New motherhood and PND (Full article. Shorter version appeared in The Guardian) (25 August 2014)
When the midwife places your newborn in your arms, you will feel a mixture of exhaustion and ecstasy. ‘This is the beginning of the rest of my life. Everything’s going to be wonderful’, not, ‘Where’s the exit? This is all too much.’ You may get the baby blues for a few days or even weeks, but that’s just normal and will go away in time. This is the received wisdom, trotted out to first-time mothers. However, the reality for most women is somewhat different. When I gave birth to Robin in 2004, I was staggered as to how extraordinarily isolated I felt. I remember the sensation of being marooned in a big tunnel straight after his birth, cocooned from reality by the effects of the epidural. I wanted to get cleaned up, to eat, to sleep. The midwife said, ‘Let’s get Mum up to the ward’ and I thought, ‘my Mum’s not here, is she?’ I couldn’t get my head round the fact that I was ‘Mum’. In the fog of the first few weeks, I kept thinking how hard everything was – I was conscious of being at odds with myself, although I’d give the impression that everything was fine. Like many other women living in a big city, without a family network around them, I struggled to find my way. I did find activities and playgroups to go to, but the focus was always on the babies and all the conversation related to that. I remember filling out that peculiar little form at my six-week check at the doctor that included questions such as, ‘Have you ever felt like harming yourself or your baby?’ I didn’t feel that, but who would want to tick ‘yes’ to this and have herself branded as an unfit mother? To admit that you are finding so difficult what many thousands, including your own mother, have done before you. That this longed-for bundle of joy should be so daunting. Add to this the stigma that still exists around mental health issues and it’s no wonder the feeling of panic sets in. When you are exhausted and tearful and all the mothers around you seem to be coping better, you don’t want to sit in a busy surgery and define your state of mind. The very phrase ‘post-natal depression’ is depressing! It is more correctly known as post-natal illness and The Association for Post Natal Illness estimates that it affects between 70,000 and 100,000 women and their babies in the UK every year. It is rightly called 'the silent epidemic'. We live in an increasingly fast-paced society, where you can leave hospital as quickly as a few hours after giving birth and are expected to get on with it. A sense of neighbourhood is fast being eroded. Excepting perhaps small villages, gone are the days when the whole street would rally round to help the new family, while the mother rested and adjusted. Families these days are small, not extended, often you have moved away from where you grew up; women delay having children while they pursue careers and travel, so to be suddenly thrust into the role of housebound new mum without a support network can be terrifying. Occasionally there is a high-profile case, such as that of Danielle Wails in 2006, where the general public can gasp at the horror of a woman who has killed her own child. There is far less coverage for a mother who has taken her own life. Few will know that, according to the Royal College of Obstetricians and Gynaecologists (RCOG), more than ten per cent of maternal deaths - that's deaths within one year of giving birth - are caused by suicide. This doesn't even include suicides which come later, in some cases much later. There was a mother from Cheshire who lay down in front of a train in 2000 because she had never recovered from the depression that started with the birth of her 24-year-old son. Relatively few women take their own lives, but at least twenty per cent of all new mothers are likely to suffer depression, and for between a third and a half of these, it will be severe. The media is full of opinions about motherhood, little jibes about the categories of mother: ‘career bitches, ‘yummy mummies’, ‘hippies breast-feeding their children into adulthood.’ Then of course those celebrity mothers who lose their baby weight within a week or two. There is an assumption that a mother’s day is filled by checking out the latest gossip on Mumsnet Towers and a spot of lunch, with a few nappy changes here and there. Very little is written by mothers detailing their life in that first year. It is recorded retrospectively, if at all. This is mostly because it can get to 2.00pm before a new mother can find the time to brush her teeth. Of the various articles written, nothing is more damning than pieces from women who have not been able to have children, castigating mothers as ‘moaning’. Yes, we’ve been having babies for centuries, so why all this fuss now? Nobody expected bringing up children to be a breeze, but there is something about a mother’s state of mind in the months following the birth, hit by the juggernaut of responsibility, that sets it apart from the challenges faced later on in parenthood. It’s not even as if mothers want very much. My group Mothers Uncovered runs