No Children Yet, Due to Fear of PPD

[Proxi]

My husband and I are considering starting to TTC in the next year or so. However, I have a looonnnnngggg history of depression and anxiety that has never really been solved. Presently, it is manageable without drugs as long as I exercise and eat fairly healthy.

I really fear (as does the rest of my family) that having a child will cause me to sink into another deep depression, or start having regular panic attacks again. We have already decided that we will have a water birth and breastfeed in order to help with any attachment issues, but even assuming all that happens (which it may not, I know even the best laid plans can change complete), I will still have those drastic hormone changes to deal with.

How many people hear had a history of depression before giving birth? Is there any suggestions you would take for managing it after you give birth? I know were considering waiting a little longer so we could afford a post-partum doula... someone to help with the housework and cooking the first few weeks after I give birth, so my husband can just be there for me rather than taking care of all the house stuff. Would something like that help with managing the baby blues so they don't evolve into anything else, or is it just like rolling the dice, you may get it or you may not?

Any suggestions/stories/anything would be helpful as we work on this decision. Thanks :-)

[thefragile7393]

Originally Posted by Proxi

My husband and I are considering starting to TTC in the next year or so. However, I have a looonnnnngggg history of depression and anxiety that has never really been solved. Presently, it is manageable without drugs as long as I exercise and eat fairly healthy.

I really fear (as does the rest of my family) that having a child will cause me to sink into another deep depression, or start having regular panic attacks again. We have already decided that we will have a water birth and breastfeed in order to help with any attachment issues, but even assuming all that happens (which it may not, I know even the best laid plans can change complete), I will still have those drastic hormone changes to deal with.

How many people hear had a history of depression before giving birth? Is there any suggestions you would take for managing it after you give birth? I know were considering waiting a little longer so we could afford a post-partum doula... someone to help with the housework and cooking the first few weeks after I give birth, so my husband can just be there for me rather than taking care of all the house stuff. Would something like that help with managing the baby blues so they don't evolve into anything else, or is it just like rolling the dice, you may get it or you may not?

Any suggestions/stories/anything would be helpful as we work on this decision. Thanks :-)

Well, you sound similar to me, several years ago. I have a history of depression and anxiety going back to a year before menarche started (the very first period of my womanhood). Since 1999 I've been on the same med (for the most part) and fairly stable on it. I never wanted children...I knew I was a high-risk for PPD and I do badly with hormonal shifts....I had horrible PMS/PMDD as a teen and even on meds stress would bring out depression/anxiety outbreaks and around hormones shifting time it wasn't great. The I accidentally got pregnant.....carelessness on our part.

I tried to wean off my meds but couldn't do it, the withdrawls mixed with hormones sent me....off. It's the only way I can describe it. I went back up to my old dose of meds and my 3rd trimester was the most peaceful. And oddly I had no problems post-partum with my son at all....some mild anxiety, but nothing horrible. (You state you don't take meds I realize but bear with me here lol)

Now #2 was fairly planned. I again went down on my meds by a small dose and tolerated it throughout gestation (looking back I should have just LEFT IT ALONE!). I took my placenta (in capsules) for the first 3 months and thought I was out in the clear. No...fraid not. Once those capsules were gone, it hit. Long story short I had to go back to, again, my old dose of meds.

So that's my background. NOW, getting that out of the way, I realize more now why I had PPD with my daughter vs. my son, the first born. Meds were a part of it in my case, I got back on my old dose that worked for me and I think that made a big difference. Another big difference is that I got to stay at home with him for a year before returning to work. I got to bond with him, sleep a lot, take care of him. It didn't matter if I was up all night, I could make up for it the next day generally. I also had him to focus on solely, not divde my attention like now.

With #2.....I had no choice but to go back to work at 6 weeks. I still cry when I thik about that. I couldn't work out even a 12 week maternity leave because I hadn't been at my company for a year. THAT was the big trigger for me. I also wasn't back on my old dose of meds yet. I also wasn't taking care of myself.....exercising, sleeping enough...my days were spent working and coming home to two agitated children (they love their sitter but at the end of a long hard day of playing, they were ready to crash). I also had less help post-partum....and I was stubborn and wanted to do stuff instead of taking care of myself.

