“Penina’s Story, Part Two: From the happiest time to postpartum depression”

In part two of her High Risk Birth Story, Penina shares her experience with IVF and delivering her son after previously choosing to terminate a pregnancy due to an abnormality. She also explains being proactive about mental health and her story of postpartum depression.

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Dr. Fox: Welcome to “High Risk Birth Stories” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you, the listener, a window into life-changing experiences of pregnancy, fertility, and childbirth. All right, Pennina, welcome back to the podcast. As our listeners know, and as you obviously know, last week you told your story of your fertility struggles and your journey to get pregnant the first time, and then the unfortunate diagnosis of a fetal abnormality and your decision to terminate the pregnancy. And we spoke a lot about that. But as I said last week, I wanted to give you the opportunity to tell the rest of your story because there’s a lot more and, fortunately, a couple of wonderful births and, you know, healthy children and some other issues we’re gonna talk about related to postpartum depression. So thank you for agreeing to do the doubleheader and welcome back to the podcast. How you doing?
Pennina: I’m good. Thanks for having me back on.
Dr. Fox: Wonderful. So, you know, again, I think everyone listening today heard you speak from last week’s podcast and, sort of, we know who you are and what your story has been. So I wanna jump right into it, you know, after you had that, you know, horrible experience the first time around, how long did it take for you to try again? Was it something that you’re like, “I’m trying right away,” or, “I need, like, some time to process this and recover from this?”
Pennina: It’s interesting because in between the termination to getting pregnant again is like that piece for some reason is a little fuzzy.
Dr. Fox: That makes sense. Yeah. Your brain was in another place.
Pennina: Yeah. But the termination was on March 5th, 2015. I talked last week about the doctors I was seeing who had done the transfer. And after that, I decided I needed a new practice. You know, part of it was just like, I needed a fresh, you know, space and fresh people. And part of it was, I just…I wasn’t happy with that practice.
Dr. Fox: Are you referring to your fertility doctor, your OB-GYN, or both?
Pennina: Both, actually, both. That was when I decided…well, I hadn’t gotten pregnant yet, but I knew that I was gonna do a new doctor. And just one quick story about that old doctor was I went in, he had me come in like a week or two after the abortion to like check…I guess he did an ultrasound to make sure everything was good. But when I came in, I actually wasn’t aware he was gonna do an ultrasound, and ultrasounds to this day are very hard for me to look at. Like, ultrasounds just have like a very…I’m not even sure how to describe it.
Dr. Fox: It’s like a PTSD. It’s like, you know, that’s where you got your trauma, just seeing that abnormal ultrasound. Sure. That’s understandable.
Pennina: So he didn’t…I wasn’t really prepared that he was gonna do an ultrasound and then also to see…this was the first time since being pregnant that I was gonna see an empty ultrasound. There was no baby in it, we’re just looking at ovaries or…you know. So that was awful. And then I went to his office and I started crying and he said, “Okay…” He was clearly uncomfortable that I was crying. And I was like, dude, if you’re an OB, like, you got…any person on this planet should probably be comfortable with, like, emotion and crying, but he obviously was not. And he was like, “All right, all right. It was a difficult thing that we went through, but it’s over now.” So I was like, first of all, we? Like, I don’t think we went through anything.
Dr. Fox: What do you mean we, kemosabe?
Pennina: Yeah, exactly. I was like, ugh…and then the fact that he’s like, “It’s over now.” It’s like, it’s over, it’s over for you. You did the procedure and it’s done for you. It’s not done for me. I’m gonna carry this forever, so.
Dr. Fox: Oh, that’s rough.
Pennina: Yeah. And I had specifically…once we knew we were gonna terminate, I decided I didn’t wanna know the sex of the baby because I knew that would kind of make it more difficult. And he knew that I had asked that I did not want to know. And then he slipped and said the baby was a girl. And then I was crying all over again. And I was like, oh my God, it was such a gut punch because it just, you know, of course, made the baby more real. And then I had, you know, picked out a girl name and then I was like, was that her? You know, it was just like…anyway. So I was like, all right, I need a fresh start, I need new doctors.
Dr. Fox: Oh my God. Yeah. I can’t imagine how someone who does OB-GYN is not used to people crying. I mean, you know, we have like closets full of tissues. And I see people crying like every day, all day. I’m like, all right, you know, happy, sad, whatever, this is like, it’s like breathing in our office, crying. Everyone’s doing it. It’s again, it’s not always sad. People cry in happy moments and people cry in difficult moments. And yeah, if you’re uncomfortable with that, you probably should become a radiologist or something. I don’t know. It’s like…
Pennina: Really just…yeah.
Dr. Fox: Yeah. Okay. So we’re getting the fresh start. And I’m curious, so you went to different fertility doctors, how did you find our practice? I’m curious. It’s totally irrelevant to the podcast, but I’m curious.
Pennina: I’m trying to remember.
Dr. Fox: Like, the Google?
Pennina: No, it was definitely, like, people, like, it was either family or friends who had, like, more complicated pregnancies that were like, “Oh, this practice is great.”
Dr. Fox: Oh, okay. Well, thank you for that. That’s nice.
Pennina: Yeah. And the theme was true with the fertility practice that I moved to. It was also just…it was not…I don’t know if this makes a difference, but I’ve always wondered if it does. It’s not a practice that’s affiliated with a hospital. So there’s not much of a focus on research. It’s more just like very patient-focused. So it felt less like a factory. And I remember we went to transfer the embryos. We could either hire a service to do it, or you could actually do it yourself. Like, they put them in this freezer, this trashcan-looking freezer thing. We did it ourselves. We were like, these are our embryos. We wanna make sure it’s like…we do it.
Dr. Fox: Oh, transfer from one clinic to the other. I thought you meant, like, transfer, like, into you, into your body. I was like, they let you do that yourself? How do you do that? Holy smokes. Do it yourself IVF home kit. You know, here’s a YouTube video.
