Sometimes you go to the doctor because a bigger than your average blackhead on your neck looks like it is about to ooze something that could garner 3 million disgust loving hits on You Tube. I don’t know about you , but I have been known to fashion a head torch at 3am to lovingly turn to the husbands back in bed to try and seek out a juicy blackhead for me to squeeze . According to him, the head torch fell out of the camping box above us and my acrylic nail accidentally stabbed him in the back while I was caressing his big strong back , overwhelmed by it in the middle of the night . But I digress…..
You think , hmm, said blackhead is a bit disgusting and is starting to do my head in a bit. I’ve left it a while and didn’t go to the doctor, as who goes to the doc with something that a fair amount of people can suffer from but no one really talks about – you don’t really hear people going ” Susan , look , look at this blackhead booming out of the back of my neck” while at the water filter in work do you ? Unless you’re me maybe . But , it hurts now and you’re finding it hard to cover up and people are starting to notice that you are wearing a polo neck everyday in your windowless office, so no one notices it. You know when you go you the doctor they will may say ,why didn’t you come sooner , ping on the latex gloves and fix your little problem there and then. If you are unlucky, they might say , yikes, that little blighter is gaining some momentum and has surpassed blackhead stage and is now a giant come done and I’m not too sure I can whip it out of your neck here so let’s refer you to the specialist to cauterize it which will fix you up good and proper. Or , at worst , which you most definitely you don’t want to hear is , you have skin, it’s a blackhead , it can happen and even though it’s three foot wide and making your life a misery, you just need to pull yourself together and think how lucky you are that you have skin. Some people would really like skin.
So – why did you wait so long to go to the doctor and pull down your roll neck to reveal your ailment ?
– you were embarrassed and thought the doctor won’t have seen anything so awful in their entire career ?
– You were ashamed and thought the doctor would think you were weak for not being able to get rid of the bloody thing yourself ?
– You were worried the doctor would have concerns about your hygiene and thought they might send you to social services ?
– Not take you seriously and say blackheads are to be expected as you have a face . And to pull yourself together and get on with it. Everyone gets blackheads?
Maybe one ? Maybe all three ? Maybe for another reason ? But its not just blackheads that make us shuffle our feet slowly when it comes to going to the doctor though is it ? What about when we produce a baby and become a mothership and don’t feel the ‘ oh my god isn’t it the best thing ever’ joy the supplement in the Sunday newspaper said it would be? When you are pregnant , we are fed the line that all the pain we go through is worth it , when you see your baby , the moons will align , your heart and head will ping together like sugar and spice and all things nice and life will continue in a more joyous way than ever.
So when this doesn’t happen , your head and heart go a tad haywire. You are a mother now, you have a beautiful child , it knows your heartbeat , your smell, your voice. But you don’t feel quite right. You don’t just feel sad, you feel like your heart is aching in a way you have never experienced. You are beyond tired, you feel scared , you aren’t quite sure if you can do this . This new job you have for life, it’s not just tough, it’s unknown. You have presents and visitors and overly helpful mother in laws coming to stay and bleaching the toilet , ironing your paper maternity pants and eating all your biscuits but you feel more lonely than you have ever felt in your life. Life is whizzing on around you , with balloons and cards clogging up the living room. But soon the balloons start to deflate. And as they do , so do you . Your head doesn’t feel like it’s yours anymore, your mind feels like it’s been taken over and you feel like nature is playing a terrible trick on you.
If your lucky, you may have heard that this can happen when you have a baby. Postnatal depression , anxiety, OCD, psychosis can rear their very unwelcome heads. And rather like your mother in law, they make themselves comfy in your space and don’t go easily. You’ve had enough , it’s time to go now thank you but no no , doesn’t budge. And sometimes it won’t easily without a bit of help. And this help usually comes in the shape of a health care professional.
However , it’s becoming more and more obvious to me, my friends who were ill like me, the fab health care professionals I have met in the last six years since I was unwell and the window cleaner, that lots of mums don’t go to the GP or tell their health visitor when they start experiencing symptoms of Postnatal Depression etc. Scratch when they start – some don’t go or say even after they have been feeling like it for a while. Why the dickens is this I hear you cry? I am a member of approx 37657546 mums groups on Facebook to try and see when a mum feels low and to signpost her to decent help. Aside from being smalltimemum1 , in the real world, I have been known to do a little bit of research and so I thought I would do some digging to see why mums don’t go to the doctor. No fancy sample sizes, no base weights , no blah blah research talk . Instead , just anecdotal evidence from real mums who have suffered. I put posts on some large Facebook groups where I know mums have posted about being unwell and asked them to say why they didn’t go to the doctor or tell another health care professional or if they did , weren’t entirely honest about their symptoms .
