Guest post: “One in 10 women will develop mental health problems during the perinatal period”
This week is Maternal Mental Health Matters Awareness Week (29 April-3 May). In this guest post Fiona O’Connell tells us what it takes to run a perinatal mental health team and Sarah, a service user, explains how important the support was to her.
Posted on: Wed 01-May-19 14:18:26
(26 comments )
Fiona O’Connell works for Tees, Esk and Wear Valleys NHS Foundation Trust, who provide mental health services across County Durham and Darlington, Teesside and North Yorkshire and York. Fiona heads up the Trust’s specialist perinatal mental health team in North Yorkshire and York, who provide perinatal mental health services to mums who have experienced or are experiencing severe or complex mental health difficulties during pregnancy or in the first year after they have had their baby.
Speaking about the service, Fiona said: “Motherhood can be an exciting and wonderful experience, but we know that this isn’t always the case for everyone. One in 10 women will develop mental health problems during the perinatal period and it can be very difficult for women who feel unwell during this time.
“It’s so important that women have someone to turn to, as well as support and treatment to help them to feel better. Not only does this help their mental and physical wellbeing, but it also improves the mother-baby bond and wider family relationships.
“Our perinatal mental health teams work with women and their families in the community to make sure they get the support they need, when they need it. Women are referred to our service by a healthcare professional such as a GP, midwife or health visitor. We see women at home or in community bases, who are experiencing or have previously experienced severe and complex mental health problems such as depression, anxiety, bipolar affective disorder and postnatal psychosis.
No one should feel alone or ashamed of how they are feeling and services and teams like ours are here to make things easier for women and their families.
“Some women may not be experiencing symptoms when we first see them, but if they have done previously then they can be at an increased risk of their symptoms returning during and after pregnancy. Knowing this, we can put plans in place to support them if they were to become unwell again.”
Sarah is a mum of two and accessed the Teesside perinatal service before becoming pregnant with her second child, having experienced postnatal psychosis after the birth of her son. “I knew following my previous illness that there was an increased risk of me becoming ill again, so I was referred to the service for pre-conception counselling, which really helped my husband and I with our decision to have a second child.
“I received further support from the perinatal mental health service once I became pregnant with my second child and the team saw me at regular intervals to monitor my mental wellbeing and put plans in place should I become unwell again.
“It was a little bit like having a midwife for your mental health, but the support wasn’t just for me, they also helped my husband, who was quite nervous about me getting ill again. He could attend the appointments with me, which we both found really helpful.
“Thankfully, this time I stayed well during my pregnancy but it was good to know the support was there had the situation been different. I was so impressed by the service that I have become a peer support worker with the Teesside team. It’s good to know that I can use my personal experience to help and support others through what can be an extremely difficult time.”
“Not all women may be experiencing severe or complex mental health problems; if you feel you are struggling in any way we would recommend you speak to your GP or healthcare professional straight away. There is a variety of support available, as well as useful self-help guidance that you can be signposted to.
“If your GP or healthcare professional feels you could benefit from a perinatal mental health service they can make a referral for you. No one should feel alone or ashamed of how they are feeling and services and teams like ours are here to make things easier for women and their families.”
