While motherhood for many is a tale of beautiful nurseries and lullabies (among the utter exhaustion), for around one in seven Australian women, it comes with the added struggle of depression and/or anxiety during pregnancy and the first postnatal year.
Despite this incredibly high incidence, research shows that women with perinatal mental illness often suffer in silence – with only 34 per cent of women who considered themselves 'emotionally distressed' after the birth of their babies seeking help. Often it's up to health professionals, such as childhood nurses and obstetricians, to look for the signs prompt the conversation, because it's not easy for mothers to admit they aren't coping.
"The stigma is quite profound," explains Dr Nicole Reilly from the University of Newcastle. "Women are worried about the repercussions of admitting to these feelings, but the reality is that seeking help means you are a really good parent and just want the best for yourself and your baby. A good clinician will listen intently to a woman and will do their best to support her to get the treatment that she needs."
In the hope of normalising the conversation around postnatal mental health, we asked three women to share their stories.
Elissa: "I was worried I couldn't pull myself together"
Elissa Harris, 31, mum to Lola, 4, and Georgie, 2
"It was after the birth of my second baby that I knew something wasn't right. I remember one really hot day when I just couldn't fathom the thought of getting dressed and going to the shops. I thought, if I see anyone I know down there I'm going to look like I'm struggling and I'm not going to be able to pull myself together. And if the shopkeeper talks to me I'm going to burst into tears.
Even though I had desperately wanted Georgie, I found being at home with a newborn and a toddler really challenging. There was the guilt when the two of them would be crying at the same time and I had to leave one while I attended to the other. I've never been much of a homebody, I liked filling my days going to story time and play dates but my children were napping at opposite times so I found it hard to leave the house. I thought, how am I meant to do this?
When I knew I wasn't OK
I took Georgie for her four month immunisations and as I was sitting there when I had an out of body experience. I felt like I was looking down on myself. That was the moment when I recognised that I really needed some support.
My post-natal depression wasn't the kind that you typically read about where you struggle to bond with your baby, it wasn't about that for me. Mine was more of an identity crisis, and not knowing where my role was as a mother and in life.
I struggled with maintaining my social connections and also with not having my biological mum around, as she passed away when I was seven. Having my own children brought her up my grief over her in a big way.
After the immunisation appointment I came home crying and told my husband what had happened. I was worried about judgement from other people… I mean, I still struggle with saying it now, that motherhood didn't satisfy me. I had assumed I would adapt to the role well but being at home made me feel like I had no direction.
Seeing a psychologist who specialises in post-natal depression was a turning point. Just acknowledging that I was struggling without my biological mum around and that I needed support... as soon as I spoke about these things and owned them, things started to get better. I also reconnected with an old friend and I really turned to her.
I probably won't have another baby. Things have become so much easier now the newborn phase of my daughters is over. They're a lot more independent now and I'm enjoying motherhood much more. I don't think I would put myself through that again.
Kelly: "I was terrified to tell anybody my thoughts"
Kelly Hansberry , 34, mum to Ruby, 3, and Jack, 10 months
"I didn't realise I had post-natal depression until nine months after my first child Ruby was born. Looking back, it actually started when I lost my job at 20 weeks pregnant. I had a rough time breastfeeding my daughter, I didn't have supply, it was painful, and my daughter had attachment issues. I felt such a huge pressure to breastfeed. I ended up on the medication motilium to boost my milk supply but a side effect of that can actually be depression and it set the ball rolling for me. My mental health deteriorated, I just couldn't sleep anymore and I was crying all the time.
Unfortunately the crisis point for me was where I started to feel that I wasn't really safe around my daughter. I was having thoughts like, 'if I let go of the pram and let her go down a hill, that would end all my problems, because she'd be gone'. I knew those thoughts weren't right, but I was having to fight against them on a daily basis.
Initially I kept things to myself because I was absolutely terrified that if I vocalised them to anyone they would say I was an unfit mother and they would take my daughter from me. I was lucky enough to have a great GP and I ended up admitting to her that I was really struggling. She did The Edinburgh Postnatal Depression Scale (EPDS) on me and referred me to an amazing psychologist.
