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Perinatal mental health

What is Perinatal Mental Health? from UHNM NHS Trust on Vimeo.

 

​​​Becoming a parent is a big life event

It's natural to experience a range of emotions and reactions during and after your pregnancy. But it's important to ask for help or support if you need it. You're likely to find that many new mothers are feeling the same way.

It can be really difficult to feel able to talk openly about how you're feeling when you become a new parent. You might feel:

  • Pressure to be happy and excited
  • Like you have to be on top of everything
  • Worried you're a bad parent if you're struggling with your mental health
  • Worried that your baby will be taken away from you if you admit how you're feeling

Around one in ten women will experience a mental health problem during pregnancy or in the year after giving birth. This might be a new mental health problem or another episode of a mental health problem you've experienced before. These are known as perinatal mental health problems.

Baby blues should not be confused with perinatal mental health problems. Baby blues are extremely common and can be normal for many mums. You might feel tearful, anxious and emotional, this usually last just a few days. 

Perinatal Mental Health Information

The Lullaby Trust
The Lullaby Trust provides expert advice on safer sleep for babies, supports bereaved families and raises awareness on sudden infant death.

Home‐start UK
Volunteers offer support, friendship and practical help to young families experiencing difficulties, visiting them at home. Local schemes.

National Childbirth Trust
We're here to support parents. We give them accurate, impartial information so that they can decide what's best for their family, and we introduce them to a network of local parents to gain practical and emotional support.

Netmums
Provide on-line health visiting support for PND and excellent information

Relate: National Marriage Guidance
Confidential counselling on relationship problems of any kind, not only marriage

Samaritans
24-hour confidential service for people who are in despair

Stillbirth and Neonatal Death Society (SANDS)

Information and national network of support groups for bereaved parents.

Fathers Reaching Out

Support network for fathers who have experienced postnatal depression either their own or been affected by their partners postnatal depression.

Healthy Minds

Healthy Minds is a service supporting patients 18 years + who are registered with a GP in Stoke-On-Trent.

Telephone number: 0300 123 0907 Option 2
Monday - Friday 9-5pm

Patients can self refer on the above number or a health professional can refer via telephone or by faxing a paper referral. 

The service helps to support patients with some of the following mental health problems:

  • Anxiety
  • Depression
  • GAD – General Anxiety Disorder
  • OCD – Obsessive Compulsive Disorder
  • PTSD – Post Traumatic Stress Disorder
  • Panic Attacks
  • Social Anxiety
  • Phobias


Therapies include Cognitive behavioural therapy, counselling, guided self help and educational programmes

Taken from www.healthy-minds.org.uk  (see for more information)

North Staffordshire Wellbeing Service

This is a service for patients registered with a North Staffordshire GP.
Two centres one based in Newcastle-under-Lyme and one in Leek.

Tel: 01782 711651
Fax: 01782 632030

Patients can self refer/ refer online for a phone call back/ health professional referral via telephone or fax paper copy

The service helps to support patients with some of the following mental health problems:
 

  • Depression 
  • Generalised anxiety 
  • Panic attacks 
  • Agoraphobia 
  • Social Phobia/Specific Phobias 
  • Obsessive Compulsive Disorder 
  • Post Traumatic Stress Disorder 
  • Health Anxiety 
  • Body Dysmorphia


Taken from http://www.northstaffswellbeing.co.uk  (see for more information)

Therapies include cognitive behavioural therapy, counselling, couples therapy.​

​​My name is Juliette Lloyd. I'm 44 years-old and currently live in Leek in Staffordshire. 

​Plea​​se tell us about your experience of being pregnant. Were you nervous or excited, and if this wasn't your first time, did you still have the same feelings?

My recent pregnancy experience was very difficult. It followed not only the death of my first child, but also an ectopic pregnancy, four miscarriages and eight cycles of IVF. We initially thought we were pregnant with twins, but a scan at 13 weeks revealed triplets. ​Sadly we lost 2 of triplets at 14 weeks, and had a very anxious wait to see if Robyn would survive. Once we were past the highest risk of losing her, I found I was able to relax a little. 

​However, I found being pregnant again very emotional and it triggered a lot of grief. I was very tearful, and the anxiety that I would lose Robyn as well was very strong at times. Sleep was the biggest issue, as I had chronic insomnia throughout the pregnancy. I continue to have anxiety about losing Robyn, but luckily I haven't had Postnatal Depression (PND) this time.

​How was the birth of your child? Was it easier or harder than you had expected and how did you find the support at this time?

We received amazing support from our consultant in Fetal Medicine, and a low-risk delivery was planned from the very beginning. Due to my age and gestational diabetes, we agreed a low-threshold induction at 38 weeks. This meant that at the first sign of any problems I would move quickly to a caesarean section. The induction was unsuccessful as I over-stimulated and Robyn's heart rate was too fast, so within minutes I was being prepped for surgery. The delivery was beautiful. I felt calm and pain-free, and my husband and I were both very emotional when we heard Robyn cry. All of the midwives and staff we met were very empathic about the loss of our son, and I felt they did everything possible to alleviate my anxiety and support me when I became emotional.

​​It is a huge change in life being responsible for a newborn baby and we know how difficult this time can be. How did you find your first week at home?

