On postpartum depression

IMG_0247.JPGGoodness, it’s been a while since I wrote a post! I have been missing Pastry & Purls, but again, the lack of hands has meant I’ve not been able to sit down and type. However, I have still been posting on Instagram, so do pop over if you’d like. (Just to warn you, the account is currently private for various reasons, but do drop me a message/request to follow me if interested.) There are a few things I’d like to write about here. Most can wait, but I think postpartum depression is worth writing about sooner rather than later.

The NHS website says that 1 in 10 women will experience postpartum depression within a year of giving birth; the American Pregnancy Association says 15%; the WHO says 13% worldwide. And these figures are just mums; dads can also experience postpartum depression. You get the idea – while not everyone will experience postpartum depression (postnatal deprssion in the UK), it’s fairly common. I have a previous history of depression, so I wasn’t surprised when I was diagnosed with PPD when Mabel was 4 weeks old. I had spent the past 2 weeks crying every day, convinced I was a terrible mom, not able to sleep at all (even apart from making sure Mabel was fed/sleeping), and feeling overwhelmed. I know a lot of this is normal for the early days of motherhood. It’s a huge lifestyle change & a tremendous responsibility. The baby blues are also quite common, but those are supposed to happen in the first two weeks, and I was fine those two weeks. R was home, Mabel spent lots and lots of time sleeping, she didn’t cry that often (I know, how lucky am I?), and I was discharged from the midwife after the standard 10 days. It was after that things started going downhill. I lost interest in eating; I spent whole days obsessing about what a vile human being and mom I was; I spent hours sobbing; I was convinced it was my fault Mabel was screaming and couldn’t help feeling guilty when I couldn’t figure out what was wrong (turns out she had silent reflux). I loved Mabel, but it didn’t feel like she belonged to me, and I really was not enjoying looking after her; everything was rote and duty. Honestly, there was no pleasure. I loved Mabel and never got frustrated with her (only very, very frustrated with myself), but I found the lack of time to myself completely overwhelming. I felt extra guilty for feeling this way after a miscarriage, keenly aware of how lucky I was to have Mabel at all.

I don’t know how much of that’s normal, but I do know from years of depression that these are all classic signs that I’m depressed. Specifically, the food and sleep issues, along with the self-loathing (to put it mildly) and guilt suggested that something was off kilter. In some ways I am lucky that I have previous experience of depression as a comparison. As a new mum, realistically I can imagine myself assuming all those feelings are completely normal and ignoring them. I was able to talk to people close to me about the risk of postpartum depression before I had Mabel because I was aware of the risks and signs. I only spoke to my health visitor about PPD when it was happening at the firm behest of my husband, mum, and friends because they were worried about me.

Well, their encouragement and one scary moment at 3 a.m. You see, while I have talked about my depression in the past, the thing I don’t talk about is the self-harm. This is the first time I’ve ever written it down, because I’m so ashamed of it. I’m still not comfortable sharing the details, but suffice it to say that I don’t cope very well in the small hours and, in my frustration with myself for not being able to calm Mabel down, passed her to R and hurt myself. It didn’t feel very significant at the time, but actually it’s looking like I may end up having scars from it. Even in my sleep-deprived state I knew this wasn’t normal and agreed (again, at my husband’s suggestion/insistence) to book an emergency appointment with my GP.

And honestly? He, my health visitor, and the local mental health services have been really responsive. I admit parts haven’t been very smooth (mainly the link with the local mental health service), but it was taken seriously without me being made to feel like I was irrational or blowing things out of proportion. I was lucky; we noticed it quite early, so for me it was a case of monitoring (I was offered medication but chose not to take it as I wasn’t sure how long this would last and hoped identifying it early would mean I could take a different treatment approach).

Between professional support and the realization that it’s okay to be an introverted parent and need time to myself, I am happy to say that I think the worst is over. There haven’t been any repeat incidents and I’ve not had any suicide ideation (which is the next step for me, usually). Some nights are still hard, but I’ve identified some coping strategies.

