My experiences so far with pregnancy and mood

As a dysthymic person with a history of almost yearly dips into depression, and as a planner, I took many steps before getting pregnant to prepare myself. I read articles and spoke to numerous psychiatrists in my search for one who I felt knew as much as there was to know about managing mental health and pregnancy and birth.

I know the statistics. As one who has had so many incidences of depression, it is very likely I will have more. My brain is used to this pattern, and it takes careful care to keep it from slipping back into that state where bed seems like the only place to be and life looks like a long gray stretch of things one has to do, or is supposed to do, just so that one can keep living to do more of those things one has to do. So, as such, I am at increased risk for postpartum depression.

As one doctor told me, at this point it’s more a question of when I will have another depression and for how long it will happen than a question of if. The best thing I can do for myself is to stay in regular care, take care of myself and watch my moods, and get help at the first sign of any symptoms. Knowing myself, I know the best way to do that is to have a doctor I feel comfortable talking to.

So I am glad to say I now have a good doctor that I am very comfortable with. She’s a reproductive psychiatrist and a mom of young children, and I feel I really couldn’t have better care at this point.

She and my OB told me that there was really no way to know how my brain would react to pregnancy. Some women’s moods get better, some stay the same, and some get worse.

Well, at about 3 months pregnant, I’m thrilled to say that so far, I’ve been feeling better. I can hardly remember a time when I felt so calm, confident, and at peace. I am filled with anticipation and excitement for the future in a way I haven’t felt since we got married (almost 7 years ago!). I feel the best way to describe it is that I feel overwhelmingly content.

The low-grade, nagging worry that I felt for years as I wondered if and when we would finally have the children I’d been wanting desperately since my baby fever days (see posts in 2006 and 2007!) is gone. I worried we’d never have the stability or health we were waiting, I worried we’d have trouble and I’d worry it was because we waited too long; I worried I we would be one of the 10-15% of couples who would have fertility troubles.

The sane side of my brain knew that I was and am lucky, being in a committed and strong relationship, with two capable individuals on solid career tracks, who earnestly look forward to having children together. Still, while I might bury it at times, it was hard to completely rid myself of those worries.

Until now. At nearly the end of my first trimester, with Husband recently starting a new, salaried job with great pay, and with me a year into a job that is my favorite yet and where I’ve earned recognition for my excellent work, all of those concerns are gone.

The anxiety that I wrote about in the trying to conceive and early pregnancy days has faded. Women in my forum groups write about their worries and nervousness, about their screenings and the baby’s health, and I don’t feel it. I know the odds and am confident that we are making a healthy baby. Our healthy baby.

I feel happy, healthy, confident, and excited. I know I am extremely lucky, and I am thankful.

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Preconception Charting

As I mentioned in my last post, after a long period of titrating down my medications and some visits with my new doctor, who is a specialist in reproductive psychiatry, we are officially trying to conceive (TTC).

One of the concerns that my doctor expressed is that just the process of trying to conceive itself can be very stressful. I can already see why, but then I’d say for us the process of getting ready to try was also very stressful, so this is just a different phase of the experience of planning to and trying to expand our family.

As I was trying to find out about the risks of antidepressants and depression on pregnancy, I read some books on pre-conception health. My favorite was The Impatient Woman’s Guide to Getting Pregnant, because it felt more like advice from a girlfriend than clinical lessons from a doctor.

I also have read portions of Before Your Pregnancy, which is practically a textbook, and Get Ready to Get Pregnant, written by a male ob-gyn. While both are filled with great information, they are also filled with do’s and don’ts that can make a woman worry that she is never going to live up to the health standards they recommend. The suggestion is that you practice these healthy behaviors for at least 3 months before TTC and then throughout the process of TTC and pregnancy. If you’re lucky that adds up to a little over a year but it wouldn’t be unusual to be 2 or more years.

