Postnatal /Postpartum Depression

Hello again, long time no see! I’m finally, finally coming back to this space.

It has taken me a long time to get my head around this blog post, because the topic is postnatal depression. There’s a lot of fear to overcome when admitting to having suffered from such an experience: the question of whether publicly discussing my illness will de-legitimize my abilities as a doula was a huge one. In the end I’ve decided that if it does stop a few prospective mothers from hiring me, that’s not too high a price to pay in order to reach those that are struggling and really do need help. So, if you’ve googled this topic because you or a loved one of yours is suffering and you’re trying to understand why and how to help, this post is for you. And from the bottom of my heart I am cheering you on, having walked through the fire and come out stronger.

I suffered from severe clinical postnatal depression after the birth of my second child. Therefore for this third birth we planned meticulously. One of the steps I took was to dedicate the entire first year of my son’s life to lying low, and I planned a whole year of maternity leave (ha, being self employed of course, the pay is symbolic!) and focus on my health and stability. I am happy to say that this time things have gone well and I’m very thankful that there was no repeat experience of last time, even though my psychiatrist said that I had a 98% chance of the illness coming back as bad, or worse. And here I am standing in the 2%! There were some tricky times a few months in ,where I was close to sliding into that hole, but thankfully we pulled through and I’ve grown stronger and stronger, and in the end I’ve returned to the birthing world earlier than I had planned, and I’m well. Thank God, I’m well!

A list of self-care steps we took when facing this third pregnancy and birth will be published shortly. 

Here’s a myth about PND* that I’d like to bust: Post Natal Depression doesn’t necessarily go hand in hand with sadness.

Now that he's crawling, the game changes! Look out, big brother's Lego...

Before it happened to me, after my second birth, I have to be honest, I didn’t really believe in depression, full stop. I was in that snap-out-it, pull-yourself-up-by-your-own-bootstraps, just-pray-harder category.  PND sneaked up on me when I was in a time of my life when I thought I had no reason to be struggling! I was (am) married to a handsome, talented man, my children are healthy and cute, I loved my home, and my work as a doula is so satisfying. I’ve had a safe childhood and never self harmed or suffered from mental illness or trauma in my past. Just because circumstantial and historical issues place you in the risk category for PND, doesn’t mean that you must be already off your rocker to have intrusive thoughts. I didn’t have all the classic signs one thinks of with depression: I wasn’t crying all the time, my house was spotless (too tidy) my children and myself were well dressed, and I smiled. A lot. What I didn’t realize is that there are a host of other risk factors and symptoms. PND is sneaky. I got blindsided.

By the time it was diagnosed in 2006, my daughter was seven months old. I was unable to leave the house to attend functions, because of panic attacks that would start three hours before an event and last for three more after we returned home – not worth the effort. I couldn’t drive our car, because I couldn’t concentrate on all the visual input and decision proccesses it takes to drive (too fast, dangerous corners, urges to crash into walls.) I often couldn’t make dinner for my children, because I couldn’t decide what to make, or focus long enough to make anything. I couldn’t concentrate to watch a movie or read a book . I was terrified of taking a shower (have you ever thought of how many steps it takes to complete that task?) and at one point went three weeks without washing my hair. Speaking of hair, one night at 2am I used the kitchen scissors to cut it all off. A few years later when Brittany Spears did the same thing just after the birth of her second child, I was like, hey! She’s copying me!

Sleep. Disturbed sleep patterns always accompany PND. While I mastered the motherly art of falling asleep in the instant after finishing a breastfeeding session, I would awaken 20 times a night to check the kids blankets/windows/oven/I have no idea what else. I was obsessive compulsive about the cleanliness of my own home, and could not sit still and chat to a guest (my health visitor) if there was a piece of lint on the carpet across the room, I would have to pick it up immediately. If I couldn’t feed my family, at least the home would be clean.

Among the worst things that happened (and the hardest to admit): I was perscribed co-codimal for a breast abcess and recurrent deep tissue pain, and was introduced into the world of abusing prescription drugs. I bought a bottle of vodka and hid it. (All this from a woman who had never been drunk, never smoked a cigarette, never abused anything!) I was self harming on a regular basis. I felt like if I cut myself and drew blood, that would satisfy the terrifyingly painful urge in my chest to harm my children, to kill myself. It was only a little blood. My children never saw, there was no ‘real’ injury. I had to plan how I would get myself and my baby away from my balcony, where the cement walkway below looked so terribly inviting.

