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The Story of an Untreated Post Partum Mood Disorder and the Journey of
a Certified Professional Midwife into the Mental Health Profession
By: Tara Tulley CPM,
MSW
My story begins long before I became a midwife, but becoming a midwife
is a pivotal time of my life in defining my relationship with a beast that I
did not know existed until many years later. I believe all paths we are drawn
to in life are no mistake, but sometimes the paths we choose are a result of
hiding pain that we do not have words for. My story of choosing midwifery as my
path is largely a result of just that, a monster that no one, including me,
knew about. The name of the monster was Postpartum Obsessive-Compulsive Disorder (PPOCD).
Historical Facts: I am a
granddaughter of a male midwife. I was born into the hands of my grandfather,
in a small township in the northern part of Wisconsin. My grandmother gave
birth to ten children at home, at a time when women were routinely knocked out
of conscious awareness of their births, rarely breastfed, and the idea of
health food was equated with quackery.
My grandparents lived in the middle of a wooded forest near the edge of
the Eagle River. My grandmother was ahead of her time in her interest in natural
medicine. After establishing a homestead they opened a health food store, and healing
center. Folks would come from miles away, because it was the only health food
store within a 2-3 state radius.
My grandmother’s knowledge and dedication
to healthy living, and thinking outside the box, led to me being raised mostly
on whole-wheat bread, homeschooled, and being born at home. My mother gave
birth to me on that same homestead that she was born, near Eagle River. I was
the oldest of eight children who were all born at home, into the hands of a
midwife.
It would seem natural that I also choose to give birth at home. When my daughter was less than 2-weeks old, I walked into the Utah School of
Midwifery, and made the decision to start midwifery school that very same day. It would also seem to be natural, that as soon as I signed up, I was not
content to study the courses in the order of the 3-year program outline. I was
so excited to become a midwife that I decided, with a brand new baby, that I
could handle taking year-1 and year-2 classes at the same time. It wouldn’t
seem out of the realm of normal to tell you that by the time my daughter was
18-months old, I had finished nearly 3-years worth of course work, was pregnant
again, and was more than half of the way through my clinical training required
to become a Certified Professional Midwife (CPM). Would it also surprise you to know that when my second child
was born (only 19 months after my first), that I attended 10 births that month,
and was attending births again by the time he was one week old? Given my ties
to natural healing, and midwifery, upon first glance, this seems reasonable. Or
does it?
Let me tell you the rest of the story: I had a difficult
period during my teenage years. I suffered from a severe eating disorder, and post-traumatic
stress disorder from sexual abuse. I graduated from high school at the age of
16, and struggled through two years of college with destructive behaviors and
thoughts. But something magical happened when I turned 18, I met a knight in
shinning armor. Needing to be rescued, and too ashamed to tell him about my
past, I made a dramatic change, and decided everything was now perfect! I
wanted nothing else than to get married, quit school, and to be the
stay-at-home, homeschooling, and perfect mother to six or seven children that
my mother had been to eight of her own. At that time I figured that all of my
problems were solved. I got married a few months after my 19th
birthday, I quit school, and the plan was for me to work while my husband was
finishing school, get pregnant, and to have a new baby by the time he
graduated.
Everything was going as planned. We had timed it just right, and became
pregnant the first month that we tried. The baby would be born right at the
time my husband was becoming a senior in college working on his computer
science degree, I would quit working, and he would increase his work hours as soon
as our baby was born. We both had a common goal for me to stay at home to raise
our children, and for me to not have to work outside the home. I had an image
of being a happy, perfect, housewife. I planned on homeschooling like my
mother, baking all of my own bread, canning hundreds of jars of fruit, and
preserves, and supporting my husband while he worked. I thought that as soon as
my baby was born, life would suddenly become perfect. I worked long hours as a
shipping supervisor at my fathers warehouse. I was on my feet for 9-13 hours a
day for my first six months of pregnancy. Even though much of the extra work I
gave myself to do was self-inflicted, I never thought that slowing down was
necessary. When I was tired I would just remind myself of how perfect my
life would be when my new baby was in my arms, and I never had to set foot into
an outside job again.
