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Postpartum Anxiety, Insomnia, and Breastfeeding Through Medication

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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 my son’s bris with my hair and makeup done and the ability to smile without grimacing.

So I thought I’d be OK with my second child.

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. I was, once again, completely sure I would never sleep again.

When I got home, things got infinitely worse. Even when I had ample opportunity to sleep while my husband took the baby down- stairs, I lay awake shaking with anxiety. 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 coupled with the fear of having to exclusively formula feed.

I sat 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: both Ambien and Xanax prescription information caution against use while 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 I had to be a functional mother first and foremost, so I began taking a small dose of Klonopin, another anti-anxiety medication with a nursing warning. I also gradually upped my Zoloft to my usual level. I was terrified that nothing would work, but that night, I finally slept soundly while my husband took care of the baby. 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, the Infant Risk Center. The counselors there agreed it should be relatively safe to temporarily take the medications at bed- time 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 fortunately I didn’t experience.

I was so happy to nurse again, even if it was just part-time. Gradually, things continued to improve. After a couple days my husband and the baby started sleeping upstairs again so we could take proper feeding shifts. I lowered my dose of Klonopin and arranged a feeding schedule where formula would fill in when my body was spiked with medication.

It was one of the hardest things I ever went through, but I got through it.

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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