No More Smoke Screens

Last Wednesday, I had my six week follow-up appointment after the birth of my newest baby girl. The six weeks that had elapsed seemed like an eternity and yet instantaneous – like any spool of time surrounding a major life event does.

In the thick of summer vacation, I marched my older three girls into the office with me. Not ideal, but with the aid of electronic devices and some seats just outside the examination room door, I was able to avoid the embarrassment of an internal exam with the oldest two looking on and retching. I stationed my six year old’s chair full of crayons and coloring books at my head, the infant nestled in my chest.

Upon my arrival, the receptionist handed me the ubiquitous clipboard with the Edinburgh Postnatal Depression Scale. I knew it was coming. I was actually looking forward to it. I took it in hand almost giddily. There were a few reasons for this.

1. I didn’t need it.

Just a few days after the birth of my baby, a visiting nurse came to our house. Since it was a holiday weekend, we weren’t able to get an appointment with our pediatrician to check our breastfed baby’s weight and absence of jaundice so the hospital arranged for the home visit. While I expected the nurse to check the baby, she also looked after me, administering an EPDS. My score fell far below the range of danger for postpartum mood and anxiety disorders. Ever the overachiever, I joked with my husband that was a test I’d happily fail.

2.  But if I did, my answers to these questions would signal to my practitioners what sort of help I needed.

3.  If they gave the questionnaire to me, they gave it to all postpartum patients, which meant that all women had access to help if they were struggling.

epds

Jennifer Butler Basile

Still, when I handed the clipboard to the nurse in the examination room, and she followed up with questions like, ‘Have you ever thought of harming yourself or the baby?’, she asked them in a hushed voice. She apologized, saying she had to ask everyone.  Her tone insinuated it wasn’t me that was crazy, but it was her job to ask every mother in case one of them was. I knew part of her low volume was to spare my very aware six-year-old the world of suicide and psychosis, but I knew that wasn’t all of it. The apologies were born of shame, stigma; to separate me from those ‘tainted’ women, those we can’t speak of, for fear of ‘catching’ what they have.

But I was like them. I had what they had. I was just six years out.

Six years earlier, I would’ve been scared off by whispers like that. I wouldn’t have answered truthfully, if I’d thought it would smear me with that shame. Not because I didn’t need help. Not because I wasn’t having irrational thoughts. Not because I knew how to fix it myself. Because I felt that saying yes would be submitting to defeat.

I’m not trying to pin the shortcomings of postpartum care on this one nurse. If anything, this one nurse’s demeanor only shows just how difficult it is to discuss these matters. But the only reason I didn’t face these struggles this time is because someone asked the tough questions. Because a friend, a mother who had gone through the same struggles insisted I get help. And because once I healed, I knew how to prepare and preempt the struggles this time.

So wave the clipboard proudly. Answer the questions honestly. Ask for help loudly.

Mental health screenings should elucidate symptoms, not throw up smoke screens.

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

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

Growing

Baby #1: I was excited. I was in awe. I read all the baby updates in all the manuals on the assigned week. I brought my legal pad of questions to each appointment. I was petrified of labor. I cried the hollowest cries while my husband slept beside me on the couch cradling our baby. Who would now console me?

Baby #2: I was excited. I was exhausted. I worried about my first baby with a new baby. I began to look forward to those late night/early morning feedings for the quality one-on-one time they provided. I was so fiercely devoted to protecting baby’s soft little skull and sacred nap time from boisterous big sister, I screamed a lot.

Baby #3: I was blindsided. I was in shock. I was overwhelmed, agitated, obsessive, irritable. I still hadn’t come to terms with the idea of a new baby even as I lay on the delivery bed. I loved her so fiercely I was afraid someone would take her from me. I flipped out at hair elastics stretched over finials of dining chairs. I swore, I flew off the handle, I hid in the bathroom. I cried, begged for it all to be over.

