Today I am honoured to have a guest post from Jennifer at Barely Knit Together.
As some of you know I am in the process of applying for my Masters in Social Work. My goal is to work with in psychiatry (my career background before I became a mom) specifically with women and families. I’d like to help change Canadian healthcare policies around the treatment of patients who have experienced trauma in any of its various forms (illness – specifically mental illness – birth trauma, breastfeeding issues, abuse, etc) and do front line work. I have been learning about trauma-informed care and the sanctuary model and I know this kind of approach is desperately needed in our health care system.
I have contacted a few women in the blogosphere who have identified as having a mental illness and being a breastfeeding mom and have asked them if they would be willing to share any aspect of their experiences with having a mental illness and breastfeeding so I can better learn how I might be able to assist women in a similar situation in the future. Jennifer graciously provided me with the following guest post. Thank you Jennifer!
This is Post #1 in my Mental Health and Breastfeeding series. The other posts can be found here, here and here.
Here’s the pattern: pregnancy is good to me. I feel wretched in the beginning, but over time I find myself eating better, being generally healthy, and not experiencing any of my usual hobgoblins, like migraines.
My births have been good – difficult, but not traumatic in any real way. And then I have this wonderful little person to hold and love and nurture the best ways I know, including breastfeeding, which has fortunately proven easy for me all three times.
Somewhere in there, though, after the first few months, something shifts.
While my births were not traumatic in and of themselves, there were circumstances in each which made for some difficulty afterward, and I always attributed my crazy moods to those situational issues. Sometimes there would be a delay of several months before I started slipping from what might be considered a “normal” state of mind, so I could hardly imagine that I was suffering from postpartum depression.
Yet the pattern is clear – a few months after the births of my children, I lose it. Sometimes a little, sometimes quite a lot.
To be clear, PPD is not my primary mental illness. I have been diagnosed with every popular disorder this side of Freud, but the one that sticks, the one that rings true to me, is Borderline Personality Disorder, a notoriously difficult illness to treat. But the postpartum period seems to propel me into a state in which I find it harder to maintain my equilibrium, and no wonder! Lack of sleep, the demands of an infant, juggling a household of responsibility in addition to other children, are enough to cause anyone to get a little irritable.
During this last pregnancy, I got my prescription early. Just Zoloft, an SSRI that is considered the safest bet during pregnancy and breastfeeding. I’d taken it when my middle child was a few months old, and breastfed him until he was three. By then, I’d been off the medication for about a year and a half and was doing relatively fine.
But the quirks of my brain were ramping up, and this time, the Zoloft didn’t do its job well.
Then, the issue became, what else could I take?
I found my psychiatrist uneasy with my extended breastfeeding plan. I was asked repeatedly when I would be weaning him, and my answer of, “When we’re both ready” was met with a chuckle, or a confused shaking of the head. I began to get frustrated with his lack of understanding. I tried to communicate that weaning early, for me, would be as devastating as the depression itself. That I would feel a failure, not because of some goal or cultural pressure (surely not that), but because I cherish that relationship, especially knowing this baby would be my last. I had no intention of weaning early.
In the meantime, my life was spiraling out of control and I was voluntarily hospitalized. My thoughts of suicide were increasing, and I was self-harming, and thought it might be a way to get some control back, to get some help.
They immediately put me on Wellbutrin for depression and Ambien for sleep, and my first night there I slept through until morning for the first time in five years.
I had done well on bupropion (the generic for Wellbutrin) before, but this time I didn’t feel I was any better. I felt frustrated that the population at the hospital were either unwilling or ill equipped to address their problems in a productive way, and so I felt I was just avoiding life for a while. My children visited, but it was disturbing to me for them to see me there. The nurses were kind and allowed me to bring my electric pump into my room to pump in private, but I had no way of storing the milk so I dumped it.
When I got out, I was no better off. I returned to a different psychiatrist, hoping to get someone more supportive of my desire to continue breastfeeding, but found someone even more fearful of the potential “harm” (more likely legal repercussions) of prescribing more aggressively.
So I lied.
