One Mom's Journey to Motherhood: Infertility, Childbirth Complications, and Postpartum Depression, <i>Oh My!</i>

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One Mom's Journey to Motherhood

Abbott Press

Chapter One

Before I begin to share my story and what I've learned from my PPD experience, let me provide you with the following eye-opening statistics. Per the World Health Organization (WHO) report from 2004, depression is the third most disabling condition worldwide. In the year 2030, the WHO estimates that depression will be the number one disabling condition across the globe, with ischemic heart disease and traffic accidents coming in second and third. Women are 50 percent more prone to depression than men. The WHO indicates that mental disorders contribute to healthy life years lost among women between the ages of 15 and 44, which happens to represent the average span of a woman's reproductive life.

Studies have shown that a woman has a greater risk of being admitted to a hospital for a psychiatric episode within the first year postpartum than at any other time in her life, particularly the first month, with peak prevalence of and hospital admissions for psychiatric episodes occurring during the first six weeks postpartum.

Generally speaking:

1. Approximately one out of eight new mothers experience PPD. In New Jersey, between 11,000 and 16,000 women suffer from PPD each year.

2. Approximately eight out of ten (or 80 percent of) mothers experience the "baby blues."

3. Research has shown that less than half of those who experience PPD ever seek medical help.

4. Anxiety is a common symptom of depression. In fact, anxiety disorders occur in 4.7 percent of pregnant patients.

5. PPD is a term often applied in a general way to a spectrum of disorders that can affect postpartum mothers, including (aside from postpartum depression):

• Postpartum panic disorder: Occurs in up to 11 percent of women following childbirth.

• Postpartum OCD (obsessive compulsive disorder): Occurs in approximately 3–5 percent of women following childbirth.

• Postpartum PTSD (post-traumatic stress disorder): Occurs in approximately 1.5–6 percent of women following childbirth.

• Postpartum psychosis (PPP): Occurs in approximately 1-2 of every 1,000 deliveries. There is a five percent infanticide/ suicide rate associated with PPP, which is why immediate treatment is required.

Antenatal (or antepartum) depression:

1. Approximately one out of ten women experience antepartum depression (depression during pregnancy), though many cases are undiagnosed. Depression during pregnancy can lead to premature labor and delivery, not to mention low birth weight babies. Depression and anxiety during pregnancy can also cause bleeding and even miscarriage. In fact, there is a correlation between severe anxiety in pregnancy and a heightened startle response and/or colic in newborns.

2. Untreated cases of depression during pregnancy have a 50 percent chance of worsening after childbirth. Depression during pregnancy generally does not go away once the baby is born.

3. Per Michael O'Hara, a research psychologist at the University of Iowa, 25 percent of women with the baby blues will go on to develop PPD.

Risk for PPD

1. The child of a parent with a mood disorder will be approximately three times more likely to develop one too.

2. Studies have shown that women with versus without a history of depression have a 25 percent versus 10 percent chance of developing PPD, respectively.

3. One in five women with bipolar disorder will experience PPD.

4. Per Venis and McCloskey, "The single greatest predictor of PPD is a previous episode of PPD. You have approximately a 50 percent chance of developing PPD again with subsequent deliveries if you sought help the first time, and the odds increase even further (to 66 percent) if you didn't."

5. There is a 60 percent increase in the risk of developing a postpartum mood disorder in women with a personal and/or family history of clinical depression, anxiety/panic disorder, eating disorders, PPD, PMS (with emotional symptoms like significant mood swings and teariness), OCD, or bipolar disorder.

6. Once you've had PPD, you have a 50 to 62 percent chance of experiencing it again. Chances increase to 70 percent if you've already had two episodes of PPD.

7. The risk of the recurrence of postpartum psychosis has been estimated as high as 40–60 percent. One study even shows the risk is 100 percent for women who give birth within twenty-four months of their previous episode.

8. Per Lusskin et al, "First-degree relatives of patients with depression are 1.5 to 3 times more likely to develop depression."

Partners and PPD

1. Studies indicate that nearly one-third of women with PPD have a1. partner who is also depressed.

2. Approximately 10 percent of men experience postpartum depression, with rates being higher during the first three to six months postpartum.

