Category Archives: Postnatal Depression

Emma’s Story of Postnatal Depression

Introducing a beautiful and deeply moving guest post from Emma Fahy Davis:

Eight years ago, with our daughter about to turn two, we decided it might be nice to have another baby. When I look back at that time, I can hardly believe how naive and innocent we were.

13 months later, just as we were beginning to investigate fertility assistance, we finally saw the two little lines we’d been hoping for and dared to hope that we’d soon be welcoming a new child to the family. That hope was crushed just a few weeks later when I began miscarrying our baby on New Year’s Eve.

Crushed and broken, I was desperate to be pregnant, desperate to have a baby in my arms, and worried that it wasn’t going to happen. Yet less than two months after the miscarriage, I once again found myself staring down at those two little lines.

Pink pregnancy test positive

I thought if I could just get through to 12 weeks, I’d be fine, I just had to hold on. Every ache, every cramp, every twinge had me wound up in knots and I was palpably terrified of miscarrying again. At six weeks, we saw our baby’s beating heart for the first time, and I exhaled just a little. At nine weeks, after a small amount of spotting, I went for another ultrasound. The rules of the game were about to change.

I lay there, waiting for the worst, expecting to be told I’d lost the baby, but in fact, I hadn’t lost a baby, I’d gained one – the scan showed two healthy babies. For the briefest of minutes, I was excited, but when a rather blunt and tactless obstetrician pointed out the increased risks associated with a twin pregnancy, the fear returned and though I didn’t know it then, that fear would invade my life, steal my precious first few hours, days, weeks, with my new babies, and cripple my life. My life separated into ‘the before’ and ‘the after’. The person I had been was gone.

The pregnancy was largely uneventful, we had a few minor scares but nothing overly dramatic, yet in my mind I refused to believe that we’d walk away from the whole thing with two live, healthy babies. I shut myself off emotionally – while I went through the motions of preparing a nursery for our baby girls, in my mind I was planning their funerals.

They were born on a Saturday night, three minutes apart after a perfect, textbook labour, and despite being 4 weeks early, required no special care. Sitting in the delivery unit watching my husband cradle our tiny daughters, I went into shock. I was completely numb. He was besotted, and I felt nothing. Not once had I allowed myself to believe that this would happen, and when it did, I had no idea how to respond.

The numbness persisted for weeks. The babies both had reflux and screamed for up to 20 hours a day, I couldn’t breastfeed them so spent hours attached to a machine pumping milk for them, and the whole time I felt as if I was watching someone else’s life pass by. It was literally like watching some other random family’s bad home movie collection. It’s hard to identify rock bottom as there were a lot of wicked lows, but if I had to choose just one, it would be the evening I ended up sitting on the driveway screaming at the top of my lungs because I simply didn’t know how else to vent my frustration, anger and anguish. They were 9 weeks old, tiny, helpless creatures. Why didn’t I love them? Why couldn’t I love them?

It wasn’t until the twins were 8 months old that I saw the first glimmer of hope that maybe I could bond with them after all, maybe it wasn’t too late. It was an ordinary afternoon, I was loading the dishwasher and the girls were sitting on the kitchen floor playing with a bowl of plastic blocks. As I watched them interacting, cheekily passing blocks backwards and forwards to each other, all of a sudden I realised that I was deeply and uncontrollably in love with them. In that moment, I knew I needed to get help.

I was eventually diagnosed with Postnatal Depression, Post-Traumatic Stress Disorder and Obsessive Compulsive Disorder. Through a combination of medication and therapy, I began to find a way to live in my own head, to forgive myself, and to accept that while my experiences frame the person I am, they don’t define me. Most importantly, I began the process of building a relationship with my babies.

It took 18 months of intensive attachment therapy with psychologists who specialise in infant mental health, but gradually piece-by-piece, my precious baby girls and I got to know each other, and to love each other. I learned to let go of the anger and guilt I felt around my inability to bond with them, and learnt that while I can’t erase the past, every day is a new opportunity to move forward in a more positive way.

I’ve since experienced the profoundly healing experience of carrying and birthing two more babies, I’ve learned to parent intuitively and not let the scars of the past weigh my family down. As I snuggle at night with whichever of my girls have crept into our bed to fill the space between my husband and I, I am content.

As the great poet Maya Angelou said, ‘we do what we know how to do, and when we know better, we do better.’

Now I know better.

The Funeral

So I had died.

