Perinatal depression

Perinatal depression is one of the most common illnesses to affect people during pregnancy and the postnatal period. Its effects can be devastating and, if left untreated, it can have a huge impact on women and their families. 

In this episode we are joined by Leanne Howlett to talk about her experience of perinatal depression, and her incredible work as a nurse in a perinatal mental health service. 

If you would like more information about the issues discussed in this episode, here are some useful resources:

• Tommy’s: depression in pregnancy
• RCPsych: postnatal depression - info for patients
• RCPsych: postnatal depression - info for family and carers
• Mind: coping with suicidal thoughts
• PANDAS: PND awareness and support

Content advisory: this episode contains content that might be distressing to some listeners, including content about self harm and suicide. 

If you or someone you know is struggling with mental health difficulties, please know that there is lots of help available. You can contact your primary care provider in the first instance, or if you are based in the UK the NHS perinatal mental health website will help you to find support in your local area.

Transcript

  📍  

 hey, everyone. Lynsey here. Just letting you know that this episode contains content that might be distressing for some of our, listeners, including descriptions of depression and suicidal thoughts. If you don't want to hear it, that's totally fine. In which case I would suggest that you skip the second half of the episode. And if you need support, we've put some information and links in the show notes to point you in the right direction.

Thanks for listening. And please take care of yourself.   📍  📍 

 Hi, welcome to the podcast. This is beyond baby blues, our podcast about maternal mental health. I'm Dr. Lynsey McAlpine. I'm a trainee psychiatrist based in east London.

I'm Dr. Chrissy Jayarajah, I'm a consultant perinatal psychiatrist also based in London. 

 And for today's episode, we're really delighted to be joined by our special guest Leanne Howlett. Now Chrissy and I both know Leanne through her work as a service user representative for the perinatal faculty of the Royal college of psychiatrists. But I know  that's just one of her many talents, and I'm looking forward to talking about some of the other things that she's been working on. 

Leanne, welcome to the podcast. It's so lovely to have you here.

Tell our listeners a little bit about yourself

Thank you.  So, my name's Leanne. I am 37, so I've had two children. I had my eldest son, seven years ago, um, when I just turned 30. And then When I was 34, I had my daughter, um, so four years ago.   I  was a solicitor, um, when I had both of my children, and I've now recently changed careers. So I qualified last year as a mental health nurse. So currently working within a community perinatal   

Hooray Congratulations 📍  

  I've already told Leanne congratulations, but officially from our podcast, congratulations Leanne it's amazing. 

Okay. So in today's episode, we're going to be discussing depression in the perinatal period. This is one of the conditions that we all see very frequently in our clinical practice. I suspect that a lot of our listeners will have at least heard of postnatal depression, which is a depressive illness affecting up to 20% of women in the first year postnatally.  But what a lot of people don't realize is that there's also a really high risk of developing depression. Antenatally with up to 12% of people meeting the threshold for a diagnosis of depression during the pregnancy. And that's why I think it's really important that we talk more broadly about perinatal depression, rather than just focusing on depression in the postnatal period.  

Leanne. I know this is something that you've had firsthand experience of. Could you tell us a bit about what happened during your first pregnancy?  



I suppose before that I had no real experience or understanding at all of, sort of,  mental illness really, generally, and particularly perinatal mental illness. 

 Um, really enjoyed being pregnant, worked right up until 38 weeks, no problem.  Pregnancy was very much planned, you know, we'd have no difficulties. falling pregnant, everything had gone really well.  And I suppose most importantly, I actually felt really prepared as well for it.  We were socializing with friends that had babies and very young children. So I felt that I was fairly equipped for that, like that we'd heard all their stories and given us all their advice and their tips. And so I felt I suppose naively quite confident, because I felt like I had that experience, I had learnt from them, and certainly no one had ever spoken to me about their mental health, or that  they'd struggled in any way,  so  it was just something which was completely not on my radar at all. 

So then what, what do you think shifted or changed?

   I think  I had this idea in my head that there was going to be this amazing birth and it'd be wonderful. And we'd all be in tears afterwards because that's what society lets you believe. 

