Weaning and PPD: I Didn’t Know You Could Get Postpartum Depression Any Time During the First Year

[Editor’s Note: Today’s guest post comes from Jessica. She writes about the depression she experienced after weaning her baby. -Jenna]

Weaning and PPD: I Didn't Realize You Could Get Postpartum Depression Any Time During the First Year -postpartumprogress.com

Post-weaning depression, huh? That’s a thing. A very real thing, with physical manifestations, anxiety, and a whole cocktail of emotions and hormones mixed to make life feel so very difficult. Just when everyone is telling you “oh, it must be getting easier now that your baby is getting older,” life seems to be getting worse. But instead of admitting it, you nod, you smile and deep down you think, if only you KNEW how hard this is. How very taxing, how completely irrational and how guilt-ridden.

Eight months after my second son was born, I decided to wean completely. He was already breastfeeding only twice a day and it felt like a light at the end of the tunnel to think that I wouldn’t have to pump while at work. I weaned quickly and without physical or apparent emotional difficulty.

I slowly started an unrecognized spiral towards anxiety which led to depression. A lot of attention has been given to postpartum depression but I was eight months out. I didn’t know that postpartum depression could happen at any time within the baby’s first year. I should feel happy and free and thrilled to get my body back. Baby was sleeping through the night, no more pumping, no more worrying about freezing milk. FREEDOM right? Wrong.

I knew something was seriously wrong a month after I had stopped weaning. It was Christmas day and my husband and I had just had a huge fight. My usually supportive husband was in a different room seething in front of the fire place while I was crying uncontrollably on the couch. I don’t remember where my two-year-old or nine-month-old were at the time. I just remember thinking this is the end of my marriage, he hates me, I hate myself, I’m a bad mother, my kids shouldn’t have to see me like this.

At the time I attributed it to marriage difficulties. We were in that seven year slump I rationalized. We have a good and supportive marriage; this will pass if I work harder. I became more and more anxious, felt like I was scared to be home alone with the kids, and most unfortunately tried to control every aspect of my day, my husband and my kids because it gave me a feeling of safety. I thought that I was communicating effectively and couldn’t understand why my closest friends and husband didn’t seem to get how very emotionally fragile I was. I didn’t understand that my husband couldn’t see that my crying and controlling was due to fear. He knows me; how could he not know this part of me and just get it?

I didn’t understand myself and that scared me. This was not me. All I could see was that I was physically nauseated, shaky, and that I made lists and lists endlessly because they gave me a sense of control. I knew something wasn’t right and I was so confused. I had never been depressed. I had done some research and was almost a year out so I didn’t think it could be postpartum depression, and I was scared to death that this was the new me.

There are two things that stick in my head from that time that were triggers to finally get me into counseling. One was my husband calling my mother behind my back and having her come from Germany to help with the kids for two weeks. I had told him that I absolutely did NOT need her there and that I was going to be fine. The second event that occurred was me crying on the phone to a friend and having her say that she didn’t realize how badly I was doing.

With much support from family and friends, I finally got into counseling. I spent the first two sessions just crying on the couch and worrying that I wouldn’t get better. And I didn’t for a while. It took a lot of grieving and letting go. A lot of grace towards myself and those around me and a lot of just being in this dark space and accepting it.

However, it did get better. Not all at once, but one day I realized that the knot in my stomach was loosening. I didn’t have to make lists any more. I exercised, I took time for myself and when the feelings of guilt for taking time came in my head I accepted them for what they were. Untrue.

I share this story because I now have my third child. It is eight months out and I have weaned. Last week I started to feel that anxiety again. I decided to give it the weekend to see if it was just food poisoning or if it was anxiety. By Monday I knew that I am headed back toward depression. It doesn’t feel any better the second time around. It’s hard. It’s guilt-ridden. It’s overwhelming. But what I do know this time around and what I hope can help those in the same space is firstly that I need help. NOW.

Secondly, I realize that I don’t do a good job of communicating even though I thought I did. So I am communicating with all those around me, as bluntly as possible, as much as possible and all the time. My husband knows what he is in for; he understands that he doesn’t understand what is happening with me, but he does know where I am at.

Lastly, I know and hold on with a tight grip to the thought that this is not me and this will end. On days when the anxiety is high and self judgement is at its worst I repeat this mantra to myself. This is not me. This will pass. Be kind to yourself. There is not always a visible light at the end of the tunnel but there is a light. Hopefully I will give myself more grace and demand less from myself this time around.

