Today is the start of Baby Loss Awareness Week 2019. A week to remember babies who were lost in pregnancy, during birth or soon afterwards. I wanted to write something in honour of little Sprout whom we lost in August. Sprout was only on the brink of being – a seven-week-old embryo whose heart had barely started beating before it went still. But they were also a tiny bundle of hope and, as those first three months passed, dreams and plans.
The impact of a hidden grief
Miscarriage is often a hidden grief. Around one in four pregnancies will end in miscarriage. Most of these happen in the first trimester. Many of us choose not to share until after the dating scan. But when things go wrong we suffer in private, without the support of family and friends.
There are thousands of us trying to make sense of these feelings alone when we could be helping each other through. Pregnancy loss is ignored in policy and in the workplace. Women and their partners are not given the right psychological and physical support. The Miscarriage Association and other charities involved in Baby Loss Awareness Week are trying to change this. I recently wrote a report on pregnancy loss, mental health and the NHS and new mental health resources for the Miscarriage Association. I’m currently working on new information for employers and I’m involved in a cross-government working group to improve guidance around workplace policies relating to fertility, miscarriage and baby loss.
I’m writing this to make sense of how I felt yesterday. I’m sharing it because I’m sure I’m not alone. Parenting is really hard and parenting with mental health problems can sometimes be a real struggle.
I became a mum in October 2017. In some ways, it’s made me more resilient. But those dark and anxious thoughts have always found my most vulnerable spot to poke away at – and now that’s my gorgeous, loveable, wakeful, clingy, frustrating, exhausting, friendly, kind, smiley little boy.
Uncertainty, blame, guilt and comparison
When I’m really struggling with my mental health, all those normal parenting concerns are magnified. I lose all perspective. I question everything. I blame myself for his tears and worries. I get frustrated that he rarely wants to get down from my arms and play, when there’s so much I want to explore with him. Then I feel so guilty for wanting him to be even the tiniest bit different. He’ll have enough of that in his lifetime without me doing it too.
I compare myself to others and find myself wanting. I overthink his naps, the amount he breastfeeds, the time he sleeps, the little he eats. I wish I could have his Dad’s strength and calm.
I struggle to find the energy to bounce him through the day. On the very worst days, I hold him with tears in my eyes, unable to see my way through the next ten minutes of parenting tasks, let alone the hours until bedtime. And then I feel pathetic – and guilty that he saw me cry.
My heart feels raw when I think of him. I hurt for the pain he’s bound to feel, for the upsets and the bullies and the difficulties I can’t protect him from. And when my defences are low, I get horrible intrusive images of him falling, or drowning, or burning. Images that send my adrenalin soaring and leave me shaky and tight chested.
Fundamental emotions, twisted and distorted
It doesn’t get to this point too often, thank goodness. Usually, I have more perspective. I’m more resilient, patient and practical. But when I do spiral down, it’s faster and harder than before.
Those fundamental mum emotions of intense love, protectiveness and wanting the best for him get twisted and distorted into guilt, sadness, fear and negativity about myself and my ability to cope. And these emotions are so strong, so deeply fundamental, that their distortions are powerful and destructive too.
Strength and love
The love I feel for Oaklan is incredible. When I’m not with him, I feel as if I’m slightly holding my breath until we are back together (even if I’m also desperate for a break!). These feelings will never fade. I never want them too. Perhaps part of being a parent is accepting that I’ll always be dealing with deeper and stronger emotions than ever before. But I hope that by starting to recognise how they interact with my mental health, I can stop letting the worries and fears take over too easily.
We’re never alone
Almost as soon as I posted on Twitter I got this response from another mum. I knew it wasn’t just me but sometimes it feels very lonely in my head. It’s good to be reminded that we’re not alone.
But this is nothing new. Reports in 2018 said existing guidance leads to misdiagnosis and harmful long-term prescribing. Thousands of people have reported huge difficulties coming off antidepressants. The longer you’ve been on them, the harder it seems to be to come off. Yet many healthcare professionals take a pretty casual approach to these brain altering chemicals.
The WRISK project is a collaboration between the British Pregnancy Advisory Service (bpas) and Heather Trickey at the School of Social Sciences at Cardiff University. They are aiming to draw on women’s experiences to understand and improve the development and communication of risk messages in pregnancy.
