A Midwife's Personal Story of Birth Trauma and a Postpartum Mood Disorder.

A Midwife’s Own Story of Living Through Birth Trauma, OCD, and Psychosis

By DyAnna Gordon LDEM, CPM

     I am finally free of hormonally induced mood and anxiety disorders. It took over 10 years and was quite a journey. I had severe PMS symptoms as a teenager including: rage and crying fits, accompanied by suicidal thoughts, and destructive behavior. I became a completely different person one week out of every month. My family doctor put my on hormonal birth control treatment in hopes of regulating my hormones, but it just made things worse. I stabbed my mother in the hand with car keys and ran away from home waking from my zombie like trance a week after starting treatment. They tried 10 different types of birth control, but the all had the same effect. I married at age 20, and by age 21, became pregnant with my first child. It was a planned pregnancy and we were very happy. I wanted to be well informed. Like many parents, I read every book I could get my hands on. After researching different birth options, I knew that I wanted a natural childbirth with a midwife.

     My husband and I pondered a homebirth, but we were currently living with and caring for an elderly woman and the situation wouldn’t have made it acceptable. We chose a Certified Nurse Midwife (CNM) at a birth center. My pregnancy was relatively easy physically. Emotionally it was a different story. I became obsessed with finishing my college degree before my baby was born. I poured every amount of obsessive energy I had into my classes. I proceeded to enroll myself into 8 credit hours in May, 24 credits between June and August, and another 20 for the fall semester. I took my last final to graduate on my due date. For months I had done nothing else but obsess about school and my birth. I finally began labor seven days past my due date, and I was an exhausted mess!

      All of my family and my in-laws had come to visit on my due date, and they watched me, waiting for me to go into labor. The anxiety could be easily measured as the days and hours ticked by. We were all up later than usual, playing board games, the night my water broke. I had been up since 6 that morning without a nap. We tried to be the dutiful parents and go to sleep, but I was just so excited. My contractions were only mild all of the next day. I tried drinking red raspberry leaf tea, walking and nipple stimulation, and nothing worked. Twenty-four hours after my water broke, I called my midwife. It was 1 am when I informed her of the situation. She regretfully told me that because of the protocols of the birth center after 24 hours of my water being broken would mean I had to change my birth plan to a hospital delivery. We drove to the hospital and they started me on a pitocin IV drip to induce contractions.

       The baby’s heart rate could only be picked up with me lying on my left side with my right knee flexed, and my other leg straight. If I rolled one way of the other or moved my legs the nurse would come in and scold me because they lost the babies heart rate on the monitor. I was having terrible back labor and my two support people, exhauseted from being awake for over two days, were finally asleep while I labored. I heard the doctor arguing with the nurse about why I hadn’t been prepped for a cesarean yet, since it had been 30 hours since my water was broken, and 4 hours of pitocin had made no change in my dilation. At this point, I lost it. The last thing I wanted, and what I was most afraid of was a surgical delivery. I asked the doctor when he came in if I could have the chance of an epidural and sleep before resorting to surgery, and he agreed.

     The anesthesiologist was un-empathetic. The nurse had to physically hold me down, when he was inserting the epidural catheter. I started pushing with the contractions and had a bowel movement on the table. I told him what was happening and he inserted the medication anyway. After that I slept, the sleep of the dead. For three hours I slept while my baby descended. When my midwife finally arrived, she could see my baby’s head. I requested she turn off the epidural, which she did, and I pushed for 3 hours before my daughter was eventually born vaginally, once I was able to feel my contractions again during the last 30 minutes of pushing. She went right onto my chest, but once the cord was cut all of my family took her from me, and held her because they had waited so long for me to give birth. They flew out of town right after the birth because it was just two days before Christmas. When I finally got my daughter back, I struggled.      

     I had severe baby-blues after she was born, and I cried every time I thought about her birth. I had done everything right. I read books, I took Bradley classes, I hired a midwife, and planned an out-of-hospital birth. How had it all turned out so differently? It was several months before I developed a real attachment to my daughter, and it showed. She would cry all day long. I could never get her to burp, and I held her very stiffly. I didn’t really want to touch her. She would have such severe gas pains by the time my husband got home from work, that he would spend the first 30 minutes after his arrival burping her. I loved her because she was a baby, but I didn’t love her for being my baby. My attachment gradually grew as I discovered attachment parenting. It was what I was already doing but didn’t know it, until I read about it from a Mothering Magazine I found at the library.

      I had wanted to become a doula and childbirth educator when I was pregnant, but I was afraid to pursue those goals after, what I believed was, my botched natural birth. My greatest fears were realized when I talked to The Bradley Method instructor trainers, and they told me that I couldn’t become an instructor unless I met some ridiculous extra requirements since I didn’t have a “Bradley Method Birth’, because three hours out of my 36 hours of labor was medicated. I put off becoming an educator and focused on my doula training. I trained with Doulas of North America (DONA) and I had a wonderful, kind and supportive instructor who listened to my birth story and assured me that I would still have great value to offer to pregnant women.  