To find out more about TEWV perinatal mental health services visit www.tewv.nhs.uk/services/perinatal-services
By Tees, Esk and Wear Valleys NHS Foundation Trust
I was one of the ten 😢. Fell pregnant at 45 with dc4. I was under a lot of stress at work, pregnancy was unplanned and I really couldn’t get my head around another little person in the house. My youngest had just started school and I was planning on concentrating on my career. A baby never fitted in with any of those plans. People told me that once i was over the shock I would be fine but all through my pregnancy and I had negative feelings about wanting to abandon the baby at birth. I thought about places to hide it, run away etc. I had no bond with the baby whatsoever. I eventually crumbled and broke down. I received advice & guidance from a mental health nurse who told me I had perinatal depression. I was sent to a councillor who was absolutely dreadful and more or less told me there was nothing she could do to help me and to get on with it. (This was after breaking my heart and telling her exactly how I felt and why.) I was promised additional support from professionals to monitor the situation, that never happened. I turned up at the hospital for my planned section and none of my medical history had been passed on. I had to plead for my own room as I was convinced I wasn’t going to bond with the baby and didn’t want to be around mums coo~ing over their newborns. Again I was promised additional support postnatal to ensure we bonded. This never happened but thankfully as soon as my ds was delivered I heard him cry and straight away my hormones kicked in and I had the overpowering love for him. There was odd times afterwards when I felt like my life would have been better without him but these gradually became less and less. No info was passed onto health visitor so I had to go through it all again when we returned home. Ds is now 5 and I love him more than the world. I think we have an extra special bond.. unfortunately my experience of perinatal support was poor. Fingers crossed people have better experiences of mine. I shudder these days when I hear stories of children being abandoned on door steps. I really get where people are coming from when they do it. I fantasised about it, looking for places to leave my ds. Thankfully I had a great family support around me!! Interestingly, I was then shafted by work on my mat leave and I decided to resign after15 years. I now work in the most amazing job. Had I not got pregnant and been treated so badly I know I would still be stuck In a job I wasn’t 💯 happy with. X
I had two horrendous episodes of post partum psychosis. I know now now that it was caused by massive hormonal changes and that if it had been treated as such I would have recovered much more quickly. I was textbook - terrible PMS/PMDD from when I started menstruating. Later terrible menopausal symptoms.
I was treated with antipsychotics that precipitated very severe depression that was only cured by ECT. Then I was diagnosed bipolar (I’m actually not, I have a relatively mild underlying mood disorder) and took lithium for many years, which knocked out my thyroid. I came off the lithium and managed, oral contraception helped with my mood...finally I went on transdermal HRT to sort the menopausal symptoms and have remained on it, intend to do so for as long as possible.
Until the medical profession treat these illnesses as the result of reaction to hormonal imbalances, women will continue to suffer unnecessarily.
My health so-called professionals spent all their time trying to get me on tbe "good mum" list of breastfeeding mums. When I struggled to bf for what turned out to be fairly catastrophic (not hyperbole) reasons, they didn't bother with me anymore and kept "forgetting". Again, not hyperbole. This actually happened. When I had recovered enough from the health catastrophe three years later and lodged a complaint, they admitted fault and said "we do it differently now". Too late for me.
Isn't it amazing how few responses there are to this post. Such a taboo subject.
I had it/have it. I was a very high risk pregnancy for mental health - multiple
Miscarriages, previous PND, husband with cancer, IVF babies, one twin died, one survived. I was given zero mental health support during and after. I am 'middle class', professional who presents well and fobbed them all off that I was ok.
Not sure it ever leaves you. I'm a changed person, I know how quickly life can be whipped out from under your feet. I didn't know who I was for a long time. Life is harder now but I'm a better person, it unlocked levels of myself that I would never have known are possible and a deeper understanding of myself, others and this thing we call life.
My DS is 19 months and only in the past 6 months or so have I been able to feel that big love that I was supposed to feel. I struggle with anxiety anyway but the low mood I experienced during mat leave was something new. I genuinely felt like I had no hope of ever feeling better, nothing to look forward to, that I had probably never felt happy and would be better off dead. I didn’t go to the doctor until DS was 10 months because everyone around me said it was just my anxiety, nothing else, and not to try and label it as PND.
That made me feel like other women, deserving, natural mothers get PND, while I was just experiencing a progression of my pre-existing shitness.
My mood started to improve when I went back to work when DS was one. I’m still not always brilliant but definitely better. I feel so sad about DS’s first year but I feel such massive, deep love for him now. I hope he never knew that I wanted to leave. He is a wonderful wee boy.
I had what I'm fairly sure was mild PTSD. I had an extremely painful 52 hr labour, followed by an instrumental delivery which left me with permanent injuries. When my son was readmitted to the same hospital at 4 weeks old, I had a panic attack in the car park when I saw the space we parked in for delivery.
