Treating my perinatal depression : thoughts.

I’m back in bed feeling miserable, this time with a chest infection. It’s an opportunity to examine my thoughts. This is the part of depression I find the hardest to deal with head on – I much prefer the sneaky, round the back, change the behaviour approach. You see often I believe that my thoughts are true, accurate reflections of the world and that my response of self pity is therefore justified. It takes guts to accept that my thoughts are just thoughts, little passing mind blips which don’t necessarily correlate to reality. When I examine them I find  some are realistic, some are unhelpful, and others are downright lies. The skill lies in knowing which are which and treating them differently.

 

Examples of realistic thoughts.
‘I feel ill.’ ‘I don’t like being ill.’ Yes, they are grumbly and complainy but I’ve found thoughts like this, honest opinions about my situation, are better to acknowledge and share judiciously than to try and persuade myself otherwise. I dug myself into a hole in the first few months of pregnancy telling myself ‘I should be enjoying this last pregnancy’ when I would have been better off accepting the truth that I was struggling and not enjoying it. Sharing that truth helped me realise that most other mums I chatted to didn’t enjoy it either, and that was ok.

 

Unhelpful thoughts.
‘What if this turns to a serious infection like pneumonia, and I spend the rest of my pregnancy feeling this bad, and then I’m ill all the way through labour….’ This is one of my familiar ‘unhelpful thinking patterns’. It’s called catastrophising and is unhelpful and like all thoughts starting with ‘what if’ it’s unanswerable. I need to recognise it for what it is, and be done.

 

Untruthful thoughts.
I’m a pathetic person for being ill in bed.’ ‘I should be downstairs helping with the children.’ ‘I’m a failure as a parent.’ Now CBT teaches great strategies for recognising and weighing thoughts like this, and coming up with helpful alternatives. But I’ve been here before and I know what they are and how to come against these ones. Quite frankly, they are lies. And the truth I need is in my faith and the Bible. ‘I’m a child of God.’1 ‘I’m accepted, beloved.2 ‘I don’t stand guilty and condemned but forgiven and free.’3
Even non-Biblical but slightly more balanced and rational thinking helps. ‘I’m an ok parent.’ I’m treating myself the best I can and following NHS advice for this infection. ‘
CBT calls it ‘cognitive restructuring’ or ‘thought challenging’. The Bible calls it ‘taking captive every thought’4 ‘reckoning the truth’5 or ‘renewing your mind’6.

 

Call it what you will, I don’t find it easy to do. It’s easier to believe the rubbish inside my head and ride the spiral path down to despair, to hide under the duvet and escape into the latest fantasy novel / self help programme on tv. Because once I accept the stuff inside my head needs to be sorted and then accepted ignored or challenged, I can’t let it dictate my behaviour any more. Which takes me back to last week’s blogs on treating my physical symptoms and changing my behaviours… And up and round the spiral I go, fighting for every step out of depression and despair.

 

  1. 1 John 3:1
  2. Eph 1:4-8
  3. Rom 8:1
  4. 2 Cor 10:5
  5. Rom 6:11
  6. Rom 12:12

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Pregnancy and the death of feminism

There was a joke we told at university: ‘Why does a woman have legs? So she can walk from the bedroom to the kitchen sink’. Funny because it was shocking, shocking because by the end of the 20th century, the sexism was out of sync with our culture.
 

Although pretty conservatively evangelical in lots of ways, my inner feminist is strong enough to affect my life and my marriage. We like to think we have a pretty egalitarian marriage – both myself and my husband work roughly 22 hours a week in paid employment, and spend the other half the week doing child care and home educating our girls. We are going to share parental leave following this pregnancy so we can both spend time at home with the family. We both serve in our local church. We both study, when we have the opportunity: I’ve done Post Grad courses through work and he’s completed his PhD. We have hobbies and friends, together and apart – I run, he buys and sells books, we garden. Housework is divided according to abilities and preference – I do most of the cooking, day to day finances and have used a vacuum cleaner fewer than 5 times since we got married 7 years ago. He is far more diligent at general cleaning and tidying, does more laundry, is better at planning educational activities and hasn’t touched an iron yet. Neither of us is much good at DIY but we are learning, together.

sleeping beauty

Sleeping Beauty woken by a kiss. Romance or sexual assault?

