Friday, August 6, 2010

Postpartum OCD Part 2 of 2: The Mom Who Couldn't Stop Logging

And so the stage was set. An intense case of baby blues, which dissolved into a few days of still-concerned but mostly oblivious reprieve, which then segued into the full-blown crisis of our multifaceted nursing situation.

From here, I could continue the narrative from where I left off in part one, but much of the details would be redundant, as I've told most of that tale already (though without as much elaboration on the early days as I just did). Rather, I want to start with an excerpt from an excellent post by Postpartum Progress: The Symptoms of Postpartum Depression (In Plain Mama English).

You may have postpartum anxiety or OCD if you have had a baby within the last 12 months and are experiencing some of these symptoms:

  • Your thoughts are racing. You can't quiet your mind. You can't settle down. You can't relax.
  • You feel like you have to be doing something at all times. Cleaning bottles. Cleaning baby clothes. Cleaning the house. Doing work. Entertaining the baby. Checking on the baby.
  • You are worried. Really worried. All. The. Time. Am I doing this right? Will my husband come home from his trip? Will the baby wake up? Is the baby eating enough? Is there something wrong with the baby that I'm missing? No matter what anyone says to reassure you it doesn't help.
  • You may be having disturbing thoughts. Thoughts that you've never had before. Thoughts that make you wonder whether you aren't the person you thought you were. They fly into your head unwanted and you know they aren't right, that this isn't the real you, but they terrify you and they won't go away. These thoughts may start with the words "What if ..."
  • You are afraid to be alone with your baby because of the thoughts. You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague.
  • You have to check things constantly. Did I lock the door? Did I lock the car? Did I turn off the oven? Is the baby breathing?
  • You may be having physical symptoms like stomach cramps or headaches, shakiness or nausea. You might even have panic attacks.
  • You feel like a captive animal, pacing back and forth in a cage. Restless. On edge.
  • You can't eat. You have no appetite.
  • You can't sleep. You are so, so tired, but you can't sleep.
  • You feel a sense of dread all the time, like something terrible is going to happen.
  • You know something is wrong. You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right. You think you've "gone crazy".
  • You are afraid that this is your new reality and that you've lost the "old you" forever.
  • You are afraid that if you reach out for help people will judge you. Or that your baby will be taken away.
She did an additional Plain Mama English post on postpartum psychosis, both of which I encourage you to read, bookmark, and share liberally as needed, especially if you work with new mothers in any capacity.

Anyway, reading that list was an epiphany for me, one of two major ones that led to the titular self-diagnosis. There are so many bullet points that describe my state for months on end. I'll go through some of them specifically:
  • Your thoughts are racing. You can't quiet your mind. You can't settle down. You can't relax.
How I relate to this. I had to spend so much time both pumping (every 3 hours around the clock, 2 alarms were set for overnight) and on feedings themselves, and both required me to more or less not be doing anything else, at least on a physical level. The various techniques we used differed depending on her progress over time, but they all required effort and focus and some combination of equipment. There was no wearing my newborn in a sling and going about my business as she suckled away, no reading books, no idly jotting down precious newborn memories into a keepsake journal, no relaxing and snoozing as we nursed in sidelying repose. Nothing I had pictured my life as a breastfeeder would consist of. Every feeding, 8 times a day, was a major Process.

Pumping, which I did for 15 minutes immediately after every feeding, took less mental energy once I got myself set up (I will describe my pumping station setup* in the footnotes; I thought it pretty ingenious and it could be helpful for anyone trying to fit pumping into their routine), but I was still immobilized. And I vividly remember how my mind would just SPIN, thinking of everything I should be doing and would be doing as soon as I could leap up and into action. I would think and rethink, order and reorder, everything. Label milk, put into refrigerator, rotate the stock and transfer oldest into storage bags, relabel, put in freezer, clean pumping shields and collection bottles, change diaper, put amount she drank and the diaper onto the logs - NO, WAIT, log the amount she drank first, then put the leftover into the milk rotation, then change her diaper, then . . .
  • You feel like you have to be doing something at all times. Cleaning bottles. Cleaning baby clothes. Cleaning the house. Doing work. Entertaining the baby. Checking on the baby.
There were the normal mothering chores and the extra lactation-related tasks I had on my plate, both carried out in a sense of focused franticness, but even healing things became tools of obsession. My lactation consultant (the second one, the IBCLC with whom I worked for months) was very holistic, and she recommended a number of associated things that were meant to support the process. All of them good things, like cobathing, flower essences, homeopathy and EFT, but my own growing mania twisted them. The feeling that I always, always had to be doing SOMETHING was constant.

