PPA Advice

Congrats on making it through this tome about my experience with postpartum anxiety. Below is the promised list of things that have helped me manage my anxiety- some days are better than others! While you won’t see therapy on this list (due to the pandemic & not making time for it in my schedule) I love therapy and certainly see how it would be beneficial during this time. I’ve had both in-person therapists and done chat therapy through Better Help, which I highly recommend if you’re open to online options!

  • Sleep. As previously discussed, when sleep goes, so does everything else. I’m more short with those around me when I haven’t slept, and little things become WAY bigger deals in my mind. It’s certainly a catch-22 because with you have anxiety and racing thoughts, you can’t sleep; when you’ve haven’t slept, it makes the anxiety worse. I’ve had to implement no phone before bed and try to read every night before lights out. I also go to bed stupidly early. I’ve been listening to ASMR videos to fall asleep on and off for 10 years (it’s only recently that you can tell someone that without them getting totally creeped out. It’s not weird!!) My current favorites are WhispersRed, ASMRvelous & ElaineSMR.
  • Exercise. Getting back to my barre studio of choice has been vitally important to making me feel more mentally well. 85% of the reason I show up for class is the boost to my brain. The other 15% is for the physical aspects of wanting to get toned and chase my pre-baby weight, but even that helps because when I’m more confident in how I look, I feel better.
  • Tossing the scale. I recognized around three months postpartum that I was letting the scale dictate how I felt about myself, and that felt like an unhealthy mind prison I’d put myself in. Now I truly have no idea what I weigh, thus there’s not a number for me to get anxious about.
  • Medication. I don’t know if I would have been slapped so hard in the face by PPA around the four month mark had I kept taking Zoloft as first prescribed at my six week appointment. I’ve tried post-baby life both ways, and right now, medication is a tool that helps me live a better life. I enjoy the experience of being a mother, a wife, an employee & myself more. I don’t feel unlike myself; I feel like a more calm version of myself.
  • Talking about it. White knuckling what I was going through helped no one. Giving voice to my feelings without letting them rule my day helps me recalibrate, whether it’s writing them down or saying them aloud. Huge love to my husband for never diminishing what I’m going through. I even let my mom know I was on medication- a big deal for me!- because I wanted to be transparent with our support systems about what’s going on.
  • Limit alcohol and caffeine. I know, right? Me! Telling you this! I love coffee and greatly abused it when running my business and in those first sleepless months, but there’s no doubt it heightens my anxiety. I’m down to one spoonful of caffeinated grounds in my pour over in the mornings; the rest is decaf, then no more for the rest of the day. As much as I hate that it’s true, alcohol is a depressant, and I’ve had to get honest with myself about how it’s no longer serving me. This isn’t a big announcement of lifelong sobriety, but it’s my next self-improvement hurdle to be more conscious about when I’m drinking, why I’m drinking, and if it’s just out of habit (it is.) I don’t like parenting when I’ve had alcohol, and it certainly isn’t beneficial to my brain- especially on meds!
  • Gabby Bernstein. Gabby’s been my guru of choice as of late. I’ve read her book Super Attractor multiple times, and she just launched a podcast that helps me remember to take deep breaths and let go of allllll the ways I try to control everything in my life. I’ll put on a YouTube video of hers in the morning when getting ready if I’m feeling especially anxious. I mentally make a gratitude list when I wake up before grabbing my phone, I try to lean in to what feels fun vs. what I think I “should” be doing, I incorporate things I love into each day because that’s the point of life, right? (Avocado toast! Trixie Mattel videos! Long stroller walks!)

Not sure any of these are groundbreaking, but again, it’s what works for one person! Always happy to chat if you’re struggling or have suggestions of things that helped you or you have great decaf coffee suggestions.

A Long One about PPA

I contemplated breaking this up into two posts, but whatever. If it’s too long, take a break & come back later. Or skim it for the most interesting parts! Godspeed if you’re on mobile.

May is National Mental Health Awareness Month, and some states also recognize it at Maternal Mental Health Awareness or PMAD Awareness Month. PMAD stands for Perinatal Mood and Anxiety Disorders, most commonly postpartum depression, anxiety, and/or psychosis. Is it as fun as National Ice Cream Month? Probably not. But it’s vitally important to talk about so the stigma and shame are removed from parents going through it. I was officially diagnosed with postpartum anxiety at my first postpartum check up, and as with everything else on this blog, I can only speak to my experience.

