To have another baby or not to have another baby. That is the question. This decision can be hard for all parents, but for moms who’ve experienced perinatal mood and anxiety disorders (PMADs), it can be terrifying. After suffering from severe postpartum depression and anxiety following the birth of my first son, Adrian, I took the possibility of more children off the table. Any lingering baby-fever was locked in a mental box marked “never open.” Two years later, when my heart started yearning for another baby, my brain railed against the urge. Although I was in healthy mental state, I feared anything that might bring back my PPD and PPA.
Nine years ago, as a new mom-to-be, I had high expectations for myself and what life would be like as a parent. Immediately after Adrian was born, I knew something wasn’t right. Instead of that post-birth feeling of euphoria, love, and joy that I expected, I felt dead inside. As time went on, that numbness was replaced by fear, hopelessness, and despair.
I felt incapable of doing the one job I had to do: mother my son.
Following a diagnosis of postpartum depression and anxiety, I started medications and talk therapy, but my condition continued to worsen. Dosages were increased; medications were switched out; more therapy sessions were added to my schedule; even Electroconvulsive Therapy was attempted. It wasn’t working. My mental health deteriorated further. There were periods of intense suicidal ideation that at times became irresistible. My husband hid all knives and sharp objects in the house. Medications were locked in a safe and dosed out daily. I knew that if I somehow survived this illness, I could never risk putting myself or my family through it again.
Megan and Adrian when she was still making her way through her PMAD
Eventually I found Dialectical Behavioral Therapy which, along with the right mix of medications, saved my life. After reaching a state of recovery, the decision to stop at one child still felt good. Knowing that the risk of PMADs is higher after the first episode, I felt no need to rock the boat. Still the unwelcomed yearning in my heart for another child persisted. After weeks of attempting to ignore it, I mentioned it to my husband, expecting him to think I was crazy. Instead, he loved the idea! He said we were ready and could handle whatever came our way. I was surprised again when my therapist said he agreed; that my new skills would help me cope through the postpartum period in a much healthier way. My mom’s reaction was the same. I was shocked. Why weren’t these people, who saw firsthand how bad it was, trying to talk me out of this? I know now that it’s because they believed in me, even if I didn’t fully believe in myself yet.
On a sleepless night while wrestling with the big decision, I made a three-page pros and cons list of having another baby. Reading over the list brought on a mental clarity. All the cons could be problem-solved. They were scary, but I was not about to let fear stand in the way of something my heart truly wanted. The pros made it obvious: baby #2 would never feel like a mistake and would be worth it. Three months later, I was pregnant (thank you IVF and frozen embryos!). The prenatal period was spent working with my therapist, psychiatrist, and support people to cope ahead and prepare a comprehensive postpartum plan, focused on my mental health. The fear was still there, though not as intense, and it felt like a natural human reaction given the stakes.
“With Wilbur, we headed out into public right away (pre-pandemic), I breastfed him everywhere without a cover and was so relaxed that I enjoyed myself!”
My second postpartum experience was immediately different. There are tears in my eyes as I write these words and recall the joy of holding my second son, Wilbur, for the first time. I didn’t want to put him down; it felt magical, special, and wonderful. Reality still settled in after returning home from the hospital. Hormones fluctuated, sleep deprivation took its toll, changes in our family dynamics were difficult and frustrating at times. But it all felt relatively “normal.” There were times that I needed to use coping skills through anxiety attacks. Postpartum depression did return but it was mild and quickly addressed with a medication adjustment, therapy, and leaning on my support people. It was hard AND it was worth it. Thinking back, I believe that Adrian taught me strength and courage while Wilbur taught me hope. I will always be grateful to both of them.
Megan’s Family today
Want to hear Megan speak about her experience? She shared at Listen to Your Mother in 2016. Watch now!
My perfect little boy was born in January 2019. Nothing was unusual about my pregnancy except, perhaps, the fact I seemed to have it pretty easy. No morning sickness, no real physical discomfort or pregnancy related ailments, low weight gain, high energy, no complications. Labor was a bit of a different story – it was long, slow, complicated and, at the end, even scary. But then he was here and, to be honest, I forgot about the unpleasant details within days.
