So You Think I Shouldn’t Have Had Children

I’m an optimist.  Optimistic about situations but mostly about people.  I believe people are good.  I believe we are are more alike than different.  And I believe in the power of communication and connection.

So when I saw this tweet from Anderson Cooper’s @andersonlive two weeks ago, I hoped for the best.

The tweet was intended to foster controversy, but surely the general public doesn’t believe that moms are taking medications because it is “trendy.”  My twitter tribe took to their computers and responded in force.

And then just when I was beginning to think that people would understand that mothers are treating their illnesses, I made the mistake of visiting the comments on the Anderson Live FaceBook page.

The PPD Blogger community responded in force there, too, with thousands of words about stigma, motherhood, and mental health.  And there *were* comments that reasonably placed the responsibility to determine who genuinely needs medication on the shoulders of the medical community.  But I was shocked at the large percentage of folks who believe that people suffering from mental illness just shouldn’t have children.

These folks believe that mental illness is a character flaw and possibly a death sentence – they believe that because I take medication for anxiety, I shouldn’t have had children.  Because I am an optimist, I choose to think they are just uneducated, products of a culture awash in stigma and misinformation.  I hope that with exposure to education and to individuals who thrive (yes, even as parents) despite their diagnosis of “mentally ill,” they might change their minds.

But if not – if they still believe that the mentally ill shouldn’t procreate because of a perceived burden on unborn children and society in general, let me ask this:

If an ideal life is the criteria on which a person’s right to reproduce is to be based, who among us would ever have children?

Would these same dissenters tell a paraplegic to refrain from starting a family because of the difficulties the children may encounter being raised by a parent with some special needs?  Should my diabetic friend and advocate Melissa have not had children because her disease puts her at risk of disorienting low blood sugars?  What about a parent suffering from a genetic disorder that may be passed onto their child?  

I am just like any other person treating a medical condition. Make no mistake.  Though they are invisible, my anxiety, PPD, and PPOCD are (or were) medical conditions.   20% of the US population suffers from mental illness, with the average age for onset of symptoms being 30.  That’s one in five.  Your neighbors.  Your sisters and brothers.  Your friends.  And quite possibly your parents.

If you are a mother with a mood or anxiety disorder, I want you to hear that those trolls above?  They are wrong.  I know you.  I know how hard you work to keep yourself healthy and happy.  I know that despite your mood swings, you are a loving parent who lights up your child’s life.  And though you may need the assistance of medication and therapy to combat your anxiety, you bring to their world your talents, your strengths, and there is no better parent for them.

Don’t let the ignorance of a few Facebook comments cloak you in shame.  We are all flawed.  It’s what makes us beautiful and real.  As people and as parents.

Breastfeeding on Psychotropic Medication

Nearly four months ago, I wrote about meeting my goal of breastfeeding for six months.  Now, No2 is almost 10 months old and we’re still going strong.  In fact, we’ve moved past the awkward “I can’t be bothered to nurse when there are sights to see and sounds to hear and kitty ears to grab” and No2 actually wants to relax and nurse.  It’s a sure-fire cure for the 5pm cranks and is a lovely way to wake up in the morning.  She’s even mastered nursing discreetly in the ergo carrier, which has made getting No1 to ballet class and preschool field trips a bit less intimidating.  I’m truly enjoying it.

It’s not without its costs, though.  If I have even one cookie baked with any milk products, she cries all night with stomach cramps.  So I’ve been completely dairy-free for 6 months now.  She’s still nursing twice at night, I think mostly just for comfort.  While I’d love to sleep for more than 5 hours at a time, it’s actually working for us (or maybe it’s just so much better than it was that the bar is absurdly low).  And then there’s the impact on my mental illness.

Many medications are compatible with breastfeeding, but unfortunately the mood stabilizer I was on before getting pregnant with No2 is not one of them.  It was a great med for me – low side effects, extremely effective at a low/medium dose, and I really felt like myself.  It managed the anxiety and the PMDD and eliminated the roller coaster of hormone-induced emotions.  When I discovered I was pregnant, I (with my doctors) made the choice to switch to a medication that was safer and better-researched during pregnancy: an SSRI combined with an as-needed anti-anxiety medication.  I truly believe these medications have helped me to have a different postpartum experience with this baby, and contributed to my healing birth experience.  Still, I am not 100% myself.  The medication handles about 80% of the PPOCD and anxiety symptoms, and I (along with my husband) am left to cope with the remaining struggle.  It’s not ideal and it is a decision that weighs heavily on me as I continue to nurse.