 There was difficulties with the labour,  Um, and it all just went wrong from there, I suppose.  I was sort of rushed down to theatre for a forceps delivery. And I just, like, remember thinking, it's all ruined,. And that was sort of what was going through my head, that this perfect moment had been ruined. 

 it all Seemed to happen so quickly after the birth, there was no real deterioration I noticed, it was just suddenly he was born and I just  remember feeling really low. I didn't expect to feel that flat and I didn't know why I felt that flat. 

 And sort of even in hospital I remember crying to the midwife that I wanted to go back to work. Because I just felt so out of my depth.  The midwife made a comment about how I wasn't holding him properly. So immediately then I took that to mean everyone thinks I'm a bad mom. I can't do it. They know I can't do it because they know I'm a bad mom. And it just almost came from nowhere.

 Thanks, Leanne, for sharing. I mean, that's, that's such a powerful story that, that you've told us.  And even though it happened years ago, it's almost when you describe it, it's like it happened yesterday

Yeah. So I noticed that you described how that small comment from the midwife set off this really unhelpful and catastrophic thinking pattern. And we know that that's one of the, what we call the cognitive symptoms of depression, where your thinking patterns become distorted in this really negative and unhelpful way. So your mind gets stuck in these negative automatic thoughts about yourself, about the world around you and about the future. And it's really hard to stop that thinking pattern once it started.

yeah, absolutely  So then, tell us Leanne, so that was in hospital, what happened when you got home

 we got home.  Even now I think like, it amazes me that nobody asked about my mental health because I was Always crying. Always. Every time I saw professionals was upset about the feeding and things. But everything always felt very practical. So he wasn't feeding, so how can we get him feeding? 

 Then he was sleeping but I wasn't sleeping because I was frantically trying to  pump and get milk for him and all of that.  I suppose I just tried to make myself go through the motions of it and didn't really accept that my mood was continuing to deteriorate, I suppose.

 I think part of it was, yes, I didn't want to accept it, but I also probably didn't understand it.  Because I think at that point I wouldn't have actually been able to explain to anyone how I felt. So I probably wouldn't have been able to put it into words anyway. 

Sometimes I think now I reflect on how many midwives I had to see before somebody picked up on the fact that I was really struggling. Um, but one midwife did see and did sort of tentatively suggest that I might need some support and I brushed it off quite quickly,  because the idea of it, just felt quite scary to me, sort of the idea of mental health services and what that would mean.

 I remember saying to my midwife no, no, it's just baby blues. It's just baby blues. And she's like, Leanne you're six weeks postnatally, you know, it's not baby blues now. Um, but trying to almost use that as an excuse, because for me, that's what I suppose I was trying to convince myself.

Yeah, and you raise a really good point there because that's a very common misconception. Chrissy, perhaps we should take a moment to talk about the difference between baby blues and depression. 

So baby blues is a really common condition and essentially it is feelings of increased tearfulness  and quite emotional. But also there's this, uh, this feeling of anti climax and this kind of feeling of flatness, kind of emotional flatness and emotional numbing,

It's usually peaks around day three to day five post delivery But it should subside on its own within about a week.  

That's right. So, as you said, it's pretty common, more than half of new mothers experience things like mood swings, bursting into tears, very easily, feeling irritable, and feeling anxious . But I think what's really key is that with baby blues it's mild and it tends to get better on its own usually within about 10 to 14 days, So women who experienced baby blues don't need any treatment because we know that it's self limiting and it resolves on its own. 

But when that low mood becomes more persistent and when the symptoms are affecting day-to-day functioning and when it's going on for more than two weeks, that's not BB blues. That's when we start to wonder about depression. And we've covered some of the main symptoms of depression already. So, for example, Leanne, you've talked about that low mood that you experienced. And in depression, it's a sustained low mood. That's there for most of the day, every day for at least two weeks and often longer. And we've also talked about the loss of pleasure and those negative thinking patterns and the thoughts that you had about not being a good enough mum. 

