Pregnancy Anxiety and Family History of Miscarriage

Pregnant BellyFirst-time mothers can find many things to be anxious about when they become pregnant. What will pregnancy be like? Will my baby be healthy? Did I start taking my prenatal vitamins early enough? Am I really ready for this? But some women may have an additional fear that seems more relevant than it might to other pregnant women: Will I be able to stay pregnant, knowing that my mom had a history of miscarriage?

This anxiety was something that I had to deal with when I discovered I was pregnant with my son shortly after beginning infertility testing. After a year of trying to conceive, I had been getting rather depressed about failing each month, and the beginning of that year of trying may or may not have started with a miscarriage I was too afraid to see my doctor about. I know now that that was a bad decision, not telling my OB/GYN about the three weeks of heavy bleeding that had forced me to reschedule my initial annual exam where I’d intended to ask for a prenatal vitamin prescription, but I didn’t bring it up because I didn’t want to know for sure. My mom had suffered three miscarriages when I was a kid – the reason why there ended up being eight years between the births of my two younger brothers – and I was trying to shield myself from the emotional aftermath of knowing for sure whether it was a miscarriage or just an exceptionally heavy period. My periods were awful and unpredictable when I went off the Pill. I still have plausible deniability.

So there I was with a positive pregnancy test around Christmastime 2004, overjoyed that I was finally pregnant, but haunted by the shadow of a possible miscarriage. Some of these things are genetic. Some are due to environmental factors. Some don’t seem to have any reason whatsoever. Were those genes passed on to me?

These fears led to a tearful call to my OB/GYN just after New Year’s. I was spotting. They tried to reassure me over the phone as they set up the appointment for me to come in. Spotting can happen in a normal pregnancy. It doesn’t mean anything is wrong. But predisposed as I was to anxiety, this was no consolation. I saw the CNM I liked at my OB/GYN’s office for a pelvic exam and a urine test. The blood was brown, though, old blood, and my pregnancy test was positive. My cervix was inflamed, though, so they sent me to the local women’s hospital for an internal ultrasound because they didn’t have any ultrasound techs in the office. I was only five weeks along, so all they could see what the egg sac and yolk sac, which was good enough for them to reassure me my pregnancy was fine. Only if I started seeing red blood along with cramping should I worry and give them a call.

I didn’t have to make another call like that, but my anxiety didn’t go away.

My inflamed cervix ended up needing to be treated, and I was prescribed MetroGel for it. MetroGel is considered Category B for pregnancy risk, but I was still in my first trimester, and I was terrified that something bad would happen if I introduced this foreign substance so close to where my baby was developing at such a crucial period. I ended up waiting until the first day of my second trimester to actually use the MetroGel. That decision in itself was risky, as an untreated infection can also potentially harm a developing fetus, but it was what I considered the safest route at the time.

Thankfully, my anxiety levels decreased appreciably once I reached 24 weeks. That was the magic number in my head where I felt I could stop worrying about a miscarriage, because about 50% of babies born prematurely at that fetal age survive. And with each passing day, I knew my son’s chances of surviving and being born relatively healthy were just getting better and better.

Unfortunately, my anxiety came back with a vengeance after my son was born, alongside my undiagnosed postpartum depression. If I’d known then what I know now, 10 years later, I would have talked to my doctor. I would have tried to get help. I know I would have avoided taken any medication during my first trimester, but I might have considered some of the lowest-risk medications during my second and third trimesters according to the best available information at the time. I certainly wouldn’t have waited until my son was three before finally seeking treatment from a psychiatrist.

I know I couldn’t have stopped worrying about losing my son, but I could have had someone to talk to about it if I’d looked into therapy. But that’s why I think Postpartum Progress is so important – so people like me can encourage other women to get the support we never had.

Dealing With Grief, Trauma, and Intrusive Thoughts

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

Let’s Rewind: The Isolation of Motherhood

Liz Bauman is an American wife, mom, and writer living in Weisbaden, Germany. When she’s not camped out behind her computer screen, she quests for castles, plays Dungeons and Dragons, and drinks a lot of tea. Earl Grey. Hot. She’s also one of my favorite people, and a woman who’s personhood and journey through motherhood while living with mental illness always leaves me inspired and hopeful. If you’re so inclined, you can learn about her, tweet at her, or hire her. I’m thrilled she’s sharing her experience with us here on Postpartum Progress this week. Here is part One of her story. 