     When my daughter was 5 months old, I discovered I was pregnant on a family vacation. Although it was not planned we were excited. On the drive home I began to feel ill. We made an emergency stop in Reno Nevada and got a hotel room for the night. I began to cramp and ran to the toilet where I remained for the next 3 hours as I passed my 10-week-old little angel baby. I was devastated. Family members said supportive things like “Well it is for the best you already have one baby.” Or “Well maybe you were wrong and you weren’t really pregnant.” I struggled additionally postpartum, due to this loss.

      My family moved to Denver Colorado for my husband to attend school and I found myself immersed in a wonderful birth community. I was well supported, and was soon a very busy doula attending 2-4 births a month. I also became a CAPPA, certified childbirth educator and began teaching classes. We decided we were ready to get pregnant again when my daughter was a little over 18 months old. We knew we wanted a home birth so we had been setting aside money every month to pay for the midwife. We tried and tried and I couldn’t conceive. I ended up weaning my daughter and got pregnant the very next month. We were thrilled! This pregnancy, I was certain that I would be even more perfect than the previous one. I followed the Brewers Diet to a “T”. I wrote down everything I ate for 10 months. I walked three miles every day. I re-read every book and even quit attending births so I could focus on my own pregnancy. I wanted to control everything. When my midwife came for my 36-week home visit she was surprised to find that I had removed all of the labels for my canned food, and relabeled them with my personal labeler so they would all match.

      My house was perfectly clean. I couldn’t stand to have any dirty laundry, and washed partially full loads all day long. Everything had to be perfect. I was not going to screw up again! When labor started 7-days after my due date, just like my first birth, I took a Benadryl and went right to bed. I was not going to make the same mistake of not sleeping like I had with my previous birth. I awoke a few hours later, and proceeded to walk and squat just as I knew I should. When the midwives were called around 6 am I was laboring well and the birth tub was filled. I would get in but the contractions wouldn’t feel as strong, so I would get right out again terrified that my labor would stall. When my water broke and I started pushing on the birth stool the midwife suggested that it might finally be safe for me to get in the water. As I was pushing I yelled to the midwife, “It’s not coming down.” The apprentice was surprised as the baby was crowning and the midwife assured her I had some trauma from pushing for 3 hours with my previous birth. Three pushes later, my son was born and placed in my arms. It was perfect! I had trouble urinating after the birth, and needed to be catheterized. A resulting kidney infection followed a few days later, because in trying to be perfect and control my anxiety I moved a piano and exerted myself too much.

      Fourteen months later I discovered I was eight weeks pregnant with child, number three. I was still nursing my son and was struggling with feeling sick and exhausted. I had two trips planned to visit family alone, while my husband was in another city studying to sit for the bar exam. After my 3 week “vacation”, I arrived home completely exhausted. I lay down to nurse my baby one night and felt a gush of fluid. I got up and the bed was soaked with blood. I continued to bleed. It was a Sunday, but I managed to find a midwife who would see me. She found heart tones right away and put me on some herbs to help prevent miscarriage. I continued to bleed heavily, but never experienced cramping. Later that week, I went to see an obstetrician. Upon examination, he found no heart tones. He returned to the room with a speculum and sponge forceps to “remove the fetal parts”. I told him I wasn’t going to let him touch me until I had an ultrasound and was sure the baby had passed away, since I still wasn’t cramping and hadn’t passed a 13-week fetus.

      The ultrasound showed a healthy baby and two large subchorionic hemorrhages between my uterine wall and the placenta. My placenta was only attached by about 30% of its surface area. They told me I most likely would lose the baby before 20 weeks, and if the baby made it to an age of viability, the chance of carrying full term was almost none. I was put on strict bed rest. It was really difficult caring for two young children while living with my mother, and my husband being 400 miles away from me. My “normal” pregnancy depression and anxiety deepened. I continued to bleed off and on throughout the pregnancy.

     When I hit the 27 week gestation mark, age of viability at the time of this pregnancy, I decided to interview midwives just in case I could make it full term. I interviewed three different midwives, and I really didn’t love any of them. My choice ultimately came to choose the only one carrying a license to carry medication, such as pitocin, if needed, due to my increased risk for postpartum hemorrhage. My husband was home and we moved into our own place about half way through the pregnancy. Our finances were very tight, and the home was a family-owned property we could rent for less money. It was infested with ants, cockroaches and black widows. There was no heat besides an ineffective, wood-burning stove. I was new to the area and didn’t know many people, and had few friends. Money was almost nonexistent, and we were struggling just to keep fed. My one year old was very “young for his age”. He didn’t walk until he was nearly 18 months old. He had stomach and bowel problems, as well as unknown vision and hearing problems. He had many needs demanding my time and attention, and I was always sleep deprived. My pregnancy issues continued to worsen. I gained over 60 pounds, due to being continually on modified, bed-rest

