We Must Do Better When it Comes to Postpartum Care

I didn’t know what hard work was until I had my first child. I was 30 years old and had never stayed at a job longer than two years, so it shocked me to my core how hard caring for a newborn was. I always hated working and the responsibility that came with it, but this was a million times harder than any job I temporarily held.

I didn’t have much help with my daughter because my husband was dealing with his father’s death just months before Isla was born. I don’t blame him now, because the loss of his father, his best friend, was gut wrenching and tragic. But back then I resented it. My husband also was dealing with serious family turmoil after his dad’s death and that was almost as tragic. My family all lives in Dallas, but my mom would try to come down and help some.

I didn’t get much sleep; I was exhausted all the time. I was breastfeeding, and I think that made everything harder. I breastfed for eight months, which I considered a feat, but I also became severely depressed and believed I couldn’t take any antidepressants while breastfeeding. My psychiatrist told me that. He was dead wrong.

There was nobody to pick up the slack while my husband was at work or at night, which made the depression and anxiety worse. At the time I didn’t have a housekeeper, so household chores fell by the wayside. I wanted to be like my mom friends who seemed to do it all — take care of a newborn, work, clean the house, etc. They all looked like they were handling being a new mom so well; it made me feel like a failure. I felt guilty all the time, too. I didn’t lose the baby weight I had gained, and my self-image went down the toilet.

I was in bad shape, to say the least, but my psychiatrist didn’t seem to care about the issues I told him about. He told me I had treatment-resistant depression and didn’t change a thing in my treatment plan, despite my suicidal ideation at times. I felt hopeless and wanted a new doctor but there aren’t a lot in Corpus Christi. The ones I called had months-long wait lists.

When my daughter was still little, we decided to get pregnant again. Immediately the depression lifted, thanks to a ton of feel-good hormones. I was tired a lot but it was a nice respite from the darkness I faced after having my daughter. But all good things come to an end. After my son was born I had severe postpartum depression. This time I talked with my OBGYN about taking antidepressants, which she assured me was fine to do while breastfeeding.

Things were different after I had my son, Eli. First of all, I had help; my mother in law moved to Corpus Christi and helped out with the kids a lot. And we were able to get a housekeeper, which lightened my load a lot. Despite things being somewhat easier, my depression continued. I started abusing my anxiety medication and was suicidal again.

One night I made a plan to die by suicide. I didn’t make an attempt, but I was close. I was sobbing and hysterical. My best friend told me to go to the emergency room, so I drove myself and was hospitalized for two days. When I left, I didn’t feel any better, but I did find a new psychiatrist from Southlake who could do phone visits.

I was still suffering though, which led me to enter an inpatient program at the Menninger Clinic in Houston, TX. I stayed there for six weeks. My medications were changed, I was introduced to new therapies, and most importantly, I was given hope that I would feel better. And eventually I did.

I know I talk a lot about my hospitalization, but I have a point — postpartum care, well, mental health care in general, is bullshit. I reached out to my doctor and the doctors at the hospital where I first stayed. But it didn’t matter. I was flailing, about to kill myself, before getting actual help. WE SHOULDN’T HAVE TO BREAKDOWN IN ORDER TO GET CARE WE NEED. I know that not everybody can go to a high dollar hospital and stay for six weeks. A lot of people can’t afford to pay out of pocket for mental health care, which I do a lot. My therapist and psychiatrist don’t even take insurance.

We must change the way we care for new mothers. We must change mental health care and make it affordable to all. One in five adults in the U.S. experience mental illness. One in 20 experience serious mental illness. Only 45 percent of people with mental illness get treatment in a given year. About 1 in 8 women experience symptoms of postpartum depression. These other types of postpartum depression include postpartum anxiety, postpartum obsessive-compulsive disorder (OCD), postpartum panic disorder, postpartum post-traumatic stress disorder (PTSD) and postpartum psychosis. It’s not a minor illness; it affects a lot of women on a daily basis.

I feel like if it happened to me, it’s happened to many others (especially women of color) who didn’t fare quite as well as I did. The National Institutes of Health reports this: Nine percent of white women initiated postpartum mental health care, compared with 4 percent of black women and 5 percent of Latinas. Black women are more likely to have PPD and are less likely to receive help.