Baby #4: I was surprised. I thought I was done having babies. I have moments almost daily where I think, ‘we’re doing this again?’ and yet, I’m strangely at peace. I still get irritable. I hurt from the physical toll of four pregnancies. I put myself to bed before my children sometimes. I see a therapist. I take meds. I go to acupuncture. I do yoga. I pray the rosary.

But I’m okay.

When I look back at the timeline of my pregnancies, I can see the mounting mental anguish I couldn’t at the time. What could’ve been the ‘baby blues’ with #1, escalated into moderate mood dysfunction with #2, and plunged me into the deepest despair of postpartum depression and anxiety with #3. It still irritates me that something that was probably underlying all the time was manageable for me until I kept adding layer upon layer. However, I am not superwoman.

I am a woman, a mother armed to the teeth with resources and self-knowledge. Fighting, clawing out of that hole after #3, I will never let all that hard work be in vain. I will see the signs early on; I will know which preemptive strikes to take; I will make self-care measures so that I hopefully won’t even need the interventions.

I do not feel strong as a victor shining brightly; but stronger in my resilience, in my survival, my steely will to not succumb.

There is life after postpartum depression. It is different. It’s not easier – but somehow it’s clearer. The unrealistic mist of life as we thought we knew it dissipates. The real, the ugly, the harsh – and the beautiful – are etched crystalline. We see it all – and appreciate the beauty that much more.

To the life, growing inside all of us

Not Mutually Exclusive

There is no need to shame a control-freak, God-fearing Catholic. There is no need to add to the torment she has already inflicted upon herself.

Yet, that is exactly what I found a quote from Marianne Williamson doing last night.

It has been six years since I started medication therapy for my postpartum depression and anxiety. Six years of low dose, slight increases, attempts at doing without – and it still serves me. And yet, a small part of me still questions my need for it.

Why isn’t this glorious life God has given me enough reason to rejoice? Why aren’t the three gorgeous gifts of heaven that are my children a daily cause for celebration? Am I not grateful enough for God’s blessings that I need an antidepressant to merely function, never mind embrace this life?

Catholic guilt is a strong force, but not one I blame for these thoughts. I confessed to my pastor that I feared my mental struggles were tied to a crisis of faith. I worried that turning to secular talk therapy turned me away from God’s gentle care. I fretted that medication was a crutch that kept me from leaning on God’s healing power.

My pastor told me that spirituality is an important piece of one’s healing, but not to the exclusion of other beneficial treatments. My trained counselor was helping me process my feelings without judgment and not keeping me from turning to God for quiet reflection. And if prescription medicine existed in God’s world, created by one of the people He put on this earth, why would I not avail myself of this beneficial tool? Most importantly, my pastor told me that God did not cause this suffering to befall me. It was not a punishment for some wrongdoing or turning away on my part. If I gleaned something good from the experience, perhaps God allowed the growth in me, but He certainly did not beset me with these troubles.

As always, the rational mind, while fully aware of such life-affirming and freeing arguments, still can fall prey to its irrational side. I thought I’d have no problem reading the social media post that started a furious online debate about postpartum mood and anxiety disorders. Yet, as I did, I felt some of the angst I’d been slowly putting to bed for the last six years come creeping back up.

marianne williamson

This statement plays to all the fears of the postpartum mother.  The guilt of needing medication to enjoy the miracle of life and her role in it.  The fact that she can’t come to terms with ‘normal’ changes in her body chemistry.  That she has somehow failed by not meditating enough; praying enough; eating healthily enough.  And then to judge her own success by the love of others – something over which she has no control.  Or does that speak to the love she fails to feel for her child?

I am only living a modicum of successful motherhood because of the very real diagnosis of postpartum depression and its treatment with medicinal drugs.  And yet, this statement still elicits a shameful, guilty feeling in me.  After SIX successful years of such treatment.  

What of the mother just beginning to wonder if she is struggling postpartum?  What thoughts and feelings assault her when she reads this?  She is already doubting herself and ‘succumbing’ to the crutches of medicine.  She already thinks she’s failed.  And now to tell her it’s all a ploy by ‘Big Pharma’?

