Becoming a mother in the time of corona

I normally keep these posts light and without my “medical” hat on – but given the times, this one is an exception! I’m back at work with women with perinatal depression and anxiety – wherever possible seeing people on Skype, Zoom etc. Here’s just an update on perinatal anxiety in the time of coronavirus.

One in seven is the most quoted statistic for postnatal depression—but add a one in three pregnant and new mothers who at some stage has to grapple with moments of anxiety, panic and being overwhelmed. No surprise to anyone—the current coronavirus pandemic isn’t going to decrease that number.

Much of the focus of perinatal anxiety is the unknown and uncontrollable. It is many women’s first significant contact with the medical system and no amount of birth plan preparation can accurately predict or cover every possible birth outcome; when I had children I decided that a good outcome was me and baby alive and able to go home together, and I’d leave the rest to the experts. The statistics for this happening are actually really good. That is why they do eleven or more years of study, and it was why I was paying them. A hundred years ago it was a very different story.

The focus for new mothers after surviving labour, is then on baby’s sleep and feeding—the moment of what the f*k do I know? First time mothers are now an average age of twenty eight, meaning many are older than that. Women with a lot of training and experience, largely in things other than baby care. Even childcare workers and midwives don’t have the experience of sole responsibility twenty four seven. For an IT specialist give them a data base optimisation problem; a nurse a catheter in a cantankerous, delirious patient to insert; and a teacher twenty five students with a level range two to year nine in a year seven class (and that’s in English. Imagine how the German teacher in coping). But a baby that’s only taken twenty mils milk instead of eighty? That the nurse said something about they might dehydrate quickly and die?

Now women have to deal with an extra uncertainty. And there are no more definitive answers to this than to what might happen in labour. Except.

This virus isn’t anything so different its going to do something we’ve never seen before. Like labour, we know the range of possibilities, and some early reports suggest that its likely any possible virus effects are towards the better end of the range; this is not a guarantee, because there isn’t enough data. Just a little sprinkle to add on the perspective scale. There are no reports of major malformations—but those exposed in utero in first trimester haven’t delivered yet. Maybe it isn’t passed from mother to fetus (a few cases, but a newborn has had it). In the WHO report (16-24 February) it was stated pregnant women were not at a higher risk of the disease (but still only a sprinkle on the perspective scale as their information was inadequate about outcomes and pregnant women do have a compromised immune system). Children don’t seem to be at a high risk. And there’s better data for this.

So what can women do to feel in control? To minimise their risk?

Avoid getting it. Now the government has made it clear what everyone needs to do, pregnant women need to lead the charge and need to be helped to do it when they can’t.

The single most important thing is to stay at home. If a family member gets it they need to be in complete isolation away from anyone pregnant. Complete. Different house. Talk and stay in contact via phones, skype, zoom, whats app and social media. In Singapore, corona positive people went into quarantine facilities even with cold symptoms. And they got on top of it. Flattened the curve. Currently we in Australia are not. Pregnant women shouldn’t do the shopping and if they are caring for children, the children ideally won’t be in childcare. If grandparents are helping then they need to be in isolation too; don’t forget you can chat with them on zoom etc too. But no restaurants, Bondi beach or family BBQs. None.

(If you already have been in contact with someone positive (or have the virus) you need to up the isolation measures; its important to keep things in perspective. Most people only get a cold and younger people especially children not vulnerable.)

The exception to going out is critical medical appointments. Pregnant women and women with children under twelve months can see psychiatrists via a skype/tele-link, but there will be some critical obstetric appointments where an examination is required. Keep the appointment. Don’t avoid the coronavirus and die of something we fixed with modern obstetric services decades ago. Ring before if you think it isn’t essential. Medical services are adapting. Home visits or collections of urine samples may be possible.

Just had a baby? Same thing. Take time out—really out—to enjoy. You had a baby because you wanted one—don’t lose sight of the joy. Partner working from home? Give them time to do that—but use their presence to have a shower. Get an afternoon nap when the baby does (and have your partner in charge for the hour. You can be woken in emergencies!). Get meditation and yoga apps. Go for a walk. Babies thrive on contact so this is THE big number one exception to social isolation (providing those in contact have isolated, for them). Lots of smiles, kisses and cuddles from both parents. And space to sleep. Space to explore as they develop and look to the outside world. To them that will be a toy, a feather, the pots and pans cupboard, some music you are dancing to. Let them know that the world is an exciting, wonderful place to explore. By the time they are one year old, and able to take it in, it will be.

