[caption id="attachment_1751" align="alignright" width="150"]<img class="size-thumbnail wp-image-1751 " alt="Postpartum Planning" src="http://www.hormonesoup.com/wp-content/uploads/2013/04/Postpartum-Planning--150x100.jpg" width="150" height="100" /> Postpartum Planning<br />Image credit: 123rf.com[/caption]
<p style="text-align: left;" align="center">When postpartum <i>anxiety </i> (PPA) struck me after my third baby I was already on high-alert for postpartum depression (PPD).   I suspected that I had suffered from some sort of postpartum mood disorder (PPMD) after my second baby but like most women never sought help and was never diagnosed.  My mood swings were extreme and, in fact, they went into overdrive when I weaned my daughter from breastfeeding at 17 months.  Eventually the mood swings settled into a cyclical pattern of extreme PMS, which I later learned was not at all unusual for someone like me.</p>
So when I got pregnant with my third baby I was concerned about a repeat of the dramatic, life-altering mood swings. I confided my fear to my family doctor.  She advised me not to worry because she would put me on anti-depressants as soon as the baby was born.  To be completely honest, the idea of anti-depressants scared me even more than the risk of PPMD.  But the mention of anti-depressants spurred me to action to come up with a preventative plan <i>before</i> my baby was born.

<b>My Postpartum Plan:</b>

I knew bio-identical hormones were used by some doctors to prevent and treat postpartum mood disorders so I visited the nearest compounding pharmacist and asked for a list of obstetricians that prescribed bio-identical hormones.  With that list of doctors in my hot little pregnant hand I picked up the phone to make sure the OB/GYN I wanted was taking new patients.  I asked my family doctor to make the referral.  This particular OB/GYN is the extremely busy Chief of Obstetrics at his hospital so it took some time to get my first appointment but I was hopeful that it would be worth the wait.  At my first appointment I told him my history and shared my fear about postpartum depression.  Like my family doctor, he too, told me not to worry.  But <i>his</i> plan was to put me on progesterone cream as soon as my baby was born.  I breathed my first sigh of relief. I finally had a plan that fit with my personal beliefs.  And if those mood swings were going to strike I’d be striking right back with my progesterone clicker.  I felt confident that I was going to be spared the fate I had suffered with my daughter.  In a way I was right – but NOT in the way I expected.

Once my beautiful baby boy was born I implemented my plan and began applying my beloved progesterone cream.  I was so relieved to have that scrumptious calming cream that was going to protect me from the dramatic mood swings.  And they never came instead I had only ONE mood: debiilitating <strong>anxiety</strong>.  You know when you’re watching a movie and you can’t figure out why the actor is oblivious to the impending doom?  Yeah, you got it - there were a few chinks in my creamy progesterone armour:
<ul>
	<li>I didn’t know as much about progesterone back in those days and didn’t realize that the dose my doctor gave me was very small, painfully too small.</li>
	<li>I also didn’t know much about PPMD – I had heard of postpartum depression and postpartum psychosis and I knew I’d had some wicked mood swings but that was it.  Sadly, I had never heard of postpartum anxiety and postpartum OCD.   I never knew to watch out for it.  Neither did my husband.</li>
	<li>I never bothered to prepare or enlist a single friend or family member.</li>
	<li>I didn’t know that PVCs (Premature Ventricular Contractions –  kind of  like a big heart palpitation that can be powerful enough to wake you out of a deep sleep) were related to hormone deficiencies.</li>
	<li>I didn’t know about pregnancy and postpartum related thyroid disorders OR that I was at risk.</li>
</ul>
<b>Looking Back:</b>

I feel like I had the beginnings of a postpartum plan that suited <i>me</i> to a “T”.   Truly though, just a <i>bit</i> more information would have made all the difference in the world:
<ul>
	<li>If I had known about PPA then I may have realized that indeed a postpartum mood disorder needed to be considered as a cause of my anxiety.</li>
	<li>If I had known about the PVC’s being related perhaps I would have told my OB/GYN about them, instead of going to my family doctor who didn’t relate them to my plummeting hormone levels.</li>
	<li>If I had known that increasing my dose of progesterone would have provided almost instant relief I would have acted quicker.</li>
	<li>If I had known about postpartum thyroiditis I may have pushed for adequate thyroid testing before, during and/or after my pregnancies.  (Because of my subsequent research I now believe in universal thyroid testing before pregnancy.)</li>
	<li>Knowing what I know now, I would have hired a postpartum doula.  I recall thinking of it with my first baby but I lived in a remote settlement in Canada's Arctic - there are no doulas north of 65°.  By the time I had my third baby, for some reason I didn't even think of a doula.</li>
</ul>
<b>The Lightbulb:</b>

One day the PPA light bulb suddenly turned on for me!  I can’t recall why it did, but once I realized that my anxiety was a postpartum mood disorder, everything slowly began to make sense.  I called my obstetrician’s office but I couldn’t get an appointment for 3 weeks – a lifetime for someone with debilitating anxiety.  I don’t know why I didn’t plead with his receptionist for help.  I should have.  I should have gotten in my car and drove to his office.   Instead I called my compounding pharmacist and told her about my dose and my anxiety.  She confirmed everything for me – mostly that my dose was too low.  I breathed my second sigh of relief!  I immediately doubled the amount of cream I applied and by the next day could feel the anxiety begin to diminish.  By the time I got to my doctor I was feeling a bit more like myself with just some underlying anxiety.  My obstetrician tripled my dose and soon my anxiety drifted away.  I didn’t have to breathe a sigh of relief anymore – I simply breathed.   And oh, the air was sweet.
<p align="center"><b>I advocate for a multi-faceted, personalized postpartum plan for EVERY mom with EVERY pregnancy.</b></p>
<p align="center"><b>I advocate for universal thyroid testing, including T4, T3, rT3 and anti-bodies (not just TSH) before pregnancy. </b></p>
<b>Whatever <i>your</i> plan is – I hope you make yours more thorough than I did – even though half a plan was better than no plan at all.</b>

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NOTE:
<ul>
	<li>Postpartum Psychosis is a life threatening emergency - if you suspect that you or someone you know is suffering from postpartum psychosis get help immediately.</li>
	<li>This article contains my personal story and my personal views and which may or may not pertain to others.  It is for informational purposes only.  If you are under medical care or on medication, do not go off them based on information you find in this article. Please seek medical advice from a professional.  This article is not a substitute for medical care. Information on this blog is general as it can not address each individual’s situation and needs.</li>
</ul>
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