I was lucky enough to have a generous, paid, twelve-week maternity leave from the law firm where I had recently made partner and, once we were home, it took a little time but we soon hit our stride. I figured out how to fill a day – the Today Show is a bit of a guilty pleasure, I enjoy working out, I was able to make plans with friends to maintain a sense of sanity and adult conversation, and it wasn’t too hard to change my pre-baby, twice daily walking routine with our Goldendoodle into a dog and stroller regime. Being at home was so different from my work life, but I tried to enjoy the downtime while it lasted, and for the most part, I succeeded.
Anxiety Sets In- Quickly
My return to work was pretty seamless and easy. I eased in but was quickly back to my pre-baby stride. I felt like I was making it as a young professional, wife and new mom. I can’t tell you the exact date things changed, but it happened so quickly. I remember feeling stressed (and now I know, anxious) when my husband and I went out to dinner to celebrate our wedding anniversary. The week leading up to that dinner I had reached out to some of my senior colleagues in the same practice group to express a willingness to take on additional work – the return-to-work buzz had sort of faded, and my plate wasn’t quite full, which any professional who has to bill someone else for their time knows isn’t a great thing. I got a positive response and plenty of cases in my practice area needed staffing. My excitement quickly turned to apprehension when I realized some of these cases were a bit different than most I had handled before. I spoke up and asked for support from my colleagues and, again, received a positive response. But, the first of many irrational or pathological anxieties had begun and they were starting to fester.
My husband was concerned enough by my anxiety to suggest I talk to someone. Thankfully, I was able to snag an appointment with a psychologist’s graduate student the very next morning. I went, hopeful I could learn something or that she could say or teach me something to help nip this anxiety in the bud. At the end of my appointment, I also met the perinatal specialist for a few minutes. We agreed I was having at least some postpartum anxiety and would benefit from additional treatment; however, I also learned the perinatal specialist had a pretty significant wait period before I’d be able to see her again. Her perinatal psychiatrist counterpart had the same wait period. So, if I needed medication, I’d probably have to wait on that too. I left the appointment down, but feeling a little lighter and more hopeful. I had taken a step, what else could I do?
By the time I got to work that day, my hopefulness had faded, and I was even more anxious than before. “I don’t know how to do this…How can I learn these things?…What if I make a mistake?” By the next day, I could not escape the anxiety and it had sky-rocketed. I had trouble concentrating on work long enough to get anything done. By mid-day, I was shooting out panicked texts to my husband and best friend. Feeling terrified, I told my office managing partner I was struggling with some postpartum issues and needed a day or two off work. He was surprised, but supportive, telling me to work it out with HR and let him know what I needed to make it happen. With a quick call to HR, I found I had more paid medical leave available and learned what I needed to do. I made a list of my cases, short-term case tasks and deadlines and I left, praying no one would see or talk to me. What would I tell them?
Driving home, I was in a daze. On a whim, I called a friend who urged me to call my OB and suggested that OBs can often see women who are struggling with postpartum and get them started with treatment. I promised to call the next morning. I got home, and my very supportive mother-in-law greeted me and offered her support. I felt so appreciative, but I also felt ashamed for the first of many times. People have babies and are successful at work all the time, I thought. What’s wrong with me?
The next morning I woke up with a pit in my stomach thinking I made a mistake by taking time off and might have even ruined my career. I called my OB’s office. She was off that day, but I spoke to a nurse who contacted the on-call OB. Within an hour, I had an appointment with him for later that morning. He listened to my story and agreed it sounded like postpartum anxiety and depression. He prescribed a standard antidepressant and suggested I take two to three weeks off work, if that was an option for me, to give the medication time to work. “You’ll get back to yourself,” he assured me. Relieved, I headed home, armed with a plan. The relief was fleeting, though. How could I take more time off?
