Two in the morning. I was lying in bed, Nathan sound asleep to my left, Pippa sound asleep in her yellow cradle to my right. The ceiling fan whirred overhead. I was wearing my headphones, and my headphones were plugged into my iPhone, which was playing the sound of a rushing river. Circumstances were perfect for sleep.

Except my wrists were throbbing. Lying in bed, I reprimanded myself. I really needed to stop clutching my smartphone during Pippa’s nocturnal feedings. Except scrolling through blogs was the only thing that kept me awake. If I just watched Frazier reruns, I fell asleep, and if I fell asleep, I might drop Pippa or, worse, lean forward and suffocate her with my own body.
I tried to put my wrists out of my mind. Thinking about the wrists just made me think about the ultrasound. I had gotten the blood test, and the results had shown elevated enzyme levels in my liver. The nurse said this was probably due to weight gain during pregnancy (you think?), but my obstetrician still wanted me to get an ultrasound of my liver before I could get physical therapy for the wrists.

I flipped from my left side to my right. The blood test had been an ordeal. My parents had watched Pippa, and the entire time I was gone, my anxiety spiked as if I were in the middle of a natural disaster. This made no sense. Pippa was safe and happy with my parents. I had pumped a bottle of breast milk in case she got hungry. The lab was only a few miles from our house so if there was an actual natural disaster, I could still get home.

Nevertheless, I suffered. My heart pounded, my skin crawled as if I were covered by hundreds of bugs, and I generally felt as if the world were about to end. It was not. There was absolutely no reason for the way I felt. At least, there was no logical reason, but there was a biological one.

Postpartum depression.

Anxiety is a symptom of postpartum depression, a symptom I was experiencing with greater intensity and frequency. As I tried to get back to sleep, the thought of the ultrasound made my heart race. There were so many things that could go wrong. What if Nathan had to go to work and I had to bring Pippa to the appointment? What if I could not pump enough milk and Pippa got hungry? What if Nathan was annoyed that he had to go into work a little late because his fat wife needed an ultrasound?

These petty concerns were easier to ponder than the deeper fear: What if I had cancer? Rationally, I knew my doctor was being overly cautious. Just as she had wanted to rule out MS when I was constipated, now she wanted to rule out some serious liver condition when all I had were sore wrists. Yet I could not stop myself from worrying that I might have cancer and leave Pippa to grow up without a mother.

I flipped back to my left side. I could not get comfortable. At least Pippa seemed to be comfortable in her cradle.

Or was she?

I tiptoed over and leaned as close as I could to her face and listened for the sound of her breathing. Her chest moved up and down but the room was dark. Maybe my eyes had tricked me into thinking she was breathing but she was actually in distress.

I gently rested my hand on the soft spot on the top of her head where the skull had not fully closed. For a moment, I felt nothing. Trembling, I inched my hand to the left. My body relaxed as I found it: her pulse.

My baby was still alive.

I got back into bed and closed my eyes. My muscles relaxed, my breathing slowed, and the chatter in my brain faded—

Had I checked Pippa’s sleep sack?

At night, Pippa slept in a sleep sack, which was like a sleeping bag with armholes. The sleep sack kept her warm without the risk of smothering her the way a blanket might. Rationally, I knew she was safe and snug in her sleep sack and told myself to go to sleep.

What if I had inadvertently nudged the sleep sack out of place?

What if it was on top of Pippa’s mouth?

What if she was suffocating this very moment?

My eyes flew open.

I closed them and urged myself to go to sleep. I knew Pippa was fine. These fears were ridiculous. I needed to get some decent rest before Pippa wanted to breastfeed again.

Just as it seemed as if I could talk some sense into my anxiety, the guilt chimed in: Was I really placing my desire to sleep above my daughter’s safety? What sort of mother was I?

I got out of bed, crept toward Pippa, and examined the sleep sack’s position. It was several inches away from her mouth.

I went back to bed and closed my eyes. I took several deep breaths.

What if, while walking back to bed, I had caused a disturbance in the air that moved the sleep sack onto Pippa’s mouth?

It had not always been this way. In the maternity ward, whenever Pippa was swaddled and in her cradle, I knew she was safe. Or, more precisely, it never occurred to me to worry about her safety.

I do not remember exactly when I started checking Pippa during the night—those first weeks are such a blur—but I do know it was not our first night home from the hospital. That first night, I was too busy figuring out a way to get Pippa to sleep in a place other than my arms. She had slept easily in the hospital cradle but screamed every time we put her in the travel crib in the master bedroom.

Nathan and I took turns holding her. Around 1:00 a.m., out of desperation, I checked a baby book the pediatrician had recommended specifically for sleep issues. The book said newborns could sleep in a car seat. I eased Pippa into her car seat and slowly withdrew my hands. She slept. I rejoiced and went to sleep myself. I was too exhausted to think about her breathing.
But eventually, probably when Pippa was a few weeks old, I started to worry. According to my baby books, sudden infant death syndrome claimed the lives of 1,500 infants every year in the United States. That is not actually that big a number when you consider the fact that in 2013, the year Pippa was born, there were 3.93 million births in the United States. That means for every hundred babies born in 2013, less than 0.04 percent of those babies died of SIDS.

SIDS still terrified me.

It was as if the Grim Reaper were hovering nearby, waiting to snatch Pippa while I had the audacity to slumber. I followed all the advice I could find. We kept the cradle in our bedroom, ran a fan all night, used the sleep sack. Pippa still seemed to be in imminent danger. And so I checked to make sure she was breathing, as if by checking I could ward off evil spirits or, at the very least, reassure my frazzled nerves.

The reassurance, though, never lasted more than a few seconds.

I got out of bed again, the fifth time in as many minutes. This time, after checking Pippa’s pulse and watching the fall and rise of her chest, I tucked the sleep sack into her pajamas to make sure it would not get loose during the night.

Now I could sleep.

Except.

Tucking the sleep sack had created a big fabric bulge near Pippa’s neck. Could that interfere with her windpipe?”

“No, I told myself, she was fine. I had pulled the fabric bulge several inches away from her neck.

But. How could I be sure the fabric bulge would stay in place?

I had to know.

***

A few weeks later, once again during the middle of the night, I put my hand on the knob of the front door and turned as hard as I could, twisting back and forth until I was sure it was locked. Then, I turned away to go back to bed.

But. Was it really locked or did it just seem to be locked?

I unlocked the door, relocked it, and then rattled the knob back and forth to make sure it was really, really, really locked.

I felt calm.

I removed my hand from the doorknob.

My heart immediately started to thump as if I were on the verge of a heart attack.

Was the door really locked?!?

After testing the lock’s integrity a dozen more times, I pulled myself away, like a spaceship escaping a tractor beam. At last, I could go back to sleep. I had finished breastfeeding Pippa almost an hour ago, but if I fell asleep right away, I could probably get into a REM cycle before she was awake for the day.

I took a deep breath. Sleep, please, let me sleep.

Was the back door locked?

I had checked the back door just five minutes ago, but maybe something had happened to unlock it.

I chided myself. I was being ridiculous.

But if the door was unlocked, and a kidnapper was prowling the neighborhood . . .

The risk was too high.

After checking the back door, I could not resist the urge to revisit the front door again because you never know.

On my way back to bed, I walked through the kitchen.

When was the last time I checked the stovetop burner?

***

If you place a frog in a pot of boiling water, it will leap to safety.

It is said that if you place the same frog in a pot of room-temperature water and flick on a flame, it will not notice the change in temperature. (This is not actually true. Still, I like the metaphor.) Even when the water has started to boil, the frog will stay in the pot, oblivious that it is being cooked alive.

I was the frog.

***

I staggered toward bed, half-assured that the doors were locked and stovetop burners lit.

What about the windows?

I started in the kitchen, yanking upward on each window. Then I moved to the living room. I could see with my eyes that the windows were in fact locked.