~Jessica

The Secret Companion of Pregnancy After Loss: Postpartum Anxiety

The Secret Companion of Pregnancy After Loss: Postpartum Anxiety -postpartumprogress.com

Birth trauma, you could call it that. My first daughter was stillborn at full-term in December of 2012. I went into labor and delivery that night expecting to soon meet my little girl only to be told by the doctor while sitting in front of a still and silent ultrasound that there was, “No heartbeat.”

Crushed, heartbroken, devastated, and numb, I fought for my life when I delivered her, because the infection that killed her, it could have taken my life too. I think it’s safe to say that birth trauma is what happened during the silent entrance of my daughter’s body into the world.

Seven months later I was pregnant again, terrified beyond what doctors and therapists would think was just normal grief. As my belly grew with my daughter inside, both of us getting closer and closer to her due date, I would panic almost daily. At night I would wake in up in sweats as nightmares of not being able to feel her move would haunt me. Then I would spend an hour at three in the morning making sure she would move, making sure she was alive, because there were days when my anxiety convinced me that she had died too. I would mentally prepare myself to go to yet another ultrasound appointment and once again hear those dreaded words, “I’m sorry. There is no heartbeat.”

While pregnant after the death of my first daughter, it was almost impossible to get through my job everyday. I was always worried that she might have stopped moving or that she died while I was engrossed in a work task. The fear engulfed me. I frequently needed to step out of meetings to splash water on my face and poke at my baby to count her kicks and make sure she was still there, still moving, still alive. I also took extra ‘sick’ days just to manage my anxiety, to try to relax at home and take it easy, which proved challenging.

Then on the days I would make it through work, I would come home in the evening and break into tears of fear as I lay sobbing on my bed. My husband held me as I cried, crying with me, and I would scream between my wails, “I can’t do this! I can’t do this anymore!”

Being pregnant again after a loss is like living inside your trauma, which, unfortunately, is your own body that you cannot escape from for nine months. It’s torture, trying not to let your fears and anxiety control you. However, now you know; you know all that can go wrong. You know you are not guaranteed this baby, just like you weren’t guaranteed the one who died

Some might think that once the baby arrives safe and healthy relief would settle in, and the anxiety and worry would disappear. However, this did not happen for me. The anxiety increased daily a few months after my living baby was born.

In the hospital, two days after she was born, I had a mental break down. I was obsessed with my health, afraid that if I breastfed her, I would somehow give her a new infection, and that my body would cause her to die too. Irrational fears like this one flooded me, and only proceeded to get worse when we went home. Yes, I was relieved and happy that my daughter was here, that I finally got to bring home a baby after 18 months of being pregnant. But the irrational thoughts kept creeping in. I would stay up late at night, unable to fall asleep because I was convinced the world was going to end due to the eruption of the super volcano in Yellowstone. I would seek reassurance from all my family members around this issue, and most of them looked at me like I was crazy.

In the days and weeks after my irrational thoughts had taken over, I visited the doctor and talked to my therapist about my postpartum anxiety. I learned that I was at a higher risk for postpartum mood and anxiety disorders because of the birth trauma from my first daughter’s stillbirth.

Slowly, over time with the help of my doctor and therapist, I learned that breastfeeding my baby would not kill her, as I thought it would. When done with breastfeeding, we discussed medication to address the anxiety, which ultimately was the right choice of treatment for me, along with continuing talk therapy that utilized dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) techniques.

My daughter is now 11 months old. Each day that passes, I seem to have less and less anxiety. I’m still going to therapy, and I’m still taking medications, and thanks to these treatments I get to enjoy more moments with my daughter and use this second chance at motherhood as a time to heal. Even if anxiety continues to be my companion I now know how to keep her at bay.

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Lindsey Henke is the founder and editor of Pregnancy After Loss Support, writer, clinical social worker, wife, and most importantly a mother to two beautiful daughters. Tragically, her oldest daughter, Nora was stillborn after a healthy full-term pregnancy in December of 2012. Since then, she has turned to writing on her blog, Stillborn and Still Breathing, to soothe her sorrow and has found healing in giving voice to her grief. Lindsey is also a monthly contributor to Still Standing Magazine and was featured as Pregnancy and Newborn Magazine’s Knocked Up Blogger during her pregnancy with her second daughter, Zoe who was born healthy and alive in March of 2014.