This plan was fine, until something happened to me around my 26-28th
week of pregnancy. I experience the first panic-attack since the beginning of my
marriage. I started to have horrible thoughts that would keep me up all night
long. What if my baby was born too soon? What if she died? What if she had a
severe birth defect? At work these thoughts ran over and over in my brain. I
tried to distract myself, and would push myself to work longer hours on my
feet, and harder than anyone else, in order to keep the horrific thoughts from
entering my mind. A friend of mine, who was only a few weeks ahead of me in
gestation, gave birth to her baby after going into premature labor at 28 weeks.
I begin worrying obsessively that this was going to happen to me. I worried
sometimes until I was throwing up, because I was so sure that this would happen
to me. I worried so much that one day, while I was walking down one of the
isles of warehouse shelving, I walked right into a pellet jack. I tripped,
falling onto a concrete floor onto my belly. I hit the floor pretty hard.
Panicking that I had abrupted my placenta, I called my midwife, and
drove directly to her home office. I was having mild contractions, and was sure
I was in labor, and that my baby was going to be born early. I was so worried,
that she sent me to the hospital to be monitored. When I was in the hospital, I
was terrified that the hospital staff was going to do something to cause me to
have a caesarian section, because that is what had happen to my friend. I would
not let my midwife leave the hospital, and she stayed there for many hours
because I was afraid. Having no indication of impending birth, even though I
continued to have mild contractions, the doctor released me to go home on bed
rest, and on medication that made my anxiety worse. I was told to stay on bed
rest for two or three weeks, and that if things stopped, that I could go back
to work.
Now I was experiencing anxiety, and not allowed to get out of bed. The
thoughts became worse and worse, and I was calling my midwife two or three
times a day, sure that the contractions had changed and that I was really in
labor. After three days of this, and not being able to convince me that I was
not in labor, I went in for a second trip to the hospital, more medication that
induced anxiety, and was sent home again.
I endured the three weeks of best rest by completing take-home projects
from work in order to keep my mind off of the fact that "I knew" my baby was going
to be born at any moment. When I did go back to work, I cut my hours back from
9-13, to 4 hours per day. This put stress on our financial situation because I
had planned on working full time for a few more months. The anxiety and
thoughts became more severe, but because I was driving everyone crazy with
them, I started keeping them to myself. I hated being in my body. I hated
feeling like I was an alien in my own body. I started to resent my baby. I knew
that as soon as I hit my 37th week, I was considered full-term, and
started looking up every natural induction method I could find. The day I hit
my 37th week, I woke up and drank 4 oz of castor oil, and started
every herb that I could find that said it could start labor. I started
contracting, but ended up with 5 long days of off and on contractions, and
premature rupture of membranes. After my water broke, my contractions stopped
for 30 hours. When my midwife was becoming concerned, and suggesting the
possibility of transferring to a hospital, I tried castor oil one more time,
and 10-hours later pushed out a perfectly healthy 6 lb 12 oz baby girl.
I had worn my midwife out, my husband out, and I was pretty tired. I was
happy that I was finally free of the pregnancy, and happy that now I could
start my perfect life. I was fine for the first five or six days after my
daughter’s birth. However, when she was a week old something changed. I was
sitting in my apartment, and I was frozen. I couldn’t figure out what to do
with myself. I wanted to run from my baby, and I wanted to run away from my husband.
I couldn’t cope with the quiet hours of having only a baby and myself in an
apartment all day. I couldn’t organize my thoughts enough to clean, I couldn’t
think of how to make dinner, and I felt trapped in my life. What made it worse,
was that my daughter had developed reflux, and was often crying all day long. I
could not console her, and I become intensely angry toward her. I wanted to
throw her against the wall. I wanted to smoother her so that she would stop.
Instead I put her safely in her basinet, closed the door, and curled up on my
couch and cried. This continued for about five days. I didn’t want to tell my husband
that I hated our baby, and that I wanted to make her screaming stop. So instead I came up with a plan. I
decided that it was obviously not a good idea for me to be a stay at home mom.
So instead I walked into the office of the Utah College of Midwifery, filled
out my application right there, and signed up for classes. I did not consult my
husband, I did not ask him what he thought about me suddenly changing the plans
of our future. I just did it because I knew I would not survive motherhood if I
stayed home.
