labor and caring for newborn around the clock
No routine
No schedule
No down time – constantly being needed, touched, suckled
Disappointment at real life not matching imagined version of motherhood
Hormones further thrown into flux after baby-growing part of process complete
Stress
Too much interference and advice from others
Not enough support and help from others
Isolation
Weaning child from breast (days, weeks, years after birth)
Being sole caregiver for a fragile, totally dependent being

After reading this list, it should be an incredibly simple and precise process to pinpoint exactly when you or a woman close to you will exhibit signs of a perinatal mood disorder. Diagnosing and treating it should be even simpler. And recovery? Piece of cake.

Hopefully it is quite obvious that the way I’ve chosen to frame this list is tongue in cheek. The individual items on the list are anything but. They are varied; some mutually exclusive and many overlapping – to show that there is no one road map for predicting, preventing, diagnosing, or treating perinatal mood disorders. Perinatal mood disorders come in many different forms with many different time lines. The one surefire tool to helping yourself or a woman close to you who is suffering is awareness. Awareness of the myriad possible causes and many symptoms that can present. And then reaching out.

To her. To your physician. Midwife. OB. GYN. Pediatrician. Counselor. Therapist. Psychologist. Psychiatrist. Friend. Mother. Partner. Neighbor.

With an illness this insidious, multi-faceted, and far-reaching, silence is not an option. The lives of our mothers, babies, and families depend upon it.

anxiety, childbirth, Maternal Health Month, May is Mental Health Month, motherhood, postpartum depression, pregnancy

Locked On

They put the baby lo-jack on the umbilical stump.

If I had to choose one phrase illustrating how relaxed my most recent and hopefully last tour of a maternity ward was, that would be it.

It may not seem like much, but to me, it’s a huge deal.

Over six years ago, it was an errant lo-jack slipping off my baby’s slender little ankle that precipitated my fall into postpartum mood and anxiety disorders (PPMAD). Her squirming and that slipping gave my irrational mind the fuel it needed to doubt whether I was taking home the right baby.

I haven’t had that fear this time or denial or doubt, and the nurse only mentioned that additional bit of information as we headed for the elevator, but it capped our visit in the best way possible. As the elevator doors slid shut, I looked at my husband with relief and said if she’d told us nothing else, our tour was worth that one statement.

It’s an odd sensation that washes over one as she walks the floors she knows she’ll next be pacing in pain. To see the calm, the fresh beds, the quiet daylight streaming in the windows. I know the harsh fluorescent lights will glare, the linens no longer be fresh, the quiet replaced with beeps and moans and directions. It’s enough to put anyone on edge – either a woman trying to anticipate something she’s never experienced before or one who knows all too well what to expect.

This fourth tour I’ve taken was the least anxious I’ve ever been, however. It was due in large part to the relaxed community atmosphere of this particular ward. I think I also have finally realized that how ever much I dread labor, there is no way around it, only through it.

The nurse was very low-key, gentle and calming, as she shared information and answered our questions. When I asked about labor positions and modifications due to a weak pubic bone, she explained how the end of the bed came off, a yoga ball could be used, a kneel or squat bar . . . she even said she’d make a note in my chart to request an automatic PT consult after the birth. I wanted to hug and kiss her.

And then she made my day even better when she shared the positioning of the lo-jack. I hadn’t mentioned anything about my postpartum experience last time. I hadn’t mentioned that a tiny locator device could be such a trigger. I hadn’t expressed any concerns about security. Maybe it was just that we were approaching the locked door of the ward as the tour ended, but she told us hospitals have changed procedure to attach the device on the umbilical stump because it can’t fall off.

With that one bit of information, that I hadn’t known I needed to hear or was even a possibility, my mind opened up. The iron grip of anxiety I’d unwittingly been living with lifted – if only enough to let me breathe. To see that this labor and delivery and recovery will be different. There will be no fear concerning the baby.

I am hers, she is mine. Everything will happen as it should.

flickrhivemind

motherhood, pregnancy

If You Give a Mom a Chore . . .

If you give a mom a chore, she’ll likely find three other things to be done before it.

