Showing posts with label breastfeeding. Show all posts
Showing posts with label breastfeeding. Show all posts

Saturday, August 27, 2011

Hesitation

Six months. Give or take. That's how long it took to convince me that I ought to at least try anti-depressant medication.

What was I afraid of?

Well. Small amounts of the drugs can pass into breast milk and I was worried about the effect these would have on my wee babby. (She was two months old when I was diagnosed with depression.) I later learnt that when the literature says 'small amounts', it really does mean that. According to the studies I've read, only a small proportion actually makes it through to breastmilk. And the baby's system is usually able to deal with that. At least, my baby coped. At introduction, her tummy was unsettled for about 48 hours. After that, I noticed no ill-effects during use, nor when I ceased breastfeeding her four months later, on her first birthday. I did nothing suddenly, and always followed the advice of my GP, maternal and child health nurse, and various other advisors with experience in the area of breastfeeding. [Southern Health  in Melbourne has a phone number you can call to discuss breastfeeding while on medication. Also in Australia, the National Prescribing Service is able to provide over-the-phone information for the cost of a local call.]

I can't give people advice on whether or not it is safe for them to breastfeed while on medication. But I can suggest that you get some good advice, from sources you trust, and find the best compromise for you and your family. And I can beg you not to be as stubborn as I was in thinking that breastfeeding and medication are mutually exclusive. The agonies I went through, thinking that it wasn't an option for me because I so badly wanted to breastfeed my baby, I would happily see others forgo.

Here we see, perhaps, a glimpse of how Post-Natal Depression (PND) is sometimes a little more complicated than some other forms of depression. Ante-Natal Depression (depression during pregnancy) is even more fraught as far as treatments are concerned. But that subject arises much, much later in my story.

What else stopped me from trying out 'happy pills'? Just this: the glib attitude I had that anti-depressants were just plain cheating. Honestly, sometimes I want to rewind and shake some sense into myself. Cheating?! Where did I ever get the idea that using a therapeutic tool was 'cheating', and that I had to tough it out with more 'natural' ways of getting through? Probably from that same place in deluded-brain-land that told me I should never feed my kids in the car, because the crumbs would make a mess.

The plain fact of the matter is, for the first six months of my depression I had no idea how dangerous a condition it can be. Things had to get a lot scarier for me to realise that.


Because I was sleep-deprived, and caring for two kids under two years, I really couldn't think very clearly at all. I didn't realise that the depression was also contributing to the tiredness and the lack of clarity.

But the day I drove home from the library with the girls in the back of the car, and thought about driving in front of a train - that was the day I realised the danger. I was so tired. So despairing. I had tried, like a good mummy, to take the girls to the library and borrow some books. It had been an unmitigated disaster. There were queues, fines, no money to pay them, a screaming baby leaking poo in the pram, a toddler throwing such a tantrum that I was physically struggling to strap her into her seat. It still stands out as The Worst Outing in My History of Motherhood, five years later. Driving home, I just wanted all the struggle and humiliation to end. I did not want to be responsible for these children. I felt that I could not. I was not doing them any good. They were not doing me any good. I wanted to not be here any more. I wanted to drive, very fast, into that train, right there. And my foot actually hesitated over the brake pedal before applying it.

That was my first deathly thought. Not my last. There are many things that have kept me from acting out any of these thoughts. My kids are three of them, and my husband is another. God has held me. Pulled me back. Kept me safe.

Anti-depressants have been a part of that. It took me a few weeks to adjust. There were minor side-effects (an upset stomach, tooth-grinding - but only for the first two days or so). It took the best part of a month to start feeling the effects. But they built steadily after that, reaching full efficacy a couple of months into treatment. I can say, without exaggeration, that anti-depressant medication has made the biggest difference in my treatment. I am embarrassed about that, still. I would like to say that something less clinical was my 'breakthrough'. But I cannot. Biggest difference. Which leads me to think that my depression is heavily brain-chemistry-related.

I'm one of the blessed ones, for whom medication worked, with few side-effects. First time around, my GP hit the nail on the head and prescribed a drug that worked well for me. It just happened that way. I'm glad it did, because having waited six months to start that sort of treatment, I was fairly desperate for something to make the difference. I'd had all sorts of fears lurking around in my head; what if anti-depressants don't do anything? What if they make things worse? (Some anti-depressants can make things worse initially, before they get better.) Have I been hanging out all this time only to find out that drugs don't really make much difference, that this is as good as it's going to get?

Time. You need to take time to get your medication right, with the help of the prescribing doctor. You need to give it time to work. If you manage to get it right, it will make such a difference.

So that's how my journey-on-anties began. And that, too is ongoing.

I'm not cheating. I'm living.

