Monday, October 3, 2022

Inside An Anxious Mind Pt 2: “I Gave Birth Alone Due to Covid Restrictions” Plus, What to Do If You Think a Loved One Has Postnatal Anxiety

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

No one has had a particularly easy ride throughout the rollercoaster of the pandemic, but one trend emerged internationally showing that the mental health of pregnant people and new parents were particularly hard hit. One Canadian study found the number of women experiencing postnatal depression (PND) or postnatal anxiety (PNA) exploded from 29% pre-pandemic, to a staggering 72%.

Here, while no official statistics have come out, it’s thought a similar surge has taken place, according to doctors and psychotherapists who say referrals have been at an all-time high. Tragically, now, the leading cause of death among pregnant women and new mothers is now suicide.

Last month we bought you part one of this series on PND/PNA and the affect the pandemic has had on the mental health of new parents. We received a huge number of responses from women – and men – who wanted to share their experiences, or to just say thanks for making them feel a little less alone in their struggles.

In this instalment we speak to Rebecca* and her husband Grant, who both developed depression, anxiety and PTSD – after a stressful delivery, in which Grant was shut out due to Covid-19 restrictions. We also hear from psychotherapist Emma Harris who shares her advice about postnatal anxiety/postnatal depression, including what to do if you’re struggling or if you’ve noticed signs that a loved one might need some assistance.

When Rebecca felt her first contractions in the middle of the night, she decided to not wake her husband – her midwife had drummed into her that first babies can take days to arrive.

So, she willed herself to go back to sleep, trying to ignore the light pangs of pain in her lower back.

But, as the minutes ticked by it became harder and harder to try to tune out. She grabbed her phone and started timing her contractions – they were already six minutes apart and were getting increasingly painful.

She dialled her midwife, who advised her to head straight to the hospital, so she went into the lounge downstairs to wake her husband, Grant, who was sleeping on the couch. He sprung into action, grabbing her bag and sped the two of them to the hospital, while they called his mother.

There, he pulled up to the entrance, helped her out of the car with her roller bag.

And then Grant got right back in the car and drove himself home.

Because just two days earlier, Grant had tested positive for Covid-19 after taking a routine PCR test for work.

It meant that at that stage of the pandemic, Grant couldn’t be with his wife when she gave birth to their first child, a little boy they named Dane.

“I know I’ll never forget that moment we said goodbye,” tells Rebecca. “From memory, all we did was just stare at each other, trying not to cry, and said ‘bye’. There was so much to say to each other right then, but also, nothing at all.”

Rebecca had hoped that they’d be lucky. When her husband tested positive – with barely a tickle in his throat – she was 38 weeks pregnant. They tried to carve out different areas of the house at first to live in, to minimize the chances of Rebecca catching it, but the logistics of being so pregnant meant they did away with isolating – except for not sleeping in the same bed.

“By that stage of pregnancy I was up so much in the night it made more sense to be on my own anyway,” says Rebecca.

With two weeks to go until their due date, she hoped Grant might be virus-free by then – a hope that was buoyed by their midwife, who reminded them that first babies tend to come late.

But instead, Dane arrived both early and in one heck of a hurry. Such a hurry, that Grant’s mum – who lived a two-hour drive away – only arrived at the hospital an hour after Dane was born. Due to Rebecca’s status as a close contact, her midwife was also shut out of the birth.

“It was the scariest thing I’ve been through, by a mile,” says Rebecca, her voice starting to shake. “Covid-19 was pretty new then, so I was immediately in full PPE – as was anyone else in the room.”

After she was assessed upon admission, things quickly went south. Rebecca was in enormous pain, but too far along for an epidural. As she began pushing, Dane began showing signs of being in distress, which quickly worsened, until she was advised they would do need to do an emergency c-section.

“From memory, all we did was just stare at each other, trying not to cry, and said ‘bye’. There was so much to say to each other right then, but also, nothing at all.”

“I have flashes of it,” she says. “I was in so much pain, I remember signing a form – beats me what was on it. But I remember wondering if I died, or Dane died, if Grant would be angry I signed it.

“Then I remember being told to sit still while they did the anaesthesia. I couldn’t stop shaking or moving, because of the contractions, which were on top of each other. I wondered if I was going to be paralysed.”

From there, everything is a complete blur for Rebecca.

“I remember being terrified, and the anaesthetist calming me down. And I remember waiting to hear the baby cry – because that’s what you see in the movies – and it being several minutes before I heard him.”

