Earnest, now: American postpartum depression

On October 1, 2010, Kristi Couvillon-Wise committed suicide as a result of postpartum depression. I didn't know her, but it cut me.

I take it very personally when women are knocked down or even let down by what is considered normal in our society. And while postpartum depression crosses all cultures, we have a unique set of variables here in the US.

(Note that when I say "we" and "us" I am talking about the predominant culture of both laypeople and obstetricians. I am not talking about myself, my community of birth professionals, or midwives in general. That "we" does much better, which I'll address toward the end of this post.)

We have high rates of risk factors: cesareans, twins and higher order multiples, cessation of breastfeeding, among others. We have competitive mothering and the desire to continue the illusion of perfection to others (see earlier post). But what came to mind for me the most is a refrain that Mason tells our pregnant mothers frequently: "In this culture, we often worry about the wrong things." Usually she's talking about adequate rest, stress reduction, and nutrition. Reading about Kristi's death, I realized how much it applies to postpartum depression.

We worry about birth emergencies that are not truly emergencies. We also worry about birth emergencies that are extraordinarily rare. We worry about harming our babies with sushi or by lying on our backs. But how often does our society pay attention to the most common complication of the childbearing year?

Can I say that again... the most common complication of the childbearing year. Postpartum depression is the primary complication and it deserves our attention. Women deserve our attention. Mothers deserve care providers and a culture at large that work for prevention, that recognize the signs, that destigmatize postpartum mood disorders, and that make simple management and more in-depth treatment easy to obtain.

As for midwifery care? (Enter new use of "we" - those maternity care providers, including MD's, who provide the midwifery model of care.) We can not prevent all cases of postpartum depression. We can do a lot. We reduce risk factors by ensuring that cesareans are only used judiciously, by enabling breastfeeding to proceed as best it can, and by emphasizing the importance of social support. We promote self-care for all, which acts as prevention and treatment: adequate sleep and rest, good nutrition, sunlight and fresh air, time to honor the self. We offer superior postpartum care, seeing mothers 3-6 times during a span of time in which mainstream obstetric providers only see a new mother once, and we check in with their emotional well-being, not just their physical healing. We refer to professionals who understand postpartum mood disorders, rather than using a single line of pharmaceutical defense.

For harm to come to a mother, her baby, or both as a result of postpartum depression is, thankfully, rare. Suffering is common, and it's time to stop accepting that and change our society's focus to the benefit of women and babies.

Music

Me: Oh Cecilia, you're breaking my
D: HEART!
Me: You're shaking my confidence daily... oh Cecilia, I'm down on my
D: KNEE!
Me: I'm begging you please to come
D: home. Ho-o-ome. Uh uh uh, ooooooooo Ciiiia ooooooooo.
(translation: makin love in the afternoon with Cecilia up in my bedroom)

Kessa (as "I Will Survive" comes on): "Eliana! Eliana! Look, mom found disco on the radio!"

Eliana (via email): "Mom, guess what? I played betovens 9th sipheney on the piano!"

Getting real

The thoughtful post about how our society lets down new mothers and babies by focusing on all the wrong things is, indeed, coming.

But I've been stopped in my tracks by the new and suddenly popular blog, Single Dad Laughing. Despite the name, and his usual lighthearted posts, he has written three hearty, soul-searching posts that have gone viral. If you haven't read them, they are all worth reading, but get the tissues out, because at least one is sure to get you.

Memoirs of a Bullied Kid
You Just Broke Your Child. Congratulations.
The Disease Called Perfection

All three made me feel and think deeply.

While I was never popular, I was also never singled out and targeted, so the first wasn't too painful. It is more the nagging feeling that I could have done more for those who were singled out that bothers me through my adult life. I appreciate this post giving tools to adults and children to try to help those who truly suffer at the hands of others.

I had good parents and I am a good parent, so "You Just Broke Your Child" served me as an excellent reminder of how important I am to my children, even in the little ways. That reminder is not only helpful to keep me in line with being there for them, but also to keep me sane when it feels like I am on a hamster wheel of parenthood.

It was "The Disease Called 'Perfection'" that got to me the most. The raw truth to it was staggering. And as someone who has always been harder on myself than anyone else has been on me, it was a painful mirror.

