For All Mothers

Three years ago, Kelly Kittel began her journey of book tours and signings, publicity and PR for her newly published memoir, Breathe: A Memoir of Motherhood, Grief, and Family Conflict.  I’d journeyed with her, on parallel paths, in a shared writing group for months before.  Kelly has journeyed today to Washington, D.C. to advocate for appropriate allocation of funding for maternal health programs.

In December 2016, the Bringing Postpartum Depression Out of the Dark Act of 2015 was signed into law.  Today and tomorrow scores of women visit the Capitol to discuss how to enact programs highlighted by the legislation.  It’s wonderful to see my news feeds filled with faces I’ve met in my maternal health circles, gathering together at the core of our country, for the health of mothers.

Kelly and I have had different journeys in motherhood.  She will be speaking to bereavement and infant loss.  She is speaking from her own personal experience.  My personal experience is with postpartum depression.  I was honored and touched that she asked me to give her my take on the care I’d received postpartum and what it may have lacked; to bring a firsthand account of what mothers in Rhode Island might need to recover and thrive despite postpartum depression.

To be a mother is to know the utmost joy and deepest despair.  While our manner of grief might differ, we all embody the emotion.  I thank Kelly Kittel for taking hers, and mine, on her latest journey.


More info on this initiative:

http://mmhcoalition.com/advocacy-days/

http://mmhcoalition.com/impact/

Aspect Ratio

I can put myself in the labor bed for the birth of my third child.  I can see the scene unfold.  I can hear the conversations with my midwife.  I remember how, even at the height of contractions with delivery imminent, I still hadn’t come to grips with the fact that I was pregnant.

I remember thinking, but wait, I’m not ready.  I haven’t reconciled this with myself yet, with the universe.

The universe didn’t care.  Nature didn’t care.  My body and the baby didn’t care.  It was time – whether I was ready or not.

I think on a cellular level I knew that pushing out that child without owning the pregnancy would only lead to trouble.  The basest parts of the body do not lie.

I grew that baby with the utmost care.  Once she was this side of the womb, I was only attentive.

But my soul was squeezed by internal pressures; my own mind that couldn’t accept this path only because I hadn’t carved it.

And so, I was amazed by the wonder that accompanied an unplanned fourth pregnancy.  Simply bowled over by the joy that flooded me when they placed her on my breast.  While I had been afraid to plunge into the depth of my love for my third, for fear that someone would take her from me, it just happened with my fourth.

And yet, because any footprints make deep imprints on the psyche, a year later now, I look at my pregnant self and cannot believe that is me.  Was that my life?  Was that a mere year ago?  How can I reconcile that exhausted, frumpy, wallowing-in-her-own-skin IMG_20160430_150358162person with who I am just a year later?  I hate that I look so miserable when pregnant.  Because of my problems in the past, I look at any such photo and second-guess myself.  Was I feeling that same way then?  Struggling the same?  So paranoid, scared, to fall into that trough – even on a timeline that has already elapsed – I doubt what’s right in front of me.

My grey matter muscle memory worries that if I have a hard time measuring this last year of my newborn’s life, that I look at this picture of me a mere year ago and see an alternate reality – am I not in just as much denial this time as the last?  If I am still getting used to the idea of having a baby and she’s turning the corner to one year-old, doesn’t that mean I am putting up some of those same walls?

NO.

Will I forever be haunted by the dark feelings and stilted growth of my postpartum depression?  Yes.  Will it make me paranoid and second-guess myself?  Right now anyway.  Is it possible to have mind and heart blown during any childbearing and rearing experience – ‘normal’ or otherwise?  Yes.

It’s so easy to let past experiences form new fears and worries.  Just like losing it with the older kids or having a low day makes me worry I’m having a relapse.  Knowing the signs and how to help ourselves is key; expecting perfection and punishing ourselves is crap.

So maybe I’ll just look at those pregnant photos of me and say, no wonder I look like rough; growing a kid is rough work.  Maybe I’ll just seal them in her baby book and never look at them again.  I certainly need to stop looking at them trying to find signs of trouble.

Notice, though, that I haven’t even begun to look at the newborn photos for this go-round.

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

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.

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

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.

flapping_cloth1

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.

