I’m Not Fine: On Being Honest with Doctors About PPD Symptoms

On Being Honest with Doctors about PPD Symptoms

Congratulations! You’ve had a baby! It is such a wonderful time in your life!

These are a few of the things relatives and friends and even strangers will coo around you, like a bee hive; buzzing about every little thing you feel is normal.

We all have a hormonal shift after birth. Don’t worry it’s normal. We all have pain down there after birth. Don’t worry it’s normal. Breastfeeding is hard for everyone at the beginning. Don’t worry it’s normal.

You continuously hear that everything is normal so much, that everything you sense going wrong with you postpartum must be normal and you should not complain.

After weeks of this physical and mental separation, you head back to your OB for your six week check up. Your doctor will ask you how you are feeling. They will ask you if you have any pain. They will ask you if you having any issues with depression. They will ask you how breastfeeding is going. They will ask if you are getting enough sleep.

This is the part where we should wave our little white flags in that office. “No, I am not okay. There are things going on that I have tried to fix for six weeks and they are not getting better. I feel no attachment with my baby. I cannot stop crying. I want to leave. I want to take her back to the hospital.”

But that’s a very dramatic and scary thing to admit to ourselves, isn’t it? After holding this baby inside of you, growing it for nine months and then admitting that you are not up for the task is a sort of embarrassment that is hard enough to admit to yourself, let alone a stranger.

So, what most women will say is, “We are doing fine.”

We are doing fine.

I am doing fine.

Everything is fine.

Women will leave that doctor’s office, with their newborn in tow and sit in their cars after, sobbing. They will grip the steering wheel with white knuckles and feel as if their one chance for relief was just wasted. They will look at themselves in their rear view mirror, black bags under their blood shot eyes and not recognize the person looking back at them.

Is this what fine looks like? Is this what everyone goes through? Sitting in a parked car, with a screaming newborn in the back seat and feeling so far away from your body that you cannot fathom how to even comfort yourself, let alone your new baby.

These women will drive home, to their empty houses, and put the baby in the swing, because that’s the only way you can get them to stop screaming. The will lay down on the couch across the room and watch the newborn swing back and forth; closer to them and suddenly far away, like the pendulum of a clock.

“I can’t have postpartum depression,” they will say to themselves; you will say to yourself.

“I was so happy before. I was so happy while pregnant. I wanted this baby more than anything.”

We are doing fine.

I am doing fine.

Everything is fine.

“It’s just the hormones,” you will repeat to yourself. “They’ll level off soon.”

But, how long is too long to wait for “what is normal” to cross over into “I am not okay”?

Perhaps you will reach the end of your rope. Perhaps you have put your screaming infant safely in their crib, closed the door, and hide in your bathroom, sobbing with your hands over your ears. “This is too much. This is not normal. This is not fine,” you will finally admit to yourself.

But admitting one thing to yourself and saying the words out loud are two different things. As you pick up your phone and call your OB’s office, you simply ask for an appointment. The receptionist will ask if this is an emergency. You might freeze up. Do you really want to be a nuisance? Do you really want to make people drop what they are doing just to listen to how you are a failure as a mother?

This, however, is your second chance that you wanted ever so badly back when you were first sitting in that exam room saying that you felt fine. You are being given a second change to wave your white flag an let everyone know that you are not fine and this is not normal.

“Yes, it is an emergency. I am having symptoms of postpartum depression.”

You may flinch as you finally say the words out loud but what you don’t know is that this receptionist on the other end of your phone call has heard this before. She believes you and doesn’t question whether or not what you are feeling is normal.

She believes you.

It is once you get past that initial fear of admitting to the world that you need help, that you can begin to realize you deserve to be helped, healed, happy.

But man-oh-man, was it easy to just say you were fine.

All Mothers Deserve Access to Affordable Postpartum Depression Treatment

[Editor’s Note: Today’s guest post comes from a Warrior Mom who struggled to find access to affordable postpartum depression treatment. This is not okay, and it needs to change. -Jenna]

All Mothers Deserve Access to Affordable Postpartum Depression Treatment

The doctor noticed I was depressed immediately.

After the initial intake, she looked in my eyes and declared, “You’re depressed.”
“Yes,” I responded.

This wasn’t news to me. My daughter was five months old and I knew what I was experiencing. The doctor began to list a number of suggestions for things that might help. I had a response for every one.

“Can someone help you with the baby?”
“No, everyone works and no one has time.”

“Could you take her to daycare?”
“No, I am breastfeeding her on demand, don’t like pumping/she won’t take a bottle, and we can’t afford it.”