I no longer existed.  I was at once two and one at once.  No longer knowing the boundaries of my own body, what was once familiar seemed alien, I was I and not I all at once.

I/we sat in the bath, I/we could not sit right, parts of me/us hit the bath that had never touched the bath before.  My/our stomach sagged, my/our breasts were enormous.  I/we looked in the mirror.  Whose body was this, what had happened… she was gone.  Tracks of green criss crossed my/our breasts in a furious pattern of growth and sustenance, blood rushing to grow this new body, this one who was no longer one, but two at the same time.  Did those breasts belong to me/us?

Vent on Tongariro, NZ, vulva
This is a still active vent on Mt Tongariro in New Zealand. To me it typifies the ever changing nature of Mother Nature, and of a woman’s body. It is always changing, always altering, and full of life and death. At once both at the same time and neither at once.

I/we showered.  I/we reached under my arms.  I/we panicked.  There were bulbous grapes underneath.  In my/our dazed state I/we wondered whether this body had developed cancer overnight.  No.  It took weeks for a specialist to confirm that no, I/we was one of a select group of women who have significant breast tissue under the armpits.  My/our armpits were swollen with milk for us/him.

I/we was now, had become the dyad.  But I was still mourning the murder.  ”I” had died, and I/we did not know what to do with this new landscape.

I/we tried to pretend that “I” had not died.  That “I” still existed.  HE did not need feeding on HIS schedule.  I could dictate that.  ”I” could be resurrected from the dead.  This was what “I” had learnt.  This was what “I” had expected.  Where was my/our “What to Expect” book… I/We found it.  And I/We devoured it searching for signs of “I”.  There it was.  HE would need to only feed every three hours.  I/We went to bed, and I/We set the alarm clock for three hours into the future so that I/we could wake HIM and feed on schedule.  HE did not know that I/We had read a book.  HE was reaching for WE and I/We was running screaming back to find “I”.  HE woke.  After 2 hours, HE woke.  HE was not expected.  Not what I/We had read.  This body was rebelling, HE was rebelling, I was running screaming to find “I”, because it MUST exist somewhere.  ”I” had to be able to be retrieved.  Day after day, night after night, my body leaking everywhere, blood and milk, HE tried to reach for WE, HE tried to tell me that WE needed, WE needed me to let go of I.  I/We were in pain, He/We were in pain.

HE would scream for WE.  Every day.  Every single day.  And every now and again WE would come together and WE would smile.  And I/We stopped looking for “I”.  And then as I/We would put HIM to bed, he would smile at I/We asking to stay with I/We and I would run screaming again, and HE would cry alone.  Alone because I/We had run off in search of “I”.  ”I” who had gone on August 14, 2005.  I/We thought he was grinning, was LAUGHING and telling I/We that “I” could never be found every again because HE was in charge.

The books told I/We that yes, HE was manipulating I/We.  That to get “I” back, there was training needed.  So I/We started to break.  I/We fell into a deep pit.  The deepest pit of despair.

I/We called my/our anchor, my/our darling husband and declared that I/We would no longer exist.  That I/We was off to find “I”, that HE would be better off without I/We, that both of them would be better off.

My/our darling husband replied.  ”I want you back”.

I/we thought, he knows.  He knows that “I” is dead.   Husband let me/we lie on the bed, screaming to find “I” as he walked HE constantly, up and down, up and down, up and down.

And then, I/We admitted.  Admitted that “I” might be dead.  That “I” needed to be let go.  I/we sunk into the drugs, the prescribed ones, the ones that would supposedly fix things.  I/we sank into the therapy

But what was left.  What was left?

Because there is no authorised script in this culture for interdependence.  There is only a script for independence.   I/We existed, in a state of mourning, in the longest goodbye to “I” because nowhere in the life of “I” had there been a narrative that allowed the growth of the dyad.

*** This is Part Two in my series on my sink into Postnatal Depression, for Part One please see here.  There will be more posts coming on my journey.  Please stay tuned.

Please also note, that this post in particular is heavily influenced by Luce Irigaray and her polemic, This Sex Which is Not One.

The Day I Died

This is a shocking post.  It’s a hard post to write, and it has been 7 years in the making.  This is the story of the day I died and what happened when I did.

On August 14, 2005, I died.

That was the day my son was born.  That was the day that I died.  Let me tell you how I died then and how I can be here today, over 7 years later writing this post.

