It was such a relief, after being discharged, that there were still other people around: proper adults who could guarantee the baby’s safety as well as my own. There was Chris, for a start, who had learned how to cup feed and nappy change, and, unlike me, didn’t appear to be afraid of carrying the baby up and down stairs, or over hard surfaces; for a day or two a week, my mother was there too, and she had also given us some money to hire Carrie, a post-natal doula, to help a few hours a week. They all pitched in, and left me free, when I wasn’t holding the baby, to tend to my milk and tear-supplies, and recover from the wound infection which my doctor had diagnosed a couple of days after leaving hospital. In a perverse way, it was quite satisfying to be able to add ‘puerperal fever’ to the list of child-bearing complications I might have died of a hundred years ago.
Ben had encouraged me to challenge my fearful thoughts about the dangers of childbirth – and crossing roads, and travelling, and leaving the house, etc. – by asking myself how often real catastrophes actually happened. ‘Have you heard of anyone dying in childbirth?’ he might have asked. ‘Do you know anyone who’s been hit by a car in broad daylight? Been involved in a plane crash? Died of an undiagnosed ruptured appendix?’ I’d found the technique useful for a while, but now I was faced with the absoluteness of my new son’s helplessness and vulnerability, and my fears for him had their very own, monolithic, unarguable Thusness.
Much as it had during pregnancy, the world seemed to agree with me about the necessity of constant fearfulness. The nurses in the ward had taken care to warn me about not allowing a feed to slip back, because then the next feed would slip back, and the next, and the next, and before you knew it your poor baby would be starving. And don’t forget to sterilize everything you use to feed him. We left the hospital with a sheaf of leaflets about sudden infant death syndrome and the importance of regulating the baby’s temperature at all times. He couldn’t regulate it himself yet; he couldn’t hold his own head up; he couldn’t control his movements or focus his eyes. He could neither perceive nor avoid danger. According to the developmental psychologists, he wouldn’t even be able to distinguish fear from any other state of arousal. According to the psychoanalysts, the processing of baby’s emotions was, for the time being, also my job.
Our household was not like the more traditionally arranged textbook ones; the father did everything he possibly could, and we both did our best: we kept up with the feeds, bought a microwave steam sterilizing unit which always seemed to be on, changed him regularly, put him into bodysuits and took him out of bodysuits and then put him back into them again; we followed the SIDS-prevention guidelines to the letter, keeping him in our room but not in our bed for the first six months, and always putting him down to sleep on his back, with his feet to the foot. When he fell asleep after feeding, half across my lap and half across my big triangular breastfeeding cushion, I remembered all the stories I’d heard about how easy it was to smother a tiny baby, and made sure to adjust everything whenever he stirred, just in case. If his little nose wound up pressed into the cushion for a few seconds, or he flailed about and dragged a muslin over his head for a short moment, or someone stepped over rather than round him when he was lying on his sheepskin, I would screech, ‘I/You/It could’ve KILLED him!’ I probably wasn’t very good at the emotional processing bit.
The first three months in a new mother’s life are sometimes referred to as ‘the fourth trimester’. This is partly a nod to the length of time it takes for a woman’s body to recover from pregnancy and birth, to make the transition, anatomically and hormonally, back to a non-pregnant state. At the same time, it is a way of acknowledging the necessary intensity of her physical relationship with the baby during this period, while he in his turn makes the transition from life inside someone else’s body to life outside. He has a tiny stomach still, and needs frequent, regular small feeds; he panics, and cries, and only those things that remind him of the womb – being held closely, or swaddled, being rocked – can comfort him. He can’t help but make constant demands on his carers, and he makes them outside office hours, and after bedtime, and at all hours thereafter, and his mother is sleep deprived, and very often his father too, and this drives them both mad.
