As a midwife with zero history of mental ill health, Caitlin didn’t expect to develop severe postpartum depression and anxiety at all, let alone after the birth of her second child.

She certainly didn’t expect to be wheeled through the same hospital where she worked down to the psychiatric ward for an eight-week admission.

And of course she never expected that electroconvulsive therapy (ECT) would be part of her story to treat her treatment-resistant depression.

In this poignant episode, Caitlin takes us on her unexpected journey of experiencing mental ill health for the first time in motherhood, of navigating the unfamiliar mental health system to receive the right diagnosis and treatment, and of confronting nearly every taboo of mental health along the way.

Finally, Caitlin recalls the special moment when she ‘saw the light’, when she no longer felt worthless, and when she felt a glimmer of hope again - which, after everything she went through, was something she never truly expected to feel again.

This isn’t an episode to miss.

You can connect with Caitlin on Instagram at beneaththepalms_midwifery where she draws on her own experiences to advocate for her pregnant and postpartum patients in Cairns, Queensland.

Please note, this episode discusses suicidality. Go gently.

“When I reflect, in hindsight, there were probably a few red flags throughout pregnancy. And I think that was unfortunately the era of COVID. So I pretty much returned post my first baby to work already pregnant with my second one. So yeah, it was quite a quick turnaround there.”

“And we were very excited. But COVID happened because I am a midwife working with the hospital system. We didn't know anything about that yet. So there were a few guidelines thrown out at that time… when you're into your third trimester, that you are better off to remove yourself from that area and work from home. But as a midwife, you can't work from home unless you're privately working during home birth. So we made a choice that it's probably best, because we didn't know what it did to babe, that I would take my mat leave early. And that was probably the first step to that, removing myself from my place that I love to socialise and work.”

“It probably looked like feeling very overwhelmed. My husband is also in the medical profession and he does shift work and on call. And when he's on call, he's about 45 minutes away. And I, very much with my first baby, just did everything. I probably definitely didn't embrace my village because my parents lived in Melbourne and I'm in Cairns, and we do have Andy's parents up here. But I definitely didn't embrace that village to seek support and help because I just did it by myself.”

“So I think when I went on mat leave early and I was pregnant, I had a lot of pelvic pain. It was really hard to look after a between 12 and 14 months old kid at that time. Very active, very wild child, and keeping up with that was really hard. And I definitely felt feelings of being overwhelmed and more than just emotional pregnancy emotion. It was, in hindsight, it was definitely much more than that. Yeah, and frustration at times. And just thinking about how I was going to manage two, essentially two babies.”

“Birth is definitely my favourite part. And I definitely do that the best. So I came out of that feeling pretty good, but Andy always takes about six weeks off. So we did that again. And then it was probably on his return to work that I started to feel really overwhelmed by that because in my head leading into this, I was like, ‘I did it with my first by myself, I'll just do the same’. And clearly, that's not reality. So I think I set myself up with that, and then I couldn't do that.”

“And then having for me to ask for help was really, really hard. And I think seeking support from… as much as Andy's family is my family, they're still not my family. And those thoughts of like, they don't have to accept me for how I'm presenting at the moment or what I'm saying at the moment or what I'm feeling at the moment. In my head, my family, my blood family have to and they will. So to ask people that are not my blood family to support and help me during this time was really, really hard.”

“And they wanted to help, but I just couldn't get past that. And being COVID, living in Cairns and my family living in Melbourne, I may as well have lived on the moon. There was no way them getting up here was going to be possible.”

“And upon Andy's return to work, I just felt very isolated. And then I fell into this very rigid, I can't leave the house because my baby needs to sleep. And then getting up all night, breastfeeding. And then I felt the mental and physical load of breastfeeding. And then I started to resent that! And then I felt like, ‘if I'm not enjoying breastfeeding my baby, what's wrong with me?’ And then it's just those spiral thoughts.”

“And I definitely remember saying the word Earth mother a few times. I'm not an Earth mother because I'm not enjoying breastfeeding. What's wrong with me? And then that social media portrayal of the mother that enjoys wearing her baby 24/7, co-sleeping, breastfeeding. And for me, I wanted that separation. I couldn't handle that constant touch at that time.”

