Amanda Hollis Garaffo
“I did survive, but it wasn't the result of any resilience or fight in me personally. It was a naturally occurring biological crisis that could hit anyone, and I was so amazingly fortunate to have seen the other side of it and had the resources that I did. But there's so much more we can do to build resources and help others survive it.”
Amanda is the mother of two young children and lives in the Greater Boston area. Through her own lived experience and that of family members, Amanda has seen firsthand the effects of hormones on mental health. She has become passionate about better understanding and raising awareness on the topic. She desires to help advocate and community-build to improve resources and support for those facing mental health challenges during reproductive transitions, be it premenstrual, perinatal, perimenopausal or beyond. Amanda is a lawyer and advocate by training. She obtained her undergraduate degree from Hamilton College and a Juris Doctor and Masters in International Affairs from American University in Washington DC.
This blog is made possible by a sponsorship from Sage Therapeutics. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc.
August 2023 | Interviewed and edited by Jessie Colbert, Executive Director, Mass. PPD Fund
Amanda Hollis Garaffo reached out to the Mass. PPD Fund this spring to share her story of surviving perinatal mental health challenges after the birth of her first child six years ago. She has since become an active member of the Massachusetts Mind the Gap Coalition working to pass the Moms Matter Act — legislation that would expand and diversify the perinatal mental health workforce and invest in community programs supporting new parents. This July, she testified in favor of the bill in front of the state’s Committee on Mental Health, Substance Use and Recovery, emphasizing the confusion, shame, and isolation she felt around her mental health challenges, and the need to increase resources for families.
In our interview, Amanda shares how her painful anxiety symptoms – panic, paralysis – were harder to identify than the better-known postpartum depression. She also shares how breastfeeding and sleep challenges contributed her declining mental health, the urgent medical condition that was a wakeup call to get more help, and the winding road to treatment that finally allowed her to turn the corner and find her footing as a new mom.
Did you have expectations about bringing home a new baby? What were your hopes and fears?
I always knew I wanted a family, ever since I was little. My husband and I both prioritized our careers for a long time before trying to have kids in our 30s. We discovered it was a lot harder to get pregnant than we'd been taught. We went through an emotional roller coaster trying to conceive, and also we had the grief of miscarriage.
When I was pregnant with my first baby, we were just beyond excited and joyful. But I think my expectations of having a newborn were kind of a black box. I didn't have a lot of real-life experience with friends’ or families’ babies. We tried really hard to be prepared. We did a bunch of classes – baby care classes, birth classes. We talked a ton to our friends and family who had kids about what they had found helpful for information, supports, baby gear, all of that, and then we researched ourselves. We did a lot of info gathering, and there was a lot of info out there! I think it felt hard to fully digest it all because there was just so much.
I also just kind of assumed I'd be able to breastfeed, even though I knew from friends and family that it was really challenging. I didn't prioritize taking a breastfeeding class or finding a lactation consultant. It’s similar with postpartum mood disorders. I remember postpartum depression being on one of the PowerPoint slides during one of the classes we took, but my takeaway was to keep an eye out for depression beyond the baby blues. We didn’t prioritize learning more about it.
Oftentimes when a baby is born, parents have plenty of support for the baby, but not a lot of support for themselves. Did you feel like you had people looking out for you?
Yes and no. We had moved into a new neighborhood a few months before the birth. We didn't know a lot of people. We didn't have family or many close friends nearby, so we anticipated needing to hire postpartum supports for when my spouse went back to work. He had planned two weeks’ vacation for after the birth – his work didn’t offer paternity leave. We interviewed and hired a postpartum doula, as well as a night nurse. I feel so fortunate to have had funds to even contemplate that. And my in-laws were going to come into town to help support us right after the birth.
I guess the “no” comes into play because those were our plans, but I think the reality was that I felt pretty alone despite all those supports that we'd set up. My postpartum doula was in many ways my lifeline — I am so thankful for her. Yet I don’t recall her really openly and meaningfully discussing my symptoms or identifying my disorder.
Tell me about your journey with mental health challenges around your new baby. When did your symptoms start and how did they play out?
My symptoms started almost immediately after the birth. But it took us about four months – four pretty hard months – to figure out what was wrong and to break through to feeling better.