There’s so much more to say, but I’m going to wrap it up. I just want to leave you with this: We need to do better. Mental health care is health care, and it’s absolutely a necessity.

If you are struggling with suicidal thoughts, go to the emergency room or call the National Suicide Prevention Lifeline at 800-273-8255.

See below for symptoms of postpartum depression.

According to the CDC, symptoms of PPD include:

  • Guilt
  • Fears of harming the baby
  • Feeling angry
  • Isolating from family
  • Feeling disconnected from their baby
  • Crying more than normal

Mental Health After Pregnancy Loss

TW: stillbirth and miscarriage, depression

Edit: After this blog was published, it was confirmed that Chrissy suffered a miscarriage, not a stillbirth. Just wanted to clarify.

Last week, Chrissy Teigan and John Legend announced the heartbreaking news that they’d suffered pregnancy loss with their third baby who they named Jack. Just devastating.

Chrissy has shared before that the couple has had fertility issues as well as miscarriages, and unfortunately, this loss came after she was hospitalized for bleeding. She was around 20 weeks along.

I’m not going to pretend to know what it’s like to lose a baby, especially after all the loss they’ve already endured. But I imagine it’s unbelievable pain to say the very least.

Chrissy isn’t alone in experiencing pregnancy loss. The CDC reports that about 1 pregnancy in 100 at 20 weeks of pregnancy and later is affected by stillbirth, and each year about 24,000 babies are still born in the U.S. I’m not sure exactly how far along Chrissy was, but it sounds like baby Jack was considered stillborn. Anything before 20 weeks is a miscarriage.

The March of Dimes report that about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage

My worry for moms like Chrissy is the increased risk of depression following the loss (women who have miscarriages also face a risk for depression). According to the MGH Center for Women’s Mental Health, depression is more common in women who have a stillbirth (14.8 percent) compared to women who delivered a healthy baby (8.3 percent). Women with an established diagnosis of depression don’t see a major increase.

It seems cruel that women have to deal with such an awful disease following such tragedy. It’s even more cruel when women have to deal with the stigma associated with pregnancy loss. Often, women are encouraged not to share their story and loss, which can lead to isolation and intensity in depression symptoms. It’s especially harmful if the stigma is being perpetuating by their family and friends — then there’s just no outlet for their grief.

That’s why I’m glad Chrissy and John are speaking out about their experience. There’s no logical reason to keep quiet about something so life-changing — something that happens to A LOT of people. I praise them in what they’re doing to help normalize pregnancy loss and miscarriage. Maybe it will encourage others to share their own grief.

I hope and pray for Chrissy and John’s entire family. I pray for everyone who has had to go through this gut-wrenching tragedy.

If you have experienced a miscarriage or pregnancy loss, please visit the Share website, a site dedicated to Pregnancy and Infant Loss Support.

If you are struggling with suicidal thoughts, please contact your doctor or call the 24-hour National Suicide Prevention Lifeline at 1-800-273-8255.

Here are depression symptoms to look for following a miscarriage or stillbirth:

  • feeling sad, empty, or hopeless
  • being irritable or frustrated
  • losing interest or enjoyment in most or all regular activities
  • feeling unusually tired and having a lack of energy
  • sleeping too little or too much
  • eating too little or too much
  • feeling anxious, restless, or distressed
  • feeling worthless or guilty
  • having difficulty focusing, remembering things, and making decisions
  • thoughts of death or suicide
  • making suicide attempts
  • having random aches and pains that don’t go away, even after treatment

Postpartum Care Needs Dramatic Changes

I breastfed Isla for eight months before I started showing signs of depression again. Pregnancy hormones and breastfeeding gave me a temporary boost, but I could feel the darkness try to creep back in. My doctor (wrongly) told me I couldn’t breastfeed and take antidepressants, so I stopped. (Some antidepressants are safe to take while breastfeeding. Read more here and always consult your doctor if you need medication).

Heather and Eli, 2016

I weaned Isla somewhat abruptly and started my meds, expecting to immediately feel better, but Zoloft was no match for my hormones. I cried all the time. I had suicidal thoughts. I felt out of control and that scared me. I had experienced depression before but not on that level.

