As Mental Health Awareness Week draws to a close, I’d like to share my story of a condition that isn’t really talked about. During my pregnancy, I suffered from antenatal anxiety and depression. Some people call it perinatal anxiety. Others use the term prenatal anxiety. But most people don’t have a clue that this condition exists.
There have been excellent awareness-raising campaigns over the years to encourage discussion about postnatal depression. Most expectant mums are aware of the so-called ‘baby blues’ and storylines such as Stacey’s postpartum psychosis in Eastenders have raised awareness of other conditions too. I have suffered from anxiety and panic attacks over the years, so I discussed my history with my GP and wondered if I was at higher risk of postnatal mental health issues. But nothing prepared me for my anguish during pregnancy.
Despite L’s eventual premature birth, my actual pregnancy was not complicated. I had scans at 8, 12 and 20 weeks which showed a healthy baby boy. I only had one episode of morning sickness throughout my pregnancy. But the circumstances surrounding my pregnancy were far from ideal. I had been dating L’s father when I became pregnant and he blocked all contact with me after I told him the news – once he’d fired off a message saying that he wanted nothing to do with the baby. I was living in a four-person houseshare in London, with no family nearby. I worked full-time in London in a busy, stressful job that I loved dearly. I had wonderful friends in London who supported me but had equally busy lives and lived all across the city. I knew I didn’t want to leave London but I felt overwhelmed about how I was possibly going to juggle a baby with my lifestyle – and how on earth I’d manage alone.
So clearly I was pretty stressed. I kept making mental lists in my head, weighing up my options and calculating the pros and cons. I began househunting for 1 bedroom flats within my budget, making allowances for a full-time London nursery place. The sums just didn’t add up. I tried to figure out how I would travel on packed commuter trains with a baby and buggy in tow. Surely no-one did that? How do London mums manage? Do they all have husbands? I was obviously the only person stupid enough to get pregnant without a partner. My head was spinning with all these conundrums before I had even reached the 12-week stage.
My stresses were consuming me, but I reasoned that I was in a stressful situation so it was a normal reaction. I had already requested counselling from my GP to help me consider my options. But slowly I began to crumble. My panic attacks returned for the first time in years. My heart would be racing and I’d be desperate for fresh air. One day I was walking along one of the London bridges and everything began to spin. I couldn’t breathe and it felt like the bridge was slipping away from under me. I ran as fast as I could to the doctors surgery (thankfully I had a counselling assessment in a few hours time) and was in such a state that they escorted me to a private room. I broke my heart to the woman who assessed me (I have no idea of her actual role) and could not control my tears. I wish I could say that she signposted me to the correct support, but she was not helpful.
I continued to struggle. Work became difficult as every task would overwhelm me – a real shock to the system, as I have always loved my job and relished challenge. But the thought of having to do a task in by a certain deadline (e.g. a few hours) would floor me. I could barely sit still at my desk. I was tapping my feet, clenching my hands, anything I could do to distract from the anxiety that swept over me. I returned to the doctors and I was signed off for another two weeks.
I wish I could provide a chronological narrative, but my illness is a huge blur. I guess my desire to tell you my story in a logical sense probably explains why I was suffering. I find comfort in order, routine and a clear plan. My pregnancy threw everything I loved and worked for into disarray. I couldn’t comprehend what was happening to me and the hormone surges produced anxiety that I had never thought possible. I can remember phonecalls to my mum, begging her to help me. A bus journey back from visiting a friend (also pregnant) where I had to clutch the handrail the whole time and could only reassure myself with the thought that there were other people on the bus to help me if I collapsed. There were days at home crying, not really understanding why.
After visiting another friend, I got lost on the way home and pulled my car over and sobbed. He tried to explain a route to me on the phone but I was inconsolable. Eventually he had to come and escort me back – I spent the journey on edge, crying whenever he drove too quickly and convinced I would lose him. We were driving in my hometown, on roads that I had driven across many times before. At my lowest, I remember feeling so dizzy and ‘unreal’ that I lay on the floor of my mum’s bathroom just crying and screaming. I got myself in such a state that I pulled my jaw somehow. My mum struggled to calm me down as I convinced myself that I needed to go to A&E immediately.
I needed help desperately. I was convinced that my stress would be bad for the baby. There was a sticker on my maternity notes which basically confirmed my fears too. I still carry guilt to this day that my placenta failed L because of my ill health. I’ll never know for sure. Luckily, being pregnant provides access to specialised mental health care and faster referrals. But as with most NHS services, the provision differs hugely around the country. I have a fairly unique experience of accessing both NHS England and NHS Wales care during the same pregnancy, as I relocated but remained under dual care as I continued to work in London.
In London, I fell victim to the complex system of the different health trusts. I was passed from pillar to post and the confusion about who was responsible for me actually caused me more stress and anxiety. My care was something along these lines:
- CBT – accessed in a GP surgery but not my own. It was only a 15 minute walk from my own surgery, so I was happy with this service. The CBT was helpful for accepting that I was under a lot of stress therefore it was not surprising that I was feeling this way. We also practiced mindfulness which I enjoyed.
