“I really felt my post-natal depression was biological and situational”
This is a quote from a blog post I read recently, very courageously written by a mother of twins who suffered from PND and Anxiety, and who wanted to share her experience in the hope of helping others in a similar situation.
I have included a link to Ella’s Story so please go and read it now, then come back to this blog because I would like to explore and expand on some of her experiences which I feel are very important to try and understand.
No one knows exactly what causes PND/Anxiety or why it affects some people and not others but the generally accepted view is that it occurs due to hormonal changes in the mothers body and/or due to situational stresses, as described by Ella.
Currently we have little understanding of the hormonal aspect of pregnancy/birth that seems to make some women more vulnerable to PND/Anxiety but we do know about some of the external stresses that contribute to or exacerbate the situation.
Parenting can be an exhausting job at the best of times, but certain things make it much harder, such as a difficult or traumatic birth, maternal illness/pain, illness or problems with baby, or difficulties feeding.Sleep deprivation seems to play a major part, and social isolation, loneliness, and lack of support for the parents can make things worse, as can financial worries.
Basically, anything that adds stress can trigger PND/Anxiety, or make it worse, and that includes multiple births.
“Nearly twice as many mothers of twins suffer from post-natal depression as those of singletons”
In repeating this my aim is not to worry prospective parents, but to arm you with knowledge that you can use to try to avoid PND/Anxiety or minimise its effects
“You cannot avoid the biological reaction but I did not have enough support in place. Now I teach the antenatal courses for parents of multiples I am really adamant on planning your childcare in the months after birth.
Which friends and family can help and when will they help? Can you afford any support at home? What can you do to optimise your mental health and your sleep? I always emphasize the importance of getting out, being outside, meeting up with others”
I wholeheartedly agree with Ella about the importance of support for after baby is born, whether you have one baby or multiple, yet so often I see parents reluctant to ask for, or accept help.
I know a lot of parents want to manage by themselves, but historically we have never been isolated child rearers. We have always lived in communities and learned from, and received help from other people. Women helped each other give birth and fed each other’s babies, men hunted, other village members gathered food that was then shared, cooking was communal, older children, grandparents and elders joined in to help mind the babies and toddlers…we pulled together.
Nowadays we move away from our families and communities to find work, we often don’t know our neighbours, we have become isolated and vulnerable.
This is a worrying situation, but the good news is that babies seem to bring out the best in people, babies, if you let them, can bring us together.
There is no shame in asking for help from family, friends, neighbours, in fact they are probably dying to help. Health professionals are trained and available, so make use of them.I know not everyone has supportive family or friends, but please take time to think about who you could ask for help, or what you can do in preparation to make life easier after the birth.
Even asking a friend to sit and watch baby whilst mum has a relaxing bath without being interrupted for half an hour can make a difference so please don’t be proud.
“They were feeding and sleeping really well until about two and a half months they started to cry a lot more, they were really unsettled and wouldn’t sleep for more than half an hour….I stopped sleeping at that point, even when the girls were asleep I would just lie awake”
This quote from Ella’s story illustrates the fact that not all PND/Anxiety is apparent from birth. You can be totally fine for weeks or even months, before something changes biologically or situationally, so be aware of any changes in your mood or emotional state and don’t dismiss it.
It also identifies a symptom that should send you straight off to seek medical help. If you are exhausted but cannot sleep you must get help. It is not normal, not healthy and can rapidly send your mental health spiralling dangerously downwards.
“All everybody kept seeing was my anxiety — health visitor, doctors, family. I still held a fundamental belief that there was something wrong with the girls but it was so difficult to fight for them when people just saw my anxiety and neuroses. I should always have trusted my instincts, but when you are exhausted and intensely anxious you lose all your confidence in your parenting ability. I lost my ability to make decisions”
In this case a massive external stress was caused by reflux. Ella’s twins started showing signs of discomfort and distress, which is stressful in itself, but made even worse by the resulting sleep deprivation for the parents. The worry about the babies health, and the struggle to figure out what was wrong and get help was obviously a nightmare. In this case the family was let down by the health professionals who seem to have been focussed on the mother rather than on the babies.
This is such a difficult situation, and if it ever happens to you, please trust your instincts and keep asking for the help you need whether it is for your baby, for yourself or for your partner.
If possible, document whatever is going on because when you are tired, stressed and unwell it is impossible to think straight. It can help if you can hand over times and notes to a doctor it can really help them understand what is going on, and video is even better so use your phone to record things too.
