Episode 8SN: Zen & the Art of the Peripartum Period: Maria

P: Hi. Can you introduce yourself.

 

M: Yeah, Hi, I’m Maria, and I have two kids. Currently, I have a four and a half year old boy, and an almost two year old boy.

P: Wow! That sounds like a busy house.

M: Oh, it’s a very busy and very loud house,

P:  and fun is my guess. So, before you got pregnant with these kids. What are your ideas about pregnancy?

 

M: You know, I didn’t really have very many ideas about pregnancy, like I never actually wanted to be a mom, up until it hit me over the head at around 29 that I desperately need a child, and then just kind of went for it but I thought pregnancy would be, you know, difficult, maybe uncomfortable but that was never the part that I really concentrated on like everybody else I was super scared of the birth and pregnancy. I don’t know what’s gonna happen.

P: And Did you get pregnant easily?

M: We didn’t have any issues

 

P: And early on, how did the pregnancy go?

 

M: it started fine. It was perfectly fine early on I didn’t even have like a whole lot of morning sickness. Some, nausea, and I was really tired but that was about it there weren’t any concerns no issues, everything was great.

 

P: And so what how far along were you when things were less great

 

M: I think somewhere in the second trimester, even though I was feeling fine, physically, emotionally I somehow stopped being excited about being pregnant. I was really excited. In the beginning I was really looking forward to it and then just as the time went on, the excitement just disappeared. I was no longer into it, I was crying a lot and just being very sad about life and the whole pregnancy situation just not knowing. That’s even something that I want to do anymore but then feeling like I wasn’t going to obviously terminate it. It was just like I wasn’t sure what was gonna happen once the baby comes

 

P: that that sounds really hard because by the second trimester, you’re kind of showing already

 

M: yeah, yeah, I was showing and you know, like on the outside, everything was perfectly fine I was healthy pregnancy from the physical standpoint, was doing great. There were no issues at all so like there was technically no reason for me to feel the way that I was feeling but, you know, I was feeling that way.

 

P: Did you talk to your gynecologist?

 

M: Oh,No I didn’t I was one of those people who very skillfully hid all of this. I presented very happy and excited every appointment and didn’t really talk, I might have mentioned to my midwife here and there that I was just a little bit, unhappy, but I think I didn’t explain it and I didn’t explain how unhappy I was but they kind of brushed it off as like, you know it happens you know pregnancy hormones fluctuate so no one really paid any attention.

 

P: Did you think that this is what pregnancy is?

 

M: Yes, I thought, that maybe that’s just how it is people just stop getting excited like you know you get a little heavier life becomes more difficult because you’re just not as into it

 

P: well that sounds hard. So I’m guessing you can’t you carry that feeling to the birth.

 

M: I did you mean I was just not like I carried on with my life and get everything but yeah, that excited but then also like the baby came about two weeks earlier than expected so we were totally unprepared we were supposed to have another meeting with the doula and obviously have appointments scheduled and everything and then it’s like boom babies coming

 

P: So Let’s walk slowly through that part like, what are you doing during the day. Did you, did your water break, were there contractions?

 

M: So, we had this plan that I was gonna, you know, finish work, about two weeks before the due date. Week 38 that last Friday I was gonna, you know that would be my last day and we’d have two weeks to prep for the baby like make sure to do all the finishing touches relax a little bit, so kind of things you do and that’s why I went into work I was tired My back was hurting a little more than normal, but it wasn’t anything like that I wasn’t used to that point it was just maybe a tiny bit more. So I went to work, finished off with work I come home, go out to dinner. Like I’m uncomfortable like my back hurts but still liveable. Go to sleep. Everything’s fine I wake up in the morning. On Saturday, and I feel worse than I did the night before. And my first thought is like, oh my god I have two weeks to go Is this what the last two weeks of my life are gonna feel like this is gonna be horrible. And I’m like, we’re gonna make it through this, when we get out, we go to Costco to go shopping. And at that point, I’m still not realizing that even though my contractions are still pretty far spaced. They’re actually now coming in as contractions because while we’re shopping. I’m walking, very slowly and there are points where I literally have to stop and hold, like the metal poles that Costco has to take a breather. Okay, know what time, we’re gonna go

 

P: yeah so did you know that was a contraction.

