• Finding Calm

    by Christine Davis, LAc MSOM

    With each passing year, things seem to get busier. More appointments, more work requirements, more life events, more things to do. Then there’s the well meaning family members and friends: why aren’t you pregnant yet? My friend tried This Thing and it worked for her, so you you should try it, too! Then there’s social media and the internet: EVERYONE seems to be happier and more successful than you – here’s what you SHOULD be doing to do to be happy ALL THE TIME. It’s all a never ending stream of NOISE. Where does it stop? How can you simmer down and quiet the stream of mental debris that constantly stimulates worry, fear, anxiety, and frustration?

    Here are my suggestions. They aren’t a complete list, but these are the important ones. It may take time to incorporate them all: 

    1. Say it with me: “No.” “I’m sorry, I’m not available.” It’s ok to put yourself first and say “no” when what is being asked of you will compromise your wellness. Clear a path for your ability to think clearly, breathe, and do the things you need to do to feel balanced. Much like Marie Kondo’s method for clearing physical clutter, you need to decide what’s important in your life mentally and emotionally. Say YES to the things that create the life you want (even though they may be difficult, too, sometimes) and NO to the things that are holding you back from that life.
    2. Disconnect. Social media has been fun over the past couple of decades, right? There are some good and some (really) bad parts, but study after study emerges showing the negative impact that it can have on your mental and emotional state. If you are having trouble completely disconnecting – especially if work or other interests require you to connect with SM – limit your interactions with these apps/websites. Give yourself a specific time frame in which you allow yourself to use them in a positive, uplifting manner.
    3. Get help. There is no shame in reaching out to a professional if you need help with mental wellness. This could be a mental health professional, a religious guide, etc. Someone who you trust, who is impartial, who has training in helping to guide you is ideal. This doesn’t mean you are signing up forever – sometimes a few sessions can really help to clarify and ground you. I feel like the best therapists are the ones who hold a “mirror” up, so to speak, so that you can see things as they are, then help you to appreciate the beauty that you see.
    4. Center yourself. This could be with meditation, prayer, yoga, journaling, long walks by the lake – whatever helps you to focus on one, two, or ten things–instead of the thousands of thoughts that are constantly flooding in otherwise. I like to think of Georgia O’Keefe’s “Sky Above Clouds” painting – the thoughts are just clouds floating past. Try not to hang on to them and instead just observe them and let them float past. There are some amazing smartphone apps: FertiCalm and FertiStrong, Insight Timer, MindfulIVF, Headspace, etc. that have tons of guided meditations for everything from general anxiety to trouble sleeping to going through an IVF cycle.
    5. Find gratitude. Keeping a Gratitude Journal helps with this. Write just a line or two each day about something you are grateful for. It could be the delicious muffin you had for breakfast, the painless phlebotomist experience, your favorite song coming on the radio, the friend who went out of her way to give you the support you needed. Many studies have shown that focusing on the positive aspects of life actively literally rewires the brain to feel happier and more positive.
    6. Try Acupuncture. A modality of Traditional Chinese Medicine (TCM), acupuncture is a therapy for the mind, body, and spirit. With regular (once or twice per week, usually) treatment, you will see many aspects of your physical, mental, and emotional self come into balance. Acupuncture is known to be helpful for everything from pain to allergies to digestive stuff to fertility, but it can also be helpful for balancing the mental state and emotions.

    Firstly, an acupuncture visit is usually very relaxing! Most who haven’t tried it don’t believe me when I say that, but when else do you take 30 min to just lie still, no phone, not going to sleep (although it’s ok if you do!), not talking or listening (except to quiet music)? This is a deeply restorative time to be quiet, soft, grounded.

    Acupuncture has mounting  scientific evidence showing that regular treatment can help with reducing anxiety, depression, and other emotional disorders. In TCM, there is a strong connection between the physical state and the emotional state. By creating a state of harmony throughout the physical body, balanced mental/emotional wellness is the natural outcome. 

    In TCM, fertility is associated with the element of Water. When water is too abundant or too scarce, the earth and all forms of life suffer, including our own bodies. The element of Water shows its emotional imbalance in the form of Fear/Anxiety. When we are in a constant state of stress (life, work, family, infertility, etc), we put ourselves into a constant state of “fight or flight.” This creates a situation in which our bodies focus only on staying alive for the moment rather than long cycles like those required for fertility. By using acupuncture, we are able to break that constant loop of stress, find grounding, and reconnect with our natural cycles which can lead to improved fertility.

    Choosing to find serenity in this life takes effort. Just think about when someone says, “Calm down!” or “Relax!” Has anyone ever calmed down or relaxed just by hearing that? I don’t think so. By regularly making the choice to build the space for quiet, for reflection, for balance, you are creating a foundation for the life you are searching for. 

    Learn more during our upcoming webinar “Acupuncture for a Medicated Cycle” on Tuesday, September 17th at 6pm! Click here to register to view it live or watch the replay at your convenience!

    Ready to get started? Book your appointment now and save with the You Pick Two special this month!

  • 5 Root Cause Approaches to PCOS 

    By Diana Zic, RPYT, Certified Functional & Integrative Health Coach

    Whether you’re starting to plan your family, you’ve been on your journey for a bit, or have had your kiddos; having a conversation with your doctor about Polycystic Ovarian Syndrome (PCOS) can be a good idea if you are having symptoms!

    What is PCOS and is who affected?

    PCOS it is one of the most common hormonal endocrine disorders in women. It affects 7 million women in the United States alone. In fact, September is PCOS Awareness Month! Statistics show this impacts all races/ethnicities including: Caucasian: 4.8%, African American: 8.0%, Hispanics/Latinas: 13%, as well as, an added concern for teens as obesity increases. 

    For some women, symptoms can appear as early as their first menstrual cycle. Unfortunately, most women don’t know they have it until they start trying to conceive. PCOS can often looks like what is termed “normal” symptoms to have as a maturing woman. For example, you may have acne, anxiety (reduce anxiety and stress!), depression, or an eating disorder. 

    The diagnosis of PCOS varies based on the criteria used by your doctor and may look for the following: hyperandrogenism, chronic anovulation, polycystic ovaries, and oligoanovulation.  

    PCOS affect 7 million women in the US alone.

    What Causes it?

    Genetic predisposition appears to be strong with this diagnosis.  Many women have mothers and sisters struggling with the same condition!

    GOOD NEWS! Lifestyle factors such as diet, exercise, and stress reduction combats against your predisposition!

    So, what are gals to do if they suspect PCOS? 

    Keep reading for tips!

    1. Talk with your doctor. It’s important to get the appropriate testing done to get clarification! A simple blood test and ultrasound is all you need to get started.  You may even be eligible for a free check-up! Learn more here.
    2. Dietary Changes. Lose the low-fat, high-carbohydrate diets. Choose complex carbs, which are high in fiber and moves through your body more slowly so your blood sugar levels stays level. According to the Mayo Clinic, even a modest reduction in your weight – for instance, losing 5 percent of your body weight – might improve your condition. 
    3. There are also supplements available that may be helpful. See the new research on PCOS and CoQ10 Supplementation today!