One of the things I read about is charting, the practice of observing your body’s fertility signs daily so that you can tell if and when you ovulate and when to expect your period. Usually this involves taking your basal body temperature (BBT) each morning upon waking and checking the consistency of your cervical fluid. It may also include taking ovulation predictor kit tests (OPK) and checking your cervix position. Using these techniques you can usually pinpoint your ovulation day, and then you can assess whether you had an optimal intercourse pattern and a healthy luteal phase (time between ovulation and period) length.

It’s not too useful to track this while you are on hormonal contraception, such as the birth control pill (BCP), because that regulates things for you. Additionally, I learned that it’s not uncommon to have irregular cycles or to not ovulate for a few months after BCP.

So even though we weren’t yet TTC, in January I stopped BCP and began charting. I didn’t really know what to expect and braced myself for the possibility that I wouldn’t ovulate for a while. While I had no real reason to believe that I didn’t have a healthy reproductive system, in the past I had experienced some very painful cysts and had vaginal ultrasounds done (not fun!), so I was looking forward to more information about my cycles and hopefully evidence that everything really was fine.

The charting was complicated a bit because a dr I saw at the time put me on levothyroxine as an addition to my antidepressants; I am often so low on energy and she has found success with that as treatment before. It’s a thyroid medication, and might affect basal body temperature. So it may have affected my chart; I think it raised my BBT a few tenths of a degree. I stopped taking it at the end of that cycle. I had a high amount of temperature fluctuations and no fertile cervical fluid (also something that takes a little while to return to normal after BCPs).

During the cycle, as I tried to track my waking temp and check and classify my cervical fluid, I experienced anxiety and confusion. At first the software I used (FertilityFriend.com) thought that I ovulated on the 8th day, which meant that some of the unprotected sex we had thinking I wasn’t fertile yet was actually during my fertile period. As I watched my temp after that, it later went up again and the software suggested it might be triphasic, which while not a guarantee of pregnancy, does occur more often with pregnancy than without. So for a couple of days I thought we may have already gotten pregnant, and somewhat anxiously told my husband of my concerns. The next day I tested negative and the tool moved my ovulation from day 8 to day 21, the point that it had originally thought was a triphasic shift. So there ended that.

Fluctuating temperatures and scant cervical fluid aside, I was able to pinpoint ovulation on the 21st day of my cycle and calculate a 12 day luteal phase. I was excited and happy to see that even after about 11 years of hormonal contraception usage, I was one of the lucky ones with ovulation and a pretty normal cycle. By the end I felt better, having charted and learned about my body, than I had before the cycle began.

But how would this experience change once we were actually trying to conceive? I’m just now finding out.

We’re finally ready to start a new journey

It’s been a while since I’ve posted here, but I’ve been feeling the need to write again lately, and today feels like a great day to start.

So much is different from the last time I wrote. About a year ago I got my energy up and my resume together and started applying to jobs. I got a good amount of interest and interviews and ended up with opportunities at several places, most of which were great and 2 of which seemed like dream jobs. After consideration I picked one, putting the opportunity to work on a team of people who I could learn from above my initial interest in the industry, and also keeping in mind how well the role and culture would likely work with our plans to start a family.

Almost a year ago now I started there, and I couldn’t be more happy about it. I’ve grown tremendously, get to do important work for the company, and really enjoy the company of my coworkers, who are smart, hard working, and fun. On top of that my income has nearly doubled! (I’m still amazed to be able to say that!)

It’s the best job I’ve ever had, and I feel so lucky.

During this year, we continued working on lowering my antidepressants, because we wanted me to try going off them before getting pregnant. At the time I was on a significant dose of both Wellbutrin and Prozac. All told I think I’ve been working on reducing that for over 2 years! As I got to a minimal dose of both and then just one, I realized I was struggling again. But when I saw my doctor in the fall in that state of mind, I didn’t have the strength to tell him no when he, not bothering to ask how I was feeling, suggested we take the final step and drop it altogether.

As the fall continued I slipped further, having a harder time talking to my husband about what was on my mind, worrying more and more, ruminating often. Life was stressful as we filed to sue his former client and my former employer for nonpayment of a considerable sum, and as he worked less while dealing with the case money was getting tight again, but I didn’t share my fears of being broke again. Instead, I stayed in my head, worried and sad.