 

And…if you have time on your hands you can always fill it with a good book!

The Long Shadow, out April 28th, is a rural crime thriller, set around a postnatal depression group. The women’s past and the town’s secrets threaten their relationships to their child…and put lives at risk.

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Why Walk: The Seven Times Two Reasons to Have a Walking Vacation

Or: How to justify a vacation in Italy in the middle of a coronavirus epidemic

 

Disclosure here; there really wasn’t an outbreak when we left to Italy in February, despite what our travel insurance says (we have another trip booked in mid-April and apparently we had to have booked before January 31st—we of course booked on January 31st—to get our money back). It’s possible we should have been more alert…but let’s face it not too many people knew (or know now) exactly what COVID-19 was or would do, and certainly not at the beginning of last month. So as I sit here a week after leaving Italy and reading everything is grinding to a standstill, I’m considering myself lucky (though another week before I can say I didn’t get COVID-19 there and after that well I guess its going to be circulating here in Aus anyway).

But it really was a fun trip and so here’s some reflections on why you should spend your vacation walking. We are long distance walkers so a mere 11 days and 238km was a warm up really, or actually a warm down, because we did Cluny (France) to Aulla (Tuscany) last year (around 1000km), two previous Caminos from Cluny to Santiago (Spain) in 2011 via the Norte/Primitevo (2038km) and 2016 via Frances (1900km). We’ve got Aulla to Rome (not sure how far but it’ll take three weeks) in September this year…well, maybe! The walk we just completed was following the Tau-dove signs on the Chemin D’Assise (ornage sticker pictured above which are dotted around on lampposts, walls and trees to follow) which started in Cluny, and we were finishing the section off to Assisi. Because we are setting a novel on the walk, and we found out having got to Aulla you can pick up the Via Francigena and get to Rome faster, we thought our characters would do this – but we wanted to finish the dove walk. Before walking this time, we spent a few days going to the towns on the Francigena so we could write the book draft. Seems like this might have been a really smart move Italy/travel is off the agenda for a while. This of course is an extra reason for us to walk – research!

This walk took us from San Gimignano to Assisi.

Why walk this walk?

  1. One gorgeous historic hilltop town after another. Good for historians, archaeologists, artists (renaissance primarily but in Pietrasanta, technically a little earlier than where we started this time, Fernando Botero’s frescos were very entertaining and the sculptures round the town, wonderful), gourmets, practising/learning Italian.
  2. It wasn’t specially hard walking.
  3. Really nice places to stay and eat!
  4. Really nice people who given the circumstances, might need tourism help (okay, when deemed safe, and yes there’s some Aussie places to stay that need support too…)
  5. Religious—St Frances as far as I can gather was one of the good guys, and he’s buried in the Cathedral in Assisi.
  6. If you are a achievement orientated person, you get a certificate…
  7. Less likely to catch the Coronavirus (or any contagious disease) – you just don’t see many people—the towns are small and most of the day its just you and whoever you are walking with. Walking in February with climate change, meant we had less tourists in the towns too, and great walking weather. Okay, and the pending doom of COVID-19 was having its influence at the end–there were a lot of empty restaurants.

Why walk at all?

  1. Cheaper than any other form or transport.
  2. Environmentally friendly (stick to the paths…no board walks like on the Overland that are there to stop walkers from damaging the flora).
  3. Evolution mandated! We were built to walk…
  4. Healthy physically and not hard on aging parts of you…
  5. Brilliant mindfulness training…to live in the moment, appreciate your surroundings and offload stress.
  6. Justifies the croissant at breakfast (marmolata in Italy, full of jam…).
  7. Way less risky than a cruise ship!
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How to co-author a book (and have a holiday and keep fit)

When we (husband Graeme Simsion and I) do author talks about our joint book, Two Steps Forward, one of the most common questions is: How did you do it? One friend (four times divorced) was completely mystified we hadn’t killed each other. It’s certainly unusual for fiction to have more than one author (there are a few in the crime genre, most noticeably Nikki French, also a husband and wife team). When we wrote TSF our original idea had been to have a his and hers—separate books, same story, different point of views (POV). So we planned together and then went off and wrote it separately.

