Welcome Anne, aka Dou-la-la, a dear friend, birth activist, student lactation consultant, and Buffy the Vampire Slayer fanatic:
I couldn’t be more honored or stoked to be guest posting here for Arwyn during her babymoon. This piece was originally published in two parts: Postpartum OCD, A Retroactive Self-Diagnosis and Part 2: The Mom Who Couldn’t Stop Logging. Feel free to click over if you’re interesting in reading them in their original long-winded glory, but I think this version is a little more reasonable anyway.
For two solid years, I never thought of myself as having any kind of postpartum depression, only as a mom who had had an extremely difficult time nursing, and thus everything I struggled with was chalked up to that. Then, last summer, I read a piece written by Bryce Dallas Howard about her own experience, and I was suddenly staring into an unexpected mirror, revealing an uncanny resemblance to my own postpartum inner life.
It is strange for me to recall what I was like at that time. I seemed to be suffering emotional amnesia. I couldn’t genuinely cry, or laugh, or be moved by anything. For the sake of those around me, including my son, I pretended, but when I began showering again in the second week, I let loose in the privacy of the bathroom, water flowing over me as I heaved uncontrollable sobs. When I visited the midwife for a checkup, she gave me a questionnaire, rating things on a scale from 1-5 so that she could get a sense of my emotional state. I gave myself a perfect score. Despite my daily “shower breakdowns” months passed before I even began to acknowledge my true feelings.
Boy, do I know those shower breakdowns. But even beyond that, the last part really resonated with me, as I imagine it would with many women. The Edinburgh Scale – the standard for assessing postpartum depression – is a great tool . . . in theory. I suspect far too many women do exactly what Howard did above, and what I almost certainly would have done: answered dishonestly in order to prove our maternal aptitude (whether proving it to the person giving the test or to ourselves). Part of it may be pride in the sense of ego, part of it may be fear of having our children taken away from us if we admit to our true feelings.
But another huge part of it may be denial – I had a hard time admitting my feelings to myself even at the time, and I actually didn’t recognize many of my own symptoms until long after the fact, through the process of working with other women postpartum. This was heightened by the fact that I believe my own postpartum mood disorder is one that doesn’t get quite as much attention as “regular” postpartum depression (I say that with tongue firmly in cheek, as there is nothing regular about it for those who are experiencing it) or the extremely rare but headline-generating postpartum psychosis.
One of the two postpartum anxiety disorders that are part of the greater PPMD spectrum along with depression and psychosis is postpartum obsessive-compulsive disorder (the other is a panic disorder). Despite being reasonably aware of postpartum depression, I had never even heard of the OCD variation at the time. Howard’s piece then spurred me to read more, and more, and suddenly my entire first year as a mother was cast in a new, much more revealing light. Many of you have read my nursing story, and I’ve always been willing to talk openly about that, but I had never talked publicly about the deeper psychological undercurrents that accompanied the whole saga.
I did start off with a pretty acute case of the Baby Blues, the most benign and the most common of all postpartum mood variations. It’s hormonally driven, and not considered a disorder – frankly, it’s quite a normal and expected, temporary state, as 75 to 80% of all mothers experience this to some degree. This much of my tale I did actually write about already, in this post about the dreaded Third Day. From there, I got about a week of near-reprieve, until our breastfeeding challenges starting to become more and more apparent. It is here that the fears underlying the OCD began to send down their roots.
Here’s the most emotionally difficult part to talk about, regarding this phase where more and more breastfeeding red flags were popping up: I was getting very frightened. And understandably, the people who were closest to me wanted to reassure me. I was told over and over that she was fine. Babies just cry like that sometimes. She’ll poo eventually – she has to, she’s eating, isn’t she? It’s good that she’s sleeping – you’re lucky! Look at those chubby cheeks, she’s not starving. She would be rooting if she was hungry. She’ll eat if she’s hungry enough. Sometimes breastfed babies just don’t poo for a while. Trust your body. She’s fine. And inside, my gut was screaming No. NO. She’s NOT fine. Something IS wrong. Her cries DO have meaning. She needs help. I need help. But I kept suppressing my gut. I listened to the reassurances and tried to ignore the sense of unease growing into dread and finally terror.
