Postpartum Anxiety, Insomnia, and Breastfeeding Through Medication

ppd

I posted last week about “What Happens After Childbirth” and spoke briefly about the common conditions of postpartum depression, anxiety, insomnia, and even plain “baby blues.” Now that I have recovered fully from the storm, I wanted to write on a more serious note about what I went through. Fortunately it was a relatively brief episode, but had I not sought the proper help and support it could have been much more serious.

I have always been prone to anxiety, as you might have guessed if you read my book. From the age of 9 I suffered on and off with obsessive compulsive disorder and anxiety. In those days there was no real definition for those ailments and children were rarely medicated, so it wasn’t until I was an adult that I was able to find the right medication to keep myself almost entirely sane. 😉

During my first pregnancy I stayed on a lower dose of Zoloft and went right into breastfeeding without any problems for myself or my son. However, the first few days were hampered by the severe hormone drop, the reality of motherhood, sleep deprivation, and the fear that I would “never sleep again.” I remember taking Ativan in the hospital and begging for “diprivan, propofol, or whatever killed Michael Jackson.”

I spent the next few days randomly bursting out in inexplicable tears and taking Xanax and benedryl to fall asleep at night. But by the end of the first week, I was feeling much better and attended Sam’s bris with my hair and makeup done and the ability to smile without grimacing.

So I thought I’d be OK with number 2.

Once again, I went down to a low dose of Zoloft during pregnancy and felt OK, apart from what I consider the sheer misery of being pregnant. I was so uncomfortable I chose to be induced at 39 weeks, a long labor process but a happy end result as she was, in fact, quite a big baby and I had no signs of giving birth naturally any time soon. She was beautiful and healthy and I was thrilled. For about 20 minutes. And then the anxiety set in. The feeling of sheer panic that I could not pin to any particular fear or reason. But I was, once again, completely sure I would never sleep again.

The two nights in the hospital were actually better than the first time around. I got about 6 hours of sleep each night with the help of my husband and the nurses and my willingness to give an occasional bottle of formula. But all day long I still couldn’t shake the feeling of panic, fear, and hysteria. I would barely let my husband leave my side, and for the next week he stuck to me like glue.

When I got home, things got infinitely worse. Even when I had ample opportunity to sleep while my husband took the baby downstairs, I laid awake shaking with panic. I kept telling myself I would never get enough sleep, not be able to function, and ultimately not be able to care for my children. It was the absolute fear of losing control.

I was on the phone daily with my psychiatrist trying to find the quickest solution to get myself together. Xanax wasn’t working. Even Ambien did nothing for me. The next step would be to try some medications that would make breastfeeding very risky and I knew I’d be even more depressed if I lost the ability to nurse. (Note: neither Ambien nor Xanax are entirely safe for breastfeeding but I discussed the risks and benefits with my doctors and did not nurse during the time when the concentration was highest.)

But I knew that I had to be a functional mother first and foremost so I began taking a small dose of Abilify and one milligram of Klonopin at night. I was also able to gradually up my Zoloft to the level I was accustomed to. I was terrified that nothing would work, but that night I sleep soundly while my husband took care of the baby. And by the next day I was starting to feel a bit better. I also began to do more research on nursing and medications by going to the premier expert in the field which is the Infant Risk Center. The counselors there agreed that it should be relatively safe to temporarily take the medications at bedtime and then not nurse for a few hours while the concentrations were highest. I just had to keep a careful eye out for sedation which I fortunately did not see.

I was so happy to be able to nurse again, even if it was just part time. And not nursing enough in the beginning had really begun to effect my supply. But gradually things continued to improve. I stopped the Abilify after only a couple days and my husband and the baby were able to start sleeping upstairs again so we could take proper feeding shifts. I’m still not pumping nearly as much as I’d like (with Sam I could have fed a village), so we are still supplementing with occasional formula bottles but I am totally OK with that. I know that she is getting what she needs from me – a happy, focused, content mother and even a healthy dose of breastmilk.

I am now slowly weaning myself off the Klonopin. After that, I should be safe to breastfeed as often as I like (Zoloft is pretty tried and true for nursing and I took it confidently through seven months of nursing my son.)

I am sharing this story because what helped me to get through this incredibly dark and scary time was reading the stories of other women who had gone through this and knowing they came out of it OK. When you are in the moment, it is so hard to believe that it will ever end – that you will ever feel normal again. That you will ever take joy in a milkshake or a long run or watching your children play. But you will. And the faster you seek help, the faster you can feel true joy again.

Here are a few resources that really helped me get through this. I hope they help someone out there reading this:

Infant Risk Center and Hotline

Great article for if you do have to stop nursing

Great blog on PPD and anxiety by my friend Anne-Marie who helped me tremendously

A great first person account of Postpartum Insomnia

There are also dozens of postpartum depression treatment centers. And remember, PPD can set in as late as a year after giving birth. Every woman’s experience is different and I guarantee that if you speak with other mothers they can almost certainly relate on some level. You are not alone.


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