Finally the doctor concluded the meeting with, “Well, there has to be something you can do,” without offering any more suggestions.

I guess that’s not fair. She did offer suggestions: a weekly massage and acupuncture routine that could be done in her office. The total cost of said treatment would be more than I could afford. I thanked her and left the office. A couple of months later I got a $400 bill for my visit.

Then there was the therapist I saw who was referred to me by another Warrior Mom. This therapist was supposed to be one of the best in the city for helping moms through postpartum depression. I saw her two or three times, but each visit cost around 275 dollars. She did not take insurance, which is something I kept coming up against when I identified the best therapists for women with postpartum depression.

“It’s worth the money,” someone told me.

Sure, I thought, but only if the money is actually there. I can’t fabricate money. I believe this therapist may have been able to help me, but I really needed to see her at least once a week and we simply did not have the resources for that.

By the time I saw the specialist who worked specifically with women who had postpartum depression, I had identified that that quality was one of the most important in my recovery. After seeing a therapist through my husband’s job who told me to “stop doing that” when I told her how my daughter’s crying triggered my anxiety and forced me to immediately drop what I was doing for her every whine and cry while simultaneously trembling, I knew that I needed to work with someone who understood and was sensitive to what I was experiencing.

My problem, which I suspect is a problem felt by many in my position, was getting access to the care that I needed. Every single specialist who worked with women who had postpartum depression did not take insurance except for one. I ended up seeing the one who accepted insurance and even then she didn’t accept my insurance. She told me that she had tried to work with my insurance company, but they claimed that there were already plenty of therapists in their network. Even though she did not take my insurance, she agreed to charge me what a normal copay would be. I was relieved to finally find an affordable option.

The whole process was extremely troubling to me. One of the things I was able to do during that time, which is not easy for someone suffering from depression, is advocate for myself. After almost a year of not feeling well, I realized that I had to take matters in to my own hands. That’s when I became more proactive. This was nearly impossible when my daughter was first born, and I wonder if I had had someone truly advocating for me who knew the proper information to help me find appropriate care, I might have suffered less.

The US Preventive Services Task Force recently recommended that all pregnant women and new mothers get screened for depression, but that is not where the work ends. It’s actually where it begins. How a doctor goes about laying out the resources available to a mother can make a world of difference in whether or not she follows through with seeking help.

I have heard other mothers in postpartum support groups say that the way their doctor dismissed them or just threw medication at them without listening to how they were feeling really turned them off from seeking help. It’s important that mothers who are suffering from a postpartum mood disorder work with understanding and sensitive practitioners. It’s crucial in those early months when a new mother may be feeling misunderstood, isolated, or like nobody cares or understands what she is going through.

The issue of insurance and cost of care were both a really huge barrier. I identified so many resources that could have helped me that I simply could not afford. My inability to access the best care made me feel that my recovery was not valued as much as the people who could afford the best resources.

There is room for much improvement. I hope that by talking about the barriers I encountered, it will encourage people to create programs that are accessible to all mothers, regardless of their ability to pay.

I hope that more resources like the free postpartum depression support groups I found will be made available. I hope that insurance companies will work with more specialists in postpartum depression who, in turn, want to work with the insurance companies. I hope that the specialists who do not accept insurance will find more ways to make their care accessible to more women. I hope doctors who screen their patients for postpartum depression will do more than hand the mother a prescription or piece of paper and send them on their way.

I hope more people will see the value in taking care of mothers so that we can take care of our families. We need to talk about how we can do better.

~Kristina Newman

The Sun Will Shine Again

[Editor’s Note: Today’s guest post comes from a Warrior Mom whose experience with postpartum mood and anxiety disorders may feel triggering for some. Please only read if you feel like you’re in a safe place. But know this: The sun will shine again. -Jenna]

The Sun Will Shine Again: Panic Attacks & PPD

It was my biggest dream to become a mother. When I got married at 30, my husband and I tried to get pregnant right away. I experienced four miscarriages in a year, and we were told we would probably not be able to carry a baby to term.

Undeterred, we turned to adoption. We were matched with a birth mother and bonded with her quickly. We were in the room when our son was born. I held him in my arms when he was less than five minutes old. He had to stay in the hospital for 48 hours with his birth mother during which time we visited him often.

When we went to the hospital for what should have been the final time, we were met downstairs by a social worker who told us the birth mother had decided to parent and had left the hospital with the baby without even saying goodbye.

Since the previous three years had been very tumultuous and stressful for my husband and me, we decided to take a break from our focus on starting our family and work on healing and grieving our four major losses. Thank God we still had each other.

