Postpartum Anxiety

This morning, Amber Koter-Puline joins us to share her story about postpartum anxiety entitled, Postpartum Anxiety- How I worried myself (almost to death). Through the first 3 month's of her child's life, postpartum anxiety robbed Amber of the joy of the early weeks of being a new mother. The constant physical and emotional side effects overshadowed her ability to utilize and trust her intuition. The relentless insomnia turned Amber into a manic and voracious information addict which propelled her into further worry.

Amber is a part-time working mother who is a graduate from Penn State University with a B.S. in Education. Amber suffered a severe postpartum reaction in 2007. Since recovering with proper treatment and care, her passion is supporting and educating expectant and new mothers about the postpartum period and being a first time mother. Amber facilitates two new mothers groups and one postpartum support group Atlanta, GA. Amber lives in Atlanta with her son and husband. She serves as the Secretary of the Georgia Postpartum Support Network. www.gpsnetwork.org Please visit Amber's blog, Beyond Postpartum at www.atlantappdmom.blogspot.com and her website, Postpartum Healing at www.postpartumhealing.com.

Be sure to check out Amber's recent interview with Lauren Hale at Unexpected Blessing http://atlantappdmom.blogspot.com/2009/02/check-out-my-interview-at-unexpected.html
and Amber's husbands interview at Postpartum Dads Project http://postpartumdadsproject.org/2009/02/19/getting-to-know-michael-puline/

Welcome Amber!!

Amber Koter-Puline: Good morning everyone; thanks so much for being here!

I think it will be helpful to start at the beginning for me. It was Jan. 2007 and I was feeling great and had come to the decision after more than two years of TTC that my husband and I would move on with our lives childless. In fact, I was actually pretty excited about the idea of the freedom that a no-kids lifestyle would continue to provide for us in terms of time and finance. I was so certain that we would not have children that I brought a special "nursing tea" to my friend Sara that I had been storing in my kitchen cabinet. She asked when I presented her with it if I should reconsider and keep it in case we changed our minds about having children. I assured her that indeed we had decided and I had no intention of conceiving.

Tiffani Lawton: Can you share with others what TTC is?

Amber Koter-Puline: Trying to Conceive. Later in the month, I celebrated my girlfriend Christine's birthday by going out to dinner on a Wednesday evening just a few days prior to her 46th. Jennifer, Christine and I dined and drank wine. We indulged in mussels, soft cheeses, specialty meats, appetizers such as tuna tartar and more wine. Later that evening, I found myself experiencing terrible stomach cramps and spent 4-5 hours in the bathroom. I had had food poisoning and stomach flu both before, but this seemed different.

It was as if my body was intentionally dispelling all the food that I had eaten for dinner before it had a chance to digest. As soon as I was able to move from the bathroom to the bedroom, I laid down and discovered that unlike with previous stomach conditions, I felt just fine. I slept well and awakened for work the next day. It was a Thursday. Sometime that day I realized that it had been quite a while since I had gotten my period and mused that perhaps I had miraculously become pregnant.

Not only had we been labeled "infertile" by my Ob-GYN, but my husband and I were not what you would call very active. We both have fairly low sex drives and I couldn't remember more than one instance or maybe two in the past several weeks that we had been intimate. I internally joked that perhaps I was God's chosen for an immaculate conception and then found myself uncomfortable with either result.

If I was pregnant, while I was far from desiring children, this would mean that my body was indeed fully functional and that nasty label of "infertile" would therefore be found untrue. On the other hand, if the result was positive, I would not be able to move forward with a life that I often explain now, more than one year later, as one that felt like "I kinda dig."

Either scenario had positive and negative facets and I truthfully was assuming I'd find out for certain that I was not pregnant so that if I became ill again I could explain to my family doctor that he should look into some other cause. I, as usual, wanted to be prepared. I made it through the work day, finding myself distracted at times, and raced home.

