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postpartum

Guest Posts, No Bullshit Motherhood, postpartum depression

Postpartum: An Inventory

April 27, 2018
inventory

By Laura Dorwart

I have taken the postpartum depression inventory a total of five times: one time honestly, the other four times lying to varying degrees. (I had good intentions, I promise).

Louis-Victor Marce is often described as the first clinician to write openly about postpartum depression and other mental health conditions. His 1858 “Treatise on Insanity in Pregnant, Postpartum, and Lactating Women” has been widely cited as the “first” depiction of pregnancy-related mood disorders and anxiety before his monograph went largely untouched for 100 years (except, sometimes, to justify the involuntary confinement of recently pregnant women), prior to the reopening of a dialogue about postpartum depression in the 1950s when the field of psychiatry took hold in the United States. His wasn’t, of course, the actual first documented mention of postpartum mental health issues—a female physician, Trotula of Salerno, wrote in the 11th century that if the womb was too moist, the brain could become filled with water and cause women to cry involuntarily and excessively, perhaps referring to conditions leading to an excess of amniotic fluid—but it was the first extensive one in Western, conventionally documented, male-dominated medical history.

He seems like he was kind of a dick, but that appears to have been a requirement for early psychiatrists and psychoanalysts, especially 19th– and early 20th-century ones (many far worse than the most obvious Sigmund “Literally Everyone Wants to Fuck Me So Badly It Makes Them Neurotic” Freud). Besides, the fact that his writings about fairly inarguable realities—“hey, so, women undergo huge hormonal shifts during and after pregnancy and also quite possibly the most physically painful and exhausting experience possible right before their entire lives change permanently and maybe that can be traumatic?”—were used as excuses to get all Yellow Wallpaper on a host of middle-class women and to institutionalize lower-class ones can’t be blamed solely on him, really.

Regardless, Marce started the clinical dialogue that eventually led to the development of the Edinburgh Postnatal Depression Scale, now used as the primary diagnostic tool in determining whether a woman has or is at risk of developing postpartum depression.

The test, which alternately starts with one of two fairly sinister statements (either “as you are pregnant or have recently had a baby, we would like to know how you are feeling” or “postpartum depression is the most common complication of childbearing”), requires you to respond as to whether a series of ten statements apply to you in the past seven days (always bolded) with one of five answers. The answers seem awkward and vague if you analyze them too carefully—“not as much as usual,” “about as much as before,” and such—but the test has been proven to be clinically significant for years. Women considered “at risk” of developing postpartum depression are given the screening regularly throughout pregnancy and usually twice postpartum, once after delivery and again after four weeks, when the risk of developing postpartum depression or psychosis lowers significantly. I am “at risk.”

I have been able to laugh and see the funny side of things.

The day I went into labor, my husband Jason and I were in Whole Foods desperately buying castor oil; one of the midwives at UC San Diego had suggested it to induce labor naturally. She had a voice like a meditation track and disarmingly perfect cheekbones, so I was lulled into a false sense of trust before I saw the warning label on the castor oil—“not to be consumed.” A beleaguered Whole Foods employee told us frankly, “No, it’s safe to eat, you’ll just have the runs really bad.” “Sure you want to do this?” Jason frowned at the bottle. I wasn’t, but I was big as a house. Jason is a quadriplegic; his service dog had started to have to help both of us pick up our underwear because nobody in our household could bend over properly. I was ready.

Luckily, we didn’t need it. We went home and I promptly started contractions that sped up to every four minutes. Jason read children’s books aloud to me, part of his job description as my personal anxiety coach. My water broke, a pop and a hiss, right around midnight, while he was reading to me about Rosalie the fairy helping Jack Frost get a makeover that seemed at the time to be gesturing at gender-affirming surgery. He wanted long hair and he needed fairies to give it to him, but they wouldn’t, presumably because of fairy codes that I think represented health insurance issues.

Jason stuffed towels under me in the front seat and a heavy overnight pad into my underwear. I started shaking and I didn’t stop for the next 30 hours.

In triage, they announced I’d need an IV. I was GBS-positive, which meant I could pass infection-causing bacteria along to my baby (a girl, presumably eight pounds according to the latest ultrasounds) if I didn’t get several doses of antibiotics. The first nurse was impossibly blonde-pretty, like a contestant on The Bachelor. I didn’t trust her; she lacked grit. I like my nurses slightly mean. She jammed around inside my veins for a while while making soft little “hmm” sounds for a while, usually right around my contractions. I tried to have polite contractions, smiling shakily at her whenever she made one of those high-pitched “hmms.” I have heard those before. that meant “I am never, ever getting this IV into you and I will have to call someone else.”

She did. And that one had to call another. “Your veins are tiny,” they said, one after another, always scoldingly as if I’d made them myself. When my arms failed, they tried one of my hands. “Is this what junkies go through?” I joked weakly (and problematically) through a contraction. No one laughed.

