Postpartum Crisis Care

I’ve been there. You are not alone.

As someone who has spent nearly my entire life navigating depression, anxiety, autism, trauma, PTSD and C-PTSD, grief, hormonal imbalance, seasonal affective disorder, intrusive thoughts, and suicidal ideation and intent, and someone who especially struggled with severe postpartum mental illness and even postpartum psychosis, it’s important to me that my birth clients to know that you can talk to me about ANYTHING without fear of being shamed, blamed, or dismissed.

Unfortunately, a major factor that prevents postpartum moms from being honest and vulnerable with their “village” is the fear of shame. I vividly remember the constant self-inflicted pressure to act like I was loving being a mother, that I had it all together, that I could handle the stress, that I didn’t need anyone’s help… it was a dark time on social media, and many influencer moms didn’t show the reality of motherhood the way we do now. The narrative was still “cherish every moment.” It’s hard to cherish the moments when you literally hate yourself and convince yourself that you’re such a bad mother that your family would be better off with your life insurance policy. Selfies were carefully curated to hide the messes and laundry, and portray a happy life and strong marriage. I remember forcing smiles, editing them in black and white to hide my splotchy red face, and posting it on social media to give this image of a mom who was doing just fine, after sobbing through a panic attack trying to do the dishes while my baby screamed at us in my husband’s arms, and being months into marriage counseling and still leaving our appointments a sobbing mess convinced we were headed straight for divorce. Thankfully our marriage is stronger than ever, but things were really bleak there for a while.

Reality was so heartbreakingly difficult that my brain has literally forgotten nearly all of those memories entirely, because I was so traumatized by postpartum mental illness that my mind effectively said “we don’t want to remember how bad this really was.” Years of time during my postpartum phases are missing from my memories. I look at photos from back then and almost feel like the photo was AI generated, because I don’t even remember taking it or posting it. I may never get those memories back, and I still cry about this often. It’s why it’s so important to me to speak about it openly with my birth clients. Maybe I would have gotten help sooner, or communicated more about how much I was struggling with my very small village, if I knew that ignoring my mental illnesses would traumatize me so severely that my brain would simply forget the most preciously fleeting moments of my children’s lives. I think trauma has permanently altered my brain’s ability to form and retain long term memories.

I believe planning for postpartum is just as important as planning for birth. I spent my entire pregnancy hyperfocusing on birth stories so I could feel prepared for any curveballs birth might throw at me… just for postpartum to stick a foot out and knock me flat on my face.

Identify your Big Things & Little Things

One of the most important parts of this self care process is honest and raw analysis of all the factors influencing your mental state. Let’s make a metaphor out of it, and say that having postpartum mental illnesses is like having car troubles; when your car breaks down, you take it in to a mechanic, and you give them a list of all the things that have been going on with your car. To fix a problem, you have to identify it, so you describe what lights you saw on the dash, you describe the noises you heard, you describe how it felt to drive, you describe the color and smell of the puddle of fluid that was under your car in the garage. Addressing the contributing factors to your mental illness and strategizing how to resolve them requires quite literally acknowledging their presence… and that alone can actually be really hard, because there’s some amount of comfort in telling yourself that things aren’t as bad as they really are. You may cry through this part, and that’s okay. Make a list, and include ALL of your Big Things and Little Things.

Some of the things wrong with your metaphorical car are the Big Things that make it literally undriveable. In regard to postpartum mental health, these are the signs that you need to schedule a doctor’s appointment now because you are on the verge of crisis or already there, and the signs look different for everyone; sudden weight gain or weight loss, insomnia or hypersomnia, severe fatigue, and persistent mental/emotional symptoms like intense mood swings, depression, feeling numb, rage, anxiety, paranoia, mania, self isolation, having a hard time taking important medications as prescribed, financial insecurity/instability and poverty, alcoholic and/or recreational drug overuse or abuse, a faith crisis, intrusive thoughts of harming yourself or baby and/or wishing you would die because your family would be better off without you, recurring panic attacks where you cannot self soothe for an extended period of time and struggle to breathe, severe arguments with your partner/spouse that leave you contemplating separation or filing for divorce, burnout at work, burnout from caregiving for a disabled or terminally ill loved one, etc.