    Here’s a prior blog of mine for some ideas of foods to start incorporating now. 

    1. Be active. Exercising daily helps to reduce and/or prevent insulin resistance, reduce inflammation and it’s the happy drug for your mind by producing endorphins. It also helps to reset your HPA Axis – reducing stress! Try the Moon Salute Sequence today to see what a difference a few minutes can make! Join Pulling Down the Moon’s 6 Week Yoga for Fertility Series starting September 24th (for those trying to conceive), or CocoonCare’s schedule (for pre/postnatal care) to see for yourself! 
    2. Get support. As I mentioned, 7 million women in the USA have PCOS, so don’t feel like your abnormal or broken beyond repair. We can help you implement these changes, reach out!

    Wanna learn more on the root cause approach? Try the You Pick Two Special during PCOS Awareness Month to try two services (Acupuncture, Massage, Yoga for Fertility, or Health Coaching) for only $199!

    Be well, 

    Diana

  • Guest Blog: The Stress of It All

    by Kellie Stryker MSW LCSW

    According to reproductivefacts.org, “Infertility often creates one of the most distressing life crises that a couple has ever experienced together. The long term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples.” 

    Kristin L. Rooney, BA and Alice D. Domar, PhD with Boston IVF wrote: “Infertility is often a silent struggle. Patients who are struggling to conceive report feelings of depression, anxiety, isolation, and loss of control. Depression levels in patients with infertility have been compared with patients who have been diagnosed with cancer.1 It is estimated that 1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Despite the prevalence of infertility, the majority of infertile women do not share their story with family or friends, thus increasing their psychological vulnerability. The inability to reproduce naturally can cause feelings of shame, guilt, and low self-esteem. These negative feelings may lead to varying degrees of depression, anxiety, distress, and a poor quality of life.”

    It’s normal to experience times of stress throughout the infertility process. However, it becomes a cause of concern when the feelings become persistent or prolonged. 

    According to reproductivefacts.org, if you experience the following symptoms for a prolonged of time, you may benefit from meeting with a mental health professional. 

    • Loss of interest in usual activities
    • Depression that doesn’t lift
    • Strained relationships
    • Social isolation 
    • Thoughts that are consumed by infertility
    • High levels of anxiety
    • Diminished ability to concentrate or accomplish tasks
    • Change in your sleep patterns, appetite or weight 
    • Increased use of drugs or alcohol
    • Persistent feelings of pessimism, guilt, bitterness, anger or worthlessness
    • Thoughts about death or suicide

    Help Is Out There 

    The following resources are dedicated to helping you improve your Reproductive Mental Health: 

    • RESOLVE: The National Infertility AssociationRESOLVE provides free support groups in more than 200 communities; is the leading patient advocacy voice; and serves as the go-to organization for anyone challenged in their family building. 
    • ASRM : American Society for Reproductive MedicineASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers. The Society is committed to facilitating and sponsoring educational activities for the lay public and continuing medical education activities for professionals who are engaged in the practice of and research in reproductive medicine.
    • Pulling Down The MoonHolistic care for family health and fertility should be highly personal, compassionate, and customized to meet the unique needs and complex challenges of each patient. Founded in 2002, Pulling Down the Moon recognizes the stress and emotional turmoil and fatigue that can come with infertility as well as your day to day health. 
    • Shine Fertility Shine supports women through mentorship, community and education. We empower women by encouraging a proactive approach to fertility health and fertility preservation.

    Taking Care of You

    It’s ok to be sad, frustrated, angry, resentful, bitter and whatever emotions you may be feeling at this very moment. You are allowed to feel all of the above and more. Sit with it. Don’t force yourself to put on a brave face when you are going through unimaginable pain. However, when you are ready, allow yourself to work through the emotions you are experiencing. 

    Georgia Witkin, Ph.D with Progyny wrote: “You may not have control over the physical effects of fertility treatment, but you can take control over many of the psychological effects. What you think and what you do shapes what you feel, so choose thoughts and behaviors that reinforce your sense of control.”

     

     

     

    Kellie Stryker is a Licensed Clinical Social Worker and owner of Rain to Rainbow Counseling. Kellie has over 10 years of experience in the mental health field. Kellie currently lives in Crystal Lake, IL with her husband and 1 yr old daughter who was conceived through infertility treatments. Kellie’s mission as a Reproductive Mental Health Counselor is to provide support to others as they navigate through their infertility journey. 

    Rain to Rainbow Counseling offers supportive services which are focused on all aspects of Reproductive Mental Health which include infertility, grief, loss, miscarriage, stress management, adoption and pregnancy counseling. Rain to Rainbow Counseling is currently in network with Blue Cross Blue Shield of IL and Optum United Health Care. In Person and Online Telehealth Sessions are available.


    Benefits of Online Telehealth: 

    • Confidential: Rain to Rainbow Counseling uses Simple Practice, a secure and HIPAA compliant program.
    • Online Client Portal: No software to download. Private login and password for each client. 
    • Same benefits and techniques: Only difference is we see each other on screen instead of in person.
    • Convenience: Can literally be done from when and wherever you are comfortable.

    References:

     

     

  • The Two-Week Wait: Your Holistic Guide to Wellness

    The anticipation, anxiety, the loss of control and not knowing what to expect can be especially difficult during the “two-week wait.” The two-week wait – between ovulation and when your next cycle is due to start – can feel as if you are in limbo as there is no way to tell if you’re pregnant. 

    You may find yourself watching for signs and symptoms of pregnancy. Each twinge in your belly, tenderness in your breasts and feeling of fatigue, asking yourself, “Does this mean I’m pregnant? Or am I getting my period?”

    The questions, the “what if’s,” the TIME all feels endless and one seems to build upon the other until what you’re left with is a gigantic ball of anxiety and feeling a loss of control. 

    What if instead of “getting through” the two-week wait, we were intentional and mindful of nurturing ourselves by creating a plan? This holistic guide to self-care will provide you with a plan for nurturing yourself in four areas: physical, social, emotional and spiritual. 

    Physical

    Sleep is not only necessary and restorative for our bodies, it also allows us to cope with our feelings of anxiety and overwhelm in a more manageable way. If you find yourself having difficulty falling asleep, here are a few helpful tips:

    • Keep a journal or notepad next to your bed and write down the thoughts, worries or items on your ‘to-do’ list. Say to yourself, “This will be here for me if/when I need it.” Sometimes the act of writing something down allows for a cathartic release of whatever we’re feeling preoccupied with.
    • Listen to a guided meditation app before bed to relax into sleep and take your mind off of the two-week wait. Bonus: the more you practice, the more this cues your body and mind that it’s time to sleep.

    Gentle exercise such as planning a walk to a scenic place, a lake or forest preserve. Getting outside can have a calming, centering effect while you are present in nature. Try Yoga for Fertility poses on your own or building community through practice with others. Schedule an Unwind the Mind Massage, “This session was created to be a safe oasis from post-ovulation stress, boosting immune and endocrine function, while supporting a potential pregnancy.” (Pulling Down the Moon, Fertility Enhancing Massage (FEM)

    Social

    • Plan a social outing with your partner or friends. Socializing provides an outlet for connection as well as a distraction from the thoughts and feelings you maybe preoccupied with. And, it’s fun! What activities do you enjoy doing? Want to try something new? Try being intentional about planning enjoyable activities, especially during the two-week wait.