This Ain’t Any Ol’ Con

So I am living the hipster life. Typing on a table so repurposedly wonky my laptop rocks back and forth disconcertingly. In sun-dappled shade as I wait to sip my freshly prepared cafe mocha and eat my just warmed vegetable quiche.

Jennifer Butler Basile

Jennifer Butler Basile

It’s delicious.

All of it.

The flaky crust. The gooey egg. The sugary froth. The warm breeze.

The ability to notice such details as the vaguely distant whoosh of traffic. The inability to safeguard little people.

I can’t.

They’re not here.

I am alone.

Which, even though it was an acupuncture appointment I had this morning, was blessedly just what the doctor ordered.

I’m at the back-end of a weekend packed with emotionally-charged, mentally-draining conference work.

The Postpartum Progress Warrior Mom Conference.

Lest you get the wrong impression, I enjoyed this conference immensely.

I so looked forward to connecting with fellow survivors of postpartum mood and anxiety disorders (commonly lumped together and referred to as postpartum depression). I expected to commiserate and trade war stories. I expected to get amazing fuel and ammo for advocacy – a role into which I thought I’d fully transitioned.

I did not expect to be so completely enveloped by the emotions I thought I’d left behind.

All throughout the first day of workshops, panels, and speakers, I teared up and misted over when particularly poignant points were made. But I was good. While I still danced with depression and angled around anxiety on random occasions of my everyday life, my period of postpartum depression was done.

And then, on the second day of the conference, Annette Cycon of MotherWoman got up to talk. As she described what transpired after an inexplicable bout of rage during her two young daughters’ bath time, my grief bubbled up and out of my body.

“I went into my bedroom and curled into the fetal position on the floor. I held my head, rocked back and forth, and sobbed. I said, ‘It’s either homicide or suicide – and I can’t do either. I love myself too much. And I love them too much.’”

Hearing this raw account, I sobbed. My face contorted into the grimace of one silently choking back tears. My shoulders shook. I experienced this incredibly intimate moment of grief in the midst of a room full of mothers. I felt so incredibly alone and yet dreaded anyone noticing and reaching out to me.

And yet, I wasn’t embarrassed.

There was no need.

I was in a room full of women, mothers who, while their own grief/rage/depression/disappointment/detachment/love/mania/compulsion manifested itself differently, had all been at the bottom of their own deep, dark hole. They were all at various footholds on their way back up and out, or sliding down and scrambling for a hand to hold – to stop them – to stop the pain, the agony – to spark the love they needed to feel for themselves and their children.

I may not have expected to awaken the grief, guilt, shame, and pain I thought I’d left behind – and apparently only buried – but I also didn’t expect to find a tribe of mothers instantly and deeply connected by their shared experience. And that was such a life-giving and validating surprise.

Soon, I will have to leave my empty coffee cup and the flaky crumbs of quiche crust behind. Soon, I will have to stop pretending I am an unencumbered hipster who can write alfresco for hours. Soon, I will collect my children and return home to our ‘normal’ lives, our harried routine, my possibly high levels of anxiety and masked depression.

But there will be hugs around the neck and hearty belly laughs. And there will always, always be my tribe of warrior mamas who’ve got my back.

An addendum

In my post Thursday, I discussed the pitfalls of postpartum in dads.  There is a major one I erroneously omitted.

One more thing for postpartum moms to worry about

In all my talk about supporting dads in their postpartum world, I failed to think what such advice/discussion would do to a mom currently suffering from postpartum.  Though I’ve still got plenty of issues to sort out, I am no longer in the deep, dark depths of my postpartum period.  I have traveled far enough beyond it to be able to reflect upon what the experience was like for my husband.  In the midst of it, however, I couldn’t help myself – let alone another human.  I apologized for lashing out; I thanked him for his support; I commiserated when he said he didn’t know what to do.  But beyond that, there was nothing I could do for him.  Nothing except put myself back together.  And that took all my energy.

So all you women and mothers suffering from postpartum mood disorders out there, my last post was not meant to make you feel bad.  It was not meant to give you one more thing to feel shitty about.  To make you think you’ve ruined one more life.

Let me reiterate the point that it takes an entire community to surround and uplift the postpartum tribe.  It should not fall to you to do everything.

Yes, dad needs support, but you don’t have to be the only one to give it to him.  You may not be able to at all.  And that’s okay.

People outside your tight-knit trio need to help put you all back together.

Tripod-of-Life_Holy-Trinity

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