It’s no secret to anyone who has known me for any amount of time (or sometimes even to the nice mom I meet in the coffee shop, within about five minutes of chatting–sorry, nice person!) that I have struggled with depression and anxiety for most of my life. Like many chronic illnesses, it ebbs and flows, and I’ve had varying degrees of success in treating it over the last sixteen years. Indeed, it was half a lifetime ago that I booked my first appointment with a mental health professional, and I can’t help but feel some sense of strength and accomplishment from this journey, from what I have learned, and from the nitty-gritty work I’ve put in.

The years have been full of trial and error, and when I first became pregnant in the spring of 2012, it felt as though the rules of the game had changed.  Now, my body (and accompanying hormones) were rapidly changing; now, I had to consider the growing bundle inside of me; now, I scared my psychiatrist, whose experience in treating pregnant women was lacking. Within that time, I lost the pregnancy, which brought a new set of challenges, of grief and hope, for both Michael and me.

All of the bits and bobs of this story, of the journey up and over, around and through the darkness and light warrant another post, or two or three. But through three pregnancies, two births, and many, many, many-many cups of coffee and tea with my fellow mothers-in-arms, I’ve learned a few things. Right now, I am at the point postpartum with Georgie where, with Winnie, I recognized that things had become very dark, and thus I am hyper aware of the challenges I face right now and how I can work through them. I write this in the hope that perhaps my footsteps can serve to help another mother who struggles with a Perinatal Mood and Anxiety Disorder— but also as a roadmap, a reminder, for myself as I work through the next months and years.

Mindfulness Practice

Far and away the lowest barrier to entry, most effective, “bang-for-my-buck” if you will, tool in my recovery toolkit has been mindfulness practice, both through dedicated mindfulness meditations and the continuation of those practices throughout my day. Guys, I am not a meditator. Before I started mindfulness meditation, I could barely close my eyes if not asleep nor could I concentrate on breathing if not, you know, gasping for air or something. The suggestion of “deep breaths” was enough for me to never return to see a therapist or psychiatrist. Part of this was, of course, that I struggled with post-traumatic stress disorder as a result of childhood trauma– closing my eyes and opening my mind to the possibility of re-experiencing the trauma was terrifying. I half-heartedly read The Healing Power of the Breath, which was developed with trauma survivors in mind, and much to my surprise, I found the tangible focus to be helpful; in fact, I used its techniques during Winnie’s birth. Also while preparing for Winnie’s birth, I stumbled on Mindful Birthing, which utilizes mindfulness techniques to help women work through the sensations of pregnancy and childbirth, as well as the postpartum period.

After postpartum depression and anxiety reared all manner of ugly heads when Winnie was around seven months old, I established an exceptionally trusting relationship with a healthcare provider (more on that later) and when she suggested mindfulness practice, I took her up on it and checked out Mindfulness for Beginners from the public library. I uploaded a few meditations onto my phone and began to practice daily. Holy crap, you guys– it worked! Unsurprisingly, I suppose, when you practice something, you get better at it. The dedicated daily time to practice breathing, to practice allowing thoughts to exist without judgement, to practice moving between difficult thoughts and comforting sensations in a safe space reduced the fear I had of my emotions and my ability to co-exist with them. It particularly helped with the heightened emotions I had as a result of hormonal changes during my pregnancy with Georgie, and with the intrusive thoughts that followed a few weeks after her birth. With Winnie, I spent nights awake in a panic, in fear and disgust at such thoughts– how could a good mother think such things? Where were these thoughts coming from? Did intrusive thoughts mean that I would act on them? No, it absolutely didn’t– but my fixation on the thoughts, my judgement of them and my fear of them exacerbated them. Mindfulness practice taught me to allow the thoughts to pass without judgement, and because of this, they resolved quickly, without the panic and terror they had previously caused.

Now, I practice mindfulness daily: I set a meditation goal using the Strides app (my other Strides goal is flossing, in case you were wondering) and use either the Mindfulness Coach app (developed by the US Department of Veterans Affairs for veterans suffering from PTSD, but helpful for anyone) or the free guided meditations from the Mindfulness Awareness Research Center at UCLA (the Working through Difficulty and Loving-Kindness meditations are my favorite). To me, mindfulness practice is, at its core, a way to practice being the person you want to be, with the brain you want to have.

 

Finding My Team

Real talk: finding a mental health team is a pain in the ass. No, it’s worse. It’s nearly criminal. It’s expensive, time consuming, requires a ridiculous level of information literacy and perseverance, all of which is completely overwhelming to someone suffering from a mood or anxiety disorder. When you think you’re worthless, when you think you’re helpless and hopeless, how are you supposed to justify the hours of google searches, phone calls to doctors, messages left, phone menus navigated, “not taking new patients”, “out of network”, ad nauseum? If you’re a danger to yourself or others, go to the ER, otherwise you’ll need to wait months and months in your own emotional hell to see if this provider might– just MIGHT– be a fit for you. It is a dance I have done, and one I wish to avoid for the rest of my life.

