[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 anxiety(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. &nbsp;My mood swings were extreme and, in fact, they went into overdrive when I weaned my daughter from breastfeeding at 17 months.&nbsp; 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. &nbsp;She advised me not to worry because she would put me on anti-depressants as soon as the baby was born.&nbsp; To be completely honest, the idea of anti-depressants scared me even more than the risk of PPMD. &nbsp;But the mention of anti-depressants&nbsp;spurred me to action to come up with a preventative plan before 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.&nbsp; 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. &nbsp;I asked my family doctor to make the referral.&nbsp; 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. &nbsp;At my first appointment I told him my history and shared my fear about postpartum depression.&nbsp; Like my family doctor, he too, told me not to worry.&nbsp; But <i>his</i> plan was to put me on progesterone cream as soon as my baby was born.&nbsp; I breathed my first sigh of relief. I finally had a plan that fit with my personal beliefs. &nbsp;And if those mood swings were going to strike I’d be striking right back with my progesterone clicker. &nbsp;I felt confident that I was going to be spared the fate I had suffered with my daughter. &nbsp;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.&nbsp; I was so relieved to have that scrumptious calming cream that was going to protect me from the dramatic mood swings.&nbsp; And they never came instead I had only ONE mood: debiilitating <strong>anxiety</strong>. &nbsp;You know when you’re watching a movie and you can’t figure out why the actor is oblivious to the impending doom?&nbsp; 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.&nbsp; Sadly, I had never heard of postpartum anxiety and postpartum OCD.&nbsp;&nbsp; I never knew to watch out for it.&nbsp; 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 – &nbsp;kind of&nbsp; 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”.&nbsp; &nbsp;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.&nbsp; (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. &nbsp;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°. &nbsp;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!&nbsp; 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.&nbsp; I called my obstetrician’s office but I couldn’t get an appointment for 3 weeks – a lifetime for someone with debilitating anxiety.&nbsp; I don’t know why I didn’t plead with his receptionist for help.&nbsp; I should have.&nbsp; I should have gotten in my car and drove to his office.&nbsp;&nbsp; Instead I called my compounding pharmacist and told her about my dose and my anxiety.&nbsp; She confirmed everything for me – mostly that my dose was too low.&nbsp; I breathed my second sigh of relief!&nbsp; I immediately doubled the amount of cream I applied and by the next day could feel the anxiety begin to diminish.&nbsp; By the time I got to my doctor I was feeling a bit more like myself with just some underlying anxiety.&nbsp; My obstetrician tripled my dose and soon my anxiety drifted away. &nbsp;I didn’t have to breathe a sigh of relief anymore – I simply breathed.&nbsp;&nbsp; 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. &nbsp;It is for informational purposes only. &nbsp;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. &nbsp;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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