Pennina: For the future, I don’t know. That’s pretty funny. But yeah, I remember we got…the other one was also in the city. They’re both in the city, just across town. So got it, got in a cab. I remember my husband was like..he’s like, “We can walk with this.” I’m like, “We’re not walking with this. We’re gonna take a cab.” We took a cab and then went across town and just like delivered. It was so wild. I have a picture of like me in the cab, like, hugging my big trash can of embryos. It was wild.
Dr. Fox: Oh man. All right. And was the IVF successful pretty quickly or did it take a while?
Pennina: Yeah, the first…the next transfer. So it transferred in July. So the termination was in March. We transferred in July.
Dr. Fox: Wow. And it took right away.
Pennina: It took right away.
Dr. Fox: Well, listen, you deserve some good news, you know? Finally. How difficult was it having that 12-week scan?
Pennina: Every scan. Every. I remember actually at 10 weeks and I went, I was at MFM at that point and what I loved about MFM also was that like I could…with their typical OB, like, they don’t even want you to come in if you’ve just gotten your pregnancy test. Right. Like, it’s like, “Oh, just like, come in when you’re like, you know, 10, 11 weeks.” And it’s like, no, I want this monitored, like every day, you know. So moving to a high risk practice and one is, like, kind of compassionate MFM. It was like, I just felt very…kind of like, “All right. Yeah, of course, come in. We’ll, like, take a look. We’ll take care of you.” It just felt, like, much better. I remember going in for the 10-week and it was so anxiety…it lost all that excitement. It was no more like, “Oh my God. Oh my God. I’m so excited.” It was just like, “I don’t know, like, we’ll see.” And I was very much protective of myself. Like, all right, I’m pregnant. But like, for now, we’ll see, we’ll see, you know.
Dr. Fox: Yeah. Intentionally or subconsciously?
Pennina: I think kind of intentionally. Because I think I was like, I can’t, you know…and the thing was with the CVS from the first pregnancy, it showed that it actually wasn’t genetic.
Dr. Fox: Well, as far as we, I mean, because you can only test so much with the CVS, so yeah, you don’t…
Pennina: Oh, that’s good to know.
Dr. Fox: Yeah, no, it’s part of the issue with the diagnosis like on [inaudible 00:08:29] you can do the CVS and come back normal, but that tells you it’s not Down syndrome, it’s not trisomy 13 or 18. And if you do a microarray, it tells you it’s not one of those conditions. But, you know, you could have babies with normal CVSs who have lots of issues. It doesn’t, you know, it doesn’t mean that the genetics are normal. It’s sort of…I tell people it’s the tip of the iceberg. It’s an important tip. Right, a lot of things are in that tip, but it’s not everything. And so there’s always a lot of question marks regarding a diagnosis like that. Whether the CVS will ensure that it’s just, you know, the surgical problem or whether it just ups the odds, and it’s really more about upping the odds than ensuring.
Pennina: That’s so interesting.
Dr. Fox: So yeah.
Pennina: Yeah. I don’t think I even understood that. That’s so interesting.
Dr. Fox: Yeah. Genetics is tough stuff. It’s real complex. Yeah.
Pennina: Yeah. Well, I remember being angry because basically the way they described it, like, yeah, this is just a fluke, like it’s not a genetic thing. And I was like, well, and so that was supposed to be good news for future pregnancies?
Dr. Fox: Yes and no. I mean, most of the times it is genetic. It’s a random thing, meaning it’s not something you carry and it doesn’t really increase your risk in the next pregnancy. Like, if you have a baby with trisomy 13, which is a genetic abnormality and they can have a [inaudble 00:09:41.928], it is genetic, but it’s not likely to recur where there’s things genetic that you carry that have a, you know, 25% or 50% chance of recurrence, which is not usually what would cause this. It’s more so just for like, you know, sort of how to, you know, get some…it’s not full closure, but some level of closure if you know that. It doesn’t give you the answer. And also all these things that we say, well, it’s not genetic because the CVS was normal, I mean 30 years ago, all the things we thought were not genetic, we’re finding are genetics. So we don’t know that, we just sort of…
Pennina: So interesting.
Dr. Fox: Yeah. It’s just, at the level of genetics we understand today, we didn’t find anything, but maybe 10 years from now we’ll have a million different diagnoses we can figure out.
Pennina: That’s really interesting.
Dr. Fox: But you ultimately did get through the ultrasounds. You made it, did you have to like do anything to get through them or you just sort of like, you know, gutted it out?
Pennina: Yeah, I just gutted it out. And I remember after the 10…my husband, he, like, was gonna come with me and then something came up with work and he couldn’t make it to the 10-week ultrasound. So I was alone and I was very angry at him and I was frustrated that I was alone, but I sent him…you know, everything looked good so I sent him a picture of the ultrasound and all I said was…I sent it and I said, “Baby’s still there.” Because that was my mindset was like, all right, we’re just checking to see, baby’s still there. Baby’s still…like, you know that, like, baby’s still okay and there. But it was just a funny story. By accident, I sent it to a group chat of my sister, my cousins, my mom, and my aunt. And I put it, I sent it, didn’t realize I sent it to them instead of my husband, put my phone down, and then continued with everything. And I opened my phone and no, they didn’t know. I wasn’t telling anyone I was pregnant this time. So that was how they all found out I was pregnant and they were like, “Wait, what?”
Dr. Fox: It’s like the inadvertent reply-all that…
Pennina: Yes. No, it totally was. I was like…oh my God. It was so funny, so yeah.
Dr. Fox: Wow. Now, my recollection is that other than sort of the, you know, post-trauma aspect of your life, the pregnancy was pretty smooth. Right? I mean, there was, you know, some thises and thats like a lot of people get, we’re monitoring you for a couple of things, but ultimately it was pretty straightforward. Yes?
