Bed Rest and Depression

Bed Rest and Depression -postpartumprogress.com

Last month the American Congress of Obstetricians and Gynecologists (ACOG) released a list of “Five More Things Physicians and Patients Should Question” when it comes to OBGYN procedures. It’s an addition to their Choose Wisely campaign which started with “Five Things Physicians and Patients Should Question.” In all, there are now ten recommendations ACOG makes for physicians and patients to question.

Four of the ten recommendations specifically address pregnant women, and one of them caught my eye for a number of reasons. Julia West at Mothering addressed it as such:

This research shows many side-effects of bed rest during pregnancy including: “muscle atrophy, bone loss, maternal weight loss and decreased infant birthweight in singleton gestations, and psychosocial problems including depression, anxiety, stress, family disruption and financial burden.” ACOG states plainly that “information to date does not show an improvement in birth outcome with the use of bed rest or activity restriction.”

I just wish you could have seen the look on my face as I read that paragraph the first time. And the second. And the third. And then when I clicked over to read the research. Jaw-dropping doesn’t begin to describe it.

I’m not your typical pregnant patient. I have chronic unilateral hydronephrosis; the ureter out of my right kidney isn’t big enough and a growing uterus pinches it off, causing a host of problems. I experienced two surgeries during my first pregnancy as they tried to insert a stent which they eventually removed because it only made things worse.

They placed me on Level III bed rest at 18 weeks gestation. Financial burden? Anxiety? Stress? Depression? Oh yeah. I ended up placing my baby for adoption because I couldn’t see past the crisis mode that I was in at the time. You can also tick off “maternal weight loss,” too. I gained a total of 19 pounds. I wasn’t proud of it; I looked sick because I was sick.

I was also alone for almost all of that time. I spent hours in my apartment, staring at the ceiling of my bedroom, or when I dared, the ceiling in the living room. The isolation only exacerbated the depression and anxiety. It was a dark, scary, and very lonely time.

I expected, with better health care and a planned pregnancy, my subsequent pregnancies wouldn’t be quite so isolating and debilitating. I was wrong, of course. Level III bed rest came later on than it did during my first pregnancy—28 and 32 weeks—but I still found myself stuck on the couch or in bed. Living in a new state with no real friends yet, I didn’t really have any visitors other than my beloved mother-in-law. My husband worked 24 hour shifts, leaving me alone with our toddler during my third pregnancy. Parenting from the couch isn’t easy, let me tell you.

Was I depressed during these episodes of bed rest? You betcha, though I worked hard at hiding it. These were pregnancies I was supposed to be happy about; these were the babies the adoption agency told me I would someday have, when I was “ready” for “my own” children. I plastered a smile on my face and made jokes about how losing 11 pounds during pregnancy meant that my figure would bounce back so much more quickly. (Of note, it did not.)

I also stressed about the financial burden my bed rest placed on our growing family. While my husband’s job as a firefighter provided well for us, I felt an overwhelming need to provide something since I couldn’t during my first pregnancy.

My anxiety continued to sky-rocket. While I was actively seeing a therapist when I got pregnant with our second son, I couldn’t visit her once placed on bed rest, and from that point on, things were kind of touch and go when it came to intrusive thoughts, fear, depression, and panic attacks.

Part of me understands that I was a special case, that bed rest kept the constant contractions from turning into progressive contractions and pre-term labor. I was lucky and carried all three babies to 38 weeks. But this new news out of ACOG makes me wonder if they would have done something differently with my case(s) over a decade ago. If I had been allowed to keep working with my daughter, would I have parented? If I had been able to continue attending therapy during the final trimester of my pregnancy with our youngest, would my relapse of postpartum depression and anxiety have been caught sooner?

I don’t know. But I do hope these new recommendations will help expectant moms avoid unnecessary stays in bed and that it helps them avoid antenatal and, perhaps, postpartum depression and anxiety. Placing moms in isolating situations doesn’t seem conducive to positive mental health.

Were you on bed rest? How did it affect your mental health?

National Adoption Month: Addressing Depression During Pregnancy

National Adoption Month: Addressing Depression During Pregnancy

To say I felt depressed during my first pregnancy is an understatement. To say that my depression went untreated is also an understatement. However, considering I presented a number of risk factors for depression during pregnancy, the fact that my depression was basically ignored by those around me feels a bit like a failure of services.

As for risk factors, I could have been a poster child for Depression During Pregnancy.

  • A personal history of depression or another mental illness – Check!
  • A family history of depression or another mental illness – Check!
  • A lack of support from family and friends – Check!
  • Anxiety or negative feelings about the pregnancy – Check!
  • Problems with a previous pregnancy or birth – This was my first pregnancy, so no check!
  • Marriage or money problems – No marriage, no money: double check!
  • Stressful life events – Check!
  • Young age – Check!
  • Substance abuse – No check!

