Punching PPD in the Throat

     Well, that's what I feel like I'm doing anyway. I think I've turned a corner. The past few weeks have been different. I've still been feeling my normal levels of anxiety and irritability, but something has changed. I'm sick of being sick. I'm tired of worrying about my moods and medication and coping skills. I'm just over it. My counselor thinks that is a pretty big step. I'm ready to move on with my life and close this chapter on PPD. I'm also ready to be done with this medication and all the lovely side effects- headaches, insomnia, and eczema. I'm also sick of being told to take Ibuprofen for my head, cortisone cream for my eczema, etc. So I recently took two big steps- I got a new general doctor and a new psychiatrist.

    My new doctor's concentration is in naturopathy and it was a complete breath of fresh air. Our appointment lasted an hour and a half and most of it was me sitting in an armchair chatting with her and discussing different aspects of my lifestyle and health history. At the end of it all, she suggested I look into at least lowering my SSRI dosage to see if it would help with any of the side effects. She also suggested some simple lifestyle changes that I should have been doing all along, but somehow just never thought about. I now try to eat much more regularly throughout the day to avoid blood sugar fluctuations. I also am much more aware of my protein and fatty acid intake and have added a fish oil supplement. I've cut back on caffeine, especially later in the day.

   My new psychiatrist has also been very helpful. She suggested weaning off my SSRI completely. She gave me the choice of either weaning off the SSRI and going med-free, or crossing over to Wellbutrin. Even though Wellbutrin isn't necessarily contraindicated for breastfeeding, it is an L3 medication, so I opted to try going med free first. I feel comfortable with that decision at this point in time. If any of my PPD/PPA recurs, I can always add in the Wellbutrin later. So far I have weaned down to half my original dosage and I should be completely med free by mid-August. The adjustment has made me feel a little sleepy and sometimes jittery, but so far my mood seems to be holding pretty steady.

   I hope all of these new events mean I am "cured" and well on my way back to good health. I am excited about no loner having to worry about the depression and anxiety. I just hope I can get back to where I was pre-Perrin. That is my new goal. But I am also realistic and know that it could still be a long way out. But at least it seems like things are moving forward after quite a long lull.

7 Tips for Breastfeeding Discreetly

   In a funny twist of the universe, this wonderfully written article has been circulating lately which is not all that dissimilar to this post I have been working on. So, my apologies if you have had your fill of satirical breastfeeding activism.
   However, nursing in public (NIP) has been getting a lot of media attention lately, so I thought I would make this nifty guide for moms whose unruly spawn refuse to only eat in the confines of their own home like decent human beings. One refrain I see over and over again in NIP discussions is "I support moms who breastfeed, but you should at least be discreet about it." Odd thing though- the would "discreet" is actually quite subjective. So what is a mom to do? How do you know if you are being discreet or not? Well, worry no more! I have made this handy little guide just for you. Or, on the flip side, if you are a person who is not breastfeeding but you are worried that the woman tending to her child in the same public space as you is being inappropriate, feel free to check her behavior against this guide to determine whether you should complain or politely calm the fuck down.
   Now, please take note- you are still completely allowed to nurse INdiscreetly if you choose to. In fact, your right to do so is protected by law in almost every single state. However, if you would like to conform to cultural notions of "appropriateness", just keep these tips in mind.

What to Do

1. You can nurse with a cover, if you like and the baby likes. Up sides- you have a cover which seems to be some kind of threshold for some people. Down sides- It's hot. Babies are wiggly. Latching can be hard enough without going in blind. And you don't get to look at the super cute human you worked your ass off 9 months to grow.

I mean, it's only 106 F today. They weren't joking when they said modest is hottest! 

Stop struggling and have some respect for others, sheesh!

2. If you don't want to use a cover, you have the option of just lifting up your shirt. Upsides- This keeps the topmost part of the breast covered, which seems to be the most offensive. Unless of course it's peeking out of a v-neck, bikini top, or lace bra. Downsides- I found out the hard way that the pressure of the shirt on top of your breast can really send an overactive letdown out of control. Use with caution.

