Guest blog - Supporting a new mum with a history of mental illness during the coronavirus pandemic
March 30, 2022
The blog post below is written by Roz Littwin. I had the pleasure and honour of supporting Roz and Zak during the pregnancy, birth and postpartum of their beautiful baby. This was during the coronavirus pandemic, in 2021, a trying time for us all but especially for expectant and birthing parents.
Afterwards, Roz kindly offered to write a testimonial about the support I'd offered her and Zak. I was very excited and grateful to hear that - when Roz started writing her testimonial - it organically grew into a guest blog post that I was of course more than happy to share!
The story and account below are Roz's, in her own words, about her experience of having a doula during a difficult time and with her own individual and personal circumstances. I'm truly grateful to Roz for her kind words and, above all, for her openness, honesty, and willingness to share her story.
Why a doula?
I wanted enhanced support during my first full-term pregnancy and birth because I have a history of mental ill-health. I wanted to have real input over how events unfolded, as I came to realise it was impossible to control or know exactly what would happen. I wanted my experience as a birthing woman and my baby’s health to be of equal consideration.
I feared an especially difficult birth experience could damage my emotional connection with my newborn or reduce my physical ability to care for him. And once his arrival forever intertwined our wellbeing, I worried that any significant mental deterioration - caused by a highly disempowered birth or unnecessary medical interventions – might engulf my husband and son. I did not want to become part of this statistic: “The leading cause of maternal death within the first year of a baby’s life is suicide” (Source: Maternal, Newborn and Infant programme: Saving Lives, Improving Mothers’ Care 2020 report).
Women like me, with pre-existing mental health conditions, are more likely to experience postnatal depression. Doulas are associated with improved birth outcomes for both mother and baby and with a reduced need for medical birth interventions, itself a risk factor for experiencing birth trauma, or even PTSD.
Sara was part of my mental health birth and postnatal tool kit: along with the hypnobirthing course, the counselling sessions, the pre-emptive Juno peer support meetings and my husband’s extended 3-month paternity leave. While no guarantee of a natural, straightforward birth, I believed a doula was a key component in cushioning the emotional impact in all eventualities.
What did Sara do?
Before the birth
Together with Sara my husband, Zak, and I had a couple of antenatal sessions to talk through our hopes for the birth and discuss any preferences. We decided that no intervention was entirely off the table and instead ranked several possible options in order of desirability. Although we would have agreed if medically necessary, I was especially keen to try and avoid the lengthy recovery time often associated with caesarean section surgery. As signposted by Sara we educated ourselves and found attending Positive Birth Edinburgh’s monthly online discussion group especially useful and informative.
In response to the coronavirus pandemic our health board had implemented a one support person only policy. I did not want to deny Zak the chance to witness the birth of his first child, yet I very much wanted the skilled support of a trained doula in the room too! I petitioned the health board to consider an exception to this rule and Sara was able to advise who to contact and we discussed how best to make a strong case. Thankfully, and I will always be extremely grateful for their decision, NHS Lothian granted our request.
I had hoped for as natural a birth as possible at the Royal Infirmary of Edinburgh’s (RIE) Birthing Centre. Sadly, this was not to be. In May 2021, during a routine community midwife appointment at 38 weeks my raised blood pressure prompted a trip to RIE for further investigation. I would ultimately leave hospital 7 days later, bewildered, bruised, and exhausted, holding my son.
Unexpectedly diagnosed with pre-eclampsia, I felt like a rabbit caught in headlights. Our first set of birth preferences, the midwife-led birth centre, was immediately ruled out. Labour ward now the only option. I had mentally prepared for two more weeks of pregnancy and it felt too early to meet my baby. What if he wasn’t developed enough? I wanted to hold on longer. But what were the risks to myself and my baby if we waited?
