Today marks the beginning of "Maternal Mental Health Awareness Week" 1st to the 7th of May 2023. Ad it felt like the right time to talk about my experience of mental health in pregnancy and the perinatal period.

28th January 2020 and I was about 24 weeks pregnant with my first baby. Just the day before I had been present as midwife at the birth of my best friends beautiful baby girl, and I felt exhausted, both physically and mentally exhausted. I had been waiting and waiting for this surge of energy and "pregnancy glow" to appear for my second trimester, and it was at this point  realised I was almost into my third trimester and not experiencing anything remotely close to "glowing!" In fact I felt that at given moment I could burst into tears, and my emotional responses felt so extreme, I simply didn't recognise myself.

Outside of pregnancy I had previously experience anxiety and had tools to manage this, but these feelings were new, to feel so low, so unmotivated, and so miserable. I went t see my GP and explained how  had been feeling, and he did complete a referral to talking therapies, with an estimated wait time of approximately 4 weeks. I approached the subject of medication, I'd been reading about the available antidepressants, and was familiar with the most common ones within my midwife role. My G.P was unwilling to prescribe me anything, he explained a correlation between use of antidepressants in pregnancy and cardiac abnormalities in the baby. So I left that appointment feeling very deflated and I honestly didn't know how I was expected to just go on feeling this way while I waited for talking therapies. I actually went back  and saw a different G.P two days later who listened to my concerns and I felt completely validated by her and together we agreed that the risk of cardiac abnormality or my child was considerably small, given I had already had my anomaly scan at 20 weeks where everything appeared normal. I was prescribed Sertraline and after a couple of weeks away from work, I felt like I was beginning too notice the medication starting to work, it lessened the extreme lows I was feeling, but it also felt like it levelled everything meaning I didn't really feel anything.

I did start talking therapies with a practitioner at my G.P surgery, but unfortunately after one face to face session the Covid- 19 Pandemic took hold and we entered the first lockdown, this meant that my remaining appointments went to phone calls. I didn't feel much benefit from these sessions, I felt very overwhelmed with my emotions and didn't know how best to communicate tis and so found t much easier to "yes things are okay". I still felt "low in mood" as they called it, which was another bug bear of mine- call it what it is, antenatal depression! I was discharged by the talking therapies on day three postnatal despite seeing little to no improvement. 

So I've already mentioned lockdown, I started my maternity leave and about 3 days later the country literally shut down. Any thoughts I'd had of shopping, lunches, massages, nails, maternity bump photos- all taken away, I think its harder when even having the choice is taken out of your hands. Even my baby shower was cancelled and I was just consumed by sadness, I was grieving the maternity leave I had imagined I would have, and I was annoyed at myself for not planning things earlier- as if I could have predicted a global pandemic putting a spanner in the works! And I felt resentment, as if I hadn't been pregnant I would have been at work and I would have been seeing people. 

These feelings continued through the remainder of my pregnancy and were prominent in most of the first year of my baby's life. In fact as time went on I felt the ugliest jealousy towards friends or people on social media who were having babies later in the year when restrictions were beginning to lift and they were able to experience some of the things I hadn't. 

I was not enjoying being a mum, I felt extreme tiredness, unhappiness, guilt at the way I was feeling and the lingering resentment towards my baby. I did self- refer to my local talking therapies, but I heard nothing, unfortunately I slipped through the system, I knew I should chase things but I mentally couldn't. Eventually though I did reach out again and my referral went sent to the perinatal mental health team, who accepted me given my scores were now in the moderate to severe range compared to the mild scores I'd had during pregnancy. I'd been experiencing some scary intrusive thoughts around falling down the stairs and making it look like an accident, by this time my baby was around 5 months old. I had attempted to reach out to my health visitor telling her how much I was struggling, but she left me on "read" and never responded. I truly felt miserable and that I was making everyone around me miserable too, I felt they'd be better off without me. And then one night I just could not get my baby to settle, he wouldn't stop crying, and I just felt so useless and overwhelmed and I needed to get out, so I got in my car and left. I started driving towards the motor way, and in that moment I felt like that was where I was most likely to get hit by a lorry, and it was so scary having those thoughts completely consume me and I felt so unsafe, so I felt I needed to get to safety and the first place that came t mind was the hospital- my place of work, so I decided to head there. 

As I drove I actually talked myself down from the extreme fear I was feeling, and I felt able to return home, where of course my child had stopped crying and was full of smiles! The support I then began to receive from the perinatal mental health team was such an improvement from my antenatal experience. I had weekly appointments with my allocated nurse, I had support from the nursery nurses, appointments with the psychiatrist who put me on a medication that suited me better, and I received compassion focussed therapy as part of a group with a psychologist. 

I was discharged from the team after Jacks 1st birthday with a really comprehensive well-being plan for my mental health and the knowledge that the support would be there should I need it again. And I did need it again during my second pregnancy- honestly my psychologist Jen is an angel and I will forever be grateful to her.

Mental health is so important and I feel I could have received better support had I paid slightly better attention to my well-being, and had I felt better able to advocate for myself, however I also know I was failed by the services and referral system at the time. Anxiety and depression are two of the most common mental health struggles during pregnancy and the perinatal period, and will affect approx 1:5 women. 

There are support systems out there and often the waiting times during pregnancy are shorter than the general public because the impact of mental illness can be so severe. The latest MBRRACE UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquires across the UK) report from 2022 significantly details that mental ill health and heart disease are now on equal footing as the cause of deaths in the UK. 40% of deaths within a year following pregnancy are from mental health causes, and maternal suicide remains the leading cause of maternal death.

If you are concerned about the way you are feeling, or someone you love is behaving, please support them and encourage them to reach out to their G.P, midwife or mental health services for support. The MBRRACE UK report details some red flags to look out for:

*New feelings or thoughts which make you disturbed or anxious

*Thoughts of harming yourself or suicide

*Severe struggles to sleep

*Feeling incompetent, as though you cant cope or estranged from your baby

* Do you feel like your getting worse

There has been improvements, and in recent years an increased awareness of birth trauma and the impact psychological difficulties that remain, can have on women and their families. My role prior to having my second baby, was as an "Emotional Well-being Midwife" within a mental health team providing treatment to women with moderate to severe psychological symptoms impacting their day to day lives, as a result of birth trauma or birth loss. It was initially extremely satisfying seeing the referrals come in, as it felt that we could really help people, it was also extremley difficult having to reject women that maybe didn't meet our strict parameters, and even more frustrating and scary when a waiting list had to be generated, because there weren't enough practitioners or hours in the day to treat the volume of women needing our help. 

A recurring theme was poor experience within maternity services, and as part of the midwives role was incorporating hypnobirthing techniques into psychological treatment, so I knew that Hypnobirthing ha a great impact on these women's subsequent experiences, but I couldn't shake the feeling that we could do more to prevent the occurrence of negative birth experiences. And that is what lead and fuelled me to become a hypnobirthing teacher, I know I will be a better midwife for all that I know now, but I also want to equip as many women as possible because it really shouldn't be down to luck as to whether you have a positive birth. 

So if you've made it this far, then thank you! And if you'd like to improve your chances of experiencing a positive birth, along with learning skills that will help you to maintain mental well-being during pregnancy and beyond, get in touch so we can discuss how hypnobirthing can help you.