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Melissa's Perinatal Mental Health Journey

It's Maternal Mental Health week, and as it comes to a close I want to share my own story - and struggle - with my mental health following the birth of Ophelia. I found it really isolating, and extremely hard to ask for support, and when I did finally ask, I had to fight really hard to get it.

The first 30 weeks of my first pregnancy were what you would call textbook. I got pregnant right away when we started trying, I was at my fittest, my nausea and sickness disappeared by about 14 weeks, and all our scans looked great. I was as low risk as they come. At our 28 week midwife appointment my bump measurement was smaller than they expected, and we were sent for a growth scan to make sure all was okay. Although everything looked okay during that scan, they measured baby around the 3rd centile for size and were concerned as to why that would be. We were all of a sudden thrust into the 'high risk' category, with multiple scans and/or appointments of some sort every week as they tried to figure out what was going on.

Whilst I do believe it is amazing that we have the technology and knowledge to be able to monitor and manage 'high risk' issues (and it absolutely is life saving in some cases!), there is a very real disconnect within the maternity care system between healthcare providers who are providing this care and the people recieving it. It felt like we were spoken AT rather than with, and that decisions were being made based on what felt right for the consultant, rather then what felt right for me, my body, and my baby. We were constantly told about the risks of not listening to them, but we were never told about any alternatives or that we had options and choices. I went from planning a home birth and making plans for once baby was here, to crying in the shower and asking myself daily what I did wrong to cause this. There was no explanations, no support for use receiving this extra care, just worry and confusion. Although we tried asking for these things, we were brushed off and told "it's just like this, do as we say", and as first time parents, it was really difficult to know how to navigate this or to know what questions to ask. Looking back on it, the 5 weeks before Ophelia was born was probably the catalyst for my mental health struggles after her birth, but not once did any health care professional check in with us or offer anything to support us.

Ophelia was born at 33 weeks by emergency section because I developed sudden onset preeclampsia and HELLP syndrome. She was fine, but MY body was failing, which meant she had to be born early and wasn't given the opportunity to grow anymore inside. The section itself was fine with no complications, but it was a far cry from the home birth I wanted and it felt like it was my fault. Ophelia was 4lb 1.5 oz when she was born, which is around the 35th centile - quite a big difference from the 2nd centile baby they were predicting on the scans (but that's a conversation for another post 😂).

It also didn't help that we went into lockdown the same day she was born (missed Bojo's first Monday evening news bulletin!) and maternity and postpartum care got royally screwed in the weeks, months, and year following that. Following an early discharge for myself (thanks COVID), and a 4 week stay in SCBU (special care baby unit), Ophelia came home with no follow ups or aftercare support. Weigh clinics were cancelled, health visiting non-existent, and because we were pushed to bottle feed (alongside breastfeeding) to go home sooner from SCBU (again, thanks COVID), we were given no feeding support because 'she can just have more bottles'.

I think I pushed through in the first few weeks following her birth - I was recovering from a c-section as well as having been so poorly myself with preeclampsia and HELLP, I was going back and forth to the hospital every day to see Ophelia, pumping at all hours to keep my supply up as well as feed her, and coping with the fact we were in lockdown and had no access to family support. Bringing Ophelia home had a positive impact for a little while, but after a few weeks it all came crashing down. We were sleep deprived, having issues feeding and her gaining weight, terrified of what COVID would do to a preemie baby, and no resources to call upon. Despite asking repeatedly, we got no help from midwives, health visitors, or the GP service because Ophelia was "fine now", and they left us to it.

My mental health spiraled. I couldn't shake the feeling that everything was my fault - my body couldn't cope with pregnancy and she was small, my body developed preeclampsia and HELLP syndrome and she had to come early, my body couldn't feed her properly and we had to give bottles. I was crying constantly, she was crying constantly, and my poor husband (who had also gone through this traumatic experience) was left to try and get on with everything and help both of us at the same time.

I felt really disconnected from Ophelia and struggled to bond with her or feel any emotion towards her. She was just there, but she didn't feel like she was mine, or that I was her mum. There was no rush of love, no urge to protect her. If someone had come to me at that point and said, 'there's been a mistake, she's not yours and we're taking her away' - I honestly think I would have just felt relief. Now, 4 years later, that's completely not the case, but at the time I had nothing left to give to her.

I want to talk about some of the things I experienced in the following months before I got support (not from lack of trying to get something sooner!). In my opinion, they are things that aren't acknowledged and talked about enough, but seems to be things that a lot of people experience as well. It's not until I started sharing my story that others started saying "hey, I experienced that too! I thought I was the only one."

• Rage. I had a lot of rage, mostly directed at this tiny baby who was doing absolutely nothing wrong. I think it stems from the anger I had towards myself and my body, but it manifested as a really short fuse in my daily life. She wouldn't stop crying? I saw red. She wasn't feeding properly? Red. Husband tried to suggest something different or help? Red. I shouted..I screamed. At her, at him, at myself, at the shit situation we were in. The come down from that anger was often sobbing or exhaustion - sometimes both - and sleeping was the quickest way to get away from it all. In a way, we were lucky that my husband got furloughed and spent a significant time at home in the first few months. He was there to take over and pick up the slack when I was overwhelmed, which was a lot. But, as with all things, that ended and he had to go back to work and I was left with this baby all on my own. Looking back, I'm so full of guilt and not proud of it, but there were moments where I couldn't get her to sleep or put her down and she was crying and all I wanted to do was throw her across the room and make it stop. Usually it meant I put her down (sometimes not as gently as I should have been) and walked away, often sobbing with my hands over my ears so I couldn't hear her crying. Deep breaths, taking some time to pull myself together, and I would return - usually calmer, but it didn't take much for the cycle to start back up again.

