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!