Even more terrifying than that, I felt like I’d lost God. My sense of the divine was gone, like heaven became cement, there was no one looking and no one hearing. Right and wrong, good and evil were all mixed up and I didn’t know who to believe anymore. I felt like I was to blame, and at the same time, that it was so unfair that the one time when I needed help most in my entire life, that I was abandoned. Desolate. Afraid of life, afraid of the world I’d brought my kids into.

I was hospitalized in a Mother and Baby Mental Health Unit for nine weeks. I tried seven different antidepressants and other drugs before we found something that finally, finally, helped me feel like ‘me’ again.

Recovery took years. Hence the age gaps: Ana and Noah are 22 months apart – and then there are five and a half years until Asher.

Ana 5, Noah 7, Asher 5 months. Aren't they lovely!?

The first glimmer of hope that spoke to me came from a nurse in the Mother and Baby Unit of my local mental health unit. Being a naturally smiley person, people were often surprised that I was one of the patients. Well, I certainly wasn’t going to erase the smile and look glum, just to fit their expectations. I still struck up conversations with staff, just to be polite. Trying to be friendly, I asked her how working on the Mother and Baby Unit was different from the other mental health wards she’d worked on over the years, and why she chose this unit in particular. (I was a very articulate kind of patient.) Her answer has echoed in my mind all this time. She said,

“I like to work in this ward because mothers suffering from PND get better.

They recover, they go home.

Not like the patients in the regular mental health wards.“

And like that, a ray of hope peirced my darkness. We get better. It is a mental illness with a very high recovery rate; I was going to recover.

I did recover.

The following are very painful lessons I’ve learned:

1. Children are scarred for life if their mother didn’t love them enough to stay around and chose to kill herself. No one recovers from that kind of hurt.

2. Children are resilient. They love their mama, they forgive their mama, they need you.

3. “If I confess what I’m feeling then ‘They’ will take my children away from me” – that fear is false. Health professionals want to help you heal and the end goal is to keep the family together. If you have these thoughts, someone needs to know so that they can heal the source of those thoughts.

4. While it does not happen to everyone, it happens to enough women so that you can know that you are not alone! And those thoughts and feelings that make you feel alone have been felt exactly the same way by so many others. This helped me understand that the awful thoughts and urges must not be true or from me; they belong to the illness. Find a support group – there are some excellent online ones, including the mothers at Postpartum Progress. So many of us do get better.

5. It is an illness. It passes. You do emerge again, changed perhaps, but truely you. I am far more me, honestly, after the re-building of my spirit.

6. So many women are scared of taking medication, whether because of the very real stigma surrounding depression (I personally have spent years avoiding writing this post) or because they are worried about taking something that might be addictive. At some point the benifits start outweighing the cons. Getting well is so very worth it.

7. Breastfeeding – is it a benefit or does it cause more hormonal upheaval? There is a lot of debate about this one, in both directions. For me, I finally needed help myself if I were to remain alive for my daughter. Yes, breastmilk is magic juice and I loved giving it to her, but she needed her Mama living, attached, loving her.

8. It is important to keep looking your kids in the eyes, hug them, and tell them you love them. Daily.

9. For a simple, preliminary online test for PND try the Edinburgh Postnatal Depression Scale.

10. There are survivors who are on call daily, and would like to talk to you. If you live in Israel, phone NITZA, the Israel Center for Maternal Health at 02-5332810, or email them at nitzappd@013.net

11. Dads and family members need help too! It is totally bewildering to see your wife turn into someone you don’t recognize. My husband has written a post about what he would like to say to any dad whose loved one is suffering, which I will post next week.

I am on the other side, a stronger, more humble woman; more appreciative of life than before.

*otherwise known as PPD. Since I suffered the illness when I lived in the UK, I refer to it as PND in this article.

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Birth Story

I always write up a birth story to read together with new parents at our post-birth visit. I find it’s amazing to re-live the experience, helps put into order events and it adds to the joy of the birth. When I went into labour 3 days ago, I didn’t expect to take notes on my own birth, but then I found I just couldn’t help myself! It is so ingrained in me to record milestones and their times, feelings and thoughts during the birth, I couldn’t resist grabbing my notebook and a pen and recording what I was experiencing too. So here is the birth of my third child, who is sleeping peacefully next to me as I type.

