This week, Dr Amal Hassan, aka fitness.doctor.mama, invites us to share our postpartum health and wellness journeys; an exercise in celebrating our resilience as mums and learning from one another. For me, it also ties in well with Postnatal Depression Awareness week, which this year runs from 4 September, as PND played big role in my own postpartum journey. Amal posed 4 questions, and each is answered below.
Q. What have you learned about your mental health since having a baby?
I have learned that, for me, the postpartum period is a particularly vulnerable one for my mental health.
I approached my first baby’s birth with an attitude of “I really hope I don’t get PND”, but gave little structured thought as to the practical steps I could put in place to safeguard my mental health. With a history of depression and anxiety throughout my teens and early twenties this was, on reflection, naive. As Emma Svanberg, aka mumologist, writes: “The perfect storm of biological, physical, psychological and social changes that occur when you have a baby makes some fallout almost inevitable.” And some fallout - or actually fall apart - is precisely what happened to me.
I cannot pinpoint the first manifestation of my symptoms of PND; the first few weeks are a bit of a blur. I remember, though, that pretty much straight from the start, I felt I was doing it all wrong. But not in the jokey “winging it” kind of way that as parents we all talk about at times. As in, I had no confidence whatsoever in my judgement or ability as a new mum, and I felt constantly overwhelmed. Our daughter was a very unsettled, cry-for-hours baby. As a lawyer I was used to due-diligence, logical problem-solving and a high degree of control. But no matter how much I read, no matter how frequently I searched Google in the middle of the night, I could not gobble up enough information to give me back a sense of control. Breastfeeding was a particular challenge for me from the start, again because of this feeling of lacking control. I found it difficult not being able to know how much milk Emi was drinking and, even when all of the evidence - wet and dirty nappies, weight gain, breasts feeling empty after a feed - told me that she was taking enough, I frequently felt anxious about it. "If you are happy and relaxed she will be happy and relaxed", everybody would say. But this felt frustratingly circular, and served only as another stick with which to beat myself.
"If you really hate it that much, go back to work early," I remember my husband saying to me when our daughter was around 6 weeks old. I had spent pretty much 9 months looking forward to maternity leave and to being a mum and had planned to take a whole year's leave from work. Some friends have described the first months of maternity leave as like being on holiday or they have talked happily about having finally found their purpose in life. I did not feel like like that. When NCT friends arranged to meet up after everyone's babies had been born, I sent my excuses . I felt like I was treading water every day to stop myself from drowning. And I felt guilty for feeling like that when others did not.
I remember calling my husband in floods of tears when Emilia was around 8 weeks old. He left work to come home and, through my sobs, we had a long chat about me perhaps needing to get some professional help. While I was reluctant, because I felt it meant I had failed, I knew what I was experiencing was too big for me to try to overcome on my own. What did that help look like? I left the busy NHS practice at which I was registered, where the stretched, overworked doctors had little more than 10 minutes per consultation and where there was no scope for continuity of carer, and I paid to join a small, private GP practice.The support I found there was much more than just a monthly prescription for medication. Each consultation lasted 30 minutes and my allocated GP would call me at least once each week (more frequently if I required) to talk about and monitor my mood. It may sound indulgent, and I recognise I was privileged to be able to afford this sort of care, but I have no regrets, as this was a turning point in my postpartum journey. It was not a quick fix. Some days were really hard, but the fog began to lift. I should add that, now I am no longer struggling with PND, I am registered at a regular NHS practice and it suits my rare needs perfectly.
We had always spoken about wanting to have at least 2 children if we were able to, and I was nervous about recurrence of PND second time round. It was entirely by design that I had both babies close together: I feared that if I did not get on with it I would talk myself out of ever having another baby. By the time I conceived Seb, my mood had stabilised and I was no longer taking anti-depressants. This time, still under the care of the same GP, I put into place a strategy for my mental health, rather than just blindly hoping that I would manage better second time around. After Seb was born, at the start, I felt considerably less anxious because I had a better idea of how to look after a newborn baby. I suppose I felt a sense of control which had been absent first time round, and that gave me comfort. Two weeks in, though, we hit a massive hurdle when Seb was diagnosed with bronchiolitis and was admitted to intensive care, where he remained for over a week. I remained at the hospital, by his bedside, for most of that time, while my husband looked after a 22 month old Emi. I have never been as tired as I was in that period and that is when some of my warning signs started to appear and things began to unravel a little. In the new year, when Seb was just over a month old, after much discussion with my GP, I decided to go back onto antidepressants. Could I have waited longer before going on medication? Yes, but I did not want to descend to the depths of despair I had experienced first time around. I am pleased I sought help and started on medication early second time around; although I found looking after a newborn and a toddler tiring and challenging, my overwhelming memory when I think back to that second maternity leave is of feeling content.