As fall turned to winter I stopped getting up to go to the rink. Still loving work, I managed to keep it from affecting my job performance more than a little, but it definitely affected my relationship and my marriage.

One day it came to a head, and I realized I could and should do something about it. So I went back to the doc and told him this wasn’t working, and I wanted some meds again. He gave me meds but sighed and acted like he didnt want to, and he didn’t consider that we should try the safest one because I might need to stay on it. He just said, “This is going to delay you further. You will need time to get this out of your system again before you start.”

I started crying, quietly, and he either didn’t notice or didn’t care, because he said nothing. So I left with my prescription and a plan to find a new doctor, crying on the train and in the park before collecting myself to go back to the office.

That’s when I found a reproductive psychiatrist – someone who specializes in mental health and medication during events like pregnancy and breast feeding. She has deep knowledge in the area and gave me lots of information about all of the studies on both SSRI’s and Wellbutrin during pregnancy. I am so glad to have her to work with me, and with her guidance we’ve switched me to Zoloft, as it has less accumulation in the baby’s system than Prozac and is better for breast feeding than Wellbutrin.

If you check my archives you’ll see that I had baby fever over 6 years ago, and I’m elated that everything is in place now. I have no depression symptoms, am happy with my job, we moved to a nicer, more baby-friendly apartment and neighborhood, and husband is ready and excited too.

So, I’m super excited to say that as of tomorrow, I will have completed my medication transition plan, and we are ready to try to conceive!

Goodbye, summer!

What a summer it’s been. Every year I brace myself as June comes along and announces that hot, sticky weather won’t be far behind. For me, with it comes extra transit delays due to track work and more time waiting in stifling subway stations. I also inevitably find myself jealously listening to other people’s vacation plans and stories, and wondering when we’ll get our finances and lifestyle in place enough to take trips ourselves. And to make it worse, I miss the convenience of having multiple outdoor rinks around the city where I can fit skating in at least weekly. I struggle to exercise as much, and start feeling sluggish. So I tend to think of a summer as a long hot slog through three months and I just bear it enough to get through.

This year, I remember thinking that maybe it won’t be so bad, that I need to try to enjoy it.

But, unfortunately that would not be so for me. This summer, my Husband and I:

Returned home from a pleasant walk on a Saturday afternoon to find our apartment had been burgled and 3 laptops, 2 of them work computers, had been stolen

Commenced an apartment search planning to finally move from our starter apartment that we’ve been in for 6 years, only to determine that we could not yet afford to move somewhere better

Worked overtime every week, feeling stressed and overwhelmed that we could not get things done in the timeframes asked of us

Learned of a family member’s struggle with cocaine use

Supported our family as they faced another eviction proceeding, which ended in us coming to the rescue with 1-2k that we’d been planning to use to book an anniversary trip, our first non-family-visit vacation since our honeymoon 5 years ago

Fought a tiresome battle with our CEO to get Husband’s freelancer paycheck in time to help our family close that eviction case

Fought another tiresome battle to get a review that was promised to me for 3 months after job start, and has still not been completed as we reach month 9

Experienced 2 painful cyst ruptures despite being on birth control which is usually prescribed to prevent cysts from forming, and

Had one breakdown that ended in doubling my dose of Prozac after months of carefully reducing it as part of a plan to try to reduce my meds before trying for baby. Now I’ll wait 3 more months and then try to reduce the Wellbutrin instead.

Now, there have been some good things happening – we are on track to finish paying down 2-4 of the debts we’ve been carrying for years, we’ve both gained tremendous experience in our jobs, and Husband is successfully charging over 20% more for his freelance work than he did just last year. Once he actually gets paid for that work, I’m sure that will feel good.

