cuttingownhairI have been blessed, for most of my life, with an outwardly sound and hearty emotional constitution (boring). The worst thing I used to do was be a bit reckless with my own heart in relationships (that’s a nice way of saying that I would fall in love with jerkfaces and think they were the cat’s pajamas). I never had issues with anxiety or substance abuse, though I had a few bouts of situational depression (but always following an event that you are supposed to be sad about), and there was never anything that prevented me from doing what I needed to do. To be fair (following the end of an earlier significant relationship), I did watch all the episodes of Arrested Development on HULU. Thank goodness they had invented HULU by 2007. Should I mention that I watched all the episodes in a row about 4x each? Whatever. I was sad. Moving on. Oh, and I watched them from under a duvet in my weird attic apartment…right-o. Moving on.

I had struggled so much with earlier pregnancy losses that the beginning of my most recent pregnancy was just one big white-knuckled nervous breakdown. For the first 6 weeks, I took a pregnancy test about every 4 hours (knowing that the levels of HCG start to drop after about 4 hours once a pregnancy is lost) and I felt better each time the lines stayed nice and dark (for about 3 hours). To be clear, I was using the Dollar Store pregnancy tests (they cost a dollar!), but the bathroom trash was FILLED with boxes and pee cups and little test strips. Bless my husband, for he said nothing other than, “Do you need me to get you more pregnancy tests?” Smart man. I wasn’t worried about what would happen once the baby came, because I was so worried that the baby would never come. This baby was the most wanted baby in the history of babies (I know, so was your baby…) and I was ready to take any hit (including throwing up every 2 seconds for a while and turning into a sweaty pumpkin smuggler for the last few months of my pregnancy) to keep her safe and healthy.

Once that period of time had passed (seeing baby’s heartbeat was magically reassuring) I researched almost every aspect of what life was going to be like once I had my baby. I checked in on all of the “Mommy sites” and I felt sure that I was prepared for anything that might come my way (BTW, is bananas). I knew that many women struggle with the “baby blues” and, as a mental health professional, I was very familiar with PPD (postpartum depression) and even knew what to look for in case of an extreme case of postpartum psychosis. I had a great support system in place, as I had heeded the advice of my very wise aunt (a fantastic mom of 3 and a former ICU nurse) who said (of pregnancy, childbirth and its various outcomes), “It’s always something.”

I went into labor on a Thursday afternoon (after becoming somewhat of a frequent flyer in L&D at my hospital by having some earlier contractions checked out) and was so determined to not get (gently) kicked out of Labor and Delivery again, that I labored at home until I was uncontrollably crying during a contraction. My mom, my husband, and my aunt all insisted that it was TIME TO GO. I arrived at the hospital 6 cm dilated! I got an impressed. “Whoa!” from the intern who did my exam. I’ll say.

The next part isn’t really the story (that’s for another time, or never, as it is kind of gross and boring to hear other people’s childbirth stories), so I will sum up:
• I was in labor
• I had the baby
• She was perfect and giant and pink and beautiful
• The next day I got so sick that I wound up almost dying and eventually needed emergency surgery a week later (I shall insert here that it would NOT HAVE BEEN EMERGENCY SURGERY HAD THEY SIMPLY DONE THE TESTS I ASKED FOR OR DIAGNOSED ME CORRECTLY. AHEM.) and my baby needed to be discharged without me for a few days while I recovered.
• That part was the worst. I had to hand her off to my mom while they wheeled me into surgery. THE WORST.

And then I went home. My mom (who lives on the east coast) was only in town for about a week after I was out of the hospital, so I was trying to quickly manage walking and holding the baby without dislodging the various tubes and bulbs that were now attached to me. And trying to figure out how to nurse her. And to make food. And to drive. And to do all the things. For about 3 weeks, the sheer busyness of trying to manage this new little life while my husband was back at work was enough to carry me through on a kind of manic wave of adrenaline. We got everything figured out, nursing-wise (with the help of a brilliant lactation consultant) by about week 6. I was able to walk and drive and kiss my baby and give her baths and feed her and it was brilliant.

And then my nice adrenaline wave crashed and some funny things started to happen. I began having perseverative thoughts about something bad happening to my daughter. If my husband was carrying her through the door of the bedroom, I envisioned her head smashing against the door frame 100 times in a row, as if I were watching the worst YouTube clip ever (Just kidding: this is the worst YouTube clip ever). If she slipped a little while in my arms, I saw her—clear as day—tumbling and smashing to the floor. In the bath, while splashing around with her, I saw the water spout turning on and gushing scalding water into the tub. I shall not list the many nightmarish visions that I had, as I don’t want to plant them in anyone’s head (especially if you are expecting or are the mother of a young infant) but rest assured that I spent most of my time terrified and in tears. It was so hard to explain to my husband (the only one I shared any of this with) because he knew me to be so mentally stable (boring) and how well I was taking care of the baby (like I had wanted nothing more all of my life, duh) and he knew that none of these things had actually happened.