Triggers and How They Affect Recovery

Triggers and Recovery from mental illness

Knowing is half the battle. I found this to ring true in my experience with managing my mental illness during my pregnancies and postpartum.

I was diagnosed with Bipolar Type 1 in 2006. It took over a year for me to find the right psychiatrist, the right combination of medications, and the right techniques through therapy to allow me to begin to manage an illness which had taken me and my family completely by surprise. After months of anguish over what was working and what wasn’t, we finally found a medication that stabilized me and I started to feel pieces of my old self emerging from the darkness.

Once I had been stable for about a year, my husband and I decided we were ready to start a family. I was scared of a recurrence of my illness, but wanted to be a mom more than anything, so we started trying and I was able to get pregnant rather quickly. Unfortunately, our joy was fleeting as I experienced an early miscarriage and had to have a D&C. I was afraid that the medication I had been taking for my bipolar disorder caused the miscarriage, so I convinced my psychiatrist to allow me to taper off the med so that we could try again after I healed from the surgery.

We became pregnant again fairly soon after, and since I was doing so well off the medication and had no recurrance of symptoms, my doctor continued to see me as a patient but allowed me to stay off my medication for the duration of the pregnancy.

This was a terrible decision on both our parts, but I didn’t realize this at the time. Four weeks after delivering my son I experienced a severe episode of postpartum psychosis and had to be hospitalized for a week. It was arguably the worst week of my life, having been ripped from my child, having to abruptly stop nursing, and it took an incredible toll on me both physically and emotionally.

I was stabilized quickly by the team of doctors at the hospital by resuming my course of medication I had been on before my pregnancy. The recovery from the trauma of being taken away from my newborn for a week would take much longer.

I learned through my postpartum psychosis episode that my triggers are: lack of sleep and lack of medication in my bloodstream. These two facts would prove essential to me creating a much more positive postpartum experience with my second child. But not without another lesson first.

Once stable again after my PPP hospitalization, my husband and I began to talk about completing our family with one more baby. Even with my three hospitalizations (two before our first child and the PPP episode), I still didn’t know enough about my illness to know that the benefits of me staying on my medication during the pregnancy and exposing the fetus to the medication, although not the most ideal situation, far outweighed the risks of not being on medication at all given this was one of my top two triggers.

Doctors can advise patients, but it’s up to the patient to follow through with the prescribed recommendations. My doctor had agreed to let me stay off medication during the first trimester due to a heart defect risk, but after week 12 we decided I would go back on my medication for the duration of the pregnancy.

Tapering off my medication in just week 5 of the pregnancy, combined with my excitement and mounting loss of sleep over how excited I was to see those two pink lines on the pregnancy test, landed me in the psych ward again. My baby was barely the size of an orange seed and I had to be hospitalized for almost a week and put on antipsychotic medication to bring me down from the mania I had been struck with.

Because of lack of sleep and lack of medication. Two things I learned I could control.

Recovery from that episode took months; experts say that each subsequent episode is more difficult and takes longer to recover from, and I’ve found this to be true. But I emerged from that setback a much more informed and capable mother, ready to truly manage my illness so that it did not cause me and my family any further pain.

My husband and I talked about how we could handle my postpartum period differently with our second child, and we made plans to take charge over my triggers so that I could stay in recovery long-term. I stayed on my medication for the entire rest of the pregnancy and beyond because my medication kept me stable. We made plans that I would bottle-feed and my husband would take over the middle-of-the-night feedings between 2am – 5am so that I could get a long stretch of sleep at night, keeping my nocturnal clock in check.

I’m not saying it was easy. But my postpartum period with my second child was so much more enjoyable and relaxed compared to my first because I took the upper hand over my triggers. With my family’s support, I made it through. And I continue to keep a firm grip on my dedication to the medication that keeps me stable and getting the appropriate amount of quality sleep each night so that I can stay steady on my recovery path.

Bipolar disorder is a condition I’ll live with for the rest of my life. Learning my triggers and techniques which allow me to stay on top of them so they don’t throw me into a manic episode has been a learning process, but it is one which has empowered me to live well even with a mental health disorder.

