Monday, February 8, 2021

Postpartum depression during a pandemic


Here’s what having two kids feels like, for me, a lot of the time right now - it feels like failing, over and over again. It feels like never being enough for anyone, no matter what I do. It feels like wanting to kick something, throw something, break something, leave the house and never come back. It feels like needing to yell “fuuuuck” at the top of my lungs but holding it in because even when I hate my life I love my kids and I don’t want to scare them. It feels like my ears echoing with sound all the time - straining to hear my toddler talking over the sound of the infant crying, three different sound machines running all night until I start to think they are driving me insane, like I’m hearing things in the white noise.

I wrote those words back in August, when I was still struggling to accept that I was experiencing postpartum depression. I touched on this in my sleep training post, but I've been wanting to write a bit more about my experience with PPD after Ian's birth. One of my big fears about having a child was the risk of postpartum depression. I've experienced both clinical depression and anxiety in the past, which I knew put me at higher risk. After my first birth I actively made a plan for myself in the hopes of lessening my chances, and I was lucky and didn't experience any PPD/PPA symptoms, which was a huge relief. I did end up regretting my decision to take so little maternity leave, and I wished I'd had more time to just enjoy her and relax, but the stress I experienced was pretty run of the mill working + parenting stuff.

For my second (and last) pregnancy, I planned to do things differently. I researched my maternity leave options in much more depth. I decided I was going to take off two weeks before my due date and just sleep, get a pedicure and a massage, see friends, cook some freezer meals - basically have a luxurious vacation while Adrian was in daycare and try to set myself up as best I could for the newborn exhaustion. I was going to take a full 12 weeks off after the birth and then work part time for a couple months to ease back in. Knowing this was my last baby, knowing I would be stretched thinner with toddler care, I wanted to fully enjoy that small window of time. 

And then there was a global pandemic. Our daycare shut down in mid-March, and I spent a month working full time from home, scrambling to adapt to an online environment, while caring for a toddler full time, while 8 months pregnant. Dustin and I were both doing everything we could and it wasn't enough. I cried every day, I stayed up at night trying to catch up on work, I had panicked phone calls with my OB trying to stay on top of all the changing hospital regulations around my birth. I still took off two weeks before the due date, but wrangling a toddler full time is not exactly what I would call relaxing or luxurious. And there was the constant pandemic stress. The worries about what would happen if I tested positive for COVID when I was admitted, because at that time they were recommending taking the baby away for two weeks, the stress of how to get milk for Adrian, which sounds so ridiculous and mundane but ended up being a weekly source of anxiety as we tried to stay super isolated the month before the birth, the guilt about being away from her for any length of time, when her world had suddenly been reduced down to just the three of us, the uncertainty of how to plan for childcare when it become clear that daycare would still be closed when I gave birth. 

I hated myself for being pregnant, I desperately wanted to be able to narrow my focus and just take care of her. I was terrified of going to the hospital, scared I’d get sick, that I wouldn’t be able to come home or that I would come home and then get us all sick. I just wanted to not do it.

I tried to come to grips with the situation and I made plans as best I could, I even managed to rally some optimism and a semblance of peace in the days before my scheduled c-section. But then I went into labor early and the birth experience was traumatic and when we came home nothing felt the way I'd expected.

 I hoped that when he arrived I’d be struck by instant blinding love, but I was so traumatized by the birth and so exhausted that I struggled. I loved him, but the feeling would come and go, and I had so little time to appreciate him. He spit up, constantly. I was changing my shirt six times a day. I had to bulk order bras just to keep up. My attention was pulled in two directions constantly. My whole plan for this time period had hinged on Adrian being in daycare. She would have a safe, unchanged space where she could go every day and get her energy out. I would rest and focus on Ian during the day and then be able to give her quality time in the mornings and evenings. Instead we were all together 24/7 without any of our usual weekend activities - no parks, no museums, no play dates.