 

Archer at 16 days old

Archer at 16 days old

If asked to describe my experience as a mother in a single word, I’d love to say something like “joyful” or “empowering.” There are certainly days where I feel like motherhood has made me a strong advocate, a better feminist, and a compassionate member of the cult of womanhood. Sometimes, I go weeks at a time feeling like my two children have made me a better, more resilient woman. Like all that breastfeeding and babywearing have somehow infused my very essence with radioactive awesomeness, transforming me into some kind of Hulked-up mama hero.

But, the truth is, my motherhood has been isolating.

Let’s rewind.

Back when my husband and I were young and wild college kids in the expansive plains of South Dakota, we decided we would get out. Get far, far away from small town life and farms and go have big experiences in big cities. Shortly after we got engaged, the husband got accepted to George Washington University and I – on uneasy terms with my family – agreed that we should set forth on our grand adventure.

After 7 years in DC/Baltimore sprawl, we welcomed our son, Archer, and my world got simultaneously brighter and darker.

Let’s rewind again.

I struggled with mental illness since my teens. My diagnosis was a fast-cycling flavor of bipolar disorder characterized by frequent, but largely harmless ups and downs that rarely affected my life profoundly. But, a miscarriage at 23 triggered some major shifts in my brain chemistry that twisted my “frequent, but largely harmless ups and downs” into a screaming spiral into the gnarly pit of mix-state madness that nearly shattered the foundations of the life my husband and I worked so hard to build.

It was my first dose of the vicious isolation of motherhood and I didn’t even get a baby out of the deal. We had told no one that we were expecting, so I grieved our lost child alone. I internalized it and the sadness wrapped sticky, black anger around my bones that eventually permeated my heart and mind.

Broken and desperate, I hit rock bottom and my husband made me promise that I’d seek help.

A new shrink and an RX for Lamictal later, I was better. That seems like an over-simplification, but it was a pretty uneventful period of recovery and we spent a couple years soaking in our baby-free life, just being young and married and loving life on the East Coast. We both had our dream jobs and, with time, overcame the anxieties of miscarriages and mental breakdowns and I weaned off my meds so we could try, once again, to bake ourselves the proverbial bun.

It took a while, but – after 8 months of trying – we discovered we were expecting Archer. And things were good. Pregnancy was wonderful to me. It was my renaissance. I was stable, productive, and happy-all while being unmedicated.

When Archer was born, via emergency c-section, his resultant NICU stay tested my mental fortitude in a way I couldn’t have expected. Without going into all the triggery details, he spent his first couple of days drifting down the “will he/won’t he” line and I wouldn’t wish that sort of terror on anyone.

As he and I recovered, I found myself alone in the hospital. I was discharged and my husband – an important dude with a high-pressure job – went back to work. The nurses, taking pity on me, let me camp out in their on-call room so I could nurse Archer through the night because they didn’t have on-site rooms available for discharged moms.

I cried a lot. I’d never felt so alone. “Is this what motherhood is supposed to look like?” I asked myself as I cradled him his next to his incubator, lights blinking and monitors blooping.

Now, as I sit on the cusp of my second child’s first birthday, I can say pretty definitively, that it may not be what motherhood is supposed to look like, but reality is Kryptonite to supposition.

 

to be continued…

The emotional aftermath of pregnancy loss

loss of a babyTrigger Warning: pregnancy loss, D&C

If you are feeling particularly vulnerable/sensitive, you may want to skip this post or may need to stop reading part way through. If that’s the case, here’s a video of pandas playing on a slide. Actually, even if that’s not the case you may still want to watch the video because it’s just that darned cute.