And it went on like this. One of the things that saved me, in several ways, was actually television. I am not a major TV watcher normally, though I don't abstain entirely either - I have select shows that I love and cherish, but don't usually indulge every day, much less for hours on end. But this season of my life? The TV was on for almost all my waking hours. It's the one thing that could help to quiet my racing mind while I sat motionless in the glider, the pump wheezing and groaning away. It didn't quell my the jungle drums (to quote Anne Lamott) completely, but it helped.

I started watching Top Chef, Project Runway and some other Bravo reality series, knew the Food Network lineup by heart. I watched Roseanne reruns at the 3 AM feed & pump and Angel reruns at the 6 AM one. I watched the Planet Earth documentary series. When nothing in particular was on, I turned it to CNN. Not only did this help with the mind mania, but it helped me feel somewhat - somewhat - less isolated. And, ironically, tethered to the real world, even if it was a fictitious one on the surface. The isolation was by far the most damaging factor, though, as a major risk factor for all types of PPMD. This was hard for me to accept, as I've always enjoyed time alone, even thrived on high-quality, productive introversion, but for new mothers, solitude quickly turns malignant.

At this time, my relationship with Lily's dad was still long-distance, with him visiting us an average of one long weekend a month - occasionally a week or a bit more, but usually less. Long story slightly shorter, in order to be a little bit closer to Boston and New Hampshire, where he would do work when in the area, I had moved 50 minutes away from where my work and friends and life had been centered, to a nice but very much isolated little cabin on a lake. Though meant to be temporary, it was obviously still a frustrating situation for both of us, and I know he agonized over the questions on what the best choices were as much as I did. To top it off, around month 3 or 4, Lily suddenly decided she hated the car after being perfectly content or instantly asleep during all trips for the first few months, and given the distance from anything relevant, this compounded the isolation.

I don't waste much time on regret, and grueling as some of my experiences have been, I still cherish their lessons, but if I could change only one thing about the whole experience, the decision to live in such solitude would probably be it. (I mean, I'm talking about things I can control, conscious decisions that I've made - obviously if I could magically have skipped the whole ordeal and nursed without difficulty, I'd choose that, despite the character-building-ness of it all.) After the initial few weeks of help, partly covered by Lily's dad being in town and partly by my visiting relative, a few midwife visits and such, I was pretty much on my own most of the time. One good friend, who had been my doula and lived a bit nearer than most other friends 45 minutes away, came by twice a week at first, bearing meals and a shoulder, and eventually leveled off into once a week, very understandably considering the busy nature of her life.

And the time stretched on. I would go for days without seeing another adult, sometimes days without even leaving the house. Daddy did the best he could from afar. My weeks were built around Lily's regular chiropractic/craniosacral therapy and the nursing support group run by my second lactation consultant, IBCLC Jennifer Tow, the one who finally figured out what was really going on. This was a group made up of women who had faced or were currently facing severe difficulties; it was not uncommon for women to have seen several other lactation consultants who had been unsuccessful in helping them to resolve their issues before coming to Jennifer.

NOTE: In my case, in case you were wondering what the hell HAD been happening during the mystifying prologue that made up part one: Lily was tongue-tied, first of all, and also had some serious reflex depression due to her extreme molding. Check it out:

My poor little squishy, about 2 hours old.

Anyway, some molding is normal of course, and even dramatic molding will eventually be resolved - and a huge part of that process is: nursing. But because Lily was unable to latch due to her posterior (and thus elusive to many well-meaning but underinformed practitioners) tongue tie and her inability to open her mouth widely, this was not happening. Cranial nerves, as her first therapist explained to me, were being compressed, in layman's terms. This is why she never rooted and never sought the breast herself. Here she is, all blissed out from craniosacral work:


So, because my milk came in (a combination of luck and pumping**), during that first week, she was able to get enough nourishment to get by just from my letdown, even though she was basically doing nothing to actively draw milk out of the breast. Then, the 10 day growth spurt hit, and she slept more than usual. My supply started to adjust. Suddenly Lily wasn't getting the effortless outpouring of milk anymore, and the descent into hell began.

