When my husband and I became pregnant in the spring of 2004, we couldn't have been happier. This was the first stage of our dream of raising a family together. So, when I gave birth to a beautiful baby girl on December 15, 2003, you would think it would have been the happiest day of my life.
Unfortunately, that was not the case.
At about 37 weeks along, I was laying in bed one evening reading "What to Expect When You're Expecting," and had classical music playing for my baby to hear (after all, I was doing my best to make sure she was a genius). I read about an expectant mom who was looking forward to becoming a mother but felt overwhelmed. Suddenly, I was struck with an overwhelming and paralyzing anxiety. I began to experience thoughts of losing control and harming the baby and myself. My irrational thought pattern went like this: mothers who harm their babies have post-partum depression; women with post-partum depression kill themselves; so that must mean I was going to kill myself.
Sadly, such tragedy can be true for some women, like Andrea Yates and Susan Smith whose stories have been told by the national media. The difference for me was that these thoughts made no sense to me. Yet the simple idea of them was so exasperating that I began to avoid anything related to the baby. For almost three weeks, I refused to be alone for fear of harming myself. I wouldn't touch knives or razors because they were potentially harmful. I didn't go in my basement or garage. I even remember one day, walking down Richmond Street in Providence and being proud that I was walking by myself. In the same thought, I realized how ridiculous this was.
I sought professional help by way of a therapist I had seen years ago. I also mentioned to my OB that I was experiencing anxiety. Yet, I declined his offer for anxiety medication …
My symptoms worsened following Annie's birth. I cried every single day in the hospital (another hospital in RI, not Women & Infants), but did not vocalize this to anyone there for fear they would take her away from me. Instead, my anxiety developed into depression and I began to avoid any contact with her. The only interaction we had was breastfeeding. It was during those times that we bonded and I become resolved to end the torture I was enduring. Five days after Annie was born, I was back in my OB's office, desperate for anything that would make this horrible stuff disappear.
My OB explained to me that thousands of women took medication for anxiety and depression. He also told me that the medication would kick in over the weekend. I left his office elated that I would finally feel relief.
The next day, I hit rock bottom. Because I refused to sleep in my own bed (where the original thoughts occurred), we were sleeping in our living room. I woke up to see my husband sleeping with my baby in his arms and realized the agony had to end once and for all. Perhaps it was the physical separation from them that made me realize how ridiculous this situation was – I lay on the couch by myself, completely exhausted, and watched them sleeping soundly and peacefully together.
I also felt betrayed and stranded. My doctor had said the medication would kick in over the weekend. To me, it hadn't made a dent.
First I called the therapist. She suggested I call my doctor and ask for Ativan, a fast acting anxiety medication. Reaching the OB on-call, he suggested that I was simply stressed by the holidays and I should relax and enjoy my new baby. That following Monday, I finally reached my OB who told me that there was nothing more he could do for me, and I should go somewhere else for help.
It's at this point where the story becomes happy.
As I was being discharged from the hospital where I delivered Annie, I was asked if I wanted a visiting nurse to come check on me and the baby. I thank God everyday that I said, "Sure, why not?"
Our first day home from the hospital, Joanne Angeloro from VNS Home Health Services came to our house as I was having a meltdown. She suggested I get help through medication and said I should look into the Day Hospital program at Women & Infants Hospital. I dismissed all of her suggestions and pushed aside the information she had given me.
So when my OB threw his hands up at me, Frank reminded me of the W&I program. Not able to find the flier about the program in the pile of forms, information and junk we had collected over the last three days, we called VNS and said we needed to speak with Joanne right away. Not 20 minutes later she was at my house with all of the details.
This is where the experts from the Day Hospital come in, particularly Dr. Carmen Monzon, MD. Immediately, she diagnosed me with "postpartum obsessive compulsive disorder," a condition in which a new mother's hyper-vigilance about possible harm to her baby leads to intrusive thoughts, obsessive thoughts, anxiety, depression or fear. She also told me that it would take up to 10 days for the anxiety medication to work, and prescribed another fast-acting medication.