If the corner of her room has to be cleared to make room for baby’s changing table, she’ll first vacuum the floor. She’ll move the bed to get under there. If she moves the bed, she’ll see the mangled metal blind she’s been meaning to put back in its bent brackets. Before she can replace the blind, she’ll need to wash the windows behind it. If she’s washing the windows, she’ll need to pull out the screens that need to be replaced. Saving the screens for another day, she uses the ball of clean sheets waiting on the side chair to change the bed – after she hangs the kids’ clothing that’s been waiting on top of the sheets. Chair clear, she turns to the writing desk she’ll eventually need to move as well. The desk itself will need to be dismantled and saved for another day, but first she’ll need to sort through and separate the absolutely essential papers and supplies, putting them in the smaller cart nearby. She needs to do that before the cart can be moved to a new corner in the dining room. To move the cart, she’ll have to move the tray table holding the sewing machine. Before she puts away the sewing machine, she’ll need to mend the fastener on the tankini top that won’t fit her right now anyway – and make that roman shade for which she’s been saving that fabric. When she moves the typewriter table and its antique occupant, she’ll have to clean the window behind that, too, adding its screen to her pile of replacements.

Are you as exhausted as I am just thinking about all this?

This is the way my anal-retentive, procedural, obsessive, perfectionist, over-achieving mind works. As I described an abbreviated version of this undertaking to a friend, she said I sounded liked the main character in If You Give a Mouse a Cookie. We both burst out laughing, as it was the perfect description. I am the mouse. Coo coo ca choo. Or something like that.

Though the mouse has a much more fun trajectory.

Do all these chores need to be completed before the simple placement of a changing table? No. But, in my mind, do I feel that they all need to be? Yes. Is it a chance to complete tasks long overdue? Yes. Is there a modicum of guilt and desire for redemption in finally completing them? Yes. Do I see the arrival of baby as a waypoint closing a window of opportunity at this point in my life? Yes. Is this a completely arbitrary creation of my mind? Yes.

A rational working through of it may help me realize the origin of such mouse mayhem, but the animal instinct driving it remains. I. still. need. to. follow. protocol. Whatever need for self-preservation I have – and physical exhaustion that comes with pregnancy – does keep me from manically pushing through the entire process at once. Well, that and three children, a husband, and a house to run.

But I’ve started the process. It’s well on its way – thank goodness – which means it’s almost done. Well, hopefully.

Hopefully, there’s also a cookie for me at the end of this trail. mouse cookie

motherhood, parenting, Perspective, pregnancy, Uncategorized

In the Market for a Mother

My pace was slow as we approached the store. Partly because I’d just filled my belly and bladder and couldn’t walk without a hitch, but also because I wasn’t necessarily looking forward to crossing the threshold.

My mother and I were headed to the baby superstore. She had kindly offered to supply our new little one with bed linens, mattress pads, etc. It would be fun to pick at least the patterns on the sheets, and it made sense to come to such a store with a ridiculous variety of options; still, I hesitated – and not just when I realized the restrooms were in the far rear corner of the store. (Seriously, people? Preggos and newborns? Damn the marketing man.)

The fact that this store had such a ridiculous variety of options was part of the problem. If I’ve learned anything after three babies, it’s that simpler is usually better. The addition and care of a little person complicates life enough. Why does a parent need a proprietary gizmo for each and every function? They only suck up money and space.

Have you ever googled ‘baby gear image’? Don’t. (pearlsonastring.com)

One of the liberating aspects of this older, wiser, and unexpected pregnancy (ie gave away all our stuff) was that it would be bare bones. All that stuff I’d registered for and thought I needed and accumulated now was non sequitur. I could pick and choose what was truly needed to care for my baby. And really, that was not much of anything besides my hands and heart. (though, disposable diapers would be nice).

Especially after the rough ride with #3, I was looking forward to a pared down experience focused on the mother-child bond rather than the circus that can sometimes surround newborns and new motherhood.

So after my mother graciously offered to walk back to the front of the store to acquire a shopping cart, she found me staring glassy-eyed at the crib sheet display.

“You’re overwhelmed, aren’t you?” she asked.

More than anything, I felt like I was in an alternate universe, never having expected to find myself in this aisle again. It had been years. I felt older. A little self-righteous in a been there-done that sort of way. Appalled – and again older – to see how much the prices had gone up since I’d last bought this stuff. Amused by the upper tier options people who didn’t have any frame of reference would actually spring for.

After choosing a good foundation of necessities, we wandered into other departments, which was probably a mistake. Bedding I could do. The child couldn’t sleep itself into a sweaty, sticky mess on a bare mattress. But cradles, and cups and spoons, and bottles, and little padded strap cushions. Mom and I decided to get a few nursing supplies since I’d need those right off and call it a day.

