Motherhood doesn't come easy to everyone, and for some it can bring about extreme anxiety. Andrea Altomaro tackles postpartum depression and depression during pregnancy in this week's post.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Spoiler Alert: This post discusses events in Call the Midwife Season 5 Episode 5

As midwives, we have the privilege of not only welcoming babies into the world, but also seeing women transform into mothers. While for some women, the adjustment to motherhood may come with ease, it can be a steep learning curve for others.

This week, we met Roseanne Dawley, an anxious, first-time mother-to-be. Roseanne’s husband, while quite a few years older than her, seems to be a loving and doting partner, and he has all the confidence in the world in his wife. Roseanne has so many worries about caring for the baby and how to manage once the baby is born, and cannot seem to understand why her husband thinks she is so capable.

After a fast and furious labor, Roseanne gives birth to her baby girl before the midwife has arrived and is coached by Delia Busby to get the baby breathing. The calmness, quick thinking and firm guidance from Delia, along with Roseanne’s ability to listen and obey Delia’s orders (despite her intense fear), saved Baby Dawley.

Nurse Crane said it best when she told Roseanne, “You’ve been so brave. Look what you’ve managed! You’re a mother now, Roseanne.”

Most of the time, despite the difficulty adjusting to motherhood and taking care of a newborn, women adjust well and find their groove. For some, it comes quickly, almost effortlessly. For others, it’s much more of a struggle.

It pained me to see Roseanne struggle, because I feel like perhaps more women identify with Roseanne than care to admit it. It’s very easy to put on a little makeup and brush our hair and show up to our routine postpartum check up looking like we have it all together. It’s quite another to be alone in your house, holding your crying infant, unsure if you’re doing anything right.

It’s the quiet moments in the middle of those sleep-deprived nights when a mother’s mind can run wild. Newborns, for the most part, are not easy. It doesn’t matter if it is your first baby or your fourth, each mothering journey comes with its own trials and tribulations, and one heck of an adjustment period.

As midwives, we do our best to help guide women into being empowered and confident mothers. Most of the time, this involves providing information or resources, like childbirth and infant care classes, and having the mothers follow up on their own. After all, there is only so much that we can cover in 15-20 minute prenatal appointments.

We do screen women for depression around their eighth month of pregnancy and again postpartum using a short, multiple choice questionnaire. We know that perinatal mood disorders, like anxiety and depression, happen in about 15 percent of women. Many times, mothers, like Roseanne Dawley, will think there is something wrong with themselves because of their anxiety or depression.

They might struggle with bonding with their new baby and then think they’re a bad mother. They may have such extreme fear about something bad happening to the baby that they cannot leave the house.

For me, the small bits of anxiety started during pregnancy. I was suddenly deathly afraid of using kitchen knives. Preparing dinner became a stressful event. I couldn’t explain it, but I felt like something horrible could happen. I could slip while chopping a carrot and slice my finger off or drop the knife and it could go through my foot.

Postpartum, I saw things snowball a bit. I was afraid every time I had to go down the stairs with my baby in my arms. I had horrible visions of slipping and falling or having one of my cats trip me while I was holding the baby.

I worried day and night if I was making the right decisions for my baby. What if he died of SIDS? What if I got in a car accident on my way home from the doctor’s? What if he’s not in his car seat snugly enough and he flies out?

My anxiety seemed to get better, but then we started planning a family vacation, a cruise to Alaska. I would lie awake for hours some nights picturing my son falling off the cruise ship and me having to jump overboard to try and save him. I have sweaty palms even just typing this and letting all of those memories come back to me.

I’m extremely thankful that I have a wonderful support system with my family and friends. I am a health care provider. I screen women almost daily for perinatal mood disorders, and yet like most women, I just shrugged it off, considering it “baby blues” or just being a nervous first-time mother.

If I’m being honest with myself, if another mother was telling me she was having all the same thoughts and feelings that I was, I would recommend follow up with a behavioral health provider like a counselor or psychiatrist.

It’s hard to admit that you’re struggling. It’s hard to verbalize the fears that you know are irrational, but feel them anyway. It’s hard to seek help, but as Nurse Crane said this week, “Hard work makes a mother. We like to think something magical happens at birth and for some it does. The real magic is keeping on when all you want to do is run.”

Please, know that if you are struggling with anxiety or depression either during pregnancy or the postpartum period, you are not alone, you are a good mother and it can get better. Talk to your health care provider and get the resources you need.

If you ever have thoughts about harming yourself or your baby, please seek help immediately at the nearest emergency department. Needing a counselor or using medication to get better doesn’t mean you failed; in fact, getting the help you need shows your strength.

Your mental health impacts all areas of your life, your partner’s life and your child’s life. If you aren’t sure if you could have postpartum anxiety or depression, check out this symptom list at Postpartum Progress and more information from March of Dimes. Resources by state or region are also listed here.

Andrea Altomaro (MS, RN, CNM) has been nurse-midwife for the past three years and is currently working for the Henry Ford Health System. Before becoming a midwife, she worked as a nurse in the emergency department and also in labor and delivery.
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