Natasha Meten
Did you know that postnatal depression is just one of a number of maternal mental illnesses that can impact women during or after pregnancy? Depression, anxiety, obsessive compulsive disorder and even psychosis can affect women at what should be one of the happiest times of their life. And in the Pacific, stigma and a lack of services can stop women from getting the help they need. I’m Natasha Meten. Sisters, let’s talk about maternal mental illness. A lot of things can trigger maternal mental illness for a woman. Stress, hormones, isolation, to name a few. For Ru Sevudredre, a Fijian mother of three living in Perth, it was the combination of a traumatic birth and isolation from her village in Fiji that led to postnatal depression.
Ru Sevudredre
I first started getting symptoms right after I had my first pregnancy. At first, I thought it was just a baby blues, but after a couple of weeks had gone by and a few months, symptoms were still there. And luckily for me, my husband was the one who picked up on it. And he had seen his mom with postnatal depression. So he knew all the signs for it. So he mentioned it to me and he said, Hey, hon, I think you’ve got postnatal depression and you really need to talk to someone about it. But I was in denial of it for a very, very long time until five years after that is when I finally got diagnosed.
Natasha Meten
And what were the symptoms?
Ru Sevudredre
Lots of sadness, crying, just feeling hopeless and like low mood, low energy, low libido, all of the usual symptoms. That is what I was thinking of. Lots of intrusive thoughts as well. Lots of mom rage and just lots of feelings, lots of emotions that was just all over the place.
Natasha Meten
And you mentioned thoughts. Did you ever think about hurting yourself or the baby?
Ru Sevudredre
The baby? No, absolutely not my baby, but myself, yes. I was thinking that I am not a fit mother for this child, that this baby would probably get a better life with someone else. So that’s where my thoughts were at. And that was exactly where my husband was like, this is not normal and that I needed someone to talk to.
Natasha Meten
What was it about your birth experience that you think contributed to these symptoms?
Ru Sevudredre
I had a very traumatic birth experience where I felt that I wasn’t being heard. I wasn’t seen. And that experience, it felt like I wasn’t empowered and that the birth I had happened to me. It wasn’t something that I was a part of that I was happy about because I got induced. Everything just happened so quickly and I wasn’t aware of what my body was doing. I didn’t have the knowledge or the education back then. So I literally just left it all into my medical professional’s hands. And when I was telling them, I’m like, I’m not feeling good and there’s just lots of pain. They just dismissed me and said, oh no, that’s normal. That’s fine. Here’s some painkillers and some sleeping pills and we’ll see how you go tomorrow. So I just assumed that they knew what was best for me. And then when I was ready to push my baby out, I wanted to go on my hands and knees. They said, nope, you’ve got to go on your back. And that felt really uncomfortable. And so it was a very, very fast, quick labor for me. It was within three hours of active labor. I had my baby and I just felt so shocked afterwards. I had an image that my husband took straight after I had delivered our baby and the look on my face was as if I wasn’t even here. It was as if I was somewhere else. And so that left me feeling very disconnected to my body, to my baby, to literally everything around me, even to my husband. And so that I feel was a massive contribution to me getting postnatal depression.
Natasha Meten
Rue, I’m really sorry that you had to go through that. In Perth, you’re also a long way from Fiji. Was that also a factor?
Ru Sevudredre
Absolutely. Being isolated from your family, from your village, from your aunties and uncles and grandmothers who’ve always been there to help and support a woman through this transition, I felt that because I was here in Australia, I didn’t have that. Even though I had my mom around, just having everyone else’s support and care, it made me feel very, very alone. And that it was literally just me against the whole world. And that I was the only one feeling like that and going through all of those emotions and all those changes all by myself. So yeah, isolation definitely played a massive part in that too.
Natasha Meten
And you said it took five years. That’s a long time to experience those awful symptoms. What did you finally do about it?
