Being a new parent can bring a surge of unexpected feelings, not all of them good. Dionne Christian relives her own battle with post-natal depression - now called perinatal distress - and talks about how to get help.
Sipping a tepid cup of tea and staring at the biggest pile of washing I'd ever seen, I looked around the living room and wanted to disembowel those who wrote the poems in the "It's a Girl!" greeting cards that surrounded me.
Just 19 days into new motherhood and I was falling apart. Rather than wanting to dance with butterflies and fairies, as the cards seemed to suggest I should, I imagined getting in my car and driving as far away as possible. Of course, I'd have to leave in my pyjamas because I hadn't found time to shower and change for the day - or the one before that either.
Nothing had prepared me for the relentlessness of first-time motherhood and the unceasing feed-change-sleep cycle, which in our house went more like: attempt to breastfeed, only to have child refuse to latch and start to scream, give her a bottle and feel an all-consuming guilt about it; change, only to have child vomit (and scream) and need changing again; try to settle baby only to have her scream and scream and scream until she falls asleep around 25 minutes before, according to the midwives, it's time to wake her and repeat the whole process.
Even when my newborn daughter was asleep, it was difficult for me to grab any myself because of my escalating anxiety about feeding her and why she cried so long and so often.
In the maternity ward, her crying was remarked on. One of the nurses said they were moving us to another room because she was disrupting the other babies and mothers with - and I quote - "all her noise, I've never heard anything like it".
Expelled from an institution 36 hours into her life; it felt like a great start.
One nurse then helpfully suggested she was an "emotionally disturbed" child. You can imagine, as a new mother, having had three hours sleep in 72, the worry and anxiety that one careless comment created. Was my baby having problems feeding because she was disabled, disturbed or sick? (For the record, my daughter was a ventouse delivery and I suspect she had a pounding headache. Furthermore, if it's right that what the mother eats alters the taste of breast milk, she may not have liked the spicy chicken curry the new mums were served for dinner the evening she was born.)
The midwives, the GP and the La Leche League woman I asked were unable to give me a straight or definite answer as to what was going on. Then again, one of the things I now realise is that caring for a baby is not an exact science and there is no "one size fits all" answer.
But family and some total strangers in the supermarket had plenty to say: I was told to stop breastfeeding and put her on a bottle because I wasn't "a good cow"; to persevere with breastfeeding because "breast is best"; to let her cry, pick her up, wake her for feeds four hourly - no, three hourly - let her sleep, don't forget to exercise and eat lots of healthy food, make time for my husband; maybe even express some milk and have a date night!
The completely contradictory suggestions overwhelmed me. I didn't feel I could trust my instincts because I obviously didn't have any. I started having panic attacks. I stopped eating. Nothing I did seemed to be right. What was I doing wrong and why did every other mother seem to have it down pat?
Although it felt as if I no longer had any control over my life, through the fog of tiredness and mounting despair, I realised I had a choice. I could struggle on and risk my sanity, and that of my husband and quite possibly my daughter's safety, or I could fess up and ask for help.
The second option appealed more, so I referred myself - yes, you can self refer - to a psychiatrist specialising in maternal mental health. She calmly listened at length to my concerns, recommended a course of treatment which included medication and counselling, and, as a mother of three, shared some of her own thoughts with me.
These included taking some of the skills I'd learnt through working for 20-odd years and applying them to home. Not so much "scientific management" but basic stuff like "just as you would prepare for a meeting, prepare for each feed. Have everything you'll need within reach - and don't wear Helen Cherry pants that you don't want baby to vomit on."
She suggested turning to just one or two friends or support organisations, like Plunket, if I felt I needed advice but she added I should make sure whoever I sought help from shared my and my husband's values, understood our lifestyle and what was important to us, and had no hidden agendas.
She also advised talking openly and honestly with the new parents in our newly formed coffee group, saying it might help others who could be encountering similar difficulties. To me, it didn't seem as if anyone else was doing it tough but I decided there could be no harm in "sharing".
Talk about opening the floodgates. As soon as I admitted how difficult I was finding things, so did around three-quarters of the coffee group, while the remaining members offered to help in whatever way they could.
From that point on, all of us discussed candidly the demands of caring for a newborn and things we wished we'd been told about: latching pain, growth spurts, how nailing jelly to a street was possibly easier than changing or bathing a wriggling newborn.
I am aware not everyone finds it as painless to bear their soul, particularly at coffee group. Other friends have talked about how competitive they found the whole scene, but I sometimes wonder if we mistakenly think mums (and dads) are bragging about their child's progress when, in fact, they are simply trying to work out whether their bundle of joy is normal.
So this is a survival tale. It might not involve wildlife, extreme weather or hacking an arm off with a penknife. More Woman Vs Domestic than Man Vs Wild, if you like, but what I faced is being played out in thousands of New Zealand homes.
It's one of the most common but least discussed mental health issues: postnatal depression - although, more recently, those working in the maternal mental health field have adopted the term perinatal distress (PND). They say this more accurately describes the range and spectrum of post-traumatic stress, anxiety and depression that some mothers - and fathers - experience during a pregnancy and after the birth of a baby.
Indeed, I don't think I was depressed; just acutely anxious and ill-prepared.
Around 80 per cent of new mothers go through the "baby blues" in the days immediately following giving birth. Characterised by tearfulness, anxiety and low mood, these feelings usually peak three to five days after birth and are gone by 10 to 14 days as the body's oestrogen levels balance out.