This seemed to work, or at least gave me something else to think about,
when my baby was screaming, or when I was panicking when I was home alone with
her. I was able to take her to class with me, and by the time I was in regular
classes, we had figured out that she had a dairy allergy. I continued to
breastfeed her, and she calmed down as soon as I stopped eating dairy. I decided
to take both year one and year two classes the first year because it meant that
for four days a week I was with other adults, and not by myself with a baby. I
thought it was better because it would keep me from hurting her. Things started
to become more stable, my husband, while initially shocked, became supportive
and understanding of my need to have an outside-of–the home pursuit, and at
least what I was doing supported me keeping my baby with me.
When my daughter was 7-months old, I was feeling better. I was adjusting
to life. I did not feel anxious all the time anymore, and I decided that I
really missed out on pregnancy the first time around. I thought that a second
time, would be a much better experience, because now I knew more about birth. I
was becoming a professional, and that it would be a perfect pregnancy this
time. I was doing what I loved, and having a second baby while attending school
with a breast-feeding baby seemed like no problem. I became pregnant for a second
time, when my daughter was just 8 months old. I was breastfeeding her fully,
but the second pregnancy didn’t last. I began spotting at just 5 weeks
gestation. Panicking, I abruptly weaned my daughter. Although, I knew that
weaning would not prevent a miscarriage, I became terrified, and stopped doing
anything that might possibly contribute to the inevitable. Within a few days, I
was bleeding heavily, and the grief I felt was beyond anything I could imagine.
I felt betrayed and hopeless, instead of processing the grief, I became intent
on becoming pregnant again as soon as possible, in order to make up for the
loss that I was feeling. I became pregnant with my son a couple of months
later, but to my surprise, the sadness over the loss did not go away. I held resentment toward the baby I was carrying throughout the last
month of my pregnancy, when I finally broke down after I had sat through a
presentation on pregnancy loss through one of my midwifery classes.
During that second viable pregnancy, I began attending births as a birth
assistant. In order to cope with my loss, I made myself available to several
midwives. I was attending an average of 8-10 births a month throughout my
pregnancy, and for several months after my son was born, without a break.
Although I loved what I was doing, as soon as I hit my third trimester, I
started experiencing the same obsessive worries and thoughts that I had
experienced with my first baby. I started feeling like an alien in my body
again, and started hating what was inside of me. I wanted out of my body more
than anything. Once again, even though by now I knew the benefits of allowing
the baby and the body to choose when the birth should occur, I aggressively
induced myself at 37-weeks of pregnancy, and gave birth to my son 3 weeks
early. I did not even give myself a chance to stay at home this time. I was
feeling insane at home by the time my son was 7-days old, and went out with the
first midwife who called me. Luckily, my son was a very easygoing baby, and it
was easy to take him to births with me. But the depression and anxiety symptoms
I was feeling continued to become worse.
When my son was 2-months old, my
grandfather died of cancer. During that time, someone made an unkind comment to
me about the amount of weight I had gained, and how I needed to just go walking
everyday and to stop eating so much. Having never truly resolved the pain
behind the eating disordered life I led as a teenager, I became angry, and I
felt a switch turn in my head. By that time I was mostly done with my course
work, and so I had many hours at home with my two very young children when I
was not attending births. To escape, I begin taking them to a gym where I could
leave my children in the daycare for four hours a day. I would spend four
hours everyday on the weight machines, in yoga classes, and swimming.
Additionally I would often run an additional 2-3 hours at night after my
husband came home from work. I started using diet pills, and quickly dropped
weight. By the time my son was a year old, I started to feel better, I stopped
being as obsessive with my exercise, and I started to build my practice. I
started to feel OK about myself again. This time, I was not so anxious to
become pregnant again. In fact, I developed PTSD about being pregnant. Having
two pregnancies in a row that felt terrible to live in, and having a difficult
year after each of them, I just was not sure I could ever do it again.
It
took me two full years until I finally decided, that I really did want to have
a least one more child and that waiting any longer would space them out too far
apart. I was panicking about how I would handle a third child. During each of
my pregnancies, I developed severe anxiety symptoms during the third trimester.
