When Postpartum Packs a Punch offers solace to mothers who have faced traumatic birth and perinatal mood disorders, as well as a chorus of different voices-parents, experts, and researchers. All are singing the same song: while the U.S. has made strides in caring for new mothers, we still have far to go. Stigma silences women, and blinds those on the sidelines. Stories of others' struggles are an antidote for stigma, because they let mothers know that they're not alone.
Kristina Cowan describes her own experience with traumatic birth and postpartum depression, and weaves it together with stories from other parents. Representing diverse backgrounds and perspectives and underscoring the prevalence of mood disorders after childbirth, these stories serve as a balm. They help heal and stir hope. And they show how an overcoming spirit can fight terrors of the mind-and win.
In praise of Cowan's debut book:
"Journalist and debut author Cowan explores postpartum depression (PPD) and other birth-related mood disorders in this informative yet personal text. After her first baby was born, Cowan was steeped in sadness; motherhood was not proving the joyride she had expected. The author sought help, finding it in a mixture of antidepressants, therapy, and her religious faith. Inspired to investigate further, she gathered the stories of other mothers suffering from postpartum disorders. (Interestingly, like the author, a number of women interviewed for the book went on to help others after experiencing PPD themselves). Cowan alerts readers to symptoms, risk factors, and neurochemical causes; outlines common therapies and medications; and defines the five major perinatal mood and anxiety disorders, including postpartum psychosis, a rare but serious condition. She also shares the stories of dads who have faced paternal postnatal depression. Talking about the issue and sharing experiences, the author notes, are important ways of addressing a subject often buried by shame. This powerful and useful book will be a boon for women facing any of these devastating postpartum disorders."
"Are you feeling the punch of the postpartum period? Many new parents do. But in her book, When Postpartum Packs a Punch, Kristina Cowan helps the reader understand the scientific and personal sides of this often-unanticipated problem. This well-researched and well-written book can help you see that you are not alone in your struggle, and that there is help."
-Dr. Jonathan S. Abramowitz, clinical psychologist, professor, and international expert on OCD and anxiety disorders
"Most books on perinatal mental health do not give a full chapter to trauma related to childbirth. Kristina Cowan interviewed the leading experts in the field and the chapter on birth trauma is beyond excellent. It is informative, accurate, and provides hope to anyone who might be struggling with this difficult experience. I appreciate the information she provides on the recommended treatment. This exceptionally written book should be recommended to anyone working in the field of perinatal mental health."
-Shannon Kane, postpartum therapist in Alberta, Canada
"'First I had a baby. Then I felt crazy.' Such a powerful and poignant beginning to this important book on postpartum illness. What Kristina Cowan offers goes way beyond the courage of sharing her own and other personal stories. When Postpartum Packs a Punch speaks the language that postpartum families long for; it is rich with compassion, hope, and much-needed resources. This book is hugely informational, it is comforting, it is healing."
-Karen Kleiman, MSW, LCSW Founder of The Postpartum Stress Center, and author of Therapy and the Postpartum Woman and The Art of Holding in Therapy
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About the Author
Read an Excerpt
First I had a baby. Then I felt crazy.
My first taste of motherhood was hardly the honeyed bliss women dream about. My son, Noah, arrived in March 2009 on the heels of a complicated birth that left me injured. A day after I brought my baby home, I was in the emergency room. Wracked by pain worse than childbirth, I believed I might die and strand my child.
A week later, I started crying. I couldn't stop. I couldn't always explain the tears, even to myself. My head swelled with images of the baby plummeting down the trash chute. I wanted my old life back, the one where I was in control.
The idea of being labeled an unfit mother troubled me. Someone would surely take Noah away from me. More troubling was what might happen if I did nothing. Would I get worse — hallucinate, maybe, or fall far from reality? My fear of the unknown trumped my fear of stigma, so I sought help. First, I prayed. My prayers were mostly nonverbal, tear-soaked pleas. I read from the Book of Psalms. I asked for prayer from those closest to me, and tabled my writing career. My mental and physical health had to come first. I needed to sleep. I wanted to exercise.
After a few weeks, I called my OB/GYN and shared my symptoms. Above all, I said I was scared. I didn't feel like myself. She quickly treated me for postpartum something. She prescribed antidepressants and referred me to a talk therapist. At first it wasn't obvious what I was fighting. Later, it was clear I had symptoms of a perinatal mood and anxiety disorder (PMAD). I doubted anything could make me well — not medicine, and not God.
I was wrong.
