an interview with Aileen McElhaney
Aileen is one of the mamas I have had the pleasure of helping breastfeed over the years. Her little boy Rory was a tiny little firecracker from the day he arrived, with a full head of downy soft, bleach blonde duck-feather for hair that stuck straight up off his head. Not only did I see Aileen for a number of private consultations, but she also came to support group. A lot. At one group, I remember her sharing that she had been diagnosed with Postpartum Depression.
I think that it is fitting that Aileen wrap up this series of blogs from us professionals on Postpartum Depression from the perspective of a mother. Here is a summary of an interview I had with Aileen about her experience with Postpartum Depression.
Aileen is a healthcare provider as well. In fact, she works with pregnant and postpartum moms every day as a Prenatal Nurse Case Manager and a Certified Childbirth Educator. Part of her everyday job is to educate about and screen for Postpartum Depression in the mothers she works with. If anyone could have been aware of her own Postpartum Depression risk factors and diagnosis, Aileen assumed it would be her. Still, because of the nature of the illness, she wasn’t able to recognize in herself what she knew to look for in other women.
“I thought I had a good support system in place,” Aileen explains. “I really didn’t think that I would be the one having Postpartum Depression. I thought I was prepared to handle the postpartum period. I was always trying to be the perfect everything. You know, trying to make sure the house was perfect and trying to make sure my job was done perfectly and that there were no mistakes. With school, I was very organized and I have a lot of attention to detail. I just felt like I could work a baby into my life.” Aileen was unprepared for the possibility that her plans might not work as perfectly as she had configured them in her mind, which is a manner of thinking that can be a risk factor for Postpartum Depression.
Other than a little hiccup mid-pregnancy, Aileen’s pregnancy went just as planned. She chose The Birth Center and planned for a drug-free, out-of-hospital birth experience: “I was going to have the water birth in the tub, no meds. It was going to be wonderful.”
But Aileen didn’t get the birth that she planned for. Far from it. She labored, with back labor, without drugs for 36 hours. She recalls, “If someone wasn’t rubbing my back, I was in excruciating pain.”
After 36 hours, Aileen’s cervix hadn’t changed. Aileen says, “I knew that I had reached my limit. I knew that I was exhausted. I couldn’t take much more. We tried everything we could at The Birth Center. Nothing that we were doing was making it progress.”
The midwife made the recommendation for transfer, which Aileen “gladly accepted.” Even on the way, though, she was convinced that an epidural would be all she needed to have a vaginal birth. After a few hours of rest, rather than her cervix dilating more, it started to swell and close.
After more than 48 hours of labor, Aileen had a Cesarean section.
Because of her background in caring for pregnant mothers, Aileen knew that this was the healthiest outcome for her delivery. “The longer and longer I was in labor, the more and more I was thinking about infection. When they suggested a Cesarean, I was like, ‘Yes at this point, this is the way to go with me.’ I still feel that with the way my labor progressed, it was absolutely the best choice and at that point it was the only choice. We couldn’t go much longer. They tried everything they could.”
After such a longer labor, the neonatologist wanted to make sure Rory didn’t have an infection, so went to the NICU. She expected to see him within the hour, but it was four hours later that she actually got to see her baby.
Aileen reflects on that day: “I found out that he was given between 40-60 milliliters of formula, which was a really large feeding. I was really disappointed it was that large of a feeding. I expected them to give him formula. I did not expect them to give him that much formula.”
When a woman has an unexpected C-section, well-intentioned family and friends will often say, “But you have a healthy baby, and that’s all that matters.” True, the health of mom and baby is the motivating factor for an emergency Cesarean, but the loss of the birth a mother has planned is a real, significant loss and it must be mourned. Having lost the birth experience she desired put Aileen further at risk for developing Postpartum Depression, but she knew that she needed to come to terms with her loss.
“I definitely let myself process it,” Aileen details. “I remember very vividly my midwife, Dorinda, asking me, ‘How are you feeling? How are you feeling that your birth didn’t go as you planned it?’”
“I remember taking a second and saying, ‘I feel disappointed. I feel disappointed that this happened.’ And just that validation from her—that ‘that’s okay’—was so important. Having someone say, ‘It is okay that you feel disappointed.’ And having them validate those feelings I think really made a difference. It made me feel that it really is okay to be disappointed and it is okay that my labor didn’t go like it should have, or like I wanted it to.”
Aileen felt that she had made peace with her birth experience, and in the early weeks of parenthood, Aileen did fairly well.
But she admits, “I ignored the problem for a long time. You know, I chalked up a lot of this to just being tired and being a new mom. But, I really, really noticed a problem somewhere around 7-8 weeks. That’s when I really started acknowledging it.”
