Eighteen years ago, I sat on the edge of the hospital bed in labor with my first child. My face was buried in my husband’s chest, into his worn, faded green sweatshirt. To a woman with a dilating cervix, it was soft as cashmere and deep as the ocean.
We were married just over a year and eager to start a family. Our eagerness escalated to urgency when I had an ovarian cancer scare six weeks after our wedding.
I woke in the middle of the night, clutched by the worst pain I had ever felt, and underwent emergency surgery within hours.
Fortunately, the mass revealed by an ultrasound was not a tumor, but a ruptured ovarian cyst. The tremendous pain was caused by the effusion of blood into my abdomen.
Though I'd lost only a portion of one ovary during the surgery, the doctor warned that scar tissue could affect my fertility. If we planned to have children, we shouldn’t delay.
In our little house in Scottsdale, Arizona, my husband and I painted one room periwinkle blue, and my dad papered one wall in diminutive blue and green flowers. I taught myself to cook from cookbooks I received at our wedding shower.
My point is, this baby was planned for, nested for, wanted.
Back in the Delivery Room
After nine hours of labor — during the last two of which the nurses whispered about the baby being in distress and hissed, “Where is the doctor?” — I was rushed to the OR for an emergency C-section.
At my prenatal visits, the baby had been measuring on the large side. To avoid birthing a 10-pound baby, my OB/GYN recommended induction two weeks early. I trusted his judgment, not knowing that induction increased my risk of C-section.
During the C-section, the OB/GYN nicked my bowel.
The perforated bowel required extensive flushing of my abdomen with sterile water and the skills of a surgeon — a surgeon who was delayed because nurses who didn’t know he had been summoned repeatedly turned him away.
After these nine difficult hours of labor I had an extended time on the operating table, and complications.
But here he was, my sweet boy, 8 pounds, 12 ounces — big for two weeks early. He was serene and wise, and not one to fuss much.
Visiting before we were released, my OB/GYN sat on the edge of my hospital bed. I asked him why I had ended up with a C-section.
“You just need to be grateful that you have a healthy little boy in the next room,” he said.
I’m no expert in obstetrics, but I suspected it was a little more complicated than his paternalistic answer indirectly accusing me of ingratitude.
I made a mental note — a different doctor would deliver my next baby.
A Hundred and One Reasons Not to Sleep
The baby was diagnosed with jaundice. Eighteen years ago, the standard treatment of newborn jaundice was to send the parents home with a light box.
The box was the size of an aquarium — which, like an aquarium — glowed blue. We velcroed a tiny white blindfold on the baby and laid him in the box the first two or three days that he was home.
A curtain of heavy, clear plastic draped the front, and to ensure the little fellow wasn’t overheating, we were required to take his temperature every hour on the hour.
So picture this. I am home from the hospital, moving tenderly with a stitched-up gut, a bit shell-shocked, trying to learn to nurse every hour or two.
My baby is in a plastic box, which buzzes like an electric fly zapper, smells of hot plastic, and emits a blue glow. We are not sleeping more than 60 minutes at a stretch.
Parents who are worried about their newborn overheating, and who set the alarm clock to wake themselves every hour, don’t sleep. They just don’t.
I began to lose my mind.
I was taking painkillers and was seriously sleep-deprived. The little sleep I did get was flush with vivid nightmares.
In one, threatening people were crawling in through all the windows of the house.
In another, my husband and I left the house, forgetting the baby, and the house caught fire. We were lost in hilly, winding Yugoslav streets where we didn’t speak the language, and couldn’t find our way home to save him.
The common theme — the baby is vulnerable, and I am unable to protect him.
First there were the nightmares, then began the inconsolable, desperate crying. I was breast-feeding my son, slammed by a rush of oxytocin each time my milk let down.
For me, the oxytocin, rather than serving to relax and bond me to my newborn, sunk me even deeper into despair. Every time the baby latched on, I felt as if the ground gave way beneath me.
I fell into a mire of inadequacy, overwhelming responsibility, and impending doom. I had postpartum depression.
Instead of cooing and bonding with the baby while breast-feeding, I buried myself in Amy Tan novels while I nursed, escaping into the complexities of Chinese society in an attempt to alleviate this free-falling, bottomless sadness.
A Perfect Storm of Risk Factors for Postpartum
What I didn’t know then was that a domino effect of circumstances had made me especially vulnerable to PPD. Not surprisingly, a history of depression is among the risk factors for postpartum depression. Having a C-section is also a risk factor for PPD.
A 2008 study elucidates the link between C-sections and postpartum depression.
MRI scans of women’s brains after childbirth showed that those who delivered vaginally had more brain activity related to emotional responsiveness and sensory processing than women who delivered via C-section.
In addition, according to VBAC.com, “Women who have a surgical birth are more likely to experience feelings of loss, grief, personal failure and lower self-esteem.”
Finally, I lacked social support. Psychological scientist Wray Herbert proposes that postpartum depression is a disease of modern civilization.
“Hunter-gatherer families lived in kin groups, with aunts, grandparents and older siblings to assist mothers with the youngest children. But today’s families are spread out and, in addition, modern families have few children spaced closer together—all of which adds up to a greater childcare burden for modern mothers,” he wrote.
My mother lived only blocks away, but her singular contribution was to hold the baby. She held him while we slept one night, and she visited after work to hold him. But the nuts and bolts help, the errands, grocery shopping, tidying, meals and laundry that arrived with the baby — no.
My mother-in-law, on the other hand, hummed like a well-oiled machine, efficient and productive. She had raised six children — had Napoleon enlisted her help, they would be speaking French in Russia now.