    Emotional

    • Create a list of friends, family members or supports you can reach out to check in with during the two-week wait. Is there a fellow member of your support group, a friend or family member who has an understanding of what you’re going through? Who acts as a sounding board, offers encouragement or provides a fun distraction? Write these supports down so that when you’re feeling especially alone or overwhelmed during your journey you have a few go-to people you feel safe reaching out to.
    • Mantras can have a powerful and empowering impact. Choose a word or short phrase you would like to be the focus during your two-week wait. How would you like to feel and respond to yourself and others? Write the mantra on a post-it note or schedule it as a daily event on your phone to be reminded of your intention. 

    Nurture ~ Empower ~ Peace ~ Joy ~ Warrior

    Spiritual

    • Practicing meditation & mindfulness “Mindfulness is the energy of being aware and awake to the present moment… Being present is the most powerful place to be.” Thich Nhat Hanh. Bringing your attention back to the present moment can help decrease feelings of anxiety and increase self-awareness. New to meditation? Try a guided meditation app. There are guided meditations specific to fertility, sleep, anxiety and grief that you may find especially helpful in starting or ending your day.

    In summary, while creating a plan doesn’t take away the uncertainty, it may allow you to feel a sense of control with how you choose to meet this part of your fertility journey. Creating a plan for the two-week can be a nurturing way to care for yourself during a time when your thoughts and feelings may be overwhelming. Take this time to connect with yourself, your partner and those you enjoy spending time with who play a supportive role in your journey. 

    Links:

    Emily Heilman is the founder of Flourish Counseling & Wellness. As a Licensed Clinical Social Worker (LCSW) and Certified Perinatal Mental Health specialist (PMH-C), she specializes in perinatal mental health and wellness, supporting women and their families navigate their fertility journey, the pregnancy and postpartum period, and throughout motherhood. Her experience in the field of women’s and perinatal mental health spans the past 13 years where she has worked in community mental health, hospital settings and private practice. Emily offices are located in the Chicago Loop & Oak Park. To learn more, visit: https://flourishcounselingltd.com/

     

  • The 4 Pillars of Health: How to Be & Stay Healthy

    By Christine Davis, Acupuncture Director

    Everyone has advice for you: Do this, do more of this, don’t do that, do less of that. This is the only thing that works. Everyone is different, so nothing works for everyone. Eat more of this. Eat less of that. Exercise more. Exercise less. Weigh more. Weigh less.

    I think that, particularly because of the internet, you can find information to support every theory out there on literally everything. It’s hard to know what to trust, what is actually true. While it can take some time to find the things that work for us to stay healthy or find balance, I do think there are a few things that we can universally take as truth.

    Here’s what I’ve found:

    • Slow Down. I started with this one because it helps to make all the rest possible. We hear this a lot, right? Take time for yourself, relax, find ways to unwind. But how do YOU do that? I think it’s necessary to take some time every single day to be quiet and listen to what your body, your mind, and your heart are telling you. Some days, you might have more time, some days, it’s only 2 minutes. But this has to be a priority like any other. When you take time to be still, whether in meditation, taking a walk, listening to quiet music, doing yoga, or even in an acupuncture session, this is time to hear yourself: your thoughts, how your body feels, where your mind is. What works for one person may not work for another. Remember there’s a reason that we call meditation a “practice.” It’s a process, not a destination. It recharges you, helps you find yourself and your goals, and strengthens your ability to cope with the challenges that life throws your way.

     

    • Eat Well. There are so many theories out there about how to eat, what to eat, where to eat. It can all get very confusing! But I think we all know what things don’t feel right – whether it’s refined sugars/carbs, greasy/fried foods, too much salt, portions that are too large, etc, so staying clear of those as much as possible is critical. The more I go through life and doing the work I do, the more I realize just how important these things are. A study that came out last month showed that unhealthy diets are responsible for 1 in 5 deaths worldwide. Even if our diets are only “kind of” unhealthy, those foods could be contributing at the very least to inflammation, endocrine dysfunction, and thereby problems with fertility. If you are feeling lost in the woods about where to start, make an appointment for Nutritional Counseling with one of our amazing Dietitians.

     

    • Sleep. Oh this is a hard one. We all think we can get away with sleep deficiency, but it always catches up to us in the end! The key is to try to stay consistent, even if you can’t be perfect every night. Aim for 7-8 hours, as close as possible to the same time to bed every night and wake up every morning. Of course, you will have special events, travel, and other things that try to throw a wrench in the works, but the more you condition yourself to stay consistent, the more your body will be prepared to sleep well when it’s time. Other things to try:
      1. Stop drinking anything caffeinated after 10am if you plan to go to bed by 10pm. Caffeine can stay in your body for up to 16(!!!) hours, so plan accordingly.
      2. Try a simple chamomile tea about 30-45 min before bedtime – steep in 4oz or less of water so you won’t have to get up to use the restroom during the night.
      3. Stay away from devices 45-60 min before bed. It’s tempting to try to catch up on emails, surf Instagram or space out to some Netflix, but trust me on this, sleep is way more important!
      4. Clear clutter from your house in general, but definitely from around your sleeping area. There should be nothing that reminds you of stressful situations or work. Keep your sleeping area as simple and comfortable as possible to invite relaxation and rest.
      5. If you are still struggling to fall and stay asleep, try acupuncture to help regulate your diurnal cycle.

     

    • Exercise. This is another one that gets pretty complicated, but the bottom line is that you need to move your body on the regular. Medicated IVF cycles notwithstanding (when walking and gentle yoga are safe, as well as, recommended), getting your heart rate up and doing some resistance (free weights, muscular isolation, etc) exercise are necessary for us as humans. Our driving, sitting lifestyle has caused us to not have to do these things for basic needs, so we have to go out of our way to find them. If you love going to the gym, then do it! If you hate going to the gym, then find what works for you – yoga, martial arts, ballroom dancing… If you enjoy it, you’re more likely to stay with it. I had a personal trainer as a patient one time. I remember asking him what the best kind of exercise was. Do you know what he said? He said, “The best kind? That’s the one that you DO.” 100% accurate. If you are someone who has strayed away from exercise or maybe never had a regular practice, it’s time to make friends with the feeling of moving your body to make it strong and healthy. Find what works for YOU.
      • >I want to make one side note here to say that you may be someone who exercises TOO much which can also have adverse effects on your body. It can be difficult to let go of an ideal of weight, shape, or status. If you are dealing with a BMI that is below optimum, consider discussing what’s going on with your MD, Dietitian, and acupuncturist.

    That’s it. That’s all I know. None of this is new. But this stuff does work – tried and true. Some of it takes real willpower, but setting the wheels in motion now can help you find your healthiest self for life.