Unfortunately our publisher thought this was a really bad idea, and the next step was putting what we’d written into one manuscript as alternating chapters, male-female POV’s. Not as hard as you might imagine—except you have a 160,000 word manuscript that needs to be halved…

So now we are writing the sequel, Two Steps South we learnt from our mistakes and only have to write half a book each. Not a job for pantsers (those that write by the “seat of their pants” and let the story evolve). I guess we could write a chapter, hand over and see where it went but if we did it like that…well that four time divorced friend might have a point. So before we went on the walk on which it is set (The Chemin d’Assise and Via Francigena from Cluny,France to Rome,Italy), we planned. I of course couldn’t help myself and had to start to write (to Graeme’s annoyance…) but then when we were thrown out of Europe (well, I didn’t get a Visa extension so we left before finishing the walk and thus the pubdate now 2021 instead of 2020) we planned in earnest (meaning some rewriting of course). Screen writers cards all over the floor of our Moroccan Riad. A bit like that card game where you have to match cards only then you also have to put them in order.

As we planned and talked and wrote the characters started jumping off the page—we’d met them all in the first book, but in the case of two, only briefly, and another two, they needed to have grown up. The Camino itself also declared itself as a major character—anyone who has walked a long pilgrimage will know this—and in ways we hadn’t predicted until we walked it. Themes emerged, again some we didn’t know were there until our characters told us.

On the walk I’d managed to get a quarter of my chapters written, and after five weeks in Morocco, my first draft done—Graeme at end of second act turning point and now closing in on the end. And still plenty of shopping done and Moroccan food eaten!

Now back home and with a crazy schedule, Graeme (schedule a little less crazy) we can write (he feels obliged to edit mine as he goes and reminds me as he does that I really do a vomit draft…and Hemingway was right about first drafts being shit…I ignore it…it really wasn’t that bad…).

And we end up with two walks later this year—first finish the Chemin d’Assise from Aulla to Assisi, then later in the year, the Via Francigena from Aulla to Rome. Why two? Well we started following the Tau-dove which goes to Assisi and I feel the need to follow it and finish what we started (and okay, I want the credential…). But our characters have told us WTF…the VF is way faster to Rome so we need to do what they walk! It also sounds a great walk…

Bon Chemin and Buon Cammino!

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On Homesickness…

On any long break away from Australia, it is inevitable that the idea of home and what it is, starts to reverberate around the subconscious. You either end up homesick—or realise that to some degree “home” is where you are and what you make of it. Or some combination of this. I recall when my first marriage broke up—I was in my late twenties—I just wanted to go home and crawl into bed and maybe watch TV and eat roast meals and heavy puddings. But the “home” I was wanting comfort from was that of my childhood, with my parents and things familiar to the me of pre-adulthood, looking for it to cocoon me in a time warp and allow healing.

Since having my own children and now a marriage of thirty years, home was where they were—plus familiar objects, surrounded by familiar places with Aussie accents, good coffee and great food of any nationality my whim dictated. But the people—family and friends—always a key part.

We have had two houses in our married life and just moved into our third. Almost immediately we left for four and a half months (six in my husband’s case) overseas, so the “new” house has all of our “stuff” and is in a familiar suburb (and with one child and her partner) but it itself has no history of family luncheons, girlfriends crying on shoulders, to warrant it being home in a home-sick sense.

We’ve also, through all of our married life, had a weekender—a shack to escape the city, where we love writing. The children had a pony when they were young—now they plant fruit trees and enjoy making cocktails and BBQ’s on the balcony. As they left home to make their own way, and the house they grew up in was sold, this now has become the place of comfort and familiarity—the place of their roots. If I’m homesick in a traditional sense, this is the home my thoughts return to.

Now is over four months since I left Australia (now heading home), most of it spent on the road—walking, staying in a different place each night for six weeks, and the rest of the time in different cultures. The last five weeks we have had the call to Muslim prayers waking us each morning before dawn, and I pause to reflect on what I have missed. For I am ready to go home; while loving the smells and tastes of Morocco, I’m wanting to be not seen as the alien—“no, all closed there” and “this way…to my shop”; familiar refrains I won’t miss, as much as they add to the excitement and difference.