Ok....after all that...my biggest piece of advice (which may not work for everyone) is to take as much time off of work as you can. Like I said I KNOW deep in my heart that's what triggered my first episode with dd. If you return to work, know that you will have to work differently then a mom who can be a long-term SAHM. You will have to figure out pumping schedules, nursing plans after and before work, sleep patterns for both of you (I'm not advocating sleep schedules for a baby but more a routine). You will be up much of the night with nursing, so co-sleeping can really really help you get as much sleep. take naps with your lo as much as possible on off days. Get as much help as you can for as long as you can...a spouse, a friend, a post-partum doula.

Exercise and keep up your healthy diet and supplements. Lots of omega
3-6-9's, the amount can vary bout I usually take about 6,000 mg a day. Lots of B-Complex, a good prenatal vitamin.

I'm not saying you will need meds but the reality is that many women need a temporary help of a medicine during the pregnancy or post-partum period. Sometimes it's going to be permanent (most likely me) but many women can wean off after a time. Just please don't let yourself suffer needlessly or beat yourself up if your prior routine isn't working...pregnancy and postpartum are a whole different ball of wax I've found out.

I hope I haven't frightened you in any way. I really hope I haven't...I just wanted to share my experience with no PPD with one but PPD with another. I've learned from my mistakes, and should I be blessed with a third, I'm NOT going down lower on my meds and taking a LONG time off again.

[AustinMom]

I got on meds after my son was born for anxiety. I have no history of anxiety, but our birth experience and breastfeeding experience kinda set us up for failure. It was hard, and I didn't have support. BUT that is NOT to say that is what is DOOMED to happen to you. You never know the hormones that go on after birth , are yes, the same hormones with PMS, but they are different because you now have a baby, and that changes a lot. You may end up getting balance just with the shift of hormones postpartum. Becoming a mother changes a lot.

I am able to stay home, and we are prego with #2 now, and are going to go about things differently. Our midwife is wonderful, and to me, all the postpartum issues that happen emotionally (not just baby blues) can be helped tremendously with a good, understanding, kind, gently midwife who can listen to you. I would interview a lot of caregivers before deciding on one. If you are really concerned with PPD, I would recommend a midwife instead of OB because they don't usually have time for the emotional side of birth.

There are a lot of Doulas who are still working on their certification, who do Doula work for free. Find out who teaches the training courses for Postpartum Doulas in your area, and ask them to recommend some. Usually, you only have to compensate gas $.

We are planning a Homebirth with a Doula, and plan on maybe having a PP Doula after, depending on the situation.

Birth Doulas also really help with PPD. They make your birth experience the best it can be, and help you to feel in control and make the decisions. If complications do arise, things seem less "done" to you, than it is you decided for interventions. You can look back at a positive birth experience and that helps with PP. Doulas lower the occurrence of PPD by about 70% or so.

Just because you have depression now, I don't believe it summons you to PPD. You can avoid it, and I think the main way is GOOD support, and taking care of yourself.

[annekh23]

That you are thinking about it puts you in an awful lot better place than not thinking about it!

Getting the right kind of help after the birth can definitely help. With my middle child we had a postpartum doula who was AMAZING. I won't attribute everything to her, but considering I had a very bad birth with that child, it's also the only child I didn't have PPD with.

However having moved from the UK to the US between #2 and #3, I found when looking for post partum doulas in our area, there was a lot of lists of what they did not do, almost all of which were things that I would have wanted them to do.

Pretty much the only think my postpartum doula didn't do was bring food! She'd go to the shops to buy food if that was what I asked her to do, she'd offer to do that if things were calm and she noticed we were running low on something. She worked hard without being so busy that it was exhausting to watch, but didn't have an agenda, if I needed to talk for the whole time she was there, she'd be available, but would somehow still accomplish a minimum level of tasks. I was honestly left thinking after some of the websites I read what did these postpartum doulas actually do!