6 Ways You Can Be an Empowered Patient During Pregnancy When You Have Bipolar Disorder

The best person on my care team? My OB. Hands down. When we found out I was pregnant (far sooner than we had planned), my husband and I decided right away that no matter what course of treatment  we decided upon after speaking with my doctors, our number 1 priority was my mental health. Still absorbing the shock, I remember my husband standing in our bedroom with his fingers lacing their way through mine, saying, “Health and wellness, Addye. That’s our focus, ok? Your health and wellness. No guilt, no shame, no matter what happens. YOU and your health are what’s most important. We’ll do whatever it takes. We’ll get through this together. I promise. Let’s do this.”  I’m pretty sure I was fighting back tears and a whopping dose of fear in that moment as I high fived him and agreed: We could do this. I could do this.

And I did. I have. I’ll be a year postpartum next month, and as I watch my youngest son crawl into the room he shares with his two older brothers, I think back to that moment in my bedroom and feel proud of that promise we made, and the treatment option I chose.

Given my previous history with PPD, the nature of my illness, and the increased risk of relapse I faced because I have bipolar disorder, we decided staying on two out my three medications was what health and wellness would look like for me…as well as for the baby and the rest of my family.

That was my choice, but I know many other mothers with bipolar disorder who opted to go without their medications during their pregnancies and remained healthy throughout. No matter what course of treatment you and your care team decide upon, the important thing to remember is that you DO have options. There’s nothing I hate more (aside from stigma) than coming across an article on the internet that gives women with bipolar disorder incomplete information regarding their treatment options during pregnancy and breastfeeding, doesn’t point to what resources they can utilize to make informed decisions, and doesn’t tell them how they can navigate the unique challenges they’re faced with.

So let’s talk about how to do that, shall we? (This post is going to a bit long, but bear with me, I believe what I’m sharing with you is important)

1. Build Your Care Team, Create a Treatment Plan

I cannot stress the importance of this enough: You MUST have people on your medical team who have experience in treating pregnant women with mood disorders. Think of this as your Dream Team. People you want on this team are your OB, your psychiatrist, therapist (if you have one), and a pediatrician. It’s possible your obsectrician will also want a reproductive psychiatrist and maternal fetal medicine doctor on your team as well, especially if their experience on this front is minimal. Thankfully, my OB had extensive experience with caring for women with bipolar disorder during their pregnancies and knew pretty much everything that’s out there regarding medication use during pregnancy and breastfeeding. He was up to date on the latest research available and proved to be my most invaluable resource on my care team. Seriously, he’s the one who gave me the confidence that all would be well, and that choosing to stay on at least two of my medications was a safe and healthy choice. Both he and my psychiatrist spent a lot of time going back and forth, weighing the risk vs. benefit of staying on meds or going without, and although they disagreed on a few minute points, they ultimately decided staying on medication would be healthiest for me, and ultimately, baby.

Also be sure to find a pediatrician to consult. You’ll need one anyway after the baby is born, so you might as well find one who knows about medications, postpartum mood disorders, AND does depression screenings at well visits. (Our pediatrician does and it has been incredibly helpful to me this past year.)

Finally, ensure that the team you build has your mental health as their top priority. As soon as a woman becomes pregnant, the focus tends to immediately shift toward the health of the baby and stay there. In the past, I’ve dealt with OB’s who only cared about how I was doing physically and what impact any physical conditions I had would have on my baby in utero. Not once did they focus on my mental well-being, let alone have it guide my prenatal care. Listen: I completely agree that baby’s health is a priority. I do. But I’m going to just come right out with it and say that a mother’s mental health is what’s most important and should be the foundation of her prenatal care, and if no one on your team shares in that philosophy? They shouldn’t be on your team or in charge of you and your baby’s care. Period. Same goes for the person treating your mental health condition. My first psychiatrist through the VA was woefully uninformed and unhelpful when I told her I was pregnant. It took a lot of pushing, but I was finally able to have my care transferred to a psychiatrist with a background in pharmacology and reproductive psychiatry, and it made a significant difference in my overall care.

2. Communicate and Advocate

Everyone on your care team should be in constant communication with you and each other through every phase of your pregnancy and delivery. They should also be able to come to an informed consensus (with you) about your treatment. There is nothing worse than having two of your doctors at an impasse over a part of your treatment plan because they just disagree. It’s incredibly frustrating and the last thing you need to be worried about. If this happens, don’t be afraid to speak up and advocate for yourself, reminding them that they are there to help care for you and your baby, and you need them to work together.

