Public Health Nurse “Deeply Saddened” At Lack Of Resources For Perinatal Mental Health Care In

The following is an article by the Canadian Perinatal Mental Health Collaborative as part of their #thisismystory campaign shedding a light on the need for improved perinatal mental health care in Canada.

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Kiersta Hazlett and her son, Lochlan.

Health care professional and mom of three, Kiersta Hazlett of Moonstone, Ontario is deeply saddened at the lack of resources for families experiencing a perinatal mental illness.

“We desperately need a coordinated strategy so that women and men are screened universally during their prenatal appointments and routinely in the postnatal period by trained providers who know the signs of mental illness and who are trained to act.” Kiersta told us.

“We then need resources and treatments that are accessible to everyone to refer them to that they don’t have to wait for. We need to remove as many barriers to accessing assessments and treatment as possible. We need to continue to work at eliminating stigmas related to mental illness, especially in the places where people access their health and illness care.”

Growing up, Kiersta was told she was great with other people’s kids.

“I enjoyed babysitting and caring for younger kids,” Kiersta told us. “It felt like a natural thing to do, and that I would naturally be good at parenting if this was what it was like for me. So making the decision to become pregnant was easy for me.”

Kiersta had been married to her then husband for just over a year when she became pregnant very easily at the age of 27. At the time, she was working full time as a public health nurse in the area of reproductive health. She taught prenatal classes and provided support in the community to pregnant and new mothers.

“I taught others how to breastfeed,” said Kiersta. “I educated families on the signs and symptoms of postpartum depression. I felt then that I was in a pretty good position to welcome a child into my family because I felt so confident that I knew what I was doing and what to expect.”

Because of her profession, Kiersta felt she had a good grasp on perinatal mental illness. She knew that it occurred often, that it was at times difficult to pinpoint the causes but that women with certain risk factors were more likely to develop it.

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Kiersta wasn’t screened for perinatal mental illness during her first pregnancy.

“I can say now that I certainly had some of the risk factors, but I found it difficult to recognize and accept that the symptoms of anxiety and then eventually depression, were actually happening to me,” said Kiersta. “Looking back on my first pregnancy, I can see just how firmly anxiety had taken hold. Prior to that I felt my mental health was stable and there was no remarkable period of time that I felt I was really struggling. Pregnancy certainly amplified any feelings of anxiety that I had.”

Kiersta was hyper vigilant about everything during pregnancy. She was worried about bacteria in her food or on cooking utensils and would beat herself up when she ate something on the list of foods to avoid during pregnancy. She obsessively counted fetal movements and was scared of going too far from home for too long for fear of something happening to her and that she wouldn’t be able to get to a hospital in time.

“I even stopped exercising because after a yoga class early on in my pregnancy I started spotting,” said Kiersta. “I was fine, and the baby was fine, and I knew that the spotting could be normal and that it likely wasn’t caused by exercise, but I couldn’t let myself take the chance so I just stopped. I started to lose pieces of myself for fear I’d inadvertently hurt my baby, lose my pregnancy or give birth to a baby who was sick or deformed because of something I could have avoided during pregnancy. Those thoughts were all consuming. I lost so much sleep and obsessed about things all day long.”

Kiersta was not screened for perinatal mental illness by either her family doctor or her obstetrician during pregnancy.

“I was never asked how I was doing mentally or emotionally,” said Kiersta. “Both of my care providers knew what my nursing job was and felt confident that I would be fine. I really believe they just felt that I would speak up if something was off. But I was so embarrassed to admit that I was struggling. And I wasn’t even sure it was abnormal at the time.”

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Kiersta with her daughter Cecelia and baby Abriana.

After being induced at 42 weeks, the baby’s heart rate began getting dangerously low so Kiersta had to have an emergency C-section. During the first few days and weeks after her baby was born, Kiersta said she felt so foreign to herself.

“It was so hard to try and recover from major abdominal surgery while learning how to breastfeed and care for a baby,” said Kiersta “I remember not wanting anyone to come visit me in the hospital but not having a say. Family from my then husband’s side kept showing up and I wasn’t able to rest. I felt like I had absolutely no control over how my labour went, and now I felt like no one was listening to me when I was asking for space and time to recover and be with my baby.”

Just 12 hours after being discharged, Kiersta returned to the hospital because her baby became significantly dehydrated. Mother and baby remained hospitalized for a following 48 hours.

“This was really when my anxiety went through the roof,” Kiersta said. “I felt like I was living in a state of constant worry but also felt foggy and sluggish. I took myself off all pain medications very quickly because the side effects were not helping with my mental clarity.”

At five months postpartum, Kiersta told her family doctor she wasn’t doing well. By this time, she was severely depressed and not sleeping. She became totally isolated at home, she wouldn’t eat, and she would sit all day in the dark without any lights or sound on because she felt it was too much for her to handle.

“I would lay in bed with my baby, only getting up to feed and change her or to use the washroom,” recalled Kiersta. “I often made excuses about getting together with friends, which was conflicting for me because that was really the only thing that improved my mood was being with them. I hid my true thoughts and feelings with my friends, but I was able to let a bit out. Venting about how heavy my load felt was helpful, but I was always scared to be fully honest with them.”