Once at home, I found a pregnancy test from more than a year prior- a time when I had desperately wanted to be able to conceive. I quickly took the test as instructed and waited impatiently for the result. It was a faint double set of pink lines that appeared in the window. "Aha!," I thought...This test is old and faulty, that is why the line is faint. I will need to take a second test. Just a few moments later, Michael was at home changing into his workout gear and flying out the door.

Tiffani Lawton: Oh those lines!!

Amber Koter-Puline: I know...not matter what result you want they always seem uncertain! I flew out of the driveway less than one minute after him and drove a few blocks to the "neighborhood pharmacy." Once home, I chugged a 16 ounce beverage, hoping that it's effects on my bladder would immediately take and ran back to the same bathroom where test number one was awaiting me. I pulled out this test, peed on the test stick and waited again.

This time, the test results were not as subtle. A large plus sign illuminated and I stood in shock for many minutes. After those initial moments, I decided to move into the living room where I sat for more than one hour in the dark and quiet. I pondered my fate. I asked God why he had chosen me. I questioned how I should tell my husband such surprising news.

I knew that I was unable of verbally getting just those few necessary words out and decided to come up with an alternative plan pronto. Michael would be home from the gym, thankfully bringing takeout with him, soon and I needed to do something and fast. I looked around our home for ideas. Write a note? No... Hmmm... Have someone else tell him? No way! What could I do? I looked across the room at the dining room table at which we had been playing Scrabble over the weekend.

Tiffani Lawton: Brilliant!

Amber Koter-Puline: I thought, yes, I can use the tiles to spell it out to him. I quickly pulled the tiles and set them into place. I took the board, placed it just to the right of his placemat and returned to the couch to wait. Just a few short moments later he entered toting a Chipotle bag which contained our dinner.

Lisa Connor: That's so funny.

Jennifer Mossholder: Cute!

Amber Koter-Puline: He casually glanced over to the Scrabble board, but appeared not to notice that it looked different than we had left it last. He looked at me, asked if I was alright, and then glanced back to the board. His face contorted, he appeared to read and reread and then he looked up at me. In doing so, he said, "No...really?"

I responded that it was indeed true and burst into tears. Being amazingly empathetic, he enveloped me into his large arms and allowed me to cry. Asking what was wrong, he received the shaky response, "I am terrified."

Lisa Connor: What a great guy!

Amber Koter-Puline: It was a Thursday evening, and I planned to call the office of my OB-GYN the following day. That night I slept very little. A pungent mixture of fear, joy, and anxiety washed over me and provided little opportunity for rest. The next day, I called Dr. Roberts office and asked if they a) believed I was indeed pregnant based upon the facts, and b) when they would like me to schedule an appointment.

Tiffani Lawton: The first bricks to the foundation are being laid, huh?

Amber Koter-Puline: Yes, this is why the beginning of the story is so important to the journey.

After speaking with the nurse, I was told that I should indeed make an appointment, but that they did not want to see me for three weeks. Three weeks!!! I could not believe that in my "fragile" state and knowing that I had previously been labeled infertile that they would not want to see me that same day. "No," responded the nurse, " if you took a home test we don't need to see you until you are nine or more weeks pregnant.

The following day, Saturday, I had to work. I remember that as I drove in that Saturday morning around 8:30am tears streamed down my face. I could not shake the feeling of sadness that overwhelmed me. I made it through the event with little issue and cleaned up. Afterwards, I walked back over to the church to put things away and found myself desperately sad and needing to talk about what was happening with someone.

Amazingly, one of the female pastors of the church was in her office and was returning some emails and getting paperwork done that day. I walked into her office, asked if she had a few minutes and once she nodded yes, collapsed into a leather chair, sobbing "I'm pregnant." "Okay." she said so slowly that it was like her mouth was filled with molasses.

We talked about what this meant for me and my life, how it was possible after a couple of years of the label of infertility and then efforts to actually prevent the very unlikely that I had recently made once I had come to terms with what I believed to be my fate and choice to live a childless life. We closed in prayer. Pr. Deb was the last person I told until my appointment nearly 3 weeks later.

Lisa Connor: God works in mysterious ways.

