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

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Nearly two years to the day after my overdue diagnosis of postpartum depression and anxiety, I found myself pregnant and still on an SSRI. 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.

SSRIs 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.

None of the people I involved in this decision took the discussion lightly. After all, this was a deeply personal decision based on several factors. One, I was a full time working mom of an active little boy who was quickly morphing into a threenager. My patience was already wearing thin due to the physical demands of a twin pregnancy, and battling the will of a small tyrant is much harder when you aren’t sleeping, can barely keep your lunch down, and can’t take any medication for anything that ails you. Two, there was an unmeasurable amount of stress that would soon be wreaking havoc on my body and my mind. Three, I was, as my OB kindly joked, the “poster child for relapse” due to all of these factors and an increased risk of having a repeat experience. 

Had I not chosen to remain on my medication, I was at risk for major depressive episodes, which could lead to improper nutrition needed to keep the babies healthy, maintain the pregnancy to a date of viability, and the lack of ability to do my job or be a functioning mom to my son. 

At the start of the third trimester, I weaned off of the Celexa. My irritability increased, I slept even less than I already was, and I had little to no patience or energy for my son and husband. The medication that had helped regulate my roller coaster moods and anxieties was no longer there to do its job, which was only exacerbated by lack of sleep,   cramping, ligament pain, shortness of breath, and all of the other fun symptoms that come along with a multiple pregnancy. The physical stress weighed heavily on my mental state. I am normally a very independent person-not being able to carry loads of clothes to our upstairs laundry room, clean the house, or carry my son nearly broke me. Getting out of the house to see friends and family was daunting, and I only left my desk at work to waddle to the bathroom. 

We all trudged through it until two weeks before my scheduled c-section, when my doctor suggested starting the medication again to make sure it would be effective by the time the baby blues would subside and real PPD may kick in. I was so down at that point, I knew it was the best thing for all of us.

The girls’ birth was somewhat traumatic. They were both born healthy and needed no NICU time, and we were successfully able to establish a breastfeeding relationship that had been my lifeline to normalcy during my PPD/A with my son. I, however, did not fare so well. My body was worn from 37 weeks of growing 12 lbs of baby in my 5’3 body. Had I not been on the medication and had the tools of therapy in my back pocket, I might not have been able to handle my experience with as much grace as one can muster during a five day hospital stay brought on by a series of complications related to twin delivery. I’m still working through my emotions and feelings on everything that happened to me, but for now my hands and heart are full enough to make that experience worth it.Family

Five and a half months later, my girls are healthy, happy, and meeting their milestones. I have good days and bad days, but the good outweigh the bad by light years. I feel so much more like myself than I ever did in the six months between the birth of my son and my diagnosis. I passed my postpartum screenings by my OB, Pediatrician, and Therapist. I am completely at peace with my decision, as difficult as it was.

The risk was definitely worth the reward.

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A Guide to Waiting

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No matter what brings us here, we have waiting in common. We wait for a diagnosis, for a doctor’s appointment, for medication to start working. Eventually, we wait again; new doctors, new medications, new diagnoses. Am I better? Will it come back? Our families wait. Our friends. In fact, there is very little action in this whole mental health and healing business. Getting a name for what is happening, a new medication, a new appointment–the exciting, newsworthy stuff happens so quickly, compared to the time between. I am impatient. I hate waiting. I have no choice.

If we’re lucky, some people who really understand wait with us; this website can help you find some of those people, if you don’t know any, and you’re looking. I have found some pretty amazing women to wait with me, through the toughest times. We will wait with you, whether it is you who suffers, or someone you love. Whether you understand, or don’t understand. We are really good at waiting. We have practice.

Nothing takes away the insidious pain of waiting. It sneaks reminders into my days; one day, the light changes, and a pill can look like a taunting little joke, filled with more doubt than medicine. My toddler’s tears inspire annoyance, or even rage, in me, and the best I can do is wait for feelings of sympathy. I catch myself going through the motions of motherhood, without feeling inspired, and resolve to keep doing that, until I can ride a wave of love through an entire morning.

I have found a way to trick the trickster, and I’ll tell you my secret. It’s a trick I saw once for making a To Do list less overwhelming–I add small things to the list of the things that I am waiting for, tiny events that will definitely happen, soon. When things feel really badly, I get really tiny. I wait for the next time my son makes me smile, and I count that one smile as a victory against depression, even if it lasts for one second and it is followed by tears. That one might not work for you, but my twenty-month-old tiny man has a pair of dimples that have been making his smiles contagious since he started showing them off.

