It’s Time To Talk About Maternal Mental Health, And Be Civilized About It

{Serious Post Alert}

I am not one to pretend I know everything about the way the mind, or the body, or the world for that matter, works. But if there is one thing I know based on factual research, history of our culture, observations in society, and my own, anecdotal experiences, it is this: having a baby seriously fucks you up. It fucks up your body. It fucks up your sleep patterns. It fucks up your life as you knew it. And it fucks up your head.

Sometimes it really really fucks up your head.

So much so that there is an entire array of postpartum mental health disorders that you can find yourself diagnosed with. Postpartum depression. Postpartum psychosis. Postpartum anxiety. I am sure the list goes on.

The question is: why won’t anyone do anything about it?

Shortly *before* I had my third little ball of perfect, I started having major problems with anxiety and panic attacks. I was approximately 8 months pregnant, 34 years old, and all of a sudden I couldn’t handle going to the doctor. I would worry – excessively – in the days that led up to whatever appointment I had. Something was going to be wrong, I just knew it. Then when I got to the office, with absolutely nothing wrong, I would have a full blown panic attack. On several occasions, it rocketed my blood pressure up higher than it has ever been.

If you know anything about pregnancy, you know that high blood pressure is bad news.

It got to the point where my OB started me on a mild sedative to make it through the duration of the pregnancy. It worked, a little. While in the hospital, they gave me something else that was safe in breastfeeding, then sent me home saying that the hormones with breastfeeding would likely fix everything. And if it didn’t, call my primary care physician.

Since then, I have lived in a constant state of anxiety. Constant. Not a day goes by that I am not worrying about things I cannot control, making myself sick to my stomach from the fight-or-flight adrenaline rushing through my body, being angry about things I am not entirely sure anger is an appropriate response to, and having about one full blown panic attack a week.

This has gone on for 21 months now.

At first, I tried to deal with it, patiently but also impatiently (as anxiety has a tendency to draw minutes out into agonizing years). I thought to myself: you know what, I am sure when the breastfeeding gets going, it’ll help like they said.

When I went in for my six week c-section follow up, I mentioned that the anxiety had not gone away, so my doctor gave me the card for a psychologist who specialized in postpartum mental health.

She wasn’t in network for my insurance.

So I called my primary care physician, who – in short – did very little. Six months later, she gave me a prescription for Xanax with the side note that no you really shouldn’t take Xanax while breastfeeding – but she finished breastfeeding at six months, so maybe this would give me the incentive to quit breastfeeding at six months too. Then I could deal with my anxiety.

By taking boatloads of Xanax.

When I said that the World Health Organization recommends a minimum of two years breastfeeding, she said that the AAP only recommended six months to a year. So think about it, here’s the Xanax if you decide to wean.

I changed doctors.

Unfortunately, over the course of the following months, it’s been more of the same. Either a doctor doesn’t support breastfeeding beyond a year, or they don’t support treating a woman with postpartum anxiety, or they don’t support either.

My most recent doctor finally said: you know, there just really aren’t many options, why not give therapy a shot with someone that is in network.

So I went on the search for a local therapist that supports breastfeeding, deals with postpartum anxiety, is in network with my insurance, and is taking new patients.

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Very few that meet all of that criteria exists.

So few, in fact, that it got down to one guy. One fucking guy. He called me back (which most of them didn’t even give me the courtesy of doing), he asked about what insurance I had, went over a little phone interview, then scheduled an appointment.

Here is how the appointment went, in a short list:

  1. {Appointment started 20 minutes late}
  2. “Oh hey – you said you have California Blue Shield? Yeah so…I’m out of network with them now. It’s August now, last week when we spoke it was July so… I’ll take your regular copay for now and then when I get the EOB in 90 days, we can just settle up whatever the difference ends up being for all the appointments. Cool?
  3. “So when do you plan to start weaning so you can take some medication? I just want a timeline to see what we are looking at here? OH you’re letting the baby decide? Huh…
  4. “Alright, if I have this straight, your husband works nights and you are alone with the kids…you say you get about 4 hours of sleep a night? Well you should do something about that, it’s probably making your anxiety worse.
  5. “I think you should consider this workbook about cognitive behavioral therapy…I mean it’s for teens but don’t think that means I think you are stupid. Well you are a stay at home mom HAHAHA, just kidding…it’s just a good workbook.
  6. {Appointment ended 10 minutes early, which – combined with the 20 minutes late, turned an hour into 30 minutes of paperwork and literally just the above comments}

So uncivilized.

I left horrified. And yet still I had scheduled a follow up visit, figuring I would give the guy another chance. I mean…I was at the point where he was literally the only therapist in a 50 mile radius that fit the bill.

But there was still that sticky insurance thing, so I called the insurance company and – long story short – out of network meant my weekly copay to see this pseudo-sexist quack was going to be $57 instead of the in network $10.