“I just had no concept of the other people felt like that, that other people maybe didn't enjoy breastfeeding, or I think I went into it thinking, ‘I should love every day. Every day of parenting should be amazing, and I should find happiness and joy’. And the more that I didn't find that, the more I didn't find any joy.”

“As a midwife, we counsel people about this, but I definitely would have been mindlessly counselling people about it because I had no actual understanding of it. So that was really hard that I've... That feeling of once I experienced it, and then I felt like, did I let all these women down that I maybe didn't support? So there was a component of that as well.”

“I guess I anticipated that having some sort of history would like increase your risk of getting it after. But I guess in my head, I was like, ‘I have a house, I have two healthy lovely children. I have a very extremely supportive husband. I work in this industry. How have I ended up like this? I don't deserve to be feeling like this. I don't have enough bad stuff happening to me to feel like this’. So I think my thoughts previously were that you need to have quite a drastic social situation to experience that.”

“And then you get fed these lines of like, ‘well, just be grateful that you have two lovely, healthy children and there's nothing wrong with them’. And it just fed it. It just grew and it grew and it grew from like this teeny tiny little comments, which are not meant in a harmful way, but they have a huge impact. And I think it's always when you go to expose yourself or reach out to someone and that's what you get, then you're like, ‘well, I'm not going to talk about it anymore because it's not the right thing to say.’”

“Well, I guess what perpetuated the visit [to a GP] is I just didn't feel right. And my anxiety presents in fight or flight and anger, rage, not towards my children, but to myself. I do get passionate, but I don't get angry. So I'm like, ‘this is not okay.’”

“So I spoke to Andy. I'm like, ‘look, I think I to go and have a chat to my GP’. And I didn't really see a GP normally. So I had to find someone and I have a very great GP and she is lovely. And I went, but I definitely lied on all those tests that they tell you because I was still feeling vulnerable. But even on lying, what I was scoring at was still not normal.”

“And presenting in that COVID time, obviously, the first line is like, we talk about it, we do the questionnaires, then we talk about, she created a mental health plan for me. But then we actually had to find a psychologist that has availability. Like the lady up here who is amazing and is now my psychologist. This was November, and I couldn't get anywhere near seeing her till February!”

“So I ended up getting in with someone else, which I went to, but we didn't click. And, perinatal is such a niche. And you got to have someone that knows what they're doing in that space.”

“And that's what I was about to find out, the lack of resources and the lack of experience in this space was definitely about to draw out before I got any recovery sign of any non-acute phase. It was about to get worse.”

“So I did one appointment with the psychologist and I was like, I don't think she's right. At that point, I was like, ‘Well, it's not useful. It's not going to help’. And then I think I had a review booked a month later with my GP, and then that's when we discussed medication. That obviously comes with a lot of hesitation.”

“I did a lot of reading about it. I had a discussion with a friend who had also had anxiety within her pregnancies, and she helped me and reassured me, Andy helped me and reassured me. So we gave it a go.”

“It did not work.”

“So I had to wait for those two weeks before it kicks in and it just did not touch the sides at all. And it just kept going. We switched to something else. Two weeks, that didn't work. And then by this time, it's December and we know what Christmas is like.”

“So that build up of Christmas and trying to make everything perfect for my kids. And to be that, to look like I'm that mother who's creating that magic for their children. Definitely one of my lowest points was Christmas Day.”

“Andy was supposed to go off to work that day, and I had an epic panic attack, and there were panic attacks leading up to this. And then leading up to that, that's when those, sorry, trigger warning here for anybody, intrusive thoughts that then became a plan. And yeah, so for someone who could never understand how someone could take their own life, I was suddenly quite willing to, which was definitely where it had to... Yeah, so I spent my Christmas 2020 in ED.”

“I was definitely not alone on Christmas Day in ED, unfortunately. It's such a build-up of a day for people. So I have full understanding of that now.”

“The Christmas Day presentation was a bit of a band-aid fix, where Andy actually had to severely advocate for me to be reviewed. And not just be like, ‘you'll be okay, we'll give you some medication to deal with the breakthrough anxiety and then just follow up with your GP’. And at that point, he was like, ‘we've done all this. This is not, I can't keep her safe’. And I think we definitely both understood at that point and now what the importance of that collateral history is and actually listening to the person knows that person better than you do. So it was definitely a big learning curve for both of us.”