Each new discussion with medical staff felt like pounding the accelerator: induction, possible caesarean section, immediate delivery. I felt frozen in time and desperately wanted to run. Sara arrived quickly and her assistance proved invaluable as my husband and I struggled to absorb ever-changing information. It felt like we needed to make an immediate decision and her presence helped to slow the process down. An uneasy compromise with medical staff was reached, and I agreed to stay in hospital to be monitored overnight. I tried to reassure myself that if the situation was truly dire, there would be no discussions and I would likely already be on the operating table.
That one night, that breathing space, was a gift. The following day, in a more accepting headspace, my waters were broken. After a difficult 12-hour birth, two different midwives due to a shift change, a catalogue of interventions (vaginal examinations, tethered and garrotted by continuous monitoring straps, epidural, episiotomy, suction cup, forceps) and an undignified stirrups delivery we met our beautiful child.
It is impossible to overstate the importance and value of Sara’s presence. She was our constant companion during the entire birth, for each step and twist in the road. Her understanding of, yet independence from, organisational maternity systems and procedures freed her to assist us without limit. For us, navigating an unfamiliar system, with unfamiliar staff, during an uncertain birth, during ever-changing pandemic restrictions, this continuity of care provided a vital light in the dark. My husband was able to take breaks, safe in the knowledge that Sara was with me during these brief absences.
She was a calm and grounding presence when I felt like I was losing my mind with pain. She rubbed my back to ease the pain of contractions, with a bespoke essential oil mixed a few days earlier. She fed me water. She softened the highly clinical environment with a fragrance diffuser and fairy lighting. She even knitted a hat for our baby. She took photographs, at our request. And while it took months to feel strong enough to view them, I am delighted they exist and show the honest, messy, empowering business of birthing.
She was my voice and my advocate when I was simply too exhausted to speak. Even though I was too tired to notice at this point, aware of my abhorrence at infantilising language, Sara proactively asked our second midwife to refrain from calling me “girl”.
Our first midwife later commented that she was glad we had had a doula to provide emotional support as she was unable to do this as her main priority was clinical monitoring due to the pre-eclampsia diagnosis.
She was my faith to suspend time, inhabit my primeval instincts and step outside my logical brain. I did not need to consider anyone else, manage or calm anyone else’s emotions or fears.
After the birth
I stayed in hospital for 7 days after the birth, the first two in the maternity high dependency unit, tethered by catheter to the bed. Time seemed meaningless during a haze of sleeplessness and medical monitoring. I could not fathom how I was expected to recover myself and simultaneously learn how to care for a newborn. Coronavirus limited visitor numbers and visiting hours. My husband was able to visit and care for our son between 1pm-8pm so I could rest. Sara supported Zak while I was in hospital and kindly passed on tiny baby clothes for our son as we had none to fit his dinky 2.8kg frame. Once we were finally discharged, Sara delivered food – delicious soup and lentil chilli – to our home and later signposted us towards further services for a lactation consultant and a childminder.
Could my husband or partner not just be my “doula”?
My husband was a phenomenally caring and informed birthing partner, and together with Sara, created a truly supportive environment where I, as a separate and distinct person, felt seen. His loving care was instrumental at every difficult stage, sensitively responsive to my changing needs and gently encouraging during each intervention.
Giving birth was brutally tough and I could entirely focus on myself as I knew my husband was also well cared for by Sara. No one can really know in advance how they will react in any situation, and I could imagine it is easy for any non-birthing parent to feel particularly overwhelmed, especially seeing the birth of their first child. An unfamiliar medical environment, that has only begrudgingly allowed men into the delivery room in recent decades, combined with the psychological turmoil of watching their loved one in visceral pain could understandably render any normally confident person stunted and mute. I found it immensely comforting and reassuring to know that however my husband reacted on the day, Sara would support him, which in turn protected my emotional resources to focus on myself.
I would not hesitate to recommend Sara. She is amazingly knowledgeable, adaptable and highly compassionate. She was a crucial acknowledgement and validation that my birthing journey mattered and, simply by her presence, signalled this to medical staff. Even if we had had a smooth experience, I believe Sara’s support would have been highly beneficial. As it was, her support was truly transformative during an unpredictable and challenging childbirth.