    Try Acupuncture for only $75 in May!  Learn more about holistic health options for the journey for you and your partner at the Shine Together In Person Meet-up with Pulling Down the Moon’s very own Christine Davis presenting on Tuesday, June 11th at 6:00-7:30pm at our Chicago office. Register to save your spot today!

  • Awaken your Yoga Practice this Spring

    by Alison Lautz RYT

    Is it over! Winter? Have we made it out of the trenches or is it going to snow again in May? One will never know in this city! Flowers and vegetation will start to grow (we hope), the birds MAY sing, and Chicagoans will start to strip off their boots and puffy coats. Spring is in the air! Now how can we bring spring and a new vibe into our yoga practice? I love spring…. it signifies a time of letting go of our old tired way to make room for the new and another chance to re-start, like a second chance on new year’s resolutions or intentions that we made four months ago.  The spring energy is all around us, and these four tips will help you awaken the spirit of spring in your yoga practice.

    Awaken new vibrations

    Spring is full of spiritual energy and more energy vibrations than any other season. This may be because the earth is working to shed the drab of winter and cultivate a more lively state of being. You may find that this is contagious, like when you see a coworker putting some colors into their outfit, you may want to do the same. Open up your energy to the season by having an open mind to any positive changes or the opportunity to try something new outside of your comfort zone.  Try Journaling for the Journey!

    Practice outside

    Let’s celebrate the fact that we can roll our mats outside of the four walls that we spend most of our days within. It does not matter if it’s in your backyard, on a roof deck, or on a small balcony in a city high rise. Any of these options presents a great chance to connect to nature. Breathe in the fresh air and celebrate the ability to get out of the house. My favorite pose to do outside is Vrkasana (Tree Pose). I truly feel how rooted I am to the earth in this pose from my feet to the crown of my head. Learn more about how to use your breath to reduce stress with this FREE Prana webinar!

    Detox your gut

    April and May are the perfect time for some big spring cleaning. Most of us hold our old habits, negative emotions, and holiday/winter vacation indulgences in our gut. Try some twists in your yoga practice. Change your diet around a little bit. Drink more water with lemon, try some kombucha…and as always EAT MORE GREENS.

    Be playful

    During spring, joy and fun are all around as new life begins. Watch the birds above or lay with your dog or cat in the grass! New life inspires a sense of playfulness that we can embrace in yoga practice as well. Embody playfulness in your practice by going for poses you normally skip and try some laughing instead of cringing whenever you fall out of a pose. Take everything even the TTC journey a little less seriously because we will all get through this. Come check out Yoga for Fertility at Pulling Down the Moon to work on some serious spring awakening. Meet new friends and a whole community of other women working on conceiving! Join the next Yoga for Fertility series on Wednesday, April 24th at 7pm or online starting on Monday, April 29th at 6pm! During National Infertility Awareness in April, try Yoga for Fertility and get 50% off!

  • The Dynamics of New Motherhood: Is This the Baby Blues or a Perinatal Mood and Anxiety Disorder?

    By Brooke Laufer, Psy.D.

    Motherhood, Not What You Thought

    Mental health issues are among the most common complications related to childbearing, and yet it is still a topic that is largely misunderstood. A conversation I had with my dentist recently reminded me how little the general public knows about perinatal mental health issues. “Oh,”  she said, “I just thought women cried a little bit, but you know, they’re usually just so happy to be mothers, right?!” We want to believe becoming a mother is an absolute joy. Motherhood is expected to be a fulfilling time for a woman, when a woman is in her most natural role–the role she was meant to play as suggested by film and other media–when her true purpose is determined. In reality, having a child is a profound, frightening, and exhilarating experience at the boundary of life, from which one comes back a transformed person. Most women bear this monumental transition to motherhood with some hardship. Experiences range from tearfulness, exasperation, and nervousness to more extreme feelings of obsessiveness, helplessness, and even murderous fantasies. While many women will have what is labeled the Baby Blues, 20% of women will have a Perinatal Mood and Anxiety Disorder, a debilitating psychological experience that interrupts their lives. With a growing amount of research and education, we begin to clearly see what distinguishes a true Perinatal Mood and Anxiety Disorder from the non-clinical experience of the Baby Blues.

    10 years ago I was as unaware as my dentist of what could happen to a woman’s state of mind when she was faced with childrearing, so after my daughter was born I learned in a shocking and destabilizing way–the way most women learn–what a Perinatal Anxiety Disorder was. For me, it started with anxiety attacks while in my third trimester. I shook uncontrollably in the evenings and experienced an overwhelming sensation of claustrophobia during the day. I found a good psychiatrist who helped me understand that taking an SSRI (the one I’d gone off when I got pregnant) would relieve my anxiety and would not hurt my baby. Then after a fairly uncomplicated birth, I was supposed to be thrilled, but I had a new baby who didn’t sleep well. I loved her, but I wasn’t completely attached to her; I was also ragged and jumpy. When she was 4 months old, I started having intrusive thoughts that deeply disturbed me. At first they were like small blips on a radar, like thoughts from the periphery of my mind that I could barely hear. But then the blips grew larger and included images. I could clearly hear thoughts telling me that harm would come to the baby.  I could see my baby being sexually violated. I had thoughts that my husband and I would be the ones to sexually harm our baby daughter. I could barely tolerate these thoughts as they began popping in with greater frequency. Luckily, my psychiatrist answered his phone the day I called beside myself in tears. He calmly told me that what I was experiencing was Postpartum OCD, he told me about Karen Kleiman’s book This Isn’t What I Expected, and he raised the dosage of my Sertraline. I was a therapist, a clinical psychologist, and I was learning for the first time what a Perinatal Mood and Anxiety Disorder was; this was not the Baby Blues.  I recovered from my Postpartum OCD, but my life was changed forever. Since that time I have done what I can to research perinatal mental health, to immerse myself in the literature and new information we have on this condition, and to talk about it. Talk to women, to friends, to family, and especially to my clients, letting them know they are not alone, they are not crazy, and they can still be the mothers they want to be.

    Baby Blues

    The term ‘Baby Blues,’ first used in Nicholson J. Eastman’s 1940 best-selling baby care book Expectant Motherhood, is an umbrella term referring to any emotional experience a woman has in the period after bringing home the baby. It is no surprise this massive life transition, along with sleep disturbance, disruption of routine, and emotions from the childbirth experience itself will contribute to how a mom feels. Her experience is also affected by the hormone changes that occur first during pregnancy, and again after a baby is born. The levels of progesterone and allopregnanolone rise during pregnancy and plummet after childbirth, and this drop is thought to contribute to emotional dysregulation. These short-term postpartum symptoms include weepiness or crying for no apparent reason, impatience, irritability, restlessness, anxiety, fatigue, sadness, mood changes, and poor concentration.The informal diagnosis of Baby Blues requires that these symptoms last no more than 2-4 weeks, occurring for a few minutes up to a few hours each day, and typically going away with rest, support, and time. Baby Blues rarely get in the way of daily life or need intervention from a medical provider.

