On Pandemic Pregnancy and Postnatal Depression

Note- What follows is a pretty graphic description of my pregnancy, birth and its aftermath. Please don't read if you don't want to know about these things or if it will be upsetting to you...

Another year, another blogpost. What started as a blog about school and teaching has turned into a platform where I very occasionally share my mental health ups and downs (mainly downs), this time my experiences of postnatal depression.

I wanted children so very badly. I was (and still am) the kind of person who looks at babies and smiles like a idiot, trying to catch their eye. When my husband and I finally decided we were financially ready for a baby (we had been emotionally ready...or so we thought... for many years), the fact that it didn’t happen instantly drove me to despair. It takes the average couple up to a year of trying to conceive to get pregnant, it took us 3 months and I was a nightmare to live with through that time. I had to be a mum, I just had to be and it made me very very low. When I found out I was pregnant, a week after schools shut for the pandemic, I was totally elated. The excitement and joy was wonderful- finally my purpose in life would be fulfilled. Not long after that, I began to convince myself that something would go wrong but generally I managed to push that feeling out of my mind and keep myself emotionally healthy for the vast majority of my pregnancy. Around me, the world was changing rapidly, coronavirus was on everyone’s mind and I had something wonderful to look forward to.

At 9 weeks we found out we were expecting twins. Nobody plans twins. Due to the pandemic, I found this out alone as I wasn't allowed to bring anyone with me to scans. The shock and concern soon gave way to even more excitement- ‘a best friend for life, ‘a ready made family’, ‘double trouble’ - people say a lot when you say you're having twins. I soon got swept along with that excitement, following endless twins and triplets accounts on Instagram and obsessing over adorable matching outfits. What I didn’t quite realise was how much riskier a twin pregnancy is than that of a singleton. However, I am young and generally fit and healthy and I wasn’t overly worried apart from around my scan dates where I was convinced something would go wrong for the babies. As my pregnancy progressed, things were going so so very well, their growth was fantastic and bar the usual pregnancy niggles like heartburn nothing was of great concern. I never clocked or expected that the pregnancy would have such a huge impact on my own health, physically and emotionally.

Things started to go wrong at 33 weeks when I developed a liver condition called obstetric cholestasis (Google it...it's crap) with the most horrendous itching of the hands and feet, caused by a build up of bile acids in the blood. The condition would have me up all night scratching or feeling like my skin was burning. The problem with this condition - which is more common in multiple pregnancies- is that nothing you apply to the skin really addresses the symptoms as the issue is below the skin in the blood. The only cure for the condition is birth and it also carries an increased risk of stillbirth. For weeks on end, I was in and out of the hospital for monitoring, worried about reduced fetal movements (it's hard to tell their movements apart) and sleeping for 1-2 hours a night, dousing my feet in freezing water for only temporary relief and crying or wailing because my feet were burning. It was agonising and debilitating. Every time I felt the itching, I had an overwhelming feeling that I was harming my babies as my blood was pumping this dangerous acid around my body. I was a complete emotional wreck to the point where I even begged a doctor to considering delivering the babies early. I contacted my midwife for support but due to a communication issue, I received no response to my desperate texts and voicemails because she was on annual leave and nobody had let me know or provided an alternative number. Around this time, I was isolating due to Covid as well and only left the house for medical appointments. I won’t labour the point but it was bleak. The hospital were a wonderful support but all that really kept me going was knowledge that my babies would be here soon then EVERYTHING WOULD BE OKAY. I’d say it over and over again in my sleep deprived stupor.

I was due to deliver the twins at 37 weeks by c section. A week earlier I began getting cramps and after about 4 days of latent labour, my waters broke 3 days ahead of schedule. These babies were coming. Finally I could meet the babies, finally the itching would end, finally EVERYTHING WOULD BE OKAY. I had wanted a c section because I wanted to have a plan: a delivery in a calm, controlled environment. I knew recovery would be hard but I was happy to prepare for that and it was better in my mind than the unpredictable nature of a twin vaginal birth (you have a 40%+ likelihood of needing a c section anyway with twins). Unfortunately my birth experience was quite different and not something I could have really prepared for. After an initial examination, the doctors decided to schedule my c-section for that morning. My contractions were quite manageable and I was comfortable and very excited. I was dressed for theatre and taken down. As we were about to enter, I was told they could not go ahead due to my unusual blood type and the high likelihood that I would need a transfusion due to it being a twin delivery. The bloods had to be requested from another hospital and would be another few hours. Frustratingly, I was taken back to maternity (postnatal of all places!) with no babies whilst we waited. In the few hours it took for the blood to arrive, my contractions intensified. I was in huge amounts of pain and this resulted in my going back in for the section with very painful labour. In theatre, the anaesthetist struggled to site my spinal injection and they had to pause multiple times as I was having such painful contractions. The staff could not have been lovelier but I was surrounded by doctors and nurses telling me to get in the right position whilst having agonising labour pains. I remember apologising in my distress and promising them I was doing my best. They had a number of goes on my spine and eventually they were in and the pain disappeared. Phew, EVERYTHING WOULD BE OKAY. Minutes later we heard a cry and then another cry, the boys were born. They were quickly checked and I got presented with one of the twins in theatre as one needed some extra checks. It was a totally surreal feeling: I hadn’t eaten, was on lots of drugs and had also had gas and air for the contractions.. there was a lot going on but I was so very happy. They kept me in theatre a bit longer than expected meaning that the babies and husband had to go ahead without me as they were trying to sort out my bleeding. Eventually I made it to recovery and things were great, I couldn’t stop smiling and I felt so brilliant. The boys were healthy bar some minor temperature issues and didn’t need special care. We returned to our room and I was up and out of bed within a few hours, feeling sore but not nearly as sore as I had expected to feel. I was totally elated.

