mrskitty I really sympathise. Since having kids we have never lived in the same country as our families. When they were little there were times when it was very tough indeed.
When dc2 was 1 I was hospitalised with what turned out to be a rare but basically harmless infection. I could have kissed the doctor who decided to keep me in for a week. He heard that I had a baby and toddler with no family support, said 'You need to rest and can't possibly do that at home' and signed my dh off work for a week instead. Still well up when I think about how kind that was. It felt like I'd been on a cruise when I got back. Got properly nursed back to health and felt amazing.
Anyway, in answer to your question what helped was:
We asked a retired lady if I could pay her to come over and play with the kids in the local language. She had been a registered childminder and had no children of her own. It was win win for all of us.
Really scaling back expectations of free time and time as a couple. I felt better when I accepted that this was a short season of life and would eventually come to an end.
Tried really hard to build networks of supportive friends. We help each other out. Watching each others' kids so that we can go shopping in peace, get stuff done around the house etc. This is easier to do when dc start nursery, school etc.
Tried to remember that there are often problems associated with having family in close proximity. We have never had to deal with these problems and can enjoy time with the wider family as it is so precious. Also, that GPs might not necessarily want to help with childcare!
Also had to accept that people who do have help don't always realise what it means if you don't.
It really does get easier, though, OP.