See Mom Run

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Image courtesy of Jonas Birmé.

Warning: I’m taking a break today to talk about postpartum issues.  If you have trouble with body talk, please don’t read this post!

Postpartum has been a real “thing”.  I have struggled with PPD.  I’ve been haunted by my ability to get back to “normal”.  I found that the things I needed to hear about a lack of “progress” which I should have expected I didn’t hear until 6 weeks out.  I wasn’t cleared to do anything exercise-wise until 8 weeks.  My doctor was so confused as to why I expected after a heinous pregnancy that my exercise abilities would just return, I would feel great, and I’d have all this energy.  She was also really upset that people had told me that my stomach would bounce back.  And, you know what, most of my friends say their tummies were forever changed and that’s okay.  I grew a human.  I worked really hard to do it.  I destroyed what was “normal” in the process.  There was no “bouncing back”.  “Mom bod” should be a thing if “Dad bod” is but it’s not.

So, thanks to societal expectations and a history of disordered eating in college, I was really, really struggling.  Add to this a stupid thing at work which is encouraging a biggest loser style competition that has public weigh ins and people asking me why I wasn’t joining and I was reeling.  Suddenly, people were comparing notes on how to starve themselves, drink only vinegar for 5 days to “win” a week, etc.  And they were actively pressuring me to do the same – all despite the fact that I had lost a ton of weight when pregnant with my daughter.  I finally started telling people, “Hey, you guys should lay off this weight talk and stop assuming that is my goal”.

I was not cleared to run until 12 weeks postpartum and 3 days after I was cleared, I ran.  I started Couch to 5k (C25K) at the recommendation of my OB.  Having been an ardent running and an endurance athlete, I was like, “This is too freaking easy and won’t do it for me” but I really didn’t have a choice if I didn’t want to harm my health, according to her.  I cut myself a break.  And, with the encouragement of my brother-in-law who runs Ultramarathons, I made plans to run a 5k in May.  It was totally doable.  And while I thought running would come really easily back, the first 2 weeks were brutal.  Once I got over that point, I notice that my stride was coming back, I was physically capable of so much more, and my runner’s high returned.

I would prefer to be on my bike (as usual) but running is what I am capable of doing quickly (you just can’t do a short ride where we live without putting your bike in the car and driving off and my daughter is far too young to be in a kid seat).  I will get back to that next year.  I plan to buy her a bike seat for Christmas.  But, until then, I run.

I’m now hedging on Week 7 of C25k.  And while one person has made me feel crappy and believes my OB is “placating” my “laziness” I’m mostly ignoring it.  My brother in law says she’s a nutjob and other runners have been encouraging.  I feel like I’m doing it well and doing it for the right reasons.

Moreover, I feel like I’m mentally more capable than ever before.  I’m more present and I’m less daunted by a challenge.  I used to abhor hills.  However, it’s not no big deal to climb them.  I work on my form and chug along hills because I live in a place where there are hills everywhere.  My route is almost always a climb or descent.  One hill, in particular, goes on for half a mile.  I just dig in.  My body and mind were tested mightily in my pregnancy.  I have sheer determination and can blow through the block most runners get half way or 2/3’s of the way through a challenging run.  I used to routinely fall in the trap of “I cannot do this” and would spend weeks to climb over that wall.  I have hit the wall and I have refused to back down.

In May, I’m running two 5k’s.  First, the HER 5k I will run for HG.  I’m completing it here remotely since I can’t get to Chicago yet,  I’m shooting to finish on Mother’s Day.  My time won’t matter to me.  Then, I will do the Zoo Run which I will run “with” my brother- and sister-in-law.  I will not keep up with their pace but my goal is to run a sub-35 time if I can.

I have more goals, though.  I bought a jogging stroller so my first goal is to run with my daughter regularly to build up my core.  My second goal is to run a 10k in July.  I plan to use my daughter as my resistance training on my short runs and then do my long training runs on the weekend.  I have run a 10k before and trained basically all the way up to a half.  My running partner bowed out and I didn’t want to have the expense, so I didn’t run it.  However, I think I may be able to do it again.  I don’t see myself ever running a marathon but I do see myself continuing on a healthy path and maybe doing a half.

