When you don’t glow
The picture perfect images of pregnancy show mothers wreathed in flowers like a Goddess, or radiant (usually dressed in white) with beaming smiles whilst they and their loved ones caress their bump. OK, photos are only ever snapshots, but when those snapshots are used to depict pregnancy in the mainstream media it can be hard to see how you fit this “mum to be” mould when you don’t glow.
I didn’t glow. Lots of people don’t glow. There was possibly nothing about my skin tone that gave it away. I may have had rosy cheeks from time to time, but I assure you, that sense of radiating joy and hope and new beginnings was missing. I had antenatal mental health illness. I was severely anxious in both pregnancies.
What causes antenatal mental health issues?
It is hard to say in any individual case what causes any mental health issues. People who have had previous mental health issues are more likely to get perinatal (meaning around birth- so including both antenatal and postnatal) mental health issues, and partly this could be because of the hormonal changes in pregnancy and postnatally, the physical changes as you grow a baby and the “symptoms” caused by normal pregnancy conditions, or by complications adding additional physical and emotional strain, the prospect of giving birth or the effect of giving birth, or of previous trauma, whether birth related or even related to past abuse or assault (I intend to cover this in another blog.)
Antenatal mental health issues happen during pregnancy. If you have regular check ups from your community midwives they should ask you about your mental health. Some, however, are better at picking up on issues than others, and sometimes you may not realise how much of an issue you are having until you are given a chance to talk about it, so it is worth considering these questions for a moment when asked. There may be support you weren’t aware of and that you weren’t sure you needed that could lighten the load in your pregnancy.
What issues are there?
The most common are Antenatal Depression and Anxiety, but other conditions such as OCD (Obsessive Compulsive Disorder) also have antenatal forms.
In my first pregnancy I was anxious. I had a history of anxiety and depression, so in a sense I wasn’t surprised, and I sort of knew it was “because” I was pregnant but I thought it was all about birth. I decided to see if seeking support for previous trauma from the local Rape and Sexual Assault Centre made me feel able to cope with the prospect of birth, however, for me, this was not the right time and seemed to exacerbate my anxiety. I read EVERYTHING I could find about birth, EVERYTHING. Every blog, medical journals, NICE guidelines. I was desperate to find the piece of information that would somehow put all my exploding fears about birth and pregnancy at rest and would guarantee me a peaceful homebirth with no interventions somehow within my control. One night, in my pyjamas, I very literally tried to run away from my pregnancy, running into the street, with my terrified husband chasing me, because I believed in the heart of this storm of anxiety that I would die because that was all I could see in this fear that had focussed itself on birth. This isn’t just something I thought about sometimes, it occupied my mind almost constantly, and I became less able to cope with any aspects of life. I was too physically ill to work with a pre-existing chronic illness. Had I been working it may have been flagged as an issue that I really needed support with sooner, as I would also have been struggling in the workplace.
In the end, my pregnancy came to an end, as they all do, and I gave birth. It was traumatic and was many of the things I had feared. Even though I felt traumatised by the birth experience, the anxiety left. I had been warned that I was at risk of Postnatal psychosis, and it was just assumed I was having Postnatal Depression. I didn’t though. I was no more anxious than any other new mum, and probably a lot less in some respects. I felt like a human again. I felt normal, and I realised I hadn’t felt normal for many months.
Second time round I knew things were going to be hard. I now had birth trauma to add to sexual trauma. This time around though, I knew some of the right people. I had met a professional in infant feeding, who in one of her many roles was able to refer me to our new Perinatal Mental Health Team. I was seen really quickly, and diagnosed with PTSD compounded by Birth Trauma causing antenatal anxiety. I had one therapist who I saw consistently throughout pregnancy. She talked to me about where my issues likely arose from and helped me to face specific anxieties. We visited the labour ward, even though I was planning a homebirth. We discussed all the possibilities of labour and how we might deal with them and she wrote letters backing up my needs, like that I might opt to have a Cesarean under General Anaesthetic if I needed to be in hospital and that I understood the risks but that it was to protect me from the real risk to my mental health. I just about coped. But that is all. Once again I didn’t glow. and at the lowest point of my pregnancy, knowing what a useless person I was (I would now strongly disagree with myself on this point) I planned how long I needed to stay alive after giving birth to express enough breastmilk for my newborn baby so that I could commit suicide and not have to live with this anxiety any longer.
The difference this time around was the professional support and the support of friends who had experience of mental health issues, of mothering, and who were just there for me. It helped. And after I gave birth, this time in a redemptive homebirth with nothing but gas and air, in a pool with nobody touching me and as in control as I could possibly, be of a birth, the anxiety left again.
And next time, and I hope there will be a next time, I intend to look up all the local perinatal mental health services as soon as I get a positive test – if not when I start trying to conceive, so that I am prepared. I don’t expect to glow. I expect to be anxious, but I will have friends, family and professional help, and I will get through it.
There is a light at the end of the tunnel and there are people who can help you along the way, and I am commited to raising awareness of antenatal mental health issues so nobody feels as alone as I did in that first pregnancy.
The treatments available are very similar to those available for mental health conditions ouside pregnancy. They are broadly speaking, medication and talking therapies. Some medications may not be an option during pregnancy, and some doctors may be unwilling to prescribe anything to a pregnant person, however there are many drugs that can help alleviate mental health conditions that can be prescribed in pregnancy, if you and your care providers feel that that is the best option for you.
If you do not feel that your problems are being taken seriously, or that you are not happy with your treatment plan, you can ask to see another doctor and can seek advice from some of the support services listed below to ensure you have information about what options there are to consider for your care.
MIND: About Maternal Mental Health (includes antenatal and postnatal issues, and has some information on depression, anxiety, OCD, PTSD and postpartum psychosis)
BabyBuddy App Designed to support parents perinatally and to link with professional support services for parents.