Warning: this article contains references to suicide/self-harm.
“I had never suffered from any kind of mental health issues before in my life, and I never anticipated that I would in becoming a mother,” Emily McCarthy told Insight.
“... I just thought that I would really flourish into this motherhood role and it felt completely the opposite of that to me.”
Emily, a lawyer, then aged 31, was excited to welcome her baby boy, Henry, into the world.
But the birth was difficult, and due to COVID-19 restrictions in Melbourne, Emily's husband wasn’t able to be there for the first two days she spent in hospital leading up to the birth. Following the birth, he was only allowed in for two hours each day. On top of that, Henry also required specialised medical treatment in the days after he was born. All this took a toll on Emily’s mental wellbeing.
“I remember getting home and I felt sick in my stomach when we arrived home,” she said.
“We were alone and the house felt cold and dark and miserable and I just felt terrified all the time that I had no idea what I was doing and that I’d made a terrible mistake. Why would I have changed what was a great life before, to this?”
Emily put her distress down to the ‘baby blues’, something many women experience postpartum with symptoms such as mood swings, teariness, feeling overwhelmed and/or anxious. It’s thought to be caused by rapidly changing hormone levels after birth.
However, Emily said her mental health deteriorated rapidly when Henry went through his four month regression - a period of time when a baby's sleep pattern shifts, which is usually associated with a developmental milestone.
Emily pictured in hospital after giving birth to Henry. Source: Supplied
“We went from maybe getting two to three hours of sleep in a chunk, to maximum 45 minutes,” she said.
“A couple of weeks of that really just broke me … I was in a pretty dark place.
“I really struggled every day to see how I was going to get through the day.”
Emily said she began to have suicidal thoughts.
“That was the point that I probably felt the worst, I didn’t want to be here anymore, I never had any clear plans …. I think what I had was suicidal ideation,” she said.
“I don’t think I was ever going to do it [suicide] but I thought about it a lot.”
Amy Dawes was 16 months postpartum when she hit rock bottom due to while giving birth.
“I ended up having a forceps delivery, at the time I was diagnosed with a third degree tear … but when I was 16 months postpartum I actually ended up prolapsing,” Amy said.
occurs when the ligaments that hold the pelvic organs - bladder, uterus, cervix, vagina, and rectum - in place are stretched or weakened. Without the support, the uterus can drop forward all the way into the vaginal passage.
A physiotherapist told Amy she would need to use a pessary, a device inserted into the vagina to help hold her organs in place. She was also told she could no longer pick up her daughter, and that her whole lifestyle, including how she moved her body, would need to be altered.
Amy Dawes pictured with her daughter. Source: Supplied
“I went into that physiotherapy appointment as one person, and I left that appointment as a different person,” Amy told Insight.
“I felt like I would never be the mum that I had imagined and because I felt like my body had so many limitations I also felt like perhaps my daughter would be better off without me.
“I just felt so utterly broken that I thought maybe I didn’t want to be here anymore.”
What the research says
According to research from the , in the decade from 2009 to 2018, 251 women were reported to have died during pregnancy or within 42 days of the end of pregnancy. Suicide was the third leading cause of death for those women, with 23 deaths via suicide.
The fact that the data is only based on those first 42 days following birth has professor of midwifery at Western Sydney University, Hannah Dahlen, concerned.
“We’re only looking at 42 days, we are not at all capturing what is going on beyond those 42 days and I think that’s the landscape that’s really worrying and potentially increasing without us knowing,” she said.
“We’ve got a couple of big flags here.
"One is the perinatal period should always be considered to be a year, probably longer to be honest, because it’s not like something magical happens when the child turns one, and we’ve really got to be thinking about our support services extending in a systematic way to capture women during that very vulnerable time during that first year.”
What was so interesting in this study was we found that a notable peak [in mental distress] occurred nine to 12 months following the birth.
Professor Dahlen, who is also the associate dean of research and high degree research in the school of nursing and midwifery at the university, said the government data follows the standards of the World Health Organisation (WHO). But she’s concerned the data is not linking other deaths to maternal suicide such as deaths ruled as accidental, or suicides where the fact that the woman has recently given birth is not investigated as a cause.
Professor Dahlen, and others, conducted a of their own, looking at maternal deaths in NSW between 2000 and 2006. They extended their research to include the first year following birth.