They asked me to blog about my experience of taking (and trying to stop) antidepressants before conception, during and after pregnancy. I was happy to oblige. I was given conflicting and simplistic advice from various GPs. They failed to give proper weight to the complexity of my experience and used the concept of risk to make me feel guilty and disempowered. This needs to change and I’m glad to support the WRISK project in trying to do so.
It struck a chord because I was feeling uncomfortably aware of the disconnect between how my life looked on my Instagram account and how it really felt. I do live with my husband in a house I love, in the gorgeous Chew Valley. We have a healthly and happy one-year-old boy Oaklan and an energetic collie Dr Watson. That much is true.
I’m very aware of how lucky that makes me. Something the article misses out is how a collection of your favourite pictures, shared with people you love, can sometimes help create that sense of perspective during darker times.
He has never been a good sleeper and three hours unbroken sleep was a rare gift. Until six months he wouldn’t nap in a cot at all and until eight months I couldn’t leave him while he slept. He hated being put down or sitting still and needed constant attention and interaction. All of which was manageable until his sleep deteriorated to the extent we’d have regular nights when he would wake every 45 minutes or so. I was surviving on the nap I would get when Al took him for a couple of hours in the morning. Four hours of broken sleep felt like a good night. My own insomnia started to get worse. Al went away for work for eight days and everything broke soon after he got back.
I couldn’t sleep even when I had the opportunity. Bedtime and naptime made me panic. I went to bed with a dry mouth and my heart racing. I felt I had nothing left to give and spent a lot of the day in tears while feeling guilty that my stress and sadness was affecting Oaklan.
Luckily, my family came down to help for a week. While we were away in Cornwall (see the gorgeous beach photos) I had another three or four sleepless nights and panicky days. I spoke to the doctor and upped my medication to 100mg/day (the highest it’s ever been).
Over the next few weeks, our sleep was up and down. The insomnia and bedtime fear was still there. After a bad night I would feel very panicky that the awful sleep times were returning. Although my anxiety slowly reduced I started to feel very low with lots of intrusive suicidal images. I found it hard to feel connected to Oaklan and could only go through the motions of parenthood. At night, I could feel my heart beating hard in my chest as I struggled to sleep.
These feelings are slowly fading now. But it takes time to climb out of the hole. For a while I was coping on a daily basis but my resilience was really low. I struggled to manage when Oaklan was difficult or if something else made the day harder. Then I felt really guilty for relying on other people and pretty useless as a mother.
But nights have got easier to manage. His sleep is improving and Alex can settle him now. My sleep is mending and I’m feeling brighter and calmer. I hope I’m rebuilding that resilience too. Returning to work has also helped. I enjoy the balance of three days writing and four days with Oaklan.
Postnatal mental health support
So that’s the honest story behind some of those lovely pictures. Postnatal mental health problems can affect you much later than you might expect (I think technically the definition is up to a year after birth). It has been really really hard. But I’m incredibly thankful for wonderful friends, supportive family and, of course, Alex. Not everyone has those kinds of brilliant and nourishing relationships to help keep them safe and well. And it’s probably worth adding that a lot of people find supportive communities and friendships on Instagram too. This post by Holly Bourne is a lovely example.
Oaklan came on the 5th October. He’s almost eleven weeks now and things are slowly starting to feel a little easier. I’m still pretty tired – and I’m writing this with him feeding on my lap – so please excuse any typos, half-formed ideas or clumsy phrasing.
I wanted to get down some thoughts about early parenthood and mental health. It’s something I was pretty worried about. I was concerned about the lack of sleep and relentlessness of it, plus not being able to exercise enough and dealing with a very different shaped body.
I was on 50mg of Sertraline throughout my pregnancy (a decision that was definitely the right one for me) and I chose to increase this to 75mg in the first difficult weeks. I think that’s helped. But, despite everything, early parenthood has also highlighted some healthier thinking patterns and approaches.