All told, I was not getting an IV put in for nearly four hours; near the end, during one particularly painful (and still unsuccessful) poke, I finally let out a scream that brought all the midwives on call in to look at me pityingly. When the three nurses finally left, muttering about calling anesthesiology, Jason (who had been squeezing my non-abused hand the whole time) decided to entertain me with an ironic sexist joke about how if the anesthesiologist was male, he could finally get something done around here. I laughed wryly and told him I hated him.

The anesthesiologist showed up four hours into my labor. He was, indeed, male. “You have great veins,” he said, sliding the needle in with aplomb, the slight slice tingly-pleasant like acupuncture. Jason and I looked at each other and grinned sideways. A punchline.

I have felt sad or miserable.

“This is Laura Dorwart, 28. She is six days postpartum and had a vaginal full term delivery of her first baby. She has a medical history of depression and chronic PTSD,” the nurse read, monotone, to her replacement, as my parents watched. My mother’s eyes flew open and her lips pursed in disapproval, I thought—or maybe it was all in my head. The nurse didn’t notice. I laid back in my gown and closed my eyes, feigning exhaustion.

Three days after our daughter was born, with Jason asleep on the table, I tried to make myself hate her, or to become so obsessed with her that she could transform into an object of sadism, masochism, something. I hadn’t felt any guilt when others picked her up or any resentment when she was handed back to me. I didn’t feel like a worthless mother. I looked into her eyes and snuggled her baby-skin. I weighed the burden of her. It was baby-sized. Not the weight of the world.

I began to realize on the fourth day postpartum that I was perhaps hoping for a crisis. Catastrophes wipe things away, don’t they? They start things new, they erase what was. They break and then you’re forced to rebuild.

Plus, I figured with my prior reactions to the mundane, a real catastrophe could do me some good. Some guy breaking up with me when I was 17 caused me to seriously consider dropping out of school. I seriously considered leaving town rather than going into work late once. I had five lemon vodka shots and threw up in a cab after a frat party in college and slept on the tile floor of my dorm room in despair. I still obsess over my breakup five years ago from a girl I knew for a total of eight months; in my mind, it’s sometimes reached Tristan and Isolde levels of tragedy.

Then there are the real crises: The day after I was raped by my then-girlfriend, I went in to work on time and copy edited a fifty-page curriculum booklet. I went to lunch and a meeting. I had chicken wings. I did not cry.

The night that my best friend died, I played a game on the computer that required me to digitally bob for apples. I felt like a sociopath for experiencing satisfaction at hearing the crisp sound bytes of capturing the pixelated apples one by one. Crisis, I remembered, does nothing for me.

Still, I tried to create one. I stared at my baby and attempted to muster some kind of resentment, some kind of foreboding warning sign of synapses misfiring in my brain and causing me to detach. No dice; sometimes I felt an overwhelming love, sometimes the lighter affection I feel for all babies, and on the negative end, nothing but mild annoyance in my most sleep deprived states.

I had wondered, alternatively, if I would feel grief and loss. Some women describe feeling empty after their babies are born, their wombs like voids aching for the return of togetherness, their tiny soulmates now skin-separate. Not me. I felt intact. I was intact. Heavy as I always ways, just thirty pounds lighter. Filled to the brim with the same longing as before, no different. It’s been four weeks. There was no crisis, no catastrophe. I did not break.

I can’t say I’m not disappointed.

The thought of harming myself has occurred to me.

Never check yes on this one.

Never let them see you sweat.

I have been so unhappy that I have had trouble sleeping.

I checked my medical records after all was said and done. For me, nothing I didn’t already know: For Ruth, her medical conditions: a CPAM—congenital pulmonary airway malformation—that we’d known about since the beginning. A benign cyst hiding in her lung. Meconium. And: “Child of depressed mother.” Born of a sad woman: A preexisting condition. A diagnosis in and of itself.

It stuns me, hits me hard in the chest, a clenched fist like a heart attack—just a slower squeeze. I show Jason, and he doesn’t get it, not really. “What are they afraid of?” he asks, though he knows. Postpartum depression makes everybody angry, even Tom Cruise, who took up quality potential Scientology-pushing time to rant about Brooke Shields’ baby blues.

Some people baptize their babies. I’m an atheist on my best days (on my worst, I assume God is a menace), but it turns out, even nonbelievers want to cleanse their offspring of original sin: Our new pediatrician asks us to forward our hospital medical records, and I opt out. She’s going to be nothing like me, no stains on her record, no sorrow-as-birthright. She’s going to be free.