“What was so interesting in this study was we found that a notable peak [in mental distress] occurred nine to 12 months following the birth,” Professor Dahlen said.
They found a number of reasons that contributed to a decline in mental health as time progressed.
“All the services tend to be dropping off; women are less likely to be going to the maternal child health nurse, they are back in the business of life, support has fallen away a bit because all the new baby and excitement of everyone coming around helping you out tends to have tailed off a bit and the other thing is women are often about to go back to work and are now juggling everything,” she said.
Professor Dahlen also pointed to the fact that while psychosocial screening is provided to pregnant women in the public health system as a way to flag any potential mental health concerns - it’s not a requirement in the private health system.
“A quarter of Australian women are not asked these questions,” she said.
A by University of Queensland researchers also found that suicide was one of the leading causes of maternal death in Australia.
"Suicidality during the peripartum period is a source of suffering for the mother and her community, but also may have direct impacts on her child, as well as other family members," said Dr Carla Meurk, a researcher at the Queensland Centre for Mental Health Research.
Dr Meurk and her team found that while mental health issues can affect all women, other factors can raise the risk.
"Our findings show the risk of suicidal behaviours greatly increases for peripartum women who have a history of mental illness or substance use disorder, although it's important to note that not all women who experience suicidality will have a mental illness or substance use problem," she said.
"Findings indicated mothers had high rates of contact with health services prior to a suicide death, however, this did not necessarily include contact with mental health services.
"Rather, they might have been in contact with the health system by visiting an emergency department, or primary care professional.”
What needs to change
Professor Dahlen would like to see three key changes implemented to help tackle the issue.
“I’d like to see a very, strong, structured perinatal health support for women and babies and families for the first 12 months absolutely embedded,” she said.
“I’d like to see more community awareness of how important that is, and how important it is to support our mums, and our dads as well, in that critical period of the first year and beyond.
“And I’d like to see a real commitment from the government to more funding to enable more timely maternal death reports with really good investigation and support and education for staff to address emerging trends.”
Amy Dawes pictured with her daughter when she was younger. Source: SBS
Amy was able to get the help she needed through a team of support people which included a women’s health physio and a mental health clinician.
“I’m a different person now, education is everything … I’m certainly a long way off to how I was back in 2016,” she said.
But Amy’s experience made her realise she wasn’t alone so she founded the – a not-for-profit trying to reduce as well as support affected women, families and health professionals.
As well as birth trauma, Amy said the challenges she sees birthing women face today are a lack of family support and burn out in our health practitioners from the COVID-19 pandemic. She said this means they aren’t always able to offer individualised care and the compassion that these women need.
Amy said she’d also like to see better postnatal support.
“In 2021 we still have women saying: ‘All the focus is on the baby and nobody is sort of caring about me,’ so too many women are falling through the gaps.”
Thanks to an intuitive doctor, Emily ended up revealing her struggles and was sent to a mother and baby unit in Melbourne where she was able to receive the proper care and support she so desperately needed.
Emily pictured with Henry and her husband. Source: Supplied
“It completely changed the course of my parenthood journey and my motherhood journey because I got 24/7 support and at that particular unit they really focussed on making sure they helped the baby,” she said, noting she was able to catch up on some much needed rest.
Having come out the other side, Emily said she would like to see changes in place for future mothers.
“We need much better support antenatally on what life looks like after you’ve had the baby, there’s a huge focus in antenatal groups and online sessions around the actual birth … there’s very little education on what happens immediately after the baby is born, and then the first week, and the first month, and how much time you should be spending with the baby awake or asleep, those things should be done antenatally so that people are more aware of it beforehand,” she said.
“If I'm an educated woman and I didn’t know that what I was feeling wasn't OK there must be so many other people who struggle to advocate for themselves and to look up and find out information about how they’re feeling, so a greater emphasis on education around mental health.”
McCarthy said she feels lucky to be able to share her story.
“I’m really grateful that I sought the help that I did and that I spent months working through some of the issues that I had with him [Henry],” she said.
“We’ve come such a long way, I adore him now, he’s such a beautiful sweet little boy but I’m so glad we got to that point because it was a real journey to get there.”
If you or someone you know needs help you can contact the on 1300 659 467. You can contact the (PANDA) on 1300 726 306 or on 1300 22 4636.
