A Little Story About Postnatal Depression

This week, September 12 is R U OK? day, reminding us to check in regularly with family and friends and support those who are struggling. I thought it only fitting to write a mental-health themed blog.  Australian Doctor magazine recently held a short story competition entitled From Where I Stand, and while I wasn’t the winner, I was happy with my little tale.  I should point out it’s fictional, a blend of stories from women I’ve treated over the last few years. I hope you appreciate it too. 

——

I sit on the ground next to her, on the cold concrete outside the hospital wing. She’s sobbing, hunched in a tiny ball, clutching her chest like it’s the only thing keeping her from falling apart. She thinks she’s failed.

She came to see me in my clinic this morning, two rowdy kids and a three-month-old baby in tow. Dark circles under her eyes, a slight tremble in her hands. Eyes flicking everywhere like a hunted animal. “He just won’t stop crying! I don’t know what else to do!” It’s the fourth time she’d seen me in a fortnight, each visit a different, minor thing, and my alarm bells were ringing.

I ask her how she’s doing, leaning in, giving her my best ‘I’ve got all the time in the world’ look. Our eyes lock, her chin trembles with a brief hesitation, then a brush-off as she glanced away. “Oh, you know, just sleep-deprived I guess.” She snaps at one of the kids as they ransack my drawers. “I’m alright.” She visibly gathers herself in the chair. I try again, “It looks like you’re having a really hard time.” Then her eyes brim with tears, against her volition. And the floodgates open.

Her five-year-old daughter starts crying because Mummy’s crying. Her seven-year-old puts his serious man-face on, and looks to me for help. We comfort her together (he pats her on the knee) as a few distraught sobs break loose. I ring for the practice nurse, who takes the kids for a biscuit and some distraction “while Mummy talks to the doctor.” The five-year-old is won over by the bribe of sugar, but her little man leaves us warily, glancing back over his shoulder as he’s towed outside.

I want to explore things further with her. I want to see how far down the rabbit hole she’s fallen. I start with easy questions to break the ice, and push my box of tissues in front of her.

She’s never been like this before. Usually she’s pretty happy and well. Her partner is trying to establish himself as a dairy farmer and he works long hours outside the house. She’s cooped up with the kids all day. They moved interstate for this chance two years ago, leaving her family thousands of kilometers away. They live forty minutes from town, and it’s not worth the effort of packing up three children just to drive in for a mother’s group – she can barely manage a supermarket trip.

This baby, things have been different – and it began with the birth. He was facing the wrong way, so she had to have a caesarian. She was sore for weeks, longer than she expected. Her milk came in late, and this baby doesn’t seem to feed greedily like the others; he’s been fussy from the start. She’s been secretly topping him up with formula because everyone kept commenting on his skinny little arms. She felt dreadfully guilty doing it, and avoided the child health nurse because she was afraid of being told off. She’s read all the books, she was desperate to breastfeed – but after three months her milk’s dried up, and every time she makes a bottle of formula for him she feels like a failure.

And now the colic! Every evening now the screaming starts. Three solid hours of inconsolable, purple-faced baby. Right when she’s trying to make tea for everyone, and put the kids to bed for school. Her husband comes in exhausted from the milking sheds at 7pm, expecting dinner on the table before he rolls in to bed and crashes for the night, ready for his 4am start the next day. She knows he’s stretched thin too – dairy farming is exhausting, especially a one-man outfit like theirs – and she feels like she’s letting their team down if she can’t even keep control of the household.

She hasn’t told him she’s struggling. If he tries to help, to take over some duties, she sees it as a criticism of her abilities. She feels ashamed. Why is it so much harder this time? This baby wakes constantly through the night. She’s so sleep-deprived; she can’t even be bothered to get out of her pyjamas most days. The house is a pigsty. The kids are being sent to school with coins for lunch. She hasn’t been to the hairdressers since halfway through the pregnancy. She hasn’t shaved her legs in a month. She feels fat, unsexy, useless and worthless as a woman and a mother. She wouldn’t be surprised if he doesn’t love her anymore, who would?

I prod a little deeper. I’ve noticed that through this entire consult, she hasn’t made eye contact with her baby. When he whimpers, she rocks the handle of the carrier. When he squawks, she picks him up roughly and pats him over her shoulder, until he stops and she puts him back down. I can see he’s mouthing and chewing his fists; he’s clearly hungry. She doesn’t seem to notice.

“When the baby’s driving you mad and you’re at the end of your tether, you can feel really angry. Does it get like that sometimes?” She hurriedly nods, relieved I’ve put it out there. “Some women even think about hurting their baby – slapping it, or shaking it. It doesn’t mean you’d do it, but has the thought occurred to you?”

This is what she’s been waiting for, to tell someone this dreadful, shameful secret that’s eating her up from inside. Her voice drops into a whisper, tears spill down her cheeks and she admits that sometimes, she wishes he’d never been born. Sometimes she has to stop herself from slapping his chubby little thigh when he’s screeching uncontrollably. Sometimes when he won’t stop screaming, she won’t pick him up, because she’s worried she’ll shake him like a rag-doll if she does.

Two nights ago, in the dead of night, she thought about ending her own life. She was up yet again with the baby, her husband was asleep. She’d take the baby with her. Something gentle, like car exhaust, where they could both slip away into sleep. Her other kids would probably be better off without her since clearly she’s not fit to be a mother.

