Morning rush hour. Step off the train at Flagstaff and sit down on the platform bench as fellow commuters flow past. The wind blows through the tunnel and cools my swollen feet. I sob. A sparrow pecks at crumbs.
People look sideways. No one likes to see a pregnant woman cry. But they do not stop and I am glad. There is not enough air in the world to breathe, let alone speak. And what to say? The panic has come back, like a big, ugly wave. Enormous, insurmountable.
I ring my partner. Stay where you are, he says, give me 15 minutes. It is all too much, I say, far too much. We need to go to the hospital. I'm not in control.
In my normal life, my life when I'm not sitting on a bench in tears, I am a journalist. I often write about mental health. When I interview someone, I ask them: was there anything that stands out in your mind? A particular day or moment? I try to elicit colour, find the hook.
So. It was the train trip that morning. The man opposite me was breathing. Pregnancy hormones had given me supernatural powers of smell. Last night's garlic was on his breath. It made me gag. Cover my mouth, turn to the window, find something else to focus on. Look at the sky. But there was only the scribble of powerlines, blunt office buildings.
My anxiety and flat mood had been building for weeks. Circling, mercurial thoughts. I couldn't sleep. After broken nights I would rise at dawn with my two-year old. Find something suitable to wear to work and stretch it over my growing belly. Throw up my breakfast. Drop my child at creche, and launch myself towards the station, hoping the momentum would carry me. Work was something of a relief, a focus. But under it all, the humming dread. It was happening again.
My first child, my daughter, had emerged serene, smeared white with vernix and her lips in a rosebud pout. But when those lips met my breast it all went wrong. Poor attachment, toe-curling agony. My recollection of that time is thankfully patchy. Days and nights folded together. The lamp was always on, the fan stirred the summer heat. The whump whump of the breast pump. My daughter woke often, I slept little. I had post-birth complications that needed bed rest. It felt impossible with a newborn.
I didn't fully appreciate it until my daughter was born, but breastfeeding lay deep at the heart of my hopes for motherhood. When I realised I would probably not be able to feed her, it was a deep loss, a grief. I pumped every two hours, counted every blue-hued drop. I berated myself. What a terrible mother, what a failure. When we finally took our first walk around the block with the new pram (bought months earlier in happy anticipation), I clutched my partner's arm in fear.
In hindsight, I know my deteriorating mental state had become entwined in a nasty symbiosis with my breastfeeding trials. Plus there were other seismic shifts of parenthood; identity, independence, confidence. Add hormonal fluctuations, sleep deprivation and escalating anxiety. And so, in just a few short weeks, I went mad.
"Is it meant to be like this? Because it feels like the worst time in my life", I confided to our independent midwife, Alice. Alice of the calm demeanour and soothing vegetable soup. She gently sat me down, and told me she thought I had postnatal depression.
Terri Smith, the head of the national perinatal anxiety and depression helpline, PANDA, says the most common question she is asked is why? Why do mothers (and some fathers), get sick? But, like the causes of cancer, for example, there is no straightforward answer.
The reasons are as complex as the woman herself, but there are some notable risk factors, some of which I recognise in myself. She may have a history of anxiety and depression (tick). She may be experiencing problems feeding her baby, or not have had much sleep (tick). She may have suffered a previous reproductive loss, had IVF or a difficult pregnancy or birth. Financial difficulties, isolation, child sexual assault, and family violence, all increase the risk.
It can happen in the period after the birth, but women also become unwell when they are pregnant (tick). You know, that blissful "glowing" period when you are supposed to "nest", like some oversized bird, and colour-co-ordinate baby clothes.
"It doesn't matter who you are, or where you live, it doesn't discriminate," says Smith.
In line with evolving knowledge, PANDA last year changed its name. "Postnatal" became "perinatal" (meaning the time before, as well as after, birth) and the term "anxiety" was added; Perinatal Anxiety and Depression Australia. This was to increase the focus on anxiety as a perinatal mental health issue, because anxiety is as common, if not more so, than depression. More than half of the callers to PANDA describe anxiety as their overwhelming symptom.
This is what acute anxiety feels like; your body and mind are careening out of control. In response to stressful circumstances, the "flight or fight" dial gets stuck on "flight", leaving your adrenal glands in permanent overdrive, pulse racing. I would fall asleep, exhausted, and then wake two hours later to spend the rest of the night awake, locked in panic. At times, I was sure my heart would simply give up.
