Mommy Shoes – Parenting While Recovering From PPD

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Please welcome Mirjam Rose to Postpartum Progress today, as she shares her experience of parenting while recovering from PPD.

Mirjam is an elementary school teacher and blogger who lives in the Netherlands with her husband and three children. She has battled and survived 3 postpartum depressions. You can find Mirjam at her blog Apples and Roses, where she blogs about her ongoing battle with depression and finding beauty in the simplest of things. Mirjam is a contributor for World Moms Blog and can also be found on Twitter.


Mommy Shoes

It has been nearly two years since I asked for help.

Motherhood and life felt like too much of a burden for me. After years of thinking that the problem was me, it finally dawned on me that there might be something wrong. I started therapy and found out that I had suffered from postpartum depression. Not once but three times. I also found out that the feelings I struggled with in my early teens, were not just regular teen struggles. I found out that it was also depression that I had struggled with.

These past two years have been the most intense years of my life. I have experienced tremendous growth. I have opened new doors and have closed old doors behind me.

People talk about therapy lightly. They think therapy is nothing more than paying someone to listen and to give you advice. Therapy is no such thing. Therapy is facing yourself. Therapy is opening doors and looking into the dark corners of your soul. It is work. Hard work that sometimes leaves you exhausted. Being as courageous as walking into a lion’s den unarmed. Vulnerable. It is raw naked honesty and perseverance. Going down a steep, rocky and sometimes dark road, without knowing when you will reach the end of it. It’s knowing that you can decide to leave that road at any moment, yet not giving in to that thought. Because you want to get well.

For the past two years I have been going down this road. To say it has been a roller coaster ride, is to take a devastating hurricane and to call it a warm summer’s breeze. The hardest part? Being a mother at the same time.

There is no time off. No time to lick my wounds or to take a break. When I come out of therapy, I need to step quickly into my mommy shoes. Some days I come out of therapy feeling empowered. I stand tall and firm and switch roles like a pro. Other days I feel delivered, freed from a burden that has been carried for way too long. Those are the days that my mommy shoes feel like dancing shoes. Then there are days that I am exhausted from the hard work and I feel empty with little left to give. On those days my Mommy shoes are put on reluctantly.

Some days the carefully constructed bandages around my heart are ripped from their place and old wounds are exposed. My heart breaks and scatters into a thousand pieces. An hour passes as I work through the pain.  When the clock strikes reality, I hastily gather the pieces and put them back into place as best I can. I wear my mommy shoes, and though it is I that longs to be nurtured, it is I that gives the loving smile; it is I that spreads my arms in welcome;  I that carries and I that offers warmth and shelter.

On such days my feet struggle to find solid ground underneath my shoes. When my child reaches for me, my grasp is firm. And as I hold her little warm hand softly in mine, the ground underneath my feet gradually feels stable again.

 

This post was first featured on World Moms Blog, March 2014.  Shared with permission.

Photo credit: Mirjam Rose

 

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Not All Situations Are the Same: My Four Stories

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postpartum depression storiesTrigger warning: This post contains some references to miscarriage.

Often, I find myself telling my story of life with and after postpartum depression (and postpartum OCD, and postpartum anxiety, and postpartum PTSD… darned comorbidity). I love to tell my story. I also love to listen to the stories of other people. Over time, I have come to realize that it’s easy to fall into a trap of saying or insinuating that [this] is what worked for me and so you should do what I did; it worked for me and it will work for you.But one of the things I have come to realize is that no two stories are the same. And it’s not just that no two people’s stories are the same, no two stories are the same even for an individual person. Even if there are similarities, there will still be differences. This certainly holds true for treatment options and strategies.

I have had four pregnancies. Three of those ended with live births, one ended in miscarriage. They also all had different mental health situations, outcomes, and treatments. I have one story, in the sense that it is the story of my life, but that one story contains smaller individual stories, and they don’t all follow the same template.

The first story

My first story is that of my oldest child. In April 2009, after a very long and difficult labor, I gave birth to a beautiful little baby girl. Unfortunately, life was not the idyllic fairy tale of storybooks and I found myself suffering a nasty case of postpartum mood and anxiety disorders. I was officially diagnosed with postpartum depression and anxiety, and had missed diagnoses of postpartum OCD, postpartum PTSD, and hypothyroidism. I believe I also had some antenatal depression that went undetected. (I didn’t even know that was a thing until a while down the road). That story involved 2 inpatient hospital stays, 9-ish months of Celexa, Ativan, and Ambien, and seeing a therapist. That was what was necessary and what worked for that story. Ultimately, an overdue diagnosis of hypothyroidism resulted in me starting on Levthyroxine (thyroid medication), which resolved my PPMD about as promptly as you could hope for, almost literally overnight.

