Background: Zara is married with two children, a daughter aged 2 and a ten-month-old son. She is a writer and lives in a regional town. Zara is from an Anglo-Australian background.
About Zara
Zara experienced postnatal depression including 'intrusive thoughts' about her first baby's welfare. She was prescribed antidepressants (desvenlafaxine (PRISTIQ)) by a GP, and had psychotherapy with a psychiatrist. Zara experienced a 'relapse' after her second baby. Seeing a female therapist, practising mindfulness and taking antidepressants (mirtazapine (REMERON)) have helped.
Read excerpts from Zara's interview
> Caring for a baby - feeding and sleeping - Due to low supply, Zara had to wean her baby at six weeks. This was a 'huge relief'
My daughter was a great feeder, she was doing all the right things, wasn't a problem with her latching on or her, not knowing what to do. I think babies generally know what to do and there was no cleft palate thing - there was nothing like that. I just didn't have milk to give her. So, the hospital stay was pretty much an obsessive experience about trying to extract milk from me and she was getting a little bit but not enough so she'd be feeding for hours on end.
And so and then my nipples were just brutalised [laughs] so I felt - bleeding and what have you. So we did everything we could, I took the pharmaceutical drugs, took the herbal stuff, did the pumping, had a lactation consultant come and see us a few times. But I got to about six weeks, you know, it was 24/7 around the clock trying to get milk coming and it just wasn't happening. So at about the six week mark I decided that - well, we decided, [partner's name] and I as a family that we'd be okay to just go exclusively formula. Thought six weeks is a fair enough timeframe to try and get milk coming. I think you know, perhaps - I don't know how I felt about that. I think probably because breastfeeding just wasn't an enjoyable experience, it was a huge relief not to have to in the early throes of a newborn experience. [sigh]
Hormonally, I think the fact that I didn't feed meant that I got my period at about the three-month mark and that was just the most intense PMS experience I've had in a long time. I was actually suicidal, I was feeling really helpless and distraught and [sigh] you know just I guess caught up in the sweep of hormonal fluctuation, it was quite a dramatic change I think for my body to try to negotiate. And in the meantime, I [sigh] I think the sleep deprivation and the [sigh] over-vigilance that I guess a lot of mothers would have was also simmering.
> Social support in early parenthood - Zara talked about support her husband provided in 'pulling her up' when he felt she was not 'managing' her emotions. Although it angered her in the moment, she was able to see his advice was for her and the family's 'benefit'
I sort of take comfort in the idea that children do need to see the full spectrum of emotions and that's the only way that they're going to learn about the full spectrum of emotions and I suppose not to be discouraged or if feel disinclined to be honest about what they're feeling about things. If they can see it role modelled, it's just a matter of managing them responsibly in a way that um, isn't destructive. I guess, taking responsibility for your feelings and not spraying them on others. Because it can be a bit of a spray. You don't really mean to, it's just hard to contain it.
I find that [my husband]'s been - I don't like it when he pulls me up on it, I really get pissed off with him, to be honest. I think, you know, "You don't understand me," and these kinds of ideas and claims but when I pause for a moment. When I sort of stop the anger and actually really listen to what he's trying to say then it's for my benefit and it's for the benefit of the family. That's why he's pulling me up on it. And I feel like I do have to take responsibility otherwise it's just going to lead to the relationship to break down and the family to break down and that is just the last thing I want.
> Identifying postnatal and antenatal depression and finding help - Zara experienced intrusive thoughts after her daughter's birth, not knowing that these could be a 'characteristic' of postnatal depression
Yeah, no it was definitely a lot of anxiety and my partner was working late so I was left alone with my daughter quite a lot and... I just started to have funny thoughts, lots of strange thoughts about the harm that could come to her. And then it just sort of [sighs] - that just became an obsession, and I was just thinking over it a lot. And then it - it stepped into territory where I was thinking that I would - you know, I could, you know, not only accidentally cause harm to her but purposely cause harm to her. And I think I just didn't know that that's a fairly common experience.