While it's normal to feel anxious and tired after the birth of a baby, for most new mums and dads these feelings pass and they adjust to family life. But with perinatal distress, the anxiety and low mood linger and can intensify. Other emotions such as fear, continual sadness and/or recurrent and intrusive thoughts may appear - sometimes not until several months after baby's birth.
Exact numbers are difficult to come by, but it's thought 20 to 30 per cent of expectant and new mothers suffer a bout of depression or anxiety. Latest figures from the Antenatal and Postnatal Depression Association in Australia also indicate anywhere between 10-33 per cent of fathers face similar problems.
Yet there is no targeted awareness campaign, no TV advertisements - celebrity fronted or otherwise - and not a lot of discussion in antenatal classes about PND. Thankfully that may be about to change.
For years, community-based groups, often run by volunteers, have worked largely in isolation to support families with PND. In October, Wellington's PND Support Group held a national conference bringing together dozens of people and organisations working in the sector.
Conference organiser Rosie Smith says the most moving moments were when keynote speakers, workshop presenters and a few "brave" delegates shared their personal stories of PND.
"There was a coming together in shared experiences and a passionate call for the voices and stories of New Zealand PND to be heard," she says.
Because there was no national umbrella group for perinatal mental health/illness in New Zealand - and subsequently no focus for awareness and advocacy - in February the Perinatal Mental Health New Zealand Trust (PMHNZ) was born.
Smith is the trust's inaugural chairperson and says its purpose is to lobby for more research into the condition and for government to put PND on policy agendas. For the organisations and groups working around the country, the PMHNZ Trust will act as a focal point and signpost for resources and information sharing.
With Mother's Day fast approaching, those like myself who have lived through PND say it's time to share stories and let other parents know they're not alone. If there's a wish list surrounding parenting, greater honesty about the emotions surrounding and experiences of having a newborn is at the top.
Mental Health Foundation CEO Judi Clements agrees parents need to tell it like it is, especially if there's a chance a PND-related issue is developing.
"PND shouldn't be Mother's little secret. We know that we are all more vulnerable to mental illness at times in our lives where change is happening around us - leaving school, changing jobs, getting married, going overseas and, yes, having babies."
There is widespread belief women are more frank than men about mental health issues but Clements believes PND tends to be something they are reluctant to discuss.
"Society tends to romanticise motherhood and, because of that, women are often reluctant to admit they are struggling with their feelings. It goes against the fantasy created around mothering."
One of the happiest surprises of Clements' working life was when EGG Maternity, who make and sell high-end maternity clothes, approached the foundation wanting to raise awareness of PND.
"I've worked in the mental health field for more than two decades in the United Kingdom and New Zealand. This was the first-time a private sector business came to us and said, 'we've identified a need and want to do something' because they were hearing, through their stores, about families living with PND."
The collaboration led to a brochure which Clements says is the most requested of all those the Mental Health Foundation publish. In 2009, 32,548 copies were distributed.
Ruth and Andrew Holt agree wholeheartedly with the need to talk. Ruth also felt huge anxiety about feeding and caring for her newborn son, Isaac. Our experiences were similar in that she found it nearly impossible to sleep and rest because her mind whirred continually with thoughts about what she should be doing.
She had panic attacks, hot and cold sweats and struggled to bond with her son. None of the advice in the baby books about settling Isaac and getting him into a routine worked - and she found it contradictory from book to book, anyway - while life as she knew it seemed to have stopped completely.
She struggled on for six months until she finally collapsed. With her father visiting from England, Ruth found herself screaming uncontrollably when Isaac wouldn't lie still during a nappy change.
"Dad rang my husband Andrew at work and told him to come home immediately."
Andrew knew his wife was finding it tough, particularly as they had no family in Auckland. But like many new fathers, he felt torn between financially supporting his family and taking time off to help his wife.
When the breakdown came, Andrew told his employers and colleagues and found them supportive. But he counts himself as lucky; he's well aware not every new dad has sympathetic employers.
Visits to doctors and referrals to a psychiatrist and cognitive behavioural therapy followed. Ruth was prescribed medication and joined a support group.
As Ruth points out, it's a misconception that PND occurs among mothers whose children are difficult: "As babies go, Isaac was actually pretty good; the problem was my high levels of anxiety. The most perfect baby can still have a mum who develops PND."
The Holts are expecting a second child later this year. The family is already putting in place plans to minimise the risk of a PND recurrence. Reflecting on what happened, Andrew Holt says he objects to the language used around PND.
"Expressions like the 'baby blues' are really fluffy and light; even the term 'post-natal depression' made it sound like something which would eventually resolve itself when the post-natal part of life is over and things return to normal.
"I think it trivialises what is a serious and potentially dangerous mental health condition with far-reaching consequences and I think we need to come right out and say, 'it's serious so don't muck around. Get help as soon as you think something is wrong'."
Of course, it raises the question of why, when it can be so difficult - but isn't always - does anyone have kids? The mums and dads I spoke to have all had more children or are pregnant again.
As well as my amazing 6-year-old - now planning on becoming a princess vet - I've got a lively 20-month-old daughter and want to have a third child.
Parenting offers the chance to be a kid again and see the world with renewed interest and vigour through the eyes of your children; it prompts you to reconsider priorities and focus on new aspects of life. Having children and being involved with a greater range of community groups can make you feel more closely connected with people in the neighbourhood.
Like most things in life, PND passes and can leave you feeling stronger and surer in yourself. The key is discussing the issue and getting help quickly.
Find out more
For help or to learn more about PND click here.
For more information about the Perinatal Mental Health New Zealand Trust (PMHNZ) email pmhnztrust@gmail.com