“I was hardly able to function“
Unfortunately, things got worse. I was lucky that my mom and mother-in-law were at our house and able to help because I was hardly able to function. I had my first appointment with the perinatal psychologist late that week, and she honed in on my irrational thoughts and gave me some reframing exercises – a facet of cognitive behavioral therapy – to work on. I felt better leaving the appointment but that hope barely lasted the drive home. What I was feeling felt so overwhelming and chaotic that it was hard to believe it when those I loved and my healthcare providers told me that things would get better. I couldn’t believe them. My next vivid memory is experiencing my first suicidal thoughts. I was so sure that everyone could see the anguish I was feeling. How could life be moving as normal? Doesn’t everyone see that I’m about to explode, that I’m hurting? Time passed and I started having trouble sleeping.
I woke up after the weekend hoping and praying for relief. I had asked for two weeks off, and this was week two. I could focus on myself this week and on getting better. I could go back to work next Monday. But, my hopeful plan didn’t even last that day. I contacted the psychiatric hospital that had been recommended to see what sort of outpatient groups they offered, and I “failed” the intake process for outpatient therapy. This meant I was sent to the psychiatric hospital for evaluation, where I admitted to the providers and to my husband that I had begun to develop a suicidal plan that day.
Admitted to the Psychiatric Hospital With Postpartum Anxiety & Suicidal Thoughts
I was admitted for the standard three days, which I know now wasn’t enough. But, the minute I got there, I realized that I had to say whatever they wanted to get out. Most of what I felt inpatient was shame. The women I was with were dealing with some horrific issues and circumstances, and I was sad, anxious and suicidal five months after having a baby. I couldn’t come to terms with it. I participated in my individual and group therapy sessions, but there was no true breakthrough. I was scared, and I was numb.
By the end of the three days, I realized I’d have to lie or exaggerate the “betterness” I was feeling to be discharged. I know my husband knew it was too soon, but he trusted the experts who said I was ready. Unfortunately, it was enough for me to tell them I no longer had suicidal thoughts. I cycled through a few different psychiatrists and the various medications they were trying weren’t working, but I had to get out of there. I would have said anything.
The next step after inpatient was an intensive outpatient program (IOP), which I started the next day. I felt immediately that it wouldn’t help me, but what other choice did I have? My husband and I agreed I had to try. I had a lot of support but, if I’m honest, it was hard to take at the time. I didn’t feel like I deserved it.
I alternated between pretending I was ok and being unable to pretend. I could hardly stand being with friends and trying to act normal. “Can’t you see I’m in pain?” was a constant refrain in my head but I didn’t feel like I even understood my own struggle, as raw and overwhelming as it was, so I didn’t expect that anyone else could either. Yet, all I wanted was for someone to help me – to save me from this anguish. One evening a few days later, I began to fear I had (and began obsessively researching) postpartum psychosis. While it didn’t seem to fit, I saw no other postpartum anxiety (PPA) stories like mine. I wasn’t worried about the baby. It was me, it was work, it was everything.
I continued IOP going through the motions and feeling worse and worse. Soon, there was a plan in place for me to finish IOP and return to work on a reduced schedule so I could continue group therapy. I was part of the plan making, but I didn’t believe it could work. I didn’t know what else to do so I convinced myself I had to move forward. I completed my second and final week of IOP with the plan to go back to work the next Monday. The baby started daycare and he did great. I was embarrassed to meet his teachers and see the other moms. I felt like a fraud. If they only knew what was going on in my head. By Sunday, I was a wreck with the thought of going back to work. I actively considered and researched ways to commit suicide.
Another Return to Work
Monday was horrible. I was almost childlike, refusing to go to work on my own and forcing my mom to drive me there, pick me up and take me to partial therapy that afternoon. I did my best to get through, but felt panic and doom almost every minute. I made it 15 days. The weekend before the 15th day, a close friend visited for the weekend. We sat down and talked about my work anxieties and how I could take small steps to get through them. We made a plan. I wanted so badly to be able to follow the plan the next day, but I didn’t believe it was possible. That Monday I sat in my office with the door closed for 15 hours, completing about 1 hour of work. My mind raced, but time crawled. My husband and friends finally convinced me I had to go home, and that I needed to take another leave.
Thankfully, I had an appointment the next morning with the original perinatal psychiatrist, returning to her after shifting to the psychiatric hospital and IOP program who were not perinatal specialists. She decided to try a very different medication, one that my mom had been on for thirty years to treat her obsessive-compulsive disorder (OCD). She told me she couldn’t accept what I’d told her about feeling hopeless and that, for this to get better, she needs me to have at least a small amount of hope that we can get through this with the right treatment.