The first lactation consultant, Judy, was exceedingly kind and caring and DID help me to the extent she was able; she got me pumping, without which I would would likely have had low supply issues on top of it all, and taught me to finger-feed. This got breastmilk to the baby, always priority one. And she also treated me with kindness. But in my last phone call, I could tell she had basically come to the end of the line. So I floundered on my own for weeks, until I finally saw Jennifer at almost 6 weeks. She was a major godsend, and that group was a godsend too. There were two other moms who were currently in the midst of a similar nightmare, and they became lifelines both in the meetings and on the phone. Again I'm at risk of becoming redundant, so I refer you to this epilogue on the nursing saga, where I acknowledge some of the lessons.


Back on the topic of the OCD madness: other bullet points that resonated, and by resonated I mean slapped me upside the head:

  • You are worried. Really worried. All. The. Time. Am I doing this right? Will my husband come home from his trip? Will the baby wake up? Is the baby eating enough? Is there something wrong with the baby that I'm missing? No matter what anyone says to reassure you it doesn't help.
I mentioned one experience in part one when Lily had peed on a heating pad and I completely lost my mind over it. That was the first incident, but it somehow set a theme in motion, I believe. The first time she threw up I was utterly terrified that she was critically ill (I'm talking actual vomit, not just spitup), and every time it happened thereafter it would plunge me into absolute hysterics all over again. The first time I had to drive her anywhere alone was an hour-long drive to the chiropractor/craniosacral therapist, and I may have had the first panic attack of my life merging onto the highway. I think I drove about 40-45 mph the entire time, often on the shoulder, heart pounding, dumbfounded by the fact that other parents seemed to manage to do this all the time, putting their precious babes into shiny metal boxes and hurtling along at what now seemed like impossibly irresponsible speeds.

Those are just a few examples. Suffice it to say that everything panicked me, everything - most of all, her input and output. Repeating from that last bullet point:
  • Is there something wrong with the baby that I'm missing?
I described in part one the experience of having my fears about Lily's issues dismissed only to later be proven right - you can imagine how this affected my parenting and my management of the situation. Actually, you don't have to imagine it - I have pictures. This says it all, in its way:


Can you guess what those are? Here's another shot:


Yes, readers, those are my logs. ONE FULL YEAR'S WORTH. I logged every single feeding and every single diaper for her entire first year. I'm not exaggerating when I say "every single". I never went anywhere without them, perplexing my loved ones. No matter what, I could not change a diaper without noting it. I literally felt physically unsettled, queasy, blood pressure rising, until it was recorded, by time (after the first few weeks, if it was poo, it was noted as such, otherwise simply writing the time indicated a wet one). No, Lily, you don't have a lovingly crafted scrapbook of your first year, with locks of hair, longhand memories and milestones recorded, but you do have a pile of chicken scratch on paper documenting every nuance of your digestive function. Precious.

And feedings? Oh, how I obsessed over the number of ounces she got per day - something no breastfeeding mother should ever need to do if things are going well. I tracked the number of ounces per feeding and added them up, and if it was less than what a normal breastfed baby was estimated to eat, I was despondent, set off into a whirlwind of worry about what was going on now on top of still not being on the breast. Eventually, when we transitioned to the Lact-Aid, I also tracked minutes spent with tube in use, minutes without, and total ounces consumed. It was positively algebraic.

Were we scheduling feedings? To a degree, yes, we were. Because I had to pump every three hours, and because we often were working on some means of getting her on the breast during every feed (i.e. offering it at the end of a feeding, with or without a shield, hunched over her, pleading and pleading. Please. PLEASE latch on. Please.), I wanted to make sure my milk was plentiful while we were working at trying to latch, and this was best done right before pumping. If she seemed hungry earlier, I absolutely would move the feeding up. But there's no denying that my life was built around 3 hour blocks of time. No denying it at all. When my alarms went off to pump overnight, I fed her first, out of a dead sleep. Every time.