Soon, my body and mind were on the mend, and I shared my story with my husband, friends, and family. Talking is a form of therapy, even when it's informal, and as long as the listener is interested. So I kept talking. I wanted to get well for my child, my husband, and myself. The seeds of my healing were rooted in those conversations. Others said hearing about my trials put them at ease to share theirs — in some cases, for the first time. They were empowered by relating their stories, and I knew I wasn't alone.
Some nights, I would fall asleep imagining Jesus, a towering figure sitting in a rocking chair, and I would grab his hand. In the past, when others spoke of such tactics, I figured they were zealots or weak-minded. Now I realized that, like me, they had reached the end of themselves. Admitting I needed God's help was akin to walking out on a tightrope stretched over a canyon, and the only thing that steadied me was my faith. I was supposed to be a parent, but I felt like a child, desperately leaning and somewhat blind. In that darkness, I collided with the generosity and compassion of God's spirit. Only suffering could have sent me to those glorious depths.
What's at the Heart of This Book?
The better I felt, the more clearly I understood what happened: the physical and mental trauma I faced during childbirth, and the days just after, triggered my mood disorder. I wondered if others had similar encounters. I revealed my story within my small social circle, and discovered that several women had either dealt with birth trauma, mood disorders, or both. I had known some of the women for years, but I didn't know what they endured after childbirth. If the women I knew hid their troubles, surely women in the general population had done the same. I suspected birth trauma and mood disorders were far more pervasive than most people considered them to be.
I wanted to find out.
I would ask more questions, conduct formal interviews, and do extensive research — all second nature to me as a journalist. Why wasn't there a book offering the sort of encouragement I gathered from others? It certainly would help. Holding a book in my hands with testimonies from others would be proof that I wasn't dreaming up my illness, and that I was part of a larger community. Such a book could help others, too. So I set to writing it. The result rests within these pages: the book I wanted, but couldn't find, one that explores stories of birth trauma and mood disorders, and offers solace.
As I expanded my research to the general population — and after having my second child, with no trauma or mood disorder — I came to believe that childbirth is naturally violent, even if no physical or mental upset are involved.
There is no graceful, easy way to extract a mini-human being from its mother's womb. She must bear a series of internal explosions, also known as contractions, sometimes for hours on end. Not unlike a soldier in combat, she's vulnerable and faces uncertainties. The stakes are life-and-death. She's saddled with gear, in the form of monitors and needles, and possibly pumped full of medication that may or may not agree with her system. Even without interventions, such as forceps or an emergency cesarean section, she braves a unique battlefield.
Though my story is woven throughout this book, its core lies in the words of the mothers and fathers I have interviewed. They're diverse in their backgrounds and perspectives, and their voices underscore the prevalence of mood disorders after childbirth. They show how an overcoming spirit can fight terrors of the mind, and win.
The book is divided into three parts. Part One covers the different PMADs, Part Two focuses on healing and recovery, and Part Three looks at the progress we've made in treating PMADs, and the work we have yet to accomplish. In addition to stories from parents, experts weigh in with their perspectives and experiences, and research is included throughout.
Each parent I spoke with navigated a different path to wellness. Some women called on their husbands, friends, and family. Others relied on therapists, medicine, or alternative remedies. Still, others pointed to mothers' groups, churches, or their faith as key. While each situation was unique, the women and men agreed that increased awareness is necessary to fight the illnesses and their stigma.
Two areas of the book are of particular importance to me: Chapter 6, on stigma, and Chapter 7, on husbands/partners. Western culture gives little more than a superficial nod — if that — to these subjects. Perinatal mood disorders are treatable illnesses, yet most cases are overlooked and untreated. Why? Stigma is one of the culprits. Women don't seek help out of fear they'll be labeled "crazy" or "bad mothers." Because spouses/partners are a new mother's first line of defense, they should know the warning signs for mood disorders, and what to do if they suspect she's struggling. Men also need to set up support for themselves and ask for help, because they too can get PMADs.
It took me more than a year to reach a place I considered solid emotional ground. Not all mothers are as fortunate. Some suffer silently. In the rare-but-worst cases, they take their own lives and/or their children's. One way to stem this plague is in sharing stories — our own, and those of women we love. By saying, "I've been where you are, and it's awful. But I got through it, and so will you," we show new mothers they're not alone. We offer hope, which is the heart of this book.
My pregnancy with Noah was uncomplicated. We were healthy, as happy as two people sharing one body can be. I opted to induce labor 3 days before he was due. I wanted my OB, who was on call that day, to deliver him.
