Wednesday, September 13, 2017

Beyond the Birth Plan, Getting Ready for Baby's First Weeks at Home

About twelve and a half years ago, I was getting ready to have a baby. I'd been married for almost two years and though it wasn't a specifically planned pregnancy, it wasn't terribly accidental either. It was somewhere in that perfect zone of an effortless happening at a reasonably good time in our lives. My husband, Tim, and I were both 24-years-old.

I wrote a birth plan.

Planning is one of my favorite things, so I was deep into the birth stories on TLC, prenatal yoga DVDs (to get the physically ready for delivery), Lamaze classes, and every pregnancy-related book, magazine, or website available. I looked into hiring a birth doula and decided instead to have my mother in the delivery room. I wrote a birth plan and thought through every possible contingency for delivery day.

I'd even frozen a few chicken spinach calzones for the baby's first weeks of life and committed to exclusive breastfeeding and cloth diapers. There was a feeding/changing/sleeping station for each level of our townhouse. We had the baby papasan and a swing. We were commercially prepared with every baby accoutrement 2005 had to offer.

I was ready.

Julia arrived at 12:19am on a Saturday in March and by lunchtime we were headed home. The express checkout was my idea. I thought I'd sleep if there wasn't a nurse coming in to "check my bottom" every fifteen minutes.

I did not.

Tim and I were on our own for the first two nights. Our new bundle would only sleep on a parent's shoulder. We took turns, but I was the one with the milk makers, so I took more turns. By the time my mother arrived on the third day, expertly swaddling her granddaughter in a way that magically got her to sleep in her crib, my brain had flipped out of sleep mode and I was lucky to get myself down for a two hour stretch.

Mastitis seemed like the worst thing that could possibly happen...

By the following week, I was alone with my infant daughter all day and up with her most of the night. A male lactation consultant at the hospital had recommended massaging my breast as the baby fed to prevent mastitis. Mastitis seemed like the worst thing that could possibly happen, so I massaged the business out of whichever booby was in use. Three weeks into motherhood, whether it was the mastitis massage or hormones or the baby's Olympic champion latching, I was shooting breast milk like a fire hose. From the moment the nipple was free of its nursing bra, milk shot at high pressure like a pinhole leak in a garden hose. It would choke the baby and so I took to holding a cup over my breast to capture that first Niagara Falls gush before I tried to feed her.

In hindsight, there were multiple warning signs. I should have asked for help instead of moving through life like nothing had changed. "Sleep when the baby is sleeping" is such great advice, except I couldn't and after a few weeks I stopped trying. At night, I'd wake up at feeding time even if the baby didn't. Sometimes my sister would visit and instead of tending my own infant I'd play with my rambunctious two-and-a-half-year-old niece, lifting her on and off of a wooden rocking horse. I was mentally and physically exhausted.

Julia and I on the morning of our first Mother's Day.
Spontaneous tears gave way to an ultra-intense feeling of energy and efficiency. I became more social, started planning a party, made 50 phone calls a day, and did everything at high speed. It was then I determined adults didn't need to sleep. I'd try halfheartedly and then surf the web between nighttime feedings telling myself it was because the Internet connection was faster at night.

Eventually my abundant thoughts became more and more delusional until only the slimmest grip on reality remained.

Just after my first Mother's Day and an intervention by my family, I voluntarily committed myself for in-patient psychiatric care. I spent six days away from my daughter, was forced to stop breastfeeding, and entered into a long, dark period of trial and error treatments with medications that produced a variety of unpalatable side effects.

I looked for a way to do it over again.

For years, I looked for a way to do it over again. I was sure that I could navigate the birth of another child without such difficulty. If only I could have another one, I thought. I'd do it better.

There was no second baby and eventually I realized the only person that needed proof of my child rearing ability was me. The only person that couldn't let go of the burden of those delusions was me. The only one that felt crushing guilt over feeding an obviously healthy baby girl formula was me.

And so I let it go. Five years after the fact.

Diagnoses varied a bit between a handful of different psychiatrists I saw at the time and in the years after. In the hospital, I was told I was bipolar and I should find a way to make myself comfortable with frequent visits to said hospital. The term "postpartum psychosis" was used and finally, one doctor arrived at "mild, sleep-dependent bipolar." She told me that a person only has to have one episode of mania in their whole life and they're still classified as bipolar. She reasoned that mine was a disease impacted by sleep and hormonal changes. Her assertion has held for all this time and sleep really does keep all bipolar symptoms at bay.

Know that there's more to self-care than quickly getting back into pre-pregnancy jeans. 

There may have been no stopping the mental illness I experienced after my daughter's birth. In my case, I think some foresight would have been necessary for me to seek professional help for the breastfeeding issues and insomnia. It didn't seem like it was a big deal and I figured I'd pull through on my own. Having a baby is hard, I figured, everything would be better when she got older. Still, I think we're risking disaster to endlessly push this concept of a "birth plan" without any mention of an "after birth plan" or a "postpartum support plan." Things can go mightily off track in a short amount of time. Asking for help in the emotionally charged new mother trench feels more like failure than scheduling core support people before the birth.

Postpartum Support Virginia has a wonderfully detailed "Realistic Postpartum Plan" that covers rest, meals, infant feeding, older siblings, ways to renew and recharge, finding friends, mental health, and returning to “normal.” The only thing I'd add to their list is a plan for caring for household pets. (We had a cat when Julia was born and it was a whole thing. The cat ended up going to live on a farm, for real, during the baby's first weeks. Looking back, I'd send her off sooner.)

Keeping an eye on maternal mental health is important and should be discussed right along with a birth plan, at Lamaze class, and during prenatal OB visits. Understand the risks and be ready to ask for help, specific help. Know that there's more to self-care than quickly getting back into pre-pregnancy jeans. Find someone to talk to and be honest about your mood and sleep patterns. Then you'll really be ready for baby's first weeks at home.