On being one of the #hiddenhalf

Wednesday, 19 July 2017



I

"Some professionals just ask are you coping, are you OK? And think that is all they need to ask but this is a very closed question and too easy for a woman just to say yes when she could be crying out for someone to notice her or help her." 

New research from the NCT has found that around half of new mothers' mental health issues don't get picked up by a healthcare professional. Consequently, the organisation has launched a new campaign - Hidden Half - to raise awareness and push for better postnatal care that will identify and treat more cases of postnatal depression (PND) and associated conditions. A key focus of the campaign is making sure the existing checkup that takes place six weeks after giving birth looks at the mental health of mothers - something that doesn't always currently happen. 

I want to talk about my own experiences in the wider context of postnatal mental health issues developing later on, after those first few weeks following the birth. I want to do this because I know from personal experience that it's easy to dismiss symptoms when they're not what you think PND looks like, when you're busy and when very few people take the time to ask. I've never written about this in detail before, but having done a lot of processing of my experiences over the past few years having come to the point of understanding much more about how to practice good self-care, I'm hoping it will be useful, in some way, to at least someone.

Many women surveyed by the NCT said they felt their six-week checkup was rushed, more of a 'box-ticking exercise' than anything else (blood pressure, weight, "Has your bleeding stopped?") and that they didn't feel it was the time to bring up mental health concerns. I remember the appointment, being asked if I'd been 'feeling down' and whether I was coping fine. Of course I was: my physical healing was good, we'd successfully established breastfeeding, I was getting out and about and eating normally and certainly not feeling tearful all the time, or feeling unable to bond with the baby, or anything like that. And besides, don't we always say that, when a complete stranger asks us how we're doing? "Oh yes, fine." "Not too bad."

It took me until I was at least 30 years old to stop pretending to all but a select few people (even myself, once upon a time; some of my teenage diaries are stubbornly upbeat and optimistic when I remember, actually, how miserable I was at the time) that everything was always fine, not too bad, no, I don't need any help, thanks. I had Sebastian when I was 27, so I hadn't got there yet. I always wonder if it's the sort of thing that comes from having been a 'high achiever' when younger, with a fear of not being able to do things and being seen to be incompetent or a failure. 

So yes, I was exhausted, but then it's totally normal for newborn babies to be up half the night feeding, isn't it? It's also totally normal for them to not want to be put down and only feel they can settle when they're on you. They're newborns. I'd read about the 'fourth trimester', frustrating as it sometimes was that other people's babies used to have three hour naps in moses baskets while, unless on the move in the pushchair, on a bus or in a car, mine would hold out, wide awake, until 4pm every day ("newborns can only stay awake for up to two hours at a time" said the books and the websites) when I would gingerly move him, on the breastfeeding pillow, across the bed slightly so I could have about 45 minutes to myself before he woke up again.

That was exactly how I wrote my very first blog post about being a mother - sat on the other side of the bed as he had his one and only little nap of the day, something he did for a good few weeks before I began instigating naptime in the pushchair or on the bus as we travelled somewhere. If you read that very first blog post about being a mother, it's actually pretty positive. And that was really how those early days were. An exhausting, life-changing learning curve, not without struggles, but not that bad. Because when you've got a newborn and you're adjusting to it all, that's how it is and to expect it to be a walk in the park would be ridiculous.

II

"I now always ask “How are you finding being a mum” and am amazed at how that helps them open up."

'Coping' is such a subjective word. When you read lists of symptoms associated with PND they often talk about not sleeping properly; not eating properly; struggling with caring for yourself; struggling with leaving the house or seeing people; having thoughts about harming the baby. I could have looked at a list of such symptoms in those early weeks and told you again and again that no, I was fine, because my life wasn't like that - and that's the truth. The slow creep of postnatal mental health issues came later.

Sleep was probably at the heart of it - mostly his, but by association, mine. As everyone jokingly says when you have a baby, "Well, they do use sleep deprivation as a form of torture". Of course, you get used to it, but then the baby ramps the night wakings up -  in our case with every development phase we experienced, with teething, with colds, with the classic sleep regression periods. And the baby doesn't necessarily sleep in the day either. So you find yourself doing what works, which is let him sleep on you after a feed in the morning. Then after lunch, walk and walk until he falls asleep in the pushchair, which can take up to an hour. Then stay out, walking, because you live in a flat with a flight of stairs directly inside the front door and to go home would involve dismantling the pushchair to take it up the stairs so you can't do that because it would wake the baby.