Or maybe they only looked that way.

I pulled as hard as I could on the first window. It did not budge.

I turned and considered the second. A huge thorny bougainvillea grew in front of that window. Not even Prince Charming could get through those tangles. The window was completely inaccessible.

Yet I could not resist. I had to check.

Next I went to the nursery and checked the windows by the changing table. Then it was time to survey the guest room.

But wait.

There was a window in the nursery closet. The old owners had sealed that window shut and it was impossible to open. Besides, it was no bigger than a shoe box. No one could climb through it . . .

I had to know.

I opened the closet door, leaned over diaper boxes, and strained at the window as if the house were on fire and this window were the only way out. Only then could I convince myself to move on and check the guest room windows.

At last. We were safe. I could go back to bed.

I turned and started walking back to bed.

What if an intruder had broken into the house during the day?

My heart beat faster.

What if he was hiding under one of the beds?

My breathing accelerated.

I marched back to the guest room. A small part of me protested. No one could be hiding beneath this bed. The frame was barely six inches off the ground and besides, I had crammed all sorts of junk down there.

What if there was a snake?

My heart started to pound even harder. I knelt down at the edge of the bed convinced that something terrible was hiding just behind the bed skirt. If I looked, it would surely kill me; but if I did not look, it might kill Pippa instead.

I took a deep breath and lifted the bed skirt.

No snakes, no fantastical creatures from horror movies.

I finally crawled back into bed, terrified of waking Pippa or Nathan. Neither stirred. Utterly exhausted, I fell asleep before my thoughts could rouse me out of bed.

***

Fourteen, fifteen, sixteen, oh no, seventeen.

There were seventeen steps.

Not sixteen, a beautiful number that could be divided into two halves of eight steps each or, bliss, four quarters of four steps each.

And not eighteen, which at least had the decency to be an even number.

But seventeen. Seventeen odd-numbered steps.

How could my parents have possibly thought this was a good place to live?

I was nineteen years old, home from college on spring break. My parents had bought a townhouse in a gated community. It was built on top of a hill, so the ground floor was also the top floor. A flight of stairs descended to the second floor, where my siblings and I would sleep.
A flight of stairs with seventeen impossibly odd steps that would torment me every time I needed to go to a different floor.

I experimented with ways to make the seventeen-step staircase feel like an even number. I tried skipping a step, but no matter what step I skipped, I knew the seventeenth step was there.

Stepping on the same stair twice also felt wrong. I tried rushing down the stairs without counting, but not counting felt even worse than counting an odd number.

Counting stairs was one of my quirks. I had a few others—turning jumbles of letters on license plates into words, folding laundry in certain ways, counting how many cars I passed when I was in the faster-moving lane of traffic—but they were just innocuous mind games that made me smile. I freely told friends and family about my little games with a sense of pride. They were proof that I was unique and marching to my own beat.

It never occurred to me that these quirks were more than just games; that they were actually a way of exerting control over my world.

It never occurred to me that I was flirting with obsessive compulsive disorder. Or that my quirks could turn into something sinister if given the right circumstances.

***

“I’m going to bed.”

Nathan glanced up from his laptop. He likes to piddle with various sports-themed games while watching television. “Good night, sweetheart.”

It was not even nine o’clock, but at two and a half months postpartum, I felt like a shell of my former self. The sooner I got to bed, the better chance I had of getting a full night’s rest and feeling like an actual human being.

I tiptoed into the bedroom, careful not to disturb Pippa. I got into bed and closed my eyes.

Were the doors locked?

My eyes popped back open.

I listened. Nathan was still in the next room watching television and playing games on his computer. I had to check the locks, but he would think it was weird if I started locking and unlocking the doors.

I’d have to start with the front door, which was on the other side of the house. The television volume would drown out the sound effects.

It took me a few minutes to convince myself the front door was locked.

Now it was time for the back door.

I sauntered into the den. Nathan’s eyes were on the television. I sidled a few steps toward the back door. The back door was technically in the same room as the television, but thanks to the position of the couch, it felt like the back door was part of a separate little mud room. Nathan was not looking at me. I sidled closer and felt a thrill, as if I were riding a bike down a steep hill. I was there, close enough to touch the back door, and he had not noticed me.

I started to lock and relock the doors surreptitiously. Nathan kept watching television. My secret was safe.

Or so I thought.

Long after my postpartum depression was diagnosed and treated, Nathan and I talked about the way I locked and relocked the doors. He’d been aware of what I was doing, but he thought it was a result of normal new-mommy fears. Where he grew up, doors were often left unlocked. No one worried about burglars, and they would have thought you were bonkers if you’d inquired about local serial killers. But I was a city girl. In my world, doors needed to be locked.

At least, that was what he told himself. Maybe he was also in denial. It would have been much easier to think his wife was being a bit silly than to confront the possibility that she was swimming in dark psychological waters.

Besides, Nathan knew only that I was checking the doors before bed. He did not know I was checking Pippa’s breathing throughout the night; or that I checked the stovetop burners, windows, closets, under the beds, and sometimes even inside the washing machine; or that I rechecked the doors—and everything else—after every breastfeeding session. Those things happened only when he was fast asleep.

My anxiety sometimes seemed to have a mind of its own. Like, my anxiety knew that it had to be surreptitious and not arouse my husband’s suspicion. Otherwise he might have taken me to a doctor, and the doctor might have helped me, and my suffering might not have lasted as long as it did.

And that concludes Chapter Seven! I will post Chapter Eight soon. In the meantime, Adventures With Postpartum Depression is available now on Amazon, Barnes and Noble, Apple Books, Kobo, Scribd, Tolino, Baker & Taylor, Borrow Box and Overdrive.You should totally tell your librarian to get the book on Overdrive and make it available for moms who need the confirmation they are not alone.

I had an idea: I should publish my memoir Adventures With Postpartum Depression on my blog. So that is what I am doing. If you want to start at the beginning, start with The Prologue. If you want the actual book (yes you do!), it’s available now on Amazon, Barnes and Noble, Apple Books, Kobo, Scribd, Tolino, Baker & Taylor, Borrow Box and Overdrive.

“How are you doing?”

“Wonderful! I’m doing great.” I knew exactly what the obstetrician was doing. She was trying to sniff out a whiff of postpartum depression.

As if on cue, Pippa started to scream. She sounded like a siren portending the world’s end, but the obstetrician seemed unperturbed by the noise. Instead, she looked concerned for me. I willed myself to appear calm and collected.

“But how do you feel?” she pressed.

“I feel great.”

I was at my six-week postpartum appointment and given my history with hypochondria, did not want to say anything that would lead to a misdiagnosis of postpartum depression. Still, my doctor seemed to think I had it.

In hindsight, I realize my appearance might have tipped her off.

I usually got my long brown hair professionally cut and highlighted every two months. During pregnancy, my obstetrician had assured me that I could continue getting my hair highlighted, but I was not taking any chances. What if some chemicals seeped through my scalp, got into my bloodstream, and hurt my baby? If I was not getting my hair highlighted, I might as well skip the haircuts too. I had read about postpartum hair loss and reasoned it was better to have as much hair as possible in case half of it fell out.

By the time my water broke, my hair was straggly and a mix of greys and faded highlights. Three hours of active labor did nothing to improve my look: the ponytail holder fell out, and my hair got tangled into a sweaty, salty mess. During my first postpartum shower, I was too tired and defeated to drag a comb through the knots.

Six weeks later, I still felt too defeated to deal with the hair situation. Eventually, I would buy detangler and conquer the knots, but that was still several weeks away. My obstetrician must have been more than a little alarmed by my hairstyle.

“Are you happy? Getting enough rest?”

(My hair was truly frightening.)

“I am doing wonderfully. I didn’t even have the baby blues. I haven’t cried. I’ve been so happy since Pippa arrived.”

