Circuit Overload

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typewriter with blank paperThis is a guest post by Sharline Chiang, a writer based in Berkeley, originally from New Jersey. She is a proud, long-time member of VONA, an amazing community of writers of color.

When my daughter was born I had no idea that I’d go from ecstatic to fighting thoughts of trying to kill her, and myself.

I was high on Anza’s birth for exactly one week. I birthed her squatting, just like I wanted to. She was slippery and pink. I remember sitting there in my own pool of shit, blood, and mucous, shouting over and over again: “Oh my god, you’re so beautiful!” My husband, Ben, was so excited he could barely cut the cord.

She had curly reddish brown hair like his (he’s half Jewish) and twinkly dark eyes like mine (I’m Chinese). We named her Anza after Lake Anza where we had our first date. It also means “beginning” in Swahili, which seemed so right because we had three miscarriages before her. She was our miracle baby.

The first few nights I rode on pure adrenaline, basking in the joy of her little piggy lips sucking on my tits and the sweet taste of milk on my fingertips. But by the end of the first week I couldn’t relax, kept imagining that she was dead, that she had suffocated in her sleep. Because of the miscarriages, while I was pregnant with her I had prepared myself mentally for her to not make it to term. Even as the doctor caught her, I had steeled myself for the monitors to flatline and for the doctor to say: “I’m sorry; it’s a stillborn.”

I would watch her sleep in her crib, worrying that at any second she would die.

Sharline-Chiang

Over the next three weeks sleep deprivation started to destroy me. I shuffled through the days and nights of nonstop nursing, burping, and changing, attempting and failing to nap and feed myself. My nipples, two spots of shooting pain, felt like someone had scrubbed them with steel wool. My crotch burned with raw tears and stitches. I had hemorrhoids the size of plums. Every time the baby cried and fussed, I wanted to scream. Even with help from my husband and mother-in-law, I was more exhausted than I’d ever been. Every morning I prayed that ten p.m. would come so I could get that three-hour window of sleep before I had to do it all over again. I cursed all my friends who are parents. No one told me it would be this hard. They duped me into joining their club of misery. I hated nursing, I hated pumping. I started to hate the sound of the baby’s voice. I started to hate the baby.

I felt tethered to the rocking chair, a used red Dutalier I found on Craigslist, where I nursed Anza for hours. There was a mirror facing the chair. Each day I stared at myself in my dirty robe, my hair greasy and flat. I hadn’t showered in weeks. I smelled like rotting meat. I’ve made a terrible mistake, I thought. All these years, I thought this was what I wanted. I’ll never get a full night of sleep again. I want my life back.

I told my husband, “I’m so tired it hurts.”

“Of course you’re tired,” he said with a smile. “You’re a new mom.”

tree-in-water

By the second month I started to shake all the time. I was freezing even though it was September and we were having a heat wave. My clothes were always soaked with sweat and milk. I stopped being able to sleep and prayed for the wired feeling to go away. I would lie awake and think: I have to go back to work in a month. How the hell am I going to do that? I’m going tolose my job. We’ll lose our health insurance. I’m going to end up in a hospital and we’ll go bankrupt.

My mother-in-law went back to Canada so we were all alone.

I told Ben that I felt like I was dying. “What do you mean?” he would ask. But I couldn’t explain, couldn’t find a way to tell him I felt like I was going crazy and that I was so tired I felt I would die from exhaustion. I didn’t think for a second that I had PPD because I wasn’t depressed. I never cried. I just felt like I was going into shock. None of my friends who were mothers had ever mentioned that they had been so tired they felt like dialing 911. Everyone else seemed to handle being new moms with such grace. I was sure my unraveling was due to a fundamental character flaw. I was weak. I was spoiled, lazy.