The achievement of labour and birth
I’d hoped that pregnancy would change my muddled relationship with my body. I’ve heard women say that it helps them see their bodies in a new light and recover from long-term eating problems. This didn’t happen for me. The whole nine months was an uncomfortable struggle with my changing body. I felt trapped and out of control. By 41 weeks I was desperate not to be pregnant. But labour and birth were more empowering. After seven hours of contractions, he came so fast I delivered him myself at home. An hour ago the midwife on the phone had told us I was still in early labour. We were lucky but it’s still an experience I’m proud of. I finally managed to see my body as something special and cut it a bit of slack (at least for the first six weeks or so). Continue reading →
Last year, James Withney of The Recovery Letters emailed to see if I would be interested in contributing a letter to the published anthology. The Recovery Letters are addressed to people experiencing depression. They share experiences and give friendship and hope for recovery.
I’ve tried to emphasise that you can find eating problems incredibly difficult to live with, without necessarily having a diagnosed eating disorder. I also wanted to make sure it was clear that you can have an eating problem or disorder without being noticeably over or underweight – and that you shouldn’t need a certain BMI or a particular diagnosis to access treatment. It was important to make sure the information was accessible and useful to everyone – including men and older women. These are both groups who are affected by eating problems but often less able to speak about their experiences and access treatment. I also tried to include blogs and quotes from lots of different people, about a range of experiences and problems.
It wanted to talk about the fact that even thinking about recovery can be scary. Eating problems can feel safe – and even exhilarating. Despite an eating problem making your life difficult, you may not feel ready to try and recover straight away. On top of this, I wanted to expand the information we provide on coping with recovery – dealing with food and eating every day in an on and offline world that can seem to spin around eating, food, weight, appearance and body image (you can read more about my own experience here). Sometimes you can look healthier physically, while mentally you’re actually feeling a lot worse. Recovery can take a long time and relapse is common.
The Information Standard
All Mind products are written to the Information Standard. This means that a first draft was reviewed by a number of people with personal and professional experience of eating problems. I love this stage of the writing process as it always gives you new things to think about, and opens my eyes areas I may not have considered or covered properly. We also make sure we consider and respond to all the feedback we receive – I’m looking forward to reading this too (whether it’s positive, negative or suggestions for improvement).
I’m pretty good at managing my mental health. I know what helps, what doesn’t and how to recognise when I need to take better care of myself or ask for extra support.
But early pregnancy disrupted this balance. I’m nearly 17 weeks now and finally ready to write about the first trimester.
Awareness of perinatal mental health is increasing. Most people know about postnatal depression but I’ve seen more conversations about antenatal depression, perinatal anxiety and postpartum psychosis too. I’ve heard less about how to prepare for the way dramatic physical and psychological changes can interact with existing problems.
Taking antidepressants, managing eating problems and dealing with depression and anxiety
It turns out I’ve got a lot to say so I have separated them into three blogs.
I’m 17 weeks pregnant and still taking the SSRI antidepressant Sertraline. I thought I was pretty firm in that decision. An attempt to stop taking it last year ended badly. But we had to try, if only to help us work out where we sat in the endless risk/benefit balancing act.
But I was still thrown when my GP (a new doctor who didn’t support me through withdrawal, relapse and re-prescription) told me I should try to come off – “You could just stop immediately on that amount – or you could take it every other day for a couple of weeks and then stop”.
She seemed convinced the main reason I found it hard to come off them last time was because I was anxious about trying to conceive. In the time we had it was hard to explain that it was considerably more complicated than that.
Mental health agendas vs. pregnancy agendas
When you are pregnant and also manage mental health problems you have lots of people telling you what to do. Different authorities often have slightly different agendas, follow different recommendations and suggest different things. It feels like an extra layer of disempowerment and it’s hard not to get caught between what’s best for your mental health and what’s recommended in pregnancy.
a well considered and discussed (with a doctor and my husband) decision to start taking them again
an awareness of the power imbalance implicit in a doctor’s consulting room
access to – and knowledge of – a lot of relevant research that emphasises the importance of maternal mental health and the danger for both mother and developing baby of coming off when it isn’t appropriate
an awareness that the ‘risk’ referred to here is pretty small and that everything has risks and benefits – I shouldn’t take the fact that something has a risk associated with it as an automatic reason not to do it
an awareness that doctors are told to advise women to stop as there is very little safety info but this is a precaution and for some women, it can be better for them and their baby to remain on medication
Questioning my decision
But despite ALL this, I still walked away from the doctor feeling pretty wobbly and thinking “maybe I should, the doctor is telling me I should after all”.
It took another discussion with Alex and some more reading and research to help me feel confident in my decision again. Continue reading →