The Story of an Untreated Post Partum Mood Disorder

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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 19^th 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 26-28^th 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 37^th week, I was considered full-term, and started looking up every natural induction method I could find. The day I hit my 37^th 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 37^th 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.