Pennina: Yeah. It was, it really was. I think there was one scan that, like you said, it was very much like a typical thing. Like, “Oh, we’re seeing something. We just wanna make sure something,” but that kind of thing just sent me into the tailspin. I just like sobbing in the waiting room at Carnegie Imaging. I was just like, oh my God, oh my God. It just felt like deja vu. And it was fine. It was nothing, it was nothing major. It was just like, “Oh, let’s just take a…” you know, I think it was like one of those things like, “Oh, the doctor just wants…” And I was like, “Don’t say that.”
Dr. Fox: Do not bring in the doctor. Doctors are bad.
Pennina: Yeah. So, but yeah, it was, yeah, I guess, unremarkable in that sense of everything was fine. But I was, yeah, definitely super anxious the whole time. But as a pregnancy, I definitely breathed easier once the nuchal had, you know, passed and it was fine. And you know, the further along I got, the more I could…like, I let myself get more excited and be like, okay, this is really happening. We’re really here.
Dr. Fox: Yeah. That was literally my next question is that a lot of people who come into a pregnancy after a very difficult pregnancy sort of the way it goes often depends on when the event happens. Right. So if it happens at the beginning of pregnancy like, you know, a fetal abnormality or multiple miscarriages or fertility or something of that, usually it’s like crazy, crazy anxiety at the front end of pregnancy that dissipates over time as things move along versus someone who had something like a stillbirth and then it’s the exact opposite where when they start pregnancy, they’re generally okay and then as they get closer to the due date, it’s all hell breaks loose. And so I was gonna ask you if you were more like the former and it sounds like you were
Pennina: Yeah, I think so.
Dr. Fox: Okay. And so tell me about ultimately the delivery.
Pennina: I was like a week overdue, I think. And I was just like, come on, like, just let’s get this baby out. Like, I just…you know, I was very ready. I think I went in…what’s that call ed, the stripping, membrane stripping?
Dr. Fox: Yeah.
Pennina: I came in to do that, just to, like, move things along. But while I came in for that, I think they realized…I can’t remember what it was, but they’re like, “Oh, you need to come in later today to give birth. Like, you’re there.” I don’t know if my water had broken, I didn’t realize, or I don’t remember what it was exactly.
Dr. Fox: Oh, I remember because I was the one.
Pennina: Oh, it was you. I was just…as I was saying this, I was like, was it you who did the membrane thing?
Dr. Fox: Who was that dashing, charming doctor who gave me the news? I just can’t remember his name. 
Pennina: Well, I do remember one funny thing you said to me.
Dr. Fox: Your fluid was low. The fluid around the baby was low.
Pennina: My fluid was low. Yes, yes. I think when you said, “All right, so you’re gonna come in…like, you’re gonna go home, you’re gonna pack your bag. It’s like no rush, but just come in to have a baby later.” And I think my eyes got big because I was like, “Oh my God, this is happening.” And you’re…I think it…like, it broke all the tension. You were like, “It’s just like taking a big poop. Like, don’t worry.”
Dr. Fox: Yeah. Well, that’s interesting. I don’t know if I say that a lot, but are you sure that was me, not Silverstein? That sounds like something Silverstein would say.
Pennina: I don’t know, maybe it was. I just remember someone saying that, it was one of you.
Dr. Fox: All right. Well, I’m glad it broke the tension, if not breaking the wind. All right. So, okay. So you go in, you’re getting induced, and again, it’s the same thing when you’re there and you’re getting induced, you’re listening to the baby’s heart rate continuously. There’s like that constant feedback of my baby’s here., my baby’s coming, like, my baby is okay, my baby’s…which is very, very therapeutic for people who’ve been through things, like, literally to hear the baby’s heartbeat all night is something that is cool. How excited were you? I mean, how do you put that even into words?
Pennina: I was really excited. I’m trying…again, like that part is actually a little fuzzy. I remember I had to be induced and it was a long kind of night…
Dr. Fox: It’s no walk in the park.
Pennina: …just waiting, waiting around. And, yeah, it was…I mean, I think it was a very typical first birth, but I just felt like I was pushing for…I think I pushed for like three hours.
Dr. Fox: Okay. That’s quite a poop.
Pennina: Yeah.
Dr. Fox: Three hours. All right.
Pennina: Yeah, it felt very intense, and I remember just when I was like, “I don’t have anything left in me, like, I can’t do this anymore,” because I was induced and I had an epidural, it’s like, I kept pressing that button, like a little more, a little more. And it’s like almost hard to push when you can’t feel anything. So I was just like, what? And I remember they gave me oxygen at some point. Yeah.
Dr. Fox: Malka was at your delivery right?
Pennina: Malka. I was gonna say it was Dr. Malka.
Dr. Fox: Yeah. And she’s a good cheerleader. She’s great.
Pennina: Oh, she was phenomenal. She was so like…yeah, she was great.
Dr. Fox: Yeah. She runs marathons. So she’s real good at motivating people to push those last few miles.
Pennina: That’s exactly how it felt. It felt like a marathon. And yeah, then, you know, he came out, he cried, all looked good. But the moment he came out, I just kind of felt numb. I was like, okay. Like, I just…everything just like…it was bizarre. And then, you know, they put him on my chest. It was a boy, I should mention.
Dr. Fox: Did you know it was a boy going into it?