 

Asher Kobi Vine

Born Tuesday, 1/2/2011 at 5:04pm

At home, Moshav Ramat Raziel, Israel

3.870 kilos, 8lbs 8 oz

31.1.2011 Monday morning I have my first bit of show, very exciting! All day I have painless tightenings, at varying intervals. They feel just like the braxton hicks contractions I’ve been having ever since week 14 (they come earlier with each pregnancy) but today they are coming much more often, every time I get up, move, sneeze, etc. I play around with contraction master while doing other things online, and sometimes they come every 3 minutes but other times there are spaces of 7 or 10 or so minutes between. I clean the house and do loads of laundry, and hang it all out on the line in the rain (it’ll have to stop raining sometime. It will smell nice. That’s a heavily pregnant nesting woman’s logic for you.) I finish re-reading Spiritual Midwifery, and go away inspired by the loving attitude of the wives towards their husbands and birthing companions. I plan on adopting that attitude during labor too.  After I pick up the children from school and gan we make lemon bars together with organic lemons off a neighbor’s tree – I’d wanted to bake these for the baby’s birthday cake! Recipe here. I’d planned on offering them to anyone who came to visit us after the birth, but we ended up eating them all instead… at least the midwife enjoyed some too before they were gone! I text my midwife to give her a heads up about the show and painless un-ordered contractions, letting her know that I may go into labour in the next day or so.

In the evening I make my favorite vegetable soup and couscous dinner, light and nourishing, and Jean-Philippe and I have a fun evening playing Settlers and enjoying eachother’s company. I do an enema supository just to clear out and possibly encourage contractions, go to bed with an Evening Primrose Oil capsule to soften the cervix, and measure my fundus during a contraction to be sure that we have time. I can still fit nearly 5 fingers, but am loosing more show throughout the evening. Sleep is hard to find, so I practice relaxing with my hypnobirthing and hypnobabies recordings.  Finally, at around 4am I fall deep asleep for 3 solid hours.

1.2.2011 Tuesday morning – Tightenings have lengthened out to every 20 minutes, I have a feeling today is the day, and Jean-Philippe and I wonder if I might go into town to the mall to walk around and have a treat, or if he should take the car so he can get home again quickly. After listening to my body, I decide I’d rather stay at home and go for a walk in the woods at some point instead.  More show, so much I check with a Mei Test to see if my waters are leaking – no it’s just a lot of stuff! Finish knitting a green baby hat while watching Grey’s Anatomy online – yes I am a medical drama junkie. I have a sleep for an hour, waking every 10 minutes with tightenings, but feel really rested afterwards. Check fundus, 3 1/2 fingers. Decide if I’m going to have that walk in the forest I’d better have it now…. go below the house and walk through the woods – if I hang from a certain acorn tree

My acorn tree - with Ana in it, a day later

it feels really really good during a tightening. I am amazed at the soft spring beauty of the day, the greenness, the rolling hills below this place God’s planted us just a few weeks ago! I feel so thankful. It takes me 45 minutes to make the loop along the edge of the forest and back up the hill through the moshav to pick up Ana and Noah from the bus stop and gan – during that time the intense feelings start coming every 3 minutes and make me stop in my tracks and breath. I’m pondering calling the midwife when she phones me! Ilana Shemesh somehow knew something was up. She wonders if she should come straight away – mama with her 3rd baby having contractions every three minutes – but I reason that they’re not painful, and that perhaps they’re just a result of my walk. My fundus is still at a reasonable height. We agree that I will go home and lie down and if they don’t tail off or get more intense I will call her. I do ask Jean-Philippe to come home straight away, though, and warn my parents that they should come get the children that afternoon. Collect children, walk home, but don’t have the energy to make them lunch so they snack in front of a video while I veg on the sofa.

2:00 Jean-Philippe arrives home all happy and excited, kisses me, and I feel myself finally relax and let go. Ask him to do lunch, go into bedroom to lie down, phone Ilana and tell her I think she should come. Timing rushes: 2:10, 2:13, 2:17, 2:19 Go to the bathroom, am suprised I can actually find my own cervix and it’s low and about 5 cm dilated! Whenever I’d checked in pregnancy and the past few days the cervix was still high, posterior and pretty much out of reach. Things aren’t going back now. Fundus is at 3 fingers. Still getting thick pink discharge. Try hypnobirthing relaxation on MP3 but children are so loud I can’t relax. 2:25, 2:30 painful contraction, lasted 2 minutes. 2:34 strong. 2:37, 2:40 very strong.  My dad arrives to bring the children to their house, Ana wants to stay but when promised treats is easly bribed out the door. I can’t go out and say hello – dealing with rushes on my knees now.

