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.

A Third Pregnancy and a Chance To Heal

[Editor’s Note: Today we have a guest post by Lindsey O. She’s experiencing a third pregnancy filled with anxiety, depression, and PTSD after two previous pregnancies. She’s honest here in a way we don’t get to read from a lot of moms. Hopefully it helps others feel less alone. -Anne-Marie]

A Third Pregnancy and a Chance to Heal -postpartumprogress.com

My first pregnancy I was blissfully unaware of what pregnancy and childbirth were like, and honestly I wish that I could get a bit of that naiveté back. Every bit of those nine months felt new and exciting and fun. I loved learning about everything my body was doing and how my son was growing. My birth was a little scary at the end but with the techniques I learned in my Bradley classes, I was able to achieve my goal of an unmedicated birth.

The second baby was conceived quite by chance shortly before my first son turned a year old. The anxiety kicked in and I felt more isolated from my husband because of the demands of his job and his inability to well, care.

My entire pregnancy I hoped and prayed that the baby would be breech so I had an excuse to not go through an unmedicated vaginal birth again. My husband assured me that I would feel disappointed in myself and the experience if I “wussed out” and agreed reluctantly to help me re-study our Bradley book. Every time we sat down to go over it, I would have a rush of fear and start to cry or get angry and decide I was done for the evening. I just didn’t want to think about what the process was going to do to me again.

At some point in the last ten weeks of that pregnancy, I decided to be “tough” and “suck it up,” telling myself that having unmedicated births were the greatest gifts I could give my children on their birth days. Also I had decided this was our last baby, so I just had to do it this one last time.

The labor went quicker. I was strong and determined and confident. I kept my wits the whole time (well transition was the usual craziness, but I held out) and experienced another unmedicated birth. This time, a nine pound, one ounce screamer. And then the room fell silent.

I was holding my baby and didn’t notice much but wasn’t allowed to sit up, and then all I really remember was a lot of fundal massage and cramping and code words. Honestly, I felt like crap and couldn’t walk and was incredibly dizzy. Later that day a nurse informed me that I had hemorrhaged and they were about to give me a transfusion but I stabilized.

The OB who delivered my baby said something about me being past the point of blood loss that “we worry about losing the mother.” They then told me that the severe cramping was because I had been given Pitocin through my hep lok. They kept me an extra night for in hospital care for GBS+ reasons which I disagreed about and then guilted me into a heel stick for my baby because he was “big” and they wanted to check for diabetes.

Where was my husband for ALL of this? You tell me. I was ALONE. However, I knew that at least I would never, ever have to go through this again.

Fast forward exactly three years later and we are stunned by the conception of another baby who will be here in less than 13 weeks. I was in a funk for two weeks, and it took me three months to get back to reality and my responsibilities with my business and mothering.

Here I am, now, in some ways getting my mojo back and in others an absolute mess. I try to do what I can when I can in different aspects of my life to maintain order, but there is a lurking emotional monster somewhere near me at all times.

I have broken down now in two midwife appointments and cry whenever I think about having to do that again. I have been diagnosed with PTSD and clearly I have anxiety and depression which I have never experienced in my lifetime. I fear that I may die next time, that I may bleed out, tear horribly as I did with the first two, or just have something dangerous or scary happen. It takes up a good deal of space in my daily life. So what do I do about this?

I have answers from everyone and suggestions and loving advice but all I can think about is this: I am not telling anyone what I really want. What I really want is control. I want to have a birth I am happy about not because I “did it for the baby” or did it to make my husband proud or did it because I felt I had to after being given a sense of control from a child birth program. I want to feel I had my best outcome in a birth because I got what I needed to have closure. (I will be getting some form of permanent birth control after this baby, as will my husband.)

I NEVER in a million years thought I would say this, but I am seriously considering a c-section. Do I care if anyone judges me in this? Honestly, I did until the anxiety took over my life. I don’t want to let the anxiety in any more than I have. I see this as a chance to heal, and I don’t think I would have been forced to deal with all of the bottled up stress from my first two births if this third baby hadn’t come along.

