New Year’s Anxiety

I don’t like New Year’s. There I said it.  Bah humbug on me.

I can’t quite put my finger on it.  There are many reasons, actually; perhaps that’s why I can’t choose just one.

It could be because, for years, it signaled the end of vacation.  One day left to recover from a whole week’s worth of revelry, never mind one night of staying up late.  But also, the start of a new cycle of anxiety.  First, back to school as a student after no routine, no work, no peer pressure.  Then, back to school as a teacher after no lessons to plan, papers to correct, or kids to sass me and throw my class off course.

I never even knew exactly what I dreaded.  And I guess that was precisely the point.  The unknown.  I was out of my groove and didn’t know what to expect upon jumping back into it.  That was what terrified me.

And then I had kids.  Little babies at home who depended on me and only me when Daddy went back to work after the holidays.  Where I’d been easy breezy and in control with him home, the thought of doing the same things without him under the same roof made my muscles clench.  Not because I couldn’t or hadn’t before or wouldn’t now, but because of the unknown.  What if something happened I couldn’t handle?

On December 31st, I shovel enough calories to counteract the headache-inducing powers of the bubbly I’m sipping and learn just how out-of-touch I am and how sad the state of popular music is by the broadcast performances.  I eat and sip and flip channels to force myself awake till the magic hour when all I’d like to do is curl up and go to sleep.  And for all that build-up, all that empty effort, all that’s left after a sweet kiss with my hubby – is a void.

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Outside my house, barely lit by the moon.  Lack of light fits the theme. Taken December 30.

The absence of a year past, the new one not yet started.  The hole where merry holidays once were.  A cold, dark, silent winter stretching before me.  Exhaustion.  Let-down.  The unknown.

 

 To say I ponder the absolute unknow-ability of an entire upcoming year in one night would be false.  At least not consciously.  But perhaps that’s part of why I hate New Years.  Each year, with December 31st, I’ve closed an expected chapter in that point of my life.  I’ve made it through the holidays, with all the tradition and routine that comes with.  I’ve made it to the end of the calendar year.  Even if I’ve not completed all the to-dos, I can rip that page out of my proverbial planner because that time has passed.

To what? Is the question.

To a person with anxiety, a new beginning, a new chapter is not a fresh start.  It is a worrisome reworking of the same fears and uncertainties that plague her at the outset of any unfamiliar venture.

When these same feelings return at the end of each holiday break, I wonder if I’ve ever grown up or grown past the fears I had as younger versions of myself.  I haven’t taught for ten years – why should I still fear returning to work!?  Well, I do and I don’t.  A nightmare classroom doesn’t await me.  But as one of the highest stress times of my life, that scenario is my psyche’s go-to when it fantasizes fear.  And in that all too familiar low after the holidays, it’s easy to build the set for the familiar script.

Now, both consciously and subconsciously, I get to ponder what I want from this portion of my life.  I get to question my worth as a mother, why naptime may be the favorite part of my day, why I don’t get down on the floor and play blocks anymore.  Why I swear, why I say things I judge fictional mothers for saying, things that make me sure I’m killing their spirit but utter anyway.  I get to think about how much I want to write, and what, and how I don’t have time for that.  I get to choose how to mete out my volunteer time and what I feel I have to do, not what makes my soul sing because I don’t want to hurt anyone’s feelings.  I get to think about how the days fly but are often filled with crap.

This has been a New Year’s tradition for so long, it’s hard to separate out what is holiday ennui and true anxiety.  I’m beginning to think the anxiety is the one sure thing that isn’t going to change from year to year.

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
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    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.

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.

baby feet

flickrhivemind

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

 

Without Wee, Within

I am very much inside myself lately.

Thinking about what needs to get done,
Worrying about pain and exhaustion,
Waiting for my next chance to lie down

I weigh this alone time
for its relaxation
vs
opportunity to accomplish,
both sans wee ones

Motherhood has brought me to this state
and yet, it’s all in my head.

I struggle and strive to survive
for them
yet yearn for me

.

power_within

powercube.net

If it’s Monday, it must be . . .

