Monday, July 27, 2009

Antenatal Depression, part I

If you've read the posts below, you will know that I haven't found pregnancy to be the easiest thing I've ever experienced. I won't reiterate every single point I've made already, but let's just remind ourselves that it was the physical discomfort that had been the top of my list of 'hard things about pregnancy', things that as a Proselytiser for 'Truth In Pregnancy' I felt you should know.
Now, however, I have a new offering: mental health. It is not well-known that women can suffer from depression and anxiety throughout pregnancy. When you look into it however you find that it is suggested that around 10% of all pregnancies are accompanied by serious depression. Some even suggest that around two-thirds of pregnant women will suffer depressive episodes at some point during their pregnancies. These are quite big numbers, and do not reflect the relative lack of recognition accorded to the syndrome. We all know about postnatal depression, the 'baby blues', that see women lose their stability when faced with the care of a newborn child. But I for one had never heard of antenatal depression, or if I had, would have ascribed it to women who faced unplanned or unwanted pregnancies. Indeed, unplanned or unwanted pregnancy is a major trigger for antenatal depression, but it is by no means the only one. So what could pregnant women who want to be pregnant have to be depressed about? Turns out I was, as so often the case, inexperienced, uninformed and about to embark on a steep learning curve.
So first things first: what is this antenatal depression? Well, duh: it is depression experienced during pregnancy. In some ways it presents in very similar ways to other types of depression, leading to feelings of worthlessness, an inability to lead a normal life, and even to self-harm or harm to an unborn baby. But it can be harder to diagnose than other depressions, for the following reasons.

1) Breaking news! Depression can be hormonally related.
Those of us who have had the pleasure of experiencing emotionally-charged PMT, or Pill-induced mood swings, will know that hormones are prime agents in the regulation of mood, and in some cases mental health. When pregnant and during in the first trimester especially, a woman is treated to not only an increase in hormone levels overall but also to a new mixture of them swirling around. These are, after all, what encourage the baby to grow and develop. It follows that one of the casualties of this process will be her ability to maintain equaninimity in the face of, oh, I don't know, an attempt to show her affection, let's say. Or someone giving the 'wrong' birthday present. Or someone being ill on her birthday. That sort of thing. The sort of thing that might (depending on the individual and of the individual's time of the month) be passed off as 'life' and all its charm normally, but in pregnancy takes on the hue of being Very Distressing Indeed, and which are greeted with a variety of responses, such as hissing, spitting, weeping, 'you-don't-really-care' speeches, or locking herself in the toilet to avoid all eye contact. Under such circumtances, it is difficult to tell whether the root cause is simply hormonal imbalance, or a deeper malaise involving self-doubt, self-loathing, fear and anger.

2) Pregnancy actually involves many of the same physical symptoms as depression.
The checklist for depression includes problems sleeping, problems concentrating, extreme fatigue, changes in appetite, loss of libido, and difficulty achieving everyday tasks. Sound familiar? For many women in their first trimester, this describes their situation pretty well, and is considered 'normal' in the context of an otherwise troublefree pregnancy. 'It will pass', the doctors, the books, the fellow mums-to-be all say. Which leaves very little lee-way for an alternative response, which might be something along the lines of 'Perhaps you need some help...'

3) Pregnancy is supposed to be this glowing, wonderful time of contentment and hope.
I have written about this before, and it is the reason for my self-proclaimed title of Proselytiser for Truth In Pregnancy. The idea that women enjoy being pregnant is endemic, even or especially among women who have had babies themselves. I am not sure if that is 'aftermath glow', by which I mean an anticipation of the happiness of a child in our lives in the future, or whether it is altogether more vague than that, a sort of universal 'wah' that mythologises and idealises the pregnant body. Either way, the expectation is that women will be over the moon about being pregnant, especially if they are not too young, too old, too sick, etc. Even if women are not the ideal candidate for pregnancy, should they decide to continue with a pregnancy it is generally assumed to be a source of happiness and positive expectation. This leads to a situation where the expectant mother's mental health is not given the support it may need, as so few people are on the lookout for potential problems.

