January 16, 2009

Tuesday, January 13, 2009

Jenny Garvey with her children, Ben (6), Emma (4) Sarah (18 months). Photographs: Maura Hickey
Jenny Garvey with her children, Ben (6), Emma (4) Sarah (18 months). Photographs: Maura Hickey
Photograph: The Irish Times

More than 10 per cent of mothers experience postnatal depression – an illness with no known cause, writes SHEILA WAYMAN .

THIRTY-FOUR-year-old mother of three Jenny Garvey, who is expecting her fourth baby in April, relishes her current role in life. “It’s the best job. I am very, very lucky that I can stay at home.”

Confident, frank and articulate, the former office administrator is every inch the capable mother figure that other parents sometimes envy.

Hard to believe then that there were times after the birth of her second child four years ago when her husband Donal found her rolled up in a ball on the floor of their home in Knocklyon, Dublin, saying, “I can’t do this”.

She is one of the more than 10 per cent of mothers who experience postnatal depression. It is an illness for which no exact cause is known and affects women across all social classes and circumstances.

Risk factors include lack of support, a bad birth experience, previous history of depression or some misfortune, but there can also be no apparent reason. Whatever the trigger, affected mothers talk of being totally “overwhelmed”.

Of course, that’s a common feeling after giving birth, with up to 80 per cent of new mothers experiencing the “baby blues” a few days later. But if that low feeling persists for more than a week, there may be the more serious problem of postnatal depression and medical help is needed.

The most severe emotional disorder is postpartum psychosis, which occurs in one to two cases per 1,000 births and can include symptoms such as hallucinations, delusions, agitation, inability to sleep and bizarre, irrational behaviour.

The trouble is many women are reluctant to admit they’re feeling miserable when they think they are supposed to be ecstatically happy after the arrival of their new “bundle of joy”.

Motherhood is put on a higher pedestal than ever these days, often postponed until the career, house and man are in order. For some women, when that longed-for baby arrives it’s supposed to be the last piece in the jigsaw of a perfect, happy, fulfilled life. The reality can turn out to be very different.

Garvey believes it was the inability to breastfeed her second baby, Emma, who was born with a cleft palate, which triggered her depression.

“There was no way I could breastfeed her and for me breastfeeding was a big thing, a huge big deal.” Not only had she done it successfully with her first child, Ben, now aged six, she was also training to be a breastfeeding counsellor at the time.

“I had medics telling me she needs this, she needs that, you have to feed her that way. There were medical timetables; when they’d fix this, when this would happen and when that would happen.

“I found it all just too overwhelming. And I think that is the biggest thing speaking to other mothers who have had it, the whole overwhelming.”

She describes her depression as “absolutely horrible”.

“When babies go right it’s brilliant but when it goes wrong, it’s really horrible.”

She urges women to seek time for themselves when they have a new baby.

In hindsight, she can say the postnatal depression hit straight away. “Emma was born at the end of September but it was after Christmas when the thought of my husband going back to work and leaving me with these two scary creatures tipped me over the edge.”

She realised she might have postnatal depression, went to the doctor and described her symptoms.

“I had panic attacks; I would try to get my husband stay home from work because I didn’t want to be alone; I would ring my mother-in-law because I didn’t want to be alone. I was scared of everything.”

The doctor put her onto medication and Garvey also asked to go to a counsellor, “as I thought that would help and it did help a lot”. After six months of counselling and nine months on medication, she felt it was safe to come off it. By that time Emma had had the operation on her cleft palate and was absolutely fine.

The medication, Garvey says, “took the edge off the panic and the fear and it gave me the space to deal with things. I think normal depression is bad enough, but when you have a small baby who depends on you for everything and who you do actually love and would give your life for, but do not like very much at that particular time because they have changed your life so dramatically . . .”

Did she ever contemplate suicide? “I did on a few occasions think how I could drive the car into the wall but I didn’t want to damage the children, although they would obviously be in the car with me. But I was never seriously suicidal. I spoke out before I got that far.”

Tragically, that is not the case for some women. Anytime Madge Fogarty of Cork hears of a young mother’s sudden death, she suspects postnatal depression as the root cause.

“Women are dying because of postnatal depression and it needs to be taken more seriously,” says Fogarty who is chairwoman of Post Natal Depression Ireland. “We have no idea what the death rate is.”

Last March, an inquest in north Cork heard how the bodies of a 33-year-old mother who was on medication for postnatal depression and her nine-month-old son were found in a river. An open verdict was recorded.

Fogarty, who set up the voluntary support group in 1992, which is partly funded by the Health Service Executive, leaves her own mobile number as an emergency number over the weekends. “A week before Christmas a woman rang me on Sunday morning and she said, ‘you are the only one I could ring, there is no one else there on a Sunday morning’.”

She finds it “so frustrating and infuriating” the way the whole issue is treated by the HSE. “We are providing a service for a pittance. We have to fight for everything. It can just wear you out.

“But I have to think of the women. I was in that situation, not knowing where to turn.”

The mother of two grown-up children, she suffered postnatal depression after the arrival of her second child and believes the trigger was a bad birth experience.

“I lost a year of my child’s life,” she says, and the whole dreadful experience prevented her from trying for a third child, “that is how bad it is. People have no idea how deep it is and what a profound effect it has on you and your life.”

People who have IVF are high on the scale for postnatal depression, says Fogarty, “and the scary thing is they are not warned about it”.

She believes the media has a lot to answer for, glorifying motherhood with images of yummy mummies, and nobody telling expectant women about the down sides.

“A woman said to me, and I remember saying the exact same thing: ‘I look at all those other women pushing buggies, and they are all so happy.’ But you never know what is going on in other women’s lives.”

