postnatal depression | Motherworldly

08 Jan

Prepare for the worst

This week I’m hearing a lot from the 3rd Annual Birth Trauma Conference, particularly about mental health after birth, and how well prepared – or not – women feel. Milli Hill pointed out in a tweet what a straw man it is to blame antenatal preparation alone:

“Blame goes to antenatal teacher, or the woman herself…but oddly never to the system that doesn’t give women optimal chance of straightforward birth but instead often traumatises her. #birthtrauma18”

There are two things to look at here. One is how possible it really is to cover birth trauma and an issue as serious as postnatal psychosis, in a group of 8 couples (for your average NCT class), in a limited period of time and alongside other huge important topics, and in a context that is intended to empower women in the birthplace? The other is, how much impact does antenatal education have in the face of the barriers to straightforward birth including but not limited to lack of continuity of care, time pressures put on women by staff with time and protocol pressures on them, lack of real informed consent, and a society-wide assumption that birth is difficult and dangerous, and a healthy baby is all that matters? It’s a lot easier to say “NCT set me up to fail” than to acknowledge that the entire system sets women up to fail.

I spend much of my working hours and my voluntary time chipping away at the system, and write and broadcast constantly about those big issues. So let’s just look at that one smaller issue, how we tell a group of already-fearful pregnant women that birth might leave them with PTSD, without undoing all the work of empowering them to trust their bodies and birth their babies with as little unwanted intervention as possible. I can’t speak for all antenatal education (and let’s not forget that NCT isn’t the only provider of antenatal courses), but I can tell you about my own. I do this in small groups, providing a set of handouts and a case study for each group. The case studies cover baby blues, postnatal depression (men and women) and relationships and expectations after the birth. The handouts also mention postpartum psychosis. The ensuing discussion covers risk factors, symptoms, self-care, support, and so on. Some groups really engage with this, and often when someone has experience of depression, they make very valuable contributions. I’m always aware that there may be people who have experienced it and will stay very quiet. Once I observed an antenatal session where the practitioner covered feelings after birth immediately after doing a relaxation, and left the lights down low; in that atmosphere of safety and calm, a woman shared the story of her antenatal depression and it was powerful.

I just want to say that if even NCT, who have the best trained and most rigorously assessed antenatal practitioners out there, can’t always get this right for women, perhaps we need to go back and take on the difficult task of addressing the big issues, and work together instead of blaming – which potentially puts people off accessing valuable support and education. It’s also worth noting that antenatal educators of any brand don’t operate in a cheerful idealistic vacuum: we sit on Maternity Voices Partnerships, we campaign, we listen to women, we make and listen to podcasts, we are mothers; and we are involved in the system and we are active in trying to make it better. “Setting women up to fail” is an unfair accusation.

15 Mar

Book Review: Why Perinatal Depression Matters, by Mia Scotland

This is the first of the Why It Matters series that I have read, and I am deeply impressed that so much insightful information is packed into this densely thoughtful little book, although I feel that it may have the wrong title. I feel this because any new parent or parent-to-be could learn a huge amount about what they might feel or be feeling, why this happens, and many strategies to protect against or cope with it.

Psychologist Mia Scotland creates a very vivid picture of what perinatal depression is, for those who have never experienced it, and then sets it firmly in its cultural context. The central theme here is support, the concept of the village that it takes to raise a child, and how hard it is in these modern times to manage without this. Her writing style is strong and clear, and she includes a great explanation of research and evidence, and the limitations of applying these to individual circumstances. I found the whole book to be excellently evidence-based and sensible, and at the same time striking a mother-centred and deeply feminist tone.

Even though the section on actual therapy for perinatal depression is quite small, the book offers a range of preventative strategies that would certainly be useful for most new parents. Rather than simply exhorting the mother to seek support or take care of herself, Scotland has plenty of practical ideas about how she can do this, and how other people can help.

This is a sensible, informative book, which I would recommend to parents, expectant parents, and people who work with parents: an absolute must-read.

[Disclosure: I was sent a free review copy of Why Perinatal Depression Matters, which you can obtain from the publisher’s website here.]

19 Oct

Book Review: The Food of Love, by Kate Evans

The Food of Love is a fun breastfeeding guide full of Kate Evan’s clever pictures and even fuller with words. I think it is aimed at mums-to-be and new mums, but I think it’s also widely enjoyed by people working with new parents.

There is a lot to like about this book. Most of the cartoons are funny (some of them are a bit judgey), and it is jammed with a huge amount of well-researched information. Evans positions herself firmly at the Attachment Parenting end of the spectrum, and is more than capable of backing up her position with evidence. Unfortunately she doesn’t, always, which relegates a lot of her bold statements to opinion. The book would be much stronger if it was better referenced.

