Becoming a parent is without a doubt one of the most life-changing things we can do as grown-ups. Life as we know it is suddenly over once a tiny helpless human arrives, ready to turn our worlds upside down.
Although pregnancy and new motherhood is a very special time, it can also be fraught with difficulty, and the mental health issues which can come with parenthood are still often seen as a guilty secret.
To this day, I am grateful to a friend who reached out to me when my first son was born to warn me of the hormonal rollercoaster of emotions I needed to strap myself in for. Motherhood really is a time of extremes – intense emotions, physical pain, sleep deprivation, vulnerability and the constant worry of am I doing this right?
Fiction vs Reality
Now more than ever, in this age of Instagram-worthy mum shots and mini-me fashion, the pressure is on for women to aim for perfection. New parenthood is often portrayed as a glowing time of soft lighting, intimate moments and sleepy cuddles.
But what if in those early weeks you find yourself in a place of darkness rather than light? Of loneliness rather than connection? Or worse still, in a place where your delusion and paranoia see your grip on reality slipping away?
For local mother and psychologist Gabrielle Micallef, the struggle of new motherhood has taken her to the limits of her mental health. Twice.
“I shut down and became a shell of my former self. I stopped talking, I stopped eating. At times my thoughts were racing and other times I felt completely numb. At my worst I couldn’t function or engage in even basic care for myself and my baby. I felt like I was standing in a hurricane of my terrifying thoughts.”
While most of us have at least heard of postnatal depression, postnatal psychosis is still a little-discussed illness, despite affecting at 1 to 2 in 1,000 mothers.
What is postnatal psychosis?
Postnatal psychosis usually occurs in the first 12 weeks of motherhood, and can put both mother and baby at risk, so seeking urgent medical attention is critical. Sufferers will almost always require hospitalisation for specialised psychiatric assessment, care and treatment. Changes in behavior and thinking are often sudden and dramatic, causing a loss of contact with reality and behavior that seems out of character.
“I learnt that a mental illness can happen to anyone,” says Gabrielle. “It doesn’t discriminate. The perinatal period is a particularly challenging time of transition and adjustment for all women, whether you struggle with mental illness or not.”
Gabrielle suffered from postnatal psychosis after the birth of both of her sons, and is now a Community Champion for PANDA (Perinatal Anxiety & Depression Australia), working to raise awareness of perinatal mental health, address the stigmas that surround it, and provide a message of hope and recovery for anyone who is suffering.
While no one knows for sure what brings on the state of postnatal psychosis, we do know that the illness is temporary and treatable – women generally experience a full recovery with time and appropriate treatment.
Conquering the darkness
Speaking with Gabrielle today, you would never know of the postnatal mental health battles she’s conquered. A bright, friendly and intelligent woman, she seems the very image of the mum who has it all together.
“It’s OK not to be OK and it’s OK to ask for help. For those that do have their struggles, help is out there and you will recover. Despite the darkness I experienced, love and hope always trumped, and despite being brought to the depths of insanity two times, I am forever thankful for my two little boys and the sunshine they bring to our lives.”
According to PANDA, a history of mental illness can be a contributing factor, but even those who have never suffered with their mental health can be brought to a halt by perinatal anxiety and depression. Other contributing factors include sleep deprivation, difficulties with feeding your baby, birth trauma and relationship stress – all fairly standard parts of the new parent package unfortunately.
Mental health for new parents
The full spectrum of mental health issues throughout pregnancy and new motherhood can range from the ‘baby blues’ through to postnatal depression and, in the most severe cases, postnatal psychosis.
Perinatal anxiety and depression affects up to one in five expecting or new mums and one in ten expecting or new dads.
PANDA runs the only national helpline for women who are finding motherhood a struggle, and receives around 1,000 calls a month. Eighty-seven per cent of these women haven’t told their midwife or their maternal child health nurse about their feelings, which is where the importance of midwifery-led continuity of care comes into the equation.
“It is so important to have trusted care providers when you’re in the grip of perinatal anxiety, depression or psychosis – a midwife who knows you will be more able to recognise if things aren’t right, and can become a trusted advocate for you and your partner as you negotiate the darkness of perinatal depression and anxiety,” says Ms Micallef.
Having a trusted care provider
The importance of having a trusted care provider and continuity of care is well recognised by Giselle Coromandel, President of Better Births Illawarra, who has been campaigning since 2016 to increase access in our region to the Midwifery Group Practice (MGP). The MGP assigns expectant mothers a known midwife to care for them throughout the pregnancy and beyond. This continuity of care model has been proven internationally as the gold-standard for maternal care, with the best outcomes for mothers and babies in every aspect of their health.
“The continuity of care offered by the Midwifery Group Practice means expectant mothers build a relationship with their midwife based on trust and understanding. Research shows care from a known midwife means a mother is more likely to have a positive experience of labour and birth, and may also give a struggling mother the courage to ask her midwife for help when she needs it.”
“Unfortunately spaces on the MGP in Wollongong are very limited, with only 3 in 10 of the women who request to join being granted a place. We’re campaigning to increase access to the programme so that more local mothers are being given the best possible experience, with the best possible outcomes,” said Ms Coromandel.
The best treatment for perinatal depression and anxiety, according to psychiatrist Professor Bryanne Barnett, is a system that facilitates continuity of care. Professor Barnett is a board member of the Australian Birth Trauma Association, with a particular interest in perinatal mental health. “I cannot stress enough that a well-trained, well-supported midwife who provides care in a system that ensures continuity of care, is the best treatment we can offer. This is universally recommended nationally, internationally and in the usual obstetric and midwifery textbooks,” Prof. Barnett said.
Support for local parents
For local parents needing support, the Perinatal and Early Childhood Program at Grand Pacific Health provides free short-term therapy for mothers or fathers who struggle with mental ill health in pregnancy or in early parenthood.
“We are fortunate to have a good working relationship with Wollongong Hospital and other local antenatal clinics, as well as GPs, with more than a third of our referrals relating to antenatal care. Seeking treatment early gives mums, dads and their babies the best chance of being well during pregnancy and after birth,” said Christine Carey, Team Leader Child and Family, Grand Pacific Health.
For women with a history of mental ill health, preparation, planning, and continuity of care are strongly recommended. These approaches provide the best opportunity for mum or dad to stay well, or to manage their health if they become unwell. At minimum, continuity of care should involve good communication between health professionals, though continuity of antenatal carer (e.g. midwife or obstetrician) is likely to be of benefit.
“Women who have experienced previous trauma are more likely to benefit from continuity of antenatal care, minimising the need to repeat their story and facilitating the development of trust. We know that infants thrive when parents are attuned to their needs, and we can facilitate this by helping mums and dads to feel well and supported,” Ms Carey said.
Author: Erin Huckle, Chuckle Communications.
PANDA National Helpline (Mon – Fri, 9am – 7.30pm AEST/AEDT) Call 1300 726 306.