When I got pregnant with my daughter Claire, I wanted what all new moms want: an easy pregnancy, a smooth labor, and a baby. But almost immediately, things seemed to be off.
By my sixth week of pregnancy, my morning sickness (or, what I thought was morning sickness) was so terrible that I was in and out of the hospital. I couldn't keep food or water down. I was severely dehydrated. I was diagnosed with Hyperemesis Gravidarum, or HG, a fancy term for extreme nausea and vomiting while pregnant. Like so many of us, I had never heard of hyperemesis — I had no idea that morning sickness could take such an extreme and debilitating form.
My doctors tried me on medication after medication, hoping to stabilize things. But after several weeks, I was still losing weight rather than gaining. So we tried a new approach. I went on bed rest for a month, and the doctors put me on a Zofran pump to deliver a more intensive flow of medication straight into my bloodstream. Home health nurses would visit every few days, too, giving me IVs to help keep me hydrated.
And with this new strategy, things started to seem more or less manageable. I would still get sick, but I was cleared to go back to work, and I did — as a social worker for people with HIV/AIDS. (Was I actually well enough to go back to work? Well, that’s a different question.)
Sometimes I still needed to go to the ER, where the doctors would ply me with IV fluid and meds to help replenish everything I’d vomited. It was a band-aid, essentially — just enough to bring me back to my very shaky new “normal.”
As the months passed, it was hard to even think about the baby coming. If I was already this exhausted, barely functioning, how would I possibly take care of her?
As it turned out, Claire arrived under circumstances I would never have imagined. At 32 weeks, I went to a routine appointment at my OB’s office. I peed in a cup, per usual — but this time, my urine showed that I was in ketosis. “You’re spilling proteins,” the doctor told me, and I had no idea what she meant. “You need to get to the ER right away,” she said, and so I did.
My husband Mike met me at the ER where I was quickly admitted to the antepartum unit and we discovered I had preeclampsia, which is dangerously high blood pressure during pregnancy, and HELLP syndrome, a life-threatening complication that threatens major organ systems. My medical treatment team was trying to balance an unhappy equation: The longer I stayed pregnant, the sicker and sicker I would get — but it would give Claire more time to grow and develop in utero. NICU nurses visited me and I remember them explaining that every day baby stayed inside my tummy saved a couple of days in the NICU.
Five days later, seven weeks before my due date, the calculus became clear. I was getting too, too sick. It was time for my daughter to be born. I had a C-section, and Claire came out crying. She was beautiful! She grew stronger in the NICU for fifteen days, and by the time she was ready to go home she was just a little over four pounds.
I had my own long recovery ahead of me. In addition to the C-section recovery, my organ systems had been stressed to their breaking point. I had been so sick that it was hard to even feel afraid about how sick I was. But as I recuperated, I could see how terrifying and tenuous it all had been.
Emotionally, things were in chaos. It proved way too difficult to function at work and I was ‘wired and tired’ at home with baby. My sleep was off, my appetite was weird. Trying to breastfeed a tiny preemie was so much harder than I ever thought it would be. During my first postpartum year my family went through several stressful events, including job changes and moving. I remember walking down the hallway in our new house and I would hold my breath and cradle Claire even tighter when I had to walk past the stairs leading to the ground floor. Scary thoughts would pop into my mind about her getting hurt and these thoughts would spiral out of control.
I knew this wasn’t normal anymore. I mean, I wasn’t certain, but I felt like things seemed out of control and my feelings, moods and thoughts felt extreme most of the time. Luckily I had a wonderful OB/GYN who was informed not only of Hyperemesis, but also knew how to properly treat and identify Perinatal Mood and Anxiety Disorders (PMAD). I felt safe to tell her about my scary thoughts. “I don’t want to hurt my baby...but I think about her getting hurt by accident all the time.” My doctor prescribed me medication and helped me find a therapist and was eventually diagnosed with postpartum depression, postpartum PTSD, and some symptoms of OCD.
My first postpartum journey after my daughter began a years-long path of multifaceted healing, including medication, one-on-one therapy, group therapy, and tons of self-care. I read everything I could find about Perinatal Mood and Anxiety Disorders (PMAD).
I also got eastern and western medical care to heal all of the complications related to hyperemesis gravidarum, including metabolic issues, excessive weight gain, migraines, rashes, leaky gut, pre-diabetes, thyroid and adrenal issues.
I absolutely recognize that I benefitted from privilege during my postpartum journey. I had quality access to health care, good insurance, a loving, safe and employed spouse to help every step of the way along with amazing family and friends. I was also a skilled social worker experienced in making connections in my local community and working with other medical professionals. And it was still completely overwhelming!