Always be open and honest with your care team about what you’re feeling and experiencing throughout your pregnancy, so they know how to help you as soon as possible. Part of my treatment plan involved staying off of my mood stabilizer during my first trimester, but remaining on my anti-depressant. At 11 weeks, I called my OB and told him my mood was starting to take a nosedive and I was worried about a depressive episode. He moved my NT ultrasound scan up to the start of week 12, and as soon as he reviewed the results, gave me the all clear to start back on my mood stabilizer.

3. Do Your Own Research, Knowledge is Power

There are books out there on  medication use during pregnancy and breastfeeding and the variety of treatment options available for women in our situation-get your hands on them and read as much as you can, being sure to talk with your care team about what you learn as you do. When researching my treatment options and discussing them with my team, books I read included Pregnant on Prozac by Dr. Shoshanna Bennet, Medications and Mother’s Milk 2012: A Manual of Lactational Pharmacology by Dr. Thomas Hale, and The Complete Guide To Medications During Pregnancy and Breastfeeding: Everything You Need to Know To Make the Best Choices for You and Your Baby by Carl P. Weiner MD and Kate Rope.  I also read everything I could on the MGH Center for Women’s Mental Health blog, which has a wealth of information on research studies and how to use their findings to make informed treatment decisions with your clinician.

4. Create a Birthplan That Takes Your Mental Health Into Account

Initially, I considered going without pain meds for my delivery. I read all I could about natural child birthing methods, and had it in my mind that I’d hypnobirth my way through labor and delivery, even if  I wound up crying uncle and utilizing some form of pain medication. But at 28 weeks, I landed in L&D with contractions that wouldn’t stop without magnesium. In fact, they didn’t really stop the rest of my pregnancy. I contracted every day of my third trimester without ever dilating more than 2 centimeters. Previous experience reminded me that neither of my labors with my older two progressed without intervention, despite having intense, painful contractions that were off the charts for a week. Looking back, I’m positive this contributed to the panic and anxiety I had during both deliveries and afterward. With this third go around, I was miserable, exhausted, starting to have anxiety attacks, and was starting to cycle between nesting induced hypomania and depression.

At week 38 I told my OB I was done and worried that continuing would put me over the edge and trigger a depressive episode-and I hadn’t done all of this preventative health and wellness work to be in a dark place when my baby boy was placed on my chest. I knew my limits, and wanted a bit more control. I wanted an induction. He agreed, and a week later I was in the delivery room smiling and laughing as I stared lovingly at my newborn-100% anxiety free. It was a calm and beautiful experience and in my opinion, gave me the strong start postpartum I needed.

Whatever your birth plan is, make sure it’s flexible, realistic, and compliments your treatment plan.

5. Have a Support Network

Having the love and support of friends, family, and your partner is so important. Lean on them when you need to, and don’t be afraid to ask them for help. Inform them of ways they can be a support to you. My friends (fellow Warrior Moms) and my husband did an amazing job of supporting me during my pregnancy and this past year. I couldn’t have made it without them to call, text, and share this experience with. A therapist can also be an invaluable resource to you during this time; they can help you process all you’re experiencing and develop coping strategies for managing your postpartum period. Consider finding support online in a private forum for pregnant and new moms with mood disorders (like Postpartum Progress’ Smart Patients Forum or the #PPDChat private group on Facebook), or find what’s available to you locally through organizations like NAMI or DBSA.

6. Self Care

Try to find ways to incorporate rest into your day as much as possible, even if you already have other children. Do not go without sleep. Create manageable to-do lists, and reconstruct your expectations about how much you can get done each day-especially if you’re working. Practice deep breathing exercises, and engage in physical activity that is both safe for you and baby and feels good. Engage in activities that are calming and nourish your soul-even if it’s binge watching your favorite show on Netflix. Keep track of your mood either in a journal, or with a mood tracking app on your phone; this will help you be able to communicate to your care team and support network how you’re doing. (I use iMood Journal) Prenatal massage, mani/pedis…whatever self-care looks like and is for you, be sure you do it and do it as much as possible.

 

I hope this is helpful and gives you a good starting point for creating a plan that works for you. Remember-You have options when it comes to treatment. You can do this. I promise. You got this, mama.