For a long time I had been motivated to breastfeed and in typical me style had done an inordinate amount of research about it. I was so determined and had spent hours watching video tutorials on breastfeeding twins and pre-expressing colostrum into tiny syringes which I lovingly bagged up and froze to take with me to hospital - I was so prepared. I had to give them the very best start in life. Cue the first setback: Both babies, being slightly premature and on the small side, struggled to latch because they were so sleepy. I had a great milk supply and my milk came in very early but no matter what the amazing hospital staff did to support us, they just would not do it. It was OKAY though because I could use the pump and express milk and they would get what they needed. I had so many staff members helping me, attaching the babies to me, doing everything they could for what totalled hours but it just would not happen. It was demoralising and upsetting but I was happy they were still getting my milk.

Unfortunately the boys lost a lot of weight initially in spite of all of my efforts to express milk. I was pumping up to 8 times a day at this point and they were getting great quantities but they kept losing. Even though we were allowed to go home after 3 days in hospital, we had nearly daily visits from midwives to weigh them. It was awful. I would look at the babies and just see numbers and cry. Everybody told me I was doing everything right but this made no sense to me. Why weren’t they gaining weight? On one midwife’s advice, we trialled them on big quantities of formula for 24 hours but it didn’t agree with them and we ended up back in hospital for a night. The stress was awful. The home midwife visits also meant I could not leave the house as we weren’t given a time for their visits. I hadn’t left the house in many many weeks apart from for hospital appointments due to a combination of being heavily pregnant, unable to drive and covid and I was so desperate for some fresh air. We were physically exhausted from the demands of caring for the twins and I was also recovering from the surgery. It was very stressful. The thing with twins is that they both need you at the same time and you are constantly having to choose who needs you the most.Eventually, the boys started to gain although still weren’t breastfeeding brilliantly and I was expressing regularly. Expressing milk is tiring. Expressing milk for two babies while recovering from surgery is even more tiring. It was hard work but I knew it would pay off. It was stressful- I felt like every time I would wake up from a nap, I was presented with a baby that needed feeding. It was a lot of pressure and most of that pressure came from me. I started feeling very low and struggled to bond as the babies were so demanding.