Well, life works in cruel ways at times because within two months of the failed adoption, my spouse’s mother, who we were both very close to, became critically ill and passed away. What should have been three happy years of enjoying being newlyweds and starting our much anticipated family had turned into a series of nightmares and heartbreak.

My husband went to Connecticut for full month to help his father deal with funeral and financial arrangements. When he returned, we slowly started to heal, together. As if an angel knew we could take no more, exactly one month after he returned from helping his father, we found out we were pregnant.

We felt cautiously optimistic at first. As time went on and my belly grew, we became more and more hopeful.

I experienced a wonderful pregnancy. I felt great and worked almost up to my due date. I delivered by c-section about three weeks early due to high amniotic fluid. I was in the hospital for five days and in love with my baby in a way I never thought possible.

During those days, I was on a “high.” I had a perfect little baby. I had constant visitors. My every need was attended to. My work issues were kept at bay. Life was good.

When I left the hospital, things calmed down a little bit, but we had a full time nurse living with us. Perhaps the “high” I had experienced in the hospital began to fade a bit, but things still felt pretty good.

The first week home, I was getting sleep, my family and friends came in and out, my husband was back at work but home at night, and the nurse was a 24 hour companion.

Then, boom.

Two weeks after the baby was born, I got “the baby blues.” I had heard so much about this that I tried to take it in stride. I had regular and frequent periods of feeling very emotional but did the best I could. Then, by week three, I was clearly experiencing something stronger.

By the time the nurse left at week four, I could barely get out of bed. I could not be alone with the baby, had frequent panic attacks, hated being a mother, and couldn’t sleep or stop crying. I had to be “chaperoned” everywhere. I went days without showering because it was “just too hard.” I didn’t eat.

I started seeing a therapist and quickly after that a psychiatrist who prescribed antidepressants as well as sleep medication, to which I quickly became addicted. The only time I felt at peace was when I slept, and I began taking more than the amount prescribed. I would run out of meds early, so I would call other doctors for more meds or steal them from friends and family.

I began to pray every night that I would die in my sleep. Though I felt very protective of my daughter, I wanted nothing to do with her. I experienced vivid fantasies of how I would end my life. I began to refer to my situation as “my private hell; cancer of the mind.”

People would tell me to snap out of it and get annoyed at my “drama,” but I couldn’t. People would tell me “just smile,” and I wanted to collapse on the floor in a puddle.

I somehow went back to work but was “asked to leave” after a few weeks. I remember one particularly difficult morning before I was asked to leave when my husband was getting ready for work and I was supposed to be getting ready as well, but I couldn’t. I couldn’t breathe, and I was panicking. I was lying on the floor with my hands locked around my husband’s ankle, sobbing, begging him not to go. He was dragging me across the floor as I clung to his ankle pleading with me to “get it together” because we needed both our jobs to pay our bills.

My hell went on for almost two years. After the first year, my sister mentioned the name of psychiatrist friend. Somehow I got myself to visit him. Slowly, over the course of the next year, the sun began to shine again, little by little.

It wasn’t all easy. There were moments, even days in a row where I regressed to panic attacks, crying fits, and so on. But little by little, things did get better. I began to make the connection with my daughter that I hadn’t made initially. I began to enjoy spending time with her, even alone.

I don’t know if it was getting off the wrong meds and on the proper meds, or meeting with the doctors regularly, or it just got out of my system. I still have not great days, but nothing compared to the absolute hell of those first two years.

I just recently celebrated my five year anniversary of no panic attacks. Today, I am wrapping up my third year back teaching full time and loving it, though I miss my daughter during the day. She is my absolute best friend and my favorite person in the world—the sweetest, most beautiful, kindest, funniest person I know. The time I spend with her is precious and means more to me than anything else.

We giggle together, tell each other secrets, read books, do special projects, and all the things I dreamed of doing with my daughter before she was born. My favorite time of day is when we snuggle in bed together before sleep time and read books to each other.

Because the “sky” was so stormy for so long, I like to say that today, the sun shines brighter for me than for other people. The grass grows a little greener. Life is not perfect for me or anyone else as I am fully aware. But compared to what I went through for almost two years, it’s pretty darn close.

I want to share my story with other people who feel so miserable they are praying at night that they die. I want to be living proof that things CAN get better. I want to be there for them in ways that people who have not experienced this can’t be because they don’t know; they don’t understand. I want to save lives because I realize more and more how close I came to losing my own.

I want to help other people see that the sun will shine again.