When I said I was happy, I was trying to convince myself as much as the doctor. The part about crying, though, was true. I had not cried since Pippa’s birth aside from the one time I started crying at one in the morning from pure exhaustion. That didn’t count. That was not the baby blues. I assumed that whether or not a new mother had the baby blues was the ultimate barometer of her mental health; that postpartum depression was an extension of the baby blues.

In a few months, I’d know better.
By the time of this six-week appointment, I had postpartum depression. I had not experienced any symptoms that would get me locked up in the mental ward (those would come soon enough), but looking back, I can see the red flags.

There was my new obsession with germs. Previously, my hypochondria had always been limited to symptoms I had, or thought I had, never extending into mysophobia, or fear of germs. Postpartum depression had helped me make the leap from hypochondria to mysophobia.

The first day of Pippa’s life, while my parents and grandma were visiting us in the maternity ward, I scrolled through the online options for face masks. I needed a cache of masks for visitors who might arrive at my house with coughs and sneezes.

“I can’t tell which one is good enough.”

“I’m sure they are all fine.” That was my mom, a woman who was always vigilant about her children’s health. When everyone, including the pediatrician, insisted my sister simply had the flu, my mom was the one who piled everyone into the car to go to the hospital. Three hours later, the nurses were prepping Katherine for an emergency appendectomy. Now that her first grandchild was here, you could be sure my mom was not going to let anything endanger Pippa’s health.

“But even the ones that are supposed to be good enough for surgery are not 100 percent effective.”

“Courtney, if it’s good enough for surgery, it will keep Pippa safe.”

“You don’t know that.” I spent another hour agonizing over the options before settling on the best bad choice. Then I fixated on my next fear: unwanted visitors.

“What if someone wants to visit and they are sick?”

My mom had Pippa stretched across her legs, facedown, and was patting her back. This seemed to help her burp. “Courtney, no one is going to visit when they are sick.”

“But what if someone wants to visit and they are already sick and contagious but they don’t have any symptoms yet? Or they think it’s allergies? A cold can kill a newborn.”

I was imagining droves of Hennings, aunts, uncles and cousins from my dad’s side of the family, descending upon our house unannounced.

“If the Hennings ask, do you want me to tell them you don’t want visitors?”

“Yes. Be nice about it. But if anyone asks, discourage visitors.”

The message must have been effectively delivered, because almost no one visited. Just my parents, Nathan’s parents, my siblings, my grandma, and one cousin. I have a lot of aunts, uncles, and cousins in Los Angeles who would have loved to meet Pippa, but they steered clear.

So the mysophobia created another red-flag behavior: isolation.

***

“Sorry, my hands are cold.” The obstetrician had opened my gown and was gently touching my abdomen.

“It’s okay,” I said.

I had dozens of questions about my abdomen. Various nurses had shown me how to check my uterus and make sure it was shrinking, but their instructions made no sense. I could never tell what part of my body was stomach, what part was uterus, and what part was flab. I wanted to ask my doctor if my uterus had shrunk back to its regular size, but talking seemed like too much work.

I like people, I like talking, and lately, my life had been lacking in the conversation department. I chatted with Pippa throughout the day, but so far, she was a lousy conversationalist. I usually enjoyed talking with my obstetrician and should have been looking for ways to prolong the interaction. Instead I could not wait to be alone again.

When my parents and grandma visited, I usually retreated to my bedroom to sleep. I was exhausted from breastfeeding Pippa in the middle of the night, and sleep is essential to health, physical, mental, and spiritual; but even when I emerged to feed Pippa, I hated talking. It seemed like an unnecessary burden. In reality, I was turning into a people-hating hermit.
Postpartum depression had changed my personality.

Just the previous week, my parents, sister, and grandma had wanted to visit during the weekend. I protested. Four visitors? At the same time? That was too much stimulation for Pippa. On the phone, I told my mom that anything more than two was unreasonable.

“Okay.” I imagine my mom must have taken a deep breath at this point. “Just your father and sister will come.”

“Thank you.” I felt so relieved. “Thank you. I have to look out for Pippa.”

A couple of days later, my mom called again. “Would it be all right if your grandma also comes to visit this weekend?”

“What? Grandma?”

“She’s going back to New York in a week and she’d like to see as much of Pippa as she possibly can before she goes.”

I gritted my teeth. “Fine.”

When Nathan got home from work, I exploded. “This is ridiculous! They turn the house into a circus. It’s too noisy and crowded with all of them here. My mom is being so manipulative.”
Less than two years earlier, the morning after our wedding, we had about thirty people over to our house for bagels and donuts. The house had not seemed too crowded or noisy then. One newborn later, I could not tolerate the idea of being visited by three of my favorite people in the world at the same time. People who bathed the baby, trimmed her fingernails, and brought groceries. People who whisked away the dirty laundry and brought it back clean and folded.

It was not my mom who was being manipulative. It was the postpartum depression. It had manipulated me into a new person.

***

“Are you still breastfeeding?” The obstetrician gently examined my chest. Over in her stroller, Pippa was still wailing.

“Yes, exclusively.”

I spent hours every day with Pippa suckling at my breast. The experts said a baby should be fed on demand, so every time she whined, I offered her a meal. Then once she had latched on, I could never tell if she was actually eating or just using me as a pacifier, so I let her linger as long as she liked. Each meal lasted at least an hour, and since she seemed hungry every other hour, I spent approximately half the day anchored to my chair.

I thought good mothers exclusively breastfed their babies. I was wrong (more on that later) but at the time of my six week checkup, that was what I believed. That explains why when my obstetrician asked if I was breastfeeding Pippa, and I said “exclusively,” my stomach heaved from guilt and anxiety. I still felt bad that we had supplemented Pippa’s meals with a little formula when she was diagnosed with jaundice. I remember the sucker punch of guilt that I felt in my gut when the pediatrician reported the jaundice on day two of Pippa’s life. The pediatrician mentioned that we needed to supplement with formula because I was not producing milk yet, and I immediately (and incorrectly) blamed myself. It was my fault that Pippa had jaundice.

Pippa’s jaundice was not my fault, but I had always had a propensity to feel guilty about things that were out of my control. In the second grade, when my vision started to fail, I assumed I had sinned and was being punished by God. My hippie parents were not at all religious, but after becoming less than enamored with the local public school, they had sent me to Catholic school. Impressed by an Old Testament God who sent floods and leveled cities, I hid my shoddy vision for two years. Every time I had to take an eyesight exam at school or the doctor’s office, I cheated. I got close to the Snellen chart, memorized the lower rows of letters, and bluffed my way toward twenty-twenty vision. By the fourth grade, though, no amount of squinting could help me decipher the blurry smudges on the chalkboard. When I finally confessed my poor vision to my mom, and she laughed and said I had inherited my dad’s vision, I felt as if I had escaped damnation.

Guilt, though, is its own sort of damnation, and six weeks postpartum, I was in guilt hell.
After Pippa’s jaundice, guilt hijacked my body. I felt guilty when Nathan got up with Pippa during the night so I could sleep a little more. Surely he needed his sleep more than I did. I felt guilty when my smartphone died and I had to race out on a Saturday to buy a new one. Surely I should have anticipated that and procured a new phone when I was pregnant. I even felt guilty when, after holding Pippa for hours in the evening (she liked to cluster-feed), I passed her to Nathan so I could go to the bathroom. My bladder should have been stronger.

At six weeks postpartum, I had no idea that the guilt I felt was extreme or that feeling guilty is a symptom of postpartum depression.

***

“Everything looks like it has healed nicely.”

The obstetrician was talking about my vagina.

“So it’s okay to have sex again?”

“Yes, all activities are fine, including sex.”

My vagina had been cleared for takeoff, but I still felt sore and tender in my pelvic region. I assumed I was supposed to be excited to rejoin the ranks of the sexually active, but my vagina felt differently. After the trauma of childbirth and second-degree tears, it was going to take more than six weeks for my body to be ready for sex.