All new mothers go through this. All prospective mothers will have been warned by midwives or relatives or friends that they will, for some or all of the time, be exhausted, and anxious, and feel alone and inadequate and quite, quite overwhelmed. To take the edge off this, there are mother and baby drop-ins, and lunches with other mothers met at antenatal classes, and post-natal coffee mornings. These can be a wonderful source of support, shared tips and advice, commiserations over broken nights and blocked milk ducts, that kind of thing. I was very fortunate to live in an area with an exceptionally good NCT coffee morning group, which was full of charming, interesting and funny people, many of whom had older children and so were able to provide a calmer, post-neonatal perspective on matters. I discovered that, like dogs, babies enable you to meet all those neighbours you’d always wondered about. The local streets, the park, the shop round the corner became abundantly peopled, and friendly with it.
When the company consisted of new mothers only, there was a far edgier atmosphere. I’m sure the sleep deprivation had a lot to do with this; that, and the fact that every new mother is secretly terrified, firstly, that she is doing everything wrong and secondly, that everyone else isn’t. This means that any admission of difference in mothering practice, no matter how tiny, which comes up in conversation, has to be followed by at least five minutes of excuse-making, shrugging, self-deprecation, justification and counter-justification; otherwise, there’s a real risk that at least one party present will feel all judged and criticized and will need to go straight home and spend two hours crying into a rancid muslin.
I couldn’t see inside these other women’s heads; I couldn’t tell you whether I felt more or less judged than any of the rest of them. What I do remember very clearly, and very painfully, is the way I experienced my feeding problems as the social faux pas my friend had described. I seemed to be surrounded by women who could do it like they did in the Norwegian breastfeeding video, any time, anywhere; some of them even complained that they had too much milk, that their breasts leaked all over the place, and that it was so easy and comforting for their babies to feed from them that they despaired of ever getting them to take a bottle – it was a terrible bind, being so indispensable to one’s offspring.
I thought that I would have given anything to have problems like theirs. For the first few weeks, I had hoped that, if only the baby and I could get our ‘positioning’ right and I pumped frantically enough, I could ‘get my supply up’ and we could get rid of the formula and the cups and the nipple guard and the triangular breastfeeding cushion and then I would be shoving my baby up my T-shirt in coffee shops with all the other girls. I was – in the colloquial sense – obsessed: the notebook I kept at the time is full of reports on volume, flow and consistency, made while simultaneously writing and pumping. It didn’t work. At my son’s nine-week check-up, he was pronounced underweight and we were told to increase the supplemental feeds. To help this, and to make life easier for Chris, who was still lumbered with most of the cup feeding, we switched to bottles, which the poor hungry baby took to immediately. My breasts were obviously harder work, and he became more and more reluctant to try to feed from them. Early in the autumn, the baby and I both got nasty colds and that was that: I remember turning him towards my breast and watching in horror as my son’s face passed in the course of a second from smiling through blank and bewildered to distressed and enraged. I phoned the NCT breastfeeding advice line and they could only tell me that, if a baby decided to go on ‘feeding strike’ like this, there was nothing I could do.
I cried for a day or two, then picked up a bottle; the baby smiled at me around the teat. We were friends again, and, as I explained to anyone whether they had asked for an explanation or not, I would always give him the bottle
with my expressed milk in it first, and I planned to keep expressing for another three months – at least. I’m making myself sound paranoid, but actually there were a fair number of people who did seem to want explanations. When I performed my first post-natal poetry reading a few weeks after the feeding strike, and included some poems about my recent pregnancy in the set, a woman came up to me in the interval, announced herself as a midwife and asked me straight off if I was breastfeeding. I told her, there in the theatre lobby, as people queued behind her to get their books signed, that my son had recently refused the breast but that I was still expressing, and approval was bestowed.