The real goal that I have is to run the 5k in my husband’s hometown (complete with hellacious hills) while pushing my then 9th month old in her stroller.  Last year, I couldn’t even walk during that 5k.  I cheered on my BiL who won the whole thing while standing next to my husband and hurting.  I took pictures of finishers but god I was beat by the end.  This year, I will come back strong as ever.  I will run fearlessly.  I will do this thing.  I will do it in under 35 minutes, damn it.  I will finish strong.  Next year, maybe I will run a half marathon in Indy or Bloomington.  I’ve always wanted to do either.  And my absolute “must do” will be that 5k in Chicago where I can meet women in person who battled (and survived) HG.  I will do it for myself and my daughter.

If you are interested in finding more info on the HER 5k, you can find it here.  The race will be run in Diversey Harbor on May 20th in Chicago.  The 5k starts at 9 AM and there is a family friendly option fun run that starts at 10 AM.  There are some fun events planned on race weekend, too, and some hotel rooms still available for cheap (especially by Chicago standards) but book soon!  The HER foundation supports research and education for women and families coping with hyperemesis gravidarum, something that plagued me my entire pregnancy.  The disease is fairly common but there are a lack of good providers out there with knowledge.  Women are often misunderstood by doctors and family members, so education and advocacy are key parts to making life with HG easier.  You can read more about my battle on the blog.  In the meantime, help HER by running either in Chicago or virtually with me and make a donation to a great cause in the process!

Maternal Mental Health: A long and lonely road

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Image courtesy of Tony Fischer.

I’ve often compared my ability to parent and have a relationship with my husband to the relationship between passengers in a row on a plane.  You can’t help your family if you can’t help yourself or help your partner when they need.  Adults have needs.  We need to meet them so we can be good parents.

Mental health care kind of falls in the “put your air mask on before helping others” category.  One of the main issues facing new parents is postpartum depression (PPD).  I was completely overwhelmed when I wandered onto the Postpartum Progress Blog and discovered that very imagery on its facts about PPD.  Studies on PPD, according to Postpartum Progress, show that PPD occurs in 11 to 25% of moms.  Symptoms may be difficult to assess but there are more diagnostics being made public.  My OB now requires this diagnostic at postpartum appointments since it is just that prevalent.  A lot of other OB’s, especially ones aware of new research, are beginning to see the utility in this as well.  After all, if you are too sick to meet your own needs – physically or emotionally – you can’t really mom your best.   Having had a mom who exhibited a number of these symptoms in the 90s with my sister but wasn’t diagnosed and a number of friends who wish they had reached out sooner, I can say it is a big problem even just in my social circle.

PPD isn’t the only thing facing moms, though.  Postpartum Support International argues that 6% of pregnant women and 10% of postpartum women exhibit anxiety.  Some women even have Postpartum Panic Disorder and a pregnancy or postpartum induced form of Obsessive Compulsive Disorder.  Having other conditions, such as hyperemesis gravidarum or gestational diabetes, makes these conditions all the more likely during or after pregnancy.

I knew all of this when I started to see really bad depressive symptoms about 2 months ago.  It was during the worst part of my HG.  I was vomiting every day too many times to count.  I loved food but suddenly couldn’t be around it.  I knew it was too much for me.  So, with my husband’s strong support, I asked for a referral.  I’ve recently moved away from student health practices after graduation so I didn’t have a current psychiatrist or therapist.  I knew there was no time like the present.

I had resources and an education to help me tell my doctor that I needed to see a new shrink and a new therapist.  She was actually really helpful and gave me a referral right away.  So then why do I still lack adequate mental health care?