When Nathan and I did have sex, it was painful. It became another source of anxiety. Most of the time, I worried we were not having enough sex. Then, when we were having sex, I worried the doctor had sewn me up a little too vigorously. Would I feel like a virgin forever?

My poor body just needed more than six weeks to heal.

To be more precise: my vagina needed eight months to heal.

I’m not trying to be lurid or sensational, but my thoughts on sex were another red flag. My doctor did not know how I felt. All she could see was the way my wounds had healed. Based on what she could see, my vagina was indeed ready for sex. Based on what I could feel, though, the only thing my vagina was ready for was hibernation.

A very extended hibernation.

I did not tell my doctor that everything was still sore in the pelvic region. That felt . . . inappropriate. Remember: this was not just any doctor. This was my obstetrician. A professional trained to take care of vaginas. Yet I felt too embarrassed to talk about my vagina with my vagina doctor.

This was new. I had never been ashamed of my female anatomy. When I needed a box of tampons and bar of chocolate from the pharmacy and nothing else, I had no problem making those purchases from a male cashier. When I needed a box of Monistat 3 and ice cream and nothing else, I had no problem purchasing those from a male cashier either. A urinary tract infection and a male doctor at the ER? I could not care less.

Shame is a symptom of postpartum depression, and I was most definitely ashamed of myself. I was ashamed that my vagina had not bounced back from delivery. I was ashamed about the physical pain I felt in a very feminine part of my body, the portal through which my daughter had entered the world. This was not rational shame. This shame did not arise from something I had done wrong. It originated from the very source of my femininity.

There was nothing rational about this shame, but as I would eventually learn, there is nothing rational about postpartum depression.

The appointment was almost over.
The doctor asked, “So are you sure you have been feeling well?”

Lovely. We were back on the subject of my mental health.

“Oh yes, I feel fantastic.”

“Have you noticed any personality changes?”

“Nope. I feel like me.”

Pippa was still crying. Why did the doctor think my mental health was so important? Obviously I was doing fine. I just had a couple of pesky issues I wanted to address before I could stage my escape and comfort my baby.

“I did want to ask you about stool softeners.”

“Yes?”

“I’ve been taking the stool softener that the gastroenterologist recommended ever since I gave birth. Do you think I need to keep taking it?”

“You should keep taking the stool softener for as long as you feel like it is necessary, but at this point, I think you can safely reduce the dose. Does that make sense?”

“Yes, yes it does.”

“Do you have any other questions about constipation?”

Six weeks postpartum, I still worried about constipation every day. I did not ask my doctor if my concerns were a problem. Of course, they were a problem. My preoccupation with constipation was a symptom of my increasing anxiety, but I did not see it that way.

With my history of hypochondria, I saw my preoccupation with constipation as proof positive that I was what I had always been: a hypochondriac. I did not want my doctor to think I was a hypochondriac, so I was not about to dwell too long on the subject. I would just have to wean myself off the stool softeners and move on with my life. Besides, I had a question about something even more important than constipation.

“Can I ask you about my wrists?”

“Of course.”

“My wrists have been in agony. Could I possibly get a prescription for physical therapy?”

“Let me take a look.” My obstetrician gently touched my wrists. “Does this hurt?”

“A little.”

“Can you describe the pain?”

“If I move my wrists, it hurts. I’ve been using cold packs and heating pads but it hurts to even hold a book.”

The doctor said that my wrists might be hurting because I had arthritis.

This is where my memory gets murky. I remember clearly that she used the word “arthritis,” but I don’t remember if she said the arthritis was related to childbirth or not.

Pippa had been crying for ten minutes now. The sound of her cries made me very uncomfortable. I’m not alone in this. Pretty much any mother will tell you that the sound of her baby’s cries is impossible to ignore. Scientific studies support this. But since I was at my six-week appointment and needed to lie back on a table for the examination, I felt obligated to ignore Pippa. Besides, if I soothed her and then put her back down to finish the exam, that would just piss her off more.

By the time my doctor mentioned the possibility of arthritis in my wrists, I was so agitated from ignoring Pippa’s cries that I could not process any more information. The postpartum depression had also muddled my brain. Sleep deprivation was not helping either. Also, I had already asked Dr. Google about the pain in my wrists, and the internet was happy to provide stories from women who ignored the postpartum pain in their wrists and eventually needed surgery. The word “arthritis,” coming from my doctor’s mouth, confirmed my worst fears. The pain in my wrists was never going to improve.

My brain started to shut down.

My obstetrician took several minutes to explain what might be happening with my wrists, but this was all I gleaned: it could be arthritis; physical therapy might help; but first, I needed to get a full blood work done at the lab.

“Do you understand?”

The obstetrician had stopped explaining the wrist situation. It was my turn to talk. Apparently I was now in possession of enough information to understand why I needed a blood test for pain in my wrists, but I was too overwhelmed to understand anything. The blood seemed to be rushing extra fast in my arteries; my lungs hurt; the room seemed smaller than ever; Pippa’s screams were certainly louder; and my skin seemed to be losing elasticity and having trouble stretching over all my bones.

I did not understand why my wrists hurt. I thought I had just strained some muscles lifting Pippa’s infant car seat. It had never occurred to me there might be something more serious at work.

I did not understand why I needed a blood test.

I did not understand why breastfeeding seemed more difficult now than it had the day Pippa was born.

I did not understand why other moms were able to go places with their newborns and I had so much trouble going to one doctor’s appointment.

I did not understand why the doctor had asked me so many questions about my mental health.

The doctor was waiting for an answer.

“Yes.” I smiled. “Yes, I understand.”

Okay, that’s the end of Chapter 6. I am rereading these chapters as I post them and damn, this chapter gave me so many feelings. Part of me is thinking, “Sweet baby Jesus, couldn’t my obstetrician see that I was suffering? And why did she think a blood test for my wrists was a good idea?” But another part of me is thinking how tough it is to help a mom with postpartum depression. I was not ready to see that I was suffering from a mental illness, and there was nothing my doctor could have said that would have made me see it before I was ready.

Also, rereading this, I feel an urge to go back in time and tell 2013 Courtney, “Pick up your baby! Don’t worry about what the doctor thinks! Get off the exam table and cuddle Pippa!” The doctor must have thought I was having trouble bonding with my baby. Then again: I must have been having trouble bonding with my baby because I was lost in a depression fog.

Another thought from 2021 Courtney: is guilt really a symptom of PPD? Or was it a sign that I had internalized some toxic beliefs about motherhood? And those beliefs were causing me so much pain, they manifested as a mental illness? Should we even call it a mental illness? Or does society have this idea of what it means to be The Perfect Mother and if we don’t fit in that box, we must be ill? Okay, that’s enough philosophical ramblings for a Thursday afternoon.

Ready for Chapter 7? Or just get your own copy of Adventures With Postpartum Depression. It  is available now on Amazon, Barnes and Noble, Apple Books, Kobo, Scribd, Tolino, Baker & Taylor, Borrow Box and Overdrive. You deserve it!

I had an idea: I should publish my memoir Adventures With Postpartum Depression on my blog. So that is what I am doing. If you want to start at the beginning, start with The Prologue. If you want the actual book, it’s available now on Amazon, Barnes and Noble, Apple Books, Kobo, Scribd, Tolino, Baker & Taylor, Borrow Box and Overdrive (whew! Try saying that three times fast).

Theoretically, I was supposed to “push” whenever a contraction started. The labor and delivery class had glossed over this part, the teacher insisting everything would make sense when the time to push arrived.

That time had arrived.

Nothing made sense.

With each contraction, I experimented with a different technique. It was like trying to do a squat without the benefit of ever seeing how someone actually performed that exercise. After several tries, I finally did something right.

