It happened every time someone picked up the new baby. The terror and self-loathing would come crashing in, like an angry sea. “Observe,” my mind would tell me. “See the competence with which they cradle his little head. Notice the love in your baby’s eyes when he looks up at them. He doesn’t do that with you. You’re bad at this, you’re a bad mother. And they’re all onto you.”
“I’m sorry, I’m sorry,” I’d whisper to the baby once the visitors were gone. “I’m sorry I’m your mum.”
I was all right directly after the birth – hallucinating from lack of sleep, yes; and shell-shocked from the violent way my son entered the world – but in one piece, breastfeeding, and loving the bundle I’d been saddled with.
But worrying images were flashing, unwanted, before my eyes – graphic visions of the baby tumbling accidentally out of my arms and shattering, like a vase, on the wooden floor. Waking up and finding the baby had suffocated in his cot. Next, the doubt set in. When anyone – my husband, our family, my friends – held the baby, I would shrivel inside, comparing myself unfavourably to them the whole time. I was fat, stupid, ugly; not a natural parent; unlovable. They deserved my baby so much more than me. I already felt as though I was being sealed away from everyone behind a glass wall. I should really, I figured, just give my baby over to those more qualified, and make myself disappear somehow.
This is really the first time I’ve revealed the fullness of my maternity mental health struggles outside of a therapist’s room, but since it’s Perinatal Mental Health Awareness Week – and today is World Maternal Mental Health Day – it seems apt.
According to the Royal College of Psychiatrists, one in five women will experience perinatal (during pregnancy and up to a year post-birth) mental health issues. Whether, like mine, it’s a worsening of an existing condition, or a completely new one, the effects can be devastating if they’re left untreated, and suicide is the leading cause of maternal death in the UK.
That my own unwanted visions and thoughts of “disappearing” didn’t take me to a place of darker intent is something I am grateful for daily. Partly it’s down to luck; partly because, as someone with existing pockets of depression and anxiety – who rocked up to her doctor’s the minute she felt a bit down during pregnancy – I had a mental health paper trail, and my doctor, midwife and health visitor were aware of the risks. I admitted to them that I was struggling, although it felt like failure at the time, and was soon diagnosed with postnatal depression, plus post-traumatic stress disorder from the birth. My existing antidepressant dose was bumped up, and I was fast-tracked for counselling and – weirdly but really effectively – a craft group for depressed mothers, and slowly I returned to more balanced thinking.
One of the problems is that pregnancy and childbirth can be such an attack on the body and mind that it can be hard to distinguish early signs of mental health difficulty with the normal (but often upsetting) hormone crash of the “baby blues” period, which is why it’s important not to dismiss your emotions, and to be as open as possible with your health visitor, your midwife, and your doctor. Perinatal mental health issues can be treated effectively with psychological help, medication, and support.
Another issue is awareness of the problem – we’ve all probably heard of postnatal depression, but anxiety, post-traumatic disorder, schizophrenia, bipolar disorder and obsessive-compulsive disorder can also occur.
One of the rarest perinatal conditions – but among the most devastating – is postpartum psychosis, which can make new mothers confused, paranoid and lose touch with reality. Although it can affect anyone, it’s more common in first time mums and mums with bipolar disorder, especially if there is a close relative who has had postpartum psychosis. Recently, Antiques Roadshow expert Alice Gibson-Watt died after suffering postpartum delusions, and her husband Anthony revealed that neither he nor his wife had even been aware of the condition.
One of the rarest perinatal conditions – but among the most devastating – is postpartum psychosis, which can make new mothers confused, paranoid and lose touch with reality
“I remember seeing a patient become so confused after the birth of her first child that she thought the nursing staff were conspiring against her,” says Dr Aman Durrani, executive member of Royal College of Psychiatrists’ perinatal faculty. “She developed a delusion that the hand soap on the ward, made by a brand called ‘GP’, was a secret message only meant for her because she was a General Practitioner. Distracted and distressed, she couldn’t focus on her newborn.
“She was admitted to a mother and baby unit where she was supported by nursing staff, counselling and medication. She was kept with her baby throughout her treatment so the important early bonding and attachment period wasn’t disrupted.
“Often mothers worry about having their baby taken away, but clinicians will always do whatever they can to keep you together. She slowly got better, initially undertaking tasks like organising bottles until she was able to care for her baby independent of help from nurses.
“The episode is now completely behind her - she’s back at work and is a healthy, happy mother. The father was also given support after going through such a difficult situation."
So how can we guard against postpartum psychosis? Dr Durrani’s advice is simple – stay informed:
“I can’t stress how important it is to learn about postpartum psychosis before pregnancy. Yes, it’s an unpleasant condition to think about, but the key thing to remember is that a full recovery is more likely if you get help early. If you’re bipolar, tell your midwife and let your mental health clinician know you’re pregnant. If you’ve experienced an episode of postpartum psychosis before and are planning another child, tell your GP so you can be referred for specialist advice.
“The most important thing is that you’re monitored in the first few days after birth to ensure there are no concerning changes in your mental state. If you, your partner or your family begin to recognise some of the symptoms – get help promptly by contacting your GP, health visitor, mental health team or out-of-hours NHS service. The sooner you get help, the better your recovery will be.”
He has a similar message for anyone suffering other psychological problems in the perinatal period, no matter how small: “Tell your healthcare professional. If you’re open about it, healthcare professionals can support you to prepare a care plan including access to counselling, advice and medication. Remember medication isn’t a default, it’s just an option.”
And as for me? Well, I’m 23 weeks into my second pregnancy, and to be quite frank I’m feeling a little low. Nothing special, just a dip that – if I weren’t pregnant – I would put down to a change in the weather, the fact that my mother is very ill and far away, money troubles, or sleep deprivation, all of which are also valid reasons. It could be something. It could be nothing. Just in case, though, I’m winding down, giving myself a break, and - most importantly – I’ve alerted my therapist, my midwife and doctor. Better safe, after all, than sorry.
If you’re suffering and want to talk to someone right now, call the Mind helpline on 0300 123 3393 (or text 86463), or call the PANDAS Foundation on 0843 28 98 401.