30 October 202230 October 2022 Health ‘Anxious, lonely, isolated and uncertain’: perinatal mental health in a pandemic Madeleine Hamilton In Sarah Watt’s 1995 animated short film, Small Treasures, newly pregnant Jane floats alone on the ocean’s surface. ‘It felt so good, like the first barefoot day of summer,’ she narrates. ‘Having a baby! I had that contented feeling that I was doing what I was really made to do.’ Cut to a kitchen interior, where Jane’s imagination conjures a wildly escalating series of catastrophic predictions involving her future infant. He slurps water from the dog’s bowl, guzzles poison from a bottle easily extracted from an unsecured cupboard, pulls a pot of bubbling soup off the stovetop onto his face. Plastic bags, scissors, kitchen knives, a low-hanging curtain cord, electrical sockets—all await the gleeful attention of the coming baby. * It is March 2020, and the perinatal mental health service I work for has just gone remote. My workspace is now a tiny desk in the corner of my nine-year-old daughter’s bedroom. My husband teaches high school from the shed. My three young children pretend to home-school in the lounge. Anchored by my laptop and headset, I let a tide of others’ mental anguish sweep over me. Perinatal anxiety and depression are common: up to one in five Australian birthing parents and 1-in-10 non-birthing parents experience a mental health decline before or after having a baby. Life stressors, hormonal shifts, birth trauma, and pre-existing mental health vulnerabilities—teamed with the profound life transition of new parenthood—can create a perfect storm. It can be frightening, however, to ask for mental health support. The spectre of social workers deeming you an unfit parent and removing your baby looms large in the collective psyche—even amongst the most privileged. For many, though, desperation subsumes these fears: by mid-2020 my service is experiencing more than a 50 per cent increase in demand, which my colleagues and I struggle to meet. We are ear-witnesses to the impact of Covid-19 on the mental health of new and expecting parents. The phone is like a relentlessly crying newborn. * Jane, now heavily pregnant feels ‘like a whale’, so her partner John humorously takes her on a diving trip to swim with the Port Philip Bay seals. Supporting Jane as she climbs into the boat, John drops the handbag he has been entrusted with. As it submerges, the bag disgorges tangible signifiers of Jane’s pre-pregnancy life: driver’s license, credit cards, a lipstick, house and car keys—all sink to the bottom of the bay. * From the lookout of my daughter’s desk, the pandemic has intensified the usual triggers of perinatal anxiety and depression. Lockdowns lead to even higher levels of social isolation. Border closures mean no practical support from family overseas or interstate—or, in Melbourne’s case, even beyond a five-kilometre radius. Huddled together 24/7 in claustrophobic domestic spaces, new parents with old relationship tensions descend into outright conflict within the immediate proximity of their infant’s developing central nervous system. Existing barriers to accessing timely support for birth injuries and breastfeeding difficulties are even more difficult to negotiate—especially in rural areas. A study examining Australian maternity care during the pandemic uses a word cloud to strikingly represent expecting parents’ experiences. Amidst the floating black type, five large words stand out boldly in red: Anxious, Isolating, Lonely, Isolated and Uncertain. In early 2022, as the Omicron variant sweeps the nation, there is an increase of people calling our service while they and their infants are Covid-positive. Reflecting the study results, often their anxiety was not about the virus itself, but rather those age-old causes of perinatal distress: isolation and loneliness, parenting with the barest of supports. Being sick is an additional complication—not the cause—of their depression and anxiety. * Small Treasures ends with the most shattering of losses for Jane and John: ‘The moment my baby was born was the most beautiful, most special moment. Holding him was just such a happiness. My poor little son who didn’t breathe.’ Earlier this month, Associate Professor Lisa Hui delivered devastating data to the annual scientific meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists: there was a significant increase in preterm stillbirths during the 2020 Melbourne lockdown. The cause for this increase, she speculates, might be ‘a maternal reluctance to present to hospital for decreased fetal movements.’ The simultaneous increase in babies born at home or in cars also suggested ‘that women were delaying presentation in labour—possibly due to fears about the risks of inpatient care, concerns regarding restrictive visiting policies for support persons in maternity wards, or home care responsibilities for other children.’ For some, by the time they arrived at hospital, it was too late. These delays, Lui said, perhaps reflected general ‘increases in stress and anxiety across the entire maternity sector during 2020.’ Many Australian parents have experienced different, less cataclysmic losses during the pandemic. They grieve that they were mentally unwell during the earliest days of their child’s life—that for so long their baby missed out on vital social connections with grandparents, cousins, aunties, uncles. They also feel the loss of missing the normal rituals around having a baby. In my conversations with just a tiny fraction of new and expecting parents, it has been a privilege—but also deeply troubling—to hold these losses. It has also given me some small insight into how we can better protect the mental health of both parents and babies when the next pandemic inevitably arrives. When this time comes, we will need a more nuanced approach to border closures so new isolated parents experiencing distress and a mental health decline may receive timely practical support from interstate or overseas-based family members. A PPE stockpile must be dedicated to maternal child health services so home visits can continue uninterrupted. There will need to be a national policy guaranteeing that birthing partners can attend antenatal appointments and be present during and after births. Lastly, a widely promoted national program offering all new parents a minimum of one free specialist counselling call in the postnatal period would attend to at least some of the mental distress of those parenting in extreme circumstances. Small Treasures is held in the National Sound and Film Archive of Australia and ACMI’s collection. Madeleine thanks Sarah Watt’s estate for permission to quote from the film. Image: Aditya Romansa Madeleine Hamilton Madeleine Hamilton is the author of is the author of Our girls: Aussie pin-ups of the forties and fifties. Her writing has been published by Kill Your Darlings, Overland, Meanjin and Eureka Street. More by Madeleine Hamilton Overland is a not-for-profit magazine with a proud history of supporting writers, and publishing ideas and voices often excluded from other places. If you like this piece, or support Overland’s work in general, please subscribe or donate. Related articles & Essays 4 First published in Overland Issue 228 30 October 20223 November 2022 Health What’s missing from breast cancer awareness Na'ama Carlin So much cancer support is about ‘masking cancer’: how to wear your makeup and etch your eyebrows so that no one can tell that you’re ‘sick’. How to wear your wig so that no one can tell you’ve lost your hair. And, in the case of prostheses, how to hide your mastectomy. I’m so tired of hiding the truth of cancer. Why is the onus on me to look like I ‘don’t have cancer’, in addition to going through cancer treatment? First published in Overland Issue 228 8 August 202219 August 2022 History On debilitation and the political economy of the accident Faisal Al-Asaad As a global pandemic joins a long list of catastrophes that have simply become a fact of ordinary life, it seems more urgent than ever to revisit and reimagine the fictions governing the accident. Conditions of debilitation, and the bodies that suffer them, deserve nothing less.