Ten years ago a midwife described how she had to cope with a psychosis after the birth of her first child. Now she’s rereading her words reflecting on what has become of her and her family. “I would have liked more support during my pursuit”.
Picture by Edgar Perez
When our first child had become eight months old I wrote about my postpartum psychosis in the Magazine for Midwives. My husband, my daughter and I had gone through an intense time. I recounted my pursuit for the right kind of help.
TEN YEARS AGO…
It isn’t easy at all to describe – in just a few lines – a period that both starts and fades away vaguely. The day my pregnancy test turns out positive, I am beside myself with joy. Our child to be is extremely welcome. But the pregnancy itself doesn’t turn out to be a happy time. I am often nauseous and feel miserable as if my body isn’t mine any longer. This is hard to accept as a future mother (and midwife).
In the second part of my pregnancy I get into a panic attack twice, in one case I even have to be admitted. My state of mind doesn’t get quite right again before the birth. Mentally I have become very dependent on my husband and I can hardly get by on my own.
In the 37th week of my pregnancy my waters break. I would like to go into labour and give birth at home surrounded by my husband and the midwife because that would be a wonderful experience. However, as our girl doesn’t want to lower I finally end up in hospital. The fantastic midwife who coached me at home, carries out the delivery. We get all the space we need and after a couple of hours we go home with a gem of a daughter.
Back at home I’m feeling rather weak, but I’m trying to stay strong. The first visitor hardly notices that I am tired and find it hard to sit down. On the third day this doesn’t work any more. Everything seems to slip away, I no longer have myself under control.
I can’t cope with this any longer
My state of mind can be compared with the panic attack, but I’m feeling even worse. I am unhappy without knowing why. My bowels are in a mess and I’m crying the whole time: “I can’t cope with this anymore”. My husband has to be around all the time and I can’t take care of my little daughter. I am fidgeting about and rub my legs over the mattress for hours on end. My husband recognizes this behaviour from the panic attack during my pregancy, notices that it is even worse, but he keeps on hoping and believing it is only temporary.
‘The fifth day I am being admitted by my widwife. There is a sense of relief as I have lost faith in myself. Saying goodbye to my husband and daughter breaks my heart, the feeling of which is impossible to put into words. I can only cry, cry and cry.’
How can it have come so far? I have the cutest, kindest and most beautiful daughter in the world. She feels so warm, she smells so great and yet it is impossible for me to take care of her.
I am admitted to a crisis psychiatric ward; a closed ward where I stay for five days. I am terribly scared. Not for or for anything, but for everything. My thoughts run wild. I feel guilty: I cannot take care of my child, my husband deserves better, I am a burden to everyone. I’m afraid our daughter will never have a “decent” mom and I’m concerned about the effect of my absence. Would that be traumatic? Does she feel my feelings when I’m with her? Could I ever forgive myself for that? My body wobbles all day long. Every now and then I doze, then my legs rub the mattress again. It is hard work. Psychological suffering.
During my stay I am being treated with tranquillizers and the dose of antidepressants, which I already took during my pregnancy, is increased. Only once I am seeing a psychiatrist for five minutes and twice a psychologist but we aren’t really on the same wavelength. I am feeling isolated between four walls and left in the lurch. The only one who actually sympathizes with me is the nurse who has a chat now and then.
In the mean time I pump milk every three hours. My husband and my daughter visit twice a day. He massages my feet which has a relaxing effect. At home the baby is fed the breastmilk. It seems that I am keeping my daughter at arm’s length, which in turn burdens me with a feeling of guilt.
After five days I am allowed to go home. I am feeling more at ease though still miserable. Now that the hysteria has subsided, the doctors seem to resign but I don’t. As a change is imperative, I contact a psychiatrist myself who I can meet in four weeks’ time.
‘In the mean time my husband has taken leave from work to take care of both me and our daughter, which he does day and night. I am living like a zombie, hardly talking at all.’
With my last efforts – no idea where they still come from – I am also searching for a psychotherapist. I can’t hide the feeling that I have to do everything on my own.
Everything changes when I can finally tell my story to the psychiatrist who proves to be a good listener. As I am diagnosed with postpartum psychosis he suggests another kind of medication which should do its job after only two weeks. The only drawback is that I can’t breastfeed my child. I am quickly resolved: I can’t go on like this any longer but at the same time I can’t deny my daughter what is only fair to her. That’s why I start pumping milk and throw it away afterwards. Our daughter will be fed artificially but I’m keeping the breastfeeding going. The diagnosis really gladdens me, especially the prospect that I will be feeling better in two weeks’ time.
As if somebody has saved my life
The unimaginable actually happens: after two weeks I do feel better indeed! It is hard to grasp after the wretchedness of the past seven weeks, as if someone has actually saved my life.
In spite of this I break down during the first consult with the psychotherapist. I have been drawing on my reserves for a very long time, but she proves to be a real godsend. After a great deal of self-analysis I thought I knew everything about myself. Nothing like that at all!
‘Thanks to this fantastic therapist I learn things about myself that I would never have thought of. It is wearing me down but at the same time, oh so helpful.‘
By now it’s been three months that I have been pumping milk the whole time, thus pouring away my precious breastmilk! I want to cut down on the medication and, miraculously, I manage to do that with its ups-and-downs.