Thursday, August 4, 2011

Nothing Personal

"Taking care of your personal appearance can make you feel better about yourself, give you more confidence...a spring in your step, a readiness for anything." Women's magazines (yes, I am going to criticise them in general, even though it is a cheap shot), advice from advertising, marketing, that silly shallow voice in your head. If you just dress nicely and put on a bit of makeup, you'll feel better. Hands up if you've heard it all before.

Well, my hand is thrust skyward like a teacher's pet's. And sometimes, this advice is true. Feel better, look better; look better, feel better. The bone of contention today is this: when you become a mumma, your appearance is not personal anymore. For a while, at least.

My personal appearance? I do beg your pardon, but I'm left barely a moment to myself to even visit the toilet, let alone have a shower, dress in anything resembling an 'outfit', or do any cosmetic-waving whatsoever. Also, these things cost money. Having given up paid work to herd cats raise kids, I don't have quite enough to splash around on this season's faux-minky-doo-blinky-whatsit. I do, however, have this charming (black) long-sleeved t-shirt with snot on it, which I would be quite happy to wear over my jeans that don't quite fit anymore, if I just give it a sponge touch-up. Go shopping? Well, thank you so very much for that sparklingly generous suggestion. Shall I go on a Saturday so that I don't have to drag two or three reluctant maningerers with me? (Yes I did make that word up: it's an amalgam of 'whingers' and 'malingerers', for those with an etymological bent.)

Ok. I'll stop it. I'm just stroppy today because my snotty almost-two-year-old will not nap, and my seven-year-old is home from school early (also snotty) The five-year-old better not get snotty or I'll have conniptions.

Sometimes, a mother's appearance is actually 'corporate' as opposed to 'personal'. Her man has loved her into a different shape. Her babies have changed her boobies, her toddlers have used her as a climbing-frame. Her older kids have run her a little bit ragged. So let her relax and dag-it-up for a season if she needs to. Soon, those charcoal bags under her eyes will be replaced with crinkles, and she'll be sporting a charcoal handbag instead. (O, gosh, no. Not 'sporting'. Erk.) Ok, she'll be carrying it, with a picnic-face on. (O, no, not 'picnic-face'. That chocolate bar add from a few years ago called the picnic bar 'ugly'; it makes her sound ugly instead of sunny-faced happy.) Ok. She will be looking ALL NICE and with SOMETHING NEW TO WEAR. (That will have to do.)

Right, the advicey-bit is here: if your friend/self/significant other is looking shabbier than usual, remember, in interior decorating: Shabby Chic is great.
"Shabby Chic is a form of interior design where furniture and furnishings are either chosen for their age and signs of wear and tear or new items are distressed to achieve the appearance of an antique. At the same time, a soft, minimalistic, and feminine feel is emphasized to differentiate it from regular vintage decor; hence the "chic" in the name." 
(Yes, I Wikied it. Four years of Uni and now most of the time I use Wikipedia and Google for research.) 


Note the key-words above: age, signs of wear and tear, distressed combined with soft, minimalistic, feminine, chic. And the most important word: chosen. Yes. Chosen. 


I now consider my changed-bits and tired-lines to be 'badges of honour', thanks to a smart suggestion from a friend a few years ago. I'd rather be chosen than selected, soft than hard, distressed than cosseted. If there is one thing I have learnt recently, it is that when things are easy, cooshy, I don't learn very much at all. 

Sunday, July 31, 2011

Looks Like I Hit the Gym...

Years (and years) ago, my brother and I (rather sadly) played a computer golfing game. Our shots would often hit the trees, roll into bunkers, or miss the fairway by half a lunar mile. There was a completely hilarious commentary kept up by two faceless american-accented men. Any time we would hit a tree, one would remark to the other, "Looks like he hit the tree, Jim." Exactly the same words, and tone, each time. We were in fits of hysterics the first few times it happened. So after a while we gave up on trying to sink the little ball in the hole. We just basically tried to whack it at the trees. So much juvenile fun.

This week, when I joined my local gym, I tweeted to my brother, "Looks like I hit the gym, Tree." He was bemused, and everyone else was most likely mystified or hurriedly clicking the 'Unfollow' button. [Ah, no. I followed another loony one.]

Exercise and I have been...estranged... for the last decade or so. Let us list, very quickly, the things that are responsible for this: year12-boyfriend-fiancee-husband-goodfood-studying-sedentaryjobs-threekids-depression-and-not-enough-partridges-or-pear-trees. Got that? I particularly like the way I managed to blame James four times (boyfriend-fiancee-husband-goodfood). No I don't. I hate it. The whole list of excuses annoys me. But the fact of the matter is, there are good reasons sometimes why we don't hit the gym. And sometimes it's because we're actually busy trying to sink a hole-in-one. Other worthy things often take our focus away from good habits.

