Tuesday, May 28, 2013

Postpartum Reflection

Some followers here may know that I am currently working towards getting my Childbirth Ed instructor certification. It's something I've been kicking around for a few years, and at the beginning of the year I officially enrolled and have been working steadily through the program.

The first section was about communication (being aware of your own biases, translating medical jargon, knowing your audience, etc.) The final assignment was a paper reflecting on your own birth or postpartum experience. It was a surprisingly difficult process for me. At first I thought, "oh, I'll just right about how he was High Need, and how that was difficult." But the more I wrote and the more I cried and cried as I wrote, I realized there was so much more to it. It took several months to get to place where I felt like I was being honest with myself.

I came away from this process with the realization that new mothers are not prepared for a lot of the feelings that come with having a baby, and we don't help the situation by keeping those feelings to ourselves. So in that spirit of "saying it out loud", here it is ... don't let its "academic-ness" fool you -- it's raw and real, and it still makes me cry to read it. But it's the truth, and I hope some new mom down the road comes across this and realizes she's not alone.


Mollie Hartford

Childbirth International – Childbirth Education Certification

Communication Assignment – FINAL DRAFT
May 12, 2013

Postpartum Experience

            The following is a reflection on my postpartum experience after the birth of my first child in 2011. I will outline the circumstances of my time at home with my son during my maternity leave and my return to work; my feelings associated with Postpartum Depression and dealing with his intense needs; the actions I took regarding his and my own care; and what I have learned about myself and other mothers because of my experiences. I have not had any subsequent pregnancies since the birth described below.

Recount the event. What were your goals and expectations at the time?

My first child, Rowan, was born on Monday April 11, 2011. My estimated due date was April 29, so he arrived about three weeks before I was expecting him (though at 37 weeks and one day, he was officially full term). Not counting “pre-labor”, I was in labor for just over 12 hours, pushing for only four minutes. I delivered at an in-hospital birthing center in New York City, New York, USA. I had no interventions and no medication during labor; I had no tears and required no stitches or postpartum procedures besides a Rhogam injection. Rowan was born healthy, weighing six pounds and four ounces and he did not require any emergency procedures. We nursed within the first half-hour with very little help and were both discharged after about 18 hours.
My husband, Chris, used company sick days and vacation days in order to remain home with me for about a week; my mother traveled from out of state to stay with us for about two weeks. After that, I was home alone with my son until about 12 weeks postpartum, when I returned to work full-time.

