PND and Premature Birth

[Itsaplayonwords]

My second daughter was born 2 weeks ago at 33 weeks. She stayed in SCBU for 10 days. My first was born at 28 weeks and stayed in NICU/SCBU for 9 weeks. I suffered really badly with PND and PTSD after my first and felt an enormous amount of guilt for everything she had to go through as well as everything everyone else experienced due to my body failing. It took me a long time to move on from that guilt and come to terms with her time in NICU and get over the flash backs of everything that happened. Now that my second daughter is home, despite her being that much healthier and having to tackle much less, the guilt is back, as are the flash backs and the memories from the first time. Something that I never really got over the first time was the mourning for everything that we all missed out on - the excitement at her birth, I didn't see her until the next day (she was transferred to another hospital and I had a c section), I didn't hold her for 4 days and that feeling of immediately feeling like a mum. This time was different - I got to hold her when she was born, my husband got to hold the cord and it wasn't as scary because we knew what to expect. But she was still taken away to SCBU and I still had to go to the post natal ward without a baby. Now we're home and struggling with feeding. I'm desperate to breastfeed but I'm struggling with that because she's small and the doctors are happier for her to have bottles of EBM as they want to see her weight go up. I understand the medical need for her to gain weight is greater than a full term baby, I agree with everything they're suggesting from a medical stand point but it's still shit. It's shit that I have to follow the feeding regime that they have set rather than try demand breastfeeding because my body failed. I failed at being pregnant and if I fail at breastfeeding I'll feel less of a woman. I know what probably sounds stupid. We planned to have two children, that was always the plan so I'm unlikely to ever be pregnant again so I have to succeed with bfing. But that in itself is too much pressure. I can't stop crying and I don't even know why. All of the above is going through my head but it's not really any of these thoughts that are making me cry, I just feel so shit and so useless. I've told the midwives that my mood is up and down and they know my history but they haven't seen me in the midst of emotion and I know I play it down. As such they're quite dismissive, I think I do a good job of seeming like I've got it together. I haven't. Not at all.

I'm bumping for you, because I had a first child at 31 weeks who was bottle fed, but she strived. My second was also early but I mix fed until 8 weeks when I went full bottle.

Just keep trying and if you can keep breast feeding for one feed a day, you're doing great....

I understand how you feel, I did not have PND but I felt like a complete failure after giving birth prematurely. Bf was very important to me because it made me feel less like a failure, so I can relate to how you feel. However, your baby is still tiny - she's only 35 weeks gestational age!! I was told not to expect a premature baby to be able to bf before its due date, and it was definitely like that for my DS - we only established bf shortly around his due date. He was bottlefed before that. Bf a preemie isn't easy, but it can be done, it often needs a lot of patience though.
Giving bottles with ebm is a perfectly acceptable solution in the meantime. It does not mean you will never be able to bf!

I'd also suggest you speak to your midwife again because you do sound as if you are struggling. If you feel you can't talk about how you feel, why don't you write it down, or even show your midwife this post? There is nothing to be gained from trying to keep a stiff upper lip, so please try and ask explicitly for help!

Thank you both. I didn't know that about a baby not being able to properly BF until full term, I thought it was 34 weeks as that's when they get the suck, swallow, breathe reflex. I don't know how sustainable it is to keep trying bfing, expressing and bottle feeding because once my DH goes back to work I'll have my toddler to look after too. I've got a whole other thread about attempting to breastfeed because I'm stressing about it so much!

I think you're right that I need to speak more candidly with the midwife. The only thing is I always get the impression they don't really care so long as I'm fit to look after both children. They just seem to pass my back to the HV who, although nice enough, the one time I met her she told me I need to be more positive and focus on the fact I have two healthy children. I know that and I'm endlessly grateful but in my experience depression isn't relative to what you do or don't have and the implication that it should be just makes me feel guilty for feeling this way.

I did speak to a mental health specific midwife who is setting up a new team in my local hospital after she herself had PND. She has referred me to a local counselling service and I've got an initial telephone appointment with them this week. Hopefully that'll prove to be useful.

My daughter was born at 34+0 and didn't properly bf until she was 35+4 and even then was having tube feeds of formula or expressed milk as she would get too tired bf. We were using nipple shields for a few days and a traditional midwife got her bf without them.

Bf a preemie is really hard work and huge credit to you so far. I put a lot of pressure on myself to bf as it felt like one of the only things I could do to help her. We ended up introducing ebm & formula top ups when she was 6 weeks as she was losing weight. I felt terribly guilty at the time as feeding had been going well. I spent weeks expressing and trying to increase my supply to get her back exclusively bf. Despite this, we ended up continuing with top ups but I managed to bf until she was 14.5 months.