So there you have it. Depression does happen in pregnancy, and it is often overlooked for various reasons. It is not often acknowledged by experts either: even the BeyondBlue website has only one information sheet buried in among many others devoted to postnatal depression. There is one website in Australia that specialises in both antenatal and postnatal depression: see http://www.panda.org.au/index.html

And what do I have to do with all of this? Well, folks, if you thought I was laying the groundwork here for some kind confessional post, you were absolutely right. But that will have to come another day. Right now, I have to eat some lamb carry, struggle with basic tidying, and head out for the daily highlight of a swim in one of the hotel pools. I will be back, however, with Part II soon.

Friday, July 24, 2009

Home births threatened in Australia

Not enough noise is being made over plans that will threaten Australian women's right to give birth at home with the help of a midwife. Proposals contained in the draft Health Practitioner Regulation National Law, due to come into force in July 2010, will effectively eliminate midwives' ability to legally attend home births in a professional capacity. As I understand it the bill requires midwives to be able to access insurance to be able to be registered, insurance that in turn is only available for midwives working in hospitals. This precludes the possibility of registered midwives attending home births, and for good measure the bill proposes a $30 000 fine for midwives who do attend home births in professional (but unregistered) capacity. (More information on the bill is found at http://www.joyousbirth.info/homebirth-is-not-a-crime.html , with further links at the bottom of the page.)

I find this proposal absolutely abhorrent, for three reasons.

1) It isolates and stigmatises the work that midwives do at homebirths by implying that it is dangerous and unreliable medicine, and thus cannot be insured.

Midwives are highly trained professionals with specialist knowledge. Those that attend home births have particular knowledge of how to make women comfortable in their own home and how to encourage women to listen to their bodies. There is plenty of evidence to suggest that such elements of birth - safety, familiarity, autonomy and control - are crucial to positive outcomes from the birth process. There is also plenty of evidence to suggest that hospitals often do not have or exercise such knowledge, preferring to implement protocols and regulations, often against women's wishes. In particular, women giving birth in hospitals frequently complain of being prevented from moving around during labour, of being given interventions they do not want, and of being given set time-limits in which to give birth. This sort of medicine should not be considered any more 'safe' or 'reliable' than giving birth at home, given the emotional and physical trauma that can be involved.

2) It penalises women who wish to exercise their choice to give birth at home.

Women have been fighting for decades to increase their choices and autonomy throughout the reproductive process. In 1973 the Boston Women's Health Book Collective published their ground-breaking and best-selling guide/polemic, Our Bodies Ourselves, which not only taught women about their bodies but also proposed radical alternatives to conventional Western medicine. Central to their analysis was the importance of autonomy: a woman's ability to choose according to her needs, needs which she herself determined. The book drew upon and inspired the work of many women setting up alternative healthcare services for women (and by 'alternative' I don't necessarily mean anti-Western, I mean services for women run by women) and was part of a wave of women demanding that their rights around healthcare be recognised.

Against this backdrop, the move to restrict homebirths to those that are either a) unassisted or b) illegally assisted by midwives, risking a $30 000 fine, is a major step backwards. It is paternalistic and patronising, and assumes that women (and midwives) do not know what is best for women giving birth. It prevents women from trusting their bodies, and will damage some women's ability to have an empowering experience.

3) It sends the message that home birthing is not a natural or safe practice.

This is simply not true. Women experience complications in childbirth wherever they happen to be, at home or in hospital. If a professional midwife is in attendance at home, it is her responsibility to make the decision to move a woman to hospital, should she need intervention, with plenty of time. This is a crucial part of her job. Thankfully, such cases are in the minority, and usually result in a positive outcome. Of course, hospitals cannot guarantee a live birth, and every year women face the tragedy of the death of the baby even when they have followed all conventional advice. Furthermore, as mentioned above, there is evidence to suggest that women experience less trauma when made comfortable in their own home, than they do within the unfamiliar and at times confronting environment of a hospital. Naomi Wolf (Misconceptions) and Sheila Kitzinger (Birth Crisis) have both written considered but passionate critiques of the ability of hospitals to bring about anxiety and stress during childbirth, seeking to change the very attitudes that are contained in this draft legistlation: that doctors know best, that hospitals are the best (only) place to give birth, and that women who argue otherwise are ignorant. They are not alone, and there are thousands of books, pamphlets, websites and support groups designed to push for greater recognition of the relatie benefits and/or dangers of both hospital-assisted and home births.


