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are prepared for the possibility. That way people will be able to reassure you that everything will be all right again, and with their reassurance and support, and patience, it soon will.

      Helen has an extra remedy of her own, however: ‘I was so sad, so sad and Kieron was flapping about not knowing what to do, so partly to get him away from me because I wanted to be able to cry in peace, I’d say, “Oh, I could just eat a Marks & Spencer prawn sandwich”, and off he’d pop to Hammersmith to bring one back. And then he ran me a bath, and then he took Jo for a long walk … And none of it made the slightest difference at the time. It only lasted a couple of days, this weepiness, but it seemed eternal, and then it was gone, without me even noticing. But a long time afterwards I thought: what loving things to do. Everything Kieron could do, he did. And whenever I was feeling down with the baby, that thought would help.’

      Puerperal psychosis

      WITHOUT WANTING to alarm people, it didn’t seem fair to write a book about becoming a family and not mention this acute illness. Puerperal psychosis is an illness completely different in kind to the usual ‘baby blues’. It is different to ordinary depression, too. Puerperal psychosis is an illness that makes its sufferers feel totally alienated from reality, as Denise explains: ‘I was overjoyed when my baby girl was born … and the joy and excitement of those first few days did not wear off Instead, I became more and more elated. For someone who is generally reserved, this was a change in personality. This powerful feeling of joy was one I had never felt before – nor have I since ever felt so happy. I literally could not stop talking – I felt that I had so much I wanted to say, so much to do, that I didn’t feel the need for sleep. I lost all inhibitions and said whatever came into my head without pausing to think. My mind had gone into overdrive. I no longer had any control. I knew that something was wrong, and told the midwife who visited me at home that I was worried I was too “high” and might come crashing down. She just gave me a strange look. My GP thought it was good that I was enjoying motherhood so much. And I was. Being a mother was the most wonderful thing that had ever happened to me. And then everything fell apart. I began having involuntary thoughts about harming my baby – not so much thoughts as real pictures of causing her harm. What bewildered me was that I adored her…so why was my mind repeatedly trying to bash her brains out?’

      There is no mistaking puerperal psychosis – it is qualitatively different to other forms of ‘depression’ following childbirth. Its onset is rapid, there is no slow build up, and it seems to be a reaction to the sudden changes in hormone levels that occur after labour. It may help partners and supporting relatives to know that this is an illness completely outside the woman’s control. She cannot ‘snap herself out of it’ and she cannot ‘be reasonable’. She needs medical help.

      Sadie saw visions and was more concerned to alert her friends and family to the meanings of these than to look after her baby: ‘I saw God and then Jesus, who was telling me I had done wrong. And I knew my child would be taken by the Devil if I didn’t protect her.’

      Most women with this illness will need to be hospitalised as they are unable to function effectively, and many take several months to recover as Denise continues: ‘I spent four weeks on an Acute Admissions ward, then four weeks in a Mother-and-Baby Unit in the psychiatric hospital. By the time I went for my postnatal check with my GP at eight weeks, I was starting to get back to normal. I felt very vulnerable, sitting there in the waiting room. I watched another mother come in and very capably start to change her baby’s nappy. The tears came suddenly and violently as it came home to me just how different I was to “normal” mums. I came home at ten weeks, but it took the best part of a year before I felt ‘myself again and not just going through the motions.’

      But women who have puerperal psychosis do recover, although it may take a long time and the demands upon partners and family will be very great. Often relatives will need to care for the child and, depending on the medication and state of mind of the mother, breastfeeding may not always be possible.

      Research continues into the causes and the reasons why some women get this rare and distressing illness, and the most effective treatments, but there are no definite answers yet. The work done by Dr Katarina Dalton on the use of progesterone injections as a means of prevention is gaining coverage and acceptance. Although its preventive role cannot help a first-time sufferer, it can be of great reassurance to those who have suffered that they do not need to go through this again.

A ‘ROUTINE’

      CHANCES ARE, at least one health professional or relative will have advised you how desirable a routine is for your baby, although very young babies may not respond well to being ‘put into’ a routine. However, it can be helpful to establish an evening routine of supper, bath, story, bed (or similar). This sort of routine, if established early, can reduce bedtime problems in toddlerhood. Indeed, it gives most children a feeling of safety and security if roughly the same things happen at roughly the same time every day. It helps to give a sense of pattern and reassurance. And it can help you, too, if you’re finding the demands of parenthood overwhelming: a routine can bring everything down to more manageable proportions.

      Beverley felt she needed to get her new life into some sort of order: ‘I think my idea of a “routine” came from my mum. Also, it came from me in the first three months trying not to have a routine. I remember thinking, “I want Josh to be a really flexible baby. I’m going to take him out with me whenever I need to go, feed him whenever he’s hungry, put him to sleep when he’s tired, and he’s just going to adapt and be really flexible and it’ll be great.” And it was a nightmare. He ended up not having a sleep in the day, and then he wasn’t sleeping well at night… it was just terrible. And I found that once I started doing things in this very strict routine – which I really resented, I didn’t like having to do it at all – things got better. I thought, “Right, ten o’clock, he’ll have a morning nap. Three o’clock, he’ll have an afternoon nap,” and I put him in his cot and he just started having them. It made a difference because I could say to people, “Oh, come round then because I know he’ll be asleep”, or whatever. I know where I stand, now.’

      YET, NO MATTER how desirable a ‘routine’ may be, one thing many parents resent is the lack of spontaneity in their lives. Whether you intended to carry on as before or not, you’ll soon find you can’t.

      Deirdre’s mental planning will sound familiar to you if you’ve already had your baby: ‘I’d think, right, she’s due for a feed in the next hour or so, and afterwards she’ll probably fill her nappy, so if I change her then, we could go out after that and she’ll probably have a sleep in the pram, but that means I won’t have had my lunch … Okay, if I have my lunch now – it’s about ten o’clock in the morning – that might do it. And if we spend longer there than I planned on, I’ll be in trouble if I don’t have what she needs, so I’ll have to take wipes, nappy cream, dummy, bottle of water … And then I have to organise all these and then she wakes up and I still haven’t had my lunch and this is all just to go round and have a cup of tea with a friend. How women go out to work every morning when they have babies, I just don’t know. This is what I can’t stand, not just being able to pop out and have a cup of tea when I feel like it.’

      Olivia’s comments ring true too: ‘There’s a picture in a book of a father typing and this baby sitting in a bouncy chair watching him. It’s got this cheerful caption like “Let the baby join in family life!” I can just see Beatrice sitting in her chair watching while Robert studies engineering. I think images like that can build up a false picture. Especially if your baby’s not conforming to that image.’

      WHEN YOUR BABY arrives, images are what you have to forget. In the mother-and-baby magazines, those are models you are looking at, with their shiny hair and their designer outfits in their polished kitchens. They aren’t real mums. Real mums have mysterious stains on their jumpers and a permanently quizzical expression, as if they’ve just forgotten which day of the week it is … which is usually because they have. And real mums have real babies.

      Coping with that reality, with all its stresses

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