As I soon learned, Rowan was a very “High Need” baby, though I did not know that was a diagnosis until nearly a year later. He cried non-stop throughout the day unless I was holding and rocking him, and then would cry uncontrollably in the evening, regardless of whether anyone was carrying him. His screams were so loud they made my ears ache, and whenever I met someone in hall, they would say, “Ohhhhh, you’re the new baby on the first floor who’s always crying.” Rowan required almost constant motion, and he was not soothed by activities like a bath or baby massage, as those activities required setting him down. He would only sleep lying on top of me or my husband, and would immediately wake up if we placed him in his crib, a bed, an infant seat, a stroller, or a carseat. This meant that it was very difficult for me to sleep at all during the day; if I tried to lie down on the bed with him, he would wake up. I spent most of the day sitting reclined with him resting on top of me.
We had very few problems with breastfeeding, and he gained weight well. He nursed approximately every hour during the day and at night, but seemed to always show some sort of hunger cue (rooting, sucking, etc.). He progressed very quickly from first hunger cues to crying (sometimes in less than a minute), and nursing was often the only thing that soothed him.
We did not leave the house very often. He cried if I put him in the stroller, and I was not confident wearing him in the baby carrier by myself. When we did go out, he would scream so loud and for so long that people would come up to me and ask if something was wrong. Strangers would approach me in the street to tell me to feed him, that he needed a pacifier, or that he needed to be burped. When I would say, “He just cries”, they would tell me I was wrong, that he must be hungry. Because nursing was the only thing that soothed him, it was often difficult to maneuver outside the house; I sometimes found it difficult to find a place to sit comfortably, and in the beginning I was not confident nursing in public or getting him in and out of the baby carrier to nurse, so I often chose to simply stay at home.
            I went back to work full-time at about 12 weeks postpartum, and Rowan went to a daycare in our neighborhood. My transition back to work went well and I continued pumping milk three times a day and sending bottles of expressed milk to daycare. Rowan’s transition to daycare was not as easy. He did not sleep well at daycare, and they reported that he still needed to he held when he was awake and rocked when he was asleep, which made it difficult for the nursery teachers to take care of the other babies. The director of the daycare would call me to tell me he was crying so loudly that he was waking up the other babies, or that they had to bring him up to the preschool so as not to disturb the other babies in the nursery. They encouraged us to sleep-train him so he could get used to falling asleep on his own.
With the exception of my husband, very few people in my life seemed to appreciate my situation. The pediatrician said Rowan was healthy and the crying was not considered “colic”. When I would tell friends or co-workers that the baby was very “needy”, they would respond, “All babies are needy” or “That’s what infants do”, and encourage us to sleep-train him. To make matters worse, when these people would see him calm or only crying a little, they would laugh at me and say something like, “You call THAT crying?! That’s not even that loud!” When people would ask when we were going to have another baby and I would say, “Never. I’m not going through this again,” I got dismissive responses such as, “You’ll change your mind” or “It can’t really be THAT bad”. I have even had a physician tell me, after I admitted to being unhappy during my postpartum period, “Next time, you need to get on antidepressants immediately. You don’t want to do that to your baby again.” Overall, I had very little support from my friends and community.

Goals and Expectations:
Most of my conscious goals surrounding the postpartum period were related to successful breastfeeding. I wanted to: nurse right away in the hospital; exclusively breastfeed for at least the first six months; delay introducing a pacifier or bottle until about five weeks, when breastfeeding was established; pump enough milk where Chris or a caregiver could give the baby a bottle occasionally and I could send the him to daycare with expressed milk; and avoid supplementing with formula. While all of these goals were met, I realize now that I also had many unconscious goals and expectations related to my feelings toward the baby and how we would spend our time together.
I expected to love this baby immediately. I had imagined those first moments to be calm and beautiful, and that I would be filled with unconditional, soul-changing love for him the moment he was born. When we brought him home, I assumed I would be fascinated with him. I pictured the two of us rocking quietly, me humming a lullaby and him being content and happy. I expected that I would take him on walks around the neighborhood, go to the park and sit quietly, or take him to run errands or get groceries. I anticipated that when he was sleeping I could do things for myself, like knit or read, cook for myself, or nap. I had hoped to join Mommy & Me groups, take him to baby yoga classes, and do baby massage. I expected to enjoy my time with him away from the office. His High Needs meant that we could not do the quiet activities I had envisioned, and as I describe next in the Feelings section, I did not feel the love for him that I expected.

At the time, what were you feeling? What about others? Your family, partner, caregivers? Immediately after the event, what were you feeling? What do you think caused these feelings?

