Tuesday, June 6, 2023

Inside an Anxious Mind Pt 1: The Explosion of Postnatal Anxiety in NZ, Thanks to Covid

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TW: Postnatal Depression, Postnatal Anxiety, Traumatic Birth, Suicide

Covid-19 has had many a trickle-down impact on our mental health but one of the biggest impacts has been on maternal mental health. Alice O’Connell looks at the rise of postnatal anxiety in NZ and shares her own experience with having her first baby in the pandemic.

If you’ve read the headlines this year, you likely will have heard that it hasn’t been a particularly great time of late to have a baby. 

Among the stories about staff shortages, a midwife crisis and a plethora of different issues plaguing our hospitals, there’s also been much talk about the mental health impact on new and expecting mothers. The worst of the headlines revealed that the leading cause of death among pregnant women and new mothers is now suicide.

As someone who gave birth just back in March it made for some pretty difficult reading at times – but, unfortunately, the one thing I didn’t feel while reading those stories was any shred of surprise.

Giving birth and entering the new world of motherhood has always been a massive, often overwhelming, challenge. Nothing can really prepare you for the wild ride of hormones that swing you from the most intense feeling of profound joy of seeing your little person for the first time and holding them in your arms. But likewise, they can swing you right down to deep lows, muddled by fear, overwhelm and utter exhaustion. Pregnancy can be tough on the body and then, well, suddenly you have this tiny human entirely dependent on you around the clock. It’s big stuff. 

But in the past two years or so, there hasn’t just been wild hormones to contend with – there’s also been a perfect storm of the pandemic mixed with a midwife shortage. While becoming a parent used to feel like being dropped into the deep end of a swimming pool, over the course of the pandemic it felt a bit more like being dropped into the middle of the Pacific.

When I welcomed my little baby, it turned out that I happened to know quite a few women who had also given birth within a few weeks of me – which also just happened to be during the first peak of the Omicron outbreak, coming off the back of the longest stretch of lockdowns in Auckland. When I found that the first few weeks weren’t all rainbows and Instagram-perfect, I also quickly discovered I wasn’t alone. Within those first weeks and months, I exchanged messages with these friends. 

One message read: ‘Hey, how are you going? Because I AM NOT OKAY’.

Another friend said: ‘Ummmm, any chance you’re also crying hysterically for a few hours every day?!?’ 

Another, from an old colleague read: ‘ARE YOU GETTING ANY SLEEP? Also, do you feel… kind of insane most of the time?’

Then, when I eventually opened my work email to check in, I discovered a bunch of emails from women across the country – but largely in Auckland – asking if I would consider writing about Postnatal Depression (PND) and/or Postnatal Anxiety (PNA), particularly in the wake of the pandemic.

“Have you thought about writing about Covid-induced postnatal anxiety?” said one. “What about talking about traumatic births – i.e. having an emergency c-section ALONE because your husband had Covid?” said another. “I gave birth in 2020 just after lockdown and I have been a mess ever since – this has been nothing like the births of my first two children,” said another.

While no one has had a particularly rosy time through the pandemic, anyone who has welcomed a new little being during this time will have experienced things that are drastically different to the usual way you prepare for and greet your baby into the world.

There are the scans and appointments that women have had to go to alone, or that have been cancelled entirely. The antenatal classes that have been canned or moved to virtual (tricky, because when you go into labour and your baby shows up, neither event can just be attended virtually). The anti-vax cousins to contend with who ask about why you got ‘jabbed’ and if you’re insane (asking a hormonally charged pregnant woman about her sanity, isn’t really advised, btw).

Many women have had to give birth without their partner or support person present. New parents have been cut off from their support networks, having to wait weeks or months to have visitors – even including the new baby’s siblings and grandparents. Follow-up appointments have been canned, or carried out in a mad dash to limit exposure. Coffee groups have had to happen virtually, or become haphazard – or, not happen at all for some. There’s been the news headlines to contend with, screaming out about resources being stretched to the limit. Midwives have been impossible to come by – in fact, all medical staff have been in short supply and hospitals have discharged new parents and babies in record speeds (some just within a few hours of delivery).

