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Fertile World Problems

17 Jul

So today I saw my psychiatrist for the first time since going on bed rest. I made the appointment now in order to get things squared away in case I have to deal with postpartum depression (PPD), which I’m at VERY high risk for. I wanted to make sure that in case of a med switch, we had plenty of time to pull it off.

I left the appointment practically in tears.

So here’s the deal:

I’ve been on a drug called zy.prexa for the last 4 months. It was a good interim solution because it can handle high-anxiety situations as well as curb depression. Though it’s not usually prescribed for depression and anxiety, it’s known to work for people who are SSRI-resistant (or in other words people who the usual happy pills don’t work on – like me).

So I walk into the shrink’s office and pretty much the first thing I tell him is that I have GD. Immediately he says that it could very well have been caused by the zy.prexa. I knew that weight gain was a side effect (knew that all too well, thank-you-very-much), but I had no idea it could affect my blood sugar. He told me that he wanted me to stop the pill immediately, and manage through the rest of the pregnancy with the occasional xan.ax (ok during the third trimester as long as I don’t take any after week 38), and that’s it. The zy.prexa has too much potential to do harm.

He also said that he would recommend I never take the pill again because he’s afraid of the long-term risks for my health, and that it may cause diabetes for me in the long run if I continue to take it.

I have to say I was a bit relieved. I don’t regret taking the pill – it helped me keep my shit together, and if GD is a side effect of that, so be it, but I’m glad to know that there’s a chance my blood sugar will even out more now that I’m going off the pill. And there’s no way of knowing if the pill caused the GD or is just not helping a set situation. Either way I can see an upside to both having been on it, and now going off of it.

Then came the bombshell:

Shrink: “So after you give birth, I want you to breastfeed for a week, then we’ll put you back on a low dose of cym.balta”.

Me: “Ok… Wait… What do you mean breastfeed for a week?”

Shrink: “There’s not enough research out there about cym.balta. You shouldn’t breastfeed while you’re on it.”

Me: “WHAT?”

There was a continual back-and-forth about this but basically the conclusion is this:

I can wait it out to see if PPD hits before I start taking the pill (about three weeks after giving birth), but if I do get PPD, I have no choice but to stop breastfeeding immediately because I would never risk it with cym.balta in my system. I can’t get another pill because me and SSRI’s (zo.loft, pa.xil and the like) are NOT friends at all, and zy.prexa is too big of a risk, so I’m stuck with this one form of happy pill, and I can’t do anything about it.

The fact is that there’s a pretty decent chance I’ll get PPD. I have practically every risk factor in the book between my losses and my history of depression. And if I get PPD, of course it needs to be treated, which means I won’t be able to breastfeed. So now here’s yet another thing taken away from me, and I fucking hate it.

Look – I joked that if breastfeeding doesn’t come easily to me I’ll happily use cym.balta as an excuse to stop. But I have a feeling that may not be the case. What if I love it? How can I give it up if it comes naturally to me and B5?

When I called Shmerson and told him the verdict he pointed out that these are first world problems. That six months ago I would have killed to be in a discussion about the risks of breastfeeding while on SNRI’s.

And he’s right, but right now it doesn’t make this hurt any less.

All I can do now is hope that by some miracle I don’t get PPD. But realistically I know that chances of that are close to nil.

So yes, this is a “fertile world problem”. But that doesn’t mean I’m not going to cry my eyes out over it. So excuse me while I go do that.

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43 Responses to “Fertile World Problems”

  1. Amy July 17, 2013 at 19:07 #

    Oh wow. I can see how it’s a good idea, completely necessary even, to have a plan in place to deal with PPD should it happen, given the risk factors you already mentioned having, but this is a fucking blow to be dealt right now, too. I don’t know if one week is long enough to determine if PPD is creeping in or not, but it’s probably not long enough for you to get over the hump with breastfeeding, in all reality. At least in my experience, the first couple of weeks are pretty hard, even if it’s actually going well, and the way I approached it was to make tiny goals (tinier ones would work, too): stick with it for two weeks, then if I can recommit, go for two months, etc. I hope that you will be able to bargain for more time IF things seem to be going okay on the mental health front, and that your psych will be willing to negotiate based on how you are actually doing at the time rather than try to make you conform to this sort of arbitrary timeline that is being laid out before you have even had a chance to try!

