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.
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.
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 →
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 →
Over the last year, I’ve been facing up to eating problems that have dogged me my entire life. This became particularly important as we tried (and for a long time failed) to conceive. It was really hard going but I got my cycle back and my hormones balanced – by the time we conceived my levels were fine. I gained weight until my BMI settled in the mid/high normal range that seems to be where my body naturally wants to hang out. I preferred being smaller but I was (slowly) teaching myself to feel positive about the changes.
This is what recovery looks like for me. After 24 years with these thoughts and feelings, I’ve pretty much accepted that I’m never going to be completely free of them. But I’ve learned to manage them in a healthier way, enjoy exercise and let myself eat without feeling too guilty (usually).
A naive hope for eating problems and pregnancy
I had nurtured this (naïve) hope that during pregnancy my muddled relationship with weight and eating would somehow vanish. Or at least become a lot easier as I nurtured my amazing baby growing body, forgiving weight gain and enjoying my new curves. HA. Load of bollocks.
I had some very low periods and dark thoughts during the first trimester of pregnancy. The myth of pregnancy as a calm, exciting and enjoyable time is still pervasive – but there were times when I felt unable to take pleasure in anything, distant from Al and scared I wouldn’t be able to feel anything for the baby either.
Nausea and exhaustion were draining and left me more vulnerable.
I couldn’t do almost anything I used to enjoy or that helped me manage my mental health – challenging myself with long runs, tiring myself out with speedy bike rides in the hills, skiing with friends, winning races, revelling in that gorgeous post-exercise feeling – even drinking tea and having a long steaming hot bath.
Nowhere felt like home – my supercharged sense of smell means that the smell of the house made me sick. It’s exhausting to have nowhere comforting to retreat to.
All of these are manageable individually but they made a toxic mix when combined with existing mental health problems.
One big anxious thought
I have a diagnosis of clinical depression and anxiety – but it’s tended to be anxiety I’ve struggled with over the last couple of years. Anxiety get’s its claws into whatever is going on and warps it out of all proportion. In the first trimester, there is a LOT for it to hook onto. Al always tells me to try not to think ‘big thoughts’ when I’m anxious but for a lot of those first 14 weeks or so I just felt like one big anxious thought.
I’m feeling a lot better now. I have a referral to the obstetrician who specialises in mental health – but my appointment isn’t until June. In the meantime, I spoke to an amazing midwife who really seemed to understand and agreed that 27 weeks was very late for starting any additional perinatal mental health support. She referred me to see a psychologist a little earlier. I’m not sure how (or if) these appointments will help but I’m keeping an open mind and making sure I have as much support in place as possible in case things get harder again.
I have a range of support and techniques in place – Mindfulness,exercise, writing being the main ones. Despite these, I haven’t managed to get below 20mg. Above 20, all is well. Below 20, things become a slog, a constant joyless fight against endless rumination and negative fog.
I’m also almost 30 and with a long term partner. It won’t be long until I’m thinking more seriously about pregnancy. Future pregnancy is one of the reasons I am trying to cut down. I’ve been told in the past by doctors that they would always recommend a mother continued with appropriate antidepressants during pregnancy if she needs them – that a depressed mother is a much greater risk to a baby than anything else. But, ideally I’d rather not be taking them – especially given the occasional headlines about the risks. These tend to ‘trigger’ increased worry and rumination associated with depression. It’s not always rational – but depressive thoughts aren’t. Continue reading →