Looking back I needed comprehensive care for all of the emotional, physical and mental challenges the first few years of motherhood offered. I needed the medical professionals in my life to anticipate and prepare me for the possibility that because of my family history of mental health issues and the fact that I had a traumatic pregnancy that I was at a higher risk for postpartum depression and postpartum ptsd. I needed a skilled mental health therapist who knew about high-risk pregnancy complications, particularly hyperemesis - which isn’t rare but rarely talked about. I needed someone to provide services in my home because I was too ill to drive anywhere much less walk. I needed someone to really understand what I was going through and stop telling me “it will all be worth it when baby comes”.
I eventually found most of those things in time. But I had to fight and advocate hard for myself. All while working full time and taking care of a sweet little baby and trying to have a healthy marriage and maintain friendships etc. It shouldn’t be so hard.
Four years later, when Mike and I decided to have a second child, I wanted things to be different.
I purposely looked for employment as a clinical social worker at an agency that valued working moms and families and offered a healthier work-life balance. I figured I would have another high-risk pregnancy and wanted to make sure I had the support team I needed. We moved closer to family and gave extended family a heads-up that we would need their help if we were to try to have another baby.
As soon as I got pregnant again, my doctor and I went into pro-active mode. We got started with oral hyperemesis medications right away, and I was told to take baby aspirin each day to help guard against preeclampsia. (Of course, talk with your physician before starting any medication.) I was so excited but also cautious because I knew things could take a turn for the worse.
I wanted to do some mental health prep, too. I had a strong sense that this pregnancy was going to be rough, so I immediately tried to find a therapist. It’s true that pregnancy is an ideal time to start therapy. Humans have a surprising capacity to “cope ahead” when troublesome events are headed our way, if we have the time and support to make a plan.
In my first session I started to explain my hyperemesis diagnosis and how scared I was about the medical and mental health journeys ahead of me.
“Have you tried crackers?” she asked.
The question was meant with kindness, of course, but it was totally off base. Saltines are great if you’re queasy, but for someone with hyperemesis, we are way past what crackers could possibly resolve.
Oh, you don’t get it, I remember thinking. I felt a rush of sadness. I don’t have time to find somebody that gets it! I guess I just won’t have any therapy….
That moment, walking dejectedly out of the therapist’s office at the end of my session, became the seed of Sage Tree Therapy.
I dreamed of a therapy practice where moms and moms-to-be could get expert mental health care and expertise specific to the experiences of fertility, pregnancy, birth, and parenting.
As my pregnancy with my son James progressed, with another diagnosis of hyperemesis and eventually preeclampsia which resulted in another emergency C-section, I became more and more committed to the idea of therapy that was specialized in what moms go through. We don’t always have control over the circumstances in our lives and in our bodies, but we do have the power to tell our stories, seek support, and give our emotional experience the space and care it deserves.
Sage Tree Therapy became a reality when James was about a year and a half and Claire was six. It was nerve-wracking to leave my wonderful full-time agency job with benefits to strike out on my own.
But I soon discovered all of the moms throughout St. Louis who were desperate for therapy that recognized the reality of what they’d experienced in pregnancy and childbirth. Moms came to me because I ‘got it’.
Since then our team has grown to include a half-dozen clinicians, each with expertise in perinatal mood and anxiety disorders. We also bring expertise in domestic and sexual violence, anxiety, high-risk pregnancies, bed rest, children with special needs, the foster and adoptive care system, suicide prevention and substance use disorder and addictions. (See our bios for details on each therapist’s focus.)
OBGYNs and other professionals know Sage Tree Therapy as a trusted resource for anyone experiencing birth- or pregnancy-related trauma, including the all-too-common, but unfortunately under-diagnosed, conditions of postpartum depression and anxiety. This is what we do. No matter how complex or harrowing a client’s circumstances, we have likely helped someone else through that same heartbreaking spot.
We make it as easy as possible for moms to get the care they need.
For the remainder of 2021, all our clinicians offer therapy exclusively online, and we plan to continue that model for any clients who appreciate the convenience of online appointments. This also allows us to serve clients throughout Missouri, from the college towns of Columbia to the rural farm towns between Kansas City and Springfield.
When public health conditions allow, we will return to offering in-person therapy in the St. Louis area in an office setting. We will also serve moms in their homes for up to 12 weeks after delivery, and/or if they are on bedrest during pregnancy.
Having been through postpartum depression and postpartum PTSD, I know that you can feel very alone sometimes. We can feel like we’re ‘going crazy’ or that we’re bad moms because we don’t like parts of being a parent. It can feel hopeless, but there is expert support available. There is help, you are not alone, and treatment works!
To get started, email firstname.lastname@example.org or call 314.485.SAGE. We can respond to any questions and get you scheduled for an assessment appointment, which allows us to match you with one of our expert therapists.