Nearly a statistic; Postnatal depression

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Trigger Warning re childhood abuse/birth trauma/suicide

I have been involved with a piece of work with the midwifery education school at my local university, the same one incidentally I am due to graduate from this summer with a BSc Hons Mental Health Nursing although this is totally separate to my academic studies.
What started as an email saying ‘you’ve talked about having had postnatal depression haven’t you?’ has evolved over the past 14 months into something I am exceptionally proud of. The email was from someone I have come into contact with in a service user voice worker capacity and on behalf of a senior midwifery lecturer at the uni, we agreed to meet for a coffee in December 2012 to discuss what was being asked and how it could work.
When I went to that meeting I anticipated telling my story to student midwives as I have done before at many conferences and training events I had no idea how much what we were about to embark upon was to impact upon me. I don’t think any of us realised at that point what was to come. I had talked freely about my experiences of pregnancy and subsequent postnatal depression, spoken around the UK and Ireland so I wasn’t concerned at this. We drank our coffee and told our stories. I told my story and another service user told hers, our birth experiences were over two decades apart but the similarities were striking. The emotions we described feeling were almost identical. Our plan began to fall together we would video our stories for the student midwives.

So we sat on a sofa and told our stories, at times I forget how shocking my experiences are for others to hear so I hadn’t prepared myself for the response this video generated.
I told how my pregnancy was a happy surprise, how we had discovered we were expecting nearly two weeks before our wedding which we had spent the past year planning down to the last table decoration and colour themes! How we flew to Cuba on honeymoon and Hyperemesis Gravadium (HG) set in. I spent my entire pregnancy vomiting violently around 25 times each day, on occasions I would go to speak and instead of words I would projectile vomit with such velocity that I broke blood vessels around my eyes giving me the appearance of something from Halloween. When our honeymoon flight landed back in the UK our taxi from the airport diverted and took me straight to hospital where I was to experience my first of many admissions to hospital during my pregnancy for bags of fluids and IV antiemetics. My electrolyte balance was so far out of the norm we overheard the worried whispers of staff at how they couldn’t believe I had actually walked in. I cried to my husband when I was pregnant that I just wanted to bloom, I was miserable with chronic dehydration to the point where my skin was peeling off it was so dry. My baby felt like a parasite and I felt like a failure. Surely everyone could cope with a ‘bit of pregnancy sickness?’ That’s how I was made to feel by both those close to me and by professionals, it wasn’t until near the end that people seemed to feel pity for me. It was earlier I needed their compassion and support.

I was open with my community midwife, I told her how awful I felt and she knew how ill I was. I answered her questions with candour and openness when she asked if I had experienced any mental illness before, she ticked her box when I told her that I had experienced bouts of depression since I was a teenager. She asked if I had experienced any abuse in my life and then ticked her box when I answered honestly yes. I told her I had been sexually abused as a child and her box was ticked with a sense of relief when I said the perpetrator was no longer around therefore no safeguarding forms for her to complete. She was lovely but at no point did she warn me that these factors put me at high risk of emotional difficulties postnatally. It seems from the exploration I have done since that unless their is a safeguarding issue raised for the baby the information on these forms doesn’t actually go anywhere. It seems pointless asking personal questions if other than a tick in a box nothing happens with that information.

As I neared the end of my pregnancy I had the same concerns any mum to be has, will I cope with labour? Will I need drugs? How bad will the sleepless nights be? But I had other concerns preoccupying me as well. I spent my days rationalising in my mind how I would cope if I had a boy, what if he became an abuser? What about the process of giving birth? Would the pain ‘down there’ generate flash backs? I’m a private person so I never raised these concerns. Would I feel ok emotionally breast feeding or would it feel like I was abusing my child with breasts which my experiences as a child had taught me were sexual objects?
What I hadn’t considered at all was how it may emotionally paralyse me if I had a girl. I had a girl and became obsessed that everyone would try to abuse her. I wouldn’t even take care of basic tasks such as bathing her as I feared people accusing me of being a paedophile. Even though she was never out of my sight my thought patterns were so distorted that I used to put a length of red cotton thread in the Velcro of her nappy so I knew if it had been tampered with. I know in hindsight whilst sat typing this as a ‘well person’ how ludicrous that sounds but it seemed so important at that time.

During my 24 hour labour each time I was examined I blinked back the tears, I felt so out of control, I felt violated. I felt seven again.
I spent so much time trying to prepare myself emotionally for how I would deal with flash backs generated by the actual process of pushing my baby into the world. It hadn’t entered my thought process that I could have ended up with a Caesarian section. An emergency section under general anesthetic actually which meant I slept for most of my daughters first day and have no memories of her first day in the world.
Again, whilst I had prepared for the emotional consequences of breast feeding but hadn’t even bought any bottles as I hadn’t considered not being able physically to feed her myself. So at this point I felt I had failed at pregnancy, failed at birth and now I was failing at breast feeding, it seemed logical that I would fail at motherhood.