Picking a date to have my baby offered me the illusion of being in control. It put me at ease until the night before, when I couldn't sleep. I greeted induction day in a haze of nervous exhaustion. Soon after my husband, Matt, and I arrived at the Chicago hospital at 7 a.m., we learned I was already in the early stages of labor. To speed things along, the nurse hooked me up to a stream of Pitocin, a synthetic hormone that spurs labor (Weiss, 2016).
For the first few hours, the contractions were mild. Then, in what seemed to be an instant, they swelled to severe. Squatting and rocking to ease the pain, a slow panic crept over me. I had a human being inside of me. My body would have to contort and squeeze him out. But I felt as stiff as the icebergs lining Lake Michigan outside my hospital window.
I needed a strong dose of help.
I summoned the nurse and requested an epidural. It was a good move. Soon, I was ready to push. Three hours later, I was still pushing, with little sensation or progress. I hadn't eaten in 12 hours. The hormone-and- medicine cocktail that swirled in my body made me vomit. I was on the brink of fainting, and the baby's heart rate fell some. My doctor suggested forceps. She assured Matt and me that a simple nudge would loosen the baby. An emergency C-section would be a last resort.
I trusted my doctor and agreed to the forceps.
A new, unfamiliar team descended on my room, including extra nurses and an anesthesiologist who boosted my epidural. The spike in drugs made me feel as if I were floating. I was strangely calm as I watched the doctor and a medical student lower two mammoth metal prongs into my body. They clamped and jostled my son's head, gashing his cheek and one of his ears. I pushed. The doctors pulled. Noah was born. Full of relief when I saw that he was okay, I exhaled. My physical torture was over — or so I thought. With the labor medication still in my system, I started postpartum painkillers. The sheer excitement of it all, amplified by the drugs, sent me into a satisfied daze.
I had sustained a 3-degree tear from the forceps, but the doctors and nurses didn't explain what it might mean for me physically. In a dreamy state of ignorance, I sailed from delivery to recovery, celebrating Noah's healthy, dramatic arrival. Family called. Friends visited. Our joy multiplied. We had created a mini-us, one who existed only because of our union. We reveled in new-parent euphoria.
Not for long.
Though I was supposed to be in the hospital for 48 hours following the birth, I was ushered out after 36, because another mother needed the room. Besides, a nurse said, I'd be happier at home. Soon after returning to our high-rise apartment, my body failed. My bladder and bowels shut down, and I ballooned with fluid. Several times I called my OB, who suggested laxatives. They didn't work. In the wee hours, Matt and I headed to the ER. We brought our 3-day-old Noah, because no family had yet arrived to help look after him.
Inside the busy ER, a staffer started my paperwork. Eyeing Noah in his stroller, she said, "I wouldn't have my infant in here if I were you. All these germs? He could get sick."
I already was afraid that my condition would worsen, and I would die. Now I imagined Noah dying too. Tears streamed down my cheeks. She apologized and hustled to get us into a private waiting room.
Another ER attendant noticed that I was crying, and assumed we were there for Noah.
"What's wrong with your baby?" she asked.
"Nothing. He's perfect," I said. "I'm a mess, and I haven't learned how to pump milk yet. I'm worried that once the doctors see me here, my body won't be available to nurse him. What if he wakes up? He'll starve."
She ordered a breast pump and helped me learn to pump milk. I filled four ounces into a bottle, which is enough for a feeding. I clung to this small victory. Although Noah was asleep, he hadn't eaten in a few hours. If he did wake up, at least he would have food.
Even so, I worried. While I was pregnant, friends and family mentioned that if infants took a bottle or pacifier too soon, they might not readily return to the breast (a condition known as "nipple confusion"; Moreland & Coombs, 2000). I wanted to nurse him as long as possible, and avoid bottles and formula. Reflecting on this now, I'm comforted. Despite the fright of my first days as a parent, I didn't lose hold of the finer points of Noah's well-being. My mothering instincts were intact.
As 2 more hours passed, we waited. Induced labor was easy, by comparison. I limped to and from the bathroom, seeking but not finding relief. My abdomen and lower back felt like a war zone, with fiery darts streaking from side to side.
Once the doctor arrived, she asked a nurse to drain my bladder. To the great surprise of us all, it held more than twice the amount considered full. It would be trickier to relax my bowels. The doctor tried to loosen them manually — the worst, most humiliating pain of my life — and sent me home with orders to take more laxatives.
