What messages would your message(s) be to midwives about PPP? How did they help you? How did they not?

[hackneygirl]

Hello all, I'm a PPP survivour and I'm writing an article for a magazine for midwives here in Australia to help raise awareness of PPP and help promote my book, Day Six. The editor has asked me to talk about what helped and what didn't help when it came to my interaction with midwives. I want as many of them as possible to know PPP exists and to mention any strange symptoms or behaviour to a doctor for further investigation. Do you have any other thoughts or suggestions you'd like me to put forward? Thanks Jen

[thyroidma]

I told a midwife at a breastfeeding cafe that I thought I had post natal depression. She said "but you're here aren't you?", I said "so everyone feels like this in the early months?" and she said "yes". I then stopped talking about my horrendous symptoms to anyone medical (the midwife didn't ask about my symptoms, neither did the GP in a similar conversation, no one took me seriously at all). I wasn't online at the time to be able to look anything up or get further help or support. Most people were quite dismissive when I mentioned feeling "a bit mad" - I always said it with a smile on my face, because I'm a naturally optimistic person, but inside I was terrified I was going to hurt my baby or myself. I didn't, although I think my daughter (now 6) has some attachment issues (not surprising really.) I wish that first midwife had just taken the time to ask "why do you say that?" or to explain about the Edinburgh scale or ANYTHING other than closing off the conversation. She was trying to help and reassure me, but I continued to have psychotic symptoms for 3 years after that. I really could have done with some help.

I wish there had been more info available about PPP and PND when I was pregnant. I was terrified that my baby was going to be taken away and that I was going to be sectioned.

[andrea_at_app Volunteer APP in reply to thyroidma]

Yes, it's really important they know & understand the early PP symptoms. Sadly, they're so often missed & action & correct treatment is delayed, making recovery much harder & longer. Also to really listen to women & partners when they say there's something wrong & not dismiss it as 'normal' postnatal behaviour. (There'll be a page about early symptoms on the APP website soon)

[Strawberry55]

Hi,

I think it is about awareness, or lack of. I wasn't aware of PPP or what it was until it happened to me. My midwife didn't even talk about PND although I knew roughly about that. Sadly my midwife didn't see me when I was ill or she may have seen a difference in me. I was in hospital at the time, it took us raising the symptoms before I was assessed but sent home with just sleep depravation. It wasn't until I was in an MBU I was eventually told it had PP but given no information about it. I think awareness needs to be raised an those professionals working with new mums need to be aware of signs and potentially highlight the risks.

[AnneMR33]

I'm not sure if it's even the same elsewhere in the UK (where I live) but I'd say that like any type of care, continuity of perinatal care in the community is essential. I realise midwives may not always have a say in how they operate but working in a large team with constant chopping and changing really doesn't help. I saw 9 different community midwives, 5 antenatally and 4 postnatally. So when I reached crisis point the first time round, 10 days after my daughter was born, the midwife who came round to assess the situation had only met me once, months ago, in early pregnancy and she sees so many pregnant ladies that she didn't even remember me. Add the obviously disjointed notes, how on earth could she judge if what I was doing/saying was in any way out of character?

I also found that the assumptive and patronising comments didn't help. There are some books on baby care that are proscribed by the NHS, esp. the Gina Ford-type promoting routine-based approaches. Now, I read everything I could find in charity shops and libraries when I was pregnant, not because I needed guidance: I was a nanny for years and as the eldest sister of much younger siblings, I've known how to change a nappy, bathe, feed, burp and soothe a baby to sleep since I was 9. But I'm also an academic (I have a PhD) and was curious to see what the literature had to say and if I could learn some new tips which made sense to me. I know a lot but obviously not everything and was aware that these books weren't written with people like myself in mind "this is most probably the first time you've ever had to change a nappy in your life". No, but this is the first time I look up average daily intake for my very own 11lb baby. Anyway, there's not always time to express this background to 9 different people, particularly when the psychosis is starting to take hold and someone is pointing at your Gina Ford book saying 'I hope you're not doing this' 'We see babies become really underweight and mothers cracking up under the self-imposed pressure of these routines'. As a matter of fact, my daughter was fed on demand and remained firmly on the 98th centile despite Ford's book on the coffee table. I should have said that, like the friendly, calm and confident person I normally am. I didn't and couldn't articulate what was going on and she didn't know that the defensive and emotional woman she had in front of her was not my usual self.

I would also say not to judge a pregnant lady by her postcode. We know there's a link between poor perinatal mental health and domestic abuse. We also know a lot of abuse starts during pregnancy. But there's this ongoing notion that domestic abuse mainly occurs in poorer households and screening is not automatic particularly in more affluent areas. So I was never screened but my friend - who lives in a working-class neighbourhood - was. Screening doesn't have to be a blunt 'are you being abused at home?'. For most victims, it's become so part of their normality, they don't realise what's going on. A subtle 'does your partner ever destroy objects that are important to you?' would've done the job in my case: "well, the other day, he smashed the kitchen table and my swivel chair in a rage as I was curling up on the floor sobbing, why?"

