Surviving the Post-Partum Storm
Two weeks into the pandemic, I found out I was pregnant. I have a chronic illness, so it was a high-risk pregnancy, and I have OCD. About six months into the pregnancy, I started having more anxiety, which hormonal shifts during pregnancy can trigger, so I started doing exposure and response prevention therapy (ERP) once a month.
I have a private practice and was planning on seeing my full load of clients until up until the end of my pregnancy, but around 32 weeks the baby was measuring small, and my doctor told me I needed to rest and reduce stress. I felt guilty terminating with clients early, but I saw the gravity of the situation. For the next few weeks, I tried to relax by cooking, watching TV, and taking walks with my husband and dogs. Because of the pandemic, I couldn’t see my family or friends or do much else.
If the pregnancy wasn’t hard enough, I labored for 54 hours, during which time the doctors kept trying and failing to make epidurals work. Because of an adverse reaction, I couldn’t move at all, while feeling full-body spasms of pain. My heart rate and blood pressure skyrocketed; I had preeclampsia, which can be fatal, and I was scared I was going to die.
A few days after my son was finally born, complications from the preeclampsia sent me back to the hospital. Then, my anxiety got worse.
I’d moved into maintenance phase of ERP, which means I was only having 30-minute monthly check-ins. When I told my obstetrician about my anxiety at my six-week appointment, she referred me to social work, but the wait was weeks long. In the meantime, I found a new therapist, who told me I needed sleep. I told my primary care doctor that I was experiencing anxiety, and she suggested a meditation app. I tried meditation, and, honestly, I think that combined with the ERP made my symptoms worse.
Ultimately, my primary care doctor suggested medication. Part of me thought, I need that, while another part of me thought, but you’re breastfeeding! I didn’t know what the meds would do to the baby. I went back and forth for weeks until the anxiety became so intense, I couldn’t take it anymore. I went on 25 milligrams of Zoloft. For a week, I felt great. Then the doctor increased my dose.
A couple of days later, I remember telling my therapist, “I don’t want to kill myself, but I don’t want to exist.” She said something like, “You’re a new mom; this happens. You need sleep. You’re going to get through this.”
Over the next couple of days, my intrusive thoughts escalated. I don’t know how to articulate it except that I was out of reality. Even the colors of the room looked different, and I’d never felt that way in my life. I started having intrusive thoughts of self-harm and flashbacks to times in my life when I’d been abused. It was as if time had collapsed, and I thought my abuser could see me. The thoughts were at their worst when I was in the shower.
While all of this was happening, I was still breastfeeding around the clock, often in a panic because I couldn’t stop thinking that I didn’t want to be alive. I’d cry my eyes out, saying to my husband, “I’m a terrible mother,” and being so scared and ashamed, thinking, What’s wrong with me? How can I be having these thoughts?
My mother and mother-in-law were living with us, and they could see something was wrong, but I couldn’t talk to them about it. My family is Nicaraguan, and my husband’s is Mexican—culturally there’s so much stigma around mental health, intertwined with ideas about the importance of family, staying positive, and being resilient. When the baby was a couple of weeks old, I’d said to them, “I’m so sick and tired of this pandemic,” and immediately they both said, “Why don’t you feel grateful you have your beautiful baby?” They were trying to be helpful, but they were implying that I shouldn’t feel that way.
I was terrified. Luckily, I have an extremely supportive husband, and I could say, “I’m scared I’m having these thoughts,” and he’d listen without panicking. I texted two friends, one who’s a social worker who has OCD and another who’s been through a lot of loss in her life, thinking, If anyone can understand me, it’s them.
My friend told me that I needed to see a psychiatrist, but when I called psychiatrists covered by my insurance, the next available appointments were four or five weeks out. I found an out-of-network psychiatrist, but she was really expensive. I doubted it was worth it, as if my mental health was a luxury item.
The same week, I finally had my telehealth appointment with the social worker referred by my OB. I couldn’t stop crying. She suggested that I go a hospital.
“No way,” I told her. I’ve worked in hospital settings, including an in-patient psych ward. I’ve seen how people with mental health issues are treated there.
“They’re not going to 51-50 you,” the social worker said. “They’re probably just going to give you some medication.”
I knew that in the United States, mothers can’t keep their babies with them in psychiatric hospitals. I couldn’t have them take my son. The thought was terrifying. And I was afraid of how the doctors would treat me. If you’re a woman, and a woman of color, and a woman of color with mental health issues, you’re at risk of not being taken seriously, and your symptoms being dismissed. There’s a lot of research that points to people of color being treated differently by medical providers, and so, unfortunately, it was strategic of me to refuse that care. Plus, I was scared that my mother and mother-in-law would find out and think I was a “crazy person.” So going to the hospital wasn’t an option for me.
I decided to pay for the psychiatrist. By the time I met with her, a few days after talking to the social worker, I could barely breathe. I was having flashbacks and delusions and couldn’t stop crying. The psychiatrist didn’t even bat an eye and knew that I was having a negative reaction to Zoloft. She put me on Seroquel instead, to help with sleep, and Lexapro. I’ll never forget the gratitude I felt when she said, “You’re not alone.” (One of the aspects of my story that I most want to acknowledge is that I got the help I needed because I had the resources. What would’ve happened if I hadn’t been able to pay for the psychiatrist?)
Even as the new medicine started to stabilize me, I couldn’t be alone in a room, and I couldn’t take a shower by myself, because I was so scared of the intrusive thoughts coming back. My husband had to sit with me. At my friend’s recommendation, I found an EMDR therapist to help me work on my unresolved trauma from the birth. It was a milestone when I could shower alone.
Meanwhile, although I wasn’t seeing clients, I was leading a clinical observation group. You’d think it’d be too much, but it helped me. I didn’t know who I was as a new mom, but I know who I am as a therapist. I’m grounded and firm in myself when I’m working, and that was necessary for me.
Since then, I’ve judged myself: why couldn’t I advocate for myself the way I know how to advocate for clients? I could’ve told my obstetrician about my OCD early in my pregnancy. But I was afraid of how my doctors would treat me if they found out about my OCD because, as a social worker, I understood that the medical establishment has oppressive systems that affect everything from who can gain access to care to how providers view you.
I’m so much better now. I’m bonded with my son, and I’m so thankful I had access to my psychiatrist and therapist. I’m seeing clients again, although not a full case load, and I don’t feel guilty about working less. I know what’s important is taking care of myself and my son.
When I reflect on everything that happened, what stands out is how the mental health field has neglected and minimized maternal mental health. Look, I didn’t even know whether I could take medicine while breastfeeding. Information specific to maternal mental health isn’t widely taught in our training programs. That’s something I want to draw attention to and work on in my career. I know this experience will give me more knowledge to help others—that’s how I have to reframe it. As I’ve recovered, I’ve felt how strong and resilient I am, and I want to help other mothers feel the same way.
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