But I kept suppressing my gut. I listened to the reassurances from friends and family and tried to ignore the sense of unease growing into dread and finally terror. When we returned and had her plummeting weight confirmed. I just wept at that. I had failed her. I had not listened to my instincts when I knew deep down that something was going very, very wrong, and I allowed well-meaning others to reassure me and talk me out of my fears. And I had utterly failed her. My baby had suffered because of my incompetence at the most fundamental aspect of being a mother.
And so the stage was set. An intense case of baby blues, which dissolved into a few days of still-concerned but mostly oblivious reprieve, which then segued into the full-blown crisis of our multifaceted nursing situation.
Howard’s piece led me to find this excellent post by Postpartum Progress: The Symptoms of Postpartum Depression (In Plain Mama English). Reading this compounded the retroactive epiphany for me. There are so many bullet points that describe my state for months on end; I’ll go through some of them specifically:
- Your thoughts are racing. You can’t quiet your mind. You can’t settle down. You can’t relax.
How I relate to this. I had to spend so much time both pumping (every 3 hours around the clock, 2 alarms were set for overnight) and on feedings themselves, and both required me to more or less not be doing anything else, at least on a physical level. The various techniques we used differed depending on her progress over time, but they all required effort and focus and some combination of equipment. There was no wearing my newborn in a sling and going about my business as she suckled away, no reading books, no idly jotting down precious newborn memories into a keepsake journal, no relaxing and snoozing as we nursed in sidelying repose. Nothing I had pictured my life as a breastfeeder would consist of. Every feeding, 8 times a day, was a major Process.
Pumping, which I did for 15 minutes immediately after every feeding, took less mental energy once I got myself set up
, but I was still immobilized. And I vividly remember how my mind would just SPIN, thinking of everything I should be doing and would be doing as soon as I could leap up and into action. I would think and rethink, order and reorder, everything. Label milk, put into refrigerator, rotate the stock and transfer oldest into storage bags, relabel, put in freezer, clean pumping shields and collection bottles, change diaper, put amount she drank and the diaper onto the logs – NO, WAIT, log the amount she drank first, then put the leftover into the milk rotation, then change her diaper, then . . .
- You feel like you have to be doing something at all times. Cleaning bottles. Cleaning baby clothes. Cleaning the house. Doing work. Entertaining the baby. Checking on the baby.
There were the normal mothering chores and the extra lactation-related tasks I had on my plate, both carried out in a sense of focused franticness, but even healing things became tools of obsession. My lactation consultant (the second one, the IBCLC with whom I worked for months) was very holistic, and she recommended a number of associated things that were meant to support the process. All of them good things, like cobathing, flower essences, homeopathy and EFT, but my own growing mania twisted them. The feeling that I always, always had to be doing SOMETHING was constant.
And it went on like this. One of the things that saved me, in several ways, was actually television. When nothing in particular was on, I turned it to CNN. Not only did this help with the mind mania, but it helped me feel somewhat – somewhat - less isolated. And, ironically, tethered to the real world, even if it was a fictitious one on the surface. The isolation was by far the most damaging factor, though, as a major risk factor for all types of PPMD. This was hard for me to accept, as I’ve always enjoyed time alone, even thrived on high-quality, productive introversion, but for new mothers, solitude quickly turns malignant.
I don’t waste much time on regret, and grueling as some of my experiences have been, I still cherish their lessons, but if I could change only one thing about the whole experience, the decision to live in such solitude would probably be it. I would go for days without seeing another adult, sometimes days without even leaving the house. Daddy did the best he could from afar. My weeks were built around Lily’s regular chiropractic/craniosacral therapy and the nursing support group run by my second lactation consultant, IBCLC Jennifer Tow, the one who finally figured out what was really going on.
Other bullet points that resonated, and by “resonated” I mean “slapped me upside the head”:
- You are worried. Really worried. All. The. Time. Am I doing this right? Will my husband come home from his trip? Will the baby wake up? Is the baby eating enough? Is there something wrong with the baby that I’m missing? No matter what anyone says to reassure you it doesn’t help.