 

And we want to bring up our children this way too – in the midst of the inevitable pink and Disney princesses that having two girls under 5 seems to bring, we hope we are bringing them up to be strong women, confident in their own worth and that of other people, aware of issues of consent and power.

 

And then I fall pregnant. I don’t do pregnancy well in general, and this one in particular. So for the last few months, Mummy hasn’t been going to work in her paid job. And Mummy hasn’t been doing any gardening with Daddy. Or taking her girls to play ball in the park. Mummy hasn’t been serving at toddler group, nor doing much housework. Mummy doesn’t run any more. In fact, Mummy doesn’t leave the house except in a car, and then only to sit down when she gets to where she is going at the other end. It’s been a struggle to even manage the washing up, but I’ve worked it out now, by pacing myself and using a stool and taking it slowly.

feminism …is all well and good if I’m fit and healthy but you put an embryo in my womb and it all goes to pot

 

So I stand at the kitchen sink, washing up, whilst my husband and father-in-law are doing the hard landscaping in the garden, and think back to that old joke. Is this the end of feminism then? It’s all well and good if I’m fit and healthy but you put an embryo in my womb and it all goes to pot?
 

Was this how the androcentric culture we live in started? Because women, through constant childbearing, breastfeeding and child rearing, physically couldn’t do what the men could? And are my feminist ideals really based in the Bible as I like to believe, that God created men and women equal in his image before the fall, that Jesus restored women to their place of equal worth both by his treatment of them and by his death which as Paul wrote means “there is now…. no male nor female“? Or is it merely because I live in a society that is used to contraception, and in particular contraception which provides women with reproductive liberty and therefore for the vast majority of my life I can live like a man, without being crippled* by this thing called pregnancy?
 

And there is the fallacy in my thinking – because for all my feminist principles, some part of me thinks to be equal to a man, I need to be like a man.
It seems I’m not the only one to succumb to this fallacy. In Australia, it has just become permissible for MPs to breastfeed in Parliament. However here in the UK, people seem to agree with the Betty Boothroyd test – that “You wouldn’t start feeding your child if you worked on a supermarket check-out or if you were a solicitor having a meeting with a client.” and therefore we don’t allow our MPs to feed in the chamber.
 

But that’s the same lie – our whole British idea of work culture is male dominated. When a father of a 3 month old child works on a supermarket checkout, or meets with his client as a solicitor he doesn’t need to consider the feeding demands of his baby. As an employed mother of a 6 week old baby I have to choose – do I take less money (and therefore accept a lower status) to be at home with my child or do I return to work, without my child? Even with recent changes in law, employed fathers don’t even have that same freedom of choice – we’ve found the loss in income in a man taking shared parental leave means that amongst all our friends, family and colleagues we’ve only heard of one other couple who have done it.
 

In our society ‘work’ and ‘paid employment’ is still something one does without having to be responsible for growing or feeding a child during those hours – or for that matter without taking into account the care needs of your grown up child with disabilities, or your elderly parents. So if you do have to consider those demands, as many women do, then you cannot work as a man does – which equates to fewer hours, less money and therefore less status and worth.
 

So is my concept of feminism embedded within this androcentric culture? Have I swallowed Betty Boothroyd’s opinion and believe that to do a man’s job (and thereby have a man’s worth), I need to act like a man?
 

This pregnancy and all its associated problems has taken away my ability to do so many things I place status and value in (like working, running, and, in this case, constructing pergolas). Furthermore, unlike a broken leg, or fibromyalgia, this removal of status has come about purely because of my sex. Were I a man, I wouldn’t have cause to ask these questions.
 