This blog is not to throw a pile of used maternity pads at doctors in disgust. Quite the opposite. I want to help mums. And to do that I want to help doctors understand mums whose minds have taken a trip somewhere they don’t want it to be after they have a baby and how their words and actions can impact on them. And I want to do this because when I became unwell with Postpartum Psychosis I encountered many health care professionals who were stumped at what was wrong with me. Some were ridiculous – ‘you have a baby now, it’s what women do, you will be ok soon’. One told me to bake a cake. Some said they had never seen a mum in a state like me before, babbling about cutting through the clouds with scissors and some said, oh my love, you’re not in a good way are you? We need to get you better.
The most helpful were those who let me cry on them , let my poor husband cry on them and who said , I’m not quite sure how to help you but I am going to phone a colleague who I think knows more than me. I’m writing this to give docs a bit more of a clue about how their actions , which may seem inoffensive and slight at delivery time , can have a long term effect on the woman. And what they can do to provide some comfort, some help and some hope to the woman in front of them , who desperately needs it.
There was a brilliant report published last year called ‘Falling Through The Gaps’ ( http://www.rcgp.org.uk/clinical-and-research/toolkits/~/media/0DF1836E7D6B46788519F79E0ACF6EB2.ashx) which surveyed women , asking why they didn’t go to the GP when displaying symptoms of a perinatal mental illness . It’s a brilliant report and I suggest you read it. All of it. And then eat it so it stays in you ( don’t really do that – imagine having to go to casualty with that one). It has a great quote which I think sums up the thoughts of the women of the world – ‘ Once a woman has asked for help and need has been identified, the way GPs and other professionals respond is then crucial to ensure women get the treatment and support they require.’
I was eventually helped when Joe was six weeks old. Hello Dr Ghandi in Psychiatric Outpatients who gently asked me questions about whether I was hearing voices while nodding his head and saying don’t worry, I know this is awful but you will get some help now. Hello to the nurses in the Nottingham Mother and Baby Unit who, upon my walking in , sans knickers with a pair of leggings covering my lady area , yelling that I could smell burning and in the middle of an enormous panic attack at the thought of being in a room on my own with my son, took my hand and gave me a warm long cuddle and stroked my cheek and hair while rocking me on the bed. Hello to Dr Mark, the psychologist who sat and listened to me self analyze about why this happened to me and saw me every two weeks to ensure my rocky road to recovery didn’t turn into a collapsed jelly. Hello to my mental health nurse Gwyneth, who did my EMDR therapy and made me follow her finger around the room so I didn’t fear my memories anymore. Hello to Dr Fraser , my old GP who is now retired who desperately tried to get me help in London when all I faced was brick walls and hello to my health visitor Louise who , upon my discharge from the unit and my return to our home 200 miles away four months later, came and sat with me everyday at home for two hours. Thank you for letting me cry on you, thank you for admitting you weren’t quite sure what had happened to me but sat and held my hand and told me it was going to be ok. Thank you for sorting out Homestart to come and help me get through the day. Thank you for telling me I was a wonderful mummy during the time I felt I had let my own child down. Without all of you , I would not be here , in my living room marveling at my six year olds football skills. I wouldn’t be making a giant Jaffa cake with him after school and I wouldn’t be able to help support other mums who are in the grip of this awful illness.
The medical profession quite simply saved my life. My family and I are forever grateful. But I also know how my recovery could have been started far earlier than it did. I shouldn’t have had to wait for nearly two months after my sons birth for someone to finally listen to me and see what a terrible state I was in. I saw GP after GP, went to casualty, saw different midwives and health visitors , all who didn’t know anything about me and some who didn’t have the time to listen to my husband run through all my hideous symptoms as there were 24 other patients waiting to be seen in reception. I was barely looked at by them. Health visitors came to my house and prodded my boobs and asked ‘ if baby is doing well/ if mum is walking around to help her recovery from her c section’. I was void of a name. I was referred to as ‘ mum’ and treated like just another entity on their very long list of new mums to visit that day.