If you are struggling to explain properly try and take an advocate with you, someone who can speak for you and support you.
When something is stressing you or your baby, stop doing it. It may sound blunt but you and your baby should be happy and healthy, that is your priority.
“I was at the point where I would bring them in for a breastfeed and they would scream their heads off….. In the end I was so anxious I couldn’t even pump and the girls were so unhappy to breastfeed anyway so, gradually, I cut down and moved to bottles”
In this case, due to the reflux, breastfeeding and pumping had become a major source of stress for everyone involved, and Ella absolutely did the right thing by stopping and moving on to formula. However, she did this after persevering for such a long time that her emotional health was being harmed.
I know there is currently a lot of pressure to breastfeed, but breastfeeding should be comfortable and pleasurable for both mum and baby. If it isn’t, if you dread feeding time, if each feed is a battle, if baby isn’t thriving, or if you know it is making you feel worse…just stop. Your baby will do just fine on formula, and will be much better off with a mum who is taking care of herself.
Even when Ella’s twins were diagnosed with reflux and CMPA, and they were starting to make progress and improve, things didn’t improve for Ella.
“I couldn’t see that they were fine and still kept thinking something was wrong and obsessing about the minutiae of their routine. I still struggled to sleep and would wake really early, at 4–5am with severe panic, drenched in sweat, filled with absolute fear and dread. It was a fear that is so wretched, I would not wish it on anyone.
Then, finally, some increased levels of medication made a difference. Thanks to four different types, I could sleep and my anxiety levels started to come down. Thoughts of running away, intense soaking sweats at 4 am — slowly all that went away, but I had to be on medication to help that happen”
Medication seems to be the most feared, and least talked about aspect of PND/Anxiety which is a ridiculous and harmful state of affairs.Drugs are drugs. They do a job fixing something that has gone wrong, whether that be relieving pain, fighting infection, or rebalancing something that has got out of synch. Taking anti-depressants or anti-anxiety medication is no different from a diabetic taking insulin, or a heart patient taking beta blockers.
If a doctor suggests taking medication, listen to them. If you are unsure, ask questions and do research, do whatever you need to do but don’t for a second resist taking them because you think there is some sort of stigma attached to them.
Also, don’t give up if a particular drug or dose doesn’t work first time. Your body chemistry is complex and unique so it might take a few tries, just like it did with Ella, but it will be worth it to get you on the road to recovery.
Just read Ella’s next quote.
“It would be great if everyone talked more about issues we’ve had and medication we’ve taken! I’d really like to remove any stigma around medication — I was able to enjoy more of my babies’ first year thanks to the right medication.”
I know that a lot of women in the middle of depression and anxiety can feel distant from their baby, or worry that they haven’t bonded, or may never bond so I particularly wanted to include this message from Ella…
“I also want other parents to know that the girls have thrived ever since that time and we have an amazing relationship, a fantastic bond. I have never felt guilty about that time and no one else should feel that way (I know some do).”
I have worked with many women who have suffered from PND/Anxiety, from every social class, every income bracket, and every education level and profession.
No one is immune.
Every one of my clients had a different journey, with different symptoms, and different treatments…but, most importantly, they all made it in the end.
When I first read the blog that this is based on I was genuinely moved by what the mother, and the whole family had been through, but what created even more impact for me was the fact that I actually knew the author.
I know Ella as a strong, happy, healthy woman. A great mother, a respected paediatrician, and the leader of a team of people who create ante natal courses for parents of multiple babies along with the very excellent career development courses that I use in order to stay up to date with the latest developments in the baby world.
I had no idea that she had suffered in this way, none at all, and it brought home to me that PND and Anxiety really can be experienced by absolutely anyone. It is a subject that needs to be brought out in to the open and talked about to the point where it is no more unusual than any other illness.
I am very grateful to Ella for having the courage to write so openly about what she went through, and for giving me permission to use her story as the basis for the blog in an effort to help more people.
If anyone is around London and is interested in Ella’s private workshops for parents of multiple babies then please click here at Be Ready To Parent for more information.
If you are worried about, or are suffering from Postnatal Depression or Anxiety I would recommend you get in touch with Cocoon Family Support that provide a range of services around London, but in their Support Across The UK page have also complied a list of links and organisations that cover other areas.
Help me help others – If you have experienced anything that has been mentioned or covered in this blog, and feel able to share your stories, please comment below to try and help people feel that it is ok to talk openly about a very common condition.