And - true, shameful confession time - I do believe I overfed her for a while, especially during the phase where we used bottles in the "paced feeding" technique. This is a common pitfall of feeding via bottle even when there's breastmilk in the bottles. There's a perception out there that you can't overfeed a baby with breastmilk - this is just patently false. If it's coming from a bottle, you can all too easily overfeed. It can be avoided, but this takes a lot of mindfulness. In our case, she wasn't reclined with me pouring it down her throat, as she needed to develop the strength to suckle***, but I found ways to get her to continue eating if she had only finished 2 ounces instead of 2.5 or 3. I tickled her under her chin. I wiggled the bottle in her mouth. I overrode her own self-regulation by attempting to get her to "finish the bottle" instead of being guided by her satiety cues. I'll forever feel terrible about this, and I even worried about it at the time, but after the scarring experience of her weight loss, I'm sorry to admit that that number on my log was more important to me at the time. (Please forgive me, Lily.)

That leads me to another part of that one bullet point:
  • No matter what anyone says to reassure you it doesn't help.
Many of my late night phone calls (during which various members of the nursing group, Lily's father, my friends, and Jennifer herself would take turns talking me off the ledge) were absolutely helpful. It lessened the despair, at least for the length of the call. But I know they must have been frustrating for them at times, because I had to run through the same conversations over and over and over. And over. And over. The same reassurances would be offered, and somehow I just could not let them sink in. This particular symptom came up not long ago, when a CLC-in-training and I were working on a case together, where the same information was being given to a mother, over and over, from multiple sources, and somehow it just could not get through. The CLC mentioned this aspect of postpartum OCD being discussed at her training, and I immediately recognized myself in it.

I remember railing to Jennifer about my terror that Lily just was not eating enough, she couldn't be, she only got 23 ounces yesterday, how can this be happening? and on and on. Jen patiently kept bringing me back to her weight gain, which had been totally fine from week three on, and diaper output, which was more than adequate. This was just not enough to convince me. I'd repeat myself, again and again, she would respond with reason and evidence in the form of diapers, rinse and repeat. Finally, understandably exasperated, she said "Anne, it's not like she's taking it from the atmosphere!"

This broke me out of it, at least momentarily, and I laughed, and had a bit more self-awareness come back. My obsession with the logs wasn't over, I couldn't let go of them until she was just over a year, but my recollection was that after that conversation, I DID ease up on my fears a bit, as I was always able to come back to the idea that my baby had found a way to metabolize the moisture in the air just to throw off the diaper logs and mess with my mind.

(I am forever after indebted to Jennifer not only for her wisdom, but her patience, and the group for their empathy.)

Logs, man. They are a double-edged sword. Proceed with serious caution. They are useful to get an idea of what's going on at the beginning, especially if you suspect something's amiss. They're also helpful for twins, maybe for a little longer. But I strongly recommend that if everything seems to be going well, DON'T. And even if there are issues, once they start to be resolved, give them up as soon as possible. It just becomes lunacy in the wrong hands. Same goes for scales - I used one to weigh her before and after feeds for a few especially tedious weeks, and fortunately was talked out of continuing. That way lies madness.
  • You are afraid to be alone with your baby because of the thoughts. You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague.
  • You feel like a captive animal, pacing back and forth in a cage. Restless. On edge.
  • You have to check things constantly. Did I lock the door? Did I lock the car? Did I turn off the oven? Is the baby breathing?
  • You feel a sense of dread all the time, like something terrible is going to happen.
Yep, these too. I never had repetitive thoughts of intentionally harming her, luckily, but I did fixate on the possibility of accidentally harming her, in every conceivable way. The OCD manifested primarily in the logs and the whole ritual that was built up out of the 3 hour cycle of feed, pump, clean and prepare next supplement, then do everything else there is to do in life in between, but these other typical OCD thought patterns were there, too.
  • You can't eat. You have no appetite.
  • You can't sleep. You are so, so tired, but you can't sleep.
On these physical symptoms, well, in the first case, I had just the opposite reaction, but this is not uncommon if there's a history of eating disorders, which there is (gosh, I'm just letting it ALL hang out here, aren't I?). I initially dropped about 25-30 pounds very quickly in the early weeks, but then I stalled, and eventually, I actually gained a bit of it back. Eating, along with Bravo, Buffy and The Soup, was one of my only sources of solace, and I gave in to it. Even this was not free of effort, as we discovered that Lily had some sensitivities, requiring me to give up gluten and a couple of the other common protein culprits as well. I know eliminating foods can be unpleasant for many moms, but for me, honestly not a big deal after the initial adjustment, especially compared to everything else that was going on. I still found plenty to indulge in, believe you me. Primarily nutritious food, yes, but far, far too much of it.

