Esther Dale

Esther Dale is a Postpartum Depression, Postpartum OCD, and Postpartum Anxiety survivor, attempted gestational surrogate, full-time college student, Army Wife, mother to three children, and staff to several cats. She loves to read, write, take pictures, and dream about taking naps.

Not All Situations Are the Same: My Four Stories

Share Button

postpartum depression storiesTrigger warning: This post contains some references to miscarriage.

Often, I find myself telling my story of life with and after postpartum depression (and postpartum OCD, and postpartum anxiety, and postpartum PTSD… darned comorbidity). I love to tell my story. I also love to listen to the stories of other people. Over time, I have come to realize that it’s easy to fall into a trap of saying or insinuating that [this] is what worked for me and so you should do what I did; it worked for me and it will work for you.But one of the things I have come to realize is that no two stories are the same. And it’s not just that no two people’s stories are the same, no two stories are the same even for an individual person. Even if there are similarities, there will still be differences. This certainly holds true for treatment options and strategies.

I have had four pregnancies. Three of those ended with live births, one ended in miscarriage. They also all had different mental health situations, outcomes, and treatments. I have one story, in the sense that it is the story of my life, but that one story contains smaller individual stories, and they don’t all follow the same template.

The first story

My first story is that of my oldest child. In April 2009, after a very long and difficult labor, I gave birth to a beautiful little baby girl. Unfortunately, life was not the idyllic fairy tale of storybooks and I found myself suffering a nasty case of postpartum mood and anxiety disorders. I was officially diagnosed with postpartum depression and anxiety, and had missed diagnoses of postpartum OCD, postpartum PTSD, and hypothyroidism. I believe I also had some antenatal depression that went undetected. (I didn’t even know that was a thing until a while down the road). That story involved 2 inpatient hospital stays, 9-ish months of Celexa, Ativan, and Ambien, and seeing a therapist. That was what was necessary and what worked for that story. Ultimately, an overdue diagnosis of hypothyroidism resulted in me starting on Levthyroxine (thyroid medication), which resolved my PPMD about as promptly as you could hope for, almost literally overnight.

The second story

In April 2011, I gave birth again, to another beautiful little baby girl. This time, in consideration of my history, I had started on Zoloft at 38 weeks pregnant as a prophylactic measure, and also had my thyroid levels (TSH and T-4) checked pretty much monthly during the pregnancy and again after giving birth. This second time, there were no problems and life was pretty rosy.

The third story

In September 2012, I gave birth to a very unexpected beautiful baby boy (let’s just say that it’s important to keep in mind that a 99% effectiveness rate for birth control still leaves 1% for whom it is not effective). This time, I had a number of things going on during pregnancy that were extremely stressful, and ended up starting Zoloft at about 35 weeks instead of the planned-for 38 weeks. However, I still didn’t really have major issues afterwards and everything resolved itself fairly quickly without further intervention.

The fourth story

The fourth story is my ongoing one, which I wrote about yesterday. In April 2014, I miscarried the twins I was carrying as a gestational surrogate. It’s been a tough road. The emotional aftermath of pregnancy loss is no joke. I haven’t had a need for medication this time; therapy alone has been very useful in helping me deal with postpartum adjustment and the grief and trauma that 2014 brought me.

Four different stories. Four different treatment plans. Four different outcomes. And that’s all for the same one person: me. If my situations don’t even follow a predictable formula, why would I expect that anyone else would have the exact same situation/needs as me or even the exact same situations for their own individual different situations and stories? I can’t. We can’t.

It is so vital to remember this. My story isn’t yours and your story isn’t mine. Our brains, bodies, and situations are different. It’s okay if and when we react differently to similar circumstances and situations; it’s even to be expected. The danger is when we start to insist that someone should follow our advice and not consider any other method because it worked for us. There is no guaranteed cure or prevention for PPMD (dear GOD do I wish there were). We must all keep this in mind and be gentle in dealing with ourselves and with other people. We must remember that we are all unique individuals with unique brains, situations, needs, and stories. We must love each other and ourselves to remember that not all situations are the same.