  There were some other symptoms of depression that we should probably mention. So we often see new parents expressing feelings of guilt and worthlessness and hopelessness about the future. Um, they might experience a loss of interest in things that they would normally enjoy and lose pleasure from doing those things.

In some cases, people really struggle with concentration and memory and decision making, which as you can imagine is really difficult when you're trying to care for a newborn.  And of course it's important to mention as well, the biological symptoms of depression by which we mean sleep disruption, loss of energy changes in sex drive and changes in appetite.

However, I'm always very mindful that if you ask any mum, you know, few weeks postnatal or even a few months postnatal, they'll probably tick the list for all of those symptoms. 

Yeah, diagnostically speaking. The, uh, the biological symptoms of depression are much less discerning in the perinatal period because as most parents will know those biological symptoms are very  common features of just being a parent with a newborn.

So Leanne, it sounds like things continue to deteriorate when you went home and your midwife eventually noticed that things weren't going so well, but it also sounds like you were kind of uncertain about getting support.  So what happened next?  

I think in the end I literally just got to a stage where I felt so low, I was like, I cannot physically, my body cannot cope with feeling this low anymore all the time and just continuing day after day.

So, I think I emailed and said, okay, and then I think later that afternoon I emailed her back and said, no, actually don't, I don't want to, but by that point she'd already put it through.  So she said, well, let's just see what comes back.

Um,  so she did and I remember someone from admin calling me to say, oh, you know, we've had a discussion and we think that you need to see the psychiatrist and, I immediately freaked out because I didn't know the term psychiatrist, but in my head it was sort of something quite scary that, oh, they think I'm mad, they're gonna think I'm a bad mum, and just sort of said to them, no, I don't want the support, and hung up.

And then luckily, I guess, Someone queried as to why that had happened and then someone else from the team called me and spoke to me and sort of went through it a bit. And I eventually agreed to go and see somebody, and my midwife came with me and did sort of a joint appointment with me.

It sounds like you were pretty ambivalent about seeing the perinatal teams. So it, it was a good thing that your midwife was so proactive and supported you to attend the appointment. What happened from there?  

So I did have really good support from the perinatal team but it was very limited as to what support I had from them because I was very reluctant to accept it.

So I sort of,  I refused to see the psychiatrist because the name was too scary. I refused a psychiatric nurse because the name was too scary. I thought they're going to come and they're going to either try and whisk me off in an ambulance, or they're going to try and take my children off me or think I'm not a good mum.

Anything with the term psychiatric in for some reason, I had this real thing against and I didn't want anything to do with anything like that. Um, so I agreed to see the psychologist because I suppose in my head, I knew what a psychologist was. 

Just to add a little bit, you mentioned about psychiatrists and that being a scary word,  and obviously you're, you're talking to two very, very scary psychiatrists right  but  thought, don't we kind of explain what the role is.  

Yeah, that's a good idea. Okay. So Chrissy and I are both psychiatrists. Which means that we're medical doctors who have specialized in mental health and then specialized even further in mental health during pregnancy in the postnatal period. We're part of a much wider multidisciplinary team. And our role involves combining our medical knowledge with our understanding of the psychological factors that are at play and the social determinants of health. And gathering information to get an understanding of a patient's diagnosis and then helping the patient and their families to understand that diagnosis.

And then we help with treatment planning and supporting women to make decisions about medication and other treatment options.

Yeah, absolutely. And I think, you know, many psychiatrists are, are trained in terms of psychological interventions as well, and particularly perinatal psychiatrists will have an understanding about mother baby bonding and attachment because it's, you know, the bread and butter of what we do. 

So Leanne you've told us about your first pregnancy and it sounds like despite having a bit of a rough start. You, you were eventually able to get some support from the perinatal team and things did improve, but we know that women who've experienced depression in the perinatal period for one pregnancy are going to be at risk of having similar episodes in subsequent pregnancies.  Could you tell us a bit about what happened second time round? 

So second time round,  was pregnant with my daughter I had a more difficult antenatal period. I became sort of very depressed in pregnancy. And again, I think because I was very fearful of what might happen and was very worried about that.  That anxiety increased throughout pregnancy, and sort of escalated probably not long before she was born. 