Pennina: Yes. We found out. I remember people are like, “Are you gonna find out?” I’m like, “Yeah. I’m not in for any surprises of any kind. Like, I wanna know everything I can possibly know, I wanna know.” So, which I was excited about. And actually, I think I was happy, kind of, because knowing the first baby we lost was a girl, it felt, like, different. Like, I was like, okay, it feels…you know. Put the baby on my chest. I think I was…I don’t know if I’m conflating emotions or times of emotions. Like, I think I was initially like, oh my God. Like, it was very exciting. And like, I couldn’t believe it. My husband and I kept looking at each other and we’re like, “Oh my God, this is it.” But I was also, like, exhausted. I’m like, oh my God, I’m like…you know. I think after that, I’m trying to like…again, this part is a little fuzzy. I think I remember them asking, like, you know, “Do you wanna keep him in the room with you?” And I think maybe that’s when the panic set in that I was like, “No, no, nursery’s good.” Like, I just…you know, it felt like a lot.
Dr. Fox: Panic like you panic because you’re a new mom and you have this young life who’s relying on you?
Pennina: Yes. Kind of just like, oh my God, I don’t know what to do. Like, this is a lot like, uh…
Dr. Fox: In hindsight, do you think that it was more than most new moms have or sort of typical?
Pennina: I don’t know. That’s what’s hard to gauge, you know, and I think what’s interesting, and I’ll talk a bit more about this, but with postpartum depression, it’s like, you know, there’s the baby blues, right, and like, there’s a lot of legitimate feelings of kind of panic and overwhelming anxiety. So then it’s a question of like, how intense is it and then how long does it last? So that’s why it’s not like…I know that there’s like 5% of women who experience, like, bliss after giving birth, which I just don’t understand. Like, wait, what? Like, just like total blissed out. I’m like, I don’t…But I know people, I actually know people who like, yeah, it’s just like in such elation. I was like, I don’t understand. It’s hard to know at that moment. Like, it was just like, yeah, like kind of like, you know, first-time mom and just like, oh, what’s going on?
And I remember I woke up and I felt like…the next day after, I didn’t get much sleep. I remember feeling like, you know, there was like…everything was beeping and there was like so much noise. And then with my…well, I’ll get to my second pregnancy later. But I remember with my second pregnancy, I brought, like, a sound machine for myself and I brought, like, an eye mask and, like, I slept so well because, like, I came in super prepared. So I woke up the next morning and I just felt like I had been hit by a truck. Like I was like, my whole body hurt. I was just like, I was in so much pain and it was just like, yeah. And then, you know, the nurses brought me the baby to start to try to breastfeed. And that was, I was like, uh, like it just all felt like so overwhelming and scary. 
And I remember, we had some family coming to visit and I remember, like, everyone’s like looking to me to be like so happy and excited. But especially after all we went through and I kind of was like, I got nothing for you. I’m just kind of overwhelmed right now. I can’t remember if it was Dr. Malka, if it was you, one of you was doing the rounds to, you know, kind of check on me. And it was, I think, my last day at the hospital and I said, “I can’t…I’m not ready. I can’t go home yet. I have to stay.” And whoever the doctor was was like, you know, “All first moms feel that way. It’s like, it’s totally normal. Like, you got this, like, don’t worry.”
But I was like, “No, I’m not ready. Like, I need to stay here. I need people to take care of me. I need people to take care of the baby. Like, I can’t do this.” And yeah. But then we obviously went home and I think those feelings just like increased. I was just so overwhelmed. I felt so anxious, then I felt super guilty for feeling that way because I was like, after everything I went through, why am I not, like, so excited and happy right now? Like I understand, I knew I’d be, like, tired and it would be a lot, but I didn’t understand why I was feeling this way.
Dr. Fox: And you felt nothing like this before the birth, like towards the end of pregnancy?
Pennina: No. I would say towards the end of pregnancy, I was very anxious and it wasn’t even about the health of the baby. It was more like I was obsessing over like his bris, his baby naming, you know, like I was like, oh, like, you know, just like obsessing when it was gonna happen and what was gonna…you know, I got a little obsessive, I guess I’d say, and kinda anxious, but not any of these feelings. The other thing that happened was, you know, they always say sleep when the baby sleeps, which is like, I think like the dumbest advice, like come on. But, you know, even when he was sleeping, I could not sleep. I was like wide awake. I just wasn’t sleeping at all, which is horrible. I mean, it felt like torture.
And, yeah, I kind of alternated between like intense panic and then being like really weepy. Like, I’d be kind of like…I’d be trying…you know, I did manage to figure out how to breastfeed, and I was very lucky that like physically like he latched and I had good milk production, but it was so overwhelming to me, like, I felt suffocated. Like, I remember I was trying to…I would take a nap and then, you know, my mother-in-law would wake me up and be like, “All right, you know, he’s ready for feeding.” And I felt so like this schedule of, like, constant feeding. He was and still is a really good eater. And I think, like, he just was, like, always happy to eat and it just…I don’t know. It just felt like so overwhelming and suffocating, like I felt trapped in this, like, new schedule of like, oh my God. Oh my God. Like, I can’t do anything. I’m just here to…I don’t know.
Dr. Fox: How long did it take until it was evident that you had postpartum depression, right, sort of clinically, as opposed to just the “normal,” whatever that means? But sort of when was it obvious to somebody that you had crossed over into that line, like, this needs to be treated? Was it very quickly or did it take a long time?
Pennina: So I remember asking, you know, like…and I had a lot of family and friends who were also, like,new moms and had newborns and babies. And so I remember asking like, you know, like, “Did you feel this way?” And a lot of people were like, “Yeah, it’s overwhelming. It’s a lot. Like, da, da, da.” And then I had one friend, I remember us telling her, like describing more specifically how I was feeling, and she’s like, “You know, I actually don’t think that’s in the realm of normal anymore. I think you should get help.”
Dr. Fox: That’s a good friend.
Pennina: It was actually the best thing she ever said because when everyone’s telling me, “Oh yeah, like this is just what it is, like, don’t worry,” that was horrible because it felt like, oh, this is what it means to be a mom. You’re always gonna feel like this.
Dr. Fox: Right. Why’d I sign up for this? This sucks.