I had no idea that intrusive thoughts can be a characteristic of postnatal depression, never ever heard of it. So I was started to get plagued by this and they were getting more and - it was almost like a 24/7 thing and trying to suppress them and push them away and not saying a word about it to anyone.
I just had no idea that it was a symptom, I thought it was a kind of madness and an indication that I didn't want to be a mum, or that I really actually did want to cause harm to my daughter. So I was just engaged in this huge self-doubt, and self-questioning about my motivations behind becoming a parent. And because these intrusive thoughts were so overwhelming, I guess I was just trying to think, 'Well how can I get out of this? I don't know how to get out of this. Is this what it's like to be a mother? No joy'.
I mean, because I hadn't heard of this phenomenon of intrusive thoughts, I just assumed that there was something really wrong with me. And probably because of my mum's illness. So, you know, it felt like a kind of madness. And it was going in that direction. So I just didn't - that's right, because at the antenatal classes the midwife was talking about postnatal psychosis, and I was worrying that I was getting into that territory. And I thought, 'Oh this is just, you know, I don't want to be a psychotic mother. I've got one, I don't want to be another one for my children'.
So I rang [sighs] PANDA and spoke to a counsellor. Spoke to a counsellor on the phone who was fantastic and they kind of talked me through it. Sort of asked all the requisite questions about you know, "Are you suicidal, are you going to cause - do you want to cause harm to your baby?", those sorts of things. And you know it was all sort of, 'No'. And [she] said, "Go and see your GP".
> Understanding antenatal and postnatal depression - Zara reflected on the 'skewed values' around motherhood and the choices available to mothers. She felt becoming a mother involved having one's status 'downsized', which was particularly challenging to 'educated, older' mothers
Being slightly older is also a factor. A friend of my mother-in-law, she was a midwife and she's got a few retired midwife friends. And one of them said to me whenever I visited a mum with postnatal depression it was usually an older mum. And I think that has a huge bearing as well because as older women you've led a full and complex life and motherhood pulls you into a state of deeply entrenched domesticity.
Or, back in the day when women had 40 days rest in bed and - it just seems like there's a really skewed value system... placed on motherhood these days, despite all of the knowledge and awareness that we have and the extent to which we've been enlightened about gender and equality, it just doesn't get played out [in terms of] the value that's placed on it.
So for a woman who is educated, older, has led a rich and full life before [be]coming a mother, instead of receiving messages that are saying this is just as valuable and just as enriching and just as important as all the things that you were doing out in the world, before becoming a mother, you get the complete opposite. And your status gets completed downsized. And - that's really confronting.
That's really hard to [sighs] accept and feel comfortable with and we shouldn't really - it shouldn't be accepted and we shouldn't be sort of made to feel comfortable with it. And I think for some women a strategy is just to go back to work as soon as they possibly can - which I did, to sort of recover that sort of feeling of value and self-worth in work terms. Or to embrace the homey mama thing where you take pride in a new identity, and not worry about the inequality that you're experiencing and just embrace the stereotype. Well not really the stereotype, [but] in a way that - that feels comfortable for you. So it's fascinating really [laughs]. For all the work that's been done for the feminist cause there's a lot more to do around motherhood.
So there's a lot of good books around it, but - I read 'The Mask of Motherhood' ... I read that while I was pregnant and I found it so depressing. I thought... [laughs], 'This is not what it's going to be like, it's not going to be like that for me'. And I had to put it down - 'No, not reading this - [this] can't possibly be what I'm facing.' But in retrospect, it's spot on and thank God... - thank goodness there's a book like that out there. Well it's strident, the tone is really strident and passionate. So you feel like - absolutely there's all these injustices that are going on and... I just didn't really think it through. What I was facing, I didn't have any close friends that had become mothers recently who might have been able to shed a bit of light on the realities of it.
> Experiences of medication for antenatal and postnatal depression - Zara's hesitation towards taking medication for postnatal depression was related to her experience of her mother taking medication for 'schizoaffective disorder'
I'd been prescribed something called desvenlafaxine (PRISTIQ) and this time round it's a different antidepressant, it's called mirtazapine (REMERON). And I've always been strongly, strongly resistant to taking any antidepressants - I think because of my experience with my mother - so I've tended to go down the path of complimentary therapies and I know which have been effective up to a point but I think when it comes to an acute case then that's when pharmaceutical drugs are helpful.