And so she was born, and for the first couple of weeks,  everything was actually doing okay.

Um, but she was quite an unsettled baby. So I think quite quickly then I started to struggle with the fact that she would cry all the time. She was really not easily settled. ,  that sort of made my mood dip, or certainly made it harder for me to keep my, maybe a facade up, I suppose.

And I think then quite quickly, that lack of sleep, just sort of made my mood plummet. And then once my mood had plummeted, those same thoughts and feelings then sort of started to escalate from there, I guess.

I remember going through nights where I was having an hour or two a night max, and that was like night after night after night for weeks on end,  just feeling really low and almost having that feeling where you  go to bed and you just think I'm just going to wake up tomorrow and it's going to be the same and it's just going to be awful and then you wake up in the morning and you know you've got that whole day ahead of you and it just feels really miserable and just got myself stuck into such a rut with that   I that I suppose I almost couldn't see a way out of it and I think what I really find interesting now looking back, I suppose, was that I was somebody who had I've been through it before and come out the other side absolutely fine, but I remember like not being able to see that then at all.

And now I think, gosh, it's amazing how much it can affect your insights when you're  depressed.

  Speaking of which, I was just thinking about that as well, Leanne. We talked a bit about the psychological aspects of depression, but there are very much social aspects too, about feeling quite withdrawn, wanting to stay in bed, not wanting to open the curtains or go out to baby groups or appointments etc. And naturally this can have an impact on on the children.   Lots of women are able to protect their relationship with the baby in terms of they're able to kind of function as it were as a mum. So they're able to do the feeding and the nappies and all of that, taking care of the baby. However, for many women as well, it might spill into their relationship, not only with the children, but also with their family members and their partners. 

And I think that's where our multi-disciplinary team is so valuable. Chrissy. Because, you know, we've got amazing specialist nurses like Leanne, um, but we've also got occupational therapists and nursery nurses and parent infant psychotherapists who can all help our patients and their family with those social and relational problems that are such a big part of depressive illnesses.  

 And I think, for me, the real benefit then was that I did have the perinatal team already around me. So at that point I didn't actually have to do the reaching out  because I was already under the team and the whole idea of getting support didn't feel as traumatic and it feel as difficult because it was just there.  And I knew what it was. I knew what to expect. 

I was very much sort of open to all the support available, so I was very much open to having a nurse, I was open to having that psychiatrist support, and I did. Um, which was really helpful in sort of looking at that medication. 

Yeah. So let's talk a little bit about medication because that's something that comes up very often in clinic. There are lots of different medications that we can use to treat depression, and many of them are safe and effective during pregnancy and in breastfeeding. But decisions about medication or all was based on the individual person's circumstances and their personal preferences. 

So we're not going to, into too much detail about specific medication options today, but it would be helpful. Leanne to hear a little bit about your thought process and your decision-making about medication.

so I think first time round, I was very anti any type of antidepressant for a long time because. I had this idea in my head that it would change me as a person. And I think that's what changed that. chemicals in my brain in a way that made me not feel like me.

 Whereas actually, when I did eventually give in and take the antidepressants first time round, I didn't have any of that.  Actually, once I'd sort of had that initial few weeks, I still was very much me. 

 Um. And so second time around I suppose automatically went back onto that same medication because for me I knew it worked for me. Only second time it didn't work for me, which is probably one of the reasons why at the time I convinced myself that it wasn't going to get better this time 

 um, but they put me on a different antidepressant and that worked really well.   I know there's sort of often, like, a bit of a debate as to whether medication's helpful and for me, I think medication got me to a point where I could then utilise all the other things I needed to do to support myself, and I think if I hadn't had that medication,  I wouldn't have got to that stage, or it'd have been so hard to get to that stage.