Some of the things wrong with your metaphorical car are the Little Things that compound how hard it is to manage the Big Things. Those might look like more minor things that come with simple coping strategies that you might be able to throw money at for short or long term; not having enough time to cook dinner so you’re ordering takeout or subscribing to a meal delivery service, being overwhelmed by dishes so you start using disposable plates/bowls/utensils, being overwhelmed by laundry so you hire a service to wash and fold your laundry, being overwhelmed by cleaning so you hire a cleaning service, needing a break so you hire a babysitter for 1-2 hours once a week or once every other week, feeling a loss of identity outside of the motherhood role and needing quality time with friends without baby, feeling disconnected from personal interests and needing quality alone time to enjoy old hobbies or try out new ones, or not having the emotional bandwidth to keep up with mowing the lawn and pulling weeds so you hire your neighbor’s teenage son or a professional landscaping service to take care of it… These are perfectly normal burdens that contribute to why having a baby is so hard, but when you’re on the verge of an emotional crisis, these things COMPOUND the stress of the Big Things, and while it’s totally normal to need to ask for help from family, friends, and neighbors, it can feel humiliating to admit you’ve been living this way for weeks or months, leading to avoidance, denial and intense shame.

Recognizing Burnout

If you read that list of Big Things above and resonated with more than a few of them… you may be on the verge of full-blown burnout and a severe emotional crisis, and it’s time to call in reinforcements and sincerely evaluate what’s going on in your life to identify the things that are within your control to change.

Some of these Big Things and Little Things may include your lifestyle and parenting choices. Is your nervous system trying to tell you that some of these things are not sustainable for you? If it’s breastfeeding that is making you feel touched out, do you need to switch to exclusively pumping, supplementing with formula, or switching to exclusively formula? If it’s cosleeping leading to severe sleep deprivation, do you need to move baby to their own room? If it’s a stressful babysitting arrangement with a mother-in-law you have a strained relationship with, is it time to pay for daycare or hire a part-time nanny? If it’s a hectic schedule with your older children’s extracurricular sports activities, is it time to drop some of them to simplify your day and eliminate overwhelming commitments? If your older kids are dealing with bullying at school, is attending a charter/private school or switching to homeschooling for the remainder of the year an option? It can be extremely hard to accept that lifestyle changes are necessary, especially when you have felt deeply committed to them and they’ve become a major part of your identity and community, like enrolling your children in competitive sports or being part of a homeschooling co-op. Remember that these adjustments do not always have to be permanent.

I want to acknowledge that some of these problems are unrealistic to resolve for people in poverty, people in rural areas, families with disabled family members, people who are caregivers of a loved one who is sick, families who have complicated work schedules, people who don’t live near family, single parents, military families, etc - regardless of your ability to resolve these Big Things or Little Things, writing them down is important. Ignoring or dismissing these needs often manifests itself eventually… sometimes with severe burnout with an emotional crisis that requires taking FMLA or quitting/losing your job, seeking expensive outpatient or inpatient rehabilitation, exacerbating substance abuse until it becomes a life threatening and financially destabilizing addiction, being at risk for homelessness, and suicide attempts (…and successes.) Even if they’re things that cannot be resolved now, or are outside of your control, by writing them down, you can always come back to the list if/when circumstances change.