At first, when she felt uncomfortable feelings, she would go for a run or flat out ignore them. “I was really in denial.”
Aileen began to recognize signs that she could no longer ignore, however. She remembers one of the early moments when she began realizing that something was wrong: “My first initial thing was that I would be able to put Rory in his swing to nap and I would close the door so the dog wouldn’t bother him. I would walk away and sit on the couch and I would forget I had a baby. Just forget that he was there. I wouldn’t remember until he started crying.”
Feeling guilty, Aileen would chastise herself, thinking, “How could you forget you had a baby?!”
“There was huge judgment on myself. ‘What is wrong with you? Why did you forget?’” But then she gave herself an excuse: “You’re just tired.”
Deep down, though, Aileen knew that she wasn’t just tired. “I think the biggest thing that made me seek help was that I started getting these really intrusive and graphic images. They were just pictures in my mind that were so vivid and real and they scared me. I would get them when I would go to pick up Rory. If we were walking out of a doorway I would have this image of his head hitting the doorway and then he would be down on the floor. Like, completely irrational, unrealistic images. I had it once and I was like, ‘Okay, that was weird.’ But then they continued. They got to the point when it was almost every time that I picked him up. I had this extremely graphic image of him being injured or dead or something.”
“I was nervous. I was really anxious about touching him. I was anxious picking him up, anxious about carrying him. I still did it, but I was anxious. It went from happening one time to three or four days later where it was almost every day.”
Being Rory’s mom was hard at first, and underlying Aileen’s yet-undiagnosed Postpartum Depression were Rory’s high-needs behaviors. “He would cry from three in the afternoon to six or seven o’clock in the evening. Nothing Katie suggested would help. We would switch off between bouncing him on the exercise ball and walking him through the house. Trying to mother him when he was awake all the time at night was really hard. My husband went back to work at a week and he had to be up at 5:00 AM. It was really hard because I wanted to be in our room and sleep in my own bed, but Rory wanted to be up from one AM to three or four. I was getting about four hours of interrupted sleep. And I am a person was used to sleeping for nine hours.”
Rory was “always moving,” Aileen recalls. “In his sleep and when he was awake. He was always on the go. He never has had time for being a baby. Breastfeeding him in the beginning was hard.”
It would be breastfeeding, however, that would help Aileen emerge from the darkness of Postpartum Depression.
Aileen pumped and bottle fed for the first two and a half weeks of Rory’s life, then he started breastfeeding with the use of a nipple shield. Aileen hated having to use the shield, but luckily Rory self-weaned from the nipple shield at three months old. Aileen remembers that at one point, when Rory seemed inconsolable during the nights, “there was talk about needing to supplement him,” but Aileen was determined to continue nursing him.
“Breastfeeding was the one thing that was going okay with my plan. I didn’t get the birth I wanted. Nothing was going to get in the way of breastfeeding. As long as I could continue to breastfeed him, I felt like I could process and get through the rest. It was the one thing that I wanted to do and was happening for me. So, I never thought about quitting. I had other people encourage me to quit. It was hard because I didn’t have that full-on family support from everyone.”
Eventually, Aileen recognized that she needed outside help. Breastfeeding was going okay, but Aileen’s intrusive thoughts and her need to meet the impossible goal of perfection didn’t go away.
Aileen made an appointment at the Christiana Center for Women’s Emotional Wellness (CWEW), where she was first given a diagnosis of Postpartum Anxiety, then of mild Postpartum Depression.
Although she regrets doing so now, Aileen remembers not being totally upfront with her care providers at CWEW. “I will say that in the beginning, I didn’t disclose everything in therapy. I was downplaying my issues. On the questionnaire that they have you fill out, I was not as truthful as I should have been. Looking back, it wouldn’t have probably been mild. I was just in denial. I just didn’t know any better at the time. I am looking back at it and thinking that I really shouldn’t have done that. I needed help and I probably could have gotten more help if I admitted that this was a problem. Again, this was denial and I didn’t want to admit that I needed help. Yup, I was good.”
Aileen’s unwillingness to be completely honest during therapy was connected to her work screening other mothers for Postpartum Depression. “I wanted to be the strong woman. I wanted to not need help. There was a lot of guilt and personal shame because here I am telling women and helping women and educating on this. How can I have this if I knew all the signs? How is this happening to me?”
Aileen was feeling a common emotion for women experiencing Postpartum Depression. With hindsight, she can label that emotion now: “I have reflected a lot on this. That was shame that I was feeling. I couldn’t tell what it was in the moment.”