After talking to other moms and doing research, I discovered I had post weaning depression, something I’d never heard of, but it’s real. When you stop breastfeeding you experience a drop in prolactin and oxytocin levels, according to Parents.com. Prolactin, needed for milk production, causes calmness and a sense of well-being. Oxytocin, needed for milk ejection, increases relaxation, lowers stress levels and lowers blood pressure.

It’s no wonder that my hormones caused such a violent reaction when I abruptly stopped breastfeeding. I turned back to my doctor but he wouldn’t acknowledge that post weaning depression was real. I got the impression he didn’t deal with pregnant or postpartum patients at all. Later he labeled me “treatment resistant”, which felt like he was giving up on me. So, I gave up on him and found a new psychiatrist — a woman.

I received inadequate postpartum mental healthcare. I’m hardly the only one who has experienced this, which got me thinking — I was able to afford new medication ($300!) to combat my depression. I was able to find a new doctor, even though she lives in the DFW metroplex (near my parents’ house) and doesn’t accept insurance. She charges $125 per hour. I was able to get the help I needed, but there are women who aren’t as lucky, especially women of color. There’s a huge disparity when it comes to the risk of experiencing postpartum health issues. This is likely due to the fact black women are more likely to have traumatic births and other complications, such as maternal hemorrhaging. Read more about that here. Also, black women are less likely to reach out, most likely due to the stigma associated with mental illnesses.

Nationally, postpartum depression affects 1 in 8 women. New mothers of color have rates of postpartum depression close to 38% compared to the 13 to 19% rate all of new mothers, according to the Psychology Benefits Society.

A disproportionate number of women of color are not even screened for depression and don’t receive the services and treatment they need. Up to 60% of women of color don’t receive any services at all. That’s crazy! Proper screening of women of color during pregnancy and postpartum is known to reduce the symptoms of depression, yet there’s still this great disparity.

There’s also this — there are documented racial and ethnic differences in perceptions and treatment experiences of low-income women of color vs. white women, including limited access to health care, a disconnection with providers, lack of access to providers that look like them and unavailability of culturally/linguistically appropriate services, Psychology Benefits Society says.

A study questioned new mothers of color about what they needed in order to access screening and treatment and it shows mothers of coloring lack the following:

  • Access to information and resources
  • Access to services (insurance coverage, transportation, childcare services, etc.)
  • Flexibility when making appointments and flexibility when finding a doctor
  • Community-based support services

This is not OK. All those numbers are probably much higher in reality than what’s being reported. Again, the stigma keeps women of color from reporting and reaching out. It is still common for people — no matter what their background — to view depression as a weakness. New moms could also fear people thinking they aren’t fit as a mother if they are experiencing depression. That was a huge concern of mine.

I’m not trying to make this about me, but I can’t help but think what if I didn’t have the means and flexibility that I do to receive quality mental health care?

What I experienced with postpartum and post weaning depression was not good, and to be honest, it was dangerous (not for my kids, just me) because of my suicidal thoughts. I could have easily killed myself but my support system and options for healthcare saved me.

But there are others who need saving. All women need quality healthcare, and closing the gap between treatment of mothers of color and white mothers should be a priority. It should’ve already happened. The U.S. is supposed to be “best country in the world” but it ranks among the last compared to other first-world countries in terms of healthcare. I love my country, but it’s not the best if the majority of women are receiving little to no healthcare postpartum or otherwise.

To My Future Self

A year ago I started electroconvulsive therapy (ECT) for my severe depression. I try to do one every four to six weeks because I need them to live, truly. When I’m going through a depressive episode, it resets my brain somehow, and after my stint at the Menninger Clinic, I want to avoid going to that dark place (in my head) again.

While the ECTs help me to be my best self, they have crippled my memory. Usually, ECT will affect your memory around the time of treatment, meaning you might not remember coming in for the treatment or directly after it. For me, I can’t remember things from years ago. My memory is just so random; I can’t figure out how my brain has decided to keep some memories and discard others. I’ve also forgotten entire people. Months ago I went to a nail salon and a woman asked about David and the kids. I did my best to talk with her but I was so embarrassed and frustrated. 