Share Button

Dealing With Grief, Trauma, and Intrusive Thoughts

Share Button

Close-up of ribbon and pearl

Trigger warning: This post contains references to miscarriage, D&C, and intrusive thoughts. If you are feeling vulnerable, you may want to skip this post for now. 

Last year, I posted about my experience with the emotional aftermath of a missed miscarriage. Quick recap: I was carrying fraternal twins as a gestational surrogate. At my 8w5d ultrasound everything was good. At my first OB appointment a few weeks later, I was told neither one had a heartbeat and they had both stopped growing a couple of weeks prior, shortly after the ultrasound where everything was good. The end result was a D&C.

It was rough. It was REALLY rough. Not only was there the guilt and grief and normal hormonal nonsense of a miscarriage, I had the added emotional complication associated with miscarrying as a surrogate. However, I pushed on and kind of stuffed it all down as my intended parents (IPs) and I moved forwards with the checkups and testing the reproductive endocrinologist (RE) recommended to clear me to try another round of IVF and have a second go at making my IPs parents. Unfortunately, my anti-thyroid antibody labs came back (ridiculously) highly elevated which my RE said could potentially indicate an increased risk of miscarriage so he recommended they find a new surrogate.

As was their right under our contract, my IPs terminated the contract. Unfortunately, they did so in a very abrupt manner that violated trust and hurt me badly. It really ripped the bandaid off the wound from the miscarriage. I told a friend that it felt emotionally like I was experiencing the miscarriage all over along with the sudden and unexpected loss of another relationship I had been assured would last no matter what.

Time went on and I tried to go on with my life since there wasn’t really anything else to do. Unfortunately, I dealt with it by continuing to stuff everything. Really, I didn’t deal with anything. You would think that by now I would know that’s a really bad idea and that not processing things and not getting help just makes things worse, but apparently I have yet to learn that lesson as thoroughly as I would like. As time went on, I wasn’t sleeping well. I was stressed and irritable. I was moody and cried a lot and was really grouchy and short-tempered. I put it all down to stress and normal fatigue from taking 16 credits in college along with dealing with 3 small children, a husband in the military, and a generally full plate.

One night though, it got really bad. It was September 28, 2014. I was driving on a windy road in the hills and suddenly started to have some really nasty and terrifying images and questions/thoughts pop into my head. I beat it back and hightailed it out of there and started to head out to a particularly beautiful scenic area to take some pictures, but the thought of the windy roads along the coast that I was about to encounter had thoughts and pictures in my head again. I turned around and headed home. Suddenly I realized, “These are intrusive thoughts and I am changing my activities and behavior to avoid the trigger. This is familiar… @#%$!!! This is a symptom of postpartum OCD.” Let me tell you, the thought of going through PPOCD again had me terrified. And I do mean terrified. Like, pulled over in a parking lot sobbing and hyperventilating, unable to breathe, having an honest-to-goodness, would-take-an-Ativan-if-I-had-a-prescription-and-one-on-me, panic-attack terrifying. I started pm’ing my short-list of Warrior Mom friends trying to find someone I could talk to and help me get calmed down and worked through it. I got ahold of Lindsay Maloan. I adore her. She talked me through it, helped me formulate and talk out my plan for calling a therapist ASAP, and sent me funny links/pictures to help me laugh until I got ahold of a friend who lives near me (who was kind enough to let me come cry on her couch). Katherine Stone and Lauren Hale were also fantastic over the next few days about helping me talk through things and generally supporting me. All 3 of them kept telling me that it wasn’t my fault and that it was GOOD that I recognized what was happening and got my butt in to see a professional to deal with it.

