Motherhood, mental illness and beyond

Posts tagged ‘AND’

First steps

DH and I have been together for 12 years now, and for all bar the first few weeks we’ve known that we both wanted children. At least 2, preferably 3 or 4 or even more. We decided on our favourite names in 2003 (our eldest wasn’t born until 2009!). For over a decade the prospect of having a large, chaotic, loving and happy family has always been a part of our plans. But not any more. Today, as a 33 year old mother of 2, I asked my GP to refer me to the local hospital to discuss sterilisation.

This is something I’ve discussed with my husband and my mother and I think it’s the right decision. I hope it is. The reason is very simple – as much as I yearn for more children I know that another pregnancy, another child, could endanger my life. My mental health has deteriorated over the last few years. I have suffered with post-natal depression after the birth of both my children, each time severe enough to make me suicidal. During my second pregnancy I had ante-natal depression which, while not as severe as the PND, still meant I was barely functioning. I wasn’t able to care for my daughter (then just 2) properly, I wasn’t able to care for myself and I certainly wasn’t able to care for the child I was carrying. As recently as March this year I was in crisis and suicidal; although I’ve recovered from that and feel stable again there’s always the possibility of a recurrence.

In addition to this, my physical health is poor. I suffered from awful PGP (pelvic girdle pain) in both pregnancies – the first time this meant I needed crutches to walk, the second time I was barely able to move by the third trimester. There’s also my spine to consider, as I have degenerative disc disease. I’d previously been told that if I wanted children I should have them before I was 30; the last consultant I saw was even more blunt and told me that if I wanted to retain the ability to walk I would limit my family to the 2 children I already have.

I know that sterilisation is a huge step to take, but to me it seems the logical one. For all the reasons listed above, if I should accidentally conceive I would have to abort the pregnancy. And I honestly don’t know if I could do that. But having conceived my son while correctly using contraception, I have very little trust in the usual methods of birth control. While I know that sterilisation isn’t a guarantee, it has far better odds of successfully avoiding pregnancy than anything else. My husband, lovely man that he is, has offered to have a vasectomy so that I don’t have to undergo a fairly major operation. But that seems unfair, to me. I’m the problem here, I’m the reason we can’t have more children. If DH and I ever split up or if I died, I would like him to find someone else and have the option of having more children if he wanted to. So I’ve said no.

I know that there will be people reading this who can’t have children, and who are probably screaming at the screen that I should be thankful for what I have. And I am, I really truly am. I realise that my pain is in no way comparable to that of someone unable to conceive or carry a pregnancy to term. But knowing that I will never have another child is very painful for me and I refuse to pretend otherwise.

DH and I have always been keen on fostering and that may be an option for us later on, if our mental illnesses aren’t a barrier. But I will never bear another child and I need to come to terms with that, somehow. Last week I took the first step and disposed of all the baby clothes and everything that DS has outgrown. Today I took the second. I’m not sure what the next step is but I hope it leads to not just acceptance, but peace.

Is it me?

I’ve had mental health issues for as long as I can remember, from compulsive binge-eating and self-harming at the age of 7 to depression which began in my early teens and my current diagnoses of cyclothymia, generalised anxiety disorder and binge-eating disorder. Despite my mental peaks and troughs I’ve always been able to function, hold down a good job and socialise with friends.

Until recently. The birth of my daughter, four and a half years ago, plunged me into a pit from which I’m still struggling to escape. Not because I didn’t want her or love her, but my postnatal depression (PND) was so absolute that it seems to have altered my mental state almost permanently. After a couple of years and several therapies I felt pretty recovered, only to succumb to antenatal depression (AND) while I was pregnant with my son. Unsurprisingly after his birth I was once again plunged into depths of PND. Once that was resolved I was referred to a psychiatrist who diagnosed me as having cyclothymia (or rapid cycling bipolar disorder) as well as anxiety issues.

At the time of writing I am fairly functional most days thanks to medication and a heightened awareness of my mood state. I do however really struggle with social situations and talking to strangers, which is utterly ridiculous when you consider that I was in the civil service for 6 years! But for how that’s how it is at the moment. I recently had to describe my social anxiety to a friend:

“Chatting to people at playgroups, in cafes, even the school run can be torture. When I have to speak to someone unfamiliar in a social situation my heartrate increases and my breathing gets shallow. My mouth goes dry and I feel as though my throat is closing up. If I can’t escape then I usually end up having a full-blown panic attack”.

Obviously this causes problems when it comes to having a social life of any kind! In the last year I’ve managed to go out with friends once. Just one time, to a local Thai restaurant, and even then I could only stay for about an hour and a half before getting overwhelmed and having to leave.