Another Leave, A Glimmer of Hope & Healing
With the perinatal psychiatrist’s guidance, I was off work for a second leave, this time, fully removed from work (i.e. no email access) to allow myself time to heal. About a week into the new medicine, I had an appointment with the original perinatal psychologist. We made a plan involving cognitive reframing exercises and I committed to trying to practice the reframing exercises daily, maybe even hourly, over the next few weeks. I felt the smallest glimmer of hope again that night. While it still felt a bit like “faking it”, it was different. I believed her that maybe this could work. The next day I woke up and felt just the slightest bit better. I told my family and close friends, but I was scared to be hopeful. Could the new medicine be working?
Over the next few weeks, I had regular visits with the perinatal psychologist and perinatal psychiatrist. Things were trending up and we were all hopeful. Of course, I was scared of being disappointed if I was not actually getting better. The final week before returning to work had a few roadblocks. It was tough, but I felt ok. My debilitating anxiety was starting to ease and everyday life was becoming more manageable. I had my final perinatal psychologist session before I was set to go back to work and I went in armed with a notebook. I told her my coping plan and went through all my reframing. She told me I was ready and I actually believed it that time.
I was Ready, I was Better
I returned to work that Monday, and things were so much better. I followed the plan and it worked. That afternoon was my last day of group therapy, and we had a substitute. The substitute was one of the therapists I had had while I was inpatient, and it felt like I may have come full circle. Things fell into place at work and I continued regular visits with the perinatal specialists – psychiatrist and psychologist – for months, and I still take a low dose of the OCD medication that finally helped me.
I’ve been back to work for over a year-and-a-half and all is well. There are even some days that I forget about what I went through. But, truthfully, I don’t want to forget. I’m hopeful that I’m a better mom, wife, family member, friend and even professional because of what I went through. I certainly don’t take anything for granted. I feel an amazing sense of gratitude for the resources and support I had in helping me through the hardest thing I’ve had to deal with in my life. I’m also certain that whether you call it luck, God, or some other higher power, it played a huge role in me making it to the other side. The least I can do is share my story in an effort to pay it forward or help even one other woman in a way she may not even realize she needs.
Chestnuts roasting on an open fire, Jack Frost nipping at your nose, Yuletide carols being sung by the choir and folks dressed up like Eskimos. Everybody knows a turkey and some mistletoe help to make the season bright…..
While there is inherent beauty, magic, wonder and awe in the Holiday season, there can also be increased demands upon each of us. One may get pulled into the frenetic pace of external tasks. Children may become overwhelmed emotionally. Our time and energy may be taxed causing stress and anxiety in our system.
When we are in stress and anxiety, the body, brain and heart are out of balance. Our brains can ruminate in repetitive thought patterns and our emotions can become overwhelmed. Both pull us out of our core center, our inner balance.
Heart coherence is the state when our heart, mind and emotions are in energetic alignment and balance with one another. This state radiates energy of peace and love and harmony.
Heart rate variability is the variation of the time between consecutive heartbeats. When one learns to influence their heart rate variability, internal stability restores itself. Balance is gained between mind, emotions and heart creating inner peace and calm.
A study by Beckham, et all (2012) worked with 15 mothers experiencing perinatal depression. They introduced a protocol of heart rate variability biofeedback using Heartmath systems. All 15 women demonstrated statistically significant changes on three assessment tools from pretest to posttest demonstrating an improved emotional balance.
Conscious breathing is a powerful tool that can bring us back to a harmonious sense of self and well-being. Puran and Susanna Bair, authors of Energize Your Heart, indicate that breath can significantly improve heart rate variability through a technique called heart rhythm meditation.
Try this simple practice daily for 2-5 minutes.
Sit upright with a straight spine and feet firmly on the ground.
Breathe in fully expanding your belly.
Breathe out fully squeezing your belly to your spine pushing all the air out.
Breathe in counting for 4 counts.
Hold your breath in your heart for 4 counts.
