2019 Physician Writing Contest: My unexpected use for postpartum

After four hours of pushing, I was utterly exhausted. “Nicole, you can’t keep pushing. We can try a forceps delivery and if it doesn’t work we will have to do a c-section. We would have to take you to the operating room just in case. What do you want us to do?” My obstetrician needed an answer. My eyes began to well up with tears. Tears rooted in fear and born from exhaustion.

In that moment I wasn’t a physician, I was a patient and I had no control over the situation I was in. I was incapable of using my years of medical education and knowledge to make a coherent decision about my own care. This was one of the most important decisions I ever needed to make. I looked at my obstetrician and asked her what she would do if she were me. She raised my bedrails in answer, preparing to move me to the OR. I made her promise the baby and I would be OK.

We made our way to the operating room in preparation for delivery. I was met by my medical team--dozens of faces in light blue scrubs and surgical masks. As a doctor, I see people like this every day. But as a patient, I was scared. My nurse held my hand as the anesthesiologist hooked me up to sensors and monitor leads. My husband sat nervously by my side, awaiting our new arrival.

Thirty minutes later I held my newborn boy for the first time. My joy was overwhelming as I shared the incredible moment with my husband and nearly 30 other medical personnel in the operating room. After Owen was delivered, my medical team worked diligently on us both. They attended to Owen, assessing him and providing support for his breathing. Hours of pitocin and magnesium resulted in postpartum hemorrhage and my obstetric team worked to stop the bleeding. My nurse continued to comfort me as anesthesiologists stood watch, helping with my resuscitation. I felt weak and powerless, but I was also humbled and grateful.

The days and weeks following my son’s arrival continued to humble me. Profound anemia made climbing a flight of stairs or doing a load of laundry exhausting tasks. I made biweekly follow-up appointments to my OB’s office to check my blood pressure and lab work.

The walk from my car to the office felt miles long and I always arrived weary and short of breath. At home I tried to keep up with simple household chores, and spent hours nursing or hooked up to my hospital-grade breast pump. I was an anemic, sleep-deprived milk-making zombie fueled by Doritos, Oreos, and iron supplements.

A week after my delivery, my baby blues morphed into overwhelming anxiety and depression. I struggled to find balance in my new life and feel like myself. My medical training did not prepare me for my postpartum experience and I found myself continually struggling to navigate simple daily decisions.

In the emergency department, I was a decision-making expert, tasked with making thousands of decisions during an average shift. I had lost my edge. At a postpartum visit to see how things were going, my OB listened carefully as I tearfully recounted how I had been feeling. “I think you should go see one of our psychiatry colleagues,” she softly urged.

I had postpartum depression and anxiety--something I knew very little about, despite being a physician. Postpartum depression is common and it affects one in seven women. This statistic likely underestimates the prevalence of the condition due to lack of recognition and underreporting. Most women do not see their medical provider until six weeks after their delivery, making postpartum mood disorders even more difficult to recognize and treat. Additionally, studies put rates of postpartum anxiety at 9 percent and postpartum OCD at between 3 and 5 percent.

I was home for three months before I went back to work. Three weeks after returning, I took care of a new mom in my emergency department. She had come in with psychiatric concerns and I needed to provide a medical screening before the psychiatrist would see her. I pulled up a chair and listened to her describe how she was struggling at home. She described thoughts of inadequacy, feelings of anxiety and at times bizarre thoughts bordering on paranoia.

I told her I understood;  just a few months ago I had been feeling the same things. I told her there was a path back to the person she used to be, to someone she actually recognized. I was grateful for the opportunity to connect with her-more grateful than I had felt in my profession in a long while.

I encounter many new parents in the emergency department. They bring their new loved ones in for concerns that physicians often find easy to address. Their faces are weary and full of concern. I now see these new parents in a new light. They are more than just the stewards of my patient-they need my attention too. I have an opportunity to ask them about the subtle signs and symptoms of postpartum fear, anxiety and depression.

I can show incredible love and compassion by asking them, “How are you sleeping? When did you last eat something healthy?” I can make a human connection even though the stress and sleep deprivation may make them feel less than human. Most importantly, I can show empathy: I care about them and their family more than just the little one I am tasked to examine and treat.

In many ways my son made me a better physician. I am more patient and more empathetic. The line separating doctors from patients is thin, and it is not something we should be afraid of. Our shared experiences and humanity can make our practice stronger. Through my time of complete vulnerability and powerlessness I became a better physician.