Story #83 - Joannie, Neufchâtel QC (CANADA) - Twins, COVID Pregnancy, Birth & Postpartum, Cesarean Section, Perinatal Mood Disorders, Psychiatry & Mental Health Care
I did things a little differently for this interview by transcribing—with Joannie's permission—the conversations that led to our interview, and those after. In between, some thoughts on pregnancy, birth, and postpartum in the time of COVID-19.
And for those in the thick of it, please know that you are not alone. We hope this story resonates with you and brings you some peace.
And if it doesn’t, do not feel ashamed to ask for help. You are worth it.
Joannie wrote to me on April 17, 2020.
Her message began like this:
Hi, Ms. Audet,
I gave birth to identical twins on January 4, two days before I turned 30. I consider myself lucky to have been able to welcome them before COVID. But now, one month into the lockdown, I'm at the end of my rope. I cannot get any real help. I have nightmares.
Yesterday, I screamed at my daughter because she was crying. I feel like a terrible mother, and the pandemic exacerbates the depressive, impatient and frustrated sides of my personality. I hate to experience the first year of their lives in this situation. I hate they'll never know the world "before" COVID.
Maybe my story is insignificant, but I'd like to share it. I can't be the only one going through this.
And she isn't. Becoming a mother during a pandemic is hard, challenging, and utterly uncomfortable. We're not sure what's "normal" postpartum, "abnormal" postpartum, or "COVID" postpartum.
Joannie and I kept writing to each other. I reassured her that no story is ever insignificant. Almost every person who participated to Faces of Postpartum told me, at some point or another, that they weren't sure their experience was "interesting enough." It is. It always it.
On April 25, Joannie and I did the interview via Zoom. Here's the (edited) transcript of our conversation:
I've always been scared to become a mom.
It took me a while to even consider getting pregnant. I didn't want my children to be "my project," so I waited as long as possible.
Earlier on the day of my ultrasound, my sister—who was also pregnant—called me crying: she was expecting twins. She already had a son and wanted only two kids. I reassured her and told her she'd be fine, and that I'd call her when mine would be done.
That night, I did call her back, laughing hysterically: as it turned out, I was also expecting twins.
What were the odds, I don't know. I was shocked, and I couldn't stop laughing.
But they're here now. And I'm not laughing anymore.
This experience has been a series of griefs.
I wanted to have a midwife and a natural birth, but since twin pregnancies are considered high risk, I landed in the hospital with an OB.
Overall, the pregnancy went ok, at least for my: I threw up for the first couple of months, and my belly got big very quickly, so it was hard to hide it.
My girls shared one placenta for two sacks, and I was monitored for TTTS*, which means that I was always at the hospital getting ultrasounds. I'm lucky all this happened right before COVID hit.
I started having contractions in December, at 34 weeks. I was hospitalized for one week as they tried to stop my labor. They gave me a bunch of medication and suffered their side-effects (pulmonary edema, waves of nausea, etc.)
I was eventually allowed to go home, and I spent Christmas waiting to give birth.
On January 4, I was induced. Even if you want to give birth vaginally, you have to labor in the OR "just in case" you need an emergency c-section. You have to give birth on your back, legs up and feet in the stirrups.
I didn't want the epidural at first, but the nurse made me do it. She said it'd be better. I don't know why I didn't want it. Maybe I wanted to be tough.
Because the labor isn't happening spontaneously, the pain of the contractions goes from 0 to 10 real fast. I couldn't handle it, so in the end, I was glad I got it. As soon as they broke my water, everything happened quickly: they were both here within a couple of hours. One was born at 4:10, and the other, 4:12.
I remember the OR was incredibly cold. They installed me on my back, foot in the stirrups as they had planned. Then they took them as I pushed them out. There were eight nurses in this tiny room, plus the doctors. It felt really cramped.
I remember someone told me, "You were made to give birth!" but it didn't feel like that. It wasn't at all magical.
Ariane, my first, was taken away because she was in respiratory distress. Eva was put on my chest.
Afterward, it's kind of a blur.
I believe they took Eva and left me alone in the room. Alone alone. I began vomiting constantly and didn't stop for two more hours. I threw up on the floor and again when they transferred me to my room. They gave me medicine, and I don't recall the rest of the evening. I have flashbacks that I had a baby on me, and I wondered where the other one went, then I would move my head on the side to vomit. I couldn't see Ariane because I couldn't stand. No one explained to me what was happening, and I was incredibly confused. The first 24 hours were really stressful and felt like a whole week had passed. I already had a baby to cared for, so even if I was thinking about the other one, my brain couldn't handle both demands.
We stayed for five days at the hospital because they lost too much weight. I tried to breastfeed them, but it didn't work. They'd fall asleep on the breast and couldn't drink enough. That was another grief. We had to give them formula.