Breathe out and exhale for 4 counts.
Stay focused on your count and let other thoughts move through.
You can add a positive affirmation phrase to the count pattern to increase focus.
As you become more comfortable with this pattern add this next step:
Find your pulse either in your wrist or at your neck.
As you do steps 4-6, synchronize your count pattern with your pulse rate.
Continue practicing this breathing technique daily to influence your heart rate variability. The more consistently you practice, the more inner peace you may feel.
And so I’m offering this simple phrase. For kids from one to ninety two,
Donna is a pediatric occupational therapist. She is also certified as a prenatal and perinatal psychology educator and Calm Birth Prenatal Meditation instructor. Donna is also the author of Love Me In: a Sacred Pregnancy Journal.
I watched my son as he fell asleep in my arms today. In a simple way, it was magical. The way he gazed at me as his eyes started to close melted my heart. He held my finger as dreams began filling his sweet head. Little puffs of breath floated against my chest as he drifted off.
And while I watched, I found myself enamored with this beautiful little soul who now trusts me to be his safe place. It felt like one of those unicorn moments of motherhood.
I cherished the moment as I realized I had experienced very few memories like that in the first part of his life. My postpartum anxiety, depression and PTSD robbed me of them all.
After a hugely traumatic birth experience and hospital stay, my early days of motherhood were filled with grief and rage. My son and I almost died in birth, and in those coming days, weeks, and months after his birth, the darkness that enveloped me made me wish over and over that I had died.
There was no light. There was no joy.
I recall taking hundreds of pictures of him as a newborn hoping that someday I’d actually care. I felt no connection with my son. Or with myself. I was supposed to be a mom now, but what did that even mean?
I was drowning in depression and anxiety. I wanted to escape from what felt like the prison bars of motherhood.
Every time my son cried, I cried too. For every passing day where I couldn’t put him down for even a moment, I felt panic grow in my suffocation.
I felt I was failing as a mom in every way. I knew I needed help. I couldn’t continue on like that.
I started seeing an amazing art therapist twice a week. I began to work through the trauma. I felt supported, and she cheered for me and supported me every step of the way.
I had to face my grief. My rage. I had to accept the work it would take to heal what felt so broken within me.
Slowly, and I do mean very slowly, the haze started to lift.
I’ve had to take motherhood day by day…most times, second by second.
My son will be 10 months on Wednesday, and I’ll be honest, I sometimes feel behind in my healing process. To my own disappointment, there are still dark days.
And yet, today was proof that I am making progress. I was able to see the beauty in that moment. There are now days when I can delight in my son’s giggles and watch in amazement as he grows. Now, no matter how dark the days, the connection I feel with him is unbreakable. It grows stronger by the day. And so do I.
When I became a mom, I thought I’d know what to do. I expected to instantly love my son in the way they talk about in movies. I believed I’d be over the moon with motherhood. It turns out that although my journey would be nothing like that, this broken and worn path I’ve had to take has ended up being even more exceptional and gratifying. Each moment…each milestone is even more meaningful now.
So if you’re somewhere in the middle of this journey, too, know you’re not alone or behind, Mama. You’re exactly where you need to be, and I promise, you’re everything your baby needs, here and now. There is light out there for you, even if you can’t see it right now. Sometimes the best things in life take time. Love. Connection. Motherhood. We’re all works in progress, and perhaps that’s where the magic happens.
Crying tears of joy, relief, gratitude, and everything in between, I looked at my newborn baby girl and said, “WE did this together.”
While I have suffered from anxiety for as long as I can remember, perinatal mood and anxiety disorders were something that I didn’t consider when having kids. After my first child was born, I was all consumed with assuring his health was good. Over the top? Probably. But what first time mom isn’t?
Pregnancy was easy. I was one of those “I’d be pregnant forever” type of women. I got pregnant with my second child when my first was only 6 months old and things were beautiful and simple. Life was good. After my second daughter was born, postnatal mood disorders took on a personal meaning for me. When she was 2 months old, I began to suspect that she had some underlying health concerns. I became extremely anxious, and though I didn’t realize it at the time, depressed. I had panic attacks for a year and lost so much weight that people were becoming concerned. I could not find joy in anything I did. I distinctly remember taking the kids to a park and staring at my family laughing and playing, thinking, will I EVER feel happy again?