 

M: You know, I didn’t think it was real contractions I thought they were just like really bad Braxton Hicks that was. That’s what I was thinking, because you know at 38 weeks I didn’t think it was going to be happening so. No, I didn’t think it was a real contraction. So we got home and we’re kind of like sitting around it was me, my husband, my mom and our friend and, like, 4pm ish. I’m like well let’s, let’s order dinner. You know I’m pretty hungry like why don’t we order dinner we go online, order some dinner, and between the time that we order, and my husband goes to pick up the dinner I all of a sudden start feeling way worse. My back starts hurting much much worse. And I’m like, I’m not hungry anymore. I don’t know what’s happening but I’m not hungry anymore so I start like bouncing on them on the medicine ball and like stretching and all of that and all of a sudden I just feel more and more in pain. I start throwing up and then like my mom was kind of like I think these are real like I think you’re actually having contractions. And so they like, got me upstairs to our bedroom I sat in our bathtub to like alleviate some of the pain, which was really helpful, and then that went on for like, let’s say two three hours before my water broke finally and that’s when we were like, okay, for sure it’s the real thing we got to do it so we had to call the birth center because I was GBS positive and needed to receive antibiotics.

 

P: I’m gonna pause the interview for a quick second to talk about GBS GBS or group B streptococcus is a common bacterium found various areas of the body in both men and women. According to the CDC about 25% of pregnant women carry GBS, although they usually don’t have any symptoms GBS doesn’t often cause health problems in adults, but can cause serious infections in newborns and it can be passed from mother to baby during birth. If you test positive for GBS, the doctor may order IV antibiotics during your labor. Okay, back to the interview.

 

M: So we at around 10pm, we drove to the birth center to go and get checked and see if. You know I’m far long enough for them to actually give me antibiotics and to be there so it was an interesting long Saturday.

P: Good Lord I’m glad your mom was there to say like I’ve seen this before and guess what this is, this is a real thing.

 

M: Yeah, cuz I kept thinking no no, no that can’t be.

 

P: So you’re at the birth center are you gonna, you know, are you gonna do like a water birth or what how’s it set up?

 

M: the birth center like it’s set up the rooms are like the most luxurious hotel room you’ve ever seen like a beautiful bed, there is a tub there. There’s a very big bathroom were like, four people can easily stand they have like a toilet with a heated seat they have a shower where you can stand or you can sit down there’s like there was like a little like bench like a stone bench, because it was nighttime there was only one midwife usually like when it’s during the day there’s two midwives at night, that’s just whoever’s on call. So it was me my husband. The midwife, and the doula but the funny part is, it was a backup doula because my doula caught a stomach bug and couldn’t show up so that was kinda kind of crazy and funny. It worked out well because she was the doula I originally really wanted

P: oh

M: but she was busy at the time when I was booking the doula. this it was not really well it was just kind of like, oh hi hello yeah I don’t know you, but hey, let’s do this.

P: Yeah.

M: So the deal was that yeah hopefully like it was gonna work out, you could do a water birth because that’s available they have some nitrous oxide to help with the pain but other than that it was just supposed to be super low intervention just it’s as if your in your own very comfortable own how with medical care at your side, that was kind of the idea of the birth.

 

P: And how was the birth?

 

M: It was a very long night of no progression, and a lot of throwing up a lot of pain. While everybody slept, I couldn’t sleep because I couldn’t lay down on my back anytime I lay down on my side or throw off. So I spent most of the night, kind of sitting on the medicine ball with like a tower of pillows in front of me and just straddling straddling the ball with my head on the pillow just like that. Obviously if I fell asleep for half an hour at some point that’s great. But I don’t think I really slept very much, and then morning comes. The midwife checks me and realizes that she feels something weird, because it’s a birth center they don’t have ultrasound so they can only go by feel, and she says that, you know, because I’m feeling something really strange. It’s not his head. We need to send you over to the hospital. And, you know, by that point I haven’t slept in well over 24 hours and I’m completely exhausted. And just emotionally on edge and so I start crying while we go into the car to go to the hospital. Luckily the hospital, right next door so the drive is a whole five minutes but we go there we get checked in, not really having that many contractions at that point, they are very sporadic to go into the room the OB shows up was very sweet lady, and you know she puts the sound one over my belly after she checks me and she’s like the baby’s breech. And we didn’t know that the baby was breech because, at least, all the appointments, and even going into the birth, everybody all the midwife that felt the baby thought he was head down and even my stomach looks very different. The night before then it did that morning so it appeared as if he actually turned mid labor but never descended, he just heads up so that was very stressful to