Pennina: I was like, no, I cannot, this is horrible. And so when she said that there was actually relief, like, oh, there’s a problem here and we can try to fix it. and then I won’t feel this way.
Dr. Fox: Do you recall about how old your baby was when you had that conversation with her?
Pennina: Yeah, it was pretty early. I mean, it was like six weeks.
Dr. Fox: That is early, but it’s not that early because you’re describing these symptoms from the moment you delivered?
Pennina: Yeah, it was hard.
Dr. Fox: So that’s a pretty long time to suffer.
Pennina: Yeah. No, it felt like an eternity, but I guess like in the scheme of things, the fact that I was like…and I’ve always been…
Dr. Fox: Yeah, it could be months.
Pennina: I’ve always been very proactive about my mental health. Like, I had never had any significant mental health problems before, but I always had like, you know, run-of-the-mill anxiety that I always get, you know, I had talked to therapists before and I was always very like, yeah, like, if I have some things I need to like work through or talk through, like, I’m gonna do that.
Dr. Fox: Yeah. No, it’s interesting because, you know, when we see people during pregnancy or before pregnancy and they have a history of mental health diagnoses, whether it’s anxiety, depression, OCD whatever it is, you know, I always tell them that there are at an increased risk for postpartum depression and anxiety. And I tell them that not…I say, “I’m not telling this to like give you bad news, even though it’s true you’re at an increased risk of getting it after delivery. The good news is you’re less likely to suffer because you’ll know within 10 minutes if you don’t feel right.” Meaning, like, immediately, you’re like, “I’m not right. I gotta go to my therapist. I go to my psychiatrist, I gotta change my dose.”
Pennina: Right. This isn’t my first rodeo.
Dr. Fox: So yeah. So it’s more likely to happen, but you’re less likely to suffer. And I say the people who really suffer are the people who don’t know it’s coming. And so it hits them like an anvil, it takes them, you know, a month or two months to figure it out. And so yes, it’s good that you were diagnosed at least, you know, at six weeks, but probably had you…if you had something like OCD, anxiety, depression going into it, it would’ve taken two days, not six weeks.
Pennina: Yeah. It’s so interesting.
Dr. Fox: There’s a routine screen for depression at the postpartum visit in six weeks. Did your pediatrician screen you for depression? Because some do and some don’t. I think it’s recommended now.
Pennina: Yeah. She didn’t, but I do remember her being like just wonderfully supportive. Like, I remember, like, you know, coming in, I was like such a mess at every appointment and she like sat me down and was like, “What kind of help do you have?” I decided to switch to formula also around that time, maybe like two months in, but I felt even more guilt. I felt so guilty because I was like, it’s working, like, you know, he’s latching. I have good production and so many women struggle with that. So like, so selfish of me, right, to like, not do that. And she was so supportive. She was like, “Formula is wonderful. Like, don’t worry, like, just do what…you know, happy mom, happy baby. Like, you gotta do what’s good for you.” So that was really helpful that she was so supportive that way. I mean, I think there are some pediatricians who can put it a little bit of pressure to do, you know, exclusive breastfeeding because their focus is the baby. Right? So I appreciated that. While she didn’t do an official screening for it, she was very, like, mindful, I’d say.
Dr. Fox: Got it. Yeah. No, no, I think that that advice is correct because happy mom, happy baby is not just a cute statement. It is a truism that you cannot have a healthy baby if the mother’s not doing well, and it’s way more important than any potential benefit of breast milk over formula, which we’ve talked…like, not you and I but, you know, in life and on this podcast we spoke about a lot. The difference is not as great as people think. In fact, it may be zero, but whatever, whatever difference there is, whatever benefit there is, it’s not at the expense of the mother’s health. It’s just not, there’s no question about it.
Pennina: One of my favorite axioms is fed is best.
Dr. Fox: Yeah. Fed is best.
Pennina: You know, rather than breast is best, it is like, or formula is best. It’s just fed is best. Make sure your baby is fed. I think I identified it like right before my six-week screening at MFM. The way I like to handle things is, like, I just, like, submerge myself in research. So like, I did that also with, when we got the diagnosis with the first pregnancy before I was emotional about it, I was just kind of head down in research mode. So I did the same thing here where I just kind of called around to a bunch of different psychiatrists. I was overwhelmed at the cost. I was like, oh, this is expensive. But then I realized like, this is like…I remember there was one psychiatrist I spoke to who was like, “Look, if you…” Because I was explaining, and they’re like, “If you don’t see me, please see someone. This is so important. This is like…” She basically was like, “This could be life-threatening, like, do not delay. Like, please see someone ASAP.”
And I just thought that was so kind to just like…she was clearly like…I just spoke to her for like five minutes and she was very concerned about me as a person. Like, she wasn’t, you know…So I ended up finding a reproductive psychiatrist. So somebody who focuses specifically on reproductive mental health issues. And, yeah, I went in and she was like, you know, basically, like, “You’re like textbook, like, postpartum depression,” which she told me typically presents as anxiety a lot of the time, which was checked out. That was exactly what I was experiencing was a lot of anxiety. But some like really weepy…the way I described it was that like there were moments where I was, I guess, okay or feeling stable. Right. Like, I was like…and then, and that was what so confusing was I would have, you know, a few hours or even a day where I was like today was a…you know, let’s say like I had…like, my whole family was over and it felt like I was okay.
You know, I was like, “I’m okay. What was I thinking? It was in my head. I’m totally fine. I don’t know what I was thinking. Why…” you know? And then the next moment, or the next day, the way I described it is like these, like, glasses that someone, like, shoves on your face and you can’t take them off and it’s just the way you see everything. Like, it’s just like this…you know, it’s just everything looks different and feels different and, like, you can’t get out of it. It’s awful. When I was doing my research, I was like, I realized that I was at a…So apparently there are studies that have shown that if going through IVF, you are at more risk for postpartum depression and experiencing, like, a traumatic loss like we did.
