8 Things I Want People To Know about Postpartum Psychosis

8 Things Postpartum Psychosis

Photo credit: Lauren Gay Photography – http://laurengay.com

 

I love all the media attention these past few weeks on postpartum depression. It’s so important for us to keep these conversations going so that more women and families understand that they are not alone and that it’s okay to reach out for help because treatment works. It’s wonderful to see celebrities like Hayden Panettiere, Drew Barrymore, and Alanis Morissette opening up about their stories because when people we admire, women we assume have it all together, open up and show us their struggles, we pay attention.

I’m just a mom, with a 5-year old little man, who wants to prove to the world that our struggles don’t define us. They only provide us with opportunities to make a difference in the world. I’m beginning to work on explaining this to him every chance I get.

– from a post I wrote dated Sept 19, 2013

We also need to be talking about postpartum psychosis. I was diagnosed with PPP a month after my first child was born, and suffered from antenatal psychosis (psychosis during pregnancy) during my second pregnancy. Both times I had been avoiding my medication for bipolar disorder because I didn’t want to expose the baby to the risks.

I want to share what I’ve learned. Maybe then, more people will understand postpartum psychosis the way they’re beginning to understand PPD, and the women and families who experience it will feel as supported as those who go through postpartum depression.

      1. Women who experience PPP are NOT monsters. Yes, it’s true that untreated PPP can lead to infanticide, but that doesn’t mean it’s the mother’s fault. She was sick and needed treatment, and the more we’re able to identify the symptoms and the sooner she’s able to get treatment, the chances of her actually harming her baby can be avoided all together.
      2. We can be good at hiding the onset of PPP. Having been diagnosed with bipolar disorder two years before I had my first child, I knew what the beginning of a manic episode felt like. I was euphoric, energized despite the severe lack of sleep, and highly social, planning playdates when obviously I should have instead been resting. I hid my initial symptoms for fear of having my son taken from me. I was terrified of failing as a mom.
      3. Family and spouses/partners are usually the first to know something is wrong. If it weren’t for my husband, who knows what could have happened. The morning my husband called 911 to have me hospitalized, I woke at 5am after having barely slept the night before due to the baby’s feeding schedule and my extreme mania. I was in the kitchen rearranging the items in our cabinets. My speech was pressured (had so many things to tell my husband but the words wouldn’t come out fast enough), and what I was able to verbalize wasn’t making any sense. He recognized these symptoms from my two previous manic episodes years before, combined with how little sleep I was getting, and immediately called 911.
      4. Sometimes the woman can’t even see how badly she needs help. Seeking help for psychosis symptoms is very different than seeking help for postpartum depression. Usually it is not the woman herself who seeks treatment, but the spouse/partner or family member who initiates treatment through hospitalization. After the birth of my first and during my second pregnancy, I became so ill that I couldn’t realize exactly how far gone I was. It was a gradual process, but once I reached a certain level of mania, the chaos in my brain took over and catapulted me into psychosis and it was up to those around me to find a way to bring me back. Involuntary commitment was what I needed both times.
      5. It can be difficult to admit symptoms. Some women have thoughts of harming their children, and some of them act on those violent thoughts. Stories like the one of Andrea Yates might make women afraid of reaching out for help for fear of being looked down upon by friends or family members. I was one of the lucky ones who didn’t have those intrusive thoughts, but it was still incredibly difficult for me to admit that I needed help.
      6. Although rare, there are predicting factors, and PPP can be prevented. Postpartum psychosis is much less common than postpartum depression. Although there are underlying conditions which can predispose a woman to developing postpartum psychosis, a diagnosis of bipolar disorder being the main factor, any pregnant woman is potentially at risk. Which is why we need to raise awareness around PPP the same way we are raising awareness around PPD.
      7. Breastfeeding isn’t the only way to feed a newborn. I put tremendous pressure on myself to breastfeed my first child. “Breast is best” was everywhere I turned during my pregnancy and I correlated my ability to feed my child from my body with how successful I was as a new mom. Not only was this wrong, it was incredibly unhealthy. With my second child, we had a plan to bottle-fed with formula from the start, which led to a much more enjoyable postpartum period as compared to my first month of new motherhood breastfeeding my son.
      8. Moms who experience PPP are good moms, too. If I would have known that experiencing this illness was not my fault, and that there were other moms out there who also had to be hospitalized following the births of their babies, it would have been a little easier. Which is why I share my story. If even just one person finds my story and she’s able to get help sooner rather than later, it’s all worth it.

3 tips for navigating pregnancy despite a bipolar diagnosis

Navigating Pregnancy Despite Bipolar Diagnosis

3 days before my daughter arrived in 2010.