Ru Sevudredre
Well, yeah, it was five years. And that was because, you know, growing up in our culture, mental health issues is just not really spoken about. And so I denied it for those five years, because the last thing I remember as a child about someone having mental health issues was that this mom had just given birth and she probably now looking back had postnatal depression as well. And so they took her to the mental hospital in Fiji and she got locked up. They took her baby away. And so that was my impression of what would happen to me if I acknowledged that I had postnatal depression. Not thinking that, you know, the system here is very, very different to Fiji. So when my husband picked up those symptoms in me and the patterns, he was like, you need to talk someone. So after five years when my marriage was probably on the brink of being non-existent and my life being almost on the verge of like non-existent as well, that’s when he really said, I need you to just please just try one last thing for me. And if you want to do whatever you want to go do it after that. But he was like, please talk to someone. So I finally went to my GP and I said to her, I’m like, I think I need a mental health plan. And she goes, Oh, really? Like she was really surprised and she was caught off guard. So she gave me, you know, the Edinburgh mental health test thing. I filled it all out. And after the appointment and she looked at my test score, she was absolutely shocked that I had scored this massive high score. And she said, I have been seeing you for the last, you know, five years when you’ve had your son, not once did I pick up at all that you were suffering from depression or postnatal depression. And she said, you know, you have hidden it so well. And I just thought, you know, I think that was just for me, that was just normal. And this is what mothers, you know, go through and, you know, just suck it up and you just keep going. So that’s when I started, she referred me to a psychologist and I worked with a psychologist for two years and it was, it was life-changing. It was absolutely life-changing. And that’s when I knew more about postnatal depression and how it affects moms and how it’s not something that people talk about a lot and that it should be spoken about.
Natasha Meten
That’s Ru Sevudredre, an Australian-based Fijian woman sharing experience of postnatal depression.
Natasha Meten
According to the organisation PANDA, which stands for Perinatal Anxiety and Depression Australia, one in five women will experience anxiety or depression during pregnancy or in the first 12 months after birth. One of these women is Mercedes Swann. She has a master’s in public health, but it wasn’t until she became pregnant that she learned mental health struggles can occur during pregnancy as well as after birth. Living in Fiji, she felt isolated and unsupported, and she noticed that the medical support she was receiving during her pregnancy didn’t extend to her mental well-being. That inspired her to start Mama Talanoa, an online support group for people like her experiencing perinatal or postnatal mental illness.
Mercedes Swann
I had a very easy pregnancy, people would say, where the physical symptoms were not very difficult for me. But what I found difficult was the mental health aspect of pregnancy. I struggled with feelings of self-harm, of feeling disconnected from my baby and from those around me. And I had never experienced these feelings prior to pregnancy. So I wondered if this was something that was unique to the pregnancy experience. And that’s when I started to learn about things like perinatal depression and perinatal anxiety. I had only heard of postpartum depression, which I think most people are familiar with, but I had no idea that you could experience mental health struggles as early as pregnancy. And so I wanted to talk to other women about this and understand if what I was experiencing was normal. So I spoke to my sisters, my mother, aunties, and friends, and a lot of them expressed that they too had felt similar feelings when they were pregnant, and that pregnancy had been a very stressful time. And so I started to get a sense that maybe I wasn’t the only one, and that surely there were other mothers out there who were going through the same thing. So I looked around for a support group, you know, through the Fiji government. I didn’t find anything. I did join a support group out of the United States, and that was really beneficial, but I felt like because that support group was set up in the U.S., I didn’t have the space to talk about the cultural aspect of mental health and from being in the Pacific Islands. So I decided to start my own support group. I just put out a call on social media to see if any moms would like to get together on a regular basis and talk about mental health and talk about things like postpartum depression, perinatal anxiety, postpartum psychosis, birth trauma. The response was overwhelming. I was able to have over 40 women sign up within 48 hours, and each of these women, I was surprised many of them were not even in Fiji. Many of them were Pacific Islander women who were living outside of the islands for work or school reasons and wanted to connect back with their culture and back with women who understood what they were going through.
