A Third Pregnancy, A Chance To Heal

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by guest contributor Lindsey O.tea

My first pregnancy I was blissfully unaware of what pregnancy and childbirth was like, and honestly I wish that I could get a bit of that naiveté back. Every bit of those 9+ months was new and exciting and fun. I loved learning about everything my body was doing and how my son was growing. My birth was a little scary at the end but with the techniques I learned in my Bradley classes, I was able to achieve my goal of an unmedicated birth.

The second baby was conceived quite by chance shortly before my first son was a year old. The anxiety kicked in and I was feeling more isolated from my husband because of the demands of his job and his inability to well, care. My entire pregnancy I hoped and prayed that the baby would be breech so I had an excuse to not go through an unmedicated vaginal birth again. My husband assured me that I would be disappointed in myself and the experience if I “wussed out” and agreed reluctantly to help me re-study our Bradley book. Every time we sat down to go over it I would have a rush of fear and start to cry or get angry and decide I was done for the evening. I just didn’t want to think about what the process was going to do to me again.

At some point in the last ten weeks of that pregnancy I decided to be “tough” and “suck it up,” telling myself that having unmedicated births were the greatest gifts I could give my children on their birth days. Also I had decided this was our last baby so I just had to do it this one last time. Labor was quicker, I was strong and determined and confident. I kept my wits the whole time (well transition was the usual craziness, but I held out) and had another unmedicated birth. This time, a nine pound, one ounce screamer. And then the room fell silent. I was holding my baby and didn’t notice much but wasn’t allowed to sit up, and then all I really remember was a lot of fundal massage and cramping and code words. Honestly, I felt like crap and couldn’t walk and was incredibly dizzy. Later that day a nurse informed me that I had hemorrhaged and they were about to give me a transfusion but I stabilized. The OB who delivered said something about me being past the point of blood loss that “we worry about losing the mother.” They then told me that the severe cramping was because I had been given Pitocin through my hep lok. They kept me an extra night for in hospital care for GBS+ reasons which I disagreed about and then guilted me into a heel stick for my baby because he was “big” and they wanted to check for diabetes. Where was my husband for ALL of this? You tell me. I was ALONE. However, I knew that at least I would never ever have to go through this again.

Fast forward exactly 3 years later and we are stunned by the conception of another baby who will be here in less than 13 weeks. I was in a funk for two weeks and it took me three months to get back to reality and my responsibilities with my business and mothering. Here I am, now, in some ways getting my mojo back and in others an absolute mess. I try to do what I can when I can in different aspects of my life to maintain order but there is a lurking emotional monster somewhere near me at all times. I have broken down now in two midwife appointments and cry whenever I think about having to do that again. I have been diagnosed with PTSD and clearly I have anxiety/depression which I have never experienced in my lifetime. I fear that I may die next time, that I may bleed out, tear horribly as I did with the first two, or just have something dangerous or scary happen. It takes up a good deal of space in my daily life. So what do I do about this?

I have answers from everyone and suggestions and loving advice but all I can think about is this: I am not telling anyone what I really want. What I really want is control. I want to have a birth I am happy about not because I “did it for the baby” or did it to make my husband proud, or did it because I felt I had to after being given a sense of control from a child birth program. I want to feel I had my best outcome in a birth because I got what I needed to have closure (I will be getting some form of permanent birth control after this baby, as will my husband). I NEVER in a million years thought I would say this, but I am seriously considering a c-section. Do I care if anyone judges me in this? Honestly, I did until the anxiety took over my life. I don’t want to let that evil in any more than I have. I see this as a chance to heal and I don’t think I would have been forced to deal with all of the bottled up stress from my first two births if this third baby hadn’t come along. I want to heal from this and I want to feel like I can close this chapter in my life and let it all go. I also want to make my body a safe place for this child while she is still there and right now I know it is not. I can’t go on hoping to have the decision made for me and suffer like this all the way to the end and then come up with some last minute decision about how I will birth. I’m still working this out in my head and will have a discussion with my midwife at the next appointment so I definitely don’t have concrete plans for anything yet, but I feel better knowing that I am finally taking full ownership of this and not allowing myself to feel pressured in any direction.