I turned 28 last weekend, and I’ve been thinking a lot. We need a change. I need a change. I feel as though inertia and lethargy have settled in, and I can barely stand it anymore. I want to start fresh, to move somewhere new, decorate our living space as the adults that we are instead of the college kid that I was when we moved here, start taking vacations, saving a nest egg, exercising and eating healthier, planning for a family, and enjoying life more. I’m trying to muster what energy I have to make that happen.

Perhaps this Fall we will get ourselves solidly on that path. I sure hope so.

Babies of high BMI mothers have more fat and less muscle

I came across this article today, which I wanted to briefly share. Yet more reason for me to get healthier before we start trying to get pregnant! I am making good progress and so is Husband, so we’re on the right track. Since we joined Traineo (a year ago), I’ve lost 12 pounds and he’s lost 27 pounds! Over a whole year 12pounds may not sound like a lot, but it’s been very easy and sustainable and because of that I’m confident that I can keep it off and continue to lose more!

Anyhow, here’s an excerpt from Reuters’ reporting of the study:

However, infants of the 39 overweight or obese moms had significantly higher percentages of body fat (13.6 vs. 12.5 percent), higher fat mass (448.3 grams vs. 414.1 grams), and lower fat-free mass (3,162.2 grams vs. 3,310.5 grams) than the babies born to the 33 normal-weight women, Fields and his team found.

Gauging babies’ body composition at birth could provide a clearer picture of their health than weight alone, Fields added, but then the question remains as to what should be done if babies are found to have a high percentage of body fat. One possibility, Fields said, would be to encourage their mothers to breastfeed. His own research has demonstrated that formula-fed babies tend to be fatter.

Aiming for healthy

Well, I’ve officially lost 3 lbs on the “We’re f*cking broke” diet. You might think that doesn’t sound so great, but I’m pretty happy about it – it’s helping me to get used to only eating until full, or sometimes being a bit hungry, and I think helping me to get back on to a healthier schedule. We’ll have some money again this Friday, and then the broke part will go away (we’ll switch broke out for poor), and then I’ll get to eat healthier, more balanced foods. But hopefully I can stay on track as far as overeating and exercise – sometimes losing just a few pounds is enough to get me more motivated again.

Overall, I just want to be healthier. Right now, I’m overweight – at a BMI of 30.4, I’m technically considered obese, but I don’t think you’d call me obese by my appearance – I have really strong leg muscles from my days as an athlete, and I wear a size 14 largely because of my chest (a large chest runs in my family). I have high cholesterol, but much more good cholesterol (HDL – high density lipids) than bad (LDL – low density lipids), and my blood pressure is always in the completely normal range. Here’s a picture of what I look like today:

Me, today

As far as exercise, on a weekly basis I walk everywhere (to get around the city) and I run around with the kids. I go to the gym to bike, use the elliptical, or take a yoga class, but that varies a lot more. I also continue to practice a sport I was competitive in as a kid – but usually only once every few weeks (it’s been even less frequent lately) – as it’s tough to get to the training center for that.

Why do I want to be healthier? Well, it has little to do with my appearance. Unlike when I suffered from bulimia, I now am much more ok with my body. My husband finds me sexy and I’ve learned to buy clothes that fit my body type. As many of my readers know, however, I hope to have children in the future, and we’re not really talking that far off. Right now we’re thinking we might start trying to get pregnant in the Spring of 2009, which is about a year and a half away. And I want to be healthier for my future pregnancy, and for my future children, and yes, for myself. There are a lot of pregnancy complications that are more likely when one is overweight, and I think since I have lots of time to plan, I should do whatever I can to put myself in the healthiest place I can be before I decide to rent out my womb to a tiny little being. One of the largest factors of that will be losing weight. Another will be to exercise regularly, some of which should be in activities that can continue throughout pregnancy, so that I can exercise during pregnancy as well.

Getting healthy, for me, is part of pre-conception planning, a practice that has become more common in the past few years. I really found the book, Before Your Pregnancy: A 90 Day Guide for Couples on How to Prepare for a Healthy Conception, to be helpful. It includes a section on diet and exercise, with recommendations for a diet and activities that focus on the nutrients and muscles that are needed for a healthy pregnancy.