PMADs and the ER: When Should You Go to the ER?

Part 1 of 4 in a series of posts by nurse and counselor Amber Thiessen.

Introduction

Hi, my name is Amber. I’m a wife, mother of 3, a nurse and counselor. I’ve served in church planting ministry overseas and as a pastor’s wife here in Canada. Currently, I’m active in my local church, and one way I serve is through teaching a women’s Bible study.

I want you to know, I’ve been through some really difficult times. You’re not alone in feeling frustrated, sad, and confused about what you’re experiencing. You never thought your emotions would be so out of control, and though you keep telling yourself you “shouldn’t” be feeling like this, trying to pick yourself up by your bootstraps, things don’t change.

Kyleigh invited me to participate in this conversation with you, to provide information about what you may expect through emergency services when you’re in crisis and to help equip you through this challenging time.

I work out of an emergency department in Canada, so I’m writing from that context. You will need to check around to understand what resources are available to you in your community and hopefully also through your local church.

My prayer for you is that though you walk through this very dark valley, you will fear no evil for God Almighty, the Good Shepherd, is with you. May you take comfort in the assurance of God’s presence and promises.

1 For the mom who has never struggled with her mental health

You may have never struggled with anxiety or depression before. You’ve known family or friends who have, but it was always someone else, not you.

Anticipating the joy of a growing family, you never thought it could change things. Of course your life, routines, and priorities would shift, but not how you felt. Then, the events of pregnancy, labor, delivery, and postpartum recovery transpire and things didn’t go as planned. You may have experienced complications, disruption in what you wanted, or more discomfort than you expected, and as you move into this season with a new baby, your body and emotions are a tangled web of yarn you can’t unravel.

You’ve heard about the baby blues, so maybe your mood is normal. Getting out of bed is difficult, you feel angry, irritable, and withdrawn from others. You don’t feel like doing a lot. You may notice anxiety when your husband goes to work or when your mom who came to stay with you for a while leaves. It’s not just a fear anymore but a physiological reaction: your heart races, your breath is short, your hands tremble, and your whole body sweats. You don’t understand what’s happening to you. You might be crying often due to a deep sadness, but your head says that doesn’t make sense.

You may start to feel hopeless, think you’re a terrible mom, feel guilty for any number of reasons: you can’t breastfeed, you don’t feel happy, you don’t have the latest best gadget for your baby. As you drift down into these thoughts, other thoughts may start to creep in, that maybe they’d be better off without you.

You’re shocked that these thoughts are in your head. Your faith has been strong and you’d never want to leave your family, but still they float in your mind like the rubber ducky in your child’s bathtub.

If this is you, talk to someone.

Start with your husband. He likely already notices you are different, sad, and withdrawn, and though he loves you, he probably doesn’t know what to do. You can figure it out together.

Next, talk to your spiritual mentors. This may be your parents, your pastor, or another ministry leader. They can provide encouragement through scripture and prayer, reassurance of their love and care, and hopefully can offer some good strategies as you begin working through this.

Also, make an appointment with your family doctor. If you can’t do this in the near future and you’re feeling unsafe at home—such as having increased thoughts about death, dying, or suicide—go to the ER.

2 For the mom who’s been here before

I live in Canada, and here postpartum depression also has increased risk over the winter months when moms don’t get out as much (sidewalks are covered in ice, cold weather deters from being outdoors, bundling in layers adds a lot of work), and receive less sunshine and vitamin D.

Paying attention to what’s going on in the world around us, our environment and our stressors are important to help us pay attention to our vulnerabilities. When our social newsfeeds are bombarding us, the news blows up with another global event, we may find it has a greater impact on us than we think.

So, when you’ve walked this path before, you may or may not have expected to land here again. Your frustration is greater because you remember the journey and how difficult it was the last time.

“Be strong and courageous. Do not fear or be in dread of them, for it is the Lord your God who goes with you. He will not leave you or forsake you” (Deut. 31:6 ESV). You probably feel anything less than strong right now, but take heart, because God is with you. Remember, the Lord was faithful to help you through and he will continue to be so today.

As you see the signs of anxiety and depression settle in, consider what helped you through the last season. What resources did you put in place? Think about the routines, skills, and people you had alongside you. What supports do you already have around you that you may need to pull in and reach out to.

If you’re exhausted and fatigued it may be hard to get there, and that’s okay. Start with the steps above by talking to others about what you’re experiencing.

You’re coming to the ER in a crisis. This is a moment where your anxiety is worse than ever before, maybe you have a panic attack that isn’t going away, and/or you’re having thoughts of suicide and your usual strategies aren’t working to keep them at bay. You’re not functioning normally, you can’t take care of the baby, things are getting worse instead of saying stable.

When to come to the ER:

1 If you’ve called a crisis line and they tell you to

It’s a great plan to call a crisis line when you’re not sure what to do. They are trained professionals who can help guide you to help relieve the distress of the moment, to talk with you and provide some ideas for distraction and skills to use. But they also know when things aren’t working and you may need more care than they can provide over the phone, and will direct you to the ER.

2 If you don’t have a safe place

Part of creating a safety plan, whether with your counselor or on the phone with a crisis line, will involve the people around you in your life. If you’re struggling with thoughts about suicide and you don’t have any  family or close friends nearby at that moment, you need a safe place for yourself and your child.

3 If an appointment with your counselor or doctor isn’t possible in the next week

Your husband may be home with you over the weekend, maybe your mom or sister comes to stay with you and they’re encouraging you to seek help, and it’s not a sure thing to get in with your family doctor or counselor. If this is a new concern for you and there’s a level of urgency to start getting treatment as soon as possible, the ER is the best way to do that.

4 If your loved ones are worried about you and tell you it’s time to get more help

When we’re in the thick of it, we may not be able to see outside of the tunnel vision of our emotions. If others are encouraging you to seek treatment, it’s probably time, and likely past time. Waiting in the ER can take a long time, but if there’s no other option it is the best one.