Women go to the GP when they feel like they have had enough. They don’t want feel like hurling their baby out of the window. They don’t want to feel they would be better off dead. They want to feel happy, to enjoy life again, to not be crying everyday. And to leave the doctors with not any flicker of hope can be truly awful because where do they turn now? They have probably booked appointments and cancelled them numerous times, with nerves kicking in and a fear of ‘ what do I say to the doctor?’ Flashing through their mind all day and night. It’s likely they have scoured the Internet for weeks on end to try and put a name to their thoughts and feelings and the moment they walk into the doctors room if they do make it to the appointment can be so nerve wracking that they can probably hear their heart pounding . They know a magic cure won’t be given to them , they know it may take meds, therapy, time , bad days here and there but they go to the doctor to start their recovery. And when no sense of that is felt when they leave , trust me , it’s awful. You feel like your options are exhausted. You’ve tried to smile, you have tried to live day by day , you tried the doctor and what now ? Where do you go now for help?
Below are some of the reasons women told me they didn’t tell a health care professional how they felt or didn’t return to the doctor after an unsuccessful first trip.
Postnatal Depression ‘isn’t real’ .
“I was told by my health visitor that PND didn’t exist in the 40s and 50s and she doesn’t understand why women have babies if they can’t cope with motherhood. She said that everyday she hears ‘ I have PND’ and that she didn’t hear it this much 15 years ago and it’s Loose Women on the TV putting ideas into women’s heads. So I didn’t go to the doctor as I thought they wouldn’t listen”
This is an actual quote from someone who messaged me. So , let’s get this straight – PND is a modern illness that is caused by women wanting to have it all ? In ye olden days , women got wed, got preg, had ten babies and then made a steak and kidney suet pudding for tea. They had no time to be depressed – they had 18 pairs of pants to boil wash ! No time to cry when there is jam to be made for your owner ( husband ) to spread on his crumpet ! Ugh.
We of course know this is ridiculous . It’s been reported that Queen Victoria had postnatal depression and that was a fairly long time ago? Look at this blog about a dear lady in 1850 who it seems suffered postnatal depression and psychosis( http://tmsorangementalhealthcaretreatments.d20blogs.org/2014/02/12/emma-riches-postnatal-depression-1850s/) – not quite this modern illness is it. In short, it’s been around since cave ladies were having a free birth in a rock pool but it wasn’t spoken about. Women were treated for ‘nerves’, had their hands restrained, put in an asylum, hidden from public view and forgotten about.
I’ve heard it all from people as to why postnatal depression is a modern illness over the last few years. Daily Fail articles and the comments sections have some real corkers , such as- wait for it- having a baby outsides of marriage must cause women to feel hysterical as there is apparently no stability. So married women never get it? Hmm. They might as well have said that Postnatal depression is caused by radio signals and for a woman to turn all her electronic equipment off and she may see her mood may improve. I’m no Bill Gates. I can’t even make an excel spreadsheet and have to use a calculator to divide a £20 lunch bill between two people but I am struggling to understand how my wifi password can cause a panic attack. And how turning Radio Four off can stop me from wanting to give the baby to the nice lady next door and walking away.
It’s not a modern illness and for a health car professional to say that is ill informed and dangerous. Not all symptoms show themselves in the same way for some women. Some paint a mask on to show they are coping – dropping one kid at school with another in a buggy to be dropped at nursery while the newborn is strapped to the chest, going to work, cooking four different dinners, waking up 17 times a night to feed the baby . People say oooohhh look at Alison, hasn’t she taken motherhood in her stride- whizzing around and still has her hair perfectly curled in place. But Alison could actually be trying to mask her feelings. The hair and make up could be a cover to how she is feeling and a doctor needs to try and find a way through that so Alison opens up. And so we come to our next section ….
You can’t have Postnatal Depression as your eyebrows are on fleek
One woman told me her doctor said ” I seriously doubt you have postnatal depression . You’re up and out with the baby and have done your face. You look lovely so go out and enjoy your baby” and another said ‘I told my gp for a year that I thought i felt sad and very tearful and has no energy. I told her I had felt suicidal. She said “but you’re able to tell me this and this means you know your own mind. I’m not worried about you”. Not all mothers with PND are wandering around with the look of a life sentence strewn across an overly aged face . Some of them can even put their own pants on would you believe. For some mums , they continue with the grooming they did before baby came along. For some , they apply more make up, iron even more clothes, look swankier than ever because they are trying to mask how they really feel. Inside they feel like a crumpled up bra in the corner but they don’t want everyone to know they are suffering . To the outside world they want to seem to be coping but not to the doctor. They trust that a doctor can see through the layer of foundation covering the cracks in their mind.