I’m not sharing this for pity or praise, but just so that if you are going through this you know you’re not alone, and to encourage you to go get some help yourself. I honestly believe that the sooner you are aware of it, the easier it will be to treat, but it’s never too early or late to take care of your mental health needs. Speak to your health visitor or GP; find a local support group; contact PANDAS if you prefer to be a little more anonymous. Just be brave and take the first step, whatever that is for you.

 

 

 

 

Fear and worrying in the last trimester

*Fair warning – this is a pretty serious post. I will post a happy entry about the 3rd trimester soon. But I think it’s important to acknowledge these feelings, too.*

P1090733I know I’ve mentioned it before, but I’ve been lucky to have a straightforward pregnancy. Physically, after the first trimester, I haven’t had real issues – no pelvic girdle pain or feelings of imbalance or even heartburn. Now, in the last trimester, some of those complaints are coming back – I can’t sleep, I’m a bit nauseous most days again, I’m getting lightheaded, my lower back is achy, and my hips ache when I’ve been for long walks.

And yet I still found myself in hospital on Tuesday, getting a scan (as I understand it, normally you don’t get a scan after 20 weeks in the UK unless there’s something to be concerned about). Everything’s absolutely fine – the baby & I are both healthy and well. We were there because apparently also standard to get a scan when your baby has been monitored for reduced fetal movement twice.

There it is: I am one of those paranoid pregnant women. Despite all the evidence to the contrary, for the past couple of months I have been absolutely terrified that when it’s all over, I will not end up taking a baby home with me. It’s particularly strange to feel like this when I’ve had so many people tell me I seem really calm about the pregnancy. And I guess I am in a lot of ways, but there are a couple of key reasons for this. One is that I feel very fatalistic about it; what will be will be, and there’s little I can do to change it. The other is that when I’m nervous, I’m really aware of how I come across to others, and work hard to seem level-headed. The truth is that I won’t allow myself to get excited. At this point, I am starting to get excited – I can’t wait to meet our little one! But every time I start to feel really excited, I make myself take a step back and remind myself that there are no guarantees. I wonder if this is normal, or if I am slightly defective. I guess it’s hard to be optimistic when you’ve already had a miscarriage. The truth is that we were so excited about that first pregnancy; we’d wanted it for some time and it was like a little marvel just for us. Having that taken away was a shock, and while I know that from a physical perspective it could’ve been much worse, we were so heavily emotionally invested, even at 8-10 weeks (contrary to what you hear, miscarriage isn’t necessarily something that happens all at once) it was devastating. So how will we cope if something happens now, at 36+ weeks? I can’t bear to think about it, yet it seems I can think about little else these days. This may be part of the reason I’m struggling to actually slow down despite being on maternity leave; I do want to relax, but being active  keeps me distracted. And it is harder and harder not to think about the miscarriage; I can’t help thinking about the fact that I should have been experiencing this trimester all the way back in February, and feeling sad about the fact that it feels like my opportunity to be excited has been stolen.

Anyway, all this means that I pay a lot of attention to the baby’s movements. Feeling it move is one of my favorite things about being pregnant. It’s even weirder when you can suddenly see the bump move, but I think it’s so cool! Unfortunately, my anterior placenta means that the movements are often muffled. Plus, I think our baby is just quiet in general. And this feeds the paranoia! It’s so hard to know whether the movements are actually reduced or it’s just behind my placenta, or whether it’s just napping more than usual. But twice I have been concerned enough to call the hospital. I am so grateful for the care the NHS have provided – not once have the midwives or doctors made me feel silly or paranoid. They’ve all been brilliant and assured me that I’ve done the right thing to call/come in. I couldn’t be more grateful for this, as it has been so reassuring & made me feel a lot less neurotic.