The first months of our son’s life were hard for Chris too. Of the two of us, he was almost certainly the more sleep deprived. He has always been a light sleeper, and infants tend to be noisy, so he found it very difficult to share a bedroom with our snuffling son. He didn’t have the benefit of oxytocin, the ‘ahh’ hormone, which helps the new mother to sleep after – and sometimes during – night feeds, whereas for several months I was capable of nodding off in the middle of a sentence. And when I was asleep, which, to him, I seemed to be for an indecent amount of time, I was, apparently, snoring like a buffalo. And while I was asleep and snoring, he would be up, with the boy on his lap, giving him his supplementary feed and trying to soothe him back to sleep. As nobody had told either of us that small babies can sleep with one eye open, he would sometimes be up for hours. And then in the morning, before he could get away to work, he would have to help me and the boy out of bed and settle us into the living room, because I was too nervous to carry our son downstairs. It was no wonder that sometimes, when I threw him a drowsy glance from my pillow at night, his face was scribbled all over with exhaustion, resentment and despair.
I could see that he was suffering; I could see that he thought I was being selfish and lazy and that he couldn’t understand why. I didn’t understand why either, and couldn’t explain to him how everything – feeding, changing, making decisions, leaving the house, talking to people – emotionally and physically, felt every day nearer and nearer to impossible. It happened at a creeping pace, this paralysis, and I was barely aware of it myself: it was just part of the general, post-natal misery of life, along with the complete absence of libido (because of lactation), continual thirst (also down to the lactation, presumably), constant migraines (stress, anxiety and sleep deprivation), insidious weight gain (because of sitting around too much? Not taking the baby out on enough walks? Eating as if I were breastfeeding properly when really I wasn’t?) and muscle aches (also my fault for not exercising perhaps?) I could see Chris was suffering, but I didn’t seem to have it in me to relieve his suffering, or even comfort him; I didn’t even have it in me to take care of myself. We were a pair of lost causes, and, by some tacit agreement, we were concentrating our last remaining resources on the baby.
Late in October, I visited my doctor to get a repeat prescription for citalopram, and to discuss my possible familial breast cancer risk. She took my concerns seriously, and arranged for a preliminary screening interview for me. Then she asked, ‘Do you mind if I take a look at your neck?’ She palpated it, and was able to confirm her suspicion that what she had seen from halfway across the room was indeed a goitre, an enlarged thyroid. I’d have an imbalance one way or another, she said, and took a couple of phials of blood then and there. I think I burst out laughing: I’d spent half my life so far wondering if and when I’d get cancer like my mother, or Crohn’s like my great-aunt, or coeliac’s like my uncle, fearing that I’d caught AIDS, quaking in my flat-soled shoes every time I had a slightly numb finger in case I was developing multiple sclerosis, and in all that time, in all my anxious cross-questioning about who had had what, I’d somehow failed to identify my father’s family’s weakest point. My grandmother had undergone a thyroidectomy; my cousin had developed hyperthyroidism; following my father’s death, my brother had suffered from stress-induced thyroiditis for over a year. And now it was my turn.
The thyroid is part of the endocrine, or hormone-secreting system: a butterfly-shaped gland that sits low down in the neck, just in front of the windpipe. Its function is to produce two hormones: thyroxine, known as T4, which has four iodine atoms, and triiodothyronine, or T3, which has three. Although they are two different substances, they are usually referred to together as ‘thyroid hormone’. The thyroid secretes the hormone into the bloodstream, which distributes it around the body. As the Thyroid Sourcebook I bought that month puts it, ‘It is one of the basic regulators of the function of every cell and every tissue within the body, and a steady supply is crucial for good health.’39 Broadly speaking, if the thyroid overproduces, and you have hyperthyroidism, everything speeds up; conversely, if the thyroid underproduces, then the patient is hypothyroid, and everything – pulse, digestion, metabolism, reflexes, all of it – will have slowed down. Symptoms of hypothyroidism include, among others, fatigue and lethargy, a constant thirst, creeping weight gain, depression and anxiety, poor concentration and memory, and muscle cramps. In women, it leads to heavy menstrual periods, and is often first suspected because of this. As I had not yet had my first post-natal period, and was already diagnosed as suffering from depression and anxiety, my hypothyroidism was easily masked.