I suppose what I'm saying is getting help is probably a very good idea, and postpartum doulas are one of the possible sources of that help, but not the only source.

You don't mention if you are under a psychiatrist or not, if you aren't you probably should be and make a plan with them. Same with a counsellor of some sort.

I had PPD with #1 and #3, with #1 I was totally unprepared, the idea hadn't crossed my mind, it sucked, we survived, but it did at least mean that with #2, I had a psychiatrist, we made a plan, I took meds etc. #3 was an unexpected pregnancy and we'd moved, I'd been off meds and doing well for years, I didn't plan soon enough, I should have been seeking a psychiatrist from the day I found out I was pregnant, I was in hospital for a month with my first, so it was severe PPD, but time had passed, it wasn't fresh in my mind, I became severely depressed antenatally before I even found a psychiatrist.

[snarky]

I went down the tubes almost immediately after birth due to breastfeeding difficulties. In hindsight I may have done better with much stronger intervention. If I do this again, I will have scheduled check in with my shrink at regular intervals (probably schedule check in for 2-3 weeks postpartum) and I will also have at my fingertips numbers to call day and night for lactation support.

One of my symptoms was difficulty getting to sleep and staying asleep. I couldn't get to sleep after my daughter got to sleep and as soon as I was down, she was up. Lack of sleep exacerbates anxiety and depression (and as a new mom, you get a healthy dose of anxiety).

Ultimately, I stopped breastfeeding so I could start taking the medications I needed to sleep and get symptoms under control. Breastfeeding is important but mom's mental health is more important. The meds helped a lot, but due to hormones and stress it still took me the better part of a year to feel normal again.

Good luck

[bjorker]

FWIW, I have a history of depression and anxiety, and I did not have PPD. However, I was on meds as a preventative measure (perhaps needlessly, in hindsight), though I went off of them when dd was about 5 months old - with little issue.

I did, however, start having crippling anxiety when dd was 3, and ended up on meds again. If you know that they will work for you, then just remember that they are there as a back-up if you start feeling badly again. It's okay to accept help in all forms.

Edited to add: there are plenty of meds you can take WHILE breastfeeding, you do not have to choose one or the other. Especially after breastfeeding is established without them, though either way is fine.

[thefragile7393]

I guess I want to add too that it's just hard to predict what will happen. Like I said in my earlier post it didn't happen wth my son and I had good situational circumstances to stave it off, plus nutritoin. It may happen, it may not happen. If you google around, the stats will say that women with a history of some form of emotional difficulty are at more of a risk. It does not mean it will happen. It is good to get books together, research research research, and perhaps find a psych now JUST IN CASE. I felt it better to plan for what could happen, that way if it happened I would be prepared. Motherrisk.org helped me a lot and Dr. Hale's books are great too regarding drugs and breastfeeding should you need it. If you choose to become pregnant, try to find books that talk about heading off PPD...regarding nutrition, situation, relaxation, cognitive work. It's not a 100% guarantee but at least you can be prepared. Whatever you decide I wish you much hugs and love...I understand what a hard decision this is.

[Bokonon]

I have chronic depression that has been treated for years with Zoloft. DS was born at 32 weeks due to severe preeclampsia, and I had an urgent c-section with no labor. I didn't get to see him again until he was about 30 hours old, and I was very sick and on magnesium sulfate for 4 more days. He spent 6 weeks in the NICU, and I pumped breastmilk for him. I wasn't able to get him breastfeeding until he had been home for 2.5 months. So you could say I had a recipe for PPD - but I didn't get it. I truly believe the Zoloft preventing me from developing PPD despite a pretty traumatizing experience.

I went on to nurse DS until he was 22 months.

I had a similar experience with DD, but knew what to expect this time. I was in and out of the hospital for 5 weeks with preeclampsia, and had severe headaches and visual disturbances. She was born at 34 weeks (another c-section with no labor), and spent 10 days in the NICU. Again, because I've been on Zoloft, I developed no PPD, though the headaches and visual disturbances persist even after 9 months. Breastfeeding has gone wonderfully with her.

