By Karenann Narkiewicz
It was the spring of 2021, and I was at Whole Foods. It was the first outing for my baby after lockdown restrictions were lifted. As I strolled through the sliding doors, I thought about how wild this was. My third-born son at 10-months-old was a true "bubble baby" and this was the first time he saw more than 4 adults at a time. I thought to myself, "What an incredibly dynamic motherhood journey I’ve had in such a short period of time!"
I’ve had first-hand experience with postpartum depression and anxiety along with a multitude of physical and emotional challenges, and have come out on the other side stronger than ever. I am telling you this story so you know that you are not alone. Struggles and challenges can happen to anyone, but there is light at the end of the tunnel.
"THE SETUP"
Studies show that prenatal anxiety occurs frequently, overlaps with depression, and increases the likelihood of postpartum depression. Anxiety was rampant when I was pregnant with my first child. Since my husband had recently started a new business and my consulting business was project-based, I realized we needed a consistent paycheck and healthcare for our growing family.
So after giving birth to our 1st child in 2015, I went to a job interview just 8 days later. I tried to squeeze into my business clothes with a belly that still looked pregnant, which was very uncomfortable. During the interview, I experienced a tornado of emotions and could only focus on my milk supply rushing in while a panel of 8 senior-level men asked me complex questions.
Needless to say, the entire interview was a blur and it didn't work out. I eventually found a job in an industry that I knew nothing about and began working at 6-weeks postpartum. Although I didn't want to go back to work right away after having a baby, necessity took precedence.
The rapid transition to working motherhood was overwhelming, but I had to stay focused. We needed a nanny for our baby, like yesterday, and it was very stressful coordinating meetings and interviewing candidates all while taking care of a newborn. But we lucked out and found a great person to help us.
My new job was in sales which required me to be on the road the majority of the time. At 10-weeks postpartum, an out-of-state training workshop required me to be separated from my son all day and most nights for an entire week, even though I brought him with me. I was sleep-deprived and was just getting my bearings as a new mom.
Over time, I had started exclusively pumping milk. I pumped in public restrooms while on the road. I pumped in a public restroom at my company’s headquarters which had no lactation room. It became very awkward with people walking in and out, so I turned my car into a “pumping station”. When I had to drive colleagues, I tried to play it cool by dropping them off at a Target or Starbucks so I could pump in the car. Due to an oversupply of milk (almost 60 oz a day!) requiring the purchase of a chest freezer for storage, I stopped pumping after 6 months since I had enough milk stored to feed my son for another 6 months.
I believe that sleep deprivation due to a colicky, inconsolable newborn, coupled with guilt from being away from him during the day and the pressure of a new job, led to a constant, dull depression that was hard to shake. Sure, I was still functioning, but not thriving. Since work distracted me, I didn't acknowledge or address my feelings of sadness. Sometimes the stress of work would make me irritable, causing me to yell at my son and be short with my husband.
In 2017, I grew more frustrated with paying someone to watch my child grow up while I was out working in a role I wasn't passionate about. So I decided to leave my company to be a stay-at-home mom. Although relying on one income was, undoubtedly, a strain on my marriage and our resources, I felt very fortunate to have this option available to me since so many mothers do not have this choice due to financial constraints.
"THE DOUBLE UP"
Soon I became pregnant again, and at 28 weeks, developed a misalignment of the pubic bone, known as symphysis pubis dysfunction (SPD). In my case, this most likely developed because my first baby was born in a right occiput posterior position. It became difficult to walk, climb stairs, and get in and out of my car. I had to use a walker which made it difficult to keep up with my son who loved to run around, especially in parking lots. I tried to stay home as much as possible which led to too much weight gain that further exacerbated the pain and discomfort. Little did I know, increasing pain during late pregnancy or postpartum is predictive for postpartum depression.
At the same time, we decided our growing family needed more space. So in third trimester of my pregnancy, I packed up our place in the city and we moved to the suburbs, all while in pain, using a walker, and potty training our 20-month-old who wouldn't nap. With so many life transitions, I knew that I needed to do something about this uneasy feeling that I just couldn’t shake.
Prenatal depression is affected by multiple factors, most of which can be identified at the beginning of the pregnancy and are potentially modifiable using appropriate interventions. So I decided to join this new place around the corner from my house which offered mommy-and-me yoga. I figured this would be a good way to make some new friends and attempt to “shake off” this uneasy feeling. One of the yoga instructors there was also a doula. I felt a kinship to her and decided to hire her to be my doula since I wasn’t sure what to expect with the SPD.
My new membership and hiring a doula turned out to be the best investments! The center was founded by an OB/GYN doctor. Upon joining, I was asked to complete the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression and address any issues right away if needed. They had classes such as “Happiest Mommy on the Block”, “New and Expectant Moms” groups, in addition to pre and postnatal barre, yoga, and pilates sessions. They even provided onsite babysitting for my toddler while I was there. Meeting the other moms was invaluable in helping me feel like a part of the community in a place where I didn’t have any friends. I wished every mom could experience something like this during their motherhood journey.