“That’s it, Courtney, that’s it,” my doctor said. “That’s exactly how you need to push.”

I panted and looked at Nathan. He smiled. Then I noticed the nurse was busy by my tush, cleaning up a mess.

Poop. She was cleaning up my poop.

Various authorities had warned me that I would probably poop on the delivery table. But I am a well-mannered woman, thank you very much, and my manners include holding doors open, saying please, and never, under any circumstances, pooping on a table. Besides, my poor obstetrician had already had to yank feces out of my intestines. Surely she had experienced enough of my poop to last a lifetime.

When the next contraction started, I got shy. I tried to push without pooping. It was a bit like trying to do a squat without using any thigh muscles. The contraction ended, but no one cheered.

This went on for at least an hour. Every now and then, I would let go of my inhibitions and push with all the muscles usually responsible for pooping. My doctor and nurse would hoot and holler and tell me to do it again. Then I would go back to worrying about pooping on the table and for the next several contractions, I would try to push out the baby while preserving my dignity.

About two hours into active labor, after a successful push, the doctor said, “I can see it, I can see the top of your daughter’s head. Nathan, do you want to come see?”

No, I thought, he does not. We had discussed this and agreed he might be forever scarred if he looked at my lady parts during labor. But before I could register what he was doing, Nathan had scooted away from me and looked.

“She has hair! Lots of dark hair!”

When he returned to my side, he was trembling with excitement and looked radiant. As I watched, he transformed. One moment, he was a theoretical father. The next, he was an actual dad, head over heels in love with his daughter. My heart skipped several beats, but at the same time, I was jealous of Nathan. He looked radiant, but I felt empty and hollow inside. The pain of active labor had drained away all my good feelings.

Now that she had crowned, I assumed Pippa was seconds away from arriving. After all, that’s how it happens in the movies.

Movies lie.

For another hour, I pushed and pushed and felt contractions ripping my body apart. Then, after nearly three hours of active labor, I accepted the truth: in order to push my baby into the world, I would have to poop all over the place. But I was exhausted and felt too defeated and pathetic to push.

As if she was reading my thoughts, my obstetrician said, “Courtney, you can push for ten more minutes, and then I have to do a C-section.”

What? A C-section? After three hours of this hell?

I pushed and roared and pushed and forgot about everything but the contractions and the pushing. It did not matter how much poop got on the doctor.

Ten minutes later, the nurse placed Pippa on my chest.

***

I had been anticipating this moment for nine months. It was the moment the heavens would part and fireworks would erupt and everything would be more joyful than I could possibly imagine.

The hospital ceiling stayed intact.

No fireworks exploded.

And though I searched for it, I could find no joy.

But here was my baby, my daughter Pippa, so I looked down at her and tried to memorize the moment. Her eyes were wide open and dark blue, almost navy, and from the way she looked at me, she seemed already to know that I was her mama.

My eyes glided down her body—head covered with black hair, plump lips, little scrunched-up shoulders, legs that seemed impossibly long for someone so small, and toes that were absolutely perfect. I wanted to hold this tiny creature forever.

But I could hold her for only a minute. Then a nurse whisked Pippa away to be poked and measured.

My doctor smiled apologetically. “I’m sorry, Courtney, but I need you to put your legs back in the stirrups so you can deliver the placenta.”

Nathan shouted updates from the other side of the room. “She is so beautiful! Ten fingers. Ten toes. Oh her ears, they are so cute. She is amazing. So amazing! They are putting her on the scale. She weighs seven pounds and twelve point five ounces.”

Some sort of enthusiasm from the mother seemed warranted, but I could think only about how much my legs hurt.

“Do you want to see the placenta?”

Not really, but before I could react, the doctor was holding my placenta high in the air, directly in my line of vision. It looked very Game of Thrones.

The doctor told me I had second-degree tears. The vaginal muscles had ripped during delivery. (Try not to dwell on that point if you can.)

“I need you to keep your feet in the stirrups a little longer,” she said, “so I can stitch you up. But you can hold Pippa while I work.”

A nurse returned Pippa to my arms, but my entire body was shaking from exhaustion. “Nathan, please hold her and give her some skin-to-skin contact.” I did not want to drop my newborn.
Nathan removed his shirt and sat down on a chair about five feet from the hospital bed. He placed Pippa tenderly against his chest and held a blanket over her to keep her warm. After a moment, he laughed. “She’s trying to latch on to me! You can try, baby girl, but I promise you won’t get any milk from me.”

I laughed as if this were the most magical moment of my life.

Inside, I felt empty.

What was wrong with me?

During that moment, when I was one of the newest mothers in the world, I thought I must be some sort of monster. But now, after lots of reflection, I know the truth: nothing was wrong with me.

I felt empty because I had given my all to bring my daughter into the world. The epidural had worn off when I needed it the most; my feet had been up in stirrups for over three hours; and my vaginal muscles had ripped. My feeling of emptiness was a vast improvement over the pain, misery, and fear of childbirth.

Still, I’d expected to feel some emotional fireworks upon meeting my daughter. Wasn’t this supposed to be love at first sight?

Well, it was love at first sight, or rather, love at first sound, but that moment had happened three trimesters ago in my obstetrician’s office when I’d heard Pippa’s heartbeat for the first time. The obstetrician had moved the ultrasound machine’s transducer probe around my bare stomach, a frown creasing her brow, and then her face had relaxed. She’d turned up a dial and the sound of a galloping heartbeat had filled the room.

My baby’s heartbeat.

My heart had done somersaults and my lungs had felt so full, it was as if I might float all the way home. My baby. My baby! After that, I was fully in love with my baby. Every subsequent kick and ultrasound made my heart expand a little more. I did not need to see or touch my baby, and I certainly did not need to experience any fireworks, to be in love. But in the delivery room, looking at Pippa for the first time, I did not have the energy or capacity to think those things. All I could think about was how my reaction to Pippa’s birth fell short of the Hollywood standard.

Meanwhile, my hormones were busy crashing. During pregnancy, my estrogen and progesterone levels had been much higher than usual. Within the next twenty-four hours, they would plummet back to their normal levels. For some women, this hormonal crash is a trigger for postpartum depression.

I had never done well with hormonal fluctuations. I could handle PMS, but the birth control pill had nearly destroyed me. When Nathan and I were first dating, I took one brand of the pill for a year, and even though my obstetrician at the time told me I would bleed a lot less during menses, my menstrual flow instead became even stronger. I tried switching to a different brand, but that only increased the intensity of the bleeding even more and, worse, gave me dramatic mood swings that made me cry hysterically—usually at dawn, to Nathan’s delight, and for no reason at all. After six months on the second brand, I decided to quit, and the next time my period started, it was as if I had never taken the pill.

Looking back now, it seems so obvious. My body was sensitive to hormonal changes, and I already had plenty of preexisting issues with anxiety. Of course I was going to have postpartum depression.

***

All I wanted to do was hold Pippa in my arms forever. After the doctor had sewed up my battle wounds, I had reclaimed my baby and held her for a second time. This time, I maneuvered her toward my chest and she eagerly latched on to a nipple and started to suck. Oh thank goodness, I thought, she is breastfeeding. I will be a good mother.

I ran a fever during the last hour of labor, so when Pippa was done breastfeeding, the nurses whisked her away for two hours of observation in the nursery. An orderly wheeled me to a room in the maternity ward where Nathan and I promptly crashed.

But even asleep, I could sense that something was missing. I woke up exactly two hours and seven minutes after the nurses took Pippa away for observation and shouted for Nathan, still asleep, to get our baby back. (I know, I know. It is so weird that I can remember that Pippa was gone for two hours and seven minutes and yet have no idea what I had for lunch yesterday.)

Pippa seemed to have gotten more beautiful while she was gone. I could not get over her almond-shaped eyes. When she was awake, I studied the color of her irises. When she closed her eyes, I marveled at her dark, dark lashes. Nathan had a hard time convincing me to put her back in the cradle so I could get more sleep.

