I'm reasonably sure that the person who originally coined the phrase about crying over spilled milk never spent any time hooked up to a breast pump. They probably did not pump for 4 weeks while their premature infant was hooked up to all manner of monitors in a NICU 15 miles down the road. I would also guess that it's safe to assume that the spilled milk was not tinged pink with blood from cracked nipples. There are times when it is perfectly okay - in fact necessary - to cry over spilled milk.

I've been working my way up to this post since I started this blog. There is plenty to say about a lot of aspects of the whole experience - but this is in many ways the hardest part. I can write about the physical issues - the way it feels to not be able to take a full breath for almost a week, the weird sensation of having a PICC line inserted through your arm that snakes all the way to your superior vena cava, the stumbling feeling of trying to walk after spending 6 days in the ICU. That's all fact. It happened. I can look it up in medical records and know that it's true even if I don't know what it all means. It's concrete. It can be recorded. There are ways to measure and assess all of the facts. All of the numbers. There's a scale to tell you how likely you are to fall (the Morse Fall Scale). There are automatic blood pressure cuffs that can take your blood pressure EVERY HALF HOUR all day and night. But there's one thing they can't measure. They try. But they can't. Not even a Catholic hospital with the crucifixes on the wall and the chaplains on call can truly measure the emotional impact of an experience like this.

Following the birth of my first son, I became depressed. I tried to enjoy the little child that I had so wanted. I tried to muster up some energy and enthusiasm to take care of this totally dependent child. I did the necessary things to keep him going. I fed him. I rocked him. I held him while he slept. I took care of his needs but I ceased taking care of my own. I ate, sometimes. I got dressed occasionally. I slept fitfully. Even when he was asleep and my husband was home I couldn't turn off the anxiety. The thought that he was going to wake up and that I was going to have to wake up too kept me from ever really sleeping. I would hear him even when he wasn't crying. My hearing was so tuned in to his cry that it was what I heard - even when I wasn't with him. I couldn't relax. I never felt like I was "off duty." He was my responsibility and that superseded all other needs. I was much better on the days when my husband was home. I could take "time off" and relax. But on the weekdays, I would be "on" for 10 straight hours - often after sleeping for only 2-3 hours the night before. I was exhausted.

When my son was 7 weeks old, my maternal grandmother died unexpectedly as the result of a car wreck. My son's first flight would be back to Ohio for a funeral. It was the Friday before Memorial Day and I had been anticipating a long weekend break. Those plans changed in a hurry. The main thing I remember from the trip was an odd mixture of sadness and relief. The relief was because I wasn't going to be alone. I was going to get a full 5 days of help with my son. My parents would be there. My aunts. My brother and sister-in-law. My cousin and his wife and their 4 week old son. There was sadness, certainly. But there was also family. I would be able to sleep. I would have help.

After we returned to California, things settled back into the pattern. But it was never quite as bad. I had realized that the pain killers that I still had from the c-section also helped with the emotional pain. And while I recognized that this could be dangerous, it also helped me realize that the moods were at least partially chemical in nature. It wasn't ME. It was hormones and brain chemicals. And it wasn't always going to be like this.

Everything about our second child was easier - up until it wasn't. We had entered into a phase of not really not trying. We were ready for a second child and we were just going to let it happen. And it did. Sooner than I thought. The pregnancy was also easier, for the most part, up until it wasn't. So when I woke up in the ICU two days after having given birth in a highly traumatic fashion, I was shocked. It wasn't supposed to be like that. There was nothing about it that fit. I had trouble processing the whole experience. Now as I wander through Google, looking up acronyms I keep finding the same thing showing up in the fine print of all the acronyms. And really, it should come as no surprise that depression is a common result of many severe illnesses. First there's the almost dying part. That takes some adjustment. It can shake you up a little bit. Second, there's the lack of oxygen and other vital processes. Your brain doesn't like having reduced oxygen. It doesn't like seizures. It also really doesn't like some of the drugs that you have to take to keep from having seizures (hello, magnesium sulfate!) Acute Respiratory Distress Syndrome (ARDS) often causes depression. It can also negatively affect your memory (Mommy brain and then some). Preeclampsia and eclampsia can also affect your memory.