    All that being said, I know you already know that your oxygen mask has to go on first, and if the cym.balta is what will help you keep breathing and taking deep breaths when needed, then I hope you will be fully supported in taking it and doing whatever needs to be done to help you adjust to your new role as Mama. I have zero to say about breast being best or whatnot, because that’s not at all the point (we’ve supplemented with formula for months now, and I HATE that I ever felt at all guilty about it – makes no rational sense, but it’s hard to avoid the stupid mommy guilt) – but if Israel has milk banks or sharing programs you may want to look into that just as a way to feel a bit better about your planned alternatives if they’re needed. I have heard good things about Human Milk 4 Human Babies (though the 4 for “for” in their name makes me twitch), but I want to again emphasize that the only things that matter are your own well-being and that B5 will be fed one way or the other, and it doesn’t really matter how. So much love to you, Mo – I hope your cry is a very cathartic one. Just because you’ve spent too long having Infertile World problems doesn’t mean that dealing with Fertile World ones aren’t just as painful at times, so I hope you don’t feel badly for being upset by this.. Big, big hugs….

  2. missohkay July 17, 2013 at 19:15 #

    Ugh, so complicated. I’m sorry that yet another part of parenthood has become a crap-shoot. And yes, the Z drug has been hit with diabetes lawsuits in the US. Used to be in the news a lot. Thinking of you and sending replacement happy-pill vibes 🙂

  3. pjsarecomfyn July 17, 2013 at 19:16 #

    What are your thoughts about placenta encapsulation? I am not sure if that is an option. If the hospital will give it to you, so you can take it to someone who will encapsulate it for you, but I remember reading a lot of info on studies about how ingesting your placenta can help you deal with PPD. I wasn’t really sure that I would get PPD or not get it, but there were lots of other things I read about the benefits of having the capsuls to help deal with low milk supply, anemia after birth, fluctuating hormones going back to work, etc. It just seemed like something I should have on-hand. So I had it encapsulated. And the week before I went back to work I started taking them and continued for a couple of weeks after.

    I don’t use them very often, but when I feel rundown or the like I will pop one to help out. Just a thought on maybe something you could do and take right away to maybe reduce effects of PPD….again obviously no full-on guarantee, but for the $70 or whatever I paid to have it dehydrated and encapsulated, it could be worth it.

    Just a thought. No matter what happens though, it will all be okay. Whether you only breastfeed for a week, or whether you never get PPD and can continue on your BFing path, everything will be fine!

    • thecornfedfeminist July 17, 2013 at 19:27 #

      I was going to suggest the placenta encapsulation as well. It couldn’t hurt!

    • melissa July 18, 2013 at 04:37 #

      I was at high risk of PPD, and despite being a total skeptic about most things, I had my placenta encapsulated. I’ll never know if it did anything, but I do know that I took the pills and I did not have PPD.

  4. Heather July 17, 2013 at 20:12 #

    I’m so sorry, Mo. Breast feeding is so important, but you’d rather be safe than sorry. You really have been through a lot. The is just another hurdle.

  5. nelipotting July 17, 2013 at 20:16 #

    Well that just sucks the big one! Sheesh. I found out the hard way that I don’t actually make any milk… okay like 2 ounces in a 48 hour period if I’m on the max dose of lactation meds, but still… basically I don’t make any. And I have had an entire grieving process over it. People think I’m crazy, but I don’t even feel like a “real woman.” I can’t get pregnant. I can’t stay pregnant, and spend several months on bed rest. Once I miraculously make it to term, I have to have a C-section or I can’t get the baby out. Once the baby is here, I can’t feed it. Like the whole thing is just so messed up. My husband’s response to that particular breakdown was similar to what your husband said… “they used to have a name for women like you” I braced to hear something awful like “barren” but instead he just said “dead. You never would’ve survived any of this, even just a few years ago. I’m glad you’re just still alive to be the mother.” Which was sweet and true… and completely NOT helpful! LOL. It is real pain and real grieving when you think of losing ANOTHER slice of your concept of womanhood/motherhood. I hope you don’t have to end up stopping bf for ppd, but even if it happens, my only real advice is this…. Let yourself have time and space to grieve for that loss. It is okay to grieve for it. It is a huge thing to lose. Let it out, let it go, and mix that formula with vengeance and hatred. LOL. Good luck! I hope your gd gets better now, and I really hope you don’t end up with ppd. Best of luck and keep us posted! 🙂

  6. SRB July 17, 2013 at 21:07 #

    Well shit. I took celexa for PPD while breastfeeding, but that doesn’t help you. Fuck. I hope, more than I’ve ever hoped, that you don’t get hit with PPD and breastfeeding is fucking awesome for you two ladies. But girl, I’ve been there. And I want you to know that I am always, always, always here to listen to all your deepest and darkest. You know how to get me, day or night. Day or night. I think your night is my day, so it works out – and is also a metaphor. Love you.

