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
    postpartum_pathways_logo

    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.

Many Peaces of Mind

By sharing our stories, we encourage others to do the same.

This was a major theme of the Peace of Mind Storytellers Series I attended yesterday. By breaking the silence surrounding mental illness, we also break the stigma. We allow people to admit and accept the struggle and begin recovery.

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As an anxious person (also mere weeks away from delivering a child), attending a day-long event with hundreds of people I’d never met solo was a little nerve-wracking. But I’d been awarded a free ticket through a generous contest by a local mental health facility, Butler Hospital. I’d been following and loving the organization sponsoring the event, PeaceLove Studios, for several years. And the format of the event, like our state’s own local version of TED Talks, sounded pretty cool. As a writer, I am a little obsessed with stories, after all. Add the mental health aspect and I was hooked.

Once the speakers started rolling out, I realized this was not just like our state’s own local version of TED Talks, it basically was one. The speakers hailed from around the country and world. They ranged from college students to policy-makers and changers to international celebrities. While I hadn’t recognized all the names beforehand, I was impressed by the vitae of these individuals – and even more so by the enthralling stories they shared.

wp-1463799329728.jpgLike Faith Jegede-Cole who said mental health has to do with the health of your soul. Michael Thompson who said the goal is not to focus on just the 1 in 4 who suffers from mental illness, but all 4 – to get the others to listen. Kate Milliken whose own family’s silence over mental illness moved her to create a platform for patients and caregivers living with MS to share their experiences. Amelia Grumbach wishing someone else would take control of her life because she couldn’t/didn’t trust herself to do so. Philip Sheppard, a soul-stirring cellist, urging the attack of any creative endeavor without the fear of creating crap. Simon Majumdar saved by love of food and its serving of soul. The rhythm of Steve Gross’ (left) spoken word carrying the buoyant message of the right attitude affecting everything. Butterscotch following her heart’s desire without compromising for anyone. The mother’s love of A.J. Wilde holding her son, Devin, as he found the key to unlock his autism. Ryan Brunty’s lovable yetis expressing the depression he’d been living with silently beforehand. Stephanie Prechter’s fierce devotion to learning as much as possible to support and treat people like herself and her father who suffer with OCD. Mark Hedstrom moving Movember into the mental health space. Ross Szabo creating a curriculum so that mental health is not something we look at only when something’s wrong, but taught much like physical health education from kindergarten to grade 12 and beyond.

The wide range of experiences of these speakers broadened my perspective of mental illness and health. One of the speakers said, after all, we all have stuff; we’re all human. There are different brands and flavors and struggles, but one thing we all have in common is trying to walk this world with grace and contentment – at least most of the time.

All of these storytellers did so yesterday with beauty. Through their various creative presentations, they gave swell to that part of the soul that makes one glad to be alive, through the ugly and transcendent, the low and the dizzying highs.

The Peace of Mind Storytellers showed in a grand way what PeaceLove Studios is doing everyday: using expressive arts as a therapeutic device for all individuals languishing, battling, flailing, and/or surviving life with mental illness. What ninety participants got to take part in after the series of speakers. Myself included.

I was transported back to the first PeaceLove workshop I’d attended with a friend a few years ago. While in a different space with different people, the atmosphere was the same: a safe place to create, process, emote, and share. Several participants commented that they didn’t consider themselves artistic, but due to the open-ended nature of the activity and low-pressure environment, they enjoyed creating. Another said that while she hadn’t started with any idea in mind, a plan slowly took shape on her canvas – and that it was symbolic and cohesive. I felt similarly. Exhausted at the end of a long day, I didn’t think I was up for any grand metaphor. But what rose to the surface in that quiet, stream of consciousness state was perhaps exactly what my psyche needed at this time. Indeed, what came out reminded me of my constant struggle for balance. But in that gentle unfolding, it wasn’t frustrating as it usually is, but a quiet reminder that it’s a process, about maintaining peace of mind, not achieving it and moving on.

In the grand and small movements of my day at the Peace of Mind Storytellers Series, the ebb and flow of life was reflected. The entire day was a reflection of life at its best and worst and the journey we all make together. Bound by our stories and in the sharing, we can achieve peace of mind indeed.

wp-1463799315756.jpg

Painting by Jeffrey Sparr, PeaceLove co-founder

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

Nighttime Jewels

An island of green encrusted in jewels
illuminated by the light of oncoming traffic

globes of dandelion fluff sparkling
in the beams undercutting the night mist

a field of glittering diamonds
nothing but a mess of a nuisance by day

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

 

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.

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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

Not in Vain

Before my third child, I never dropped the JC.

I was no pure linguist, but I did not take the name of the Lord in vain.

In the months and years following her birth, it became a regular part of my vocabulary, satisfyingly venting my rage and frustration at things gone wrong. Stupid things. Teeth not being brushed. Butts not being wiped. Nothing that should unleash rage, but they were the proverbial straws.

I knew its use signaled a loss of center, of control.

Perhaps it was a desperate plea. But it came out sounding like a kid forced to say please and thank you. Totally inappropriate in tone and timbre.

Finally, one Lent, I decided to make a focused effort to stop saying it improperly. Keeping track of my missteps, I counted eight uses during those forty days. A significant reduction. I never did decide what would be an appropriate penance for each of those eight uses, but my non-JC oath habit stuck.

So here I am 32 weeks into pregnancy #4 and I’m being pelted with more stupid little straws.

My six year old has decided this is a fabulous time to assert her independence. Not in a dig-your-heels-in toddler sort of way, but in a snotty teenage you-can’t-make-me sort of way. Holding a stuffie I’d told her to put away at least three times, I stood over her as she sat on the bathroom floor fully dressed and not making any attempts to prepare for bed. I had to fight the urge to bean her over the head with it. After numerous non-oath reminders, I unleashed a torrent of reprimands peppered with choice words (though no JC – does that earn me some credit?).

Having to remove myself from the situation, I stalked in our bedroom, where my husband stood.

“This kid isn’t even born yet and I’m already swearing!”

He laughed. I think he appreciates seeing me get as frustrated as he does sometimes.

But his laughter also signaled to me that perhaps my reaction, while a bit overblown, was natural. I may be hyper-vigilant to signs of rage due to my postpartum experience last time, but that doesn’t mean that every freak-out is a bad sign. It could just be a bad day. Or a bad moment.

Just as uttering Jesus Christ in a proper context is not a bad thing, expressing anger or frustration in an appropriate way is not either. I need to watch the tone of my words and actions to see whether I’m struggling. It may not be a spiral, but a slight dip in the mood of the day.

I know many postpartum women – or anyone who’s suffered a mental health crisis – who see a bad day, a down period, a low point as a relapse. But even if it is, having been where we have and coming back from that place, we are equipped to do so faster, better, and with the proper supports.

We also are entitled to the same bad days our “normal” counterparts have all the time. Not every infraction is a sign of our condition, a harbinger of more to come.

Of course, all of this is easier said than done. Ironically, the organ we must rely on most strongly to convince us of our strength and resiliency is also the one most affected by our illness.

In that case, perhaps a call to the Lord would not be in vain.

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.

raindrops

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.

light

Jennifer Butler Basile

The Ghost of Winter

The ghost of winter,

a puff of breath

whisking swirls of snow
off the branches and into the air

suspended

a last gasp of cold crystals

the pine boughs flash frozen for a moment
and then it’s gone,

green grass poking through the raised mounds of snow
pushed upwards
by the fledgling growth of spring

a delicate dance

threatening
but gone in the blink of an eye

snow.Still0021

blackhillsfox.com

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

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