I haven’t posted on Women Makes Waves for a while. I haven’t had something that I could write about specifically for women. However, the recent disappearance of new Bristol mother Charlotte Bevan, caught my attention. Stories like hers always catch my attention because I know how she felt.
Charlotte disappeared on Tuesday from St Michaels Hospital in Bristol centre. Between bidding farewell to her partner at 8.30pm and a nurse checking her room at 9pm, she had managed to leave the Maternity Ward and hospital with her new born daughter. Her daughter had been born three days earlier in a fairly routine birth. Charlotte left the ward on a bitter and cold night wearing no outer wear herself, with her baby wrapped up in a couple of hospital blankets. CCTV shows her walking through the hospital, passing several nursing staff and going through the front doors just before 9pm. She raised no alarm, nobody noticed her and the new baby was in the comfort of her mother’s arms.
The first question that springs to mind is ‘where was she going?’, then the second would probably be ‘what was she thinking?’. On behalf of Charlotte and all the other women I have spoken to that have had similar experiences, I can tell you that she was going out of her mind and she certainly had no idea what she thinking. Charlotte, like many others before her seems to be suffering some sort of mental disturbance. Her history suggests that she was prone to depression and symptoms of schizophrenia and this may be so, but I can guarantee, if she had been questioned that night by a psychiatrist, he would have diagnosed her with the most severe form of postnatal depression. It has a name actually, it’s called Puerperal Psychosis.
Postnatal depression statistically affects one in ten women. It is not uncommon and it’s treated by talk therapy such as counselling and in worse cases, a small stint of taking anti-depressants. Your GP can diagnose postnatal depression and in most cases the mother will never get to see a psychiatrist or any other mental health team professional. It is mostly assessed on the ‘baby blues’ lasting longer than a couple of days. Women feel unable to cope, miserable and tired. However, this list of symptoms isn’t exhaustive. Depression is one of the illnesses that is specific to the person. One person’s generic ‘bad mood’ can be another person’s nightmare. Depression, the diagnosis and treatment, is governed by how you feel. It’s that simple.
Puerperal psychosis is different. It’s rare, it happens to one in one thousand women. It’s serious, it’s urgent and as in Charlotte’s case, it can be deadly. Postnatal women in a psychosis will suffer from terrifying symptoms. They hear voices. They hallucinate. They have obsessional negative thoughts. They can’t sleep, sometimes going a week with no sleep at all. They can be compelled to self-mutilate and then the worst symptom comes at them with no announcement. They are almost always going to feel the overwhelming need to harm their newborn baby.
Whilst postnatal depression can take up to twelve months to manifest. Puerperal psychosis will happen within the first eight weeks after birth. You then have to take a myriad of medication to re-balance your body, you will always be prescribed medication and hospitalised. Confinement to hospital is the ONLY way to ensure yours and your baby’s safety. However, sadly for Charlotte it seemed the system failed. The most important thing you will be told is that you will get better from puerperal psychosis. It takes time, the correct cocktail of anti-psychotics and anti-depressants, a lot of patience from your loved ones and the unbridled need to feel like a mother should feel.
So how do I know all this and why has Charlotte’s story gut punched me in this way. For me, Charlotte has joined a long line of mothers that have suffered from this and gone on to harm herself or her baby. It’s a list that I could have easily been on. I have had postnatal psychosis four times, but I and my children have lived through it, we were the lucky ones.
In May 2007, 3 days before my wedding, I learned that I was pregnant with my last beautiful son. I wasn’t a novice at pregnancy, I had done it three times before. That particular year I had a thirteen year old son and a ten year old already. But, I met the love of my life three years previously and wanted to marry him and have at least one child. When I told my Mother that I was pregnant again, it was hardly a joyous occasion. She looked at me, sighed and said ‘Oh no’. When the rest of my extended family found out, they reacted in much the same way. It wasn’t fabulous, but they had their reasons. After my first and second son I had suffered a postnatal psychotic breakdown and my family were concerned by this new baby, to say the least. Prior to this, in 2003, I became accidentally pregnant as a result of a casual fling. That pregnancy ended in a mis-carriage at twenty weeks, but I even suffered from a psychosis following that.
