Guilty Of Postnatal Psychosis

(Content Note: suicide and infanticide are mentioned in this post)

Who am I?

I am a veterinarian.

I had my first baby at 32.

I developed postnatal psychosis after the birth of that baby.

I had no history of mental illness before that.

I have a perfectionist personality.

This is me.

But given this information, you could mistake me for Melissa Arbuckle.

If you’ve read even just the headlines this week, you will know Melissa’s baby Lily died in horrific circumstances, as a direct result of Melissa’s undiagnosed postnatal psychosis and depression.

Melissa’s story is an important one. But I have yet to read a story by a journalist who gets the narrative of postnatal psychosis (or any form of psychosis) right. Journalism around psychosis, even decent journalism, focusses on the sensational.

But despite the inevitable sensationalism, in this case the journalists got one thing right. They investigated the lead up to this horror story. And that shows us the number of times this horrific outcome could have been prevented.

Melissa’s baby was born in April 2021.

The Age reports ‘Maternal health notes showed that as early as May 19 the new mother revealed she was having difficulty coping and became teary, later telling a lactation consultant she felt ‘out of control’.

According to News.com ‘Victoria’s Supreme Court heard that in the weeks leading up to Lily’s death, Ms Arbuckle had been ‘really down’ and she believed she injured her baby after rocking her bassinet too vigorously.’

She hadn’t injured her baby at that point, but her thoughts (believing she had injured her baby) were delusional, for weeks before her daughter’s death.

The Age also reports ‘The night before the incident, Arbuckle told her husband she was having suicidal thoughts, but assured him she could never go through with it.’

Lily died and Melissa nearly died after being struck by a train on the following day, July 11 2021.

Melissa was diagnosed with postpartum depression and psychosis the day after her daughter died.

When I think of all the points on this timeline that Melissa’s and Lily’s odds could have been dramatically improved, anger steals my breath.

Regarding the Maternal health notes made in May 2021:

‘Maternal health notes’ imply a nurse or midwife assessed Melissa at some point and, aside from making some notes about her difficulty coping and being teary, did nothing.

Midwives and nurses need to be taught: The baby blues and mild anxiety are not always the cause of a teary mother who is having difficulty coping. They need to know when and how to refer a new mother for assessment with a psychologist, psychiatrist, a mother baby unit, or at least a GP. And they need to err on the side of caution!

I am not surprised a lactation consultant didn’t know what to do with a mother feeling out of control. Lactation consultants tend to be laser focussed on getting breast milk into babies at all costs. But again – educating lactation consultants to look far enough beyond ‘latching issues’ and ‘milk supply’ to consider referral to qualified mental health care professionals when red flags are raised, would be a good idea.

In the weeks before Lily’s death, when Melissa is described as ‘really down’ – these were the weeks that preceded the night before Lily’s death.

The night when Melissa told her husband she was having suicidal thoughts.

From my standpoint and lived experience, I struggle to give Melissa’s husband much benefit of the doubt here. I understand (based on the article in The Age) that her husband lost his own father to suicide as a teenager. So, there is possibly a barrier of unresolved grief and trauma that prevented him from reacting appropriately to his wife’s symptoms.

But presumably he noticed Melissa being ‘really down’ for those weeks. Did he attempt to get help for her? And if not then, what was stopping him when she expressed suicidal thoughts to him on that night? The fact that she claimed she wouldn’t act on those thoughts? Did he not consider the amount of mental pain one needs to be in just to have suicidal thoughts?

For everyone reading this: If anyone ever expresses suicidal thoughts to you, PLEASE ACT! Even if there is no option but an ambulance to the nearest hospital. And if the person experiencing suicidal thoughts tells you they won’t act on them, not only are they too unwell to make that assessment, they are also suffering intensely and need help!

Yes, our public mental health system needs a lot of improvement, and there are nowhere near enough public mother baby units available. But even if the ideal of a private psychiatric hospital with a mother baby unit, was not available or an option for Melissa and Lily, a public hospital might have given them a fighting chance.

Back for a moment to the journalists reporting on psychosis. They tend to give all the characters surrounding the person living the horror of psychosis a voice, even if some of those voices are irrelevant and add to the stigma psychosis is already steeped in.