Do I really believe the Bible when it says that my worth and value as a person – as a woman – is not connected in any way to the money I am paid, the work I do, or the status or hierarchical place I hold?
 

I’ll be honest, part of my grumbling is down to simple jealousy – both myself and my husband enjoy being out in the garden and because of my need to manage the pain, he gets to do the job we enjoy and I’m stuck inside making the coffee. But part of it is that I have accepted the lies of my culture – deep inside me lies the belief that out door physical labour (‘man’s work’) is of more value that looking after the home (‘woman’s work’), and unless I can do the man’s work, then I am not equal in worth to a man.
 

So until I can stand here at the kitchen sink with bump so big I can barely reach over to turn on the taps and know that what I am doing — both in growing a child, and in serving my family by washing up last night’s dishes – is of equal worth and status as my husband’s construction of the garden pergola, then the answer is not that feminism is dead and therefore has nothing to say to me at this stage of life. It’s that I’m not feminist enough.
 

*I mean this is the most literal sense, because of the SPD type problems I have.

 

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Creating the Working Garden

Inspired by The Arts and Crafts movement, with its ideas of formal landscaping, informal planting, and by Hidcote Garden with its separate garden rooms, our final plan had some distinct different garden areas.

 

The first of these to be tackled was the Working Garden. Situated between kitchen door and immovable air raid shelter shed, this contains our greenhouse, compost bins and washing line.
When we bought the house, this area was a mixture of shrubs, low level plants and broken patio slabs, which had been interplanted with mini conifers, fuschias, ivy and bindweed. I’m assuming the last wasn’t deliberate.
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  1. Pull down and replace the collapsed back fence. We met our pleasant over the back neighbours, Colin and Sue, and hired Darren, a local builder, to help us with this.IMG_2282
  2. Rip it all up. Whilst we had the digger in, up came the old concrete path and heavy concrete patio slabs. We dug a foundation trench for the raised bed.IMG_2476
  3. Lay the new patio with a little help from our friends. We re-used the intact slabs, and laid a firm base for the greenhouse. We decided on a firm patio slab base, with gravel in the middle. Our plan is to use the greenhouse for propagation, seed trays and maybe overwintering, with perhaps growing veg in bags/pots rather than in the soil. Lloyd in ‘A Well Tempered Garden’ recommends a soil base for better humidity, but I hadn’t read that then. Plus, that area now covers a lot of buried old concrete from our dug up back path. The raised bed foundations were filled in with rubble.IMG_2774
  4. Erect the greenhouse. Having been lovingly cared for by our good friends Nick and Becs, their imminent move to Australia necessitated bringing the greenhouse home. I drove some of it round in the car : the main frame parts Simon carried down the Southmead Road.9D00D63F-A734-4316-9359-FB17872F7103
  5. Build giant compost bins from freely acquired pallets tied together with cable ties. I managed to do this my last piece of manual labour before the pregnancy had progressed too far.IMG_2796
  6. Employ Darren to build the raised bed which borders the working garden. We realised at this point that perhaps designing brick walls which simultaneously curved and descended may have been beyond our fairly non existent brick laying skills. The bricks we had acquired via gumtree back in the summer too. The raised bed is filled with top soil from our neighbour Tim at number 11 and left over sharp sand to provide a different planting environment from our normal heavy clay beds.
  7. Fill in gaps with gravel from our neighbour Melanie on the corner.D5EB6B93-B8A0-409B-930E-36087032B8D6
  8. Erect and paint the entrance arch and trellis. Painting this took much longer and was far fiddler than we had anticipated, but it does look good. We also painted the shed and outdoor toilet door to tie the whole area together. The trellis helps define this garden section, and will mean than our view from our lounge window will now be flowers leading up to the (one day) green roof on the shed, the leylandii and the sky, rather than the greenhouse and shed as it was. (The rhododendrons and the elder tree you can see currently in the raised bed, like so many of our plants, are just there till they find their final homes).
  9. Finishing touches included painting the back fence dark green to make it fade away, installing my potting bench (gumtree again). In this photo you can also see the inserted pavers (bought 2nd hand via gumtree) to aesthetically tie the different garden areas together, and the pavers beginning to cover the area immediately outside the back door leading towards the main path.IMG_2818
  10. Simon and the girls made slatted fronts for my compost bins as pregnancy had defeated me by this point. In the foreground is the large pot with rose and daffodils which we bought Nick and Becs for their wedding 9 years ago and acquired as a leaving gift from them along with 3 box balls and a washing line.IMG_2824