And if you are also pregnant, I would also encourage you to do the same – the midwives really do mean it when they say they want to see you if you are worried. Stillbirth isn’t hugely common & isn’t likely to happen to me, but it’s also not that unusual; in 2015, 1 in 227 births was a stillbirth, or around 9 per day. This means that most people won’t be affected, but if you are, obviously it would be hugely devastating. It is so, so much better to be cautious and use the healthcare that is available to you. This is not to make you as paranoid as me, but I think it is important to be aware of this. I don’t think I’ve had any conversations about this with pregnant friends and it has made me feel a little lonely, to be honest.

To get support around stillbirth or neonatal loss, do contact the charity SANDS. Tommy’s is another great organisation that funds research into baby loss. And more information on baby movement is available from the Royal College of Obstetricians and Gynaecologists.

 

 

Pregnancy after miscarriage: how I got through the first trimester

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For me, one of the most upsetting things during/after the miscarriage was people telling me I would probably have another chance to have a baby; I was young, blah, blah, blah. I just didn’t want to hear it. The truth is that there was no way to know whether I could get pregnant again, or whether I could cope with the stress of being pregnant after a miscarriage. I just found it such an insensitive thing to say, even if people did have the best of intentions. And now that I am pregnant? While I am really happy to have another chance to have a child, I will say that the first trimester was absolutely awful. I don’t mean physically, though I may mention that in another post. I mean I basically spent the first few months trying really hard to forget I was pregnant. Last time I rushed out & bought a journal and started thinking about baby names and looking at cute baby things, but I just couldn’t do that again. I made my midwife appointments, etc, but only as a matter of rote, like things you do for a job that you don’t really want. I obligingly took my prenatal vitamins; I stopped eating salami (sob!); I stopped drinking completely, rather than having the occasional G&T. I also obsessively looked at toilet paper every time I went to the bathroom, convinced there was going to be blood on it.

And then, quite early on, at 5ish weeks, there was. And there is no terror like it. We had to wait a week for a scan, because nothing’s really visible that early on. There it was, a tiny little heart beating, floating away in the womb. It should have made me feel better, right? But it didn’t. There was about an hour of relief, then 6 weeks of conviction that it had stopped, and that I would find out at the 12 week scan that I’d had a missed miscarriage. Fortunately that didn’t happen, but honestly, those 6 weeks were absolute hell. I think I cried every day.

So how did I cope in the end? There were a few practical things that helped me. I can’t promise they’ll help you if you end up in the same position, but I thought I would share just in case.

  • Scheduling in treats for myself

For whatever reason, this timeframe ended up coinciding with lots of annual leave. This could really have gone either way, but not thinking about work actually helped in the end. I did make sure no days off were completely empty, though. I tried to go out for lunch, or go for a nice trip somewhere, or go to a gig, etc. I also tried to do a bit of gardening, but as I was at the allotment the day the miscarriage started, that didn’t work out so well. Visiting gardens was good, though.

  • Reading peer-reviewed articles about ultrasounds & miscarriage

What can I say? I like to be informed. Reading Internet forums was awfully anxiety-inducing, but for some reason reading about miscarriage in a factual way was actually calming for me. I think this is very much to do with how I was brought up, and I am aware that this is probably not the case for everyone! Because I work in a hospital library and in an academic library, I was lucky to be able to access this kind of information pretty easily, but I think most public libraries will have at least a couple of textbooks available. Abstracts for journal articles are often available from PubMed, even if the full text isn’t, and there is also the database Free Medical Journals.

  • Joining the Miscarriage Association forum

Having said how anxious Internet forums make me, I would like to point out the exception to the rule. The Miscarriage Association hosts private, moderated forums. We had decided not to share the news about the pregnancy, and I joined this forum in the interest of my mental health. I really needed to share my feelings somewhere, and this forum felt like a safe space. Everyone was very sensitive (perhaps not surprising, given we’d all experienced miscarriage). If you’re considering joining, I would recommend it. You don’t have to share if you don’t want to, but personally, I found even reading other people’s posts made me feel less lonely (which, aside from anxiety, is what I felt the most during the first trimester).