My fiancé and I certainly had it a lot easier than a lot of parents over the pandemic, but it wasn’t without its challenges. A good chunk of my first trimester took place over the Level Four Auckland Lockdown, with the following trimesters mostly spent under some kind of lockdown, so things looked a little different to usual. Most of the difficulties were just little inconveniences, like having horrendous morning sickness and not being able to get acupuncture or even a frozen Coke to help ease the nausea, or not being able to tell friends and family – including my parents – our happy news in person.

Others were slightly strange and sometimes a bit unexpectedly emotional. Like, the fact that the first time my partner met our obstetrician was when she was about to perform an emergency c-section on me, because he’d had to stay in the car for every single one of my appointments. He’d also had to wait in the car during our scans – I found the 12 week one particularly nerve-racking, and desperately wished that he had of been able to be there. At the time, we were in Level 4 in Auckland – but after a friend had been to a scan a few days earlier and had her husband on Facetime, I asked the technician if I could do the same, or maybe get him on speaker phone? That way, at least he’d kind of be there.

The poor woman had to tell me no, there was a new policy after an “incident” a few days earlier. My heart dropped – I could only imagine what that incident might have been. But thankfully, I was one of the fortunate ones who got to wave a happy little print-out strip of ultrasound photos at my partner as I burst through the doors to the carpark.

Mostly, though it was just the uncertainty of the whole situation that I found hard on the nerves. We hit a bit of a rough patch when – on the same day RAT tests became available – we had a Covid positive case at home. To give me the best shot at not catching it, everyone cleared out, including my fiancé (we figured it’d just be a couple of days until we were all showing symptoms and would come back together anyway). Somehow, luckily, I managed to escape getting Covid, but my partner wasn’t so lucky – and in the end, with isolation periods being 10 days at the time, I spent the last two weeks of my pregnancy entirely on my own, willing my baby to stay put.

My Lead Maternal Carer (LMC) had prepared me to have someone else on call to be with me, but thankfully, our little guy decided to wait until after his due date to be born and my fiancé was allowed to be in the room with me when he arrived. I don’t know how the women who did have to go it alone got through it – or navigated those first few days on their own, in a system that was clearly very stretched.

So, it comes as little surprise to me to hear that many women have been experiencing some issues in the wake of all of this.

It used to be that around one in seven New Zealand women experienced postnatal depression (PND) or postnatal anxiety (PNA) – with a similar number of new dads also experiencing PND. And while no new stats have come out here since the outbreak of the pandemic, over in the UK, numbers have absolutely skyrocketed.

A study in May 2021 found that almost half of women with babies aged six months or younger now met the threshold for postnatal depression.

A Canadian based study – conducted between April and May 2020 – showed a spike in anxiety among participants who were pregnant or postpartum, which ballooned from 29% pre-pandemic to a staggering 72%.

A Canadian based study – conducted between April and May 2020 – showed a spike in anxiety among participants who were pregnant or postpartum, which ballooned from 29% pre-pandemic to a staggering 72%.

The US showed similar stats, with a Harvard study finding that while the number of people experiencing PTSD, depression and anxiety had increased in general amongst the population during the pandemic, pregnant and postpartum people were now far more greatly overrepresented. Numbers were believed to continue to spike in the US – which experts put down to the fact that the pandemic lessened access to breastfeeding resources, which likely caused many to switch to formula… right on time for a formula shortage to hit.

Here in NZ, the doctors and psychologists/psychotherapists I have spoken to say that while there may be no official stats out, they have seen a profound increase in the number of people experiencing PND and/or PNA and reaching out for help or referrals.

Auckland psychotherapist Emma Harris says she’s seen a significant rise in women – and men – reaching out to her. “Particularly over NZ’s first lockdown in 2020 and Auckland’s second lockdown last year I noticed a sharp increase in enquiries from new mothers in distress, pregnant women and mothers experiencing PND and/or postnatal anxiety,” she says.

While I know a lot of women who’ve given birth and got on just fine during this time, like Emma says, not everyone has been so lucky. Unfortunately, I’m one of those women.

After I welcomed my son into the world, like the majority of new mums, I went through a bit of the baby blues – that two-week stretch after birth when your hormones send you on a complete rollercoaster. Am I crying because I’m so happy?! Overwhelmed? Tired? Perhaps all three?!?

It’s super common. But, if your symptoms continue beyond two weeks though, you’re technically thought to be out of baby blues territory and instead moving into the PND/PNA realm (although some medical professionals put that window of ‘baby blues’ closer to six weeks).