However , the Falling Through The Gaps report showed just under half of the GPs surveyed said they ‘received no specific training in this field of work to identify an unwell mum and of those who had received training, just under a quarter had accessed it as part of core specialist training for general practice’. So I can totally see why it’s difficult. Doctors are human, it’s hard to spot things sometimes and we have all had that thing when a friend is sad or low and we say ‘ ooh but she seemed so happy, it’s come out of no where’ . But what you could do is do more than look. Looks can be deceiving , that’s the point of them. Ask questions , glance into her eyes, hold her hand . Tell her it’s ok to be open , tell it that you know having a baby can be hard . Even if your a male doctor who has never had a kid. You might not know what’s it’s like to push a half stone lump of flesh out of your vaginal area or to have major surgery on your stomach to help the baby into the world, but you have a heart and a head. Ask the questions that give you more answers than yes and no and listen to her responses. One woman who sent me some comments wrote ” Mental health is different for us all. Listen to us, listen hard and you’ll hear us telling you”.
Really listen. I was asked if I wanted to flush the baby down the toilet by the first doctor I saw. I actually think in reality that I wanted to flush myself down the loo as my husband liked the baby and I didn’t want to be alive anymore,but as she asked me she laughed . So I let out a fuzzy laugh and said I don’t know. Letting out a laugh when asking your patient if they effectively want their baby to go away forever, as if an answer of yes would be the most ridiculous thing in the world isn’t helpful. And won’t give you a true reflection of the real answer.
Maybe something like this could help ? A fab PND charity in Cheshire called The Smile Group have produced this GP checklist for mums to fill in and hand to their GP should they not know how to or are too scared to verbalize their symptoms. It’s brilliant and has helped many mums. Maybe it could help some health professionals too ? http://www.thesmilegroup.org/wp-content/uploads/2014/08/GP-Checklist.pdf
I don’t want to go back to the doctor as they said before I can take any anti-depressants, I have to stop breastfeeding.
‘I don’t wanna go to the docs and talk as I don’t want to feel pressured in to stop breastfeeding to take medicine/ my doctor said he can’t prescribe any anti- depressants until I stop breastfeeding and to come back when I have and he will give me some / my doctor said I can’t expect to be able to take any tablets while I am feeding and to stop reading things on the internet that say I can’
I am not a doctor. If I was, I would most probably pin someone’s ears back if they came to see me about an ingrown toenail. I once thought my child had two bum holes when in fact one of them was a dimple so consider yourselves lucky I didn’t have any big ideas about wandering around with a stethoscope. However, knowing some truly splendid doctors now I do lots of awareness raising work for maternal mental health ,I am aware there are some anti depressants you can take while still being able to give your child boobie. For some mums, as it was for me, breastfeeding is key to help them bond with their baby. I couldn’t look at or hold Joe on my own but I could breastfeed him. If I had been made to give it up, it would have been terrible. Thankfully, when I was ill, I went into a mother and baby unit and the docs had libraries worth of info on what meds I could take and I was able to untangle the mess my mind was in while being able to continue nursing Joe.
Obviously , there are some anti depressants you can’t nurse on. And then it’s for you and your health care professional to discuss the best way forward to ensure you get better and what choices need to be made.
But doctors – please please talk to mums who come to you with some care and if you arent sure what you can prescribe , there is a medication fairy called Wendy Jones who knows about medications breastfeeding and who more than happy to talk to health care professionals and or mums – her website is here http://www.breastfeeding-and-medication.co.uk. You can also call the Drugs in Breastmilk helpline on 0844 412 4665 for advice – more details are here on the Breastfeeding Network’s webpage https://www.breastfeedingnetwork.org.uk/contact-us/helplines/.
The doctor said it was normal to feel overwhelmed after having a baby. So I thought wanting to feel like running away was what every mum on the street felt like.
‘The worst thing a GP said to me was ‘its normal’. I believed them and it was ‘normal’ for me to be depressed for a long time. I wish he had listened, I wish he’d said ‘come back if you don’t feel more positive in a couple of weeks’, I wish he’d asked me why I was feeling that way’
It’s not normal .Its normal to have the baby blues but these go after a days or weeks. If it lasts longer and it’s causing you to feel like a sack of potatoes that have been mashed while raw, it needs help. It may be common but it’s not normal and it’s not ok to not be well. Mothers deserve more. They deserve to be happy and feeling sad , fearful and at times to the point of suicide,is not normal in any way, even if as a doctor, you have seen four other mums that morning saying the same thing. The Falling Through The Gaps report had this quote – ” At the six week check the GP asked if I felt low and I told her I felt dreadful and she just said “every mum feels that – it’s normal”. I really believe that support in those early months might have changed my life, and my child’s life for the better. I asked for help and felt unheard” .