3. If you have experienced the aforementioned overactive letdown issues or simply don't like pulling your shirt up, you can always use the pull down method. Simply take your breast out over the top of your shirt. Upsides- easy access. Downsides- Depending on the cut of your shirt, this can be difficult. When Perrin was itty-bitty and I was super engorged, I used a variation of this where I would also slip the strap of my tank top of my shoulder completely in order to get my ginormous boob out.

4. When nursing in close proximity to others, just makes sure they are able to look in any other direction just in case they don't want to look directly at your beautiful cherub (psh, as if). Upsides- this is pretty much always possible. Downsides- It may be difficult if you are sitting directly across from an individual in an orthopedic halo whose eyelids are either missing or propped open and who does not have enough muscle control to move their eyeballs. 

This man is being 0% affected by the baby eating next to him.

  Seems simple, right? BUT WAIT! While you are employing all of these awesome tips, make sure you are also avoiding the following behaviors.


What NOT to Do

5. It's cool if you want to NIP, but you don't have to be all up in everyone's face about it.

6. Try to make sure you aren't just looking for attention. 

7. Don't be an exhibitionist.

So there you have it. As long as you avoid those three behaviors, you qualify as a perfectly decent and discreet breastfeeder! Nurse on, mamas!

Our Rebirth Ceremony

    Rebirth ceremonies can hold many different meanings for different people. Often times, a rebirth ceremony is chance for a mother to heal after a traumatic birth experience or even a fulfilling birth experience that didn't go as expected. Sometimes the birth itself was wonderful but the baby had a hard start, such as a NICU stay. Or some people just like to celebrate the most amazing day of their life by doing it all over again! The ceremony can be as long and drawn out as you want it to be, or simple and sweet. A lot of people like to incorporate a bath since the water represents the baby's life in the womb. Some include prayer or meditation. It's really up to you.
     Our birth went wonderfully, but I was very tired from the long labor and felt like I wasn't all "there" for those first few moments with Perrin. I also suffered from severe post-partum depression, so those first few weeks were especially rough. So to celebrate Perrin's birthday, I wanted a do-over, a fresh start. Joey suggested going around town to the different places we visited while in labor. We didn't go to every single place, but we hit the big ones and reminisced about those few days that led up to Perrin. For dinner, we made eggs and toast- the same meal that the midwives prepared for us after Perrin was born. Then Perrin and I shared a special bath. I filled the tub with warm water, bath salts, and lavender oil and dimmed the lights and lit some candles. We snuggled in the bath and nursed while I talked to him about our past year together. I told him his birth story, laid him back in the water in my arms, then pulled him up onto my chest just like when he was born. By that time he had had enough of pomp and circumstance and wanted to play, so Joey came in and sat with us while Perrin played and splashed and snuggled some more. After the bath was done, we all went and cuddled in bed. The whole thing was barely half an hour. But it was a nice way to reflect on Perrin's first year and commemorate the event of his birth.

Happy Birthday Perrin

   Today Perrin turns one year old. We made it! We all survived! We may have barely stumbled across the finish line, but we finished. Only it's more of a first mile marker than a finish line. The only thing even that even remotely resembles a finish line is still 17 years away. So, what is one year old Perrin like?

  Well, he's an adult portion of crazy stuck in a two year old's body with a one year old's brain development and motor skills. Imagine if you gave a kangaroo crack then set it loose in the McDonald's play place. It's slightly exhausting. I know I write a lot about the struggles of motherhood in an effort to help normalize the unromantic parenting experience. But today is not that day. Today is the day to celebrate all the stuff that doesn't suck and is actually pretty fun. So Perrin, these are the things I love about you:

- You are super affectionate. You started giving hugs and kisses around six months old and they have only gotten better. Now you'll get in our laps to snuggle and hang on to our necks so tight it's hard to breath sometimes.

-You are a really good climber and have great adventures. You are always willing to explore and take the risks and leaps that make me feel like I'm going to have a heart attack. But you usually reach whatever it is you were going for and then you look back at me with a huge smile to make sure I saw you. Sometimes you don't make it, and you cry and it hurts, but all it takes is snuggles and milks and you are right back at it.