My blog turns four years old this August. Having come to this little corner of the internet for nearly four years, writing my story of how I’ve navigated pregnancy and beyond despite living with the diagnosis of Bipolar disorder type 1, I tend to get quite a few questions from my readers. The most common ones come from young women who like me, wondered how they would be able to manage their illness and still be able to care for a newborn. A newborn who would grow into a baby with many demands.

I certainly am not perfect, nor am I an obstetrician or psychiatrist. I’m just a regular mom who, after having found out she had bipolar disorder, wasn’t going to let it get in the way of her dreams of having a family. These are my reflections, looking back on my experiences of having my two children (now 6 and 4). This is what happened to me, and how I’d do things differently if I were to have a third child. (We are 99% sure we won’t be having another one, in case you’re wondering.)

Accepting the diagnosis

Bipolar disorder is a challenging, life-long illness. The first year or two of learning to live with the diagnosis can be devastating and all-consuming. When I was first diagnosed, ten years ago at the age of 26, I had to resign from a career that I excelled at in order to focus on getting well. It took an entire year for me to work with my doctors and therapist to find a medicine and figure out a treatment plan that worked for me. I was able to overcome severe depression and crippling anxiety, and even suicidal thoughts thanks to the vigilance and support of my husband and parents. Once I found stability, and was able to maintain it for a year, my thoughts of starting our family began to take root.

Although I was able to taper off my medicine (under the close supervision of my psychiatrist), and I had a normal, healthy pregnancy, we were not prepared for what would happen next. Not only was having our first child an incredible shock to my system (I had an emergency C-section after 17 hours of laboring – no pushing, but since the baby wasn’t tolerating contractions and I wasn’t dilating, my OB made the call for surgery), but nothing can prepare you for how you’ll react to motherhood. On top of all this, I had put an enormous amount of pressure on myself to breastfeed. I thought, from all the pregnancy literature I had been devouring before the baby arrived, that breastfeeding was the only acceptable means of feeding the baby.

I was wrong and I learned the hard way.

Even though I knew that lack of sleep was a trigger for me, I didn’t realize how little I’d be sleeping once the baby arrived, especially due to trying to nurse. I barely slept at all in the hospital since the nurses checked my vitals every hour because of the surgery. Exhausted doesn’t even begin to describe how I felt. But I couldn’t take my eyes off our son. We had created a baby. I was in awe of this little person I was holding. It didn’t seem real. Maybe partly because I was headed into the throws of mania even before we left the hospital.

1. Have a plan for once you get the baby home

With our first baby, I did everything and wouldn’t let anyone help. I was trying to succeed at breastfeeding and if someone gave the baby a bottle, he might not go back to nursing. Which meant that I was always the one getting up in the middle of the night to feed and change the baby.

With our second, we had a plan. For the first two weeks, someone would be available to take the middle-of-the-night feedings. My parents stayed with us for a week, so they took turns during the first week home, and then my husband took over during weeks two to four. This allowed me to get a solid stretch of 6-8 hours of sleep a night, critical to my recovery from the birth (a repeat c-section) and to prevent mania from creeping in. I learned to protect my sleep, and because of this, was able to stay mentally healthy once we brought our daughter home.

2. Don’t feel guilty for formula-feeding

I breastfeed our son for the first four weeks of his life, and then ended up in the psych ward for a week because of postpartum psychosis. Having to stop breastfeeding was devastating, but on the way home from the psychiatric ward of the hospital I realized that being healthy for him was more important than anything. If I didn’t have my health, I wouldn’t be able to be present as a mother, no matter how I wanted to feed him.

For our daughter’s arrival, we planned ahead of time that I would not breastfeed. Instead, I got excited about picking out bottles and supplies to formula-feed her, and my postpartum time with her was so much more enjoyable since I didn’t have the extra pressure to make nursing work. I ended up having antenatal psychosis (mania during pregnancy) during the first trimester of my second pregnancy, so I had to take antipsychotics and a mood stabilizer during the pregnancy. Nursing was never an option and I accepted this reality.

3. When a medication works for your condition, weighing the benefits and risks is critical

Having experienced postpartum psychosis after the birth of my first child, we were better prepared, or so we thought, to navigate a second pregnancy successfully. We knew that I needed to protect my sleep, and I planned from the moment we decided we wanted to have another baby that I would formula-feed since I’d be returning to my medicine after the first trimester. Going off my medicine for the first trimester was my mistake.

From my research, I knew there was a risk to the fetus of a heart defect during the first trimester of pregnancy when women took the medication I was taking during pregnancy. So I made a plan with my psychiatrist and the high-risk OB-GYN that I’d taper off the medicine when I found out I was pregnant, and I’d return to it once I cleared the first trimester. Only I hadn’t weighed the benefits of staying on the med against the risk I was taking.

I was closely monitoring things, testing for pregnancy on the earliest day possible following my fertile period. When I finally got a positive test, my excitement over finally being pregnant (we tried for about nine months) took ahold of my body and would not let go. My mind raced with potential baby names as I’d lie awake in bed not able to fall asleep.

