Vacant seats in our surgery waiting room are a lot like my granny's welsh cakes - a bit too thin and never quite enough of them, especially these days. Once the front doors open at 8.30am there is a constant hustle and bustle past ever patient receptionists - gouty toes throbbing, the widowed sobbing, young children whimpering, sports injuries limping. They scan the room for the few places to sit and once spotted, move with some speed to claim them. Some concentrate on avoiding eye contact, others look for those they know - old friends, new in-laws, next door neighbours. The electronic call system interrupts the chitchat and by the time that person is up and walking down the long corridor to see their GP or Nurse, someone else has slipped onto the warmed up seat. I sometimes wonder what impression this might give someone new to the surgery of what to expect the other side of my consulting room door.
Is the doctor busy? Yes. Is she running late? Almost certainly. Is she going to be able to help me today? Perhaps she won't have time.
Consider this scenario: an anxious new mum, sat in those seats in the corner trying to settle her 6 week old colicky baby. Whilst half the waiting room coo over this new bundle-of-joy, she is feeling confused and holding back the tears. It may have taken significant courage to actually pick up the phone and book this appointment. She may feel like she is a terrible mother, not deserving of such a beautiful baby. She is quite likely to have considered if coming today will lead to social services getting involved. But she's made it and now she's sitting in front of me, crying her eyes out, mascara running down her tired face. I have only 10 minutes to help fix her broken world and for a few seconds, I hesitate. I feel a searing pang of guilt for not having had the same experience of motherhood. And then 13 years of training kicks in.
I listen, validate, listen, reassure, listen, offer hope, and listen again.
There are many common misconceptions about Perinatal Mental Health problems (affecting pregnant women and those up to one year after giving birth) and Health Professionals of all specialities can make a real difference by correcting these myths.
"Yes, parenthood is hard but no, not all women experience these symptoms. No, this is absolutely not your fault. No, this doesn't make you a bad mother. And no, I'm not phoning a social worker."
By the time I reach the point of discussing treatment options, I am inevitably running late but I need to keep going. Talking therapies may be helpful, referral to our Health Visitor, online Cognitive Behavioural Therapy, local Mother and Baby group details, Third Sector organisations offering on-line supervised peer support and for some, safe medication options. Too much to take on board today, perhaps, so I will signpost her to the RCGP Perinatal Mental Health Toolkit and arrange a follow up consultation in a week or two. I keep listening and help her formulate a plan that she finds acceptable. The recipe for recovery from mental illness is complex, unique to each person and sometimes difficult to find. A bit like the secrets of grandmothers and their welsh cakes. By the time she leaves my room and walks back out into that waiting room, she has something that she doubted I had time for, she has hope.
Launched by the Royal College of General Practitioners in July this year, the Toolkit ( http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx ) is a free, open access collection of over 400 resources to help GPs and other health professionals support women and their families facing perinatal mental health problems, as well as having a section specifically for them to look at too. If you think issues in this blog sound familiar for you, a friend or relative - please do speak to your GP and get the help you need.
Dr Carrie Ladd is a GP in Oxfordshire and works with the RCGP as a Clinical Fellow in Perinatal Mental Health. Earlier this year, she received payment from NHS England to create this Toolkit but receives no ongoing funds to promote it. She regularly writes, blogs and speaks about issues related to Perinatal Mental Health.
Find out more:https://drcarrieladd.wordpress.com/ and follow her on Twitter @LaddCar