 I didn't feel that magical heart expanding love that people talk about. A lot of the time I felt more like his babysitter than his parent, and there wasn't ever time to focus on him or soak him in the way I had with Adrian. I was still having nightmares and intrusive flashbacks to the birth, and at my six week follow up my OB referred me to therapy, suspecting both PTSD and PPD. But how would you even know if you have PPD in a global pandemic? Isn’t everyone depressed right now?

My plan to work part time for a few months had been based on the idea that I would just be keeping things on track at work over the summer, but the pandemic meant that instead I was reinventing the wheel every week. It was impossible to stick to a part time schedule. We sent Adrian back to daycare in June, after a lot of anxious waffling, but the hours were reduced a bit to allow staff more time to clean, so we had less than eight hours a day toddler free, and we were both working full time with an infant (who refused to EVER nap in his crib). Unsurprisingly, these circumstances didn't facilitate bonding.

We were already on fairly rocky footing when Ian started going through the usual sleep regressions. I could feel whatever tiny reserves I had evaporate. I could hold it together during the day, mostly. But at night I fell apart. Adrian would fight her bedtime or Ian would throw up on me right after I’d showered and the rage I felt was all out of proportion. I wanted to cry or scream or quit. My anxiety would ramp up as evening approached, as I anticipated yet another sleepless night. At 3am frantically pacing the living room and attempting to get Ian to stop crying, hoping he wouldn't wake the toddler or the neighbors, I hated him with an intensity that took my breath away and made me grit my teeth. I wanted to throw him across the room. I wanted to run out of the house and drive away and never come back. I couldn't see a way out, and I hated my life. As the weeks went by I alternated between rage and numbness. It wasn't exactly unrelenting - sometimes we'd have a decent stretch of sleep and the next day I would feel more like myself, but those days felt fewer and further between. We ended up putting Ian into daycare in October as originally planned, despite my reservations. It didn't feel like we had much of a choice, as my work was about to ramp up significantly and we were barely surviving as it was.

I was speaking to a therapist on the phone semi-regularly, but in a lot of ways it made me feel worse. We'd talk about strategies and she'd urge me to try to figure out what I could take off my plate. But in 2020, a lot of the solutions you might use in normal times felt impossible. We couldn't even have someone come over and hold the baby for a bit and the repeated suggestions that I "remember to make time for myself" only made me more angry. I felt like I was failing at being a mother and failing at therapy, because I could never manage to follow through on even the simplest suggested actions, like taking time to call a friend or getting outside for a walk. They sent me the link to a virtual postpartum support group multiple times and I never even opened it. The unread mail sat there like a silent rebuke every time I opened up the app. I had gone to a breastfeeding support group after Adrian was born and I remembered discussing struggles with bottle acceptance and tummy time strategies and debating the merits of different carriers. How could I go to a bunch of moms I'd never met and tell them that I hated my baby and I wished I weren't a mother? How could I explain that I was sometimes so angry that I had to step outside of our apartment because otherwise I might scream at my toddler? 

At my lowest point I started wondering if it was possible to give Ian away, convinced that he deserved a better parent. I was afraid to even tell my therapist how deeply broken I felt, because my depression brain was convinced they'd separate me from my family. And here's the shittiest part - the thought of being away from my children didn't even sound that bad in the moment, but I was overwhelmed with guilt at the thought of leaving Dustin stranded alone in this situation. We were barely surviving with both of us doing everything we could, and I couldn't imagine how one person could handle it alone. So I pushed on, doing my best at going through the motions of daily life, feeling increasingly disconnected from the world around me.

The therapist gently suggested medication, and I kept refusing. I'm still not sure where my reluctance came from, other than my strong belief that most of my rage stemmed from exhaustion. I think it's also possible that my resistance was simply a symptom of my depression - I felt so hopeless and I didn't feel like I deserved the help, since I was failing at doing anything to help myself. It's hard to explain this feeling but it was something like "Look, you can't even get it together to take a fucking walk or do the sleep training, so why do you deserve medication?"