Amber Koter-Puline: Those three weeks passed rather quickly as I tended to my business with my news hidden in just three heads- mine, my husband's and Pr. Deb's. While I was still a bit anxious an overwhelmed by the idea that my plans would be drastically changed, something about carrying around a secret of this magnitude intrigued me. I have never been a great liar. Well, I will just be honest, I can't lie. My body language, tone of voice and other subtleties are all too obvious to even the least keen listener.

But this secret, this tiny little secret in my belly, was one that I treasured. What a gift to have this knowledge that only God and a few others shared. Coming from families of Italian heritage, secrets were like family gatherings without food to Michael and me...non-existent. Gossip travels faster among our clans than around the water cooler and we knew that we could not possibly share this news without it being public knowledge.

While my husband does not mind sharing personal information with his family on a daily basis, I am more private. It seemed as both a child and adult that I was incapable of having any sacred information and I wanted this to last as long as possible. Mike hates secrets, but he agreed to a few weeks of keeping the information to ourselves before my doctor's appointment.

Finally, in mid-February, I went to see my OB-GYN. Having been with Dr. Roberts since we moved to Atlanta and also having had him involved in our fertility testing and my previous surgery to remove uterine cysts, I felt so comfortable. He welcomed me, with a bit of shock, as he knew how long we had been married and had not been using birth control and that he had told us that it was unlikely we would conceive without intervention.

He examined me, did the traditional pregnancy testing, and once confirmed led me to another exam room. There he performed an inter-vaginal ultrasound. On the screen we saw a peanut sized being. Dr. Roberts commented on how active this little human was at just 9 weeks gestational age. There was no doubt in my mind at that point, that indeed this was a baby created by Michael and me and that I would work and grow to love it.

I left the appointment relieved that all appeared healthy and with lots of things to discuss with Michael. I was due on September 26, 2007. I called Michael to update him on the health and age of the baby and he exclaimed that he could not wait any longer to share the news. He said he wanted to tell his immediate family and asked if that was okay with me. Feeling like I had asked all I could of him, I agreed.

Since he was sharing, I knew I couldn't withhold the information from my family any longer and proceeded to call my parents. They were vacationing in Florida at their second home. When I called, I asked to be put on speaker phone and told them they would be grandparents again- for the third time!

They were in shock, but my step-mother, still in the shower with it running, began crying and congratulating me. I thought perhaps my father had lost the connection, as he hadn't said a word since my announcement. "Dad," I asked? He was still silent. I was sure what to make of it at this point, but I told them I would be calling my siblings and that I would talk to them soon.

My Dad was REALLY scared for me...he shared why later...amazing how he knew something that early...

That afternoon I drove back to church to work. I had so many things to think about. Images and thoughts were swimming in my head. Who would I tell next? How would I announce my pregnancy to other friends, family, and colleagues? What sex was my baby? How would I look in maternity clothes? When would my baby be born? Would he or she have hair? What would we name him/her?

INSERT- you can see already how my mind works...

It felt so strange to be thinking about all of this. In this moment I realized that I had never really seriously considered any of this, as I never realistically pictured myself as a mother.

It seemed like the next couple of weeks and months of my pregnancy, from week nine to sixteen sped by, almost as if each day seemed like a tiring effort, but that the combination of days was a blur.

Just knowing that I was a couple of months pregnant changed the way I thought about conversation around ministry, as well as parenting. I realized that while my child-free status had allowed me the necessary time to devote many extra hours to growing Family Ministry at Redeemer, that my child-carrying situation was leading me to a much more whole view of what the ministry could offer in the future.

As soon as we learned we were expecting, we began exploring ways to make our pregnancy and childbirth fall in step with our lifestyle. I carefully watched my intake of food, beverages and vitamins. We made sure I was not exposed to VOCs, cleaning supplies, pesticides or any other chemicals that might harm me or our baby.

We were adamant that our child would be as strong as possible, and we took all the steps we could imagine to make that a reality. Along with these efforts, we explored childbirth preparation and methods that would be least intrusive for me and our child and would provide a natural, calm childbirth experience for all three of us. After exploring the many options available, which were quite a few in a large city like Atlanta, we finally settled on Hypno-Birthing.

