PPD – Libby

March 22, 2013

When Libby called and said she needed help weaning her 11-day-old baby I knew it was the right thing to do.

When I met Libby to work with her when her baby was 4 days old I saw she was an especially shaken new mom. When she told me she had a history of depression I knew I had to tread carefully.  She was so unsure of how she wanted to approach feeding her baby and I understood. Typically I make up a plan for a mom with directions to make enough milk and to get breastfeeding going well.  But with Libby, there were obstacles – the baby had been jaundiced, he had a tongue-tie, which tethers the tongue to the floor of the baby’s mouth and can cause a great deal of pain at every feeding.

While I was with her, Libby had a wild look in her eyes. She paraded around her apartment with only white cotton panties and her thick hair falling over her shoulders. Pacing back and forth like a caged animal, her eyes looking everywhere but in the room. Wanting nothing more than to be able to comfortably nurse her baby and feel at ease, everything caused her pain: the baby, the pump, hand-expressing. I think her own skin was causing her pain at this moment.

I gave Libby three plans: one to build a complete supply and get breastfeeding going normally, the second to mix feedings at the breast with bottles of formula and I gave her a plan to reduce her milk supply and wean completely. I asked if she was under the care of a psychiatrist. Yes, she assured me. I stayed with her longer than usual because I was afraid for her. I left after her husband came home.

When that call came seven days later I was at once relieved and saddened. The medication that had worked for her was truly incompatible with breastfeeding. I called the Infant Risk Center to clarify. The lovely woman on the phone in Texas felt the weight of my sadness and listened to me as we both mourned the loss of breastfeeding for Libby and her baby boy.

When I spoke with Libby a couple of days later she was calm and expressed her sadness at the loss of breastfeeding. As I hung up I thought of Kelly. At her funeral Joel told me that he saw how connected she and Katie had been whenever they nursed.  Those moments with Katie where when she was the happiest and most focused in the last five months of her life.

The part of me that ached for Libby found peace in knowing she was going to be well and that her baby was going to have his mom. And her would have her longer than five months.

PPD – Kelly

March 19, 2013

I have been exploring Postpartum Depression for a long time. I believe my mother had it when I was a baby. I believe I had it after my first and third babies were born.

So, I am sharing a few stories. They may come in quick succession or they may come over a few weeks or months.This first one is likely the most dramatic. I have been sitting on this story for some time. I decided it was time to share. In some of the stories I have changed some identifying details but the stories are real.

Kelly

I met Kelly in the late 1990’s at the Murray Hill Players on East 36th Street in Manhattan. Tuesday evenings, actors gathered to read new plays while the playwrights listened to their words spoken out loud. Kelly was a bit younger than I. She lived with her boyfriend. I was married with a toddler.  We both lived near the theatre so we would walk home together and we would talk.

I am a nurturer. I was a second mom to my little sister. I started babysitting in the neighborhood when I was eleven years old. When I went off to college I started really ogling pregnant women enviously.  I earned the reputation as Earth Mother in my twenties.  I cared better for some of my cousins than their own mothers did. When I finally had my own children I drank each of them in. I studied them. I nursed them. I fell in love everyday.  For my second career I chose to become a lactation consultant, a career that allowed me to guide other mothers to follow their instincts and build relationships with their babies. That I can guide some of these mothers to nurse their babies into toddlerhood is a great gift. But it doesn’t always go that way.

Kelly and Joel got married and I had another baby. Kelly’s office was on Wall Street.  On September 11 she was there. She stood outside of her office building.  She watched as papers blew about like confetti. She brought dust-covered people into her lobby for water and comfort, for safety. This triggered in her the desire to be a parent.   She was hesitant as she told me she and Joel were planning to have a baby.

She told me, “ I may not be able to breastfeed.”

“Why not? Of course you can,” I assured her.

“I have been on Prozac for six years,” was her reply.

“I will look into it,” I promised.

Summer 2002 was the time I would sit the exam to become a Lactation Consultant. I still had so much to learn. Soon Kelly was pregnant and still on Prozac.  I contacted my colleague whose husband was a physician with a special interest in suicide prevention. At that time there was not much research on breastfeeding and Prozac.  Margot assured me it was more important for a mother to be alive than to be breastfeeding. Her words were a foreshadow that I could not even imagine.

When Kelly was about seven months pregnant she asked me to be at her birth. I was so excited and honored. On July 30 Kelly called to say she was in labor and that I should meet her at New York University Hospital.  A bit past midnight on July 1 a rush of excitement pulsed through me as her baby crowned.  I watched as her dark, hairy little head seemed to soften and move with a gentle force as Kelly opened up like a tulip. The bolt of energy that rushed through me as I witnessed a life come into the world kept me flying for weeks. This was the first time I had been present at a birth other than my own.

The next day I bought a pink outfit and brought my girls to see the new baby. While I was there a young intern stopped in to go over her medical record.

“Are you on medication?” he asked her.

“Yes, Prozac,” she answered as she gazed into Katie’s new eyes.

“Are you breast-feeding?”

“Yes.”

“OK, then, no Prozac, “ he said as he turned and exited the room. I remember the sound of his feet echoing down the hall on the white tiles.

I didn’t know then what the impact of stopping Prozac could be. I didn’t understand the postpartum physiology. As it turns out Prozac is considered safe with breastfeeding.

When Kelly called a few days later and asked if Chloe and I could stay with her and Katie because “my doctor says I am racy and she wants to admit me into the hospital but I told her I did not want to go and that I would make sure I am not alone and that I will have a schedule full of people hanging out with Katie and me,” I did not understand that she really could not be alone. Not for a moment. I did not understand.

When Kelly talked faster than usual and laughed louder than usual and started finding coincidences in all the numbers in her life I did not understand.

Three weeks later, Kelly, Joel and Katie moved out of their Manhattan one-bedroom walk-up apartment into a newly purchased house in the suburbs of New Jersey. Kelly said it was good that Joel was getting his MBA. Even though it meant he worked all day and went to school three nights a week. I didn’t know that Kelly had a fear of driving. I didn’t know that all of her friends with babies were in Manhattan.

I worried that most every time we spoke on the phone she cried.  She told me, “I have told Katie I am so proud of her and I love her more than my own mom told me in my whole life.” I felt helpless being so far away.

I didn’t know that Kelly had started taking Prozac again at Thanksgiving. I didn’t know how long it takes for Prozac to move through the body and begin its balancing act.

I did know that when I received a phone call on December 11 telling me that someone named Kelly had stepped in front of a commuter train in New Jersey I knew that was my Kelly.