Planning for Postpartum

Postpartum Depression (PPD), some describe it as drowning, sinking, dark. No mother ever expects to experience PPD. We do not want to think about that while we are all glowing, magical pregnancy unicorns.

Credit to Lionsgate films “What to Expect When You’re Expecting,” for our favorite term!

We go through weeks of birth plans, choosing the right doctor, touring the hospital, and if you are anything like me, even looking up the patient menus on Yelp to see what kind of food there will be. We plan and plan for the moment our children enter this world, this beautiful moment, sometimes things do not go as planned. But what happens when we get home? What happens two weeks after we get home, when the baby blues begin to feel much more dark, much more sad, and much less manageable? I want to share my experience jumping through insurance hoops, while battling PPD, and things I wish I had done differently.

I wrote about my story recently and ways I recognized, and ignored my PPD symptoms. I waited much too long, and the number one reason was “I didn’t know who to call.” How tragic, in this country, in this day and age, a woman feels so isolated she has no idea who to call for help. I felt anxiety over facing judgment, of having to explain my symptoms over and over again to every operator I would speak with. In the middle of the storm that PPD throws you into, sometimes you cannot get out of bed, let alone Google “Post Partum Depression Help.” Those words were so concrete, like a death sentence, and I did not want to doom myself with that dark mark in my scorebook of motherhood.

So, I waited it out, and that worked wonderfully (read sarcasm). I got worse, I buried deeper, and I felt less and less capable of looking for help. I just could not get my brain to do it. There was a roadblock; I could not add one more thing to my to-do list. Then one day I broke, and I had to seek emergency medical attention. That is where my second journey begins, on a hotline my insurance provides to screen calls for psychiatric help. They place them in a queue for a referral to a psychiatrist, psychologist or therapist. There were no direct psychiatric services I could access without a referral with my HMO, and I would be called in 1-2 business days.

So I waited, and in two days shuffled into the office on the brink of tears, a norm for me by now, and sat and retold my story to another face. After a few minutes she started rambling off that she needed to see me twice a week, I needed medication, I needed to get help around the house, I needed to get out of the house, I needed to get a hobby, I needed to cut down my hours at work. Well, yeah those things were great, but it was not helpful to add to my to-do list. Meanwhile I keep thinking about the financial burden of all of this. Psych care was considered a specialty service, so my copay was $45, and she wanted to see my twice a week, and cut my hours at work, and find a hobby. No way. My guard immediately went up. Then I was to be evaluated by a Psychiatrist where I, once again, told my story, he took notes the entire time. Then he handed me a packet with a couple tests, which took an hour. I went to turn it in only to find out he had left for the day and had already prescribed me medication! I asked if it was breastfeeding friendly and not one person had a clue. They told me I should look it up.

I never returned. I retreated into myself and tried to stifle this monster again. My partner returned from his work assignment on the other side of the country and sat me down and told me that our daughter needed me, but needed the real me, and I needed to find her. So I called my primary doctor and made an appointment. Once again, I told my story and symptoms, he talked about medication, I got scared and retreated. One day I saw a flyer at school, “Do you feel depressed? Do you need someone to talk to? We’re here. Student Health and Psychological Services.” I got a same day appointment.

This was the first time someone asked what I needed to talk about, I did not feel like I was being diagnosed just to get medication. I felt heard. And at the end of the session I had coping mechanisms, I had skills; I had finally been thrown a life raft. As the weekly sessions went by, we talked about medication more, and I became comfortable with the idea because I had tried other outlets. So I called my primary to send in the Zoloft prescription. In about 3 weeks I saw light for the first time. After opening myself up to so many people, I finally found a solution for myself and my family.

I went on to speak about the topic with The Boob Group and realized that so many of us have to start this battle already in the water. We are trying to blow up our life raft while drowning; it should not be that way. PPD is dark and scary, but we have to be realistic about it. It is estimated that 10-15% of us will experience PPD; about 12% of us will get breast cancer. Imagine if we had PPD awareness levels in line with breast cancer awareness? What if we treated it as a normalized medical condition, with clear risk factors and a focus on early treatment? What if it was talked about it at our prenatal appointments, and we included it in our birth plans? I can tell you what, I did. My next child, I made my care providers aware of my previous experience, and I did so with pride. It is not a mother’s fault, and often there is nothing we can do to prevent it. However, we can be open, we can educate one another and we can take steps to be prepared. Familiarize yourself with medications, therapy and other treatments, and be open about what steps you are willing to take first. There are wonderful PPD groups on Facebook, blogs and websites out there. Planning for postpartum is just as precious as planning for that sweet day your baby comes earth side.

Who should you call? I recommend you call your HR department and insurance department while pregnant. Not only should you ask about your coverage and resources for childbirth and prenatal care, but you should ask about resources for PPD and psychiatric care. Ask if you will need a referral, what offices are covered, and what your copay will be. Ask about group and one on one therapy. It turns out my partner’s company has a special hotline and services specifically geared toward PPD and family therapy , I only found out after the fact. Look up hotlines online and keep those numbers in a visible place like your hospital L&D numbers. Google PPD symptoms, and talk about them with your partner just like you do your labor symptoms. Bring up PPD at your prenatal appointments! And those pamphlets they give out at discharge, do not leave them in your labor bag in your closet for months like I did. Pull out the ones that talk about PPD, and put them on your fridge right next to your first sonogram, because those numbers are just as precious. And if you find yourself in the middle of the storm right now, reach out, at least to one person. Let them carry your burden with you, let someone help you. You are so strong, and you can take that first step.