Perinatal mental health

​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.​​