I worked so hard to try and separate my son from his horrendous birth, that for a while it felt like we'd adopted him. I couldn't possibly link him to the memory of his birth. In time I came to feel like it didn't matter if he was "adopted", as I loved him so much. Now he's firmly mine!
I should probably have got some help, but I was convinced that if my injuries would get better, I'd feel better. Also the thought of talking about my birth made me feel physically sick and panicky. I still don't talk about it now, but I don't turn it over and over in my head like a horror movie like I used to.
I have been very lucky in that I was under the peri natal team for my first pregnancy and was given very good support. I had preexisting mental health problems and was very very unwell during the pregnancy. This was in 2013, and I received a lot of support. I didn't end up with PND, and I put that down to the brilliant support received.
My current pregnancy has been much tougher physically and that has recently started to take a toll on my mental health. I had previously been well for a long time. At the moment I am at that in between stage where I'm still able to brush myself off and pick myself back up after each thing that goes wrong, but my midwife has been on alert about my mood and how well I'm coping. The offer is there to go under the peri natal team and I have been offered antidepressants if I want them. I'm not there yet, but my midwifes view is that it's better to take medication than be on my knees by the time the baby is born.
I've been referred to the perinatal mental health team. Suffer badly from depression and anxiety, also BPD, and was diagnosed with post natal PTSD after the birth of my son over 16 years ago as it was a traumatic birth in which we both nearly died.
I've stopped taking my antidepressants as they are unsafe during pregnancy, so am struggling a lot. Been over 2 weeks without them now, the longest I've gone without them in 26 years
British health, social services and culture treat pregnant women and new mothers appallingly.
That many women survive both motherhood, patriarchy, and mental illness is a testament to their courage.
We should be fighting for maternity rights and financial benefits. We should also be fighting for informed, safe and enjoyable pregnancies and births.
WIth the sharp decline in western men's fertility they are seeking to take ever harsher controls over our bodies, including our pregnancies and childbirth, and our babies.
The NCT has just had a management change making them change focus from reproductive rights and health to a focus on 'mental health'.
Look carefully at social and political agendas at work here.
to women who have got through difficult and dangerous births, which can cause and exacerbate intense trauma and mental illness.
It does not have to be like this.
Imagine if men went through this..........
I had post natal depression...surprised it is only one in 10 tbh. Changes your outlook on everything.
I didn’t want to run away. I wanted desperately to feel a connection, and I just felt blank when DD was born, and then increasingly distressed as it didn’t come.
I couldn’t bear seeing other people, as they all insisted on holding her and talking about all the things they’d be doing with her, talking about how much they “loved her”, when I was her mother, she was MY baby, and I hadn’t got to feel any of that yet. I genuinely felt like I was a surrogate, and then a wet nurse, for everyone else’s baby.
From the minute I got pregnant both my family and my in laws, neither of whom I’m close to, were unbelievably overbearing. My dad refused to speak to me for most of my pregnancy because I said I didn’t want him and my mum waiting outside while I gave birth, ready to run in for photos and generally make it all about them. My MIL turned up uninvited after I gave birth and burst into my cubicle as I was sitting in a nightie crying trying to learn how to breastfeed.
I had a horrible pregnancy as I was extremely anxious following an earlier miscarriage and to cut a very long story short, house renovations went completely wrong and we were left living in a building site. Mine and OH’s relationship regularly hangs in the balance on the back of all this stress.
I genuinely believed for the first 18 months that DD would be better off without me, that it would work out very nicely for everyone if I leapt from the nearest multi-storey, DD wouldn’t have to suffer me as a mother, OH wouldn’t have to suffer me as a partner, everyone else could hog my baby and do whatever they want to their hearts content because her horrible mummy wouldn’t be in the way.