In Melissa’s case that person is her baby’s great aunt. In The Age article, this great aunt doesn’t want to be named, but she does suck up more than her share of oxygen. She has publicly expressed that she thinks Melissa’s actions were ‘catastrophic’ and ‘cruel’.  Catastrophic – absolutely. But ‘cruel’ implies the malicious intent of someone whose mental health is totally uncompromised. She used the words ‘Melissa’s actions’ but what she communicates is ‘Melissa is a cruel woman, and that is why she killed her baby.’

To that great aunt, I would say this:

If people like you didn’t perpetuate the stigma surrounding illnesses which feature psychosis by giving uninformed stigmatising quotes to journalists, then Lily’s father may have had some clue about what to do when presented with the symptoms of severe mental illness that were obvious in his poor wife for months before they led to such unbearable pain for everyone. If you want to blame something, blame this horrible illness, in the same way you might blame cancer for taking loved ones too soon.

News.com reports ‘The case has revealed just how quickly the 32-year-old’s life spiralled out of control after she developed severe major post-partum depression and psychosis following the birth of her daughter in April 2021.’

Melissa’s life didn’t spiral out of control quickly. She developed a life-threatening illness, the symptoms of which were either ignored or not acted on for months, until it was too late. Reporting it was quick, implies it was too quick to do anything about.

My postnatal psychosis set in by day 6 of first-time motherhood. By days 7 and 8 I was completely detached from reality, denying knowledge of my baby and my husband.

And when I was accurately diagnosed with postnatal psychosis in the safety of a mother baby unit in a private psychiatric hospital, my husband asked what he should have done if this had happened at home. This is what he was told:

‘Call an ambulance. Postnatal psychosis is a psychiatric emergency, but it is treatable.’

My greatest sympathy and compassion go out to Melissa. She was failed at so many points.

My memoir Abductions From My Beautiful Life was published last year and (among many other events) includes details of my experiences with Postnatal Psychosis. You can find an excerpt here: Book and it is available to buy online, including at Booktopia, Fishpond, and Amazon. If you are Brisbane based, you can also buy it at Avid Reader and Riverbend bookshops and Ruby Red Jewellery at 107 Romea St. The Gap.

If buying a new book is not in your budget, Abductions is also available to borrow from the Brisbane City Council Library Catalogue.

Other Thought Food posts that may interest you are:

My Sliding Doors Encounter With Our Public Mental Health System

Welcome To Motherhood

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Am I A Stay-At-Home Mum?

Taken around 2008 – consent to share given in 2022

My 11 year old clobbered me with this question recently, and it felt complicated.

I say ‘clobbered’ because – for me – the words ‘stay at home mum’ come with baggage. This phrase and I have an uneasy history. My judgement started early.

As a child I never dreamt of future motherhood.  At thirteen my family and I moved from Germany to Australia. The change in schools was ‘resilience building.’ The first year or two I learnt to live with being intermittently bullied. Then, to my relief, at the end of grade ten several of my tormentors left school. They were either pregnant or would soon be.

The idea of motherhood, when linked to these girls who had taken such joy in making my life hell, became abhorrent.

Homing in on my goal of becoming a vet drove me through my last two years of school and into university. I worked hard, and with tunnel visioned arrogance. I saw children as a hindrance and the women who devoted their lives to staying at home and looking after them as little more than shepherdesses tending their flock while life passed them by.

When Michael (my now husband) and I started going out I spent the first years of our relationship reiterating that I would never want children. My career would always come first. He supported me.

8 years later we married and moved to the UK to work and travel. After we returned to Australia I continued working and started a second university degree.

Then, somewhere between 31 and 32, I sensed I would regret not trying to have a baby. It took one month to conceive that first baby. The plan was for me to stay at home in the beginning and go from there.

The universe laughed heartily.

I spent close to the first four months of motherhood in the mother baby unit of a psychiatric hospital. Along with parenthood I was served postnatal psychosis, catatonic depression, electroconvulsive therapy, and a lot of medication. I had no history of mental illness before the birth.

 At times I was too unwell to look after my baby. And even when I could – my survival and care had to come before caring for my baby. I didn’t have the luxury of martyrdom. My baby and husband needed me alive.

Eventually I recovered from that episode of illness. But as much as I loved my baby, I found the stay-at-home mum loop of feeding, cleaning, settling, on endless repeat mind numbingly dull.

I returned to veterinary work part time.  

My work re-engaged my brain. A day’s work felt like I had achieved tangible results, instead of running on the hamster wheel of domesticity all day.

