Delayed Postpartum Depression: A Post C-Section Journey
by Sebdann Ingen Shinaig
When Earth Mama asked me to write a guest post, I wasn't sure how. Was I writing about delayed PPD? Was I writing about birth trauma? Was I writing about the emotional effect of an unplanned cesarean? And how could I possibly separate any one of those things from the others when telling my story? I guess the only way, really, is to share my own journey of discovering and battling all of those things.
What follows are mostly excerpts from my journal, starting at almost 11 months postpartum. Every time I read over it, I'm still a little surprised at the changes I've gone through in one short year. From frustrated but-okay-with-it and resigned, to “what is wrong with me,” to “next time I will…” to rage, to fear, to obsession, to research. Despair, hope, progression, regression, cycles and circles and spirals... mostly spiraling up, these days.
At the beginning, I was consciously being very rational. I wasn't one of those women over there who were depressed or traumatized by their cesareans. I simply had learned from the experience and was “fine.”
29 March, 2011 (11 months postpartum) - All in all, it wasn't a horrible experience, and certainly not a traumatic one. And I healed so quickly and cleanly it's ridiculous. But it's not the experience I want for me, my husband, or the next baby we have.
A little while later, I started realizing that I might not be “fine,” and immediately felt tremendously guilty. What right did I have to be struggling when I had it so good?
25 June, 2011 (13.5 months postpartum) - Everyone says my healthy baby and healthy me are all that matters. I even said it for a year. Why isn't it all that matters to me? Why am I so upset over DD's birth when it was so long ago and I was fine at the time? Don't I love her enough to make up for it? Why does it hurt now? Do I not love my baby enough? Nobody gets it. I feel so alone. And so stupid for sounding like an angsty teenager.
It's funny how one person you don't even know that well, saying the right thing at the right moment, can change everything.
2 August, 2011 (15 months postpartum) - Just before S left, she said something amazing. She gave me a hug and said, "It was good to see you, and I'm sorry you didn't get the birth you wanted." That was it. She didn't add anything to it, she didn't remind me of the silver lining, she just said she was sorry.
S's words tore everything apart that I had so carefully constructed to keep myself safe from confronting the rage that I was so afraid to associate with my baby.
15 August, 2011 - It took me so long to realize that it was okay to love my baby and HATE how she was born. Every life is a pile of good things and bad things. For a long time, I thought the pile of good things was supposed to make the bad things not hurt. So I tried really hard not to let them. When sometimes they did anyway, I pretended they didn't. And felt guilty that they did, and wondered if there was something wrong with me. I still wonder sometimes. After all, I failed at birth, and you don't get more basic biological function that that, right? Am I also failing at loving my baby enough?
Somewhere in there I consciously realized the importance of my support network, and came far enough out of my hole to reach out to a select few.
19 September 2011 (16.5 months postpartum) - The next time I make the journey through birth and Motherhood, I will take with me the strength of those women I know who are strong in the ways I want and need to be strong, the women who've gone before me on this road, the women who are beside me on this road, the women I now know from experience will be strong for me when I'm not and hold me up as I learn how.
In early November, 18 months postpartum, I wrote a list of things I would say at my daughter's birth if I could go back in time. I won't go into it here, but it was extremely cathartic, full of expletives, and an important step in my healing.
Then on New Year's Eve, my husband reduced me to sobs, in a good way. I still had not talked about any of this except to my sister, but somehow, subconsciously, he knew how much I needed to hear exactly what he said.
1 January, 2012 (20 months postpartum) - "I know I get frustrated, and I get distracted, and I'm not always there for you like I need to be. But I love you, and I love our daughter, and I love our life together. Do you know that? Do you know it all the time?" Remember that moment. It means everything.
It was somewhere around this point that the obsession stage really took off. If I had asked for more information here, if I had refused an intervention there, then it would all have been different. Now I know it's the bargaining stage of grief, but I hadn't thought of it in those terms, that I was legitimately grieving the birth I had wanted. At any rate, when I obsess, I research. Among many other things, I ate up “Ina May's Guide to Childbirth” and “Birthing from Within” in a matter of days, and came out with my head spinning. I had a wealth of information from Ina May, and a wealth of introspection from Pam England.