     

    “A baby opens you up, is the problem. No way around it unless you want to pay someone else to have it for you. There’s before and there’s after. To live in your body before is one thing. To live in your body after is another. Some deal by attempting to micromanage; some go crazy; some zone right the hell on out. Or all of the above. A blessed few resist any of these, and when you meet her, you’ll know her immediately by the look in her eyes: weary, humbled, wobbly but still standing. Present, if faintly.” Elisa Albert, After Birth (2015)

     

    Perinatal Mood and Anxiety Disorders

    When a disturbing emotional state lasts beyond 2-4 weeks, clinicians should start to assess for a perinatal mood and anxiety disorder (PMAD). Formerly referred to as Postpartum Depression, or simply “postpartum,” we now use the term “Perinatal” because the symptoms can occur not only one year postpartum, but also during pregnancy, or after a pregnancy loss. We say “Mood and Anxiety Disorders” instead of “depression” because it more accurately covers the range of experiences women have. These include major depression, generalized anxiety, OCD, PTSD, and postpartum psychosis.

    Although there is no clear indicator of who will experience a PMAD, previous mental health issues, trauma, and lack of resources are some of the risk factors. Important to note: PMADs do not affect just biological mothers.  Growing research shows us that men experience postpartum anxiety and depression. In fact a client of mine came in a few weeks after her baby was born and reported that her husband was acting strangely: yelling a lot, throwing pillows at the wall when the baby cried, uncontrollably crying, and openly fantasizing about leaving the baby out in the snow. We were able to get him in for a session with her and help him understand that he needed help. The couple was surprised that he was having postpartum rage, while she was adapting well. He actively resented his child for destroying their former life, while she’d become protective of the child. Eventually, with months of treatment, he was able to love and attach to his daughter.

    Similarly, adoptive parents may report symptoms of PMADs: it can be particularly confusing to resent or feel disconnected to an adopted baby whom you wanted and planned for and possibly spent much or most of your savings on. Likewise, LGBTQ families who may have worked for years on fertility treatments or with a surrogate to finally bring home a baby are also vulnerable to PMADs and should not be ignored as a population worth assessing.

    Perinatal Depression

    Perinatal depression mimics that of a major depressive disorder but with certain symptoms specific to mothering. A woman may be withdrawn from the baby and her family, not want to hold the baby or have difficulty bonding, have a flatness of facial expression and voice, exhibit excessive tearfulness, or severe self loathing. She may have a belief that she can’t handle motherhood or be a good mother, she may be unable to enjoy most of her life, or she may believe her family would be better off without her.

    A client of mine described feeling like she couldn’t see herself in the family picture. She vacillated between dissociation and depression. This mom had twin baby girls with whom she was not bonding.  She felt like a machine part going through the mechanical motions of caretaking. After her first session of unburdening herself of the sadness and shame she carried, she was able to start to locate herself. Her experience points to the invisibility some women feel as mothers. The erasure of self to motherhood is well noted by the poet Alice Notley:

     

    “For two years, there’s no me here….

    Two years later I obliterate myself again

    having another child” (1972)

     

    Perinatal Anxiety and PTSD

    Perinatal anxiety, or anxiety during and after pregnancy, has received little attention compared to its well-known cousin, postpartum depression, yet anxiety symptoms are more frequently reported. Worrying, of course, is a normal part of new motherhood–checking that the car seat is secure or that the baby is still breathing, for example–but if it interferes with a woman’s life so that she cannot think about other things or take care of herself or her baby, then it verges on mental illness.

    For women who are prone to anxiety, the information-saturated era we live in is loaded with potential stressors about conceiving, being pregnant, and parenting, requiring women to be vigilant about what information she is exposed to. An anxiety disorder can be spotted in the repetitive fears and questions moms have, in extreme over-protectiveness such as not letting anyone hold the new baby, or in the too well put-together mask some moms wear, hiding an internal world out of control.

    Post-Traumatic Stress Disorder (PTSD) in the perinatal period refers to past trauma resurfacing during the perinatal period, including flashbacks and nervous system responses (freeze, flee, fight) that can interrupt caring for a new baby. What many doctors do not realize is that women who have experienced sexual trauma may have fear of a baby coming out of the vaginal canal, a fear of male providers, and/or a fear of being alone with baby.

    Perinatal Obsessive-Compulsive Disorder

    Obsessive compulsive disorders are possibly the most insidious of the postpartum conditions because they include the intrusive thoughts that haunt many mothers. Intrusive thoughts are thoughts that happen frequently and randomly, feel uncontrollable, and are often disturbing. These disturbing thoughts, or obsessions, can lead moms to engage in repetitive behaviors, or compulsions, to try to ease their anxiety. Many moms with OCD are plagued by repetitive fears of harm coming to their babies, possibly due to the extreme helplessness of a newborn baby. It is horrifying for mothers to have uncontrollable thoughts and images of their baby tumbling down the stairs or falling out a window, or images of themselves smothering the baby or sexually abusing their own child. Because of the disturbing nature of these thoughts, it can be the most difficult disorder to admit, yet, as was my experience, by breaking the silence women can find tremendous relief in the normalization of Perinatal OCD.

    Postpartum Psychosis

    Postpartum Psychosis is the most rare of perinatal conditions, occurring in .1% of moms, but it is the most dangerous. Psychosis is a break from reality that can happen over time but can also become a medical emergency very quickly. As with Postpartum OCD, a mom may experience intrusive and paranoid thoughts, but instead of being disturbed by them, she may begin to identify with them. For example, a new mother may have the thought that someone is going to steal her baby, so she acts on it by hiding the baby or running away with the baby. Unfortunately, it is typically after a postpartum psychotic episode has ended badly that the media gives it attention. Just a few years ago a woman who I know from my hometown was arrested for the death of her 14 month old boy. After months of working full time, bad day care experiences for her baby, an unstable partner, and increasing symptoms of OCD and paranoia, she came to believe she and her son would be better off dead. After she suffocated her baby she attempted to overdose on medications, but she survived. Even though the she had an expert forensic psychiatrist diagnosed her with Altruistic Filicide, deeming her Not Guilty By Mental Defect, she was sentenced to 25 years in prison. Unfortunately, there is still little understanding or mitigation done for mothers convicted of infanticide, resulting in excruciating treatment and excessive sentencing.

    Treatment

    Women may find it difficult to reach out for help, as it is taboo to admit you are unhappy or unnatural at motherhood. To the extent that women in our society are still seen as playing their most natural role as mothers, to acknowledge unhappiness or discomfort may have high stakes relating to women’s own identities and how others may see them. A mom may fear being seen as a “bad mother,” which would ostracize her from mainstream society. With more education and awareness around the frequency and epidemiology of perinatal mental health issues, much of this silencing can be alleviated. What is essential to understand is that a woman herself should not be blamed–not by her providers, her family, or herself–for a perinatal condition. We often have little control over the occurrence of a Perinatal Mood and Anxiety Disorder, but we can do much about its treatment.