I want to be perfectly clear here - this is not my actual stance on medication! I am strongly in support of medication, or whatever other interventions can help. I've taken meds for depression/anxiety for a few years at a time twice in my life, and I know they can be life changing. I look back on this experience and wonder if/how things would have been different if I'd accepted help sooner, if I'd truly explored all my options. And I feel guilt about that. I wish I had put a plan in place before birth, maybe had a defined cut off point where I told myself that I would do xyz (sleep train, take medication, etc) even if my depression brain was telling me it wouldn't make a difference or I didn't deserve it. I wish I hadn't let myself get so deep into it that I couldn't see a way out.

As I wrote in the sleep training post, I was also resistant to starting sleep training, even though it had always been our plan, even though I wanted to believe that getting more sleep would help me. I couldn't really visualize my life improving, and I was so terrified that sleep training wouldn't work. I finally agreed to do it after a particularly bad evening, when I was going on three days with almost no sleep and it was my turn to put Adrian to bed. She was playing around and being mildly uncooperative and I was so tired I could feel myself losing it. I forced her into her pajamas as she became increasingly angry and then I just roughly dumped her into her crib, turned out the lights and left the room while she screamed frantically for me, confused and scared. I felt trapped inside my body and the need to escape was so strong that I ran out of the house, down the street, away from her cries. Every part of me was vibrating with anxiety and frustration. But there was nowhere to go. I couldn't even go for a real walk because I'd hadn't grabbed my mask. So I turned around and came back, and listened to Dustin soothing Adrian and getting her settled. I thought about how I didn't recognize myself anymore, and now I was losing the ability to even keep a veneer of functionality intact. When he came out I cried and said yes, let's do the sleep training. 

The process was hard, but I was amazed by how different I felt after even a few nights of sleep. The fog started to rise, and even though life with a baby and a toddler in 2020 was still not ideal, I was able to start seeing moments of joy and brightness. The sleep helped put me on the right path, and the kids also moved towards an easier age. Over the winter break I looked over and noticed that both kids were playing independently for a few minutes, while I sat on the couch and drank some tea. It felt huge, and I could suddenly imagine a time in the near future when life would seem more manageable. Two weeks after we started sleep training my depression index score was so drastically different that my therapist initially thought it was an error in the system. 

To be clear, we are still in year one with two small kids. I'm still tired a lot of the time, I'm still sick of being isolated, I still feel stretched thin. But the difference is that I feel like myself feeling all those things, and I can clearly visualize our life gradually continuing to get better. I feel hopeful again, most days. And I can see Ian for the first time, it feels like. The exact shape of his smile is finally imprinted on my brain, I can take delight in the rolls on his thighs. I still sometimes think about our pre-pandemic decision to have a second baby, and I can imagine how much simpler our life would be right now with just one kid, but I don't regret the fact of Ian anymore, and I'm looking forward to seeing how his little personality, already so distinct, develops over time. 

I'm still very vulnerable to PPD and it can come in waves. In fact, last week, after I'd written the first draft of this post, we had a rough few days where Ian was getting four teeth at once and Adrian had a couple 3am wake ups, and I could feel myself spiraling down again. The fact is that I'm living right on the edge of enough these days, in terms of sleep and time and energy. I'm trying to build in little bits of joy for myself - a quick walk outside at lunch, a cup of tea on the couch after they go to bed, a shower where I've actually taken the time to put away the bath toys first so I'm not stepping on plastic buckets while being serenaded by baby shark (possibly the best/worst bath toy of all time). I'm hoping that these moments will be enough to shore me up. This is what I can do right now.

As I've started to recover, I'm also able to grieve the new baby experience I had imagined for myself. I feel guilty that I didn't learn to love Ian until he was nearly 8 months old, that I don't have many sweet memories of snuggling him when he was tiny. I have to let that guilt go. Ian is fine, he is loved. I feel the pain of those first months deeply, and it is a real loss, but when Ian sees me he reaches out his arms for me. Despite being deeply imperfect, I am still his home. We survived and we'll keep surviving.