  7. Kathryn July 17, 2013 at 21:23 #

    goodness. you just cant get a break! untreated ppd is definitely worse on your baby than not breastfeeding (you clearly know this). my baby blues fortunately did not turn into ppd (have hx of depression too).. but I sobbed multiple times a day for the first 3 weeks. I was a wreck despite the fact that I had family over every single day to help me.. sometimes all day. breastfeeding hurt like a mofo for 4 weeks. I would cuss and sob every feeding but now its easy. and I feel better too. its just so hard to diagnose ppd bc the first few weeks are hell. do what works for you. I hope you have lots of support!

  8. Kate @ Infertile First Mom July 17, 2013 at 21:35 #

    I’m sorry to read about this turn of events. I do agree with Amy, though, that one week is barely enough time to get into the nursing groove. It can take half that time or longer for your milk to even come in, then you really wanna give yourself a month or two to get the swing of it. Having said that, I, too, saw my shrink in my third trimester to “make a plan” for the PPD that I was positive I would get (due to my own sordid history, genes, etc). A plan was made, which included a bit more flexibility in terms of maintaining a wait and see attitude. But at the first sign/symptom of ppd, I would immediately begin taking the celexa/Wellbutrin combo that had worked for me in the past… And I’d stop BFing.
    Guess what. It never happened. In fact, I’m nursing as I type this on my phone now… 4 months later. I’m not saying that bc I didn’t get ppd, then you definitely won’t either. Obviously we’re all different and there’s no telling… But I hope you get to give BF a real shot before having to start back on the meds. After all you’ve been through, I tend to want to give you and your mind/body all kinds of credit! You deserve to be able to start your parenting journey exactly the way you want to. Here’s hoping that smooth sailing starts right about now…

  9. Mo July 17, 2013 at 21:39 #

    Thanks ladies. I pretty much told my shrink I’m going to wait longer than the week – at least two or three, and if I have to suffer a bit while the meds kick in, so be it!
    I can’t believe I’m saying this but you guys have me looking into placenta encapsulation! So far no luck in finding someone in this country who does it – but I plan on making a few calls tomorrow. I never EVER thought I’d even consider something like that – it’s soooo not me. But desperate times call for desperate measures!

    • Mo July 17, 2013 at 21:50 #

      But I don’t want to get my hopes up only to have them broken again… So we shall see.

      • Amy July 17, 2013 at 21:59 #

        Good for you! I think it’s very smart to have the plan in place, and I hope it will give you some feeling of security that if PPD does show up you have a concrete way to combat it – but the timeline should be more flexible; things can change from dreadful to idyllic and back again eight times in one day with a newborn, so you don’t want to have this crazy short deadline hanging over your head making you feel like you have to have it all figured out and be feeling great within a week if you want to keep breastfeeding – that’s insane! But being truly, truly miserable in order to keep breastfeeding wouldn’t make any more sense. Between how well you know yourself, and Shmerson, and your other in-person people in your support system (and us!), I’m sure you will make the right call if or when the time comes.

        I wanted to do placenta encapsulation, though I was just as skeptical as you are. I felt like it was one of those things that couldn’t hurt, even if it didn’t really help (and there’s nothing wrong with a good placebo effect anyway!), but in the end I didn’t want to pay what was being asked around here, and certainly wasn’t going to go without a doula (which is proven to help) in order to finance something that still lacks strong evidence. I hope you find a person to do it and that it really does help you! (Seems like your doula would know someone who does it, unless it’s really not a thing there?)

        • Mo July 17, 2013 at 22:02 #

          It’s totally not a thing here. I asked my doula and she has no clue! Thanks for your insight Amy, you’re totally on point.

          • Amy July 17, 2013 at 23:10 #

            That’s fascinating to me. It’s apparently popular enough here that the hospitals have had to find a way to accommodate the requests mothers must make to keep the placenta, because it was included as a question on our hospital/birth center birth plan questionnaire. I wonder if there’s a way to package it properly to ship it overnight somewhere to have it done and then have the capsules shipped back. I would think freezing it and packing it with frozen gel packs would work for a quick transit, but I clearly don’t know enough to be anything but dangerous on this topic. 🙂

            You’re super welcome. I hate that you have yet another hurdle to jump (or knock down or whatever, you’re going to pass it!) in this seemingly never-ending journey, but it is also so freaking exciting that this one is located around a giant corner you’ve been trying to turn for what must seem like forever. Terribly excited for you!