Every thought that crossed my mind was an obsession about my daughter’s health or whether or not something bad would happen. Followed closely were compulsions of checking her body (if I just looked ONE more time), information seeking (hello google), and seeking reassurance (are you SURE that is what the doctor said? Tell me one more time that you believe she will be okay). Sometime in the interim, my anxiety crept from concerns about my daughter to concerns about my own health. What IF. WHAT IF something happens to me and I can’t be here to take care of her? Anxiety is like a drug. A drug you know you hate but feel you can’t exist without. My brain literally felt addicted to worrying and obsessing and engaging in compulsions. And it all got so out of hand before I even had the chance to realize it.
After seeking some much needed professional help, the next couple of years were better. Lexapro became a close friend and Xanax became a distant acquaintance that I no longer relied on. I was really feeling good. I was, dare I say, happy. My husband and I started to discuss having another baby. The thought of relapsing lurked nearby, but I didn’t put too much thought into it.
Quickly becoming pregnant, my anxiety/OCD remained at a distance for the first 20 weeks. I had gone off my meds and was somehow coping beautifully. Around 20 weeks, everything hit me, or should I say, gut-punched me. Weeks 20-40 were weeks from hell. My anxiety returned with a vengeance. I was lost, scared, and sick. My husband feels that it was the worst he has ever seen my anxiety. I fixated on various components of my health for weeks at a time. I could not escape the pain and I had no where I felt safe. I felt helpless and alone. OB referred me to psych, and psych referred me to OB. It was like everyone was scared to make med changes for a pregnant woman. Friends would casually ask, “Are you SO excited about the baby?” I would smile and politely make up something along the lines of “Oh you know, I am excited and just so busy I barely have time to think about it.” Busy was code word for anxious. Excited was code word for “I haven’t bonded with this baby at all and sometimes think I wouldn’t even be sad if it all ended today.” (While I certainly did not WISH for that to happen, my brain couldn’t get past the fact that I was so miserable inside.) On top of it, I had well-meaning people in my life who said things such as, “You just need to be strong. You have two kids at home to take care of. Just stop worrying.” (PSA: Telling an anxious person “just don’t worry” is like telling mountain to “move just a little”…. correct me if I’m wrong, but this has never been effective as far as I am aware.)
When my baby girl was born, I somehow bonded with her more than I bonded with my first two right away. I don’t know if my motherly instincts took over and made me realize that I was indeed excited to have a new baby, or if it was truly my hormones finally allowing me some peace. My mental health was not great for the first few months, and I am still working daily to conquer some of my demons, but I am feeling SO much better than I was during pregnancy. I recently decided to wean my daughter from breastfeeding because I wanted to give my hormones a chance to finally balance out. I have been having mostly good days with a bad day sprinkled in now and then. I am blessed with three beautiful children and have decided that it would not be healthy for me to have any more. I strongly believe that it is important to regard our mental health as we would any physical ailment.
For anyone who this may resonate with, you are not alone. There would be days where a momma who walked in my shoes would tell me “tomorrow is a new day”, and the clouds would lift, if just a little bit. I will look you in the eyes and promise you that it will not always be this way. You WILL look back and see your strength. You.are.fierce. At your weakest and most vulnerable, I promise that you are being so, so, brave for fighting this fight. I won’t promise that tomorrow will be better. I won’t promise that next week will be better. I do promise that one day will be better. I won’t promise that your mental illness will go away and never come back. I continue to fight this fight every day. I do promise that health is waiting for you, and you WILL find it.I see you, momma.
I see you pushing the shopping cart at Target with two little ones, putting on a happy face for them, but going home and crying because you don’t feel like a good mom. I see you look at your babies with so much love, but go home and have nothing left to love yourself. I see you look at other mommas, thinking, “If only I was happy” and quietly panic inside because you don’t think it is possible for you. I am here to let you know that you are loved. You are honored. You are appreciated. You are me. WE are women. WE are moms. WE are the face of strength.