I also live in one of the most competitive areas in, likely, the world: the San Francisco Bay Area. It's just a part of the culture here to keep up appearances. A dear friend - who is from outside of the US, lived nearby for over a year, and is living in another country entirely now - put it this way: "I hadn't seen people clinging to the illusion of perfection on such a scale anywhere before I moved to California."

The post calls on us to be real. I have always agreed with that - we lock ourselves into despair by believing we're alone in it. It's a catch 22, because the shame of admitting it means we won't ever tell someone else they are not alone, and they will never say the same to us. But except in rare instances with close friends, I have not lived up to my ideals. I have not been brave enough to be real. This post spoke to me and tonight I'm going to tell you some real.

If you've read this blog for a long time, you know how much I love my children. You know the cute things they do and say, and how ridiculously smart they are. All this is true. But the reality is there's more.

Real #1:
My babysitter quit without notice two weeks ago. I sobbed. Not because she was a fabulous babysitter - in fact it's been a bit of a relief having her gone - but because this is the 4th time in 3 months that I am looking for childcare, and this is making me feel like a failure as a mother.

Mothers, whether they work or stay home, see it as their responsibility to raise their children. In our society, fathers may parent well, but mothers raise the children; in the same way, mothers may earn money, but the father carries the burden of supporting the family. (I know this is a generalization but it is also the cultural norm and hard to erase from our psyches, even in families that have chosen to have a working mother and stay at home father.) I carry this weight on my shoulders: to take wonderful care of my children, including making sure they are well taken care of while I am not with them, whether that means they are with their dad, another loved one, or a childcare provider.

I am not living up to my own expectations in finding solid childcare for my children. This is the number one stressor in my life right now. It has even made me think about staying home with my kids - as Mason says, women aren't about to stop having babies. But the trade-off would be greater and more stressful: I would miss my work. I would miss out on what I call my "reset button" (the refocusing I do at births and even at prenatal appointments brings me home refreshed and ready to appreciate what a gift my children are to me). I would be vastly disappointed in myself for leaving my apprenticeship. I would resent my kids for driving me away from my calling. I would feel as though I was failing in different ways, some related to parenting and some to self. None of this would be pretty. None of it would serve my kids better than pushing forward with finding them a new childcare situation, to be strong, reframe "failure" into a past mistake and succeed in the future. That is what I need to do, and while I am struggling with the feelings around this, I am hopeful. I am grateful to have a preceptor who also chose to push through her apprenticeship with small children, because she understands how I can be stressed out about it and yet remain dedicated to midwifery.

Real #2:

Read this list: Cognitive distortions

Eliana has every single one. In massive doses.

I've known she was an intense and passionate little girl for a long time. I've read and re-read the definitions of ADD and ADHD, confirming each time that no, that wasn't what was going on. So what was?

This summer, she got in trouble for something - I can't even remember what it was, normal kid disobedience stuff, and I told her to go wait for me in her room... standard discipline in my house, to separate and then reconnect, talking over the issue after reconnecting. This time, however, when I went to reconnect, she said to me, "You don't like me because I'm ugly."

WHAT???
For those who don't know me, I didn't give that to her.

It is one of my highest priorities and perhaps the biggest output of energy in my life to cope with Eliana's huge personality and guide her through her issues without, as Single Dad Laughing would say, breaking her. She is an incredible kid and it would be horrible to subdue her - to destroy not only the parts of her that hurt herself and others, but the beauty and vibrance that is at her core.

And here's your real: I don't know what to do, and I'm terrified. After finding this list of cognitive distortion, I'm definitely up for counseling, but I don't know how well it's going to work for her. I don't know how to love her any better than I do, I don't know how to help her feel better about herself, more or less discipline ain't gonna help. And here's what scares me the most: cognitive distortion is a prime recipe for depression (if not a symptom of it!) and she hasn't even hit puberty yet. This needs to be ameliorated before hormones are thrown in the mix.

