Before my husband and I tried to get pregnant, before toying with names or choosing a room for the nursery, we sat down for confronting consultations with three psychiatrists. I had long been warned of the risks pregnancy posed to bipolar mothers, and had the devastating suggestion made that not having a baby on health grounds should be a serious option for me. My grief, when that was suggested, was immense.
Pregnancy is the single greatest biological event of a woman’s life. The combination of surging hormones, rapid physical changes, a labile emotional and psychological state and no or minimal medication creates a perfect storm for women with mood disorders to relapse and experience the worst episodes of their lives. Of all groups, bipolar mothers are most at risk for postpartum psychosis. My likelihood was put at 95%.
So it was with a heavy heart that I read a new study in Lancet Psychiatry finding women with pre-existing mental health conditions have an almost 50% higher risk of preterm births. The study, the largest of its kind ever undertaken, also found a link between the severity of previous mental health difficulties and adverse outcomes at birth. Women who had been admitted to a psychiatric hospital had the highest risk of all.
From conception, my pregnancy was classified as “high risk”, based on my mental health diagnosis and history, and I spent much of the nine months gestation in a parade of somewhat tense medical appointments. GP, obstetrician, midwife, psychiatrist, perinatal psychiatrist, psychologist, bloods, ultrasound. Five weeks before the birth I was flown down to a specialist hospital in Perth for intensive monitoring, a 2,500km trip.
During my first appointment with the perinatal psychiatrist I began to go manic, my mind no longer able to stay earthbound so close to the birth and the preventative medication thinning in my blood as my body grew. As I was walked up to the ward for foetal heart rate monitoring, I emphatically praised the hospital food, which was not only the best of any hospital I had been too, but simply the best food in the world. The nurses, with kindness, laughed and laughed.
On these wards for high-risk mothers, the priority is to keep the baby inside as long as possible. At first I felt like a fraud among mothers with real physical issues – babies in the third percentile, high-blood pressureand pain (no contractions!) months early.
But 10 days later I had physical issues of my own. My baby had dropped to the 10th percentile and wasn’t moving very much. Under the pressure, my mind again took flight and I began planning a cruise to Tahiti for me and my newborn.
The Lancet study looked at the data of 2 million UK women, but can’t tell us yet why preterm babies are more common among women with serious mental health issues, though they posit that stress responses triggered in episodes may contribute.
The doctors couldn’t tell me why either, when my daughter arrived skinny and underweight, despite me eating a lot of steak and potatoes. Such are the many mysteries of pregnancy.
For me it helped to be labelled “high risk” because it gave me good access to support throughout the pregnancy. Around eight months pregnant, my obstetrician at my country town hospital said he was happy to admit me to the labour ward “for a rest” if it got too much having my husband away in the bush and managing on my own. “We don’t want you to be lonely,” he said. “That’s not good for baby.”
It struck me at the time that all mothers should receive this level of care and attention through the delicate months of pregnancy, not just women with a red sticker on their file.
Pregnancy is a time of heightened mental health risk for women across the board, with around 10-20% of all new mothers developing a mental health condition either in pregnancy or in the year after delivering the baby. These figures come from a recent report from the UK Royal College of Midwives, who also estimate that at least 50% of anxiety and depression cases in new mothers go undetected. They estimate 70% of mothers conceal and downplay their mental health distress, in large part due to “societal expectation” that the passage to parenthood “can be very different to the reality”.
A special class of antidepressant has just been approved by the FDA for postpartum mothers in the US. In the years 2018-2020 suicide was reported to be the leading cause of death for mothers in the year after their child’s birth in the UK. This is an appalling statistic.
Whenever I see groups of mothers together – strapped up to heart monitors at the special women’s hospital, singing a nursery rhyme at playgroup – I am struck by how earnestly we all want the best for our babies. And how much we are all willing to downplay our own needs and wants once a baby is on the scene.
And then I wonder, who is looking after us? Where are our carers, putting themselves out so that we have a chance to thrive – or just sleep in? While some of us have help, the help is not at a societal level, and can always, always be more.
I think the world is kept spinning on maternal love. Now I want to see the world love mothers back.
• Eleanor de Jong is the former New Zealand correspondent for the Guardian. She now lives and works in the Kimberley town of Derby, Western Australia
• In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and ChildLine on 0800 1111. In the US, Mental Health America is available on 800-273-8255