Then at 42 weeks, I experienced precipitous labor and our baby started to come out while in our SUV as we sped to the hospital. There was no need for a final push. Our beautiful boy was born on the hospital bed with my pants still around my ankles. Although my doula missed the birth, she was critical in helping me feel ready and gave me excellent guidance leading up to the delivery.
"THE DEPTH"
I was excited to be home for the next few weeks to enjoy the newborn stage for what seemed like the first time. Little did I know, I would soon be overwhelmed by a newborn with constant reflux coupled with the lack of sleep, healing from a split/misaligned pubic bone, a hyperactive toddler that doesn’t nap, and a dog that needs to be walked and fed. I was alone every day and most nights from the time we arrived home from the hospital and had no hired help. My husband had started a new job in the months leading up to delivery and needed to work days and well into the nights most nights. I'm sure he didn't enjoy coming home
to no cooked food, dirty dishes piled in the sink, laundry stacked so high that it toppled over, and toddler toys everywhere.
In addition to multiple bouts of mastitis requiring antibiotics, my postpartum weeks were busy. I dragged both kids with me to a chiropractor (recommended by the motherhood center concierge) and an osteopathic manipulative doctor (DO). These doctors were integral in helping me recover from the SPD. It’s crazy to me that mothers are not taught about pelvic floor health before or after having a baby. It is so vital yet completely underrated and not discussed.
Chronic sleep deprivation became an issue since laying in bed was a rarity and I continued to exclusively nurse because the baby would not take a bottle. Each day I wanted to sink deeper into my bed and not get up. I just wanted the darkness to be even darker so I could sleep a little longer. Screaming with rage at my toddler for the silliest things like wiping sticky hands on our linen furniture was commonplace because I was so tired, irritable, and depleted. Most days I would lock myself in the bathroom or closet and scream as loud as I could. I was filled with sadness, anger, physical pain, guilt, and full-on rage. I had no time to process these emotions because I was solely focused on keeping two children alive while my physical body craved sleep and self-care to recover from childbirth, mastitis, and SPD.
I realized something was off when my dog started shaking if I yelled at my toddler, probably because I was being so loud and scary. That was my breaking point. If I was making my dog shake, I was probably traumatizing my impressionable toddler too. I knew I needed to do something immediately that would help me break out of the vicious cycle. I reached out to the maternal consultant at my motherhood center and she suggested that I take the medication recommended by my OB and arranged for me to speak with a therapist. She also provided a multitude of valuable resources for postpartum depression and anxiety.
Although the standard medical treatment for depression is usually medication, there is often reluctance among mothers and providers to use a pharmacological intervention due to the fact that these medications cross the placental barrier and are passed into breast milk. Regardless, I called my OB and started on medication. It was like night and day...completely! After about 2 weeks, things slowly became more clear. It was as if a veil was lifted and I could tread water. Like the static from a fuzzy TV channel was gone. Going on medication was imperative to helping me stay afloat.
Sometimes I believe medication is necessary, especially when there is a chemical imbalance and a family depends on you. However, I realized that a lot of my depressive and anxious feelings could have been addressed right away if I had the tools to prepare and eliminate the negative contributing factors and bolster the positive. Hindsight is 20/20. It’s ironic when you keep holding on to old ideas of who you think you are, you continue to give them energy. Watering them, reaffirming their reality in your life. I was giving all of my energy to this reality of these labels as depressed and anxious and not allowing a new reality to exist. Over time as I became aware, the labels started to fade. None of them were me, just ideas I once held. After about 10 months, in a better state of mind and body, I was able to come off of medication on my own. It was then that I chose to devote myself to a personal experiment, one of inner focus.
In Part 2 of Karenann’s story, she talks about her 3rd pregnancy and proactively managing her anxiety with inner focus, new coping tools and skills.
Footnotes:
(1) Heron J, O'Connor TG, Evans J, Golding J, Glover V; ALSPAC Study Team. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004 May;80(1):65-73. doi: 10.1016/j.jad.2003.08.004. PMID: 15094259.
(2) Mathur VA, Nyman T, Nanavaty N, George N, Brooker RJ. Trajectories of pain during pregnancy predict symptoms of postpartum depression. Pain Rep. 2021;6(2):e933. Published 2021 Jun 3. doi:10.1097/PR9.0000000000000933
(3) Míguez MC, Vázquez MB. Risk factors for antenatal depression: A review. World J Psychiatry. 2021 Jul 19;11(7):325-336. doi: 10.5498/wjp.v11.i7.325. PMID: 34327125; PMCID: PMC8311510.