Laura Dorwart is a Ph.D. candidate at UCSD with an MFA in creative nonfiction from Antioch University. Her work has appeared in Catapult, McSweeney’s, The New York Times, VICE, BuzzFeed Reader, Lady/Liberty/Lit, The Eunoia Review, Blanket Sea Magazine, and others. 

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Child Birth, Guest Posts

Postpartum Bleeding and Power Chords

June 25, 2017

By Bess Vanrenen

It was a Friday, six days after the birth of my first child, Marcel, and I was bleeding. Almost every nurse, doctor, and aid who had come into my hospital room told me that while postpartum bleeding was normal, I should tell them if I filled a pad in under an hour or passed a clot larger than an egg. After Marcel and I were discharged from the hospital, I kept a running list in my head of symptoms I should look out for in him and in me. We had already dealt with weight gain issues in him and had bought formula to supplement my breast milk, and six days later, I thought we were beyond the intensity of the postpartum period. Then I started bleeding. The kind of bleeding they tell you about. Though I hadn’t filled a pad in under an hour, it was a heavy flow. Pacing our tightly woven living room rug, I called the advice line at Kaiser, and the nurse who answered the phone ran the all-too-familiar questions by me. No, I hadn’t filled a pad in under an hour and no, I hadn’t passed a clot larger than an egg. So far, my situation was within the normal range.

An hour or two later, I sat on the toilet changing my pad yet again when I felt something substantial slip out of me. Fear coursed through my body, and I jumped up from the toilet. I knew what it was—a blood clot significantly larger than an egg—but I had to be sure. I could only manage a quick peek in the toilet. There, I saw what looked like a baseball-sized clot—impossibly large, red, and viscous. I called out to Jared, my husband, “We have to go to the emergency room. Now.” Continue Reading…

depression, Guest Posts, Pregnancy

Not Waving, But Drowning: Pregnancy & Depression

February 25, 2016
depression

By Anonymous

As I idly looked at the prescription bottle of sertraline, I realized that one of the light blue warning boxes on the label read: Third trimester use can cause health problems. Discuss with your doctor or pharmacist. My third trimester started yesterday.

Since adolescence, depression has been a presence in my life. When I say depression, I’m talking about the kind that is clinically significant enough to warrant a low dose of antidepressants, but never interfered with my life to ruin a job or school. When I am overwhelmed with responsibilities or work, I take on more. And fulfill all of my obligations. Well, I might add. But when I got the news about my fertility last January, I went off my antidepressant, thinking I would get my body as “healthy” as possible for conception.

I made the decision to become a single mother by choice after getting the news that my ovarian reserve was very, very low. This pregnancy was planned meticulously. I had always wanted to be a mother, fiercely and desperately.

Things went well, until I started progesterone for the second half of my cycle every month for a luteal phase defect. The progesterone caused dark moods, irritability, and depression. Then Clomid gave me mood swings. When I got pregnant, I had to take an even higher dose of progesterone, twice a day, for the first 13 weeks, in order to improve my chances of keeping the pregnancy. That, along with the stress of not knowing how my family would respond, caused me agonizing, crippling anxiety and depression. Constant nausea and bone-crushing fatigue beginning at 6 weeks only added to my depression.

Arriving at my 20 week ultrasound and OB appointment by myself, the tech exclaimed, “All alone?” I said yes, and climbed up on the table. I was more interested in the actual fetal anatomy than any cute pictures – which, to be honest, I didn’t fawn over, nor did I think were cute. In the waiting room, another patient was there, along with her husband, her parents, his parents, and various brothers and sisters, poring over their ultrasound pictures. My pictures were folded up in my bag, and all I wanted to do was go home and sleep.

Continue Reading…

Guest Posts, healing, motherhood

The Rocky Path To Grace.

January 22, 2014

                                                       By Lindsey Mead 
I have so few memories of the first weeks after Grace’s birth. It’s fascinating the way the mind recovers and copes, isn’t it? My memory has smoothed over those weeks of tears and panic like the airbrush facility in photoshop: the pain is still there, I can’t forget it, but its pointy, prickly granularity is sanded down to a more general, uniform memory. So I strive to remember specific moments, but I mostly can describe the overall experience. In my letter to my friend, I referred to the crucible of bewilderment, fear, and wonder known as postpartum depression, and I still think that’s a pretty good summary.

What do I remember about those first days and weeks?  I remember a blur of tears, darkness, crying, and most of all a visceral, frantic sense that I had made the biggest mistake of my life. This fear was powerful enough to almost topple me: the panic that I had ruined my life was layered with the guilt for having those feelings in the first place in an incredibly toxic cocktail. I remember walking one raw, early-November afternoon, Grace strapped to my chest in the baby Bjorn, my hand almost freezing off as I held a phone to my ear (one of very few phone calls in those days) and cried to a poor, unsuspecting friend who was expecting a joyful new mother. I remember sitting in the rocking chair in my kitchen, a week-old Grace asleep on my knees, wondering numbly why it was that my doula (there for her postpartum visit) was looking at me so oddly, why she kept urging me to call my midwives, why she took Matt into the other room and whispered something to him.