If you're thinking I should have been working out, then, at least, well, sure, that would have been fabulous. I was originally a dancer, after all, and had thrived on yoga and Pilates for years as well. I love exercise. If I have it to do over with another baby someday, you bet I'll find a way. But aside from walks every few days, I couldn't bear to have another demand placed on me, especially a physical one, and that's just the way I felt at the time. Judge me as lazy if you will.

The sleeping, I managed most of the time, though my racing mind would often cause me to take a long, long time to drop off (which I could never do unless EVERYTHING was done and set up just-so). Naps? Forget about it. I could be so exhausted that I was literally fighting off falling asleep at the wheel in the middle of the day, on the way back from nursing group (this happened far too often), and still I couldn't follow the oldest new parent adage in the books: "Sleep when the baby sleeps." Impossible. There was just too much to do, and no one else to do it.

One final bullet point of note:
  • You are afraid that this is your new reality and that you've lost the "old you" forever.
This one cut pretty deep. This was the crux of so much. One of the most affecting things Judy did for me in her first visit, when I was at my most despondent and vulnerable, was to grab my hand, look me in the eye, and say firmly, "It is not always going to be like this." And though it took longer than usual for us, eventually, she was right. In a broader sense, I'm still working on this in a way, as integrating parenthood into one's identity is a process, not an event. But compared to the freefall of the first 6 months to a year, I can assure other moms from experience that the best qualities and passions of their former selves are still there, even if on the back burner; hell, even if in cold storage.

So by now, some of you may be wondering, especially if you don't self-identify as a lactivist or breastfeeding advocate: MY GOD, WOMAN. Why didn't you just stop? Trying to breastfeed was literally driving you CRAZY. You tried. Sometimes it just doesn't work. Your baby needs a sane and happy mother more than she needs your milk.

I can see why people might feel this way, and yes, I do agree that children need truly happy parents more than anything (I actually have a draft of a post addressing that very matter). But I don't believe that letting go of the breastfeeding would have helped me at all, and it most certainly was not the cause. In a way that's hard to articulate, I think it's exactly what kept me afloat.

For one thing, it's been shown that mothers who wean early undergo physiological processes that mimic the death of a child and the hormonal process in response is the same. Breastfeeding has also been shown to help prevent postpartum depression itself, or at least lessen its impact. Yes, as I now recognize, I was dealing with a form of it already - but I believe in my gut that it would have been a million times worse if I had stopped. The obsessions would simply have taken different forms.

I could have tried to continue to pump exclusively, in order to avoid formula, and I did in fact consider it on many an especially difficult day, but that is extremely challenging to sustain in the long run (massive kudos to the moms who need to do it), and I would also always wonder: What if I had tried for just another day? Another week? Another month? What if we were on the verge of a breakthrough? How could I sell Lily short when we had worked so hard, when SHE had come so far? I couldn't live with that on my mind.

Also? I am stubborn. To say the least. Some who believe in the theory that children choose their parents have pointed out that Lily needed someone who was unusually, even hyperbolically, stubborn; and so if my persistence was literally pathological, perhaps that was part of the plan.

She finally began nursing at five months old, but it took a bit longer for the OCD to fully recede. We eventually emerged, slowly, as she neared her first birthday, partly because nursing eventually became so successful that even I, with all my doubts, couldn't deny that all really was well at last, and, not coincidentally, because we moved to live with her daddy full-time.