The Day Hospital is a five-day treatment program for pregnant and post-partum women with post-partum depression, anxiety and mood disorders. Participants receive such services as group therapy, individual therapy, mother-infant assessment, family assessment, educational support, infant massage instruction, massage therapy, lactation consultation and drug therapies. Infants accompany their mothers, allowing for the mother-child bonding experience to continue uninterrupted. Nurses are available in a private nursery to care for the infants when the mother is in meetings, group sessions or just needs a rest. Fathers are also brought in for family meetings.
For me, the best part of the Day Hospital program was the other mothers – to know you're not alone speeds the recovery process exponentially.
Words cannot express the fear and panic I faced. Since I had viewed motherhood as a positive experience, the confusion about my condition and my own personal stereotypes about mental health significantly added to the overwhelming anxiety and inhibited my ability to care for myself or the baby. The reality is: Andrea Yates didn't have post-partum depression but post-partum psychosis. These stereotypes slowed the process for recovery and cost me days away from Annie. Within days of participating in the program, I felt significantly better, primarily because I had a better understanding of what was going on physically and mentally. I was surrounded by people who were educated about the treatments that work best for pregnant and post-partum women.
Even following the Day Hospital, I sought treatment – in the form of talk therapy as well as a specific form Cognitive Behavioral Therapy, tailored for people with OCD. CBT is considered a results-oriented form of therapy (I guess people with OCD wouldn't have it any other way!). Working with Dr. Barbara Van Noppen at Butler Hospital, I was forced to question and test the thoughts that caused me incredible anxiety. Dr. Van Noppen and I used The OCD Workbook which to learn new ways of behaving and reacting around the very things that I had been avoiding for over a month. And because CBT is diametrically opposite from "talk therapy," I worked separately with Ann Back Price, RN, MSN, CS; a fantastic psychiatric clinical nurse specialist whom I met in the Day Hospital. Fortunately for me and dozens of women, Ann splits her time between Women & Infants Behavioral Health department and her own private psychoanalytic practice at Butler. While the symptoms persisted, I understood that I wasn't going to lose Annie because of them. Through my follow-up meetings with Ann and Barbara, I learned important behavioral health strategies to quell them. And most importantly, I learned that I was Annie's mother and my natural instincts would lead the way.
Today, I am the proudest mother, not only to Annie but to Kelly who was born in February 2006. My post-partum experience with Kelly was significantly better. I worked with my team – Dr. Monzon, Ann, Barbara and my new OB, Dr. Tolga Kokturk, to understand what and when the symptoms would occur and how to approach them. (In fact, I noticed the symptoms the day after Kelly was born and we notified the entire team!). Because I knew what to expect, no time was wasted in treating the symptoms and employing the tactics I had learned nearly two years before.
I thank God every day for VNS Home Health Services and Women & Infants Hospital. While I've always been an advocacy-oriented person, I often think about the countless other families who have been impacted by anxiety, depression and other disorders that can be associated with pregnancy and post-partum. I remember one day pleading with my health insurance company for "permission" to see a psychiatrist. I was redirected three times to the right people to speak with. All I could think of during this arduous process was, what about the women who don't have access to resources or information – never mind the wherewithal to tolerate the bureaucracy.
As a result, I'm on a mission to raise awareness that significantly more resources are needed for other women who have and will suffer from this and other horrible conditions. There is action in the U.S. Congress to address these issues: the Melanie Blocker-Stokes Postpartum Depression Research and Care Act seeks to require more funding and attention to these important issues. At the same time, Rhode Island's congressman from the First District, Patrick J. Kennedy (D-RI), has lobbied for legislation that would end health insurance discrimination against people with mental health disorders. And in New Jersey, a law was passed just a year ago which requires health care professionals to provide pregnant women with prenatal education about depression, anxiety and mood disorders for women in the pregnant and post-partum stages. Here in Rhode Island, I am part of the Rhode Island Maternal Health Coalition, a collaborative that is seeking to have the same legislation passed. And perhaps some day, more programs like Women & Infant's Day Hospital will be established around the country to provide a more havens for other women who have the same experience as me.