The time that I did not spend in tears I spent pretending that everything was fine. Everyone who knew me knew that I was so thrilled to finally be a mommy and I also felt like I had used up my drama points by getting sick after I had her (I am still not sure my poor mother will ever recover—she had to be conscious while watching me get sicker and sicker—I was so loopy I had no idea what was happening!). I was pretty terrified and was not sure what to do, as nothing I was experiencing sounded like what I knew about PPD or even PPP. I didn’t want to hurt the baby—I was just plagued with a never-ending loop of visions that the baby was going to get hurt.

And then one day some new stuff started to happen. I felt a tidal wave of the worst, most homesick (I was such a wuss the first time that I went to camp that I cried all the time every night for a WEEK), grief-stricken, damp and heavy sadness a few times a day during this period. One day, when she was about 4 months old, I was in the bath with my baby and I heard (or felt) a kind of whooshing sound and then I was in the bath with a baby. I had no idea who she was (or even who I was). I was completely thrown out of reality and was experiencing an episode of depersonalization. I had no problem recognizing that moments after the episode ended, but during it I had no ability to connect with who I was or that the lovely baby happily splashing in the water with me was mine. I like to think that there was a tiny part of me that knew who I was and who my baby was, but I am really not sure.

I had 3 more episodes like the first one the next day. I stopped driving out of fear that it would happen behind the wheel, but had not yet really put together that something was terribly wrong—even more wrong than when I was just having the intrusive thoughts. When the episodes were over, I was so grateful to come back to myself that I would burst into tears of relief.

The following day, something different happened. I put the baby down for a nap, walked into the kitchen, got a pair of kitchen shears, and with no thought or pause walked into the bathroom and cut my hair off in front of the mirror. I had just spent lots of money getting my hair cut by a fancy lady at a fancy salon, and she had left me with long, gorgeous layers that fell past my shoulders. When I “came to” I had cut about 8 inches off my right side. There was nothing left to do but to do the other side and try and make it look as normal as I could. As I was finishing my “trim” I was already concocting my cover story—It’s easier upkeep, blah blah blah, just had a baby, blah blah, it’s getting hot, blah blah. The truth is, it looked OK (it’s actually cute) after I was done fixing it—I have a lot of hair. I had not given myself a Mohawk (Oh, subconscious actor—why are you so conservative!?) or stabbed my eyes out, but the whole thing had happened without me knowing what was going on. I had visions of walking out the door in a fugue state and leaving my baby alone and helpless, all the while not knowing who or what I was.

I remember sending a text to my friend Anna (who writes a brilliantly funny blog about motherhood and describes her experiences with classic PPD here) that started off as light and conversational and ended with “I just flipped the %$#@ out. What’s the number for the therapist that you saw?” I called the therapist as soon as Anna texted me her number. She called me back within an hour, and with a brilliant mix of humor and kindness and an arsenal of clinical knowledge she had me a bit more sure that I was not going to totally lose my mind BUT that something was seriously wrong. I made an appointment with her for the next day. Bless her and her “of course you can bring your baby to therapy” policy,  and the tea that she served.

I started to see her and I got better. The specifics don’t matter, because all of the things that we worked on were (and have to be) totally individualized and probably wouldn’t help anyone else. We talked about medications and I told her that I wanted to give it a go with using CBT and talk therapy approaches first, as I wanted to continue nursing. I was able to avoid medications, but I would have taken them if the episodes had continued. I will share that she diagnosed me with postpartum OCD (the terrifying visions) and postpartum PTSD (the depersonalization episodes). I had never heard of either, but apparently you are at a greater risk for both if you have had a traumatic birth experience (check) and you lost consciousness during some part of that experience (check) and if you are a bit isolated after you have a baby (check, to some extent. Apparently all of your friends without kids don’t really want to hang out with you once you have kids and all of your friends with kids don’t have time to hang out with you). She recommended a book that I ordered and devoured. I incorporated many of the strategies in the book and they helped. I got out and met other moms even though it is weird and squirrely to meet strangers. I managed to get the baby out for a walk every day. I learned a breathing/visualization technique that I could use to stave off a depersonalization episode if I felt the edges start to shimmer. I started to place my experiences after her birth in a context that allowed me to move forward without anger or confusion.

And so, today, I am better. I almost never have even a whiff of those terrifying thoughts and I have not had a “check out” episode in months. If I do, I know to get help immediately and that they will recede. And that is a happy ending. — Liz Schwandt

One thought on “Postpartum PTSD

  1. Another incredible post, this time more personal, so I wanted to just say you’re amazing and thanks. Reading your posts is important to my week.

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