Read the last sentence again.
She felt unheard. Even though she spoke out.
Do you know how much courage it takes for a mum to come to you and say she isn’t feeling good? As women, we are born and grow up knowing that nature has blessed us with a body to bear the fruits of a loom should we desire. According to nature, we have wombs in case we want to grow a baby, breasts are there as natures way of feeding them and our vaginas are there for a baby to come into the world and so when we have a baby and it all goes a bit haywire, we think , what on earth? My body has done what nature says it can do so why isn’t my mind doing the same ? I would stare at women on the street with a new baby and think , how come you haven’t pulled your hair from its roots yet? How are you smiling ? How can you hold your baby as I can’t hold mine as I shake too much as I am scared of him? We have this perpetuated image of how things should be, having read every single mother and baby magazine going while pregnant . So, when we don’t feel like that and we feel we need medical help, it takes a lot of strength for a mum to book the appointment , attend the appointment and speak at the appointment.
‘I never had a diagnosis after my first baby but I was incredibly unwell, I finally plucked up the courage to see a GP and he told me I had the baby blues and to go home have a cup of tea and a chocolate bar and everything would be fine. It was 18 incredibly dark and painful months, filled with a longing to take my own life, the certainty I didn’t deserve my baby and almost the end of my marriage before I found the courage to step into the Dr’s surgery again. Please don’t treat us like silly little girls and suggest chocolate as a solution to mental health issues’
Where do I start with this example??? This is familiar to me as I too was told by a doctor, after my husband telling them I thought the duvet cover was dancing and I couldn’t be in the same room as my son, to make a cake and really spend some time eating it and to enjoy it. As nice as cakes and tea are, a slice of cheesecake isn’t going to stop someone from being scared of their child. If it did, the shelves of Tesco’s would be permanently empty and pharmacists wouldn’t have a job. Its not normal. Can you imagine the absolute bravery it takes for a mum to go to her doctor and say I keep having visions of hurting my baby? Imagine her spilling that all out, how she is afraid to be with her baby in case something happens , for a doctor to say go home home and eat a walnut whip ? Eating a walnut whip will not stop you having visions of dropping your baby. I doubt there needs to be any research into this either , it seems fairly obvious. This mum sums it up here – ” I had my third 3rd baby I started to get horrendous thoughts . I attempted to speak to my gp who was really not hearing me and told me it was normal.”
The doctor snorted when I said I wasn’t coping and made mine feel stupid for not being able to cope
“I was feeling no bond with my baby, i had most of the symptoms of PND including the crying all the time, feeling hopeless, useless etc, feeling like something terrible was going to happen etc. I tried to ask the GP for help (i was about 9 weeks PP) my husband was there too. I told him how i felt and that i feared i was battling PND. He chuckled to himself (the DR) and told me that it was normal for new mums to feel this way, then turned to my husband and said its probably just womanly problems. At this point i just wanted to cry. I didnt ask for help again until i was pregnant with my second child, and my depression came back with force”.
Womanly problems eh? Us hysterical women moaning as we are being forced to do more than wash the pots and service our husbands. Can’t cope with a baby when 97 year old Mrs Smith who lives at number 13 down the road , managed to have 12 babies and always had a smile on her face. Didn’t see her depressed did you? She had no time to be depressed! Pull yourself together woman. Chuckle chuckle vision.
I had a doctor ask me if I had planned my own suicide. I said no . Reason being , I was unable to get myself dressed or go to the toilet as I had forgotten how to. My poor husband turned into my carer and the only reason I was able to get to the doctors was because he sat me on the toilet, dressed me and plonked me in a seat at the surgery . I was in such a state i don’t think I could have planned anything let alone my own death. The doctor, without looking at me and staring at her screen said ‘ then you are low risk, go home and get some sleep. All will seem better the morning’ .
Well that morning I woke up and smashed my forehead into a wall. I told john I wanted to go under a bus and at one point locked myself in the bathroom babbling that the razor I was holding was nice and shiny and peaceful . I refused to look at my son and went on fours on my in laws bed and barked like a dog. As you can see, all that rest the doctor advised four hours before at 3am hadn’t made all seem better had it? I thought I was a jack Russell looking for my lost tail…… I was in a psychiatric mother and baby unit a few hours later.
Reacting in a different way however can prove such a difference. Someone sent me through the following quote and my mood shifted from sadness to joy ask read it. Take a look.