Meanwhile I start wondering whether my milk will suffice and whether my daughter will still like to be breastfed. When I put it to the test, she takes my breast, which is all it really takes. She’s drinking, only stopping now and then to take a look at me and smile, as if she means to say: thank you, mummy. Three days later I have enough milk to feed her completely. It is so wonderful that my efforts are rewarded!
After eight months I go back to work slowly putting my life on the rails again. Though it was hard at the time I have learnt a great deal and I am so grateful for my beautiful family. The lonely search for professional help has left its marks, though. Whenever you are ill you lack energy, let alone if you have to look for help.
TEN YEARS LATER
Now, ten years later, it feels strange to reread my own words after the birth of our daughter. We got two sons besiders her, each time with an interval of two and a half years. Those pregnancies meant a hard time for me too, although they were less intense than the first. In the course of the final weeks those panic attacks started all over again – probably hormonally induced – and, at the moment of birth, my mental state was in pieces.
And yet, the births of our sons proceeded very differently and both of them were home deliveries. Candles were lit everywhere creating a very serene atmosphere and, despite my mental state, I didn’t experience any fear of what would follow. On the contrary, there was an immense confidence in both myself and the midwives. I could do what I wanted: go in and out of the bath whenever I felt that was ok. My husband and I formed a real team while the midwives guarded the health of both me and our baby in a very professional way, though in the background. They only interfered when I was losing my grip on the situation.
‘After all, I did what I felt should be done and our sons both swam into the world, in the birth tub that was placed in our living room.‘
After those two births a full ten days were required to come round; a long babyblues is what I call it now. I am convinced that I recuperated so quickly because I was in my own surroundings and the deliveries didn’t leave a nasty feeling. I had brought two sons into the world and I had felt the pain.
I relive my first birth in a very different way
After such a long time I actually experience my first birth in a very different way. Reading the report about it makes it look like an amazing experience. But as I recall it now, I remember the unfriendly reception at the hospital. I had to lie down on the delivery table and without a single word, without even notifying me, let alone asking my consent, my legs were put into the supports.
I had to be monitored for twenty minutes which was simply unfeasible. I was in labour and had a dilation of six centimetres. Although it was impossible to keep lying on my back I simply had to. Fortunately, when the midwife, who had coached me at home, came in I just cried out: “This doesn’t work!” which she confirmed. Taken off the monitor I was able to cope with the contractions again as I wanted to.
An ultrasound confirmed that our daughter was a stargazer. Shortly afterwards I overheard the gynaecologist saying it might be a caesarian. I tried to cope with the contractions though dealing with the pain became harder and harder without really making a lot of progress. I wanted to give birth without an epidural because that seemed the right choice to us. I had my husband’s full support in this.
According to the gynaecologist, a hot bath as an alternative for pain refief was no option because it was more than twelve hours since my waters had broken. Instead an epidural was advised. I remember my husband asking me if that was really necessary. I didn’t reply. When the question was repeated I glanced at my husband with an inquisitive “yes” to which he replied: “if that is what you really want”. A few moments later I was lying on the delivery table relieved of all pain. After an hour I was fully dilated and my widwife guided me through the birth of our daughter.
I was wondering how I could explain the difference between my past memory and the one ten years later. On the one hand it surely was ignorance; the difference only became clear after the other deliveries. But at the same time it was due to my mental state, as a result of which everything that happened later was pushed to the background.
‘I was wondering how I could explain the difference between my past memory and the one ten years later. On the one hand it surely was ignorance; the difference only became clear after the other deliveries. But at the same time it was due to my mental state, as a result of which everything that happened later was pushed to the background.’
The necessity of (complementary) therapy
In the mean time our eldest daughter has become a wonderful teenager who is so perfect to us! But, actually, she is going through a tough time. Besides being self-conscious, it is hard for her to fend for herself and to deal with the fear of abandonment. The latter is, according to me, a remnant of the split between mother and baby when she was only five days old; a remnant of the fears I was facing during and after my pregnancy. And, possibly, also a remnant of the epidural anaesthesia.
Recently we both consulted a therapist specialised in bonding difficultties arising during pregnancy. In a very delicate way she made me see that the relationship with my daughter is not as it should be. What a painful observation, for both me and my daughter. I do not have a guilty conscience, but I believe the main issue is to face the facts and deal with them.
My own experiences have made me aware me that there is a lack of knowledge concerning complementary therapies, both with midwives and in the rest of the medical world. Of course, the treatment and guidance of mother and child towards a safe delivery must be scientifically based. Besides this, also the mental aspect is of importance.
‘There are so many different ways to offer help to pregnant women who feel miserable. The bulk of carers is, however, not informed or sceptical just because the impact hasn’t been proved in black and white.’
Eventually I got to know haptonomia, which is a way of making contact with your baby not only during pregnancy but also, ideally, during the birthing process and the aftermath. Scientific research has established that this approach can limit the damage to both mother and baby, even in the case of traumatic experiences. If only I had known this sooner… Is it too late now? Of course not, I refuse to believe that. It is tougher, I admit, and yet I am certain we will get through this!
I hope that my testimony will help pregnant women and mothers choose what feels right and to make sure they are extensively and fully informed. It is certainly not my intention to push people in a certain direction. Look for what is beneficial for you. In my case it happened to be haptonomia.
My message to carers is: break down the taboo, listen to your clients and walk the path together, even if the path is unknown to you!
(1) Prenatal Affective Exchanges and Their Subsequent Effects in Postnatal Life – C. Dolto, 2002