Friday, July 30, 2010

Postpartum OCD, A Retroactive Self-diagnosis: Part 1 of 2

I've been mulling this post over for quite a while. I've mentioned it in passing before, and the combination of one topic in Breastfeeding Cafe's Blog Carnival plus actress Bryce Howard's deeply affecting piece about her own postpartum depression (scroll down a bit in the link) is finally the catalyst. I've long since missed the deadline for inclusion on the topic in the first carnival, but I decided to go full steam ahead anyway, and then found out about the World Breastfeeding Week (which is next week, by the way) Carnival by The Leaky B@@b.

As prelude, an excerpt from Howard's story:
It is strange for me to recall what I was like at that time. I seemed to be suffering emotional amnesia. I couldn’t genuinely cry, or laugh, or be moved by anything. For the sake of those around me, including my son, I pretended, but when I began showering again in the second week, I let loose in the privacy of the bathroom, water flowing over me as I heaved uncontrollable sobs.

When I visited the midwife for a checkup, she gave me a questionnaire, rating things on a scale from 1-5 so that she could get a sense of my emotional state. I gave myself a perfect score. Despite my daily “shower breakdowns” months passed before I even began to acknowledge my true feelings.
Boy, do I know those shower breakdowns. But even beyond that, the last part really resonated with me, as I imagine it would with many women. The Edinburgh Scale - the standard for assessing postpartum depression - is a great tool . . . in theory. I suspect far too many women do exactly what Howard did above, and what I almost certainly would have done: answered dishonestly in order to prove our maternal aptitude (whether proving it to the person giving the test or to ourselves). Part of it may be pride in the sense of ego, part of it may be fear of having our children taken away from us if we admit to our true feelings.

But another huge part of it may be denial - I had a hard time admitting my feelings to myself even at the time, and I actually didn't recognize many of my own symptoms until long after the fact, through the process of working with other women postpartum. This was heightened by the fact that I believe my own postpartum mood disorder is one that doesn't get quite as much attention as "regular" postpartum depression (I say that with tongue firmly in cheek, as there is nothing regular about it for those who are experiencing it) or the extremely rare but headline-generating postpartum psychosis.

One of the two postpartum anxiety disorders that are part of the greater PPMD spectrum along with depression and psychosis is postpartum obsessive-compulsive disorder (the other is a panic disorder). Despite being reasonably aware of postpartum depression, I had never even heard of the OCD variation at the time.

Many of you have read my unusually difficult nursing story, particularly after linking to it in the conversation that followed a recent piece, and I've always been willing to talk openly about that, but I've never talked publicly about the deeper psychological undercurrents that accompanied the whole saga. I haven't even talked much about it privately, even to my good friends. So please forgive me if this comes across as a bit of a purge.

I did start off with a pretty acute case of the Baby Blues, the most benign and the most common of all postpartum mood variations. It's hormonally driven, and not considered a disorder - frankly, it's quite a normal and expected, temporary state, as 75 to 80% of all mothers experience this to some degree. This much of my tale I did actually write about already, in this post:
That third day. I still shudder to think about it. I had probably slept a total of 4 or 5 hours since the birth. A foreshadowing of the breastfeeding difficulty to come was a growing concern, as Lily showed no rooting reflex and seemed totally uninterested in nursing, and had not yet effectively latched on, so I was desperately pumping to ensure that my supply would still come in without Lily stimulating me, and to produce a few drops of colostrum which then would be cupfed to her.

Adding insult to injury, my hemorrhoids were positively frightening, making every position uncomfortable. I needed to take both my and Lily's temperature regularly, I needed to massage my uterus gently but regularly to help it shrink back down, keep replenishing my witch hazel and comfrey pads in the freezer to soothe my perineum and bottom . . . all endless tasks I could never seem to keep up with enough. I also had to put Lily in the sun for a few minutes several times a day to help with her mild jaundice, and at one point I was CONVINCED I had given my newborn a sunburn and was despondent.

Then, I could never decide whether it was better to swaddle her or keep her skin-to-skin with me - whichever one I chose, I'd feel guilty that I wasn't doing the other. I had a gorgeous
Maya Wrap ring sling given to me at my shower, but for the life of me I couldn't figure out how to use it thanks to the incredibly confusing instructions on the DVD that came with it. I watched it over and over and over again, and couldn't even get beyond the intro part of threading the damned thing. I finally threw it across the room in exasperation. Then Lily's umbilical cord started to look seriously funky, possibly gangrenous in my increasingly paranoid mind, and I had NO idea what was normal. More than anything, the sheer responsibility of it all was starting to really hit me. At one point I had her wrapped up and lying on a heating pad, and her diaper leaked, wetting the pad (I hadn't gotten the hang of using the waterproof covers yet). I decided that I had almost electrocuted my own daughter in my carelessness andshecouldhavediedanditwasallmyfault and proceeded to sob hysterically - and I do mean HYSTERICALLY - over it for at least half an hour.