“I went to docs after speaking with m HV . Doc said I was over reacting, worrying about nothing and I shouldn’t expect to feel the same about my second baby as I did my first!! I was so shocked!! I told him things i had never said out loud!! I came out, called my HV and within 5mins was back in and seeing a different doctor who was amazing. He saw me ay least once a week until my councillor appointment came through. With my 3rd I decided to take the advice of my midwife and saw a councillor every week through my whole pregnancy x so far so good xx hard work and I use the coping strategies I learnt every day. My son’s (12yrs, 6yrs,22mths) are amazing!! Most of the time;)”
Look at the difference with a different approach. And how positive the mum is at the end. Her happiness, her children’s happiness and her recovery happened because someone listened to her and took steps to help her. This my friends is what good looks like.
I don’t want to tell anyone how I feel as I am worried my baby will be taken away by Social Services
” I never talk to anyone about how I feel and the thoughts I have had continuously going through my head because I worry that if I got professional help , they would take my daughter from me.”
“I didn’t ask for help because I had thoughts of hurting my little boy. I’d heard so many stories about Social Services and I just knew he would be taken away and id be called a bad parent. What I had wasn’t normal at all & I would be taken into a mental hospital.”
You can see that mums are terrified of opening one up. They are terrified their baby will be taken from them and that ‘bad mother’ will be written all over their files. An article in the holy grail that is the Daily Fail ( bear with me , yes it’s awful and I usually take glee in chucking into the bin) said that as many as 35,000 mothers each year are suffering in silence from post-natal depression, with many too afraid to seek help in case their babies are taken away from them. To live your life day after day with distressing visions entering your head on loop is like Nightmare on Elm Street crossed with Groundhog Day. They don’t just go. They seep through and stop you in your tracks. And most importantly, you don’t want them. You don’t like them. You want them to go away go away go away.
“Everyone worries about their baby and whether they’re safe so I thought it was just normal, never mind the fact I was washing my hands to the point they would cracking and bleed from fear they were contaminated and something awful would happen to him. That was just the begining. Negative scary thoughts started ruling my life. I was scared all the time but more scared if telling people what these thoughts were o was sure my son would be taken away from”.
Please please please when someone comes to you with symptoms of something like intrusive thoughts, what you should be saying is , well done for coming , I know this wasn’t easy. You aren’t evil, this doesn’t mean you want to hurt your baby and we are going got get you some support. Reassure them that Social Services, if intervention is ever needed in any case , doesn’t mean their baby will be automatically taken from them and repeat repeat and repeat again that they are not a bad parent but rather they are experiencing the symptoms of an illness. And why ? Because this may be the only chance to . And if you handle that chance wrong , that mother may not come back again. And if you read the first example above , that mother sunk to a terrible terrible low where she admits she almost took her life and she didn’t go to another GP for almost two years. And that isn’t good enough. That mother deserves to lead a happy life with her baby. And she deserves to be alive.
The fear of a baby being taken is undoubtably one of the biggest reason mums don’t divulge their symptoms. It is beyond terrifying to think that by opening up to not feeling like you are in a rose petal covered bubble , that a doctor will say, right then, here take these pills, make yourself a cup of tea and pack the babies bag because Social Services will come and swoop them away at any moment. Without explanation and with a fear that they will never see them again. As health care professionals, you need to do all you can to reassure mums what will and won’t likely happen, point them to guidance that explains procedures and also explain that Social Services, if they do ever become involved, actually want to support . A doctor friend of mine pointed me to this page that she shares with her patients when they say they are scared to be honest about their feelings because they are scared their precious baby will be removed from their care – http://childprotectionresource.online/reporting-post-natal-depression/. We know that very few mothers are a real risk to their baby but there may be times of course where extra help , support and intervention is needed. But, by helping to soothe the very real fears of mums would undoubtedly mean we would have more of them coming forward early on in their illness and getting help more quickly.
The doctor said I was too young to have pnd so I left and didn’t go back. I felt stupid for going and wondered what the hell could be wrong with me.
Hmm. Mental illnesses don’t discriminate . They can affect anyone at any time and seeing as 10-15 women in every 100 who have a baby develop postnatal depression,these women can be any age. Maybe it’s the ‘you are young , what have you got to be worried about attitude’ that is sometimes chucked at younger people that made this line come out ? What should this lady have done ? Counted down , sadly , to her next birthday where her symptoms would suddenly be valid? ‘ happy birthday to me , I’m not full of glee. I feel very sad and don’t want to drink tea’. There was some research done into age of mother and risks of postnatal depression which you can read an abstract from here http://www.morrispsych.com/postpartum-depression-are-older-mothers-more-at-risk/ and it confirms that age alone is not a factor for increased risk. So , whether you are 16 or 65. It can affect you .