In the early chapters, Evans covers the basics of how breastfeeding works, using cartoons to demonstrate very clearly the mechanics of breastfeeding as well as a lot of the interesting sciencey stuff about breastmilk. The section on hand expressing is excellent; the section on positioning is surprisingly prescriptive – I’m sure laid-back Kate didn’t always sit bolt upright to breastfeed.

Evans’ passion and enthusiasm for breastfeeding comes across on page after page of often rather stream-of-consciousness text, as though she has scribbled down everything she can think of about breastfeeding, and when she runs out of that she goes on to talk about parenting in general, sleep, postnatal depression, relationship stuff, and toddler discipline. It’s a really useful general parenting book in that respect and could probably reach a wider market if sold as such.

I enjoyed the lovely bit on the evolutionary context of attachment theory, again illustrated with amusing drawings. Occasionally she follows a fairly idealistic opinion section with a contrasting realistic cartoon, for example the starfish baby in the middle of the bed showing the reality of co-sleeping for many parents.

We have the obligatory dip into alternative medicine (which if it worked would be called medicine), which is a shame when she’s so clear and comprehensive on brain chemistry and other sciencey stuff. The recommendation of homeopathic belladonna as a treatment for mastitis is a highway to a breast abscess.

The chapter offering solutions to common breastfeeding problems includes some excellent flowcharts (pp131-132), however the solutions offered are a bit garbled in places and there is no signposting to reputable breastfeeding support organisations such as NCT or ABM, nor any discussion of breastfeeding support groups (which surely would lend themselves well as subjects for caricature).

In summary, I loved parts of this book but not all of it. I probably would give it to a new parent, but not universally; I think some people might be more receptive to it than others. I’d love to see it repackaged as a general parenting book as it’s so good on attachment parenting. And I can strongly recommend Kate’s blog!

22 Jan

Let Someone Catch Hold Of You

Relly is a writer, speaker and web content person. She lives in the Home Counties with her husband and their two small sons. As a result she thrives on country air and can be guaranteed to stand on Lego at least once a day.

I have a good life. I have a nice house which I rent. I have a good husband who I have been with for over ten years and 8.5 of them as a married couple. I have two amazing little boys who have both enthralled us and worn us to a nub for the last 6.5 years. I have a good brain that writes cool stuff for people, sometimes even for money.

I also have depression. I’ve had that longer than anything, around 17 years now, like the manky old sweatshirt that ends up in the back of your drawers – even though you’re sure you chucked it out last century.

I have seen depression described as a black dog, and a great comic book illustrating it as such, but for me a dog would be a comfort compared to depression. Depression, to me, is a dead weight that you must lug around from room to room, job to job, relationship to relationship. It feeds on you and your inner fears about yourself.

When my first son was born I had post-natal depression. I went to the doctor, practically dragged by my husband, two weeks after the birth and told him I was upset because our sink wasn’t working properly. The house was a mess after the baby. I was still heavy with milk and the midwife said I could get something to help with my sore skin. He listened to all this, with his head cocked to one side, and let me trail off to silence after I was done telling the carpet under my gaze all about my material concerns.

I looked up briefly. He asked me if I had bonded with my baby. I looked at the 7lb bundle sleeping jerkily in his carseat, fourteen days into our lifelong relationship. I was convinced I was not good for him. I was convinced I wasn’t even adequate. My husband was the most stressed I’d ever seen him. My body was an uncontrollable, lurching, leaking disaster after an emergency caesarean. My baby was uncomfortable drinking my milk, drinking formula, drinking reflux formula.
“No.” I said in a shaky whisper. “I want to give him away. I am not a good mother.”

I had fed my baby, rocked his crib for hours, researched ways to help him with his reflux, dressed him, changed him. But I hated holding him. If I picked him up he puked on me. Every time. So, I stopped. I sat at an arm’s length distance to him for around 72 hours. I tried to imagine telling everyone that I was giving him up for adoption – my husband, my parents, my inlaws. I realised that was not going to work. I started to plan running away but I had nowhere to go, and I was still so, so tired from the birth and everything after.

Then I stared at wall for three hours straight and wondered about suicide. I didn’t really feel suicidal but it did seem like a solution that meant both my husband and my baby were off the hook. These two people that I was not actually worthy of, who were being severely hindered by me. My husband made a doctor’s appointment for me during my three hours of quiet contemplation (I’m sure I was meant to have been napping really). I agreed to go because my husband asked me.

Two weeks later, I got offered a talking therapy session with a local counselor. I was really not into this at all but I went because, well, because the look in my husband’s eyes when he looked at me was breaking my heart. I attended a 35 minute ‘introductory’ session. The chap was very miffed that I’d brought my 4 week old newborn (who I was still part-breastfeeding), listened to me talk for a bit, asked if I was sleeping well (I remember my husband and I looked at each other for a moment with a look of despair – we had a four-week old baby, who was the only person getting any sleep round here!), and then declared I was not depressed – just ‘a bit of a worrier’ and I’d feel better when the baby slept.

