Wednesday 21 March 2012

Baby Blues?

"4 month old baby, crying, mother not on scene"

To be honest, it seemed like a rather bizarre call to get. A crying baby is hardly a medical emergency now is it! We had no other information other than that to go by so mind open we headed round. We arrived at a block of flats and waited an eternity to be let in. Eventually, as someone was leaving we bundled in and headed up the stairwell. I could hear the babies crying as we entered the corridor, so just followed the noise. The door to the apartment was ajar so we knocked and entered. Standing in the living room was a guy with his hands in his pockets. On the floor, in a car seat, was the baby crying.

"What's the problem today?"

"The mum gave me the baby and said she can't do it anymore"

"How do you know her?"

"She's my neighbour, she hasn't been right"

I started checking over the baby, he seemed well. I opened that bag that he was left with and found some milk. It worked a treat, we could now start to try and unravel what has happened. 

We called the police and requested social services. While waiting we managed to track down a friend on the phone. It turns out that the baby's mother may have been suffering Postnatal Depression. She had been crying a lot, been very irritable and had been losing her temper with the baby. Apparently there had been weight loss through not eating and a distinct lack of sleep. She hadn't received any help either which I found strange. PND can often bring feelings of denial to services because new mums fear their child may be taken away, but in this case it appears she had fallen through the cracks in the system. Not speaking fluent English maybe she didn't know what services she was entitled to or maybe her symptoms had simple gone unnoticed by those she came into contact with. What we did know was there was a vulnerable adult missing and no one seemed to know where she might be.

Postnatal depression is very common, yet too often new mothers are left to suffer in silence, struggling alone with the pressures of parenthood without any diagnosis. Giving birth brings with it a range of emotions from pure happiness to anxiety and mild depression. The mixed emotions and tearfulness are often put down to 'baby blues' by GPs and other services alike and are fully expected to clear up on their own.  When it doesn't and the depression gets worse the PND occurs. It usually happens when the child is between 4 and 6 months old and effects 1 on 10 new mothers. It can be a gradual or sudden onset and can be mild to extremely hard hitting. Clearly in this case it reached the extreme of abandonment. With no father around and an apparent lack of access to services she had left the baby and run; that to her seemed the only logical option. Obviously for an outsider looking in it isn't a rational thing to do but not being in the mindset of a mother in such difficulty it's hard to comprehend what she is going through.

The signs and symptoms of PND are extensive and varied and I think it's important that anyone close to a new mother is aware of them. New mothers may go through one or more of the following experiences, although it's extremely unlikely that they will go through all of them:
  • feeling very low or despondent, thinking that nothing is any good
  • feeling tired and very lethargic, or even quite numb
  • not wanting to do anything or take an interest in the outside world
  • a sense of inadequacy; feeling unable to cope
  • feeling guilty about not coping, or about not loving the baby enough
  • being unusually irritable, which makes the guilt worse
  • wanting to cry
  • losing your appetite, which may go with feeling hungry all the time, but being unable to eat
  • difficulty sleeping: either not getting to sleep, waking early, or having vivid nightmares
  • being hostile or indifferent to your husband or partner
  • being hostile or indifferent to your baby
  • losing interest in sex
  • having panic attacks
  • an overpowering anxiety
  • difficulty in concentrating or making decisions
  • physical symptoms, such as stomach pains, headaches and blurred vision
  • obsessive fears about the baby's health or well being
  • thoughts about death
It is the latter that was concerning us today. Intrusive thoughts about death can be frightening and make the person fell they are losing control. Clearly it had got to the point where the mother could no longer cope alone and desertion seemed the best thing to do. It was imperative she was found for her own well being so she could receive treatment and prevent her son going into the care system.

Under normal circumstances PND is assessed by health visitors who use a tool called the Edinburgh Postnatal Depression Scale. When originally designed it was meant for British women and its usefulness and effectiveness on women from ethnic minority communities has been brought into question. Perhaps this job was a case in point. Maybe her poor grasp of the English language had caused her to continue without diagnosis. Like with most things with the ambulance service, we are limited to what we can do. We have an hour window to diagnose, treat, refer or convey so even if she had been in contact it isn't necessarily likely that we could have helped. New mothers need to rely on friends and family and the health care professionals they come into contact with to get a diagnosis. 