If I could say anything to anyone who utters one word to a pregnant or postpartum mom, I would urge them to take consideration for the mother and her well-being and not spend so much energy on the baby. Let her shower, rest, do the chores for her, hold the baby for her while she eats dinner, and let her cry to you if she hurts. But most of all tell her it’s okay and it’s normal to feel whatever she does or doesn’t feel. Let her be in charge and own the entire experience and not feel like she has to put on a brave face for you. I wish I had been more vulnerable after those first two pregnancies so that I could be more open for this one.

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Perinatal Mental Health Hero

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Perinatal Mental Health Hero

I recently was introduced to a Labor & Delivery nurse who is making a huge impact on the state of perinatal mental health care pathways. I could feel the passion come through in her voice as we spoke a few weeks ago on the phone for nearly two hours about what she was doing to raise awareness and increase access to quality care in our local area (Washington, DC metro area) for women who desperately need it.

I asked Kisha to share her story in a few paragraphs, and this is what she sent me to share with you:

“I grew up in the small southern town of Crowley, Louisiana. After graduating High School, I enlisted in the Coast Guard to see the world. I was stationed in Hawaii for 3 years at a small boat station, then became a USCG Dental Technician Petty Officer 3rd Class. My final duty station was at the Department of Transportation in Washington, DC. Prior to leaving the USCG, I became a Massage Therapist. It was during my 5 year stint as a Massage Therapist, that I rediscovered my heart for nursing. I graduated college, became a Registered Nurse, and a mom at 30 years old. After working as a Mother-Baby and Pediatric RN, I took a chance on Labor & Delivery and found my niche in nursing!  Eight years later, I am still working as a full-time night shift L&D RN.

Being a Labor & Delivery RN is one of the most exhilarating & frustrating experiences. Over the years, I have gained invaluable frontline skills, instincts, and knowledge about calming a woman’s fear in the throes of labor and empowering her to embrace motherhood. I am proud of these abilities and love sharing the birth experience with women and their families, but in all honesty the realization of perinatal mood and anxiety disorders (PMADs) prevalence among mothers and its detrimental impact on families has dramatically shifted my perception and purpose. My heart breaks knowing that over 8 years and countless births, 1 in 7 of those pregnant women and new mothers that I cared for inevitably went home suffering in silence from a PMAD. Maybe some of them already knew they were high risk and had support in place, but for many they went home with an infant and the expectation that their mental health was secondary in motherhood. As I continue to bear witness to the subtle shifts that seem ‘normal’ after childbirth (lack of sleep, lack of self-care, lack of support) that directly contributes to this needless suffering, I have found my life’s work is to destigmatize PMADs, while alleviating the unnecessary suffering of these women and their families.

As a frontline nurse, I believe that we as a profession are key to a long overdue paradigm shift in perinatal mental health. We are well-positioned and equipped to assess the mental health of pregnant women and mothers in the acute care setting, provide them with the first aid emotional support they need, and connect them to the appropriate perinatal mental healthcare providers and resources in their community.”Kisha Semenuk is a mama to two young boys. And as a night shift nurse who recently obtained her Masters of Science in Nursing, Kisha completed her Nursing Capstone Project on the knowledge gap she identified when researching perinatal mood and anxiety disorders and effective postpartum depression screening using the Edinburgh Postnatal Depression Scale (EPDS) among frontline perinatal care providers (OBs,Perinatal RNs, & Mother-Baby RNs).Through her deeper research, Kisha became acutely aware that as a frontline RN she was bearing witness to the silent suffering of so many women and families. Nothing was being done about it on the frontline and Kisha wanted to take action to make lifesaving changes.