I was fortunate to find a therapist who has quite a bit of experience and specialization with grief and loss, postpartum adjustment/PPMD, and infertility. It’s been a great combination and nice to not have to explain everything like I would with someone who doesn’t have experience with infertility or PPMD. We’ve done a combination of eye movement desensitization and reprocessing (EMDR) and talk therapy and it’s been working great. At this point, we’re pretty sure that my problem this time isn’t PPOCD or any other type of PPMD so much as it is just straight grief and trauma. She told me that it’s perfectly normal to need help working through what I went through. The official diagnosis for insurance purposes is postpartum adjustment, or needing help adjusting after pregnancy (specifically with the loss of the pregnancy and everything that’s happened since). She also pointed out that lack of sleep can exacerbate or even cause intrusive thoughts, so that combined with some other anniversaries/milestones (such as my due date) may have been the culprit behind that nasty little bugger.

I think there are a couple of main points I hope people take away from this post.

  1. Even without postpartum mood and anxiety disorders, it’s perfectly normal to need some help working through thoughts, feelings, and emotions, especially after a miscarriage.
  2. Don’t put off seeking help.
  3. Have a network of at least a few people you know you can turn to if you start to have a rough time. For women who are postpartum, especially those with a history of PPMD, it can be especially helpful if you have a few women who have experienced PPMD themselves, who are educated and know what’s up, who understand where you’re coming from. Lindsay was my lifeline that night. She got me through a REALLY bad spell where I was having trouble breathing (you know that whole my face is getting tingly and it’s making me panic even more thing? Yeah. I was there). And she, Lauren, and Katherine, and my friend here at home, and another friend who is working on becoming a social worker, gave me support. I can’t even express the value of that in words. I would love to give them all huge hugs.
  4. When you seek out a mental health professional, try to find one with experience/training in your situation. Having seen mental health professionals before who were PPMD clueless (it’s disconcerting to be explaining postpartum depression to the person who’s supposed to help you work through it), it has made a HUGE difference to be working with someone who knows her stuff.

I’m still not totally “there” yet, but I’ve made a lot of progress with my therapist, and it’s been a big relief to feel power in actually dealing with things on MY terms instead of just letting it happen to me and not have anything in my arsenal of “what to do.” When I had PPMD after my first baby was born, I felt so helpless and powerless. This time, I took control. That alone has made a difference.

If you are reading this and you’re in a bad place, know that you have a community ready and waiting with open arms, wanting to support you. We send you our love. I send you my thoughts, prayers, warm vibes, crossed fingers, and whatever else helps. There are resources. There are people here to support you. You are not alone. You do not have to go through this by yourself. We are here for you, we want to help you. Let us help you. As we support each other, we learn how to better support and help ourselves.

What advice do you have in how to help yourself or how to help someone else?

Photo credit: Esther Dale

Share Button

Misdiagnosis and Missed Diagnosis: Part 2

Share Button

Trigger Warning: This is part 2 of a 2 part story (part 1 can be read here) of my misdiagnosis and missed diagnosis after giving birth in 2009. This post contains some references and details about Postpartum OCD, Intrusive Thoughts, miscarriage, and D&C. If you are feeling particularly vulnerable and prone to triggers, you may want to avoid this post until a later time. 

After I was discharged from my second hospitalization, I still hadn’t been able to get in to see the psychiatrist and ended up at the ER because I was out of Lexapro and had no more refills. Since TriCare doesn’t cover Lexapro on the formulary, I was switched to Celexa (the generic version) and told to keep trying to find a doctor who could see me. I called various doctors and they either weren’t accepting new patients, didn’t have any openings, or in one case, “Refused to take me on” and wouldn’t explain why. Let me tell you, this didn’t make me feel any better.

I went in to see my PCP (Primary Care Physician) to get my Celexa refilled and while I was there, he ordered a lab test to have my thyroid levels checked. I never heard anything back so when I returned to get another refill ordered, I asked the nurse about the results. She looked it up and said “Oh yes, it’s abnormal, he’ll need to talk to you about that”. When the doctor came in, I asked him about it and he said “We’ll take a look at that after we get your meds taken care of”. He never looked at my lab results and left without saying anything.