On a subconscious level I think I refused to accept how bad I felt and subsequently I spent the next five weeks racing around manicly, I decorated our entire flat from walls to floor, carpets to curtains spending a fortune as I went. Parcels arrived each day that I had bought online and I had friends and family over to dinner each evening for weeks. Christmas happened during those five weeks too so my over activity wasn’t as noticeable as it may have been at other times in the year. When our daughter was five/six weeks old I didn’t just slow down I stopped, depression hit me like a shovel in the face. Those first few weeks were almost forgotten about until much later when we found a calendar from that time, the depression and ultimately keeping me alive became our priority for a long time.

My mood went downhill rapidly, I was diagnosed with postnatal depression when she was five weeks old and then as my condition deteriorated I was referred to secondary mental health services for the first time in my life when she was 12 weeks old. When she was 18 weeks old I decided to return to work as I’m my warped sense of reality ‘I had failed at motherhood so I’d be better at work where I knew I could succeed. My role at the time was Head of Human Resources for a charity, I covered all of England and Wales, it was a fast paced environment where I thrived usually. When my daughter was 22 weeks old I had traveled down South for work, attended the meetings I needed to on automatic pilot and then as I went to travel home I found myself stood on the very end of the platform at the train station thinking how easy it would be to throw myself in front of the next fast moving train. Not one that was stopping at the station but a really fast one that causes you to shudder as it races through the station on it’s journey. I shocked myself and stepped back. I was scared, I knew I wasn’t safe any more. I couldn’t live like this. I didn’t want to live.

First thing the following day I went to see my GP, she was wonderful she listened without judging and asked me to go back the same time the next day to see her again. The following day I did as I was asked and returned to see my GP but as I was stood in the waiting room my thoughts were racing, I had admitted being suicidal the day before and in those minutes in the waiting room I managed to convince myself that she would have social services waiting to remove my baby. Now remember I didn’t really like my baby at this stage but I also didn’t want anyone taking her out of my sight where she could be abused. I fled. I ran down the road and into my home locking the door behind me when the telephone began to ring. It was my GP and she was worried about me she aid she was sending the crisis team over to see me and that they would be in touch within a few moments. The crisis team came over and over the next week or so changed my medication and visited me daily to try and lift my mood. My mood didn’t lift though, I felt no better and now suicide didn’t frighten me. I felt like suicide was my only option, I’d be doing my family a favour by removing myself from the picture. I had gone through a phase where I considered putting my daughter up for adoption and having another baby ‘who didn’t hate me’ but this passed and I knew I had no choice. It was time to die.

The crisis team decided that my risk of completing suicide was too great and that I needed to be in hospital. They talked of this wonderful place where my baby could go with me, a mother and baby unit at a psychiatric hospital.
I had not had any involvement with mental health services until a few weeks prior to this time so the idea of a mental health hospital terrified me. I anticipated a large red brick asylum type building with militant matronly staff and patients who wailed. I’m ashamed of how stigmatised my views were back then, I was so naive.
My experience in hospital was actually really positive, I had my own double bed with en suite facilities in a brand new hospital and the staff were outstanding. Suicide was still my aim I just had to find an opportunity. One evening after about ten days in hospital the time had come, I had written carefully thought out letters to my husband and my daughter and a shorter note to staff apologising for being a burden and for not managing to recover even with their help. I was on five minute observations so I waited until they had checked on me and then put my full face of make up on, I wanted my husband to remember me as I used to look, to see my body and remember the woman he fell in love with. After the next five minute check I took my previously carefully tied noose out from under my duvet and placed it around my neck. I remember how soft the cord of my dressing gown felt against my skin and how calm I felt as I knew within moments it would all be over. My pain was nearly gone. I stood on the chair and was kicking it over just as staff came back to check, they hadn’t waited five minutes they said later that they just knew, that intuition said they needed to come back. Their intuition saved my life. As I fell to the ground people seemed to surround me, I know now that staff had pulled their alarms. I remember struggling with the night manager who was trying to put an oxygen mask on me, I was furious that they had spoiled my plans. I should have been dead by now.