And then—I don't know why—they gave me another room where the babies weren't allowed. They spent the afternoon and evening in the nursery, with twenty other babies. The nurses were overwhelmed, so I would find myself in the nursery corner, before a huge bay window, trying to breastfeed them. I had a massive panic attack because I just wanted to take them with me, but they wouldn't let me. They told me to go home and rest while they formula-fed them and come back the next morning to see if they'd gain enough weight to go back home. So that's what I did.
That was the best night we've had ever since.
We now have two babies home, and I don't want to think about it.
We're only surviving.
I'd like to change my story, but I can't.
My mom stayed for four days with us. It was nice, but she lives five hours away so she couldn't stay longer. I guess things are going well, but we have two babies who have to eat every three hours. I'm not able to breastfeed, so I pump six times a day.
Finally, last month, I pumped enough to get some in stock. But I think I'm going to stop now. I don't want to do it anymore. The doctors and nurses kept telling me not to breastfeed, but I'm stubborn. Yet, I feel incredibly guilty. Honestly, it's my fault; I want to give them the best of the best. Right?
When I learned I was expecting twins, I joined many parents groups of multiple children and educated myself on what I would need. Everybody told me, "Don't hesitate to ask for help!"
But nowadays, I can't ask for help. There's none, and no one can come. I can't visit my sister, who had her twins one month after me. My parents live far away, and we've been stuck at home for four and a half months.
It's not going well.
This week, I self-diagnosed with depression. I'm always angry. It's not like me. I often see myself killing my children and throwing them onto the wall.
When that happens, I leave the room for 10 minutes.
Real Life FTW (Family Photo)
My partner is the one who found me a psychotherapist. It was simple. You know, you just have to open google and type, "psychotherapist + postpartum + depression." But even that, I couldn't do.
We don't have a primary care doctor—like most of the population in Quebec—so I couldn't call someone immediately. I'm lucky my partner is there for me. I don't know what I'd do if I were by myself.
I never said that to anyone else.
I'm not there yet.
I've been battling with depression since I'm a teen. I never saw anyone or went on medication. I think that if I say that to my friends and family, it'll only worry them, so I don't. Especially now, because they can't come and help. It'll make them feel bad.
We live in a two-bedroom condo with two babies. We don't have a backyard, and we currently can't take walks farther away than our little park because of the lockdown. We're trying to stay afar from people, but we all know that families with young children can't follow these rules.
I'm angry. So angry. I feel the pressure building. The rage. The violence within me. I feel so guilty, too. Always feeling I'm neglecting one of them.
The first week by myself was horrible. I would find myself in the bedroom with one to feed and the other one who howls from hunger. I tried all the techniques, but it didn't work.
I like to think that the worse is behind us. But my mood keeps deteriorating. It's not acceptable. I think, "life sent me twins, so I should be able to care for them by myself. I'm a big girl."
Sure, I could ask for help, but I should also be able to do it all: sterilize the bottles, pick up the dishes, do the laundry.
I can't stop. I can't stop before everything is done. But right now, it's never over—a neverending story of domestic chores.
When COVID happened, three months after they were born, my panic attacks came back. I'm trying to use breathing exercises to calm myself. But it's not working anymore. I never know when I'll be triggered by something that will send me spiraling down.
When I was depressed by myself, it didn't affect me the same way. But now, my mood has an impact on others. I'm scared to fuck my children up for the rest of their lives. I'm afraid they'll think, "My mom was a bad mom."
Their basic needs are covered: shelter, food, some level of care. And I think they're doing ok. They're sleeping.
But even with all the will in the world, I can't do everything I should for them on my own.
I just can't.
(Family Photo)
After our talk, I reached out to Joannie again.
During our interview, I had suggested—off the records—that she spoke to a professional and I wanted to make sure she was well taken care of.
From personal and professional experience, I knew that what she was going through could send a new mom spiraling down very quickly.
She wrote back:
Yes, I spoke with a psychologist yesterday. It went well, considering I cried for the whole hour. I thought it'd magically fix everything, but I had another rage episode this morning. The road to recovery will be longer than I'd hoped.
I knew that feeling too well. I invited her to "break the lockdown rules" and ask for more help to support her on a day-to-day basis. Not to say "fuck COVID" but to state that there is a risk vs. benefit in all things postpartum, and that her particular situation demanded particular measures (namely 4 to 5 hours of consecutive sleep and possibly a psychiatrist.)
We emailed back and forth for a week or two. Joannie mentioned more than once how hard it was to have access to mental health resources.
She said, "I'm googling and reading all these lists, and it's so discouraging."
Luckily, her daughters' pediatrician asked how she was doing during their four-months appointment:
I admitted to her that my therapist had diagnosed me with postpartum depression. It felt like an admission of guilt. It was horrible. But she quickly asked me for more info and will look into finding someone from her practice to see me. It's new, this feeling of being cared for by a practitioner. Even though I'm not sure it'll lead to anything tangible (I'm pessimistic nowadays.)
I was glad to read about her daughters' pediatrician, as they are the ones who see new parents most regularly. Until OBs extend postpartum checkups beyond the current and ridiculous 6-week appointment (fingers crossed,) pediatricians are our best chance to offer suffering parents and mothers the help they deserve.