At the end of November, the day after Thanksgiving, my husband, daughter, and myself were in a car wreck. I was driving and we rearended another vehicle. I had a nasty case of whiplash and a concussion, my husband broke his ankle, and our daughter’s car seat did it’s job and she wasn’t even sore. I was given a small amount of painkillers to help with the whiplash, but the whiplash persisted past the medication. I went back to the medical clinic and saw a different doctor. While I was there, I mentioned the thyroid labs that had been done and that I was curious to know what the results were. She took a look and hit the roof, saying that my thyroid results were WAY outside normal limits. She wanted to do a re-test since it had been months since the last test, so she put in a lab to recheck my thyroid levels and put a rush on it, promising to call me back to let me know what the results were.

In less than 24 hours, I got a call back from her nurse telling me that I definitely had hypothyroidism and could I come in that day to see the doctor so she could talk to me about the condition and get me started on medication, and let me know how it would all be handled moving forwards. I was at the hospital with my husband in surgery having his ankle repaired, so I had to wait a couple of days but they got me in ASAP. The numbers on my lab results were extremely bad and I’m surprised my symptoms weren’t worse. I promptly switched doctors so that this “new” doctor was my primary and I refused to ever see the other doctor again. In hindsight, I should have filed ICE Complaints on both him and the Nurse Practitioner who ignored my Edinburgh Scale at my 6 week postpartum check up, but hindsight is 20-20 and all that.

The new doctor informed me that hypothyroidism can be caused by pregnancy. It often clears up, but in some cases it just sticks around. I was started on the lowest dose of Levothyroxine, 25 mcg, and had my thyroid levels checked again in a week or two. The repeat lab showed that my thyroid levels were improving but I needed a slightly higher dose so I was bumped up to taking 50 mcg of the Levothyroxine, and that turned out to be my magic dose. After 3 months of Levothyroxine, my PPMD symptoms were totally cleared up and I was able to wean off of the Celexa, Ativan, and Ambien. I had finally found a therapist to see, and she had me come in a little more often until we were sure that I wasn’t going to have a recurrence of symptoms but soon I was able to stop seeing her as well.

It’s been 4 ½ years since my hypothyroidism was diagnosed and 50 mcg of Levothyroxine has managed my condition ever since. Normal protocol is to have my thyroid levels checked once a year, but when I’m pregnant my levels are checked once each trimester. Even with the pregnancies, the same dose of Levothyroxine has done me right and I haven’t had the same issues, even through 3 pregnancies, one of which was as a Gestational Surrogate and ended at 12 weeks with a D&C for a missed miscarriage.

There are several morals to my story. One is that we desperately need better availability of mental health care, both inpatient and outpatient. I should not have had as much trouble finding a doctor and therapist to see me as I did, nor should I have needed to wait for a month or longer to have an intake appointment after inpatient treatment. The second moral of the story is that medical professionals need to have better training on the difference between suicidal/homicidal ideations and intrusive thoughts and between the various forms of PPMD. Screening on intake (including arrival at the ER) should include noting the differences. There also needs to be better availability of treatment options for postpartum mothers. Being put in a general hospital wing wasn’t that helpful. People who are recovering from substance abuse and addiction aren’t going through the same thing and we just weren’t able to really understand or offer much helpful advice to each other because the situations are so totally different.

The biggest lesson in this story is to be your own advocate. Don’t let medical professionals shirk on their jobs, don’t let them overlook symptoms and cries for help, definitely don’t let them leave an appointment without going over your lab results. Don’t let them rush off without giving you the attention and help that you need. This is not “causing trouble”, this is asking them to do their job. You are your own best advocate.

Share Button

Misdiagnosis and Missed Diagnosis: Part 1

Share Button

Trigger Warning: This is part 1 of a 2 part story of my misdiagnosis and missed diagnosis after giving birth in 2009. This post contains some references and details about Postpartum OCD and Intrusive Thoughts. If you are feeling particularly vulnerable and prone to triggers, you may want to avoid this post until a later time. 

