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Postnatal Depression: What Helped Me

Today marks the start of Maternal Mental Health Matters Week, with a focus this year on ‘supporting mums during difficult times’. As mother, author and trainee integrative counsellor Bridget Hargreave points out, new and expectant mothers are likely to be especially vulnerable to mental health issues in the wake of Covid-19. Drawing on her own experiences, she shares some basic principles for helping women with postnatal depression.

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With pregnant women categorised as being at increased risk from Covid-19, a whole new layer of anxiety has been added to new and expectant mothers’ lives this year. Previously, the figures showed that one-in-ten women develop mental illness during pregnancy or the first year after childbirth. Surely the numbers are set to rise in 2020.

It’s been 11 and a half years since my first son was born. But the memory of how postnatal depression (PND) overwhelmed me at this time – and again just over two and half years later when his brother was born – has never left me. This was before the age of smartphones, and PND also received only a couple of sentences in the library of baby books I’d read, in antenatal classes and at midwife appointments. I felt isolated and scoured the internet for stories of mothers like me.

What I did find was that, when I shared my story, a surprising number of women said, “Me too”. So I wrote the book I wished had existed, Fine (Not Fine): Perspectives and Experiences of Postnatal Depression, in which I shared my own story and the case histories of over 20 mothers with a range of experiences of perinatal mental illness, alongside interviews with mental health professionals.

It’s no coincidence that I’m now nearing the end of a diploma in counselling. My own experiences in therapy were a key part of my recovery, and led to an interest that became a career change. Today, there are counsellors and psychotherapists who specialise in working with perinatal women, and many more support groups are thriving.

But PND can still throw people, counsellors included. Therapists are trained to ‘hold’ their clients metaphorically. How can we do this for a client who may feel her new purpose in life is to be the one doing the holding? Here are some things to bear in mind for anyone working with this client group – at any time, but particularly in this febrile year:

Sensitivity to judgment

A mum with PND, or a pregnant woman experiencing antenatal depression, will be judging herself already. What she needs, perhaps more than anything, is someone to show her the kindness she can’t show herself. One of the mothers in my book described her therapist as ‘didactic’. In contrast, another said she had a health visitor who ‘didn’t make me feel like a lab rat, but like a human being’. These women were talking to me years after these encounters, but the experiences had stayed with them.

You don’t need to be a parent yourself to empathise

And while we’re on the core conditions… bear in mind empathy doesn’t mean you have to have experienced PND or even having had children. I had a therapist after my second son was born who self-disclosed she had no children. We went on to form a very strong therapeutic relationship.

Empowerment is important

Think about how you can empower mothers who are struggling. Many healthcare professionals encourage new mums to get out of the house and yes, it does help. Fresh air, sunshine (if you are lucky), a change of scene. When I interviewed ‘Lily’, she told me about long seaside walks that aided her physical recovery and would help her baby get off to sleep, giving her a sense of freedom.

But what if a new mum can’t get out – either from being in self-isolation during the Covid-19 outbreak, or because she is so depressed that leaving the house feels impossible, which is often the case? How can you empower her to take the steps she thinks she can’t?

She is probably already managing to do so much more than she realises. It can be very helpful for a therapist to gently reflect this.

Mums with PND wear metaphorical masks

We know that mothers often disguise the difficult feelings they are experiencing, and thoughts they are having. Several of the mothers I interviewed admitted hiding their state of mind at the time. One, ‘Isabel’, said, “I didn’t want to accept help”. Mums with PND can be very adept at hiding their depression, maybe even from themselves. Counsellors may find the work around helping clients to sit with their feelings is even more challenging with PND. But it is so important.

Normalising and psychoeducation really help

Many mothers with PND are suffering from the additional concern that what they are feeling is abnormal. The reality is that perinatal mental illness is common, even in the most conservative estimates. The likelihood is that many women go undiagnosed.

‘Lindsey’, a mother who spent time in a residential Mother and Baby unit, told me she had been hugely reassured by a perinatal psychiatrist around her feelings that her baby was somehow ‘not real’. The psychiatrist explained to Lindsey that this was her anxiety manifesting itself.

Crucially, PND does get better with the right support: be that from family, counselling, medication, friends, peer support schemes or all of the above. In the black pit of depression, with a new dependent to care for, this may not seem credible – so normalising PND and providing psychoeducative information may be crucial.

Useful online PND resources:

You and your clients may find the following sources of information and support helpful (many have adapted their services in light of the Covid-19 outbreak):

  • The Maternal Mental Health Alliance is a coalition of over 90 organisations campaigning for change and improvement to perinatal mental health support for women in the UK. You can find out more about Maternal Mental Health Awareness Week 2020 via this site.
  • The NCT is a charity supporting families through the first 1,000 days of parenthood. They campaign, provide guidance and help create networks for parents through 333 branches.
  • Bristol-based Bluebell provides services to support families’ wellbeing during the perinatal period, including peer support, a group programme and support for dads.
  • Cocoon Family Support helps parents affected by perinatal mental illness, offering counselling, peer support and advice.
  • The Smile Group, in Cheshire, was founded and is run by mothers who have experienced PND. As well as support groups, they offer virtual support worldwide and self-help resources.
  • Juno Perinatal Mental Health Support was founded in Edinburgh by a group of mothers who all have personal experience of perinatal mental health difficulties. They support mums through peer and trauma support groups, one to one befriending and access to subsidised counselling.
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Bridget Hargreave

Bridget Hargreave is a freelance communications consultant, writer and trainee integrative counsellor. In 2015 her book, Fine (Not Fine): Perspectives and Experiences of Postnatal Depression, was published by Free Association Books, chronicling her own experiences of PND alongside case histories of other parents, and insights from health and mental health professionals. She lives in London.

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