Maternal mental health is far more complex than most realise, and for many women, problems start well before the baby is born. Here, four women share their experiences of perinatal distress – and how to get through it.
Josie Gritten has three littlies and she is a perpetual motion machine, a superwoman. One day she goes to the supermarket and does the laundry and takes the kids to the dentist and she gets a flat tyre and it’s pissing with rain.
She gets home, gets dinner into the kids, sits down on the kitchen floor, and cries.
Hours pass. Her six-month-old crawls up for a feed sometimes and then crawls away again. Her four-year-old plays Lego at her feet. Her six-year-old comes in and pats her on the head.
Superwoman has a vague plan to walk to the hospital and tell them that she can’t cope. But she can’t get off the floor.
Rebekah Lyell is pregnant with her second baby and vomiting constantly – she has hyperemesis gravidarum, and on this day the anti-nausea medication isn’t working. Her husband is away on a four-day shift. She can’t see through the “black cloud” that has dogged her each time she’s pregnant. She gives her six-month-old daughter a banana and some grated cheese, lies down on the floor beside her with a bucket, and falls asleep.
Rachel Keller* knows about postnatal depression and she thinks she might have it. But an online screening test tells her what she’s going through is normal. She is worried about something bad happening to her son. It’s just a matter of when and how, she thinks. She’s terrified of starting him on solids. She spends way too much on a mat that beeps if the baby stops breathing. But still she can’t switch her brain off at night.
Joanne Rama is hallucinating that her children are devils, and that they have to die.
All of these women had maternal mental distress and all of them asked for help. They’re all OK now and so are their kids. They spoke to me for this story because they know other women are suffering – and what they also know, more than anyone, is that there is a way through.
“What I want [mothers] to know is that they’ll get through this with support,” Joanne Rama says.
It was an episode of The Oprah Show that saved her: Oprah was interviewing a woman who had killed her children during severe postnatal delusions. The realisation hit Rama like lightning. She was in a bad way, too. She needed help.
Twenty years on she is a mother of seven, a grandmother, and a proud activist in the area of Māori maternal mental health. She’s been a nurse and a midwife – the first Māori midwife in South Auckland, she believes – and she sits on the board of Te Mate Tuatea, me te Mate Pōuri o Aotearoa / Perinatal Anxiety & Depression Aotearoa, a national group working to educate and eliminate stigma around maternal mental health. Rama is a pregnancy and parenting educator.
Covid-19 has been tough on the women Rama works with. She’s used to seeing mental health disorders in roughly 10-20% of her clients; through lockdown that leaped to more like 95%, she estimates. It was anxiety, and fair enough: imagine preparing to give birth in a hospital that’s preparing for a pandemic.
Birth plans have always been a paradoxical concept but through Covid-19 even the predictable aspects, like who would be with you, and who would come with food and cuddles and care afterward, were upended. That was particularly hard on Māori women, Rama says, “because birth is a family event for us, and the whānau come, and so having to choose between your partner, your mum, your sister …”
Lots of women investigated home births, scared that if they went to hospital they or their pēpi would get sick. There were horror stories from overseas, where mothers and newborns were forcibly separated. Some women told Rama they’d started having panic attacks.
Clinical psychologist Kelly Kerrisk specialises in perinatal mental health (perinatal is commonly taken to mean the period including pregnancy through to one year after the birth) and has worked in maternal mental health services and at Starship Hospital’s Mother and Baby Unit, treating those with severe perinatal distress.
She says Covid-19 made it difficult for most of her private clients to continue with therapy – many lacked the quiet space or headspace for a Zoom call – and compounded anxieties that were there already, such as financial stress, relationship problems, lack of support, feeling isolated, illness or sleep issues. At the same time, lockdown stripped away coping mechanisms like childcare, coffee groups and hands-on antenatal and postnatal care. For many things still haven’t returned to anything near normal, with kids still out of childcare, jobs lost and pay cuts enforced.
But even at the best of times, maternal mental health is an octopus of a thing to grapple with. The spectrum it covers is vast, ranging from feelings of stress or being overwhelmed, through to conditions like anxiety and depression, post-traumatic stress disorder (sometimes linked to birth trauma), obsessive-compulsive disorder, and psychosis.
You likely know about postnatal depression (PND). It gets bundled up with anxiety in the statistics, and together they’re thought to affect about 14% of New Zealand mothers. Midwives and Plunket nurses screen for PND, we get talks on it at antenatal classes and pamphlets when we leave hospital – but too often that’s the only one of these conditions we’re on the lookout for.
In fact, many mental health problems start well before the baby is born. About 12% of women are depressed during pregnancy, and 11% are anxious. These women are at higher risk for problems postnatally, too. Others, like Rebekah Lyell, feel better after the birth.
“It sounds bizarre but I felt like a black cloud, as soon as she was out of me, just rolled away. I felt completely different.”
Pregnancy is so hard for Lyell that she’s stopping at two children. But it was easier the second time around, because in the aftermath of her alienating, confusing first pregnancy, she talked to a godsend of a midwife who spotted what was going on.
“She was like: ‘That’s not OK, you shouldn’t feel like that, no one should feel like that. Let’s make sure if you have another one, you don’t go through that again’.”
We can also be caught unawares, as Rachel Keller was, when we’re hit with anxiety rather than depression.
Keller had to go back to work when her son was seven months old and now sees that as a turning point. Work was something else to focus on, and it forced her to let go and trust her husband. Eventually she started sleeping.