That would be $228 instead of $40 a month. An unreasonable difference that – honestly – was out of my copay budget and – frankly – not worth it. I’ll deal with the fucking worrying and upset stomachs for now. My baby – now a toddler – is 21 months old; it is very VERY likely this will begin to subside soon anyway. And if it doesn’t, by that point he will likely wean on his own and I can explore a safer non-narcotic medication approved for anxiety.

So I called the guy to cancel the appointment, explaining – what I thought politely – was that I had called the insurance and the copay was just going to be too high, and here was the TEXT MESSAGE he sent me, within minutes:

“Heather i will take you out of the book for friday. You are PPO fyi, and although you would likely pay some what more, it shouldn’t be exorbitant as you claimed.”

Okay.

At what point are we going to talk about maternal mental health, or mental health in general, and actually make the situation better? Or how about we just address the general lack of healthcare available for anything?

It is terrifying to think that so few doctors in my community want to actually doctor. It is even more terrifying to think that so few doctors in my community seem to be able to put their personal opinions and beliefs aside so they can assume their call of duty as practitioners of whatever specialty they chose.

To be honest with you all: the thought of going back to the drawing board with this therapist situation seems to have straightened my anxious head right up, anyway. Every time I start worrying, I think to myself now: Heather, the last thing you want to do is have to go back to a quack like that jerk that called stay at home moms dumb. Panic: away!

It’s 2018. We should be able to talk about this shit, and for that matter to be civilized about it. Not everyone is so lucky to be able to redirect their thoughts so easily as I seem to have. It is for those people that we need to have this discussion.

 

 

 

 

 

Are We Really Supposed To Believe Angelina Jolie Is A Heroine Or Something?

Yesterday Angelina Jolie announced to the world that she underwent an elective, preventative double mastectomy after learning that she was positive for the BRCA1 gene mutation that greatly increases her risk of breast and ovarian cancer. For being aware and doing what she felt was the right decision for her and her family in the face of heightened risk, I applaud her.

But all over Twitter, Facebook, and the Google News aggregate, people are harrowing her as a 21st century heroine; a pioneer in women’s health and preventative medicine. She is so brave and an inspiration to us all – blah blah blah.

Huh? Are we really supposed to believe Angelina Jolie is a heroine or something?

Jolie decided to undergo a genetic test after careful consideration that she might be at heightened risk because of her mother’s own cancer death. She had the money to spend on a test that many, many women cannot afford, and that very few insurance companies even cover. Why does the fact that Jolie had the money to have this test, and therefore went ahead with it, make her brave? A national heroine? Wealthy women around the country do this test every day. Do they all get to write op-ed pieces about their harrowing experience? Does Twitter make them national legends and pioneers in modern medicine?

Or what about all the women that very likely carry the gene, know they probably carry the gene because of their strong family history of disease, and yet cannot afford to ever know? Do they get hashtag trends like #bravewomenthatwillneverknow or #alwayslivinginfear?

When Jolie found out she was positive for the gene mutation, she decided to have an elective, preventative, double mastectomy, with nipple preservation and complete reconstructive surgery. In other words: another pile of procedures that are expensive and usually not covered by the vast majority of American health insurance policies. So basically, up to this point, all Jolie has done is opt to have a number of medical tests and procedures done that are reserved for the wealthiest and most elite members of society. She has opted for luxuries when it comes to her medical care, which many women in this country have absolutely no access or ability to afford.

How is Angelina Jolie a heroine and pioneer in women’s health again?

Many doctors do not even recommend prophylactic mastectomy in the event that a woman has a heightened risk with the BRCA1 and BRCA2 gene mutations. There are a number of preventative hormone treatment options available, increased preventative testing, and lumpectomy options that are much less invasive and expensive. Why this is worth mentioning is in the discussion over our country’s current trend towards going to extreme lengths to eliminate risk (which can never truly be eliminated entirely). And in understanding the drastic difference between risk factor and cause – as Americans, we tend to misunderstand that risk does not equal certainty or causality.

But as a culture obsessed with trying to cheat death, we tend to heighten risk into the most extreme measures possible to the point that we do more damage than good. People are so afraid of the extremely rare risks of vaccines, so they avoid them altogether and then die of polio. Families are fearful of GMOs and processed foods, so eat only whole foods and fats then die of heart disease from ingesting high fat foods for years on end. And we look to national figures, such as Jolie, for guidance on what we should do. How we should think. Even when we don’t have the same resources that they do.

Each woman’s health is a different matter entirely, though. As is her financial status, and the risks and health issues that she will face. I am not suggesting that Jolie or anyone should or shouldn’t do any particular thing relative to her own health. That is not what I’m saying here. What I am saying is that none is more special of a circumstance than the next. We are all the same in the playing field of life. We just have different stories.