Around this time, I noticed that something wasn’t quite right with my body, in spite of being very active around the house and going on walks, I wasn’t feeling brilliant. I developed an awful itchy rash on my stomach which turned out to be an allergic reaction to my c section dressing. Turns out I have a plaster allergy. I also started feeling tired and shivery at night after feeding or expressing but put this down to the exhaustion of caring for newborn twins. What did alarm me was that I started getting a lot of bleeding, far more than I’d had before. I knew it wasn’t normal, it didn’t feel right. When I called the hospital they told me it was probably that I was doing a bit much and that it didn’t sound concerning. About 3 weeks after giving birth, I was in bed feeding one of the baby and became extremely shivery and cold. When I measured my temperature, it was high- 38.4 and I could not get out of bed. I really wasn’t well. Initially suspecting corona virus, I booked a covid test. I remember bawling down the phone at a poor NHS 111 call handler asking whether I had to isolate from my babies whilst waiting for a covid test result. I was in a complete and utter state. It turns out I didn’t have Covid... I had sepsis and was very ill. My heart rate on admission to hospital was dangerously high- 144 and my blood pressure was low. I found myself back in hospital, admitted to the maternity department, with spiking temperatures and no babies. The same wonderful staff who cared for me when I had the babies cared for me then. They took me to postnatal, gave me a big room, hooked me up to a drip and iv antibiotics. I don’t remember ever feeling so low. There was an empty cot in the room and I spent hours just looking at it -crying and crying. I was very weak from the sepsis and emotionally broken. The staff could not have been kinder to me but there was no way I could be picked up out the hole I was in. It was a very dark lonely place. I hadn’t expected to be admitted and had no clothes with me. I still remember trying to change into a hospital gown but not being able to do so because the drip was in my arm so sleeping in my clothes. I could have asked for help - the staff were only to willing to- but I couldn’t even bear to speak to anyone. I cried and slept. The sepsis temperature spikes made me feel unbelievably cold and shivery. I could not shake the feeling that my babies were at home, crying and I wasn’t there to hold them or feed them. It was really awful. The next day, I felt worse and was seen by a lot of doctors. A plan was put in place to operate and remove whatever was in my uterus that was causing the infection. I was consented for surgery, dressed in a gown and told to wait for my slot. The consultant on the night team decided that it was best to not operate that night but there was a miscommunication and nobody told me this until very late. I was lying in bed, very unwell, temperature spiking, tearful and drenched in my own leaking milk for hours waiting for surgery that never happened. It was very traumatic. I wanted more than anything else to go home to my babies. I knew if I could only get home, EVERYTHING WOULD BE OKAY. Fortunately, after just 2 nights in hospital, I was well enough to go home. I was so happy and found the most incredible energy to get myself ready and walk out of the ward. When I got home, I realised that I was still unwell and needing to recover. Just picking up a baby and feeding him floored me energy wise- I was so so exhausted. Nobody had really warned me how hard it is to recover from sepsis and that I would need to rest. How I was supposed to rest with newborn twins, I don’t know. I was lucky to have a wonderful husband and mother in law on hand to help but I wanted to be the one to do things for my babies. I wanted to feed them, to cuddle them and to do things for them especially as I hadn’t been there whilst in hospital. I put a huge amount of pressure on myself and became extremely down about the whole thing. I dragged myself out of bed and did everything I could but I had to give up breastfeeding. Whenever I would leak milk (my supply was completely out of sync with their needs) I would be taken back to the trauma of being in the hospital, surrounded by doctors, leaking milk on my hospital gown. It felt like my body had been hijacked and walking round the house, soaked in my own milk when I didn’t have the energy to latch the boys was upsetting. Switching to formula feeding was the right decision for me but it still was- is- upsetting and I would have so so liked to have fed by boys for longer.

The demands and exhaustion involved in caring for two babies is huge. The sense of responsibility you feel is even huger and there have been many a time when I just haven’t felt up to it. I love them and feel immensely protective over them but my god are they hard work and they have broken my body a little (a lot). I find myself fixating over the trauma of what has happened, a periodic sense of ‘I can’t do this’ and worries about the future and whether I am good enough to care for them. It’s hard hard work.

My energy levels have slowly started to pick up and I am definitely enjoying the babies a lot more. The bond is most definitely there now. Unfortunately my mental health has really suffered and what hasn’t helped is the isolation that lockdown brings. We are lucky to have the most wonderful friends who have rallied around us and met us for many a walk in the park. Unfortunately, not being able to legally see people indoors and having winter babies means that we are at the mercy of the weather and it gets dark very early indeed... Round the clock feeding and up to 20 nappy changes a day between them is hard too but that’s improving. The prospect of my entire maternity leave being spent in lockdown doesn't feel me with joy either but I think that's what I'm facing. I have a lot to be grateful for - I have two healthy babies, a wonderful husband, a lovely home and fantastic friends and I sometimes need to have a word with myself and remember it.
I don’t think it’s surprising, writing that all down (I skipped the bit about needing a tooth extraction soon too) why I am not really okay. It's also not surprising that this last 6 weeks (and longer if you count the end of the pregnancy) has been the best and worst of my life and why I have spells of lots of tears and low mood. Postnatal depression was probably inevitable anyway given my history but the severity with which I’m experiencing it is unsurprising given what's happened. But it’s still shit. I am getting professional help and I have a lot of support but I think it will take me a long long time to feel like me again...if that ever happens. I have good days and dark nights. I am more sensitive than I used to be, more anxious than I used to be, more stressed than I used to be. What I am, slowly, learning is that feeling like that is OKAY and is not something to be ashamed of. I do not think anyone will read this to the end and I don’t expect anyone to because it is far too long, repetitive and waffly. I hope people do read or skim it though as I think there is a big stigma about not feeling entirely wonderful and blissful after birth. The guilt that I have felt for not feeling that has definitely compounded my feelings. It’s hard and it’s complicated but i know I’m not the first person to feel this way and I certainly won’t be the last. Talking helps; writing things down helps and if it helps me then maybe, hopefully, it will help someone else too. I do honestly still believe that EVERYTHING WILL BE OKAY eventually but it’s not quite there at the moment and that’s probably okay too.