“It wasn’t until my daughter was born, though, that I realised how bad things had been … It wasn’t that I loved my daughter any less, it was just that I worried about her the right amount.”
It was amazing for Keller to discover, years down the track, that what she’d been through – what she calls her “prison of fear” – had a clinical name, and that while postnatal anxiety was fairly common, it was not something she should have had to cope with alone.
Time to run through the warning signs. They’re often hard to parse through the fog of new parenthood, so it helps if friends and family know what to look for too.
Psychologist Kelly Kerrisk says key indicators of depression are a sustained lower mood, and a loss of interest and pleasure in things that previously the woman would have enjoyed.
“Post birth it might be lack of positive feelings toward the baby – or maybe the baby’s actually the only thing that brings them pleasure or interest.”
Mental distress can affect cognition: you might have difficulty making decisions or thinking clearly. They can change your appetite. Panic attacks, mood swings, obsessive or compulsive behaviours, a feeling of being twitchy and on edge, leaning on drugs and alcohol are also red flags.
Perinatal distress can hammer your sleep, which seems desperately unfair on pregnant women or new mums. Are you having trouble falling asleep even when bub is finally down? Waking in the night worrying? Or still feeling knackered even when you do manage to catch a few blessed nights of consolidated sleep? Those are signs you should seek help, Kerrisk says.
Here’s one we don’t hear much about: rage. “Irritability” is what the professionals and checklists call it, and it can be mild, but it can also be a feeling of rage, Kerrisk says, like no one can do anything right.
“It can be quite a scary feeling, and it can also be really hard to notice that. Because actually it’s not talked about – people don’t talk about feeling irritable as being one of the warning signs but for quite a lot of women, in fact, it is.”
Joanne Rama agrees. “It manifests differently for everybody. I think people think that you’re walking around crying all the time. That wasn’t my reality. I was an angry bitch. And actually that’s what I need to get out there: that’s what it is for a lot of women, just angry.”
You might be ticking a few of these boxes. That’s OK. What happens next?
First, know that any thoughts of suicide or harming someone else are a sign you need help immediately. Talk to your friends and whānau, anyone you trust – it’s what they’re there for. If you need an expert, call a helpline, or talk to your midwife, Plunket nurse or GP. (It’s a worry to Rama that some GPs don’t use the gold-standard Edinburgh Postnatal Depression Scale, instead opting for other checklists that take less time. She urges women to ask about this.) If you don’t get the help you need, keep asking.
As well as professional help, many of the women interviewed for this story emphasise the power of knowing that just one person is primed to drop everything to help.
The basics of staying well as a mum – the odd bit of time alone, sleep, good food, enriching social contact or activities – can only really happen if you have help. And when things go wrong it should be the most natural thing in the world to lean on your village. But there can be shame attached to that. Some women have a fear that their baby might be taken from them; others see reaching out, and working to recover, as just another job to do at an already overwhelming time.
Josie Gritten now runs DHB-funded antenatal classes and debrief sessions after births. She tells parents the story of her own breakdown, and her recovery. And she gives them an SOS system she calls “salami warnings”– (her daughter’s mispronunciation of “tsunami warning”).
“When you’re feeling like you’re down the hole, it’s very difficult to ask for help,” Gritten says. “It’s really difficult even to text your mum or your best friend and say ‘I’m broken, please come and help me’. But it’s really easy and quite funny to text ‘salami warning’ to someone. And as soon as your friend gets that they’re at your door, bam, ‘What can I do to help you?’ They’re on the phone, going ‘I’m available’. And it is amazing.”
People love being asked to help like this, she emphasises. “Particularly if it’s another mother, they get it.”
And it doesn’t really matter what the help looks like – maybe you need a cuddle and a cry, maybe wiping the highchair down seems insurmountable, or you’re scared of how angry you’re feeling – “it’s that somebody gets it, and you feel heard”.
There can also be healing in realising that you might be that person for someone else.
Rebekah Lyell tells all her friends, when they get pregnant, that it’s OK if it doesn’t feel glowy and wonderful, and that she will be there like a shot, with no judgement, if they need to talk.
Rachel Keller has written an essay about her postnatal anxiety and is steeling herself to publish it.
For Joanne Rama, perinatal distress is an enduring part of life. It’s hit each of her daughters, and they work together to pull each māmā through: they use a triple-1 text system similar to Gritten’s salami warnings, setting up rosters and taking time off work to make sure someone is always on call.
She still has to be diligent about her own wellness strategies and self-care, but says the whole experience has made her a better nurse and midwife, a better advocate, a better person. And that sort of hope is contagious.
“I said to a mum yesterday, maybe just look at it like you’re in training, and at the other end of it you’re going to be the person who’s going to be able to help the māmā going through this more than anyone else. And that made her smile. It didn’t take it away – we’ve got a wellness plan and she’ll work at that. But she smiled.”
*name has been changed
Looking for support? It’s available:
Need to talk? Free call or text 1737 any time for support from a trained counsellor
Plunket. Need free support or advice? Call PlunketLine 24/7 on 0800 933 922
The Postnatal Distress Support Network Trust
PADA (Perinatal Anxiety & Depression Aotearoa)
Depression helpline: Freephone 0800 111 757
Healthline: 0800 611 116 (available 24 hours, 7 days a week and free to callers throughout New Zealand, including from a mobile phone)
Lifeline 0800 543 35
Samaritans – 0800 726 666
Ministry of Health online self-test