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Thread: Postpartum Depression
March 16th, 2013 12:49 PM #16
Thanks to everyone thus far for sharing their stories. I really have noticed one common theme (which I felt too, exhausted and cradling my newborn): there is an incredibly perverse belief, sometimes unfortunately propagated by 'experts,' that once the baby is born the mother must subjugate absolutely everything to the child. After all, motherhood is about sacrifice, right? Firstly, I reject the belief. I think new mothers need to sleep, shower, socialize, engage their brains, relax, etc, just like other human beings. But secondly, if you're grinding yourself down to a little nub in caring for this child, you aren't providing good care.
I personally found it impossible to appreciate the degree of sleeplessness. As crunchymama can attest, there is nothing quite so sleepless as surgery residency, and I was thriving in surgery residency. What I failed to appreciate is the unrelenting nature, the lack of a 'post-call' day. Sleeplessness is usually a symptom of, rather than a cause of, mania and depression, but it can absolutely tip people over into mania. This is why again I think the incidence is so high in women with preexisting BPD (50% in women with bipolar I, 40% in BPD II). And the thinking on psychotropic medications thoroughly rejects their complete and total withdrawal throughout pregnancy and breastfeeding. Lithium in particular is safe after the first trimester, as are most anti-depressants. Again I think this reinforces the point that new mothers absolutely should prioritize their health and sanity equally with their baby's, because in doing so they are providing better care.
@labmama what happened to you was horrific. I'm not sure that could even be called PPD since it had such a specific and readily identifiable cause. The position of wetnurse has existed since the beginning of time in all human cultures precisely because the ability, and desire, to breastfeed is nowehere near universal. A minority, but still a very substantial fraction, of women cannot produce enough milk to adequately nourish a baby. It has always been thus. It is not a matter of willpower or technique. The kind of shaming and bullying you experienced really upsets me.
I will also echo ottilie's recommendation of a cleaning service. It might seem like a luxury to some, but if you find a spare $100/wk in your budget it makes a great deal of difference. And while a night nurse will frankly be out of most people's budgets (and in the US at least unavailable outside of major cities) coming up with shifts of care duties helps a great deal. I personally found breastfeeding to be enjoyable-- in moderation. I was more than happy to hand off feeding to duties to someone else. As you baby is older it is more realistic to pump extra milk throughout the day again to allow someone else to feed the baby, if you are truly deeply philosophically afraid of formula.
Last edited by blade; March 16th, 2013 at 12:55 PM.Blade, MD
XY: Antoine Raphael (3.1.2012)
XX: Cassia Viviane Noor (11.30.2013)
March 16th, 2013 01:29 PM #18
Thank you so much everyone for your bravery and honesty in your posting. Ladies, you need to know that I have so much respect for you all. Depression isn't easy.*
And thank you Blade for bringing this topic up.*
I'm not a mum, nor will I be one soon, but this thread caught my eye.
I've been dealing with depression and anxiety attacks for years. It really hit me while I was in the midst of high school. I've never liked the way I look, the way my voice sounds, my personality, etc, and being an insecure teenage girl in a cliquey high school didn't help.*
One of my fears is that when I do have a baby, PPD will hit, and I won't know what to do with myself. Even now I have a hard time realizing I'm getting more and more depressed (I like to deny it. A lot.) and how I can prevent it, or help myself. I already find myself nervously wondering if someone like me would be able to be a good mother. I struggled with thoughts and intentions of suicide for a few years, and while I don't have those anymore, I am still afraid of them returning in my future, even more afraid of them returning while I'm a mum.*
I also had a question for anyone who has taken anti depressants; I've been told by doctors that most are not safe to take while pregnant or nursing. One my doctor wanted to put me on wasn't safe if I ever wanted to become pregnant. Is this true?*
Blade, you mentioned that most are safe after the first trimester?*
Thank you again, ladies. You are all super women.
March 16th, 2013 01:37 PM #20Senior Member
- Join Date
- Jul 2012
- London, England
I'm on a rather strong dose of lithium. I went off it when I found out I was pregnant (lithium can lead to heart problems for the baby). I didn't plan on going back on it till after baby was born, but I had a massive manic episode and then crashed into a complete depressive state (which lead to hospitalization) and was put back on. I've had to go into the hospital to have my baby's heart monitored pretty regularly after that, but it's worked out fine. There are other medications that are safer when you're pregnant, but lithium is the only medication that works for me. You can't breastfeed on lithium though, because the baby will absorb it through the milk.My darling Marian Illyria Aphrodite, March 2013 & Little Bunny (a girl!) due 9th of February 2014
March 16th, 2013 02:13 PM #22
Actually lithium is safe in lactation. The biggest risk is a certain anatomic anomaly in the heart, called Ebsteins Anomaly, but once the heart is formed (very early in pregnancy) thou can take lithium safely. It does prolong the qt interval on the electrocardiogram which predisposes to certain arrhythmias, but very good long-term data (18 years following the same cohort of children) shows children who breastfed to lithium-taking mothers, or those exposed in hero in later pregnancy, have no increased risk of Mila, mental cognitive, or emotnal problems.
The anti-seizure medications sometimes used as mood stabilizers, valproate in particular, are NOT safe, at all, and are strictly contraindicated in pregnancy and breastfeeding.
Atypical Antipsychotics such as quetiapine are often used in bipolar patients. There isn't as much long-term data but a very very low percentage of the drug is excreted in breast milk so they are thought to be safe.
Lamotrigine is also safe.
SSRIs in particular are very well-studied in pregnancy and breastfeeding and are considered safe; sertraline in particular is used as the first-line treatment for PPD in a breastfeeding mother.
@ottilie thank you very much for candidly sharing your story. To be honest I did wonder if something like that had happened to you given some of your comments here, as well as your brief absence from the forums. If you don't mind me using your story as an example I think that's exactly the sort of thing we were discussing above. All of obstetrics, and to a lesser extent pediatrics, is about the maternal-fetal dyad, and privileging one exclusively over the other isn't good for anyone.Blade, MD
XY: Antoine Raphael (3.1.2012)
XX: Cassia Viviane Noor (11.30.2013)
March 16th, 2013 02:45 PM #24Senior Member
- Join Date
- Jan 2010
@irelandrae, I'm sorry to hear of your struggles. I find it maddening that your doctors would tell you so blithely that antidepressants are off-limits; I think this reflects a very poor understanding of the seriousness of mental health issues during pregnancy and otherwise. As others have said, the implicit (and explicit) pressure upon mothers to sacrifice their mental health is toxic to mothers, babies, and families alike. It's good to be informed about about any medicines you might ingest during pregnancy, but generally speaking I think that what's good for the mother is what's good for the baby. I think, too, that ottilie offers a good example about how any risks to the baby of exposure to medication must be weighed against risks of exposure to maternal illness.
And @ottilie, I know that can shame can be a very formidable aspect of depression and other mental health issues, especially for mothers. It sounds like you've take some important steps to help yourself both now and postpartum, and it sounds like your partner is very supportive, which is awesome. Unfortunately, many messages that are perhaps meant to be empowering (e.g., with regard to natural birth and breastfeeding) can on the flip side be very shaming and blaming. My one piece of advice would be to try to limit your contact with anyone who is not completely supportive, with anyone who doesn't get it or who stirs up any self-blame or shame. This isn't always possible, and I myself wasn't so great about setting limits, but I think it might have helped if I'd managed to keep certain people away for longer.
Last edited by hilary; March 16th, 2013 at 02:48 PM.