Another difficult admission: It took a long time for me not to feel gripped with jealousy every time I heard a new mother describing her blissful babymoon with little to no relative difficulty, and I still occasionally get pangs, if I'm to be completely honest. But as much as I think is possible, I've grown to accept that this was my experience, and that it has its own gifts, especially in the form of my drive to help other new mothers, in various contexts, as my true life calling. (This is also emphatically NOT to suggest that in the absence of challenges like mine, motherhood is always a breeze. Far from it)

The irony is not lost on me. The OCD manifested itself in the things I had to do in order to make nursing work. Breastfeeding was thus both the means of its expression and the very thing that saved me . . .


. . . along with Lily herself, who gave me glimmers of hope all the way through, who continued to draw out my love with her glorious baby self, and who never, ever, ever gave up on me.

DSC07410


Please check out these links on Postpartum Obsessive Compulsive Disorder:

Postpartum Progress: Rate of Postpartum OCD May Be Much Higher Than Current Statistics

Babble on Postpartum Anxiety Disorders



*Pumping setup: I plan to devote a post to the handy pumping setup I devised, using a glider, a Boppy and a pillow. It would be best illustrated with pictures and more description, and as this post is already ludicrously long, I'll put it up next week sometime instead. (Handsfree pumps and pump devices are making this much easier for everyone these days already!)

**Pumping and My Left Boob: Also to be elaborated upon next week. Stay tuned.


*** Another post on paced feeding and other best practices for bottle-feeding when necessary, will also be forthcoming.

10 comments:

  1. It's amazing that you came through all of this and are able to tell the tale so eloquently.

    I also overfed my infant... After the first few days of him not even waking up on his own or being willing to take a bottle (nevermind breast, at that desperate point) I gave him ALL of the milk I was pumping--3-5 ounces sometimes. Same wiggle-the-bottle to get him going again and not even realizing how very severely overfed he was...

    I had no clue how much he needed and never thought to look it up. I thought if he took it, that meant he needed it. My paranoia that he would go hungry overrode all other thoughts. And then an LC told me he was under-eating when we went in for help with latch. That is an LC I would not recommend to ANYONE.

    I'm fortunate to have worked out all these issues early on, I can see now. I still hope I can help other moms avoid them altogether though.

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  2. So, what does it mean when your "baby" is 2 years old and you still feel this way? Is this just plain ol' depression then, or something else? Because I can STILL relate to a LOT of things on this list.

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  3. Arual, hugs to you. It's so good to know that other moms can relate. I understand why we both did it at the time - let's work on forgiving ourselves.

    Jill! I'm sorry to hear that. Without knowing more, I would wonder about general depression, and perhaps talk to someone? Do you have good support around you, enough breaks, enough companionship?

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  4. wow, I only had time to skim this but WOW intense!

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  5. Really informative post.
    Thank you for sharing your experience.

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  6. Oh, yeah. Been there. Done that. X2. My boys never nursed, even after craniosacral therapy and some AWE-INSPIRING lc's. Logged every cc & every diaper. I pumped for eight...months.... so happy that I did! Boys are happy, healthy, sweet & sassy (not to mention 2 1/2 -y-olds who are NOT napping right now...). Kudos to you and Lily for extreme courage in the face of chaos!

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  7. Except that my breastfeeding woes sorted out at six weeks, this could have been me--bf trouble, weight loss scare, new town, no friends or family, logged for a year, TV on all the time, constant anxiety and no sleep. I also had a thyroid problem that caused a host of physical problems. My memories of that time are a constant reminder to me to reach out to all the new moms I know!

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  8. Heh, the answer would be no, no, and no. Plain ol' run-of-the-mill garden-variety depression most likely as I've struggled with all my life. :sigh: But in a morbid way, it's slightly comforting to know that these are all signs of such and not just me becoming a crazy person.

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  9. Almost a year late, I know. But wow, this is just so moving!
    You are an incredibly strong person! And with what you had to face:
    mostly single parent, isolated, first time mom, even if breastfeeding
    had gone well your story would still be one of inspiration!

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  10. Just came over from RMB, and wow. I have struggled with OCD and intrusive bad thoughts for a while, triggered by birth control, and I've often worried about how it will manifest when I become a mother. These posts were amazing and I found so much worth and comfort in reading them. Thank you.

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