Don’t get me wrong, Mom and I swooned when we saw the adorable itty bitty sheep on a crib sheet. I picked up a little fox and she nearly hugged a fuzzy penguin. Humans love fresh starts, soft little fingers and toes, and the fragility of life we often forget otherwise.

But I feel like the culture of modern motherhood and merchandising drowns all that. Sure, it shines through in a precious petite bodysuit. But the rows of cribs, reclining chairs, canvas art work, and countless accessories? No mother needs all that. If she wants it, fine. But I think the first insidious brainwashing of the perfect mother myth is that she must have it. The material, the physical accoutrements must be perfectly laid for her to perfectly welcome and care for her baby.

For those times when the maternal bond is muddled, all that material just masks the root problem – and ultimate solution – further.

It’s time to get back to basics.

I picture myself holding my baby, swaddling her* close, and facing the world together – without the marketing man anywhere in sight.

*And no, this is not a veiled announcement of the sex of our child; female pronouns just roll off the tongue after three girls

childbirth, motherhood, postpartum depression, pregnancy, Recovery, Survival

Bitter Sweet

I never wanted another baby. I didn’t desire to hold one. I didn’t get the ‘aww’s and the itch when I’d see someone else’s. I wouldn’t wistfully remember packing them into footies when I saw someone with toddlers preparing to leave a late-night party.

I would bless my lucky stars it wasn’t me.

The very thought of returning to that period rife with anxiety and stress, dark anger and overwhelming feelings made me a bitter, sarcastic person. I was most certainly the old crone in the corner who said, better you than me.

Jennifer Butler Basile

In fact, just this last summer, a friend and I attended an outdoor concert on the grounds of a winery. As we toasted each other in the camp chairs we’d squeezed into the back end of the event tent to avoid the rain, I thought how lovely it was to get away. We ate our cheese and crackers, we laughed, we reveled in our unfettered evening. As the clouds broke just before sunset, some people ventured onto the surrounding lawn and set up blankets. A stylish young mother in a flowing skirt with dark hair to match, swaddled her baby and rocked to the music. Though we hadn’t said a word to each other, both my friend and I watched the scene; for as soon as I opened my mouth, she knew exactly of whom I spoke.

“Good for her,” I said, in a tone that unmistakably meant – better her than me; taking an infant to an outdoor evening concert, contending with rain; controlling wine intake if he needs to breastfeed; leaving early if he gets cranky.

My friend laughed and, in effect, toasted that sentiment.

The very sight of a mother and child, lovely as it was, brought my back up in disdain, for fear of the anxiety that wasn’t far behind. I was here to escape; I wanted no such reminder of that part of my life I was trying to escape.

And yet, though feelings like this were very authentic, they didn’t sit well with me.

I loved my girls. I welcomed them willingly into my life. I may not have liked or gracefully handled every aspect of my days with them, but I was dedicated to the role and importance of family in the world.

And so, to scorn other people doing the same thing – it did not compute. I knew exactly how hard it was and should have been supportive rather than snarky. And I suppose I wasn’t overtly snarky, but my attitude toward life had changed. I think the snark helped me build a shell around my wounded psyche. I’d returned to real life, but I hadn’t healed. I needed some fail safe so my wounds didn’t weep everywhere while I went about my business.

In September, I got pregnant.

I had referred to number three as a surprise; what a poor example that was compared to this! Six years out from our youngest. All three kids: potty-trained and self-feeding; able to run around without a bodyguard; play dates with friends and some quiet time for us adults.

What!?

I felt really silly when I thought back to that scene at the concert. I’d served myself up a huge slice of humble pie. How could I have made such a remark and then go and do it to myself? But there was no way I could’ve held my tongue in preparation for what was to come. I never imagined it would be so.

In the days following the birth of our third, I slept fitfully while the baby dozed nearby. I awoke at one point in a cold sweat, having dreamt I was in labor, contracting forcefully. When I realized it was a dream, I thanked God it was over and prayed I’d never have to do it again. It was almost a PTSD reaction. (side note: my postpartum depression was swiftly developing and I’d had a traumatic recovery from labor)

Yet, here we were. Preparing to do it all over again. With a strange sense of calm. I’d had a spiritual epiphany of sorts at the start of my pregnancy that set me off on a good foot. But I also had already faced nearly everything of which I was afraid. I’d seen how shitty it could be – and how I’d survived.