We left the session. I cried a bit in the car park. I then refused to see anyone else for four months. I pretty much holed myself up in my house, bar trips outside to get nappies and milk if we ran out, and started running headlong into getting back into work of some sort. Our baby went to a childminder two afternoons a week so I could do baby-free chores and tasks, which was actually great for him and me, and this kept me buoyant (or at least in denial) for another couple of months. I was taking care of this baby. At some point, everyone would realise I wasn’t a good mother and then I’d be okay.

Except of course, inevitably, I did fall in love with him. He was my baby. We bonded. And then I was terrified. Terrified that people would realise I was inadequate. That I couldn’t face rhyme time at the library or making purees. That I hated NCT groups and mummy dates and baby swimming. My favourite days were the ones I’d pack him in his buggy and we’d take a train ride somewhere and I’d walk round parks and shops having to talk to no-one, save asking to use the baby change facilities. I could soak up human contact and conversation without having to be properly social. No-one would know I was an inadequate mother if I didn’t spend time with any other mothers.

That’s what depression does. It takes something that should be joyous and challenging and full of discoveries, and turns it into a time of loneliness, fear and a desperate feeling of not being good enough. Of shredding every last ounce of self-esteem and self-respect. It turns you into your worst enemy. It feeds off your inner self doubt.

Eventually, I cracked. I was so tired and so withdrawn and so miserable that when baby turned five months old, I cried for a week solid. My husband had to stay off work just to get me to eat, sleep and wash – and, of course, the baby needed the same things. I would be asleep from 3am-3pm, and then on the sofa as a burrito of misery, wrapped in my duvet and eating a single yoghurt, watching cbeebies and hating all the happy mothers and children.

My husband took me back to the doctors. This time they skipped the talking therapy preliminaries and prescribed an anti-depressant. It had some interesting side-effects – like yawning every three minutes, for five days – but it started to work. I began to come back to a more normal timetable, and a more stable mood. When I stopped crying, I realised that I was still as tired as the day after I’d given birth even though my baby was now a pretty good sleeper. I could barely lift my son in his car seat now. I went back to the doctors.

I had some blood work done and was told to call for the results in a week. The next day I had a message from my surgery, asking me to make an appointment urgently. I attended evening surgery. My thyroid had all but given up, probably in pregnancy, and I needed to take a thryoxine replacement immediately. For me, this was the last piece in the puzzle. The thryoxine and the anti-depressants worked together and I finally felt human again. Still vulnerable, still full of self-doubt – once you begin the self-sabotage of the depressive mindset it does not shake off easily – but getting better.

This story doesn’t have a ‘happy’ ending because, well, depression is a condition that has a habit of turning up and wrecking the kitchen at a party. But I made it through that time. Most people I met, not that I actively sought many out, would not have thought ‘that is a depressed person’ because if I was out of the door, I was able to wear my happy face that day.

And that’s still how it is today. Even if I’m feeling terrible, I personally can usually wear my happy face for a day or two – for important events, like my own wedding day(the year before my wedding I was heaving around the dead weight of undiagnosed depression) . The thing is, I pay for it later on. I usually get physically sick with an infection or virus, that forces me to stay inside and take up the duvet burrito position again. Sometimes I tumble down a metaphorical deep dark stairwell head first into misery.

Mostly I end up self-sabotaging – which is a bit like self-harming but instead involves somehow contriving to bring down your standard of work/output/creativity etc to somewhere around the murky mire depression would have you believe it exists. When I have days like this I am very conscientious not to charge my clients for work, which means I am both poorer than I should be and also sometimes miss deadlines. When I finally worked this out, therapy suddenly seemed both encouraging and financially cheaper than the alternatives.

I have recently started psychoanlaytical and cognitive behaviourial combined therapies to tackle the issues I have hanging over me from depression and its aspects as a mental illness. I describe myself as a broken doll to my boys, and they understand – at least a little – that Mummy is sometimes sick and that can make her not very happy.

If you are/ or think you might be depressed, or know someone that is, it does get better, mostly, for at least a while – and then you might slip and you have to haul yourself up again. You think you’re alone but so many of us are struggling and existing and improving and slipping and improving again. Screw up all your courage and put out your hand for help. Let someone catch hold of you.

Relly’s original post can be found here.

Get support:
Samaritans
NCT Information Sheet: Postnatal Depression
NCT Shared Experiences Helpline
Facebook: Berkshire Postnatal Support Group
House of Light Postnatal Depression Help