 

P: a professional gymnast on our hands here Wow.

 

M: Oh, he is yeah he’s very wily always have been still.

 

P: So, the breech position means C section right?

 

M: yeah it means c section I mean maybe there are hospitals that will do otherwise but not here. It was immediate c section I was. Luckily, nobody was in distress baby wasn’t in distress wasn’t having any issues. So it was sort of like, I like to call it a, an emergency non emergency c section.

 

P: Yeah.

 

M: So they started like while they were going to prep me but I sort of went to the bathroom, and basically just closed the door for half an hour. t wouldn’t come out. And then the, the nurse had to kindly come and knock on the door, and ask figure out why am I not coming out why am I not coming out and asking me to please come out because your scheduled time is coming up and we need to get on with it, and I was crying and just completely lost it because that was, we were not prepared for a C section out was not mentally prepared for a C section it was not something I wanted. That was my first major surgery in life so I was incredibly scared of what that would be like, and then

 

P: all that seems rational especially since you. I mean I think that would be rational no matter what. But on top of you know 24 hours no sleep and you were already in this beautiful, beautiful birthing center where everything was all set up. That’s really the rug being pulled out from under you at the last second.

 

M: yes, Absolutely. It was like the last hope was like just shattered because it was like well okay fine I’ll deliver in the hospital. But then, yeah, like, oh he’s breech and you’re not delivering.

 

P: Yeah. So my guess is they eventually got you out of the bathroom.

 

M: They did. They got me out of the bathroom, they start prepping me they brought in an anesthesiologist who was less than kind. He was not very nice talking to me was very condescending man, just a very unpleasant gentleman, he, he kind of wanted the attention on himself, and he didn’t get it he was very pissed. So when he when he was administrating the spinal block he clearly you know missed the spot a little bit right like I mean we’re talking about like millimeters, and he hit a nerve because I just had like just, it felt like there was liquid fire over my right side of the body and so I kind of started screaming and he wasn’t he started screaming at me as to like Why are you screaming Why are you screaming like and I could barely even get a word out because I like…

 

P: because you have a needle in my back in the wrong place?

 

M: yeah, you have a needle in my Back in the wrong place and you know I’m barely lucid because you know the 24 hours no sleep and pain the whole time like I can barely form a sentence here. Luckily the nurse was very nice she was holding my hand and everything since you’re not allowed to have anybody in the room with you while they’re administering the anesthesia, so it was nice to have the nurse who was very comforting and kind and then the C section itself was. It was just rough because I don’t think it’s an unusual response but not everybody has this type of response to the anesthesia, I was shaking really badly they had to strap my arms because I couldn’t keep them in one spot and. And the people around me like his whole team was about as arrogant as he was it was a very unpleasant kind of situation I just like kept talking throughout the whole time just to keep myself awake and engaged, but it was not the best, not the best people to have around.

 

P: Yeah, that sounds like a hard circumstance when you’re already, everything has been turned around, that’s a bummer. And did they let your husband in once the block was on.

 

M: He was allowed inside so he was sitting next to me and he was like trying to like talk to me and everything and trying to you know just sit with me and be there so that was, that was very, very comforting to help at least somebody,

 

P: and the C section went smoothly after that.

 

M: The C section was perfectly fine It’s just that when they pulled the baby out, we wanted to do like delayed cord clamping.

 

P: I’m gonna pause the interview for another second to say that I found an article from December of 2012 that says that the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30 to 60 seconds after birth. in term infants delayed umbilical cord clamping does things to hemoglobin and iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.