Six out of eight, and add in a side of extreme pregnancy complications due to my own health, and well, it’s easy to see that I was at least at risk for antenatal depression. Yet, not one doctor or nurse ever asked me, “Are you feeling okay? Do you need to talk to someone?” The woman parading as a counselor for the adoption facilitator I began talking to never once asked, “Would you like to talk to some other mothers who also had these same fears during their pregnancies?” No one in my family sat me down and said, “Listen, Jenna. I think you’re depressed and I think it’s affecting your decision making skills regarding this pregnancy.”

Because it did.

After surgery to place a stent in my kidney at 18 weeks, my doctor placed me on Level III bed rest. I had to quit my job as I could only get out of bed to shower. I began to panic not only about my financial situation but about my perceived inabilities as a mother.

I chastised myself all day long in my bed or on the couch watching movies on VHS tapes sent by an online friend as I couldn’t afford cable. “What kind of mother cries when she finds out she’s pregnant? A bad one, that’s the kind. You can’t do this. Look at you: You can’t even do pregnancy right. You’re biologically horrible at pregnancy, so why wouldn’t you be biologically horrible at motherhood? You’re going to fail this baby. You’re going to be a failure as a mother.” The voices in my head taunted me all day long.

So I listened.

I contacted the first adoption facilitator I found in the back of a magazine. I filled out their medical history forms to the best of my knowledge, including that I had previously been on antidepressants. Still, not one person I had contact with at their office ever asked, “Have you considered that your beliefs about your lack of ability to be a mother are signs of depression?” Instead, they preyed on my anxiety, my depressed state, my lack of support, my financial problems, and my age to help me paint a negative self-portrait—one who couldn’t be a mother.

Years later, when I found myself in therapy for postpartum depression after the birth of my second child, a son, I felt anger. I felt angry not only for the young mother who slipped through the cracks, but at myself for not being able to see; not being able to see through the anxiety or depression, not being able to see through the lies and half-truths, not being able to see my child as my own. I held on to that personal anger, the anger directed at myself, for years, much longer than I held on to the anger directed at the adoption facilitator. After all, as so many willing to dismiss birth mothers and their grief say, I “signed those papers, so it’s my decision, my fault.”

It wasn’t until sometime in the past year that I’ve been able to see that young mother with a sense of compassion. I didn’t know what I didn’t know. If you ask any person who suffered from depression, they will tell you that a period of time existed during which they simply didn’t know they were depressed. I simply thought I couldn’t be a good mother, that these thoughts were proof that I lacked maternal instinct, that maybe I’d never be the motherly type.

I’ve cried many tears for the young mother that I was in the process of healing, and yes, forgiving myself. I’m still working on the forgiving part, but I now fully understand how and why I ended up on the path of adoption and eventually relinquishing my child. I firmly believe if we offered mothers considering adoption access to legitimate mental health care resources, we’d see an improvement in the numbers of mothers who both choose to parent and, should they choose to place, feel as though it was an informed decision, not coerced by people seeking to gain from their loss.

However, while we’ve made great strides in acknowledging and providing resources for mothers and families fighting postpartum depression, ethical reform in adoption remains a slow-moving process. If we admit that mothers who are single, who maybe don’t feel worthy of being a mother are worthy of being mothers, then for-profit newborn adoption begins to make less sense. And there’s the rub.

For now, I take comfort in knowing I’m not alone, in offering hope and support to other scared mothers, and in continuing the work of forgiving myself. Maybe someday I’ll get there.

When Postpartum Depression Makes You a Stranger to Yourself

for p p dSeeing someone struggling through postpartum depression and anxiety cracks my heart wide open. I don’t care if I’m a stranger to them or not, I want to take their hands into mine and tell them to trust me.

I want them to believe me when I tell them I have been where they are, in that frightening place when you’re filled more with fear and pain than strength. When you look in the mirror and don’t recognize the person looking back.

I want them to listen when I say that I have lived in the skin they are in now, when you are not who you used to be.

I have walked through those days, those hard days, when you’re too frightened to look anyone in the eye because you don’t want them to see straight through to the dark despair and hopelessness that fill your head.

I have been there. The days of pulling clothes out of the closet and letting them fall over my body, wondering where the person is who used to wear them. I remember sitting in the driver’s seat of my car and it didn’t feel like it belonged to the person who now sat there.

These days are anything but easy. Living through postpartum depression is harder than we can ever explain. We struggle to give words to the choking jumble of our thoughts. We want to be heard, but when someone asks us to tell them how they can help, we can only break down in tears.

Postpartum depression is a wall that hides our strength from us. It won’t let light in so we are unable to see how tough we are. The dark clouds of this time block the real view, the one that would show our determination to get better.