Many women value their ability to give birth at home and will be devastated if this option is taken away from them. I myself have been put off this option due to the uncertainty surrounding the future of home-births (and it must be said, the prospect of making arrangements for a birth in Castlemaine from Alice Springs). I hope that for future pregnancies I will be more settled (waiting to settle down, after all) and will be able access a registered, legal midwife to help me labour at home. But this won't happen if we don't fight. To make your opposition to this bill known, write to:

The Health Minister, Nicola Roxon (Nicola.Roxon.MP@aph.gov.au)
Your state or territory Health Minister - they are all in this together.

Sign the petition here

And tell your friends and family all about this - it's vital we make MORE NOISE!!

Friday, July 17, 2009

'Oh, yes! Pregnancy is horrible, dincha know?!'

Well, Simon and baby and I have passed the twelve week mark and have made the big announcement to all of our friends. Many congratulations have poured in, and even the first gift - some teeny tiny socks, jumpsuits, rompers and singlets, all in neutral colours, from Chris, Paula, Georgia and Isabel. (Thankyou!) There has been a lot of goodwill sent in our direction, promises of visits to Castlemaine, and too many emailed exclamation marks to count!!!!!!!!!!!!!!!!!!!!!!!!!

What also came through, though, were a few emails from friends who for various reasons are not pregnant but would like to be. Confessions of slight jealousy at our good fortune have not surprised me; I have expressed exactly the same sentiments to previous mothers-to-be of my circle, when they have made announcements that I wished I was making. Well, ladies and germs, I want to relate to you a conversation I had on Sunday morning with my old school friend Kirsty, mother of two:

Me: 'Hello?'
Kirst: 'Ohmigod! You're pregnant! I just read your email and I started crying! I am so excited for you it is such amazing news!'
Me: 'Kirst, thankyou.'
K:'Are you excited?'
Me: 'Actually, Kirst, I'm finding that pregnancy is quite hard...'
K: 'Oh yes! Pregnancy is horrible, didn't you know?'
Me: 'No one told me....'
K: 'I told you.'
Me: 'I don't think I was listening...'
K: 'No, you weren't. It's really a terrible experience.'

Now, I don't want to confuse 'being pregnant' with 'having a child', because I am told that the latter is much more a) pleasant and b) permanent than the former. So please don't think I am not looking forward to having a little Jess or Simon to name, influence, discipline, and do craft with. No, I am talking about the nine months preceding the start of that phase, those months that are, in the scheme of things, quite short, but by their nature seem to pass glacially slowly.

I can hear the clicking of tongues and the furrowing of brows from here. What could be so terrible about growing new life? Isn't that the crowning achievement of womanhood, should one be lucky enough to be able?

Well, consider this. How would you like it if suddenly you lost all ability to stand upright for more than ten minutes? And stay awake for more than about six hours? Have to eat every two hours, but not too much at a time? And could no longer eat some of the most convenient foods around, that might give you sustenance without too much effort (sushi, premade salads, ham)? And could on many occasions stomach nothing but hot chips and lemonade anyway? Had to give up all activities based in standing up/walking/cycling? Alternated constipation and diarrhoea for weeks and weeks? Had to endure mystery stomach aches for days on end? (Don't anyone dare say anything about the chips and lemonade.) Headaches that lasted for days? A runny nose permanently? Sensitive teeth, anyone? Muscle loss due to lying in bed all day? Pretending none of it happening so as to preserve the secret? And finally, the piece de resistance: massive, unpredictable, extreme mood swings, from despair to jubilation in a matter of hours.

Oh yes, pregnancy is horrible. Do not be fooled. Do not aspire to it. See it as a necessary stage of life that will, all going well, produce a bundle of joy that will be your most amazing achievement. But it is not fun.