I mentioned one experience in part one when Lily had peed on a heating pad and I completely lost my mind over it. That was the first incident, but it somehow set a theme in motion, I believe. The first time she threw up I was utterly terrified that she was critically ill (I’m talking actual vomit, not just spitup), and every time it happened thereafter it would plunge me into absolute hysterics all over again. The first time I had to drive her anywhere alone was an hour-long drive to the chiropractor/craniosacral therapist, and I may have had the first panic attack of my life merging onto the highway. I think I drove about 40-45 mph the entire time, often on the shoulder, heart pounding, dumbfounded by the fact that other parents seemed to manage to do this all the time, putting their precious babes into shiny metal boxes and hurtling along at what now seemed like impossibly irresponsible speeds.
Those are just a few examples. Suffice it to say that everything panicked me, everything – most of all, her input and output. Repeating from that last bullet point:
- Is there something wrong with the baby that I’m missing?
I described in part one the experience of having my fears about Lily’s issues dismissed only to later be proven right – you can imagine how this affected my parenting and my management of the situation. Actually, you don’t have to imagine it – I have pictures. This says it all, in its way:
Yes, readers, those are my logs. ONE FULL YEAR’S WORTH. I logged every single feeding and every single diaper for her entire first year. I’m not exaggerating when I say “every single”. I never went anywhere without them, perplexing my loved ones. No matter what, I could not change a diaper without noting it. I literally felt physically unsettled, queasy, blood pressure rising, until it was recorded, by time (after the first few weeks, if it was poo, it was noted as such, otherwise simply writing the time indicated a wet one). No, Lily, you don’t have a lovingly crafted scrapbook of your first year, with locks of hair, longhand memories and milestones recorded, but you do have a pile of chicken scratch on paper documenting every nuance of your digestive function. Precious.
And feedings? Oh, how I obsessed over the number of ounces she got per day – something no breastfeeding mother should ever need to do if things are going well. I tracked the number of ounces per feeding and added them up, and if it was less than what a normal breastfed baby was estimated to eat, I was despondent, set off into a whirlwind of worry about what was going on now on top of still not being on the breast. Eventually, when we transitioned to the Lact-Aid, I also tracked minutes spent with tube in use, minutes without, and total ounces consumed. It was positively algebraic.
That leads me to another part of that one bullet point:
- No matter what anyone says to reassure you it doesn’t help.
Many of my late night phone calls (during which various members of the nursing group, Lily’s father, my friends, and Jennifer herself would take turns talking me off the ledge) were absolutely helpful. It lessened the despair, at least for the length of the call. But I know they must have been frustrating for them at times, because I had to run through the same conversations over and over and over. And over. And over. The same reassurances would be offered, and somehow I just could not let them sink in. This particular symptom came up not long ago, when a CLC-in-training and I were working on a case together, where the same information was being given to a mother, over and over, from multiple sources, and somehow it just could not get through. The CLC mentioned this aspect of postpartum OCD being discussed at her training, and I immediately recognized myself in it.
I remember railing to Jennifer about my terror that Lily just was not eating enough, she couldn’t be, she only got 23 ounces yesterday, how can this be happening? and on and on. Jen patiently kept bringing me back to her weight gain, which had been totally fine from week three on, and diaper output, which was more than adequate. This was just not enough to convince me. I’d repeat myself, again and again, she would respond with reason and evidence in the form of diapers, rinse and repeat. Finally, understandably exasperated, she said “Anne, it’s not like she’s taking it from the atmosphere!”
This broke me out of it, at least momentarily, and I laughed, and had a bit more self-awareness come back. My obsession with the logs wasn’t over, I couldn’t let go of them until she was just over a year, but my recollection was that after that conversation, I DID ease up on my fears a bit, as I was always able to come back to the idea that my baby had found a way to metabolize the moisture in the air just to throw off the diaper logs and mess with my mind.