The second story

In April 2011, I gave birth again, to another beautiful little baby girl. This time, in consideration of my history, I had started on Zoloft at 38 weeks pregnant as a prophylactic measure, and also had my thyroid levels (TSH and T-4) checked pretty much monthly during the pregnancy and again after giving birth. This second time, there were no problems and life was pretty rosy.

The third story

In September 2012, I gave birth to a very unexpected beautiful baby boy (let’s just say that it’s important to keep in mind that a 99% effectiveness rate for birth control still leaves 1% for whom it is not effective). This time, I had a number of things going on during pregnancy that were extremely stressful, and ended up starting Zoloft at about 35 weeks instead of the planned-for 38 weeks. However, I still didn’t really have major issues afterwards and everything resolved itself fairly quickly without further intervention.

The fourth story

The fourth story is my ongoing one, which I wrote about yesterday. In April 2014, I miscarried the twins I was carrying as a gestational surrogate. It’s been a tough road. The emotional aftermath of pregnancy loss is no joke. I haven’t had a need for medication this time; therapy alone has been very useful in helping me deal with postpartum adjustment and the grief and trauma that 2014 brought me.

Four different stories. Four different treatment plans. Four different outcomes. And that’s all for the same one person: me. If my situations don’t even follow a predictable formula, why would I expect that anyone else would have the exact same situation/needs as me or even the exact same situations for their own individual different situations and stories? I can’t. We can’t.

It is so vital to remember this. My story isn’t yours and your story isn’t mine. Our brains, bodies, and situations are different. It’s okay if and when we react differently to similar circumstances and situations; it’s even to be expected. The danger is when we start to insist that someone should follow our advice and not consider any other method because it worked for us. There is no guaranteed cure or prevention for PPMD (dear GOD do I wish there were). We must all keep this in mind and be gentle in dealing with ourselves and with other people. We must remember that we are all unique individuals with unique brains, situations, needs, and stories. We must love each other and ourselves to remember that not all situations are the same.

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3 Ways We Can Improve Maternal Mental Health Care For Women of Color

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women of color Earlier this week, I shared my growing concern with women of color and their maternal mental health being underserved by professionals and those in the mental health advocacy space. (Note: “Women of color” refers to women who are not considered to be Caucasian: Hispanic/Latina, Black or African-American, Asian/Pacific Islander, Native American, Indian, of biracial heritage, etc) Today, I’d like to offer just a few ways in which I think we can improve our efforts, and make maternal mental health advocacy more inclusive of mothers of color, our experiences, and our needs.

Believe Us

I mentioned in my earlier post that many of the women I’ve spoken with expressed frustration and dismay that they were not taken seriously when they told their doctor, social worker, pastor, or a mental health professional that they were struggling. Their symptoms were minimized, their concerns and lack of awareness about what they were experiencing dismissed, and some even stated they were degraded by the professionals they reached out to. That’s unacceptable, and does more harm to women already suffering. One mother, who is African-American, described her experience to me as this:

“When I FINALLY went to a therapist, after my second child, I was dealing with PPD then. We began talking about my life (two kids under 3, stressful full time job, lack of support from significant other), and her response was to ask me if I was on birth control so I wouldn’t have any more kids.”

Her experience mirrors my own. After the birth of my second child, I knew something was wrong but couldn’t identify what. I was depressed and anxious and my moods were out of control. When I mentioned it to my OB at 8 weeks postpartum, he said I just needed more sleep. When I told him how out of control I felt, he wrote me a prescription for an anti-depressant, said I should discontinue it in a few weeks once I was feeling better, and told me to follow up with my primary care doctor. The medicine didn’t work. I was still a wreck. I went to my primary care doctor and she just told me that again, I was just tired. When I finally realized what I was experiencing was PPD and anxiety (thanks to Postpartum Progress’ Plain Mama English Guides), I called the NJ state PPD hotline. It took two days for a call back, and I was told that because I was on Medicaid, I’d have to see a social worker who was also a therapist from the state’s mental health program. At that appointment, I unloaded everything to him: my swinging moods, rage, intrusive thoughts, depression, fear. He asked me questions about my “living situation” and his next words I remember to this day:

“Well, you know, I mean what you’re experiencing isn’t postpartum depression or anxiety. You’re just experiencing the stress of being an unwed mother to two children who’s in a rocky relationship. Women like you…in your type of situation…in your culture, experience it, you know? Of course you’re stressed. You’re young, with an infant and toddler, going to school and working full-time…there are plenty of other Black women like you who face these kinds of daily challenges, you know what I mean? You just have to shoulder it and keep going the best you can. I think you’re going to be alright once you figure out how to manage it all.” 

