Sitting in the exam room at my local maternal-fetal medicine clinic and repeatedly clicking the top of the drug rep pen in my shaky hand, I stared at the Edinburgh Postnatal Depression Scale resting on the ink-streaked clipboard in my lap.
"I have been anxious or worried for no good reason."
I stilled my hand against the page and let the kinetic fear travel to my swollen foot, tapping a staccato beat. My maternity pants were pulled high to keep the waistband above the still-fresh incision, simultaneously painful and numb, and away from the lone piece of dissolving stitch peeking out from one corner.
I pictured my son, curled under blue lights in the intensive care nursery on the fifth floor of the nearby hospital. Panic rose to fill the exhausted space behind my eyes. Did he count as a "good reason?"
"I have felt scared or panicky for no very good reason."
A month earlier, I sat on the toilet, taking in the quiet after celebrating my daughter's fifth birthday. As my gaze fell across the purple underwear at my knees, I saw a pool of bright red blood. Feeling a gush of something gelatinous, I stood, blinking slowly at the crimson water.
Over the next few days, the partial placental abruption gave way to severe preeclampsia, and I spent the greening of spring between the suffocating walls of a hospital-turned-prison. The earth was coming to life as I was closely monitored to keep the baby and myself from dying. My medical record stated, "if headache persists, proceed with delivery," multiple times until my son's birth at 31 weeks. The fear was three-dimensional, having lost a friend to complications of eclampsia two months prior.
Were memories of the doctors' and nurses' urgently grim faces as they rushed to place an IV into my arm to prevent the same fate a "very good reason?"
Now free of the hospital alarms and intermittent blood pressure cuff, I experienced a sort of hospital Stockholm Syndrome. Though I had felt trapped during my inpatient weeks, I found myself panicking without the constant vigilance of the monitors. Each night, I used the rail of my daughter's top bunk to lower myself slowly onto the bottom mattress and shook with the knowledge that I was going to die during the night. I knew that each night was, without question, my last. Every night, I said a mental goodbye to my loved ones.
As soon as I drifted off to sleep, the fear for my children would come to life. Nightmares of my daughter drowning as I watched helplessly, haunted dreams of losing my son. During the day, between visits to hold three pounds of baby to my chest, I would take micro naps, only to be assaulted by those dreams before I was even really asleep.
Was I so "unhappy" that I was having difficulty sleeping? Or was I traumatized?
With a sharp knock, the doctor came into the room, introduced himself, and held out a hand for the paper in my lap. Those tiny checkboxes contained all my fear, exhaustion, and pain. That's the purpose of the postnatal depression screeners—to help healthcare providers understand who is suffering and how deeply.
"I mean, I feel like I have pretty good reasons," I joked, sarcastically.
With what he likely meant as a reassuring shrug, he said, "Yeah, we expect preemie moms to fail these," before immediately moving on to tell me about the plan for any future pregnancies. I cackled and furrowed my brow. This uterus had closed for business. Just the idea of going through this again was enough to bring up vague nausea.
"I have to talk to you about this," he said, as he continued about baby aspirin and relegated the depression screening to be a data point in my file.
At that moment, I felt invisible and hidden behind my reproductive potential. The theoretical possibility of a future, unplanned pregnancy supplanted the current reality that I was falling apart at the seams. In the world of maternal medicine, I was no longer Rhiannon; I was just "high risk."
So, what did I expect from the doctor? His statement was accurate, after all. Mothers of preterm babies are 40 percent more likely to suffer from postpartum depression. Moms with babies in the NICU frequently describe feelings of guilt and feelings of helplessness as the nurses and doctors take control of the baby's care.
However, being commonplace does not negate the gravity of a situation. I wanted to be seen as an individual human with complex emotions beyond the medical labels. I craved acknowledgment that my suffering was valid. In reducing me to the moniker of "preemie mom," he minimized rather than recognized my pain.
It is easy for us "preemie moms" to feel like we have disappeared behind the needs of our baby. In fact, much of the journal articles about depression in mothers of premature babies focus on the mother-baby dyad and rarely the mother as an individual. So it is no wonder we feel as though we are not allowed to shout our pain. People ask how we are doing, and we quickly calculate the risk and benefit of telling the truth vs. the half-truth of, "Oh, I'm tired but OK."
I was lucky to have a therapist already. But what about the new, terrified mothers for whom these postpartum visits were the only safety net? After informally surveying a large online group of mothers, it is clear this was not an isolated flaw of one doctor at one moment. Several said their health care providers dismissed their high scores as being just one part of the experience of having a preterm or sick child.
I urge providers to remember that it is possible to normalize experiences without also devaluing or discounting what a patient went through. While the stress of "preemie moms" as a group may be unexceptional to you, we are individual people who need someone to see us and acknowledge our pain.