3. Research shows that the occurrence of paternal depression can be as high as 50 percent when the mother has PPD.

Chapter Two

For the first few weeks after delivery, I shed tears of joy. Later, I shed tears of anxiety and guilt that seemed to all start on the day after my six-week postnatal exam, after Ed and I took Sydney in for her one-month exam. The pediatrician asked us if we were considering hiring a nanny or leaving Sydney at a day-care center. We told her we decided to go with a day-care center. She asked us what the ratio of providers to infants would be and we said 1:4 but that there would be two providers and eight infants under twelve months old. That's when she frowned and warned us that we should expect Sydney to be sick for half the year with respiratory ailments from being in one room with more than four infants at a time. As soon as she said that, it was like she turned on my anxiety switch. I started to obsess that I'd be responsible for making Sydney sick.

Right about that time, Ed came down with the flu. Try as I might, I couldn't avoid coming down with it too. My greatest fear at the time was giving the flu to Sydney. Fortunately, she didn't come down with it, even though Ed and I both coughed like crazy for two weeks. They say that the immunity of newborns is boosted from the nutrients they get out of breast milk. It made me feel so gratified that my effort to pump milk was already deriving benefits for Sydney!

And on top of everything, I was breaking out in massive numbers and sizes of hives every day. The only places my hives didn't appear were my back, shoulders, and calves. Occasionally, my top lip would swell as if bitten by an insect. This, I later determined, was a more severe reaction called an angioneurotic edema.

Insomnia Sets In

On my 45th day postpartum, I suddenly couldn't sleep at all, even though I was completely and utterly exhausted from sleep deficiency that started at the hospital and never let up. When I told my OB/GYN about my not being able to sleep, he automatically prescribed Ambien, which he instructed me to take as needed. Since I wanted to see if I only needed half the pill to help me sleep, for the first three nights I broke the ten-milligram pill in half. But then the doctor's office advised me to take the full tablet each night, as prescribed. Before I knew it, I needed to take an Ambien to sleep each night. Since both the doctor and directions for the medication indicated that I needed to be able to devote seven to eight hours to sleeping, I had my doubts about taking the medication since I had to get up during the night and feed the baby. But then Ed so graciously offered to do the late-night feedings until I got better. I felt so guilty about that, since he was the one that had to go to work early each morning.

There was a window in which I had to take my Ambien each night. The fear of waking up too early was a primary factor in my daily ritual of calculating the time I should take the Ambien. Ambien was so effective that I could sleep so soundly for six to eight hours straight that I wouldn't even hear Sydney cry during the night. That was a bad thing. Setting the volume for the baby monitor, which we kept next to Ed, was tricky too, since if it was set too loud, I could even hear the humidifier running in Sydney's room, while Ed normally can't even hear our multiple alarm clocks go off on a regular day. Of course, we didn't want to let the baby cry too long from hunger! Before I went to sleep each night, I had to sit there and calculate what time I had to take the Ambien by in order to be sure that, once Ed left, I would be able to hear the baby cry. Since what time the baby woke up in the morning would depend on what time she was last fed/went to sleep the night before, the schedule changed each night. For example, if it took thirty minutes to one hour for the Ambien to work and the warning labels for Ambien stated that I needed at least seven hours of straight sleep to prevent memory loss, I had to take the medicine by 10:30 p.m. latest (to make sure I fell asleep by 11:00 p.m. and was out of deep sleep by 6:00 a.m.).

Later on, my pharmacist indicated that my doctor should've started me at a lower dosage of five milligrams instead of ten milligrams. A patient is typically not supposed to start at a higher dosage right from the start. I told myself that I'd become dependent on Ambien and would never again be able to sleep on my own. Not knowing that I was afflicted with PPD, I felt like I was going crazy and would never be the person I was before I became pregnant. I felt hopeless, since no one else could empathize and no one could provide me with any advice or comfort. It was like I was isolated, in my own world, where no one could help me. All my fears fed themselves in one cruelly vicious and nightmarish cycle.

Next Came the Panic Attacks

I kept trying to see if I could get myself to fall asleep without needing the Ambien. I wanted to prove to myself that I wasn't totally losing it, that I wasn't going to be dependent on Ambien to sleep for the rest of my life. I tried many different natural sleep remedies suggested by my mom and friends, including deep breathing exercises, drinking some kind of vinegar concoction, and putting lavender oil on my pillow. I'd be lying there for one hour ... then two hours ... then three hours. As the clock ticked away, I grew increasingly more agitated. I would eventually cave in and take the Ambien.

I was consumed with guilt that, not only did Sydney start sleeping in her own bedroom a lot earlier than we'd originally envisioned, but Ed resorted to sleeping on the couch in his den each night starting from the time I tried to fall asleep without Ambien so his snoring wouldn't keep me awake. After a week or so of sleeping on the couch, which was hurting his back, he moved to the living room floor (not the couch because the couch there has even less support than the one in the den). At the time, we didn't even think to get an air mattress. Sounds pretty bad, I know. I had to live with that then, as I have to live with the memory now. He really sacrificed quite a bit during the months I suffered from PPD.