 

M: And they pulled the baby out and my husband. We were doing the  C section with the clear drape, you know, when we lift up now. Yeah, so he saw her pull the baby out and he sees that she’s reaching for the scissors or the clamp whenever she needs to cut the cord and he, and he was like, yelling at the OB, no no don’t cut the cord we want delayed cord cramping and she looks at me she’s like I can’t do that, like he’s not breathing

 

P: as Maria is reliving this part of her pregnancy, she’s gotten upset, and it sounds like silence in this interview but she’s gathering herself emotionally. I left it in here it is.

 

P: I’m sorry, that is stressful,

 

M: It’s fine. Just a couple of seconds…. Sorry I actually never had an emotional response to this before.

 

P: Well it is it is kind of shocking I remember when we had distress in my own pregnancy and literally the minute they pulled her out I said I don’t hear crying. Why isn’t there any crying?  I don’t hear any crying…like it is something that you’re so kind of primed to listen for and very distressing when you don’t hear it immediately. So did they spank him or something or what did they do?

 

M: I’m not sure. She didn’t have to do anything; she pretty much just rubbed him and he started breathing just fine but yeah when they pulled him out I think he was pretty blue like, it took them like a second maybe two to take a breath, but then I think they took them under the lamp right away and they never told us what his Apgar score was but he concerns because after about like two or three minutes under the lamp they just let my husband hold him so while they were stitching me up he was holding him right next to my head. It was very sweet but it also was very funny because he was very hungry and trying to latch on to my husband the whole time and he was very disappointed. So we always held on to that as like a funny memory that he was his first disappointment.

 

Yeah, the reason why I’m so surprised in some ways that’s an emotional response is that when, when it was happening. I didn’t have a response, I didn’t actually care, that he got pulled out that he wasn’t breathing, it was like, Okay, cool. We’re done. I kept asking like Is he okay Is he okay but I don’t remember feeling anything, it just almost felt like an obligatory like, well, what’s going on with this human but it wasn’t like, oh yeah I’m really worried it was just like, well, what’s going on. And then when I saw he was okay like I was like okay I just want to sleep I don’t really care. But yeah, that initial Bond was just not there at all. It was very weird disappointing feeling just kind of like emptiness

 

P: And at the time did you think this is depression or, or.

 

M: No, I don’t think, I thought, you know like, as pretty much any mom I thought there was something wrong with me, like, you know, because I was already not excited about motherhood that, to have. Even though I had him nearby I was still not excited just felt somehow. Well there’s something wrong with me I’m that mom like missing the mom gene or something like that just the usual things that mom’s think about, and that’s what the fact that I’m a therapist, and I have plenty of knowledge of depression what depression looks like what postpartum depression looks like but when it came to being able to identify it in me, nope. I Didn’t I even remember filling out a depression inventory.

P: Yeah.

M: In the hospital and then they also gave me one, like, the first appointment of my son. And I remember showing out being like, No, I’m fine, I’m fine. You know I’m the same as with pregnancy was like, This is what my wife is like this is normal like everything sucks but hey, this is what motherhood is like so. No, I didn’t think that that’s what it was, even though I was. So I was crying I was so upset and then as I started recovering, I had a lot of rage. So I was very angry all the time. And at the time,  four and a half years ago, no one really talks about rage being a symptom with postpartum depression, so I don’t think anybody would have even really paid attention to that even if I told them, and I didn’t think about that as a, as a symptom so we just we just felt like, well, I just hate motherhood and then I’m not cut out for this and this and this sucks.

 

P: I talk to a clinical psychologist to get some insights about peripartum depression. Hi Dr Shosh, thanks for coming on the show, why don’t you introduce yourself.

 

Dr. Shosh: Oh, certainly, and thank you for inviting me. I am Dr Shoshana Bennett commonly known as Dr Shosh, and my work in this field came from personal experience, I’d been a special education teacher and then I plummeted into a very severe postpartum partum illness. And this happened actually twice after the birth of each of my children and it launched me into a brand new career back in the eighties. I became educated and got varying degrees and I am now a clinical psychologist have been for, for many many years,

P: let’s start off with something basic How common is depression?