     By the time I reached 32-weeks of my pregnancy, things were terrible. I started to hear voices, telling me to do things, such as running away and abandoning my family. It felt conflicted and confused, since I really loved my husband and children, and had no true desire to leave. However, the obsessive thoughts and voices commanding me to leave would not leave my head. It was worse during the night. I would kneel by my bed and just pray, and cry for the voices to stop and leave me alone. I began experiencing repeat nightmares and day-dreams of running away to Reno (where I had had my miscarriage), and having the baby there alone and leaving him at the hotel. I finally developed the courage to tell my husband what I was feeling, and he was loving and supportive but he didn’t really understand the seriousness of my illness.   

     My due date came and went, and I was a complete basket case. I wandered around the house in a fog, barely able to function. Late at night I spent my time crying and praying for the voices to stop until I collapsed in exhaustion. A dear friend and doula traveled to me, from out-of-state, and stayed for 3-weeks prior to the birth because she was so concerned about me. During the last few weeks of my pregnancy I began to beg my husband, nightly, to take me to the hospital and request a c-section. I knew intuitively and from past experience that my psychological symptoms were caused by hormonal changes induced by the pregnancy. I knew if the pregnancy was over, I would be better. He did not ever take me in to the hospital, despite my pleas. Finally 7 days past my due date, I told my midwife in greater detail what I had been experiencing and begged her to take me in for a c-section. Instead, she stripped my membranes, resulting in uterine contractions, about 8 hours later. I was handling my contractions well, and it was about four o-clock in the morning, when I felt like it was time to call the midwife. Upon her arrival and examination, she found my cervix to be 7 cm dilated. However, the baby’s head was not presenting firmly against the cervix. She told me that if I wanted to have the baby born at home she needed to hold open the “hanging sleeve of cervix”, and I needed to push, and the baby would be born in a few minutes. Four excruciating hours later of her fingers manually opening my cervix and my pushing against a partially-closed cervix, I was finally completely dilated.

      The midwife continued to apply pressure to my perineum with her fingers, even after I repeatedly requested for her to stop. She was talking to her child on the phone, who had left her lunch at home with one hand, and applying pressure to my body with the other. I finally kicked her aside and pulled myself into a squat and my baby boy was born with his face up toward me. The midwife delivered the placenta, weighed the baby, and left my home. When I got up to use the bathroom a while later, I was brought to my knees by the pain I felt. It was impossible for me to stand up straight. I crawled to the bathroom, and when I wiped myself, I felt something between my legs. My cervix and part of my uterus were hanging outside of my vagina. I called the midwife telling her what I was feeling, and she said it was normal after the difficult birth I had experienced. She called again three days postpartum to check on the baby. I saw her at six weeks after the birth, to fill out the birth certificate, but I could never share the trauma symptoms, I was experiencing, surrounding my birth. When my baby was about 2-months old, the midwife asked me to come speak at a free community childbirth class she offered to share my birth story. When I stood up to address the classroom, I couldn’t speak, and I began to shake. This was completely different than my normal self. My husband shared our brief story. I struggled greatly with pain and depression after the birth. I felt abandoned: by my two friends who where there who acted as my doulas, by my husband, but most of all I felt betrayed by my midwife. Homebirth was supposed to be safe and what happened to me was far from safe.

     It took years, and I never fully recovered mentally or physically from the birth of my third child. I couldn’t stand or walk for more than about half-an-hour without having to lie down. Sex was very painful. I had problems holding my urine or passing a bowel movement. When I finally saw a gynecologist the diagnosis was; a severe uterine prolapse, perinial tear that was not sutured (the midwife said I didn’t tear), a cystocelle, and a rectocelle. Upon my baby’s first birthday, I began my apprenticeship in midwifery. I believed that if homebirth was going to be an emotionally safe option for women, I needed to be the one to provide care for them.  

      My apprenticeship was intense and I struggled mentally and physically during the entire three years. A year into my training, I discovered I was unexpectedly pregnant. I was terrified of having another baby. What would happen to my body? Would I emotionally be able to handle the pregnancy? I vomited eight to ten times per day throughout my third trimester. I knew it was related to emotional trauma.  I had never had morning sickness with my other pregnancies. I had a great distrust of my husband being able to support me through the pregnancy or the birth. The mistrust combined with both of us having difficulty accepting another baby into our lives, greatly affected our relationship. I experienced daydreams of having an abortion and ending the pregnancy. I prayed continually for a miscarriage.