She began actively networking with frontline OBs and built a team of fellow perinatal mental health champions who helped her to compile and organize an online resource which will allow women and their families to easily locate specialized, local professionals, support groups and treatment facilities. This resource will be kept at the fingertips of frontline nurses who are often the first healthcare professional to recognize the emergence of a perinatal mood disorder.Kisha’s mission with the DMV (DC-Maryland-VA) Perinatal Mental Health Resource Guide is to develop, disseminate, and maintain a comprehensive, up-to-date, regional directory of specialized mental health providers, support groups, advocacy organizations, and other relevant clinical resources pertaining to perinatal mental health. This directory will assist providers, patients, and their families with obtaining specialized mental health evaluation and treatment during pregnancy and postpartum.

How amazing would it be if we could create a guide like this for every city in our country? I am so energized and extremely appreciative of all the blood, sweat and tears she has poured into this project and I cannot wait to see it take off and bring help and relief to so many families who in the past did not know where to turn.

I applaud Kisha’s dedication and drive for instituting change in an area all of us here at Postpartum Progress care deeply about.

{The DC-MD-VA (DMV) Perinatal Mental Health (PMH) Resource Guide is launching online by November 1 and is a result of an ongoing collaboration between the DMV PMH Resource Guide Team and existing DMV-based PMH Professionals and Perinatal Mood and Anxiety Disorders (PMADs) survivor support network. Team members include: Kisha Semenuk, L&D RN and MSN; Aimee Danielson, Director of MedStar’s Georgetown University Hospital Women’s Mental Health Program; Lynne McIntyre, the Mid-Atlantic Postpartum Support International Coordinator/Mary’s Center Maternal Mental Health Program Coordinator; Helen Conway, Psychology Major (C’15) Summer Intern; and Dina Karellas, L&D RN and Nurse Informatics Graduate Student; in addition to Adrienne Griffen, Founder of Postpartum Support Virginia (PSVa), and Nadia Monroe, Founder of Postpartum Support Maryland (PSMd).}

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Reward and Risk: My Decision to Stay On An SSRI During Pregnancy

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postpartum depression medicationNearly two years to the day after my overdue diagnosis of postpartum depression and anxiety, I found myself pregnant and still on an SSRI antidepressant. We had been trying; I had done my research, consulted my OB and my Pediatrician for their thoughts on wether or not I should taper off of my medication prior to becoming pregnant again. They both agreed that the risk was outweighed by the reward-a healthy me was the best way to guarantee a healthy baby in the long term. When I specifically asked my pediatrician about the increased risk in heart and lung defects, she stated that we could handle it on the back end, IF it needed to be handled.

Fast forward three weeks. To our complete surprise, we discovered we were expecting not one baby, but two. Fast forward a few more weeks, a lot of tears, panic, a couple of therapy sessions, and dozens of honest conversations with my husband, doctors, and some other Warrior Moms later, and I had decided that the best thing for me and my babies was to remain on my Celexa until the third trimester of the pregnancy.

SSRI antidepressants do cross the placental barrier during pregnancy. This means that the fetus will be exposed to the medication while in utero. My doctor suggested that I wean off of the medication during the third trimester because some babies exhibit “‘withdrawal’ symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (Psych Central, 2006).” However, she stressed that many of these symptoms, specifically irritability and trouble feeding, are normal for newborns and would likely be hard to discriminate from the normal behavior of newborn twins. [Read more…]

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How My Doctors Missed My Antenatal Anxiety

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antidepressants pregnancyI was in my first trimester of my first pregnancy when antenatal anxiety washed over me like the tide, insidious and unstoppable.  We were living on our own in the midwest at the time, and the loneliness was crushing.  I compensated for my irrational worries by donning a brave face and making light of my anxiety, to both friends and my doctors, and I assumed all newly pregnant women felt the same trepidation and slight panic I was suppressing.

I was 8 weeks pregnant when my OB called me into her office.  My fears and worries were suddenly compounded by a previously-undiagnosed kidney disease.  A giant mass in my abdomen.  And they had no idea what it was.  I taciturnly absorbed all the doctor said and then politely asked for a few moments alone.  When the door shut behind her, something in me broke.  I walked out of there a shadow of myself.  The next 6 months brought a multitude of diagnoses.  I was ultrasounded and MRIed (twice).  I met with several surgeons and had a cathertized void test done.  There were very few cases of pregnant women with my eventual diagnosis of severe unilateral hydronephrosis with 1% kidney function, and so few doctors could tell me exactly what to expect or how it would impact my pregnancy.  And that scared me to death.