My current state seems to be hard for friends to cope with. Over the last few years I seem to have misplaced quite a few peripheral friends but also 2 very dear, loved and trusted friends. These friends knew everything about me, about my struggles with mental illness, and encouraged me to be open with them. But in the end the burden of my problems became too much for them to deal with on top of their own lives, and they disappeared. Now I may be losing another good friend, someone I’ve been friends with for over 20 years, because of my mental ill health.

There are only so many times DH can tell me that these losses are not my fault but theirs, before it starts to ring hollow. If it’s not my fault then why does it keep happening? Maybe I don’t try hard enough – I’ve been told in the past that I wallow in my depression instead of fighting it. Or maybe I’m too truthful, I’ve been told that by being honest about my struggles I’m making others miserable and overwhelmed. I wonder whether it would be the same if I had a long-term physical illness? Would friends still drift away or would they cope? Am I the problem? Am I asking too much of my friends? Am I too needy, too confiding, too overwhelming? Because to be blunt, it’s pretty bloody overwhelming being trapped inside my mind day in and day out. At times the despair (will I ever recover?), the self-loathing (I’m so pathetic!) and the constant self-examination (is that a rational thought or is it my illness talking?) are so overwhelming that I would do almost anything for just a few minutes peace. Even my nights aren’t restful, thanks to frequent and vivid nightmares.

Whatever the reason may be, with a couple of notable exceptions I’ve stopped confiding in friends now, and even with those exceptions I’m careful about what I say and how much I reveal. I have a couple of trusted family members and of course I’m completely honest with DH, but as I explained in my last post he has his own issues to deal with at the moment. My only other real solace is Twitter, where hundreds of people who barely know me are kind and supportive. How odd, that I can be so open with virtual strangers yet have to be so wary around friends.

Musings on depression and pregnancy

I read about a study this week that claims women who suffer from depression in pregnancy may pass the illness on to their children. The article in question on the mental health website Black Dog Tribe explains:

Researchers at the National University of Singapore asked 157 pregnant women to answer a questionnaire to ascertain their mental health during the 26th week of pregnancy. Within two weeks of birth their babies were given MRI scans to look at the structure of their brains – in particular the amygdala.
 
It was found that the mother’s level of depression had no effect on its volume. However, researchers found reduced ‘structural connectivity’, or abnormal wiring, in the right amygdala of infants of more depressed mothers. The finding suggests that abnormal amygdala function can be transmitted from mothers to babies before birth.
 
Researchers believe that a history of maternal depression might contribute to a tendency to the life-long increase in the vulnerability to mental illness in children.

Great. Wonderful. Women are already expected to exist in some weird sort of protective bubble while pregnant, constantly threatened with potentially disastrous outcomes for the unborn child if we even think about breaking the rules on eating, drinking, smoking, taking medication, exercising – the list seems endless. But now women must also worry that the state of their mental health may affect that of their child for life.

Don’t get me wrong, the research is interesting (although I would like to see a much larger and more thorough study examine the same question). If these conclusions are upheld then it becomes all the more important that mental health during pregnancy is monitored and the woman supported. But I worry about the impact that the publicity surrounding this study may have on women who are already struggling.

Post-natal depression (PND) is becoming much more prominent in the awareness of both the public and healthcare professionals. Although the media tend to sensationalise any news story where a mother is believed to have PND, it is becoming less stigmatised and pregnant women are usually given literature or at least a chat explaining the warning signs. Far less publicised though is its counterpart, ante-natal depression (AND).

I have suffered from both – PND twice and AND once. They were equally awful and traumatic but at least when I had PND I sort of knew what was going on. It was a “thing”, something I’d been warned about and that my husband had been on the lookout for given my history of depression. But I’d never heard of AND. When I plucked up the courage to tell my midwife how I was feeling it was dismissed as being down to my circumstances (an unexpected and difficult pregnancy, having a toddler, having to move twice in 4 months then claim benefits etc etc). A few weeks later a remarkably unsympathetic GP told me the same.

But I know now that it was AND. The sinking feeling every morning when I woke up still pregnant; the dread that I might miscarry warring with the dread that I might not; the certainty that I was ruining my daughter’s life. Instead of joy I felt disgust whenever the baby moved inside my expanding belly. I felt as though I was infested, occupied by an alien being, but I was rational enough to feel searing guilt as well. What kind of mother was I, to loathe my unborn child? True, the pregnancy was unexpected but we’d always planned to have another child at some point. I couldn’t understand why I felt the way I did but I knew it was wrong. At times I even felt suicidal but I didn’t act on those feelings because, ironically, I didn’t want harm to come to the baby.

