Two weeks after the birth of my first baby, I found myself in my local ER, crying so hard that I couldn’t explain to the nurse behind the desk why I was there. I was also soaking wet, since it had been raining all day, and my sneakers made sad little squishy noises when I was led into a private interview room. The decision to go into that room was the last decision I’d get to make for the next week.

My baby, thank every deity who may be out there, was just fine. I, however, was not.

By that point, I couldn’t stop crying – but that was slowly becoming the least of my concerns. I’d slept maybe four hours out of the last forty-eight and eaten one peanut butter sandwich. Thoughts of suicide were my boon companion. That morning in the shower, I couldn’t stop thinking about the expensive chef’s knife in my kitchen, which I used to break-down chickens and julienne carrots back when I still cared about food. I started to plan what I would do with the baby, which responsible adults I’d call right before I sliced myself up so that my infant wouldn’t be alone for too long.

When I got out of the shower, my husband convinced me to call my OB. When I asked him later why he brought it up then, his only response was that I looked “vacant.”

Twenty-four hours after presenting myself to the ER, I was in a locked psych ward, which is where I’d spend the next five days, wandering around in a haze of pharmaceuticals and exhaustion.

A psych floor is everything movies have conditioned you to expect. The patients immediately strike you as insane. Some babble on; some sit in stony silence and flick at imaginary bugs. You wait for a visit from Nurse Ratchett. About the time that you start to feel like you never want to leave, they send you home.

It was the last place I expected to be during my six-week maternity leave. Psych wards are for crazy people, not professionals who have a couple of college degrees, who’ve been married for a decade and have no criminal record or substance abuse problems. But mental illness doesn’t give two craps about any of that.

Modern science doesn’t have any firm theories about what causes postpartum depression, which affects up to ten percent of new moms. An even smaller percentage of new moms – less than one percent – will experience postpartum psychosis, which is marked by a severe untethering from reality. Andrea Yates, the Houston mom who killed her five kids because voices were urging her to do so, was probably suffering from psychosis.

While there are some strong warning signs, like a family history of mental illness or previous depressive episodes, it’s still a crapshoot to predict whether any given mom will experience it. Medical minds do know, however, that postpartum depression tends to become more severe with each subsequent pregnancy. Yates herself was warned after her fourth baby to not have a fifth, since that would almost certainly trigger another episode. She didn’t listen.

The eagle-eyed reader will notice in this essay’s opening sentence that I refer to the Deep in the darkest recesses of my psyche, I knew that if I could go through it once and come back out, I could do it again. baby who kicked off my own locked ward-level depression as my “first.” I stepped back into the potential PPD thunderdome, knowing full well what could happen. I had my reasons, of course.

First, my husband and I always knew that if we had one baby that we would have two. I grew up as an only child and still wish for a sibling, even though that ship has long since sailed. We both believe that parents need to spread the guilt and joys between at least two kids. Three offspring were briefly considered before we had the two. Now we think of three and just laugh.

Second, I’d had two years of relative sanity before we stuck our heads back into the lion’s mouth. Deep in the darkest recesses of my psyche, I knew that if I could go through it once and come back out, I could do it again. Not that I wanted to – but I could.

Third, it’s one thing to have postpartum depression spring up on you with little warning. It’s another to know what can happen and put plans in place to prevent it. My first meeting with my new OB – we’d moved from Tennessee to New York between kids – consisted of my putting my four-inch-thick file on her desk and making it clear that I wanted to not do that again. She agreed that that was a perfectly sane response and that it was completely do-able with some planning.

Some of the decisions were hard. While no one wants to expose her growing baby to prescription drugs, I stayed on Zoloft because the risks of not taking it seem greater than the risk to the baby. At every appointment, my OB and I talked about my emotional state as well as my physical state. During month seven, when the kitchen knives were starting to hold a nebulous appeal, we upped the dosage. It took the edge off.

More controversially, we decided that this second kid would be formula fed from the start so that I could get the larger chunks of sleep that my limbic system needs to stay regulated. Yes, I know that breast is best. Yes, I know that I’m setting my kid up for a life of being stupid and sick. I still believe it’s better to have a parent who knows where all of her marbles are. I look at kid number two and wonder if I’ve set him up for a lifetime of issues.

Those first two weeks, which were my Waterloo the first time, almost did me in the second time, too. I spent the first week crying, this time with a three-year-old leaning against my shoulder and her brother across my lap. Family and friends who knew my colorful babymaking history looked at me like they were doing a silent study. Should we check her in now? Or give it another twenty-four hours? Still, they stayed and helped and let me be the judge of what I could handle.

When I stopped sleeping, I called my OB, who suggested Tylenol PM. If it didn’t improve, she said, I should call back, no matter what the time. That knowledge – that there was expert help only inches away – was enough. Eventually, I slept. I stopped crying. I felt like myself, for better or for worse.

With two kids, it’s hard to say that it got easier. Two small people are more than just the sum of one and one. It’s an exponential parenting progression rather than a linear one. Life in my house is a continual haze of nuttiness – but luckily not the clinical sort. I look at kid number two, now two himself, and wonder if I’ve set him up for a lifetime of issues because we made some compromises when he was only a handful of cells. Then he flashes a goofy grin and runs off to climb all over his big sister, who pushes him away with a giggle.