He was my first baby.  I was a career woman prior to getting pregnant.  I was a career woman lost in a corporate path, alienating people and forever climbing the ladder.  I knew I wanted children, it was something else to tick off the box, but in the latter stages of 2003/4 I actually wanted children because I wanted children, it was no longer a box to tick.  My husband and I lived in London, when we became pregnant we had been living there for three years.  It was time to come home.  It was time to come home to New Zealand.  We gave our notice, and we spent the next four months preparing and learning about pregnancy.  Well, I did.  Learning about pregnancy and birth.  Because that’s what you do isn’t it?  Especially when you work in a bookshop and have access to what the top selling parenting books are.

I was armed.  My bible swiftly became “What to Expect When you Are Expecting”.  I lapped it all up.   I read it like a bible.

We returned to New Zealand, I was mid way through my pregnancy.  I was armed with my books and my hospital notes and found myself a good doctor to help.  Yes, a doctor was best, wasn’t it?  I mean, this was my first baby, and I would be “safer” in a doctor’s hands than a midwife’s.  Surely.  I rested.  I did not get a job, I had 4 months to go, and there was no way an employer was going to take me on so close to being a parent.  I mean, laws are one thing, but in reality I knew that I wouldn’t get a look in for a job interview.  So, I sat and brooded at home with my books.

I thought.  And I brooded.  Didn’t I think in the past that a homebirth would be amazing?  Didn’t my Women’s Studies degree teach me to know my body.  I quietly questioned people.  Homebirth?  No they said.  No,

definitely not for a first time mother.  Maybe for a second, but definitely not for a first.   I put those niggles away.  I told them to be quiet.  What did they know?

I knew a lot about pregnancy.  I knew a lot about childbirth.  I knew a lot before our Childbirth Education classes.  I felt like a star pupil.  I knew a lot of answers.  I was planning to go as natural as possible.  Didn’t want a C-section, didn’t want an epidural, certainly didn’t want pethidine.  Absolutely I wanted to breastfeed.  Vague niggles about Nestle bubbled up from my Women’s Studies degree, yes, I definitely wanted to breastfeed.  For six month, of course, then don’t all babies go onto solids?

I was prepared.  I had my bags packed.  I had wee speakers to play my favourite music into the delivery room.  Yes the delivery room.

The labour started, it went beautifully, it was short, I had a wee bit of gas, he was born vaginally, I had a perfectly healthy baby boy, and I was perfectly healthy.
Except I wasn’t.  I died that day.

My labour was fast.  My doctor could not come to the hospital.  She was sick.  I got stuck with whoever was on duty at the time.

I was labouring in the water.  Couldn’t I have a water birth?  I felt like I needed to push.  The midwife told me that wasn’t possible.  I couldn’t be ready yet.  I was.  I involuntarily pushed again.

She whipped me out of the bath, flat on my back, to examine me.

I wanted to get back into the pool.  She wouldn’t let me.  She strapped a foetal montior on my belly.  I snarled at her “Is that necessary?”  She said “yes”.

People started doing things to me.  I had to stop one to ask their name, because they hadn’t told me, they hadn’t bothered to introduce themselves.

The obstetrician came in.  He asked me if I would like to be cut.  I asked why.  He said because it would “speed things up”.  He did not say anything else.  I was already upset.  I wanted this over.  I felt myself losing my grip on reality.  My body was no longer my own, I was dying.  I said yes.

He cut me.

My beautiful baby son was born.  He was lifted onto me.  I looked at him.  Who was he?  I didn’t know this person, this wailing, crying blood covered thing.  Was I meant to?  Who was I?  Where was I?

The obstetrician proudly announced that I was great.  That all first time mothers should be this fast.

I felt like a slab of meat.  I was drowning.  Fast.  I was dying.

I started to shake.  My own death rattle.  It started in my heart, and it radiated outwards.
Suicide

I shook, and shook and shook.  I was back.  I was 16 again.  I was in hospital after downing 16 Nuelin Slow Release asthma pills and my stomach had been pumped.  My body was in shock, the effects of the Nuelin were taking control and my body was shaking so hard that the bed was rattling. I couldn’t stop the bed rattling.  I was 16 and 31 simultaneously.  I had tried to die then, I had tried to kill myself.  This time I was dying.

I could not stop shaking.  I was in pain.  I was holding my son, I tried to breastfeed him.  I couldn’t.  Who was he?  Who was I?