“He definitely had to fight, not fight, but advocate for me a few times because I think the lack of resources up here is that lack of experience within the perinatal space. So techniques that work outside of the perinatal space don't work in this situation, which is, yeah, very unfortunate.”

“And him watching me, my brain was completely broken. I was so not the person that he knew. And he copped it. The frustration in the rage and how I would voice my frustration at him and I would walk out of the house and he wouldn't know where I was - And there were so many components that he had to deal with leading into this admission.”

“So I remember, I didn't want to go home, but they made me feel like that I didn't need to be there. I wasn't ‘bad enough’, whatever that even means… But that was my crisis point, yeah.”

“I do have a support system and those protective measures, but he couldn't protect me anymore.”

“I had to follow up with that acute care crisis team, which were really good. And then I think at that point, we do have a perinatal outpatient team, which I think I don't... And some of my memory is a bit fuzzy at this point, but they did end up participating in my care. But then I think I presented two more times to ED, and on that third time, I was actually admitted.”

“And then that's when I was admitted for about eight weeks.”

“And obviously we have no mum-and-baby unit here. So it was just me within a mental health unit, which was frightening.”

“The extra layer to this is like, this is my workplace as well. This is where I work.”

“So I remember, you get escorted from ED down to where you're going and you have to have a security guard with you, and you're in a wheelchair. You can't walk, you're not allowed to walk, and Andy wasn't allowed to come with me. So obviously, you're in a wheelchair with a security guard and a nurse that's pushing you into this area of the hospital that I've never been before. And then I didn't have anything, but whatever I did have, my handbag was put away and I was in a room. And with people, that were also at their crisis point to different degrees with all different mental health problems. So that was extremely terrifying. I couldn't believe I got to that point.”

“In the first two weeks, there was a lot of changes in medications because it was still... It was very treatment-resistant! We were still trying to find something that worked.”

“There were a couple of times where Andy would come and visit and they'd encourage me to have an hour's leave and go for a walk with him. And then we ate something and then we came back. And then the next day I was reviewed and they were like, ‘oh, so you're happy now. You look like you enjoyed that’. And I'm like, well, ‘you told me to do that.’”

“And then it escalated to ‘well, do you even have PND? Do you have PNA? Do you have bipolar?’”

“It was a very interesting experience to have that. And then it switches into this, ‘am I making this up?’”

That was very confronting. And at that point, I think Andy had to advocate again and he was like, ‘well, I think we need something more, some more experience in here.’ And that's at that point, I was incredibly lucky that the perinatal mental health outpatient team actually stepped in and looked after me as an inpatient. And at that point, when I had my first meeting with them, was just like a turning point.”

“I went into that room and they got it. They understood. And then they're like, ‘this is exactly what is going on for you.’”

“They saved my life. Man, and there was a whole change in medication. We went really old school to overcome the crisis.”

“I had done my own research into ECT because this medication changing is just, you know what it's like with the side effects and then it doesn't work?! And I was like, ‘well, maybe this is a road to go on’. And then so I floated that with them and they were like, ‘well, I'm glad you brought it up because we were going to bring it up, but it's so taboo’. And as soon as you mention that term, people think, One Flew Over the Cuckoo's Nest. That's exactly what people go to. And that's exactly what my parents went to when I told them.”

“Because I was admitted at that time, I had met another mum who was further down the track than me, and ECT had worked well for her. And then I met someone who had a ECT and they found it very helpful. So then I discussed it with Andy and we looked at it from the perinatal health view and he did a bit of research. And we just wanted to see what the perinatal outpatient team thought. And that's what they were like ‘That's what we were thinking. We didn't want to scare you, but that's what we were thinking.’”

“I think it's just that taboo and what it actually is. And I think what people visualise it to be versus what it actually is. And I definitely feel like I suppose commencing ECT as well as that, going back to a really old school medication got me through that crisis point. And it can reset my brain to be able to repair.”

“Mine was, instead of being bilateral, it was unilateral, trying to minimise the memory loss.”

“But I do remember waking up from my first one and then the lady in recovery asking me how many children I have. And I couldn't remember having children at that time. And that was terrifying. About half an hour later, I did, but I didn't remember initially… it was terrible… crying in recovery because I couldn't remember.”