To diagnose hyper- or hypothyroidism, you take a blood sample from the patient and then measure the level of ‘free’ T4 present in that blood, along with the level of the thyroid-stimulating hormone (TSH), which the pituitary gland secretes in order to prompt the thyroid to produce its goods in whatever quantities the body may require. In a hypothyroid patient, therefore, you would expect TSH levels to be elevated. If you have a T4 level of between 11.5 and 22.7 and a TSH level between 0.4 and 4, then your thyroid would appear to be functioning normally. When the doctor phoned me with my results she explained this to me, and then told me that my T4 was 3, while my TSH had come in at over 100. It seemed probable that my thyroid had started to underperform about halfway through the pregnancy, and had been deteriorating ever since. She put me straight on to a ‘starter dose’ of 50 mcgs of synthetic thyroxine per day, and referred me to the local endocrinology clinic. I referred myself to the Internet and the nearest branch of Borders.
Among the new pieces of knowledge I acquired was the fact that it is not uncommon for women to experience transient hypothyroidism post-natally (and that this is often misdiagnosed as post-natal depression). At first, I was hopeful that this might be the case with me, but my doctor told me that with my test results, and family history, it looked quite certain that my hypothyroidism would be permanent. I would depend on medication for the rest of my life. ‘Goodbye, whole body, whole life,’ I wrote, ‘such as you ever were. From now on, my body will have to import one of its most essential regulatory hormones from a pharmaceutical manufacturer.’ On the positive side, I added, the diagnosis explained all the disquieting changes I’d been noticing in my body and in myself:
the fatigue
the depression / ‘low mood’
the intolerance of cold
the parched throat
the onset of creeping weight gain
the anxiety
the dry skin
the irritability
the muscle aches
the loss of leg hair
the constipation
the daily migraines
the short-term memory problems
the ‘brain fog’ / difficulty in concentrating.
As the health visitor put it, I have indeed been ‘wading through treacle’. I just hope that medication alone shrinks the goitre. What with that & the weight – and OK I know it probably seems a lot only to me, I feel like I don’t know my own image any more, my own body, its processes, its boundaries. How do I manage such a body? feed it? dress it? regard it? I’m dressing down, avoiding mirrors.
In another entry I said that I had gone, in a matter of days, ‘from young, slim and healthy to old, fat and medicated’. This, as I was discovering, was not that rare an expe
rience post-partum. The usual cause of permanent hypothyroidism is Hashimoto’s disease, which is an autoimmune condition: the body’s own defence systems mistakenly identify its thyroid tissue as alien, attack and then destroy it. Like autoimmune conditions in general, it is more common in women than in men, and is not uncommonly triggered by pregnancy. In the weeks after my diagnosis, I learned that at least two women I already knew had developed the condition post-partum. Meanwhile, my best friend, who had given birth to her second child in August, had suffered two strokes and been diagnosed with an autoimmune blood-clotting disorder. I had also recently come across a woman who had given birth to her first son in May, and been admitted to hospital three months later, unable to move, suffering from what turned out to be a rare form of rheumatoid arthritis.
In answer to the question: Who is vulnerable to auto-immune disorders? my Thyroid Sourcebook replies:
Women who are either pregnant or have just given birth are particularly vulnerable to autoimmune disorders. During the first trimester, and in the first six months after delivery, the risk of an autoimmune disease is at an all-time high in a woman’s life. During the first three months of pregnancy, the body is naturally more fatigued because it is busy providing nutrients (including iodine) for the growing fetus and adapting itself to the pregnancy in general. In fact, pregnant women are naturally iodine-deficient for this reason. Pregnant women are also immune-suppressed to avoid rejecting the fetal tissue. The immune system may then ‘rebound’ to an aggressive state, causing an autoimmune thyroid disease. [pp. 47–8]
Woman Who Thought too Much, The Page 26