Tuesday, January 12, 2021

Sleep training, again

I always like to start baby sleep discussion with a HUGE disclaimer - all babies are different and all families are different. You should be doing what works for you (baby + family). If what you are doing is working FOR YOU then why would you change? I'm a huge fan of sleep training because it saved my life, but I don’t believe everyone needs to sleep train. Some kids are good at sleeping, some parents are more able/willing to live with less sleep, etc. We sleep trained Adrian around 9 months using the Happy Sleeper method, and it was the best thing we did for our family. I swore that if we had a second baby I wouldn’t wait until I was desperate.

Then we actually had a second baby ...

Ian had pretty normal sleep, for a newborn. We knew a little more this time around, and we purchased the Taking Cara Babies newborn course, and he actually did better than Adrian had initially. But a four hour stretch doesn’t go quite as far when you’re chasing a toddler around all day and can’t ever take a nap or even just veg out on the couch. We broke down and bought a used Snoo at 6 weeks, and it did help but as he went through the normal ups and downs, and the four month regression, we were getting progressively more sleep deprived, and I was falling apart. We have a two bedroom apartment, so Ian shares a room with us and I swear he could smell me. He started waking up every time I would creep into the room or when I'd roll over in bed.

I’ll probably get into this more at some point in the future, but the first several months of Ian’s life were incredibly difficult for me. I had given birth, alone, during a pandemic. We were isolated, trying to care for a toddler and a newborn without any of the social outlets or help we had planned for. I don’t know if it was circumstances or just the luck of the draw, but I was hit hard by postpartum depression. I was trying so hard to be a good mom, a functional partner, a productive employee, and I was just white knuckling it through each day. I felt like I was watching my soul walk away from me down a long hallway, like I was dematerializing, like I might suddenly just dissolve in a puff of air. I cycled between rage and apathy and guilt, but the constant was regret. I regretted this baby. I resented the fact that I wasn’t even able to enjoy my toddler, who used to be the light of my life. All I wanted was to be alone, in a huge white bed, where I could sleep and no one would bother me. The thought of it consumed me.

We had said we would sleep train at 6 months, and Dustin was ready but I was so tired that I wasn’t sure I could do it. And there was this strange barrier for me - sleep training was my one hope. I kept telling myself that if I could just get some regular sleep that I would be myself again. I held onto that idea so tightly and it helped me keep going. But it also held me back because I was so afraid that sleep training would fail, and then I would have nothing, not even hope. I was convinced that if sleep training didn’t work my life would be over.

I was speaking to a therapist for my PPD and we talked about how this was ridiculous (not her words) thinking. Because if the specific method of sleep training didn’t work, we would try something else - a different method, a sleep coach, something. We would not just give up and accept never sleeping again. I knew this, but I still delayed.

By 7 months it was clear even to me that we had no choice because I’d hit a pretty brutal breaking point. In order to give me enough rest to get through the process, Dustin slept in the bedroom with Ian for a few days while I slept on the couch (something he'd been begging me to do for the last month but I'd felt too guilty to actually do it). I felt so much better after just a couple nights of rest that I knew this was the right decision for us. 

We share a bedroom with Ian, and will until it feels like he's sleeping well enough to move in with Adrian, so we set up a little bit of separation by finding the narrowest mini crib we could (the Bloom Alma Mini) and fitting it into our smallish closet. I hung a blackout curtain in the closet doorway, so that we can keep it dark for him. We have a portable noise machine under his crib. We had stopped swaddling when we moved him out of the Snoo, and now he uses a regular sleep sack. During the initial sleep training process we slept in the living room for two weeks, so that we wouldn't risk disturbing him.

We decided to go with the same method we used for Adrian, following The Happy Sleeper book. It's a modified Ferber method, which means you do let your baby cry but you do timed checks to reassure them that they aren't alone. We had already introduced a consistent night time routine, so it was really just a matter of accepting the crying. Ian is very vocal, and very stubborn, so I was dreading this. When we sleep trained Adrian she cried for a little over an hour for a full week and I didn't know how we could do it again.