- A one-off pregnancy anxiety/stress workshop – this was in a local children’s centre and I was referred by the CBT service. This was an excellent workshop and it helped SO much to meet other women who were feeling the same way. I wish it had been an ongoing initiative.
- Perinatal team – my GP had mentioned the existence of a perinatal team at my first appointment to confirm my pregnancy. She anticipated that I would need their services given my history and the circumstances of my pregnancy. Despite the fact that she referred at the earliest opportunity, I had not received a response by the time I became unwell. It took a lot of chasing and phonecalls to the GP to finally get accepted onto the team. It wasn’t worth the bother. I had a few strange sessions with someone based in the hospital where I was booked to give birth (which was what I expected) but she specialised in caring for children. I wasn’t really sure what she had to offer me as we seemed to just have counselling-type conversations. One day it all got too much and I spent most of the session shrieking that I couldn’t cope with my feelings anymore. So she referred me to the psychiatry team.
- Perinatal psychiatrist – finally I felt like I was getting somewhere. This appointment was also at the hospital where I was booked. Despite the fact that the psychiatrist spent the first 10 minutes telling me that the other perinatal woman wasn’t actually qualified to help me (!), she listened to my symptoms and finally gave me a diagnosis. I had ‘severe antenatal anxiety and antenatal depression’. I cried tears of relief as someone finally validated my symptoms. She prescribed me anti-depressants and reassured me they were safe for pregnancy. The appointment seemed too good to be true – until I was told that I was actually accessing the wrong service for my postcode, and I needed to be transferred to a ‘community team’. I had no idea what that meant.
- Another perinatal psychiatrist – so this turned out to be my ‘community’ referral. This was in a different hospital, miles away from where I lived. Well when I say miles, it was a 30 minute bus journey which is significant in London terms! I had an amazing appointment with the consultant. She really understood my concerns, asked pertinent questions and devised a care plan for me. Unfortunately, I only saw her a few weeks before I gave birth and I had already moved back to Cardiff. I wish I had been able to access her services from the start as I know she would have made a real difference to my care.
- Mind counselling – now this referral came out of the blue. I think it must’ve originated from my GP surgery, but this care made the world of difference to me. I accessed free counselling from Mind on a weekly basis for a set number of weeks – I can’t remember how many but I know my sessions were extended. I had the most wonderful counsellor who remembered every detail that I told her, had the perfect balance of empathy and advice and made a tangible difference to my life. She encouraged me to complete exercises before each session; one of these was compiling a list of pros and cons of living in Cardiff or London. I had been so set on keeping my London lifestyle. And it was such an obvious exercise to complete. But once I took the time to actually consider my options, the answer was staring me in the face. Cardiff could offer me the stability and support that I so desperately needed. My counsellor helped me to come to that conclusion on my own. I spent many hours with her talking about my deepest fears and how I was feeling. She helped me turn a corner in my pregnancy and I am eternally grateful. I will be donating to Mind once I return from maternity leave.
Thankfully (for both pregnant me and you the reader as this post is rambling on…) my care from NHS Wales was much more straightforward. My midwife made a referral to the perinatal team. I made one phonecall (out of desperation from the ping-pong in London) chasing up my referral and I was allocated a mental health nurse to support me. She came to my house to visit me and we’ve never looked back. I have accessed amazing services through the perinatal team – support groups, walking groups, regular visits from the nurse and nursery nurses, a jewellery support group, medication review and a psychologist – all seamlessly arranged by one point of contact.
I won’t apologise for the length of this post. There is very little online content about antenatal anxiety and depression. I should know, I spent hours searching for it. And what I could find didn’t reassure me that things would get better. It certainly didn’t happen overnight and my care was complicated. I didn’t magically get better once my baby was born – but that isn’t surprising considering the trauma of L’s birth and his subsequent neonatal stay. But I had already made the appropriate connections with NHS services who continued to support me and I was on medication which potentially minimised my symptoms.
And of course, despite all the support I received, the antenatal anxiety and depression didn’t just go away. Whilst things remained stable, so did my mood. But I had a massive relapse once I was admitted to hospital before L’s birth. I didn’t sleep for 48 hours. I had the worst panic attack of my life, needing to ring the buzzer for the nurses to calm me down, and my mum was called into the ward to try and help me sleep. But that isn’t surprising considering the enormity of the situation I found myself in.
Antenatal anxiety and depression is a terrible condition. Everyone expects you to be excited about the anticipation of your new arrival. You should have that ‘pregnancy glow’. Maybe you’ll have a little moan about swollen feet and morning sickness, but no more than that. You’re lucky to be pregnant, right?! It’s an amazing thing! And yes, it is. But antenatal anxiety and depression is/are debilitating conditions. Be kind to yourself and speak to your GP or midwife about your feelings to access the support that you need.
More information about antenatal anxiety and depression can be found on the following sites:
- Mind (the mental health charity)
- NCT (National Childbirth Trust)
- PANDAS (Pre and Post Natal Depression Advice and Support) Foundation
- Tommy’s (information for parents-to-be)
- Centre of Perinatal Excellence
- National Institute for Health and Care Excellence
If you are in Cardiff, you can also access support via PMH Cymru.