• Intrusive thoughts. This was something I really had no idea about before having a baby, and didn't know that so many women have this following birth. They would enter my head at random times, without warning, and they left me feeling utterly terrified. Standing at the top of the stairs about to walk down holding Ophelia and all of a sudden the thought of just dropping her and letting her fall down the stairs would pop into my head. Going for a walk and I'd suddenly just think that I should put her down and leave her, walk away and not look back. The thoughts tended to be focused around something that would potentially harm her - and I never once even came close to doing any of the things, but the thoughts were there all the time. I was living in a state of panic almost all the time, terrified because although I didn't WANT to do any of those things, I always felt like I could do them - I just had to give in to the thoughts.

• Maternal OCD. This was something I didn't know I had until after my diagnosis, but once it was explained it made so much sense to me. It wasn't OCD in the way you tend to think when you hear the term (locking doors multiple times, having to do something in a particular way before moving on ect.) but more that I was trying to control everything. Although I felt really disconnected from Ophelia, I also struggled to step back and let anyone else do anything. I was tracking her feeding/eating/sleeping and constantly obsessing about if she'd had too much/too little of anything. I didn't trust my husband to manage it all, so it meant I was often criticising and critiquing what he was doing (and he wasn't doing anything wrong!), even when I was meant to be sleeping or taking time for myself. I was getting very little sleep because every noise or movement she made I was up to make sure she was okay, watching her for a period of time before feeling like I was able to try to sleep again. I had massive health anxiety over everything, and my poor mother-in-law (who is a nurse) got many a panicked phone call at all hours about one thing or another, many of which were nothing to worry about at all.

• Depression and anxiety. I struggled to eat properly, I struggled to sleep properly. I felt like I was walking around in a haze that I couldn't lift. It didn't take much to make me break down and cry, or for my anxiety to spike and catastrophize every little thing. I felt physically, mentally, and emotionally drained and exhausted all the time. And I had no idea why or what to do to help.

I have a counselling degree and have worked in social care for a long time, so have supported people with mental health issues and helped them to access what is available to them many times. I knew something was wrong with me, and I reached out many times to try and get extra support. I kept being told it was normal - "you've just had a baby and it's hard! You're sleep deprived and it's hard! Babies are tricky and it's hard!" It wasn't until she was about 5 months old and I told my health visitor (it wasn't my health visitor, it was whatever random health visitor happened to get back to me on that day) that I didn't want Ophelia anymore, that everything was my fault and she'd be better off with anyone else that they started to get concerned. I finally - FINALLY - 5 months in got a face to face appointment where they screened me for mental health issues and, unsurprisingly, it was off the charts. They made an urgent referral into the perinatal mental health team, and within a week I was allocated someone from the team for weekly sessions. Granted, it was all over the phone (thanks again COVID), but it was better than nothing.

I was officially diagnosed with postnatal anxiety, depression, and maternal OCD. I was offered medication right away, although I declined because I wanted to try alternatives (like therapy) before going onto medication. In a way, knowing that the meds were there and I could pick them up at any time should I choose was a big help, it felt like a had a failsafe and allowed me to focus on getting better in that moment. I had therapy weekly, with someone from the perinatal mental health team who also had experience with preemies and the toll that can take. I also had something called Video Interaction Guidance (VIG) therapy, which was crucial for allowing me to bond and connect with Ophelia, and I was able to grow and develop that attachment with her. I was so scared at the time that it couldn't be fixed, and that our attachment was so broken and always would be, but I can tell you wholeheartedly that is not the case, and 4 years later she knows nothing of what we went through.

I had a couple months of support and it was life changing, literally. The problem was that I got to a point where I was no longer "bad enough" to qualify for the support, but I also wasn't "recovered" enough to manage on my own. I was told to self refer into IAPT (now called 'talking therapies') and that they would support me from there. Whilst they were helpful, they aren't trained in perinatal specific support, and I felt the difference, although it was better than nothing I suppose.

It took a long time for me to feel like my old self, and being completely honest - 4 years, 2 living children, a TFMR at 14 weeks, and a miscarriage later - I'm not sure I'll ever feel exactly the same as I did before all of this. But I do know that my life would look very different right now if I hadn't of managed to get the help and support I didn't at the time when I needed it most. I wish I had been able to get it sooner than I did, but that's not for a lack of trying and it highlights just how broken the system is.

My last pregnancy, with my now almost 2 year old Rowen, was completely different. I was worried about what might happen, but was able to use the coping skills I had learnt previously to help manage, and I knew if I had any issues I could tap back into the perinatal team. Whether it was because COVID was "over", we had more support generally, or I had more knowledge and training, but my mental health stayed steady during and after my pregnancy. Don't get me wrong - I had the baby blues, and I've had my dips because it's fucking hard raising babies and children! But overall, it was a completely different experience.

I don't think we talk enough about maternal mental health, and as someone who has never struggled with my mental health I never thought I would have any issues. But I did. And they were big. Too big for me to manage and to deal with on my own. The support needs to be there and it needs to be accessible to everyone - when they need it, and not months later when it's potentially too late. My advice is to know what to look for, know what your normal is, and reach out when it changes. I know firsthand how hard reaching out can be, how much you can feel like a failure or like you're giving in, but trust me - you're not a failure. The best thing you can do for you and your baby is asking for help, no matter how big

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