It all came crashing down at my 2 week midwife check-up. I am still horrified that most women have to wait until 6 weeks for their own appointments after giving birth, and am intensely grateful that my midwifery practice mandated this 2 week appointment. I sat across from the midwife, Grace asleep in her bucket carseat, and dissolved into tears. I remember crying with those all-encompassing sobs that make you feel like you are drowning. I could barely breathe. I was not allowed to leave until the end of the day, at which point I left with prescriptions and therapist appointment cards clutched in my hands and a dawning sense that I was truly not okay.

I have heard many funny stories of how control-fanatic women like myself struggled to adapt to motherhood. I always laugh, but the truth is that my reality was different. I crashed off the cliff of depression so quickly and so utterly that I was not even trying for control (for the first time in my life?). I didn’t even care, which was for me much scarier. I just sat there and cried. I think the fact of my surprise pregnancy contained within it the seeds of my PPD: I had never been in control of this, not from the very beginning. I, who have been able to muscle my way through basically any challenge (mostly because I was good at only selecting those challenges that I could conquer), was completely undone by this 7 pound, 12 ounce baby, and it devastated me.

My body fell apart as rapidly as did my mind: within 2 weeks I was 10 pounds thinner than I had been pre-pregnancy. I did not sleep, I did not eat, I did not smile. I looked like a cadaver, with deep circles under eyes that would not stop crying. I would not talk to anyone; the phone rang and rang and I refused to pick it up. Now I see I was recoiling into the deepest recesses of my body and spirit, trying to physically hide, to pretend somehow that this was not happening.

I tried reasoning with myself. I had had the unmedicated delivery I wanted so desperately, despite it being long and arduous. How could I have survived that experience, whose pain was fresh and blinding, and not be able to bear this? I had delivered a daughter, the gender of child that I’d never even allowed myself to admit how much I wanted. How could I not be grateful? In the face of such a thick, inarticulate fog of despair, whose power felt primal, logic absolutely failed. I could not see past the storm clouds either in my heart or on the horizon (and there were many there, too: an economy in collapse and a terminally-ill father-in-law awaiting a heart transplant).

I admit that for all of my pretense at open-mindedness, I had always thought that people who took anti-depressant medication were simply not trying hard enough. That arrogance disappeared overnight when I swallowed my first zoloft. Grace’s arrival was my hint – and, frankly, it was more like a sharp slap to the face, since I seemed to have trouble hearing the hints – that trying hard was not always going to be enough.

My recovery was gradual. If I plunged off a cliff in a near-vertical line when Grace was born, I climbed out on an angle just north of horizontal. I got significant help. I saw more than one therapist, frequently. I took medication. I can’t remember a specific day that I looked at my daughter and felt the swell of pleasure, of joy, of love that I had expected when she was born. It did happen, though I hate that I can’t note a specific day that those feelings arrived, and I love her fiercely now.

The truth is that I expected motherhood to be simple. I had been told that it would be instinctive, that I would look at my baby and realize I’d always been waiting for her. I didn’t. While I’ve spent my life working for specific achievements, I think I thought that this one thing, being a mother, was my birthright. It wasn’t. I am dogged by a profound guilt about those early days. I ask myself all the time what kind of damage my ambivalence did to her and to our bond. My passage to parenthood was marked by a deep grief that is integrally woven into my identity as a mother.

I delivered Grace myself, pulling her onto my chest with my own two hands. From that moment I began a long and difficult passage to the grace of motherhood. It did not come easily to me. I’ll never know if this has made me a more confident mother, for knowing the treacherous shoals I traversed, or a more insecure one, for the lingering knowledge that I did not embrace my child immediately. I try to tell myself it doesn’t matter now.

 headshot
Lindsey Mead is a mother and writer who lives outside of Boston with her husband and two children.  Her writing has been published and anthologized in a variety of print and online sources, including the Huffington Post, Literary Mama, Torn: True Stories of Kids, Career, and the Conflict of Modern Motherhood, the Princeton Alumni Weekly, and Brain, Child.  She blogs regularly at A Design So Vast and loves connecting with people on twitter and facebook.
Jennifer Pastiloff is the founder of The Manifest-Station. She will be leading a Manifestation Retreat in Costa Rica at the end of March and her annual retreat to Tuscany is in July 2014. All retreats are a combo of yoga/writing and for ALL levels. Read this post to understand what a Manifestation retreat is. Check out her site jenniferpastiloff.com for all retreat listings and workshops to attend one in a city near you. Jen and bestselling author Emily Rapp will be leading another writing retreat to Vermont in October.
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