The next few weeks are a blur, I know I had someone on arms length observations by my side 24 hours per day. I had ECT (See blog post ‘Shocking’) along with medication and lots of nursing support. I was in hospital for five long months over summer 2007, it’s was Halloween when I was discharged, I had lost an entire year to post natal depression. Recovery was a long and slow process but I got there in the end that’s why I feel I owe it to women everywhere to speak up about my experiences. That’s why I became involved with that project with the Uni to help midwifery students have a greater awareness of mental illness in the mums they care for. My awful birth experience although not directly to blame certainly contributed to the post natal depression I suffered and some of the things I experienced could have been done better. To hear the first cohort of student midwives say how much my story had affected then and how it had already impacted upon and influenced their practice made it worth talking about. If they can use my experiences of depression or of childbirth after abuse to help another woman then I can feel proud of my achievement.

We have now co-authored an article which will be in next months British Journal of Midwifery about how service user experiences can have a hugely positive impact upon the learning experiences of student health professionals. I’m immensely proud of being involved with this and hopefully we will continue what we have started with ethical approval for some empirical research.

I hope this blog shows you that Hyperemesis is much more than morning sickness and Postnatal Depression is much more than baby blues, those terms belittle the debilitating nature of those conditions. If you have any questions please ask…

12 thoughts on “Nearly a statistic; Postnatal depression

  1. Thank you for this. More than twenty five years ago, when I did the midwifery placement during my general nursing training, I asked about talking to pregnant women about the possiblity of developing post-natal depression. The subject was in my mind because a relative had been (belatedly) diagnosed with it at the time. The midwife just looked embarrassed and said it was ‘inappropriate’ to mention such a thing at what was meant to be a happy and positive time for a woman.

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    • It annoys me so much that we are allowed to tell women about things like gestational diabetes or pre eclampsia but not to warn them about emotional complications. It equally annoys me that it’s acceptable to tell someone you meet at baby clinic for the first time how cracked your nipples are or how many stitches you have in your vagina but it’s not acceptable to say you aren’t enjoying this ‘special time’. Well done you for telling those women, if only others did. Or if only things had moved on in 25 years.

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  2. Thanks for writing this post about such an important subject. So many issues that women encounter during their journey to motherhood are stigmatised, leaving us feeling ashamed and isolated. Thank you for working towards the removal of those taboos.

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  3. This post had me in tears.

    I was worried about how I’d feel after the birth of my son, as someone who has been raped and has also suffered from anxiety and depression on and off since I was 11 years old. I was lucky I guess that my midwife and GP were incredibly supportive and saw me regularly to check on my emotional state as well as how the actual pregnancy was going. My husband and I were warned about being at risk of PND and/or PTSD and I find it shocking that this does not routinely happen.

    I really hope that through your work and project you can help make this happen. x

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  4. An incredibley powerful read. The abyss that I fell into after the birth of my eldest son was mind-numbing. The thoughts and feelings that I had in those early months about my son, none of which were pleasant, fills my now well mind with shame. When I look at the pictures of us in hospital, I can see the dead look in my eyes, and it compounds my sense of failure. I hope and pray that I might recognise that torture in someone else if I’m ever faced with it. Thanks for sharing.

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      • Damn you wordpress. Probably better as an email tbh. First I’m really sorry if this is intrusive or telling you what you already know or any number of other wrong thing it might be. I just wanted to say that after reading the para in your post about the first 5 weeks after having your little girl, I was very surprised that you said your diagnosis was PND. Because it sounded (just off what you wrote) like hypomania which after childbirth indicates post partum psychosis. So I wondered whether this was ever mentioned by your doctors. You don’t mention losing touch with reality as such so I don’t know, maybe psychosis doesn’t sit right with you. It didn’t with me either, but that’s what I had. Projecting, moi?? I realise I’m both making assumptions and jumping into your business but I just raise it because I think it’s so important that PP is recognised and that people are aware of the signs etc, but that often doesn’t happen at the moment. All the best.

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      • I am a mental health nurse so very aware of te implications of my experiences. I didnt come to the attention of mental health services until I was severely depressed therefore hypomania is not something which can be diagnosed in hindsight, it is something which must be observed by a clinician at the time. A psychiatrist at a later date (which is covered in another blog post) said that he was fairly sure my diagnosis sat on the biplolar spectrum however I have not chased this as a certainty. I am firmly of the opinion that effective treatment is far more important than label but labels can make a difference with things such as occ health so I manage my mental health daily and hope for the best. If I ever choose to become pregnant again or indeed become unwell again then i realise this is the diagnosis i will likely attract however having already lost a career and a business to stigma it is something i intend to avoid for as long as possible.
        Thanks so much for reading and for caring enought to share your thoughts. I’m sad to hear you also experienced mental illness postnatally, it feels like theft of what should be the most perfect time doesnt it? Take care

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