Dr. Fox: Yeah. No, it makes a lot of sense.
Pennina: And, you know, I had some, like, anxiety that I had treated just with, like, talk therapy before. So like, I had this like…you know, I was like a triple threat for, like, postpartum depression. I was like, oh yeah, okay. And I think psychologically, when you think about it, when like going through everything we did, so first the infertility and then the loss, it’s like you’re so focused on just getting pregnant and having that baby, like that’s been the focus for forever, or it feels like, and then you get there and it’s like, it’s amazing, but it’s like, it’s also hard. It’s an adjustment. And so you’re like, wait, what? You know? It’s like, so just from beyond the chemical pieces of it, I think from the psychological perspective, it just is like, it’s a lot to deal with.
Dr. Fox: Yeah. Did you ultimately need medication?
Pennina: Yes. So she prescribed me Zoloft and…
Dr. Fox: So simple yet so effective.
Pennina: The thing about Zoloft…Yeah, so effective. And the thing about it though is that it’s not…you know, takes about six weeks to kick in.
Dr. Fox: Yeah, to fully kick in, sure.
Pennina: To fully, but yeah, like it is kind of like, you know, there’s an on-ramp, like it kicks in slowly, but even just knowing that I was doing something that it was going to get better made a huge difference so that when, you know, as I continued to struggle, it was like, all right, it’s not gonna be like this forever. We’re on it, we’re doing something. Kind of there were other things I did. So, you know, she was like, sleep is so important. And so my husband was amazing. I stopped doing any night feedings because, at that point, we were on formula and he’s like, “You sleep, I’m gonna get up and do the night feedings and do the formula. That’s it.” And he was…
Dr. Fox: Wow, good dude.
Pennina: Yeah. He was back at work. To this day, I don’t know how he did it, but he was like…you know, he didn’t have like a long paternity leave or anything. So he was like waking up and then he would go to work. And then it was like wild. Then, of course, that increased the guilt because I was like, well, I’m not pulling my weight and he’s doing it. And then I was like, I gotta not focus on that. I just need to focus on getting better and getting back to myself.
Dr. Fox: Yeah. What you mentioned about sort of just the knowledge that you’re being treated, it’s something that really is so true that there’s…and you described this earlier, that when you said you had your emotions and your feelings that were sort of like there that’s sort of uncontrollable, but then you had the guilt about them. Right. Sort of I call like the meta emotions, like that sort of lives above that where you sort of start judging yourself and the shame and all that over sort of like the biologic. And so when you start getting treatment, you get a diagnosis, yea, it may take time for that biology to change, for your brain chemistry to change, to sort of take those glasses off that you were talking about where you’re seeing the world in a different way. But what goes away very quickly is that shame and guilt over it and/or the, “Why do I feel this way? I’m a bad person.” Like, all of that stuff, it just sort of melts away and it really does make you feel better. Like, you still have depression, but you’re not depressed about your depression.
Pennina: Exactly. Yes. Yes, I think that’s exactly right.
Dr. Fox: So interesting.
Pennina: It’s sort of taking agency and control too. Because, you know, part of the feeling is being out of control. It’s like, I can’t predict how I’m gonna feel and my emotions are all over the place. And I think it’s very typical with depression for people to feel like they’re a burden on those around them and their loved ones. So feeling like, all right, I’m being an active participant here and I’m just trying to do something to help myself is a really good feeling.
Dr. Fox: Right. And sort of in parallel to what you mentioned on last week’s podcast, you were open about this and you talked about it and you wrote about it, you know, and spoke about it with others. Was it sort of the same thing that, you know, this is who I am, I’m doing this for support, I’m doing this because I’m just an open book? And also, what was the response to it?
Pennina: That’s a really good question. I think I was open because I was such a mess. Like, I felt like I couldn’t even be myself. So I was like, everyone around me knew I was struggling. But mental health is interesting. Like, there definitely was stigma and shame around the abortion piece of it. But like, somehow that still felt like it was happening to me more. Whereas not that mental health is a choice, but there’s still…you know, even today, I think there’s been great strides in reducing stigma and having awareness around mental health. But there is something that just felt inherently embarrassing about it. But I felt like something I couldn’t hide. Right. Like, it was so like…I was a mess. So I was really open about it. I think one of the things I think that was also interesting was I had never been on any kind of medication before for mental health. And that was a big deal for me. It felt like this…like I kind of had seen myself as like, all right, I’m somebody who needs like…I’m a, you know, like, New York neurotic who needs to talk to their therapist. Like, I’m not like someone who needs, like, medication, you know, it wasn’t…
Dr. Fox: Right. That’s next level.
Pennina: Yeah. It felt next level. And I was like, “Oh my God, I’m a…” Similar to IVF, I was like, “I’m a person who needs medication now. I mean, I’m a medicated person now.” Like, it just felt like this…And now I’m like, come on. It feels, like, so not a big deal. And it’s like…
Dr. Fox: Yeah, one out of four people listening to this is on one of those medications. Those are the odds.
Pennina: Totally. I think Zoloft should be in the water. Like, I think it’s like…you know, I don’t know. So it definitely was complicated. I remember somebody…before I experienced any of this, a friend, or like someone, an acquaintance, not even someone I knew well was very candid, like, “Oh, I had postpartum depression.” And even at that moment, I was like, oh God, that’s so weird that she’s being so open about it. And I’m so embarrassed that I felt that way. But I’m like, you know, when I talk about it, is that how people see it, like, that’s so weird that she’s being so open about it? And I’m like…
Dr. Fox: Some do, but fewer…those numbers are getting smaller and smaller because more people are understanding that this is not your choice, obviously, and it’s not your fault, and it’s something that happens. Just like you wouldn’t, you know, feel weird about someone who said I had postpartum preeclampsia or postpartum hemorrhage. You’d be like, “Wow. Why did she have a hemorrhage? What’s wrong with her? Like, you know, why did she choose?” And people are really coming to understand that more that this is no different. It’s just, it hit you, you know, the anvil fell on your head. You know, you didn’t choose that postpartum depression. It’s just, that’s what happened. And like anything else, like getting diabetes or high blood pressure, just whatever, these things happen and they’re dealt with. And how long did it take for you to sort of get well, let’s say? Well is a very vague term, but that you sort of felt that you were back to who you were.
