For 33 days, Katrina Weynberg was separated from her newborn twins by a hospital floor. They’re 33 days she’ll never get back.
After becoming pregnant for the first time in 2021, Katrina was excited. But that was soon overshadowed by anxiety after she found she was having twins who shared one placenta, which carries a high risk of complications.
In December 2021, when she was 33 weeks pregnant, a problem in the blood flow of one of the twins led to her having an emergency C-section at Westmead hospital. Katrina describes the birth as traumatic: “I didn’t get my children on my chest, I was watching one of my children get respiratory support while I lay there paralysed because of the epidural.”
In the following days she lined up at 4am and waited hours to get a Covid PCR test so she could see her sons in the neonatal intensive care unit.
At the same time, Katrina began experiencing symptoms of postpartum psychosis. She stopped sleeping. Her speech became rapid and slurred. She experienced heart palpitations, hallucinations and anxiety.
But completion of Westmead’s mother and baby unit, specially designed so women experiencing mental health problems could stay with their baby, was delayed, so Katrina was admitted into a mixed adult psychiatric ward.
Although she and her twins were just one floor apart, Katrina was only able to visit her babies once or twice a day. Her husband would collect her breast milk from the psych ward.
“It was traumatic,” Katrina says. “How do you split a mother and their newborns?”
Katrina recovered from the psychosis after a 33-day admission but being separated from her newborns led to her developing postnatal depression, she says.
When she was diagnosed with postnatal depression in June 2022, the mother-baby unit at the Royal Prince Alfred hospital had opened – the first of its kind in the state. During her one-week admission she was able to have her children with her as she received treatment. She says the experience “changed my life”.
About one in every 1,000 woman experiences postpartum psychosis and experts say the physical stress of delivery, particularly if there are other medical problems, can contribute to the condition. Up to one in five women are diagnosed with a mental illness during the perinatal period, from pregnancy up to the first year of their baby’s life.
But new mothers in New South Wales are increasingly finding it hard to access mother-baby units, as perinatal psychiatrists leave the public system amid an ongoing dispute between psychiatrists and NSW Health. NSW has lost one-quarter of its beds in public hospital mother-baby units since January – there are just 12 beds servicing the whole state, according to a perinatal psychiatrist.
Eight of the state’s beds are at Royal Prince Alfred hospital, although Guardian Australia understands two out of three of the hospital’s perinatal psychiatrists have resigned.
Guardian Australia asked the local health district covering Royal Prince Alfred hospital about whether the resignations of two out of three of their perinatal psychiatrists had affected services in their mother-baby unit. A spokesperson said it was “open to patients and fully operational”.
‘There were already so few beds’
NSW psychiatrists are in a dispute with the government, claiming they are paid 30% less than psychiatrists in other states. They say the pay difference has led to staff shortages, resulting in a mass exodus of doctors who say they can no longer keep working in these conditions.
Earlier this year the whole state was served by only eight public mother-baby unit beds after psychiatrist resignations led the entire Westmead hospital unit to close on 24 January. The unit reopened at half capacity on 10 February.
A spokesperson for the local health district which covers Westmead hospital said during the temporary closure, “services were reassigned to ensure mental health care remained available to consumers in need … there were no active patients, and no one was on a waitlist”.
But even before the dispute, there were already so few beds within the state’s mother-baby units, according Dr Rohini Vasudevan, a perinatal psychiatrist who resigned from St George hospital on 20 January. She says there were many times she tried to get a woman a bed but none was available.
While the postnatal period is often seen as a joyful period, it can also be incredibly challenging, Vasudevan says.
She says mental illness after childbirth can have a “profound impact on the entire family, not just the woman, but their attachment and care of their baby”.
“That has long-lasting effects for years, decades going forward.”
Vasudevan says she felt compelled to resign and claims there was chronic understaffing and the resources required to do her job were “slowly eroding”. “The threshold to receive care just continues to increase over time.”
“Your worst fear as a psychiatrist is that a patient you are unable to provide adequate care for – due to a broken system – ends up having a bad outcome. For perinatal psychiatrists like myself, this could mean the death, not only of the woman, but her children as well.”
‘Women won’t get the care they need’
The peak body for psychiatrists, the Royal Australian and New Zealand College of Psychiatrists, recommends babies and mothers should be admitted together for mental health services whenever possible. RANZCP also recommends more units to achieve a minimum of one eight-bed unit for every 15,000 deliveries each year.
Ariane Beeston, a spokesperson for the non-profit Centre of Perinatal Excellence who has experienced postpartum psychosis, says Victoria – which has six eight-bed mother-baby units – is the only jurisdiction in Australia which meets those recommendations.
With more than 90,000 births in NSW each year, the state would need more than six eight-bed units.
With only 12 beds available in the state and limited staff, there is a lot of anxiety among women who are now pregnant or planning a pregnancy, Beeston says.
Beeston says the beds are not only a resource for women in crisis but can be an important part of pregnancy planning for women who are at risk of a recurrence of a perinatal illness with a second pregnancy.
Given that NSW has only had the units for three years, Beeston says it is “devastating” to see the situation go backwards.
In an attempt to deal with the psychiatrist dispute, the NSW government has replaced permanent staff specialists with temporary locums or visiting medical officers. But Vasudevan says they don’t have subspecialty knowledge.
“A great number of women who are suffering simply won’t get the care they needed. They’ll either be turned away or admitted to an adult mental health unit where there can be sometimes aggressive or violent patients and their children are not allowed to visit,” Vasudevan says.
“I can’t imagine that they would allow paediatric beds or oncology beds to be closing around the state, and yet this is what’s happening to mental health beds.”
• 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, call or text Mental Health America at 988 or chat 988lifeline.org
