Moving to the Middle: Joy on the Other Side of Postpartum Depression
I met preemie mama Rachael a few months ago and I was so excited she was willing to share such a personal story about postpartum depression and PTSD. These are topics not discussed enough and I am hoping the more we talk about it, the more aware people become, and hopefully things will start to change in terms of preventing, identifying, and treating postpartum and PTSD for NICU parents. I can totally relate to Rachael, especially when it comes to feeling guilty about our bodies failing us. She has inspired me and encouraged me to seek a therapist for myself, so I can begin to work through some of these things. Rachael, you are such a brave and fierce Mama for Liam, and I am so honored you shared such an intimate story with us! - Stephanie
We were home, we were so incredibly lucky that our baby was doing so well, and yet, I couldn’t shake the anxiety, the sadness and the guilt. And that damn beeping in my head was a constant reminder I wasn’t okay.
Liam is the reward for all of our heartache in trying to get pregnant: the infertility drugs, the injections, the procedures. He is the gift we were given for the loss of his two siblings in utero and every day I find more joy than I thought I possible in his inquisitiveness, his smile, his laugh and his snuggles. I remember the first time I saw him in the ultrasound following the embryo implantation. There were three little heartbeats – a set of identical twins sharing a small egg sack, and our Liam, who we joked was spread out and enjoying his own growing placenta. At 10 weeks were discovered we had lost the identical twins; an experience with many mixed emotions: grief at the loss of these babies – my babies, and gratitude that Liam would now have the best chance possible at a normal pregnancy and positive outcome.
And it was normal – morning sickness, a sore body, sleepless nights of tossing and turning, videos of watching him move across my tummy – until my 34 week routine OB appointment. I had been feeling like death for days, but this being my first pregnancy, I assumed that was normal. It was not. I was diagnosed with preeclampsia and admitted directly to the specialty care unit of the maternal/fetal ward at our hospital. Over the next hour, the news went from bad to worse; I had severe preeclampsia and was diagnosed with HELLP syndrome. Liam had to be born now to save both our lives. He came out mewling and they placed him on my stomach to clean him off, but immediately took him away. Liam had stopped breathing and was unresponsive. He had gone into respiratory arrest and was intubated in the delivery room and placed on mechanical ventilation.
Almost 12 hours later I was finally stable enough to go see him. They wheeled me through what I later termed the “happy maternity ward” full of smiling moms and fat babies, and into the NICU to see my son for the first time since they pulled him off my stomach. Because of the drugs I was continuing to receive to prevent seizures and stroke, I don’t remember most of it, but I do remember the feeling of overwhelming guilt. My only job as this baby’s mother was to keep him safe, and my body had failed to do that. He had suffered from significant intrauterine growth restriction and was barely on the growth curve for a 34 week baby, at just over 3 lbs. His lung development was that of a much younger preemie and he required both oxygen support and treatment with surfactant (thank you March of Dimes for surfactant therapy!).
He was only in the NICU for three weeks. After he was extubated, he received C-Pap therapy and then nasal cannula oxygen, but his lungs strengthened and after a little over a week, he was off all oxygen support. He lost a lot of weight in the beginning but after adding calorie supplementation to his gavage, he started to grow. Three weeks and we were HOME. He wasn’t even five pounds when we took him home, but he was healthy and he was whole.
So why wasn’t I doing better?
We’d lose Liam. Add the overwhelming exhaustion and I was a wreck. I would look at Liam and instead of seeing the healthy, developing, growing baby he was, all I could see was the baby who coded in the delivery room; the baby I thought we were going to lose; the baby my body failed.
It came to a head when Liam was about 4 months old. My husband was feeding him pureed carrots for the first time and Liam was loving it – like LOVING it. He was covered in it and was just laughing his big baby laugh and my husband was laughing with him and it hit me: this is likely going to be the happiest part of my whole life and I am missing it. I became determined that I would not be an observer to this happiness, but that I would do what I needed to be in the middle of it. It didn’t come easy. The effort to call my primary care doctor felt overwhelming – but I did it. I was lucky in that I had already established care with a therapist prior to getting pregnant, so I didn’t have to go through the work of finding one who I meshed with and trusted, but oh wow, did it feel hard to text her that I wasn’t doing okay and that I needed to see her.
I opened up to my husband, my mom, and some friends. I had so much shame around how I had been feeling that I was scared to let them in, but there was so much relief in just saying out loud that I was not okay. Turns out, I was not as good an actress as I had thought and they knew very well I wasn’t doing okay and were relieved that I was willing to seek care.
I went to my doctor’s appointment (a feat in itself) and accepted medication help. I went to see my therapist and she helped me cope with the trauma of my birth experience and Liam’s NICU stay. Just having someone acknowledge that a NICU stay – any NICU stay – is trauma, brought relief.
I laughed more easily and didn’t get as overwhelmed by just getting out of bed in the morning. I learned to accept help from my family so that I could take time to take care of myself – even if that meant just sleeping in or taking a bath. Or going to the bathroom without a nursing baby on my lap.
Living with postpartum depression and postpartum PTSD, as I was diagnosed, has had a silver lining I didn’t expect: I feel like having walked that side of darkness and desperation has made this lighter side so much sweeter. Today Liam is 15 months old. He is giant – like an actual horse baby, no trace of that teeny tiny baby he was. He is walking and babbling and loves kissing dogs with an open mouth and chasing balls. Joy is all around me and I am in the middle of it. I am still on medication and I still see a therapist regularly because I need all the tools and help I can get.
It is well documented that we survivors of the NICU are at increased risk for all postpartum mood disorders, with some studies suggesting up to 70% of NICU moms may experience postpartum depression and/or postpartum PTSD (Tahirkheli, et al.) (Lefkowitz, et al.). If you are finding that you’re struggling, know you aren’t alone. Let someone know – don’t keep your feelings to yourself. Let your family and friends help – we can’t do this alone. If it feels like too much, ask someone to call your doctor for you to make an appointment. The most important thing I did was make that call and then show up to that appointment. Be open to treatment options: going on medication, if needed, doesn’t make you a bad or weak mother. Most importantly remember that you are so worth all the work it takes to get better, because I promise you – it does get better.