Asking for help: it’s not a weakness, it’s essential

Posted on 15 January 2018

She’s a model, actress, businesswoman and serious cyclist. He’s a full-time ultramarathon trail runner. Yet this power couple stumbled hard when their first child, Max, was born.

I clearly remember sitting in front of my laptop with Max on my lap and tears streaming down my face,” Vanessa Sandes recalls. “I was booking an air ticket so I could visit my parents in Polokwane. I knew that if I didn’t get help, I would hurt either myself, my child or my husband.”

Today, the Cape Town-based Sandes family is happy, chilled and united. Ryan, South Africa’s premier off-road ultra-marathon runner, recently won the 2017 Western States Endurance Run in California – one of the most challenging 160km races in the world – and 15-month-old Max is the centre of the couple’s universe.

But Vanessa, who is perhaps best known for her leading role in District 9, is the first to admit that falling pregnant, being pregnant, and the first few months after giving birth were far from perfect.

To begin with, the couple struggled to conceive. Only after intervention from fertility experts and numerous luteinising hormone injections did Vanessa enjoy the experience of seeing a thin blue line emerge on a home pregnancy test.

“I eventually conceived naturally,” she explains. “I think my initial difficulties were stress-related. My mom, a Mediclinic staff member, had just been diagnosed with secondary breast cancer in her hip bone and was in the throes of chemotherapy. Plus, we’d had the upheaval of a six-week trip to the States for the racing season so Ryan could compete. My system completely shut down. I thought I was going into early menopause.”

Vanessa’s initial elation turned into extremely severe morning sickness, known as hyperemesis gravidarum, a condition she shared with the Duchess of Cambridge, Kate Middleton.

“I wanted to tweet Kate to ask for advice,” Vanessa recalls. “I vomited all the time and was often as white as a sheet. I suffered severe heartburn and oesophagitis, but I was trying to be a hero so not even my gynaecologist knew how bad it was. Eventually, a urine test revealed I had ketones in my blood – in other words, my body was breaking down muscle to survive because I had no fat left.

“My gynaecologist hospitalised me for a few days so I could recover. It was tough to take time off as I was managing the PR and social media for a big New York-listed company. I was also prescribed anti-nausea and anti-acid medication to ease the symptoms, which helped. But it was a tough pregnancy. Throughout it all, Ryan was training hard for Ultra-Trail du Mont Blanc (UTMB) in the Alps, but he was constantly there for me.”

The extended Sandes family flew to France to support Ryan in his UTMB attempt and Max’s birth, just weeks after Ryan’s return, was a cause of great celebration. But the elite ultra-runner was devastated when he didn’t manage to complete the race. With hindsight, the couple acknowledge he was still recovering from the glandular fever he’d contracted after months of over-training and over-racing.

Shortly before Max’s birth, Ryan broke the news to his wife that due to not finishing at UTMB, he had to compete in the upcoming Grand Raid de la Réunion, another brutal race.

Although this meant the champion athlete would be away from his wife and newborn baby for no more than a week, Vanessa knew that with his gruelling race preparations, he’d be an absent father at night, sleeping in the spare room for the first six weeks of Max’s life to ensure he got enough rest.

But she was stoic.

“The point is, Ryan is the main breadwinner in our family and one night’s bad sleep can throw him out for a week,” she explains. “If he doesn’t sleep he can’t race. And if he doesn’t race he doesn’t earn. He needed to do well as he’d had a fairly poor two years by his standards, and hadn’t managed to finish any of the major races. He also has obligations to his sponsors. We simply had to make it work.”

Vanessa says that’s when her post-natal experience hurtled into a dangerous emotional roller-coaster ride.

“As a new mom, I felt so insane from exhaustion and stress I often alternated between screaming and crying. I had suicidal thoughts at times and even fantasised about being in a light car accident so I could be booked into hospital where I could sleep. As horrific as it sounds, I also had moments of wanting to throw my baby against the wall, just to have some silence.”

It was a slow build-up to an eventual psychological breakdown. “Max had bad reflux and was a wriggly, niggly baby,” she says. “Just getting him to sleep after a feed was a performance, and although I was constantly busy with him I felt I wasn’t accomplishing anything. The level of exhaustion I experienced was excruciating – it was like torture. And because I couldn’t exercise after the Ceasarean, and was also just too tired, I felt unhealthy and unwell all the time. Ryan is an amazing dad and very hands-on during the day – cooking three meals a day and serving me breakfast in bed. But the nights were mine to deal with.”