And actually that literally turned my sleep around in no time at all. And I think that was, so key to everything. So  Once I was sleeping, my ability to be able to face the day ahead and almost fight that depression, I suppose, was so much stronger,   because I was rested. So, so yeah, for me, they played a huge part in my recovery

I think you, you explained it so beautifully, when you were saying about how starting the medication got you to a place where you could then take on the psychological therapy that was needed because if you're too depressed and too low, you're not in a place to even start to think about it. So yeah, I very much believe that medicine is just one piece of the puzzle and it can really help for some people, not for everybody, but for some people it can really help

And I suppose that's one of the things that's unique about treating depression specifically in the perinatal period. Um, we want to get people better as quickly as possible because we want to support that bond and attachment with baby, uh, medication can allow people to get started on that recovery journey. 

And as you say, Chrissy, you're totally acknowledged that medication is not for everyone. But it can be transformational. And for some people it's a really important part of their recovery.

 So I, um, I wanted to pick up on something else that you mentioned earlier, Leanne. So you said that when you were really unwell and you were thinking about getting support with your mental health, the first time round, one of the things that was on your mind was this fear and this worry that social services might get involved and they might try to take your children away.

This is something that we see people worrying about a lot when they come to our services and it's a really big barrier to getting the right support. 

So I thought it'd be helpful if we could talk a little bit about that concern. 

Yeah, so I think in my head, because I had probably limited experience with mental health services and what that looked like, I think there's an assumption in your head that if I can't look after myself, how are they possibly going to think I can look after a baby? I remember thinking I'm somebody who  would never be on anyone's radar otherwise usually and suddenly now  I'm going to be on everyone's radar.

I don't want to be on people's radar. I want to just sort of  hide away in the background a little bit and just being really worried that they would think I was a bad mum, that they would They would either take the children or if they didn't take the children they'd be sort of watching me constantly and I'd be under all sorts of social services plans and the reality was even when I was sort of incredibly suicidal and really struggling to function  social services were never involved in my care ever because me being a good mom was never something that came into it. And I think if I've known that earlier on it to save me a lot of extra worry and stress where I spent a lot of time thinking about that? I suppose, and worrying about what it would mean. 

Yeah. And honestly, I think it's a very understandable and natural thing for someone to worry about, especially you know, as we discussed with people that have depression, the often have all these thoughts about not being a good enough mum and they might be struggling with some aspects of childcare because of their depression. 

So I think that leap to worrying about social services getting involved is it's not surprising in a way. But, well, I like to reassure my patients is that it's incredibly rare for there to be any need for social services to get involved, especially in situations where someone is working with our perinatal team and making use of all the support around them because that mitigates a lot of the risks. And ultimately in situations where social services do need to get involved. They're there in a supportive capacity and their priority, much like the perinatal team. Is to keep families together and to put support in place alongside the perinatal team and other healthcare services to, to support people through the depressive episode 

I remember  one health visitor, did call social services because she was concerned at one point with how distressed I was. And what was reassuring was actually social services called up, we had a quick phone call and they were like, do you need any support?  Like they're not actually as scary as you think they're gonna be, they literally did just call and ask if I wanted any extra help, if I felt any extra support would be helpful, or what did I need, and if people knew that, I think they'd probably be a lot less worried about it. 

Yeah, I agree.  So Leanne you mentioned that when you were at your most unwell, you were experiencing another symptom of depression that we've not really talked about yet, which is that you were having these really upsetting and intrusive thoughts about harming yourself. And we know that a lot of people with depression will have thoughts about self harm and suicide at times. And these can be really difficult to talk about.

Yeah, so um, particularly at night time I suppose, lots of time really thinking, that I didn't Want to be here and what did that look like and what would I do  and then imagining that actually the kids are going to be so much better off without me and almost be able to explain to myself why everyone was better off without me and sort of spent a lot of time.  I suppose thinking about? that and then even when I wasn't thinking, if I was trying to distract myself from that or I was sort of trying not to think about it, I could find that something would very easily tip me that way so I could be sort of managing a long Okay. and something would happen and it could be something really minor like I dropped a glass once and I think it smashed and then straight away it's those really intrusive sort of thoughts of, you're useless, you're so useless, you can't even do this, what's the point?

