Episode 60SN: Managing Abortion and Postpartum Depression as a Psychiatric Nurse: Nina’s Story, Part I

P:  Here are some excerpts from her writing. First, she writes:

“How do you know?” the patient might ask. I lean forward a bit in my

office chair, a magic mix of science and empathy, or so I would like to

think. The woman sitting across from me may be dabbing at her eyes

with her fingers. If her nails are chewed to bloody shreds, I will fold my

own more tightly in my lap.

“I’ve been a nurse practitioner for a long time,” I will say. “More

women than you think go through this. It’s hormonal…”

And a little later in the piece she writes:

Early on I figured that postpartum depression was

a risk for me, but expected I could balance my emotional happiness and

stability against my physiological tendency towards clinical depression,

if I was ever so lucky as to get pregnant. And besides, I was a

professional. With training and resources.

So here’s the thing with training and resources: Depression robs

you of the clarity to use any of those skills or supports.

One note to add: I’m changing the format of the show a little: sharing people’s stories in more manageable pieces. So you’ll hear the front half of the story right now, and the back half next Friday…and with that, we’ll get to the story

P: Hi thanks so much for coming to the show. Can you introduce yourself and tell us where you’re from?

Nina: Oh, my name is Nina gaby long i Long A I am originally from Rochester New York and I now live in Central Vermont.

P: Oh wow nice. Oh is that cold for colder? Is that the trade

N: cold for we came to Vermont like got a on an adventure.

P: Nice Vermont’s Nice. So do you will you define your profession?

N: So I am a psychiatric nurse practitioner and clinical nurse specialist. And you know some of your listeners may know that that entails being an RN and then becoming an advanced practice RN with additional clinical experience and a master’s degree and many are getting doctorates now to become nurse practitioners. and it’s a state by state kind of certification. So in the state of Vermont, I have prescriptive authority. So I can prescribe medications, I diagnose people, evaluate them, give them complete workups psychiatric works up workups and then I, I prescribe medications and then I follow them. And I do psychotherapy, when time allows

P: Okay, so that’s a that’s a pretty broad specialty. And I imagine you’ve seen a lot of things in no small part because of the writing that you sent me which we will get to because I have read your piece called No stranger. I know more than I do going into Most interviews. So why don’t you tell us about the first pregnancy first just to kind of set the stage.

N: The first pregnancy was in 1974 and it was an unwanted pregnancy. And I forever will be so thankful to Roe v Wade it allowed me to go on with my life. I would not have been able to have been a good mother. At that time. I was in a relationship that it had been an International Love Affair once we were speaking the same language it it wasn’t working well at all. I had just graduated with my first degree, which was a bachelor’s in fine art. And I had already set up a studio and I already not even out of college had orders for galleries. From again, I was very fortunate from Hawaii to Cape Cod, fine, fine craft galleries. So I was just on the precipice of my life and despite significant birth control. I found myself pregnant in a relationship that I could not handle. I was drinking heavily and there was no way I could have been a mom and I

P: Yeah, was looking for. I saw you said two forms of birth control or something like that.

N: I had you remember to remember the old Dalcon shield.

P: You know that’s before my time. So I’ve heard of it but I don’t know how it works.

N: So it looks like it’s like a little bit like a scorpion with lots of legs coming off of it. It is a an evil looking thing and hurt like hell all the time. And I don’t want to get pregnant i mean I knew I thought I knew what I was doing. So we use, you know, condoms and we were so incredibly careful. And nonetheless, you know, pregnancy happens no matter how careful we are. And so yeah so that was the first pregnancy and then the second pregnancy.

P: Wait, so wait before you before you get to the second one. You say Can I quote your piece? Yeah, say I recall. Now my preoccupation with how how maybe because I’d had an abortion at 23 I would never be allowed by the powers of the universe to ever get pregnant again. This is not normally the way I think and finding it crazy. I mentioned it to no one.

I think I think a lot of people do carry that with them.

N: I also think that people don’t talk about it. Yeah, I mean, I think we would have to, so when I was thinking that way I was in you know, kind of throes of depression leading up to the pregnancy and I was I was already depressed because I was turning 40 And I wanted to have a baby and now I was I was so stable now I was sober for some I had been sober since I was 29 years old. I had a wonderful solid relationship of, a really solid marriage. I had a career a career that, being an artist was a wonderful career but, moving into healthcare was significantly more stabilizing. So I had decided I wanted to have a baby because I could be a great mom

P: yeah

N: and provide for that baby and it was a whole different thing. And then it wasn’t getting pregnant and pro and prone to depression and anxiety anyway. And so, as that was happening, I was just I was approaching 40 I was really depressed and that’s when that’s that’s kind of crazy cause and effect, thinking, you know, that magical thinking stuff starts happening where it’s like, oh, I’m being punished by the universe, which is not not what happens. that’s not why we don’t get pregnant. There’s a lot of reasons why we don’t get pregnant and that’s not one of them.