I wont bore you with the details of all these illnesses as they are irrelevant, but I will just say that with immediate hospitalisation and medication I got better and I made it up to them by being a resourceful, chirpy young mum. The main negatives to take from those periods was that the relationships with their fathers and I never worked after the psychosis. Even though we had been through the so-called ‘mill’, I became a very independent and resourceful single mother of two very happy young men. They are now 21 and 18 and thankfully still very, happy albeit older and now legally classed as adults.
Fast forward to 2007 and my planned pregnancy. I spoke with my psychiatrist (I have a psychiatrist on speed dial,) and we decided prevention was better than cure. I was assigned a community mental health nurse at 26 weeks and she came to see me every week for a catch up. Things went well up until the 35th week, Christmas was approaching, I was on the final stretch of baby cooking (pregnancy) and we were planning a big celebration. As it turned out, we did do something big, just not what we had thought.
The week before Christmas, the mania began to creep in to my life. One minute I was out, driving and wondering about looking for presents, the next I was slumped on the couch. I couldn’t sleep, but was beyond tired. My speech and mannerisms changed and I was falling into psychosis before birth. This was a complete shock to my system and on Christmas day that year I suffered a breakdown. I hadn’t slept for 48 hours. By boxing day, I was convinced that my baby bump held a large, velvety black spider. By the end of boxing day, I had been admitted to hospital and was going about organising my bedside cabinet. However, that night, even in the safety of the hospital, I still couldn’t sleep. In the middle of the night I locked myself in the toilet and slashed my wrists apart quite badly. Safety in hospital I thought, not blooming likely.
The next day I was told that I would be induced. I was 37 weeks and terrified. I needed the spider out, but my small, strong side was saying no. I needed medication ASAP and the baby needed to be let out. This is the odd part; I had a perfect birth. 6 hours, no pain relief, husband by my side, and when he plopped out I saw a baby boy, not a spider. I was so relieved. Two hours later, psychiatrically medicated, cleaned up, but tired beyond any description I returned to the maternity ward and the games began.
First of all I wouldn’t go near my son. I felt not love, not care but terror at the sight of him. The other babies on the ward had a similar affect and within the space of a morning I went from birth euphoria to being overwhelmed to kill every single baby on that ward, including my own. After my husband demanded to see my psychiatrist, I was assessed and on my request (more like beg) I was moved to the adult psychiatric ward. I was delusional, panicking, sick and scared. I couldn’t go near my child but insisted on doing his washing so I could feel close to him. I couldn’t feed him, bathe him and to be honest, look at him. He stayed nameless for 6 days, as I had no idea what I had to name him for. When I finally agreed to spend time with him, I would do it on the proviso that I was supervised by my husband. Only by my husband, because I didn’t trust anyone else. I had two moments when I felt something for my son over the next ten days. One where I was stood in the maternity nursery staring at him. I lent over him and told him ‘I am sorry that I cant love you,’ and another time when I was sat in the nursery after agreeing to feed him, when I saw the eyes of my middle son looking back at me. I was bereft, but felt a smidgen of hope.
The midwives and maternity ward staff treated me with contempt. They had no point of reference for what I was experiencing and felt as though I was a burden. Their treatment will stay with me forever. I just needed people to be calm and kind. Now looking back on it, I can remember the lack of care in their eyes. The psychiatric staff were a little better, but not particularly trained in postnatal mental illness and felt that I was getting preferential treatment over the other psychiatric inpatients. I was allowed to leave the ward with my husband when I wanted to, to see my son and the other patients were set a strict allowance of time off the ward.
After five days I was released into the care of the crisis team and came home with my son and my husband. My older sons stayed at their fathers for a little bit and I thought maybe I might of swerved the worst of it. On the tenth day post-birth, almost in textbook time, I had a full nervous breakdown. The psychosis completely took over. I didn’t know who I was, what I was doing and all I wanted to do was kill this baby sleeping peacefully in front of me. I was admitted to the mother and baby unit forty miles away from where I lived and I stayed there, with my son, for the next eight months.
