‘It’s bloody awful and unbelievable all rolled into one’: What I wish I knew about the first six weeks postpartum
When we think of women’s emotional well-being in the first few weeks after giving birth, we think of a rush of love and relief when the baby is born, or a drop in hormones that triggers the baby blues, and we might even think of postpartum depression think. But what is left unsaid is everything in between.
6 years ago I gave birth to my second child. In a retired blog, I wrote about those early postpartum days and said, “It’s bloody awful and unbelievably amazing, all in one day.” For a while, I pushed those overwhelming forces. There were times when I had everything she needed, but I couldn’t comfort her. I found my body awe-inspiring and grotesque. I was totally fine and completely overwhelmed.
As Ursula Nagle, advanced midwife at Rotunde, says, “The first six weeks is a time of many physical, emotional and psychological changes… There is often a focus on staying well in pregnancy and there is a big focus on to give birth. There is less attention paid to what happens afterwards.”
Danielle, from Cork, whose youngest child is 15 weeks old, says she had to adjust to life with two children immediately after a difficult birth. “He was born. Then I was at home and I felt like my head wasn’t there after I left the maternity ward,” she says. “After labor, he came out blue and wasn’t breathing. It was like I would mourn for a baby even though I had it.”
The first night home she was extremely anxious and these feelings continued. “I used to go upstairs to sleep and I called John (her partner) downstairs in the room below me to check if the baby was breathing because I wasn’t the one watching him. I felt like nobody would do it like me.”
When her baby was a week old, she went grocery shopping by herself, but when she sat back in the car, her heart began to pound and she couldn’t breathe. “After that, I didn’t like being apart from him at all…I cried from heart palpitations, 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 having an emergency c-section. So my first six weeks were not what I had imagined. It was a lot to get my head around. I thought I would come home in a different state. That first week was brutal.”
Karen found there was a lack of postnatal support. The midwife called the day after she got 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 about me.”
She found it a difficult time. “It goes in your head because you feel outside of your body. You’ve never felt like this and you don’t know what’s going on.”
“It goes in your head because you feel outside of your body. You’ve never felt like this and you don’t know what’s going on.”
Danielle spoke to her public health nurse about how upset she was. She was told the nurse would call her next week to talk to her, but then didn’t. “He was four weeks old. He’ll be 15 weeks and I still haven’t heard from him,” she says.
Their experience reflects what was found in the HSE-funded study by Daly et al. (2021) stating that women who give birth in Ireland have reported that their postpartum care is predominantly infant-focused and does not give women many opportunities to discuss their own physical or mental health.
Both women said the first six weeks were affected by their labour. I spoke to an HSE spokesperson to ask how women with traumatic birth experiences can be supported.
“All women have the right to request a meeting with a midwife or obstetrician for a debriefing to better understand what happened during their birth. The Rotunda and the Coombe have developed and implemented formal debriefing services. But in all of our maternity services, this service is offered,” the spokeswoman said. Importantly, there is no set time limit for women to apply for this service. The National Women and Infants Health Program supports the debriefing service and says they can be of great benefit “particularly after a traumatic birth experience or when emergency procedures were required.”
The debriefing service was not mentioned to any of the women, although it is available. Instead, they sought emotional support from loved ones. Karen’s partner Josh took a combination of annual leave and maternity leave, which meant he was home for the first four weeks after their baby was born. When they were learning how to be parents together, Karen says he was the one she spoke to about how she was feeling. Similarly, Danielle confided in her partner and her mother. She stresses the importance of talking: “If you don’t, it just builds up and makes things worse.”
Noting that there are women who don’t have the same support at home, veteran midwifery practitioner Ursula Nagle says, “Peer support is really helpful and it connects you with other women. Whether it’s through breastfeeding groups or postnatal cafes, a lot of those things are happening now.” Many women live apart from their families and Ursula says more and more mothers are “moving to online groups”.
Even with community, online, or family support, sometimes additional, professional help is needed. Within maternity services there are specialized perinatal mental health services that have been developing nationally since 2017. Perinatal refers to both pregnancy and the first year after birth. There are six centers – Cork, Limerick, Galway and three hospitals in Dublin with multidisciplinary teams – and specialist midwives in perinatal mental health are based in the other 13 delivery centres.
But what’s the difference between baby blues and times when you need professional support? according to dr Richard Duffy, perinatal liaison psychiatrist at Rotunda, “the baby blues hits fairly early, usually in the first week. It can last a day or three days. There is a lot of emotional vulnerability, overwhelm, fear and sometimes a very bad mood. But if it persists and one week turns into a second then I would be much more concerned that it could possibly be a depressive disorder.”
“We used the term postnatal depression as a kind of catch-all for all mental health problems that occur after childbirth, but women are not always depressed,” says Ursula. “Women are often quite anxious. Women can feel very depressed and very anxious at the same time, there can be a mixture of symptoms. For example, women can develop obsessive-compulsive disorder. Intrusive thoughts are very common in women in the first few weeks after giving birth.”
“This is a time of tremendous transition and adjustment. When you add that to sleep deprivation, physical recovery, and hormonal adjustments, it’s natural that it’s an emotional rollercoaster of a time.”
This is a time of great transition and adjustment. When you add that to sleep deprivation, physical recovery, and hormonal adjustments, it’s natural that it’s an emotional rollercoaster of a time. But both Dr. Both Duffy and Ursula Nagle know that if either of these issues persist, it’s time to seek help. They advise women to seek help by first contacting their GP, who can refer them to perinatal psychiatric services if needed.
“These common mental health problems are very treatable, and the sooner women seek help, the sooner we can help them recover and get well,” says Ursula.
Ursula and Dr. Duffy understands the potential challenges postpartum and encourages women to not only plan for their birth, but for the support they may need. Ursula suggests that women “seek early support. So have this conversation with your family, with friends, with your partner, maybe even with neighbors” when you are pregnant or as soon as possible.
For both Danielle and Karen, the basics of survival, like food and sleep, were what was needed during those first few weeks. Friends bringing food, family calling to do chores, visitors not expecting to be entertained and instead offering practical help were all things they found supportive. It was just as important to have people to talk to and who really listened to you.
With support, sleep, and food, their base feelings went away, but for those whose feelings didn’t go away, help is there.
dr Duffy explains that the six perinatal mental health centers have teams that do “group work, individual work, they can do trauma-focused work, bonding work. There’s a lot of things that don’t require medication, but if medication is required we can provide this nuanced information about it as well.
If I had read this article when I became a parent, I would have berated myself for not taking care of my emotional health and not taking a shower. But I would encourage other self-deprecating parents to consult psychiatrist Dr. Hearing Duffy say, “People are so hard on themselves. A lot of what we do is ask people to be a little kinder to themselves.”
Not everyone has a difficult time after giving birth. Many don’t, but for those who do, or in my case did, it’s comforting to know that anxiety, intrusive thoughts about the baby’s safety, and bad moods can be part of adjusting to a new role. And they happen. Regardless of how you experience those first few weeks, the constant message is that you don’t have to do everything on your own.
https://www.independent.ie/life/family/parenting/its-bloody-awful-and-amazing-all-in-one-what-i-wish-id-known-about-the-first-six-weeks-after-having-a-baby-42332384.html ‘It’s bloody awful and unbelievable all rolled into one’: What I wish I knew about the first six weeks postpartum