How much PND do you think is a rational reaction to awful circumstances?(60 Posts)
This is a thread about a thread really, but I didn't want to hijack a very supportive thread (or, worse, find I posted some thoughts and no-one replied!).
There's a thread in parenting (here) which started as a thread about how parenting affects mental health. I posted on there because I do struggle with parenting a small child, but increasingly I started to feel a fraud because (a) I only have one, albeit a demanding one and (b) a lot of the women on that thread aren't only struggling with parenting, they're suppressing enormous (and justified) rage and resentment against partners who simply aren't pulling their weight.
Clearly PND is a real illness and where it exists needs to be treated, but isn't it rational to feel pretty damn depressed if you're sleep deprived, isolated from adult company, spending 24 hours a day with a tiny infant who can't respond to you yet, and not getting support or understanding from your partner? I wondered, reading that thread, whether PND is overdiagnosed because it's easier and cheaper to dish out pills than to provide actual real support.
The other point that really struck me about reading that thread is how little you have to do to be regarded by the world as a perfectly adequate father. If most women opted out of the bits of parenting they don't like as easily as some men do, there'd be a whole generation of starving and neglected children and there would rightly be an outcry. But the men who behave like this get away with it. How? And how can we change that?
I would include support from the health services as well, I think.
I've just seen in the last year my two SILs having babies here in France. Their births were straightforward, no real issues. After birth, they were given private rooms, where they stayed for 5 days until breastfeeding was established, and mum and baby fully recovered. Nurses took care of the babies at night so the mums could catch some sleep (they would bring them in for feeding). They had physiologists and gynecologists come see them to make sure physically things were looking good, and to give them postnatal exercises. They had breastfeeding support workers.
Every French woman who has heard my labour story has been shocked, I mean jaw-droppingly shocked. The idea that a woman with an emergency section after 2 days of labour would A) be forced to take care of her baby all on her own, on a noisy ward, and then B) sent home 36 hours after surgery, was simply insane to them.
I arrived home with DS having not slept a wink in 4 days, totally shattered from labour and surgery -- and then expected to hit the ground running, as it were. I feel like I never got a chance to recover at all from birth, and that massively affected my ability to cope with newborn life.
I feel like it's a feminist issue because I strongly believe men would not be forced to cope with such physical demands with so little support. And I wonder how many cases of PND might be prevented if women had access to more care in the aftermath of birth.
This is a really good thread DogsAreEasierThanChildren thank you for starting it. It is one thread I have been wanting to start for ages but never found the right wording/time!
I haven't got time at the moment to add some thoughts (other than I agree with your OP) so just marking my place for later when hopefully I can join in more!
I agree, OP.
I was fortunate to have an excellent HV who said although I scored highly for PND she was of the opinion it was more PTSD after a horrendous and prolonged stay in hospital and traumatic birth. I am very grateful she recognised this and held off on a formal diagnosis of 'straightforward' PND.
Support is crucial and your points about partner involvement are very true.
We talked about exactly this in a lecture last week and it really made me think about PND in a new light. My lecturer's view was the same, that we overpathologise a lot of new mothers and "diagnose" them, when what they are feeling is just the normal reaction to one of the biggest life changes you can go through. You're exhausted, out of touch with your normal social circle and daily routine, mourning your single life, and you've got a wailing baby who is solely reliant on you. Who wouldn't be on an emotional roller coaster? The key is making sure all women get support, while picking up on those cases that are more serious and do require medical treatment.
Forgive me for posting in ignorance and with something some may find trite. I just thought it was a good way to look at it.
I've seen someone compare getting PND when your situation is unsupportive and misogynistic to getting a septic wound. If you got a septic wound, no-one would say the cause wasn't real or physical, because it is. But if you live in a culture where people don't know you shouldn't expose wounds to dirt, you're more likely to get one.
The implication was to say that women are constantly being put in contact with misogynistic ideas about how they should heal after a birth.