Aileen’s first few appointments at CWEW included talk therapy; a discussion about medication wouldn’t occur until later. For many reasons, Aileen hesitated to incorporate meds into her treatment plan. “I didn’t think that my issue was that bad,” Aileen remembers. “I thought that I was okay. I was wary because I didn’t want to do anything to jeopardize my breastfeeding relationship. I was scared.”
Talk therapy helped, but therapy alone wasn’t lifting Aileen from the darkness of Postpartum Depression. Aileen explains, “I had all these layers. All these layers of stress. It wasn’t just the one thing. She felt it would help. It would help my brain realize I didn’t have to worry about a thousand things at one time.”
But Aileen did have a thousand things to deal with, even just with her various approaches to treating her illness. She was practicing good nutrition, exercising, working on communication with her husband, and attending regular therapy. All of this was in addition to her job, school, and being Rory’s mom. A multi-faceted approach to overcoming Postpartum Depression, though challenging in itself, helped Aileen discover balance in her life.
Aileen began seeing Advanced Nurse Practitioner Janet Brown, who understood Aileen’s need for medication and prescribe something that, in combination with therapy, helped Aileen begin to heal. Megan O’Hara, Licensed Clinical Social Worker at CWEW, helped Aileen see the benefits to beginning a medication regimen. “One of the things that I was concerned about with starting medicine was how it would affect breastfeeding. Megan was great. She was really knowledgeable. She gave me some really sound advice. She looked up the medications and said, ‘This is what it says. It looks like it is safe to use and we are starting you at a low dose.’”
After beginning medication, Aileen began to see a marked difference in herself. She continues to take her meds today, and she is feeling more like her former self because of them. Aileen describes the benefits of medication: “I feel like I am better able to cope with situations that may have overwhelmed me before. I feel like it put things into perspective. It made me realize ‘I know I am going to get these things done.’ I don’t have to worry about how I am going to get it done. When I am going to get it done. I am organized enough and I have enough time management skills that I will get it done and I will do it to my level of expectation.”
Of course, Aileen was doing those things all along, but her thoughts were constantly swirling around what she should be doing, what she’s not doing, when she’s going to do it. Aileen’s medication quieted the extra chatter in her brain, the chatter that was telling her that she wasn’t a good enough wife, mother, Childbirth Educator, or student.
The medication has helped Aileen in one other very important way. The thoughts of harming Rory didn’t go away until Aileen started medication, even after almost a month of talk therapy alone. She says she has had them once or twice, but only in times of high stress. “I think I would have felt more like myself earlier,” Aileen says, “but I had a significant loss in my life.” Though she thought she had mourned, the loss of her ideal birth experience had a far-reaching consequences. “I finally started feeling like myself when Rory was about ten months old. I felt like I missed some opportunities for bonding during that time.”
Many women who experience Postpartum Depression think that breastfeeding is standing in between them and seeking help because they are so scared that the medication will harm the baby or is the only option for treatment. In particular, women are hesitant to take medication while breastfeeding. Aileen, too, had this fear, but the care providers at CWEW were “one hundred percent supportive” of Aileen’s desire to continue breastfeeding her son. There are a good number of medications that are very safe to take while breastfeeding, and Aileen’s fears were put to rest. In fact, breastfeeding Rory has helped Aileen feel connected to him despite the difficulties she has had transitioning to motherhood, which has contributed to her healing.
“That’s the cool thing about breastfeeding through depression. Even though you felt mentally absent, you can look back at that ten months. Even though I wasn’t there, I know I was touching him. I know he felt my love. I know that we were connected even if my brain wasn’t present. By default.”
Like many of the mamas I’ve worked with, Aileen has been able to grow into motherhood through her breastfeeding relationship. For Aileen, though, it wasn’t an easy relationship to develop. At support group, Aileen talked about her hatred for the nipple shield. “I had mentioned that nipple shields felt like a barrier between my breastfeeding and my bonding with him,” she recalls, thinking that it was “because I can’t feel his mouth, that must be the barrier.”
After she began medication for Postpartum Depression, she had an epiphany about her relationship with Rory. “For me, that was the first time that I really acknowledged that there was a barrier and it had nothing to do with the shield. It was all the anxiety and depression. That was my barrier and I just didn’t know how to identify it at that time.” For Aileen, the physical barrier of the shield was standing in for the emotional barrier of Postpartum Depression.
Treating Postpartum Depression opened new doors for Aileen to bond with Rory. “After therapy, I started being more mindful when I was breastfeeding. That was the time that I really made sure that I was present. That I was there. I was in that moment and I wasn’t in school or having anything else interrupting that time. And I was really letting myself take it in because, even if it was three o’clock in the morning and I had to be at work in three hours, it didn’t matter. I knew once that moment was gone, it was gone and I wouldn’t get it back. I think it helped me in other areas and helped me make it through those periods. It is not that I didn’t love him; there is a problem in my brain that makes me not present.”