Three years later, we had a carefully considered second baby whose arrival was also accompanied by a savage return of psychosis, mania, depression and a now definitive diagnosis of Bipolar 1 Disorder.

Once I’d recovered, I struggled with the same aspects of stay-at-home motherhood I had with my first baby and returned to part time veterinary work.

Veterinary work is not particularly compatible with motherhood.

Shift ending times are academic. Needing to be home by a set time after work guarantees an emergency turning up, a regular appointment blowing out, or needing to catch up on phone calls and notes.

Childcare centres with their sharp closing times were not an option. My husband took over childcare when he wasn’t working. My mum helped too. But we largely relied on a nanny to cover my work shifts during the week.

By the time the nanny had been paid, my hourly rate sat at around $15 hour – to consult, perform, diagnostic tests, soft tissue surgery, dentistry, radiography, radiology, pharmacology, emergency medicine, euthanasia – for my patients and to communicate effectively and compassionately with my clients.

I worked for my sanity rather than the money.

At one point I switched to weekend work to make it a little more financially worthwhile. My husband was the stay-at-home parent for those days. He worked weekdays. We tag-teamed parenting and never had any time together as a family.

Veterinary work is rewarding.

It is also emotionally and mentally demanding. Many clients carry anxieties into the consulting room with their pet. At the end of a workday I had little emotional energy left for my family because I’d spent it on my clients.

Thankfully my children’s demands on my emotional energy were minimal when they were little.

But now, at 15 and nearly 12, it is all about being emotionally available.  And unlike changing a nappy or cleaning up pureed fruit, sensing where on their emotional barometer they sit and responding appropriately, is something I don’t believe can be outsourced.

Just over 2 years ago I stepped away from veterinary work.  In large part to focus on having my book published and explore my writing interests further, but also to be there for my children at ages when I feel they need me most.

I am grateful we can afford this choice.

My thoughts on stay-at-home motherhood have thankfully changed since I was fifteen. But some flinty fragments of my old views persist. I still don’t like the term ‘stay at home mum’. It implies too much domesticity, and that the bearer of this title has no interests outside of her children.

I would be a terrible mother if I hadn’t built a career first, and if I didn’t have interests outside of mothering. But the balance has shifted from shoving my family around the demands of an unyielding career to finding interests and opportunities that drape themselves more gently around the needs of my family.

So, in answer to ‘Am I a stay at home mum?’ My answer is ‘Sometimes.’

My memoir Abductions From My Beautiful Life was published in April 2021 and is available through most online booksellers including Amazon, Booktopia, and Fishpond. You can find an excerpt here Book

You may also like to check out these links

Welcome To Motherhood

Veterinary Work And Bipolar Disorder: A Podcast Interview

Your Mental Load = Your Responsibility

The ‘Breast Is Best’ Myth

Alex baby foto
Alex March 2010

Last week was breastfeeding awareness week, and the irritation I feel when I see strong pro-breastfeeding messaging flared. I usually bite my tongue and suppress my politically incorrect opinions about this emotive subject. I don’t care about how anyone chooses to feed their baby. But I do care that the ‘breast is best’ myth is still being drip fed to (especially first time) mothers like a sugary subtle poison.

Fourteen years ago I had my first baby. I lapped up all the breastfeeding propaganda from the hospital antenatal classes and my antenatal yoga classes. Because I trusted these sources.

And they didn’t exactly feed me falsehoods. But they did imply a mother who switched to formula before she had exhausted every possible option to keep breast feeding was not doing the best for her baby. Posters in the maternity hospital told me that exhaustion, blood streaming from cracked nipples and tears streaming down your face were all worthwhile prices to pay to feed your baby this liquid gold.

After going into thirty three hours of labour on two hours sleep, my daughter was delivered by caesarean. I fell asleep as I was being stitched up. The midwives wasted no time. I woke with a start, in recovery to find my baby attached to my left breast. It was so important to these midwives that my baby attached ‘immediatley’ that they didn’t even do me the courtesy of allowing me to wake up before making this most intimate of introductions.

The focus on the holy grail of establishing breastfeeding in the maternity hospital was so strong that I sat up for three hours at a time thinking I was feeding my baby, when she was comfort sucking for most of that time. It left me exhausted and my back a wall of pain from sitting in the ‘feeding chair’.