My parents and Grandma Shirley arrived in the late morning for the beginning of hospital visiting hours. Pippa had turned them into first-time grandparents and a brand new great-grandma. As soon as Pippa seemed to be done breastfeeding, I proudly passed her to my mom. This seemed like a good time to feel some excitement.

All I could think about were my bowels.

I had started obsessing over my need to move my bowels a few hours ago, about seven hours into motherhood. Of course, at that point, I had nothing to poop. I had taken care of that situation on the delivery table.

That did not stop my anxiety from turning constipation into an obsession. While my parents and grandma gushed over Pippa, my brain fretted.

When would I poop?

Was I already constipated?

Would I need manual extraction again?

What if that didn’t work?

I did my best to ignore the questions and enjoy our visitors. Pippa was lying stomach-down across my mom’s legs, getting her first back massage to relieve gas. I thought I should be bouncing with excitement. After all, I had been so happy to tell my parents and siblings that I was pregnant. But now that my parents were here, snapping photos, and my siblings were sending excited emails and texts, the excitement felt so far away, it might as well have never happened.

Only the threat of constipation felt real.

***

By afternoon, I was certain that I had to poop. I had devoured a large breakfast, an even larger lunch, and multiple desserts. But every time I tried to have a bowel movement, I got nervous. Could I burst the stitches the doctor had sewn into me if I pushed too hard? Then I would imagine my bladder tumbling into the toilet and abandon the effort.

I got angry with myself. I was supposed to be bonding with my daughter, not worrying about my bowels. Surely all other mothers gracefully navigated these first postpartum hours. I berated myself as if I were spending every minute in the lavatory. That was hardly the case. The first day of Pippa’s life, I spent all of fifteen minutes away from her. Most of the time, she was in my arms napping, breastfeeding, or both. I sang her lullabies, admired her toes, and cooed whenever she opened her eyes. My first day as a mother was mostly tender and sweet.

My anxiety about constipation, however, was an ever-present vibration in my personal atmosphere. It did not prevent me from bonding with Pippa, but it did keep my body humming with an edge of fear. And what had started as a single buzzing bee in the morning turned into an angry hive by day’s end.

Around midnight, twenty-four hours after I had given birth, the night nurse tiptoed in to check my vital signs. Pippa was asleep in a cradle at the foot of my bed. Nathan was snoring on a cot near the door.

“Please,” I whispered, not wanting to wake husband or infant, “I still haven’t had a bowel movement and constipation was a big problem during pregnancy and I know from the way I feel that I’m going to need an enema.”

I had mentioned the constipation issue at least a half dozen times to the day nurse, who was not impressed. The night nurse was much more sympathetic. She offered to fetch me a stool softener, and I gratefully accepted.

I thought I was solving an immediate medical concern, and that was indeed the case. But on a deeper, darker level, my anxiety, previously manageable, was increasing so much, it was interfering with my basic needs. Pippa and Nathan were both fast asleep. Exhausted from childbirth, I should have been sleeping as well. Yes, I felt a twinge of constipation, but the discomfort was on par with an itchy knee. The situation could have waited until morning. It was probably mostly a figment of my imagination.

The anxiety that had always been so manageable, that had given me the edge that made me a successful student and lawyer, had tipped into new territory. It was going to take a lot more than a stool softener to make me feel better.

***

“Can I still hold her?”

The nurse nodded curtly. “Yes, of course. You can take her out for feedings, but the rest of the time, she needs to be wrapped in the blanket. Make sure the eye mask stays in place.”

Nathan transferred Pippa from her cradle to my arms. The biliblanket was made from thick, clear plastic. It was plugged into the wall and glowed blue.

The blanket crunched as I tried to find a comfortable position. I studied Pippa’s face. Her skin still looked pink to me, but according to her blood test results, it was actually tinged yellow with jaundice. It had been less than nine hours since the nurse had given me a stool softener, and already my anxiety had found a new way to stay busy.

The paper mask covered half of Pippa’s face, so I stroked the top of her head, the only part of her body I could safely touch without compromising the light therapy.

“Babe, that doesn’t look comfortable,” said Nathan. He was sitting on a fabric folding chair with armrests and cup holders that we had brought from home.

“It’s not,” I sighed. “How am I supposed to get skin-to-skin contact? I’m supposed to get as much as possible. It’s important for breastfeeding.”

“You got plenty of skin-to-skin with her yesterday, and you’ll get tons more whenever she needs to nurse.”

“I guess so,” I said. I let Nathan put her back in the cradle and turn off the light so I could try to nap. In the dark, the biliblanket glowed an even deeper, more brilliant shade of blue.

“She looks like something out of a sci-fi movie,” Nathan said.

“She’s our little sci-fi burrito.”

My heart was pounding as I tried to rest. At least Pippa had to be a sci-fi burrito for only one day.

***

The insurance company had decided it was time for my discharge, but the pediatrician wanted Pippa to stay in the nursery for another night. The biliblanket had not been intense enough. Pippa needed extra therapy from a light box, a big, clear container with a lamp at the top. It looked a lot like the sort of contraption that cook churros and pretzels at the zoo.

This was not part of the plan. We were all supposed to go home together, as a family of three. Nathan and I were not supposed to abandon our baby.

“You can stay until midnight if that makes you feel better,” a maternity nurse suggested.

“Yes.” I nodded. “And then we can come back at three to breastfeed Pippa.”

I looked to Nathan for approval. “Whatever you want, babe,” he said.

The nurse said, “That’s fine, if you want, but you also need your sleep. We already have to give Pippa formula to help with the jaundice. You can come back in the morning after you have slept.”

I hesitated. It was as if the room were crowded with the ghosts of breastfeeding experts, all of them wagging their fingers at me, urging me to be strong and not miss a single feeding.

But I was so tired. I had gone into labor a little before midnight on Saturday. I had labored all day Sunday, giving birth a little after midnight on Monday. Pippa had been the sci-fi burrito on Tuesday. Now it was Wednesday, and I could not remember the last time I had slept longer than three hours in a single stretch. My body needed some deep restorative sleep.

“We’ll be back at six,” I said. Pippa would miss only one nursing session. I could wake up at three and pump.

But once we got home, shortly after midnight, I could not bear the idea of setting up the pump and all of its bits and pieces. Surely the universe would forgive me if I let myself have a little uninterrupted sleep. I set my alarm for six in the morning and closed my eyes, assuming I would be asleep in seconds.

Except my body was too wired to sleep.

For two hours, I tossed and turned. The authorities had warned me to sleep whenever I could, but no one had told me what to do when a toxic mixture of guilt and anxiety—for leaving my baby, for not stopping the jaundice, for not being a breastfeeding superstar—pressed so hard against my chest that sleep was impossible.

***

By morning, the guilt and anxiety had spread until they had contaminated all my thoughts—as if someone had reprogrammed my brain and changed the default settings. When my alarm pinged, instead of yawning and hitting snooze, I leapt out of bed (or did the best approximation of a leap that a woman with second vaginal tears can do) and woke Nathan.

Now, on top of my guilt for abandoning Pippa, I felt guilty for waking Nathan.

According to what the discharge nurse had told me the night before, we were right on time for Pippa’s first feeding of the day, but by the time we got to the nursery, Pippa had already been fed and put back in the Blu-ray player. My anxiety soared.

“Go have breakfast,” the nurse said, “and come back in an hour. Then you can cuddle her as much as you like while we wait for the blood test results.”

The cafeteria was serving french toast covered with a tragic banana mush. As Nathan scraped away the mush, I felt responsible because I had ordered my breakfast first. By choosing the french toast, I had given it my vote of confidence. Now poor Nathan was eating a revolting breakfast because of me.

He hates me, I thought. He doesn’t love me anymore. With every bite of breakfast, my adrenaline increased.