My main advice would be that if you really want to bf, you can do it but don't put too much pressure on yourself. I was so stressed trying to express 3-4 times a day to get her off top ups and think my mental health would have suffered if I hadn't calmed it down. I tried everything going to increase milk supply and now with hindsight wish I'd worried less about it. The most important thing is that they are fed and that you are well enough to look after your children. You might find once she is a bit bigger she will get more efficient at feeding too

Congratulations on your DD and sorry to hear you are struggling.
I can't help on bf as I never managed it myself for any length of time (wish I'd been told the due date thing too) but I did have ptsd treatment - emdr which I'd recommend if you want to do it / can get referred. It's drug free and done with eye movement. Sounds like nonsense but it works and the military use it.
Did you get any help with that the first time?
Also you are doing brilliantly even though it doesn't feel like it now

I second the suggestion for ptsd treatment - my counselor used the eye movement technique too and it was very effective, which I didn't expect.
Are you open to taking antidepressants? If so, could you speak to your GP? Your HV sounds a bit useless, to be honest. "you've got two healthy children" is a completely useless comment which doesn't help at all in your situation. It is also very dismissive of your situation - having a preemie, even a healthy one, is really tough. I hope the midwife you have an appointment with will be able to help you more!

Firstly congratulations on your new baby.
But secondly, you poor thing - what a ridiculous thing your health visitor said.
Of course you are going to be traumatised by going through having a prem baby again. A friend of mine found it so difficult she never had a second.
Have you contacted the charity Bliss? They may give you useful support too, and possibly link you in to other mums in your situation.
Breastfeeding is not the be-all and end-all, which I'm sure you rationally know, but you have done great to have given your new baby breast milk so far.
My main advice would be to be kind to yourself, you have a toddler too, and I managed to express a total of about five times for my second, so well done for getting this far already.
Hopefully this telephone consultation will help, if you feel worse please do flag up, maybe an understanding GP? I found my female GP had great empathy and just opening up honestly to a professional who took things seriously and didn't just fob me off helped.

As an aside, if I were you I would consider requesting to switch health visitors - your's sounds like she had no insight at all into your circumstances.

Thank you everyone for all of your supportive replies. I've read all of them and will look into the suggestions.

I'm having a bit of a rubbish day. I just feel really hopeless. I've started taking 10mg Citalopram (I had weaned right down during pregnancy to 10mg every 4 days). I don't feel like anyone is really aware of how I'm feeling, not professionally anyway. The midwife visited today and didn't even ask how I am despite my notes saying that today's visit was to check my baby's weight and my mood. She didn't ask anything about me, not physically or emotionally.

I just want to go to sleep. I read anther thread on here about a woman who is considering leaving her family because she thinks it's the best thing for everyone. I'm scared that I'll get to that point. I already think I'm bringing everyone down. I just feel so crap.

Sorry you're having a crap day.
You're HV sounds useless. Do you have a supportive GP or are there any Bliss groups or PND groups near you? I found Home Start to be an amazing help to me if you have one near?
Please remember that you are doing a fantastic job. Everyone I know has felt crap in the first few weeks even if they have a sneeze birth on their due date so don't be hard on yourself.
Do you have any support at home from a DP DH or family?

Thanks Abbey. My GP has been very good in the past. I've done a lot of fundraising for Bliss but never been along to one of their groups. Maybe now is the time to go.

I had a Google last night to see if there's a recognised link between breastfeeding hormones and depression. While most people find that oxytocin elevates their mood, some people can't cope with the increased level and it can lead to low mood. I wonder if that's what's happening with me. My anxiety and low mood reaches a peak when I'm due to express and I actually feel far more sane and stable after I do. I remember after I stopped expressing/breastfeeding DD1 that I thought I would feel awful about it but I actually felt fine and more like me. If I was 100% sure that it was the bfing hormones making me feel like this I would stop immediately, but I can't ever know that for sure and I don't want to stop and then regret it.

Hi

Congratulations for your new DD. I'm really sorry you are feeling so low. My DD was born at 26 weeks and I EBF as BF just didn't work for us. We were given the option in hospital of staying in until BF was established - which could have taken up to 2 weeks more. I made a conscious decision that my mental health and escaping SCUBU was more important than BF for me and my baby.