5 January, 2012 - Ironically, the very fact that I wasn't at all nervous or scared of birth worked against me because I never 'needed' to do the research that would have given me the info to make and stand up for my decisions. I didn't need anything for pain, so I was okay with following doctor's orders for every other reason. I didn't know risks to baby, or 'cascade of interventions' it could (and did) cause.
I now thought I had learned enough to order my medical records from the birth. I was pretty sure I knew what had gone wrong, what to do differently next time, and wanted to be sure there wasn't anything I was forgetting or hadn't known. And this is where I experienced my first regression. DD's apgars at 2 and 5 minutes were 8 and 9. Wait... I thought she was in distress? This leads me to read over the labor notes. Turns out pretty much every time they told us something scary and advised an intervention, they were writing in my chart that everything was fine, even perfect. And when they were telling us things were fine, they were writing, “advise c-section.”
2 February, 2012 (21 months postpartum) - The part that the records showed me that I didn't know before was that they weren't just wrong, they lied to me. Before, I didn't trust them to advise me correctly. Now, I don't even trust them to tell me the truth so I can make my own decisions. I'm angry, and I'm hurt, and I feel like I've gone back months in the healing process. I thought I was in a good place. I don't want this. I need to be more than this, for my daughter, for my husband, for my friends, most of all for myself. More information usually makes me feel more solid, like I know where I am and can plant a foot firmly to start a journey. Now I just feel lost. I don't even recognize myself some days. Birth fundamentally changes you, it's supposed to, but not like this. Oh my god, this hurts.
About this time, I discovered the birth trauma community Solace for Mothers. The above is an excerpt from my first post there, and the responses were... simply amazing. I was sure I was insane. But here were women saying, "Yes, I felt just like that. Here's how I got through it." One in particular pointed out that for her, "knowledge of how someone else experienced or perceived the birth and recorded it didn't do squat to change how I had perceived it." The medical records were useful for what I intended them to be useful for, and were irrelevant to my emotional recovery. I'm recovering from my experience, not the doctor's.
3 February, 2012 - Perfect words for the change of perspective I need to re-frame it. Not over, but I will work toward this. Easier said than done...
Talked to husband about this whole mess for the first time. Had a false start, but managed to get across to him that I don't need him to fix it, I need him to hear me, know where I'm at, and why I'm crazy, know he thinks I do anything right. I need him to see how messed up in the head I am right now and know he still loves me, still respects me. I need him to see all my crazy and all my ugly and not run away. Because I'm doing enough running right now for both of us and I'm trying not to but it's so hard and I need help.
Opening up isn't easy for me. I wanted so badly to run away after that, to hide, to protect myself with layers of armor. I was so afraid. So, knowing myself, I did the opposite. I started seeing my massage therapist again, and let her know that I needed specific work on the physical damage resulting from my cesarean, and that I was leery of touch around the scar, and that I was likely to be an emotional wreck on her table sometimes. She's awesome. It has helped so much.
31 March, 2012 (23 months postpartum) - I knew body work was my best way to heal what my mind does to my body. I'd forgotten what I always insist is true, that it goes both ways. Not only does my body chronicle what my mental/emotional state has done to me, but this yoga/massage process of healing my body is helping my mind. As J traces back through the layers of locked up tissue, unlocking places my body is physically holding on to, it gives me direction for where to direct my mind. First we worked on neck and shoulders. I had to work between treatments on sitting and standing tall, which meant I had to want to stand tall, I had to know I deserve to stand tall. I had to be proud confidently, not defensively. Then down into my hips and legs and lower back, all the areas surrounding the real damage, and I had to work on balance, symmetry, openness, uncircling my wagons, sort of. We're just starting to work on my belly. I hadn't realized how tightly held I keep my abs until I had to consciously relax them for J to work. Even lying flat in my bed, the habits formed by the necessities of healing keep my core and my pelvic floor always some degree of flexed. And so I wound up lying on the massage table, yoga breathing through my belly and having to continually tell my muscles to relax. Just touch is enough to make me focus there, and I reflexively close up. So she gave me exercises to take home, and when I do them, focusing on breathing into my belly and relaxing that tissue, it makes me focus on the thoughts and emotions that go with it. But now instead of it being this overwhelming flood, there's a system, an organization of sorts. Just like we have to unlock my body's protective layers before we can work on the real damage, so I'm following along with my mind, also unlocking the layers of defense mechanisms to get to the hurt I really need to work on. It's not easy. It hurts, and it's scary. I had a not-quite break-down moment after yesterday's massage, and doing the little belly-focus exercises this morning is harder than I thought it would be. Now I have to face my fear. I will permit it to pass over me and through me, and when it has gone, I will turn the inner eye to see its path. I think I understand those words and their meaning on a gut level more now than I ever have. I've been more afraid in the past year than I ever have. That inner eye part, that's the rough part. Where the fear has passed, there will be nothing. Only I will remain.