Natasha Meten
Mercedes, you did your research about when the symptoms first started. Did you understand why you were going through that?
Mercedes Swann
I thought that this was just pregnancy. This is just part of life to be stressed, and while that’s true, I felt like I didn’t have the coping mechanisms to get through it on my own. At the time, I was dealing with a lot of stress with being a full-time student, having my family responsibilities. Here in the we live in multi-generational households, and so all my responsibilities to my parents and my siblings. Then on top of that, my husband living two hours away throughout my whole pregnancy. I just thought maybe I was just stressed and maybe I was just not strong enough to cope with it, but it was only when I spoke to other women that I realized that maybe I was at higher risk of having poor mental health because of pregnancy and because of the hormonal changes that are happening and because of the impending birth. This whole life transition of becoming a mom was really, really stressing me out, and I’d never gone through such a huge transition in my life.
Natasha Meten
What did you do to try to combat it?
Mercedes Swann
I spoke to my husband, who was really understanding. I spoke to other women who said, you know, this is part of pregnancy or if you want to talk, we can talk about it. Talking through what I was going through really helped me. I did also seek some free counseling that was available to me through my university, which was wonderful, but I think just being able to talk to other women and realize that this is normal or that this is very common really helped me feel encouraged and say, okay, if they went through it and they’re okay, I’m going to be okay too.
Natasha Meten
What about medical support? Did you have that?
Mercedes Swann
I had medical support in terms of looking after my pregnancy and baby’s health. It wasn’t much more than medical support on the physical side of things. You know, there was no question from any of my doctors on how I was feeling, and that was exactly the same after I gave birth. I had the medical support to, you know, look after baby and there were nurses and doctors checking baby’s weight and checking baby’s length and making sure that she got her vaccinations on time. But I was never asked how I’m doing. I was never asked how I was coping with the challenges of new motherhood and breastfeeding and all the struggles that come with being a new mom.
Natasha Meten
And how long did the symptoms last?
Mercedes Swann
It lasted for a couple months. My symptoms lasted for a couple months and it was after I started the support group and we started to meet regularly that I was able to really just feel encouraged. And I had a lot of moms telling me, you know, you’re going to be fine. You’re doing a great job and, you know, thank you for speaking up and sharing what many of us have gone through, but haven’t been able to share or haven’t had an avenue to share it. So that helped me feel encouraged. And I think my mental health was a lot better for the rest of my pregnancy after that.
Natasha Meten
You said there were no questions about your mental health in Fiji. How did that compare to when you had your baby in Australia?
Mercedes Swann
I guess I wasn’t surprised that there were no questions about mental health. Here in the islands, our health system is so saturated and overburdened with chronic diseases, like, you know, diabetes and heart disease that our healthcare workers are only focused on, you know, delivering healthcare. And we don’t have the extra health professionals to meet the mental health demands of mothers or of anyone really. So when I went to Australia, I was given resources even during pregnancy. And then at my two week follow up with my doctor post birth, he advised that I get what’s called a mental health care plan, which the Australian government provides to Medicare recipients. And I had told him, actually, I feel pretty great. I don’t think I really need it right now. And he said, just take it anyway. So that at any point, if you feel, you know, if your mental health changes tomorrow, you can go, you can talk to a mental health professional. So there’s just a completely different approach. Every time I met with a midwife or a doctor, my mental health was asked about. And even though I was feeling pretty good, they always checked because what you see on the surface is not always what’s going on inside of a mom’s mind.
Natasha Meten
Mercedes, were there any self stigma in experiencing mental illnesses coming from a place where it’s not talked about?
Mercedes Swann
Yes, I started to share my journey on social media about my mental health struggles. And I talked a lot about what would be helpful versus not helpful for family and, you know, those supporting pregnant women to share with a pregnant woman when she’s pregnant. And while most of the comments were very positive, I did have comments from people who simply said, that’s just part of pregnancy. You know, you just got to put up with it. You chose to be pregnant. So you have to deal with all of the struggles that come with pregnancy and birth and motherhood. So I’ve definitely received a lot of negative responses. And it really shows that we have a long way to go when it comes to destigmatizing mental health here in the Pacific Islands.