I’m incredibly thankful to have a forthright group of friends who became moms before me, and I’m grateful to be a patient of a hospital system that is putting continually more resources towards parental mental health education pre- and postpartum. PMADs don’t just affect the birthing person; partners can absolutely suffer, often silently, as well. I wouldn’t say I had negative expectations about my mental health after becoming a mom, but I had realistic ones. I was definitely more versed in the signs of postpartum depression, however, so when my provider first said “postpartum anxiety,” I tried to brush it off as hormones and a lot going on in my life.

In retrospect, I suffered from anxiety my whole pregnancy (and, let’s be honest, my life.) My husband had his pay permanently cut by 25% due to COVID two months after we conceived, and my small business was greatly affected by the uncertainty of quarantine. We’d had our house listed for sale then took it off the market. We went for a month without health insurance (not recommended when pregnant AND in a pandemic!) Thankfully my business stabilized, he found a new job with insurance, and we moved when I was 36 weeks pregnant. In those final few weeks, I laid awake at night ruminating over how we were going to keep our baby safe from COVID, mass shootings, and being bullied by other kids while trying to not outright have a panic attack any time I glanced at news about the upcoming election.

All of this is relevant because at my six-week postpartum appointment, when the conversation turned to my mental health, I reported that I was “back to normal,” and I meant it. I was now in the process of selling my business and transitioning to a new job while figuring out how to be a mother to an unsleeping newborn with a husband who only had five days of “if HR asks, tell them you’re working from home” under the table paternity leave. We had supportive family nearby, a new home with tons of potential and a healthy baby. Nothing to actually complain about! Situational anxiety was my normal.

What wasn’t my normal was the panic I’d feel leaving my son with my mom or husband if I had an appointment. I’d get shaky in the Trader Joe’s parking lot thinking about how I had to rush home because they’d be mad at me for being away too long. (They weren’t. They would never be. This was something I’d made up in my head.) I thought it was “just hormones” that for the entire 12 minute drive to my son’s first doctor’s appointment with just me taking him, I was convinced he wasn’t breathing in his car seat. On more than one car trip, I’d pull over to check on him in the backseat despite having a mirror where I could see him while driving. During the really gnarly first week of baby blues home from the hospital, my husband went upstairs to take a shower, but I had insanely dark thoughts that he was doing something else up there and would never come back down. I had terrible insomnia, and it would take hours to go to sleep even when it was my husband’s turn to be up with the baby.

I didn’t realize that when I got up to do anything away from my son, I wasn’t breathing. (I mean, technically my brain stem was doing what it needed to in order to keep me alive, but it was the shallow breaths of a panicked person. I probably didn’t take a full, deep breath his entire month of life.) I was constantly waiting for him to need something from me and anticipating his cries. He’d meltdown during diapers changes his first two months of life, he hated getting dressed– I was constantly on edge. I thought since my anxiety wasn’t always about him, though, it wasn’t PPA. Since I felt confident as his mom and had bonded right away with him, I figured this was just how I handled life now.

My doctor finally convinced me it didn’t have to be this way. She prescribed me a low dose of Zoloft which I took for a few weeks. I shared on Instagram that I was taking it for a PPA diagnosis and so many other people commented or sent private messages that they, too, had been there. But I didn’t want to be medicated. I know, I KNOW. I believe in medication for other people, I believe there should be no stigma around medication for your brain, and yet I’ve got a lot of subconscious baggage from being raised in a “tough it out” (or drink through it) environment that had me wanting to get off the meds. So I decreased my dosage and eventually stopped taking them after maybe a month.

Things were fine; nothing crazy happened. The business transaction closed, I got more comfortable in my role at my new job. I stopped breastfeeding and tried to embrace formula feeding. Most of my clothes started to fit again. Things got even worse with his sleep, but then we Ferber-ed and our lives were suddenly *clouds parting, angels singing.* Out of the woods, baby!

Oh, boy. It was like once my brain knew he could actually sleep through the night and would be fine, it came completely unglued. This was not the situational anxiety of before; this was full on PPA. Did you know that PMADs can happen any time the first year postpartum? I didn’t! So many of the other parents in my Reddit monthly bumpers group were experiencing the same right around that four month mark. Did you know your body has another insane hormone surge (or drop, I don’t remember which- I’m not a doctor) around 16 weeks after birth? I was a ball of panic. I had to leave Walmart because I couldn’t find Total in the cereal aisle but couldn’t take the time to slow down and look again for it because I had to get home to my baby.

Thankfully, I’d kept picking up my prescription when it auto-filled and this time, I felt no shame in using it as a tool in my mental health toolbox. My son is now over six months old, and things are a lot better than they were two months ago. In the next post, I’ll share the litany of things that have helped get me to this place, fully realizing that this really is a journey I’m not at the end of (and I loathe when things are described as a #journey!!)