The Hyno-Birthing experience was a blessing. We learned lots of helpful techniques and my husband easily on-boarded to something about which he was initially skeptical. Hyno-Birthing is based upon the theory that the body is created to give birth and that just like any other muscle, the uterus, if relaxed, can contract with little to no discomfort. Therefore, the techniques associated with this method all include relaxation and visualization that allow for the body to be at its optimum...

Shara: Did it work?

Amber Koter-Puline: ...and least tense condition during labor. While I ultimately did have to concede to an epidural and interventions that I had not planned for, the first 36 hours of my labor were tolerable and at times even joyful utilizing this method. I am so thankful that I had the tools to endure such a lengthy experience.

Shara: That's great!

Amber Koter-Puline: I gave birth to Lorenzo on my thirty-first birthday, September 30, 2007. If I had only known what those 29 days in September before that last, long day would preface, I am not sure what would have happened. I experienced a long and complicated labor that ended in an emergency C-Section delivery.

Tiffani Lawton: Another brick laid....

Amber Koter-Puline:Thankfully, Lorenzo Jesse Puline was born healthy (and heavy) at a whopping 8 pounds, 15 ounces. Now, that certainly does not win him, or me, a Guinness record, but it does help to explain my inability to birth him through natural means. I weighed 103 pounds (my body's "ideal" weight) before I became pregnant.

I gained 34 pounds during my pregnancy, and while I had a few weeks of nausea and the weight gain certainly took its toll on my back and tummy, I felt wonderful throughout the nine months. My obstetrician commented on my "picture perfect" pregnancy during my regular visits.

Here comes the PPMD story...

Once out of surgery, I was taken to a small recovery room where two nurses- one for me and one for my baby, tended to paperwork. Every few minutes they would ask for an update on my pain level and my shakiness. Each time I would respond similarly and tell them I was not recovering quickly from the surgery and anesthesia and that I was not yet ready for "visitors"- including my baby.

Thinking back, I can't believe that I didn't muster up some super-human strength to find a way to see the baby I had been yearning for. During the three weeks prior to Lorenzo's birth, already having begun my maternity leave, I had literally swayed for hours in my glider, reading a book of prayers for moms gifted to me by my friend J. and praying that God would bring my baby to me.

I wanted him/her (at the time we did not know the sex for sure, but I knew in my heart he was a boy...) in my arms more than I could fathom and therefore the tears of anticipation flowed often. After his birth, how could I not have wanted to catch a glimpse of this beautiful boy and bring him immediately to my breast as I had planned?

Anticipation is the precursor to anxiety which I realized TOO LATE in life at 32.

Tiffani Lawton: Visitors: I had requested no visitors but they all piled in anyway...I personally, would have preferred that all visitors waiting until I was home and brought me meals, helpful support, etc...but that never seemed to be the case. They all drop like flies once you are home.

Shara: True!

Lauren Hale: Which is of course, when you need them the most!

Amber Koter-Puline: You are so right- people came by at 8am- less than 12 hours after my surgery...I was SO not ready and no one seemed to care...They just wanted to see the baby! I still can't believe I didn't even want to hold my own baby!

Jennifer Mossholder: I got visitors at the hospital and home and no one really did anything but "play" with the babies. I work as a doula, a lot of moms go through that.

Amber Koter-Puline: Other peculiar signs that followed during my hospital stay were the difficulty I had getting in and out of bed or being motivated to walk. Also, when my OB asked if I was ready to go home on Thursday, I wanted in my heart to reply, "No!" but instead, knowing the appropriate answer was "yes" I managed to fake a grin and seem excited by taking my son home. I had been in the hospital since Saturday afternoon and in labor since Friday night.

Lauren Hale: A mom I know actually got her midwife to sign a letter that she then posted on the front door stating that if visitors were coming over they would only be allowed in if they agreed to do certain chores. LOL.

Tiffani Lawton: That should be the case!

Shara: That's a great sign - wish I'd thought of it!