Now, if that were the worst of it, I would have probably gullibly pushed through all further discomfort to establish and continue breastfeeding. Had I succeeded, I would have probably felt proud of myself. And after being told time and time again children who are breastfeed are healthier, smarter, more empathetic, and more likely to poop rainbows, I may even have been arrogant enough  to attribute all of my daughter’s future, health, smarts, and empathy to my valiant efforts to persist with breastfeeding. (She has yet to poop out a rainbow – but I can live with that.)

But within a week of her birth, whether or not I breastfed was injected with some desperately needed perspective. She was at home with her father, contentedly guzzling formula while I was tipping my breastmilk, tainted with antipsychotics, down the sink in the Special Care Unit of a private psychiatric hospital. I had come down with postnatal psychosis and I was clinging to my life with my fingernails.

To my credit, I quickly forgave myself for ceasing my ‘breastfeeding journey’ 7 days into motherhood. And I didn’t look back. I had been too sick to ever be riddled with the guilt I saw in other mothers who had been less unwell but had also made the smart choice (for them) to stop.

But we shouldn’t need extreme circumstances to justify feeding our baby formula to anyone. Breastfeeding is a personal choice. Nothing more. Nothing less. But our society has turned it into a religion. And it’s opt out not opt in.  We are all automatically given anti formula education classes antenatally and then baptised in breastfeeding once the baby is born.

The high priests of this religion are lactation consultants and midwives who set ironclad commandments and rule with fear. The fear of harming our babies with our actions.

The pressure to breastfeed is a known contributor to and risk factor for developing perinatal mental illness. Mental illness that can leave a baby motherless if it is severe. Unlike the maternity hospital midwives, the nurses in the mother baby unit in the private psychiatric hospital I was an inpatient in don’t pressure new mothers about how to feed their babies.

But they do spend a lot of time undoing the damage done by overzealous midwives and lactation consultants who have bullied new mothers into believing they will hurt their baby if they consider formula anytime earlier than as a last resort.

For my second baby I had one breastfeeding aim: Get some colostrum into him. He went onto formula at day 7, just like my daughter. And just like my daughter, now you wouldn’t be able to pick what he was fed as a baby.

Breastfeeding is cheaper than formula feeding. It is more environmentally friendly. It is the safest and most convenient way of feeding a baby in a third world country and/or if you don’t have regular access to clean water or formula. If your baby is premature and/or has underlying health conditions for which a paediatrician has recommended breastfeeding or expressed breast milk, then – for that baby – breast is best.

But if your baby is full term, healthy, you have access to clean water and can afford to buy formula, then (beyond the first few days’ worth of colostrum) whether you choose to formula feed or breastfeed is as irrelevant to your baby’s wellbeing as the colour of your underwear while you’re doing it.

 

You may also like to check out:

World Maternal Mental Health Day: It’s Not All Postnatal Depression

Your Mental Load = Your Responsibility

Modern Martyrdom

My First Time

World Maternal Mental Health Day: It’s Not All Postnatal Depression

Alex pregnancy and Elsa
End of 2009

My mental illness was born with my first baby.

I never considered my mental health as part of the decision to have a baby, because when I first fell pregnant within a month of trying, I had never experienced mental illness.

The pregnancy was uneventful.

Then I went into a thirty-three hour labour on two hours sleep. This severe sleep deprivation and the swirling hormone levels woke a slumbering monster, a genetic predisposition, which ensured that by the time my baby was one week old, psychosis had wrenched me away from reality. I found myself in the Special Care Unit of a private psychiatric hospital trying to explain my way out of my delusions, while my husband and mother cared for my daughter at home.

Welcome to motherhood.

Continue reading “World Maternal Mental Health Day: It’s Not All Postnatal Depression”

The Comparison Trap

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Photo by Skitterphoto on Pexels.com

I liken comparing myself to others to a landscape of skin. In some areas that skin is as thick as a crocodile’s. Very little penetrates it. Take social media. I came to it old enough to have a solid sense of myself. My self-esteem and body image didn’t grow up in the glare of Instagram. FOMO generated by someone else’s curated holiday/body/green smoothie/adorable family snaps is foreign to me.

Other tracts of skin are a little thinner but still not easily breached, a bit like a callused heel. My career path and choices have held few twinges of comparison. Maybe in the early years of my veterinary career I did some comparing. But that was part of the trek of working out what sort of vet I wanted to be.