Natasha Meten
And how large is the membership of the online support group?
Mercedes Swann
We’ve been running for six months and to date we have had just over 300 women sign up. Now, not all those women attend regularly due to other commitments and, you know, the time difference, sometimes an issue for moms. But we have consistently about 10 to 15 women attend every fortnight. And during these sessions, we have free education on things like sleep, self-care, boosting your mental health. So it’s been really wonderful to meet women from not just Fiji and the South Pacific, but places like the United Kingdom, North America, Australia, and New Zealand. And even people in Japan and Solomon Islands and American Samoa. It’s been really wonderful to see them all come together and show that there really is a need for a place to just tell a lie about maternal mental health.
Natasha Meten
And what have you learned about maternal mental health since having your own experience?
Mercedes Swann
I’ve had to learn a very hard lesson for me as someone who’s very independent and driven. I’ve had to learn that it’s okay to ask for help, that it’s okay to rest and to slow down. And sometimes when I don’t feel like speaking up about what I’m going through, I have to get over my own pride and say, you know, I need help and this is not going to get any better if I don’t share what I’m going through. Even if I see myself as weak or, you know, don’t think that people will really understand. Every time I share what I’ve gone through mentally during, you know, the motherhood experience, I’ve always had women say, I went through the same thing. You’re not alone. This is very common and you’re going to be all right.
Natasha Meten
Mercedes, what sort of support do you wish was available for women in Fiji during pregnancy and after birth?
Mercedes Swann
Here in the islands, we have such a strong social support system with family members and our village and our wider community, even from churches that we go to, which is wonderful. It’s such an asset and I’ve really drawn from that throughout my motherhood experience. But I think what is lacking is treatment for women who need just a little bit more than a Tala Noa and to be validated, we need mental health professionals who can treat postpartum depression, postpartum anxiety, and the other perinatal mood and anxiety disorders. We need health professionals to ask about a mother’s mental health when she’s just given birth and as early as pregnancy, because the women who are struggling with their mental health prior to giving birth are more likely to experience perinatal mood and anxiety disorders post-birth. So we need to ask women how they’re doing and really listen and then refer them to the appropriate mental health treatment. Here in Fiji, we do have mental health treatment available. What is lacking is the referral from doctors and nurses to those mental health treatments. So that is what we need to work on as a country, is strengthening the referral system from the general baby clinic to the mental health professionals.
Natasha Meten
That’s Mercedes Swann, a new mother from Fiji who started Mama Tala Noa to support people like her experiencing peri or postnatal mental illness.
Natasha Meten
While Mercedes wasn’t able to find the support she needed in Fiji, there are services available to people experiencing mental illness in the country. You might remember we met Reshmi Singh from Empower Pacific in our episode on loneliness. Reshmi is a team leader at Empower Pacific’s Lautoka Nadi branch.
Reshmi Singh
When we talk about maternal mental health, this is something that has usually come up when we reach out for support or when we go out to the communities to raise awareness. So it’s very important for everyone, for the individuals out in the community and everyone to understand that maternal mental health is not just shaped by the hormones, but this is also about the mother’s relationship, the support system she has, the physical recovery, and also takes into consideration social pressures and financial stress and even loneliness. So these are some of the key issues that usually come up. So in terms of specific support, we have our counsellors based in the respective divisional and subdivisional hospitals and upon referral, they provide the specific counselling support. There could be issues such as relationship and family issues, or they could be stressed out about bonding with their child, or just particularly looking at social support in relationship. So I mean, these are some of the key factors that usually emerge. And when it comes to socioeconomic factors, particularly like for instance, if the client is going through, the mother is going through financial stress or probably unstable housing. So this is where our social workers step in and try to link them to the specific stakeholders who can provide this support. And definitely one of the major factors that has emerged is like loneliness and isolation. So when we have new mothers, sometimes they feel cut off from their friends, routines. So this is a total new routine that they have to adapt to, you know, becoming a new mom, bonding with a child, they could be fearing isolation. And sometimes it increases the risk of postpartum depression and anxiety. I mean, if there’s no rightful interventions happening, there is a high chance that sometimes in severe cases, it can lead to deliberate self-harm to the mother or even to the child as well.