I've had to accept that I also put a lot of pressure on myself in relation to the way I viewed motherhood and what I should and shouldn't be doing. I thought I'd enjoy not working, and that breastfeeding and attachment to your children should come naturally. I had PND with both of my children and one of my hardest symptoms was not being able to feel emotions towards them. When they would smile or do things that should generate emotion in a mother, I didn't really feel anything. I knew that wasn't right.
The fog lifting
Returning to work after both babies sped up my recovery, and having time without the children enabled me to appreciate them more.
Unfortunately my PND and suicidal ideation returned after my son was born. It wasn't surprising, but it was still awful. Through working intensely with my psychologist I was able to get back on track after about six months. I still have challenging days, and on them I try to focus on positive self-talk self-care strategies like checking in with my diet or having another coffee or going to the gym when my husband gets home from work. I also volunteer with PANDA as a community champion and with CFS the local country fire service. I find it's often helpful to divert my focus outward.
There is most certainly light at the end of the tunnel, mothers matter too and we are worth just as much as our children."
Felicity: "I remember my husband sitting on the couch with his head in his hands"
Felicity Flanagan, 42, is mum to Emily, 3
"My husband James and I were in the process of being matched with a child for adoption through Barnardos when I fell pregnant with Emily.
I had a lot of anxiety during my pregnancy. It was a pre-existing condition, but I didn't enjoy the feeling of being pregnant. I had such intensely painful breasts and nipples that I couldn't wear bras and as I grew bigger, I started to feel trapped in my body. I would go driving at 2am to try to escape the feeling, I was so anxious and uneasy, it was keeping me awake. I felt really weird and detached and I kept thinking "I can't do this."
Emily was born prematurely and she was in the NICU for three weeks, wired up to machines. It was in the hospital I started to have strange thoughts and feelings. I felt really, really low and I was in my room just crying all the time. I couldn't leave the hospital to go anywhere and I started to feel really trapped.
At this point, Emily was too little to breastfeed, so I was in the milk room, pumping milk every two hours for her. When we got home she still wasn't able to feed. We tried everything, including lactation consultants, getting tongue tie fixed, hypnotherapy, nothing worked. Emily latched on for three minutes during this whole time, I filmed it, but other than that I just pumped exclusively and fed her breastmilk through a bottle so she got what she needed.
I began to feel really, really angry about not being able to feed my daughter, I had intense feelings of rejection. I would say to my husband that I hated that Emily wouldn't latch, and that she doesn't love me. Sometimes I had to put her down and leave the room because in my heightened state of anger I knew that I could potentially hurt her.
I recognised that my anger was out of control but I couldn't help it. People would try to advise me on breastfeeding and it just made me more upset. I got my mum to come and stay and she and James looked after Emily and I didn't have anything to do with her for a little while, other than pumping.
A blessing in disguise
I remember my husband sitting on the couch one day with his head in his hands after listening to me saying very irrational things. He went and got advice on what to do. My GP intervened and we started going to the child and family health clinic and they helped by getting me some counselling and also helping with Emily's sleeping. It was really helpful to talk to somebody, they gave me self-care and relaxation strategies.
Then when Emily was five months old I got sick and I had to stop pumping straight away as I was put on medication which would transfer through to my milk. That time turned out to be a blessing in disguise, as James had to take over with Emily. After using up the pumped milk in the freezer he put her on formula, and when I got home he taught me how to feed her that way. I began to have a sense of freedom for the first time in five months.
Things slowly got better for me as I've adjusted to motherhood. I was wholly unprepared for what happens behind closed doors. I had just assumed I'd breastfeed, I didn't know about the challenging behaviours of children. I just felt so inadequate and constantly assumed I wasn't doing the right thing by Emily.
As a mum you need to take breaks, ask for help when you need it, it's essential. When Emily turned two she started going to day care for two days a week and that balance has been good for us all. My relationship with my daughter has really improved in the past 12 months. She giggles a lot more, and I'm not so serious. Now, when my husband walks in to the house after work it's a happy household, we now definitely have more good days than bad."
If youneed support, please speak to your GP, call PANDA's National Helpline on 1300 726 30 , Lifeline on 13 11 14 or go to Beyond Blue.
To help us learn more about perinatal mental health, you can donate to Australian Rotary Health research.