<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 had suspected I had suffered from some sort of postpartum mood disorder (PPMD) after my second baby – 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, both my husband and I were concerned about a repeat of the dramatic and 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.

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Because I felt like I was aware of my potential for PPD, my coping and recovery began while I was pregnant.  How? The mention of anti-depressants spurred me to action and to come up with a preventative plan <i>before</i> my baby was born.  And although the plan didn’t work as smoothly as it could have, when it eventually did come together, I was sure glad to have it in place.

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<b>My Postpartum Plan:</b>

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I already knew bioidentical 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 bioidentical 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 certain 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 the baby was born.  I breathed my first sigh of relief. I had a plan!  And if those mood swings were going to start I’d be swinging right back with my progesterone clicker!  I felt confident that I was going to be spared the fate I had suffered with my daughter.   And in a way I was right.

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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 but….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 armor of progesterone:

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<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 – like a big heart palpitation) were related to hormone deficiencies.</li>
	<li>I didn’t know about thyroid disorders in pregnancy  and postpartum and that I was at risk.</li>
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<b>Looking Back:</b>

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I feel like I had the beginnings of a postpartum plan that suited me to a “T”.   Truly though, just a bit more information would have made all the difference in the world:

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<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>
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<b>The Lightbulb:</b>

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One day the PPA lightbulb 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 remember how busy he is? I couldn’t get an appointment for 3 weeks.  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 the anxiety drifted away.  I didn’t have to breathe a sigh of relief anymore – I simply breathed.   And oh, the air was sweet.

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<p align="center"><b>I advocate for a multi-faceted postpartum plan for EVERY mom with EVERY pregnancy.</b></p>
<p align="center"><b>I believe in universal thyroid testing (including T4, T3, rT3 not just TSH) before pregnancy. </b></p>
<p align="center"><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></p>