I want to heal from this and I want to feel like I can close this chapter in my life and let it all go. I also want to make my body a safe place for this child while she is still there and right now, I know it is not. I can’t go on hoping to have the decision made for me and suffer like this all the way to the end and then come up with some last minute decision about how I will birth.

I’m still working this out in my head and will have a discussion with my midwife at the next appointment so I definitely don’t have concrete plans for anything yet, but I feel better knowing that I am finally taking full ownership of this and not allowing myself to feel pressured in any direction.

If I could say anything to anyone who utters one word to a pregnant or postpartum mom, I would urge them to take consideration for the mother and her well-being and not spend so much energy on the baby. Let her shower, rest, do the chores for her, hold the baby for her while she eats dinner, and let her cry to you if she hurts.

But most of all tell her it’s okay and it’s normal to feel whatever she does or doesn’t feel. Let her be in charge and own the entire experience and not feel like she has to put on a brave face for you. I wish I had been more vulnerable after those first two pregnancies so that I could be more open for this one.

When PPD Makes It Hard to Bond with Your Baby

Baby's Birth DayIn the delivery room back in 2005, I remember that blissful hour after our son was born when the doctors and nurses left the room to allow my husband and me to bond with our newborn baby boy. I was exhausted, but not in pain, thanks to my epidural. We’d wanted him so much, waited for him for so long, and now he was here. I’d already loved him before he was born, and I loved him even more now that I could see him as a tiny human being. We couldn’t stop touching his little face, his hands, his little baby toes…it was amazing.

A few weeks later, I knew I still loved my son. I was his mother, and he was my child. But I was really grasping at that feeling of overwhelming bliss that I’d felt when he was first born. My love felt more dutiful than anything else. I would have done anything to protect him, but there was a disconnect between my head and my heart. Everything told me I was supposed to be so happy and excited to spend all my time with my new baby – movies, books, even TV commercials were filled with happy new moms who were so in love with their babies. And I could see that in the faces of the other new moms from my Lamaze class that one time we met for lunch with our infant carriers in tow.

I just wasn’t feeling it.

And I was tortured because of it. I wasn’t sleeping. Breastfeeding hadn’t worked out, and no matter how much fenugreek I consumed or how often I tried, I wasn’t pumping enough milk. I cried all the time. On top of that, I had the shame and guilt on my conscience that I didn’t love my son enough, not the way a mother is supposed to love her son. I would pray for him to just fall asleep – he had colic – and dread those piercing cries that meant he was awake again. The constant cycle of feeding, bathing, diapering, and trying to soothe him back to sleep felt like a chore. It wasn’t supposed to be like this.

Maybe it would have been different if someone had caught on that I had postpartum depression, PPD, if I had been diagnosed while it was happening instead of after the fact. Medication would have helped; I know this, because I’ve been on antidepressants now since 2008, and I am more of a functional human being than I was before. But more than that, knowing that I wasn’t the only mother in the world having these feelings, that I shouldn’t blame myself for the nasty tricks my brain was pulling on me – that would have changed everything.

I’m happy to report that, once I freed myself from trying to force breastmilk when my body clearly wasn’t going to produce it, once the colic phase was over, those loving feelings from the first day he was born rushed back. I was still depressed – no question about that – but the constant state of “crisis” that marked his first few months of life were gone, and I had more physical and mental energy available to me. And with that, I was able to start enjoying my relationship with my baby.

If you’re struggling with feeling like you don’t love your baby “enough,” or if it feels impossible to form that connection or bond with your baby, try not to blame yourself. Remember that “depression lies.” It lies to you and tells you you’re not good enough. It makes you feel ashamed and guilty of not living up to some imaginary standard of how things should be. If you haven’t already talked to a medical professional about how you’re feeling, I strongly encourage you to do so. (And don’t be ashamed about taking medication or going to therapy! They work for so many people!) More than that, know that you’re not alone, that countless other moms have been right where you are now – and we’ve come out the other side. You can find that connection with your baby , even if it takes a little longer than you thought it should. How do I know this? Because you’re concerned enough that you looked for and found this post, that you do care about your relationship with your baby and want to improve it. And because, nine years later, I have a great relationship with my son, who tells me every day that he loves me. You can get there. You just need the support to get you through this hard time – and you’re not alone.