Obviously not unscathed, given my snarky attitude, but I think that’s precisely why I find myself in this lovely predicament. This baby is a chance to wipe away all my negative associations with expecting and bringing a child into this world. Does that mean I’ll push out roses and sunshine? Hell, no. It’s going to be a hard road, but I feel this experience will also rebirth my wonder in life. My ability to see love and light in little faces and the tired faces of mothers. To once again give a shit, to stand and support myself and other mothers around me. To say, not only will you survive, but you will enter a place of peace – at some point.

Jennifer Butler Basile

Children, Humor, motherhood, parenting, pregnancy

Murphy’s Child

There are some sure-fire ways to guarantee the growth of your family. None are medically proven; none are rational – but all fall under the accord of Murphy’s Law.

First and foremost, tell everyone who asks – even those who don’t – that you are done having children. Your family is complete.
Further this point by passing along all your baby paraphernalia, with the caveat that you never want to see it again. They can do with it whatever they like when they’re done with it, but you don’t want it back.
Sweep maternity clothes out of your home with great aplomb. Plunk the rubber tote you’ve been storing them in on your neighbor/co-worker/friend’s front step with great and resounding authority.
Start to enjoy the long-forgotten freedom you and your spouse can reclaim at parties and cook-outs, even when the children are present. You can sit for 2.5 seconds without rushing to pluck them from the jaws of salmonella, see-saws, or swinging bats. Up the ante by enjoying a refreshing adult beverage.
Dream of a day in the not-so-distant future where you may actually be able to take a family vacation. All the kids are potty-trained, done with naps, and significantly less likely to throw a tantrum. The rosy glow on the horizon – and substantial sums of money no longer going toward diapers and pull-ups – even make you consider opening a dedicated savings account.
Send your youngest off to her first full day at school. Look at the seemingly endless hours that stretch before you and marvel at how you’ll fill them. Begin to dream and scheme for something soul-fulfilling, personal, even professional.
Most importantly – and the penultimate step – is to engage in quality intimate time with your spouse. Have actual conversations, canoodle, and connect in ways you haven’t since you conceived your last child – wait, what?
Too late. Murphy strikes again.

shedka.com

motherhood, postpartum depression, pregnancy

Not PPMADetermined

Postpartum Mood and Anxiety Disorders (PPMADs) rob mothers of so many things, but perhaps the cruelest thing they take is the joy. The joy – which makes the overwhelming job of motherhood worth it – is replaced by fear.

Fear that you’ve made a terrible choice in having a child
Fear that you don’t deserve this child
Fear that someone may take this child from you
Fear that you may do something to hurt this child
Fear that you won’t survive another day without hurting yourself

The fears of the early days will pass – through time, gentle care, therapy, medical intervention. You will be able to envision a bright future for you and your child

Even still, there are some things PPMADs may steal that can never be replaced. The memory of the pain and anguish, the trauma linger on. There is no peace to ever be associated with that time in a mother’s life. So much so, that she will never, ever attempt it again. Women who dreamed of large families stop at one child, not because they are bad mothers or lack the desire, but because their pospartum experience was so bad.

There are the women who achieve pregnancy fully armed with the warning signs and therapeutic tools available to them, should PPMAD strike again, yet are paralyzed by the anxiety that it could happen again.

There are women who must face the scrutiny of others who deem them crazy for even attempting pregnancy after their previous experience. They second-guess their own intuition and self-knowledge and the fact that they’ve come out the other side beat-up, but stronger – all because of the well-meaning souls who give critical advisories for mothers’ own good. Well-meaning souls who have never inhabited the dark spaces of these mothers’ individual hells, who have not fought the daily internal battles it takes to stay out of them, and who don’t realize that every negative comment saps one more drop of the mothers’ resolve.

PPMADs are an insidious band of thieves. They take without provocation, without discrimination, without consideration. They come under cover of dark; they aren’t cloaked because they’re faceless. But with help and support, mothers can choose to face them. And take back what is rightfully theirs: their own vision of motherhood.