-You are incredibly social, which is strange because neither your dad or I are. You make friends easily and will play with anyone. You warm up to new places and new people quickly. You are generally pretty at ease, which makes me feel better because I worry that my anxiousness will rub off on you sometimes.

-You are INTENSE. Happy, sad, mad, excited...it's all 100% emotion. You don't hold back. You have feelings and you make them known. You are incredibly confident in yourself and never hesitate to express!

-You are the most curious baby I have ever met. You watch and observe with purpose. You explore and investigate and try new things without a second thought.

-You barely got your 4th tooth before this birthday. Your gummy smile is fading fast but I love it and miss it.

-You are still the world's worst latcher, but you nurse like a champ and your preference for nursing probably has a lot to do with us getting this far. I'm so glad you are getting so much out of our breastfeeding relationship and that you stuck through it with me even though we struggled so much at first.

-You are an adventurous eater. You love spicy foods, and sushi, and pretty much any vegetable you've ever tried. You LOVE when we get Ethiopian take out. And if you had it your way you would eat yogurt with everything.

-You like being in groups with mixed ages. You like to watch the older kids and interact with adults. We could be at the museum or zoo when it is complete chaos and you will make your way across the room, in between people's legs if need be, to do your own thing. You are so sure of your place in the world.

-You nurse less at night now. Sometimes I wake up and you aren't even touching me; you're sleeping on your own in your own space. So I scoot closer and snuggle you up.

-You are my tiny little side-kick. This has been the hardest thing to get used to- having you with me all the time, never being able to do anything on my own whim but always having to plan you into daily life. But it's also fun, because for you everything is an adventure. It's all new and exciting. And you don't need to have a plan or purpose. We can roam around or just sit in the floor with blocks all day or lay in bed and read books. We kind of rock. Some days are really rough, but then are others where I feel like we really "get" each other.

So here's to you, Perrin! Happy Birthday! I'm sorry this year has been a bit of a bumpy ride, but straight and narrow just doesn't seem to be your style. As much as I am sure it may kill me some days, I wouldn't have it any other way.

A Scary New Trend

    My apologies if this seems like one of my ranty posts, but I’m starting to get kind of annoyed with a new trend that seems to be popping up. This is purely anecdotal, but from what I can tell natural and or evidence based birth has become some kind of marketing strategy. Now, part of this is desirable and to be expected. More women are being informed about their rights and options and are pushing providers to, well, provide. So in a way it is kind of encouraging to see hospitals remodeling L&D to be more family friendly and comfortable and to see places offering tools like birth tubs, stability balls, and wireless fetal monitors.  One would expect that more doctors and midwives would be looking at the actual research on things like doulas and VBACs and the hydrotherapy and adjusting their practices accordingly. These are all wonderful things.

   The problem is- from what I can tell, there also seems to be trend of providers paying lipservice to these practices and the failing to deliver. I’m talking about OBs saying they are supportive or pro natural birth and VBACs, but then at 38 weeks talking big babies, ruptures, inductions, failure to progress, and c-sections.  Or OBs and even pediatricians who claim to be pro breastfeeding or even having lactation credentials suggesting formula and supplementation without even addressing latch issues or supply. It’s like they realize that women want these things, but they aren’t invested enough to actually help them achieve it. There could also be a more insidious reason, which I hope isn’t the case- providers patronizingly assume that these women are jumping on some trendy natural birth bandwagon and don’t really know what they are asking for (and I guess ignoring the fact that these practices are based on the best medical evidence).

   Whatever the reason, it’s a worrisome trap because we have women who are well informed who are actively seeking out support for their choices- they know they need to find a OB who is on board and seek one out- only to find out at the eleventh hour that they were mislead.  So how do you tell the phonies apart from the real deal?

-          Interview. You are hiring this person to assist you in the birth of your child. Get recommendations, interview several people, and pick the one who feels like a good fit.

Red flags: If you don’t have enough time in your initial visit to go over your questions or the provider seems annoyed with you, it’s a good indication that they are not going to be very helpful or supportive. They are used to doing things their way and everyone else is just along for the ride.

-          Ask them to walk you through a typical birth of theirs. What procedures are standard? It is true that you can opt out of whatever you choose, but if your provider is used to doing things the exact opposite of what you want, there will be stress and friction and that is bad birthing mojo.

