If Rivki Dwek and Freidi Sanger know everything that would help free a new mother from the debilitating claws of postnatal depression (PND), that would be because they have gone through it themselves.
“It was so severe and it took 18 months for me to get the support that I needed in order to begin recovering,” Dwek, 35, recalls of the PND she suffered with her second child.
“I had really awful feelings and it tore apart everything in my life at the time.”
Don’t suffer in silence: Rivki Dwek (left) and Freidi Sanger (Photo: Blake Ezra)
Dwek may co-head a perinatal service, but talking about her own story still brings back painful feelings.
“It’s very difficult to think about it,” she says, her eyes welling up as she cradles her fourth baby. As someone who loves to sing to her children, she recalls, painfully, how she was unable to sing for 18 months. “I lost my voice,” she says.
“When I look at videos from that time, I was hoarse.”
With a psychology degree, Dwek was only too aware of how unwell she was and sought help early from the GP.
She was finally diagnosed at ten weeks with postpartum anxiety and depression, but sharing her distress with family didn’t help, and neither did the community.
“When I did reach out for help, I was met by silence,” she says. “I looked emaciated − it was literally eating me up inside.
"A lot of people afterwards said, ‘we knew something was wrong’, yet no one actually came up and tried to help me.”
Her family members were well-meaning, she says, but “at the time, it was, ‘don’t talk about this, it’s going to affect the family’. I was told ‘OK, you’ve got your diagnosis, now keep quiet about it.’
"So there was a lot of shame around that, and it just doubled what I was feeling. Now there was guilt as well, because not only was I suffering, but I was going to make other people suffer. I was just so ashamed.”
Freidi Sanger (Photo: Blake Ezra)
While there is a pressure on any new mother to feel blessed and enjoy every minute, in the religious Jewish world, where the emphasis on motherhood is so great, the stigma is much greater. With the Torah obligation to be “fruitful and multiply” comes the expectation for Jewish mothers to be joyful in their role.
Not easy when you are suffering the symptoms of postpartum depression, which include difficulties in bonding with your baby; withdrawal; extreme negativity about yourself; and insomnia.
Menucha originally came from the Orthodox community and sought to encourage mothers to seek help without fear of judgment “because of the additional stigma that there is on top of the one that already exists”.
“It didn’t make sense that women have to suffer like this,” says Dwek. “We really value motherhood, and yet there was no help for mothers. It didn’t feel right to me that there was so much physical support, but not the mental support.
"Having a baby is such a huge thing. I knew there must be other women who were suffering like this.”
Given the 50 per cent chance of PND striking again with the next child, Dwek and her husband looked into ways of preventing her from becoming ill again.
`She reached out to a local organisation who put together a group of Jewish women who had suffered from postpartum depression, and it was there, five years ago, that she met Sanger.
A self-professed “Golders Green girl through and through”, Sanger, who married at 19, spent much of her second pregnancy throwing up, with her first baby at her feet.
"Then the crippling anxiety and depression began. It threw a serious spanner in the young Orthodox family’s plans to have multiple children.
“I envisioned constantly having kids — having a baby and 18 months later having another, 18 months later the next one,” the 30-year-old mother-of-three says.
Spreading the word: a Menucha event (Photo: Blake Ezra)
In fact, she had invested in a double buggy, and the best baby equipment, every baby bouncer, swing and mat, “because it was worth it if I was going to be using it every two years.”
But all that changed when the reality of motherhood was somewhat different.
Having returned from Israel to Golders Green, to be close to family when she was ill, Sanger looked around for support, but like Dwek she found nothing for the Jewish community, which left her feeling like an anomaly.
“There’s fear that you’re alone, and the only one going through this, because if I wasn’t and somebody had had it before me there would already be some sort of organisation to help. We live in a community where there is everything.”
Dwek agrees. “That’s a Jewish thing. We build this ecosystem, we see what needs to be done and someone does it.”
So tough was Sanger’s three-year recovery that she could not face the prospect of having more children.
It was not until she took her son for his first haircut at the age of three, that she realised she was “normal” again, and she turned to her husband and said, “Should we do this again?”