Clearly the system failed on this occasion. We were left with an innocent baby whose mother was missing. It was impossible to imagine her mindset and frustratingly we never find out the outcomes. It's one of the most annoying parts of the job we do. All we can do is try and understand the causes and symptoms in the hope we are able to spot and prevent similar in the future. What this job highlights is the fragility many new mothers face despite apparent well being. If they become isolated a vicious cycle of denial can occur leading us to the situation we found ourselves in. It was this point that gave me the idea of combining my thoughts on the issue with that of someone who has suffered from postnatal depression. It is with great pleasure I introduce a fellow blogger and friend BookwormMummy. Gem shares her thoughts and personal experience with PND in an attempt to show the vicious circle and mindset of the patients we often come into contact with and how their feelings are often marginalised as 'Baby Blues'.

"Perhaps the majority of you reading the above felt a mixture of concern and disgust. I read it and felt a mixture of relief and hopefulness. Relief that the mother had walked away leaving her baby safe with someone who did the right thing, and hopefulness that by doing so it allowed her to find the help she desperately needed. I hope that she was found to be well and reunited with her baby with the proper support in place, which is the outcome everyone would hope for. I also secretly wish I had done something so bold to indicate that everything actually wasn’t OK. 

I have never been medically diagnosed with postnatal depression; I am not truly sure what my medical records must say about the three visits I made over a 3 year period to discuss my mood swings, irritability, anger, anxiety, night terrors, exhaustion and tearfulness. I do know that I have a phone number somewhere from my first GP for a local counselling group I could never get an answer from. I know the same GP told me on my second visit that I was perfectly normal and would be fine, that perhaps a diary where I recorded all my feelings and moments that made me happy each day would help give me a boost. I have that diary still; the few entries I made do not make happy reading. I know that from the third visit, to a different GP (that I burst in to tears in front of which rarely happens!) I have a leaflet about contraception. I know from the list above I had almost all of the experiences listed. I know no one ever really asked me the right questions, probably falsely assuming the smile I painted on my face every day meant everything was OK, and that joking about sleep deprivation and comparing myself to a milk machine at the baby clinic meant I was fine. I wasn’t fine, I was unable to make any decision or even speak properly when my baby would cry, my skin would itch with tension and my heart would race. I know I gave up on explaining myself properly to a GP and decided it was probably ordinary and I was just tired. I know that I felt isolated, alone and inadequate, even when surrounded by family, friends and my children that were hard work yes but thriving. I know that I am lucky to have made my way through it. I’m not entirely sure I am through it.

What probably made a huge difference to me was having good friends and a supportive family around me who picked up the slack on days I ran away, who helped the best they could to get me to rest, and who provided me with enough encouragement and reassurance I was doing OK that I believed them. Another godsend was having somewhere I could feel in touch with people also having a bad time. The Internet makes it easier to seek solace and support even when you’re too anxious or exhausted to leave your front door; it is also fairly anonymous or at least I don’t have to look someone in the eye when I type “I am struggling” or “I’m not sure I can do this anymore”. I wasn’t really aware of any support groups or charities that I could approach; I felt they were for the really ill ones, or people that didn’t have anyone there helping them, I didn’t think I deserved to be a bother or would get treated with the same vague shrug and a hug I got from my GP. I should really have realised I needed to reach out, but until I emerged from the really ugly fog I didn’t actually realise how immersed I was. That is the difficulty with depression, it isn’t a choice or a state you trip up in to suddenly; it creeps up, masked usually by other events like illness, or sleep deprivation, or a bad turn of events; then before you comprehend it you’re stuck in the fog unable to think clearly or find your way home."

This was a very valuable exercise from a patient care point of view and one I intend to use more often. As health care professionals we are often far too focused on our own job and those of the services we interact with. The patients voice is often lost amongst all the hypocrisy but if we can start to understand the mindset of the people we are trying to help then perhaps the level of care they receive will be greatly improved. 

If you are suffering with PND, or know someone who is or might be, then contact Mind
for advice. Don't allow it to go unchecked.

Mind infoline 0300 123 3393
or email to

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