It would be really nice to see the same person more than once
A massive reason for no disclosure appears to be because people are simply fed up of having to re- tell their story 87 times to 9767 different health care professionals. So you pluck up the courage to see one doc, blurt it all out, doctor is brilliant, supports , talks and books you a follow up in two weeks where they will discuss meds and you go back and it’s a new doctor. Who reads the screen instead of looking at you and nods while you re-tell your tale of wanting to run out of the house at 2am and never return and then says I don’t think meds are right for you . You think , but the other doctor said such and such. And then the health visitor comes round who is different to the one who came and weighed the baby and she throws in that postnatal depression can’t be diagnosed until12 weeks. When the first doctor said it was after six weeks. And this rings true with the Falling Through The Gaps report says that a few GPs said that information sharing did not work as well as it could.
‘Finally screwed up my courage to go to GP when #2 was a few months old. He seemed embarrassed and gave me a helpline number. Couldn’t face opening up to someone again who might also be so totally disinterested, so just decided to soldier on – probably took about 2 years to find my way out. I didn’t have enough spare energy to fight for the help I needed’
‘I had pnd & ptsd after #1 died, whilst pregnant with #2 I asked for mh referral. 3 times I asked my midwife to refer me, 3 times she told me the notes said they had contacted me & I hadn’t responded. Utter rubbish I’d never been contacted but it made me look bonkers so i gave up asking for help’.
‘I lie, put on a front and hide until I trust. That takes time. Apart from my perinatal team, i never saw the same person twice in 3 years’.
Head bang on table. Everyone is saying different stuff and they all have the common issue of not being able to access the same notes. We know this is a problem that cant be fixed easily but its really confusing to mums , at a time when things are confusing enough , to have different ideas thrown at them by a hundred different people. We all know that on one the Edinburgh Postnatal Scale could score overwhelmingly high and the next day not so much so and team this with two different doctors then it all gets a bit out of control. Being able to see the same doctor , HV or mental health professional ensures a consistency of care . I had an anxiety collapse a few years ago when I found out I was pregnant again. I went from being a very happy mummy to my gorgeous three year old, 2.5 years recovered, to a total wreck in the space of a couple of days . The wee covered pregnancy stick had sent my mind into total panic mode at the fear of going psychotic again and the doctor who knew me and what had happened to me after my son was born,after liaising with the mother and baby unit I had been in advised me to go back on to my meds. I went on these when I had psychosis after much trial and error with other pills and knew they were he ones for me. However , a duty psychiatrist asked me why on earth I was taking these meds and wanted to change them. This was the first time I had met him , he had spoken to me for 3 minutes and had no access to any of my notes. He said he was too busy to hear my whole back story ( it was 4am and I had waited 19 hours to see him) and said the meds he suggested would help but if I didn’t want them , then he couldn’t help me.
This was not helpful. The next day , we travelled 200 miles and saw the treatment team from the mother and baby unit I was in three years earlier. They liaised with a doctor I knew and the psychiatrist who was treating me and I went back on my old meds at a reduced dose. And my recovery began. I felt safe with doctors who knew me and my story.
I felt like the doctor wants to get me out of the door and he kept looking up at the time. Tick tick tock .
‘My first baby, we had her post birth gp check (usually at 6 weeks) and my post birth 8 week check combined at 8 weeks as a time/money saving initiative. My partner wanted to be there for my daughters check up. They did the pnd test where you score your mood etc from 1-5 while he was there (it was 4 and a half years ago so pretty hazy now) I remember not scoring as accurately, and negatively, as I felt because I didn’t want my partner to think I was weak’
All the alarm bells should be ringing . One lady said her six week check, which took place at about 12 weeks ,consisted of the doctor washing her hands , saying ‘things will start picking up now’ and then saying to give the baby orange juice to make him poo. It lasted about 4 minutes and she walked out wondering what had just happened. Gps are beyond busy. They are worked to the god damn bone and we should support our doctors to the very end but when you go in the door and feel like you are being pushed out the other twenty seconds later, it can have a terrible effect on that mother it’s happened to. And she may not come back . The Falling through the gaps Rory talked about the time pressures on GPs said they ‘are noted to act as a disincentive to disclosure’ and this is so worrying.