Here is a before and after shot of the completed Working Garden. Along the fence on the left (a shared boundary we can’t repainted as the colour would drip through) I have planted a Parthenocissus henryana: this is a Chinese Virginia creeper, slower growing and more suitable for a smaller garden than its cousin, and am keeping an eye out for a particular evergreen ivy (Hedora helix ‘Oro do Bogliasco’, for its colour) to join it.

We also need to under-plant the beautiful Photinia which of all the plants in the area has managed to survive the makeover. I’m ignoring the Ribes sanguineum here, which is between the leylandii and the compost bins at the back. I’m rather inclined to agree with Monty Don’s summary of it “pink flowers, boring leaves and smells of cat pee”.
Neither the rhododendrons nor any of the other plants in the raised bed will be making their final homes there, and I’m still pondering climbing roses and clematis for the arch and trellis.
Back Garden, 2013

Out with the old…

IMG_2819

In with the new…

What I love most about this area of our garden is that it now looks like it did in my head when planning it all those months ago. This gives me hope for the next 3/4 of the garden with its piles of rubble and tumbling mounds of clay.

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Antenatal Clinic Trip and Tears

Emotionally tough trip to the hospital this morning. I was expecting my first appointment with the new mental health nurse on the team – not that you’d have known from my appt letter which just said I was seeing a doctor at the antenatal clinic. But my midwife had checked I was being followed up and confirmed that was what it was for, despite the name being different.


I’d had to rearrange it from last week, so had yet a different name on the letter, and this name was a male doctor which I felt unsure about. I hate waiting rooms, and then there was the doctor strike today, and a huge queue at reception, so all in all by the time I’d given in my yellow notes (no idea why they wanted them) and waited 10 mins past the appointment time  I was feeling quite teary and lost.

Then I was called for a blood pressure test and urine sample… That had me in tears as I really wasn’t expecting that. I checked with the midwife, and said I was expecting a mental health appointment – she was lovely and reassured me that they just did this as standard every appt.

Waited some more, feeling a bit better, until I was called by the (thankfully female) consultant obstetrician. As she sat me down by the desk, and introduced the student I couldn’t hold back the tears and had to ask precisely what  I was attending for…. Turned out it was to discuss my birth plan. Only, I had that booked for this Fri, and had arranged babysitters so my husband could be there too. 

I explained through the tears that this really wasn’t what I was expecting today and bless her, she asked if I was in touch with Sasha, the mental health nurse. Anyway, within a few mins we had sorted that my appointment had been arranged on a day that the mental health clinic wasn’t on, and that she would email Sasha to contact me, and whilst I was there we might as well have my birth plan appointment and scan to save me coming back on Fri. I calmed myself down, blew my nose, and went back to ‘coping absolutely fine’ mode, which I’ve been functioning rather well in for the last month.

So, on the good side, I’ve seen baby again and he’s fine, heart beating, wriggling, and best of all head down. I don’t need to go back on Friday. Birth plans are all agreed and in the notes and finalised.  I’ve signed up for the IMOX research study.  And the mental health nurse phoned me this afternoon and we’ve agreed a support plan up to and after birth.

And learning points? As a patient, I need to check the receptionist knows exactly which clinic/ practitioner I’m seeing when I book or rearrange an appointment. As a professional, the more information the patient has on their letter about who they are seeing, what for, and if they need to do extra tests or questionnaires etc first, the better… Because that waiting time and uncertainty beforehand is horrible, and the emotional distress from it being wrong can last even beyond a cup of tea and chocolate bar once back at home.