We had trouble breastfeeding from the outset. The lactation consultants at the hospital tried really hard to help us, but we were sent home still not feeding successfully, not really having a plan. In a pretty fateful turn of events, our next-door neighbor was a lactation consultant and came over to help, which was so incredibly kind of her. She confirmed that even though I thought I was nursing and feeding the baby, he actually wasn't taking in any milk. I recall this realization was deeply unsettling. How could I not know that my baby wasn’t getting fed?! He had a lip tie, and a tongue tie, and torticollis -- conditions that were making it really difficult to nurse. At five days old, we had a procedure to release his lip and tongue. Then I began a feeding cycle called triple feeding: trying to nurse him, then bottle-feeding, then pumping. By the time I was done with that cycle, an hour and a half or more would have passed, and the baby would be hungry again. I felt like I was stuck in the nursery chair, just trying to perform the most basic of functions to keep my kid alive. And failing at it.
When my spouse went back to work at two weeks, I was terrified. My in-laws had gone home, my postpartum doula was there a few times per week, but otherwise I was alone. And I felt like my feeding efforts left me little bandwidth for doing, or contemplating, anything else. I'd never changed the baby's diaper on my own. I felt like I couldn't put the baby in the car seat or leave the house by myself for doctor's appointments or otherwise. I had no clue how I was going to keep the baby and myself alive.
I wish we'd had more awareness of the various ways that perinatal mood disorders can present, because we thought it was really limited to depression, and my symptoms were so different than that. For me, postpartum anxiety was like panic, pure terror. I was like a deer in headlights, frozen, just incapable of doing basic, executive daily functions. I had postpartum rage, which honestly I only recently learned was an actual thing. I exploded. I yelled at my spouse over tiny, trivial issues, like he used the wrong detergent on the baby's clothes. It didn't feel like me. And it felt awful for him, it felt awful for me. And then I had postpartum insomnia. That was like, lying awake after night feedings, exhausted but not able to sleep for hours, panicking about how I would be able to function the next day, alone and on no sleep.
Also, this was our first child, so everything felt new and we struggled to distinguish what were common postpartum challenges versus uncommon ones that could signal a disorder, like rage. And I think honestly, we felt a lot of shame. We saw images and stories from friends and family and Instagram that the postpartum period should be joyful and beautiful and natural. We were struggling, and we saw that as a failure on our part as parents, rather than indicators of mental health challenges. I thought my behavior meant I was just an awful, angry mother. That maybe I wasn't cut out or meant to be one.
How did you realize that you were experiencing Perinatal Mental Health challenges and needed help?
Looking back, it’s so hard to remember exactly how it played out versus how it felt. Those months felt really hazy to me – one big blur of time during which I recall feeling just so viscerally alone.
I think that at about five weeks, I contacted a specialized therapist who focused on perinatal mental health. Honestly, I don’t remember reaching out to her at that point, nor why. But I do remember it was critical that she made house visits because my anxiety kept me from being able to leave the house. Our visit was about six weeks postpartum, in between Thanksgiving and Christmas. I remember her sitting in my living room on my coffee table and the contrast between her dressed in a suit, and me sitting across from her on the couch, wearing sweatpants and a flannel button-up shirt. She diagnosed me with general anxiety and postpartum depression, she validated my need to care for myself. She couldn’t prescribe me medication, but had names of local psychiatric prescribers who could. I think she also flagged for me that my OB/GYN could prescribe. I recall I felt more seen and less alone. She felt like a really important touchpoint for me.
But I continued to struggle so much. Around that same time, I believe my OB asked about my mental health during a routine visit. I recall sharing that I was struggling and had met with a therapist, but I don't think I shared the whole picture. I recall her essentially responding, something like, A little anxiety is normal, psychosis is not, and asking if I wanted medication. I think I requested a super low dose of Zoloft. I was nervous to start medication without more specialized mental health supports, concerned about the meds transferring to the baby via breastmilk and the possibility of side effects. I don’t believe my OB followed up on my mental health or the medication—and I don’t think I was surprised because she wasn’t a psychiatric prescriber. I absolutely would not fault her, as I similarly would not fault my lactation consultant, or my postpartum doula. I don’t think they had sufficient awareness about what to look for, or sufficient supports to get me the help I needed.