Actually, first I researched. I put out feelers about this topic and got recommendations to read Dr. Thomas W. Hale’s book Medications and Mothers’ Milk: A Manual of Lactational Pharmacology. I went to my doctor and asked what the possible medication options for me would be when I weaned my son, and then I went home and looked them up. It turns out that at this point in our breastfeeding relationship, there are few things contraindicated. My son was eating table foods and only getting a little breast milk, plus his weight was above twenty pounds – very unlike a newborn whose sole nutrition is from mother’s milk and who weighs a scant six to ten pounds.
Because I lied, I received medication that ultimately proved helpful to me, though I am now completely off any drugs at all and am doing very well with a particular kind of therapy called dialectical behavior therapy.
My situation, my illness, is unique to me. However, the stumbling blocks I found to getting treatment are likely wide-spread and frustrating for any number of women. Not only are symptoms of severe PPD not being recognized (anger, obsessions, event violent outbursts, not just the usual weepiness and lackluster feelings), but medications which could help moms get well enough to address their difficulties are being withheld because psychiatrists are simply uneducated.
I find it disturbing to look back and see that my treatment was really ultimately devised by me. Granted, I do have a science background which made it easier to do research, but what if I didn’t? What if I was unable to find the information that would help me? I imagine many women simply stop breastfeeding in order to get the medications and/or treatment they need, despite the fact that this could later cause sadness or regret over the early loss of the breastfeeding relationship.
I don’t mean to imply that there are no pro-breastfeeding psychiatrists, or that every woman should take things into her own hands. I’m not even saying that continuing to nurse is the right thing for every mother, if it means sacrificing proper treatment for a devastating illness.
I believe the onus is on our care providers to start better preparing themselves for these issues. Despite spending more than any other country on obstetrical care, the United States still has the highest rate of postpartum depression in the world, and I don’t imagine that will start to improve without a new paradigm for care of mothers and families.
To read more about Jennifer’s experience with Post-Partum Depression where she talks about the problem with diagnosing PPD, its symptoms, and “medications used to treat depression, anxiety, irritability, anger, and suicidal ideation, and their place during breastfeeding” you can click here to read The Results Are In: The Elephant in the Living Room Part I and here to read The Elephant in the Living Room Part II.
To read her personal story on BlogHer click here to read Post-Partum Depression: My Story
Related posts:
Tags: breastfeeding, Dr. Hale, postpartum depression, pregnancy, Zoloft
Melodie, Jennifer, thanks so much for sharing this info. I’ve been feeling so lucky at 3 months postpartum to have escaped PPD so far. I wish that moms with PPD and other mood disorders and mental illness had doctors like Lucy Puryear who wrote _Understanding Your Moods When You’re Expecting_ – I reviewed it on my blog here: http://breederbrain.blogspot.c.....moods.html
Jennifer – good for you for taking matters into your own hands, or as you put it, lying, to get what you needed!
Mel – looking forward to more posts on this topic!
CJ
.-= CaroLyn´s last blog ..Hypnobabies Review =-.
I am currently breastfeeding my second daughter (4 mos.) With both girls, I have experienced PPD, albeit this time around has, so far, not been nearly as bad as the first time around. I have thought so many times how unfair it is that we are encouraged to breastfeed, but then when we express concerns to our doctors about our own mental well-being, we are told we have no options. I feel as though we either just have to learn to “deal with it” or quit nursing. An awful desision to have to make. I also sometimes wonder if women who breastfeed have more emotional issues because the hormones take longer to stabilize (no scientific theory behind that one – just an observation of me and my friends).
Thank you for this post – I hope the medical & psychiatric community begin to soon start focusing on this more.
.-= Lauren´s last blog ..The Mommy post =-.
It is so, so disappointing that you had to lie in order to receive treatment. Yours is far from the only story I’ve heard along these lines. The medical community still has so much to learn about supporting breastfeeding, and supporting breastfeeding mothers.
I am glad that you were able to find the treatment you needed, but I share your concern that others may not be so successful.
.-= Amber´s last blog ..Rehabilitating my Shower Curtain =-.