I have to say EBF with a baby in hospital is much easier (ironically) than when the baby is home. When DD had been home for few weeks an extremely kind doctor who could see how I was struggling kind of gave me permission to stop. That sounds strange but he just said to me that I had been through enough and I had done the best I could. I felt a wave of relief and stopped EBF that day - my milk was waning anyway and I found I had spent no time just enjoying or even just being with my baby - the strict expressing and feeding routine had sapped that.

I had had PND with my first DC and was on progesterone treatment after having my last DC which helped me avoid PND with my prem. It might be worth looking at but I don't know if it is routinely given. As others have said your GP should be able to help and it's great he sounds so supportive

Please don't feel like a failure or like you are not a good mum. You are a GREAT mum. You have been through an awful time and are just trying to find your way through as we all do. Bliss also have a helpline you can call for advice or just a chat.

Thank you Showme. It's interesting that you mention progesterone as I was prescribed progesterone pessaries (Cyclogest) at 24 weeks as my cervix was shortening. It's a relatively new treatment for delaying premature labour and the information leaflet didn't make reference to it at all as it's usually used for pre menstrual symptoms, however one of the other uses listed in the leaflet was for PND. I spoke to my GP about it but he said he's never prescribed it for that purpose so doesn't know enough about its use that way. Maybe I should do a bit more of my own research.

Itsaplay My PND with my first child was undiagnosed and dragged on for an awfully long time. I read a book by Katherine Dalton took the info to my doctor and begged for the treatment!

I'm not sure either doctor who prescribed the progesterone believed in it. But I think it worked for me and that is all that matters iyswim. The info on the link below may help and it includes details of the book by Katherine Dalton I used to take to my doctor. I also made sure my blood sugar levels kept stable and took the advice re that and diet in the book too as it kept me on a more even keel

apni.org/leaflets/post-natal-depression/

I hope this helps. Please remember you are not alone and you will get through this

I don't know how to get through this. I know that I will, I know that it won't last forever but I don't know how to get through it in the meantime. I feel so sad and so guilty for them both being born so early and so guilty that their mum is like this now. They deserve so much better than me.

Your children won't want anyone but you - you obviously love them to the moon and back but you need to seek some help. Never think that they deserve better .

I had twins at 27+6 (so almost the same as your first baby). I don't know how you have the courage and determination to get home now with a 35 weeker having been through it all again. Hats off to you, honestly. You are stronger that most other women would be in your situation and you need to pat yourself on the back.

Do you have family around? Friends that could pop in? I don't know very much about PND or PTSD but it sounds as though you really need a friendly GP on board, and some help and if you have friends or family. FWIW, I made a complaint about my health visitor, so I don't hold them in high regard at all (she had no understanding about premature babies AT ALL) so take anything she says with a pinch of salt.

I also agree that the focus on BF shouldn't be the be all and end all, you're putting yourself under enormous pressure. I can't imagine trying to sort BF with a toddler in tow either. But just to reiterate what everyone else has said - until term, they're a bit hit and bit. My twins were tube fed right until we were discharged after 9 weeks and although they did get the hang of breastfeeding, we used nipple shields. Is that something you can discuss with a midwife. The reasoning apparently is that they find it hard to latch on (excuse the too-much-information) but the nipple doesn't go far enough into their mouths for the sucking reflex/muscles to kick in (its at the back of their mouths) so they find bottles / teats / nipple shields much easier. As they get a little bigger, and the sucking reflex gets stronger, they BF much more easily. Hope that makes sense. We established BF (properly - without the shields) only when they were a week or so after their due date.

Itsaplay I know how hard it can be. I decided from day 1 that it was not my fault that my DD came early. You could only be at fault if you made it happen - you didn't. Your body did. You can not control a stomache ache or your menstrual cycle can you? There was no way you are are fault for your darling DC's coming early. That is your PND talking not you

Try and take it one day or one hour at a time. If you can try going to see your GP asap and explore the treatments you can have. Maybe your OH could go with you? Sometimes that can really help. Try and eat well and rest as much as you can and please don't torture yourself over breast feeding. If it isn't working for you you may find you and DC would be happier on formula. There is no one size fits all

The bliss helpline is 0808 801 0322 . They are open til 2pm today - why not call them now. They are so helpful and will be able to talk through all your concerns

Your DC don't deserve better that you. You are what they need and love.

Thank you all for your supportive messages.

I had an awful day on Saturday where I couldn't stop crying and started packing a bag to leave. I don't want to leave and I know I would be filled with guilt but sometimes it seems like guilt would be a more manageable emotion than what I'm currently feeling.

