I'm almost 36 weeks pregnant and really happy I've made it to this point with a healthy body growing a strong and active baby. I've got my confidence back now thank goodness, but I did have a three-week long dip in my confidence and self-esteem following an unhelpful psychiatrist appointment (I will explain more below). As you may know, 37 weeks is considered a 'term' baby so I'm on the home stretch now and will have my baby in my arms in the next four weeks or so! I cannot wait for that moment, I will be overflowing with love!
I thought I would take a moment to write the third of my three trimester posts and share with you what it has been like from week 29 onwards in my pregnancy.
[This post mentions food and body image. It also mentions trauma and sexual abuse with no details.]
getting ready to meet our baby
My husband and I talk non-stop about the baby. She is all we can think about because we are so excited and love her so much already. We have been doing lots of tidying, de-cluttering and cleaning as I really feel strongly I want our home as organised as possible before the newborn chaos ensues! I know when the baby arrives there won't be time or energy to clean anything and I thought I would be helpful to get everything around the home as clutter-free as possible. Living in a big city, dust is my nemesis and I can get a bit obsessed with it. My dog sheds her fur so much too, so I am in a constant battle with hair. Sometimes these two irritations get me down, but I know I will need to let it go when the baby arrives. I am sure she will keep me so busy that I won't have time to even notice dust and dog fur.
packing and preparing
As I'm a teacher, I've been on summer holidays for the last few weeks. This has given me lots of time to do baby prep, but honestly it still feels like I haven't done enough. Just when I think I have bought everything, I think of something I've missed. My washing machine has taken a hit with all the washing and cleaning I've been doing. Maybe I've been overly obsessed? I probably have as it has felt stressful. Some people talk about the 'nesting instinct' and whether it's a real thing or not, it has hit me (too) hard.
Getting my hospital bag (bags!) ready has been a big theme. I have packed and re-packed my bags too many times out of excitement and fear of having missed something. It's still not 100 percent ready, but will it ever be when I keep thinking of more things to put in it?!
I've also been doing everything I can to prepare my body and mind for birth and the early days postpartum, as well as learning all I can about birth and giving a baby a wonderful start in life.
The third trimester has been a walk in the park compared to my first and early second trimesters when I had relentless nausea day and night seven days a week. I have experienced the usual pregnancy discomforts though in the last few weeks, from back ache to aching hips, not being able to get comfortable wherever I sit or lie, foot pain, feeling hot, intense hunger, lethargy, tiredness, heartburn and more. However, they have all been manageable. The most uncomfortable aspect of the last few weeks for me has been the heatwave and high temperatures which were really unpleasant, especially at night when trying to sleep.
anxiety about the world
During the heatwave, my anxiety about climate change ramped up and it began to stress me out. It was starting to give me panic attacks and make me cry a lot, so I had to talk myself out of worrying about it for the sake of my own mental health and for the baby.
Secondly, I've been experiencing worries relating to the cost of living crisis in the UK, soaring energy prices, inflation and so on. It does feel like a fraught time politically and economically to be having a baby. I am doing my best to stay in the moment and think about what my husband and I can do to give our baby a great start in life. I think she will have a great start in life and we will do everything we can to make that happen.
my psychiatry appointment made me feel awful
Definitely the worst thing that happened in my third trimester was my 'pre-birth care plan' appointment with the psychiatrist from the perinatal mental health service. I was confused from the word go... What does 'pre-birth' mean? Does it refer to planning for the birth before the birth or planning for the period that leads up to the birth? Isn't 'pre-birth' just called pregnancy?
Deliberately, I remained optimistic that this would be an opportunity to make a plan with a mental health professional to protect my mental health during the birth, so that I would be in a better place emotionally after the birth. After all, as a study from the University of Manchester attests, 'people with BPD are 13 times more likely to report childhood trauma than people without any mental health problems'.* Surely therefore it makes sense during such appointments to think about how past trauma could be re-activated through the birth process and how any new trauma can be mitigated?
I got all geared up for the appointment, keen to make a plan that would make me feel confident and like my mental health needs would be protected in the hospital. My appointment was with a psychiatrist I hadn't met before from another area, as the psychiatrist for my area (who I saw for first two appointments) had left the service. She was lovely and introduced herself in a friendly manner.
To my dismay though, she quickly turned to the usual medication reel of questions and I explained myself (again) that I wasn't on medication, hadn't been for a while, was fine off medication and had no plans to start it because I was fine off it and didn't feel it helped me massively anyway. I told her that I was familiar with the NICE guidelines for treating BPD which state that medication should not be used specifically for borderline personality disorder.**
She then went on to give me what felt like massive scare tactics about why I should take sertraline as a 'preventative measure' as soon as I give birth:
Did I know that postpartum mental health problems can be very serious? Yes, I am very aware.
Did I know that a postpartum relapse can come on incredibly fast, so fast that I should consider taking preventative sertraline as soon as I give birth just in case I get a relapse? This means I won't have the delay of getting an appointment, ordering sertraline and collecting it from the pharmacy by which time my relapse could be in full swing.
There is a mother and baby inpatient unit for those experiencing severe crisis and if I should need it, it's there for me and my baby. I know, but you are now terrifying me a lot and I am not sure why you are talking about this right now.