Eventually, when he was about six months old, I decided enough was enough and attempted putting him down for morning naps in his cot, which resulted in him getting more and more distressed. The health visitor thought that if I went back into the room every minute or so and soothed him, he would get the hang of it and nod off within ten minutes. I reported back that one day, I'd done this for two hours before giving up.

Finally, at seven months old, we did it: morning naps in the cot. The Holy Grail. A whole hour to get things done (or not). Afternoon naps still took place in the pushchair, because there was no way I was staying cooped up in the house all day. And that was the killer. The routine. Every day more or less the same: wake, feed, breakfast, play, feed, sleep, lunch, play, feed, walk and sleep, dinner, feed, bedtime. The occasional baby group or coffee with friends or trip into town, which were always good, but never quite seemed to break up the relentless repetition of everything else. It was winter and it was miserable. I became obsessed with the clock and its ridiculously slow progression, counting out the day in five minute slots and fifteen minute slots and hours until Luke would get home.

When I was pregnant, we used to joke about what on earth we'd do if we managed to produce a really extroverted child. Reader, it happened. And when Sebastian was an older baby, he didn't want to play with his toys or sit in his bouncy chair or sit in his cot and chat to himself. He wanted to interact with people. Everything I did that didn't involve him was an ordeal through which he would usually wail (showering, preparing dinner, catching up with social media). As I was to learn, there's evidence to suggest that mothers are wired to have a particular response to crying infants and if I've had one too many coffees I still find myself getting on edge at the noise of a crying baby in a supermarket. It's really not easy having it as an accompaniment to everything you do.

There was an interesting thread on Mumsnet some time ago, where women shared stories about not really enjoying stay-at-home parenthood. It's such a taboo subject - a lot of people can't comprehend it and a lot more people won't talk about it openly because to do so is so often to be judged. Numerous times, the words 'introvert' and 'perfectionist' popped up on the thread as women sought to describe themselves and explain why those years of having very young children felt so hard. Perhaps that had something to do with it; I could certainly identify.

I've noticed a tendency for more conservative writing on motherhood to lament the way that increasing gender equality and feminist values being more accepted have supposedly led to girls and women not being truly aware of the value and importance of being a stay at home mother. This has, in the eyes of some, led to women feeling unhappy, anxious and resentful about motherhood because they feel that their worth lies in working, in earning money, in being a 'valuable member of society'. It could be argued that capitalism needs just as much critique here and that society does not value caregiving roles, but I always think about how these conservative writers mustn't know many feminist mums because if they did, they'd realise what a straw (wo)man they've created.

For me I could never ascribe that unhappiness and anxiety to simply 'not being at work' or 'not seeing motherhood as valuable'. I saw it as incredibly valuable. At a time when I was finding it all particularly hard because I was used to doing so much that I was no longer doing and I just felt lost and alone, God actually told me as much. There was never any question of it not being valuable; the mental, emotional and physical exhaustion just got so relentless and made it hard to see a way out. It was also so lonely. I wanted to talk to people without having to make small talk about babies and feel like there was a subtle game of one-upmanship about child development being played. I was so immensely grateful if a friend ever 'checked in' to ask how I was or offered to help out in any way. 

Before I had Sebastian I didn't know anyone who had young children - something that's changed as he's grown older and more friends have become parents. I was so thankful to keep in touch with and see the other women from my NCT classes every week when we were on maternity leave. A very few other friends kept in touch and came to see us, but people are busy and they work. It's not their fault. And I know that if you don't say much about how you're really feeling, people won't assume you need support. We knew a lot of people who were particularly involved in church life - and we no longer were. The loneliness and sadness of a shifting relationship with church and church community that year have been very hard to deal with and this continues to be the case, highlighting the value of good support networks. Add a faith shift onto a huge life change and identity shift and you've got a whole load of issues.

III

"...around 30% of women diagnosed with postnatal depression still have depression beyond the first year after childbirth and a significant proportion of women who experience perinatal depression and/or anxiety will develop recurrent long-term mental health problems."

It happened that I went back to work, relieved and happy, after nine months at home. Things sort of got better. I still wouldn't have identified with having any postnatal mental health issues because I'd still never fitted the descriptions of PND that I read. I probably should have twigged, when I spent countless lunch breaks walking and trying to process it all, over and over, a neverending internal monologue about the relentlessness and the loneliness and the feeling of loss of self. I was very much in the midst of attempting to process my shifting relationship with church and had got to the point where I could barely go any more. The last couple of occasions we attended our former church, I had panic attacks after the service.