~Jessica Orenstein

Talking to Your Kids About Postpartum Mood and Anxiety Disorders

[Editor’s Note: Today’s guest post comes from a Licensed Clinical Social Worker who offers sage advice on discussion postpartum mood and anxiety disorders with your children. -Jenna]

Talking to Your Kids About Postpartum Mood and Anxiety Disorders

When you are ready, talking to your child about your experience with a perinatal mood and anxiety disorder can be very beneficial. It can help to decrease stigma around mental health, encourage discussion of caring for your well-being, and assist your child in understanding changes he or she has seen in your mood, behavior, or within the family.

Often adults believe they are protecting children by not sharing information with them about these kinds of sensitive topics, but without accurate information kids will make assumptions about what they have observed. When we are missing information and are confused, our minds tend to fill in the blanks.

Children’s minds operate in this same manner, filling in the blanks with some kind of explanation. Giving children developmentally appropriate, accurate information will help to alleviate any fears or incorrect beliefs they have created.

In making the decision to have a conversation with your child, consider the following before deciding how and what you will say:

Think about what you’d like your child to gain from the discussion.

Are you hoping to help your child understand the changes in your mood or behavior that he or she may have observed? Or maybe you would like to start having open conversations about mental health and taking care of yourself. Whatever your objective is, knowing this will help you in deciding what details of your story are important to share at this time.

Look at this as the first in a series of talks.

As children grow, they will have different needs with respect to understanding mental health and your experience. For example, a toddler may simply need you to label with words why mommy was acting differently. Whereas an elementary age child may have more questions about how someone develops a sad sickness, or whatever age-appropriate name you may choose for the PMAD.

Keeping an open dialogue throughout your child’s development will benefit both of you. Your child will have an understanding of what he or she has seen, will know that it is okay to discuss mental health, and will know that caring for yourself is important. You will feel more relaxed, as you no longer have to worry about keeping things from your child or how to explain them.

Take care of yourself first.

Having explained why it is helpful to share your story with your child, it is important to note that you need to be in a good enough place where you can handle this discussion. If you’re not there today, that’s okay. Take care of yourself first.

Healing is a process, and now may not be the right time in your recovery. In the meantime, you can simply label your feelings for your child when necessary, rather than having to address the broader topic of battling a PMAD. You may want to say something like “Mommy’s feeling sad/worried today and I’ll do something to feel better.” If your child has questions, you can explain that it’s hard to answer them right now because you are not feeling well.

It would be helpful then to make the comparison of a time when your child was sick and all he could do was sleep or rest until he felt better. When you think you may be ready, talk to your therapist, healthcare provider, partner, or someone in your support system about any concerns you have and let them help guide you in making this decision.

Consider your concerns about having this talk, as well as what the benefits would be.

What are you comfortable speaking about? What are you uncertain about? Talking to your therapist or someone in your support network can help you to sort this out. You may also find it helpful to practice what you would say with this person.

Once you have a general idea of what you might want to say to your child, review the age guidelines below to help you prepare for this discussion:

Toddlers and Preschool Age

This age group needs the simplest explanation, labeling moods or behavior with basic terms. For example, “Mommy feels sad sometimes. When I’m sad, I talk to someone to help me feel better.”

Elementary Age

These children can handle a little more information. They are very perceptive and have active imaginations, which is why clarification of what they have observed is so important. With this age, you can introduce the idea of mental illness and compare it to a physical illness. This would be particularly helpful if you are currently struggling with a PMAD or experience ongoing episodes of a mental health disorder such as depression or anxiety.

Avoid using any medical terms in explaining your story. Instead, try naming your struggle something associated with the predominant emotion your child would have noticed, such as a “sad or worry sickness” or for postpartum psychosis, you may prefer to use something like “jumbled up thoughts or confused thoughts sickness.”

Adolescents

Adolescents can understand more detailed information about perinatal mood and anxiety disorders. They will likely be interested in understanding how it developed and how it will affect them presently, such as how available you will be for them, or in the future by wondering about their own mental health. Some adolescents may be more comfortable having this conversation while also doing an activity (that isn’t distracting) such as walking, drawing, or playing with a ball. Encourage them to ask you any questions they may have now or in the future.

Regardless of the child’s age, there are some general messages that are important to convey in your discussion. Assure your child that she did not do anything to cause the illness and it’s not her responsibility to make it better. Instill a sense of hope by explaining that you are getting help and are working on feeling better. Or if you have recovered, you can simply make a point of saying that you got help and are doing better now. Finally, encourage your child to ask questions.

For more information on this topic, Children of Parents with a Mental Illness is a wonderful resource. Their website is www.copmi.net.au. There you will find more age-appropriate considerations, as well as videos to help facilitate discussion of depression and anxiety.

~Laura Winters, LCSW
Postpartum Health & Harmony