    Psychotherapy and Medication

    With a proper diagnosis of a Perinatal Mood and Anxiety Disorder, good treatment can support a full recovery. The best form of treatment is individual psychotherapy that reduces stigma and shame and normalizes the client’s experience. Besides reassuring women that it’s normal to feel ambivalent during pregnancy and motherhood, I also educate each woman about her particular diagnosis. Women often feel desperately alone and deeply ashamed when they experience PMAD symptoms, especially ones that are less talked about like rage or intrusive thoughts. I reassure my clients that these inner experiences don’t indicate their worthiness as mothers but are instead treatable symptoms of common disorders. Women express tremendous relief when they realize that their scariest and most shameful symptom is something others also experience–and something we know how to treat. Helping women accept all the parts of themselves will reduce symptoms of anxiety and depression. One important goal I look to when working with PMADs is helping women regain a sense of self.  It may not be the self they knew before the baby but a new self that emerges in the transformation. Questions we consider: How does having a baby disrupt a mother’s sense of who she is, of her body, her understanding of life and death, her relation to the world and to her sense of independence, her experience of fear and hope and time, and the structure of her experience altogether?

    Therapy may include the new baby, so that I can support a secure attachment and help the mom experience the infant’s behavior without insecure projection and negative interpretation. I may recommend infant massage or, inversely, setting the baby down for an extended period. Therapy may also include the partner or other family members. Marital disharmony is the most commonly cited non-biological cause and consequence of PMADs, so by bringing in and educating the partner on PMADs, a mom is more able to be understood and get her needs met at home.  Group therapy, such as a moms support group, can be an excellent way to reduce shame and isolation, as it can provide universality, catharsis, socialization, and good information.

    Additionally, psychopharmacology is an effective form of treatment for Perinatal Mood and Anxiety Disorders. Current research and an updated classification system (no longer the A, B, C labels for medications that were often misleading) suggest many medications are safe during pregnancy and breastfeeding. There is still damaging stigma around medication and pregnancy that needs to be fought with accurate information. Reducing a previously prescribed medication for pregnancy or changing a medication during breastfeeding are potentially misguided recommendations that can put a women at risk of relapse. The American College of Obstetricians and Gynecologists and the American Medical Association agree that treating the mother’s health is the priority; the trace amounts of medication that a fetus or nursing baby will receive should not keep a mother from the medical treatment she needs.

    Although public awareness of postpartum depression has increased in recent years thanks to celebrities like Brooke Shields and Serena Williams, many people–including therapists–are still learning that PMADs are serious and pervasive experiences.  When I started talking about my Postpartum OCD experience one of my aunts told me the story of my grandmother, who had three children in four years. The day after they brought home the third baby my grandfather got in his car to go to work, as he started to pull out of the driveway my grandmother came running outside and threw herself on the hood of his car. She spent the next 7 months in a sanitarium, a nicer version of an asylum in a neighboring state, and came home to her children who were being cared for by a strict German nanny. It’s possible my grandmother was experiencing depression or anxiety or even psychosis, they sent her away and no one discussed it. Although awareness and treatment have improved since the harsh days of my dear grandmother, perinatal mental health is still overdue for the attention it deserves, considering women are doing some of the most laborious and important work of our world.

     

    Brooke Laufer is a Clinical Psychologist who has been practicing psychotherapy since 2005. Brooke began her clinical work in psychiatric wards and then in schools with adolescents and their families. After having her first child Brooke had a disturbing Postpartum OCD experience, which inspired her to begin researching, understanding, and specializing in the treatment of perinatal mental illness. She has a private practice in Evanston, where she continues to treat adolescents and adults, specializing in perinatal mental health issues.

    Brooke Laufer, Psy.D.
    847-440-7361

     

  • Supplements for Immune Support: Separating the Research from the Hype

    By Margaret Eich, MS, RDN

    It’s January, which means it’s officially cold and flu season. When you’re trying to conceive or pregnant, you have to be extra conscious of what you’re putting in your body. Certain over-the-counter medicines may not be appropriate during this time; so it’s important do what you can to stay healthy. Hand washing, getting plenty of sleep, eating healthy, and managing stress are all helpful ways to do that. What about supplements? There’s plenty of info online about miracle immune support supplements, but what does the research really show? Here’s a quick summary of some popular immune support supplements and the ins and outs of what you should know while trying to conceive or pregnant:

    Vitamin D: Vitamin D supplementation may help prevent upper respiratory infections, though the evidence is mixed. Vitamin D plays an important role in the immune system, so you definitely want to avoid vitamin D deficiency as this may impair immune system function. Vitamin D also may affect fertility, so it’s a good idea to have your vitamin D level tested, so you can supplement at an appropriate level. Vitamin D is a fat-soluble vitamin that can be toxic at very high doses, so make sure to discuss an appropriate dose with your healthcare practitioner.

    Vitamin C: While there is currently no evidence that taking vitamin C once a cold starts helps reduce severity, people who take vitamin C regularly tend to have colds that don’t last as long as people who don’t take vitamin C. Also people who take vitamin C regularly and are under lots of physical stress (marathon runners, skiers, etc.) had lower incidence of colds in one study. Vitamin C is generally well tolerated and safe to take while try to conceive or pregnant, though high doses of vitamin C may cause diarrhea. Vitamin C supplementation is not recommended in people with a history of oxalate-containing kidney stones.

    Zinc: Zinc deficiency makes it more likely that you’ll catch a cold or other infection, so ensuring adequate zinc intake is important. Make sure to avoid oversupplementing zinc. The daily upper limit is 40 mg. You should not take more than 40 mg daily except for short time periods as directed by a healthcare practitioner. Make sure to check all supplements for zinc content when determining your daily intake, as some prenatal vitamins have as much as 25 mg zinc.

    Sources

    1. Linus Pauling Institute at Oregon State University: Vitamin D: https://lpi.oregonstate.edu/mic/vitamins/vitamin-D#immunity

     

    1. Linus Pauling Institute at Oregon State University: Vitamin C: https://lpi.oregonstate.edu/mic/vitamins/vitamin-C#common-cold-treatment

     

    1. Linus Pauling Institute at Oregon State University: Zinc: https://lpi.oregonstate.edu/mic/minerals/zinc

     

  • Exhale 2018, Inhale 2019

    By Cassie Harrison, Yoga Team Lead RYT, RPYT

    A new year, new you! We often make a New Year’s resolution at the start of a new year in hopes of making changes to improve our lives during the coming year.  What starts off as a optimistic plan for the future, Go to the Gym More (i.e. You’re Not in Shape!) or Call Mom and Dad More (Guilt!) comes from a place within us that says we are not good enough and rarely works.  What starts off a noteworthy concept, instead becomes a list of our faults. What about instead trading in those old and (albeit) familiar ideas instead for an intention or Sankalpa.  A yogis new year’s resolution.

    Sankalpa is an intention formed by the mind and heart, it’s what’s behind the emotion of the traditional new year’s resolution.  To make a Sankalpa is to make an intention or to resolve (a resolution). A sankalpa allows you praise your effort rather than focus on what you are doing wrong.  This is a change from how traditional new year’s resolutions tend to leave us feeling guilty and mad at ourselves for breaking them. Release yourself from holding onto the past and instead create an intention full of possibility for the future.