But she lived far away in Chicago.
Fortunately, my mother-in-law did fly in for a week — twice. She returned our home to order and routine. She restored within us the sacred, primeval knowledge that babies are born, and families adapt, and life goes on as before.
But then she had to leave.
My inability to coo and connect, the magnetic pull of “The Kitchen God’s Wife” being stronger than that of my precious baby, and my despair, were a soup of inactivated brain centers, physical exhaustion, traumatic birth, and a lack of social support.
Inducing Irritability
After a night or two of tears, my husband called the OB-GYN and explained my symptoms. This doctor — this obstetrician-gynecologist — prescribed a sleeping pill and SSRI antidepressant over the phone for me, sight unseen, without any type of examination.
By nightfall, I had my pills on board and I was good to go.
As time progressed, I was more functional, feeding the baby, running the house, cooking dinner. But I was as prickly and unforgiving as a nettle patch, high-strung and angry — a bad mother.
Now that I was on antidepressants, whatever was wrong with me had to be my fault. I should be content, nurturing and grateful, and the fact that I wasn’t, even with pharmacological help, was evidence that I was just a bad person.
For years I was prescribed Prozac or Paxil or Zoloft without the benefit of a psychiatric evaluation. Two different obstetricians prescribed them, and my GP prescribed them.
Victoria L. Dunckley, M.D. refers to this practice as “a dangerous game” in an article in Psychology Today.
“These medications can occasionally have a paradoxical reaction, meaning that instead of having a calming effect they cause disinhibition, agitation, or even psychosis,” Dunckley wrote.
And that is exactly what happened, first with the irritability, snap judgment and anger, which left me ashamed and discouraged. You’ve seen mothers like me at the store, snapping at their children for sneaking candy into the cart, their indignation disproportionate to the offense.
Then I started rapid cycling. Like the blades of a windmill, my emotions whipped from the “highs” of agitation, insomnia and rage, to the depths of debilitating inertia and depression, round and round, sometimes several times a day.
I became so ill that I eventually made it to the right caregiver, a psychiatric nurse practitioner. And finally, in 2002, six years after my son was born, I was diagnosed with bipolar II disorder.
I wasn’t a bad mother. Rather, I had an illness exacerbated by SSRIs and the misjudgment of doctors who had minimal psychiatric training.
The GPs and OB/GYNs who prescribed me the SSRIs may have asked, preemptively, if I had periods of emotional highs, spending sprees and hyper-sexuality — the symptoms of bipolar I disorder — but I did not experience these things.
Melancholic since earliest childhood, I was generally low-energy and inhibited—markedly not bipolar.
I sometimes had what I now know to be hypomania, a common symptom of bipolar II disorder, characterized by periods of increased creativity.
However, I’ve never heard a doctor ask, “Do you find yourself sometimes inspired to spend five hours straight writing a poem?” They don’t ask that.
“Women’s emotionality is a sign of health, not disease; it is a source of power,” Julie Holland, a psychiatrist in New York, wrote in the New York Times article “Medicating Women’s Feelings”.
We should treat women’s emotions, their postpartum depression, as a reaction to the physical strain of birth and isolation, as they transition into the sometimes fearful and often lonely challenge of new motherhood.
Facilitating low-stress, least-possible-intervention births, and reducing C-sections, as well as increasing social support, should be the standard of care. When a patient presents with PPD, obstetricians should have the authority to prescribe postpartum doulas.
Psychiatric medication should be the exclusive purview of specialists trained to properly diagnose, treat and monitor women for side effects. Medication should complement, not complete, postpartum care.
Today my son is a young man headed to college. He is still reserved and quiet like his newborn self. He is self-conscious, sensitive to criticism, and easily wounded.
I’ll never know if that’s just his nature, or the result of our first years together, when my best intentions at mothering were tangled in side effects and failure.
My story is almost a generation old. Hopefully my experience is ancient history and unrelatable, but if any young mother does see herself reflected here, I hope it helps her on her journey toward wholeness.
Be brave and be well.
Sources:
Ovarian Cysts. MayoClinic.org. Retrieved March 10, 2015. http://www.mayoclinic.org/diseases-conditions/ovarian-cysts/basics/causes/con-20019937
Maternal brain response to own baby-cry is affected by cesarean section delivery. NIH.gov. Retrieved March 19, 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246837
A Dangerous Game: GPs Prescribing Psychotropics. PsychologyToday.com. Retrieved March 16, 2015. https://www.psychologytoday.com/blog/mental-wealth/201303/dangerous-game-gps-prescribing-psychotropics
Labor Induction Risks. mayoclinic.org. Retrieved March 18, 2015. http://www.mayoclinic.org/tests-procedures/labor-induction/basics/risks/prc-20019032
Rapid Cycling And Mixed States As “Waves”. psycheducation.org. Retrieved March 23, 2015. http://psycheducation.org/diagnosis/mixed-states/rapid-cycling-and-mixed-states-as-waves
Is Postpartum Depression a Disease of Modern Civilization? psychologicalscience.org. Retrieved March 20, 2015. http://www.psychologicalscience.org/index.php/news/were-only-human/is-postpartum-depression-a-disease-of-modern-civilization.html
Medicating Women’s Feelings. NYTimes.com. Retrieved March 20, 2015. http://www.nytimes.com/2015/03/01/opinion/sunday/medicating-womens-feelings.html
Reviewed March 25, 2015
by Michele Blacksberg RN
Edited by Jody Smith