My milk then came in and left me freakishly engorged with what felt like rocks in my boobs and armpits. Again, I had no clue, no sense of what was normal, and rather than resting when Lily slept, I took to scouring the web for advice. I remember sitting at the computer on the message boards at 6 am with cabbage leaves stuffed into my bra, weeping and feeling like the most pitiful mother ever to barely-qualify for the title.
. . . Yeah, you could say I was a little overwhelmed.

Later that day, starting to see how unhinged I was becoming, Aaron wisely insisted that I take a walk, as I literally had not once set foot outside the house since I was about 6 hours into my labor. Lily was asleep, my list of tasks would wait for 5 minutes. I protested a bit and finally reluctantly agreed to walk out to the mailbox, at least. I put down my checklist and I ambled out the front door in a daze, and got about three steps before suddenly realizing I had walked out there with my shirt COMPLETELY unbuttoned and hanging open, the state I'd been walking around the house in. Thank goodness no neighbors were around to see, and it did give me the first laugh I'd had.

Hopefully, as I grow into my field, I'll be able to help mothers through the labyrinth with a little more grace than I.

This was the baby blues, no doubt about it. The third into the fourth day, man, this was what it means to stare into the abyss.

Not a happy mama.

Things DID ease up a bit for almost week, but just when I thought I was out of the woods, our nursing took a turn for the worse. I thought we had ironed out our initial difficulties. She seemed to be nursing, even though I had always thought that the sucking sensation would be much more vigorous than what I was experiencing. She was producing enough diapers, and put on a few ounces, almost regaining her birth weight. She was 7 even at birth, dropped to 6 lbs 10 oz by day 3 (perfectly normal), and then went back up to 6 lbs 14 oz. I thought it was all basically behind us.

Then it all went to hell.

She had a day where she slept a LOT - over three and even four hours, and she hardly nursed at all. I knew this amount of sleep for a brand-new-born could be a very bad sign, and I started to worry. Since she'd been nursing so much the day before, the first lactation consultant I had worked with thought it was a growth spurt. Well, overnight, we had our first glimpse of real hell - 7 hours of trying to nurse and flailing around and crying instead. It was like she had just FORGOTTEN HOW.

Not a happy baby.

This went on for four days, and her diapers started to dwindle. She still wet, but went for well over 72 hours without any poo, and then the wet diapers, too, started to become less frequent. Nursing still happened on something of a pattern, but it always started with at least 10 minutes of fussing and crying and flailing before she eventually settled down - usually falling asleep after what seemed like far too short a time. Despite this, she still slept, had quiet-alert stages, and displayed no signs of extreme hunger like constant rooting, frequent crying, no physical signs of dehydration like 'tenting' of the skin or 'brick dust' uric acid crystals in her diapers.

Here's the most emotionally difficult part to talk about, regarding this phase: I was getting very frightened. And understandably, the people who were closest to me wanted to reassure me. I was told over and over that she was fine. Babies just cry like that sometimes. She'll poo eventually - she has to, she's eating, isn't she? It's good that she's sleeping - you're lucky! Look at those chubby cheeks, she's not starving. She would be rooting if she was hungry. She'll eat if she's hungry enough. Sometimes breastfed babies just don't poo for a while. Trust your body. She's fine. And inside, my gut was screaming No. NO. She's NOT fine. Something IS wrong. Her cries DO have meaning. She needs help. I need help. But I kept suppressing my gut. I listened to the reassurances and tried to ignore the sense of unease growing into dread and finally terror.

A video of her nursing behavior at the time (I cannot believe I'm posting this), taken in case we needed to show a lactation pro:

My heart still aches hearing those cries. Look at her there, my poor innocent babe trying so hard, and so hungry and upset and bewildered. I put on a brave face for the camera, and make some sort of blase-looking remark the end, but I guarantee you, the memory of sobbing along with her during these nightmarish feedings will never leave me. One of the other things that pains me about this video is the way she's dressed. I had been trying to do skin-to-skin much of the time, until a relative arrived to help out of the extreme goodness of her heart (seriously), and with the best of intentions, subtly convinced me that I really ought to keep her in layers of clothing and bundled up warmly instead. And I didn't fight it. I had so little fight left in me.

Anyway, I finally had Judy, the lactation consultant, come back because I wanted her to evaluate my latch and observe her nursing behaviors. What we finally figured out, after some experimentation, is that her tongue was not coming forward to suck - therefore it was taking forever for my letdown to happen and she was frustrated because she just wasn't getting anything! (Her posterior tongue tie was still not identified, despite this observation.) We concluded that she must have been getting SOMETHING eventually, since she still had some wet diapers, but nowhere remotely near the amount she should. Because she was not able to actively remove milk from the breast, the initial letdown was all she had been getting. The day before she came, Lily had only three wet diapers the entire day, and hardly soaked ones at that. You can actually see the growing despair in the written diaper tracking logs I kept (more on those later).