While no one used the term “Postpartum Depression” at the time, it was clear that I was depressed for most, if not all, of the 12 weeks I was home with my newborn son. I was tearful and sad, had lost interest in most things, was very anxious about leaving the house, and had a lot of difficulty focusing on anything. I spoke to my therapist and neither of us was worried about me harming myself or my baby, so I did not feel I needed antidepressants, especially because I thought I would have to stop breastfeeding. But I felt alone, both physically alone in my house, and emotionally alone with my feelings. I have a history of depression and anxiety, so I was not surprised to experience Postpartum Depression; I was, however, surprised by my feelings towards my baby as well as my role as his mother.
I had many expectations for how I would feel toward this child, and I was shocked when I did not love him immediately. I did not even feel like his mother. I remember saying, “I must be the best nanny in the world,” because I felt like a hired baby-nurse or wet-nurse, a live-in nanny that also breastfed the baby. It felt as if someone had left their baby on my doorstep, and one day they were going to come back and claim him. I felt irrationally angry at these imaginary parents; it was unfair that they would leave me in this situation, solely responsible for someone else’s screaming infant but without any instructions. I felt guilty that I did not love him, ashamed when people would ask me how things were going or make comments like “You must love him so much, right?!” I felt like I had to lie and say that of course I loved him, even though it took two months to even begin to feel something that resembled love. At work, when people would ask me if it was very difficult to be away from him, they seemed surprised when I said it was not hard and that I was genuinely happy to be back. While other working mothers spoke about feeling guilty for being away from their babies, I felt guilty that I was NOT upset about being away from mine. It seemed everyone expected me to be a mess when I returned to work, to be homesick and crying over my baby’s photos at my desk. Instead I was excited to get back on top of my work, and it seemed wrong that I did not miss him. When I would finally admit that he was not a good baby or that I did not love him, people would seem shocked, and those reactions just intensified my feeling that I was doing something wrong. Everyone else seemed to love their baby no matter what; what was so wrong with me that I could not love mine?
I was also embarrassed by how much he cried. I felt like people were always staring at me when we were out and he was screaming. I felt badgered by strangers when they told me what they thought I was doing wrong and dismissed by my friends when they did not seem to believe how difficult Rowan was. I was angry that when admitted I was struggling and reached out for help I received criticism instead of support, as if I were actively mistreating my child rather than caring for him. I felt humiliated that I could not comfort my own son and even angry at Rowan because he never seemed satisfied. When daycare would call to tell me he was waking the other babies and making it hard on the teachers, I would be overcome with shame. I thought about quitting work and keeping him at home, not because I missed him but because at least he would not be disturbing anyone else. I felt like everyone saw me as a bad mother because he was always so upset.

Even today, as I write this reflection, I have tears in my eyes remembering the severity of these emotions and the anger I feel about the reactions I received. It was not until very recently -- nearly two years after the birth of my son -- that I have begun to receive supportive comments from other mothers and even appreciation from other new moms when I share my truth about those first few months. However I am still often blindsided by the occasional negative comment. I can usually dismiss a look of shock or an admonition from a stranger with the knowledge that my son is thriving, and that my feelings at the time were completely natural and normal.  However, there is still a part of me that senses their judgment and I cannot help but feel that I should still be ashamed.

In what way did your actions meet your goals? What else could you have done to meet your goals and why didn’t you do this?