I think it is intersting, expected but annoying that all the breastfeeding while taking medication info is based on nursing newborns. I mean I haven’t looked at the studies done with each and every medication but I imagine they were done with very young babies that were ONLY breastfeeing. I wish there were more info on the amount of medication older babies and toddler got. I know many women that worried imensely about it even if they had a 25 pound one yr old! There has to be some range!
.-= Naomi´s last blog ..Fun with Swine Flu =-.
@Naomi – That’s exactly how I feel. More studies need to be done on medication effects on nursing babies based on weight and exclusive versus non-exclusive breastfeeding. I’m pretty sure a lot of meds that nursing moms like me won’t take until the children are completely weaned are completely safe for the child of 20-30 lbs who nurses only occasionally. But we need the scientific community to bother to look into these things so we can know for certain.
.-= Melodie´s last blog ..I Lied to My Shrink, and Other Hazards of Breastfeeding =-.
Thank you for posting this. I know I need some help (hello, violent outbursts? Been there!) but I don’t really trust any physician to help me in any way other than throwing pharmaceuticals at me. Today I started taking a natural alternative, and we’ll see if that helps. I’m hell bent on not getting back on Zoloft (simply because my son had problems with it when he was first born, and even though he’s big enough that it probably won’t have any impact on him, just the mere fact that it did cause problems before means I don’t trust it at all anymore.)
It’s so hard for me to even admit that I’ve had depressive issues since these kids came along. The only reason I admitted it the first time was because the doctor told me she didn’t think I should get pregnant again until I got treated because it could get worse. So I played along and took my Zoloft, and I did feel a lot better. I felt fine when I quit it too… all the way up until my son started nursing less. Then it came back with a vengeance. But mental illness is not something my family tolerates. I try not to do anything that I’m ashamed to tell people about, and being medicated is most definitely something I’d be ashamed to admit to my family. They think “crazy pills” are for people to lazy and spoiled to deal with their life. I’m not saying I agree, but that’s what I grew up with, so I’d prefer just to pretend I have no problem at all and find ways to quietly deal with it without a prescription.
.-= TheFeministBreeder´s last blog ..Wordless Wednesday =-.
I always enjoy reading stories about dealing with PPD. Not because I enjoy PPD or the fact that people suffer from it (because that sucks, ya know?) but because I am going through it to a low degree and it makes me feel a little more normal. LOL.
Thanks to Jennifer for writing the post.
.-= Erin W.´s last blog ..It Comes Down to Trust =-.
I always enjoy reading stories about dealing with PPD. Not because I enjoy PPD or the fact that people suffer from it (because that sucks, ya know?) but because I am going through it to a low degree and it makes me feel a little more normal. LOL.
Thanks to Jennifer for writing the post.
.-= Erin W.´s last blog ..It Comes Down to Trust =-.
P.S. – Sorry, forgot to tell you great post!
@FeministBreeder – Please, please, do whatever you have to do to be well. My situation spiraled dangerously out of control, but it started off pretty typically. It’s hard for me to say how much of it is PPD related and how much is just my history/temperament/psychology, but if you don’t take care of yourself your world could implode. And that, even more than breastfeeding or not, makes a huge impact on our children. I know you know all this already, but it bears repeating. Hugs, mama. Real, big, warm hugs.
.-= Jennifer´s last blog ..I Lied to My Shrink, and Other Hazards of Breastfeeding =-.
Jennifer, I cried reading your story. When my youngest daughter was born I was going through hell at work with a perfect ***hole of a supervisor. Here in the US you don’t get paid maternity leave; you can take 12 weeks unpaid leave, but he told me if I took it, I could kiss future recommendation letters from him goodbye. It was a temporary postdoc position, and I needed his recommendation to get another job. So I very reluctantly returned to work right after my baby was born because not to do so meant I was throwing my PhD away.
