Everyone knows someone who has had post natal depression (PND). In the UK about 1 in 10 of mothers get it, and a third of those start to develop signs during pregnancy.
I got a very severe form of PND which I wouldn’t wish on my worst enemy. Common things people say to you when enquiring as to why I may have got it often suggest hormones, along with chronic lack of sleep, the stress of caring for a newborn. All those contributed, I have no doubt.
Factors known to contribute to PND on the NHS website include a history of mental ill health, a lack of support, stressful life events like bereavement and a poor relationship with your partner. One of the key things missing, or at least an extra level of detail, is the level of work-related stress during pregnancy.
Antenatal and postnatal anxiety are known to be related to postnatal depression. I work in the charity sector and there is a relatively high proportion of women going on maternity leave, returning, perhaps going on leave again to have a second or third child.
Outwardly we see the changes, people coo over the growing bump. But we don’t often stop to think whether this person is being properly emotionally supported as they approach a HUGE life change. It is irritating that a lot of people view maternity leave as time off, rather than a crucial (and gruelling) time. A time to bond with one’s child and learn a vital new skill–being a parent–a skill that can make or break a child’s life.
My personal experience of working while pregnant was stressful. I was the third in a string of people working at my grade to go on maternity leave in quick succession. As well as taking on some of the earlier maternity leavers’ work in addition to my own, the organisation was undergoing a period of restructuring with a lot of people leaving. My work support network was dwindling, the atmosphere was bad, and I felt an enormous amount of pressure.
I was working towards a promotion which added to the mental load. In my final week of work I gave a two day workshop in 35 degree heat, while handing over my project work and preparing to have a home birth and get all the kit needed for having a baby. My partner was in ‘start-up mode’–working from home with a small and uncertain income.
It became fairly normal for me to begin a day doing breathing exercises with a meditation app to keep the morning’s anxiety at bay. Then saying affirmations to myself on my cycle to work (encouraged by my hypnobirthing teacher) that ‘I am a confident woman!’, ‘I am capable and can do my job well!’ After long days at the office I’d get home, eat and then do yoga to unwind before bed. Repeat 5 x per week.
Then, maternity leave arrived. And…breathe! It was wonderful. I spent it reading under a tree in the park and napping. It felt like the anxiety lifted all of sudden. It did. But when my baby was born, its legacy lived on.
I had been doing a lot of project management. I brought my strict ideas about productivity and getting things done, making lists and doing things to the best of my ability, to the way I went about being a new mother. The whole learning style needed as a new mum, at least the one I think works best psychologically for many of us, is one of trial and error. Realising we know nothing and having a go. Realising that there isn’t always a right or wrong way of doing things. That certainly wasn’t my mindset.
I was lucky to have a year’s paid maternity leave. But the one year mark felt like a grim deadline awaiting me. I was stricken with terror at the thought of going back to work. I did, in fact, get promoted. This filled me with horror. My thoughts at the time (in the grip of post natal depression) went along the lines of… ‘I can barely function. I will have to resign and pay back my maternity leave to my employer. There is no way I will be able to fulfill this role’ (this belief remained until about a month after I actually did return to work).
There are a lot factors behind me getting post natal depression. But prenatal anxiety was a big one, I’m sure. Which begs the question- how can we better support pregnant women and new mothers, people who are so vulnerable to mental distress in our society?
In particular we need to be extra supportive towards single mothers, poor mothers, disabled mothers, and black mothers, among other marginalised groups of women. Black women are five times more likely to die as a result of childbirth in the UK than white women, and four times more likely to be sectioned under the Mental Health Act. The reasons behind these awful statistics are complex, but include the fact that black women are less likely to be listened to by healthcare professionals, and carry the trauma of racism.
Furthermore, stress in workplaces is rife. It’s more or less accepted as normal. A 2018 survey found that 74% of UK adults have felt so stressed at some point over the last year they felt overwhelmed or unable to cope. 81% of women said this compared to 67% of men.
All workers need to be better supported. A lot of the stress we suffer can be avoided with fairly simple measures. But we need to acknowledge that the pressure on women returning to work after having a child is huge.
Questions weigh on us, like:
How will I adapt to working a challenging job when I also have to look after a baby?
Is it worth me going back when my salary is almost cancelled out by the cost of childcare?
I’m so tired, I don’t think my brain is going to remember how to work.’
So, what can we do to better support mothers at work?
Managers need to be extra vigilant and check regularly with pregnant women and new mums that they can cope with their workload and responsibilities. In pregnancy in particular women undergo huge, physically draining changes, not to mention physical ailments at all stages along the way in addition to the mental burden.
Flexible hours and the ability to work from home should be offered wherever possible.
When returning to work after maternity leave, it would be hugely beneficial to offer a staged return, where working hours are steadily increased over a number of weeks. This would allow women to adjust to the return to work (which can feel like a brutal shock after a long period of unstructured time with a baby), new duties like nursery pick-ups and the sheer fact of having to return to a job on reduced hours of sleep.
Going further, employers could proactively discuss the risk of postnatal depression with their staff. Not in order to scare people, but to let people know what to do if it happens and how their workplace can support them. Your entitlement to sick leave, whether the employer can offer phased return to work, how it has supported others with depression and, of course, your legal rights.
Staff should be strongly encouraged to look out for their colleagues’ mental health and, if possible, be trained to spot the signs of mental distress and how to support others. The ‘Ask Twice’ campaign from Time to Change puts it nicely — “Sometimes we say we’re fine when we’re not, so if your mate’s acting differently, ask twice.” Most people will soldier on, ‘put up and shut up,’ and the early warning signs of depression can be hard to spot.
These are just a few ideas. I’d love to hear more from people about what has helped (or hindered) them.
So, spare a thought for the pregnant women and new mums in your life. Check whether they’re doing ok. Twice. And, whatever you do, don’t blame it on the hormones.