I know I overcompensate by buying her absolutely everything, by continuing to breastfeed, by taking her out to lots of activities etc, because I feel so fucking guilty about how I felt for so long. I could always see how beautiful she is, how perfect she is, I remember this constant panic that I wasn’t good enough, that we didn’t match. I still do feel that most days, a horrible nagging in the back of my mind that one day she will cotton on to how shit I am and realise she needs better than me. I hate writing that, I worry it sounds like I’m attention seeking or fishing for compliments and I swear that’s not the case, that’s how I genuinely feel (spot the lifetime of being told I’m attention seeking every time I voice a negative emotion)
I still have days like that, and days where I find it hard to cope with the lack of sleep (DD is 23 months and still wakes frequently at night and needs a boob to settle), days where I feel completely overwhelmed with the ongoing building site situation, lack of support from OH or family, feel irrationally frustrated with DD when she refuses to sleep or eat and just wants to be on my boob and I’ve got so much to do and I have to do it all alone, it’s still hard. I’ve just started CBT and really hope that helps.
I would love another child, in part because I feel so sad that my experience of pregnancy and having a young baby was completely stolen from me, but I don’t know if I dare given what I’ve been through.
Just wanted to share my “story” in case it resonates with anyone else going through anything similar.
Thank you @Ohhellothereladyface
I know I overcompensate by buying her absolutely everything, by continuing to breastfeed, by taking her out to lots of activities etc, because I feel so fucking guilty about how I felt for so long. I could always see how beautiful she is, how perfect she is, I remember this constant panic that I wasn’t good enough, that we didn’t match. I still do feel that most days, a horrible nagging in the back of my mind that one day she will cotton on to how shit I am and realise she needs better than me
This. And pretty much everything you’ve said @ohhellothereladyface
Mine is 19 months and still wakes a lot at night for breastfeeding. I think it’s true as well that if you’re not going through/haven’t been through that experience then you can’t understand how tough it can be. I could never countenance stopping BF or sleep training as I felt I had already let DS down enough by being me.
I disclosed at my booking appt that I had a history of depression and felt that birth and a new baby was likely to spark a new episode. Was assured by the MW I'd get loads of extra support, daily visits etc and... nothing.
Whole host of problems from late pregnancy onwards. I developed diabetes and was hungry the whole time trying to control my sugars levels, losing huge amounts of weight (I'd been thin to start with) which made me feel very low. Birth was difficult but empowering but afterwards I was handed this bloody yucky baby to breastfeed and I just wanted to be left alone to recover. I can't believe they don't bath babies now on maternity/postnatal. Her hair was matted with my blood - it was revolting.
I did loads of skin to skin, BF on demand etc even though I hated it. Complicated first week but baby was then readmitted to hospital with hypernatraemic dehydration as my milk hadn't come in. Several MWs had pooh poohed my concerns, undermining my confidence. I'd barely slept in the first week and fell asleep holding my baby and dropped her. In SCBU we were put into triple feeding to try and make my milk come in. It didn't, but my mood was spiralling downward with the continued lack of sleep and pressure to breastfeed.
Back home again, I was berated by HVs for using formula (ignoring our readmission and the fact my milk didn't come in for several weeks). Far from daily visits I barely saw any MWs or HVs and those I did see were patronising, pressured me to carry on BFing and didn't care
about my mental health. I realised I was spiralling further down and went to my GP where severe PND diagnosed at 4 weeks. I disclosed this to HV who then told me they couldn't provide support for PND. I was googling 'putting baby up for adoption', still losing weight as the anti-depressant side effects made me throw up and it was all a total mess.
What saved me in the end were wonderful ladies at a toddler group who reassured me that I wasn't a bad mother for using formula alongside BFing, finding a reassuring book that encouraged us to get into a routine, which really helped my sanity (The baby book by Rachel Waddilove), limiting BFing because I hated it so much (I should really have stopped completely) and, eventually, returning to work so I got a break from my baby. We had no family support so there was no help available.
I really don't think the MWs or HVs cared at all about my mental health. Their only interest was in their breastfeeding stats.