The bottom line is that I’ve chosen to stay on this medication regimen to facilitate breastfeeding.  Here’s why:

1. Though I am not symptom-free, I am not experiencing the red-flag symptoms (rage, inability to sleep, intrusive thoughts) that would send me back to my doctors for re-evaluation.  I feel like myself.

2. I have no hard evidence that the mood stabilizer would be the magic bullet this time.  My situation, stresses, and life are so different now than they were before getting pregnant with No2.  At that time, I was sleeping 10 hours straight each night, working out 4 times a week, and had only one child, and was working only 3 hours a week. Given the same factors now, the SSRI may work just as well.

3. Breastfeeding contributes to my happiness and is a time of meditation and relaxation for me.  This wasn’t always true.  I fought tooth and nail to get to this point, but now that I’ve made it, I don’t want to give it up.  I also believe that breastfeeding is the best option for my daughter, who suffers from a milk-soy protein intolerance.  And while she would absolutely be fine on formula, I’m thrilled she’s getting all the health benefits of being breastfed.

4. Changing medications is a long and sometimes difficult process.  Weaning from my current SSRI and tapering up to an therapeutic dose of the mood stabilizer  would mean weeks of side effects and emotional symptoms.  I’m mostly stable these days and not exactly excited to sign up for that little adventure.

I’m not advocating that everyone limit their medications in order to breastfeed.  I did not nurse my first past a few months.  There were some medical reasons, but honestly, when I stopped nursing her, I felt a huge sense of relief.  Breastfeeding was an intense trigger for my PPA with No1 and I am still so glad I decided to formula-feed her.  It was the best decision for both of us.

While I wish everyone could enjoy the benefits of nursing, it’s a personal decision that each mom (with her doctors and family) must make for herself.  Hell, sometimes it’s not even a decision – may mothers cannot breastfeed.  Instead of adding to the “you must breastfeed to be a good mom” lies, I simply want to tell my story in the hopes that it will help new mothers understand all their options.  Because you do have options, and no matter what you choose, your physical and mental well-being need to factor in.

More information on breastfeeding, PPD, and medications can be found below.  And as always, this blog is a memoir of sorts and is not intended to replace the advice of your doctor.

Dr. Hale’s Keynote Address to LLL in 2002 on treating PPD in breastfeeding mothers

Katherine Stone writes about why expectations to breastfeed can weigh PPD sufferers down

Mass General’s Center for Women’s Mental Health on Breastfeeding and Medications

PPD and Marriage

Marriage is hard.  Marriage with children is challenging. Marriage with PPD is formidable.

Think back to your dating years.  Now imagine you arrange a date with a guy who has everything.  He’s handsome, smart, funny, caring.  He loves cats and doing dishes.  He washes his hands after using the restroom.  He compulsively buys presents – can’t help himself.  He picks you up, you drive to a restaurant on the beach, and find the perfect table for watching the sunset.  And then a loud man drags a chair over to your table and plops down in-between you and your date.  He blows cigarette smoke in your face as he introduces himself as Horace.  He talks over you and your date all evening, spitting chunks of food as he complains about every possible detail.  When you get up to use the restroom, he takes it as an insult and spends the rest of the evening sulking.  You finally ask your date who this man is and he tells you that Horace goes everywhere with him – they are rarely apart.  At times during dinner, your date seems to waver between being annoyed with Horace’s antics, trying to shut him up, and egging him on.  One thing is for sure. . . if you see your date again, you’re going to be spending time with Horace, too.

Would you go on a second date?  I mean, you really like this guy.  But Horace?  Who has time for him?  He makes spending time with your man nearly impossible and even seems to change who he is entirely at times.