In July of 2009, 3 months after having my first baby, I finally admitted that all was not well in my world. For 3 months, I had been falling deeper and deeper into a spiral of awful. Sometimes I felt indescribably angry. Sometimes I felt a deep sense of sadness and despair and would just cry and cry and cry, or maybe I’d be about to get out of the car in the parking lot at the store and suddenly burst into tears and not even know why. Sometimes I felt completely numb; I would just sit in my rocking chair holding my beautiful little girl, staring off into space, not really thinking or feeling anything at all other than blankness and emptiness. The worst of all was pictures and thoughts that flashed unbidden into my mind. Thoughts and pictures of dropping or throwing my daughter down the stairs. It terrified me and I would actually cancel appointments if I was upstairs because I didn’t want to carry my child on or near the stairs and those pictures and thoughts become reality. As soon as they entered my mind I would chase them away and hug my baby a little closer and pray “God, what’s happening? Please forgive me and make this go away”. I had no idea what was wrong with me.

At my 6 week Postpartum check up at the Wilford Hall Medical Center OB/GYN clinic, I filled out the  Edinburgh Postnatal Depression Scale questionnaire that I was handed. My answers clearly indicated that I needed further screening but the Nurse Practitioner who saw me just put it to the side without saying anything and never really asked how I was feeling, so I figured that what I was experiencing must be normal (news flash: it wasn’t). Things kept getting worse until eventually, one night in July, I found myself standing at the top of the stairs while everyone else was asleep thinking that everyone else would be so much better off without me if I threw myself down the stairs. I walked away and started to go to bed and then thought that it would be easy to take a massive amount of the painkillers my husband had left over from ankle surgery and just go to sleep and not wake up. I called the chaplain and he met me at the Emergency Room.

I was diagnosed with Postpartum Depression and transferred to a psychiatric facility in San Antonio, since WHMC (the military hospital on Lackland Air Force Base) only admitted service members for inpatient treatment of mental health issues, dependents automatically got referred out. I was breastfeeding my baby and didn’t want to have to stop, so we tried going the medication-free route first with talk therapy, both individual and group. We quickly realized that it wasn’t making enough of a difference, so on to medication it was.

During this time, one of the biggest questions asked of me was “Do you have thoughts of harming or killing yourself or others?”. I answered yes. Partly because I had found myself on the brink of attempting to commit suicide, but also partly because of the thoughts I had been experiencing. I later found out that the thoughts and images that shoved their way uninvited into my mind were Intrusive Thoughts, one of the classic and tell-tale symptoms of Postpartum Obsessive-Compulsive Disorder. I didn’t know, at the time, that there was a difference between suicidal/homicidal ideations and intrusive thoughts, or that there was a whole spectrum of Postpartum Mod and Anxiety Disorders, I thought it was just all part of Postpartum Depression. Unfortunately, it seems that none of the staff caring for me at either of the hospitals knew this either, and I was diagnosed as simply Postpartum Depression. This is one of the things that I eventually hope to see changed: to see better education for medical professionals making them aware of the differences between types of symptoms and the various PPMD.

It only took a few days after starting medication (Lexapro) before I started to feel better. Before starting medication, my mom and my husband had come to visit me at the hospital and when my daughter started to cry, it was a noticeable trigger. My mom and husband had to keep the baby up front and switch off who had her and who was visiting with me. After starting meds, I was able to cope better when she started to fuss, I started to open up a little in therapy instead of sitting huddled up in the corner unable to speak without crying. After a little over a week in the hospital, I was sent home with prescriptions for Lexapro to manage my symptoms on a daily basis, Ativan for sudden anxiety attacks, and Ambien to help me sleep at night. I was also given an appointment to see a psychiatrist outside of the hospital.

When I went to my first appointment it was a total disaster. I ended up having to reschedule after I had been there for a couple of hours and still not been seen, because I had to get home since my babysitter had to leave. They weren’t able to reschedule me for another month or so out. I ended up back in the hospital a month after being discharged due to a recurrence of my symptoms (again, the intrusive thoughts that I didn’t know much about and didn’t know how to manage), and had my medication dosage adjusted. Thankfully, I only had to stay for about a week again and was able to go back home.

To be continued tomorrow…

Share Button