When I try to remember something I often come up with nothing – just a fuzzy gray wall in my brain. Sometimes it shakes me to my core because I’m afraid I’ll forget my most cherished memories — being with my grandmother as a child, getting married and memories of my babies being born, etc. And as weird as it sounds, I want to remember what it was like before I went to Menninger, so I can recognize those painful feelings and behaviors and stop them as soon as possible.    

But above all, I want to remember me and the memories that helped shape me, so I thought I would write myself a short reminder. 

To my future self, please remember how strong you are. Remember when you bravely moved to Corpus Christi, hundreds of miles from family and friends and didn’t know a single soul. That you had two children in 23 months and won a horrible battle with postpartum depression. Remember when things got hard again and your brain betrayed you, telling you to kill yourself but instead you found hope in a psychiatric treatment facility for six long weeks. And that during that time, how you fought like hell for your family and friends.

Please remember your big heart and limitless capacity to love. Your sense of humor and generosity. Don’t forget how loudly you laugh (it’s more of a guffaw, really) and your ability to be inclusive and open-minded. Know your worth, that you are deserving of love and respect.

Remember that you are the best mom to raise Isla and Eli and to always lead by example. Never forget the words to George Strait songs you sing to Eli at bedtime or that Isla gets scared at night and needs extra cuddles. How Eli is totally obsessed with seahorses and named his seahorse stuffie Weerow. That Isla’s sense of humor is beyond her years. Remember how amazing your mama is and how you feel such comfort and love when she is near and that Mema made you feel the same way. You are loved – and were shaped – by very strong women. YOU are a strong woman, despite what your brain tells you. 

And finally, when it is dark and you can’t seem to find the light, remember that one shines within you. If you can’t remember that, just know that you have really good friends with really good flashlights. 

 

 

 

Out of the ashes, baby

I’ve had depression since I was young; I can remember feeling anxiety in middle school and I definitely had depression in high school, I just didn’t know it then. It wasn’t until college (when my Mema died) that I really had a problem. When she died, I couldn’t handle it. I dropped classes because of the stress and overwhelming sadness I felt. I dropped so many classes that I was only going part-time. I can remember leaving campus to drive to my parents’ house multiple times a week.

I started therapy at my college and after a couple years, I realized I needed medication to help with the depression. I was so embarrassed. I didn’t even tell my parents. Now, my parents have always supported me and never really talked about depression with me but I had it in my head that this was a major flaw – my family seemed stronger somehow, that I should just pull myself up from my bootstraps and get a grip. But I couldn’t.

After I graduated college and started my first job hundreds of miles away from my family and friends, my depression got worse. It made me miss work….a lot of it. My other coworkers were resentful and I felt like my bosses hated me. I didn’t fare well in Corpus Christi and after a bad breakup I moved back home. I felt unsuccessful and like a loser. My depression got even worse.

Fast forward to me going back to Corpus Christi: I got married, bought a house and got pregnant. After my first pregnancy I felt ok but after having my second child I was not ok. Postpartum depression reared it’s ugly head. I had to stop breastfeeding at 4 months so I could get back on my antidepressants but even the meds couldn’t save me from being suicidal. It was awful. I spent my energy on making sure my kids were ok and I simply didn’t have enough strength to fight the ugliness that had infiltrated my body. One day I had to go to the ER for suicidal thoughts. Luckily my parents were with my kids. I was sent to an acute behavioral center and saw an awful doctor who wouldn’t listen to anything I was saying. I was released after a couple days and I found a new psychiatrist who started me on different meds. I’d like to say that fixed me but it didn’t. I was diagnosed as having treatment resistant depression, meaning my meds were not effective in fighting the depression off.

Things were pretty bleak and my depression was not controlled at all. The only thing keeping me going were my kids – they of course had constant needs that I had to focus on. It was when they were sleeping that my anxiety increased. I couldn’t control ugly thoughts like I was a bad mom, a bad wife and a total loser.

I was running on empty with no hope in sight. After talking with my therapist and husband, we decided that I would go to a psychiatric facility for help. It was the hardest decision I ever had to make. It would mean at least 6 weeks away from my babies and husband and I felt incredibly guilty. But I had to go.