For me, it was a slow slide from feeling that rollercoaster of emotions, to a nightly feeling of something closer to panic and dread. It’d linger around in the background during the day, then, as the sun would set each night I’d eventually feel a sudden hard spasm in my chest – so violent it would expel the air out of my lungs. Then, my heart would immediately race – sometimes so aggressively it felt like it was going to quite literally leap out of my chest.

It was as though my body knew it was in some sort of immediate mortal danger – as if there was a sabre-tooth tiger in the room and I needed to go grab my baby and run the hell out of there. But, while my body might have been screaming at me to get out of harm’s way, my mind couldn’t see anything that might be putting us in danger.

As my mind raced to find an answer (or get a visual on the sabre-tooth tiger!) that might explain this intense feeling, I’d eventually come to the same conclusion: this must be that ‘mother’s intuition’ everyone talks about and there must be something terribly wrong with (or about to happen to!) my baby.

But, of course, he was always completely fine. And continued to be fine for the next – rather exhausting – 12 hours, while I continually fretted about whether he really was fine. I’d spend the night rehashing the entire day and whether anything had been out of the ordinary, or if there had been any opportunity where I could have done things differently or better. To really dial things up a notch, I’d then spend the next day – obviously already quite worn-out – being hyper-vigilant to make sure that in my nightly audit, I’d have as little as possible that I could possibly pick over as being ‘wrong’.

At first, I figured maybe everyone felt like this – but then as it started to drag on, I hid what was happening – downplayed it or completely ignored it until one night, things came to a head. My partner woke up at 4am to find that everything was completely fine – except, as I sat there feeding the baby, I could not for the life of me stop crying.

Thankfully, despite the hour and a serious lack of sleep on both our parts, he didn’t just accept my insistence of, “I’m fine, I’m fine, I’m fine” and instead held my hand, listened and made a plan when I finally managed to say, in a little voice, “Okay, actually, no, I’m not okay. I think I have postpartum depression or anxiety or something”.

I’m lucky – and actually just very privileged – in that I’ve talked to a psychotherapist in the past (I highly recommend therapy – and talking to someone before you really need it!). So he suggested that we get in touch with her in the morning. And then, when my GP’s office opened on Monday, we would make an appointment with him.

My psychotherapist was amazing and even though she was at a family wedding on Waiheke, responded immediately by text and then a call – and come Monday I made that GP appointment, which both my partner and son came along to.

My GP was equally incredible. As soon as I walked into the room, he said, “Oh look at the baby! But more importantly, how is his mum doing?” To which, I promptly burst into tears and explained that I was not doing well.

He responded in the best possible way, by saying: “Okay. Now, there are three things you need to know. Repeat them after me. One: This is not my fault. Two: This is not my fault. And three: This is not my fault.” 

“Now, there are three things you need to know. Repeat them after me. One: This is not my fault. Two: This is not my fault. And three: This is not my fault.” 

It was everything I needed to hear. I left with a couple of prescriptions and a blood test form. And, like my psychotherapist, he checked in on me again each day, until a couple of days later when he called with different news. “Okay, so I don’t think you need to take that antidepressant after all,” he told me.

It turned out that I was actually suffering from postpartum thyroiditis and experiencing some rather extreme hyperthyroidism. I should note here that I already have a thyroid condition – the autoimmune disease Hashimoto’s Thyroiditis – but, somehow I was still shocked that an imbalance in my thyroid could be the root cause of my anxious feelings.

I came to learn that postpartum thyroiditis isn’t uncommon, and causes many women to experience hyperthyroidism – where your thyroid goes into overdrive. Its symptoms include a racing heart, heart palpitations, sensitivity to heat, insomnia, panic attacks – so essentially, it closely mimics postpartum anxiety.

It’s believed around 5% of women develop postpartum thyroiditis after giving birth, although the number could be much higher when you consider that many more women may never actually get tested or diagnosed – perhaps because they never tell their GP about how they’re feeling or never reach out for help. One of the cruellest parts of anxiety is that its best friends seem to be shame and guilt, who can stop you from opening up to those closest to you. [Side note: those bedfellows love to hang around too – I can’t tell you how many times I questioned adding my own experiences to this story, fretting: ‘But what if people read this and think I haven’t loved being his mum?’]