“But yeah, [ECT is] definitely what kickstarted my functioning again, having any expression and feelings… I can't recommend it highly enough if you got treatment-resistant PND, and if that's been presented to you, it's definitely worth investigating.”

“The first time was not so bad, but after waking up, not remembering I had children and waking up very panicked, I was then anxious about every other time after that.”

“I had about six sessions over a fortnight, on alternate days, about six to eight, I think. And I just remember going in and thinking, ‘how is I going to wake up this time? And am I going to remember I have children? Or am I going to lose my memory of my little people? Or am I going to lose memory of times with my husband and my family?’ And I didn't want to lose those components of my history and my life. So that was definitely the hesitating part.”

“I also remember being wheeled in a wheelchair down to the theatre and down a hallway and seeing people that I work with walking past me saying hello to me and being like, ‘why are you in a wheelchair?’ So I think that was confronting because at that point I hadn't told, I wasn't, at that time, where I felt open to talk about it. I felt very strange, I guess a component of shame to it and stigma.”

“There's components of that section that I still don't remember. Sometimes I'll see a face and I'm like, I know that face, I can't place it. There's conversations I don't remember having people I spoke to, I don't remember speaking to.”

“And that's normal to a degree for that depressive episode as well.”

“And you get a headache for 24 hours and I just give you some pain relief after for the headache, but that usually is just for the day after. But then I felt the effect of it working. And then I felt less worried about going into it. I knew that it was... I felt less weird about it because I knew it was working.”

“And that for me was a relief because I, at that point, thought nothing was ever going to work and I was just going to feel like this forever.”

“I definitely felt more feelings of like, I want to be here. I want to be present to be their mother. I want to be present to be with Andy. I guess I do have something to contribute. I do have good components of me. I could see those small components of becoming a mother.”

“At this point, my mum had come up from Melbourne and she was living in the granny flat to help. And so Andy had to take long service leave from the hospital and all that to help. So yeah. And he was doing as much as he could for me as well as looking after the kids. And then my mum was looking after the kids.”

“So as my medication worked, I did try to get home at dinner time. So I would do that and then [Andy] would drive me back.”

“I think I couldn't do more than an hour at home, I couldn't do that. That was enough, before I got too anxious.”

“As I was being discharged, that's when my psychologist took over as well. And I feel like the medication gets you through your crisis point, but the psychology has such a significant component to it. And I definitely felt like once I started seeing her, developing strategies and understanding what's normal and how to work through those thought trains that you get, I was like, ‘I'm not enjoying today. I'm not a good mum’ and how you acknowledge them and you can work through them.”

“[The outpatient perinatal team] took over my care and I was seeing the consultant psychiatrist and the registrar psychiatrist. And I had such a good team and a psychologist within there. And then the acute care team also did a couple of components because recovery wasn't straightforward. It was up and down. It's not linear.”

“So there were components where I had deep downs, but then they really just kept everything going forward. And then they hand over to my psychologist, and I still see her. Yeah, but at the start, I think I was seeing her weekly as well as the perinatal outpatient team. Now it's every three months. So I'm graduating, getting there.”

Medication is still part of Caitlin’s long-term mental health care. “So I used that to get through my crisis mode. So that was started in January. And I think about May, when I was an outpatient, my depression had resolved and it was just more anxiety now. So I switched on to something that I'm still on today. And there's something in addition that if I get that physical anxiety or I'm feeling a little bit overwhelmed, but I take that less and less now. But I mean, I'm still on that. I'm It's going to be a long term thing, I think.”

“And the stress, I don't know, the stresses of parental life and having had that experience, I can't imagine coming off that and going back down. And yeah, I'm very accepting that's my road. And it helps me, whatever helps me to be who I am.”

“I remember the point where it became more than hope.”

“I was sitting in the front yard with Pete and he was climbing up a slide and he just looked at me and he smiled. And I just went, ‘oh, there it is’. I'm like, there's his love for me and there's my love for him because that bond was obviously broken and because I was broken. And I knew that I loved him, but I couldn't feel it. I couldn't feel anything other than just worthlessness.”

“But then I remember looking at him and he looked at me and I just cried because I was like, ‘oh, this day has actually arrived’. I can feel it. And I'm like, ‘I've actually made it’. I can see the light and the sun shining through. It was just a big dark cloud for a long time.”

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