    Start by looking at you resolutions (I know you already made them!) and note how they make you feel (anxious, mad, jealous!). You might need to journal about these feelings over the next few days before this last step.  When ready, ask yourself how would you like to feel this year and turn those results oriented resolutions into something that will give this years journey more value.

    Here are some suggestions of sankalpas given by Satyananada Saraswati in his book “Yoga Nidra”:

    -I awaken the spiritual potential.

    -I am a positive force in the evolution of others.

    -I am successful in all that I undertake.

    -I am more aware and more efficient.

    -I achieve total health

    Or from Catherine Guthrie at Yoga Journal:

    -May I be Happy and Open to What Life Brings Me.

    Be gentle on yourself, these changes don’t happen overnight. Make your intention/sankalpa a part of your daily ritual to remind yourself what you will accomplish this new year.

    Join the Moon in any of our yoga classes to explore and support your sankalpa. Learn more about our free community classes (in Chicago and Highland Park), our Yoga for Fertility series (in Chicago, Highland Park, and NEW Long Grove option near our Buffalo Grove office!), how our Prenatal Yoga is unique and more! New additions are added to our Calendar every month!

     

  • Waiting for Elijah

    The night before you were born, there was so much lightning. It wasn’t raining though, just hot– the hottest night of the year. Sitting on the big blue birth ball, rocking from side to side, I’d rest my head on the hospital bed during the in-between. When a contraction came, I’d sit up, open my eyes and watch the jagged stabs of light through the window as they punctuated the clear, distinct pain in my body.

    Later, the white haze of high noon would blur the edges of the clouds. By then, nothing would be clear for me. The pain and the urge to push or not push and the exhaustion and the panic would all run into and over each other, a hot, foggy murk, and I would not know when or if or how you were coming, or what my body was doing, or if both or either of us would survive.

    Everyone said it would be a snap. A breeze. A walk in the park. There will be nothing to it, they said. They said, he’ll slide right out. Nothing is like the first one, after that, it’s all downhill. Your body is ready, they said. Your body knows what to do. Your body will take over. You’ve been through it all already.

    Everything they said should have been true; but nothing could have prepared me for birthing you.

    I cannot say your birth tore me open. My body did not literally tear. Somehow, I managed to expand beyond my own capacity to accommodate not only your body, but also the hands and wrists and forearms of the midwife who reached inside to turn you and free your shoulder from the umbilical cord that had wrapped and twisted its way around you.

    And yet, later, I needed to mend.

    It’s hard to know what happened to me afterwards, where I went. I thought I knew how to have a baby – how to birth a baby and then how to mother an infant back at home. I’d done it before – I knew how.

    But I didn’t know anything. I didn’t know how to handle you, the colic. Who could blame you for being so fussy!  You had swallowed so much amniotic fluid, having descended into the birth canal, then waiting there for much longer than you should have. The fluid was in your ears and eyes and belly. You needed to recover from your own birth. You needed to be held all the time, and of course I wanted to hold you, but you have a brother too, and he also needed my love and attention.

    It’s not like things ever got That Bad, really.  I was not incapable of joy, because I did laugh and love with you. I could never not get out of bed. I did not want to harm myself or others. I never fantasized about abandoning you or dropping you out of the upstairs window.  I said “no” to many of the criteria on the doctor’s checklist when I finally went, nine months later, to get some medication.

    It was hard to describe, other than to say that I didn’t quite feel like myself. But then again, it was hard to know who my “self” was anymore. There was a dark heaviness, an anger and sadness and loneliness. There was a feeling that nothing was wrong, but everything was wrong.

    I slept upstairs for months, on the guest futon in my office. I did not know how to be married. I had no space. I felt so empty and hollow and heavy, there was no way anyone could meet me where I was.

    It was, and still is, vague and blurry and hard to understand.

    Maybe I just needed time to breathe, to mend my overstretched ligaments and allow the holes in my psyche to close back up again, after experiencing what was beyond my comprehension, to replenish the reserves of energy and fortitude that had been used up in birthing you.

    Maybe if I had been allowed to stay in the hospital for another day or so I would have been okay. Just some time to collect myself before heading back out into the world where so much would be asked of me.

    Maybe it’s because I felt so inept.

    Maybe it’s because the only ways I knew to love were suddenly limited by time, attention, and energy.

    Maybe it’s because your birth was so difficult but maybe it’s because that type of difficulty is not recognized as trauma.

    Maybe it’s because I wanted to tell my story – the story of your birth – over and over and over to make sense of it, to find a context, but once everyone knew the basic details – 20 hours of active labor, the cord around your shoulder, no c-section, nine pounds, two ounces, everyone’s fine – they had heard enough.

    Maybe I had post-partum depression. Maybe I had a chemical imbalance.

    Maybe I just needed help. Everyone had told me – 2 kids is more like 10 kids, the workload increase is exponential, etc. etc. But no one ever said, you will not know how to handle it. You will not know how to love so much, so separately, at the same time, and this not knowing will tear you apart.

    Maybe it was simply that I was an almost-40 year old woman who spent many long days alone with a toddler and an infant, and I could have used some time to myself.

    Maybe it was nothing more than that.

    My water broke first. That was a surprise. It hadn’t been that way the first time. Later, I was told that that there is much lore and myth around births where the water breaks before contractions have begun because contrary to common portrayals on TV, this sequence of events is actually rare.

    I had just gotten your brother into the bath and I bent down to kneel beside the tub and there it was, as if the bathwater had overflowed onto the floor. Of course I knew, but I still wanted to be sure. I waited. Soon, there were puddles of amniotic fluid all over the house. We called your grandparents to come for your brother. I stood on the front porch, waving until the car disappeared around the corner into the clear evening light. My heart ached, saying goodbye to my “only” son, bursting to welcome you.

    Back home again when everything was over, I was nostalgic for the hospital. There was a hippie deli down the street, and I missed the tuna sandwich on thick, soft, grainy bread, with tomato and sprouts brought to me on my one day of convalescence. I would miss the quiet, the solicitude, and that single night, alone with you, in the bed beside me, swaddled, nursing, as we figured out how to be together with you outside of me.

    Afterwards, I wanted to do it again right away, which was crazy, given what I’d just been through. I thought it was the post-partum euphoria, the hormones and dizziness. But the feeling lasted.  I wanted a third. A girl. I felt myself clinging to the hope that I would go through it all again. I knew that if I was going to do it, it was going to have to be now, that I could not make the transition in and out of this space again. I needed to keep the momentum going.  As the months wore on, though, I knew I could not handle more. This was plenty. We were enough.

    But first I had to be sad.

    I had to be sad that I am not younger. I had to be sad that I didn’t do this sooner. I had to be sad that I’m someone who needs a lot of solitude in order to feel fully whole. I had to be sad that I will never have a daughter, a Violet or Ruby. I had to be sad that your birth marks an ending for me. I had to mourn the loss of possibility, that while it is still technically possible, it is not actually desirable, given our circumstances, our lives, to have more children. I had to actually say the words to myself, No, I can’t handle more. And then I had to be sad that I can’t handle more. I needed to be sad that this will be all, and I had to go through all of that to recognize that this is plenty. That you, I, we are enough.