We’ve reached the crux of the consult. She looks fearfully at me. She’s exposed her soul, put it out there for judgment, and she’s instantly regretful – yet at the same time, she’s desperate for someone else to take the burden from her. Shame and guilt radiate off her in waves. “I think you’re having a really, really hard time of it. I think you have postnatal depression. And I’m worried for you. I think we need to help you, fast. What would you say to a short stay in hospital, a bit of R&R?”

I’m lucky, you see. I have admitting rights to my local hospital. And what I think this woman needs first and foremost is sleep, as well as recognition of her predicament and pretty urgent help. My practice nurse and I arrange the details – call her husband to explain, ask him drop off clothes and take the kids home, while I run her case past some experts over the phone.

This is how we’ve come to be sitting on the concrete outside, later today. I find her here, freezing in the cold, after discovering her bed empty on my evening rounds. I pat her on the back as the deep sobs choke their way out of her. I sense a catharsis, a release, in their violence. She’s been trying to keep it all under wraps, under control, not letting anyone know for so long. And now, of course, everyone will know. She’s not sure how she feels about that yet. I help her up; we wander back to her room and talk.

We talk about how these things she’s feeling – guilt, shame, worthlessness – are all part of postnatal depression. I explain that many women in her place have similar thoughts of hurting their baby, or hurting themselves – it doesn’t mean she’s a bad mother, it means she’s very, very unhappy. I tell her we can help her, and we’ll make plans in the morning once she’s rested. But for now, we’re going to send her off in a chemically-assisted snooze until morning.

A last shuddering sigh escapes her as she climbs under the covers.  She looks down at her hands. “Thanks for listening… I must look like the worst mother in the world right now.”

“Not from where I stand.”

Advertisements

BAD BABY NAMES: THEY’LL MAKE YOU SICK

My name is Marlene. That’s pronounced Mar-lane-ah, as in Marlene Dietrich.  Over the years, I’ve cursed my non-phonetic name when I’m ordering pizza, or coffee at Gloria Jeans. In their defence, my parents were schoolteachers and didn’t want to use the name of any memorable kid they’d taught over the years.

At least Marlene is a real, bona-fide name. According to a study* of over 4000 kids in Perth, this name protected me from serious childhood illness. Not surprisingly, there was a strong correlation between Nomenclatural Adventurism and rate of admission from ED to the kids’ ward.

(And yes, before I get howled down, it’s unlikely to cause ill health. But who ever let truth get in the way of a good statistic?)

Do parents realise that doctors, nurses and teachers collect bad baby names and trade them later for laughs? Like Meadow Lea, and Anarchy Reign.  Though at least those are actual words, if not real names. My absolute favourite non-word, non-name is Abcde. It’s pronounced Ab-si-dee. Uncurl your toes now.

Interestingly in Australia and NZ, you can’t use numbers in names. Which is lucky for baby Number 16 Bus Shelter, whose name was rejected. One wonders whether the parents’ inspiration was similar to the parents of baby Midnight Chardonnay? And perhaps the parents of Kiwi twins Benson & Hedges were romantics, inspired by a post-conception cigarette they’d shared.

But if you think laterally enough – which is not a virtue, by the way – you can slip in numbers using Roman numerals. Like Kviiitlyn. Yes, that’s K(VIII)lyn. Or you could try Kviiite. Have you figured it out how to pronounce it yet?

You CAN use apostrophes and dashes as liberally as you want, unfortunately. Like T’Neal, or Max-ine, or Ad’m.  Or you could be really clever, like the parents of La-a, and Ka-a. Yes, that’s La(dash)a, and Ka(dash)a. Read it and weep!

Personally, I’m waiting to meet baby Chlamydia. Doesn’t it sound pretty? I do know there’s a Candida out there. While we’re on bad names, I’d like to point out that all boys with a J-name are naughty: Jai, Jett, Jamie, Jack, Jordan, Jonas, Jayden, Jaiden, Jax, Jaxon, or even Jaxxon. Save yourself the jail visits later, and give them a nice well-behaved name like Larry, or George.

Why not wait for your baby to become a unique little person, instead of giving them such a unique name that they’ll probably change their name by deed poll the minute they’re a legal adult? Happily, for ‘Talula Does The Hula From Hawaii’, the NZ Family Court stepped in first and forced a name change in 2008 when she was 9 years of age, because it was “embarrassing, and made a mockery of the child.”

Such names are no doubt capable of causing psychological trauma. But what about physical? These naming categories, identified with the study, were statistically proven** to correlate with ill-health in your baby, and should therefore be avoided at all costs:

Popular Culture Names

  • Avoid the likes of Bella, NarniaArya, or Narla

Apparently Unique Names

  •  Like poor kids Rysk, Zaniel, Rilo or Kaixin

Surname as First Name

  • Watch out for Connor, Harrison, and Mackenzie

The best test? If you can imagine a news reader announcing  “Prime Minister <name> met with the Surgeon General today…” without collapsing in fits of giggles, then you’ve got yourself a real bona-fide name.  And hopefully a healthier future for your child than J’Adore, Drifter or Xenon will get.

* Children’s Nomenclatural Adventurism and Medical Evaluation Study J Paediatr Child Health. 2009 Dec;45(12):711-4. Princess Margaret Hospital for Children, Perth, Western Australia, Australia.

**  Never trust the phrase statistically proven without reading the fine detail. Correlation does not equal causation. Moustaches are statistically proven to be correlated with injury. That’s because men grow moustaches AND do more stupid things. It’s not the moustache that causes the injury.