I put on my birthing skirt that I’d sewn from an old dress earlier in the week, long with a stretchy waistband, and a vest top with a shawl to keep warm. I don’t feel comfortable taking everything off and had kept my skirt on all the way to the end with Ana’s homebirth 5 years earlier. I want to try using the birthing ball, so go into the kitchen and lean over a chair while rocking on the ball. I have Jean-Philippe put on my TENS machine, and then he’s all busy being told to fetch a pillow for padding the chair back, putting on music, lighting candles, getting me a drink, mopping up said spilled drink, and squeezing my hips with every contraction. It feels soooo good to have my hips squeezed! Hot water bottle is wonderful, little instant warming hand packs not warm enough.

3:00 Ilana arrives, with bags and equipment and birthing stool. I miss my husband’s hip squeezes while he helps her bring them in. I greet her by saying it’s gotten more intense for sure, but I’m fine. I find that when a new rush hits me I’m scared by it’s intensity and don’t want to feel pain – but if I manage to relax and let go and breath, the more relaxed I am the less pain I feel. I start out a contraction by making moaning sounds and getting scared, but when I let go and completely relax and focus on my breathing like I’d practiced in hypnobirthing, I really do not feel pain. I feel really intense sensations that require all my attention, but they don’t overwhelm me. I can let them go, thinking wide, open, soft, peaceful. I keep thanking Jean-Philippe and complimenting him for how perfectly he’s squeezing my hips, telling him I love him, that I’m enjoying myself at this birth. I comment that it’s a beautiful day to have a baby, that this is so much fun. I try singing along with a contraction, The Color Green by Rich Mullins, Wonderful Life by Hurt, and it feels so good to sing loudly during a contraction, words that I really feel in my gut.

3:25 Ilana asks if I want to check dilation, I agree and she finds I’m 8 cm, and is very pleased. I pass one contraction lying down on my back, not nearly as comfortable but if I do relax my body completely and smile, it’s not unbearable. I tell myself it feels so good to lie fully supported on the bed, and enjoy not having to hold myself upright. After the bed I want to try the rocking chair – this reclining position puts more pressure on my weak sciatic nerve and I have to have the hot water bottle at my back, and can’t bear the rushes without a hip squeeze. It’s harder to relax, but really nice to rock while listening to music. He tells me stories of how we met, wonderful times we’ve had together at a B&B in Wales, what fun we had cycling for 2 weeks before our first child was born, a magical town we stumbled across and how enchanted I was listening to the locals conversing in Welsh. I murmur back little additions to these memories even in the middle of contractions, it’s so lovely to share the memories.

I decide I want to try a few contractions in the shower, aware that I’m close and this is my last chance to try water therapy! We don’t have a bath in this house, one thing that I’d really, really wanted for this birth was to get in the bath, but I’ve reconciled myself to not having one just because our new little home (we moved in 1st of January) is really wonderful and perfect in every other way. It’s a peaceful home. I am scared to walk (my legs don’t work so well when I’m in labour) and so Jean-Philippe and Ilana pull me up and help me make it to the bathroom. Ilana helps me undress really fast – no time for socks before the next contraction so I get in with them on =0) and oh the hot water is so nice! I experiment with where it feels good – there’s no room in the shower for anyone to be with me so I can’t focus it on my back, and during a contraction it seems to feel best on the top of my bump, moving slightly but not in big circles. Between I like it all over just keeping me warm. We keep the bathroom light off, with just a nightlight illuminating the room gently, warm. I end up crouching on the floor of the shower, on my knees sitting upright. I feel for the baby – there’s a bag of waters bulging down my birth canal. Still time. Three more rushes and I check again, and the bag of waters right there. One more contraction and I feel pressure in my bottom, so I call Ilana that it’s time to get out I need to push! Do I want to push in the shower? No, I want to go to the bedroom. Towels are wrapped around me, unfortunately not the old natty ones that are set up in the bedroom but my mom’s white ones that are in a neat stack in the bathroom; I should have spread the old ones around the house a bit better!