I remember I still wasn’t sleeping, and I got a stomach ulcer at around three months. That kind of stopped me in my tracks. It took a physical manifestation of my suffering mental health to be like, Something is still very wrong. You need to address this. I had to heal in order to recover, in order to eat, in order to take care of my baby.
After the ulcer, I remember following up with the specialized therapist to get the name of the local psychiatric prescriber. The psychiatrist required in-office visits and was a twenty-minute drive away — I suspect big reasons why it took me so long, and a stomach ulcer, to finally see them. When I finally started appropriate medication, my panic and paralysis dissipated. And that's when I started to move again. I remember being like, Oh, ok, now I can create my authentic identity as a mom. I think, at first, I associated my diagnosis as the result of my just having a really hard time and struggling with the postpartum experience and circumstances. I’m sure those circumstances contributed to my mental state, but I don’t think I fully understood the extent to which hormones were a chemical cause for my anxiety and other symptoms. Nor the extent to which medication could help.
What do you think you or others around you could have done so things had gone differently? And how were you able to set yourself up for success with your second baby?
That first experience was so traumatic for my family that we almost didn't have a second child, even though we really wanted one. I knew I had to get supports before we could even try for a second, because the risks felt really huge to us. We moved and now live closer to extended family, and I very clearly requested and scheduled frequent family visits for after the birth. I found a therapist who was wonderful and took my insurance and had experience with postpartum disorders. I found a prescriber who was also wonderful, only saw perinatal and postpartum women, took my insurance, and helped me go on medication while I was still pregnant. I found a lactation consultant who genuinely connected with me on trying to breastfeed, but not at the sacrifice of my mental health. My husband finally had paternity leave through his job, so he took six weeks off instead of two.
I feel so fortunate to have identified and had access to these resources. But it was interesting to me because I still didn't really feel completely seen. You know, I had set up the supports by myself. And I had spent hours, hours trying to research and identify ones covered by my insurance and then ultimately not all of them were. Most families do not have that luxury, especially in the throes of crisis.
And while I didn't experience postpartum [mental health challenges] immediately after the birth of my second, I found I wildly did when I stopped nursing at 15 months. The symptoms looked very similar to those during my first bout. Yet, despite my medication, prior experience, and all of that work that I had done, the onset took me and my family completely by surprise. Thankfully, we identified what it was after a few days and my support team was able to intervene. But it reminded me how chemical the disorders are, how quickly and unpredictably they can crop up. It felt particularly harsh to me when I considered it in light of recent awful tragedies. Those stories just totally triggered me and broke my heart. I kept thinking that could have been me or really any new mom.
Do you think of yourself as a “survivor”? How do you understand your experience now?
I’ve really been grappling with this one. The first time I heard the term “survivor,” I loved it. Because I did survive this. And it felt really hard, and really traumatic, and I feel beyond grateful to have gotten through it. I also liked the term because there were parallels that I thought were appropriate to overcoming other medical illnesses, which this is.
Then I started to question it. I started to think about the term in light of those who hadn't survived. I really want to clarify that I did survive, but it wasn't the result of any resilience or fight in me personally. It was a naturally occurring biological crisis that could hit anyone, and I was so amazingly fortunate to have seen the other side of it and had the resources that I did. But there's so much more we can do to build resources and help others survive it.
What else would you like to share with other new parents, based on your experience?
If you're struggling as a new parent, know you're definitely not alone, even though it so viscerally feels that way. There’s a community that’s walked this path too and is here for you.
The other thing I would say is, knowing that when you're in crisis, there are really important [resources] in place. Postpartum Support International has super helpful information on their website. And I was also really grateful to see there's now a National Maternal Mental Health Hotline. The Hotline is confidential, 24/7, offers real-time mental health support, and can offer at least an initial touch point.
I also think quite often the partner is trying, and expected, to be a source of support when they're really maxed out themselves. I really think meaningful intervention has to come from somewhere else. My spouse was totally overwhelmed – becoming a new dad, working a full-time, stressful job, commuting, carrying the chores at home because I couldn't, helping with night feedings because we were triple feeding. And then he was often facing my rage outbursts. So he was underwater and he didn't have the ability to meaningfully intervene, and we need to recognize that. Even more reason why we need to be able to show up for new families as a community.