I was cautiously optimistic that things would fall into place for Joannie.
Not because I didn't have faith in her ability to recover, but because I knew too well that guilt + loneliness + intrusive thoughts can be a dangerous cocktail.
And dangerous it became.
On May 17, one month after our initial contact, she wrote again:
Hi Ariane,
Thanks for your kind words.
I am writing to you from the Psychiatric Institute of Quebec, where I have been admitted as an in-patient for one week.
Two days ago, I planned to commit suicide.
Her partner caught her in time and brought her to the ER.
As she said, "it's unfortunate that I had to get that far before getting appropriate help."
After these initials lines, everything she wrote was like going through my own experience in the psych ward: the jail-like feeling, the restlessness, and anger. But in her case, she also couldn't have visitors because of COVID and was deprived of her daughter's presence.
"I'm hurt," she wrote. "I started an antidepressant yesterday. I can't wait to see if it'll help. I guess—I hope—it will."
I found the number of the hospital and called. After four or five transfers, I was able to talk to her.
We chatted for twenty minutes or so, and then the line cut off, disconnecting us mid-sentence.
My therapist repeated these following words to me when I was ill:
"You are standing on the shoulders of all the mothers who came before you, and those who will come after."
This has become my favorite mantra.
Mothers and parents struggling with ppd and ppa need a safe place to land. The saying "it takes a village" is cliché because it is true.
Partners who tend for their loved ones during these difficult times also need relief. Mike and I are still revisiting this period of our lives in couple therapy, almost four years after the fact. Because if I ended up feeling empowered by the experience, he still has moments of panic when my anxiety takes over: "Will she be okay? Will she relapse? Will I lose my wife?"
Trauma—any kind of trauma—demands to be honored and confronted in order to heal.
Joannie left the hospital a little less than a week after her admittance. She said she was ready to leave, and when they offered her to go back home with her babies and partner, she jumped on the occasion:
I couldn't handle being away from them much longer. It was quite an experience because in only six days, the burgeons had blossomed, and the trees were full of leaves. I remember looking at the sky in front of the Institute and seeing green everywhere.
It's crazy what the right cocktail of medication and social support does for your mental health. I'll keep seeing my psychiatrists weekly, and I'll have help from Les Relevailles. It's an NGO that comes to new parents to help. Because of COVID, they can't come inside, so they'll take the girls for a walk for an hour, one to three times a week.
Next week, I'll meet with a social worker to figure out what can be done to help me long-term. My parents and my sister are also around more. It helps.
I decided to say "fuck you" to the COVID guidelines (pardon my French) and care for myself first instead of trying to save the world. It feels good.
It will sound strange, but I'm happy to have been hospitalized. It's one of the best things that ever happened to me. It's crazy to think that less than two weeks ago, I was ready to die.
It feels like a lifetime ago.
The first few days after her hospitalization, Joannie writes that she thought she was "miraculously cured."
Unfortunately, all of her problems didn't disappear during her stay at the Institute, and one evening, she snapped at her partner:
I was naive to think it would all go away. But that time, I was kinder with myself. I thought, “Uh. Ariane was right. It will get better, then not so much, then better again. Then shit will hit the fan once more, and that too will be alright. There's no shame in not being top shape every single day of my life.
Truly, I'll be okay.”
(Family Photo)
We kept writing to each other, although less than during the month of May.
Because "life" or, as Joannie puts it, “because let's just blame it on our children."
She still had help from Les Relevailles, her psychiatrist, therapist, and her parents. She was getting used to her medication and kept up the good work about "not giving a flying fuck about the COVID guidelines" regarding visiting her family: “There's nothing over there but a lake and the forest (my remedies.) And with three people to care for them, including very eager grandparents, it'll give me a good break.”
A village, they say.
Joannie ended her email with a postscript. To this day, it still makes me cry:
Last Saturday, for the first time since I gave birth to the twins, I felt grateful to have them in my life.
They had just finished eating their cereals and I'd left them in their highchairs to get their bottles ready. When I turned back to them, they both smiled at me.
Huge, joyful smiles.
I broke down (in tears, in gratitude.)
I can say it now: since that day, I am head over heels in love with my daughters.
My first reaction was to say, "Boy, you suck! Why did it take you five months and a half to bond with them?" But then I paused for a second and thought, "Nope! This is happening now, and it's perfect. Thank you, life. Thank you."
With love,
—Joannie.
*Twin-to-twin transfusion syndrome (TTTS) is a rare pregnancy condition affecting identical twins or other multiples. TTTS occurs in pregnancies where twins share one placenta (afterbirth) and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. Sometimes the vessel connections within the placenta are not evenly dispensed and there is an imbalance in the blood exchange between the twins. One twin — the donor twin — gives away more blood than it receives in return and runs the risk of malnourishment and organ failure. The recipient twin receives too much blood and is susceptible to overwork of the heart and other cardiac complications.
Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/twintotwin-transfusion-syndrome-ttts