At the Menninger Clinic I was diagnosed with major depressive disorder, generalized anxiety and avoidant personality disorder. I started electroconvulsant therapy (ECT) and different meds. I was able to come home after 6 weeks but I have to do ECT treatments every now and then.

I still get depressed. I’m actually in a little funk right now but I know I’ll get through it. I will always rise. I used to think that people with depression were weak but now I know that’s nothing but bullshit. We are strong. We fight to live every day. It’s hard and some of us don’t make it because they don’t have the means or a support system. They suffer in silence and that’s why I cannot. Please do your part in eliminating the stigma around depression and help normalize it. Check on your loved ones, let them know you care and shine a little light in their darkness.

Post partum depression, trucks and ponies

I’m cleaning out my car the other day and finding the odd little things moms find in their cars – a pair of shoes, one sock, three My Little Ponies and a monster truck. These make me smile because at one point in my car all that was there was Chick-fil-a trash, which also makes me smile, but for different reasons. I love finding toys here and there, reminding me how lucky I am that I have two beautiful, clever children who love me.

But to be honest, after giving birth to them my depression worsened. My hormones and brain chemistry were altered and I went down dark roads I never imagined existed. Do I regret having babies? No way. Will I have more? No way. But I do want to discuss Postpartum Depression and Post Weaning Depression.

During my first pregnancy, I was happy a lot, albeit anxious, even though my family was facing terrible times – my husband’s dad died and there was chaos within the family. But my hormones wouldn’t let me be sad a whole lot during these times. After giving birth to a girl, I breastfed her for 8 months. I felt the depression creeping back in and I no longer had the protection of pregnancy hormones to keep me happy. I stopped breastfeeding cold turkey, without so much as talking to a lactation consultant or my doctor. I just wanted to get back on meds (at this time I was told by my now former psychiatrist that I would not be able to be on meds and breastfeed, which is not true).

The pain in my breasts was nothing compared to the waves of depression that crashed down on me over and over. I was suicidal. My husband and mom didn’t understand what was happening. My doctors didn’t know what to do so they recommended I go to the local psychiatric hospital, which I didn’t want to do and I found inadequate. I felt my whole postpartum care was inadequate, except for my OB’s care. Once I was on meds, and then more meds, the darkness began to let up. The suicidal thoughts receded.

I was on meds on top of meds and it was then I was labeled “treatment resistant.” I felt brushed off my psychiatrist. This was what it was going to be like forever? When my daughter was about 16 or 17 months old, my husband and I decided I would get off my meds and try for another baby. Secretly I was hoping to feel the happiness I had felt with my first pregnancy but no such luck. I felt anxious and moody, but I could go several weeks without a migraine, so there’s that. It was a difficult pregnancy – I was diagnosed with gestational diabetes at 20 weeks followed by polyhydraminos which led me to give birth to my son at 37 weeks. So I was relieved when it was over and I was prepared for the PPD, asking for Zoloft as soon as I could get it. My OB understood. Nobody wanted a repeat of last time.

And even though I was prepared and on medication, it still hit. It was more than the “baby blues.” I was sad all the time, I didn’t think anyone else could take care of the baby the way I could which led to exhaustion, which led to more anxiety and irritability. I constantly checked on the baby and worried. I was weepy. And worst case scenarios always popped through my head. Plus, I had a toddler to take care of. Whether you have help is irrelevant. You feel so alone and scared.  It’s like someone has taken over your body and brain. When it gets really bad, you have suicidal thoughts. If that happens, you need to tell someone and seek help immediately by going to the ER or calling 911.

The “baby blues” affects up to 80% of births, according to the National Institute of Mental Health (NIMH), but those symptoms are mild and usually go away after about two weeks. The NIMH also says that PPD affects almost 15% of births – that sounds awfully low to me – symptoms are severe and can began between a week to a month after delivery. Because of the severity of PPD’s symptoms, women may have trouble taking care of themselves and the baby, so it’s really important to take note of your symptoms – how long they stick around and just how bad they get.

Postpartum depression is no joke and I had never heard of Post Weaning Depression after breastfeeding before I experienced it. People are starting to learn more about PPD and Post Weaning Depression but it’s still something that needs to discussed. It’s not just a “women’s problem” that should be discussed behind closed doors. Forget that. It really does take a village.