Dr. Shosh: The statistics vary depending on how the study was done. So anywhere from 10% you see to 20%. I say on the safe side we can say around 15%. So we’re talking about one in seven. This is a very high statistic. We’re not talking about the usual worries and concerns that face a pregnant. Mommy, you know that you know she might be worried about what kind of a mom she’s gonna be or she might be worried about her body changing and she might, you know, many of these things are quite normal. But when the feelings get in the way of her daily functioning, or her ability to sleep at night. That’s one of the biggest warning signs that this is out of the normal range. Same with postpartum if the symptoms of either sadness, grief, anger, rage, low self esteem, insomnia. These are some of the most common if they get in the way of mommy’s ability to mainly enjoy or to feel like herself, or to get in the way of her functioning. This is a big indicator that she needs to be checked out.

 

P: Okay. Let’s alk about how this issue is identified. How does the person experiencing what may be symptoms know there’s an issue, or how does the clinician know they’re dealing with postpartum depression.

 

Dr. Shosh: There are a number of things we can look for, for instance, as I mentioned during pregnancy there are normal feelings that can come up, normal worries that float in and out. But if it becomes for instance an obsession. If she is focused on. Oh my goodness. What if this, what if that the what ifs are big, you know, The perinatal anxiety is is huge. Anxiety is one of the most common symptoms of the perinatal depression. So, what you’re looking for is an inability or difficulty sleeping at nighttime. Yes, if the mommy is having heartburn or if she’s peeing more frequently. This is normal during pregnancy, postpartum, the difference between normal baby blues and what might be a disorder,  two main ways. One is in the duration of the symptoms how long they’re lasting because the baby blues the normal baby blues should be gone after about two weeks postpartum. She should be feeling much more like herself. The other way you tell the difference is in the severity of the symptoms.

 

P: So My issue with this system was that it depends very heavily on self reporting. Maria said she was angry all the time but it would require her to tell someone that for her to get treated.

 

Dr. Shosh: Sometimes the person living with her, somebody very very close to her can tell you know that she’s you know facial expressions body language not wanting to be with a baby or not being able to relinquish the baby to anybody else. you know that it can look one way or the other. Sometimes they’re holding on and they will, they’re too afraid, just too anxious to even put the baby in their partner’s arms, but often it’s, I can’t do this, I am overwhelmed I can’t handle this, I should never been a mother, mommy putting herself down. These are the kinds of things you listen for these are signs of low self esteem. So yes, in answer to your question, the mom, often does feel that something isn’t right. Often, unfortunately, it’s normalized or she herself, you don’t know what she herself thinks is normal. She might say, Well, I’m sure all new mothers are feeling this way, or their motherhood is terrible. I was never cut out to be a mother.clearly, you know, rather than this as an illness. But if the right questions are asked, or the right observations are made these, you know this illness, and all of these illnesses are 100% treatable.

 

P: At what point did you figure out like oh this is, I’m not a bad mom This has nothing to do with me this is some other kind of force in my body.

 

M: Honestly? I think after I had my second son. I it finally clicked into me that it wasn’t anything I did, and I didn’t do anything to like, bring those feelings on that it wasn’t my fault that I didn’t bond with him. It wasn’t his fault that I didn’t bond with him it wasn’t anybody’s fault that that happened it was illness that that got missed I didn’t get any help for it and yes I suffered yes our relationship and a lot of ways suffered in the beginning because we didn’t really get the bond.

 

P: Next, I’d love to talk about the chemistry in this condition, Maria was talking about how she had a hard time bonding with her son, and wondering if he can explain how chemistry contributes to that circumstance.

 

Dr. Shosh: You know, I’ve got to see that’s not my forte and explaining exactly what’s going on with the brain chemistry and I will also add that I follow the research, very very carefully and belong to those organizations doing tremendous research, we still really don’t know precisely what is happening. We do know, generally speaking, that when the reproductive hormones are shifting. When the estrogen and the progesterone etc are are shifting it does affect the neurotransmitters in the brain and other brain chemicals. So, I can’t tell you precisely what is happening, you know, some women will report not feeling close to their infants or feeling like as you mentioned that they can’t bond, we’re thinking this might have to do with oxytocin changes. Again, there’s a tremendous….as we speak, all that there is a tremendous amount of research going on as to what precisely is happening. And sometimes it is chemical only that affects behavior. Sometimes it is the. A woman thinks she’s feeling something abnormal. And so she starts feeling horrible about herself. So that isn’t just strictly chemical they they bounce off each other. And so it’s very interrelated we call the bio psychosocial factors because one can definitely influence the other.