As this was our second time around, it wasn't a huge adjustment. My husband had three weeks off work so he was able to help while I recovered from surgery. The thing I find the hardest is the constant stream of visitors and appointments, which are all happening when I really want to just rest and bond with my baby. I also found that being with Robyn triggered a lot of grief for my son in unexpected ways. This improved a lot after the first month or so.

​​Did you get any support from your health visitor or local services and if so, how did you find them?

Due to losing our first child in sudden circumstances, and because the cause of his sepsis was unknown, we were eligible for the CONI (Care of Next Infant) scheme. This has been a great network of support. We have a health visitor who specialises in supporting mothers after loss, and Robyn is seen for regular and thorough health checks by a paediatrician at the CONI clinic at Royal Stoke. I can contact my health visitor as often as I need to, and the whole team are aware of my grief and potential triggers so I have additional support at difficult times. I was made aware of the CONI scheme by our bereavement liaison following Billy-Joe's death, so I asked to be registered once I knew I had an ongoing pregnancy.

​Did anyone talk to you about perinatal mental health when you were pregnant?

My midwife asked some basic screening questions about my mental health at my booking appointment. As she was aware of my circumstances, having been my midwife during Billy-Joe's pregnancy, she felt it was best to refer me for further assessment at Royal Stoke. I had one session with the perinatal mental health midwife, with the option of further support if required. I was already accessing CBT-based psychological therapy through the perinatal project at the local IAPT (Improving Access to Psychological Therapies) service, which I accessed by self-referral. The CBT focussed particularly on my anxiety and how to manage the worst of the symptoms, as well as dealing with ongoing grief, and I found it very helpful.

​Did you get help and support from midwives?

My community midwives tended to change frequently, as my usual midwife was off work for an extended period. However, given how high-risk and complex my pregnancy was, I received most of my care at Royal Stoke. All of the midwives we saw, before and during delivery, were very supportive and thorough, and they all seemed to understand how difficult and emotional it is to have another baby after child loss.

​​​Do you feel there is a stigma around perinatal mental health? If so, how can we help tackle this?

Yes, I think there is. Unfortunately, when we see news reports about mothers killing themselves and their babies due to Post-Natal Depression, that's what some people think PND is. I have had conversations with older people who seem to think that PND is an inability to cope with having a baby, and one woman I spoke to thought it was the result of career women 'wanting to have their cake and eat it'. Even people close to me think that I didn't have PND (despite being diagnosed by my GP) and think that I felt low because my baby had milk-protein allergy and reflux which made him very challenging. While it's true that Billy-Joe was a challenging baby due to his difficulties, it's also true that I had PND and it improved within weeks of taking the right medication. I think PND and other forms of perinatal mental ill-health are very misunderstood. If people understood that they are caused by hormonal changes, and not bad decisions or poor motherhood skills, maybe more people would feel able to seek help.

​​What would you like to see around mental health and maternity services?

My community midwife was unaware of some of the support available to me, such as the CONI scheme and the IAPT perinatal service. I would like to see more information being circulated in the community so that everyone is given the same information and opportunities.

I would also like to see more information being given to patients and their families. Despite engaging with mental health services throughout my pregnancy, and my previous diagnosis of PND, I was never given a leaflet to give to my husband or parents about my problems, which might have helped them to understand what I was going through and how to support me. I wasn't given anything to read to help me understand PND or perinatal anxiety, or how other mums coped with it.

I wasn't given any resources that could have helped. I asked for some relaxation materials but was given a website through which I would have to pay to download certain apps or audio files, which I wasn't in a position to do at the time. The onus was always on me to find resources online. It would be great if the NHS could produce resources and make them readily available, like they do for other issues like breastfeeding and gestational diabetes. It seems that perinatal mental health is not very well resourced like other aspects of pregnancy and motherhood, but is equally important in my experience.

Anything​​ else you would like to add?

I would like other mums to know that Post-Natal Depression doesn't necessarily look like lying on the sofa, crying, and not wanting to go out. Mine didn't look like that at all. I was full of energy and very motivated to stay active, and I didn't feel particularly sad. My feelings were intense anger, at other people, my husband, myself, and worst of all, my baby. The 'red mist' dropped at the least little trigger and I could fly into a rage. I wouldn't have dreamt of hurting my child, but I slammed doors and shouted.

Once I had calmed down, I felt intense remorse, failure and embarrassment, and that's when I would cry uncontrollably. I didn't think I had what it took to be a good mum, and I was often overwhelmed and anxious. My professional background in mental health did nothing to prepare me for what I was going through, and I didn't know how to help myself. I compared myself constantly to other mums, and always found myself feeling like the oldest, fattest, poorest, worst mother in the room. I had desperately wanted to breastfeed but couldn't, so that added to my feelings of failure.

My husband eventually persuaded me to see my GP and I was prescribed anti-depressant medication. The first week was hard, as I was very tired and a bit 'spaced', but after a couple of weeks there was a huge improvement. I stopped spending time with other mums who made me feel worse, and my GP gave me some great guidance on how to handle my son's bad days. I wish I'd gone sooner, and I'd encourage any new mum with any of those feelings to talk to their doctor. Don't wait to feel 'depressed' as you might not. You might feel a million other emotions that change all the time. There is no need to suffer in silence or worry that you will be considered a bad mother. Seeking help for mental health problems should be as acceptable as taking antibiotics for an infection, and getting the right help will benefit both you and your baby.​​