POSTNATAL DEPRESSION… Should it discourage you from ‘going again’?
The politically correct, medical and popular view would be ‘No, absolutely not’. But as someone who has encountered both post and peri-natal depression, I am not sure I subscribe to that view, much as I might like to.
As with many angles in relation to depression and its treatment, the decision as to whether or not to have another child after suffering peri or post natal depression involves a balancing act. Similarly to the question I wrote about several weeks ago as to whether antidepressants are ultimately a ‘friend’ or a ‘foe’, the answer to the above question is not a simple ‘Yes’ or ‘No’, but lies somewhere in between. But the general societal view which pervades that depression should not be in any way life-limiting is just not realistic. Or helpful. And it conveniently allows the system to do nothing to help those who have suffered from it in the past to avoid a recurrence.
To gloss over an episode of depression and how it will inevitably affect the rest of your life is to belittle its impact upon the individual in the first place. To take the view that your life should not change and that you are fundamentally the same as the person next to you who hasn’t faced down such struggles is naive, and even, irresponsible to those who depend upon you. And as I watch my son approach his second birthday and my daughter ask for a sister, I once again encounter the balancing act that is life after depression. And I face the age old question. Could I cope?
I know women who have chosen not to have another child simply because of their history. And that, to me, is the most selfless act of all that a mother can take for the sake of her children. To go against her instinct and her own desire to have another child for the sake of those she already has.
I refused to commence medication whilst pregnant. I considered it and listened to the reassuring words of the psychiatrist. But I decided to take things one day at a time and eventually limped over the line at 39 and a half weeks. Fear and guilt stopped me. An unequivocal love for my unborn child and the inevitable uncertainty around how any such decision on my part, however justified, could potentially impact him into the future.
Undoubtedly there are those for whom the physical symptoms of depression during pregnancy are so severe that whatever impact anti-depressants could potentially have on baby pales into insignificance compared to the inevitable impact of the mother’s insomnia, panic, loss of appetite, embattled immune system, on her unborn child. I was pretty sure I didn’t reach that category, and just as the scales fell in the other direction once my son was born and I immediately went on medication, I decided that during the pregnancy, if I could bear it, my son would probably be better off without.
But I am not sure that I could do it all again. Or that it is fair to my two beautiful children to take the risk. And to blindly assume that I can have and do all the things others can is selfish and unrealistic. I have a medical ‘history’ like it or not. An irreversible one which says that my mind and childbearing do not like each other. Much as my heart may be bursting with love for them. And that to me is not stigma. Is not branding. Is not discrimination. It is reality. It is forward planning. It is being a responsible parent to the children I already have. But it is also unspeakably sad.
Looking back I wish I had been screened for PND during my first pregnancy. Three months after my daughter was born I found myself reading the risk factors and symptoms as if I were looking in a mirror. Have you suffered a recent bereavement? Tick. Have you had financial difficulties? Tick. Have you a history of anxiety/depression? Although I may not have fully recognised it at the time, tick, tick, tick.
No such screening exists. Probably because the powers that be feel it might turn into a self-fulfilling prophecy. Or because it is deemed somehow insensitive or inappropriate to expectant mothers to highlight those at risk. Or perhaps it is simply because nobody could be bothered. Who knows? Whatever the reasoning, noble or not, no preventative measures are taken and no early intervention exists.
Similarly on my second pregnancy even after my difficulties first time round no such screening existed. I am confident and self aware enough to seek help early once I saw the signs and so I got the support I needed. But I shouldn’t have needed to go looking. And many others simply don’t.
So if we are serious about removing the stigma around depression and breaking down barriers, the medical approach to it, particularly during pregnancy, needs to become like any other illness. Had I a history of high blood pressure, anaemia, cancer, diabetes, these would all have been captured, recognised, monitored and managed throughout my pregnancies. But mental health weaknesses are not. Despite the fact that indications are that one in seven mothers will suffer peri or post natal depression.
So can we please start to screen pre-and post delivery? And have a transparent, open, clinical discussion about its likelihood, its impact, and its treatment that is more scientific than the Public Health Nurse asking the age old loaded question around ‘How mummy is feeling?’
Can we spend less time in our Ante-Natal Courses discussing the ‘Stages of Labour’ and more time on the ‘Stages of Survival’ after the event? For the last time I checked the former takes care of itself, whilst the latter routinely does not.
Can we consider having an informed and honest debate around medication and pregnancy? Roughly 10% of the population will take anti-depressant medication at some point in their lives. Which means that literally tens of thousands of women out there must find themselves in a similar predicament to my own. Yet I have never seen or heard it openly discussed. Ever.
I now have a bond with my children as strong, if not stronger, than most. Probably because we went through so much together. My daughter after she was born. My son, for some unknown reason, before. But do I want to risk that bond for the sake of another child? No, not for now at least.
But that question has never been discussed with me by any medic. Never has it been called out, highlighted as a risk for me and my family that needs to be watched and managed. Never has any additional support been offered or suggested other than whatever I have been brazen enough to seek out and fund myself.
Because, despite all the rhetoric, depression is not treated just like any other illness. And perhaps as with any other illness within our struggling health system, you are very much on your own.
The author still sits in the Mental Health Closet. Who knows, perhaps she’ll be brave enough to come out soon. But for now at least, for the sake of her and her children, she prefers to remain anonymous.
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