I believe I spent so much time preparing to breastfeed and expecting breastfeeding to be difficult that I neglected to prepare for the realistic and practical management of Postpartum Depression (PPD). I had read several books on breastfeeding, had all the supplies I needed, and had on-hand the contact information of all the local La Leche League leaders and even a Lactation Consultant. All of this preparation led to very few breastfeeding problems, quick resolutions to the minor nursing issues we had, and a long and rewarding breastfeeding relationship. I realize now that perhaps if I had spent more time learning about how PPD really manifests itself, I could have dealt with those feelings more effectively. I had a general overview of PPD from my pregnancy books – the percentage of mothers who suffer from Postpartum Depression, how it differs from “Baby Blues” or Postpartum Psychosis, and the symptoms. I had an overall understanding and felt that I and my partner would be able to recognize it. Having dealt with some bouts of depression myself, and having never taken medication for it, I assumed that I would deal with PPD the same way: talking with my therapist, being aware of it, and letting it pass. I expressed concerns to my therapist, and made plans to speak with her on the phone and to come in for sessions while on my maternity leave.
I realize now that this was not enough preparation for me. During my maternity leave, I began reading a book called “What Mothers Do, Especially When It Looks Like Nothing,” by Naomi Stadlen, and at the time I remember wishing I had read it before having the baby. The book contained quotes from mothers in support groups describing certain aspects of motherhood, including bonding and depression. It was tremendously comforting and validating to hear other mothers describe the same feelings I was experiencing, and it made me aware of many of the assumptions I had made about myself (and about motherhood in general). As I look back, I wish I had found more references like this book, ones describing the feelings real mothers have in an honest, nonjudgmental way. The top-line information about PPD and the cursory statements of “there’s nothing to be ashamed of” in the pregnancy books was not enough for me to truly understand the complexity of the feelings or be ready for them.
I also now realize that it was not enough to simply acknowledge that I was depressed, or to prepare my partner to recognize that I was depressed. I should have sought out more help. I could have spoken to my therapist more often, or I could have gone to see her more consistently. I could have found a sitter for the baby during those sessions so I could have focused more on the treatment. Of course, at the time, that did not seem like a viable choice -- leaving my High Need, exclusively-breastfed baby in the care of someone else was a very stressful thought for me. Additionally, my partner had used all his sick time and vacation time to stay home after the baby was born, and I felt like it was too much to ask a family member to travel from out of state just so I could go to a doctor’s appointment. Perhaps I could have found a PPD support group, much like the La Leche League meetings, where I could have brought the baby and met other mothers in my situation. Finally, while I was willing to admit that I was tearful and sad, I never once admitted the truth that I felt like harming my child. I knew in my heart that I would never hurt him, but still the fleeting urges and intrusive thoughts to throw him, shake him, or let him drown terrified me. Not only was I afraid that if I told anyone these feelings Child Protective Services would take him away, I was worried everyone would view me as an even worse mother than I already felt to be – not only could I not comfort my constantly-crying child, I also wanted to hurt him. I never said these words out loud, even to my therapist, and this only intensified feelings of shame and isolation that most likely hindered my treatment.
There were also a few actions I could have taken but chose not to because I was dedicated to breastfeeding. I could have chosen to take antidepressants to treat the depression, but I dismissed this option immediately because I believed it meant I would have to stop nursing. While I still do not know the specific guidelines regarding breastfeeding while taking antidepressants, I am sure we could have found a treatment that would have allowed continued breastfeeding. There was also the option to transition the baby to formula, which could have led to more sleep, more help from my partner or outside caregivers, and potentially less social isolation. Again, I dismissed this option immediately because a successful breastfeeding relationship and my goal to avoid formula were more important to me than treating PPD.
Finally, I believe I could have dealt with my child’s High Need temperament more effectively had I known more about it. I did not know that “High Need” was a diagnosis until about a year after he was born, and I remember asking, “Why didn’t anyone tell me?!” Much like reading about other mothers’ postpartum feelings, learning of the characteristics of a High Need baby was immensely comforting; I finally felt validated in my feelings about how difficult my child had been. My therapist remembers mentioning to me that he seemed High Need, which makes me think that I either had not understood what she meant, or that I was so overwhelmed with my situation that I was not really listening to her. Again, perhaps if I had made myself available for more therapy and found alternate care for the baby during our sessions, I could have heard her recommendations and sought support and guidance in dealing with his needs. I do not think I would have changed much about how I had cared for him had I known the term “High Need”, as we were already following many of the recommendations for High Need babies (breastfeed on demand, wear him in a baby carrier, etc.), but I believe my attitude would have changed towards the baby had I been able to pinpoint our difficulties. Perhaps I would not have been so bothered by his constant nursing but instead would have realized it was exactly the comfort he needed; I would not have been as embarrassed by his constant crying, but rather I would have seen it as simply part of his personality and not as a reflection on my skills as a mother.

What do you feel now, looking back at the event? If your feelings have changed, how have they changed and why do you think that is? What have you learned about yourself and others as a result of this experience and the way you have chosen to feel about it?