For the last year, s
he has been allowed to contribute to antenatal classes at Cork University Maternity Hospital and describes this as a “big breakthrough”. However, she is still fighting to have the organisation’s administration office moved there from St Finbarr’s, which no longer has a maternity service and is now mainly a geriatric hospital.

“Women who have met me at classes in the hospital presume we are based there and just turn up. They do not provide any other facility for women with postnatal depression.”

Mothers are leaving the maternity hospital after 24 hours with no back-up service, except for the public health nurses who have a huge workload, says Fogarty. The quick turnaround means there is no time for hospital nurses to pick up on signs of risk for the condition.

“A woman is at her most vulnerable after giving birth. She is not going to stand up to people and demand services,” points out Fogarty.

While the stigma of postnatal depression is not as bad as it used to be, she still sees new mums who are ashamed to tell their families about it, “and that’s really sad”.

Such stigma prevents cases of postnatal depression being picked up, according to Patricia Leahy-Warren, senior lecturer in the School of Nursing and Midwifery at University College, Cork. Yet if it is detected early, it can be relatively easy to treat.

“We don’t talk about it enough,” she says. “Anyone can get it, it’s not because you’re poor or less educated, and it can be devastating” – for the baby and the rest of the family, as well as the mother herself.”

Preliminary results of Leahy-Warren’s PhD research into first-time mothers and social supports in Ireland show that 13 per cent have symptoms of postnatal depression at six weeks, which corresponds with international findings.

Having interviewed 600 first-time mothers, Leahy-Warren has found that high levels of support lessen the risk of postnatal depression. The support of the woman’s mother and/or partner is particularly important, she explains.

It is extremely hard for the partners of women who do develop postnatal depression. Looking back, Jenny Garvey wonders how she and Donal got through it.

“He couldn’t do anything. One day he’d suggest we take this approach to it, and the next day I’d say I don’t want to do that. The goalposts kept changing.”

Once she had recovered and was keen to try for another baby, Donal took some persuading.

“He wasn’t bothered if the child had any disabilities, we could deal with that. But if I went . . . He said the woman he had fallen in love with and married suddenly was gone. The rock he could leave in the morning to look after his children was gone.

“He did not know what he was going to come home to. He did not know if he was going to get a whole day out at work, or if he was going to have to come home early. He had no idea what state I would be in.”

She tried to reassure Donal by saying at least she would notice earlier this time if she was developing postnatal depression. However, they need not have worried as there was no recurrence after the arrival of Sarah 18 months ago.

“As soon as they put her in my arms, I knew I was fine. I just knew. I think I am more apprehensive about this one because the last one was so perfect.”

Garvey had been a member of the parent-to-parent support group Cuidiú since before the birth of Ben and, coincidentally, found there were about four of them in the branch who suffered postnatal depression around the same time.

“We got to be quite good friends. So we have these postnatal depression support mornings about once a month now. It took a couple of years to get off the ground but now there’s three of us and five or six others coming to talk about it. It’s great to know you are not the only one who’s going mad.”

Trying to support other mothers means women like Jenny Garvey and Madge Fogarty have to revisit that black time in their lives. But it is that firsthand experience, which they and other volunteers have, that is so vital for the people they are helping.

“It is so important that they know you know how they are feeling,” says Fogarty. It also proves to these mothers that they too will come out the other side.

Signs and symptoms

The most common symptoms of postnatal depression include:

A persistent low mood, often described as a dark cloud overhead which refuses to lift.

Utter exhaustion and inability to concentrate on even simple tasks.

Crying frequently for no obvious reason.

Feeling unable to cope and inadequate as a mother.

Irritable and angry, sometimes afraid of being left alone with the baby.

Feeling anxious and fearful all the time, worrying about your own health and that of the baby. This can cause physical symptoms such as stomach churning or pain, nausea and loss of appetite. Tightness in the chest or panic attacks may also occur.

Difficulty in getting to sleep, even when the baby is sleeping.

In very severe cases of postnatal depression, you may have thoughts of harming yourself or the baby.

Need help: who to contact

Anybody who suspects they, or someone close to them, might be suffering from postnatal depression should seek medical help, from a GP or public health nurse. Early diagnosis and treatment result in a speedier recovery.

While medication may be required, counselling, or becoming involved in a support network, are also important steps to recovery.

Post Natal Depression Ireland:

Set up in Cork in 1992, it organises monthly support meetings in the city. But women throughout the State can make contact with each other through the discussion forum on its website, www.pnd.ie.

Its helpline, 021 4923162, is attended on Tuesdays and Thursdays between 10am and 2pm, while messages can be left at other times. You can also seek information and support by e-mailing support@pnd.ie.

Cuidiú – Irish Childbirth Trust:

Building up friendships with other new mothers can be very helpful when trying to cope with postnatal depression.

Cuidiú not only has branches that meet regularly around the State, but also runs an “experience register” through which you can contact somebody else who has suffered postnatal depression.

See www.cuidiu-ict.ie for local contacts or phone 01 8724501.

Parentline:

It is the most available helpline that deals specifically with this issue, operating on 1890 927 277, Monday to Thursday, 10am-9pm and Fridays, 10am-4pm.

Volunteers are specially trained on the subject and it is the only type of calls where they give direct advice, such as go to your doctor, don’t try to be superwoman, ask for help.

It also encourages partners or other family members to use the confidential helpline for support. Its website, www.parentline.ie, has a section on postnatal depression.

The Samaritans

Emotional support is available at any time of day or night from The Samaritans on 1850 60 90 90.

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