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Treating my perinatal depression: behaviours

Behaviours

So it’s not rocket science, but one thing CBT has taught me is that if you can work out what you are not doing when you feel down, and then start to do it, it will help you feel better.

At first I wasn’t sure that was possible – there seemed so many good reasons (like being pregnant) for not doing all the things I wasn’t doing I didn’t think I could change things. Thankfully, being off work not only gave me some time and some energy back to deal with my physical health but it removed some of my excuses for dealing with my mood too.

The ‘not doings’ in depression can be typically divided into 3 categories: routine, pleasure and necessary. I’ll give an example for how I’m tackling one of each.

Routine: these are ordinary everyday things we do, like cleaning our teeth or cooking a meal. My example is washing up, which I’ve never enjoyed but is a considerable part of my normal daily life. Due to the pain and dizziness I really struggled to do it, and thankfully my husband /friends/ lodger helped me out a lot during the first 6 months of pregnancy.
Since being off work I’ve learnt to take my time. I don’t rush to stand after eating, and when I do it I take breaks in between loads. If I need to lie down I do and if it takes all day I don’t worry about it. Consequently I’ve been able to get the washing up done at least once a day.

Pleasurable: This category includes anything we do, or used to do, which gave us enjoyment. So many times I meet mums who are great at doing everything routine and everything necessary, but who have nothing in their life purely for pleasure. I’ve found being pregnant, in pain, and tired in the evenings has cut out most of my pleasure activities, like exercise and seeing friends.
Seeing my friends is huge for me. Since stopping work I’ve found I have time to plan in coffee during the days, either with my girls or even (gasp!) on my own. It takes planning but being able to see the people I love and who I can be honest with, who love and support me, who I can laugh and really talk with, has been a wonderful joy.

Necessary: all the jobs that just have to get done- bills and food shops and mending the car and Christmas planning etc. Mine was writing Christmas cards (always traditionally my job). I achieved this by the means of breaking it down into manageable chunks.

  1. Buy stamps
  2. Get up to date addresses
  3. Print out card labels
  4. Write bare minimum in cards whilst watching tele.
  5. Post overseas cards
  6. Post hand delivered cards to neighbours
  7. Post all other cards

This turned my insurmountable task into achievable goals which I could do over a period of time.

So by not being at work; reassessing my priorities; working around my health; breaking big tasks down and planning in pleasant things I started doing the things I had stopped doing during my pregnancy. This interrupted the negative cycles I had got caught in, and I started enjoying life a whole lot more.

This method of Behavioural Activation has been adapted from an evidence-based CBT strategy for treating depression. You can find the whole strategy in this simple workbook from the NHS: Getting active

 

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Treating my perinatal depression: physical symptoms

blog medsBack at the beginning of my sick leave I posed the question: ‘How does one do resting?’  highlighting the paradox between looking after myself by not doing as much, and yet still needing to pro-actively treat my depression.  To ‘understand my pnd’ I found it helpful to distinguish between my physical symptoms, my behaviours and my thoughts. This then gave me some helpful hints on actually what it is I need to be doing in this time of rest.

I’ve started with my physical health – I hope by posting it here if anyone has similar symptoms they might gain some insight into things they can try.

 

Managing my Physical Symptoms

 

symptom cause treatment
Feeling faint, breathless and palpitations

 

Anaemia

 

Take iron tablets regularly. Take with food to manage side effects.

 

Feeling faint and dizzy after eating

 

Postprandial hypotension (low blood pressure after eating)

 

Eat smaller meals, with fewer carbohydrates. Eat more often to manage hunger, and avoid simple carbs like sugar. Lie down after eating.

 

Pain in hips, buttocks and thighs, particularly in my piriformis muscle and illiotibial band

 

 

 

Because my ligaments are relaxed, the right side of my pelvis rotates out of position. My muscles around my hip, buttocks and thighs contract and spasm in order to keep my body stable.