The link between exercise and good mood has been made many times. Endorphins get bandied about a lot in conversation. For the last few years, during my most depressed times, I have seriously struggled not to hit people who have suggested that all I need is exercise and I'll feel very different. Depression not only disturbs your mood, but also your energy levels, your motivation, your thought-processes, your sleep, and your concentration.

Post-natally, there are also issues for those contemplating exercise. A weirdly-different body, possibly still recovering from major trauma (caesareans, internal injuries, tears), often breastfeeding (where-o-where to find time to be fitted for a good sports bar in size 14Double-Bazillion, or the suitcase of cash to pay for one? Can I get a bra for my other floppy bits too?), perhaps with continence issues, and so, so tired. When a walk doesn't feel like 'enough', people like me think if we can't do exercise 'properly' we won't do it at all. Add to that the predictable pressure of comparison to the strange breed of famous women who 'lose' their 'baby weight' and 'get their body back'. You end up with motivation in the negative. Yes, there are many women who are wonderful and manage to ignore all the pressure, who are not perfectionists and don't hold to the all-or-nothing imperative, and just get on with things. And there are many women who are wonderful, and falter.

I faltered. In some ways, I'm glad. I ate well, and that fuelled three years of breastfeeding (one for each child) very well. Many depressed people go off food and struggle to eat healthily. If I ever go off my food you will know that I'm at death's door. Food and I are good friends (except when I'm in the early stages of pregnancies, of course). Plus, food gives us mums the energy we need for this demanding job.

But exercise has been largely missing from my life. I am now convinced that it is also going to be an important part of my recovery process.

So, I have joined the gym. As a side note, this has coincided with a reduction in my medication. So far, so good. Brilliant, actually. Far from wanting to hit the people who suggest endorphins will help, I now want to high-five them. It's true. How annoying.

Of course, if you know someone is clinically depressed, it's not a good idea to go in all-guns-blazing and tell them exercise will create a smooth path to wellness. They might hit you.

Wednesday, July 6, 2011

Thinking Through Mud: Talking

Depression is hard to get a handle on. It's difficult enough for people who are living through it. It's even harder to understand if you've never had a chemical imbalance of the brain. I've lived with it for half a decade now, and I've learnt a lot. But there are still times when it amazes and humbles me; when I feel like a rookie. That's life in all its richness. 

The other thing that makes depressive illness a little difficult to understand is that it affects people so differently. And there is no true way to quantify it. Yes, there are surveys, and scores, and all that. But many practitioners in the field of mental health are wary of those, and so they are not always utilised. 

So it was with some trepidation that I made an appointment to see my GP. She was wonderful, and offered to put me straight onto anti-depressants. I was concerned on a number of fronts, and asked about other options. I argued that I wanted to continue breastfeeding, and that I didn't want the drugs to be anywhere near my baby. I was under-informed at this point, but my GP recognised a brick wall when she saw one. She referred me for some counselling [and later linked me up with a PND group called "Moving Forward"]. 

Counselling. I was actually quite looking forward to it. Having a chance to air my thoughts with a professional. I went to see one of the Maternity Support Workers who was based at the hospital where I had given birth. She was a former psychiatric nurse. Problem number one: I believe she had seen so many people in terrible psychological states that anyone who could string a sentence together was perceived by her to be 'fine'. She was, therefore, a minimiser. Lesson number one: it doesn't help to downplay the situation, to point out that it's 'not really all that bad'. That just makes a depressed person feel that they are being a malingerer, and should really just pull their socks up and get on with things. (The truth is that they actually can't. If they could 'shake it off' or 'snap out of it', don't you think they would?)

Problem number two: I just didn't like her. Now, I know that sounds petty, but it's actually a key factor in determining how successful counselling will be. Lesson number two: find a counsellor that you respect, and can easily talk to. You don't always need to agree. You don't have to feel an affinity for them as you would a friend. You do need to be able to spill your mind's inner workings. And you do need to be able to stomach what they might say. Some of what a good counsellor will say will be tremendously encouraging and affirming. Some of it will be tough to hear, and even harder to implement. But a good counsellor is paramount to good management of depression. I would go out on a limb and suggest that you cannot reach a good level of mental 'wellness' without some counselling, even if you have no significant traumas to re-hash. The reason I say this is that, especially during early parenthood, it is well nigh impossible to find the time to commit to thinking about all the dross you need to work through, let alone making any sense of it. 

Problem number three: my first counsellor was not all that sure I had depression. She cast doubt after doubt on the diagnosis, which left me feeling confused and even more angry. If it wasn't depression, what was it? Go down that thought-path for too long and all you're left with is the conclusion that there is something very wrong with you. This is a particularly common experience for depressed mothers: "I'm a terrible mum" is a regular self-accusation.