I believe that the greatest issue I had with my postpartum experience was that even after months of preparing for this child, I was unprepared for my feelings and the limited social support available to me. I was not the slightest bit prepared for the overwhelming desperation I felt, the fleeting, terrifying urges I had to hurt him, or the social stigma I felt when I tried to seek help. I thought I had been prepared for depression, ready to recognize symptoms and seek help. I had not been prepared for how difficult it would be to bond with my child, especially considering I had complication-free birth, breastfeeding was going well, and neither of us had any problems that required us to be separated. I was surprised and disappointed by the reactions of my friends and community, who seemed dismissive or shocked by my struggles. I was left feeling alone with the certainty that these feelings were abnormal and that there was something wrong with me for feeling them.
The more I speak about my postpartum experiences, the more confident I am that my feelings were normal, natural, and probably more pervasive than we, as a society, are willing to admit. Reading the Childbirth International training manual’s section of Postpartum Depression was especially eye-opening, as it described perfectly how I had been feeling. I can now tell people that I had Postpartum Depression (though sometimes those words are difficult to say), and I can even say that I did not feel love for my child for the first two months of his life. Just this morning, I joined an online discussion about the feelings associated with going back to work full-time, saying that I believe going to work actually helped my PPD, as it gave me an opportunity to be away from my child and excel at something else. Still, there is always a moment after speaking these words when I crave someone else’s approval; I still dread a shocked and judgmental response and feel relieved when I see the reply of “Me too!” As confident as I am in how I have raised my child so far, there is still part of me that guards this part of our experience, fearing society’s continued judgment of me that I did not try hard enough to be a better mother.
I believe there is an issue with how PPD is explained to mothers. While pregnancy books include a paragraph about PPD, our doctor’s warn us about “baby blues”, and the hospital makes us sign a form saying we promise not to shake the baby when he cries, mothers today are not prepared for the real feelings that can accompany having a newborn. We do these mothers a great disservice by not being honest about our feelings or by keeping them quiet. The only acceptable response to “How is the baby?” seems to be “Great!” with a big smile and a hug and kiss for the child; an honest response of “I haven’t slept more than 20 minutes in the last 5 weeks and I want to drown him in the bathtub” is regarded as either comical or warranting a call to Child Protective Services. We are not honest with each other about the very real feelings of absolute desperation, so when these feelings arise, it is no wonder we begin to question our own maternal value. As someone who works in the TV industry, I know first-hand how motherhood is portrayed on TV and in movies. Picture a woman, perhaps ambivalent about her pregnancy, delivering a baby. The doctor hands her the baby and everything else falls away. She and her baby lock eyes, and she forgets her past life and immediately embraces her role as a mother. She instantly loves the baby, would die before letting anything happen to it, and feels that this child is the best thing that ever happened to her. I hate to admit it, but this picture-perfect image is burned in my brain as reality, and I believe some of the shock of not feeling immediately connected to my baby was due to my desire to be just like the characters in those scenes. I grew up with these archetypes and, I am sad to say, they are my role-models for how mothers should act, because I did not see any alternatives in the media. We do not see real bonding struggles on TV; we do not see real Postpartum Depression in popular movies; imagine the backlash if Kate Middleton (or some other new-mom celebrity) gave an interview after her baby was born and said she did not love him – she would be portrayed as a monster.
While not every mother experiences Postpartum Depression, I believe we owe it to each other to be honest about our feelings, so that every mother is prepared for the possibility of these feelings. If all we ever see is happy mothers, content babies, and stories of tummy time and sleeping through the night, we cannot expect to know how to handle a needy child or our own ambivalent feelings. And the more we talk about our real feelings, the more socially acceptable these feelings will become, and the more comfortable future mothers will be to seek help.


          Before writing this reflection, I was unaware of the power these feelings of anger and shame still had on me. I believed I had moved on and was completely comfortable discussing Postpartum Depression and my own experiences. However, as I began writing and the tears came, I realized just how painful these memories still are. I appreciated that I still need to process the feelings before I can really move on and before I can confidently teach about the subject. I know now how important it was for me to be prepared for these feelings, and I feel that that knowledge will make me a better teacher and a better support-person for women in my life. I know how it feels to have my emotions dismissed, and I know how long it has taken to recover from that treatment. I believe I can truly help other women in this situation because I have been there and I can be the one to validate their feelings and help them understand that they are not alone. 

Friday, May 24, 2013

Things I'll forget ...

Yesterday morning he climbed into bed with me and started reading the clock to me.