Luckily, there are some resources. First, from my own experience: Postpartum Support International. PSI offers a warm-line, online support meetings, free weekly phone support meetings with a postpartum expert, a Facebook group, and– my personal favorite– a resources map with area coordinators. Before we moved to New Mexico, I contacted the PSI coordinator for the area, and she provided me with a list of resources, tracked down doctors, support groups, and therapists. She even called doctors’ offices to see if they had experience treating PMAD. So much footwork done, so many obstacles removed. (PS: PSI has resources for dads, too.)  I haven’t personally used their services, but many recommend Postpartum Progress, as well.

I also can’t stress enough how important a trusting relationship with a mental health provider is, once you’ve jumped through those hoops. I was lucky to find an incredible psychiatrist with training in reproductive psychiatry, who took an integrative approach to my care: she ran blood work to test for nutritional markers and any other physical problem that could interfere with my recovery, she recommended mindfulness practice and respected my desire not to delve into trauma work, instead recommending structured Dialectical Behavioral work. She helped me balance breastfeeding, pregnancy, and medication, giving me the vocabulary I needed to approach the issues with my birthing team. I had never before put in the work that I did with Dr. Hermann, and it was the trust we built that led me to do so.

I was, admittedly, nervous when I moved and changed doctors. Memories lingered of a bad experience following my first pregnancy loss and subsequent pregnancy with Winnie. The psychiatrist I had seen then was less than supportive, reluctant to provide any information about treating depression with medication during pregnancy outside of FDA pregnancy categories, and seemed to think that my decision to get pregnant while still struggling with depression had been a mistake, and that was that. But after the work I put in treating my PPD/PPA after Winnie,  I felt armed with the knowledge that the medications I was taking were safe, that any risks were outweighed by the benefit of having a whole, present mother, and that I deserved answers to questions and treatment as a human.  And lo! The psychiatrist I saw here in New Mexico totally agreed! We discussed each medicine, each supplement, and concrete exercises to overcome a recent flare-up of traumatic experiences, recurring nightmares. We both talked about how if a doctor/patient relationship doesn’t work, you can and should find someone else, but at the end of my appointment, when I expressed relief and my previous apprehension, she smiled sincerely and said, “Don’t worry– I’ll take good care of you.” Isn’t that just what every patient wants to know?

So, I don’t do therapy, and I won’t until I’m in a place to pursue trauma work, but I know it’s so important for people. My other “team” tool, in addition to a capable mental healthcare provider (be it psychiatrist or therapist), is pretty simple: other moms.

For me this meant  a local moms group (shoutout to my Summer13 Cortelyoumoms! woo woo, party people!), full of women who had and hadn’t experienced depression and/or anxiety, full of women who were approaching the same challenges every day, full of women who could go for a walk, or make a joke about diaper on Facebook. Parents’ groups are an invaluable resource– I’m not a joiner, and I was afraid that either I would hate everyone in the group, or everyone in the group would hate me, but it turns out that people are people, and being able to talk about Dinosaur Jr while wrangling a toddler or about Judith Butler while nursing is pretty rad, and definitely helps mental health!

Finding my mom team also meant attending a support group after Georgie’s birth to process my experiences and learn new tools. Hearing the varied experiences of other women, empathizing, and in some cases, even being able to offer my own experience as valuable, as a tool for others, was incredibly empowering. Brooklyn moms, I highly recommend Sarah Moore’s PMAD group as a part of your toolkit.

Self Care

Okay, here’s the fluffy but oh-so-important stuff:

• Taking a shower.
• Brushing my teeth, not once but twice (!) a day.
• Eating good fats and proteins.
• Having a hot (or warmish) cup of coffee in the morning.
• Getting sun on my face.
• Putting on real pants. If I’m feeling extra in-need, real pants THAT FIT.
• Listening to WQXR.
• Calling a friend.
• Wearing wool socks.
• Spraying this stuff on my face.
• Checking out a library book, because it feels kind of like guilt-free shopping
• Taking my prescribed medicines at the same time, every day
• Taking the vitamins I need, like B-Complex, postnatal, and vitamin D
• Turmeric supplements for depression, because it might help, and my doc says it can’t hurt

This list changes, but there is *always* a list, and there must be. I need to start each day with a bank of things that can lift me up if I start to fall. When I was in crisis mode following Georgie’s birth, after Mike had gone back to work, family was all gone, and I was alone with two lovely creatures who desperately needed me and also sometimes hurt me (I struggled mightily with the physicality of parenting) and a rollercoaster of postpartum hormones, I sometimes felt like the sky was (metaphorically) falling. And during those times, I put Georgie in the carrier, Winnie in the stroller, filled up a mason jar with coffee, and walked and walked and walked and walked. Miles. All throughout Prospect Park, where I could find a grassy spot, near people but not too near them, let Winnie sleep in the stroller and Georgie in the carrier, in such a way that they were cared for but I didn’t have to actively engage, and I would just CRY. Quietly, but fully. We were all safe. We were all loved. I’d certainly rather have filled my days with less crying, less emotional turbulence, but there it was. We did it.

We’re doing it. Every day, getting by.