P: I 100% agree, right. that’s not scientific. I just think I’ve talked to a lot of women who get an abortion for one reason or another, and then condemn themselves and feel like, come up and say or whatever happens, right, they’re joining to things that are unrelated 

N: easy to do, isn’t it? Because, I think when we first you know had access to safe and legal abortion, we were kind of on a high from that, and when we didn’t really, think that much about it. I mean, I really don’t know that many people who didn’t get abortions at some point because they were, women who were thinking through their lives, and this is what I need to do right now and I can’t do this right now and you know, just, make these decisions and then probably you remember more and more, like Saturday mornings, you’d go to the farmers market and there’d be, people protesting abortions and then people lining up in front of the abortion clinics and, screaming and shaming people and more and more it got no, it it got much more difficult to ignore the fact that there was a faction. I don’t know if you recall Dr. Bernard Slepian. from Buffalo, New York, but he was an abortion provider and in in Buffalo, and he was shot through his kitchen window and kill and I was still living in Rochester at the time. So it was,right next door of city right next door to us and route called, the lambs of God took some responsibility for that, for that murder. Although I don’t think they actually were ever charged would have nobody was from that group was ever charged with doing it.

P: According to his Wikipedia page, Dr. Slepian murder was the climax of a series of five sniper attacks in four years in Northern New York and Canada. In 1988, he was the fourth doctor in the United States to be murdered for performing abortions. He’s killer James cop went on the FBI 10 most wanted list and was ultimately found hiding in France in 2001. That cop was extradited, tried and convicted of second degree murder in Buffalo and is currently serving a 25 to life sentence. cop was also convicted of federal charges and sentenced to life in prison without parole.

N: But they came to Rochester and threatened another doctor Dr. Wartman we’re applying a whole bunch of us went to Dr. woman’s house and we circled the house to protect him you know and have the like these anti abortion people on one side of the street and then the news people were in the middle of the street and we were on the other side of the street. And I’ll never forget it was it was so interesting because the news people really wanted a story. And you know what happens? You know, I walked across the street and I started chit chatting with one of the anti abortion people and somebody else came across the street and started talking to us and before you knew it, we were all in the middle of the street talking. There was no news there was no shootout. But more and more of those things kind of started to happen. And so we really started to realize that maybe there was something to all this you know, I don’t know, I I think I changed my mind every few minutes about what all that means. But yeah, 

P: that’s a lot. The politics around this is so loud, it’s hard to have a real conversation. Okay, so now flash forward, you’re 40 you do get pregnant. 

N: I get pregnant. Yep. On my 40th birthday. 

P: Oh, wow. 

N: It was really I mean, I I bought up pregnancy tests because all of a sudden I realized, oh my god, I haven’t gotten my period. I feel like I’ve been PMS thing but I don’t have my period and so I woke up on my 40th birthday and, and the you know, the little pink lines happened and and so well that was great. Until Until a lot of the hormones started to kick in. It wasn’t it wasn’t a fabulous pregnancy.

P: So what hormones kick in pretty quickly. Does that mean the first trimester was hard or