On Sunday, February 13, I tried to substitute Ambien with Tylenol PM on the advice of one of the nurses at the OB/GYN office. Thinking that I was saved from dependency on Ambien, I was thrilled and relieved at having stumbled on such a simple over-the-counter remedy. When I took the Tylenol PM and it didn't help me sleep at all, but in fact made me feel worse—I had trouble breathing and my head started to spin—I had my first panic attack. I was frantic. I waited as long as I could before paging my OB/GYN. I knew I should only do that for emergencies, but I didn't know what else to do. I needed someone to talk to. He didn't sound pleased at all when I explained what had happened. I explained that I was still experiencing insomnia and experiencing what seemed to be a panic attack because I was out of Ambien and Tylenol PM didn't work for me. I asked if he could prescribe me some more Ambien. He said "I'm afraid not. I can no longer help you. You need to see your regular doctor." Yes, that was exactly what he said. Since I didn't know any doctors nearby—my then General Practitioner (GP) was a twenty-five minute drive away—he referred me to his own doctor in town.

Right at nine o'clock that morning, Monday, February 14 (Valentine's Day), I called to make an appointment with that doctor. He had an opening for me two days later. Two days is not a really long time in a normal person's perspective, but from a panic-stricken person's perspective it felt like an eternity. I had to force myself to get through the next two days without being able to consult with anyone. It was such an awful experience ... quite beyond words.

During my appointment on February 16, I told this new doctor what was going on (reiterating the fact that I had had a baby on December 10, I had my uterus removed on December 13, exactly six weeks later I started experiencing insomnia, and have been on Ambien for the past two weeks). All he did was prescribe me more Ambien. I had another panic attack that night. I felt so helpless and needed to talk to someone so badly that I paged the doctor. I left a message for him, apologizing for feeling compelled to call him despite the fact that this was not a medical emergency. He did not call me back.

The next day, February 17, the nurse called me back saying that the emergency number was for medical emergencies only. I explained what was going on and she scheduled another appointment for me that afternoon. I came up with a list of questions and a detailed explanation of what I was experiencing, which I thought might help him with my diagnosis.

The first thing I did when I saw the doctor the next day, February 18, was apologize to him for having felt the need to page him. I'll never forget his response to me, while shaking his head with disdain: "That's not good ..." Back then, I was upset with that remark. Today, I am furious with that remark. Granted, the doctor had never met me before, didn't know me, and had no prior experience with treating me as a patient. Therefore, he had no basis for comparing my healthy state with the state I was in under the influence of PPD. However, he should've just let it go as, "Okay, please don't do it again. If you need to talk to someone, you can call Postpartum Support International or your local hospital's PPD Support Group." When I asked if he knew of someone for me to talk to, in an uncaring, nonchalant sort of way he told me he didn't and gave me this look like, "Why should I?" This is a prime example of what I refer to as silos among the different aspects of health care with an invisible yet clear separation between medical and mental health care. I wholeheartedly believe that, if a patient sees her doctor about any health care concern, even if the doctor doesn't specialize in whatever it is she is ill with, he should be able to respond with concern and provide appropriate referrals. In my honest opinion, having a panic attack is extremely scary and deserving of a call to the doctor, even if it's at the terribly early hour of 9:00 a.m. on a weekday when the office hasn't opened yet or on a weekend when the doctor doesn't have any hours.

During that appointment, the doctor listened briefly to my symptoms and prescribed Paxil (antidepressant) and Xanax (for the panic attacks). I told him I understood why he'd prescribe me an antianxiety medication like Xanax, but why Paxil? He explained that Paxil is usually prescribed for depression, but his explanation at the time didn't help me understand why and I certainly didn't think that I was depressed. He reassured me that the Paxil is not addictive but Xanax can be addictive so I had to take that only when I absolutely had to. He warned me that it would take at least four weeks before the Paxil would take effect. And let me tell you that the next four weeks felt like an eternity to me. It used to be that there weren't enough hours in a day, with my main complaint being that time was flying by way too fast. Now each day crawled by as if there were forty-eight hours in a day. It was tortuous. He had me take 12.5 milligrams of Paxil every day for one week, at which point I would have to double the dosage and stay on it for several months.

(Continues...)

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Excerpted from One Mom's Journey to Motherhood by Ivy Shih Leung Copyright © 2011 by Ivy Shih Leung. Excerpted by permission of Abbott Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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