Updated February 19, 2022
Dancing on the Edge of Sanity
asks once again
How Often Must We Ask for Sensitive Care?
It’s easy to connect with Ana Clare Rouds’ personal story of the reality of motherhood in her book, Dancing on the Edge of Sanity. She shares her personal story about her experience with postpartum depression, anxiety and obsessive-compulsive disorder, and she eloquently brings out several issues.
Her story reminds us that:
we need shame-busting! the anxiety, hyper-vigilance and scary, negative thoughts that can accompany new motherhood exist on a spectrum of normal. The roller coaster emotions are exacerbated by the enormous physiological hormonal adjustment after birth plus the psychological and physical adjustment of parenting a newborn.
nationwide, inpatient psychiatric facilities are not equipped to care for the unique therapeutic needs of the postpartum woman suffering from a perinatal mood disorder
there’s a lack of education among psychiatric professionals about the different forms of perinatal mental illness
as a culture, we need to support parenthood as the important transitional time it is for the family, and lean in to protect this time
Ms. Rouds’ personal story is well written and engaging. I found myself rooting for supportive family and friends to swoop in and help mama and papa as they hurdled the adjustment to parenthood.
Ms. Rouds tells us about her history of depression, anxiety and panic attacks She says she had become fairly expert at managing her emotions. She’s no stranger to therapy, Zoloft, reframing her thoughts, relaxation techniques and using exercise and expressive work to manage her emotions. She’s good to go with this stuff.
In addition, she was educated: she knew was already set up by her biology and experiences to suffer from postpartum depression. However, this new level of symptoms: the intrusive scary thoughts, the imagery of her baby in danger, was not what she expected at all.
She describes her anxious and scary thoughts on the first page of her book:
“Hypersensitive to every sound…how come I can’t relax?…(I want to escape) the mental anguish, this private hell in which I am trapped…what am I worried about? ….Suddenly…an image of …(my baby) emerges in my mind ..underwater…I shudder and and blink my eyes, trying to erase this image from my mind…I need sleep…(I can’t sleep)..” (p.1, Rouds, 2014). And on page 36 “..I suddenly envisioned little John falling off the table, …what if he fell and died? …That would be awful. But then at least everything wold go back to normal. The thought flew in and out of my head before U could even grab it and hold onto it. Did I really just think that?….I love that little men more anything.…So why did I have that thought?”
Are you shuddering as you read this?
Her imagery brings to our collective imagination the tragedy of Andrea Yates, who drowned her baby and all of her children in her bathtub at home. Andrea Yates suffered from undiagnosed bipolar disorder, which is a risk factor for postpartum psychosis.
Ms. Rouds shudders at her own imagery as well as she struggles in new motherhood. And this causes her extreme shame, anxiety and feelings of worthlessness. She wonders, Am I crazy? She shares her relentless, streaming thoughts and irritability. She tells us she must keep these a secret. They are too scary and shameful. But she knows something is wrong. She is able to reflect on her situation. She is in touch with herself and reality.
What’s important about Ms. Rouds’ personal story is that it brings into contrast the difference between postpartum psychosis and postpartum obsessive compulsive disorder and anxiety. She knows there is something wrong.
By day ten postpartum, Ms. Rouds is feeling anxious, scared, exhausted, and is wired and is unable to sleep. But she knows something is wrong and reaches out for help. She calls her midwife who suggests she go to the hospital emergency room. Once there, she gets the standard of care in a where the staff must err on the side of caution to prevent harm. So she is admitted for an overnight stay, but there are no beds available in the hospital. So she’s sent to a state psychiatric facility, which is understaffed and filthy: “..Like a dungeon…” (p. 125, Rouds, 2014)…
She’s separated from her baby, from her family, and placed in a facility that treats persons with severe and persistent mental illness. Of course the staff isn’t educated about how to manage a nursing mom separated from her newborn who is suffering from a postpartum anxiety disorder.
The psychiatrist at the facility recommends she stop taking the Zoloft her midwife prescribed her or stop nursing. I found this pretty appalling as this is not the standard of care for nursing mothers with perinatal mood disorders. There are numerous research articles and books about this topic available. The information has been round for a long time. Nursing mothers are to keep taking Zoloft as the risk is deemed greater to the mom to stop the medication than the risks are found to be to the baby. So, Ms. Rouds gets set up to stay ill.
My point here is not to bash the psychiatrist, but that the psychiatrist is not specifically trained in the management of prenatal mood disorders as the facility doesn’t normally host nursing mothers with a mood disorder. The psychiatrist then correctly assesses Ms. Rouds isn’t a risk to herself or others and sends her home after staying one night.
But she is sent home without a proper diagnosis. So she feels off balance and unsettled. What does she have? Is it like Andrea Yates? She wonders…
Fortunately, the author has a supportive extended family and her in-laws come and say with her and cook and take care of the house while she recovers. She realizes she needs to keep taking the Zoloft. She talks to her midwife and her midwife supports her in this decision, as she reiterates the risks to the mom outweigh the risks to the baby.
Which brings me to what is so important about this book once again.
There’s a difference between postpartum depression postpartum anxiety, postpartum obsessive-compulsive disorder and postpartum psychosis. A very big difference.
Ms. Rouds’ work helps mothers to understand the more common postpartum anxiety and obsessive compulsive disorder, which have symptoms of anxiety and scary thoughts AND the person has a complete grasp on reality; there are no psychotic delusions.
It’s important to note that Ms. Rouds recognized the images as horrifying and had no intention on acting on her thoughts. She had a complete grasp on reality. She realized she needed help. And she sought help.
Postpartum anxiety and obsessive compulsive disorder occurs in about 10% of all deliveries. There are approximately 400,000 babies born in the US every year, so that’s about 40,000 mothers.
Healthcare provider screening and prevention is relevant to recognizing, differentiating and treating these postpartum conditions.
Someone who is suffering from postpartum psychosis does not, cannot separate her delusions from reality and does not believe she needs to seek help. The most significant risk factor for postpartum psychosis is previously (un)diagnosed cyclical mood disorder (bipolar disorder), a previous psychotic episode or a family history of schizophrenia or bipolar illness. Postpartum psychosis is extremely rare and occurs in .1% of deliveries.
I highly recommend this book. It’s easy to connect to Ana Clare Rouds as a stigma and shame buster as she bravely shares her story of the reality of motherhood. She also provides a great deal of educational and supportive information in her book. The book reads well and it will broaden your understanding of human nature!
If you want to learn more about the tragedy of Andrea Yates’ untreated psychiatric disorders, I recommend Are You There Alone? by the journalist, Suzanne O’Malley. This book is excellent and well researched. The author reviewed the trial transcripts, the news around the story and personally interviews Mrs. Yates and much of her family. It is a heartbreaking account about mental illness and how it is viewed and treated here in the United States, and the medical and legal issues surrounding this case.
Good resources are the books, Dropping the Baby and Other Scary Thoughts by Karen Kleiman and Amy Wenzel and Postpartum Mood and Anxiety Disorders by Cheryl Tatano Beckn and Jeanne Watson Driscoll
The University of North Carolina at Chapel Hill’s Perinatal Psychiatry Unit is an example of a mother baby psychiatric unit in the United States.