Q What did you do to keep things ticking over?
1. Prioritise sleep. I have learned that there is a huge correlation, for me, between not getting enough sleep and my mental health declining. Without sufficient sleep, I become anxious, irrational and paranoid. Clearly, then, in retrospect, the postpartum period was always going to be a dangerous one for me. First time round, I had wanted to spend evenings with my husband, aware that having a baby can strain a relationship and wanting to preserve some time for us each day. It was a nice idea in theory, but in reality my chat was not great and I used to yawn an awful lot. Second time round (hospital stay aside) I would have an early supper and get to bed as soon as my husband was home and our toddler was in bed. I avoided my mobile phone during the night, to try to improve my chances of getting back to sleep quickly after feeding. In the daytime, I napped whenever I possibly could.
2. Ask for help. When you have a baby, people are only to keen to help. People like to be useful. However, my tendency first time around was to want to do everything myself: yes, I can keep this tiny human alive on little sleep whilst also walking the dog twice a day, maintaining a clean home, making my visitors a freshly-cooked lunch, and occasionally checking my work emails. Second time around, I was a lot more realistic, and leaned on relatives and friends a lot more. It was all about relinquishing a little control, and while it was uncomfortable at first, I soon adapted.
3. Identify and watch for warning signs. This was about thoughts and behaviours which may not have been apparent to others around me: I had to be honest and accountable to myself. Some of my warning signs were: becoming obsessive about baby routines; cancelling plans for no proper reason; watching the video baby monitor relentlessly, even when Seb was sound asleep; feeling like I was failing for all sorts of reasons; turning to Google for answers whenever I hit a bump; and lying awake in bed worrying even if the children were asleep. Knowing my warning signs and monitoring them meant I was able to maintain oversight of my mental health second time around and seek help sooner.
Q How important is exercise to you?
Exercise has always been a trusty instrument in my wellbeing toolkit. As new mums, though, there are potentially a multitude of barriers in our paths, some actual and some perceived. Lack of time, lack of energy, feeling self-conscious, not knowing what is safe, feeling too unfit to get fit, not having any workout clothes in the correct size, not wanting to jeopardise milk supply - as well as physical issues like prolapse, diastasis recti or stress incontinence. For me, the biggest hurdle first time round was fatigue and lack of energy (perhaps linked to PND but common for all new mums). PND added an extra complication. I knew that exercise might help my mood, but I often did not want to leave the house, or was anxious about leaving anybody else to look after the baby if I did leave the house or, if I took the baby with me, I was worried she would cry the whole time, causing everyone to question my parenting skills. The mainstay of my postpartum fitness routine after our first baby was born was walking; not because it was something I particularly wanted to do, but because Emi would settle well in the buggy or sling, so I would walk for miles and miles each day, sometimes in the freezing cold. Second time around, I focused primarily on pilates for the first 18 months. I enjoyed it and my healing body responded well to it. I did not resume more strenuous, higher intensity activities until around 18 months postpartum. As new mums, I think it is important not to make exercise another obligation; something else which, if we do not manage to do it, adds to feelings of failure.
Q How has your body's physicality changed?
Despite some aesthetic changes - loose skin, saggier boobs, varicose veins - at almost 3 years postpartum, I feel my body is fitter and stronger than before I had children. Exercise is my me-time. It helps me to focus. I love feeling strong. After the birth of our second baby, I experienced stress incontinence whenever I attempted activities like skipping or box jumps, and sometimes during sprints. I sought help for this from a women’s health physio and I believe that the rehab process has benefited me beyond just stopping the leaking. I am now more conscious of my breathing and the position of my spine, and I have a greater appreciation of the role of my core (which includes my pelvic floor).
Moreover, I have reframed quite dramatically the way I approach exercise. There is no longer room for ego. Whereas before I may have rushed and raced through a sequence to get as many reps as possible, or forced myself to lift a heavier load, I now put correct form above everything else. Pregnancy, childbirth and postpartum recovery have given me a greater respect for my body’s abilities, as well as an understanding of its vulnerability. I intend to look after it well for the rest of my life.
As a new parent, it is tempting to try to normalise your feelings, feel you should just battle on or hope things will improve on their own. If you think you may have perinatal depression of anxiety, or if things just do not feel quite right, please speak to your GP, midwife or health visitor.