Red flags: If they say “everyone” or “all of my patients,” be suspicious. Unless they have only had one patient, I highly doubt that every birth, mother, and baby were exactly the same. You want someone who can recognize each birth as a unique and individual situation and can do what is best for YOU and YOUR BABY.

-          Ask for stats to back up their claims. They say they are pro-VBAC? Ask what their VBAC success rate is. Ask for their c-section rate, their rate of induction.

Red flags: If they don’t know or won’t tell you, it’s a bad sign. Doctors with good rates are proud of them and they are happy to tell you.

-          Get the specifics. Under what circumstances would they recommend induction? C-section? Supplementation?

Red flags: Be wary of dismissive language. Any “you don’t need to worry about that” or “just leave that to me”s. You are asking for their professional expertise. Hell, you are paying them for it. It shouldn’t be guessing game.

-          Don’t be afraid to switch. This is your birth and your baby. It’s kind of a big deal- like, way more of a big deal than some doctor’s ego. If you don’t feel 100% comfortable with that person, find someone else. There are way too many amazing doctors and midwives out there for you to be giving the shitty ones your business.

Other red flags: Watch out for the words “try” or “let” or “see how it goes”, i.e. “we can try a VBAC” or “I will only let you go to 40 weeks before inducing”.  You need someone who is completely supported and invested in your birth. You need a provider who is going to say “you will have a wonderful natural birth”, “you are going to VBAC this baby”, “ I recommend X, but the decision is up to you”.

You have a right to change your mind. If you decide you want that epidural, or that induction, or that c-section, or that you don’t want to breastfeed- that is totally okay. It’s one thing for people to try and help you stick by your original decisions (the “Are you sure?” and “But you said…”s), but no one should make fun or belittle you or make you feel guilty about changing your mind.

Don’t put up with providers who make fun of or talk down doulas, birth plans, etc. It’s not uncommon to hear statements like “one way ticket to the OR” or “oh, one of THOSE patients”. These birth practices are based on the soundest medical research and backed by ACOG. Would you go to a heart surgeon who scoffed at evidence-based medicine?

I know it seems sad and suspicious to be so distrusting of providers, but I have seen too many people get railroaded into a disappointing and even traumatic birth experience by someone they thought had their back. Do your homework and trust your gut. 

On Entitlement and Respect

          This may be another hard to follow post due to the sheer amount of ideas floating around in my brain. Most people have probably read about the recent shooting in Santa Barbara and the vitriol that the shooter had been spewing beforehand. The incident is disturbing, if unfortunately not surprising, and brought up some familiar thoughts that I have in regards to raising Perrin. What strikes me the most about these events is the sense of entitlement. Not entitlement as in “kids nowadays have no respect” blah blah blah, but entitlement to other people. To their bodies and their behavior. This man thought he was entitled to other people’s bodies for his own personal gratification and when he didn’t get what he wanted he threw a tantrum- with a gun. This situation is not uncommon. Those in power feel that they have the right to get their way from the disempowered. The disempowered are not individuals in their own right but a means to an end- the gratification of the empowered.

     So what does all of this have to do with Perrin? Well, two things. First of all, these same exploitive power structures can be found in parent-child relationships. Because the parent is bigger, older, more cognitively developed, they have the ability to exact their will on the child without regard to the child as an individual. Second, my hope is that Perrin will understand how to respect others as people and not be given a sense entitlement. I truly feel that the best way to teach him this is by treating him with respect  Because if I tell him he must respect others while not showing him that same respect and dignity, all he is learning is that respect is something that the disempowered owe the powerful. And that when you are in power, you can demand respect without ever having to give it. That is not the lesson I want to bestow on Perrin. But I think for some this is a hard distinction to make. How do you parent- guide, teach, and keep safe- without overstepping your role and infringing on your child’s rights (because let’s be clear, children are people and just as deserving as basic human rights and dignity as anyone else)?

   With this in mind, there are a few things we try to be very aware of with Perrin in order to try and instill this sense of respect and empathy. I am by no means saying that families who don’t do these things are disrespecting their children and the list is by no means exhaustive, but these are a few ways in which we try to respect Perrin.

