Sometimes you set out to have a conversation with someone, and you think you kind of know what to expect. And sometimes an interview turns into something else entirely. My talk with Cara McNulty became an intimate discussion about maternal mental health, and what it feels like to be a career-driven mother with anxiety.

Dr. Cara McNulty is leading CVS Health’s strategy to expand mental health services and resources, and she has a powerful platform to help improve access to mental health care for millions.

Her own anxiety story began many years ago when her 6 month old daughter got RSV - and Cara found herself rocking on the floor, refusing to let the baby go. Refusing to eat or shower.

Like me, Cara is a “person who looks like she has it together.” I appreciate her reflections on the pressures she felt while being a mother with anxiety: the pressure to be perfect at breastfeeding, the guilt of being passionate about your career, the overwhelming need to be the “right” kind of mother. 

Cara says, “I knew I wanted to be a mother before I knew I wanted to do anything else. I also knew I wanted to work. And so I felt that struggle of, I need my own identity, but am I screwing up my kids? Going back to work, I had anxiety. It just sparked my anxiety.”

My mental illness surfaced as antenatal depression and anxiety when I was pregnant with my first son. He is now almost 14, but I can remember those excruciating first months of pregnancy, when I could do nothing but wail on the floor. I just felt like such a failure. 

Because when you tell people you are pregnant, they are usually excited for you. Especially when you are a 31 year-old married woman. Friends' voices rise several octaves in squeals of congratulations. You are expected to respond with similar enthusiasm, jump up and down a little bit, and grin unreservedly.

For the first couple months I told people I was pregnant with my first baby, when they squealed, I had the instinct to cry and tell them to go F themselves. I would want to scream, no, I don't want this baby. I'm not happy about this. Somehow, I'd fake my way through it, and then go home and lie on the floor. Sometimes I would sob uncontrollably. I was mean as a snake to my husband (his exact words). I felt the baby was the end of my life. I had just finished graduate school and in summer of 2008 the world economy was going to hell. I had no job, and was in the middle of a career transition. I blamed my fetus.

One day when I was about five months along I went to prenatal yoga. Lying in the yoga studio, looking up at huge glossy photos of newborns that adorned the walls, I felt a surge of anger towards the babies in the photo. I hate you, I thought. I hate all of you. I said to my mom, I don't want it, I don't want this baby.

I was clinically depressed. I was literally not myself.

My therapist called a summit with my husband and my mom. We discussed antidepressant medication and decided I needed it. We made detailed schedules of my day so I would feel less anxious. I was told not to think of when the baby was born, but only to focus on the here and now. But when you are anxious, depressed and pregnant, thinking about attachment is terrifying. Doctors tell you that your chances of postpartum depression are so high that you may not attach to your baby. And because you feel so awful, so unloving, you can't imagine loving your baby like you know you should. And you feel terribly guilty because a mother must love her baby. That's what has to happen.

So what happened to me? The months passed, my pregnancy progressed, and I grew more at ease with the idea of being a mother. Slowly, the depression lifted. I was able to start buying things for the nursery, to attend birth preparation classes, and to think of life after the due date.

The minute my son was born, I fell madly in love. Literally, as I felt his shoulder pop out of me after a 52-hour labor, I knew it was going to be ok. I felt such joy. I had that euphoric feeling that I was unstoppable and could climb mountains with him attached at my hip. I went on to  have two more children.

As I'm writing this I hate myself for thinking of my beloved son as the "it" I once resented. How could that have been? The mind can betray us. But we can climb back.

If you have a story about maternal mental health, I’d love to hear it. 

Morra