The midwife came to see me yesterday and when she asked how I was feeling I said I was fine to which my husband said "that's not true is it". He helped me to talk to her about how I was on Saturday. He apologised afterwards for speaking up for me but I wasn't annoyed, I know I'm very British about it all and it's difficult to say "my world felt like it was ending yesterday" when you actually feel okay at the time you're being asked. I'm really lucky to have such a supportive husband. When I was in the midst of emotion on Saturday he just cuddled me. He didn't tell me I shouldn't feel that way or try to fix me. He just told me it's okay to feel shit and he told me to let myself cry.

Anyway, the midwife contacted the perinatal mental health midwife who previously saw me and she called me this morning. I also contacted my GP last week and I've had my medication increased back up (it's still a low amount but I'd pretty much stopped taking it in pregnancy). I had a telephone assessment on Thursday for support and they've recommended CBT and they've put me on the waiting list. As a new mum I'm considered a priority so hopefully I won't have to wait too long. I hate that all of this is necessary but as it is I'm proud of myself for reaching out and asking for help.

I'm always concerned that they'll think I'm an unfit mother because of how low I'm feeling. I know that's probably the anxiety talking but I do think that they care about my mental health for the impact it could have on my children rather than just caring about my mental health.

Well done you and well done your lovely DH.

I know it may not feel like it at the moment but you have just taken a HUGE step forwards and before you know it daily things will get a little better until one day soon you will have a whole day without feeling so anxious and down. Then it will be 2 days, then a week and then it will be a distant memory.

The support is there, use them all and if you don't feel you are expressing yourself enough ask your DH to help you. You are not an unfit mother in any way, you are right it is your PND talking. I know it has taken a terrible day for you to get this far but I am so pleased that things will now start improving for you...and I am sure they will. You will still have up and down days but such is the nature of PND

Thinking of you and giving you even more

Itsplay I just wanted to say hi and that I hope you are ok and getting the support you need.

I had my DS 2 years ago at 34 weeks, EMC, very traumatic birth and also never established breastfeeding. He was in NICU for a couple of weeks. I expressed milk for him but could never express enough to build up a proper supply so ended up mix-feeding and eventually full formula at about 12 weeks.

I drove myself insane expressing a pitiful every 4 hours. I was exhausted but wouldnt stop. My son was small, poorly and my body had failed to keep him safe for the 40 weeks its meant to. I felt the one thing I could do was to give him the small amounts of milk I had.

It's only now with the power of hindsight I can see I had it so wrong. But at the time it was all-consuming. That feeling of failure was at times, completely overwhelming. I also had a very unhelpful health visitor who told me I should be grateful that my DS was healthy and thriving. Just because you are feeling the way you are feeling does not mean you are not gratfeful.

I am now pregnant with my second child and my anxieties are starting to surface again. Its impossible to ignore them.

You are in no way and unfit mother. You are looking after 2 children whilst feeling like this. You are doing so well. I really hope that you had the telephone assessment yesterday and that it went well and that its the start of your recovery.

I've had a rubbish few days I've just felt so lost and trapped. My eldest daughter is going through a difficult phase - lots of tantrums, ignoring me and refusing to do what I ask. I know it's probably a reaction to having a new sister and trying to adjust but I just don't know how to deal with her at the moment. I don't know what's happened to my happy little girl and I feel like I'm the one who's making her unhappy now. Perhaps she's picking up on how I feel. Sometimes I'm fine and I get on with what needs to be done but other times I just sit there staring into space and feel progressively sadder. I feel like my perspective is all off. I know that sounds weird but have you ever viewed a situation as if from someone else's point of view. I suppose what I'm trying to say is that I don't feel like me. I'm hopefully wishing for someone to come and wave a magic wand and make it all better. I know that's not going to happen but I don't see any other way of this sadness ever ending. I've found myself talking in my head to my Nan who's been gone 5 years asking for her to help me or guide me. I don't even know if I believe in that kind of thing. I suppose I'm feeling desperate.

I also would love a glass of wine for a bit of escapism! But I know that's not a healthy choice and it's also not a possibility as breastfeeding is actually going okay!

I had first DC at 29 weeks - I had PTSD and had counselling which really helped - I just couldn't stop crying and feeling sad. It is so hard. I found HV didn't get it - no experience of premature babies and said unhelpful things, kept telling me how well I was coping when I wasn't, once we got home. It sounds like you are doing really well. Definitely see if you can get some counselling just to have someone to talk to. It sounds like you are doing an amazing job to me. Also I felt I wanted to do everything myself because I'd done such a naff job of being pregnant, but in hindsight that was really silly - I should have asked for help - having a new baby is really hard work.