I thought maybe I was experiencing diabetic shock so I got tested. My doctor said everything was fine. My sugar, iron and thyroid were all normal. She gave me Tylenol PM and benedryl to help me sleep. It worked for one night.

curve in the road

Soon I became OCD. At first it was just the bottles. I had to make sure they were boiled. Then I had to boil them twice. Then everything that touched the baby had to be boiled: pacifiers, toys, towels. If anything touched a “dirty” surface, I had to start again. I could barely handle holding the baby because I was sure I’d give her germs that would make her so sick she would end up in the hospital. I couldn’t afford for her to get sick. I thought: if I start sleeping again and then she gets sick that will be the end of me. So I boiled everything and only touched doorknobs with my sleeves.

I stopped being able to dress myself, I was so tired. Ben would help dress and feed me. It was like I was the baby. Most of the time I was too tired to eat. Ben did pretty much everything except nurse the baby: he did all the laundry, the dishes, took out garbage, cooked (well he tried his best), all while running his own business building websites. At night I’d lie in bed sweating feeling my heart race like I was having a heart attack. He would hold me and say, “Just try to relax and sleep. You’re going to be okay.”

By the third month I started seeing a therapist who specialized in postpartum depression. While she was helpful, it didn’t stop what was happening to me. My behavior was increasingly erratic. I felt less and less in control of the “real me” and watched with terror as some other woman, a “crazy” Sharline, took over. I would mutter and talk to myself loudly. People in stores would look at me with concern and step away. I had trouble connecting thoughts when talking to Ben, who was becoming increasingly concerned. I had to fight with all my will strong urges to do inappropriate things: grab some woman’s hair in the store, plunge my hand in a box of used needles at the doctor’s office.

We hired an amazing woman named Sara to help take care of the baby and with much of the housework. My mother-in-law and brother-in-law moved in with us from Canada to take care of me.

lamppost-snow
Ben and I still didn’t realize how seriously sick I was. “Everything’s going to be okay,” he kept saying. Like good Berkeley-ites, we chose to take the natural route. We didn’t trust antidepressants. I was terrified of them, terrified that drugs would take away the last remains of my brain that seemed to be the only threads left preventing me from hurting myself, Anza or someone else. We didn’t trust Big Medicine, white man’s medicine, and we wanted to make sure I could still breastfeed. For weeks, Ben took me to all sorts of natural healers who tried endless remedies on me: acupuncture, Chinese medicine, massage, reiki, B12, spirulina, breathing exercises, meditation, and even crystals and chimes. Many of them helped me relax in the moment, but none stopped the downward spiral, and worst of all – no one diagnosed me.

One day, I rolled around on the sidewalk outside our house. It felt good. I didn’t want to get up for a long time. People just walked around me. (It’s Berkeley after all.) I shouted over and over, “No! How did this happen?” The next day, I had a major panic attack in the car and tried to jump out while Ben was driving. When I was home, I spent a lot of time crying. Now I was depressed. Also around that time I started having nonstop dark thoughts, of how to kill myself, and Anza. I started having urges to stab her, drown her, throw her off the deck, crack her head open, bite her cheeks off. I told Ben and my mother-in-law everything. They assured me that I wouldn’t actually act on my thoughts, and that they would watch me and Anza carefully and keep us both safe. Still, I felt like a monster. I told Ben, “I can’t be alone with the baby. I don’t trust myself anymore.”

We finally decided to try medication, and the bigger, harder decision: we switched to formula (which felt like giving our baby Diet Coke). I felt like the worst mother in the world. A total fucking failure. My OB and family doctor put me on Xanax, Ambien, Klonopin and Zoloft. The drugs helped me sleep a bit and calmed panic attacks but I was still mostly an insomniac wreck.

I called a few friends to let them know what was happening to me. Some of them visited and it helped me immensely, having people to talk to and just give me a hug. They felt sad for me, and helpless. It was so difficult to get anyone to understand when I said I wanted to live but I couldn’t bear to be in my body one more second, that I felt like I was being tortured.