Later that morning, Matt drove me three blocks to my OB's office, and I struggled to sit upright, preferring instead the fetal position. Jolted by my ashen appearance, my doctor said, "This isn't your fault. We need to blame someone, so let's blame me." She explained that the trauma caused by the 3-degree tear made it difficult for me to go to the bathroom. The injury ultimately caused my bladder and bowels to stop working. She hooked me up to a transportable catheter, and instructed me to buy a few enemas, go home, and sit in a warm bath.
Her formula worked.
Three days later, my body was functioning and on the mend. But my emotions started to crumble. I feared something would happen to Noah. What if he fell down the trash chute? What if I hit him on the head with a frying pan? I thought my husband would discover that I was a terrible wife and mother, grow to hate me, and leave.
I rode a hormonal seesaw, crying at moments that would otherwise elicit a smile, such as when my father-in-law called to check on us, when a little girl on the street waved at me, when one of my clients sent a baby gift.
Worst of all, I saw myself as a failure. By inducing early, I had rushed my child into the world before he was ready. I wasn't able to give birth the "right" way. Now my mind was a coil of dark thoughts.
Silent suffering isn't my style. I didn't hide my tears. I shared my intrusive thoughts, as they're called, with my husband, and with our families and friends. Eventually I called my OB. She was warm, nonjudgmental, and swift to act. Within a few days, I was taking antidepressants and visiting a therapist. The therapy went a long way to restoring my jilted sense of self-worth. The medicine quelled the constant crying. It also cast me onto an emotional tundra, and froze my capacity for laughter, tears, or any strong emotion.
I stopped taking the antidepressants after 4 months, and wrapped up therapy at the same time. A few months later, I thought my postpartum depression had reappeared. I developed a rash of unusual symptoms — fatigue, aching joints, and unexplained irritability. Some days, my attention crept down the dark alleys of memory. I would cry as I thought of how my parents had been mean-spirited to one another during their divorce. As their child, I wondered if I had a cruelty gene. Would I too hurt my own child and husband?
I went back to my OB, the doctor I trusted most. She ordered blood work to test my thyroid, and results showed it was imbalanced. I sought the help of an endocrinologist, who determined that as a result of the pregnancy, I had developed Hashimoto's disease, an autoimmune disorder. With Hashimoto's, the immune system attacks the thyroid gland, disrupting its ability to produce hormones. Over time, this leads to an underactive thyroid, also known as hypothyroidism, which slows down all of the body's processes, including brain function, heart rate, and metabolism. It can even mimic depression (Office on Women's Health, 2012).
I started medication to restore my thyroid shortly before Noah turned 1. Six months later, I felt much better. Treatment and time stitched my frayed ends, but I was fundamentally changed. Parts of me are stronger. Parts of me are still broken and messy. That's long been true. But motherhood forced me to admit it.
It was easier to carry the weight of Noah's little life once I fessed up to my many imperfections.
Unqualified Perinatal mood disorders are like yeast devouring sugar. They feast on an emotional hardship in a woman's life and ominously rise, dominating her daily existence. In my case, the emotional sugars were related to my tendency to be an overachiever, and the early loss of my mother. Yet, the feeding frenzy was ultimately a good thing. It forced me to confront issues I would've just as soon swept into a dark corner.
The unraveling of my self-worth started with the forceps delivery, the trip to the ER, and uncontrollable crying spells. A capable mother would have done better. I thought of myself as Hester Prynne in The Scarlet Letter (Hawthorne, 2011), with a red emblem stamped on my chest, only mine was an "F," for failure, instead of Hester's "A," for adultery. If the people around me knew how inept I was, they would snatch Noah and send me away.
Excerpted from "When Postpartum Packs a Punch"
Copyright © 2017 Kristna Cowan.
Excerpted by permission of Praeclarus Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
List of Acronyms 9
Foreword by Dr. Diana Lynn Barnes 11
1. Nobody Told Me It Wouldn’t Be Perfect:
My Story of Postpartum Trauma 15
Part One: The Illnesses
2. A Different Kind of War: When Childbirth
Leads to Posttraumatic Stress 31
3. Postpartum Depression and Anxiety: Worse than We Think 65
4. Over and Over: The Unsettling Spiral of Postpartum OCD 83
5. Postpartum Psychosis: A Break With Reality 107
Part Two: Fighting Back
6. Shaking Off the Shame: How to Confront Stigma 127
7. What About Dad? Help by and for Men 141
8. A Struggle Worth Sharing: How Women Heal From PMADs 169
Part Three: Hope for the Future
9. Getting There: Where We’ve Been, and Where We Need to Go 193
10. Better for It: When Postpartum Pain Is Used for Good 237
About the Author 254