various events, performances and exhibitions. The mainstay is a four week facilitated discussion group with the same group of up to twelve women who meet for two hours once a week. They talk about their babies, of course they do – one wouldn’t expect them to be discussing Schrödinger’s Cat theory on two hours sleep – but it is in context of the whole person, because behind every mother is the woman she has always been. The participants, who are not all middle-class WASPs, are delighted and grateful to be mothers, but they need an outlet to process the mammoth event they’ve been through. They record their experiences in diaries, in interviews and through art and photography. People might say there are church halls up and down the country packed with Mum & Baby groups, which is true. These are usually informal drop-ins however, not suitable for discussing issues that might be difficult and painful. The last thing a vulnerable new mother needs is to walk into a large room of chattering women who all seem to know each other. All is needed for groups like Mothers Uncovered is a room and someone to lead the session, the best person being a mother who has been through the same stage herself. And perhaps some tea and biscuits. It’s not exactly the moon on a stick, is it? Peer support is a wonderful thing. It enables women to feel that they are not mad or bad mothers, just going through an enormous life change. But hang on, I hear you say, what about those post-natal depression groups? There are groups yes, but many women feel that this is a sign of failure, of ‘not coping’. Common wisdom reports that most women just have ‘baby blues’, only a few have something more serious. These women are kept apart, in ‘closed groups’ at health clinics. I know this, because I have had a devil of a job infiltrating these groups to see if any of the women would like to come to Mothers Uncovered. It’s as if there’s a fear that they might ‘infect’ the other mothers. I’m not disputing the fact that post-natal depression does exist and sufferers of it may well need medication and counselling. However, every single mother I have spoken to in the last few years has felt they couldn’t find an adequate outlet for their feelings at the beginning. Were they all suffering from depression? Additionally, on some days they wanted to celebrate how much they loved being a mother and share that with others. They didn’t want to describe themselves as depressed then. It seems that both the terminology and the attitude to this period of motherhood is wrong. It is summed up perfectly in Naomi Stadlen’s book ‘What Mothers Do’: “Mothers may be given a “running-in’” period of a couple of weeks. After that, they are usually expected to be calm and capable. Would it not be much more realistic to expect new mothers to be unprepared, anxious, confused and very emotional for at least the first six months? If we could accept that this beginning is the norm for most new mothers, we would be in a better position to be supportive and respectful.” What I would like to see is equal weight being given to the post-natal period as to the pre-natal, with regular appointments allocated at baby clinics for new mothers, in addition to more support groups. They wouldn’t be obligatory of course, but it needs to be realised that the mental health of a mother following a birth is as important as her physical health beforehand. There is a cost implication, but a mother who feels supported will surely relate better to her baby, which would benefit society in the long-term. I felt so strongly about the issue I wrote to then Health Secretary Patricia Hewitt in 2006. I received a letter back from her office saying the Department of Health was proposing to extend the current duration of postnatal care. ‘The Department has recommended that midwifery-led services should be provided for the mother and baby for at least a month after birth or discharge from hospital and up to three months longer depending on individual need.’ With the NHS resources being ever stretched, this seems an elusive goal. In my case, like for so many women, I gradually realised that rather than being a strange freak, I was just a normal mother trying to cope with the enormity of the responsibility with inadequate preparation. That in turn put the feelings in proportion. I had a relatively mild case of depression (I suppose – I was never diagnosed), which lifted in time, as Robin and I grew together. For most women, they do just ‘get on with it’ and the memories of that turbulent time fade. By the time they re-enter the fray, they may find it hard to even remember that time clearly and may well not wish to, feeling thankful that they seem to have survived relatively intact. This is why the problem still continues. Just because women do ‘get on with it’ and seem to be managing later on, doesn’t mean they should have to. Doesn’t it behove us as a society to offer more than that, especially when the support is easily achievable? And for the women whose lives are permanently blighted by their experiences of becoming a mother the situation must change.
© Maggie Gordon-Walker