The problem is a lack of providers.  The only doctor I could get a quick referral to was a quack who didn’t believe in therapy and thought my HG was basically just a binge eating disorder or bulimia.  She had no idea I was pregnant and neither did her staff despite the LOADS of paperwork my provider and I had faxed.  She was supposed to be good at taking care of patients dealing with prenatal depression but she had no empathy and wasn’t even sure what was safe to take while pregnant.  And, rather than consult with my OB, she basically said, “I don’t know, take it or don’t”. Very convincing.  She also blamed me for past trauma and said I had bulimia. All in 20 minutes.  And the entire time I was trying not to puke. She told me to “puke in my hands” rather than bring me a wastebasket.  Because, you know, that’s how you deal with patients.  I’ve been seeing a psychiatrist since I was 18.  This was a terrible experience.  I’m at least glad I have some other data to pull from because if my first experience was to get checked out by someone like this, I would run away screaming never to ask for help again.

So, I thought, I’m not going back to her.  My OB’s office concurred and will no longer refer to her.  But the problem didn’t end there.  I’d found a therapist, which helped.  He didn’t know about HG but he educated himself.  He was experienced with PPD/A.  So, I was lucky.  But I still to this day have not found another psychiatrist who could get me in before 3 weeks postpartum.  In a town littered with hospitals, I still cannot find someone.

I turned to the internet to two support groups I belong to and found, basically I was not alone in my predicament. Most psychiatrists, like all specialists, who are in private practice are affiliated with a hospital group.  There are almost never enough of them.  And they are all only taking in-group referrals.  And even those take months.  If you can’t get into a private practice, you get somewhat spotty community mental health resources.  These place can be either very good or very bad – it just depends on your provider and the area.  There is high turnover of providers and you will usually don’t get a typical 60 or 90 minute evaluation like you would at a private practice.  Here, these services are actually quite good but definitely over-taxed-especially in more rural areas.

This stark difference between community mental health and private practice is due to a lack of resources. Private practices only provide resources to paying clients or clients who have good insurance.  Community providers can’t really turn anyone in need away.  You don’t get a lot of input into the type of care you have there – not because the providers aren’t good or don’t care but because they are set up to meet the needs of as many people as possible.  In my experience, this meant a 30 minute intake consult a few one-on-one sessions with a therapist, a meeting with a psychiatrist, and then a lot of group therapy.  Since my agency works with community providers to provide services to at-risk people, this isn’t an option.  I could end up working in group with people who are in our database and who need our services.  It was a serious professional faux-pas I wasn’t willing to involve myself in and I would then have to warn my boss and see if this was even allowable.  I did not want to do that.  For some without professional issues, this system still doesn’t meet their needs.  For some, it does.  These places meet a great need for those who need substance abuse care or for unipolar depression.  Still, for other issues, they may not be enough.  And without insurance, women who do succeed here can still have trouble paying – even with a sliding scale setup.

So here I sit.  I know I need to be back on medication but I can’t find anyone to evaluate me. My doctor wants me to get the best care via an evaluation and agrees that because I have a history of OCD, PTSD, and a mood disorder, it is best I go to a private practice where I can get consistent care.  I have great insurance. I can afford care.  I am not a newb.  I knew to ask for help.  When I found myself let down, I knew it wasn’t the rule but the exception.  I know I will still find someone eventually so I try to stay positive.  Because, as a mom and stepmom, I have to.  I need to find a way.

But if I was new to this life, I am not sure I would press on to find another provider.  The worry for these women is to be let down again.  So, they go along in silence.  After all, mom takes care of everyone before herself.  And that’s the problem.

We need to take serious care of new parents and women dealing with depression.  So, even when screening shows it is needed, even when providers and patients are trying, it’s still not enough. There is a mental health provider shortage in this country.  According to the Washington Post about half of the counties in the U.S. lack a mental health provider.  Especially in rural areas.  Until we make mental health care attainable, these issues will still remain.  And the vulnerable time for most women – that time right after a baby is born – will continue to remain a high, lonely hill to climb.