Jennifer Mossholder: Lauren -I tried that! Amber - the nursing staff and I always try very hard to get the new mom to hold the baby.

Amber Koter-Puline: Lauren- what a great idea. For a friend I put a cooler with a photo of the baby in their carport that said- thanks for stopping by!

Tiffani Lawton: We are such experts at donning the masks...that show the world, everything is A- OK when in fact it is not.

Amber Koter-Puline: You would think I would have done anything to return to the solace of my own home, but instead I was scared to death. I didn't want to go home where I couldn't call for room service each time I had a craving or call a nurse when I needed baby advice, help, or just a little rest. I didn't want to be the main caretaker and be responsible for all the decisions I needed to make about every aspect of my son's day.

Lauren Hale: I remember getting home with my first and thinking Um, what have I done?

Amber Koter-Puline: I was already OVERWHELMED with anxiety! I needed the lactation specialist at my fingertips and a nurse who could help to discern the best next steps for things like when the milk was taking too long to come in and my baby needed more than I could provide. If I made those decisions on my own, then I would have to take full responsibility. For the first time in my life, I didn't want to. I didn't want to be in control! I wanted to be told what to do and how to do it and be helped in the process. This should have been the second clue...

Tiffani Lawton: You have my heartfelt empathy...I so identify with these emotions!

Amber Koter-Puline: I struggled after Lorenzo's birth with several physical issues and eventually was also diagnosed with several PPMDs. I have recovered beautifully with the help of a fabulous physician and great friends and family. Through my PPMD, I kept steadfast in my faith and relationship with God and knew that He would use my experience for some good.

Lisa Connor: When I came home with my baby, My husband went back on the road again for work. So I was all alone all week. He was only home on the weekends. I was terrified.

Amber Koter-Puline: Desperate and hopeless. If I had to narrow suffering from a Post Partum Mood Disorder down to two descriptors, I would certainly choose these words. Today I write this entry as a beacon of hope for those who are feeling this way. I hear these words over and over again, and while the daily happenings of my life during the worst days are difficult (thankfully) to fully recover in my memory, those words resonate with me.

I think of it as losing every ounce of zest for life and appreciation for the blessings in it completely. Imagine not having the energy to shower, dress yourself, comb your hair, or brush your teeth. Imagine being convinced that what you are feeling will never, EVER, go away. That you have been given a true life sentence (not the 20 years the federal courts mandate for criminals) but the true life sentence that those who live out their entire lives on Death Row face.

Lisa Connor: I think mine started the last trimester. I went 3 months w/o meds. I kept think it was hormones but It wasn't. I saw the dr. and went on medication. Everything was so much better.

Amber Koter-Puline: I had never been on meds before 6 weeks postpartum...

Lisa Connor: I didn't take meds till after his birth. 3 months after his birth I started the meds. Sorry.

Tiffani Lawton: With the anxiety...so much limited energy goes into the anxiety...that there is no energy left over for showering, dressing, etc

Amber Koter-Puline: Tiffani- you are so on target...the anxiety made me a complete insomniac...then the physical and emotional energy I used being anxious completely wiped me out! My main and initial symptom was heart palpitations. I thought I had a heart condition or that my weight loss of 27 lbs in the first week was the problem.

Shara: Does this usually happen with a FIRST baby? Or any time?

Tiffani Lawton: Shara: no, it can happen with any baby...

Lisa Connor: I know I used to feel like a worthless human being but didn't know why.

Tiffani Lawton: You certainly are chock full of worth, Lisa!!

Lisa Connor: Back then, I felt that way but not anymore. I remember I would cry for no reason at all.

Lauren Hale: Also, it can happen with one child and not another - I had it with my first two but not my third.

Jennifer Mossholder: However, your chance is higher if you have had it with previous pregnancies.

Amber Koter-Puline: I went to the ER and had to have heart medication which meant I couldn't BF for 24 hrs. My son LOVED the bottle he got that day and then wouldn't go back to BF. I had to pump and then bottle feed- 12 hours a day just feeding!

Lauren Hale: Amber - I pumped for my second daughter. It was so hard.