4:55 Race to the bedroom, Ilana gives me the option of pushing on the bed or using the birthing stool – I’ve never tried a birthing stool so I think it’d be nice to give that a go. A contraction hits and I lean over the bed with one knee on and one foot on the floor, Jean-Philippe squeezing my hips, trying not to push. Finally make it onto the birthing stool, Ilana has Jean-Philippe sit behind me and I lean back against him and try to let go and relax and be held. That totally helps. Because of the sciatica this position isn’t the most comfortable and if I couldn’t lean back and be held it wouldn’t have worked at all. Jean-Philippe is a bit dissapointed because he had wanted to film the birth itself. Ilana has warm oily water ready and together we apply hot compresses. I gently stretch myself and I can feel the bulging bag of waters emerging already. I relax and listen to my body and breath J-breaths down and out, thinking open, loose, let go. At the end of a pushing contraction a huge urge hits me and I push harder – the bag of waters pops all over the place and Ilana giggles “I knew that was going to happen!” Breathing the baby down is nice, but then when a huge pushing sensation hits me I loose it, because pushing means movement and it hurts! Birthing hasn’t hurt so far and I don’t want it to now, but I have no choice, my body wants to push. I shout “No, no!” which makes Jean-Philippe stop providing counter pressure which then hurts even worse – I was voicing how I was feeling about the contractions, not expressing a wish for anyone to do anything. Then I get a leg cramp – just like at Ana’s birth except this time in my upper right thigh – and have both of them jumping trying to figure out which muscle to rub out for me. Then one more big push and Ilana tells me to pant, the head is crowning! I pant and blow my lips, trying to relax the baby out, the head stings anyway. It’s out! I reach down and run my fingers all over the slippery little roundness, feel it lean away and there is no shoulder dystocia, the neck is free and no cord. I reach down and it feels so far away, Ilana supports the baby too as one hand comes free and I can reach under the armpit and oops the rest of the baby slides out.

Seconds after the birth

5:04pm I pull the baby to my tummy, it’s a boy! Ilana gives me a towel and I rub him, holding him upright talking to him to breath, he’s gurgly for a minute but then gives a strong cry. I start to cry too. “Oh baby, it’s a baby!” Jean-Philippe tried to film the birth, but in the excitement pressed the wrong button – so we have the following pictures instead. Ilana comments a couple of times at how thick the cord is, and that it already stops pulsating after just a couple of minutes! She has me feel it and confirm this. I comment that his cheeks are dusky but she points out that his chest is pink so he’s okay. Jean Philippe cuts the cord, Ilana leaves a long tail on it so as not to have to mess with the baby yet.

5:14 I wanted to move to the bed and try a breast crawl, but Ilana asks that I stay on the stool as it’s the best way to birth a placenta, so I have Jean-Philippe fetch the strong, sweetened Red Rasberry Leaf tea that I’d prepared earlier to create uterine contractions for birthing the placenta, and I offer the baby to have a go at breastfeeding. He has a strong suck and latches on straight away! After 10 minutes I feel a good push and the placenta comes right out. Make it to the bed, I’m cold, so all the blankets and duvets in the vicinity are fetched and we’re bundled up together with a cup of tea. Baby boy continues to feed for another hour and a half solid!

When we finally weigh him he is a big boy – good thing I’d followed a gestational diabetes diet for the second half of the pregnancy, just as a precaution. (I don’t have GD, I simply had a feeling this was going to be a boy and my first was 8pounds 4oz.) This child is my largest yet, at 8lbs 8oz or 3.87 kilos, and his head is round and 36cm, 3cm larger than normal, just like my first born son! But instead of pushing on my back with an epidural for 3 hours, I was upright and relaxed.

Ilana Shemesh making sure the placenta is complete

As Ilana is leaving she comments that this was a beautiful birth to attend, one of the most beautiful she’d ever been at. Which is quite the compliment for someone who has attended thousands of births over the last 40 years, hospital, birthing center, and home births! “And so social – I get to go home for dinner and bed.” Happy to oblige.

I learned:

1. I like TENS, still!

2. Living in Denial works

3. Hypnobirthing works

4. Hot water bottles work, little hand held hot packs don’t

5. Relaxing makes the pain go away, it really does

6. Hanging from a tree feels really, really good

7. I like hot water, especially on the top of the bump during a contraction

8. Hip squeezes, wonderful

9. Reflexology pointed pressure at the base of the spine, also really feels great

10. Measuring your fundus by finger widths really does correlate with dilation (See my External Assessment of Dilation post)

Day 5 – As I finish typing this story, Asher Kobi Vine is a laid back, easily settled little guy. My milk came in at day 3, and he has turned into a super efficient milk processing machine. We have him sleeping with us in bed, and from the first night of milk (Thursday night) he has been feeding only 3 or 4x a night, and he goes right back to sleep as soon as he’s fed. He loves to be in bodily contact, so doesn’t get put down very much, but I have a couple of different slings so we’re allright. I tried to offer him a pacifier but he gets all agitated and angry – he prefers my finger if it’s just a need to suck and not hunger. So I have a feeling I may be attached to this little man for a while. That’s okay. I have one birth planned for April, and after that I’m on sebatical for the rest of the year. I am training for my IBCLC (breastfeeding consultant), although when I manage to do the mentoring and exam I don’t know. No pressure. I may do some more education this year, but mostly I’m going to rest, be a mother, and enjoy my last baby’s first year.x

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