I wait to see proof that my child is thriving, because that is how I know that we are meant to be together, mother and son. If you do the right kind of learning about child development, those signs are there every single day. I remember the first time I held up a blanket in front of my face, and he pulled it away. That meant that he knew I was there, behind that blanket, and that he had the motor skills and motivation to move away the obstacle. He laughed, and I laughed. Every time his block towers get taller, I try to remember: tell yourself that this means he is thriving, learning, growing.

Lately, my husband has been “doing” bedtime. He used to do the bath and the nighttime diaper, and then I would read a story and sing and nurse the boy to sleep. Then, he got bigger and demanded more nursing, more playing, until my patience gave out. I wait for bedtime in a new way, now, because I get to listen to the little conversations he has with his dad. He says “boat!” and his dad makes the noise for the motor, and they both laugh. I wait for bedtime, because the way he waves his hand exactly once and says a staccato “bye!” just kills me. He sounds just like a grown person heading out to run the most mundane errand. At first, I saw this change in the bedtime routine as a sign that I had failed, again, and I wished that my anxiety would stop long enough for indefinite nursing sessions, just once a day. Now, I wait for the overheard laughter and the casual goodnight (preceded by many hugs and kisses) because I see them as signs that he enjoys his father and trusts that I will be there for him, if he needs me. He hates to be without either of us, but he adapts. When a child’s mother is failing, he is afraid. My son is not afraid. Therefore, I do not fail.

I wait for the next success. If all I can feel is despair, I wait for that next success, however small, and I hold on tight. It may be small, but it is my proof that the waiting is worth it.

We do a lot of waiting, and we move slowly, but each step matters. Even in the rain.

We do a lot of waiting, and we move slowly, but each step matters. Even in the rain.

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When Everything Is Unexpected: From Natural Birth Plan to C-Section

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RaivonToday I’m happy to welcome Raivon Lee from Climb Out Team Atlanta to the Warrior Mom community and share her story with you. Raivon wanted a natural birth at home, but the stress of a breech baby and C-section were the start of her experience with postpartum depression and anxiety.

Hi, my name is Raivon and I’m a 28-year-old mom of a sweet 15-month-old boy.

Back in April of 2012 when I found out I was pregnant, I was literally shocked! I couldn’t even say the words to my husband so I typed out the words “I am pregnant” on the notepad on my phone during church and showed it to him. I eventually got used to the idea of being a mommy and I was very excited. I knew I wanted a natural water birth at home and submerged myself in everything about natural birth. Books, classes, forums, groups, etc. A few weeks into my pregnancy the morning sickness hit. It was rough but I was sure it would be over by the 2nd trimester. After all that’s what EVERYONE told me.

Unfortunately for me I had morning sickness and took medication for it until the day Ari was born. My idea of an awesome, healthy pregnancy, and long jogs through the park were replaced with the reality of me struggling to make it off the sofa just to brush my teeth.

During the last month of my pregnancy, I went in for an ultrasound to make sure that everything was a go and safe for my home birth. We found out then that Ari was breech. This devastated me. I did NOT want to give birth in the hospital. Being a nurse made me scared of  hospitals (crazy, I know), and it just wasn’t in my plan. My midwife and back-up OB thought I could possibly still give birth vaginally depending on the type of breech positioning of the baby at the time I went into labor, but a home birth was out of the question.

My husband and I did everything we could to get the baby to turn. Chiropractic adjustments, moxibustion, inversions on the ironing board, cold packs, flash lights and last but not least … external extroversion. This was the most painful experience I think I’ve ever had. Imagine two grown men trying to turn a baby by pushing and twisting your stomach.

We did all of this and by the time my water broke, Ari was still breech.

I was admitted to the hospital and a few hours later after crazy painful contractions, I had a C-section and my sweet baby boy was born. I was actually ok with the c-section and my birth experience, even though it was the complete opposite of what we wanted.

Fast forward a week. I was home crying in pain. No one told me that breastfeeding and engorgement would be so very painful. The scabs on my nipples made it impossible to nurse, and I was so engorged that even when I tried to nurse Ari could not latch on. The thought of possibly having to give Ari formula sent me over the edge. I felt that everything else I wanted for my pregnancy and birth had been taken away from me and breastfeeding was the only thing I was doing right. It was rough but we got through it and eventually breastfeeding got easier.

But still…

I was not sleeping, but I was exhausted. I wasn’t eating and I was crying daily, and I NEVER cry. I would just be sitting and tears would begin flowing from my eyes uncontrollably. I would look at picture of Ari and cry. I thought maybe it was just baby blues and that it was normal. It would go away. I was afraid for my husband to go to work. I didn’t want to be left alone, yet when he was home I didn’t want him to take care of or help with Ari. I HAD to be the one to care for him. My husband and I had many arguments about me letting him help. He wanted to help desperately but the thought of him helping caused me great anxiety. Yes, I was exhausted and I wanted to sleep but I couldn’t let even my husband help.