If this is trite or unhelpful, do ignore, I only mention it because I know some people would worry that if we say PND is a response to circumstances, it's like saying it's not a 'real' illness. I don't agree with that, but I think this provides a way of looking at it that shows something can be both real, and dependent on the attitudes of society.
Yes yes yes Beer I would definitely say my problems were PTSD - although I was never diagnosed with PND, I did have a lot of bonding issues etc but I had a horrendous birth.
This is a very interesting thread. I do think generally/traditionally women's health problems have either been ignored or medicated (which, when you think about it is just the same as being ignored really). However, important to acknowledge too that many women who do have supportive partners, good births etc still go on to get PND.
I think johnny's post up-thread makes a lot of sense.
dreamingbohemian, that's a very good point about the shocking post-natal care in this country. I was much more frightened of being left along on a PN ward with a new baby to look after than I was of giving birth because I'd heard such horror stories from friends - thankfully I was one of the lucky ones in the great giving birth lottery and in the end I didn't have to be in overnight.
I coped really badly with sleep deprivation. I still can't think of the phase when DS was between 6 and 9 months (when I was back at work full time and he was still feeding several times a night) without feeling sick and shaky because I felt so desperate at the time. With hindsight I have no idea how I coped with work at all. I posted a few times on here saying how desperate I was and I got a lot of suggestions that I had PND and should see my GP. I didn't have sodding PND, I needed a few nights' unbroken sleep (and lo, as soon as we managed to night wean DS, the despair lifted).
reading this thread with interest. Especially as the 2 HVs I had after the birth of ds were amazing and instrumental in me getting the support I needed to recover from ptsd.
both of them booked me extra appointments to check I was ok and kept seeing me until 14 months after ds was born. I cannot rate them high enough. I am tearful with thanks just writing this. A terrible first year that I only survived intact because if the help and support I got. I feel it very likely I could have descended into pnd had I not been so fortunate.
Don't, however, get me started on post natal care in hospitals. That's what caused the fucking ptsd in the first place
I don't wish to undermine the OP's misogyny angle - it's her thread, she can say what she wants. But I have some questions for any health professionals in here. Is the UK particularly bad at dealing with mental health issues, compared to other Western nations? I have heard anecdotal accounts of soldiers with PTSD being left to their own devices countless times. There also seems to be a very high rate of male suicide - one report states that in 2011, of just over 6,000 suicides in the UK, 75 per cent were male;
And no, this isn't whataboutthemenz. I am asking those in the know whether the OP is part of a wider mental healthcare problem/attitude in the UK.
Also, one thing I have learned from this site is that a woman's right to choose pregnancy and partner (or lack of) is sacrosanct. How many women who have no supportive partner/father for the children have actually chosen this path?
namechangeguy wrote - "There also seems to be a very high rate of male suicide - one report states that in 2011, of just over 6,000 suicides in the UK, 75 per cent were male; news.sky.com/story/1068998/huge-problem-of-male-suicide-rate-in-uk And no, this isn't whataboutthemenz. I am asking those in the know whether the OP is part of a wider mental healthcare problem/attitude in the UK."
Every person who has mental health problems should receive much better support and care.
I think a more accurate indicator of mental illness is attempted suicide, not "successful" suicide. Achieving death in a suicide attempt is often a function of which method was used, and typically men use more effective methods. I think the statistics show that males and females attempt suicide in roughly equal numbers, but I do realise that it's much more difficult to collect and analyse statistics of attempted suicide, e.g. because of issues surrounding the question of "when does self-harm become attempted suicide?". (Statistics show females self-harm more than males).
A person who ends up dead did not necessarily have more severe mental illness than a person who does not die. For example, depression in some people is so severe that it removes their ability to attempt suicide.
Agreed vesuvia. I researched this 20+ years ago. Men choose violent methods of suicide as a rule which are more likely to suceed.