Over the last year, one of the things I’ve been doing is going through the process of becoming a Gestational Surrogate. In January of this year, we did an IVF transfer of two frozen embryos. Both stuck and I was pregnant with twins. Unfortunately, at 11 weeks and 2 days pregnant an ultrasound showed that both babies had passed a couple of weeks prior. At the end of an agonizing and emotionally tortuous week, I ended up with a D&C. I won’t drag you through the whole story (you can read it here if you’re interested, at my surrogacy blog) but today I want to focus on some of the emotional aftermath of pregnancy loss and the risk of postpartum depression or anxiety.

When I gave birth to my second and third children, I knew to expect some up and down, some hormonal changes. I know about the ups and downs and what to watch out for that might signal that I was dealing with postpartum depression and not “just” the baby blues. For some reason, it didn’t occur to me that I might go through the exact same process after miscarrying, but with added twists and turns to the roller coaster given the grief I was dealing with at the same time. It took my mom telling me, “Yes, you need to be on the lookout for PPD, but keep in mind that your hormones are going through the same type of adjustments that they would with a normal postpartum period”.

It hadn’t even occurred to me that a pregnancy ending means my hormone levels fluctuating, regardless of how or why the pregnancy ended. Once I realized that it was normal and natural (for my situation), it was a bit of a relief and helped me feel a little less antsy. I was able to take some of that energy I had been directing towards “OMG I feel *whatever* is this PPD?” and direct it towards processing my grief. It was a grief I wasn’t prepared for, because even though I went into the surrogacy knowing “Anything could happen”, I’ve never had a miscarriage before and especially once I got to that 8w5d u/s with two healthy babies and heartbeats, I felt like I was “safe”. That feeling of safety was an illusion; I realized that in about .025 seconds, but it still made it that much harder to accept the miscarriage.

I was fortunate, in that I didn’t suffer from postpartum depression after the miscarriage. But for too many women, that’s not the case. It has been more difficult than I can put into words to deal with the grief from the miscarriage; I can’t imagine if that had been compounded by PPD setting in to rub salt in an open wound. In 2012, Psychology Today posted an article titled “Pregnancy Loss and Depression: Understanding the trauma of fetal loss” by Karen Kleiman, MSW, LCSW. In this article, Karen says:

A study from the Journal of the American Medical Association (JAMA, 1997) concluded that major depressive disorders are more common in women who suffer a miscarriage than in those who have not been pregnant. Furthermore, they suggest that women who suffer miscarriages should be monitored in the first weeks after reproductive loss, particularly those who are childless or who have history of major depressive disorder. Among miscarrying women with a history of prior major depression, half experience a recurrence. It is also interesting to note that this risk did not vary significantly by maternal age, by time of gestation, or attitude toward pregnancy.”.

This is information that all medical professionals need to be very aware of and disseminate appropriately to their patients dealing with pregnancy loss, as does everyone with a loved one dealing with loss in pregnancy.

One of the frustrating things about watching for PPD after my miscarriage was the difficulty in distinguishing symptoms. Symptoms that I know to often be associated with PPD were also easily attributed to my grief. Anger, feeling down, lack of appetite and interest, just wanting to sit around, crying a lot, mood swings, and more had me thinking “Is this PPD or is it just because I’m coping with a miscarriage?”. Thankfully, before too long, everything eased up and there was no PPD for me. I was lucky and I am grateful for that.

If you have been through a pregnancy loss, you have my deepest and most sincere sympathies. I am so sorry for what you are going through and if you need someone to talk to about it, I am here and I am more than happy to talk in the comments, on twitter, on Facebook, by email, whatever. Also please know that you are not alone. There are people who understand what you’re going through and who want to support you. There are resources out there for you. There are two websites that I personally found helpful in processing the miscarriage: The Amethyst Network and Unspoken Grief. Postpartum Progress has a couple of posts that also helped me (links here, here, and here). And last but certainly not least, let yourself grieve. Give yourself permission to grieve. No matter how early or late the loss, it is a loss. Whether it was an early miscarriage days after you got a positive pregnancy test, a stillbirth at 40 weeks, or anything else (I am definitely not setting limits, the possibilities are unfortunately broad), give yourself the time and space and permission that that you need to deal with your loss in whatever way you need to. Remember that there’s no timeline on grief and no one right way to grieve. Don’t worry about offending other people, just do what you need to do to take care of yourself. We are here for you. I am here for you.