Despite taking down my family and personal history where I detailed several things that placed me at risk for PPD (family history of mental illness, personal history of depression and anxiety, single, unexpected pregnancy, early childhood trauma, minimal support from family and friends), this therapist ignored all of it and said what I was experiencing was expected because of my cultural experience. This (White) man was not helpful nor was he culturally competent and a good match for my particular needs. I struggled to find adequate help for two more months.

Tell Us, Talk to Us, Become Culturally Competent

During my first and second pregnancies, I wasn’t screened for PPD or told anything about it, despite being at risk for developing it.  I didn’t even know PPD was A Thing. Other mothers of color have told me they’ve had similar experiences:

“I wish my doctor had told me anything. I had no information whatsoever.”

“When I had my daughter I was 20 and unwed (but my boyfriend was present). I got lectured from a social worker about my elevated risk for shaken baby syndrome. But no one asked about my mental health, either at discharge or at my follow up appointments.”

” I was upfront about my bipolar disorder with staff at the birth center. In the office, they even said, “You know you’re at increased risk for postpartum depression, right?” Then after the birth, the midwife attending just went about her business doing paperwork and asked me to sign to accept financial responsibility. Another midwife came in to check on me and asked me how I was feeling in front of family and friends. I was NOT about to say that I was having intrusive thoughts (I didn’t even know what to call it then). A lady who wasn’t a midwife (I think she was in billing) called to ask how I was doing. I broke down in tears on the phone. She called me weekly for several weeks. She gave me more care and concern postpartum than any of the midwives did.”

“She (my doctor) mentioned it, I just wish maybe she talked about it more in depth with me- signs/symptoms, etc.”

We need those in charge of our pregnancy and postpartum care to do a better job of informing us about what the signs and symptoms of postpartum mood disorders are. We need to be made aware of how they can manifest in our lives, and what places us at particular risk for occurrence. Providers need to become more culturally competent on how issues such as racial and gender discrimination, racial profiling and harassment, the high rate of domestic violence in our communities, our high rates for chronic illness, violence, poverty, and other sociopolitical aspects of our lives impact our mental health. Treatment plans then need to stem from an understanding that takes all of these factors into consideration.

Advocate for Better Access, Better Quality of Care, More Awareness

Reports have shown that there are disparities in mental health treatment, quality of care, and access to services when it comes to minority mental health, especially for women of color. Aside from cultural stigma, barriers to treatment include lack of insurance coverage post pregnancy, the costs of mental health services, and very little community resources in neighborhoods with significant minority populations. Educational literature and books on maternal mental health are hardly written with our experiences and needs in mind. Research on women of color and maternal mental health does exist but it is not extensive. Many awareness campaigns lack a multi-cultural focus, despite pregnant mothers of color facing significant and unique physical and mental health risks .

How can we do better? I’d like to see more literature featuring women of color distributed in doctors offices and where social services are located. It would alleviate a huge burden if mental health offices had childcare so we could safely leave our children in the care of others while we are seeing a therapist. We should create more spaces for mothers of color to gather and discuss their struggles and experiences with each other to gain support. More mental health professionals should offer reduced rates or at least accept Medicaid. There should be collaboration between cultural institutions our neighborhoods trust and national mental health organizations to raise awareness and eradicate cultural stigma on an ongoing basis. I’d like to see the expansion of Medicaid so more mothers can have comprehensive and longer coverage that enables them to access mental health services.

I think while some strides have been made, we still have much further to go to help women like myself. I’d like to see a more concentrated effort made in advocating for better care, easier access, and more awareness that empowers mothers of color. Doing so will help us give our families and ourselves the strong starts we deserve.

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Suffering in Silence With Intrusive Thoughts: What I Couldn’t Say

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african american, intrusive thoughts, postpartum depression, postpartum anxiety, treatmentToday I’m bringing you a story from my (beautiful) friend Arnebya (pronounced Arnebya). She is a DC-based writer and editor (by day). A three-time BlogHer Voice of the Year, Arnebya’s work has appeared on multiple lifestyle and parenting blogs. She was also a member of the 2013 Listen to Your Mother DC cast. Most recently, she was published in the HerStories anthology “My Other Ex: Women’s True Stories of Leaving and Losing Friends”. She blogs at arnebya.com. You can find her on Twitter and Facebook. She can be persuaded to do illegal things if you pay her in steamed Brussels sprouts. She is one of the wittiest women I know and I’m honored she’s bravely chosen to share her very serious experience with you. Also, I’m putting a trigger warning here for detailed descriptions of the intrusive thoughts she experienced. Please read with care.