Lesson number three: high-functioning does not necessarily mean that everything is alright. People who have a high capacity to push through immense pain can really look fine, when inwardly they are far from it. Just as people have differing pain thresholds in the realm of physical pain, some people are better at holding things together in the arena of mental anguish. I might venture to add that this is particularly the case with mothers of small children. They are physically forced to attend to their children's needs. They must function. It takes a greater crisis to knock them flat. If they have a breakdown, they appear like a car driving along the road on a couple of blown-out tyres, rather than a smoking, stationery vehicle with its hazard lights blinking. 

Lesson number four: if you see someone struggling, it's quite possibly worse than it looks. Offer help. What is the worst that could happen? That you'll be knocked back? Well, then the ball is in their court. That you'll be asked to do too much? Well, then set some sensible boundaries around what you're willing to do. People - especially mothers of small kids - do need help, and don't like to ask for it. Accepting help is easier. And you know what the best thing is? Offering something specific. Handing over a lasagne is much more helpful than asking, "Is there anything I can do to help?" People who are struggling to survive depression have trouble thinking. It's just so much effort. For me, it was as though my mind was filled with mud. Thinking through this mud was slow, difficult, and required more effort sometimes than I could find the energy for. 

I was blessed, again, with a wonderful GP who took me seriously when I said the counsellor wasn't helpful. She referred me to a fantastic counsellor with a good deal of experience with female mental illness. She became an important helper in my recovery process. 

My final note today is an example of what NOT to look for in a counsellor. 



the story is ongoing


Monday, July 4, 2011

Thinking Through Mud, Part 2

How can you not notice you are depressed? It's fairly easy, for a time.

When you have two children under two, life is very, very tiring. All of the time. For the first year or so. When you're in the thick of that, you don't see the end. You don't know whether things will ever settle down again. The 'now' becomes your life, and you might just lose the ability to believe that things will ever change.

After the birth of my second daughter, I was on a complete high for two weeks. I didn't get the usual baby-blues. The labour and birth had gone quite well, really. My recovery was quick. The baby was gorgeous. We had bonded. That seemed to me to be a crucial indicator of how things were going. If you were going to get post-natal depression, you were going to be one of those mothers with a) a difficult baby, b) no support, c) a traumatic delivery to recover from, or d) an inability to form a bond with your baby. None of those boxes was ticked for me. I had: a) a fairly easy-going baby, b) very good support - my husband James took about 5 weeks off work, c) smooth delivery, and d) instantaneous bonding. Even the breastfeeding was going well. (And breastfeeding is NOT a piece of cake.)

I was, however, tired. I'd been mildly anaemic during the pregnancy, and also extremely nauseous. My beloved grandmother had also died very early in the pregnancy. I had had to telephone my parents, who were in Alaska at the time, to tell them. It was 4am their time. It was the most terrible phone call I have ever had to make. Although I went to the funeral, I think the grieving was somewhat muted; my mind and body were busy dealing with the next generation. I did miss my Nana terribly. I still do. But I was comforted by knowing that my lovely Dad had seen her before flying to Alaska, and had told her about the baby I was carrying.

And now that the baby was here, I was tired. Have I mentioned tired? And exhausted? Ok. So I was very tired.

One night my husband put his hands on my shoulders, hoping a hug might ease some of my burden of weariness. I jumped and shrugged him off with terrifying rapidity. It was an unconscious reaction, and one which shocked both of us. For James, it confirmed some suspicions. He brought me a large book, and opened it to the Post-Natal Depression pages. He gently said that he thought I might have PND. I looked at him blankly, furious at I-didn't-know-what. Then I determinedly read the pages he had referred to.

I had read these pages before. Kaz Cooke's KidWrangling is an amusing and enjoyable read. Like all well-prepared mothers, I had read the PND material so that I could be ready to spot any warning signs. But that had been months ago. Now, when I read the checklist, I cried.

Only two tears squeezed themselves out and landed on my cheeks. They didn't even have the momentum to roll downwards. They just stopped there in their tracks. Inside, it felt like I was sobbing. But nothing much was coming out. There was a dam wall of anger and confusion blocking it. James knew, though. The lack of protest on my part was disconcerting for him.

One of the things I'm grateful for is that Kaz Cooke's book had a wide range of possible symptoms of PND in it. It actually made me feel a bit better to realise that there could be something deeper going on than just being desperately tired all the time, and quite possibly a terrible person - or worse: a bad mother. Because, for me, the single biggest symptom of depression was anger. I don't mean hormonal grumpiness, either. I mean full-on rage. Mostly inside my head, but sometimes, dangerously, leaking out into my dealings with my beautiful daughters. And making me shrug off the love of my life.

to be continued...

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