Namechange, your last paragraph is a bit confusing. Are you suggesting women whose partner turns out to be unsupportive have culpability in their pnd?
Lunatic, no. I was referring to the OP, who alluded to men not doing enough to alleviate pressure on their partners, which could lead to pnd. Others have mentioned absent fathers as increasing pressures on women as lone parents. Whilst I agree that men who don't take responsibility for their children are, in essence, scum, I also think that there are women who choose to conceive without ever planning to include the father in the child's upbringing. Women who choose this path cannot then complain about the pressures of bringing up a child alone.
I find this interesting, I had PND with both of mine.
First time round I had a big support network but felt undermined and judged by essentially 3 different generations all telling me what to do and feeling weak from a haemorrage.
Second time, horrendous birth think I've spoken on here before,I was so traumatised I began smoking again.
I agree, definitely.
DP works long and often anti-social shifts and none of our family are near enough to help out on a day to day basis, so I was alone a lot during maternity leave, looking after the baby from the moment she woke up until the 11pm dreamfeed. I was tired, struggling with the house, often quite lonely and, quite frankly, rather bored (babies are not intrinsically interesting a lot of the time). So while DP wasn't deliberately being unhelpful or useless, he just wasn't there and at times I illogically resented him for it.
I was fortunate not to have PND but there were many days when I was tired, grumpy and distinctly down. I felt able to understand that it was because, as you say, I was sleep deprived, isolated from adult company, spending 24 hours a day with a tiny infant who can't respond to you yet, and not getting support or understanding from your partner. I assume that it was because it was fortunately not PND that I was able to at least appreciate why I felt so shit a lot of the time.
"Women who choose this path cannot then complain about the pressures of bringing up a child alone."
Thanks for that! So I'm never allowed to have a bit of a whinge? Thank heavens my friends in real life (of both sexes) have never been anything other than entirely supportive of both my decision and the fact that it's not always the easiest decision to have made (and who, whether in a relationship or not, can honestly say, hand on heart that they knew how hard bringing up children would be before they actually had their own?)
On the general topic of this thread, I did want in those early months to have a t-shirt which said "it's not post natal depression, it's a rational reaction to intolerable circumstances." Because extreme sleep deprivation and a baby that cries all the time is pretty intolerable whatever your circumstances and whether you chose those circumstances or had them thrust upon you. Looking back, it's possible I had mild PND too, but it would be difficult to establish how much was circumstance and how much hormonal.
Luckily it got steadily easier after the four month mark, DS was a remarkably easy toddler and is now a delight as a primary-school age child. (By the law of averages, I suppose I'm in for the teenage years from hell - though I do realise that's an instance of the gambler's fallacy).
I agree. Just been discharged from the Mother and Baby Unit but I am sceptical I was ever "ill" in the sense they would see it as.
I grew up with chronic alcoholism and my mother couldn't cope so was very frequently absent either physically or emotionally e.g. she did some really weird shit like taking a girl in the year above me at school on holiday because she had such a "difficult family life" and taking her for walks/meals out and ignoring my suffering entirely, when we used to fight when I was a teenager she would drive off in the car with me begging and screaming for her to come back, blah blah Angela's ashes etc.
There are generations of poor parenting in my family, violence and abuse and all sorts of weirdness and when I had my children I was VERY anxious about realising that I had no "template of normality" and this was heightened by the constant stream of professionals coming into my home to tell me I wasn't getting it right (ds1 and 2 both had serious issues with breastfeeding which we later realised was tongue tie related.., as all my family had breastfed but were otherwise shit I made the leap that I had already failed my children and became depressed).
But let's look at this differently:
I was living with my husband in a different country with no family
My best friend effectively dumped me as soon as I got pregnant as she found it so hard as she was having serious fertility issues
I was told I was going to lose my job
We were having financial difficulties
My father went into a coma and I hadn't been speaking to him
My grandmother who raised me was critically ill
I threatened miscarriage all through the first and second trimesters - literally experiencing labour like pain every few weeks with no cause found
I had morning sickness until 29 weeks
I had been raped as a young woman and found my initial forceps birth had triggered a lot of strong feelings around this that made me super-anxious about birth.