It took 5 hours before I had the Anti D medication that I required before being allowed to transfer to the birthing unit where I could recuperate.  I couldn’t urinate.  My body was dying.  The midwife inserted a catheter.  My body was not my own anymore.  Cups and cups of urine gushed forth.  I was still shaking.

I was placed onto a wheelchair and wheeled to the car.  I could not sit.  My wounds were raw.  On the way a midwife snarled at me to sit down or else I would heal all wrong down there.  I sunk down.  Remember, I was dying, my body was not my own.

My husband bundled me and our son into the car to take us the five minute drive to where I could recover.  Our son was asleep.

We got there.  I couldn’t sit up.  I was floating away.  They came to get me from the car.

I got inside, I couldn’t move.  I couldn’t help myself.  I didn’t see my son.  I was still shaking.

There was another doctor, he came to see me.  He pronounced that I had to go back to the Hospital, they didn’t know what was wrong with me.  I knew.  I was dying.

I got back to the hospital, in the ambulance.  Separated from my husband and son.  They told me I was in shock.  I wasn’t in shock.  By then I had died.

The woman that I knew was gone.  She had been brutalised.  Treated like a slab of meat, butchered.

My normal birth was anything but.

I had died that day.   This was the day that “I” died.  This was the day that “I” was born again, with my son.  We were both thrown wailing back into the world.  Because that day I died.  I died.  Because “I” became “we”.

But it took me months to mourn the loss of “I”.  I had died.  And I wanted me back.  No one told me that I might not love my son.  No one told me that I might actually actively not like him.  No one told me that there is a MYTH of the instant bond.  No one told me that there is a myth about natural instincts taking over.  No one told me that I might die.

I was born again.  Born into the shroud of Postnatal Depression.  Because I didn’t want to acknowledge that I had died.  Like a lover mourning her dead lover, I was in shock.  I was in deep grief.  I wanted her back.

Because “What to Expect When You are Expecting” never told me this:

“… with the first childbirth the old status of non-mother is annihilated because of the central importance of ‘mother’ in relation to female identity and the ideological symmetry between ‘woman’ and ‘mother’. This makes it more difficult for women to experience the loss of their old self in a way conducive to their peace of mind. They are not permitted to grieve or mourn, as with other change. So strong is the taboo that women themselves frequently fail to admit their sense of loss in a conscious way.”  Paula Nicolson

** Please note, I will continue this post, with a follow on piece about the grief process, about the mourning, and about the rebirth.

Please click here for Part Two: The Funeral 

Postnatal Depression – An Evolutionary Mechanism?

Postnatal Depression is an awful experience, I know, I’ve had it.  I experienced it with my son, and I could hypothesize a lot about the various causes, antecedents and factors that contributed to my presentation of it, but I’m not going to here.  What I am going to do is discuss a theory which I explored within a University paper I undertook last year, that PND is perhaps, an evolutionary adaptation.  I appreciate that this is largely theoretical, but to me it explains a lot, so bear with me.

Postnatal depression can be defined (loosely, I don’t see this as being prescriptive) as a depressive disorder that generally occurs within 4 weeks of baby being born and can occur up to three months post birth (Cuijpers 2008).   It is estimated that PND affects approximately 15% of all births in the postpartum period (Pearlstein 2009).   In a review of literature undertaken for a meta analysis of psychological treatments of PND, Cuijpers found that PND has been positively correlated with a wide range of negative outcomes, including marital stress and divorce, increased risk of abuse and neglect, maternal suicide, infanticide, attachment insecurity and an extensive range of increased risk of cognitive, behavioral and emotional problems in the infant and indeed, adult child of the depressed mother.   In reviewing literature surrounding parental depression and the effects on children, Cichetti (1999) found that many depressed women had also experienced “negative caregiving” which would suggest that an incidence of PPD could have a generational effect.   Such generational effects would (quite obviously) have high community social and financial costs.
Woman with PND

Evolutionary theory suggests that there has to be some sort of “purpose” to all aspects of our personality, that they all have an evolutionary basis, some reason to help us survive and thrive in order to have been made a part of us  (Cervone & Pervin 2010).  Trivers (1972) hypothesized that much of our behaviours around sex and reproduction is related to what he calls the “Parental Investment Theory”.  Parental investment theory is the concept that the amount of time any parent puts into raising their offspring is often done at the cost to their own wellbeing, largely for genetic gain, the continuing of your lineage.  Women “invest” more in reproduction than men do, therefore this affects our behaviour, our personalities and the way we view the world.  As women, we, effectively, put more up, when we get pregnant, than does a man who gets us pregnant.  We gestate for around nine months, we lactate for years afterwards (remember we are talking about pre-formula days) and we have to look after a dependent child for years.  This is partly because, a woman can be sure that the child is hers, a man (lets face it) has no such sense of surety and therefore not only has less to lose/invest, but can be less sure that the return on his minimal investment is truly his.  Now please note, I’m not bashing men here, I’m merely reducing this down to it’s basics, to an evolutionary view.

