The birth of a child can be messy, painful, and mind-blowingly incredible. Then the hard work begins.
Having a child may well be the biggest life-changing event that will ever happen to you – so it's hardly surprising that it can trigger mental health issues for many new mums, and their partners.
The trouble is, when you're a new mother, it's really hard to tell whether you are mentally ill, because your whole world has been turned upside down, you haven't slept forever, you can't tell the difference between half-awake dreams and reality, you are paranoid about things you had never even dreamed of before, and a tiny little tyrant is ruling your every move. Basically, if you're not losing your marbles, there's probably something wrong with you anyway.
So how do you know when you really need help?
The first thing to recognise is that the 'baby blues' are normal – most women get some sort of emotional reaction during the first week after childbirth. Just to make everything a bit more challenging. Isn't nature wonderful?
So you might feel emotional and irrational, you might burst into tears for no reason, and feel irritable, touchy, depressed or anxious.
All these symptoms are normal BUT they usually only last for a few days.
If these feelings continue beyond that and you feel increasingly depressed and despondent, you may be suffering from postnatal depression. This is thought to affect around one in 10 women, and up to four in 10 teenage mothers.
If you are a new mother and you're depressed, you may also be feeling incredibly guilty. Here you are, with your wonderful new baby, which might be everything you ever dreamed of – but you're in the depths of despair. You'll probably wonder what's wrong with you – why can't you be normal? But you're not alone, you're not a bad mother, and there's nothing to feel guilty about. Motherhood can be lonely, exhausting, and stressful.
The first step is to recognise that you need help. The second step is to seek it out. Speak to someone you trust, a partner or a friend, and start to think about talking to a midwife, health visitor or GP. Just taking a small move towards seeking help can feel like a burden has been lifted slightly.
Your GP may offer you medication or counselling – although there can be waiting lists and access varies vastly depending on where you live. It may be a case of fight, fight, fight. And if you're the partner or friend of somebody suffering, then please, fight for them.
If you're incredibly lucky, there may be some kind of local charity or organisation aimed at helping mums with depression.
Ruth Jackson suffered from pre and postnatal depression herself, and set up Bluebell in Bristol in 2009, a charity which supports mums, dads and families who are affected by antenatal or postnatal depression.
"There seemed to be a lack of community based services for mums," says Ruth.
"I've got a very supportive husband and I've got great siblings and parents who supported me. But I realised there were a lot of mums out there who really had no one, who were really struggling and actually were really seriously ill. There seems to be a real gap in local services."
By surveying other parents, Ruth found that what people really wanted was a place to talk. "There was still a lot of suspicion and fear, mums were worried about their babies being taken away and that they would be labeled as a bad mother," she says.
"What they really valued was talking to people who had been through it and people who had recovered. They wanted to see that you can get better – and you can. Very few people don't recover. Even people who have been very seriously ill can recover very quickly."
Bluebell runs a buddy service, and a group programme, led by an occupational therapist, which aims to bring meaningful activity back into people's lives.
"When you're depressed, you just stop doing everything and your whole life becomes totally consumed by these awful thoughts and feelings," says Ruth.
"We teach a range of strategies and techniques and different ways of thinking that can help you manage your anxiety and depression. We bring in yoga teachers and we do music and art and drama therapy.
"Whilst the mums are in this place they can get to know each other and these friendships then carry on afterwards. Not knowing anyone is a huge thing and I think a lot of people are surprised by it. Women can become very isolated and I think that's right across the board.
"You see young mums who can become very isolated and they become very agoraphobic, they're worried that people are going to judge them. Then on the other side of the fence you see older, professional women who don't understand how they've gone from being this very organised professional person to someone who can't get dressed in the morning."
The kind of help offered by Bluebell can work in conjunction with medication and other support.
Ruth says: "I know for many women medication is a real life-saver. We never ever say to mums, don't take medication. We always encourage all the mums we work with to go and talk to their GP, but for other mums it might be more complex. They may have had mental health problems in the past, there may be issues to do with relationships or a previous issue that's unresolved. Sometimes having a baby can bring all these things back again.
"I often say to people, I don't think PND is the right word for it. It encompasses a very wide spectrum from mums that are struggling but might not ever need medication or access mental health services but for a couple of years they're really low, right through to the mums who have psychosis experiences and end up being sectioned. I don't think people really realise what a wide spectrum of an illness it can be."
Of course, as we know, if you had mental health problems during pregnancy, this really should have been picked up at the time and ideally you should have been offered help after the birth as well. But in reality, this doesn't always happen. "A lot of women slip through the net and that's something that's really sad," says Ruth.
And there just aren't enough services like Bluebell around the country. "There are other charities like us around the UK who are doing similar kinds of things but it's very much a postcode lottery," says Ruth.
"There's a real gap and a lack of services. It's not good enough yet, there's a long way to go before the support that everyone needs is available.
"All our groups have all got waiting lists. We're a small charity and we don't get any funding from the NHS. If we had ten times the money we could help ten times the number of women."
Lucy Jolin, of the The Birth Trauma Association, agrees. "For some reason people don't seem very keen on funding women's mental health services," she says.
Birth trauma and postnatal depression often go hand in hand. The BTA is run by mums who have been through birth trauma experiences themselves, offering peer support. "We understand. We know what they're going through. We can let them know they're not alone," says Lucy.
But she says there are 'shocking gaps' in services. "It really is an absolute postcode lottery and it's an absolute disgrace," says Lucy.
"There should be sufficient services to support women who suffer PTSD after birth."
Symptoms of post-traumatic stress disorder can range from person to person, but can include flashbacks, intrusive memories, nightmares, triggers, panic, problems bonding with the baby, anxiety and guilt.
"It's important to first of all recognise that something is wrong and you are not a bad person," says Lucy. "You're not a bad mother, what happened was not your fault and you are not alone. Then you can think about what steps you think you should take." This could mean talking to your partner, a friend, or a relative first, and then talking to a health professional.
"We would always stress if you have any thoughts of harming yourself or harming your baby, you need to go to A&E or make an urgent appointment to see your GP. I can't stress that enough," says Lucy.
While postnatal depression is relatively common, a rarer form of mental illness known as post-partum psychosis may affect some women.
The symptoms of this can include 'high' mood or mania, racing thoughts, the urge to talk constantly, to low mood, and psychotic symptoms, such as delusions or hallucinations.
With treatment, the vast majority of women will recover fully and there are usually no long term effects on the relationship between a mother and her baby.
But as with postnatal depression, it's vital to seek out the right sort of treatment as soon as possible. This isn't always easy. There are some heart-breaking stories out there, including Anna's. She was diagnosed fairly quickly with post-partum psychosis after the birth of her daughter, but was hospitalised in a psychiatric hospital for two months, where her baby could only stay with her during the day. It was only when she saw a perinatal specialist that she began to recover properly.
But the thing to remember, and the crucial thing which seems to help so many people, is that you will recover from this. However unlikely it seems. This was the turning point for Anna – when she realised this. "I took a tentative seat and began to recount my story to this new psychiatrist," she says.
"He nodded knowingly and within minutes, I heard the magic words, 'Anna, you do know you will recover from this don't you?' No one had been able to say that until now. It changed everything."
Useful contacts for advice and support:
The Samaritans: 08457 90 90 90 (UK)
Action on Post Partum Psychosis
The Birth Trauma Association
Bluebell: 0773 8628 842
Family Lives: 0808 800 2222
Family Links: 01865 401800
Maternal Mental Health Alliance
Pandas Foundation: 0843 2898 401
Royal College of Midwives