I was incredibly lucky that my version of anxiety could be eased by taking medication for my thyroid – but I couldn’t help but think of all the other women going through the same thing who weren’t quite so fortunate. 

My midwife didn’t pick up on what was going on (the midwife shortage is very real – those who are left in the business are severely limited on how much time they can spend with you), and by the time I had my follow-up appointment with the obstetrician who was my LMC, I had already started taking medication and was riding it out.

Both the psychotherapist I reached out to, and my GP called Maternal Mental Health before my thyroiditis diagnosis. Both of them were told that I didn’t meet the threshold to be seen, such is the strain they are currently under. I wasn’t considered “severe”, nor had I been taking antidepressants or anti-anxiety medication, (apparently I would have needed to be taking them for a couple of weeks without an improvement to get in).

So, if services aren’t available, what happens if you don’t already have a support network? Private therapy is expensive – and even if you can scrape together the money, psychotherapists and psychologists are seriously tough to get into at the moment. None of the therapists I’ve spoken to for this story series had space on their books for new clients, which seems to be the case for the bulk of those in the profession at the moment.

One of the saving graces is Plunket – who I will take this moment to sing the praises of. In their in-depth first chat with me (over Zoom of course, because of Covid), they asked some super nitty gritty questions, but seeing as I’d been to my GP the week before, I answered truthfully about the anxiety I was experiencing. They then sent the most lovely woman to my house, who checked in on my son and gave me great advice about anxiety, as well as a wonderful pep talk. She also said to get back to my GP if things didn’t improve within a couple of weeks, to really push for a referral to MMH.

While they don’t have any stats about increased pressure on their services due to the pandemic, the spokesperson I talked to at MMH acknowledged it has had an impact.

“Mental health and child wellbeing are both key priorities for the Government,” they said. “Parents and their babies deserve the very best start. We recognise the added pressure of the pandemic, which has been felt by a range of health services over the last two years.”

They also added that some changes are afoot, which were outlined in Kia Manawanui: Long-term pathway to mental wellbeing, released last year. The  high-level plan for transforming New Zealand’s approach to mental wellbeing over the long-term recognises that “achieving the needed changes requires a collective approach where government agencies are working together to improve the mental wellbeing of New Zealanders”.

Work on the strategy is expected to begin work this year. Meanwhile, the spokesperson told me, the Maternity Action Plan allocates $500,000 per year to enhance early intervention initiatives for women with mild-to-moderate mental health needs and their whānau. “Māori in rural and isolated areas were prioritised, with Lakes and Northland receiving ongoing funding and Waitematā, Counties Manukau and Hawkes Bay DHBs receiving one-off funding,” they said.

It’s great news – but, at this stage, it’s really just a drop in the bucket.

While some women out there may have been experiencing mild to moderate symptoms that have settled down on their own – perhaps thanks to postnatal hormones resettling – many will have continued to dial up, which is no doubt what will have increased the number of women now categorised as severe, being referred to MMH.

If my email inbox is anything to go by – there are a lot of women out there, still trying to get on top of PND/PNA. For some, it has been two years since their symptoms began.

Which is why I wanted to share my story (if for no other reason than maybe someone might ask their Dr for a blood test to check their thyroid levels if they’re feeling anxious after giving birth!) – and open up the floor to allow others to share their experiences.

In part two of this story, I’ll share advice from a psychotherapist who specialises in PNA/PND and believes the pandemic has very much exacerbated the problem. I also chat to a woman – and her husband – who are both suffering from postnatal anxiety following her traumatic birth, which she went through alone, due to Covid restrictions.

If you’d like to add your experiences to the mix (which you can do anonymously if you prefer), I’d love to hear from you and include your story too. Please drop me a line at [email protected].

Where to go to get help:

  • PlunketLine – call 0800 933 922 or text 1737 (24/7)
  • Mother’s Helpers 0800 002 717
  • Perinatal Anxiety and Depression Aotearoa (PADA) (+64) 04 461 6318
  • Post Natal Distress Support Network Trust: 09 8464978 (great Auckland area only)
  • 1737, Need to talk? Free call or text 1737 any time for support from a trained counsellor
  • Anxiety New Zealand – 0800 ANXIETY (0800 269 4389)

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