But, I think the fact that I actually don't have a really serious mental illness like schizophrenia and what I am dealing with is just a low level mild thing - if it works then I don't mind. Because if it means that I'll be a happier person and therefore a happier mother and therefore generate a happier family environment, then, I'm happy to do that. I just remember mum being zonked out a lot and detached, removed emotionally from me, so I just don't want to repeat that.
> Non-medical approaches for antenatal and postnatal depression - Due to a history of 'depressive phases', Zara was careful about her physical and emotional health during pregnancy
I certainly didn't have a depressive phase in the pregnancy. There was just no indication that something like that would ever happen in the postnatal phase. I think the pregnancy was so comfortable and optimistic - we were really excited about having the baby.
Despite the fact that I've got a history of having depressive kind of phases, I almost felt like it would just be near impossible to have postnatal depression, given the pregnancy was such positive experience. It wasn't until we went to some antenatal classes and the midwife there was talking about postnatal depression that I thought, 'Oh, I'd better start thinking about this'.
Because my mum was diagnosed with schizophrenia - which was recently re-diagnosed as schizoaffective disorder. And my dad has chronic anxiety and my brother's got Asperger's and has had depression.
And so I don't have much of a hope of coming out of that kind of a family environment without having mental health-related issues. Which I have had over the years, and I thought I was quite an unhappy teenager - 'cause that coincided with mum's psychosis.
I think that was probably why I was focusing a lot on being fit and health in pregnancy... [So] it wasn't until the sort of the final stretch where I thought, 'Oh actually there's a mental health risk here as well'. So I approached a local centre there that provides a lot of perinatal support to women. And - this is while I was pregnant - and I just said, "Look, I don't know if I'll develop postnatal depression - I just think I need to touch base just in case I do".
So I think that was good and it was good to know that they could be supportive if I went under. So I felt like throughout the pregnancy I did all the right things, in terms of physical and mental health. But I guess I didn't really think much about what it would actually be like to become a mother and how that experience would trigger childhood issues.
> Social support during experiences of antenatal and postnatal depression - Zara said she was more willing to be open about her second 'bout' of postnatal depression than her first because her second experience had not been characterised by 'intrusive thoughts'
I've kept it fairly contained. I'm quite a private person as it is and as I was saying a little earlier, the fact that the PND with my daughter came with the intrusive thoughts, it led me to be a lot more contained about it with people who I didn't know so well. So I confided with close friends about it, but interestingly most of my close friends don't have children so it's still a bit hard for them to relate to that. And if the mothers group - I got the postnatal depression in the early stages of the group forming so I missed a lot of meetings so I felt like I never really had a chance to really weave into the fabric of that group.
So, even with my partner I could tell him if I was having what I would call a 'thoughty' day. But I couldn't - I didn't feel like I could tell him much about them, and I don't think he really wanted to know much about them either. Because that would cause him distress. My parents were really good at the crisis stage but I wouldn't sit down and talk with them about it at length.
Whereas I think this time round I feel a lot more comfortable, I've been really straight with people, so disappeared to [city name] for three weeks... if people wonder what I was doing in [city name] I just told them, "Well I had a bit of a breakdown, I've had a relapse of the PND," and partly because this time round it's not so loaded with stigma. Because the thoughts aren't a symptom this time around and secondly, I just feel a bit more confident or something. I just feel like I should be upfront with people and if they can't tolerate it then that's fine.
> Recovery and getting better after antenatal and postnatal depression - Zara contrasted her more recent 'bout' of postnatal depression after her second child with her experience after her first child, which she felt she was 'on the way' to recovery from
That put me on to halfway towards recovery of sorts... Now that it had a name, now that I knew that it had been described to me as intrusive thoughts and I was able to do a bit of reading and research on it. And Google can be overwhelming yet reassuring in equal measure. It was comforting to be able to read the stories of intrusive thoughts, other women's experiences and realise that I wasn't an isolated case. And in talking to - I went to another GP and she was great, she'd seen it all before. And the fact that it was a little bit passé to other mental health practitioners that I'd been in touch with was reassuring as well. Okay, this was a pretty ordinary case of PND. And nothing over the top, but in saying that, the symptoms were still there and they were still really intense.