I started to experience a lot of anxiety about spending time on my own with Sebastian - flashbacks to maternity leave. How were we going to fill the time? Would I cope? When he was two I had a panic attack about the Christmas holiday period because I was going to be on my own with him for four days. In the end it turned out to be better than I had expected. We survived. But it took me a very long time to stop watching the clock, trying not to panic too much, when we were alone together. It seeped into every area of my life and not just the time I spent with Sebastian - time off work, holidays, weekends - anxiety about filling up the day and making the time pass more quickly, panic about free time with no plans, or time to myself, when I couldn't actually relax and my thoughts would race, spiraling downwards.

It's funny, the things you remember about these times in your life. I remember a particular post about motherhood on Facebook. You know, the sort of thing that gets shared thousands of times by all the mums you know because it's so relatable. I think it probably featured a cartoon. It talked about the sleepless nights and the endless repetitive days and wailing babies and feeling rubbish but finished by saying that "and you know you'd do it all again at the drop of a hat". I don't like to use the word 'triggered' lightly, but there was a time where seeing anything like that was deeply upsetting.

I also remember the day I came across information about anxiety and the penny dropped - seeing as it wasn't something I ever would have considered myself to struggle with, even though it immediately became clear I have actually done so since I was a small child. In the same, eye-opening way, coming across information about high-functioning depression. The reality is that postnatal mental health issues don't just look like not sleeping or eating properly and failing to bond with your baby. They can look like a lot of other things as well and they can be evident at six weeks postpartum, six months or three years, which is when I would say that things finally started to turn around for me.

I have a five-year-old now and things are so enormously different. Four was a great age. Five is a brilliant age; it's so much fun. And last year, we made the decision to add to our family, meaning that I'm now expecting another baby later this year. I'm not going to pretend things might not be completely different, but I feel better equipped to deal with it when the time comes. Luke has always been a very involved parent (We shouldn't expect anything else but sadly that's often not the case and I know I'm fortunate) and thanks to the shared parental leave policy that has appeared since Sebastian was born, we hope to share time off together this time around, which should be a huge help.

IV

"60% of mothers who said there was an emotional problem they didn’t feel able to discuss at the six week check cited feeling embarrassed, ashamed or worried that the health professional would think they were not capable of looking after the baby."

This is key. I've seen it in countless online discussions. Women worried that admitting to struggling will mean social services involvement. I don't think I ever felt this way, but a huge barrier to decent mental health that I've worked hard to overcome over the last couple of years has been the fear of what people will think. I've had aspects of my life as a parent that I've always been fairly unapologetic about - the fact that I was happy and relieved to return to work, for example - but others that have caused a lot of stress, like feeling my parenting is judged by some and linked to the fact I work full-time, feeling that people have negative opinions about only children, feeling that it's impossible to relax because you must constantly be seen to be making yourself busy and productive and useful, or feeling that you'll be judged for being open about some of the struggles you've had with church. 

And another important thing to own has been 'feeling my feelings' - sitting with them without responding in a reactive way or indeed falling into a pit of despair or judging myself for having said feelings. I found the 'Sleepy Hedgehog Model' of managing emotions in Emily Nagoski's brilliant book Come As You Are amazingly helpful and remind myself of it on a regular basis. When you've spent years beating yourself up about things you feel, seeing yourself as less than and convincing yourself that your feelings are a problem or invalid, that's not easy - but it's so transformative. 

I do wish in some ways that I'd sought professional help at an earlier point but nothing is ever easy. All you hear is talk of waiting lists and cuts and finding it hard to get help unless things are really bad. And getting help privately isn't an option open to many due to its cost. All that felt discouraging and pointless. And so I've had to do a lot of work on my own, with a small amount of professional help, with friends who have been helpful to talk to, with good resources, learning to be kind to myself and to process events in a helpful way and understanding how my mind works. If the Hidden Half campaign helps more women to access help when they're struggling, it will be amazing and so necessary. And if an increased focus on mental health at the six-week checkup starts to make a difference, I hope that more women will find it easier to access help and to know who to talk to if they find mental health issues develop later on.

There are no prizes for just getting on with it and telling people you're fine. I've finally learned that while I may be tempted to fly under the radar and shut myself off from people when things aren't great, I can reach out to people too. So often, women struggle under the burden of feeling like they must be seen to have it all together, that to admit to anything less will mean being judged and that even to be truly honest with close friends may be taking it too far, opening up too much and becoming that friend who's a needy, irritating burden. We make ourselves smaller and our needs lesser until we become invisible because it's somehow distasteful to have needs and wants and feelings. For the sake of mothers everywhere, this must be resisted. 

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