Pennina: Yeah. Like, it definitely took the full six weeks. Although it did feel like small…like, incrementally I was getting better, and then…
Dr. Fox: But six weeks is not that long under the circumstance. It could sometimes take much longer.
Pennina: Yeah, no, it was pretty effective. And I also…it was like it was perfectly timed with my maternity leave. Although I felt frustrated that like…I felt like I wasn’t able to enjoy my maternity leave, but by the time I went back to work, I was feeling much better. And I think going back to work was amazing for me at that time, it felt like this like return to normalcy and like having a little…like, my own…you know, having autonomy and a little space to myself. It was so…you know, it’s hard to know like how much was the medication? How much was, like, going back to work? Probably a combination. So, yeah. And so, yeah, then I was really able to enjoy him and I was like, oh, this is what it’s supposed to be like, like you…like, yeah, there’s like, you’re tired and there’s hard moments, but like you’re on the balance. You know, you’re pretty happy about it and you’re excited and you love your child. Like, I think that was the scariest thing was like, I kind of felt like this numbness. I was like, I would look at him and be like, I know I’m supposed to feel something, but I’m not really…like, ugh. It was so…like, it was awful.
Dr. Fox: All right. Wow. How long did it take you to decide to do it again? Because you went through this another time. You have a daughter.
Pennina: Yep. We were gearing up when my son was about…let’s see, he was about a year-and-a-half and we were…or maybe a little less. And we were like, all right, well, we’re gonna gear up to do IVF, you know, the next few months. And that’s what we were planning on doing. And we, at that time, were not using birth control, but we figured, you know, if it happens, like that would be like a miracle, but, you know, there’s no point right now because we know that it would be such a struggle and we have the embryos waiting for us and we’ll just do another transfer and that’ll be it. And then I started to have certain symptoms. Like, I started to have, like, hot flashes and I was like, that’s weird. And I took a pregnancy test and I was pregnant.
Dr. Fox: Wow.
Pennina: And it was wild. Like, we were like…I remember my son was still crawling. Like, he wasn’t fully walking yet. And I remember, like, looking at the pregnancy test and looking at him and then I just started laughing. I was like, “Oh my God. Like, how is this possible?” But I think it’s actually decently common.
Dr. Fox: Yeah. It’s not that uncommon. It isn’t.
Pennina: And I will say that I never had a regular period before I had my son. And then after giving birth, I was like clockwork. So I think, I don’t know if like it reset my who knows what. So that was really wild.
Dr. Fox: I’m sure it reset it to some degree. In that pregnancy, so in your third pregnancy, all the feelings that you had in your second pregnancy regarding, sort of, you know, the anxiety of it, was it removed? Was it lessened? Was it exactly the same? How was it for you going through that next pregnancy when the previous one, sort of, was a good outcome pregnancy-wise?
Pennina: Yeah. I’d say it was lessened.
Dr. Fox: Yeah, I think that’s pretty usual. It’s not zero, you know, it’s not the same, but it’s not zero, it’s somewhere between.
Pennina: Exactly. Like, you know, ultrasound still gave me anxiety and I was still a little nervous, but it was definitely the fact that I had given birth to a healthy baby, like, it was definitely better. I was sicker. I actually was sicker with that pregnancy. Like, just first trimester I was super nauseous, but I was like, all right, I can handle it. And then I’d say her birth and then the after, like, it was such what therapists like to call a corrective emotional experience.
Dr. Fox: And I assume you were plugged in with your reproductive psychiatrist the whole pregnancy, right?
Pennina: Yes. So that’s another thing was the…So it was a big discussion, right, do I stay…you know, I was still on the Zoloft and I was like, “Do I stay on it while we try to get pregnant again?” And we talked through it and she gave me…you know, she very helpfully, kind of, walked me through it. She’s like, “Well, you know, this is a very typically very safe medication. Lots of people get pregnant on it, have babies, breastfeed through it, you know, but with any medication, we don’t know 100%, right. We can’t say with 100% certainty that there isn’t any kind of effect, but from what we know, this is super safe.”
Dr. Fox: Right. And if you go off it, you may be a disaster, which is not gonna be so helpful to anybody, you and the baby.
Pennina: Yeah. The way she put it, which was really helpful, she’s like, “There are also risks to being unmedicated and you have to think about that.” So I was like, “Yeah, that’s a really good point.” So I decided to stay on it and so I stayed on it through…
Dr. Fox: Right. Plus you got pregnant on it either way.
Pennina: Exactly. So it was like, well, I guess…yeah.
Dr. Fox: Here we go.
Pennina: Right. And I wasn’t gonna go off of it then, so I stayed on it. And yeah, I remember the hospital…first of all, her birth was like, I was home and I started to have contractions. So I realized I was in labor, but they…you know, in movies and I guess what the doctors tell you is that, you know, once they get five minutes apart, that’s when you’re like…you should go to the hospital. So they started to get very close together, but then they widened and got really far apart. So I was like, I guess, I guess not, I guess I’m just gonna stay home, but they were getting very intense. And then at a certain point, I’m like, all right, I think I need to go in because they’re getting very intense. So we live on the sixth floor of an apartment building and went to the elevator and it was out of service that day. So I ended up…yeah, it was like quite an adventure. I had to walk down the stairs and I got to the hospital. I was 7 or 8 centimeters dilated, so.