Would it be a girl? How would our toddler react when he met his new sibling? What would it be like to be a Mommy to two little ones?

Within a week of very little sleep I was manic and it was quickly leading to psychosis. Having witnessed my manic symptoms before, my husband quickly took action and had me hospitalized. I was five weeks pregnant with our daughter.

When I returned home, medication was required to keep me stable. I went back to the high-risk OB-GYN for a post-hospitalization check-up and was scheduled for regular checkups and monitoring of the baby throughout the pregnancy. Luckily, she was born completely healthy and I had a wonderful postpartum period with no complications. I learned that my risk for psychosis due to the lack of medication in my system was far greater than the risk to my baby in utero.

*****

If you’re considering pregnancy or are currently pregnant, I urge you to work closely with your psychiatrist and OB-GYN to monitor and manage your bipolar symptoms during pregnancy and in the postpartum period. There are great resources available online to help you as you navigate pregnancy: Postpartum Progress, Postpartum Support International, and if you’re in the Washington, DC metro area (Virginia, Maryland and the District), the newly developed DMV-PMH Resource Guide maintains a comprehensive and current regional directory of specialized mental health providers, support groups, advocacy organizations, and other relevant clinical resources pertaining to perinatal mental health.

There are resources available. Please don’t hesitate to ask for help. You can be a mom despite bipolar.

Dreaming Tree

10552368_10204353021647962_127558677699681406_nThis photo was only my fourth Instagram shot taken in March 2012

 

There is an enormous old tree in the lot next to our house. It’s full of big climbing branches and there is a rope someone nailed into the massive trunk so that you can get up. I haven’t tried it yet.

I remember the tree being a big selling feature when we were deciding on which house to buy six years ago. The house had plenty of other pluses on our list of pros and cons: a finished basement, an open kitchen and family room layout, nice big deck, corner soaking tub in the master bath. But the tree tipped it over the edge for us. Never will another home be built in the space next to where we’ve planted our roots.

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Six months after we moved in, October of 2008. The smell of autumn danced in the breezes and I was finally home again after a week of receiving antipsychotics via injections, then by mouth, then back to my regular meds for good. I was somehow able to release the bleeding ambition I had to be a breastfeeding mom. It hurt. We had seemingly made it through the hardest part – the learning curve of the first four weeks. And now, as quickly as my mania lurched into psychosis, my baby had converted to formula from my motherly nectar.

Why was I so hung up on being my first baby’s sole source of nutrition? Why couldn’t I see past all the outside pressure, push past my own sense of guilt over using formula? Why did I equate breastfeeding with being the ultimate mother? I don’t know.

What I do know is that after twenty-eight days of getting by on the amount of sleep reserved as a form of torture, I fell apart. That morning, on the twenty-ninth day of my newborn’s life, my husband handed our son to his mom, as I flitted around the house collecting my journals from nightstands and closet corners. I clutched them in my arms, along with all the cards friends and family had sent to congratulate us on becoming parents for the first time. I piled them up by the fireplace, making a shrine to my myself. A temple of my words and the love of others to remember me by.

I was terrified of being forgotten.

Lucky for me, a few days of a high dose of Lithium does wonders to balance out the chemicals out of whack in my head. I went from feeling like the sand was about to run out in my hypothetical life timer to realizing that I was still very much alive. I now had someone to take care of other than myself, and if it meant I needed to take medication for life, that’s what I would do and I wasn’t a bad mom because of it or because of having to change feeding methods.

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In the bathtub my first night home from the hospital, looking out the mini-blinds to the branches of the tree glowing in the moonlight, I reached a conclusion. Dave Matthews was playing on the mini CD-player and I remember singing The Dreaming Tree, my heart swelling with the energy of renewal. A deep longing to see my future life in recovery from my mental illness came alive within me.

I had officially been broken. A new mom is fragile to begin with. Throw in an episode of postpartum psychosis and the result is pure poison dissolving the paper thin skin. I thought maybe I had made a mistake. Maybe people like me weren’t meant to have kids. Being diagnosed with mental illness had ripped apart my confidence, my ability to see more than a day ahead at a time, and for awhile it was ruling my life. There were a few months when I rationalized it would be easier to end it all than to try to learn to swim through the waves of anxiety pummeling me day in and day out.

I was being pulled down by an anchor, drowning by waves of this emotion which everyone around me seemed to think I could just push out of my mind. Gulps of air were all I could manage and thankfully there were enough to sustain me. Because eventually, after bobbing in the waves for the roughest storm I had ever known in my 27 years, I was able to pull myself out of the water and onto dry land. With the wherewithal that the rains might very well come again.

We wanted children and so we took a leap of faith that I’d be able to handle motherhood.