Writing and advocacy work have only evolved in the last few years, and I view other people’s work in these areas as something to either aspire to or steer away from. Yes, it’s comparison, but a cool, dispassionate kind.

Then there are the areas of soft skin, vulnerable, but hidden away too deeply to be strip searched by comparisons. My relationship with my husband fits here, I couldn’t compare us to anyone else, because what we have is as unique as a fingerprint.

Then there’s skin ripped open at unnatural angles.

Continue reading “The Comparison Trap”

My Sliding Doors Encounter With Our Public Mental Health System

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Have you ever had a moment when your answer to a question determined whether your life imploded?

I have.

It came five days into parenthood. I was lying on the floor in my maternity hospital room crying because I was trying to outrun a jaguar chasing me towards a cliff. Things were starting to go very wrong in my brain.

In the following months, when my mind warped and writhed in the grip of psychosis and later catatonic depression, and when what started out as postnatal psychosis turned out to be a first episode of bipolar 1 disorder, I could not imagine things being worse.

But they could have been.

Continue reading “My Sliding Doors Encounter With Our Public Mental Health System”

Visiting Someone In A Psychiatric Hospital?

BCPND visit 2010
2010 My daughter visiting her little brother and I in the mother/baby unit of the psychiatric hospital

‘My daughter never visits me in hospital. She doesn’t like this place.’

An elderly woman told me this in a private psychiatric hospital several years ago.  Sadness dripped from her words.

The thought of visiting someone in a psychiatric hospital (especially for the first time) can leave people feeling: Awkward. Uncomfortable. Fearful. Repulsed. Guilty. Ashamed. Misinformed. Unsure. To name a few.

What do you say and do if that’s you?

Continue reading “Visiting Someone In A Psychiatric Hospital?”

Who Holds You When You’re Broken?

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I’ve been told the first time we met I was shuffling slowly up and down a blue carpeted corridor. Slumped body. Empty eyes. I barely registered being asked how I was with a slowly exhaled

‘Not so good.’ before moving on with my pram.

I say ‘I’ve been told’, because I don’t remember our first meeting or the following weeks. I was sicker than I’d ever been. Not many people would have repeatedly made friendly conversation with someone as unresponsive as I was.

She did. At a time when she wasn’t well herself.

When I finally re-emerged after several months of illness, I was delighted to find I had a new friend. A friend I never would have met in my geographical or professional circles. A friend who, like me, had spent the early months of first-time motherhood in a psychiatric hospital instead of at home.

Continue reading “Who Holds You When You’re Broken?”

My Mental Illness Makes Me A Better Parent

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I am giving my eight-week-old son a bath. One hand supports his head and neck, the other gently moves a wash cloth over his delicate skin. He kicks his legs, rippling the shallow water. His dark eyes stare up at me. Pools of trust. I make a minute adjustment to my hand supporting his neck. His head slips under the water, for less than a second before I instinctively lift him up. He splutters briefly and is fine. But I am not.

I hit the call button next to the baby bath and a nurse pops her head in:

‘Are you ok?’

‘No.’

I hand her my baby. Nausea clamps my stomach and works its way up my throat. Black mist hovers in my peripheral vision and I sink to the ground. I put my head between my knees, as red-hot malignant words shoot through me:

‘Did I just try to drown my baby?’

Continue reading “My Mental Illness Makes Me A Better Parent”

Suicide Watch

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(Confronting content ahead)

Suicide is the leading cause of death for people aged 14-44. Our prime minister is giving Lifeline (our suicide hotline) $34 million to:

‘dramatically boost staff numbers dealing with pleas for help. The funding to Lifeline comes as national suicide rates reach a 10-year high, with more than eight deaths a day.’ (Sunday Mail 6/05/18)

I don’t doubt the PM’s good intentions. It’s easy to look at those statistics and think:

‘Let’s throw some money at this problem.’

But injecting funds into the surface of such a complex issue and proudly announcing it to the media, is like patting the captain of the Titanic on the back, as water rushes into the hull of his ship, and saying:

‘Don’t worry. We’ve got this. We can see this huge iceberg is the problem. We’ve got people sitting on top of it, hacking it down. And, to distract everyone from the drama we can make snowcones from the ice that’s falling on the deck. Continue reading “Suicide Watch”

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