Joyce Fegan: Maternal mental health is not solely a mother’s issue — it's about all of us

'What role are the village, or the State, playing, or not playing, when it comes to maternal mental health?'

In 2021, there were 58,443 births. There’s a ripple effect there, for partners, newly pronounced grandparents, siblings and friends.

When you leave hospital after treatment or surgery, recovery and convalescence are paramount, and promoted, both by the medical community and your own. There’s an unquestioned understanding that you’re not in a position to be of service to others, the opposite in fact, and the length of time it takes to “get back on your feet” is certainly not limited to a single day. We’d laugh at that.

And yet, when women give birth, either vaginally or via caesarean section, they are immediately in service to another being — scars, tears, bleeding, leaking and trauma aside

This week marks Maternal Mental Health Awareness Week, looking at mental health during and after pregnancy. Articles like this are usually confined to women-focused publications, the health sections within major publications, or else, in women-dense spaces online, like certain Instagram accounts.

But, tens of thousands of babies are born in Ireland every year. In 2021, there were 58,443 births. There’s a ripple effect there, for partners whose lives are also changed, newly pronounced grandparents, siblings and friends.

Maternal mental health, is therefore, not a women’s issue — it’s an “us” one.

New findings from the School of Nursing and Midwifery in Trinity College Dublin found that more than one-third of first-time mothers are giving birth by caesarean section in Ireland. That is women, newly initiated into motherhood, having had several layers of skin, tissue, muscle, and organs cut through. These women then go home to feed, burp, change and wash a brand new life. In no other major abdominal surgery of this kind, would we expect a person to walk out the door of the hospital, with someone else to mind — the idea, again, seems laughable. But it’s the accepted way of doing things.

In any other medical treatment our empathy seems endless, our understanding of recovery time generous, but when it comes to maternal health such awareness is lacking at best, and completely absent at worst

So when we have a week such as this, and hashtags trend, and women give their stories to major publications and radio stations for the day that’s in it, there seems to be a missing piece of the puzzle. What role is the village, or the State, playing, or not playing, when it comes to maternal mental health?

I will not be alone as being the recipient of the many varying, yet similar stories of postpartum life. One woman, who birthed nearly a dozen children back when contraception was illegal in Ireland, always shared the one story, and with a smile, like it was some kind of a family heirloom. And this story was repeated by the other women in the bloodline — how she returned from hospital to a bath full of washing. This was not only pre-contraception Ireland, but pre-washing machine Ireland too.

Then, of course, there are all the stories about mothers and aunts birthing alone, because the men weren’t, or couldn’t, come in for the event. These people, who birthed alone, often came to my mind during the pandemic restrictions when a campaign was launched to allow and extend partner support during labour in Irish hospitals.

Other stories include a first-time mother, two weeks postpartum on the morning of her partner’s return to work. As he was about to walk out the door, she asked for assistance with the baby while she readied herself a quick breakfast before facing a day all alone with a newborn. The response was that she had to get it together because she was on her own from here on out. The partner was not entirely wrong in his compassion-lacking logic. She proceeded to sign up to every baby group going and grew her own village.

But what if your mental health is so tested postpartum that leaving the house or walking into a room full of strangers is just not on the cards for you? 

What if the time of the group coincides with the time of your child’s guaranteed nap? What if you have a second or third child to accommodate?

When it comes to facts and statistics surrounding maternal mental health one in five women and one in 10 men will experience perinatal mental health issues. Peri being Latin for “around” and natal meaning Latin for “birth”.

In the NHS, perinatal means the time you are pregnant and up to 12 months after giving birth. Another statistic matters here very much — 70% of women affected by perinatal mental health issues will hide or underplay how unwell they are. So what happens 13, 14, and 15 months postpartum — are problems no longer maternal mental health related?

These are all issues that affect mothers, yes, but entire families too, so maternal mental health can not be confined to a women’s issue any longer

Often after having a child, the question is: “How are they sleeping?” This once sleep-deprived mother, upon having someone compare two babies’ sleeping patterns, one ideal, one non-existent, replied with: “Are we now grading babies solely on their ability to sleep?”

The topic of conversation promptly ended, never to be discussed again, but the question of “how are they sleeping” is often an attempt by someone in your village to see how you are.

And sleep is a tremendous and foundational building block of mental health, but one sorely lacking in the early years of parenthood, so much so it made its way into the poetry of people like Eavan Boland.

“I crook the bottle.

How you suckle! This is the best I can be: Housewife to this nursery, where you hold on, dear life.” writes the late poet in Night Feed.

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Early parenthood is so much about survival, holding on for dear life, and yet the areas of focus are “bouncing back” in terms of the aesthetic and mass of your body, routines, routines, routines, and obsessing over maintaining an immaculate home.

One observation is that as parents get further into the journey of parenthood the hobbies return and the shoulders drop, notwithstanding the fact that problems about sleep or tantrums, or food refusal, are now problems about phones and porn, and possibly illicit substances. This dropping of shoulders seems to correlate almost perfectly with a pick-up in support — the Early Childhood Care and Education (15 State-supported hours from around 3 years old) and the start of primary school.

One mother of triplets, discussing motherhood in an article for this newspaper, said her life only vaguely returned after her children turned 5 — the start of school. That’s a long stretch of time to care for another without adequate support. So in our conversations around Maternal Mental Health Awareness Week, let’s hope they start happening outside the realms of women-dense spaces and include not just mothers, but all of us.

Support in every area of life, from grieving to recovering to early parenthood, is something that makes the world of difference.