-Bodily autonomy. This is a big one for us. Perrin’s body is his own and we try our best to not make any decisions about it that do not have to be made for medical or safety reasons. We don’t cut his hair because it’s not our hair. We don’t try to discourage him from touching or exploring any part of his body. It’s his body. Obviously there will a conversation about privacy when he is older and can understand, but for now we keep our expectations developmentally appropriate. This also is a partial factor in our decision not to vaccinate as I explained in this post. Preventative medicine is tricky because you aren’t actually addressing an issue, you are acting on a “what if…” and we carefully weigh what risks we are willing to incur without Perrin’s consent. We present him with healthy choices, but at the end of the day he eats what he wants and how much he wants. He eats when he is hungry and stops when he is full. As he gets older and is more capable of making decisions about his body (such as clothing choices, body modifications, vaccines, etc.) we will leave those decisions up to him. We ask before picking him up. We put him down when he wants to get down. If he doesn’t want to interact with someone, we don’t force it. He doesn’t owe anyone affection or attention.

-Giving him a voice. Just because he doesn’t yet say actual words doesn’t mean he doesn’t communicate. He has been communicating since day one and we have done our best to acknowledge what he is trying to tell us. We work very hard to read his body language to and remember that even crying and “fussiness” is communication and not something to be ignored anymore than I should be ignored when I’m trying to talk to Joey and upset.

- We don’t downplay or dismiss his emotions. When he falls down or is upset, I don’t tell him he is “fine”. I don’t know if he’s fine. He may not be physically hurt, but he could be scared or tired or frustrated. Those feelings are real and he has a right to express them. He isn’t punished for expressing frustration or anger. As he gets older we can help him learn healthy ways to display those feelings, but he has a right to let them out.

     It may not seem like much, but I hope that by instilling a sense of self in Perrin, he will learn that respect and dignity are the default ways in which to treat human beings. A person does not have to earn the right to common decency. I hope he learns that kindness isn’t something you do expecting something in return. It’s something you do because it’s the right way to treat each other. 

Update on the PPD

      As most people know because I try to be very vocal about it, I have been dealing with post-partum depression and anxiety since Perrin was born. I was put on a low dose of Sertraline (Zoloft) when he was about 5 months old and have been doing individual and couples counseling with Joey this whole time. I haven't mentioned it in a while, so I thought I'd be honest about where things are currently at.

  I am currently still taking the medication but have been talking with my FNP and counselor about possibly starting to wean off of it soon. I'm excited to be done with the stupid pills, but also kind of scared that I won't be able to manage without them. However, because I now have new insurance, I also have a new counselor and I am very excited to be working with her. My previous counseling has mainly focused on developing tools to cope with my issues and find healthy ways to deal. However, my goal with this new counselor is to actually start working through some of the underlying baggage that leaves me so disposed to depression and anxiety in the first place. I'm glad because I feel like I will finally be solving the problem rather than just sticking a band-aid over it. It does feel weird to be paying someone to basically just ask random open-ended questions, but I really feel like this talk therapy may be the "cure" I've been hoping for.

  Mostly I am excited about it because I feel like by letting go of my own baggage I can save Perrin from it becoming his baggage. I know he will accumulate his own junk to deal with as he gets older, but at least I don't have to worry about contributing to it before he's walking. It's odd how much clearer our own psyches become when we are suddenly responsible for the development of someone else's. I want to get rid of all of the negative energy in my own life so that I'm not radiating any of that onto Perrin's fragile little being. The wonderful side affect will also be my own mental health, which is nice.

   So that is where things currently stand. It could still be months or even years of recovery, but I am okay with that. As Perrin's first birthday approaches, I'm partially in awe of how far we have come and at the same time completely surprised at how much today still feels like that very first day he was born. He is still that same incredibly spirited little person he always has been and this whole parenting thing is still so incredibly hard. I still wonder sometimes- if I had known it was going to be this hard, would we have made the decision to have a baby? I really think we would have, if only because we would otherwise always have wondered what would have been. But we have done our best and continue to try and do better. I just hope that if Perrin chooses to have his own children, I can be honest with him about our own journey.