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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14 Tips for Mamas with Past Sexual Trauma

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As I teen, I experienced a date rape. It was a one time incident, but it rocked my mental health in ways I never knew possible. In fact, its the event that brought my chronic mental illness to the surface. It affected my self image and sexuality in ways I don’t care to admit.

I never considered that one time thing could have also impacted me during the process of getting pregnant, birthing my children, and the subsequent postpartum depression and anxiety that resulted. But after recently discussing it during the #sexabusechat on Twitter (Tuesdays at 9pm ET/6pm PT) , I started to think about it in a different light.

These kinds of sexual assaults are so common, and I’m willing to bet a lot of you are shaking your heads right now because it happened to you too. I spoke about it once at a retreat and afterward several women came up to tell me they had lived through it too.

I’m also quite sure a few more of you have also experienced more long-term childhood sexual abuse. Its sadly way too common, and when you’ve lived through that kind of pain, it can absolutely have a lasting impact on your lifelong sexual experiences, pregnancy and motherhood.

So I reached out to Kathy Morelli, a Licensed Professional Counselor and author who focuses on Holistic Counseling for Maternal Mental Health, Family Systems and trauma from sexual abuse and medical intervention. Today she’s sharing with us how we can start to move beyond sexual abuse before and during motherhood.

So without further ado, I want to welcome Kathy to Postpartum Progress.

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Childhood sexual abuse and a woman’s subsequent reproductive years, including menstruation, pregnancy, birth and ongoing sexuality, occurs years or even decades apart. Yet, in my clinical practice, I have found these issues to be intertwined.

Sexual themes resonate with a woman on multiple levels: within her body, her emotions and her psychology. And distress from childhood sexual abuse can resurface during the emotionally and hormonally charged time of pregnancy and postpartum. What research exists, finds that women who suffered from childhood sexual abuse have an elevated risk of postpartum depression, besides other physical and emotional symptoms.

Related triggers around reproductive health:

During Pregnancy

Body-based feelings in pregnancy can be re-triggering to a woman who has deep, somatic memories of childhood sexual abuse. Simple things such as the position of your body during vaginal exams can bring back emotional memories of past abuse.  The baby moving inside your body might cause intense joy, but might also create an underlying uneasiness.

During Birth

Childbirth is an intense experience; a time of hormonal, physical and emotional exertion.  Early trauma can be triggered by a particular scent for example, or a body position.  If you feel powerless, not heard, or disregarded by your healthcare providers during childbirth, it can activate the symptoms of post-traumatic stress and flashbacks of your past trauma.

During Postpartum

There are many physical, emotional and psychological factors feeding your emotional health during this time. And it’s true that a pre-existing personal depressive or anxiety disorder, or pre-existing PTSD, sets your body up for another episode postpartum.

Intense physical and hormonal changes, plus adjusting to a new lifestyle caring for an infant is physically and emotionally challenging. Feelings of frustration emerge as you adjust your schedule to accommodate your baby. The endless touching may leave you feeling like your body isn’t your own anymore. Breastfeeding may feel triggering to some, as it too may cause confusing sexual feelings.

So what can you do to proactively manage your mental health during these phases of motherhood?

First, I want you to know that your childhood sexual abusive does NOT define you. Your past does NOT have to be your destiny. With perseverance, you can move beyond being a survivor towards thriving and blooming beautifully.

It’s not an easy task, but your self-esteem is worth the fight! Managing the effects of an abusive childhood is an on-going deeply personal experience.  It’s honorable life work, and highly individualized. As you move along your healing path, you’ll choose what’s right for you.

Tips to help enhance your experience of pregnancy, birth and postpartum:

  1. Recognize that post-traumatic stress is a real disorder, not some fake diagnosis.

  2. Practice Self-Love. Self-love is not just an empty cliché, it’s something worth fighting for. Allow yourself to rest and be gentle with yourself during all three stages of motherhood.

  3. Try to make time to get help with a licensed mental health professional before pregnancy. It’s best to put in your emotional work before starting a family, but it can also be done if you are already pregnant or postpartum (see below.) It’s never too late to begin.

  4. Face your fears and past, at your own pace, in a safe and professional environment.

  5. Work with a gynecologist/obstetrics/midwifery provider with whom you feel comfortable enough to discuss your history of trauma. Investigate the hospital or birth center where your provider practices to make sure it’s the right fit for you. If your provider or institution don’t meet your needs, you are empowered to find another. It’s important to advocate for your own health care.