I cant tell you much about the first two months at the unit. As with all four episodes of puerperal psychosis, I have no recollection of any of my sons first three months in this world. This particular time, I started to bond with my son in month four. I started by feeding and bathing him. This led to a little play, then a little dance and then one day, I began to love him. It happened with all three of them, that moment when I started to love them. I can’t recall the locations or situations, but if I close my eyes I can remember the feeling as clear as day.
However, not all of my time there was positive. I had many medication changes. This alone can send even the mostly mentally sound person over the proverbial edge. My behaviour was so erratic that I was sectioned for twenty eight days so that I had no choice over whether I could stay or leave. Social services where involved and that gave us the gift of having them pressuring us until my son was one year old, then they finally accepted it was a temporary illness and I wasn’t actually a child killer. The treatment was devoid of any kind of counselling and my days were spent either caring for my son or sleeping. This may sound like bliss, but to someone with a delusional psychiatric illness all it did was give me time to think negatively. The mother and baby unit itself was under-staffed and whilst advocating itself as a place for mothers with postnatal illness, it was actually three quarters full of mums who were being assessed by social services due to alcohol and drug problems. Often it was a chaotic environment and not a unit to rest and recuperate. BUT it did keep myself and my son safe. I will always be grateful for that.
On my release, eight months after my sons birth date, I was still ill. My panic attacks were frequent and I was still nervous to be left alone with my little boy. I walked around with a brown paper bag to breathe into as a comfort blanket. I started to go out on very short walks. Then I began to drive. I slowly returned to the outside world and my elder sons eventually returned to me from their fathers, relatively unscathed by the whole experience. Even during my darkest and hardest times, I still maintained my presence in their lives with two long phone calls a week. As I said, they were thirteen and ten at the time and I couldn’t let them visit me in the unit as it was beyond what I personally felt they needed to see. But they knew I was ill and why, so they settled for our chats on the phone. When my son grew to around eighteen months, I was almost back to normal. I let go of the brown paper bag and my confidence returned little by little. I started to laugh again and I never lost the love for him, once I found it.
My whole story is very long and difficult. It was twenty one years ago when I first suffered from puerperal psychosis. The whole tale would provide enough material for a book, so this is an abridged version.
My son is seven at the end of December. We have an amazing relationship and my other boys, though now men, will always be my babies. My husband has returned to work after giving up to care for me all those years ago. Though, he would say he was not with me 24/7 because he was worried I couldn’t cope or needed special care, he would say that he was doing his job as a dad and keeping us safe. I am still on medication and will be for the rest of my life. Too much damage was done to my mind, so the tablets keep me level headed. I have had a hysterectomy, so I could not get pregnant again, though I still suffer from bouts of broody mania. I occasionally mourn for the three newborn babies that I missed out on. I didn’t meet my sons until they were at least three months old, but even so, I ritually thank god for what didn’t happen rather than moan about what did.
I started to write this because I felt compelled to share the story. I have seen over the past few days multiple messages left for the family Charlotte has left behind. I can’t tell Charlottes story, I never met her. I wish I had, if only to sit there and tell her that she will get better. Earlier this year I was given the opportunity to work with women suffering from postnatal depression. I found this difficult as I am a very blunt and down to earth person and it was crippling to try and sympathise with a mother that felt rough and down. In my opinion, this kind of mis-representation makes it easy for health professionals to ignore the deeper more serious cases. I am now re-evaluating my decision. For every mother that I meet that may just be down, I could meet a mother like Charlotte who genuinely needs serious help, guidance and understanding. If I can help just one of them with my experiences it will be worth it.
This morning I felt guilty because voicing my experiences to the right audiences may get the NHS to do the right thing about this illness. Maternity staff need to be trained to recognise the symptoms and deal with them swiftly. Mother and baby units need cleaning up and to be used for their intended purpose. As a developing society, postnatal illness needs some sort of level-headed research and systems put in place. A health visitor with no training, just simply isn’t acceptable anymore.
I am no stranger to psychiatric illness, I have had a personality disorder since I have had a personality, but ultimately my own plans when I was of sane mind, saved us as a family when I lost my mind. But really I shouldn’t have had to do that for myself. My medical team were aware of the risk that I was facing and were still nothing short of poor in their response to my care needs. However, I was still one of the lucky ones. Charlotte and her baby girl were not.
May they rest, as mummy and baby, in peace.