If you are struggling and need support for any aspect of PND/Anxiety, feeding, sleep, routines or anything baby related please come along to my Baby Detective Parent Support Group which is full of lovely, supportive people, and is non biased and non judgemental. I keep a close eye on the group and am in there every day to help people if needed.
A mother told me she felt so symbiotically attached to her daughter that she couldn’t leave her with anyone without feeling anxious. A friend of mine who went through postnatal anxiety and depression tells me, on the opposite that she couldn’t connect to her baby from the begging and it was, of course, a very unexpected and uncomfortable feeling to have.
Either way, they ended up feeling anxious or depressed and that built up an unhealthy attachment to their baby that nobody around them spotted. According to the Guardian 2008 article on postnatal depression, there are more than 17,000 undetected and undiagnosed cases in the Uk. That’s why is called the ‘silent illness’.
The attachment styles described above are opposite but as it happens, psychologically, they both bring to the same result: An insecure attachment between mother and child, an unhappy mother and as a consequence, a mirroring unhappy child. Nowadays, psychoanalytic research teamed up with neurobiological confirmation on the importance of secure attachment in the treatment of inter-generationally transmitted personality disorders.
The good news is that there is a lot that can be done in personal therapy especially when the mother-child relationship is just being built up and the child is small. By helping the mum with her anxiety and/or depression is possible to make the mother-child relationship improve.
It’s proven that mothers with anxiety and depression following birth, give attention to more things for a shorter period of time and research has confirmed the psychoanalytic idea that through mirroring, the small child ends up doing exactly the same. Those children have more difficulty concentrating for a long time than children of mothers who are not sufferers.
Anxiety is contagious and is transmitted from one generation to the other. Awareness in therapy helps put the mother back in control of her emotions and starts up a journey of self-discovery and improvement, as I have encountered many times in my clinical work with mothers.
Have you heard of the ‘allergic/atopic march?’ – if not, read on….
Genes can predispose us to develop allergies – and that’s why it often runs in families… but the same genes which cause allergies can also lead to other atopic conditions: asthma, eczema, hayfever. It often begins with eczema in infancy although eczema could also be stand alone as a skin disease.
Unfortunately, when we see kids begin to outgrow their food allergies at or before 4/5 years of age, we frequently see new conditions appearing, usually allergic rhinitis (the persistent itchy/runny nose & sniffing, with a dry cough), and asthma. Sadly, children are increasingly NOT outgrowing their food allergies (or outgrowing them later) but still accumulating the other atopic conditions like asthma and rhinitis along the way.
The ‘march’ in the name ‘allergic march’ refers to the progression of diseases which we see unfold at different ages of atopic children. It does not affect ALL food-allergic children and is not a one size fits all, but the pattern we see is this:
From age 0 – eczema – eczema may be the first sign of atopy, then…
From age 6months – 2 years – food allergy starts to appear
From age 3 years onwards – rhinitis (a persistent runny nose, sniffing, itchiness of the nose/eyes)/hayfever symptoms
From age 7 years onwards – asthma
We know egg, milk and peanut allergies are independent risk factors for development of asthma later on. And if you had BOTH peanut and egg allergy, the risk of developing asthma is even higher. There is also evidence that severity of food allergies may be correlated with the risk and severity of asthma, and sensitization to aeroallergens (e.g. grass) is also associated with the development of asthma.
This is why, despite the fact that both Sarah and Thomas have outgrown allergies (all for Sarah, some for Thomas), I carry on with the things I talked about in ‘How I helped my children grow out of their allergies’ and monitor them closely. Thomas had SEVERE allergies to milk, egg and peanuts – he also had severe eczema as an infant. So in terms of risk factors for developing asthma, he ticks ALL the boxes (sigh!) and statistically speaking he has a very high chance of developing asthma later on, and I am definitely swimming against the tide here. I may not be able to alter his genetic destiny with the dietary and lifestyle changes I’ve adopted, but I am trying my damn best! I treated asthma patients day in day out as a family physician, and I knew the impact this had on the child and family.
Aside from lifestyle measures, there is some evidence to suggest immunotherapy could alter the course of allergic diseases and prevent asthma or at least reduce its severity. Thomas is on the wait list for immunotherapy currently, because I know statistically he has a very high chance of developing asthma. In the meantime, I will just keep trying to alter his epigenetics with lifestyle measures and stay positive. I’ll keep you updated on his progress.
This is an article I wrote in August 2012
I wanted to say thankyou to everyone who helped me through my journey,
it is very honest.