These are the warning signs that full blown burnout is imminent if not already occurring, leaving your metaphorical car on the side of the road with smoke billowing out of the engine bay. You need professional help from trusted providers with specialized skillsets. This may include your OBGYN/Midwife, General Practitioner, a Psychiatrist, a Therapist, a Marriage Counselor, an outpatient intensive therapy program, and even short or long term inpatient crisis care if the other providers cannot adequately support you or your symptoms are escalating quickly in severity or making you fear for your safety. It is critical that you seek professional support to prevent acute problems from becoming chronic or life-threateningly severe. It’s natural to want to shield our loved ones from seeing just how much we are struggling, especially if we’re worried that we’re going to scare them or make them more concerned than we think they should be… but not only does grabbing these lifelines protect your ability to be the caregiver your children need and deserve, it also models for them that self care is important, and shows them they can talk to you if/when they find themselves in an emotional crisis someday. It also prevents passing on generational trauma that your children will need therapy for someday. Trust me - it’s worth it to get the help now. Your children will thank you for it. This is suicide prevention, yes it’s worth the money.

Making The Gameplan

Now that you’ve identified the list of contributing factors, it’s time to evaluate the options you have to address them. Make a new list. Under every Big Thing and Little Thing, write down every solution you can think of, every person or provider who can help you with them, and every way you can think of to set yourself up for success to overcome them.

Here’s an example of what my lists might have looked like if I had written them down in some of my darkest times:

Big Things:
- weight gain & emotional eating: talk to GP about it, my psychiatrist put me on vyvanse, meal tracking app to document habits/patterns
- insomnia: express a need for a routine change, implement sleep hygiene rules, ask partner/spouse to keep you accountable
- fatigue: get hormone levels checked with a specialist (NOT your GP!)
- depression/anxiety: talk therapy, trauma therapy, medication, guided meditation, exercise program/class (ugh, i know)
- rage: put baby in a safe place, put in ear plugs or noise canceling headphones, go outside or go somewhere quiet, & let feelings out
- overstimulation: ear plugs, noise canceling headphones, turn off lights, turn down volume, deep pressure/weighted comfort item
- intrusive thoughts: talk therapy, trauma therapy, psychiatric support, medication, reach out to friends/family for extra support
- self isolation: scheduled recurring movie night with a good friend, establish weekly check-ins, video calls or marco polo with loved ones
- medication lapse: set alarms/reminders, ask spouse/partner to help you take your meds, evaluate potential need to change meds
- severe fights/arguments: marriage counseling, talk therapy, trauma therapy. identify sources of contention and communication issues
- suicidal ideation: emergency support (spouse, friend, psychiatrist, therapist, 988 crisis hotline, hospital, inpatient or outpatient rehab)
- professional burnout: WFH accommodation, FMLA leave of absence, move to a different team/department, apply for new job
- panic attacks: identify effective self-soothing techniques, ask partner/spouse to help with panic attack self care, medication
- trauma/PTSD: trauma therapy, talk to partner/spouse, talk to friends, medication

Little Things:
- need help with dishes: paper plates and plastic utensils, meal subscription service
- need help with laundry: spouse/partner provides additional support, or hiring laundry service
- need help with cleaning: spouse/partner provides additional support, or hiring a cleaning service
- need help with landscaping: spouse/partner provides additional support, or hiring a landscaping service
- need quality alone time: scheduled with spouse/partner/babysitter for 1-2 hours. enjoy an old hobby, learn a new one, take a class.
- need quality spouse time: family/friend/babysitter takes baby while you enjoy dinner or an activity
- need quality friend time: scheduled with friends on a recurring basis that is manageable for your lifestyles

You will have days where only a few of those Things are what is pushing you to your limit, and you may have days where many or all of them are pushing you to your limit. I’ve found that when I’m in the thick of it, I can’t really identify what I can do to address it, to adequately communicate with my husband how he could help me or what he could do for me. I also had established hyper-independent habits through severe trauma and PTSD that took substantial effort to overcome, in order to even express those sources of stress to my husband, let alone communicating a need for him to help me. I learned that when I am struggling emotionally, I have a heightened paranoia that I am over-burdening my loved ones, or that they will reject or shame me. In healthy relationships (romantic, family, friends), these needs are communicated, and the other person offers support because they love you. If you cannot express these needs without it being shamed/rejected, starting a fight, or having it weaponized against you in a later argument, you are in an unhealthy relationship that likely needs to either change or end. It is not a burden you can sustainably carry, and your baby deserves to have healthy relationships and reasonable boundaries modeled to them - leaving may be the best outcome for you and baby.