The overcompensating thing is interesting. I bought an expensive ring after my son was born - that I didn't even particularly like - that had his birthstone in it. I showed it off to everyone as proof of how special he was to me, and how much I obviously loved him. I can't bring myself to wear it now. It reminds me of "playing" mum to this baby that I would quite happily have left in a supermarket at the time.
Same here @RidingMyBike , all they cared about was their bf stats. And when I failed due to catastrophic ill health, they stopped bothering or wrote me off. Or both.
i'm new on here but there are some really great replies....totally relate to loads of this stuff. Thanks to all who took the time to post
My children are teenagers now but I had what I consider to be undiagnosed pnd after my first child. I felt dreadful. I lied on the health visitors questionnaire because I didn't want anyone to know how I was feeling. She said she thought I was borderline for pnd even though I thought I had lied enough to have a low score, this made me realise how bad things actually were. I told her I was fine. I wasn't, I wanted to run away, I felt an absolute failure, as soon as dh left the house for work each day, I would spend hours crying. I did slowly improve but had no help whatsoever. I will never forget those awful times, feeling so alone and unable to cope.
In my second pregnancy I approached the GP early to tell her about my experiences. She told me that I would not have had pnd as I would not have recovered without support. I knew then I would never ask a GP again for any help with mental health. I was incredibly lucky that my second pregnancy did not go down the same road. I got to enjoy it the second time around without those horrendous feelings. I don't like to think what would have happened had I been struggling though as I felt I could not approach the gp because she had been so dismissive with me.
I disclosed to my midwife I was feeling anxious during my pregnancy, and she said she would refer me for mental health support which I never received. By the time it was my 6wk check, I was distraught and convinced that if I did anything other than walk in beaming and talk about how brilliant DD was etc, I would be put on some sort of “watch list”. And to be honest all the GP did was ask me if I was breastfeeding, I said yes, and that was it, box ticked she’s fine. I wasn’t, I really really wasn’t.
As a PP said about not being able to wear the ring, I find it hard to look at photos of DD’s first year because I know the smiles are fake, I know the absolute despair I felt and it makes me so, so sad that I feel I missed out on my baby “as a baby”.
I find it hard to look at photos of DD’s first year because I know the smiles are fake, I know the absolute despair I felt and it makes me so, so sad that I feel I missed out on my baby “as a baby”
I completely know what you mean about a lack of happy memories in the first year. I struggle to think of a single time where I was genuinely happy/not putting on a brave face while my mind swirled nonstop with sadness, anger and just absolute desperation.
I wish I could go back to the first day, armed with the benefit of hindsight, and tell myself somehow that I would be able to breastfeed so don’t panic that I couldn’t immediately get the hang of it, tell myself to be more assertive and tell all the unwanted visitors to leave me the fuck alone while I got to know my baby because frankly that’s much more important than them constantly muscling in, I wish I had been able to just spend time breathing her in and connecting with her instead of being completely consumed by panic and the fear she wouldn’t want me. I wish I could do that now to be honest, because I still worry daily we don’t have the deep bond and she just sees me as the person who feeds her and keeps her safe, rather than her actually having any genuine affection for me.
I too feel like my oldest Ds's first year was just such a hard time. I feel I missed so much of what should have been a special time with him, I also worried about our mother baby bond. I was 24 so quite young as well. It was just so overwhelming.
If its any consolation he is 19 years old now and we have a great relationship. Although through that first year I could have quite easily run away, he has no idea how I felt and our bond really formed when I started to feel better. He has grown into a really hard working happy young man. It is his younger brother who gave me a problem free pregnancy and a happy worry free time postnatally that is causing me the most stress and worry now!
@bellinisurge yep, that intense pressure to breastfeed from HCPs was so unhelpful. I really wish someone could have looked at the bigger picture and seen how miserable BFing was making me.
There's this huge assumption that Bfing is good for mental health but I hated it and forcing myself to do it a million times a day, as you have to with a newborn, just made me resent my new baby all the more. I hated her being totally reliant on me. I ended up BFing her for over 3 years but I really regret not switching to formula as soon as possible as BFing wrecked our first few months.