    Last time, I had birthed naturally, as I had wanted, but in a traditional hospital, with an O.B. With you, I was going to have a water birth. We had switched OB practices so that I could employ a midwife and use the Alternative Birthing Center and give birth in the giant bathtub. I could labor in water, which was said to be so relaxing and warm and peaceful. Floating took pressure off the joints and alleviated the affects of gravity and you would not be shocked by the sudden change from water to air and I could catch you myself as you slid out.  

    But the night you were born was the busiest of the year in the birthing wing. Someone said it was because of the lightning, the way it pierced the pressure of the atmosphere which induced labor. The tub was not available. It’s rare that so many women are laboring at the same time that those who desire the tub suites cannot have them, but as I breathed through my contractions in the triage room, I was told that there was a chance we might not be able to have a water birth.

    There was much confusion then, and conferring with various staff members. But I left that to the trusted others to handle, your father and godmother, who were with me in the hospital. I was busy, breathing, focusing, rocking, turning further and further inward in preparation for the work I would do later.  

    The lightning began to fade as the first signs of daylight appeared in the sky. There was a shift change for the staff, and once my regular midwife showed up, I knew we would be alright. She was taking charge of the situation and said that yes, we could get into the tub room because I had been there longer than the others. I only had to be dilated 5 cm before I could get into the room but that surely that would not be a problem because I had been there all night.   

    But when she checked, I was only at 2.5 cm, still. I didn’t know why it was taking so long, what was wrong, what I was doing wrong.

        Even at this hospital, with all their alternative methods, there were still rules; they followed the standard hospital protocol which allowed no more than 24 hours to elapse between when one’s water breaks and when the baby is delivered. Without amniotic fluid, the theory goes, the baby has no protection from harmful germs and bacteria and is potentially exposed to danger of all kinds.

        5 cm to get into the water, 24 hours without water.

        5 cm to get into the water, 24 hours without water.

        5 cm to get into the water, 24 hours without water.

    Later, somehow, in the space between trying to return to normal and recognizing that my notion of normal had vaporized – during the time when I tried to show your brother how much I still loved him and how much attention I still had for him, how much I could still dance and romp and play and be silly, and how much it was okay for him to be mad at me for having a baby, and how it was okay for him to not want me to sit next to him, or tuck him into bed at night, all while trying to figure out what would make you happy, not the car nor the stroller nor the bassinet, only my arms, my breast – somewhere in there a part of myself became dormant, as if stunned into stillness. It felt as if nothing within me was growing, that I had shed all the life I had.

    I was already a mother when I had you, so your birth was not the dramatic transformation into something else that had occurred the first time. One birth revealed to me how much I was capable of, was for me about capacity; the other illuminated my limitations, the point where branches can bend no further, the point of breakage. Both showed me to myself. Both were necessary for me to be whole. At the time I did not know that. At the time I did not recognize that anything was growing or alive, that deep underground, my roots were stretching, absorbing nutrients from the rich soil of my life, of our lives together.

    By now I’m Tired. I’ve been having steady contractions for 14 hours already. The tub is open. We are moving. We parade down the hall, carrying pillows from home and clothes and bags and cups of coffee and cups of ice. I feel that I’ve earned this and here we are, the large room with the queen sized bed with the flowered spread and oak headboard. The tub. The tub is full of water and waiting for me, for us. Through the window I see the blue sky and white, puffy clouds. Late morning light. I sink into the tub. Getting close to transition now. The contractions are coming quick and hard and I am breathing and the water feels so good, I lay back, rest, so that only my face and the apex of my belly with its protruding navel are not submerged in water. And then I wait. And nothing happens. When a contraction comes, several minutes later, it is weak, and barely a moan escapes my body. I wait some more. It’s afternoon now. We’re close to 20 hours now. I’ve gotten to 8 cm and now my contractions have stopped. I’ve reached transition and now I’m going backwards. I am closing back up.   

    Out of the tub and into the shower. Out of the shower and on to the bed. A walk down the hall. Nipple stimulation to get contractions going. We’ll try a breast pump. This works; the contractions are back and they are quick and hard and we are ready to go and they are in my back now. There is no water inside me and no cushion. I’m having back labor now and I’m on all fours on the bed and I have never had pain so deep and hot that it pushed me to the edge of consciousness. I do not know who I am. I do not know what I am.

    Then back in the tub and do I feel pushy now?  

    I’m not sure; I can try to push but I don’t know how. I don’t know how to push anymore and it’s not time yet. It should be time, but it’s not time yet. We’re not ready yet. Back into the shower and down the hall and back and nipple stimulation and now I feel pushy. I want to push in the tub but that doesn’t work. We’ll try the bed and now the pain the pain the pain. On my back and I am screaming and I can’t take it. I can’t do it any more I am done. The contractions are too much, it’s too fast now. It’s happening too fast and too slow and it’s not over yet and it should be and out the window is only white haze and my eyes are blurry. The room is flooded with light and I scream into the light it’s too much I’m pushing now. I’m pushing now. My body is on fire and you will be here now.

    I am in and out of that place within me that I have never known before, that I will not remember afterwards, that place that allows my body to take over. That place that pushes me out of itself, that is myself. That is fluid. I will need this later. I will want this later. But my moments here are so fleeting I will not know how to come back and this is not a place to return to, only to bring back with me. But there is no time to come back here, like waking from a dream and wanting to remember it before the day begins.

    I am pushing now for you to come but you do not come. You move down but then back up and something is wrong. It is not supposed to happen this way. It’s not supposed to be this way. I am to push and you are to emerge but you are not coming out. You have descended. You can’t stay there too long but you stay. Your head is moving now your head is out. Your skull your brain your mouth your eyes are here but now your body is stuck. We’re both stuck. There is nowhere to go because of where you are and where I am and I am done but you’re not out and there is nothing to do but scream and sob and push and breathe and pray and beg to be cut open but they cannot cut because your head is out and the only way out is through me. It’s not supposed to be this way, your body should slide right out now, but there is the cord. The cord is keeping you here, part of my body holding strong to your body, not letting you out and this is when we could die. Like a flash of lightning, I suddenly know, in my bones and skin and fluid and a new kind of scream, that something is very wrong, that you or I or both of us might not survive this. Darkness descends now. But now there are the hands and wrists and forearms, reaching in and turning. I don’t know what is happening, only more pain but there you are now you’ve been turned and you’ll slide out now, and I’m pushing and just like that there you are. You’re out. You’re out now and I’m done. My shaking sobbing body is done. But you’re quiet. There is no sound from you yet, not yet not yet and I am waiting for you still and I don’t know I don’t know if-  

    Here you are. You’re on me now, blue and slimy and crying too and mine. You’re here and you’re okay and we both made it we’re both alive and you’re out and both our hearts are beating and you’re fine and you’re here.

    Oh my God – you’re here.

     

    “Waiting for Elijah” appeared in the Winter 2010 issue of Calyx Literary Journal and is republished here with the author’s (Christine S, Massage Therapist LMT) permission.