Natasha Meten
And is there a stigma preventing women from even realising that they have maternal mental illness?
Reshmi Singh
I guess it would be safe to say that, like, you know, when it comes to cultural expectations and pressures. So sometimes, you know, there are certain norms. And thankfully, I would say it’s changing. I mean, there’s been a lot of work done around it as well. So social norms sometimes expect women to cope naturally, you know, or to stay strong all the time. As women, you should be able to do this, you should be able to face stigma and shame. But there are still shame and stigma, unfortunately, which prevents mothers from speaking up. And sometimes they could be also reflecting back to some of the cases we have been attending to, like unrealistic expectations from family or even cultural expectations that can lead to feelings of failure.
Natasha Meten
And what about the stigma within the system? Are doctors and midwives doing enough in Fiji to alert pregnant women and new mothers to the risks of maternal mental illness?
Reshmi Singh
In terms of that, I think I would say that there has been some positive change on that. I’m once again referring back to the work that Empower Pacific has been doing. The Ministry of Health and Medical Services, this is one of the key line ministries that we work with, apart from the Ministry of Women, Children and Social Protection. So given that our counsellors who are based in the hospital’s premises, they continuously provide professional development training to the doctors and the nurses. And one of them is talking about mental health impact and pre postpartum depression and things like that. So through those professional development sessions, training sessions, and along with the referral pathway that exists within the Ministry of Health, I guess we share a strong relationship with them and we do get referrals coming in for counselling and such.
Natasha Meten
And when they get help, what does that look like? Or what sort of help do they receive?
Reshmi Singh
That depends on the specific support that the new mother could be needing. It could be just emotional coping, bonding with the child. It can also be presenting or existing relationship issues at home, sometimes financial stresses or other socioeconomic issues. We’ve also come across cases of gender-based violence. In the context, we were looking at the prioritising the safety of the mother. So if they have disclosed that they have gender-based violence or domestic violence going on at home, and they do not feel safe being discharged, so this is where our social workers step in. And then we do a case management with the other stakeholders to ensure that the safety priorities are met.
Natasha Meten
And Rashmi, you mentioned self-harm and harm to the child. What can happen if maternal mental illness goes untreated?
Reshmi Singh
If it goes untreated, it can become very severe in terms of they’ll find them, the mothers may find it very, very difficult to cope, very difficult to manage with the child, with the baby. So that’s why having the family support is very, very important. So having said that in those severe cases, this is where we also have family facilitation. We include the family members to get them to understand what this new mother is going through, what sort of support does she need, and how can the family members step in to provide that support while the counselling and support services continue to be provided to the
Natasha Meten
mother. That’s Reshmi Singh from Empower Pacific in Fiji. Thank you to my guests today, Reshmi Singh, Mercedes Swann, and Ru Sevudredre. Sharing your stories is so important for reducing stigma, and it will no doubt help other mothers and pregnant women to recognize their own symptoms if they are experiencing maternal mental illness. Those symptoms can include excessive sadness or worry, irritability, fatigue, loss of interest in joyful activities, and intrusive thoughts of harm to yourself or your baby. Some of those symptoms like sadness and worry are normal when you have a young baby, but if they feel too overwhelming, you should talk to your doctor or maternal health nurse so they can get you the help you need. Sisters, Let’s Talk is presented by me, Natasha Metten. Our supervising producer is Kim Lester. Our executive producer is Fala Faleagafulu Inga Stünzner. Sisters, Let’s Talk is an ABC Radio Australia production. We acknowledge the Yaggera, Turrbal and Darumbal peoples on whose land this program is produced. Emta Sol na lukim yu next time.
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