Sometimes I think that’s how my husband feels.  I KNOW he loves me.  I know he believes in me – in us – and the life we are creating together.  But he’s fed up with Velma*.  I used to take his frustration with my anxiety personally and felt like he was angry with me.  In my defensive state, I would argue about how hard I was trying and tell him he wasn’t being supportive enough. But I’ve come to understand that he’s entitled to be angry. . . I’m angry.  I hate having an anxiety disorder and on my worst days, I want to whine and scream  like a child about it.

My husband just wants the partner he married.  He wants me – just me – with no Velma standing at my side, whispering that I’m not good enough and tricking me into starting an argument over something silly.  He wants to have fun with the woman he fell in love with over ten years ago.  He wants me to be happy.

It’s relatively easy for me to say this and take responsibility for giving his feelings respect because he is the definition of support. He takes the kids on weekend  mornings so I can catch up on sleep.  He is standing behind my decision to postpone the mood stabilizer so I can continue to nurse the baby.  He gently reminds me to take my medication if I’m feeling overwhelmed, and he adjusts plans to meet my needs.  We are a team this time.

His anger?  Isn’t AT me.  It’s FOR me.  For us.  And thought it may hurt some days, I have to afford his feelings the same respect he gives mine, and support him as he processes them.  After all, marriage is hard enough already with two kids.  We don’t need Velma’s lies about his frustration to make it any more difficult.

*Velma is the nickname the online PPD community has give to depression and anxiety.  We frequently tag our tweets about PPD with #velmasucks or #velmaisabitch or (my favorite) #velmaisalyingho. It’s a way to signal that we’re struggling and that we know that our mental illness is a separate entity from ourselves.

Giving Up Control

My mom is ever the boy scout.  Prepared for anything and everything.

Yesterday while we were out shopping she picked up a microwavable syrup bottle.  Apparently my dad fails to read warnings and almost melts Mrs. Butterworth on a weekly basis.  When we got back to her home I noticed that she had saved the packaging.  She explained that it had a 5-year warranty, and should any of the seals leak, she wanted to have the paperwork handy.  After stapling the receipt to the warranty, she filed them together.  I don’t know about you, but I figure when I spend $5 on a syrup bottle that I’m accepting a risk.  If it should break after 5 years of dutiful syrup-warming, then at least I got my money’s worth.  If it falls apart after three days, I call it a $5 lesson.  But not my mom.   I told you.  She’s prepared for everything.

I truly admire her organization and preparation, and I have to say that it’s come in handy on more than one occasion. When I have forgotten my toothbrush on a weekend at the lake, she always has an extra.  She has sterile strips for paper cuts in her bathroom cabinet that I have used more than once.  Need a foldable luggage carrier?  Boom.  Apple corer? It’s yours.  Forget about your gynecologist appointment and need someone to watch the kids?  She kept the day free just in case.

She was a stay-at-home-mom and cared for me and my two brothers in much the same way back then.  She is an amazing mom, and the best grandma a kid could hope for.

But.

I’m beginning to think all those years of being prepared for absolutely everything played a part in the development of  my OCD – specifically my need for control.  Deep down when things go wrong, I find myself sure that I could have prevented them if I just had just planned better.  And thus I tend to anticipate anything that might go wrong and overcompensate by over-planning.

It’s as if I’m waiting for the house to spontaneously combust for no reason.  But instead of the typical safety precautions like smoke alarms and fire extinguishers, I’ve summoned the fire department and sit patiently aiming a fire hose at the roof just in case.  It’s difficult to relax when you’re holding a fire hose.  For one thing, it’s heavy.  And its exhausting trying to maintain control over its pressurized contents.

I want to be clear.  I do not blame my upbringing for my mental health issues.  But I do think it’s helpful to look at contributing factors like societal conditioning, personality, birth order, and life and childhood experiences when I’m trying to work though my anxiety.  If I can find fault in an idea I always accepted to be true based on my past, than I just might have a chance at letting it go.

Giving up control of the world around me means giving up responsibility.   It’s liberating to give myself permission to simply respond to difficult situations instead of feeling the need to prevent them.  I don’t always succeed at this venture, but when I do, I feel my anxiety melt away.

I’m truly grateful to my mom for teaching me responsibility.  But in the spirit of self-care and mental health, I’m going to try to be a little less careful from now on.  But only a little.