  6. Find an experienced childbirth educator who is accepting of your personal choices. Birthing and breastfeeding classes really do help on an emotional level as well.

  7. Remember that birth is an unpredictable experience. If your birth experience doesn’t follow your birth plan, you can still feel good about it. You are not less of a woman or mother, no matter how your birth happens.

  8. Honor the achievement of childbirth and motherhood. You are growing a life! That is a huge accomplishment.

  9. Understand that your hormonal balance takes at least three months after birth to come back to pre-pregnancy levels.

  10. Honor and protect yourself during “the fourth trimester” and beyond, as your body shift towards balance:

    1. Rest; develop the mindset of being, not doing.

    2. Practice good nutrition with whole foods and good supplements.

    3. Get help.  If you can afford it, set up some time with a postpartum doula or a baby nurse so you can rest. Enlist the help of family or friends. You don’t have to do this on your own.

    4. Don’t underestimate the power of sleep. Work out a sleep plan. Even if you are breastfeeding, don’t be the only one getting up to feed the baby.

    5. Practice mindfulness and relaxation to counteract the inevitable challenges of caring for a newborn and the emotional change of identity in motherhood

  11. Nurture yourself with complementary care. Safe touch such as shiatsu and acupuncture can re-balance your body and mind.

  12. Expect some emotional ups and downs and realize these are normal.

  13. Social support is important. Women who “Tend and Befriend” in real life and online feel supported.

  14. If you feel very sad or anxious, there is a lot of professional help available to you. You are not less of a mother if you see a doctor or therapist. Taking care of you makes you a better mother.

A beautiful book about healing from child sexual abuse that I highly recommend is “A River of Forgetting” by Jane Rowan.

If you had the experience of childhood sexual abuse, know that post-traumatic growth is possible. Don’t wait to honor yourself by doing the emotional work. You can ask for and get help. You and your family are worth it.

And know that you are not alone.

Reference:

Perez-Fuentes, G., Olfson, M., Villegas, L., Morcillo, C., Wang, S. & Blanco, C., (2013). Prevalence and correlates of child sexual abuse: a national study. Comprehensive Psychiatry, 5(1), 16-27. 

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The Importance of Screening and Support: Jenna’s Story, Part 2

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fighting postpartum depression, Warrior MomJenna’s story differs from my own in one key area: support.  She did not receive the support she so desperately needed from her husband.  Warrior Mamas need our support and love.  Jenna needed to hear that she was not alone and that she would get well.  My husband told me that he would do whatever it took to help me get better. That unwavering support helped me so much.   

With my Postpartum Depression and anxiety continuing undiagnosed, I became more and more emotionally detached from my family. I couldn’t handle everyday life without reacting to even the smallest things in explosive anger. And as soon as I flew off the handle, the shame from my out of proportion reaction punched me in the gut. I felt helpless to react any other way, and the spiral of shame was almost paralyzing. I felt unsupported, misunderstood, and like I was a failure as a mom and a wife every single day. But you would never have known, because my facade was one of a happy, pulled together, suburban wife and mom. If other women could do it all by themselves, I didn’t want them to think I couldn’t keep it together. So I kept silent, soldiered on, and gave up thinking that life could be any different.

 My PPD and anxiety went untreated for a total of almost 7 years, by which time I’d had two more children with my ex. Eventually the rage, dissociation, self-loathing and isolation became more than I could bear.  I couldn’t stand the numb, closed off feeling any more, and something had to give. I decided that my children and I deserved a better quality of life. So, I went against my then-husband’s wishes and made an appointment with my family doctor. I didn’t go into any depth about the severity of my emotional issues, but casually inquired whether rage and detachment were possible features of depression. Without much discussion, I was prescribed my very first anti-depressant, and it quelled the rage substantially.  

Unfortunately, the intrusive thoughts and anxiety continued to exhaust me at night, and a few months later, I approached my doctor about additional medication. I was prescribed an anti-psychotic, and I have to tell you, that first pill was really difficult to take. For the first time in a very long time, the intrusive thoughts that had plagued me went completely away. Every night for all those years, I’d panicked about being murdered in my sleep, and my children being kidnapped because I didn’t deserve to be their mom.  Every night, there was a video loop in my head that replayed my failures as a wife and a mom.  With the additional medication came a degree of apathy and some significant weight gain, but it was still a relief.