Six months into my pregnancy, we moved to the North East.  My need for my family (who had moved up to the Boston area a few years before) outweighed my terror at the prospect of moving, but leading up to moving day, I had increased symptoms of panic attack.  I refused to drive while house hunting, irrationally fearful of the alien traffic patterns of our new-home-to-be.  I fought back waves of nausea at each apartment-hunting appointment, instead playing the part of the happy, expectant couple.  The night before our final flight out of the midwest, I became convinced I had a blood clot in my right leg – and the resulting (unnecessary) hospital trip ended in a 2am leg ultrasound for me and a busted blood vessel in my husband’s eye from the stress.  My husband tells me that when I fainted from panic on the 4 hour flight to Boston the next day, he took special notice of the halfway mark in the flight.  “At least there was no turning back,” he says, only half-jokingly.

Unfortunately, arriving in Boston alleviated the anxiety only temporarily.  As I neared the end of my pregnancy, I began having irrational, intrusive thoughts about my husband leaving me.  “He’s only staying until the baby is born,” the lies whispered, “he never wanted a baby anyway.”  I became increasingly irritable and emotional, and finally suffered enough to mention it to my OB, a high-risk, high-profile doctor at Massachusetts General Hospital.  With my mother in the room, I explained my heart palpitations and my trouble breathing.  I outlined my mood swings and my panic attacks.  It took every ounce of courage in my body to admit that I was struggling.

In return, she told me to “stop worrying.  Pregnancy is an emotional time.”

That was it.  We moved on to belly measurements and discussions of pain management during labor.

With only two sentences, she had me doubting my need for help. I suddenly “just wasn’t trying hard enough.”  And I believed her.

Throughout the course of my first pregnancy, I saw 5 different OBs, 3 surgeons, 2 primary care physicians, and a myriad of nurses and techs.  None of them EVER asked about my emotional well-being, and when I did speak up for myself?  I was ignored.  Dismissed.  And the thing that angers me the most is that MGH has a world-renouned Center for Women’s Health, run in part by the incomparable Dr. Marlene Freeman, an expert in the field of pre and post-natal mood and anxiety disorders.  Sitting in my OB’s office, I was one elevator ride away from help.

Instead, it took me 5 months after my daughter was born – five months of intrusive thoughts about shaking my baby or letting her slip in the bath tub (I would like to emphasize here that intrusive thoughts are distinguished from psychosis by a mother’s ability to recognize the thoughts as scary) – five months of obsessively folding and lining up burp rags and matching bottle tops to bottle bottoms by shape and color – five months of rage and of falling apart behind the scenes before I recognized I needed help.

It’s hard for me to think back through that time because I find myself so ANGRY.  My struggle was preventable.  Avoidable.  Not once during or after my pregnancy was I asked about my emotional well-being, and when I mentioned physical and emotional symptoms of my condition, they were ignored.  A few simple questions and an honest conversation with a trusted doctor was all it would have taken.

I want you to know that there are many wonderful doctors, psychologists, and social workers out there.  Many obstetricians and primary care physicians are well-educated and have amazing bedside manner.  But a large percentage of them are still grossly undereducated about antenatal and postpartum mood and anxiety disorders.  Advocates in the PPD community are working towards universal postpartum mental health screening, but in the meanwhile, each mama has to be her own best advocate.

  1. If you are struggling, tell the truth, the whole truth, to someone you trust.  I know how scary this is (really and truly), but it’s vital you are honest about your symptoms in order for you to get the best treatment possible.
  2. Keep telling it until you are listened to.
  3. Ask for help finding a therapist or doctor who has experience treating postpartum mood and anxiety disorders and seek support groups in your area.

You deserve to be well.  We’re here fighting with you and ready to help you find the care you need to feel like yourself again.

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