 

PPD, the Second Time Around

“Every pregnancy is different,” you hear over and over while waiting for your second baby to arrive.  And mine were like night and day.

My first pregnancy was punctuated by moments of overwhelming anxiety.  I wondered if my husband would leave me; if he really wanted to have a child.  I obsessed about every little detail of the nursery.  I went to the hospital at 34 weeks having shortness of breath and heart palpitations.  And my delivery was a terrifying combination of panic attack, induction with pitocin at 37 weeks, and a baby who had to spend 12 hours in intensive care and then receive antibiotic injections for days after delivery.

It took me 6 months to recognize and seek treatment for postpartum depression and anxiety, but both gripped me from the second day in the hospital.

My second pregnancy, I was prepared for the anxiety.  So when I felt myself spiraling out of control and wishing I hadn’t gotten pregnant, I ran to the doctor and started a medication regimen.  And though I had difficult days, for the most part, I enjoyed my pregnancy.  I felt relaxed and confident.  So I rubbed my belly, decorated a nursery, and wished and wished to be free from PPD the second time around.

The first two weeks were blissful.  No2’s birth was healing.  The first four months or so I was so glad that I continued on my antidepressant and anti-anxiety medications.  They were working.  I stopped waiting for the other shoe to drop, so to speak.

And then five months in, the wheels came off.

This time, it’s not depression.  I don’t feel hopeless, or worthless, or empty.  I vibrate with nervous energy.  I feel the need to control everything.  When the baby eats, when the baby sleeps, what color diaper she’s wearing, what tv show the preschooler watches, what my husband does when he’s got the kids to himself, and on and on.  Any variation on my plan results in tension and rage.  The intrusive thoughts are agonizing.  Now that she’s 7 months old and *still* not sleeping more than 4 hours at a time, the sleep deprivation has made all of this all the more overwhelming.

I’m adjusting my medication doses, supplementing with an additional “as needed” med.  My husband and I are teaming up to find ways for me to avoid sleep deprivation.  And I’m visiting my doctors.  A lot.

It’s been bad, but this time?  I haven’t once lost a sense of who I am.  I’ve had to fight for my sanity.  But I’ve been present enough to fight.  This time I feel bonded to my new baby.  I love my girls.

So if you’re expecting another child after a postpartum mood disorder, I want you to know that it’s possible you won’t have to suffer again.  But if you do, you will be alright.  Just like every pregnancy, every experience with PPD is different.  And just like with the second baby, you aren’t  a rookie anymore.  And at the very least, now you have online communities like #ppdchat, Mama’s Comfort Camp, and Postpartum Progress to help you navigate your journey to health and happiness.

You will be whole again.

Anything

I used to have to do everything perfectly.

So I learned how to do everything well enough.

Then I learned how to do just some things.

These days, I’d take anything.

I’m really struggling with how little gets accomplished around here these days.  All of a sudden, my anxiety  is back with unwelcome company… postpartum OCD.

I want to take apart the kitchen cabinet that houses the bottles and reorganize everything – daily.  Each bottle has a corresponding-colored top and it’s driving me literally nuts that they aren’t matched up, but I’m consciously avoiding fixing them.

The bottles work fine mismatched.  Breathe.

A load of laundry is overwhelming – all that washing and drying and folding.

It’s just laundry.  Take your time.

And deep down, I feel like if I could just get the house spotless, I would be a better mom.

Your kids will never remember the messy house.  It is clean enough.

I obsess over how much No2 nurses.  It never seems like enough.

She will nurse when she is hungry.  She’s growing like a weed and obviously eats just what she needs.

But the worst part is the intrusive thoughts.  The thoughts make me feel unworthy, insecure, tense.  I feel so angry at nothing…everything.

You cannot always choose your thoughts and feelings but you can choose not to believe the story they tell you.

I know I will be better.  I know that this is acute, treatable, and temporary.  And I know that these thoughts and obsessions aren’t me.  But it hurts.  And it’s hard to battle every day.

The anxiety and OCD whisper, “Don’t tell anyone –  they’ll think you’re a bad mom.  Look how great everything is – they’ll never understand.”

Mental illness clouds rational thinking.  Tell someone.  Scream it from the rooftops.  You are not alone.

I will not let shame bury me.