Real #3: Today, I would have really liked not to be the mom. I love these kids so much, but just for one day, I would have liked not to be the one feeling guilty about using friends for childcare, to not be the one doing the nanny interviews, to not be the one who bears responsibility for getting my wonderful, hurting daughter the guidance she needs to become a well-adjusted adult. I'd love to be the auntie for a day and play and love on these children with all my might and none of the weight of parenthood.

For the record, this is not a plea for help fixing these issues; thankfully, I've got plenty of resources and I'm working on it. For me, right now, help looks like your love, support, friendship. It looks like stability wherever I can get it. It looks like grace and understanding when my bandwidth is taken up. It looks like an open heart that can feel the love I have for you even when it comes in small glimpses.

It IS a plea to listen to Single Dad Laughing and get real. Let down your guard. Let's not all pretend to be perfect. You're lovely the way you are.

American priorities for mothers: version one (snarky)

Birth and postpartum the standard American way:

"Why would you want to have a baby at home? Something could go wrong! You could need a c-section! Your baby could have the cord around its neck! You could bleed to death in five minutes! And the hospital is life-saving! You want to check out before 24 hours? Ludicrous! Your baby could stop breathing! You could get an infection! Stay here where it's clean and we take good care of you!

OK, now go. Go home. No we don't need to see you any more. Sure, your baby absolutely needs to go to the pediatrician, at one week, two weeks, four weeks. Absolutely. You, though, you just go take care of yourself and be thrilled with your baby. Breastfeeding is tough? That's okay, formula is perfectly fine. Here, have a free sample. No, we don't care how you're doing, not until your six week visit. Then we'll be happy to tell you how much less you should weigh by now, how breastmilk is best - oh whoops, I forgot, of course formula is fine, no I didn't mean to make you feel guilty! Now of course, you wouldn't imagine stopping at one child, but you'd better go on the pill right now so you can space them appropriately and not ruin your body or screw up your kids irreparably.

Isn't motherhood amazing? Oh, it's hard? Well, what did you expect, it's a baby... you could've just bought a cat if you wanted easy. You don't seem depressed at all, you just need to sleep train your baby and then you'll feel better. But isn't motherhood amazing?"

I will follow up with an actual thoughtful post on the culture of fear of birth, blame on mothers, and complete ignorance of postpartum depression.

Pink parts

Eliana comes in the kitchen tonight to tell me that Kes needs to wipe better because her vulva is red. So Kes pulls her pants down and va-moons me. I tell her it's not really red, just a little pink, but it wouldn't be a bad idea to wipe a little better after she pees. She says, "Can I go look at it in your mirror?" and I give her permission to open up my room to access the full length closet mirror.

A few minutes pass, and I totally forget about the previous conversation, lost in chores. Until Kes comes running full speed down the hall toward me:

"Mommy, mommy! It's such a lovely pink! My vulva is beautiful!"

Boop

= boat = official cutest D word of the day.

Yeah, I'm that important.

Last week my parents took one of my girls, alone, and then the other, so that they got special one on one (two!) time with their grandparents and so that I got to parent two children instead of three. Totally awesome, all around. The girls really enjoyed not having to deal with each other! (I enjoyed not having to LISTEN to them deal with each other!)

I called Eliana on her second night there:
"Hi, Elly!"
"Hi... who is this?"
"It's your mom!"
"Oh, Mommy! I almost forgot about you!"

The Legend of Kesenia Lily

Far away, tucked in a corner of the galaxy, is a secret, safe space where spirits come into being. They sparkle and glow, and all the people on earth think that they are stars in the sky like any other. But these spirit stars are so much more, holding within them everything that will be special about each baby born into the world. Their spirit mother is the moon, and she guides the spirit stars until she chooses their Earth Mother and sends them into their mothers' wombs, into the growing baby, to be born.

Once, there was a spirit star named Lily, who sparkled and shone extra bright. Moon Mother could see that she was an unusual spirit, and would be a gift to all around her. When Moon Mother looked at this spirit star, she felt peace and love, and could see that Lily would soothe sickness and sadness, and work to uphold justice in the world. In fact, Moon Mother loved Lily so, that she decided she would wait as long as possible to send her to Earth, and would keep her as her own special spirit child.