After my third pregnancy, it felt like I saw every specialist under the sun. Midwife, general practitioner, physical therapist, behavioral therapist, chiropractor, podiatrist. It took a lot of work to put me back together physically and mentally.

My schedule hasn’t changed much this time around, except I’m starting my visits prenatally rather than post. And I haven’t hit everyone on the laundry list yet – which is probably a good thing, given I’m already having continuity of care issues.

Today I saw my general practitioner.

It was to be a followup after my visit to a psychiatrist. Shortly before my pregnancy, I’d started with this GP. When discussing my mental health history and current condition, she suggested I get a specific diagnosis from a psychiatrist since what initially presented as postpartum depression was persisting. I’d been continuing care with a LICSW I’d been seeing. Thanks to hospital systems and network nightmares, I’d need to go through 12 CBT sessions at his facility before even seeing the psychiatrist – even though that’s what I’d been doing for years with my own therapist. Already spooked by the red tape and thought of strong psychotropic drugs, I put it all on hold once I found out I was pregnant. I couldn’t start on new meds anyway and didn’t need any additional stress.

Through the guidance of my LICSW and midwife, I decided the benefits of continuing my low dose of meds were greater than the risk of harm during pregnancy. That’s not to say the decision was made lightly. I cut out mostly everything questionable when pregnant. I’d always felt guilt for taking meds in the first place. But after weighing all my options – and a few bad days of trying to wean – the meds stayed.

Now, my GP didn’t know any of this.

When I tried to verify my protocol and discuss my midwife’s suggestion to possibly wean toward the end of pregnancy so the baby would not suffer any possible ill effects of the drug as a newborn, she wondered whether she would’ve advised taking meds at all had she found out earlier in my pregnancy. She said that’s why she wanted the input of the psychiatrist, especially now with a pregnancy, to know exactly with what we were dealing.

Now, this GP is solid. She did not shy away from discussing different prescription therapies. She wanted me to see the psychiatrist to get to the origin point at the bottom of my pit. She is candid, empathetic. Today, however, I felt the doubt and guilt over taking meds during pregnancy try to push up. The doubt that I’m not getting the best possible prenatal care cropped up when she suggested I see an OB in my group rather than only a midwife; her reasoning being that should my situation become critical I would need someone to assess and intervene immediately.

She is following due process. She is looking out for the best interests of me and my baby. She is talented, trained, and professional.

And yet there are gaps in her knowledge of perinatal mood disorders and their treatment.

My midwife, fully aware there is no definitive research saying meds are 100% risk-free during pregnancy, also knows the research that an anxious and/or depressed mother can also have ill-effects on a developing fetus.

My LICSW knows the mental anguish I put myself through in making this decision and that I can’t hang without the meds.

All three are looking out for the best interests of me and my baby. All three are experts in their fields. And yet, at times, all three have told me something different.

Where is the continuity of care in the perinatal period? Yes, the knowledge base is growing. Yes, awareness is spreading. Yes, some practitioners are training themselves to be experts in this ever-growing area. But there isn’t enough widespread know-how. There are gaps in which women can and will fall through.

I haven’t met any of the OBs in the group I visit, but seeing one doesn’t guarantee me swift and effective intervention in the postpartum period. Not taking meds doesn’t guarantee a perfectly formed baby. Taking meds doesn’t even preclude mood disorders.

There is always some mystery involved in making and growing a baby. Insert mood disorders and mental health issues and the lines are blurred even further. Unfortunately, it still falls primarily to the mother to advocate for her own health amidst all the conflicting care.

Though still haunted by the postpartum experience in my previous pregnancy, I feel that I can advocate for myself this time. Knowing the danger signs, the markers, the despair, I feel equipped to request and access care as soon as it’s needed. I know who to ask and how to get it. However, that doesn’t mean that all of my helpers will be on the same page. One perinatal hand may very well have no idea what the others are doing – just as I don’t know which specialist I’m seeing unless I know which day it is.

hands

Bonus Day

Yesterday, the first day of spring, my children had a snow day from school.

