Guest post by Steph Cullen

During my first pregnancy in 2015 my mental health spiralled quite quickly.

I have always battled with mental illness since my very early teens. Hormones are a huge contributing factor for me, as I live with the mental health condition Premenstrual Dysphoric Disorder (PMDD).

Pregnancy should have given me some relief as [my hormones weren’t] cycling. However, my sensitivity to hormones dates back to childhood, where I grew up with a hormone imbalance called premature adrenarche. So, maybe it’s no surprise that pregnancy hormones, coupled with the idea of becoming a first time mum, sent me reeling into an asphyxiating pit of anxiety.

I didn’t feel excited, I was physically disabled from symphis pubis dysfunction, and my days were spent laid on the sofa playing out worst case scenarios in my head. I’m a person who catastrophises often anyway; I can go from zero to panic attack in seconds.

During my first pregnancy there was no such thing as a perinatal mental health team – at least not in my area. I was taking medication to manage my mental health, and this was increased to suit several times during that pregnancy. What was missing was conversations with my medical team. Nobody asked me if I felt I needed additional support, nobody mentioned that my baby might be (and later was) born addicted to antidepressant medication. I was expected to get on with it.

My daughter was born and spent ten days in NICU with neonatal abstinence syndrome from antidepressant medication. This isn’t common, but nor is it especially uncommon. 1 in 3 babies born to medicating mothers will suffer withdrawal symptoms and I believe had someone had the discussion with me, that this might be a factor post-birth, it would have left us in a much better position to tackle the emotional undoing that came with the trauma of having a baby in NICU.

For the first year of my daughter’s life I struggled – to bond with her, to get a grip on intrusive thoughts and to be a good mum – whilst feeling a sense of overwhelm every time she needed feeding. She would scream for 15 hours a day, every single day, and it was for all intents and purposes horrific.

With this is mind, it wasn’t overly surprising when anxiety crept back to the surface when I found out I was pregnant for a second time in 2020. But five years after the first was surely enough time to get over the trauma, wasn’t it?

What I now personally believe is that you never really get over trauma. You learn to work through it, and take positive lessons from it, but it never leaves you completely. In the space between my first and second pregnancy, I managed to regain some equilibrium. I was managing my health, both mental and physical, the best I knew how. I’d had lots of therapy over the years, but I was currently in a place where I didn’t feel I needed it.

This equilibrium I speak of was short lived. When I found out I was pregnant this time, I panicked. I have chronic health conditions that require medication and I also live with the invisible but very real disability, fibromyalgia. Knowing the impact this has on my life and subsequent mental health, I was keen to access support early.

I asked my doctor to refer me to the perinatal mental health team that was now in existence. Once referred, I felt relief that I would get the support I needed. They offered me talking therapies, which sadly turned out to be an absolute waste of my time.

When I phoned them and explained that I’d previously suffered severely with my mental health in pregnancy, and wanted to be proactive in seeking support this time around, I was offered an assessment. I’ve had appointments like this before, where you are assessed and scored for anxiety and low mood. The woman I spoke to said I had scored too low to warrant free therapy at this stage, and to come back if things got worse. I was stunned. I knew I wasn’t in the depths of depression, but the whole point of me accessing this service was to prevent the spiralling that had occurred so quickly during my first pregnancy.

I’ve learned the hard way that, unless you are in crisis, your mental wellbeing is considered low down on the list of priorities on the NHS. The resources are simply not available for preventative mental health care. I understand it to a degree, especially during a pandemic, but it doesn’t make it easier to tackle.

I once again found myself completely disabled at 16 weeks pregnant, for a second time with symphis pubis dysfunction. I phoned my GP, who asked me to self refer to the physio department. The physio department called me, said they couldn’t see me as they weren’t doing in person appointments. They had no crutches available so I’d need to buy my own, but they would send me some exercises in the post. Whooppeee! *Rolls eyes*

Poor physical health can have a huge impact on our mental wellbeing, especially when growing another human, and I’m so over the idea that us mothers should just struggle through. The common theme that we’re having a baby seems to imply that nothing else really matters.

Again I reached out to my perinatal mental health team, explaining my depression at finding myself bedridden and unable to bathe myself or cook meals for my family. They suggested going back on antidepressants. I’m not against medication at all, especially not antidepressants – I’ve been on and off them much of my life. My problem though is that, because of my past birth trauma and the fact I already take medication for physical health problems, I don’t want to add more medication in unless it’s absolutely necessary, and I still feel best placed to decide when that is.

I’m now 31 weeks pregnant and have lasted this long without medication for my mental health. I’d like to try and get to the end of my pregnancy without them too. It’s definitely not a case of being noble; I believe we should all take medication if we need to. The trouble is, I feel had I been supported with my health in other ways, I wouldn’t be in a place where I needed them at all.

The shining light for me has been grassroots organisation Bluebell, who put me in touch with a mental health occupational therapist and signposted me to my local council to get disabled adaptations made in the home. They also coached me through my internal embarrassment at needing mobility aids and a wheelchair.

They advised printing off my conditions and listing them at the front of my maternity notes, to help me explain symptoms when seeing medical professionals. Best of all, they listened. They didn’t push solutions on me that I didn’t want. They worked with me in deciding what I felt would help most.

Whilst I won’t lie and say things are going great since – I still feel like more needs to be done to support expectant mums who suffer from a variety of symptoms – I will say that being listened to, really listened to without judgement, is a step in the right direction.

More needs to be done to support people suffering from complex conditions. We can do better to get the mental health stuff right, but what doesn’t seem to be happening is a collaborative approach to heal both physical and mental health simultaneously, in pregnant women especially. We are asked to ‘cope’ with so much whilst trying to bring a healthy baby into the world.

Everyone wants to hold the baby, but who holds the mum?

Medics need to talk to each other, and they also (for the love of god) need to listen to their patients.

You can find Steph online and on Instagram @divamumsteph