"Mummy, 7 (6:07)
Mummy, 8 (6:08)
Mummy, 9! (6:09)
Um ..."

It had changed to 6:10 and he didn't know how to read it.

Saturday, May 11, 2013

Saturday May 11 ... 2 years, 1 month


I'm having trouble keeping up with these posts now. So much is going on, and he changes so quickly, I can't remember if all the cool shit he does today was happening a month ago.

But here are some highlights ...

Babywearing ... I wear him to school nearly every day now, even in the rain (he likes to hold the umbrella). Our new fav carry is Christina's Ruckless Back Carry, which doesn't fall off my shoulders like a regular Ruck carry does.

2-year Doctor's appointment was hysterical. He totally freaked out when we got to the doctor's office, but was immediately excited about all the new toys in the waiting room. 


We went back to the exam room and he got really upset with the medical assistant trying to measure him, but she was very sweet about it.


We were able to distract him with all the cool stickers on the wall ... until ...

The doctor popped in to say he's be in in a minute, and R completely freaked. I hugged him and said that that was the doctor saying hi, and that he was going to come back in a minute. "SCARE!!!!" R started yelling! "HE SCARE ME!!!!" 

Of course he screamed the whole time, which is expected. The doctor said he was "excellent", which I translate to be "wow, you're kid is awesome, so much smarter than any other two-year-old I've ever seen, but I'm not allowed to say that." Boom. Parented.

Then, for DAYS he would suddenly stop what he was doing and say, " Doctor scare me."

(Stats from doctor visit ... 24 pounds, 31 inches tall)

Ear Infection. 
It didn't help the whole "Doctor Scare Me" situation when a few days later he came down with a nasty fever that kept him home for a week. School sent him home early on Tuesday with a fever and an upset stomach. 

I stayed home Wednesday with him, where he acted fine as long as we gave him tylenol for the fever. Just more random napping than usual.

Same thing Thursday, when Dad stayed home. 

Then Friday all hell broke loose. I called the Doctor's office Friday morning to ask if I should bring him in since he'd had a fever for a few days. As soon as I got off the phone I hear "Uh-oh ... POOP!!!!!" His diaper had exploded in diarrhea all over the recliner. I got him cleaned up and we laid back down on the couch. He then throws up all over me, himself, and the rocking chair. I get us cleaned up again, and we spend the next few hours alternating between explosive diarrhea and projectile vomiting.

I manage to get us to the doctor (though we had begun to run out of clean clothes at this point). We spent longer than I liked in the waiting room, and it showed how sick he was that he fell asleep there AND in the exam room instead of freaking out. 

(Mummy enjoyed in the in-flight entertainment though)

We saw a different doctor than his check-up the week before, and Ro was actually very excited to tell this doctor how "Doctor scare me". Turns out he had an ear infection. "Don't ask me why," said the doctor, "that some for some kids ear infections mean pain and yanking on the ear, and in some kids vomit and have diarrhea. I have no idea."

So we trekked to the pharmacy (on the "choo choo train!", which cheered him up) to get antibiotics. (The kid in front of us in line was getting the same thing). There's something about Amoxicillin that causes me to have flashbacks of grossness. I had a lot of ear infections as a kid, and that smell ... blegh. 

However, my kid, who eats everything, effing loved it. 
That's him dipping goldfish crackers into amoxicillin and yogurt. We started mixing it with yogurt, but then were giving it to him straight from the dropper, then from a spoon. Ever time he asked for "more".

Saturday he slept for most of the day, and then Sunday he was back to normal (and a little stir-crazy). Monday he was back at school like nothing had happened.


He's been "writing letters", usually to Grampy. We were able to have some "homework time" a few nights.


He knows what a freaking Octagon is.

Random weirdness ... he puts his hand in his shirt and holds onto his booby. I'm not sure why.


Breastfeeding ... when he was sick he asked to nurse a few times. One time he actually latched on and nursed for about 5 minutes. Otherwise, he asks for it, grins, sort of kisses the booby, and then snuggles on it. I'm afraid we may be done. :(