We ate in silence. We had been together for nearly five years and spent hundreds of waking hours together in companionable silence—sitting on airplanes, floating around our pool, driving to Santa Barbara, waiting in lines at Disneyland, and in a myriad of other places. But this silence was terrifying.

“Why did they have to put this banana mush on the french toast?” I said, feeling like the nerdiest girl at the bar making a pass at the movie star.

“I don’t know, but it’s disgusting.”

His tone of voice said, I agree, this banana mush sucks, but inside, I winced and thought, He hates me, it’s my fault this food is so gross. I felt an intense need to say something clever and interesting, as if our entire relationship depended on it.

“It’s like cat vomit.”

“Yep,” Nathan said.

We were doomed.

Or at least, that was how the postpartum depression made me feel. I had no idea that I had postpartum depression, but looking back, I know that’s what was happening. I cannot pinpoint the exact moment my symptoms turned into an illness. It’s a bit like trying to determine when a snowball becomes an avalanche, but I strongly believe the snowball first started rolling as I tried to push Pippa into the world. By the time we were having breakfast in the hospital cafeteria, I had entered the postpartum depression zone.

Postpartum depression is a tricky illness. In the past, when I’d had a cold or the flu, I felt miserable but was still the same person. The common cold never made me question my relationship with Nathan. The flu did not make me hyper-analyze everything about his body language, down to the way he breathed.

But that was what postpartum depression did. Practically overnight, it shattered my sense of self. When we were dating, I often drove myself crazy with doubts about Nathan’s love for me (thank you, Sex and the City), but those doubts had been gone for several years. My postpartum hormones resurrected long-dormant fears and increased their intensity by a power of ten. Instead of seeing my sweet, loving husband, I saw a man who emanated hatred and disdain for his lazy failure of a wife.

And the postpartum depression was only getting started.

Onward to Chapter Six!

I had an idea: I should publish my memoir Adventures With Postpartum Depression on my blog. So that is what I am doing. If you want to start at the beginning, start with The Prologue. If you want the actual book, it’s available now on Amazon, Barnes and Noble, Apple Books, Kobo, Scribd, Tolino, Baker & Taylor, Borrow Box and Overdrive (whew! Try saying that three times fast).

I settled my feet on a stack of pillows and clicked on the nightstand light. “Okay, baby girl. It’s week twenty-eight. Let’s see what the third trimester has in store for us.”

I cracked open my favorite pregnancy book and started reading about Braxton Hicks contractions and delivery. I could not wait for this pregnancy to be over.

In the first trimester, I had discovered that morning sickness was not always limited to the morning and could in fact last all day. Once I got my arms around the fact that a man had probably coined the phrase “morning sickness” in order to get his wife back into the kitchen and making supper, I started counting the days to the second trimester, when the all-day sickness would end. The sickness, however, did not abate until several weeks into the second trimester. When it did, I was so relieved, Nathan and I planned a trip to Orlando to visit family and have some fun. The nausea returned with a vengeance as I was drinking a virgin strawberry daiquiri by the pool. (I’ll never drink another daiquiri.) I prayed my stomach would return to normal after the birth.

The constipation was even worse than the nausea.

Around week seven, I felt my bowels grind to a stop. I did everything I could to reboot the system. I guzzled prune juice, various pink and green potions that my obstetrician recommended, and walked around our block. The pain was so bad that if my bowels had felt inspired during one of those walks, I would have gladly squatted on a neighbor’s lawn.

Day three of the Great Constipation Ordeal, I could not pee. My bladder was ready to burst from all the prune juice I had been imbibing, but no matter how I squeezed or crouched above the toilet, only a few drops would trickle out. My obstetrician told me to go to the ER for a catheter.

A concerned doctor listened to my stomach with his stethoscope. “Well, I believe you when you say you’ve been drinking prune juice. I can hear a lot of activity in there.”

That sounded promising.

“But unfortunately, your plumbing is all blocked up and nothing is coming out until we deal with that.”

That sounded less than promising.

“Pregnancy can be so hard. I remember my wife had terrible constipation during her pregnancies. I could give you a catheter, but I think if we relieve the constipation, then your bladder will sort itself out.”

A kindly nurse arrived quickly and asked me to roll onto my side. This was my first experience with an enema, and I actually thought the nurse was going to squirt a liquid solution up my derriere. I was more than a little surprised to discover what an enema actually entailed.

The nurse patted my shoulder. “Try to lie here for ten minutes before using the bathroom.”

That would obviously not be a problem. After three days of constipation, I doubted the next ten minutes would bring any relief.

Three minutes later, I practically skidded into a wall as I made my way to the bathroom down the hall. The constipation crisis was over.

My humiliation, however, was just getting started.

By the time we left the ER, it was eleven o’clock on a Sunday night. The doctor had given me a prescription for a bladder infection (because if a pregnant lady shows up with constipation, I guess her urine needs to be tested as well). I wanted to fill the prescription immediately to keep our baby safe, but our local pharmacy was closed for the night. We had to drive to the next city to find a twenty-four-hour pharmacy and wait another hour to fill my prescription. Not only were we both exhausted, we were famished, having left for the ER before dinner.

As we waited and waited, I wandered the store. In the gastrointestinal aisle, I spotted a box of enemas. The warning on the box cautioned that pregnant women should not use the enema unless directed to do so by a physician, and my physician had told me to go to the ER, but I still blamed myself. I had been living off white bread, cheddar cheese, and more white bread to manage the nausea. I should have known that would make me constipated.

My cheeks burned. Was this all in my head? Was I being a hypochondriac? Since college, I had done my best to conceal the hypochondria, but I knew the truth. If I got a headache, I worried it was a tumor. When I got a cold, I fretted my immune system was collapsing. And though I knew in my rational brain that I was extra-sensitive to arachnids, I still suspected every spider bite was actually a flesh-eating virus.

Everyone – my husband, obstetrician, the nurses and doctor at the ER – must think I was so pathetic and weak for needing to go to the hospital for a little constipation. I should have been stronger and found a way to resolve the problem on my own. Hospitals were for severed limbs and deadly viruses. They were not for hypochondriacs who overreacted to something simple like constipation.

I resolved to do a better job of being the master of my body.

***

After the ER trip, I started eating double-fiber bread and apples to make sure my bowels stayed happy. This aggravated the nausea, but between puking and constipation, one must always, always choose vomit. A little before Thanksgiving, though, I got cocky. I was halfway through the pregnancy and sick of nausea. Surely I could mix some bland foods with the fiber.

Then again, maybe not.

This time, I ended up in my obstetrician’s office.

“I could do a catheter—”

“Last time, I just needed an enema. That relieved all the pressure and then I could urinate.”

My obstetrician winced. “I don’t have any enemas—”

“That’s okay, I brought one,” I said, pulling the box out of my purse. (I was a Girl Scout.)

My doctor inserted the enema, I waited as long as possible, and then . . .

Did you know enemas do not always work?

Enemas do not always work.

“I was afraid this might happen,” my doctor said. “I wonder if you have MS.”

“Multiple sclerosis?” I yelped.

Was I dying? Would my baby be okay? Would Nathan have to be a single dad? And for the love of all things holy and sacred, could we please do something about the constipation before we sorted through the possible neurological underpinnings?

Not to worry: that was next.

“Since the enema did not work, I’m afraid I will have to manually extract the excrement.

I turned onto my right side, and the doctor lifted my paper gown. When she put her gloved hand up my rectum, it hurt, but the humiliation was far worse than the pain.

As the room filled with the smell of my poop, the doctor said, “I’m a little concerned. You say you can’t have a bowel movement, but your feces is actually quite soft. Based on your description, it should be hard.”

To my ears, it sounded as if the doctor did not believe me. She was probably just puzzled, but in my already humiliated state, I assumed she thought the constipation was a figment of my imagination.

