CRIPPLING panic attacks and anxiety Tabitha Rickard felt as an expectant first-time mum was an experience she did not talk about - even for a couple of years after her daughter's birth.
There was a sense of shame, a fear of being written off as that overly worried, hormonal pregnant lady. Tabitha had even labelled herself as such until her diagnosis with perinatal anxiety.
Even with the support from a dedicated midwife specilising in mental health, Tabitha hid her struggles, particularly at work.
Emotionally, Tabitha was up and down in a corporate environment. She was wary of panic attacks striking her in the office. Her blood pressure was soaring.
While her colleagues were fantastic support, Tabitha said no-one questioned her behaviour and mood. She suspected they assumed she was one of those stereotypical hormonal, pregnant ladies.
Tabitha says we should all be speaking up and asking expectant and new mums and dad the question this Perinatal Anxiety and Depression Australia awareness week. She suggests starting with "congratulations and how are you feeling?".
It is a little publicised fact suicide is the leading cause of maternal death in Australia during pregnancy and in the 12 months following birth, as shown in Australian Institute of Health and Welfare data.
PANDA, Murdoch Children's Research Institute and James Cook University this week announced a study collaboration into maternal suicide prevention and mental health during pregnancy.
The full extent of maternal suicide remains unclear, Fairfax Media reports, because states and territories only have to provide data during pregnancy and the 42 days after giving birth. There is also a lack of data on those who may have attempted to die by suicide.
About 15 per cent of women will have anxiety or depression during pregnancy and this rate rises in the postnatal period.
PANDA is also focusing on a push to raise awareness for new and expectant parents in the workplace. This highlights one in 10 new and expecting Australian dads grappling with perinatal anxiety and depression.
Data shows 79 per cent of new dads and 89 per cent of new mums with perinatal anxiety and depression symptoms find it hard to focus, remember or make decisions.
"I didn't even know perinatal anxiety was a thing," Tabitha said. "When I started PANDA (Perinatal Anxiety and Depression Australia) training, I realised this was something that needs talking about a lot more.
"My colleagues were fantastic but once I knew I had perinatal anxiety, I still didn't tell and everyone assumed I was just emotional because I was pregnant.
(Don't) let any stigma or shame stop you from seeking help you deserve. Not everyone has a picture-perfect and when things aren't great, it's easy to hide in shame.Tabitha Rickard
"...My main message for women is to not let any stigma or shame stop you from seeking help you deserve. Not everyone has a picture-perfect and when things aren't great, it's easy to hide in shame."
Tabitha's perinatal mental health concerns were picked up by a midwife during routine checks in the public health system. A lack of continuity in care proved a big trigger for Tabitha, who was referred to a Perinatal and Emotional Health Program in Ballarat for added support through her pregnancy.
Even so, the prospect of a second pregnancy terrified Tabitha. Giving birth had also been traumatic. But she was better prepared.
"I thought maybe this is how I deal with pregnancy, or this is how my body responds to pregnancy," Tabitha said.
"There's a program where you can handpick your own midwife and I did this before I even conceived - I picked someone really calm, which was exactly what I needed, and you could make appointments in the comfort of your own home and around work, at the weekend or in the evenings."
PEHP program helped Tabitha avoid her triggers and practise mindfulness to calm her anxieties and promote self-care.
Early intervention for anxiety and depression during and post-pregnancy is lagging in the private health system, a University of New South Wales researcher says, but St John of God Hospital Ballarat is turning this around.
Research fellow Nicole Reilly, working in a study with St John of God Healthcare, delved into why the Ballarat private hospital's screening program was so successful.
Dr Reilly said success was largely in normalising mental health screening in antenatal care. Research found more than 87 per cent of women who attended the hospital for antenatal care completed screening for depression. Of these women, 25 per cent identified as having one risk factor and 10 per cent for three risk factors.
Dr Reilly pointed to St John of God Ballarat's preparedness to allocate training resources and teamwork across the health service and strong ties between midwives doing the screening and clinical supervisors in the hospital's Raphael House support services for new parents.
"We want to use that information to help guide other private hospitals who are feeling less positive about screening or viewing it not easy to ask the questions," Dr Reilly said.
"There is still so much shame and stigma in seeking help when needed. Pregnancy is a unique time with close, constant contact with health professionals - that's the time to have conversations and to intervene if needed so we can have happier families."
Meanwhile, Tabitha has been helping other mothers and babies to bond and find support in specialised group fitness as a Kangatraining instructor in Ballarat.
Kangatraining was part of Tabitha's recovery.
Tabitha had been going to fitness classes and wondering why her baby would relentlessly scream on the sidelines. Her personal research suggested baby-wearing could help, particularly for anxious mums or clingy babies, and she adopts this in her sessions.
Most of all, Tabitha wants new parents to know there is lots of help and support available rather than merely accepting the struggles as a normal part of parenthood.
I thought maybe this is how I deal with pregnancy, or this is how my body responds to pregnancy.Tabitha Rickard
For workplaces and expectant parents wanting extra advice on perinatal anxiety and depression, visit panda.org.au.
Support is available: PANDA; 1300 726 306; Lifeline 131 114; beyondblue 1300 22 46 36.
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