I want to start off my saying how wonderful it is to have 3 under 3, actually we had 3 under 18 months at one stage!
It is rewarding, fun-filled and full of adventures. However, I must admit to it not being always like this. I want to be honest in this article but also positive. We have 13 month old identical twin girls, Miriam and Leila, and a son called Joey who is 2 and a half. The girls are delightful, charismatic, busy and beautiful. Joey is charming, sensitive, affectionate and both scooter and book mad in equal proportions!
The first 3 months were actually ok, the girls were born 4 weeks early and they did a lot of sleeping from what I remember, being identical they were similar in their patterns and breastfed without any problems. My son did not seem to remember being an only child and took to his role as big (although I was very careful at remembering he was not so big really) brother superbly.
The difficulty is that this honeymoon stage does not last forever, the girls needed more attention as they developed, and rightly so, they also developed reflux, secondary to cow’s milk protein allergy (CMPA), which went undiagnosed for a while, and help soon started to disappear after the first few weeks. If I could have done things differently it would have been to organise proper help to start a few weeks into the journey, to help with the running of the household and to help with the twins, giving me proper time with my son and also giving me some well needed rest.
The sleep deprivation I had led to a very low point in my life, and thankfully one I have worked through, and got help with, as well as having a supportive husband and family and friends that helped. But all this when I personally knew how to navigate the NHS and knew how things worked, being a paediatrician, married to a psychiatrist, of all things. So you can see I am being very honest.
Thankfully the girls and my son are all healthy children, I cannot even begin to imagine what other families go through if they also have lots of hospital appointments as well. Help arrived in abundance while I was not so well and as I recovered I was able to take more control of life, my children and house.
I think weaning was tough, messy and time consuming – so my advice would be to get help in whatever shape it comes in at this stage, get friends to puree and freeze for you or make food! Get friends to make dinners for you and your partner to save you time.
I read somewhere in a twins book that “a visitor is not a guest but a helper” and this motto really applies here. I probably did not take this to heart, and took on a bit too much all round, in addition to the breastfeeding which I stopped at 3 months. In practical terms, there is lots of equipment advice I have so please feel free to contact me if you need any support or help.
Getting out and about with the 3 – it was never as difficult as I was led to believe, Joey was either in the back-pack or on his scooter, he never took to the buggyboard. The girls were in the double buggy or one was in a sling when Joey was in the pram. One thing I have learnt is to trust your instincts – by this I mean your maternal ones, you know if something is not right with your children, I wished I had listened to mine a bit more regarding their reflux (was “silent” reflux as they never vomited, but were in immense discomfort, so was never actually “silent”) and CMPA, and this from a paediatrician! Try and rest, really try and don’t be a super woman, it just won’t pay off.
Saying all this, there is not one inch of me that regrets having them so close in age, it is just fantastic and I love being a mother to my 3 adorable monkeys. They are just delightful, they play together, they eat together, they sleep at the same time both at lunchtime and at night, they swim together – just such fun and I am so glad I have been able to overcome my challenges and can enjoy our children and reap the benefits of having them so close together.
My journey has made me a different person, I can honestly say that hand on heart, and not in a wishy-washy touchy-feely kind of way. It really has made me more sympathetic, confident, insightful and determined; I now know even more what is important in life. I know the value of true friends and family and I am now passionate about supporting others through their challenges.
http://interactivepdf.uniflip.com/2/79260/295873/pub/ MummyMag Page 14
31st October 2012 – my awareness of postnatal depression and it being under-recognised and under-treated is increasingly at the forefront of my mind following the tragedy this week of a mother who was so desperately unwell she killed her two children.
I can only hope that this has highlighted how important good antenatal care and postnatal support is and I hope the new charity backed by the prime minister actually listens to parents and works with them to make a sustainable difference. Of course it took a minister who actually had PND herself to even get the ball rolling,
http://www.bbc.co.uk/news/uk-england-18076819 and another minister talks about her struggle,
There is still a stigma surrounding post-natal depression, with some young women afraid to speak out or ask for help says singer and TV personality Stacey Solomon, as she shares her experience of the illness.
Support for fathers is essential – luckily there are some support groups and online information now available. After all fathers also can get postnatal depression and also suffer greatly if their parners have PND. A father whose wife had PND has set up his own website and support for fathers, I have been able to talk to him and he is passionate about information for families, http://www.fathersreachingout.com/ There is also information at http://www.dad.info/about-us