And then, a month later, less than a month ago, the light came on and I finally understood. I accidentally saw this article about a link between weaning and depression, and started googling like mad. There it was! There was all the information I needed a year ago when I was trying desperately to figure out why I was suddenly guanopsychotic, as it were.
28 April, 2012 - I had never head of 'delayed postpartum depression', but now the past year makes so much sense. With DD nursing less starting with the debacle of November 2010, my period started again, so I was dealing with those hormones. Then she went on that nursing strike in March 2011 and my mental state got tenuous, and then she totally weaned herself at a year and that's when it all went really bad. 'Oxytocin withdrawal', and suddenly, too. Weird stages of grief: avoidance, obsession, bargaining, guilt, anger, depression, rage... acceptance, I think, finally. Learning to love my baby-making apparatus again. I still grit my teeth at being naked with my scar showing, but I can grit my teeth and fight through it. I got some C-Mama salve and have been rubbing it in every day. It's making me get to know it, sort of. How the tissue lies against the layers below it, how the hair grows funny over it. It's part of me. It's time I got around to understanding it as well as I understand the rest of my body, instead of pretending it doesn't exist. One good thing about the last year though, the silver lining I guess, is that the obsession stage combined with my research tendencies means that I now know more about the physiology of birth and how it's supposed to work, than most women who've given birth multiple times. This puts me in a distinctly different position if and when we have another baby that I was in last time. It's not over yet. I'm still getting used to this me, and there are good days, bad days, and semi-uncomfortable days. But there are more good days (days where I don't think about it or avoid it) than bad days now, and I'm getting better at turning the uncomfortable days into good days. DD's second birthday is next week, and we're doing her party today. This long, hard year is over... Spring is here, and things are finally looking up.
One thing I realize now that I would have been truly lost without is my triumvirate of support. I'm lucky enough to have had my husband, my sister, and an old friend, who knew at various times, to various levels, what was going on.
My husband was there. He could not understand at all, he just loved me, even though I know it scared him, especially before I explained it all to him, when I just seemed inexplicably crazy. That let me have one thing somewhat solid, even when I was wondering why anyone would love me.
My sister... is amazing. I would have been so lost without her. She listened. She understood. She responded. She had a cesarean too, though in different circumstances, and it didn't ruin her life, didn't ruin her mothering. She gave me hope that it didn't have to ruin mine. She didn't make me explain when I didn't make any sense, she validated my emotions, she supported me in my role as a mother, and she loved me.
My friend did not understand. She's not a mother and doesn't necessarily want to be. But she knows me inside out, we can communicate volumes without words a lot of the time, and I talk to her about this stuff when I know I need to be rational for a minute. She did make me explain, because she didn't get it like my sister did, but she was outside it enough not to be scared of it.
So I had someone to give me a foundation, someone to hear all my crazy and ugly, and someone to help me organize the pieces. They'd probably all be shocked to learn how essential they were. Everyone else is shocked now when I tell them I'm finally coming out of a year of pretty severe depression. My facebook wall is full of delighted posts about my daughter's shenanigans, and I was and am truly delighted by her. As I said just today to someone who was surprised by a rare post about a rotten day (today has not been one of the good or semi-uncomfortable ones so far), "Being depressed doesn't necessarily mean you don't have fun. It doesn't necessarily mean the sun never shines. Sometimes it just means you're always wearing sunglasses."