I think keeping an eye on yourself is key. Plan for regular visits with a therapist while pregnant - there is such a thing as pregnancy depression. Don't discount meds if things start to get bad - there are many that are safe, and time is of the essence when you have a newborn, as like you said, postpartum hormones can throw even the most balanced woman into a tailspin! A postpartum doula sounds like a great idea.

Good luck!

[etsdtm99]

just being aware of these issues is a big step in the right direction! I had a history of depression that was under control without meds..with my first, in the immediate PP period i felt pretty good.. i had a colicky baby and all the issues with her kept me distracted i guess.. everyone was worried about me because my baby cried all.the.time. but i was fine.. then somewhere around 4 mo pp the ppd hit me hard.. it was just when things were getting better with DD and i wasn't feeling challenged anymore, i was just bored and i guess the reality of it all just set in .. (the transition to being a SAHM etc.) it took a surprisingly long time (2ish months) for me and my DH to realize what was going on .. once we did, i was able to change things up, set goals for myself, get a hobby, start seeing friends, get out of the house, DH helped otu more, cut down on caffeine and junk food. etc. and in a couple more months i got better without meds.. so, being aware and proactive really is SO important.. the next time around i was completely prepared to start meds at the first sign of ppd because i did not want to go through that again, but i ended up feeling 100% different.. now, comparing the 2 experiences i can tell how bad it was the first time around,t here were lots of signs that i didn't recognize, i just didn't feel right and i didn't know that wasn't normal/right.. anyway, i think you are one step ahead by thinking about all of this, just try to be prepared, whatever you need to do to feel more comfortable with the situation, even if that just means mentally preparing for not being in control of certain things..

[K-Mom3]

I think that for some people, the hormones are enough to trigger ppd. All the other factors--stress, exercise, diet, etc...can definitely contribute but I think that some people are just really vulnerable to those hormone changes and will have depression no matter their circumstances. So can you prevent it? Depends. Will doing those things help you? Yes, yes, yes! All those things you listed will help you even if it doesn't prevent ppd.

Is your depression usually linked to hormones? Like, is your depression worst premenstrual? Have you taken bcps and had issues with depression with them? Those things could help you predict what might happen.

I never had depression before my first episode of ppd 3 years ago but I've been struggling with it ever since. It seems like the longer I go on, the less it takes to trigger my depression. I think that your body kinda learns how to be depressed.

I agree with the encouragement from others--you are so aware of this and considering lots of important questions and you know how to treat depression That will help you so much!

[sunfish21]

Having a history of both depression and anxiety I (and others) were concerned about PPD. Oddly, I became quite depressed during the pregnancy and was fine afterwards. I did get on meds after the first trimester and stayed on it for over a year. When I was ready to TTC #2, I saw a Dr. and we went with Zoloft. I have been on it this entire pregnancy and have been doing great. Ideally I would not be on anything but to me the risks are too great. I need to be here and well for my babies. Down the road I will look at getting off the meds and trying other approaches.

I would not only consider a post-partum doula for housework but for support for you. Our birthing doula returned and spent an entire day helping me when we were having breastfeeding concerns. Regular appts with a therapist might be good to address the wide range of feelings that may come up. Support/informational groups like Le Leche League are a good place to get advice and meet other mamas with simialr struggles; several of the moms that I have met there have had their own issues with depression. Extra cooked food in the freezer, housekeeping and laudry help--anything to lighten the load as you adjust would be helpful too.

I also made sure that my DH, best friend, and mom all remembered my "warning signs" and I told them I wanted them to let me and another person know if they were getting concerned about anything. Good luck!

[Proxi]

Thank you so much for sharing your experiences... it really is an encouragement. Luckily (although that may not be the right word), my depression isn't really hormone related, although I worry that I have never had that extreme of hormone change in my life, so maybe this would be the first.

I suppose the main thing I have gotten from this is that I will have to get over my therapist/psychiatrist-ban and actually be willing to see one again, which may take some time.

Thanks again for your stories and advice :-), I really do appreciate such honesty and help.