N: the first trimester? I was working a very intense job. I was working on a crisis team. It was my job to work with people with very, very severe mental illness who were very symptomatic. And nobody wanted to use up the hospital beds for for psychiatry. So they created the crisis team and I was just immersed in it. I mean, I was working so so so hard, and so I didn’t really think that much about too much. and we were buying a house so that we would have a nice house and a tree lined street because we’ve been living in a in a strange little place. So we were like, we’re gonna get a real house and the closest picket fence, I think. Um, so the first trimester it was like really exciting because everybody you know, had a lot of colleagues and everybody was really happy for me and,then I I just really started to get more tired and I didn’t want to admit that I wasn’t going to be doing the Stairmaster on the day of my delivery date. And I think I mentioned in the, in that piece that I wrote that I did know a lot of women who we’re having these beautifully filmed births, home births, and like literally expensive mascara and French lingerie, and,it’s like, I was getting more and more ungainly. I was gaining all this weight. I was so tired and then I took on more and more I was teaching a class as well as working full time and we had just moved into a house and we hadn’t even gotten it. the inside rooms painted and, it’s really, I was going about 20 hours a day and then my my body just said no more. And I had a case manager who was my teammate, and she said, Something’s very wrong. And I said, I’m fine. I’m fine, I’m fine. And she said, No, something’s really wrong. And she said, you’re short of breath and you’re just not yourself. And so she, she came into my office, she locked the door behind her. She sat down, she shoved the phone over at me and she said, you’re going absolutely no place until you call your OBGYN and she and she was right. I called my OBGYN and he said I don’t want I don’t like the way this sounds come on over. What was holding me together was work. Like work was work with holding me together. I mean, these patients and they needed me and, I was so vital and you know how it is. And I went over and he said, you’re starting to efface. And what you experienced the other night probably was losing your mucus plug. And so I’m at seven months, right seven months, and he said, so. I’m gonna go lie down and you don’t get up again until I tell you you can put this like his little plastic basket up against my cervix to hold my cervix shut. 

P:Wow. 

N: And, and that was that I was on bedrest. So these are all

P: he’s putting on divers to prevent premature delivery. And what you mentioned that he said, Oh, that thing that happened before was probably the mucus plug. Did you have something that happened that alarmed you? 

N: Yeah, well, I was totally in denial about it. Like oh, what’s that? Well, you know, I don’t know. And so here I was a health care professional. And I was just not, you know, ready to pay attention to my own fallibility. And, and that’s you know, that’s when the the postpartum stuff the pre postpartum stuff really started to kick in because there I was, you know, lying on the couch. Living for Geraldo Rivera Rivera. I mean, that way, he was just, you know, he was he was my guy, and I, you know, I’ve always it’s my guilty pleasure. I love soap operas.

I have since I was a child with my you know, in what would watch them with my grandmother.

N: So, you know, I would I got like, totally, there was soap operas then on all day long. And so if anybody called me while the soap operas around to see how I was, I wouldn’t answer the phone. You know, I mean, I got I was really getting crazy. And then

P: that sounds pretty difficult to go from the whirlwind of all the cases in the crisis center to bed.

N: Bed, right. That sounds pretty bad. Yeah. Yeah. So it was it was it was a very, very difficult time and of course, we don’t know how different I mean, I would hope that it would be different now. I did not feel as though though I was part I was I was in a good OBGYN practice. I mean, they’ve been around forever and, and an artist for so long and the reason I knew my OB GYN was because his wife was an artist and they used to buy my work. So I felt a connection and you know, it wasn’t like I was completely dismissed. But I think the emotional, emotional component of what someone like me a woman of you know, high powered woman, like me goes through when suddenly dreadful I don’t, I don’t I don’t think that I was not tended to. Well, I was I afterwards, but I refuse to let anybody know how bad things were afterwards because I was convinced that once I told anybody how crazy I was, that they would take my daughter away from me.

P: Well, we’ll get to that because it’s totally interesting. And it is. I mean, it highlights how difficult it is to find someone’s postpartum. You know, even even therapists and people who are trained in this field, don’t necessarily recognize it in the most in themselves. So it’s a really difficult thing, but why don’t you take us to the birth I guess it sounds like you were not imagining a home birth with French lingerie and a video camera. But But what were you hoping?

N: No, I actually kind of was initially and then my, my OB GYN said, Don’t you be thinking about none of those births or nurse midwives or anything like that because I had shared with him that when I went into when I went to nursing school, I had thought about becoming a nurse midwife. That’s a whole other story. And so he was like, that’s not happening. You are going to do exactly what I tell you to do. You’re going to have amniocentesis, you’re going to have this you’re going to have blood glucose levels. You’re going to you know, you’re going to do you know, your elderly primigravida And you’re going to do what I tell you to do. So, the birth was two weeks late, because once I settled down, nothing happened. And so they actually, they actually lied to me about my water. Having broke I asked them if they thought my water had broke, because you know, when when the baby is lying very heavy on your bladder, you can leak urine, or you wonder did my water break in? Is it slowly very slowly leaking out? So he told me yes, that’s what he thought. He thought my water had broke. So then I knew enough that you know, baby had to be born with in a certain amount of time. And when I didn’t progress, labor wise, told me I had to have a C section. I didn’t want a C section. More than anything I didn’t want to see section.