Like Aileen, many women who suffer from Postpartum Depression see the inability to be present or to enjoy breastfeeding as a flaw in their ability to mother, when in reality it is a chemical imbalance—a diagnosable disease. “You look to anything under the sun to blame” for feeling as though you’re not a good mother, explains Aileen. “To look for reasons that it is happening. Then you start with the guilt. That was really hard.”
Postpartum Depression also caused difficulties in Aileen’s relationship with her husband. They couldn’t communicate with one another and everything between them started to disintegrate, so part of Aileen’s therapy was learning new ways to communicate with him. “I think the partner part was the hardest,” Aileen says, describing her work in therapy. “I said things and did things, but I was never really up-front honest, like, ‘This is exactly what I need.’ I never spelled it out for him.”
“At the same time,” Aileen discloses, “he was having trouble adjusting to being a new parent. We have talked a lot about it since. Looking back, he has said he felt like he may have had depression. I think that a big area that healthcare and everyone else ignores is dad. But, it is definitely real. That contributes so much. He was overwhelmed. Here I had nine months to prepare. For dads, it’s not real to them until the baby is there and he is holding them.” Aileen makes an important point; becoming a parent is a huge life changer not only for moms, but for dads, too. If mom is debilitated by depression, dad loses his support system, and no one gets the help they need. The effects of Postpartum Depression are felt far and wide, impacting every member of a family.
Although it originates with pregnancy and childbirth, Postpartum Depression affects every facet of a woman’s life. As with Aileen, many women are not able to see for themselves that they need help. Looking back, Aileen identifies her mom as one of the people who first helped her emerge from the darkness of Postpartum Depression. “She was always there,” Aileen recounts. “She was always encouraging. She could always go to her with my concerns. She was always there to listen.”
Megan O’Hara from CWEW also helped bring Aileen out of the darkness. “She helped me recognize things and be able to realize I need to communicate more effectively. I am not going to get what I want if I don’t tell my husband. We even had a session with my husband there so we could talk. Things were bad. They got bad.”
Lately, however, Aileen’s husband “has become much more supportive. We had a sit down right around Rory’s birthday and we talked about getting divorced. Since then, making that conscious effort, not just by him, but by me, to be present for each other has really made a huge difference. We are better parents and a better couple for it. He was helpful before that, but before we talked I didn’t really feel it.”
Of course, Aileen has a new understanding of her bond with her son. “Rory is always my little anchor. He was always there. He is a very active child, but he hit his milestones early, so it became much easier when he is talking to you, smiling.” Although Aileen struggled for much of Rory’s infancy, she and Rory are now in a much better place.
Postpartum Depression isn’t spoken about enough, and many women underestimate their own risk factors. Aileen is a wonderfully well supported, healthy, high achieving woman who works daily with other women experiencing Postpartum Depression. She didn’t believe that she could develop depression after delivering her son, but Postpartum Depression doesn’t discriminate. Anyone can develop the condition, even those who are highly educated about it.
As a result of seeking help, Aileen has been able to overcome many of her struggles with new motherhood and Postpartum Depression. Although she was always passionate about her work helping other women climb out of the darkness, she has a new appreciation for bringing awareness to this issue.
There are a few things that Aileen wants you to know, so I will conclude with her words:
“I want women to know that they should know themselves and if they feel something is wrong, they should talk about it with the people around them. Don’t hide it. Don’t run away from it. It is going to catch up with you. It isn’t going to go away. In five or ten years, it will still be there. You can’t just let it go. It will find its way into every aspect of your life. It seems scary to be in treatment. It seems scary to go and talk to somebody. It seems like it may not help sometimes. Just putting something in place and making an action plan can make all the difference in the world. Sometimes it takes one visit, sometimes it takes one year worth of visits. It has taken me a long time to get to the point where I can reflect on how I was feeling at the time. I know that you don’t always recognize the signs in yourself and if you do you may minimize, guilt, and shame yourself.
Your friends and family need to know the signs. They will probably notice it before you. And they need to know to speak up. Sometimes they are going to be the ones that go to your doctor and say, ‘Something’s not right. She needs help.’ That is so important, too. To make sure that the support system knows the signs. I don’t think my support system knew a lot of the signs. They didn’t know what was going on with me and they couldn’t help me because they didn’t recognize what was happening.”
Join us this Sunday, June 14, 2015. Help raise awareness about Postpartum Depression. Help your sister, your best friend, your neighbor, or yourself to Climb Out of the Darkness.