I have always believed that the only real preventative medicine we should be engaging in is accepting the imminence of our own deaths and enjoying every minute of our lives, rather than spending them all cowering in fear of what may come. Or at the very least, let’s worry about things that are really important right now. Not saying breast cancer risk is unimportant or should be forgotten, but much worse by the dozen is heart disease risk, obesity, diabetes, war, famine, the threat of nuclear holocaust, global warming.

Congratulations to Angelina Jolie on her new, risk-free boobs. Now can we all shut up and move on already?

Things I Have Learned In the Last Week

I suppose you most faithful of blog followers may have noticed I was relatively silent this last week or so. This was because on Monday of last week we entered what I will officially term Hip Hell 2013. My dad was in the final few days before his total hip replacement and he fell outside a gas station, where the attendant just stood there and refused to help him get up. From there it was a downhill spiral of bad, bad and more bad – from dealing with how he felt after the fall, to getting him into the hospital for his operation, to getting him well enough to leave the worst hospital on the planet – until finally my dad came home today.

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In the last week I have learned a lot. In fact, I’ve probably learned more than in my entire time in graduate school – practical things, that you never would learn in a book or a lecture. And things about myself. Here they are, in no particular order:

1. My community really is full of assholes. I mean, you see an older man fall, you should probably help him. You never know what could have happened, and just ignoring him makes you a jerk. The number of people that ignored my dad when he tripped and fell at the gas station last Monday astounds me. I hope all of them rot in hell for being such assholes.

2. When leaving someone in pre-op to move on to their operation, with their wallet and house keys in your hand, saying something like “don’t worry, I’m going to max out your credit cards and spend all your cash” may actually – legitimately – raise their blood pressure instantly.

3. Sometimes when you tell a hospital you are allergic to a certain medication, they will still give you that medication anyway.

4. Medicare is a farse. Social workers that are assigned to assess what should and should not be covered for a patient on Medicare are even more of a farse.

5. Very few people that work in hospitals know what the shit is going on.

6. Hospitals are becoming meat factories: slice ’em, dice ’em, get ’em on the shelf and out of your hospital bed.

7. If you ever have to stay on the orthopedic floor of a hospital, expect to find some crazies. I was lucky on this note when I had my back surgery – I was only 13, so went to the children’s hospital. There were no crazies there (at least that I was aware of). When you’re an adult, you’ve got a much different set of bozos rooming with you.

8. On the orthopedic floor of the hospital for adults, it is not uncommon to hear someone screaming in the hallway at 2 o’clock in the morning that he/she is going to call the police. It often winds up being a man named Earl (wonder if it’s always the same guy?).

9. I am a Daddy’s Girl. I can’t take it when my dad is away from me for more than a couple days.

10. I am a Daddy’s Girl. My dad calls me a lot. The day of his surgery, he called me twenty-five times in the six hours after getting to his room.

11. I am a Daddy’s Girl. When confronted with the possibility that my dad might be going to an inpatient rehabilitation facility (instead of coming home), I cried for three hours. Straight.

12. I am a Daddy’s Girl. I always get my way (my dad came home straight from the hospital, and today, like I wanted).

13. When wanting to make sure a person doesn’t fall, for whatever reason, it’s as simple as strapping a regular pants-belt around their stomach so you can grab them. Works like a charm.

14. Walkers are the shit. I want one for myself. They’ve got these rad fucking baskets you can attach to them, so you never have to carry anything ever again.

15. If you are nauseous because you haven’t eaten in four or five days (nervousness and shitty hospital food), all you have to do is pork down a bag of popcorn and a package of Twizzlers and you feel like a million bucks again. Throw in a bowl of Rice Krispies and a baggie of dry Cheerios and you really feel good again.

16. They make these really cool toilet toppers for adults. As a mom, I thought they only made potty toppers for kids – you know, when they’re potty training? They have pictures of Dora or Thomas the Train on them, so your kid thinks going to the bathroom in the toilet is as exciting as watching TV. Well the adult ones don’t, but they are just as awesome – they actually raise the toilet up high enough so you barely have to get into a sitting position to use the pot.

17. Staying with a family member to help them after an operation really does feel sort of like a vacation. Even when medications and running errands for them is involved.

18. My dad walks really fast. I had forgotten this – it’s been about two or three years since he has slowed down considerably because of his hip problem. That’s how long it was prolonged, and now that he has a new hip he’s already ready to go. I like to refer to his walking pace as “rapid with a hint of rage.”

19. I am the source of my dad’s optimism. When we’re apart, he gets gloomy. But when I tell him everything’s going to work out great, he gets up, walks around, does his physical therapy, and says “fuck yeah – let’s do this.”

20. Did I mention I am a Daddy’s Girl? Yeah, big lesson on that for me this last week. I’m so happy my dad is home and I can get him back in top form. Thanks to everyone – friends, family, and bloggies – that have sent love and encouragement. Keep it coming!!