Dr. Fox: Amazing.
Pennina: She was very ready and it was like so quick and I…
Dr. Fox: No three-hour pushing this time.
Pennina: Yeah. It was like, she would’ve come out within minutes. I think she was sunny side up. So then it took a little more time, but like, not that much. And I got the epidural, but like right before I started pushing, so it hadn’t really…like, didn’t really kick in. And so I could feel…even though, you know, I felt the pain more, I could feel myself pushing, which felt better. And yeah, just the whole experience was different. Like I said, like, I feel like I came prepared this time. Like, I brought, like, my, like, sound machine. I had my spa mask. Like, I was like, you know, I was like, this is…
Dr. Fox: Your Zoloft.
Pennina: Yeah. My Zoloft, exactly. Like, I just felt…and I remember just like holding her in the hospital and it like felt so exciting and fun. And I was like, oh my God, like, this is what…this is it. This is what it’s…And then, look, again, with the first-time mom, like a first-time mom without postpartum depression could just be very overwhelmed and have a hard time enjoying that time in the hospital. Like, you know, I think this isn’t…
Dr. Fox: It is normal.
Pennina: Yeah. It’s pretty typical of a second-time mom to be able to be like, “Oh, now I can kind of enjoy it. I know what to expect a little more.” And I remember I had…going into it, I was like, “I’m not gonna breastfeed this time. I’m just not gonna breastfeed.” After I had her, I’m like, “Well, maybe I’ll try,” because I kind of felt like I should try. And she was, like, much rougher than my son. Like, she was like tearing apart my nipple. I was just like, “Oh my God.” So I was like, “Nope, nolpe, nope, nope.” So I ended up just like pumping for a few weeks just to get whatever milk I had and then doing…you know, so she got a little bit and then was the rest was formula and I felt really good about it.
And I really enjoyed my maternity leave. It was, like, so nice. I felt like I really…yeah. I just like…I would, you know, I don’t know. It just was like a really corrective emotional experience. It was just, it felt really good, and yeah. It’s interesting because you asked in the beginning, like, how big…or what did I envision my family to look like? And I kind of always thought about three, but then like after my daughter, I was like, this just feels, like, complete. I feel like, you know, like, it felt like she kind of completed the experience for us. I can’t explain it. Like, it was like starting with, you know, IVF and then ending with her. I was like, all right, this is it. This is our journey to have a family. Like, we just felt like this was it.
Dr. Fox: Yeah. I wanted to end by asking you…Your story’s incredible and it’s just such a whirlwind, but looking at where you are now and when you compare yourself to where you were before this whole story began before you even started trying to get pregnant, how are you different as a person from all of this? I mean, because I mean, it’s like, you’re a different person, right? It’s, like, unbelievable how different you’re gonna be just from going through all these experiences.
Pennina: Sure. I think going through anything difficult like that…well, certainly, and it’s a clichĂ©, but it makes you stronger. Right? So like, anytime you’re faced with a difficult situation, it’s like, all right, like, you’ve been through stuff, you’ve been through hard things and you can do this too. So I think a good example actually was when the pandemic first hit and it was like that, like, March, April, May when everything shut down, we had to just literally be home. We couldn’t see family, we couldn’t see anyone. It was just me and my husband, like, trying to manage our work schedules and our kids at home. It was like so crazy. And I remember waking up every morning and being like, okay, another day, it’s a marathon again. And I just felt like I was pulling on these reserves of like, all right, this is…and then not to compare, it’s such a different experience, but it was like, okay, like, you got this, you’re gonna get through this. It’s gonna be fine. You know?
And again, that same level of uncertainty of like, I don’t know what’s gonna happen here and I’m not in control. I was joking with my therapist that…kind of like what you said about women who’ve experienced, like, mental health issues before and then they don’t suffer with postpartum depression as long. You know, when it came to the pandemic and, you know, there was a crazy rise in anxiety and depression among everyone and everyone was running trying to find therapists. And I’m like, I feel like I’m like an expert here. I’m like, you know, this is my time just shine, I know how to deal with my anxiety and depression, like…
Dr. Fox: I got this.
Pennina: Yeah. I was like, “Hey, like, you guys are all, like, you know, novices and I know what I’m doing here.” So, and then I think also, and going through any of this kind of thing increases your empathy for people, not even going through this exact situation, but like any kind of grief, any kind of hardship, emotional turbulence, you kind of just like, yeah, you can kind of have that empathy in a way that I think it’s harder for people who haven’t been through it.
Dr. Fox: Yeah. Those are amazing lessons. Really amazing. Pennina, thank you so much for doing this again, the doubleheader, the back-to-back podcasts. It’s a lot of time, but I believe it’s really, really important stuff. And I’m so happy that you came on the podcast so we could record this. We can put it out there. People can hear it, people can think about it and about your story and everything that you went through and how you’ve, you know, come out on the other end such a…you know, with such wonderful insight into everything we’re talking about, you know, fertility, and pregnancy loss, and termination, and birth, and depression, and doing it again, and family. All these things are such complex situations to be in and it’s really helpful for people to hear this. So thank you.
Pennina: Yeah. Thank you. Thanks for creating a platform for this. I think it’s…I love how you created this podcast to just help share these stories. So thank you.
Dr. Fox: Thank you for listening to “High Risk Birth Stories” brought to you by the creators of the “Healthful Woman” podcast. If you are interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at hrbs@highriskbirthstories.com. If you like today’s podcast, please be sure to check out our “Healthful Woman” podcast as well where I speak with the leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Have a great day.
The information discussed in “High Risk Birth Stories” is intended for information and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcast are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on “High Risk Birth Stories” have given their permission for us to share their personal health information.