She has no idea if she did skin-to-skin or at what point she first saw Dane.

“I have no photos either,” she says. “It’s one of the reasons I can’t go on Instagram anymore – I see photos of mums and their newborn babies and it either makes me cry or, at worst, I have a panic attack.”

Dane had to spend two nights in hospital due to being jaundice – otherwise they likely would have gone straight home – and she says her mother-in-law was a godsend during this time. “I don’t know if she was actually allowed to be there, but she bought me food, showered me, helped me with my latch and really advocated for me, and Dane.”

Then, they finally got to go home and introduce Dane to his father.

But – not at all surprisingly – the next few weeks weren’t quite all Rebecca had expected, and nothing like the joy of the “newborn bubble” that she’d heard other people talk about.

“It was hard, and it only got worse,” she tells. “I was in shock and processing so much – all while dealing with those surging and falling hormones.”

During this time, Grant was her rock. No one else in the family ended up catching Covid-19 and Grant was one of the lucky ones who never experienced anything more than a bit of a cough and having his sense of smell disappear for two months.

“I was a mess,” says Rebecca. “I cried a lot and was having flashbacks constantly and just felt so robbed. I was also terrified that something was going to happen to Dane. Like, would he catch Covid-19? I had all these awful intrusive thoughts – like, I became obsessed with this worry that I might fall down the stairs with him or drop him on the hardwood floors.”

It wasn’t until a Plunket nurse called her, eight weeks later – and explained to her what intrusive thoughts were and asked if she ever had any of those – that Rebecca began to see that she might need some help.

“She asked if she could do a screening test for postnatal anxiety. It’s the highest score I’ve ever got on a test. It’s a shame it was for the wrong kind of test. A test you don’t want to nearly ace.”

Rebecca – with the help of her GP – was referred on for counselling and was eventually diagnosed with postnatal anxiety and PTSD.

Part-way through her therapy – some three months after giving birth – she got a call from her husband. He’d been on his way to visit a friend, but called Rebecca – in quite a state – from the side of the road where he’d pulled over.

He couldn’t keep driving and he couldn’t get out of the car.

“It was heartbreaking and just… awful,” she tells. “He hadn’t driven in that direction in months – it was the same route as going to the hospital. It gave him a panic attack. I felt so guilty that I hadn’t realised he was also in a dark place, but having to hide it.”

Rebecca’s neighbour came over to watch Dane as she drove to pick up her husband – who was feeling a kaleidoscope of emotions: shame, guilt, regret, rage and a deep, deep sadness.

For months, he’d been pushing down his feelings, trying to support his wife and baby – but he too was suffering from anxiety and depression.

He says he felt an extreme sense of guilt for not being with Rebecca when she was in labour.

“It’s the one time, the time when your wife needs you most and I wasn’t there,” he says. “Everything she went through afterwards was as a result of being alone and terrified and that fell on my shoulders.”

Grant too began seeing a therapist to work through what happened and nearly two years later, he says he’s in a much better space, but still hasn’t told his friends or workmates – or anyone really, apart from his mother and one mate, what he’s been going through. (It’s why Rebecca and Grant have asked to share their story anonymously for now)

“I will eventually, probably” he says. “But this is about as much reliving of it as I’m comfortable with at the moment. It still chaffs. When it stings a bit less, I’ll talk to more people about it.”

“It’s the one time, the time when your wife needs you most and I wasn’t there,” he says. “Everything she went through afterwards was as a result of being alone and terrified and that fell on my shoulders.”

He says he’s talked to one friend about it: an old friend who had a baby during the 2021 long Auckland lockdown, who caught Covid – along with his newborn baby, who was just two weeks old at the time.

Grant says he called him as soon as he heard and asked how he was doing. “He said, ‘y’know, all good, mate.’ So I said, ‘No, how are you really?’ and we got into it.”

Two years later, Rebecca and Grant are in a better place and Dane is thriving.

“It one thing that really scared me,” says Rebecca. “I felt like my anxiety and everything would have a negative impact on him – like, I genuinely thought we’d have a baby who never smiled. But he is the happiest little toddler we know of. That’s what I want people who are in the thick of it to know – your baby is going to smile and be okay!”

Rebecca and Grant are just two of the many women – and men – who’ve experienced anxiety and/or depression after welcoming a baby. And as we discussed earlier, PND and PNA rates have skyrocketed since the pandemic hit.