Self Care When You’re Drowning

The times I’ve been in the most severe emotional crisis have been the hardest times for me to even consider what my options are to feel better, and even times where I have avoided doing those things out of a desire to self harm. For me, when I get to the point that I am unable to perform the most basic daily hygiene and self care habits without substantial effort or breaking down crying, this is my red flag that I need to communicate the severity of my dysfunction and self neglect to my husband, schedule appointments with my psychiatrist to talk about my medications, schedule appointments with my hormone therapist to get my levels checked and get dosage adjustments, and/or schedule appointments with my therapist to get additional professional support to keep me safe and start returning to a functional level. In addition to these professional tier crisis interventions, recovery requires deliberate and intentional self care. Consider what has worked for you in the past, and make a list - when I’m drowning, I literally cannot remember at least half of these things. The time to make this list is BEFORE you are in active crisis. For me, when I’m in the middle of a severe ongoing panic attack that has persisted for over 30-60 minutes, I actually become nonverbal and it’s extremely difficult for me to even choke out 1-2 words to respond to a question, let alone compiling a list. My husband and I (both autistic) have each had many severe panic attacks where we want the other person’s help and comfort, but we can’t express what we actually need from them. We made a document that we call our PARACHUTE PROTOCOL. This master list has multiple categories of support tools and techniques that we can literally point to when we’re unable to communicate verbally to help the other spouse understand what’s happening, immediate needs, and if professional/crisis intervention is necessary.

Our real Parachute Protocol, designed to easily suggest support strategies when verbal communication skills are limited.

Making A Long-Term Recovery Plan

If you find yourself approaching burnout/crisis mode, your nervous system is begging you to intervene with more effective and impactful accommodations. You can’t keep quietly riding out persistent panic attacks, and continue waiting for things to fix themselves, without deliberate action on your part to address your social, physiological, emotional, physical, and medical needs, and expect that anything is going to be better a month or two from now - if you don’t crash now, you’re going to eventually. I promise it will catch up with you. Your nervous system WILL demand to be heard if you insist on ignoring these red flags, and avoidance behaviors can literally manifest themselves through heart palpitations, precordial catch syndrome, anaphylactic shock, and asthma attacks. Therapists, psychiatrists, hormone specialists, medications, and outpatient or inpatient crisis intervention programs can be expensive, but it’s money much better spent than on ambulance ride and an Emergency Room bill, a lost job, etc… and you’ll likely end up needing those afterward anyway!

To make a Recovery Plan, consider what your options are, and consider how urgently you need them, and the frequency that you need them. It is normal to need the help of a trusted loved one to make the calls needed to get appointments scheduled, and even having them drive to these appointments with you, sit with you and help express their perspective and concerns so your providers understand the severity of your situation, and take part in making sure you follow through long-term. The first few weeks are critical to recovery - it’s easy to “forget” an appointment you don’t really want to go to, “forget” to pick up a new prescription and start taking it every day as prescribed, and “forget” to make important calls, and if you have loved ones that are willing to support you through these efforts, PLEASE lean on them. While it’s understandable that you may feel like this is too much of a burden to ask of them, to your loved ones, this is an opportunity to show up for you the way you’ve always shown up for everyone else.

Recovery works fastest with multiple simultaneous methods of treatment and support. If you can afford to do more than one at a time, and have the village to support you, I highly recommend it - it was critical to helping my husband through severe burnout in 2021, and he needed to take FMLA and do therapy and psychiatric appointments on a weekly basis, in addition to medication, seeking permanent WFH accommodations and team changes at work, face-to-face visits with close friends and loved ones, and very deliberate time to recover where we severely restricted the stressful things we committed to, as well as lifestyle changes like ordering food to make sure our children were fed when we didn’t have the energy to cook, using paper plates and plasticware, etc to reduce the mental load of household tasks.