  10. Louisa July 17, 2013 at 21:58 #

    Ugh…. I’m a psych Nurse Pracitioner ( I prescribe the meds you are talking about) and I think I would get a second opinion (if possible). What does your high risk OB think about it? I know they wash their hands of us once the baby is out but maybe he/ she could recommend a psych prescriber who has actually worked with women with PPD. Your doctors reaction seems based on fear not experience. Sorry you are going through this.

    • theyellowblanket July 17, 2013 at 22:15 #

      I agree, Louisa!

    • Mo July 17, 2013 at 22:19 #

      Thanks Louisa. I’ve been with my psych for going on two years so I’m wary of a second opinion from someone who doesn’t know my history. But I’ll definitely consider it. An talk to my OB for sure. Great idea!

  11. theyellowblanket July 17, 2013 at 22:14 #

    Mo, IRL, I happen to be a specialist in the PPD world. Here’s my friendly/non-therapeutic advice: I think the most important thing with high risk factors for PPD is to put in place a care-plan. Make sure that Shmerson and your Mom (and anyone else close to you) know what to look for to know you’re backsliding. Also, keep in mind that 80 percent of new moms experience the baby blues, which peak at about 3 weeks postpartum. So unless your symptoms are so severe that they are interferening with your functioning during the first 3-4 weeks, you can probably chalk it up to Baby Blues, not PPD. Of course, you know yourself best, so if during that time frame, you’re like “I need meds!” by all means, go get ’em. Otherwise, hang in there and know that meds are always available to you when the time comes. Also, I would look into having a consulation with Psychiatrist who specializes in mood disorders during pregnancy and lactation. You can look on the Postpartum Support International website to find out if there are any near you, or any you can call on the phone for a phone consult. I’m not sure what your psychiatrist’s background is, but a lot of psychiatrists air way way way too far on the side of caution. There are many meds that are safe during lactation. Anyhoo, that’s my two cents. Sounds like you have a good feel for what your plan is, and that you have a very strong support network in place! xo

  12. slese1014 July 17, 2013 at 22:36 #

    OH Mo….that’s so not fair to be dealt this kind of blow….I wanted more than anything to breastfeed and it wasn’t to be. It sucked more than anything and I still struggle with it today. I hope against all hope PPD stays away for you and breastfeeding is the best experience for you and your baby, making it the best medicine to keep you on the upside. I think the ladies above have given you some fabulous advice and definitely some things to look into. Good luck!!!

  13. Daryl July 18, 2013 at 03:54 #

    I’m so sorry, Mo. You know yourself best, and I think it’s a good idea to wait beyond the first week to see how things go. If you need the meds, you need the meds, and I know, in the end, you’ll do what’s best for you and B5. But I really really really really really really hope it doesn’t come to that, and you and B5 can enjoy breastfeeding for as long as want.

  14. Esperanza July 18, 2013 at 08:49 #

    I just wanted to say that you getting PPD is NOT a sure thing. I know you’re at high risk to get it but that doesn’t mean you will get it. I was at high risk as well and I never got it. In fact, I spent my first weeks and months on a kind of postpartum high (despite the fact that breastfeeding and I did not get along well and I had thrush and it was a fucking nightmare.) So don’t mourn your ability to breastfeed yet. Yes, you may get PPD but then again you may not. You just don’t know yet. It depends on so many things, so don’t throw in the towel just yet. There is still hope.

  15. marwil July 18, 2013 at 11:14 #

    So sorry you have to deal with this possibility, it doesn’t seem fair should PPD hit and you wouldn’t be able to breastfeed. You have got some awesome advice here and I really hope it can be dealt with in some other way.

  16. ozifrog July 18, 2013 at 13:44 #

    Oh that sucks. I was an SNRI girl back in the day , and I did the whole “line up the disaster plan” during bedrest too.. But ssri’s were an option for me. I am sure my little spell of a few years on the happy pills led to my insulin resistance and helped me get GD too.

    I was told I had a 50/50 chance of PPD. everyone was on the lookout and knew what the plan was if it hit. I felt a bit “mummy radar running a bit hot” for a couple of months, but nothing that needed medicating ( and I’ve been in that take this pill before you step in front of a bus place…)….have your people lined up, do the post partum follow up, but just see how you go and forget the whole deadline thing, that has too much pressure and self fulfilling prophecy written all over it. You won’t even know what the hell is happening until the baby is six weeks old.

