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.

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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

 

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.

baby-essentials-4-8-months-853x1024

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

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

Ode to Maternity Clothes

Thank you, maternity clothes, for making me feel less attractive than I already am

I realize the orb-like appendage extending from my midsection leaves you with lofty goals to attain; still, you fall grievously short of your endgame

With fabrics somewhere between highly viscous jet fuel and canvas starched to within an inch of its life

With shoe-string thin ties that either knot in one’s back or threaten to dip in the toilet in an already awkward dance

With handkerchief hems that add volume to our thighs, yet leave our sausage-like backside showing

Thank you

Thank you for pricing anything that looks remotely like real clothing out of range of anyone in her right mind – for three months of wear

Thank you to your merchandising gurus who decided to place your displays next to the plus size wear

Thank you for providing an infinite amount of baby-doll tops to go with three proffered pairs of pants

And to your partner in crime: the fitting room mirror

Thank you for showing me the parts of myself that I hadn’t realized has gotten so hairy under that belly

Thank you for accentuating just how wide my side view now is

Thank you for sallow skin, double chin, and purple circles under the eyes

Maternity clothes, you suck – only slightly more than trying you on

1595-maternity-clothes

‘Portrait of an Unknown Lady’ by Marcus Gheeraerts II

 

 

Murphy’s Child

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

  • First and foremost, tell everyone who asks – even those who don’t – that you are done having children. Your family is complete.
  • Further this point by passing along all your baby paraphernalia, with the caveat that you never want to see it again. They can do with it whatever they like when they’re done with it, but you don’t want it back.
  • Sweep maternity clothes out of your home with great aplomb. Plunk the rubber tote you’ve been storing them in on your neighbor/co-worker/friend’s front step with great and resounding authority.
  • Start to enjoy the long-forgotten freedom you and your spouse can reclaim at parties and cook-outs, even when the children are present. You can sit for 2.5 seconds without rushing to pluck them from the jaws of salmonella, see-saws, or swinging bats. Up the ante by enjoying a refreshing adult beverage.
  • Dream of a day in the not-so-distant future where you may actually be able to take a family vacation. All the kids are potty-trained, done with naps, and significantly less likely to throw a tantrum. The rosy glow on the horizon – and substantial sums of money no longer going toward diapers and pull-ups – even make you consider opening a dedicated savings account.
  • Send your youngest off to her first full day at school. Look at the seemingly endless hours that stretch before you and marvel at how you’ll fill them. Begin to dream and scheme for something soul-fulfilling, personal, even professional.
  • Most importantly – and the penultimate step – is to engage in quality intimate time with your spouse. Have actual conversations, canoodle, and connect in ways you haven’t since you conceived your last child – wait, what?
  • Too late. Murphy strikes again.
tostada-1000x666

shedka.com

DJ Khalid Pregnancy Redux

All I do is eat, eat, eat no matter what

Got nausea on my mind,

man, I’ve had enough

When I walk into the bathroom

the toilet lid goes up –

and I stay there

morning-sickness

Baby Center blog

and I stay there

and I stay there

Up chuck, up chuck, up chuck

make me say, what the *$@%

These flippin’ hormones

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