You may want to print off a few weekly calendars and monthly calendars to put your recovery plan into a visual schedule to write your plan down, or you might choose to make a separate calendar in your phone or a shared Google Calendar that your support people are invited to see and edit. It’s okay if you only have the desire or emotional energy to implement some of these things, and you don’t have to include all of them. These are suggestions, not rules! Take what you like, and leave out what you don’t.

Things you could include in your Recovery Plan:
- A checklist of mandatory daily/weekly self care tasks (basic hygiene tasks, 30 min with happy light or sunlight, drink 80-100oz water)
- A list of 3 supplemental self care tasks per day that you pick from your Parachute Protocol (ex: 1 hour quiet time, bubble bath, skincare) to make sure you’re consistently doing mindful things throughout the day to give yourself an extra boost, preferably with things that you can likely still manage to do even on the days when you’re past your limit.
- A list of all medications/supplements sorted by day/night, their dosage, and any scheduled dosage adjustments to taper up or down as needed, so you don’t have to hope you can remember your medication schedule, a loved one can help you take your medications if you’re struggling to do it alone, and you can refer back to it when you have check-ins with the prescribing provider.
- Appointments with professional crisis support specialists including a psychiatrist, a therapist, a hormone specialist, doctor, follow-up lab work, consultations, etc. If you’ve already scheduled these appointments and they’re part of your routine, ask yourself if you need to increase their frequency, if you aren’t connecting with your provider and need to switch to a different provider or practice, etc.
- Quality time: by yourself, with your partner/spouse, with a bestie, with family members, etc.
- Scheduled check-ins with your partner/spouse/trusted loved one on a monthly basis (if not biweekly) to assess if things are getting better or worse, which things you feel have been effective, if any of your strategies need to change, if additional support/care is needed, if calls need to be made to schedule appointments, change dosages, switch medications due to adverse side effects, etc.
- Things to look forward to: monthly bestie movie night, biweekly lunch with mom, dungeons and dragons with friends every other week, upcoming movie releases you can plan a date night around, a concert in 3 months, a vacation/staycation, a spa day, a massage, a 4 week ceramics class at your local rec center, a yoga retreat, etc

“What if things get scary?”

What are some options if you find your mental wellness degrading to a point of becoming an emergency?
NOTE: If you’re at the Scary stage, you definitely need more support and personally tailored suggestions than a non-exhaustive list from a blog. Please call a licensed mental health professional to discuss your options!

• Call the 988 Suicide Prevention Hotline, or 911, if you are having dangerously persistent suicidal thoughts.

• You might try cognitive behavioral therapy, trauma therapy, or even ketamine therapy if you haven’t found success in basic therapy, or you may need to increase the frequency - many people need therapy daily or multiple times per week through a severe emotional crisis.

• If you have tried multiple over-the-counter medications without success, you may need bloodwork done to check for hormonal deficiencies that exacerbate mental illness.

• You might need a more heavy duty rescue medication like Xanax, Ativan, or Valium for the worst days - call your psychiatrist and ask what options are available to you, and be honest if you have a personal or family history of addiction.

• If you have been self-medicating with alcohol, recreational drugs, or prescription drugs, stop using them immediately, and dispose of all substances you might overdose on if you are at risk of an intentional lethal overdose. Make calls to inpatient and outpatient rehab programs.

• Your spouse/partner could ask about a temporary WFH accommodation to support you through a particularly strenuous few weeks, or take FMLA to give you 12 weeks of full-time support, especially if you need emergency inpatient crisis care.

• Your spouse/partner may need to change jobs if their schedule/commute/travel is no longer realistic for your family and you need them home more, but their current job does not allow it and denied a WFH accommodation.

• A family member might move in with you temporarily to help out with cooking and cleaning.

• You might temporarily move back to your home city/state to be closer to loved ones and put your education/career on hold.