  • Talking to family (and one or two friends)

Eventually, I did tell my mom, sister, and a couple of close friends about the pregnancy as the 12 week scan approached. Telling others and having a chance to talk about what I was feeling definitely helped. I couldn’t bring myself to be excited about the pregnancy, but letting other people be excited for me was definitely a good thing.

  • Setting boundaries – making it clear to others when I didn’t want to talk about it

This was really important, too, both in regard to R and the people I chose to tell early. Because while talking can help sometimes, it can also go too far sometimes. There were a lot of times I really didn’t want to think about it, let alone talk about it. Making sure people understood that was crucial. Everyone was really good about this, and let me bring up the pregnancy rather than asking me about it directly, and I think that’s because I made it fairly clear that’s how I wanted it to be.

  • Telling the midwife about my concerns

I have a lovely midwife, and it was great to know that she was there to support me as and when I needed it. She gave me some practical ideas for local support, too. In the end, I didn’t follow up on that advice, but it was important to know the options, especially with all my family being so far away.

 

Learning to cope with a miscarriage – A World Mental Health Day update

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I’ve been thinking about sharing an update on how I’ve been dealing with the miscarriage, and as today is World Mental Health Day, it feels appropriate. Of course miscarriage itself is physical, but it has significant impact on mental health. Like all grief, it can so easily slide into depression.

It has now been just over 2 months since my miscarriage completed, but I think it’s still appropriate to say that I am learning to cope with it, rather than coping. How can it be anything else? I have never experienced it before. And if someone happens across this post when googling for blog posts about miscarriage, I don’t want to give the impression that I have moved on. Because in all honesty, I haven’t yet.

Life has been tremendously busy recently, which I’m grateful for as it means I don’t have time to think about the miscarriage. But it means that when I do think about it, I am caught slightly off guard and can’t stop thinking about it for the rest of the day.. It’s funny how many things remind me of different parts of it. There’s a brand of water that makes me think about it because it’s the one the nurse brought me when I found out & almost fainted. It’s stocked by the NHS, which means I see it at least 2 days a week while at work. We share a library catalogue with a women’s hospital, so when I had to search for a book about bleeding patients, one of the first results was about bleeding during the first trimester. (This may have been the hardest moment so far.) I was okay with spending time with babies and pregnant right afterwards, but I’m now finding it more difficult for reasons I can’t explain, so there are certain blogs I avoid now. I don’t have any resentment or jealousy as such, it just makes me sad. Seeing friends’ kids is mostly fine, but seeing cute families out & about in public is still awful. Because how can I stop feeling like I should still be pregnant and comparing myself a little bit? I mean, my body reminds me at least once a month. The rational part of me knows this isn’t the healthiest way of thinking, but then the thing about mental health is that it has nothing to do with rationality.

So those are the hard things. There are a lot of them.  Life doesn’t feel like hell anymore, but it still sucks. But from a mental health point of view especially, I’m proud of myself. I genuinely thought I was going to get clinically depressed. There were days I couldn’t stop crying, didn’t want to leave the house, felt like there was no point in life (this last is partly because of the political climate this year). But here is the silver lining – because of my friends and family, I was able to pull through this time without feeling suicidal. Maybe a little bit of suicide ideation, but I am grateful that what I have experienced as a result of the miscarriage has not been as severe as my previous depression episodes. The only good thing that’s come out of this ordeal has been that I’ve been in contact with all of my dearest friends again, and there have been phone calls and Skype sessions and emails that sometimes take a backseat to life. It has been such a relief to talk to them, and a joy to hear about the happy things in their lives.  They have helped me feel less alone, a crucial step to avoiding/finding your way slowly out of depression.

Find out more about World Mental Health Day here. If you think you might need support with mental health, do have a look at Mind’s website. It’s always okay to ask for help, and always try to remember that you’re not alone. You don’t deserve to suffer, so please, please make use of the organisations that have been set up to help you.