The reel in my head flashes. Flashes of thoughts, ideas, memories flit through my mind in snatches of scenes. I see breakfast. Flash. My mind is a View Master but I don’t know who’s in control of the little orange switch. I wish whoever is making the picture change so quickly would depress the lever slowly, more softly. That damn boing slap noise is starting to irritate me.

Flash. Me. Dancing.

Flash. Lunch.

Flash. The baby, so sweet. Me. Hanging. It would be such a relief, hanging. It would hurt, though, that’s why it’s a no-go. Wait, no, it’s a no-go because I don’t necessarily want to die. I just kind of – ok, wait, yes, I do want to die BUT I’m fine; it’ll pass. It’s time to feed the baby.

************

It is 2001, January. At the baby’s two month checkup, the pediatrician asks questions about how the infant with the weird name is faring. How many wet diapers? Is her stool runny? Are you exclusively nursing still? Oh, this baby is thriving. She’s a joy, so easy, except when she’s crying and I don’t know what she wants and I wish she’d just stop it already because I am so tired and he’s playing chess online again like he doesn’t hear her and…FLASH. I see the baby in a casket. Poor baby. Who did that to you?

 Flash. Come back. Pay attention.

And you? How are you, Mom? Fill out this form for us, OK, and let us know how you’re doing.

The form reads: I feel sad sometimes, all the time, never. I feel anxious sometimes, all the time, never. Uh huh. Lie. Lie about these questions because if they knew about the flashes they would take this baby and your man would hook up with that busty woman from the club. Take the middle child. Give them back sometimes because that seems normal. Is it normal? It wouldn’t be on the paper if it wasn’t normal to feel this way sometimes, right? I wish I could ask. I can’t.

**************

It’s 2003. The second baby is two months old. The same pediatrician asks questions about the infant, nursing, wet diapers. Fill out this form. I lie. Again. At home, my mind races. The baby is in the microwave or the dryer or the tub filling slowly with warm water that I’ve neglected to add bubbles to. I never see myself doing these things, never see myself as the culprit, the one who hurts the babies. I just see the babies . . . there. In perilous positions. I don’t tell anyone. I’d hoped it wouldn’t happen this time.

In the middle of the night with my first infant, I cried. I couldn’t sleep. The baby would die if I slept. Either I would hurt the baby and the baby would die, or the baby would die peacefully while I selfishly slept and didn’t know. Elaborate scenes of investigations and tiny, white funeral gowns, flooded my mind. I knew what songs would be played at my daughter’s funeral because I made the program in my mind.

When my second daughter was a few months old, I refused to leave the house for a week. My hair wasn’t right. Nothing fit. I needed a shower. I couldn’t find my shoes. Leave the house? With a toddler and an infant? On purpose? I would agree, then bail, standing in the kitchen at the sink, crying, holding onto the counter, whirling around, away from my husband’s inquiring (I saw accusing) eyes. Another day, I’d say. And then I’d sit in the bathroom with sweaty palms and itchy underarms and shake my head to clear it of the scenes that wouldn’t stop on the reel: an accident, mangled bodies, an airborne baby. Best to stay at home. Something bad will befall us if we leave. Maybe I should kill us all, beat fate to the gate.

I’d hoped it wouldn’t happen again.

************

It’s 2009. The third baby is nestled in my arms, still breathing after a frightening birth. The same pediatrician smiles, says, “This’ll be quick; you’re old pros.” Flash. Throw the baby. Run. Convince them it’s for the best. I look up at her, glance at my husband, smile.

Not again, I think.

************

I never did tell the truth about the intrusive thoughts I was having. I suffered quietly, afraid that my children would be taken because I was off in the head; afraid that speaking my fears of hurting the children or myself would only make the desire stronger. Even as I knew the facts, even as I knew the statistics, even as I knew the doctors only wanted to help, that my husband was trying his best to understand and help, I never once got close to actually admitting how I truly felt, what the flashes felt like.

I both love and respect our pediatrician. Even that wasn’t enough to beat the stigma associated with asking for help with postpartum depression. And I knew what was going on, every time. And still I remained quiet. I’m five years postpartum from my youngest now. The flashes still happen, sometimes. I got medication once, but it was just last year which is funny because I was much less embarrassed when it wasn’t associated with post pregnancy depression. This is something we have to change, socially, personally, medically.

While there may be similarities in each woman’s postpartum depression experience, none are identical. My struggles with undiagnosed and untreated postpartum depression are my own, my story. If you are suffering, tell someone. If I were to get pregnant again, I would immediately tell my doctor about my difficulties after each child. It is unfortunate that it took three postpartum experiences to know that this is what’s best, it doesn’t have to. There is no shame in what happens to our brains chemically after birth, and there is no shame in seeking help.

You deserve it. Your baby deserves it.

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