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I remember sitting in that tub for almost two hours, scrubbing the film of hospital grime from my skin. I’d only showered once while I was in, as the first few days the psychosis held me tight in its grip, rendering me incapable of taking care of personal hygiene. As I lathered up my body, rinsed the soapy bubbles from my hair and let the rest of me soak, I kept thinking of the tree.

My brain had begun to process feelings and emotions and random images floating through my psyche at a normal rate, as compared to only six days before when the rapid fire of information flooding my mind crashed like an old computer’s hard drive. The meds were doing their job, and although I was lucid, my thoughts were still swirling a bit.

Thoughts of being chosen to go through this. Thoughts of feeling grateful for the trauma my family and I had endured. Thoughts of getting well and making memories with my son under our dreaming tree.

I just knew in my mind that I would find a way to use my story for good. I would give meaning to all the pain and heartache. I had to. I had a child now who’d be looking up to his mom. And I wanted to show him how to fly.

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The Relief In Finding Postpartum Progress

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I don’t remember exactly when I found Postpartum Progress and Katherine Stone, but it was probably during my son’s naptime in late 2008. I was googling “postpartum psychosis,” desperate to find someone who could tell me I wasn’t a monster because of what had happened to me. My mind was still raw, my emotions fragile. I was scared. What would people think of me when they found out? Are my friends going to turn their backs on me? Am I ever going to be able to be a good mom to this beautiful baby?

In the back of my mind I couldn’t help but remember the story plastered over the news during the summer I graduated college (2001) and how the mom who was so severely sick from postpartum psychosis that she committed an unthinkable act and her five children were gone in an instant. We shared the same diagnosis, and yet I still had to search. If I looked hard enough, knew I’d find what I was looking for.

Postpartum Progress was one of the first websites generated from my search. Once the blog came onto my radar screen, I knew I had found the answers I was seeking. The community Katherine had built reassured me that:

  • No matter how isolating it felt at the time, I was not alone in what I was going through.
  • With proper treatment and support I could recover and lead a successful, fulfilling life.
  • There were thousands of other women across the globe who wanted to talk about postpartum mood disorders in order to break down the stigma.
  • My story was important and I should share it to help other women and families.

Having lost complete touch with reality for several days, being forced into the hospital to get the treatment I needed in order to bring me back, and missing out on a week of my newborn’s life is enough to make any woman doubt her abilities as a mother. Especially a mother living with a mental illness.

I had been expecting postpartum depression to deplete my new mama energy and excitement. I was prepared for the baby blues which never came. I had read all the literature on PPD in the pregnancy magazines and pamphlets in my OB’s office. Several times.

With my diagnosis of bipolar type 1 in the spring of 2006, I should have anticipated the onset of psychosis after the birth of my first child in September of 2008. Especially given to the teeny amount of sleep I was (barely) surviving on during those four weeks when I was trying my hardest to be a breastfeeding mom. I should’ve known. I should’ve been ready. But I wasn’t listening when my psychiatrist said we needed to have a plan for the inevitable and instead was left beating myself up over what happened until I found Postpartum Progress.

I spent many a naptime reading the blogs of the women who were featured writers on the site. Each time I read a new post, I felt my spirits lift a bit, the weight on my shoulders growing a little lighter. Eventually I found the courage to start talking more openly about my own mental health with my close friends.

Katherine showed me the beauty in bearing our scars to show other mamas we’re still here. We’re making it because we have each other and because we want to change society’s perception of maternal mental illness.

I applaud Katherine Stone and Postpartum Progress for the incredible work they’ve done over the past ten years. Because of the blood, sweat and tears Katherine and her volunteers have poured into the organization, they have been able to offer the following amazing resources to mothers and families seeking support and information about postpartum mood disorders:

  • PostpartumProgress.com – the most widely read blog in the world of perinatal mood and anxiety disorders.
  • “Plain Mama English” guides to understanding postpartum mood disorders – lists of symptoms for the various PPMDs written in language moms can use to recognize whether something is wrong.
  • Climb Out of the Darkness – Postpartum Progress’s annual worldwide fundraiser, raising awareness for perinatal mood and anxiety disorders.
  • Mother’s Day Rally for Mental Health – held on Mother’s Day each year, contributors post letters to new mothers – one an hour for the entire 24 hours of Mother’s Day – to let moms who are struggling know that they can and will get through a PPMD.
  • Private Peer Support Forum – a safe place for moms who are not yet ready to talk publicly.

I am in awe of everything Katherine has done for the good of all moms who experience postpartum mood disorders and I am so very grateful for her passion which fuels Postpartum Progress. In her I found the relief I so desperately sought out. The beauty in sharing my story to help others which led me to where I am today. Thank you so very much, Katherine!

Happy 10-year Anniversary, Postpartum Progress!!!