Had I been told, back then, that I might be condemning my child to an increased risk of mental illness – well, it may well have tipped me over the edge. Studies like the one described above are necessary but when there is little or no support available for women who may have AND then they could be dangerous. I was so utterly ashamed of how I felt during that pregnancy that I barely spoke of it to anyone, especially after having my concerns summarily dismissed.

Why is PND becoming such a well-known illness but not AND? They’re two sides of the same coin, in my experience. The feelings of worthlessness, despair, shame, guilt and unrelenting misery are the same whichever side of the birth you are. Women and healthcare professionals need to be educated; they need to be taught that like PND, AND is a treatable illness and not a character flaw.

To any woman who’s reading this and is concerned that she may be suffering from ante-natal depression I say: you are not alone. You are not a bad person, nor are you or will you be a bad mother. Talk to someone about how you feel. Don’t be ashamed and certainly don’t worry about what one small study suggests. Far more research needs to be done in this area before the suggestion of a causal link even becomes a real possibility.

As for me, my son is now nearly 2 and is a happy, sunny little fellow. I try not to worry about what the future holds, mental health wise, for either him or his elder sister.

Depression, SSRIs and pregnancy

Today the BBC has reported that according to an adviser for NICE (the National Institute for Health and Care Excellence) women who are fertile should be discouraged from taking SSRIs, a class of anti-depressant. The rather aptly named Professor Stephen Pilling was quoted as saying:

“The available evidence suggests that there is a risk associated with the SSRIs. We make a quite a lot of effort really to discourage women from smoking or drinking even small amounts of alcohol in pregnancy, and yet we’re perhaps not yet saying the same about antidepressant medication, which is going to be carrying similar – if not greater – risks”.

Professor Pilling claims that there is evidence that taking SSRIs in early pregnancy increases the risk of a baby being born with a heart defect from 2 in 100 to 4 in 100. If this is true then of course new guidelines need to be considered. (Having said that, in my experience doctors are already extremely cautious when prescribing any kind of medication to a woman who is pregnant or breastfeeding.) However it is other quotes attributed to him that have infuriated me. According to the BBC article :

He says that women not suffering from the most severe depression who become pregnant whilst taking the drug are taking an unnecessary risk.

“You’ve got double the risk. And for women who are mild to moderately depressed, I don’t think that those risks, in most cases, are really worth taking” he said.

“It’s not just when a woman who’s pregnant is sitting in front of you. I think it needs to be thought about with a woman who could get pregnant. And, that’s the large majority of women aged between 15 and 45.”

First of all the diagnosis of depression is extremely subjective, often relying on the individual answering a multiple choice questionnaire that has points assigned to each answer. If you score above a certain number then bingo! You’re depressed. But what one person interprets as mild depression may be what another person feels is moderate depression. Someone who is severely depressed may not believe they are because they’re not considering suicide.

I’ve had episodes of depression since my early teens, including 2 bouts of post-natal depression (PND) and 1 bout of ante-natal depression (AND). The first time I had PND I refused to take any medication because DD was breastfed and I was scared that the anti-depressants would affect her through my milk. As a result I was severely depressed for a very long time despite various other therapies and I planned my suicide on multiple occasions. I am concerned that if Professor Pilling’s reported opinions become guidelines the same may happen to women who are pregnant.

If, through the media sensationalising this or through poorly worded new guidelines, a pregnant woman is made to feel the way I did it’s entirely possible that she may consider taking her own life (and therefore that of her unborn child). If a woman suffers from depression that requires a particular treatment then she should be given that treatment. At the end of the day, uncomfortable though it is for me to say, the life and wellbeing of the woman is more important than that of her foetus.

Any suggestion otherwise removes a woman’s bodily autonomy, her right to decide what happens to her body. This is dangerously close to a number of anti-abortion laws that have been proposed in the United States, where the supposed rights of the foetus (usually a non-viable foetus) would outweigh the rights of the mother, who is reduced to the status of a mere incubator.

As for Professor Pilling’s apparent suggestion that “pre-pregnant” women (so any woman who is capable of conceiving, and therefore presumably including pubescent girls) might be refused access to SSRIs, it’s ludicrous. Would a doctor refuse a diabetic woman her medication? Or an epileptic woman? Both of these conditions often require medications that can be risky for a foetus yet I doubt that many doctors would recommend their patients stop taking them merely because they might conceive a child.

What are your thoughts?

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