Each night I would get up and search the house for my sleeping pills. (I was only allowed one a night. Ben hid them from me.) I tried to find ways to keep myself busy until morning. With a shaky hand, I wrote thank you cards to people who had sent baby gifts. I tried yoga. I tried meditating. But mostly I would lie on the couch and feel my body tremble and pray to make it through one more night. The OB had asked if I had plans to kill myself, and I remember thinking, as I shook my head no, Yeah, I’ve got plenty of plans: pills, razorblades in the tub, kitchen knives. How can I buy a handgun? Does putting your head in an oven really work? If I slice my wrists, how much will it hurt before I pass out? I fought images of going into Anza’s room and smothering her.

At a friend’s urging, we decided to find a psychiatrist. After calling 20 psychiatrists, we finally found one who would take a new patient and could see me right away. Her name was Dr. Cedars and she asked me a bunch of questions. I paced the room, told her I felt like I was dying or that I wanted to die. She asked me if I had plans to kill myself. I whispered, “Yes.” “What kind of plans do you have?” she asked. I told her.

She immediately called Herrick, the local mental hospital, and asked them to reserve a spot for me. “I highly recommend that you go tonight, but I can’t force you,” she said. (Later, when we got home, Ben convinced me that it was worth trying to get better at home. But I  packed a suitcase just in case.) Then she prescribed Seroquel, an anti-psychotic.

“You mean I’m psychotic?” I said.

“Well, marginally so,” she said.

I was scared shitless about what was happening, and ashamed. I had an Ivy League education, was a director at a national nonprofit – and I was cracking up, headed for the nut house.

I was diagnosed with extreme postpartum depression with anxiety with intrusive images.

Dr. Cedars referred me to Dr. Alexander, a leading expert on PPD. Dr. Alexander doubled my Seroquel and had me continue taking Klonopin and Zoloft, and that’s what did the trick. What I learned was that each person’s brain is different. I got lucky that it didn’t take long to find the cocktail that worked for mine. In a week I began to dramatically stabilize. Ben noticed the difference right away. “Your thoughts are more organized. You seem more calm, more like yourself,” he said. I started sleeping through the night, stopped having bad thoughts.

The truth is science still doesn’t fully understand PPD – why it happens, why it happens to some women and not others, and why it manifests in different ways in different women. Most experts agree that the sudden change in hormones and brain chemistry are partly to blame. The woman’s body and brain is flooded with hormones during pregnancy and the minute a child is born those chemicals plummet. “Your brain didn’t like that,” Dr. Alexander told me. “It’s like a computer that had a circuit overload. We need to do a hard reset.”

In December, I started going to a support group for women with PPD. Some of them were in worse condition than I had been in. One mother had been in and out of Herrick. Another had OCD so bad she accidentally burned her kid with hot water in the bathtub. We talked about our shame, our guilt, and the myth of motherhood.

I was sure that I would get worse from the drugs before I got better, but I didn’t. I didn’t have any bad side effects. I didn’t completely lose my mind though I suspect it’ll always be broken. The therapist who led the support group said that some people believe PPD “cracks women open, in a good way.” I don’t know about that, but I do know that it changed me forever. I still have fears about having survived a major mental health crisis. I’m grateful that I’ve survived, but wonder: will I always be damaged, my brain like a car that’s been rammed once too hard? Will I always be prone to crazy? And if so, what does that mean? Is that who I am?

train tracks

I couldn’t go back to my previous job because I was too sensitive to stress. By the following summer, I had weaned off the Seroquel and Klonopin and stayed on Zoloft for another six months. Right now I’m not taking any medication. I try to manage my stress and anxiety by trying to get enough sleep (still hard since she still wakes up each night), eat well, try to stay active, make time to go out and have fun with friends, write, and meditate when I can. I’m really lucky that Ben has supported my decision to stay at home for now so I can focus on getting better. It has also given me more time to spend with Anza, who is now a spirited, book-obsessed toddler. Sara comes to our house twice a week so I can take walks and write. I am forever grateful to her, and my husband and in-laws, and many good friends for supporting me during my darkest times.