And then there's PTSD.  I didn't have that with my first child. But I was certain I was going to have problems with it now. Warning signs? Traumatic incident with threat of death for you or loved one - CHECK! Infant in NICU - CHECK! Previous issues with depression - CHECK!!!! I knew it was coming. I knew I couldn't stop it. I knew that as soon as the help dried up, as soon as I was going to be left alone in my house with an infant - I was going to lose it. Not in a big scary way - but in a small, seemingly controlled way. The isolation would eat me up and I would not be able to function to help myself or my son. Plus this was the same house, the same setting as the day of his birth. Being alone in the house (with a very tiny infant) was going to bring all of that back now, too. My husband had not been blind to the issue with our first son, despite the fact that I tried to hide it. So this time as he readied to go to work and I was set for my first solo day as a mom to a preemie - I didn't let him leave. I asked him to call  my doctor. I asked him to make an appointment because I knew I wasn't going to be able to do it myself. And he did.

All the while, I had been trying to establish a good breastfeeding rapport with my not-so-newborn. We had been apart for a long time. He had been getting pumped milk and was used to a bottle. Latching on did not come easily to him or to me. I pumped when I wasn't feeding him bottles. And I fed him bottles when I wasn't pumping. I tried to stay ahead of his pace, but it was becoming more difficult. So I pumped using a hospital grade pump that one of my husband's coworkers had rented for us (she sent a 20-something male runner - very Hollywood - to pick it up - and I can only imagine how embarrassed he must have been). Breastfeeding is almost sacrosanct these days and with good reason. It is healthier for the baby. It is healthier for the mother. It provides all sorts of benefits and it has very few downsides. Except one.

When I got to my doctor's office, the nurse was ready with a box of kleenex. After all that had happened, I had become a minor celebrity in the office. When I called for an appointment, they got me in immediately. When I arrived the first time after my son's birth, I got hugs from nearly everyone and "that look" - the one that conveys a mix of pity, fear, and perhaps a little awe. I didn't cry - I was with people. That in and of itself made the whole thing easier. I explained the issue - though it hardly seemed to need an explanation. He asked about the previous issues following my first son's birth. He asked about the anxiety and the depression. He wrote out a prescription. He asked about breastfeeding... Oh, uh, yeah, I'm still pumping right now - we haven't really figured it out yet. Well, if you go on this drug, you will need to stop breastfeeding. Now. Immediately.

So, there's that to weigh. Do I suck it up and keep breastfeeding? Do I stop now? Will this even work? Will the added guilt of stopping be cured by the antidepressant? Will the anxiety fade away? Will I be able to sleep? Will I be able to look at a pregnant woman without wanting to stop her and warn her of what can happen? Finally, I weigh it all and decide that I can't go through another round of postpartum depression. I can't allow the PTSD that is threatening to take over. I have to take care of my health now. It is more important that my sons have a functional mother than it is that my younger son get breast milk. It is more important that I take care of myself so that I can take care of them.

The first time I took an antidepressant, I cut it in half as the doctor had advised. I was committing to at least 6 months of this when I agreed to take the prescription. There was no going back. Later that night, I could feel the milk coming back in. It was becoming increasingly painful. I was going to have to pump just to relieve the pressure. I sat down and hooked up the machine, feeling very much like a cow. I pumped and tried not to think of what I was going to have to do with this once I was finished. I knew I was going to have to do this repeatedly until I weaned that damn breast pump. I was going to have to do it until it didn't hurt any longer. Until the milk was gone. This took around two weeks if I remember correctly (which might be off a little, damn memory). And this next step was always, always the hardest part: I would go to the sink and spill the whole bottle down the drain.

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To read first hand accounts of women who have experienced perinatal depression and anxiety, click here.