“I thought there was something wrong with me”: why postnatal depression is a class issue too

Pre and postnatal depression can affect all women, but it often hits working-class mothers the hardest.

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Sitting in a South London cafe, Katie (not her real name) bounces her nearly one-year-old baby on her knee. He looks around in an attempt to engage passers by, and his blue eyes light up as he realises he's won the attention of a stranger, a coy smile spreading across his lips.

Katie says: "You think that becoming a mother is going to be the most natural thing in the world, like your maternal instincts will just kick in and you will fall head over heels in love with your baby. I was pretty shocked when I realised that's not the way it always goes. After having my son I felt lonely, scared, isolated, overwhelmed and anxious."

This week is pre and postnatal depression awareness week. The statistics surrounding postnatal depression and maternal mental health give a stark indicator of a society that is failing mothers. One in seven deaths of pregnant women and new mothers in the UK is a suicide. It is the leading direct cause of death for mums within the first year after their child is born.

"When we got home from the hospital, that mother and baby bond that everyone speaks about seemed missing," says Katie. "Worst of all, I didn't want to say any of this out loud – I thought there was something wrong with me, like I was the only woman to ever feel like that. I now know that actually it's pretty normal and I no longer feel ashamed to say that I was suffering with postnatal depression."

But whilst pre and postnatal depression can affect all women, is is an illness that can hit working-class mothers the hardest. The link between maternal depression and poverty has long been established. A report into poverty and mental health by the Joseph Rowntree Foundation says: "The social determinants of mental health are not limited to individual attributes (emotions, thoughts, behaviours, interaction with others) but also include social, cultural, economic, political and environmental factors such as living standards, working conditions, social protection and community social supports."

Beauty, a cleaner in a London hospital, suffered with prenatal anxiety. She says: "I was having palpitations all the time, sometimes they'd turn into full-blown panic attacks and I'd have to lock myself in the toilet at work. I was scared to tell my employer I was pregnant, as I hadn't been working for the company long, but I knew I wasn't meant to work with some of the chemicals we use for cleaning."

The problems faced by working-class mothers are being compounded by ongoing changes to the labour market. The increasingly precarious nature and low pay for work in female-dominated sectors, such as cleaning, creates a sense of powerlessness.

Beauty says: "There was no company maternity pay, so I was only entitled to statutory maternity pay. I was constantly stressed about how I was going to pay the rent and bills, while also having time to bond with and enjoy my baby. The whole set up just seemed so heartless, like no one cared about my needs as a mother."

A report by Shelter and NatCen Social Research has said that "Mothers were more likely to have clinical depression if they lived in bad housing, and 10 per cent of mothers who lived in acutely bad housing suffered from clinical depression." Telling me about her experiences with inadequate social housing, Katie says: "As if dealing with a new baby wasn't hard enough I was constantly battling with my landlord just to give my baby somewhere decent to live. I just felt like no one was listening to me."

For mothers, and particularly new mothers, a lack of security and the ability to provide a safe, warm and secure home for your child can be devastating. Katie continues: "I was at home with my new baby, but I would have to constantly be on the phone to the housing association. It's like they didn't want to take me seriously. I would have to wait in all the time for different contractors to come over, but none of them would ever fix what was actually causing the damp and leaks, they just wanted to paper over the cracks. I felt like I was constantly banging my head against a brick wall, no one would listen."

We can talk about removing the stigma around mental health problems, of peer to peer support, breast feeding and positive birthing experiences all we like, but until we start talking about class and austerity we are not going to address the systemic causes that afflict maternal mental health.

Amy Greer Murphy, a PhD student at Durham University, is studying localised impacts of austerity on health by examining the experiences of women living in Stockton-on-Tees. She wrote in a blog post: "One woman told me 'she just wanted to be a mam'.

"My findings suggest that women found their roles as mothers increasingly devalued, with the expectation that caring work should be provided by the market and that they should seek formal work as a primary source of income. However quality work is unavailable, childcare unaffordable, and an important source of identity formation – their role as mothers and carers, is diminished under austerity.

"Discussions of everyday struggles with depression, anxiety and serious bouts of postnatal depression were worryingly frequent. Women, particularly mothers, face a set of distinct risks under austerity through labour market changes, reliance on the welfare system and the public sector."

Mental health services in the NHS are desperately failing mothers. A report published by the NHS in 2015 found that specialist perinatal mental health services are needed for women with complex or severe conditions, but fewer than 15 per cent of localities provide these at full levels of provision, and 40 per cent provide no service whatsoever. Almost half of all trusts have no access to any specialist mental health midwives at all. Given that PND can affect one in ten women (probably more given the low rates of reporting) it is a sad indictment that nearly half of all NHS trusts are not adequately geared up for dealing with this. 

Yasmine, a mother of two, says: "I knew after having my second baby that I needed help, I recognised the symptoms and knew I had PND. But when I reached out to my GP, he was very quick to offer me tablets. I didn't want to just take pills, so they offered me five therapy sessions - but these were all over the phone. I didn't feel like I could arrange childcare for a phone call, so I was having to discuss my feelings whilst looking after my two small children. I just felt that if only I could sit down face to face with someone and talk through what I was experiencing, then my mental health could have improved more quickly and I would have felt like I was being taken seriously"

The safety net once provided by the welfare state has been deeply eroded. Working-class mothers are ever more vulnerable to the worst ravages of austerity and its impact on mental health. The Women's Budget Group found that tax and benefit changes will leave women £1,003 a year worst off by 2020. The new Universal Credit system pays benefits into the main earners account, potentially leaving women open to financial abuse. But the charity Gingerbread say that it is lone parents, 90 per cent of whom are mothers, who will be worse affected, potentially losing up to one months income as a result of benefit cuts.

The conversation around mental health has started to remove some of the stigma around it. But as a mum, it can often feel like we just have to get on with it - our babies should come first. There is an unwritten set of rules prescribed by society. A set of norms and ideals tied up in the image of motherhood - of being saintly, pure, maternal, wholesome, natural, inherently good. The pressure placed on us to achieve this can make it all the harder to admit when we need help - at exactly the time we need it the most.

Mothers and particularly working-class mothers have seen their ability to fulfil their role challenged at every turn. Society continues to fail working-class women. Often robbed of support networks, decent jobs, properly funded public services, and safe and secure housing. But of course it doesn't have to be this way.

My own experience of perinatal mental health means I am this week supporting Pre and Postnatal Depression Awareness week organised by PANDAS. I am donating my fee for this article to them

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