Things that have been said to me by "professionals":
Well all women worry about their babies but yours is definitely at the disordered end of the spectrum.
I spoke to your GP and he was really surprised you had OCD as he thought you seemed quite competent!
No one thinks there is anything wrong with his tongue but you - you have to consider what this means (no one had looked inside his mouth and I am a speech therapist with training in the anatomy of the mouth!)
Worriers like you always find the aspects of childcare other women find easy difficult but that's just your nature
Your problem is that you overestimate the importance of your own thoughts
There is nothing to worry about but you are interpreting your experience as though there is something to worry about which is what is making you ill
It must be very hard for your husband to live with your anxiety
Your husband sounds as anxious as you, you might want to consider what this means for the future if you get help and he doesn't.
Even better, the experience of being in appointments where people spoke about the most shaming and private experiences such as my father defecating in my room and forcing me to sit in a chair while he shouted at me until I "admitted" I had done it, my father screaming at me for three hours in a crowded dining carriage that I was a useless narcissistic bitch etc as though I wasn't there... and when I said these things, there were sage nodding professionals humming and hawing over how I fit to the literature.
Feeling crap about having been abused = "ruminating about the past". Worrying that your child might be at risk as you appear to be having labour like pains and had a shit first birth = "catastrophising".
Saying hey, I feel really well today = "minimising the severity of your illness".
As if that weren't enough, I missed ONE appointment when my son was 6 weeks old and had to endure endless discussion about whether this represented disengagement WHEN I was attending weekly therapy from the time he was 10 days old which involved me having to get to the session on public transport when I was terrified that he would get germs from being on the bus. Apparently I "didn't really want help" and I had to realise that my condition would become chronic if I didn't do what was suggested.
When I eventually complained IN WRITING, I had a response saying that they wished to meet me - the entire care team and me, no advocate so four of them, one of me - to discuss "the challenges faced by everybody in your episode of care". When I said I didn't care about the "challenges" they faced by me missing ONE appointment when I was ill with a SIX WEEK OLD, they said I was trying to "control" and "manipulate" the situation and that I needed to realise their "experiences were as valid as mine" and "there were rights and wrongs on all sides".
What? To miss ONE APPOINTMENT out of, perhaps, 30? Thankfully I had a CBT therapist I was seeing weekly who helped me realise and not take on responsibility for this but in the review meeting, everything I said as challenged and dismissed until my therapist could "vouch" for the fact that actually, you know, I was working pretty hard at pretty much everything.
My experience has been a disgrace. Thankfully I am nearly at the end of my complaint about it now but it was VERY sobering and eye opening about how women's distress is pathologised and made intrinsic to them rather than a product of life experiences etc.
That's horrifying, working
I feel like mental health is treated in such a black or white manner -- either people completely discount your problems, or they pathologise them into something much worse than they are.
I also agree that it is part of a broader problem with mental health services. But as noted earlier, there is also a lot of continuity with the way women's issues have been treated in the past, so you have to consider it from a gender point of view as well.
Working - I am truly sorry to read that.
I have been told that I had post natal PTSD, rather than PND. It makes sense given that I had a traumatic birth experience and a stay on the post natal ward that was beyond my worst nightmares.
I sometimes wonder how much money the NHS might save if it worked out the cost of dreadful maternity care in the longer term.
working9while5, all that practically has me in tears. Well done for getting through it - and for complaining.
I had a HV who harrassed me about things that might go wrong. I was marked as at risk for pnd because of previous depression. So I was surprised that she was so awful and doomy. First she told me "You should not have had your baby at home. She could have died. That was a very selfish choice." But the midwives advised it! Where I was they are very pro home births for low risk pregnancies because they get good outcomes. In fact I said no the first time it was mentioned and they talked me round over the millions of ante natal appointments. (It was lovely)
then we had a series of exchanges like this:
HV: do you smoke?