I hope this helps. It'd be great to read your article when it's published, would you be able to link it or post it on here or private message those interested.

Very best of luck,

Anne

[hackneygirl]

Thanks so much for your replies. I'll def post a link to the forum if you think people would be interested. Jen x

[Kat_at_APP Volunteer]

Hi Jen, please do post the links!

I'd second all of the above, especially Anne's eloquent response.

My fractured brain really didn't cope at all with the myriad number of MWs, nurses and others who came and went during my labour and post natally. In the end I convinced myself I was nuts and didn't have the capacity to remember names - or anything else. This petrified me. I accept continuity of care is difficult to achieve in a modern hospital setting, but perhaps MWs could be trained to always introduce themselves clearly and wear large-font name badges for extra clarity.

Another MW thing is around BFing, and the general lack of support to choose anything else while in hospital. It would have helped me immeasurably to have had just a few hours sleep - so if someone had given me the equipment and knowledge to give my baby a cup of formula, who knows how things might have turned out. My baby was so hungry right from the start and my meagre offerings were not filling him up. But getting this practical assistance was like getting blood from a stone. If there's a next time round, I'll pack my hospital bag with aptimil!

Hope this helps. K

[AnneMR33 in reply to Kat_at_APP]

Hi Kat,

My experience in hospital was very different from yours and perhaps proves your point... the MW and nurses on my ward were actually really on the ball, introducing themselves, supportive with feeding, help with latching on, literally the minute my milk came in and thanks to that I managed to establish a decent supply. They also showed me how to use a breastpump.

When I was exhausted one night, they fed my baby formula and had her in the nursery to let me sleep a bit. It is shocking they didn't have any pre-packed bottles to offer you. How stressful. What about the women who don't wish to BF at all?

It just shows how inconsistent the care is and I wonder if my first symptoms were 'delayed' in a way as a result maybe compared to yours. Stress is definately a factor and I too wonder: if I hadn't experienced severe levels of stress and felt so unsupported at home... who knows?

[Ellie_at_APP Partner]

Hi

It was interesting to read everyone's responses. I paid to do NCT classes, and it was mentioned but the class focused most of its questions on post natal depression / baby blues etc, as I guess it is more common and is talked about quite a lot in the media etc.

I have to say I have been so lucky in all my interactions with midwives. Just as I was getting ill, and was quite exhausted and emotional (3rd day after birth) I was getting support from a midwife with breastfeeding as and when I needed it. I don't think she had any big concerns when she saw me though, I think she put it down to baby blues and lack of sleep. I got PP very acutely so was admitted to A&E on the 3rd day after birth very unwell (it came on very suddenly though there were signs) and the support in A&E was amazing. I was in A&E for about 24 hours. I've had to rely on my partner to fill in the blanks for me. The head midwife stayed with me for a lot of the time, holding my hand, and just saying reassuring things, but not lying to me either. So saying I was unwell but that I would get better now, and that they were getting me the help that I needed, and that they were trying to find out what was wrong. She then fought for me to get into the best MBU (a private one that was probably more expensive than the NHS one - I think she had to get it pass some panel that agree things like that). The nurses and midwives looked after my son in the staff room and let my partner go in and out of the staff room to be with my son. The head midwife didn't say "she has postnatal psychosis" but did say that it was psychosis and she had seen it once before in another patient, and it is rare but can happen. The head midwife stayed beyond her shift to see me off to the MBU. She walked with me onto the ambulance, showed me around the ambulance etc. It was obvious she really cared.

When I was back home after coming out of the MBU I did go back to the hospital to see if the head midwife was there and she was - she recognised me straight away and took time out from work straight away to talk to me and was genuinely really pleased to see us, I got to thank her for all the support she gave me.

After the MBU I was under an early intervention team - and received amazing support from them as well - but I didn't really see many midwives after that apart from specifically about my son, they let the early intervention team support me with the mental health issues.

For me the most important thing I needed from midwives, but also from anyone who would support me, is that they genuinely care and want to support - are passionate about their job, and the people they support, have empathy, want to build a relationship of trust with me etc.

I realise, having joined this forum, that I was so lucky with all the support I received, I really couldn't fault any of it.

I hope that this garbled response is helpful.

[andrea_at_app Volunteer APP]

Great replies above, thanks all. The difference in treatment in different areas is quite shocking, we're campaigning to end the postcode lottery of treatment & MBU provision.

There's this great thread on here a while ago that might help, 'What are the key things you think health professionals should be taught about PP?': healthunlocked.com/app-netw...

Yes, antenatal awareness is so important, for midwives, all pregnant women & their partners - just having heard of it before & knowing it existed would've been a huge help.

There's an online tool for midwives to help identify women at high risk here: app-network.org/what-is-pp/... Also, midwives should understand the risks in women with Bipolar & treat accordingly: beatingbipolar.org/women_an...