After our initial story in this series, we received a huge number of emails – there was Kate, whose heart pounds every time she puts a face mask on, because it reminds her of her labour where she had to wear one for the entire nine hours of active labour.

There’s Jane, who also gave birth alone after her husband got Covid in late February this year – four days before her scheduled c-section. “It was my third baby, thank God,” she says. “Otherwise, it would have been a lot worse. But I still developed postnatal anxiety afterwards.”

There’s Melanie, who feels she missed out on a “proper” pregnancy because Auckland was in lockdown for much of her pregnancy, meaning very few people saw her pregnant. She missed out on a baby shower and went alone to every scan.

There’s Noelle, who is overseas right now, introducing her toddler to his grandparents – who had planned to be there for his birth, but had those plans cancelled by Covid. There’s Kath, whose husband was made redundant, due to Covid, the same week she gave birth (both she and her husband have since been diagnosed with depression). There’s Julie, Sasha, Nicky, Joy and Rachel who all had PNA and felt they might not have, if it wasn’t for the pandemic.

While there have been no official statistics to come out in NZ about the affect the pandemic has had on rates of postnatal depression and anxiety, overseas, numbers have exploded. And, according to psychotherapist Emma Harris, the trend has very much been the same her in NZ.

“Over the last two years and particularly over NZ’s first lockdown 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 anxiety,” she says.

Emma says the increase has come down to what she believes are several factors: many women (and men) have experienced isolation and loneliness during this time. Many have had a lack of family support due to physical separation – only exacerbated by the borders being closed. Most new parents have faced some sort of anxiety over the actual and unknown risks of contracting COVID for mother, baby and family.

Then there’s been having to attend scans, appointments, check-ups alone without the support of a partner, the reality of needing medical intervention within an over stretched health system and concerns about medical staff and midwife shortages and burnout. “People ask themselves, will the help be there when I need it?” she says.

What to do if you think you might be suffering from postnatal depression/postnatal anxiety, or if you think a loved one may be

Emma Harris says it takes courage to reach out an ask for help. “And sadly there isn’t equal opportunity for getting help, both due to cost and the lack of availability of therapists,” she tells. “Māori and Pasifika are most greatly disadvantaged, I believe.”

She says the best advice she can give is to seek help early on – and by early on, she means even prior to getting pregnant!

“In the same way you might go to your GP for a general check-up before trying to conceive I suggest going and doing some psychotherapy as an emotional and mental check in with yourself. For example – what would it be like to reflect on one’s own experience of being mothered/parented? Some women have unresolved trauma and conflicts from their own upbringing that may impact on their own maternal capacity.

“Engaging early in therapy can be of great value as a preventative measure – particularly if there is any familial mental health history.  Having an already established trusting relationship with a therapist prior to birth can provide a new mother with the therapist’s ongoing containment should postpartum concerns arise. Failing that, anti-natal groups, Plunket, SPACE groups, friends with babies can provide important support and reduce isolation.”

But if you’ve already had your baby and are feeling a bit out of sorts, and wondering if it may be PND/PNA, she advises you to take it seriously.

“this is not the time to let a struggling mother and family down.”

“Shame about not coping is common, particularly I think for women who have had long fertility journeys or who are used to success and a sense of control in their world. There is a myth that women can do it all and we need to be real with ourselves about what we can and can’t manage.

“We are only human – we need sleep, we need food, we need love and care too. How many women function as mothers and wives without attending to themselves? It’s a sign of strength not weakness to put your hand up for help. A mother who can attend to her own emotional needs will be better equipped to attend to her own baby and develop a secure attachment. It is possible to thrive, not just survive.”

But what about if it’s your partner who is “just surviving”, or a loved one who you are worried about? Emma says now is the time to get engaged – whether it’s providing some practical help, or just lending an ear.

“Friends and family need to look out for signs in the woman she is not coping and take her seriously if she is tearful, angry, frightened, depressed etc. Encourage her to talk through her feelings and offer time to listen. Without judgement!

“If you feel overwhelmed or unsure how to proceed try and get professional guidance. On a practical level cooking meals, cleaning, doing the dishes, holding the baby to let the mother (and partner!) have periods of uninterrupted sleep can make a huge amount of difference to the mental wellbeing of the family unit. A wrap around system of family, professional, friend support may be required for a period of time. If you offer support you need to deliver it, follow through, this is not the time to let a struggling mother and family down.”

*Names have been changed for anonymity

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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