Lily watched one after another spirit star disappear, and each time she would ask Moon Mother to help her find that baby on Earth so she could watch the baby grow into a child. It was thrilling how she could recognize each of her friends even now that they were people. As time passed, Lily started feeling like she might want to be a baby too, but she trusted that Moon Mother would choose the right baby and Earth Mother for her.

Then one day, as Lily watched one of her old friends, Rose, playing with her mother, she noticed that the mother was growing round, but that no spirit star had gone to her yet. Concerned, she watched Rose every day, and pretty soon she had fallen in love with Rose's Earth Mother. She wanted to go to be this baby's spirit, to be this Earth Mother's baby, but she knew that the way of the spirit stars was to follow Moon Mother's decisions. She kindly approached Moon Mother: "Moon Mother, I love you very much, and I know that you will send me to a good family. Look there, how about that Earth Mother? Her baby grows large and ready, and yet you have not sent a spirit star to her yet." Moon Mother answered simply: "My spirit child, I have not chosen a spirit star for this family, nor will I send you."

The Earth Mother had also noticed that although she could feel her baby moving inside her, the baby felt empty to her. As her belly grew larger, and she started to feel her womb preparing to birth the baby, she listened daily for her baby's spirit. She worried about what would happen to her baby if no spirit came, and she spoke aloud, "Please, let my baby be healthy and whole," as she looked up into the moonless sky.

Lily watched that night, as the Earth Mother slept, her belly tightening rhythmically without waking her. "Soon," she murmured, "soon this baby will be born, with no spirit to sustain it on Earth. I love Moon Mother, but I also love this Earth Mother and Rose." Lily made up her mind. On this night, the New Moon, the one night of every month that Moon Mother slept, she would sneak away and become the baby in this Earth Mother's belly.

And so she did, kissing Moon Mother gently as she left. But she arrived on Earth in a new place, and in daylight. It was a room, with a beautiful bed, but not Earth Mother's bed, and Earth Mother was not sleeping in the bed but in a strange pool of water nearby. She was naked and was making sounds that Lily had only heard when watching other star spirit babies be born. "Wait!" she cried. "I'm not there yet!" But of course, no one could hear her, and she didn't know how she was supposed to get into the baby without Moon Mother's help. The baby's head emerged underwater, and she dove quickly into the water, wishing with all her might that it would work.

Earth Mother suddenly felt an electricity and a flash of light, and with a cry of triumph and joy, she pushed with her body and reached with her hands to fold the baby into her arms, onto her chest, and up out of the water. "You're here!" she cried. "You made it!" Lily squalled with all the pleasure of being in her mother's arms, and relief from the effort it had taken to so quickly transition from star spirit to a real baby. Earth Mother felt under the water, between the baby's legs, and exclaimed, "A girl! Oh, my Kesenia. Hello Kes! Kes." Lily heard her baby voice crying, as she tried to say, "Yes, Mama, I am your Kessa Lily."



To my sparkly, loving healer child
Kesenia Lily

DNA

"But Mom, does the sperm have REAL directions on it? Like are the instructions for the baby all written out all over it so tiny that we can't see?" - E

On a side note, how to get this kid off of her sperm hangup and realize that the egg is equally important DNA-wise? I swear she still thinks the dad gives the directions and the mom grows the baby, no matter how many times I tell her half the instructions come from the egg. OWN IT, Elly! You've got massive baby directions waiting in your ovaries right now!!! (Is this my progeny's version of penis envy?)

Signing and cussing

Kes holds out her thumb, forefinger, and pinky, and says, "Mommy, what does this mean?"
Me: "I love you."
Kes: closes up the pinky "And what does that mean?"
Me: "That's an L."
Kes: closes her fist and holds up her middle finger "What does that mean?"
Me: "That's a bad word sign that people use to tell other people that they're really mad at them."
Elly: "What's the word???"
Me: "I don't want to tell you the word because it's not appropriate for children to use it."
Kes: "Is it poopy-butt?"
Me: "No, you have never heard it before because grown-ups don't use it around children."
Elly: "Is it poo-gas?"
Kes: "Is it tuchis-boofer?"
Elly: "Is it booty-bumper?"
Kes: "Is it poopy-booty?"
Elly: "Is it poo-poo guns? Is it stupid-butt?"
And so on...