The second bout of PND is quite different to the first. I think it's a matter of stress, exhaustion and isolation I guess. It wasn't really the same emotional territories that I went into after having [my daughter]. I feel like a lot of that through the therapy has in a way been - not really taken care of completely, but it's been addressed adequately. So that it's clearly not um, manifesting in the symptoms that I had had previously.
With the intrusive thoughts I think I've done with that cycle of the PND... I feel like I'm on the recovery path with that because it is so rare that I have days or moments of the thoughts still coming through. And the level of self-awareness and understanding that I have with that is obviously effective because it's minimising their presence. So I think it was just intensely valuable to have the opportunity to have regular psychotherapy and to talk it out and I think I worked really, really hard at trying to understand where they were coming from, and to understand the familial history and how that has sort of been embedded into my psyche and my sense of self. And so that's given me the chance to let go of a lot of that which has led to, I guess not full recovery but on the way.
And this time round with - probably more of a stress and exhaustion-induced postnatal depression it's been chance to really pause and think about the things that I was doing wrong by, I think sort of overdoing it and taking too much on my plate.
More about Zara
Zara and her husband met when they were both in their thirties and were 'focused from an early point' on having children. They soon conceived and Zara described her pregnancy as 'pretty comfortable'. However, when postnatal depression was mentioned during antenatal classes, Zara was prompted to contact a local centre that provided perinatal support to women. She said she thought she might experience postnatal depression because of 'mental health-related issues' in her family.
After her daughter's birth, Zara had difficulty breastfeeding. She did not have enough milk, and switched to formula at six weeks. As a result, Zara had her period at three months and experienced 'intense' premenstrual symptoms. Combined with sleep deprivation and 'over-vigilance' towards her baby, this made her feel 'suicidal' and 'distraught'. Zara was often home alone with her daughter due to her husband's long work hours, and said she began to have 'strange thoughts' about the 'harm' that could come to her baby. She was worried there was 'something really wrong' with her but was afraid to tell her husband.
Zara's thoughts soon became 'overwhelming'. Concerned for her baby's welfare, she called PANDA and was advised to see her GP. Zara went to a late night clinic where she saw a 'pretty dodgy' GP who prescribed antidepressants (desvenlafaxine (PRISTIQ)), without offering other support.
Finding the antidepressants were making her 'more agitated', Zara went to stay with her parents for 'a break'. One afternoon she felt she 'couldn't be trusted alone' with her daughter. Zara told her parents and again called PANDA, who recommended she contact the local mental health Crisis Assessment and Treatment (CAT) team.
The CAT team told Zara she was experiencing 'intrusive thoughts' and that these were very common and a form of postnatal depression. Her husband's 'first reaction' to this was to say he knew she would never hurt their baby. Having worried about telling him about the intrusive thoughts, Zara said this was a 'big relief'. Having 'a name' for her experiences was also 'reassuring' and she began seeing a psychiatrist who recommended psychotherapy instead of antidepressants.
Zara and her husband decided to have another child. Although Zara was 'free of intrusive thoughts' towards the end of the pregnancy, her relationship with her husband became strained after their son's birth due to moving house and financial pressures. After a 'breakdown', Zara began seeing a 'fantastic' female therapist, and started taking antidepressants again (mirtazapine (REMERON)).
Zara was recently diagnosed with dysthymia, which she feels 'explains' how she has felt through much of her life. As well as antidepressants, Zara is undergoing psychotherapy, cognitive therapy, and practising mindfulness, as she wants to 'recover' for the 'benefit' of her family.
Zara believes adjusting to parenthood is 'confronting' for 'older, educated' women due to 'really skewed' values around motherhood. However, she feels 'optimistic' about the future and 'lucky' to have an 'emotionally intelligent' husband and supportive parents. She advises other mothers experiencing intrusive thoughts not to be afraid, and 'seek help and support as soon as you think something's amiss'.