Each year as November approaches I plan to do this story – this is the annual awareness-raising week for perinatal depression and anxiety. My daughter is now five. And finally, this year I felt ready to write about what it was like to get sick, and recover. Because I did. And you out there, who are gritting your teeth and inching through each day, you will too.
After my talk with Alice, it made more sense. I went to my trusted GP, sat in her chair like a sack made of trackpants and misery. I knew little about medications such as antidepressants. And I was suspicious, and sanctimonious. What about herbal alternatives? What about acupuncture, or exercise?
But acute mental illness allows no space for vacillation. My baby needed a functioning mother. For me, the only option was counselling and medication, in consultation with my doctor. A call to the PANDA helpline prompted a weekly check-in with their calm telephone counsellors. They didn't seem to mind if I asked them to wait while I changed a nappy, or told them I didn't feel like talking. And, after a few months, it worked. The gloom rolled back and my heart rate slowed. And my daughter and I were in love.
But about half of women who have suffered from perinatal anxiety or depression go on to experience it again in their subsequent pregnancies. Tick.
So here we are, again. Confronted by a tearful, heavily-pregnant woman, the triage nurse at the Royal Women's Hospital is deft and efficient. We see the psychiatric registrar, a woman my own age wearing a mustard sundress, which, in another life, I might have coveted.
As I rock back and forth I tell her, naively, that I want to – must – be admitted. No, I tell her, I am not suicidal, but I am worried I may become so if left untreated. I explain we have called my doctor but she is away, and that the younger colleague I saw instead was out of her depth. To her credit, this younger GP asked the advice of a senior colleague. To his discredit, he told her she should "never" prescribe a sedative to a pregnant woman. He was wrong but I believed them, and my despair ballooned. I still feel angry about that.
But it is not uncommon. There is widespread ignorance about safe medication during pregnancy. And not all doctors have access to current information about drug use at this vulnerable time. Professor Louise Newman, from the Centre for Women's Mental Health at the Royal Women's Hospital, says early intervention is always best.
"We weigh up the costs and benefits of a particular intervention. Medication for something like depression or anxiety are only one part of support and treatment that are going to be helpful in the transition to parenthood."
You don't want to enter the mental health system, the psychiatrist tells me gently. That's for people who are really sick. She sends me home with a new script, regular appointments and a place on a six-week class for pregnant women who are vulnerable to anxiety or depression, at the hospital's mental health centre.
A class with other mad women? It is a revelation. I meet them each week to talk about expectation, and fear. Fear of becoming unwell again. Fear so powerful it triggers the very thing you dread. One of my classmates is so anxious she paces the room, sweat pouring down her pale face. Her baby is induced early because of concerns for her mental stability. Another seems caught in treacle, heavy with melancholy. We talk about mindfulness, eat chocolate biscuits and try to focus on the moment. We make lists. When one person talks the others often cry. I download a mindfulness app, and sometimes even use it. And, like before, slowly, I get better. You will too.
I know there are many good reasons not to use the word "mad". Women battling with their minds, or with the hand they have been dealt, have been labelled mad for a long, long time. It is a historical relic, long superseded by the fluency of contemporary psychiatry and our knowledge of the capricious mind.
But when I was in the midst of it, this was the best description I could find. "How do you feel?", my partner would ask. "Like I am going mad," I would reply. And this lineage gave me unexpected comfort – I was thankful I was not the first, nor the last.
As a patient, I felt so fortunate to live in an era that is more accepting of mental illness. As social affairs writer, I feel a responsibility to remind people it is common.
When I was unwell, and unable to breastfeed, I was deeply afraid people would think I was an uncaring mother. An incomplete woman. It saddens me that this judgement (real or imagined) permeates so much of motherhood.
Looking back now, I realise something else. My experience was an early lesson, albeit a searing one, in becoming a parent. In relinquishing control and expectation. In being thankful for the most important thing: a healthy baby. Our second child, a son, was born on the floor of the hospital in a great rush of pressure – and joy. I was well, and able to savour it. I scooped his long limbs onto my chest. He was a buttery white and beautiful, like his sister. I whispered: "You're here. It's so nice to finally meet you".
Perinatal Anxiety and Depression Australia (PANDA): 1300 726 306
Beyondblue (24 hours): 1300 22 4636
Miki Perkins is social affairs reporter for The Age. You can follow @perkinsmiki or her Facebook page.