And, and then that quickly, I suppose, would spiral into like spending hours Googling things and, you know, really becoming quite obsessed with sort of finding a way out.

And  I think.  That was really difficult to know how to deal with that. 

 That's awful Leanne. I'm so sorry, you had to go through that.. But I'm glad that you're in a better place. Now at the time, was there anything that helped with those thoughts?

one of the things  the perinatal team would say regularly to me is, you know, you really need to distract yourself when these thoughts come in. And at the time, initially, I'm thinking like, that is a load of nonsense, as if I'm actually going to be able to distract myself from these things, which are so intrusive in my mind, and I cannot push them away. 

But actually, Once I started trying to do that, and then it slowly became easier to do that,  it was actually amazing how much that actually, that, that did work, it almost does make them become less intrusive, I guess, and less at the forefront, and then it does feel a little bit easier.

 Yeah. So some people do find that distraction can be very helpful. Um, in the moment.  And there's lots of other things that you can do as well to keep yourself safe if those thoughts become really overwhelming. We'll put some resources in the show notes in case anyone wants to take a look.

I find that sometimes people are scared to tell health professionals that they're having suicidal thoughts. That fear is completely understandable. The thoughts themselves can be really frightening. And sometimes I think it's just terrifying to put it into words and actually say it out loud.  And sometimes there's a fear about being judged, about being seen as a bad parent. Um, like we discussed before, some people are worried about social services involvement. And some people are worried that if they talk about these thoughts, they'll be forced to go into hospital.  I know that in your case, Leanne there had been some discussion about whether you should go into hospital and some people do get admitted to a psychiatric mother and baby unit. Um, that can be incredibly helpful. But it sounds like in your case, you didn't go to hospital in the end. 

Yeah, I think one of the things that sort of I'll be forever grateful for the Perinatal Team for, was that actually they did work with me to stay at home. And although they sort of wanted me to go into a mother and baby unit, they completely respected my decision not to. Um, it was COVID so it was very difficult for me because I would have had to be separated from my eldest and there was no visitation so they very much saw that I didn't want to.

The fact that they could work with me to keep me at home, even when I was having those thoughts and those feelings and help me manage that, like, does mean a lot to me now when I think back  that I could stay at home and sort of get better at home. 

I was wondering Maybe it'd be , nice to  sort of fast forward a bit, Leanne, and think about how things are now, and, and what you're doing, and 

Yeah, so, um, I have had a complete career change since,  um, since I have my youngest. So I'd always sort of known, I suppose, since having my eldest, that I, liked the idea of doing something in perinatal, but didn't really have any idea what. And, I toyed with it over a few years and then what would it look like?

What would I do? And I sort of set up a charity locally, which I ran in my spare time, and I was sort of the main earner, that was quite difficult as well. And I'd worked really hard to get into a career And I didn't dislike my career.

I liked being a solicitor. I just didn't have the passion for it that perinatal gave me, I guess. Um, so obviously  my nurse was amazing when I had my youngest and she really did sort of, she held that hope for me constantly when I did not see it myself and she kept me at home and she just was such a big part of my recovery.

Um, that I just had this real sort of revelatory moment where I thought that's what 

I'm going to do. , so I was pretty much discharged from the perinatal team and then literally went straight in to start my mental health nursing, um, degree.

And Yeah, so and qualified last summer and now have a job working as a nurse for other mums that are unwell which is really lovely  it's just Nice to be able to support other mums in the way that someone supported me and I can hold that hope for the people because I know it does get better and I know that it is short lived and you know, you do get through it  and then it's just  a distant memory, you know, something that happened once upon a time. 

And I think that's one of our most important jobs as healthcare professionals, is to hold that hope when other people can't hold it for themselves.  

That's amazing. And what a journey that you've been on. And I'm just in awe. I'm so inspired listening to you and listening to your story and how you've explained it so well not just for us, but obviously for the listeners,  thank you so much.   I'm just thinking, is there, if you had one piece of advice for someone who's listening in,  who might be experiencing depression or a bit scared to contact health services, what would you say 

I'd say, I guess, reach out because I think the hardest part is asking for help and actually when you do ask for help,  And then, you know, you'll get that support around you, but don't hold off and don't fight it because that's certainly what I did first time round and I regretted it afterwards because I don't know, who was I fighting? What was the point? I was fighting my own recovery really.

