Maternal Mental Health

Mental health awareness for mums

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I have written and rewritten this article more times than I care to admit, but the main reason is I really want to get this right. This week is perinatal mental health awareness week and that is what has prompted this post. This post started as a 5000 word piece and this is what is left.

As a GP, a significant proportion of the patients I see present with mental health concerns. This can range from stress related insomnia to psychosis. I see patients with depression, anxiety, personality disorders, schizophrenia, bipolar disorder and obsessive compulsive disorder to name a few.

More than 1 in 10 women develop a mental illness during pregnancy or within the first year of having a baby (Source: Maternal Mental Health Alliance)

Maternal mental health is a specific challenge that I generally discuss in it’s own right. Most of you will have heard the term Postnatal Depression and the vast majority of discussions around maternal mental health do focus on this. I think it is important to understand that the challenges pregnant women, and women in the postnatal period face can not always be defined as depression. Maternal mental health discussions should also include discussions that encompass feelings around a sense of failure, feeling isolated, worrying that you may not be bonding appropriately, fatigue, generalised anxiety, health anxiety and so on.

Of course, mothers and expectant mothers can have conditions that any other person can have yet it is pertinent to say that suicide is the biggest cause of maternal death in the UK. That statistic can not, and should not be ignored.

Opening up about your mental health is not something we use to take away your child. Our only goal is to support you and your child.

Now, before I share some thoughts from women who have been affected by mental health concerns during pregnancy and motherhood, I thought I’d explain how we approach mental health as clinicians. Firstly, the objective is never and has never been about finding women who are unfit to be mothers and taking away their children. If there is one thing I would like to stress it is this; Opening up about your mental health is not something we use to take away your child. Our only goal is to support you and your child. Please, please do not hide how you truly feel because of fear that you will have people swarming around your home ready to take your child away. From experience this fear stops many women from feeling able to open up to clinicians.

All pregnant and postnatal women are screened for risks of mental health conditions. If a woman has previously suffered with a mental health complaint then more support is usually offered during pregnancy and in the postnatal period. Occasionally the questioning around mental health from midwives and GPs can be fairly direct and probably not conducive to an open discussion. I generally ask “how’re you getting on?” or “how are you coping? Do you feel supported?” Sometimes I have a feeling someone may be struggling more than they are telling me so I say “Most people would be really struggling if all of this was going on. Are you struggling?” My patients normally know me very well and that certainly helps. My questions never come from a place of judgement and always a place of genuine concern. I like to think my patients can feel that and are therefore open with me. Sometimes though, I miss the cues. As do family and friends. So, I still like to stress that being open is not a negative. If you reach out for help, we will smother you with support and empathy. Things will be better.

7 in 10 women will hide or underplay the severity of their perinatal mental illness  (Source: Maternal Mental Health Alliance)

So, I’m not a mother and I didn’t want this piece to be a lengthy blurb about how doctors see perinatal mental health. You have Google for that. I wanted to get real experiences from women who have required some support because it’s these stories that help people going through the same realise that they are not alone.

Story 1

I have 3 children, all within a 7 year age gap. The first 2 seemed to go to plan, the 3rd, my boy, who was a surprise older age pregnancy (I was 35) took me by surprise when the post natal depression (PND) took hold. Things are a bit hazy but a turning point for me acknowledging how low I’d been feeling was kicking off at my other half leaving the house angry, upset and with the baby in the pram, tears streaming down my face, I’d walked like this for approximately a mile until I started thinking, what am I doing, where am I going? Why was I crying, why was I angry at my other half? I couldn’t answer any of these questions. I’d got a mile away from my home crying, confused and clearly not thinking straight (with my baby) he was happy, sleepy, and beautifully safe in his pram but I stopped myself, this could have been a lot worse if I had carried on in a complete haze!

I sat in a bus stop, calmed myself and texted Mr P, told him I was sorry and was coming home.

I ended up going to the GP and we’d kinda worked out that the contraceptive pill was having this effect but had only come on after giving birth. We tried another pill but that didn’t work well with the hormones either. We ended up with the Mr getting sorted (he had a vasectomy) and I just came off the pill. It was the best thing I ever did.  Guess I just wanted to share my story as I believe this could have been a slippery slope to something a lot worse if I hadn’t acknowledged and realised what was happening. The deep depression which came in waves monthly disappeared once I stopped putting these extra hormones in my body. Not sure if it was full on PND but I believe the hormones after giving birth have a lot to answer for.

Story 2

Having never suffered with mental health before pregnancy, I was completely thrown to get antenatal depression. It was awful. And I knew then that things would be a million times better once baby was born (and it was! I consider myself very lucky to have not suffered with PND).  But it all makes me very nervous and a bit scared of ever being pregnant again. I’m not sure I can face those dark depths again. The NHS were amazing though. The DR I saw at my GP surgery spent 45 minutes with me. Just having someone listen and not think I was over reacting or going mad made all the difference. My midwife was amazing and the perinatal mental health team were incredible. Thanks to the help I received, things got so much better and I was able to pull myself into a good place before labour.”

Story 3

“I had extra appointments while I was pregnant first time round as I’d had a previous mental health admission the year before. They decided at 33 weeks l was low risk as I had been fine during pregnancy but I was given an appointment for six weeks postnatal. A couple of people made me feel like it was a 100 per cent certainty I would get PND because of my previous issues. However when I subsequently didn’t attend that appointment (because I was in intensive care), there was no follow up at all. Presumably if they’d thought I was going to get PND anyway, the addition of nearly dying after my baby was born would have made it even more likely!? Thankfully I didn’t become depressed but I do think the follow up should have been better, even just a call, to see if I was okay.”