Did I know that sertraline is safe for the baby in pregnancy and during breastfeeding? Yes, of course, but I am also aware that some studies show possible (and generally short term) side effects for the baby and I decided before I got pregnant that I didn't want my baby to experience those and that would trigger my anxiety causing me distress anyway. I explained again that sertraline didn't do an awful lot for me anyway and I felt fine to be off it even if I wasn't planning a pregnancy.
I was then totally on the defensive for several reasons. 1. Please don't think you know me and my life after five minutes of seeing me on Microsoft Teams. 2. Please don't speak about medication for BPD as if it's the holy grail when medication is generally not the most important factor for the well-being of a person with BPD. 3. Why are you not exploring more options with me for managing my BPD postpartum? I explained that I didn't feel it was necessary for me to take preventative sertraline 'just in case' of a relapse for the following reasons:
My BPD has been fine throughout the pregnancy.
I am excited about the birth and have prepared as much as anyone can be.
Managing my BPD is all about my relationships, environment and lifestyle, not medication.
If I feel mentally unwell after the birth I will contact a doctor and most likely take sertraline again to see if it's helpful.
I respectfully told the psychiatrist that I felt she wanted me to take medication because it's easier for doctors that I take it than not. She disagreed and I empathised with her, but then I moved the conversation onto what I hoped the point of the meeting would be— making a plan to help me manage any flashbacks or panic attacks in the hospital. She told me that we couldn't do that and it had to be done with my midwife! What a joke! I was there ready to tell her SO many things that could be in place to make me feel mentally safe and protect my mental health and she couldn't accommodate any of them into the consultation or onto my plan. Seriously?! What was the point for me then?! Several weeks have passed and I'm still angry. It's not the care people with BPD or any sort of trauma history or PTSD need or deserve.
The psychiatrist told me she would write up the plan we had made and email it to me for checking before it would be uploaded to the system for all professionals to see. I didn't think we had made any plan, but said okay and thank you. A few days later, I got the plan and it didn't sit well with me at all. It didn't capture my needs, had inaccuracies about pain relief and breastfeeding (which we never discussed in the appointment) and the wording made me anxious.
I emailed back requesting changes and explained that I had felt disappointed the appointment and resulting plan didn't capture what I had hoped it would. I explained in my email that people with BPD need support with environmental factors and have often experienced trauma, including sexual abuse which are very important to think about during birth. My reply was an updated care plan with the deletions I had requested and then copy and pasted sentences from my email in quotes: patient says 'x, y and z'. Honestly, it made me feel ****. I don't usually swear on my blog, but that's the only word I can use.
For about three weeks following that appointment, my mood dropped significantly. I should have remembered that just as mental health services can lift you up, they can knock you down. I should know, I've experienced some horrific trauma at the hands of mental health services as I described in my book. I started to fear this 'relapse' that the psychiatrist described and doubt myself as a mother. I cried a lot, felt anxious and it sucked some joy out of my days. I only came out of this dip by discussing the above with a few different people, including my lovely midwife. Everyone I spoke to said I am making the right decisions for myself, can understand how this appointment knocked my self-esteem and if I do feel low when the baby is born I can go back on sertraline if I need.
[Can I just add here, please can nobody tweet or email me saying why don't I just take sertraline anyway? I have nothing against sertraline or medication. As I have said, medication can be fantastic and life-saving for lots of people. However, I don't want to take it if I don't need to take it and it doesn't support me. I don't want to pay £9.35 prescription charge every month, book and attend regular GP appointments to review my medication (and explain my circumstances from the beginning every time), go to the pharmacy to collect the medication. There's also the rigamarole of tapering off it when the time is right which is a fuss. I just don't want to and right now it doesn't feel necessary. Rant over. That's my decision which I feel should be respected.]
excitement is the main emotion!
I am over those few weeks of low confidence now and back to feeling empowered. As always in this pregnancy, the overriding emotion is excitement. That moment when the baby comes onto my chest is going to be the best feeling in the world. I know I will look at my husband and our baby and feel so much happiness. Really, I can't wait. I know there are many unknowns with birth and I have anticipation over what the sensations and emotions will feel like. I've been doing hypnobirthing which is all about preparing to birth your baby as calmly and confidently as possible. Let's do this, let's meet this baby!
I hope you've enjoyed these trimester posts. I'm sure there's so much more I could say, but my energy has been finite. If you're hoping to have a baby or growing one right now, I hope they have been helpful. I will try to write something about the newborn days once I can, but when my baby is here I will be spending all my time loving and nurturing her as best as I can. Sending all my best wishes to you as always, especially to those of you struggling.
- Rosie x
*'Borderline Personality Disorder has strongest link to childhood trauma', University of Manchester, November 2019.
** Here is the wording from the NICE guidelines for 'Borderline personality disorder: recognition and management' (January 2009):
'184.108.40.206 Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder (for example, repeated self-harm, marked emotional instability, risk-taking behaviour and transient psychotic symptoms).'
That's not to say medication can't be used or isn't helpful for people with this diagnosis. It can be incredibly helpful for lots of people! My understanding is that the medication needs to be used to treat something discrete such as depression, anxiety, obsessive thoughts, psychosis etc, rather than throwing the medicine at BPD as a whole in the hope that it stops an individual's emotional pain. As I explained to the psychiatrist, as a person with BPD positive mental health for me is linked to supportive relationships, lifestyle and environmental factors.
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