We are still there, behind the empty sadness in our eyes, there is the fight and fire we need to recover. We are imperfect in this life, we are lost, confused and we are more scared than we have ever been. When our lives become survival for one moment at a time, our souls can’t rest to see the beautiful spirit of survival that lives within us.

I want those in the heartbreaking midst of postpartum depression to trust me, as hard as it is. We need to believe that inside we have what we need to make it through. It’s a leap of faith, a desperate grab at hope, but it’s necessary.

I want them to hear this message of hope, so that they fight, so that they keep fighting. Because it is the promise of hope that someone asked me to believe in during my own postpartum depression, that saved me.

You will see this through to the other side.
You’re not alone.
You will find yourself again.

Someone once promised me that I would be myself again. I was too scared to believe that who I once was, was still there. What if I wasn’t going to get better? What I would have told the frightened new mom that I was back then, would be this, You may feel like you’re in a thousand irretrievable pieces right now–too broken beyond anything that can be made whole again. But believe that you will heal.

You will find happiness again. The numbness will lift one day and you will hear yourself laugh. The sound of it will surprise you so much that you’ll laugh a second time from the joy of it. You will look in the mirror one morning, and this time the eyes you see back will dance and shine. And you will come back stronger than you ever thought you could be.

You are still there, inside.

Even if now you feel lost, scared and alone, you are there.

Please let my words here be the ones that take you by the hand and hold you until you are back home again. Reach out, ask for help, don’t stop until you feel you are getting the care you need. Believe that with time, professional care and treatment, and the support of your PPD community, that the help you need to find the way back to you again will be there.

The incredible you that you used to be is still there. You will find yourself again. And just as I did, you will smile again.

Antenatal depression and antenatal anxiety: Jen’s story

antidepressants pregnancyI struggled with undiagnosed antenatal depression and antenatal anxiety.  I felt like such a fraud.  My husband and I had planned for this baby.  I should have been overjoyed and glowing.  Instead I walked around in a fog of self-hatred, irritability, and unrelenting worry.  My internal monologue consisted of, “I should be happy, dammit!” Why couldn’t I enjoy this pregnancy?  It was my final pregnancy, and we were giving our nearly three-year old daughter a sibling.  Where was my pregnancy glow?  Why did I feel like all I did was complain, vent and whine?

Why couldn’t  I relax?  I felt so much pressure to get my oldest potty trained before the new baby arrived.  I felt like all loose ends needed to be tied up.  I had to finish my toddler’s baby book before the new baby arrived.  I had to make sure I was exercising daily.  I had to maintain a tight control on my blood sugar.  I had gestational diabetes with my first pregnancy, so I spent my final pregnancy watching my food intake.  Every time I heard a comment about “eating for two”, I wanted to rage.  I did not have that luxury of eating whatever I wanted.  The meal plan made me miserable.  If my numbers weren’t within the expected range, I immediately panicked.  I was terrified that my daughter would struggle with complications from my gestational diabetes.  Not even the ultrasound showing a healthy twenty week baby girl diminished those fears.  I felt like I had no right to complain or worry.  I knew what to expect.  I needed to just suck it up and deal with it.

Like postpartum depression, antenatal depression looks different for each mama.  My lovely friend Susan describes her antenatal depression like this.  “I just remember feeling a crushing weight and numbness. I wanted to not be pregnant anymore and had thoughts of throwing myself down the stairs. That’s what sent me to a perinatal psychiatrist. All my joy left like I was in a vacuum – and I was suddenly convinced a new baby was the end of everything as I knew it.”

My experience of antenatal depression differed from Susan’s.  My depression manifested itself in extreme irritability, bordering on rage.  I had no patience for anything – traffic, my husband, my daughter, my parents and my sister, my friends, and my co-workers. One of the triggers for my rage was my daughter’s refusal to take naps on the weekends.  I could barely control my reaction.  I would yell and scream at my husband.  I would need to leave the house to give myself an adult timeout.  I still cringe when I remember an epic tantrum that occurred during my seventh month of pregnancy.  I was at a concert at an outdoor venue.  I cut in front of everyone waiting in line for the bathroom and for water, simply because I was pregnant.  I was rude to everyone that day. I took out my rage on anyone in my path.  This irritability and rage manifested itself in full-blown postpartum depression and postpartum anxiety after my youngest was born.  I wish I had recognized these signs sooner.  I could have treated this during my pregnancy when my initial struggle began.

Antenatal depression and antenatal anxiety are not as widely known as the other perinatal mood disorders.  We do moms a disservice when we fail to screen for depression and anxiety during pregnancy.  We need to focus on both the needs of the mother and the needs of the baby.  Mothers are vulnerable during both pregnancy and the postpartum period.  Ask the pregnant mom how she is doing and really listen.  I read this amazing piece that Andrew Solomon wrote regarding depression in pregnancy.  Thank you Andrew for speaking up for both the mothers and the babies.  If you are feeling fragile, do not read Andrew’s piece.