Logs, man. They are a double-edged sword. Proceed with serious caution. They are useful to get an idea of what’s going on at the beginning, especially if you suspect something’s amiss. But I strongly recommend that if everything seems to be going well, DON’T. And even if there are issues, once they start to be resolved, give them up as soon as possible. It just becomes lunacy in the wrong hands.
- You are afraid to be alone with your baby because of the thoughts. You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague.
- You feel like a captive animal, pacing back and forth in a cage. Restless. On edge.
- You have to check things constantly. Did I lock the door? Did I lock the car? Did I turn off the oven? Is the baby breathing?
- You feel a sense of dread all the time, like something terrible is going to happen.
Yep, these too. I never had repetitive thoughts of intentionally harming her, luckily, but I did fixate on the possibility of accidentally harming her, in every conceivable way. The OCD manifested primarily in the logs and the whole ritual that was built up out of the 3 hour cycle of feed, pump, clean and prepare next supplement, then do everything else there is to do in life in between, but these other typical OCD thought patterns were there, too.
- You can’t eat. You have no appetite.
- You can’t sleep. You are so, so tired, but you can’t sleep.
On these physical symptoms, well, in the first case, I had just the opposite reaction, but this is not uncommon if there’s a history of eating disorders, which there is. I initially dropped about 25-30 pounds very quickly in the early weeks, but then I stalled, and eventually, I actually gained a bit of it back. Eating, along with Bravo, Buffy and The Soup, was one of my only sources of solace, and I gave in to it.
If you’re thinking I should have been working out, then, at least, well, sure, that would have been fabulous. I was originally a dancer, after all, and had thrived on yoga and Pilates for years as well. I love exercise. If I have it to do over with another baby someday, you bet I’ll find a way. But aside from walks every few days, I couldn’t bear to have another demand placed on me, especially a physical one, and that’s just the way I felt at the time. Judge me as lazy if you will.
The sleeping, I managed most of the time, though my racing mind would often cause me to take a long, long time to drop off (which I could never do unless EVERYTHING was done and set up just-so). Naps? Forget about it. I could be so exhausted that I was literally fighting off falling asleep at the wheel in the middle of the day, on the way back from nursing group (this happened far too often), and still I couldn’t follow the oldest new parent adage in the books: “Sleep when the baby sleeps.” Impossible. There was just too much to do, and no one else to do it.
One final bullet point of note:
- You are afraid that this is your new reality and that you’ve lost the “old you” forever.
This one cut pretty deep. This was the crux of so much. One of the most affecting things Judy did for me in her first visit, when I was at my most despondent and vulnerable, was to grab my hand, look me in the eye, and say firmly, “It is not always going to be like this.” And though it took longer than usual for us, eventually, she was right. In a broader sense, I’m still working on this in a way, as integrating parenthood into one’s identity is a process, not an event. But compared to the freefall of the first 6 months to a year, I can assure other moms from experience that the best qualities and passions of their former selves are still there, even if on the back burner; hell, even if in cold storage.
She finally began nursing at five months old, but it took a bit longer for the OCD to fully recede. We eventually emerged, slowly, as she neared her first birthday, partly because nursing eventually became so successful that even I, with all my doubts, couldn’t deny that all really was well at long last, and, not coincidentally, because we moved to live with her daddy full-time.
Another difficult admission: It took a long time for me not to feel gripped with jealousy every time I heard a new mother describing her blissful babymoon with little to no relative difficulty, and I still occasionally get pangs, if I’m to be completely honest. But as much as I think is possible, I’ve grown to accept that this was my experience, and that it has its own gifts, especially in the form of my drive to help other new mothers, in various contexts, as my true life calling. (This is also emphatically NOT to suggest that in the absence of challenges like mine, motherhood is always a breeze. Far from it)
The irony is not lost on me. The OCD manifested itself in the things I had to do in order to make nursing work. Breastfeeding was thus both the means of its expression and the very thing that saved me . . .
. . . along with Lily herself, who gave me glimmers of hope all the way through, who continued to draw out my love with her glorious baby self, and who never, ever, ever gave up on me.
Please check out these links on Postpartum Obsessive Compulsive Disorder:
Postpartum Progress: Rate of Postpartum OCD May Be Much Higher Than Current Statistics