Real Time

It’s taken me five months to realize what’s wrong.

Five good months since the birth of my child.

Five months of kisses and cuddles and bleary-eyed marches; blaring noise and silent sleep.

All this time and all this experience it took me to notice things around me:

Systems out of whack. Needs untended. Tweaks to be made.

Funny, how the way you realize you’re surviving is the ability to see what’s awry.

One day, you feel the slight twinge of annoyance. Stress at the the logistics of life. And you think, wait, I’ve reentered the real world without even realizing it. Without any fanfare. No great plunge. But a gradual dipping in of toes, then ankles, calves – until suddenly the cold on your belly button makes your breath catch.

It is exhilarating and chilling at the same time.

You’re doing it. You’re living life, your life, while navigating the care of that of your little one. It’s never easy, always imperfect. It may turn your lips blue and make your teeth chatter, but you’re afloat.

And that is a feat in and of itself.

floating

Pinterest, multiple sources

 

Two to Two

I went to sleep in the springtime
I awoke in summer

A riot of green,
a vibrant rush,
an air of energy

My body reclaimed and yet not my own
Inside out
the protective covering of conception gone

Gaunt fingers and ankles
ghosts of padded appendages
no longer needed to sustain life
for two

Whole again
and yet suddenly separate
A new path split
in two

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.

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

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

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.

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