While my PPD was happening, I didn’t tell my parents and to this day they still don’t know. For many reasons, largely cultural (they’re Chinese immigrants), I didn’t want to them to know because I didn’t want them to worry. They’re older and live in New Jersey and they would either have tried to fly out and help or spent sleepless nights of their own feeling helpless. The reason why I still haven’t told them? PPD isn’t discussed enough in any society or culture, and I fear that they might blame me or make me feel like I’m exaggerating about my experience.

Looking back, I wish my doctors and infant care teachers had spent time talking to me and my husband about the serious nature of PPD, how to look for signs and get help. I wish they had told me that PPD is now also called Postpartum Depression Spectrum because it manifests in so many ways, including intense prolonged anxiety, and rage. I also wished people had shown me articles written by survivors, especially women of color like this African American mother, and this Asian American mother.

I hope to keep sharing my story, to be part of a movement to put PPD in our collective face, so we can see the whole picture of motherhood. As women, as a society, we need to talk about these experiences, the dark side of motherhood. We need to take PPD out of the darkness.  I want us to tell each other it’s okay, that there is no such thing as being a perfect or normal mother, that it’s okay to say I’m really fucking tired and I need help, to say I’m sick and I need help, to say there are ways to get better and we don’t need to feel alone, and most of all, we don’t need to feel ashamed.

 

This article originally appeared on Mutha Magazine.

Image credits: Sharline Chiang and Unsplash

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Minority Engagement, Diversity and Inclusion Survey

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postpartum depressionPostpartum Progress is hard at work behind the scenes to improve our support and inclusion of minority and underserved women in our community outreach and engagement. While we often feature stories on the blog from mothers of color and offering Spanish versions of the blog and nonprofit’s website are in the works, we want to go above  our current efforts to develop programs and initiatives that will reach and engage minority women both online and off, all across the country.

However, in order to do that, we first need to know what your experiences have been, and what we can do better to help you. We’ve spent the last month developing a survey that we hope will help us gain some insight into what women of color experience with their mental health during pregnancy and postpartum, levels of awareness & education on postpartum mood disorders, cultural stigma, and barriers to treatment you’ve faced.

It will help us determine what kind of support you desire and how Postpartum Progress can improve on building a community that’s inclusive.

The survey was created by our new intern Denise Carter from Emory University’s Rolllin’s School of Public Health, with input from myself based on my personal experience with PPD and anxiety. Denise is currently getting her Master of Public Health in Behavioral Sciences and Health Education. She also has a Bachelor’s in social work, with minors in non-profit management and African-American studies. She has extensive experience and a passion for helping women of color care for and improve their mental health-we are thrilled to have her helping us!

The survey is 100% confidential and anonymous-your identity will not be tracked. Please feel free to answer honestly and with as much detail as possible. The more we know about your experience with perinatal mood and anxiety disorders, and what kind of support you need, the better we can help be an effective and valuable organization: changing the landscape of maternal healthcare locally and globally. Will you join us in this mission?

You can access the survey here: http://fluidsurveys.com/s/minority-engagement/

Questions, comments? Send them to us: addyeb@icloud.com or denise.carter02@gmail.com

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

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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.

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Navigating Your Perinatal Mood or Anxiety Disorder

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8363033986_503c7a47f3As a mom with bipolar disorder who blogs openly about my experiences surviving a postpartum mood disorder, people often ask my opinion on ways to deal with and manage their diagnosis. I am not a medical professional, so I hesitate to even answer these emails. But my heart tells me I need to address their questions.

Having been in the same shoes not long ago, I remember the desperate desire to connect with others who had gone through something similar. Back then, people weren’t talking as openly about mental illness, the stigma was thick and heavy, and I felt as though I was harboring a shameful secret. It wasn’t until I found Postpartum Progress that I truly felt I had found a group of women who understood.

So I get it when other moms, and sometimes dads, write to me about their story, asking for advice on what to do after receiving a diagnosis. They’re looking for the same connection I found. The same searching that led me to join this community.

Here are my suggestions: [Read more…]

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