It took a lot to tell her husband how she was really feeling. This was because she felt like everyone thought she was just being lazy or dramatic. Kiersta was told by a member of her husband’s family who found her crying in the bathroom of a restaurant while changing her baby’s diaper to “get over it”, that she wasn’t the first person this has happened to.

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Kiersta’s midwife screened her for perinatal mental illness during her 2nd and 3rd pregnancies.

“I was so overwhelmed with being made to attend this event with the baby that I just couldn’t cope any longer,” said Kiersta. “I was in pain and exhausted but that didn’t matter. I had to be there because it was an important celebration for another family member. On an average day, my husband would become frustrated with me and told me to get out of bed because we had things to do. I was still expected to maintain our household and try to get meals ready but I couldn’t do it. When I tried explaining how it felt impossible to even get my teeth brushed he said, “what do you actually have to do every day?” He didn’t get it, he didn’t want to get it. And instead of looking elsewhere for help, I felt defeated, like there was something wrong with me.”

Kiersta felt guilty like maybe she was somehow taking advantage of the situation, that if she was tougher, perhaps she would have been able to handle it all.

“It was definitely driving my husband and I apart,” said Kiersta. “He didn’t understand and he didn’t care to try to help me. He thought I was just giving up. When he told me he wanted to go on a trip with his friend I was at my lowest point. I felt I needed to fully disclose what was happening to me inside so he could realize how horrible I felt. I told him I wanted to leave and never come back, I told him I wanted to die. He told me I was overreacting and being selfish. What about what he wanted? What about his needs?”

Kiersta’s then husband went on his trip while she moved in with her parents for a week. It felt impossible for Kiersta to leave her home, but she did it because she was afraid for her baby if she didn’t. Through all of it, she only wanted her baby to be well.

“I was starting to have intrusive thoughts about throwing her into traffic outside of our home,” said Kiersta. “I would walk past our knife block at home and I pictured myself grabbing a knife and stabbing her with it. I was so scared of myself. I never wanted to do anything that would risk hurting her. It was during this time that I stayed with my parents that they really saw how I was doing.”

After telling her mother about the intrusive thoughts, Kiersta was surprised to hear her mother respond that she too had them after giving birth to Hazlett.

“My mom came with my to that first appointment,” said Kiersta. “My doctor prescribed me an antidepressant that is also used to treat generalized anxiety disorder. I began taking it that day. Once I started taking those first steps I felt like I started to regain control. Because I was familiar with our healthcare system, I felt confident eventually reaching out to a therapist and have accessed counselling here and there over the past ten years.”

Though she started feeling better once the medication took effect, Kiersta feels she should have been more closely monitored during the initial phase after her diagnosis. She only went back to see her doctor once after four weeks to assess her symptoms once she began treatment.

“It took me almost five months after starting my medication to climb fully out of the depression,” said Kiersta. “But even after that, I still struggled functioning to my full abilities at work when I returned. I had a hard time managing work and life. I felt stressed a lot of the time. The anxiety still remained but I slowly built up my toolkit.”

Kiersta’s second and third pregnancies were completely different. She chose to receive care from midwives and was screened for perinatal mental illness early and often during her pregnancies.

“I felt better supported and understood,” said Kiersta. “I felt like I could be open with what my first pregnancy was like.”

In the postpartum period after her second baby, Abriana was born, when she became sleep deprived and started to feel symptoms of depression, she was able to get support from her parents.

“With my third baby, Lochlan, I have my awesome partner Matt to lean on,” said Hazlett. “It made a world of difference for me.” Hazlett said she’s currently the happiest she’s ever been and has a partner that supports her, but she still becomes easily overwhelmed and stressed at times and has to actively work at managing her anxiety.

“I have been able to come off treatment for periods of time, and I do end up coping, but all it takes is a stressful event like needing to return to work after my maternity leave or even just every day stressors to trigger some of my anxiety symptoms which usually show up like irritability, worry, chest tightness and difficulty sleeping,” said Hazlett. “I find now that it is just best to stay on my medication versus risking relapse. I’m better for everyone when I’m stable and well. I’m the person and the parent I want to be instead of someone I don’t recognize and don’t like. For me, protecting my sleep and carving out space for me to be alone and quiet each day help keep my symptoms at bay as well.”

Hazlett encourages those currently struggling to find one person you trust that you know will help and support you through this, and lean on them to help you get started with treatment.

“People who truly love you won’t see you as a burden,” Hazlett said. “They will recognize you aren’t well and will help you get what you deserve. People struggling with mental illness aren’t able to fully advocate for themselves like they would if they weren’t having symptoms. They need a champion.”

Hazlett also wants moms and dads suffering to know that recovery is possible and that if you have been trying for a while to get better and one method doesn’t seem to work, try another medication or another therapy.

“Keep searching for a counsellor that feels like they are the right fit if you aren’t satisfied with the support you have now,” said Hazlett. “This isn’t a ‘one size fits all’ plan for recovery. We need options because we are all so different. Put everything you can into yourself to get better. Unfortunately, this isn’t something that can be done for us. We need to do the hard work of climbing out of the well. This is possible if there are enough good options to help us climb up.”

If you would like to tell your story and contribute to the #thisismystory CPMHC campaign, please email us at canpmhcc@gmail.com.

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