Well, Ian cried for over three hours at a stretch, and then woke up and cried again later the first night. I was in agony, in a very physical way, just listening to it. I wanted to crawl out of my skin, I wanted to quit. But what was I going to do? I was a shell of a person, I still hadn't managed to bond with my baby, I needed to sleep. So we kept going. We stayed committed to the method, we stuck with the timed checks and the scripts. He cried for two hours the second night. Then on the third night, we laid him down and he babbled to himself for 10 minutes and then fell asleep and slept through the night without crying. And every night since then he's gone happily to bed. After the first two weeks we moved back into the bedroom and it's been fine, although I do think that we probably wake up more often than we would otherwise, because I'm aware of even his small wake ups where he rolls around for a few minutes and goes right back to sleep.

The difference I felt was immediate. I actually had a follow up appointment with my therapist two weeks after we started sleep training and she always has me fill out a depression index survey, and the improvement was so huge that she thought there was an error in the system. Nope. It turns out that yes, massive sleep deprivation will absolutely make it hard for you to function. We are coming up on two months now and I feel like myself again in so many ways, and I've been able to bond with Ian. At night I can enjoy reading him a book and feeding him, knowing that he'll go to sleep and I'll have an hour or two to clean up the house or relax or (gasp) watch an episode of something. In the morning I'm excited to get him out of his crib and I appreciate his toothy grin so much more.

This isn't to say that he never wakes up! He's still a baby, he still wakes up, we are still tired a lot of the time. When he's popping a new tooth he'll need extra snuggles and help sleeping. If he's going through a developmental spurt he'll have trouble with waking up at night. We feel pretty confident handling those situations at this point, and I just trust my gut for the most part when deciding whether to let him handle it or to step in. He got sick over winter break (did you know that the roseola virus lies dormant in your body and you can periodically shed it and infect your baby and send yourself into a tailspin about how your baby could possibly be sick when you didn't even see family for the holidays?) and we did a lot of rocking and holding and comforting for a few nights. 

We had originally planned to drop all night feedings because his weight gain was good and he was drinking so much milk at daycare. That worked well for a couple weeks but recently we noticed that he was struggling with waking up around 3-4 am and having trouble going back to sleep. We tried watching his daytime wake windows, making sure his naps were the right length, etc. After a couple weeks we decided that maybe it was an indicator that he wasn't really ready to drop all night feeds. This might be because his solid food intake has ramped up and he's less willing to drink milk during the day. So for now we are back to one night feed if he wakes up around 3am. We'll adjust that when it seems like the right time for us. Adrian still did a night feed most nights until 17 months, when she gradually dropped it on her own. You can absolutely sleep train even if you don't want to night wean. 

Managing two kid's sleep schedules is still much more exhausting than one, but I am so grateful that they both have a solid sleep foundation. The weird upside to the pandemic for us is that we're both at home for evening routine, which was never the case in the past because we worked offset schedules. So for now we get to handle bedtime by alternating nights, with one of us putting Ian down around 7pm and the other one putting Adrian down around 7:30/8pm. Whoever puts Ian down comes out and handles the dishes/tidying, so by 8pm we generally have a fairly clean slate for the next day. 

Sleep training does not necessarily give you a kid who sleeps 12 hours a night without fail. I don't think that either of our kids is a naturally good sleeper. Even at nearly three years old, Adrian still has phases where she struggles with being awake for a few hours in the middle of the night. But because she has that solid foundation and feels comfortable putting herself to sleep she gets through most of it on her own. I will sometimes turn on the monitor at night and catch her rolling around, looking at a book, or playing with her stuffed animals. We leave her to it unless she calls out for us but if she needs us we'll come in and take her to the bathroom or offer some milk or just give her a hug and remind her that it's still night time. 

Big sleep transitions we'll be looking at in the coming year - moving Adrian to a toddler bed (insert scream emoji, I am not mentally prepared for this), moving the kids in together and getting them on a single bedtime routine. I'm not looking forward to these things, although I will really enjoy not having to creep into my room in the dark every night. But I feel confident that we'll somehow get through it, because I know that the kids are capable of sleeping independently most of the time.

Do I still sometimes dream about getting to sleep/read/sleep without interruption for a full weekend? Absolutely. But for now I'll take this.