She knew that this time round that she had to arm herself in preparation for what was to come: “The system had failed me badly.”
In her next pregnancy, she contacted the one therapist who had helped her (the seventh she’d tried), and put a plan into place for every step of the way from birth. She was relieved to find the PND group. “Everyone had their own story and we all understood each other,” she says.
Elisa with Geoff and their baby (Photo: Elisa Bray)
Dwek had brought her newborn, and it was all Sanger needed to give her the encouragement that she too could recover enough to have another child. That was when she thought, “other women need this as well. They need to be able to speak to someone and know that you can experience it and then move on.”
The pair discussed how they’d love to put together an organisation that supports women. After that it was full steam ahead.
As evidence of how vital the organisation is, four years after it was set up, Menucha has now reached its milestone 350th client, helping not just those 350 women, but also their families.
From the outset, Menucha has welcomed Jewish women of all levels of religiosity and none.
They are especially keen to reach the strictly Orthodox segment of the community: until they achieve this, they know women are out there suffering in silence.
Jane Smith*, a psychologist who works across the NHS and with the Jewish community, says: “Being a mother and a good mother is held in particularly high regard in the Jewish community.
“If things go wrong, are complicated and difficult, how does that feel for the women themselves?
"Are they still able to fulfil this role that they hold in such high regard? And how will they go on to have future pregnancies?”
Putting on a brave face: Elisa with husband Geoff and their younger son (Photo: Elisa Bray)
It has been proven that the earlier treatment for PND begins, the quicker the recovery. If left untreated it risks becoming a long-term, rather than postnatal, depression.
A range of phenomena can contribute to PND: poor mental or physical health during pregnancy, including hyperemesis gravidarum (severe morning sickness); childhood abuse; a traumatic birth; and lack of support.
But having multiple babies raises the risk, due to the higher risk of complicated pregnancies, and the sheer workload of having more children to look after.
“It can then be very hard to think about subsequent pregnancies, without really high levels of support,” says Smith.
Having gone through the experience, both women had seen firsthand how under-resourced the NHS system is for perinatal mental health.
It’s a fact highlighted by recent research by PANDAS (Postnatal Depression Awareness & Support), which revealed that more than a quarter of women who sought NHS support for perinatal mental health felt their concerns were not taken seriously, and 43 per cent of those offered treatment had to wait too long to receive it.
At the PND group, they realised just how many similarities cropped up in the mothers’ stories: that it took too long to get a diagnosis, then too long to find the right support.
“The road through the medical system was really frustrating,” says Dwek. “So we wanted to create a service which was safe, which understood the nuances of our community, and for which women didn’t have to wait.”
But they also wanted Menucha to be recognised by the NHS. So they sought help from perinatal staff who confirmed that they had difficulty reaching women from the Orthodox community: they were reluctant to come forward for support as they didn’t trust them.
Elisa with her baby (Photo: Elisa Bray)
The pair “bulldozed” themselves to the top of different services to find the best support, and built a medical advisory board including a local midwife and the head of the Coombe Wood mother-and-baby unit.
She also happens to be a religious Jew. It was only once they’d built this support team, with their own designated psychologists, case workers, and peripheral services providing childcare, home help and meals, that they launched three years later.
They may not be medical professionals, Sanger adds, but “we come from the other end of it. We know where things can go wrong, and we’re going to make sure that doesn’t happen again for another woman.
"We based Menucha on our journeys, and the beauty of our model is it’s led by people with experience.”
Dwek has met several people who wanted to start an organisation such as Menucha, but unlike her and Sanger they hadn’t lived through the horror of postnatal depression.
“I don’t think either of us thought our lives were going to take this route, but someone had to do this. It really is that lived experience, that understanding of the pain, and the thought of other people struggling unnecessarily, that drives us.
“I was silenced,” says Dwek, her voice steely, yet brightening, “but no one else has to be silenced because they know now that there’s someone to talk to.”
And I am one of those 350 women who found someone to talk to at a time of utter despair. Thanks to Menucha I was able to receive the help I needed for that dark veil of postnatal depression to lift, and to make it out the other side.
* This name has been changed
menucha.info