No, the irony does not escape me. Yes, I realize our region of New England does not preclude such occurrences (one blizzard happening several years ago on April Fools’ Day – apparently Mother Nature has a healthy sense of humor every year). Alas, the snow totals fell drastically short of the predictions and the sun shone and snow melted by what would have been dismissal time.

As I lay in bed Sunday night, after receiving the robo-call from the school department, I was more relaxed than usual knowing I wouldn’t have to rush the kids out the door the next morning. I did say to my husband, however, that I wasn’t looking forward to a whole day inside with the kids. He agreed with me that my comment didn’t exactly sound nice, but I’ve gotten used to some quiet school days as a respite. Plus, I’ve been having iPad battles with the oldest (see previous post), all the girls have been having battles with each other, and I just end up yelling.

It made me laugh, then, when a friend called in the morning, saying I had a ‘bonus day’ with the kids. None of us were dressed. I’d been on my phone all day. They’d bounced between their rooms, the Wii, iPad, and computers. Her use of ‘bonus’ implied unexpected and appreciated quality time. I think I was on vegetation/survival mode.

I finally got my butt in gear enough to strip all three of their beds, a task – believe it or not – they’d been bugging me to do. My very particular middle wanted tightly tucked sheets. My little wanted new blankets. The oldest sleeps with such reckless abandon her bed was just torn to shreds. I figured with them home, perhaps they could help me. I also hoped I’d find my middle’s long-lost library book shoved under her mattress. Ha ha!

When I pulled the bunk beds out to sweep for books and animals lost to the abyss, I made the mistake of leaving the room for a bit afterwards. We all know what empty spaces and crevices and unexpected configurations are for, right? For me, it meant extra room to tuck in those pesky sheets on the far side of the bunks. For them, it meant fill with stuffed animals and baskets and blankets!

'Sure I know what would solve this problem. More floor space.'

Or personal space . . .

 

Suddenly, awash in piles of bedding flooding the hallway, random crap scattered everywhere on the bedroom floors, another step added to an already unwelcome task – I was transported back to days when all three were pre-school. When it was one step forward, two steps back. When it was literally shoveling shit against the tide. When keeping them happy and/or entertained and a house with the least order of squalor attainable and some semblance of sanity was a nearly impossible balance.

And I was scared.

I was reminded what life was like with a house full of littles. As the sole caregiver, comforter, cheerleader, coach, craft guru . . . I am well aware that I need not be all these things at all – and certainly not all at once. But my anxiety treats any deviation from a perceived plan or expectation as a misstep, a notch closer to irritation, panic, anger. It makes me hide in a corner of my couch, balled up in my pjs, content to try nothing rather than get frustrated with things not going according to plan. Or overwhelmed by the enormity of a whole day with all these people – when it should be about the moments.

Even when summer vacation starts and I have not only the new infant, but the older three, it will not be the same as those insular days when they bounced off the walls like ping-pong balls. They are not all toddler and preschool age. They can have some independent and alone time. Even while I tend to the baby, they can play on their own or swing outside. Hopefully they will understand that I won’t be able to – nor should I – entertain them all day. Hopefully I’ll remember that, too.

And to take each moment one at a time for what it’s worth – not worrying the whole day away before it’s even started.

 

I’ve Been Had

I had to clear out months of clutter in a matter of weeks.

I had to squeeze in cleaning sessions between naps.

I had to let some things go that seemed absolutely essential.

I had to receive guests into an imperfect house.

I had to admit that the next week was lost due to physical and mental recovery.

I had to hope that it was just the exhaustion of overextension and not the harbinger of a downward slide

into

anger

irritability

the dull padding of apathy.

I have to rally the hopeful spirit of the season and strive to be reborn each day.

 

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.

I’m Baaack

I remember peeling off the cocoon of my bulky winter jacket one of the first times I came here.

Perching nervously on the edge of one of these same chairs.

Feeling completely vulnerable and exposed.

Wanting desperately for someone to mold me back together – yet not touch me.  Not look at me.  Not judge me.

For my weaknesses, my failures, my inability to just be.

It’s been awhile.  But I’m back.  And so are all the same feelings.

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