‘Big Pharma’ is not issuing me any big paycheck.  I’ve written thirteen different posts about the decision, pros/cons of taking psychotropic drugs, most notably Happy Pills.  When the news initially hit that new recommendations called for all pregnant women and mothers to be screened for depression this was my reaction:

duh

I never dreamed news that was so obvious to me would be seen as a negative by others.

I’m going to imagine that Williamson’s comments were born of the assumption that those standing to make a financial gain would encourage a mindless mass to pop a pill and forget their troubles – and a meaningful life.  I do not encourage anyone to medicate their troubles away without also doing the hard personal work of introspection and spiritual growth.  Meds are not successful in a vacuum.  They must be supported by close medical monitoring, therapies, and lifestyle changes.

Choosing medication is not a mutually exclusive option over meditation, prayer, and love.

I fear that the way Williamson’s stance has been presented, the ensuing social media storm will portray just that.  God-fearing people do not fear medical marvels.  God-fearing people do not judge others for decisions they make concerning their own care.  God-fearing people would never want someone to suffer needlessly while thinking it was a fatal flaw of character.

Point of Contact

I entered the world of mental health advocacy kicking and screaming.  Some days, quite literally.

Studying English?  Easy, I loved literature and writing.  Teaching?  A way to purvey that love to another generation while parlaying it into a paycheck.  Motherhood?  An extension of the love my husband and I shared.

Postpartum depression and anxiety?  A most unwelcome and unpleasant recalculation in my life’s journey.

For years, I looked for reasons.  I hadn’t recalibrated my compass, had I?  What had happened to lead to this catastrophic turn of events?

I am not the grand cosmic poomba of all things so I cannot answer those questions with any sort of certainty, but I do know that my struggles awakened a raw, yet steely inner strength I’d never had before.  They fostered an empathy of a whole new level for others’ suffering; for the mantle of motherhood and all its ‘come-withs’.

I had to polish some ragged rock I’d gotten caught up on and dragged along on my journey into at least a burnished gem.  Something positive had to come out of all that suffering.  And perhaps even prevent another woman from travelling the same path.

I started this blog as a way to tell my story, which very few knew.  I thought, with complete disclosure, I might open the dialogue for others.  At least become an ally in an all too commonly silent struggle.  Perhaps I didn’t tackle postpartum directly enough – for many of my discussions and observations were integrated with my life.  However, I still haven’t decided if that was/is a failure, for mental health struggles quickly become an intimate part of one’s life, touching all parts of it.  It also hinted at some version of depression/anxiety becoming part of my ‘new normal’.

And with my ‘new normal’ so different from my old one, I began to develop further plans for burnishing rocks into gems.

I knew what I wanted to do, but with no clinical experience, I had limitations.  I could not mention the word ‘therapeutic’ in any official capacity.  I was petrified that if the programs I had in mind reached the end of my personal experience and empathy, that I wouldn’t be able to help someone in crisis.  

I embarked on a series of webinars offered by Postpartum Support International.  The Social Support Training series, one session every other week, stretched from January to June of last year.  While many of the participants were clinicians in the field of maternal mental health, the course was user-friendly and aimed at individuals interested in starting and supporting groups of mothers in various presentations of mental health.

The Social Support Training was the perfect first step toward a solution.  It offered a wealth of information – statistical and anecdotal, researched and proven – paired with the assurance that social support people are not meant to be clinicians.  They are meant to offer a safe place for mothers to gather and vent, ask questions and talk, discover resources and camaraderie, and just be.

I finished the series a few weeks before I headed to Boston for Postpartum Progress‘ first annual Warrior Mom Conference, the first ever maternal mental health conference for survivors of PMADs.  With my new-found knowledge and training, I looked forward to building on that momentum and connecting with other moms doing the same.  While I did that, I also found parts of me that hadn’t fully healed.  I realized I still had my own work to do and how very complex maternal mental illnesses are.

