Much of the care after birth centres around the infants, but mothers also need to mind their own mental health. We talk to mums who needed support postpartum, and the experts who know how to offer it
When we think of women’s emotional wellbeing in the first few weeks postpartum we think of a rush of love and relief when the baby is born, or a hormonal drop that brings the baby blues, and we might even consider postpartum depression. But what’s left unsaid is everything in between.
Six years ago I gave birth to my second child. In a retired blog, I wrote about those early postpartum days saying, “It’s bloody awful and heart-swellingly amazing all in one day.” For a while I jostled those overwhelming forces. There were times I had everything she needed but I couldn’t comfort her. I thought my body was awe-inspiring and grotesque. I was totally fine and completely out of my depth.
As Ursula Nagle, advanced midwife practitioner in the Rotunda, says: “The first six weeks is a period with a lot of change physically, emotionally and psychologically…Often there is a big focus on keeping well in pregnancy and there’s a big focus on giving birth. There is less focus on what happens afterwards.”
Danielle, from Cork, whose youngest child is 15 weeks old, says that after a difficult birth she immediately needed to adjust to life with two children. “He was born. Then I was home and I felt like my head wasn’t after leaving the labour ward,” she says. “After the labour he came out blue and not breathing. It was like I was mourning a baby even though I had him.”
That first night at home she was extremely anxious and those feelings lingered. “I used to go upstairs to try and sleep and I’d ring John (her partner) downstairs, in the room below me, checking if the baby was breathing because I wasn’t the one watching him. I felt like no one was going to do it like me.”
When their baby was a week old she went food shopping by herself, but once she sat back in the car she had palpitations and couldn’t breathe. “After that I didn’t like being away from him at all… I’d cry with a tug at my heart, mostly in the evenings, because I was so tired.”
Karen, from Middleton, Co Cork, whose baby is six months old says: “ I actually ended up in an emergency C-section. So my first six weeks weren’t what I thought they’d be. It was a lot to get my head around. I thought I’d be coming home in a different condition. That first week was brutal.”
Karen found there was a lack of postnatal support. The midwife called the day after she came home, “but then I didn’t see anyone.“ The next visit was brief with two midwives calling to do a quick handover. Karen says: “They didn’t actually ask me anything about me.”
She found it a difficult time. “It does get into your head because you feel out of your body. You’ve never felt like that before and you don’t know what’s going on.”
“It does get into your head because you feel out of your body. You’ve never felt like that before and you don’t know what’s going on.”
Danielle spoke to her public health nurse about how upset she felt. She was told the nurse would call her next week to talk but then didn’t. “He was four weeks old. He’s turning 15 weeks and I still haven’t heard,” she says.
Their experience echoes what was found in the Daly et al (2021) study, funded by the HSE, which said that women birthing in Ireland have reported that their postpartum care is predominantly infant-centred and doesn’t offer many opportunities for women to discuss their own physical or mental health.
Both women said the first six weeks were influenced by their labour. I spoke with a spokesperson for the HSE to ask how women whose experience of labour is traumatic can be supported.
“All women have the right to request a meeting with a midwife or an obstetrician for the purposes of a debrief so as to better understand what happened during their birth. The Rotunda and the Coombe have developed and implemented formal debriefing services. But across all our maternity services, this service is provided,” the spokesperson said. Importantly, there is no set deadline for women to request this service. The National Women and Infants Health Programme is supportive of the debrief service and says they can be hugely beneficial, “particularly after a traumatic birthing experience or where emergency action was required.”
The debriefing service wasn’t mentioned to either woman, though it is available. Instead, they sought emotional support from loved ones. Karen’s partner Josh took a combination of annual leave and parental leave meaning he was at home for the first four weeks after their baby was born. As they learnt how to parent together Karen says he was the one she talked to about how she felt. Similarly, Danielle confided in her partner and mother. She stresses the importance of talking: “If you don’t, it just builds up and makes everything worse.”
Considering there are women who don’t have the same support at home, advanced midwife practitioner Ursula Nagle says: “Peer support is really helpful and linking in with other women. Whether that be through breastfeeding groups, or postnatal cafes, there’s a lot of these things happening now.” Many women live away from their family and Ursula says more mothers “are moving towards online groups.”
Even with community, online or family support, sometimes extra, professional help is needed. Within maternity services there are specialist perinatal mental health services which have been developing nationally since 2017. Perinatal refers to both pregnancy and the first year postpartum. There are six hub sites — Cork, Limerick, Galway, and three Dublin hospitals with multidisciplinary teams — and specialist perinatal mental health midwives are located in the other 13 maternity sites.
But what is the difference between baby blues and times when you need specialist support? According to Dr Richard Duffy, liaison perinatal psychiatrist at the Rotunda, “Baby blues occur quite early, usually in that first week. It may last a day or for three days. There is a lot of emotional vulnerability, feeling overwhelmed, anxiety and sometimes a very low mood. But if it persists and if one week rolls into a second then I’d be much more concerned that this may potentially be a depressive illness.“
“We’ve used the term postnatal depression as a kind of a catch-all statement for any mental health issue that presents after birth but women are not always depressed,” Ursula says. “Women are often quite anxious. Women can also feel very depressed and very anxious at the same time, it can be a mix of symptoms. Women can develop OCD, for example. Intrusive thoughts are very common for women in the first few weeks after giving birth.”
“This is a time of huge transition and adjustment. Add that to sleep deprivation, physical recovery, hormonal adjustments, it is natural for it to be an emotional rollercoaster of a time.”
This is a time of huge transition and adjustment. Add that to sleep deprivation, physical recovery, hormonal adjustments, it is natural for it to be an emotional rollercoaster of a time. But both Dr Duffy and Ursula Nagle are clear that if any of these persist then it’s time to seek help. They advise women to seek help by first contacting your GP who can make a referral to the perinatal mental health services if needed.
“These common mental health problems are very treatable and the earlier women seek help the earlier we can help them recover and get better,” Ursula says.
Knowing the potential challenges postpartum, Ursula and Dr Duffy encourage women to plan not just for their birth but for the support they might need. Ursula suggests women “seek out your support early. So have that conversation with family, with friends, with your partner, with neighbours perhaps even,” when pregnant or as early as you can.
For both Danielle and Karen, the very basics of survival, like food and sleep, were what was needed in those early weeks. Friends bringing meals, family calling to do chores, visitors not expecting to be entertained and offering practical help instead were all things they found supportive. So too was having people that they could talk to and who really listened.
With support, sleep and sustenance their low feelings passed but for those whose feelings don’t pass, help is there.
Dr Duffy explains the six perinatal mental health hub sites have teams who “do group work, individual work, they can do trauma focused work, bonding work. There’s a huge amount of things that don’t require medication but if it does require medication we can also give that nuanced information around that.”
If I read this article when I became a parent, I’d have berated myself for not caring for my emotional health on top of not showering. But I’d encourage other self-deprecating parents to hear psychiatrist Dr Duffy who says “people are so hard on themselves. A lot of what we do is asking people to be a little kinder to themselves.”
Not everyone has a difficult time postpartum. Many don’t, but for those that do, or in my case did, there’s comfort in knowing that anxiety, intrusive thoughts about the baby’s safety, low moods can be part of adjusting to a new role. And they pass. Regardless of how you experience those early weeks, the consistent message is you don’t need to do it all alone.