    The things I would recommend are time outside EVERY DAY with your newborn (eg at least one nap in pram or carrier while you walk), higher intensity exercise from six weeks post partum ( pref a dedicated mums n bubs type thing), eating enough good food to fuel that breastfeeding, time to shower and get dressed every day, and time out alone every few days, even for ten minutes. They sound hokey suggestions, but they do make a difference.

  17. Lise July 18, 2013 at 14:12 #

    Ugh, that sucks! But I agree with a previous comment, it’s not at all certain that you get PPD just because you are high risk. I was totally expecting to at least get some baby blues since we had a long and hard journey to have our little girl, but instead I turned out to be the calmest and most relaxed mom around 😉 Weird! I really hope you will feel ok after the birth, for me I think the fact that breast feeding finally was something that I was good at (I’m terrible when it comes to get pregnant and not much better at being pregnant) was very healing somehow. But no matter what, you will be a great mom!

  18. hannah2186 July 18, 2013 at 16:06 #

    Im a lurker and I was also going to suggest placenta encapsulation. It’s 200$ here so I’ve found some easy tutorials online where you can just do it yourself.

    • Amy July 18, 2013 at 16:13 #

      That is a good point, though I can’t imagine wanting to take on that project myself right after giving birth. Mo, do you think your doula would be interested in learning to do it? If she comes to visit you at home after the birth, which I think is pretty standard, she could do it right in your kitchen. Seems like that’s how it’s done here after home births, from what I’ve seen on a few blogs. May seem a little strange, but your own home, your own germs, etc. also seems like a good strategy.

      • Mo July 18, 2013 at 16:16 #

        My doula is waaaay removed from this kind of stuff. Right now I’m checking out a few pharmacies that deal in homeopathic medicine. Hope to get a few leads by next week. They seem like the most realistic option, because doing it at home just seems a step too far for me 🙂

        • Amy July 18, 2013 at 16:19 #

          Yeah, I wouldn’t want to do it myself either. I hope the pharmacies have some ideas! I’m sure you are not the first one to look for this service there. Someone has to know how to get it done!

          • Mo July 18, 2013 at 16:19 #

            That’s what I’m hoping!

            • melissa July 22, 2013 at 03:22 #

              You’ve endured remarkable challenges to get a baby in the house. I don’t think it would be out of line to ask Shmerson to do the encapsulation for you (and based on your description of him, I suspect he would be willing). There are tutorials and even kits you can buy. It won’t be fun or not gross, but it would be worth it just to know you did everything you could, right? Plus, it would make for a very funny story someday. Good luck either way! And remember, risk is not the same as certainty!

  19. fromheretomotherhood July 18, 2013 at 22:56 #

    I haven’t done my research on this, but there aren’t only SSRIs and SNRIs, what about MAO inhibitors and Tricyclics while breast feeding. I know tricyclics carry some heavy risks of their own so I can see them being out, but maybe??? Also, is it just cymbalta that’s too risky with breastfeeding or all SNRIs? I’m an SSRI girl myself but I’m also a psychologist, so I’ve studied the other drugs to a degree (I can’t prescribe them), but not in relation to pregnancy and breastfeeding.

    • Mo July 18, 2013 at 22:59 #

      I think it goes for all SNRI’s. But really the logic behind it is that after 2.5 years and 6 different meds cym.balta has been the only one that was truly effective for me, and I think my psych doesn’t want to risk experimenting with even more meds if I’ve got PPD.

      • fromheretomotherhood July 19, 2013 at 05:00 #

        Makes sense. Well if you do need the cymbalta remember that you are making the best decisions you can for your baby and you are a good mother for it. Many women can’t breast feed for a whole host of reasons and it can be psychologically difficult, but your baby is going to think the sun rises and sets with you regardless.

  20. Gina July 19, 2013 at 20:35 #

    Oh this just sucks. After I just read your last happy post and now this. You just can’t get a break. I know you feel like another seemingly normal experience for most women is being taken away from you, again. The truth is, you don’t know if you will love breastfeeding or that milk supply may be an issue. (not that I know, I still can’t get pregnant) I know we always worry about what lies ahead of us, and it’s hard to just say “stop,” it may or may not be. While I sincerely hope that you get all that you deserve (no PPD and a wonderful breastfeeding experience), who the heck knows what will happen. It sounds like the other ladies have given you some good ideas. Still, I hate that you have to deal with this. Ugh! Virtual hugs coming your way!

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