That fall, my PMAD baby started full-day kindergarten and, though scared as hell, I began formulating plans to kick my ideas into high gear.  I applied for a scholarship offered by Postpartum Progress and the National Council for Behavioral Health to be trained in Mental Health First Aid, which I was awarded a few weeks after discovering I was pregnant with my fourth child.  I faltered, wondering how I would enact my plans with a newborn baby.  But then, they were never my plans anyway.  And now I would have the full-circle experience informing my advocacy.  Up until now, I’d only ever experienced the postpartum piece of mental health; now I could speak to both pre- and postnatal.

I spent two days in New London, Connecticut with two fabulous humans from Child & Family Agency of Southeastern CT learning how to assess and support a person’s mental health status.  Again, the trainers stressed that we were not expected to diagnosis the individuals we come into contact with, but to assess their situation and determine whether they need additional help.  We then must help them feel comfortable and safe until such professional help is acquired.  The trainers helped me gain even more practical ways to help those in need as a civilian, a concerned individual, an advocate.

As I sat in that auditorium, surrounded by empathetic professionals and persons, I flashed back to an article I’d read a week and a half earlier.  “The Community Maternal Mental Health Professional” on The Burnout Cafe (click image for link) discusses the gap between women who need help and the services available to them.  While the central point of contact in this graphic from the article lists a woman’s professional caregivers, and a woman certainly does see these people quite frequently both before and after the baby is born, I would argue another layer of contact needs to be added.  If practitioners aren’t well-informed or comfortable dealing with maternal mental health issues, the assessments, diagnoses, and referrals needed will not occur.  Having been down that dark hole myself, I am well-versed in those discussions.  I can help normalize the feelings a woman may be experiencing, yet not want to admit for fear of retribution to her or her child.  I can point her in the direction of practitioners specializing in the exact type of care she so desperately needs.

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“The Community Maternal Mental Health Professional” as point of contact (via The Burnout Cafe)

With my personal experiences and new-found knowledge via recent trainings, I am a point of contact for mothers.  

My plans may morph and grow as my own life and family does, but the end goal is the same:

Helping Mothers Get the Help They Need.

Recovery Contd.

In an online forum, a mother asked if she was the only one who thought about her experience with postpartum each and every day since she had given birth four years earlier.

I am six years out. While it’s not an everyday occurrence, it often comes to mind. In many ways, it has and continually shapes who I am – as an all-around human, not just certain aspects of motherhood.

Though I wouldn’t recommend it as a means of self-discovery, my postpartum experience taught me a lot about myself. I realized, that while I had been managing it, I’d been suffering from low-level depression and anxiety for years. What I thought was a failure to contain, control, was actually the event horizon of a long-simmering beast’s debut.

So I find it hard when people talk about postpartum recovery. I don’t feel as if I’ve recovered from postpartum depression. I feel like I’ve learned to manage it, but it’s the new normal. While I took an extended hiatus, I’ve returned to my therapist. I never stopped taking my meds. I still have low points that make me wonder if I’ll ever be healed; that make me seek out new treatments and pray for cures.

A cure lies somewhere within the intersection of self-acceptance, medical marvels, and divine intervention. I think it’s impossible that any one will work without the combination of the others.

I need to accept that this may (notice I’m not quite ready yet) be how my chemical makeup operates. That I didn’t fall short on some courage or stick-to-it-ness factor. That I didn’t fail to attract good things through my thoughts. I cannot will myself better with positive thoughts. Though my heart works that way, my mind simply is not wired for that.

Taking medicine to augment your mood is okay, even acceptable. It’s beneficial to your quality of life. It quiets the rage and keeps the nervous energy at bay.

And to fill the gap that always is – there is God. A spiritual dimension to the healing process is essential – and one I was missing for a long time. Unfortunately, this is not a one and done. I must continually seek this solace.

All three spokes of the wheel need continual attention. They all need periodic tweaking and developing. Much to my chagrin, my recovery and learning to live a full life is not a mountain to be scaled and topped with a banner of victory. I have to drag that flag with me wherever I go. As long as it still flies, I guess, there is still hope.

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barkergroup.info

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.

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