Depression, pregnancy, Uncategorized

I Wept

For the pregnant woman
who loved her child enough to stop taking the psychopharmaceuticals she desperately needed
to guarantee its unencumbered growth –
and that of her paranoia and compulsion
until she threw herself and that unborn child off the top of her building

Because she loved her child so much and had run out of ways to keep her safe

For the grown man
acutely aware of his condition and how to manage it
with a cocktail of meds and careful counseling –
until one tile shifts out of place and sends the rest clattering to the floor in an instant

Because he thought he didn’t have to look over his shoulder for the rest of his life

I wept for their stories, their lives, their pain
I wept for the syncronicity, the melancholy, myself

I wept
because there is never a safe enough distance from the places they – I’ve – been

As inspired by the June 6th edition of Fresh Air, “Pregnant Women With Depression Face Tough Choices, No Easy Answers” with author Andrew Solomon. Click below to listen – well worth the time.

pregnant-depression

childbirth, dialogue, help, motherhood, postpartum depression, pregnancy, prevention, Recovery

More to the Story

I spent an hour and a half sitting on the basement floor of my local library the other morning. I’d found the general Dewey decimal neighborhood I’d wanted and set about meeting the locals.

One good thing about living in a small town on a frigid morning and rushing the library doors as soon as they open is that you have nearly the whole place to yourself. I was the one who flipped on the banks of fluorescent lights as I descended the stairs. I sipped from my travel mug of tea as I decided which books would aid me in my research journey. I read nearly an entire chapter of one that I eventually set back on the shelf – one I’ll certainly return to, but didn’t match the goals of today’s project.

Today’s project is preventing postpartum depression.

Though I checked out nine books, welcoming jokes from the clerks at the front desk as to what kind of wagon I’d need to transport them to the car, none is about postpartum depression. One is about ‘regular old’ depression. Others have a few pages, maybe a section specifically about postpartum. But not one of the towering stack I selected gave an in-depth discussion of postpartum depression.

In the online catalog of our state’s inter-library system, there were some, but still not that many. And none that looked, on first glance, like they offered the kind of practical information and solace that a woman in the throes of postpartum would want or need. I know. It doesn’t take much to put myself back to that hopeless place I experienced myself.

I ended up checking out mostly childbirth preparation books or ‘how-to’ guides to pregnancy, which made my children, upon seeing Mommy read a book with a woman’s round belly on the front, very suspicious. Two of my girls put in orders for a baby brother. I asked my eldest if she’d want me to be pregnant, to which she said, no, but if you were I’d want a brother. Only now do I see the irony in their thinking I needed to read another book about pregnancy after three times around the mountain.

Been there, done that.

But this time, I was trying to read these pregnancy preparation books with new eyes. Having been through it and having had the experiences I did, what would help me do it differently? Or more importantly, what support systems would have kept me from plunging into the depths of despair? And how can I apply those to helping other women?

I was surprised to enjoy Ina May’s Guide to Childbirth (Ina May Gaskin) as much as I did. I figured that title would be one I skimmed to find anecdotes or info pertaining to postpartum, but I am thoroughly enjoying delving into the personal accounts of unhurried, gradual childbirths. I am rediscovering the empowering parts of my own labors and deliveries – the first two for their strengths and victories, the last for my eventual triumph over seemingly insurmountable odds. With that last one as my capstone, I’d forgotten the positive parts of pregnancy and childbirth. Remembering that gives me something to help women to which to aspire.

The disparity between parts of my own experience and beautiful birth stories brings into sharp focus those areas that can serve as triggers, flashpoints for distress and disorder. And by beautiful, I do not mean perfect or idyllic. As Anne Cushman says in The Mindful Way Through Pregnancy, “labor and delivery are wild and messy and animal and angry and bloody and painful. The transcendent act of giving birth is made up of the earthiest of elements: bodily fluids, a hospital gown stained with blood and excrement, the bruises left on your partner’s arm by the agonized grip of your fingers.” (Piver 16) All this is normal, to be expected. That’s not what we need to worry about. We (women, mothers, humans, physicians, therapists, ob/gyns, midwives) need to help women recognize when there is cause to worry.

So maybe sitting on the floor of my local library and freaking my kids out with pictures of the ocarina found in one of my books will help me figure out how exactly to do that. As with anything, it’s all about dialogue. Whether that dialogue comes through books at the library, blog posts, or conversations with doctors, expectant and newborn mothers need to know there’s more to the story.

Chopping Potatoes

and other metaphors for motherhood

Category Archives: pregnancy