     I shared all of these thoughts with my new midwife (she was also my preceptor).  She listened sympathetically and encouraged me to enter psychotherapy. Physically I was a mess. The added weight of the baby caused even more problems with my prolapses. I spent the majority of time in bed. About five months into the pregnancy when I realized that I was going to carry the pregnancy to term, I began to see a therapist. She had a Masters degree in Marriage and Family Therapy, and I had seen her as a teenager. She had a good grasp on my history and family dynamics, plus she had given birth to her children at home. She worked with me using Somatic Experiencing treatments, to physically work through the emotional-trauma I had experienced during my previous birth. She also counseled me to try to help reduce my depressive, anxiety and OCD symptoms that popped up with my pregnancies. I was able to work through the trauma enough and gained confidence that I could have this baby.

      My depression and anxiety continued, and the voices in my head returned in my final month. I had a supportive midwife and husband who would have supported a c-section if I chose. I considered it continually, as I argued with the obsessive voices in my head telling me to run away. I began to take a nightly dose of Tylenol and Ambian to get me through each terrifying night. About one week before my due date, I could no longer ignore the voices anymore, and I left. I pack everything and went to a hotel about thirty minutes away from my home. I called my husband and my midwife who were out driving around looking for me, and told them I would be home after I had the baby. I was gone for a full day before I came home. Even with all of the therapy and work I had done, I was still terrified of the birth and of the baby knowing that he had been unwanted.

      Every morning I awoke to find that he had turned into a breech position. I would talk to him during the day and gently push his head down and by nighttime he would be head down, only to turn again every night. This continued for two weeks and my greatest desire just might have been met, a cesarean delivery. I met with my back-up doctor but he said it would be a tragedy to give me a c-section (what a good guy). He tried to convince me to try an external version to turn the baby, and then break my water to induce me. I declined. I went home and struggled a few more days every morning waking to a breech baby and going to bed with him head down. Finally, seven days after my due date I awoke, knowing that the only way the baby was going to come out was if I did it, and he was head down.

      In my normal pattern labor started that night. I labored well alone, just as I so often fantasized about during my pregnancy. The midwife came early that morning and an hour later my husband caught, my son who was also born with his face upward, in an almost painless water birth. The pain of the contractions paled in comparison to the physical and emotional pain I had been feeling. I knew the only way to healing was through my birth.  I was so looking forward to the shift in hormones during the week that followed just like my other births, so that would allow me to start feeling like “me” again. It never came.  We loved our surprise baby the minute he joined our family, but he had some medical problems, and was very fussy and demanding. We had breastfeeding issues. He was tongue-tied and he had to be on medication daily. I never came out of my pregnancy-induced, brain-fog like I had before.

      The obsessive thoughts and anxiety continued, and I stopped sleeping. I remember very little until my son was about eight months old. I have fleeting memories of a baby crawling in a certain way, to later discover after talking to others, that it was my son. I have baby outfits in my mind, but no memory of him wearing them. My midwife urged me to go and talk to my family practice doctor, and he started me on medication. He had been my doctor since my youth. He knew my family history of depression, and he also knew how sensitive I had been to hormones over the years. When he prescribed the antidepressant he firmly stated, “You are not going to need this forever.I can’t really explain what happens to you when you are pregnant and nursing but you feeling this way shouldn’t be happening. I believe that when you wean and your hormones balance you will not need this anymore. Make sure you come and see me again then.” A light was opened for me. I hated the stigma that came with a midwife taking antidepressants. I must not have done enough yoga, taken my omega 3s, or used the right essential oils. Upon beginning medication I started to be aware of my baby’s babyhood, and the tragedy was that I had already missed out on most of his first year. The voices went away and the fog cleared. The anxiety was still high but livable.

     I had a hysterectomy, a rectocelle, and cyctocelle repair when my youngest was just twelve months old. It was very difficult physically and emotionally. I was in the hospital four days longer than expected due to a hemorrhage and was flat on my back, in bed for six weeks. I struggled emotionally with the truth that I never would have another baby. I knew it needed to happen, but I felt betrayed by my body and by my mind. I slowly grew to accept that things turned out as they did, and physically my health began to improve. Two and a half years later, I am still not fully recovered. I stayed on antidepressants until I weaned my youngest at the age of two and a half. I slowly weaned myself off Zoloft. True to my doctors and my own beliefs, I have been fine. The obsessive thoughts, OCD tendencies, depression, and high unlivable anxiety have gone. I still retained some residual anxiety. My therapist commented that she thinks it is a habit I have developed and I am working on things.

     I believe that I suffered needlessly, partly due to the belief by the natural birth community that depression, anxiety, OCD and psychosis do not exist when a mother chooses to birth at home. I also suffered because my midwives were not able or willing to refer me out to the mental health care that I truly needed. This is not ok. It is a tragedy that is affecting far too many naturally birthing mothers. It is for these reasons that I have chosen to share my difficult stories as a midwife, a mother, and a birth professional.