Most devastating of all, we weighed her again. She dropped to 6 pounds 5 oz during this time. I just wept at that. I had failed her. I had not listened to my instincts when I knew deep down that something was going very, very wrong, and I allowed well-meaning others to reassure me and talk me out of my fears. And I had utterly failed her. My baby had suffered because of my incompetence at the most fundamental aspect of being a mother.

When we weighed her, the lactation consultant and my mother both apologized to me right then and there. "I have to admit, I didn't believe you," Judy said of the increasingly panicked calls I had made to her over the last several days. Extremely long story short, Judy set me up to start finger-feeding her with a syringe, explained the "suck training" technique I was supposed to try, as well as the pumping schedule I would need to follow until she was back on the breast - none of us having any idea how many months this would take.

My postpartum obsessive compulsive disorder took root in these early weeks, but this is all prelude. Next up, in part two, I discuss how the disorder played out in the months to come.


  1. I've considered blogging about my 3rd day this past time: random crying and the whole lot. I've kept my head above water since then, but I'm not sure what will happen next week. My husband's paternity leave ends and he goes back to work Monday.

  2. What kind of other support do you have nearby, TopHat? Do you have friends or relatives nearby, other community organizations you participate in? I hope you find some good, regular support!

  3. anne, just want to thank you so much for sharing this... i'm looking forward to reading more. it touches me, not only as a mother who struggled, but as a lactation consultant. all the best to you.

  4. This post made me want to cry--flashbacks to the first few months of my son's life. It's always nice to know you're not alone in your experiences.

  5. Thanks for sharing this, it must be hard to put such personal feelings out there for the world. I know you also want to become a birth doula, but do you think that it was your difficult experience that made you want to become a postpartum doula first? I want to become a postpartum doula eventually, but I think my bad birth experience is what motivated me to want to do that first.

  6. Wow. Mamas should be taught to follow their instincts and the first step is that helping professionals should trust mamas when they say, "something is wrong!" I had a similar experience explaining to an overworked midwife that my baby wasn't getting any milk, and she was, "I'm sure it just seems like he isn't, I'm sure it's all fine," even though I was an experienced breastfeeding mom! Argh!

  7. Thank you so much for sharing this part of your story with the world of mothers out there who need to know that they are absolutely not alone when they have doubts about what is going on (especially with breastfeeding). Yes, it is a natural process, but not always an easy one. And part of the "nature" of the process is that mom KNOWS when something seems to be wrong. It's how we are wired.

    That's how the nurses found out about my daughter's intestinal atresia that was life threatening and demanded a transfer to a NICU and immediate surgery. Some of them thought that I should give her formula because she was fussing and refusing the breast the night after she was born, but I KNEW something else was wrong - that it wasn't her refusing my milk (since she had been nursing like a pro just hours before) - it was definitely something else. And thank GOD they listened to me. I banished the formula-pushing nurses from my room and brought in the one nurse I really trusted and asked her if it was strange that I felt Abbey's tummy was full, but she hadn't pooped yet. She immediately did some external palpitations and even tried to help Abbey poop manually, and then she called the transfer unit at the children's hospital and had Abbey moved so she could get more diagnostic tests done. The surgery my tiny newborn baby got a day later saved her life. The formula that some of the nurses though my daughter "needed" probably would have burst her intestine behind the blockage and killed her.

    It's important to let moms know that their natural tendencies and reactions to their baby after birth are strong feelings for a reason. Thank you so much for writing this - I think it will help many moms out there! I'm sorry that my comment got long- I just was moved to give another example of how mom's intuition is vital. Your post definitely helped me get through the mental block I've held for the past two years that kept me from writing at all about Abbey's birth and her surgery and NICU stay. I've never written about it before in detail. I couldn't. Because of your strength, I think I can go there now. Thank you!

  8. Wow, September, what a scary experience for a fresh new mama to have - and GOOD FOR YOU on sticking to your guns. I love this: "Yes, it is a natural process, but not always an easy one. And part of the 'nature' of the process is that mom KNOWS when something seems to be wrong. It's how we are wired." And I am so glad you feel ready to write your own story - please send me a link when you do!

    Renee, I DO think that part of why I was drawn to the postpartum portion has to do with my experience, but to be honest, a lot of it is just practical concerns, like childcare coverage. I can't be regularly on call for births for quite some time yet. Someday . . .


    Above is the link to the blog post I wrote about Mother's Intuition and our amazing natural emotional state for Breastfeeding Week, inspired by the bravery and candor you modeled for me by sharing your post partum experience! It's long, but everyone who has read it so far has raved on facebook about how moving it was....and that makes me feel so good that I got up the stamina to revisit that place after Abbey's birth.

  10. Well, its not really a link. I forgot I can't do that in comments. I'll send you a message :)