My midwife, who had never been trained to see anxiety in pregnancy, nor had any
other midwife I knew, did not catch onto what was going on with my mental
health. No one saw any of my extreme reactions to childbirth as being related
to a postpartum mood disorder. Everyone just thought I was superwoman, and a
little bit on over-drive. I didn’t want anyone to know what I was really
feeling inside. I made sure I looked so well put together, that I convinced
most people that I was just an amazing person who didn’t need a postpartum recovery
period.
I finally decided that it was time to have another baby, and after only
one month of trying, I became pregnant with child number three. From the
beginning, this pregnancy was more difficult than the other two. I developed
morning sickness that was severe, and never went away for the whole nine
months. By this time, I was completely done with school, I was a Certified
Professional Midwife, and I was teaching CPR and First Aid and Safety Courses
to midwives and for The Red Cross. But most of the time, I was home with my two
children. I became depressed much earlier this time. I had promised myself that
for this pregnancy, I would not let what had happened the first to two
times happen again. That I would love my last trimester, and I would allow
labor to begin on it’s own. I had promised myself, that I would not be needy
and whiny to my midwife, and drive her insane about every small thing that I
was sure was an impending problem.
Between the morning sickness, and not being able to handle being home
all day, when I hit my third trimester, I became worse than before. I was sure
that my baby was breech. I knew she was going to die. I knew that this time I
would have a bad hemorrhage and die. No matter how much I tried to use my objective
brain, and put the thoughts to rest, they just would not go away. When I hit my
37th week of pregnancy, once again, I started trying to evict the
baby that had pushed me out of my body. When she did not come, and was pregnant
until 12 days before her due date, I lost all reason. I broke down daily, with
my husband and midwife not understanding, that with my knowledge and skills,
why I could not just go about my day and be OK with being pregnant. After all,
I advised all my clients to allow their body to choose, and to try to enjoy the
last few moments with my baby inside. But I could not do it for myself, and I
didn’t understand why. I was no longer Tara, the midwife, with a clear head.
Instead I believed I could not handle another minute of
pregnancy, and convinced my midwife to rupture my membranes at 38.5 weeks of
pregnancy. About 12 hours later I had a baby. But the baby-moon did not last
even a few days this time. This time, I was panicking and feeling violated
every time she would breastfeed. I became so anxious, and unable to rationalize
my state of being, that I often give her a bottle of formula at night so that I
could at least have one feeding that did not cause me to feel violated and
anxious.
Feeling guilty, because I was a midwife promoting breastfeeding only, I sunk into a deep depression. I
started taking my children, and going places away from home all day long. I
went to a professional photo studio with my ten-day old baby, and had taken all
three of my children to Costco, and several hours later ended up at my parents’
home. While I was sitting in a chair at my mother’s house, I started to feel
ill, and I went and lay on her bed. I developed a high fever, and became delirious.
My lack of rest resulted in a severe case of mastitis and a uterine infection.
I was unable to leave my mother’s bed for 3-days, I could not hold my baby to
feed her. My mother would bring her too me, and hold her to my breast so that
she could eat, and then take her away.
Upon recovering from my physical illness, my mental state continued to
slip. I found myself developing an unhealthy friendship, which turned into a
business partnership. Because I could not cope with being alone, I became involved
with a toxic business partner, and let others dictate my parenting skills. I
started working more and more, and allowed this partnership to take over my
reasoning and my family life. This continued for a couple of years, and in the
end resulted in me becoming severely eating disordered again, and finally
resorting to therapy, and gaining enough power to break away from my business
partnership that was destroying my life and my family.
However, by this time, no therapists connected any of my behaviors, or my
emotional state back to my pregnancies. While there were underlying trauma
reactions that I had never resolved, much of the distress I experienced was
really triggered during and after my pregnancies. The first two pregnancies I
had suffered, but the third pregnancy put me into a cycle that I was stuck in
long after I was no longer having babies, and no longer breastfeeding. In fact, the anxiety I was experiencing
after the birth of my third child was so severe, that it caused my baby to
self-wean at 10.5 months. Feeling ashamed and guilty, at not being able to be
an example of a “natural mother” to my clients, who seemed to have no problem
following my advice, I hid what my postpartum life was like from my family, and
from my collogues. My midwife never suspected that what I was experiencing
during my pregnancy was anxiety, and she did not know that I struggled at all
after my births, because I seemed so put together, and I told her I was fine.