We live in a culture that, rightly, exults the process of pregnancy and childbirth. It is a tough business and women should be praised to the skies for it. But don't romanticise the process too much. I am told there are some women who 'love' being pregnant. All power to them. For the rest of us, it's akin having to a giant hangover, PMT, and chronic fatigue syndrome all at once.

So says Jess, proselytiser for Truth About Pregnancy.

Questions? Comments? Challenges? Bring it on! I'll fight the lot of yer! Gah...

I'm off to eat baked beans from the tin, shuffle into the shower, and then have a nap.

Thursday, July 16, 2009

Close the Uluru climb now

Last week we went to Uluru with friends. They had never been there; I have been once, and this was Simon's third trip. Off we trundled in two camper vans, making the compulsory stop at Stuart's Well to see Dinky the Singing Dingo (don't ask - but if you already know about Dinky and want to see him for yourself, be aware that he has been fed many snaggers over the years and no longer feels inclined to get up on the piano to sing, preferring to yowl from his position flaked out on the floor. It's quite disturbing). We were unaware, when we left, that this would be the week when the question of who can/should climb Uluru would be revisited at a federal level, but we sure found out when we got there.

To recap: the Uluru-Kata Tjuta national park is owned by its traditional owners, the Anangu, but was leased to the federal government in 1985 for 99 years, which now regulates access to the site. Prior to this arrangement, a climb had been established that allowed people to ascend, with the help of a chain bolted into the rock, the 800m to the top. More recently, the Anangu have requested that visitors do not attempt the climb, partly because it crosses a significant Dreamtime track and partly because of the danger involved. Thirty-five people have died attempting the climb, and it is frequently closed on days of high temperatures or high winds. Nevertheless it is still an experience that is freely available, and it is down to the choice of the individual visitor whether to climb or not to climb.

When we visited, I was struck - as I had been the first time - by how many appeals in numerous languages have been signposted at the foot of the climb, urging visitors to refrain from doing it. It can scarcely escape the notice of any visitor that the traditional owners of the site do not wish people to climb what it an extremely important place for them. And yet, there is a steady stream of people, moving like ants up and down the climb. Furthermore, numerous conversations overheard or entered into with other tourists confirmed that the wishes of the Anangu are often barely considered.

It was during these conversations that we learned that the federal Environment Minister, Peter Garrett, had been flirting with the idea of closing the climb permanently, on the grounds that it was dangerous and culturally insensitive. The reactions to this at Uluru were furious. 'Well, we climbed it today because who knows when we will get another chance? It's ridiculous!' and 'Tourism will suffer if the climb closes - people won't want to visit any more.' Echoing these sentiments elsewhere, Australians then chorused that it was their right to climb Uluru (or Ayers' Rock) and that to close it would be unfair, unwise and extreme. Prime Minister Kevin Rudd immediately bowed to this kind of populism and contradicted Garrett, stating that the climb should stay open for the enjoyment of everyone. The debate ended there.

Such sentiments fly in the face of the Rudd Government's significant and moving gesture of apology toward the indigenous people of Australia, for the injustices associated with the Stolen Generations. The apology means nothing if traditional owners cannot enforce their wishes over their land, especially on a matter as trivial (for white people) and as dangerous as the Uluru climb. Visiting Uluru and not climbing it is not a hardship: there is a 9km base walk around the whole thing that allows tourists to access caves, waterholes, traditional art, rock formations and unbelievable beauty. Visitors should respect this place as the cathedral that it is, and not even think about climbing all over it. Peter Garrett has been a most ineffectual Environment Minister - just this week he approved the first new uranium mine in Australia for decades - but here he was on to something.

We thoroughly enjoyed our visit. We all felt, we agreed, that this was not a place for white people to stay, as if we were intruding slighly. This was not due to a lack of facilities or a lack of welcoming spirit. It was more to do with a sense that here was a place so complex, so vast, and so different from Western norms of living, that we were groping for words and concepts to explain it to ourselves. On this basis, we all felt that the Anangu and their understanding of Uluru's significant has to prevail - they are better placed, culturally, historically, politically and morally, to explain what Uluru is to visitors. And visitors we are, all of us.

Stop the desecration of this stunning, overwhelmingly significant site, and the disregarding of its traditional owners' histories. Close the Uluru climb now.