 I no longer live in that place of crippling overwhelm, and not just because of the medication.  I sought out a therapist on my own, and I eventually weaned off all of the medications I was taking. In the couple of years since my diagnoses of depression and anxiety, I’ve come to a place of peace with who I am as woman and as a mom. I know my limitations for dealing with stress as well as sleep deprivation. I started making self-care a priority. I’ve (mostly) stopped comparing myself, my parenting skills, and my particular children to others. As my confidence has grown and my healing has continued, I’ve done a lot more sharing, a lot more reaching out, and a lot more self-analysis. I’m involved with the PPD community on Facebook and make time to read blogs authored by women who suffer with Postpartum Mood Disorders. I have a support system now. Those closest to me (including my boyfriend of 18 months) are familiar with anxiety and depression.  After dealing with so much on my own, it’s important to me that I can be real with those I allow close to me, and that they get me, can identify with my struggles, and respect my story.  I can trust them to encourage me, and when I feel ashamed, they can remind me that it takes strength to reach out and be vulnerable. Trusting people who can give validation to my emotions has been instrumental in my healing and helps a lot with my day to day stability.

I’ve often wondered how I survived those dark, lonely years when I was coping with PPD and PPA on my own. It was certainly by the grace of a higher power. Having traced the onset of my symptoms back to my second pregnancy, I also wonder whether my quality of life might have been better if I’d been screened for PPMDs during my pregnancy or at any of those six week checkups. The truth may be that I’d have hidden my feelings from my provider, if I’m honest.  I would have at least had the opportunity to decide whether I wanted to reach out if anyone had asked. 

Thank you so much Jenna for sharing your story.  I appreciate it so much.  Again listening and validating a Warrior Mom’s struggles is so key to stomp out the stigma that surrounds perinatal mood disorders.  Consistent screening coupled with strong social support can help ease the struggles of Warrior Moms.

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The Importance of Screening and Support : Jenna’s Story, Part 1

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pregnancy depressionI’m welcoming a fellow Warrior Mom friend of mine today to share her story with the Postpartum Progress community.  Jenna and I met online through #ppdchat, and we became fast friends.  Since I only experienced postpartum depression and postpartum anxiety with the birth of my youngest, I really wanted the perspective of a mama who had suffered multiple episodes of postpartum depression.  I wanted to showcase the idea that all women should be screened for perinatal mood disorders throughout their pregnancy and all through the first year postpartum.  Thank you so much Jenna for sharing your story.  It is a pleasure to welcome my dear friend.

My longest lasting episode of depression began during my pregnancy with my second oldest child. It was marked by anxiety and irritation, and a loose cannon rage that would come out of nowhere over both big and little things. I was ashamed of my lack of ability to control my anger, and that I’d become a parent who yelled often. I attributed it to being pregnant and hormonal and having a high need 2 year old, but I didn’t connect it with depression at all. I didn’t make that connection because I wasn’t sad, tearful, lethargic, or unmotivated. How could it be depression if there were no tears?

After my baby was born, things only got worse. She had colic for 3 months, screaming from 11 pm to 2 am most nights, while I walked a groove into the living room floor. Once the colic abated, she was a terrible sleeper. She woke as many as half a dozen times a night for the first two years of her life, and I was the primary caregiver. Due to the chronic sleep deprivation, I was detached, full of rage, and anxious.  I also began having intrusive thoughts and paranoia, most often involving fear of home invasion or replaying the worst parenting moments of my day. Some were worse and more vivid than that.

I mentioned my anger and detachment to my ex (who I was still married to at the time) when she was about 10 months old, and he told me, “If you had a closer relationship with God, you would not be in despair.”  Medication and therapy would be a waste of money, he said, because the problem was in my head and was rooted in sin.  I was devastated and felt even more shame as I internalized this possibility.

When you’re already feeling worthless and ashamed, it’s easy to believe unkind words about why you feel the way you do. Because of his reaction and invalidation, I never told anyone about how I was feeling. I didn’t have the courage to admit to the intrusive thoughts and paranoia once he told me that I was the problem. But I knew my feelings were real, and I knew they weren’t normal.  I didn’t know I could look for support or help because I didn’t really know what to call my emotional state other than angry, detached, and overwhelmed. It didn’t seem like any depression I had ever heard of.

… tune in tomorrow for part 2 of Jenna’s story …

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