And with two pink lines, it was official. Ashley and Matt Pauline’s long journey to parenthood was finally over. With twins on the way, the Paulines couldn’t be more excited – but nothing could prepare them for the difficult path ahead. Making it through this journey would be a fight for their lives.
From Sinking to Swimming, Ashley Rides the WAVES of Postpartum Depression
Postpartum support through Lehigh Valley Health Network saves Ashley Pauline’s life
Ashley walked into her 20-week appointment feeling good and was excited to see the babies. However, that excitement quickly turned to concern. While all was OK with the twins, there was an issue with her cervix. It was opening, and she was at risk for going into preterm labor. If born this early, the twins would not survive, so they needed to act quickly.
After arriving at Lehigh Valley Hospital (LVH)–Cedar Crest, Ashley had a cervical cerclage where maternal fetal medicine specialist William Scorza, MD, with LVPG Maternal Fetal Medicine, used stitches to close the cervix. They had successfully delayed labor.
But a couple weeks later, the stitches had migrated, requiring Dr. Scorza to revise her cerclage in order to prevent Ashley from going into labor. Still not quite to the age where the twins could survive, Ashley was admitted to LVH–Cedar Crest for intense monitoring. Dr. Scorza and the maternal fetal medicine team at LVH–Cedar Crest were determined to help Ashley get as far along in her pregnancy as possible. The longer they could delay birth, the more time the twins would have to grow and develop, and the better their odds were for a bright (and complication-free) future.
Sinking to the depths
At 26 weeks and four days, the twins arrived. On Nov. 19, 2022, Ashley gave birth to her daughter, Madison (Maddy), weighing 2 pounds, 0.8 ounces, and her son, Landon, weighing 2 pounds, 5.2 ounces. Born extremely premature, the twins were immediately rushed a few floors away to the neonatal intensive care unit (NICU) at Lehigh Valley Reilly Children’s Hospital.
The Paulines spent the next 118 days at the NICU, where they experienced every emotion imaginable, as well as ones they never imagined. For Ashley, this included postpartum depression (PPD).
“Postpartum depression and other associated perinatal mood and anxiety disorders are conditions that affect a mom’s mental well-being during pregnancy and within the first 12 months after giving birth,” says physician assistant Melissa Aylesworth, PA-C, with LVPG Obstetrics and Gynecology. “This can include traditional depression, anxiety, other nonspecific mood disorders, and it can look a little bit different for everyone.”
While Ashley was experiencing anxiety and depression, the symptoms of her PPD at first felt manageable. But then things changed 77 days after she gave birth to the twins, when Landon was cleared to come home from the NICU and Maddy was not. Ashley says it was that night that something changed in her.
“I think I was on autopilot up until we brought Landon home,” Ashley says. “It was like a transition of real life, but with Maddy in the hospital, I couldn’t fully transition. My heart was constantly in two places, always happy and sad at the same time, and it became so overwhelming that I just sunk. And that’s when the biggest struggle of my life began.”
At first, Ashley didn’t understand what she was feeling or why she was feeling it. “I felt like it should have been the happiest time of my life, especially with what we went through,” Ashley says. “And I couldn’t understand why I was feeling such sadness and such anxiety and dread to face the days. I know depression and anxiety. But this was something completely different. It was such a tug of war because I had two amazing babies, but I was struggling.”
Ashley soon learned she had developed postpartum depression. “I have a history of battling anxiety and depression, but it was nothing like what I experienced with postpartum,” Ashley says. “I feel like I completely lost myself. I was severely depressed. I didn’t want to get out of bed, everything irritated me, I cried all the time, and I needed my husband home a lot. I didn’t feel a connection with my son. And I didn’t know why I was experiencing any of it.”
Ashley did everything she could to battle back against PPD, and her family did everything they could to help. But she kept sinking deeper. “I couldn’t face a reality I couldn’t be in. Everyone was having fun with my kids, and I didn’t want to be there – I just wanted to crawl into bed,” Ashley says.
Ashley knew she needed help. But finding the help she needed was harder than she thought. Then, she was introduced to a program that was unlike the other programs and support she had tried. This program was directed toward women just like Ashley – women who were struggling their way through motherhood instead of enjoying it. “Finding WAVES wasn’t just a game changer. It was a lifesaver,” Ashley says.
Happiness comes in WAVES
Women Adjusting to Various Emotional States program, also known as WAVES, is a one-of-its-kind program offered by LVPG Obstetrics and Gynecology. Designed for women who are dealing with the emotions of pregnancy and motherhood, WAVES provides education, resources, treatment and support from obstetric professionals who have extra training in perinatal mental health.
“One in five women can experience a mood or anxiety disorder during pregnancy or in the postpartum period,” Aylesworth says. “It’s the most common pregnancy-related complication, yet studies show the vast majority of these patients don’t seek help or don’t get appropriate treatment. Our mission with the WAVES program is to change that. Women deserve to enjoy their pregnancy and enjoy being a mother.”
Ashley met Aylesworth through the WAVES program, and credits her with saving her life.
“The difference with WAVES than with other programs was the reassurance and the validation,” Ashley says. “Through WAVES, you’re getting help from someone like Melissa. Someone who understands what you’re going through and won’t judge you for not feeling how you think you’re supposed to feel. Someone who is invested in your well-being.”
While the highs and lows of PPD would still come, Ashley no longer had to ride the waves alone. With Aylesworth by her side, Ashley knew she would make it to shore as long as she just kept showing up.
Calm waters ahead
Today, Ashley is feeling great, and she absolutely loves being a mom. She’s enjoying being back at work, but she says she can’t wait to get home to the twins. Now 1 year old, Landon and Maddy are as healthy as can be and crawling everywhere.
“I try to be in the moment as much as I can when I’m with my kids because there were so many times where I was in a fog,” Ashley says. “From where I was to where I am now, it’s night and day. It was the darkest time of my life, and it was nothing I could control. It messed with my body so bad, and I didn’t know who I was.”
Looking back, Ashley doesn’t know how she made it through. But she does know that her family and Aylesworth are two reasons why she’s here today.
“Postpartum depression is not the baby blues. It literally rewired my entire brain. Postpartum is real and it’s scary. And it’s not talked about enough. I wouldn’t have made it through without my husband and my dad – who were down in the trenches with me through it all – and Melissa. She was literally my rock, and I would consider her part of my family at this point,” Ashley says.
“The kids fought for their lives, and I fought for mine,” Ashley says. “I love being a mother, and I’m proud to say I’m a darn good one.”