After four months of this I decided I needed help. My husband talked to my midwife (our home birth midwife) and she gave me a list of natural supplements to try. I did and I felt a little better, like the edge was taken off, but it didn’t last long. I eventually went into my OBs practice and the midwife there prescribed an antidepressant. I started it immediately and honesty I felt worse. I felt like I was outside of myself. I’m sure I was hearing things as well. After two days I stopped taking it. And I suffered three more long months.

During those months, I spent the day at home alone with Ari, not eating, not showering and crying. I was so tired (Ari wasn’t the best sleeper). I thought to myself, “If I die I could finally get some sleep.” The thought of death was so peaceful to me. I was on forums constantly trying to figure out what was wrong with my baby -why wasn’t he sleeping? What was wrong with me? What was I doing wrong? I would try to talk to others about how I was feeling but I feel like they down played the pain I was in.

My husband would come home and thanks to him I would eat. Then I would go into a dark room and try to sleep with Ari (because he couldn’t sleep or stay asleep on his own) I’d be in that room for 12 hours. This this was my life.

One night while crying, I just couldn’t take it anymore. I knew I had the prescription somewhere, and I was going to give them another try. I decided to start with half of the dose.

I am so happy and blessed to be able to say that taking those meds saved me! I was able to find a PPD support group that was an awesome help. Knowing that I wasn’t alone, that I wasn’t overreacting, and that postpartum depression and postpartum anxiety are very real and serious things, made me feel good, but honestly a little sad too. I needed to know that it was real and serious, and not just in my head. I think overall I was trying to downplay my issues.

Today I’m feeling great! I feel like Raivon again, maybe better. I often think of what it will be like to stop taking my meds. Sometimes I feel like a fraud, like the person I am now isn’t really me. But until then I’m going to try to enjoy each and every day I’ve been given.

Raivon

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Cutting Teeth: Two Authors Share Stories of Postpartum Anxiety

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Cutting TeethI am so excited to share the following interview with you, between authors and fellow Warrior Moms Elizabeth Isadora Gold and Julia Ferro on the occasion of the release of Julia’s new novel, Cutting Teeth. Both had risk factors for postpartum anxiety, but were never warned or screened, and both found it difficult, as so many of you do, to find the help they needed.

I met Julia Fierro in 2009, when I was her student at one of her fiction workshops. We were both struggling writers, but Julia was also the mother of a toddler, Luca. I would sit in her kitchen, allegedly discussing a short story, but really staring at photos of her beautiful boy, wondering if I’d ever have a child. One day, towards the end of the workshop, she casually mentioned she’d had postpartum depression and postpartum anxiety after Luca’s birth. Though I’d heard of PPD, I’d had never known anyone with such a (to my mind, then) “rare” condition, and didn’t know what to say. We weren’t in touch much after the workshop – she had a second child, Cece (now four), I had my daughter, Clara (three). When I suffered my own postpartum mental illness, isolated and fearful, I didn’t feel comfortable reaching out to Julia. Then, last spring I saw via facebook that Julia had sold a novel, Cutting Teeth, and she would be reading a preview at a local Brooklyn bookstore. The excerpt was hilarious: a lone stay-at-home-dad in a mommy group, admires his nursing friends’ lactating breasts. After the reading, Julia and I hugged like long-lost friends. We’d spent several years on parallel tracks, both suffering from postpartum anxiety, writing about parenthood, community, and anxiety. In a happy coincidence, we were also each writing books about mother’s groups, though hers is a novel and mine is nonfiction. As Cutting Teeth (St. Martin’s Press) approached its release date, we chatted for Postpartum Progress about writing, motherhood, and life.  ~ EIG

EIG: So we should catch each other up on what we never talked about:  I was your student when Luca was a toddler, and knew you’d been sick, but I didn’t really understand.

JF: I’ve been obsessive compulsive since I was a child. I went on medication at the end of my college senior year, because I was having debilitating panic attacks. The first twenty-five years of my life were very exhausting. Obsession, obsession, and depression. When my husband, Justin, and I started getting ready to have a baby, the psychiatrist I was seeing made me go off medication a year before we even started trying. But she was the only person I could find on my insurance within miles.

EIG: No psychiatrist takes insurance. Which is an issue, because if you can’t afford a psychiatrist who doesn’t take insurance, you get less good psychiatric care.