In tried to understand and recover from my postpartum downward, spiral,
and business partnership that resulted in tens of thousands of dollars in debt. I had difficulty finding a mental health provider who really could understand
what was going on behind my face. I found a sympathetic therapist, who
understood that the disordered eating I showed, was a bit different in
treatment response then the standard clinical example of an eating disorder,
but neither she nor I really made the connection of how pregnancy and
motherhood played into my mental struggles. I had to search and study, and in
the end resorted to obtaining a mental health degree myself. However, even my
graduate studies barely mentioned or touched on the subject of maternal mental
health issues. In a graduate program that promoted itself as reaching areas of
diversity in underserved populations, it seemed to totally miss one of the largest areas of disparity: maternal mental
health.
I am now a healthy woman, with prospective, and a midwifery career and
now a mental health career. I've spent thousands of dollars in obtaining college degrees, in
therapy, and countless hours in studying in order to understand out what was
feeding my pain. I am not sorry that for the educational qualifications I have
obtained in the process. I love being a midwife, and I love the work that I do
in the field of maternal mental health. I am grateful that life is a good
instructor, and I have learned how to become well. But sometimes I wish that
training in prenatal and postpartum mood disorders had been a part of my
midwifery education. I am perplex that postpartum mood disorders are the most
common complication of childbirth, and yet get so little attention in the
mental health field. I sometimes wonder if I would have been able to avoid the
life-threatening times that I was severely eating disordered as a mother with young
children. I wish I had not missed the first few years of their lives because I
was not well enough to be present. I had wanted to have more than three children. I wonder if I would have
been able to, had someone recognized my disorder either during my pregnancy or
soon after my birth. If someone questioned the rationality of starting a new
career path and registering for school without my husband's input, with a 2-week
old baby, and realized what I was covering up. What could I have gained in
being diagnosed and treated early on? I may have still gone to midwifery school, but perhaps I
would have done so after having time to consider my decision, and not because I
was trying to avoid harming my baby at all cost.
I do not
regret my life journey. I have learned how build relationships with my
children, and in my recovered and stable mind, I am able to sit with them and
enjoy them as teenagers. Although, I am still on the go much of the time, I
have learned to be OK with quiet time, and I think through my pursuits before
taking action on them. I have learned to recognize when I need to find balance,
and when I need to slow down. I enjoy healthy friendships, and good boundaries
with those friends. I have a wonderful relationship with my spouse who has
stuck through with me during the times I was sick and did not know it. I also
am passionate about early detection and recognition of perinatal mood and
related disorder so that women do not have to suffer long after they have left
the side of their birth care provider. My pain led to years of unnecessary
suffering. I could have still pursued my degrees, and my career without the
suffering for as long as I suffered had mental health screening and training
been a part of my prenatal care. Had someone recognized, and had I received the
proper treatment, I could have been enjoying my children and the life I enjoy
now much sooner.
As a professional in the natural birth movement I think that there is a
perception about our clients being healthy, and we are tempted to
believe are clients are immune to mental health concerns because we are
avoiding interventions. We strive to empower our clients throughout their
care. Emotional illnesses are difficult to spot, and unless we are trained to
screen and to look for the signs of these unique disorders, we will miss them
completely and fall under the elusion that our clients do not suffer from them.
The birth provider may be the only touch point a woman has to be educated and
to be screened for pregnancy-related, mental health disorders. She may
otherwise not ever tell, and may suffer long-term. Her relationships will
suffer, her children will suffer, her marriage will suffer, and her life will
suffer. In the best case, she will recover on her own, and go on to be happy.
It the worse case, she will develop a long-term mental health disorder, or
possibly take her own life or the life of her baby.
If
you are a healthcare provider, doula, or professional providing care to women
during this important time, I urge you to educate yourself, and to take the
time to learn about postpartum mood disorders. I am a midwife and even armed
with knowledge and empowering birth choices, I still fell prey to a postpartum
mood disorder. I urge you all to take advantage of the trainings offered by Postpartum Support International (http://www.postpartum.net) or The Healing Group (http://www.thehealinggroupcom). I hope that my story will inspire
you, as a fellow birth or mental health professional, to take time to learn more about perinatal
mood disorders and that you may become a resource to women during this
important time.