 

M: And I think after I had my second son, just by being a surprise pregnancy was not a pregnancy when I felt it wasn’t wanted a bike in fact with him was the opposite I was very not into it in the beginning and then as it progressed, I became super excited when he was born and I was bonded to him right away and I was kind of like, just clicked in my head but like, it just happens you can’t you can’t change whether you bond right away or if it takes you a little while and if you have postpartum depression or not like you are not in control, whether it happens.

 

P: Yeah, not at all. You can’t control it, you have no control as you said it and it requires treatment.

 

M: Yeah, Absolutely. And I think as moms we’re so programmed to blame everything on ourselves that it’s just too easy to be like well it’s my fault I’m not being good enough mother, or I’m not doing something well enough. And so you don’t actually even think that like maybe there’s something wrong on the outside. This is not me it’s like my body’s just not functioning the way it’s supposed to but it’s not through any of my own fault so. But it took it took a second pregnancy for me to actually truly get there, really see and understand like what happened.

 

P: Well I’m grateful that happened so you could, you know, think back to what happened the first time and maybe reevaluate and kind of change your narrative around what happened.

 

M: yeah, No, it was I mean we always talk about our second one was definitely a blessing in many different ways that even though we weren’t sure if you ever wanted a second one, just because the first time was so hard and it’s not unusual for people to not want a second child when they have severe postpartum depression, but I’m kind of so glad that that happened because it just puts so many perspective on.

 

P: That’s Awesome. What so there Did you say they are four and two?

 

M: four and a half and two –they’re two and a half years apart.

 

P: so what are they into now?

 

M: Oh gosh, Paw patrol is a big one, you know, like every boy at that age Paw Patrol is huge. The younger one really likes Daniel Tiger’, so that’s really cute and the older one will watch it with him, they love chasing each other, and also they  have indoor scooters they love chasing each other and scooters and hide and seek is another one so they’re, they’re very active. They like to play they’re very loud like yelling a lot. It’s a very boisterous household because those are two dogs that are also not quiet and not calm so it’s just like chaos.

 

P: That sounds fun actually.

 

M: I mean it is fun, it just gets overwhelming…

P: yeah yeah yeah

M: they’re a lot like they’re cute and I kind of like the age difference the first year was very difficult having a toddler and the baby is no joke there

P: Yeah,

M: but right now that there can play a lot together and do a lot of things together, definitely really fun to watch.

P: That’s awesome. Now if you could give counsel to your younger self. Before you got pregnant or you can during the pregnancy. What would you say?

 

M: I think I would say is that a with pregnancy and birth you kind of need to prepare for the unexpected because it truly is, you have no control and thinking goes for pregnancy birth motherhood is, like, you have to relinquish control, you’re not going to be in control of a lot of situations and the best you can do is learn to be flexible and adapt to things and Do the best you can, and that other one is kinda is be giving of yourself, give yourself as much self compassion as possible because you will make mistakes, things won’t go right and it’s okay, we’re all human and like that happened.

 

P: That was beautifully said, and I’m going to end this here now, because I want that to be the last thought in everyone’s head. That’s a really nice message to your younger self and to everyone else.

 

M: Thank you.

 

P: Thanks again to Dr. Bennet, also known as Dr. Shosh

and thanks again to Maria for sharing her story

 

1. shosh and I had a long conversation, much longer than I could reasonably include in Maria’s interview. If you want to hear more about peripartum depression, I’ve put a link to my whole conversation with Dr. Shosh in the show notes that you can check out wherever you got this podcast, or on the website, warstoriesfrom the womb. com. In this conversation Dr. Shosh mentions some resources that may be helpful for peripartum depression and I’ll include those links in the show notes as well.

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