By Beverley Turner
This isn’t a fun game for a spring evening, but guess the biggest killer of women who go through childbirth. Is it excessive bleeding? Undetected infections? Nope. Women are most likely to die during pregnancy or within a year of giving birth at their own hands – suicide is the biggest killer of new mums, and despite all medical services being aware of this fact, there has been no decline in this number over the past 10 years.
Between 2009 and 2013, a major report on maternal mortality revealed that 101 women in the UK could not face another day of life; half of them had long-term struggles with depression and yet they were rarely asked about this by doctors or midwives once pregnant.
Furthermore, one in every thousand new mums will suffer from postpartum psychosis: hallucinations, delusions and quick mood swings. Essentially, women with postpartum psychosis completely lose touch with reality around them. And they are at an extremely high risk for suicide and infanticide.
I recently spoke at an inaugural House of Commons event to raise awareness of the need for better recognition and care of mental health during the perinatal period. Organised by Consultant Obstetrician and Gynaecologist Dr Raja Gangopadhyay, it brought together MPs and researchers to discuss the problem. The conclusion? That this is a neglected area of medicine that needs much greater understanding and urgent action.
Dr Gangopadhyay explains: “Pregnant mothers often don’t like to talk about their mental health with others because they feel they might be looked at differently, so unless we engage the wider community, we can’t remove the stigma or the shame of mental health. Once you give women an opportunity to talk, they will, and that’s what we’re doing. I feel that more perinatal psychiatric support is urgently needed for providing better care of mothers.”
If you’ve ever asked a new mum for her birth story, you will know how much they will talk: the minute chronological detail, the sighs, the pauses, the laughs…this is how we process the momentous experience of birth (even a straight-forward happy birth), and it is absolutely crucial to our mental and emotional wellbeing to be heard. And yet, when you emerge shaken but elated from your place of birth and dare to ask: “What the f*** just happened?” you may well be met by the (well-intentioned) response that you have a healthy baby and that’s what matters. In other words: “Shut up.” So who can you talk to?
A recent NCT survey of 2,500 women who gave birth in 2014 found that nine out of 10 had never met the midwife who delivered their baby. The tragedy of this cannot be overstated. A known midwife is statistically the most effective intervention to reducing perinatal mortality and postnatal depression. Building that trusted relationship carries a pregnant woman into motherhood on a comforting cloud of compassion and confidence. It’s efficacy is so profound that if it were a pill, not prescribing it would cause outrage. But as it’s only women looking after women, it isn’t deemed terribly important to men holding the purse strings. How many of those 101 women who took their own lives wouldn’t have done so if they had a trusted midwife to whom they could pick up the phone when they felt a dark wave about to subsume them?
It’s normal to feel momentarily annoyed after having a baby – 70–80 per cent of new mums describe feeling the ‘baby blues’ – a temporary sense of tearfulness, lethargy and despondency. The sudden change in hormones that occurs three to four days after giving birth can give some mothers a sharp dip in mood that can feel like a bad-ass dose of PMT. It often coincides with your breastmilk supply coming in – a double-whammy of Mother Nature’s sick sense of humour. Postnatal depression can actually appear at any time within the first two years of birth. But if you don’t emerge after a day or two feeling brighter and more loving towards your baby, it might indicate a more serious problem.
Postpartum depression is normally described as feeling an intense sadness; crying frequently; being irritable; suffering low self-esteem and exhaustion; being unable to concentrate and feeling no pleasure from family, friends or activities that you’d normally enjoy. There may even be physical manifestations: headaches, chest pains and hyperventilation, although these symptoms may be better categorised as ‘anxiety’ disorders rather than depression. Personally, I believe that we need more research to draw the distinction between new mothers who feel ‘postnatal anxiety’ rather than ‘depression’.
I suspect that anxiety disorders are more common than we realise and are all too quickly lumped together as postnatal depression. As we pile greater pressure on ourselves to achieve Pinterest-worthy ‘perfection’, we whip ourselves into a frenzy of anxiousness, questioning our lifestyles, our choices, our houses and our relationships. And beneath each of these new concerns lies the overwhelming distraction that forms the basis of evolution – is our baby going to survive? We suffer sleep deprivation, which turns up the volume on our worries and throws rationality out of the window. It really is no surprise that suicide can feel like the only exit route to women without consistent, careful support and a place to scream, cry and wail if they need to.
And yet, as Dr Gangopadhyay identifies, the importance of being judged to be a ‘good mother’ is so profound that many of us would choose to hide our anxieties behind a smile and a platitude about parenthood being tough for everyone.
At the end of 2016, the government announced increased funding for perinatal mental healthcare in its spending review, which may help to meet its target of halving maternal deaths by 2030. I wish them luck with that. Because all the perinatal mental health units in the world won’t be sufficient to mop up the fallout if the proper care and attention is not provided during pregnancy and birth. We need to get better at saving new mothers – from the despair inside themselves.