HV: your partner? Anyone who comes to the house?
me: no, nobody smokes.
HV: second hand smoke is a serious risk to small babies. [long spiel about babies dying, which is of no value to me, because she cannot dissuade me to do something nobody does anyway]
HV: where does the baby sleep?
me: in a moses basket.
HV: co sleeping in a very serious risk to the baby. [long spiel about babies dying]
HV: never leave your baby on the changing table, your bed, or any other item of furniture [long spiel about babies dying]
HV: you need to take the baby to the GP and have her breathing checked [long spiel about babies dying]
HV: your baby is gaining weight and feeding well but sometimes dehydration can be a problem with breastfed babies [long spiel about babies dying]
I think it was all pretty depresso-genic.
My HV was wonderful. However I had the mad scaremongering in hospital. Foe example, as the HCPs never once woke me when they promised they would, I used my phone alarm to wake me for feeds on SCBU - a midwife caught me and claimed I could cause babies like mine to die. I was so exhausted I believed her. Even though the SCBU was on the other side of the hospital, several floors up.
Quite a lot of 'mental health trouble' in women is actually 'abusive man trouble'. And men who do no housework and childcare are abusive.
This is such a fantastic thread, and it's so so true. I don't have children yet so no personal experiences to comment on, but I'm sure it will help mothers reading this who are suffering so many of these 'symptoms'. Sleep deprivation, for example, has such a detrimental effect on the mind that it's used as a torture tactic fgs! I have such admiration for all of you who have got through such tough times...it must be incredibly hard (as well as being amazing) to have a tiny person suddenly dependent on you for all their needs 24 hours a day.
Also vesuvia, I found your comments regarding male and females using different suicide methods, and therefore having different outcomes, very interesting. Things really aren't black and white when it comes to statistics.
This is such a great thread and so much has been said I wanted to comment on - too much really, very insightful posters.
I didn't realise just how much my issue with `did I have PND or not' still troubled me, until reading this.
I was terrified of saying how I felt to the HV as her exchanges were similar to above, I was on my own with a baby and scared they would take the baby if I mentioned anything.
I had gone through almost the same emergency section hell that dreaming had, was dealing with a threatening and abusive exp and I guess is why I have chosen not to have any more DC, it was not the wonderful start to being a mother I had wanted/thought I was going to have.
Eventually after my father also became ill and with problems at the hospital, him sadly dying and work trouble I hit the deck... months off work anxiety and all kinds. Did it just build up - did I have PND for a long time, at all.. I have often wanted to untangle this mess - I still can't. If I had to say I would say it was a natural reaction to the circumstances as I don't think it was hormonal but some could have been?
I did the PND test on paper twice - I tried to cheat I wasn't really helping myself was I?
Should I have asked for more help? - praise to the person who went to the GP I was terrified.
Working my CBT man saved my life.
The care in France is really interesting. This is a feminist issue as this says it exactly: I feel like it's a feminist issue because I strongly believe men would not be forced to cope with such physical demands with so little support. I thought just that at the time and even more so now.
While I very much agree with the points raised on the thread, and what everyone has said,
I want to say that I have a very kind, caring thoughtful partner who does stuff (when asked!) but that I suffered from MH issues from my first pregnancy. For me, I never had MH issues until I was pg and there is no argument but that the whole thing was kicked off by pg, and once started continued for a few years, all related to the children. Meanwhile my DH did everything, keeping the house going while working full time and having a basically bonkers unresponsive mad partner. He frog marched me to the GP in the end and I got some ADs (4 years later) and am pretty much better now.
But still - yes I agree that a lot of the probs are caused by massive change in life circs/isolation/sleep deprivation etc. But to say that sometimes it is a direct consequence of being pg/having a baby and not to put that aside entirely.