And Chrissy, what's your most important take home message? 

Gosh, good question. I think my most important take home message is that your feelings are valid and  that If you feel that something's not quite right with yourself, whether that's in the pregnancy or in the postnatal period trust your gut instinct.   So I think it's really important to just be mindful that it's common. It affects women from all walks of life and there is support available for you if you are experiencing these kind of symptoms. 

 Go on, Lynsey what's your one bit of advice? We've done ours  

Okay.  So I'm in depression, things like guilt and shame and self-blame are all really common parts of the illness.  So I just want to end with a reminder to anyone that's experienced perinatal depression in the past, or who's going through some of these symptoms right now.  , just a reminder that it, it is an illness. , like any other illness, it's not your fault. This has happened to you, and there is lots of treatment and lots of support out there. 

 One final thought before we end the podcast. I know that we have a lot of healthcare professionals listening in. So I thought it might be helpful to talk about the, what we call the red flags symptoms  that they should be looking out for when they're working with people during pregnancy and the postnatal period.

When we say red flags, we mean the signs and symptoms that suggest that something is seriously wrong. That needs urgent support from a mental health team.  These red flags are relevant for any mental illness that presents in the perinatal period. But I think it is helpful to remind ourselves of them while we're thinking about perinatal depression.  

So  the first red flag is um, a worrying change in the mood and mental state of that person. 

Yeah. And that's quite a broad red flag. And we often find that family members and cavers are best placed to tell us if there's been any sort of worrying change. So asking family members about their concerns and then assessing and acting on those concerns is really important. 

So that would be the first red flag to be aware of.  The second red flag would be if the mother  expressing thoughts of harming themself or, thoughts of ending their life or even harming their baby or, or their children.

Now, this is a bit of a difficult red flag because As you can imagine, lots of people don't disclose what they're thinking and what they're feeling to, family and friends, let alone health professionals. So I think you, you do as a health professional, need to explicitly ask this question.

And as we mentioned before, thoughts about self harm are not uncommon in people with perinatal depression. But in situations where those thoughts become persistent, or if they're having thoughts about particularly violent methods of ending their life.

Or if they're expressing a desire to act on those thoughts or in fact, if they've actually acted on them already, that's, that's the red flag that they need urgent, help.  

And then I suppose the final red flag to think about is a flag that everyone always forgets um, which is the sudden detachment and an emotional detachment from the baby . 

Yeah, and that can manifest in several different ways. So in some cases, a mother might feel like there's no bond with her child, or she might feel like that bond has  suddenly disappeared.  In some cases, people will express this feeling of estrangement from the BB. Um, and in some cases,  The express feelings of incompetence as a mother, or they'll say that they think their child would be better off without them. 

So I think it's a question that we need to be asking regularly, uh, , any health professional working with mothers,  antenatal or postnatal, asking about their relationship with the baby, but also how they feel about themselves being a mother. Obviously, all mothers will have some element of maybe not feeling good enough, and we talked about good enough mothering in the previous episode, but, uh, there is a fine line when the concerns about their competencies  as a mother starts to spiral down and down,   that is a huge red flag of something is really going awry. 

Yeah, so those are the the symptoms that we think all mental health professionals working with pregnant  📍 people should be asking about

 So that brings us to the end of the podcast today.  I want to really thank Leanne for coming in, joining us and sharing your story with us. And as always, thank you to the Royal College of Psychiatrists and the perinatal faculty for all of their support and for all of you who are listening in,  

Yeah, thanks everyone. We're really thrilled at how many people are listening in and we've loved seeing all of your messages and your comments online.

If you want to learn more about perinatal depression, we will put some links and resources in the show notes. And if you'd like to hear more about maternal mental health, in general, you can listen to all of our episodes on Spotify, apple podcasts, or wherever you get your podcasts.

So we'll catch up with you next time.