At first it can be difficult to see why PND would have an evolutionary basis.  Why would a woman get depressed enough to, potentially reject her young, or even, in the worst case scenarios, commit infanticide?  Afterall, shouldn’t she have an investment in seeing her genetic line continue?   However when we examine it through the Parental Investment Theory we can hypothesize that it’s a reaction to a potential cost to the mother “which motivates her to evaluate whether to continue or cease to provide care to her offspring” (Tracy 2005).  Tracy states that evolutionary theory suggests that psychological pain is an indication that the individual has suffered or is suffering from a social cost or injury.  He asserts that PND is a sign to the woman that the cost of raising that child is potentially not worth the gain and so PND becomes a way to help the woman switch off.   The cost of raising a child can seem higher to the woman if there is a perceived lack of support from her partner, paucity of effective social networks, if there is a complicated birth or health problems for mother or infant, or if there is a lack of resource with which to provide for the child.  Tracy further claims as proof the fact that many other studies point to these being significantly high risk factors in the onset of PND.

For an evolutionary theory to have validity it needs to be a human universal and thus be seen cross-culturally (Cervone & Pervin 2010).  Tracy maintains, through review of research, that PND is found cross culturally, which would support his theory that PND is an evolutionarily evolved defense mechanism to guard against extreme cost to the woman.

How can we see this in the here and now?  Well, given that many families, many women, give birth devoid of community, devoid of support, it’s not too great a leap to see how a woman could feel a complete lack of support, she could feel this in a deep part of her, a part where she feels alone in this new and foreign land of babyhood.  Such a lack of community support could well “switch on” that evolutionary mechanism, that would enable her to “detach” from the baby purely because she recognises, at some deep level that to continue to care for the child would be to her detriment.  So, she, quite literally switches off. She becomes depressed.

Even *if* she is actually surrounded by family, that may not actually translate into the sort of support that she feels she needs.  The support must be, at least to the woman, a deeply personal thing.

So if we are seeing a lot of postnatal depression, then surely that’s an indication that women might be, in a deeply survivalist sense, feeling unsupported in our communities?   This should be a clarion call to action.  If this theory is true, if PND is an evolutionarily developed mechanism, and if we are seeing it, supposedly in a time of plenty, then maybe we need to rebuild the support structures around women, around mothers.

Oddly, I don’t even need to think about evolutionary theory to think that’s true.  I don’t think that we support new mothers very well in our societies.  I don’t think our communities are set up to support new mothers at all.  And I think that this is seen in rates of postnatal depression, and if we do hold to the evolutionary theory of postnatal depression, then this should be a wakeup call, that women, in a very primal way, are saying loud and clear, that our society is sick, and they are the canaries in the mine.

__________________________________

Cervone, D., & Pervin, L., (2010).  Personality : theory and research.  (11th ed.). Hoboken, NJ. : Wiley

Cichetti, D., Toth, S., & Rogosch, F., (2006).  The Efficacy of Toddler–Parent Psychotherapy to Reorganize Attachment in the Young Offspring of Mothers With Major Depressive Disorder: A Randomized Preventive Trial.   Journal of Consulting and Clinical Psychology, 74(6), 1006-1016.

Cuijpers, P., Brannmark, J.G. & van Straten, A. (2008).  Psychological treatment of postpartum depression: a meta-analysis. Journal of Clinical Psychology, 64(1), 103-118.

Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum Depression.  American Journal of Obstetrics and Gynecology, 200(4), 357-364.

Tracy, M. (2005). Post-Partum Depression an Evolutionary Perspective. Nebraska Anthropologist, Paper 12. http://digitalcommons.unl.edu/nebanthro/12

Trivers,R. (1972). Parental Investment and Sexual Selection.  In Campbell, B. G. (Ed.), Sexual Selection and the Descent of Man 1871-1971 (pp 136-179). Chicago, United States: Aldine.

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