Amber Koter-Puline: I then began to experience insomnia...no sleep after the first night feeding.

Lisa Connor: I didn't produce enough milk no matter what I did.

Amber Koter-Puline: Laying awake worrying about EVERYTHING, esp. when he would wake next.

Lisa Connor: I wanted to sleep all the time.

Amber Koter-Puline: By 5 weeks postpartum I was a MANIAC! I knew I needed help. I called a psychiatrist and made an appt. She put me on Lexapro.

Tiffani Lawton: Thank God you were able to realize that you needed help.

Lauren Hale: I agree - so many moms don't recognize the symptoms and think it will just go away.

Lisa Connor: I couldn't believe I went that long without help-3 months.

Amber Koter-Puline: For two weeks I was on the meds but not feeling any better. I was completely obsessed with every aspect of sleep for me and Lorenzo...even things that seem unrelated! I could not stand how miserable I felt. I wanted to die, but was not willing to commit suicide. Thank God for my faith impacting that!

Jennifer Mossholder: It's called passive suicide.

Shara: Why don't Dr's give paperwork on the symptoms when you go for checkups?

Amber Koter-Puline: OBs are scared to screen b/c they don't know what to do next if a woman screens positive.

Lauren Hale:Precisely. They don't want to be responsible and they don't necessarily know where or to whom to refer.

Shara:They become more responsible by doing nothing.

Tiffani Lawton: Amber, it is also wonderful that you were able to find helpful medical support when you began looking for it.

Nadia Delshad: Was anyone with you helping with Lorenzo?

Lisa Connor: I know what you mean. I never spoke of it or hurt my baby but the feeling of worthlessness was over whelming.

Jennifer Mossholder: They HAVE to put you on a 72 hour hold after a declaration like that.

Amber Koter-Puline: I had a nanny most days beginning at 3 weeks and even with 8 hours of help I would lay in bed and obsess about everything she was doing wrong. In hindsight she was Mary Poppins! But, I NEVER slept and I began to read like 3 books a day- I was totally manic and would try to implement all these sleep regimens...meanwhile I had a dream sleeper!

Tiffani Lawton:A brief word from our sponsor: Join The MOM Team!!! Stay home and earn the money you need! We offer Fantastic Support, Free website and Customized Training. Internet required. www.thesolutionsforyou.com

Tiffani Lawton: So tell us about your father's reaction....what did he know?

Amber Koter-Puline: My father was concerned for my physical health, but more for my emotional. My mother has a history of mental illness and though I was always quite emotionally healthy despite the horrible childhood I had with my single mom, I had the heredity! I think he just knew that my rigid and anxious over planning personality would not be able to be as flexible as you need to be with a newborn!

Tiffani Lawton: Another brick in the foundation....it all stacked up.

Amber Koter-Puline: I would like to address other signs and symptoms and how they manifested through my Postpartum Anxiety Disorder.

Trouble concentrating and remembering things
Difficulties finishing everyday tasks
Trouble making decisions
Difficulty relaxing
Insomnia
Exhaustion
Feelings of extreme uneasiness for prolonged periods of time
Loss of appetite
Possible suicidal thoughts
Anxiety/panic attacks
Muscle tension
Tingling/numbness
Rapid heartbeat
Diarrhea
Dizziness
Anger/rage
Hyperventilating
Immobilizing Guilt
Continuous irritability
Agoraphobia Fear

Tiffani Lawton: Thank you Amber for a wonderful and inviting glimpse at your personal journey. You should definitely consider publishing a book...your writing style is certainly intriguing leaving the reader wanting more! I thank all the guests for joining us. Be sure to check the events section of the PP&B Community for upcoming events at www.PameperedPreggerandBeyond.com If you are interested in being a sponsor, please check out the advertising opportunities in the community. Also, Amber has a teleclass coming up in April. You will find our events listed in the events section at http://www.pamperedpreggerandbeyond.com/events

Amber Koter-Puline: I feel blessed to have been asked to chat! Thanks to all of you for caring about women with children! :)