Tears filled my eyes. I had tried to poop. Believe me, I had tried. Pregnancy hormones do crazy things. They make women weep, drool, fart, and even eat dirt. In my case, the hormones had made the business of bowel movements a little more difficult. Still, I blamed myself.

“I’d like you to see a gastroenterologist to rule out something more serious.”

Lovely. My obstetrician seemed to share my view that I was either a hypochondriac or dying of an obscure illness.

A month later, a gastroenterologist assured me the constipation was just a pregnancy symptom. “It’s severe but still on the normal spectrum.”

“So it’s not MS?”

“No, you don’t have MS.”

Relief flooded my body.

“You will most likely experience more constipation and hemorrhoids after childbirth.”

And there went the sense of relief.

“Is there anything I can do to prevent that?”

“I’m going to give you a list of things you can do while you are pregnant, but constipation after pregnancy is inevitable.”

Oh good, I thought as I left the office. Another opportunity for me to be utterly humiliated and act like a pathetic hypochondriac.

***

I thumbed through the third-trimester pages, noting topics of interest.

“Braxton Hicks contractions, that sounds sci-fi . . . oh, vaginal discharge, lovely . . . frequent urination. Even more frequent than it already is? Well isn’t that exciting.”

There was an entire chapter devoted to breastfeeding. I had already bought several books about the lactation arts and registered for a breastfeeding class but made a note to read the chapter with a highlighter and pen. There were also several chapters devoted to labor and delivery. Those would require meticulous study.

My hand flew to my stomach. Pippa had started kicking. Even though my uterus registered every thump, it was still cool to feel the force of her foot banging against my fingers.

We had picked her name weeks before her first kick, a few days after the expensive blood test revealed we were having a girl. It was a Saturday in early September, and Nathan was watching college football while I flipped through some baby name books. After a couple hours of entertaining various names, we agreed that “Pippa” sounded right.

I frowned from my spot on the couch. “So do we have to name her ‘Philippa’?”

“Of course not. That was holding!” Nathan turned back to me. “We will just name her Pippa.”

“I like that. But since ‘Pippa’ is quirky, let’s give her a solid middle name, like Ann.”

Nathan paused the game. “You know I love the name ‘Ann.’”

“But it has to be ‘Anne’ with an E.”

We had not told anyone else, but ever since that Saturday, our baby’s name was Pippa Anne Novak. Of course, we said we were open to other names. We still had over two trimesters to discuss, but there never were any other contenders. Now, with just one trimester to go, she was most definitely Pippa Anne.

Pippa was still kicking. “Are you going to be a soccer player? Or a dancer? I’m so excited to see who you want to be.”

I spent a lot of time these days lying in bed, surrounded by pillows, and reading pregnancy books. The law firm I had been working for from home had recently hired some new attorneys. My services were no longer needed. I was going to be a stay-at-home mom and was ready to be done with the law, so the timing could not have been better.

A little before Christmas, I had finished the first draft of my novel. My sister had read it and given me a ton of ideas to make it better, and I had created an extensive checklist of revisions I wanted to make. Those, however, would have to wait until after the baby arrived. Revisions and nausea do not mix. But hey, at least newborns nap a lot. There would be time enough for writing once Pippa was here.

“Meconium? Poop that’s like tar? Gross. We’ll just let Daddy change those first diapers, okay?”

Pippa kicked. We were already coconspirators.

I flipped through the chapters about the first weeks with a newborn.

“Oh, here’s some ideas for the registry. I don’t think we need a diaper bag, do you? No, they are too frumpy. What about a baby carrier? Would you like me to carry you in a sling?”

Pippa stopped kicking. She was saving her strength for the midnight hour.

“The baby blues . . .” I skimmed a few paragraphs. “Pippa, this says 80 percent of new moms get the baby blues. Well, that is not going to happen to Mommy. You’ll see, Mommy hardly ever cries. I’ll be so happy to finally have you here in my arms, I won’t have time to be sad.”

I turned the page. A heading in bold immediately grabbed my attention: “Postpartum Depression.”

For a moment, it seemed as if someone had hit the pause button on the universe. I stopped breathing, and everything became very, very quiet. I can’t explain why or how, but it was almost as if some part of me knew what was going to happen after Pippa was born.

I started to read—“extreme sadness, low energy, crying episodes”—but quickly turned to the next page. Sitting on my bed, twenty-eight weeks pregnant and reading up on the postpartum period, I was not about to pay attention to irrational premonitions or put any silly ideas into my head. It was bad enough that I had to worry about postpartum constipation. My inner hypochondriac would have a field day if I knew the symptoms for postpartum depression.

***

“How are you doing?” The obstetrician had just arrived to check on my progress.

“The contractions just started hurting again. I need the anesthesiologist to give me another refresher.”

I was in a private labor and delivery room at the hospital. The room was larger than any room at our house and had dark wood paneling on the walls. It felt more like a nice hotel room than a room for giving birth.

Nathan and I had been in this room, sleeping and watching movies, for the past eighteen hours. My water had broken the night before, a little after 11 p.m. I had been asleep and woke up to use the bathroom. After I finished peeing, a trickle of water kept coming out of me. My due date was eleven days away, so my first thought was that I had broken my bladder. It took me a minute to realize what had happened, and when I did, excited adrenalin flooded my body.
I would have run to wake Nathan if I had been capable of anything more than a waddle. He was out of bed before I could finish the sentence, “I think my water broke.”

My contractions had not yet started, but my obstetrician told me to head straight to the hospital. This did not surprise me. At the beginning of the pregnancy, I had tested positive for Group B Strep Infection, a bacteria that tons of healthy women have in their digestive tract. The bacteria can occasionally make a newborn sick, so my doctor had warned me multiple times that I would need to take antibiotics intravenously as soon as my water broke.

On our way to the hospital, Nathan played Europe’s The Final Countdown on his phone. Our baby was coming!

Before I was admitted to the labor and delivery ward, the nurses had to confirm that I was actually in labor. I had a queasy feeling I was going to be sent home with an admonition to stop pissing myself. A nurse, though, tested the liquid coming out of me and confirmed it was amniotic fluid. She hooked me up to a machine and said I was in fact having regular contractions. Every time the machine registered a contraction, more liquid whooshed out of me. Still, I felt nothing.

I was a goddess. Contractions could not hurt me!

Ten hours later, the contractions were so bad, I wanted to die. My sister called. We had talked several times since my water broke. During the first several calls, I sounded cheerful and upbeat. About ten hours into labor, though, I sounded as if I had been possessed by a demon.

At least, so my sister says. I myself have no memory of that conversation.

All I remember from that stage of labor was the delivery nurse’s suggestion I wait a little longer for an epidural. I was only four centimeters dilated, and she thought I should wait until I was at least five centimeters. My obstetrician, however, had told me to get the epidural as soon as I wanted. I was not going to be a hero and wait for the five centimeter mark. The anesthesiologist had applauded my aversion to pain as he administered the epidural.

Now it was 9 p.m. Approximately twenty-two hours had passed since my water broke, the pain was back, and I wanted it to go away. My obstetrician, though, thought otherwise.

“You are ten centimeters dilated.” She was standing at the head of my hospital bed. “It is time to push. It will be a lot easier if you can feel the contractions.”

“But I want another epidural.”

“Honey,” the nurse said, “you will be able to push better if you can feel the contractions.”
I looked at my doctor. “So it’s better to feel the pain?”

“I think so.”

“Okay.”

And that is how I, a woman fully committed to having an epidural, entered the final stage of labor sans pain medication.

You can continue reading Chapter Six but you know, you deserve the book. Adventures With Postpartum Depression is available now on Amazon, Barnes and Noble, Apple Books, Kobo, Scribd, Tolino, Baker & Taylor, Borrow Box and Overdrive. That’s right, Overdrive! Tell your friendly librarian to hook you up.