It doesn’t really work but I appreciate the fact they try.

 

Do nothing. At all. Ever. Don’t walk anywhere, don’t drive for more than 20 minutes, don’t lift or push anything, don’t stand for too long, don’t sit for too long. When you do any of the above and get in pain, then take paracetemol ASAP. Lie down, and ask husband to dig an elbow into the cramping muscle, Follow my physio’s instructions to re-align my pelvis. Visit my massage lady and physiotherapist regularly.

 

Tiredness

 

Growing a human inside me

 

Rest. Nap. Sleep as well as I can.

 

Obviously all these things were much harder to do when I was working 3 days a week and home-educating and caring for my children for the other days. Especially napping – I have at least one nap a day now and I can’t imagine coping without the time to pace myself and lie down when I need to.

The benefit has been that I am not in pain for the majority of the time (which is incredible compared to my previous pregnancies and the first 6 months of this one). I can go days where I don’t feel unwell, sorry for myself, and think ‘I will never be well again’. But that’s running ahead – I will get to thoughts but the next most important changes I made were to my unhelpful avoidant behaviours which were reinforcing my depression.

 

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Garden Blog

2 years ago we first viewed our forever home, and fell to in love with the garden. Or shall I say, the potential garden. Unlike a normal terraced city home, with a rectangular strip going back from the kitchen, our end of terrace house sits in a triangular corner plot in a cul-de-sac. The front garden narrows to a point at the wrought iron gate, and consisted of a weedy triangular patch of lawn surrounding an overgrown weeping goat willow.

IMG_1223

The garden then stretches out behind and to the right of the house towards the garage and back entrance out to the alley. By the time we’d moved in, some of the boundaries surrounding our patchy lawn with its occasional shrubs and worn out patio had given way to the wind.

The fence and wall on the long boundary down the hypotenuse needed entirely replacing, as did the section of back fence between our back left corner and the air raid shelter- or shed, as we like to call it. This section of back fence is fronted by two leylandii who form part of a row of 9 grand trees across the back. To the right of the air raid shelter stand the other five, doing their best to disguise the council breeze block wall, topped by various timber panels according to the taste of each of the three other houses we share a boundary with. Unfortunately, the foliage has been lifted to head height, exposing the ugliness. Above that, the trees tower tall enough to block out any sight of neighbours even from upstairs windows, giving a sense of privacy to our space.

garden 2014

Hexagonal paving slabs marked a path under the washing line, and the common Bristol thin concrete path led from kitchen door to garage.

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Round to the side of the house the lawn has been bisected by an ankle height brick wall, and past nettles and grasses an old shed base shelters beneath the concrete wall and broken wooden side gate leading to the front.

We knew as soon as we moved that we would change much that was there. Simon has loved gardening since a teenager, and has been involved in landscaping his parents’ gardens. Since our marriage gardening has been a growing joy to me, especially growing things to eat and in each of our rented houses we have done our best to make our gardens our own. With the lack of vegetable beds, large flower borders, trees and compost bins, plus needing a home for our greenhouse, our new patch of land cried out to be used well. Coupled with a path entirely unsuitable for buggies or bikes and a lawn which neither of us had any desire to mow, we turned our minds to complete garden re-design.

Throughout our first year in the house we learnt our garden:  what was already growing, ground level changes, and how the sunlight fell across the garden throughout the day in each season. We visited Gardeners World Live and took our tentative designs to see what a professional landscape designer thought. We visited RHS Rosemore, and loved their potage garden with its structured curving paths and glorious abundant planting in the beds. Our most inspirational moment was seeing a local Henbury garden through the National Garden Scheme. Slightly bigger than ours, and a traditional rectangular shape, it was divided in such a way to look even bigger and was a pure delight. The owners had moved there as a young couple 30 years previously and loved, designed and planted ever since. We decided then that we too could make our scrubby patch a place of beauty and worthy of the National Garden scheme, despite its city location and dreary grass.

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