JF: Right. She said, “You don’t want any medication. You don’t want to hurt the baby.” I didn’t have anyone to talk to. It was hard to go off medication, but I was working from home, I didn’t have a kid yet, and the business wasn’t as big. The pregnancy was difficult – I threw up every single day.  It was a difficult birth. I was in labor for three days. On the third night, they gave me the epidural and pitocin, but it still felt like he was going to come out of my hip. The delivery room was where the insecurity and the self-doubt that would hang over me for years began. The midwife was yelling at me to push, and I was like, “I don’t know what you’re telling me!”

EIG: For so many women, the birth is the beginning of feeling like you’re doing everything wrong. I don’t know if that’s a chicken and an egg thing. Would someone who had a difficult birth but not go on to get postpartum depression or anxiety feel okay about the birth? Or should part of the diagnostic for postpartum depression or anxiety be, immediately after birth, “How do you feel about this experience?”

JF: There should be some kind of therapy. Even a social worker in the hospital to ask, “How do you feel?” Just talking for five minutes would be more than nothing. I couldn’t even get a lactation consultant to visit me.

EIG: Me neither! You know who came to my room? People wanting to take photographs that I could pay for. They came twice.

JF: Yes!

EIG: Did you have a c-section?

JF: Yes. After that, for two days, it was great, Luca was beautiful. On the third night, they took him to get his vitals checked, and they didn’t bring him back! An intern came, stopped in our doorway, and said, “Your baby has a fever, so we took him up to the NICU.” And she just walked out! We were so exhausted, we cracked. Now, I met Justin when I was 21, so he practically raised me, getting me through my obsession, and the medications. So seeing him crumble? I actually said, “If the baby dies we can have another baby.” He just had a fever! Our family wasn’t there because they don’t live nearby. It was the worst moment. (Sighs.) I can’t believe I’m getting upset about it. It was seven years ago. His birthday is next week.

EIG: I’ve been doing interviews with moms for my book, and everyone starts crying when they talk about the birth.

JF: Luca was in the little bubble incubator, and I turned to the pediatrician – I was so out of my mind –and said, “Is he going to die?” And he was like, “No.” When they moved him to the bigger room in the NICU, and then I saw how big he was compared to the tiny preemies, that made me realize he was okay. That shaky feeling stayed with me for the next two years.

EIG: I had a very similar experience after my c-section, and I think it’s very common for women who have had surgery. I was very jealous of how Danny (my husband) was with her, how easy it seemed for him, how proud he was of her. For example, I didn’t seen Clara’s fully naked body until I was home for like a week, which was so upsetting. In my mind, I was supposed to have this experience where I would see her body come out of me, we would be naked together, and she would be on my chest. Because of the surgery, I never had that moment. As a result, for me, it took me a longer time to attach. I was like, I don’t know who this person is, this could be anybody’s baby. There was a sheet over me when I gave birth. It’s a very primal, primate-like thing when someone else touches your baby first.

JF: For me the breastfeeding was such a disaster that first time. I couldn’t breastfeed, because I was too anxious. I wish I could go back in time and fix that.

EIG: Do you wish you could go back in time and make the breastfeeding better? Or that you could get on medication, and make the feeling better? 

JF: Yes. (Laughs.) I didn’t know things like, your baby is going to want you to hold him. My babies were not the kind you could put down. They would cry endlessly. My philosophy of early parenting: do what’s easiest. That’s always going to be the right thing for you and your baby. I realized later we should have put Luca on formula, because it was so agonizing to breastfeed. Trying to nurse that first day when we were back home, I’d left the breast pump on, and I thought it was saying to me, “You can’t do this, you can’t do this.” I decided to stay off medication because I didn’t know you could go on medication and nurse. I didn’t have anyone to turn to. Our parents did this thirty years ago. They didn’t remember.

EIG: Having kids later, you don’t receive the same benefit of parental wisdom, because they don’t remember. My mom always told me, “We carried you around in a basket!” Once I had Clara, I was like, “With a pillow? Was I smothered?”

JF: Justin was back to work, and here I was with the baby who cried all day long. One weekend I panicked because I was worried about him getting dehydrated (which is why he got the fever and ended up in the NICU). He wasn’t nursing. We went to our pediatrician, who said to me, “Look at your baby, he is so healthy and fat. Do you think maybe it is your own anxiety that is causing him not to nurse?”

EIG: In that moment, he could have caught the fact that you were sick, and reframed it. He could have said, “Look at your baby. He’s healthy and fat. I’m concerned about you.”

JF: Or how about, “You’re doing a good job!” Instead, he said, “If you’re anxious, the child is going to feel that.” When a woman is feeling an uncontrollable postpartum depression or anxiety, to have someone say, “If you don’t stop feeling what you’re feeling you’re going to harm your child.” It’s so irresponsible. [Read more...]

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