I suffered from crippling depression for months, probably not helped by just having given birth. For three months I struggled on, medication free, because I wanted to breastfeed my new baby for as long as I had breastfed my older daughter. Finally it was clear I needed medical help, and I was diagnosed as severely depressed. I was put on anti-depressants, and I was told I had to wean my baby. I weaned her, but have always regretted it. However, I try not to knock myself out over it, because I was in an extremely difficult position at the time, and it is difficult to see a clear path when everything in your life is going to hell and a handbasket. Interestingly, my youngest daughter had a boob fetish for years afterwards… she would “root” whenever I would cuddle her up until she was about 15 months old, and for years afterwards would stroke my breasts when I was cuddling her. She even still occasionally does it, and she’s six now! I’ve always wondered if it was because she was weaned early.
PPD, the medications used to treat it, and viable options when you are breastfeeding are subjects that need to be discussed openly. Mental disorders have such a stigma attached to them in our society, and I am so happy you have come out an been so open about your experiences. The stigma can only be removed if people like you step up and openly tell your stories.
PS: You might be wondering what happened to my career; I sued my employer and the case was ultimately settled. I’m not permitted to state the amount of the settlement because of a gag order associated with it. In other (completely unrelated) news however, our mortgage is paid off and we have a nice retirement fund in the bank. As another (completely unrelated) comment, I can also say that justice is sometimes served. I did lose my career as a physicist over the whole mess, but I now have another career as an epidemiologist, and it rocks, so I’m pretty happy.
@Sherry – I have a similar story of a much smaller nature from when my first was born. She was ten weeks early, and this was two months before the Family Leave Act was passed, so I only had six weeks out (unpaid, and it was a minimum wage job). I wanted to come back to work and use the remaining leave when my daughter was released from the NICU to come home. When I couldn’t tell my boss exactly when that would be, he fired me. I’ve often thought I should have sued, but my position was of a much less valuable nature that yours, and it wouldn’t have been worth much to us. It just angered me. I feel fortunate that we were somehow able to survive on one minimum wage job with our baby, and I breastfed until she weaned herself at 9 months – before I was as knowledgeable as I am about the benefits of extended breastfeeding. I’m so sorry about your experience with having to wean early. I am happy you have found a rewarding field of work, and honestly, my kids are fixated on my breasts and one nursed until he was three and the other is still going. They’re soft, squishy, comforting, and right there within reach. What’s not to like?
.-= Jennifer´s last blog ..I Lied to My Shrink, and Other Hazards of Breastfeeding =-.
Thank you so much for posting this. I’m three months pregnant with my second. The first time around, I was on 90mg of Cymbalta throughout my pregnancy. No problems. If I had gone off of it, I would have been crazy. Then, the PPD came on a couple months after delivery, and I totally lost it despite breastfeeding and remaining on the medicine. It was hard enough by itself, but there were some major life issues going on that made the PPD so much worse. My husband was trying to fix his relationship with his kids from a prior marriage. They were all in family therapy from the mom withholding his parenting time, plus, my boss at work was on a mission to use my already high stress against me. I know he was trying to make me quit, but I held out until they “laid me off.” Didn’t help my stress. I was a wreck. But at least I had unemployment. And when they tried to take back the severance pay they had promised, I was able to get a lawyer to knock some sense into them. Come on, you don’t get rid of a person on their first full week back after a disability leave. LOL.
Anyway. My doctors have been very good about letting me take my normal meds. My problem is alcohol. I hate it that there are no good resources about alcohol. Everyone just says across the board, don’t do it. Well, I can’t have my normal xanax, and I’m not allowed to stress either. So WTF? In the end, during my first pregnancy, and now during this one too, I self prescribe one glass of wine or beer each week. And I lie. No, I don’t drink during pregnancy. That’s bad. But you know, xanax is worse. And my personal opinion is that at least alcohol is natural. I don’t touch the hard stuff, and people have been drinking forever. I really wish I had more scientific data to base my decision on. First pregnancy, I didn’t have a drop until after the first trimester. This pregnancy, my doctor wanted to see how it went if I got off the cymbalta completely. But I was miserable, and so was my family. But it does suck that we can’t just get real information and real answers. It’s like because we are pregnant and/or nursing, we don’t matter anymore. And yes, the developing baby is more important than mom. But if momma ain’t happy, ain’t nobody happy.
.-= Danielle Miller´s last blog ..What Have I Been Up To? =-.
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