Great things health care professionals did :
But like I said. This blog isn’t to tear Heath Care Professionals down. Its to inform – as the reality is , we know you have to see about 74 people a day , which is why you whizz through appointments We know you are under so much pressure and that can be super stressful. And we know that you aren’t supported enough , and we support you. So , I wanted to include things form people about the brilliant stuff health care professionals have done to help mums who walkthrough their door search for a kickstart to recovery. I owe my life to the medical profession and know how much you do work to get your patients the help and support they need. The Falling Through The Gaps report showed that ‘women appeared most positive about the care they received when it felt personalised and integrated, when they were involved in making decisions about their care and when it was experienced as wrapping around their needs’.
So , where there is a real sense that women don’t feel listened to at times, there is , of course , many many examples of amazing care. There may be no perinatal pathway in your area, you as a GP may not have much knowledge of mental illness or even more specifically, perinatal mental illness and we know that. We know you work like hell in a system that doesn’t support you in anyway and we the patients support you. But what you can do is show kindness and compassion when a mum who comes to you really needs it. You can even say , look I am not quite sure how we are going to get you help but take a tissue, have a cry, tell me your biggest fear. If you can’t tell me , write it down and show me and I will see what I can do. Sometimes, a bit of understanding and kind words are all that are needed to show that mum it’s ok to go to the doctor and open up.
‘The best thing my GP did was praise me for seeking help. When you’re in a bad place it’s very difficult to view yourself in a positive light so the fact she’d made a point of saying it was very thoughtful. She also highlighted the various ways I could keep myself safe (Samaritans, a&e, back to her, family help) whilst I waited for antidepressants to kick in, including satisfying herself I had a good support network in place. She also liased with pharmacist to work out the best ad’s to take whilst breastfeeding. She really was exemplary in her care, in fact my whole GP practice are fantastic no matter who you get, I’ve been really impressed’
‘My health visitor was amazing and really helped me, took me to the doctors because I didn’t want to go alone/leave the house by myself with a very unhappy cmpa & reflux baby’
‘The one thing the GP told me that I’ll never forget and what helped me through the shittest of times is ‘You are all that little baby knows, he’s been inside you for 9 months and is now in the big world all by himself, he just needs his mummy and that’s okay, but it’s okay for mummy to need time’
‘When I was feeling even worse a few weeks later, I called my HV in tears to tell her what had been happening – she came round to see me in person, sorted a CBT referral there and then and put a complaint through to my GP about the way it had been handled. I don’t think I can thank her enough for how she dealt with it!’
‘I’m currently 35 weeks pregnant and have had antenatal depression during this pregnancy – I spotted it early, self referred to the counselling service after chatting to my husband, updated my midwife and HV and avoided going to the GP. It seems to be under control at this point, but if it comes back as PND after the baby is born, then we know what we’re looking for this time and the best way to get what I need from the system round here’
There is a harsh reality that mums avoid going to the doctor or don’t return to the doctor because of a previous negative experience . and this is so sad as its at a time when its vital for a mum to feel supported and comforted . Without doctors, health visitors etc, I know I am not alone when I say I am alive because of them ,which is why when I hear of a mum not wanting to go back to a doctor for help and is slipping more and more into a state because of a previous experience or because of fear , that I feel like something needs to be done to show mums they can come back.
Perinatal Mental Health Toolkit
I was lucky enough to be able to , as a survivor of perinatal mental illness, review and contribute to the Perinatal Mental Health Toolkit , a resource for GPs which is here http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx . It’s Brillo- pads and I am delighted Carrie Ladd invited mums to view it and review it . It is designed to help doctors support women who come to them displaying symptoms of a perinatal mental illness and contains details on clinical resources for professional, details on medications and breastfeeding, resources that can be shared with the patient and their families, best practice info and details of support in the community that can compliment mums while they are suffering and in recovery, as well as a whole wad of other stuff. I urge you to read it and have a scan if a mum comes into you tomorrow. It’s a wealth of info in one place that’s easy to guide yourself around. If you do have any questions , there is an email address you can message and I think it’s brilliant that there is a specific resource that is bursting at the seams with great info to help not just women, but doctors, who have a hard enough job as it is , seeing so many people day to day with so many different medical issues.
The fabulous Judy Shakespeare did a presentation on International Women’s Day and advised that if a woman consults a GP saying she thinks she has a perinatal mental health problem, she is almost certainly right. It’s a big step to go the doctor or open up to a health visitor about how you are feeling and when it feels like you leave the doctors 4 steps backwards , that can be truly terrifying.
Do not send her away without a flicker of hope or tell her it’s normal when , if you really listen, it isn’t. She might look okay. It it doesn’t mean she is. She is sat in front of you because she wants help and more importantly, needs it.