Story 4

“I was diagnosed with post natal depression when my second child was 1, it came as a huge surprise as for the first 10 months I was bossing it (or at least I thought I was).”

Story 5

“I didn’t struggle with a specific mental health issue but just wanted to say that pregnancy and motherhood are bloody hard work! I had HG (Hyperemesis Gravidarum) during pregnancy which was a very lonely and worrying time. And I had a period of very low mood/exhaustion around 12 months postpartum. I felt there was a lot of support for new mums – and quite rightly, that newborn period is so intense – but found myself googling things like ‘can you have PND after a year?’ I did speak to my health visitor about it and guessing she could have taken it further if I’d been really critical. But it would be great to have continuing mental health support with a view to that first year being a proper slog and cumulative effects of sleep deprivation.

Both times I reached out online, Pregnancy Sickness Support and Postpartum Stress Support on Instagram were great resources. As was my supportive husband who happens to be a psychologist, so think he helped me from tipping over – lots of talking and tears during the hardest parts.”

Story 6

I’m currently 28 weeks pregnant and under treatment from the perinatal psychology team for Post Traumatic Stress Disorder. I have suffered from it quite severely for many years but had been pretty much free from it for a couple of years following EMDR therapy.

I started trying to conceive (TTC) last year and unfortunately suffered a string of early and not quite so early pregnancy losses. Every time I got pregnant I would experience a surge in PTSD symptoms including hyper vigilance and dissociative episodes as the hormones came into my body. Eventually I had a pregnancy that stuck but still suffered heavy bleeding on several occasions, which caused me a lot of pain and anxiety. I became too anxious to leave the house at one point because I was convinced I was going to lose the baby any minute and was horrified at the idea that it might happen in the toilet at work. I then developed terrible sickness and fatigue, which again affected my mental health as I felt very low and lonely.

The biggest thing that has helped is an understanding why this has happened – because pregnancy triggers your threat systems, so my brain is trying to protect me and my baby.

At around 18 weeks pregnant, the intrusive thoughts and flashbacks had returned with a vengeance and I felt completely mad. I didn’t tell anyone for about two weeks and even hid from my husband that I was off work. Luckily earlier on I had spoken to my midwife and doctor about my worries it was coming back and told them I found it difficult to ask for help when unwell so I did have a crisis plan ready and eventually felt able to put it into action. I’m now feeling so much better although the symptoms are still as strong I’m coping with them much better. I have weekly sessions with a psychologist who is giving me strategies to build up my resilience and make me feel safe.

The biggest thing that has helped is an understanding why this has happened – because pregnancy triggers your threat systems, so my brain is trying to protect me and my baby (from imaginary rapists). This has helped me to be more compassionate towards myself and keep it in perspective. Knowing that I have the support of a multi disciplinary team is also very reassuring. A specialist mental health midwife at home will visit me before and after birth and have an appointment with a psychiatrist to discuss medication options in a few weeks. I am also being prepared for birth with everyone working together to help me come up with a plan that will allow me to stay in the moment as much as possible and reground myself if the experience triggers me.

There are lots of resources and expertise within maternity services for supporting women with a history of sexual violence or abuse because sadly it’s very common. So although it’s still really hard, currently awake in the middle of the night after a nightmare and can’t get it out of my head, I am feeling better because the support I have received has been amazing”

Story 7

I’m 36, live with my Husband and our two boys aged six and three. My Husband and I met nearly 14 years ago. I’m now a stay at home Mum. With my first pregnancy, I had an emergency c-section which I hadn’t prepared myself mentally to have. I struggled to cope with that outcome, my recovery and the isolation of the first five weeks not being able to drive and look after myself, baby and house properly. Second time was about a year in and I think I’m only just coming out the other side two years on; new location and being a stay at home parent has led to feeling lonely and useless. Also the monotony of day-to-day looking after kids and limited expendable income means a lot of time at home or at the park.

The first time I was pregnant, my midwife definitely picked up on how limited I felt so encouraged my husband to make sure I was getting out. The second time, I think a lot of my feelings were down to iron deficiency anaemia and a simple blood test 6-12 months post birth would have picked this up much quicker. My husband tried to help but that’s difficult at the end of a working day.

With my first child, I improved as soon as I could drive and was very good at getting myself out and about. Second time I’d had a really long run of colds, coughs, and feeling exhausted and I just wasn’t coping very well so went to see the doctor. This was 18 months after the birth though.

I’ve never sought professional help for my mental health. But have identified it’s really important for me personally to have a break from the kids. Seeing friends or time to myself at least once or twice a month. Finding places I feel comfortable with both kids so I’m not in a constant state of anxiety worrying about them. Just general social interaction!

If I could share one thing back that I’ve learned it would be, get out. Even if it’s on your own and for short bursts. It doesn’t have to be every day but getting out no matter the weather and discovering new places has been great. Admitting you are struggling doesn’t mean you’re a failure. In fact it means you’re facing up to how you feel and you want to get better. Sometimes the road is long but you will get there.

__________________

So finally I just want you to know that you’re not alone. You’re not weird. You’re not going to lose your child. You WILL get better. You are powerful beyond comprehension. You made a human and nothing is more amazing than that.

See your GP, talk to your health visitor, talk to friends and family, talk to your consultant, talk to your neighbour. Whatever you do just talk. We’re all on the same team and the help you need is out there. Please don’t suffer in silence.

Aish x

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