For as long as I can remember, I wanted to be a mother. As a child, I have clear memories of poking my little tummy out with a stuffed animal in my shirt, pretending to be pregnant.
Fast forward 20 years, I was married, at the end of residency, my 3 best friends had all just had their first babies and I got THE FEVER!!! It took 5 months (which is not actually a long time at all but felt like forrrevvvverrrr) but it happened! I was pregnant!
That was where the excitement ended. I got
morning all day sickness from week 5 that was relentless. If you’ve had morning sickness – now imagine having it while having to examine infected toenails of vagrants or while talking to a chain-smoking person into quitting or while a woman in labor is herself vomiting and pooping on the bed. I lost 15 pounds in my first trimester.
Then came headaches, insomnia and fatigue combined, sciatica, pubic symphysis pain, round ligament pain so sharp I would cry out, then premature contractions and labor scares. I was NOT basking in my joyful pregnant glow. I was confronted day to day with women with infertility, pregnancy loss or worse so I felt unbelievably guilty about any negative pregnancy thoughts. But I. was. miserable.
At 39 weeks 3 days of pregnancy, I was still having on and off contractions as I had been for 2 weeks. During my morning clinic, they got progressively stronger and were coming every 5 minutes. I called my afternoon clinic and told them I wouldn’t make it. Rosalyn Elizabeth was born 12 hours later. I was so excited! Labor and birth had been (relatively) easy for me. My baby latched well. I was finally going to get my motherhood bliss on!
3 days later, post-partum anxiety and depression hit. Hard. I naively thought since I was used to working 30 hours at a time with no sleep that having a baby wouldn’t be that much worse. But, in parenting, there is no “post-call day” that you sleep for 8 hours and recover. Hormone sh*% hit the fan and I remember sitting up in bed in the night, tears streaming down my face, seriously contemplating leaving the baby with my husband and running away to Mexico. I wanted this baby so badly, but I had never been more depressed. What was wrong with me??
I thought I had “baby blues”. I struggled through. I hated motherhood. Week 6 hit and I had to go back to work. I couldn’t stop crying and was in a panic about how to get through a day of clinic when I broke down doing things like making toast. The day before, I scheduled a last-minute appointment with one of my attendings (the boss-doctors). It finally dawned on me that she had given us a lecture on post-partum depression. She had admitted that she had it too.
We had both been taught – AND taught others – about this but fell into it without recognizing it ourselves. I started Zoloft and though it’s theoretically not possible for the full effects to kick in that fast, within 2 days I was well on my way to being a (mostly) normal person again.
When you are in the depths of that kind of depression and anxiety it is nearly impossible to even recognize there is another way to be. Of course you worry about your baby. Of course you feel guilty for not getting things done the way you used to. The issue is when this prevents you from living a relatively normal day to day life. One in seven women will experience postpartum depression. There is a lot More Information In This AAFP Article. It can hit any time between 1 day post-partum through the first year, but the peak is 2-4 months of baby’s life and it can harm not only mom but baby too. It’s harder for bonding, breastfeeding and nurturing when mom is suffering from PPD.
The screening tool for depression we traditionally use is SIGECAPS:
- Sleep issues? check.
- Loss of interest? how could you possibly do anything fun when the baby takes all your everything, so check.
- Guilt? Oh man, there is no guilt like mom-guilt.
- Decreased energy? duh.
- Lack of concentration? what was the question?
- Changes in appetite? Does EAT ALL THE THINGS count as appetite?
- Psychomotor retardation (aka do you move slowly)? Took 2 hours to get dressed, so, yeah.
- Suicidal thoughts? This one is less universal. But was there for me. Never in an active way, but did I think “wouldn’t they be better off without this useless lump of human?”, yes. I did.
A few positives, some of the time, yes, is “baby blues”. I hit all of the above. every. day. of that time. But I still couldn’t visualize a happier me. So when that serotonin finally hit my struggling brain cells, it was an absolute revelation. I wanted to shout from the rooftops “YOU DON’T HAVE TO FEEL THAT WAY FOREVER!!”. Yes, I still worried about my baby, but I no longer stayed up for literally days on end because I was convinced she would stop breathing in her sleep. Yes, I still felt a little guilty about not getting stuff done, but I no longer felt like the world would be better off without me if I didn’t get the laundry folded.
That’s the thing about depression and anxiety treatment – it’s not meant to make you a zombie or to fix all your problems. The medicines can help your brain chemistry. The therapy helps you retrain your wayward thought processes. You also need to fix what is lacking – not enough social support? thyroid out of whack? not sleeping when you can? not eating well? Treatment helps you get back to normal, which is, yes, tired, out of your comfort zone, but mostly happy.
There are a lot of resources for parents with anxiety and depression, but the most direct access to care is usually your primary pregnancy care provider. Your family doctor, OB or midwife can help you get therapy, medication and other treatment or testing. If this is you, ASK for help. If this is your friend, partner, sister, colleague – share this story with them.
As you may have noticed, I got “momnesia”, forgot all of the above misery and decided to have another baby. I had been able to wean off the meds after about 6 months and was back to my usual
crazy awesome self. This time, week 4 post-partum, when the all-day crying jag hit, I knew what to do. I called my doctor and got treatment right away again. Wouldn’t you know, it went so much better, now I want a third baby! I could never have been as effective of a primary care doctor myself had I not gone through all of this. We live and we learn and life is a beautiful adventure that way.
Annie is a mama and family physician in California.