When it’s not just the baby blues

As your body and lifestyle adjusts to the new demands of a baby, it is normal to feel tearful and overwhelmed sometimes, says Dr Elsa du Toit, a maternal mental health expert at Mediclinic Panorama. “Hormonal changes after birth are profound and influence your mood. However, if these negative feelings persist for longer than a week, you might be suffering from post-natal depression (PND). Sadly, the fear of being seen as a ‘bad’ or ‘inadequate’ mother may keep someone from seeking help for this treatable illness.”

What causes PND?

“Post-natal depression is a multifactorial illness that any woman can develop,” says Dr du Toit. “However, certain women are more vulnerable than others due to genetic and environmental factors.”

Women more at risk are those who:

  • have a history of mood and anxiety disorders
  • stop their medication when they realise they are pregnant
  • experience anxiety or depressive symptoms during pregnancy
  • had a complicated pregnancy and birth
  • are exposed to violence and abuse
  • are adolescent moms
  • and have poor support networks

Yet, despite all the symptoms of post-natal depression, Vanessa simply thought it was an adjustment to her new life as a mom. “I kept telling myself I could deal with things; that I’m a strong woman and I must just push through the difficulties,” she recalls. “It often crossed my mind that I should see my GP but I was too busy – my life was a constant blur of nappy changing and burping and cleaning.

“Then one night, after being awake from midnight to 5am, something inside me snapped. I marched into the spare room where Ryan was sleeping, handed Max to him and threw myself on the floor. I just lay there, screaming and crying. Then I went to bedroom and wept manically for almost an hour. Ryan was unbelievably calm and rational.

He suggested I see my GP and that we needed extra support at night. I think deep down he just thought his wife was nuts and unstable, because like many men, he believes happiness is a choice and he’s fairly black and white when it comes to emotions.

“At that point we were in a very brittle space as a couple. I knew I loved him, but I actually hated him at that stage. I just felt so empty. I had just enough energy to keep Max alive, let alone worry about myself. My life had become a black hole of despair. I knew I needed to vist my parents where I could have some proper rest and recuperation.”

Shortly afterwards, Vanessa’s GP diagnosed her with post-natal depression and upped the dosage of Eglynol she’d been prescribed. “She also phoned Ryan to explain that I could be instutionalised if I didn’t get help and sleep,” Vanessa explains.

“And that’s when we turned the corner as a family. I spent a week at my parents’ house, Max started sleeping better, and we arranged for a helper to come in on Saturdays so I could exercise and have some me-time.”

People can be very judgmental about mental illness, but post-natal depression is a very real disease, says Vanessa. “Too often, strong women don’t even know they have it. We put it down to the natural changes that come with being a new mother and battle on, trying to do too much ourselves. Now that the worst is behind me, I am still very aware of my emotional state and I keep tabs on my moods and anxiety. After all the chaos, I wouldn’t change my life and my family for the world.”

Ryan did well in Réunion and also won the 76km Addo Elephant Trail Run earlier this year. But Western States was a watershed moment for the whole family. “I told Ryan that whenever he was feeling low during the race, he must think of Max waiting for him. Crossing that finish line in first place was a high for all of us. And Max had everything to do with it.”

Symptoms of PND include:

Problems bonding with your baby, constant fatigue, lack of concentration and energy, feeling overwhelmed, tearfulness, feelings of worthlessness and inadequacy, and thoughts of suicide or harming yourself. In extreme cases – known as post-partum psychosis – women can experience hallucinations, delusional thinking and emotional disruption.

How is it treated?

  • Medication: During pregnancy and lactation, the risk of the mother’s illness is weighed against the possible risks medication can have on the baby. Untreated maternal illness can be more harmful to the mother and unborn baby than the use
    of medication.
  • Psychology: Interpersonal Therapy and cognitive behaviour therapy (CBT) are effective for anxiety and mood symptoms.
  • Support: Help from partners, family and friends is extremely important.
  • Hospitalisation: Postpartum psychosis is a rare but serious condition that demands immediate action to ensure the safety of both the mother and her baby. Most cases require admission to hospital.

 

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In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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