Travelling with my partner of course helps—and it’s been a working holiday (just finished my “half” of Two Steps Back”). But I miss friends and family—Facebook, emails and texts and Messenger have kept me in touch, but it is only the superficial, not the pulse of their daily lives; the late skype calls for work that reminds me my little girl is all grown up, the enthusiasm for the next walk which might take my son and his partner to somewhere that will cause me to fret until they return, the furrowed brow that tells me my friend is worried about one of his patients.  I think of this when I think of all the displaced people around the world, many in countries I have been to recently living in camps for years with no sense of the future. Many will have family with them, many will not—none likely to have all the family and friends I return to, still safe. I think of the comfort in having family with you—but then know that they cannot be comforted when they worry for their children’s future—something more in peril than any child in Australia, certainly my own.

But beyond that, what stuff have I missed? I miss the birds—which were terrifyingly absent in rural Italy; the magpie’s swooping into the birdbath and three at a time sending water in all directions; the tiny wrens darting in and out, the rosellas cautiously sipping between descents on the surrounding fruit trees. I look forward to seeing the Moroccan rugs in the new house and despite the Camino (which did teach me to need stuff a whole lot less) I am really, really, sick of the same set of clothes that I’ve been managing with carry-on luggage. I look forward to good coffee and muesli (omg how I have missed unsweetened muesli…or actually, right now, any muesli…not a Moroccan thing), and real books (travelling light you have to use kindle). And I look forward to sharing how grateful I am to be Australian, and however much I will probably complain about politics and climate change…I wouldn’t want to live anywhere else.

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A Writing Pause

 

I’m in one of those incredibly lucky moments in my life that I am stopping (briefly) from writing (well, from books and editing) to just take breath. Everyone is freezing back home in Melbourne (my son returned there from Europe on the days coldest for the year, and felt it); I’m in rural France where the temperature range is from 14 to 31; nights cool enough to sleep and days not too hot (the stone walls of the farm house keep the workplace at a delightful 25). Sunshine and rolling green hills outside my window. Another two weeks before I don a back pack and start walking to Rome (a mere 1200km after the 2000km we did twice to Santiago from the same French farm house). A morning and evening walk just to keep in shape, healthy food (trialling Don Tilman’s standardised meal system for my husband’s new book) and nightly “good” sleep ratings (one excellent even) from my Fitbit.

I can bask in the glow of being shortlisted for the Davitts (not alas for the Ned Kelly’s, though This I Would Kill For would have been eligible last year for that), knowing the company is excellent (and that Jane Harper is a favourite to win I should imagine, but as I loved her book I can’t complain if I lost to it!). All the while editing my new stand alone rural thriller, The Long Shadow. Each edit making it better, word by word. Because its different to the prior ones—a less kick butt heroine but one with her own arc, a rural setting, a good twist—there is always the hope maybe another country or television company will buy it. You don’t stay a wake thinking about it, but still…Then after reading two articles on Adrian McKinty hitting the big time (hell I loved his earlier books and he’d won prizes and was still doing Uber to support his family…a timely reminder of how tough this gig really is) I wonder…should I have set it in USA rather than rural NSW? I’ve also been spending nights talking plots of a new book with my husband and asked the same question but after yet another gun massacre in USA the idea of three months in Montana or New Mexico to do research seemed less appealing.

Just because I don’t already have enough to do, have also been talking about the plot for a sequel to Two Steps Forward (Two Steps South) – which will be set on the upcoming walking path we are doing. Keeping this many plots and characters in my head at once if challenging…but not complaining. All my own doing…

I’ve had some time out to read as well—Joanna Cannon’s Breaking and Mending (prepub copy my husband was sent) which is a thoughtful poignant take on becoming a doctor and psychiatrist. She has then gone onto to be a very successful British author and this book doesn’t cover that transition, but having been a medical student and psychiatrist and knowing she is also a writer, it was interesting to see the overlap and very different reactions we had to the inevitable challenges that being a doctor throws at you. She had a very serious MCA as well (which I thankfully have not) which added to her narrative. I’d have liked more…it’s got me thinking about maybe my own memoir one day. If I run out of other things to write…

So back to the edits.

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Parenting Assessments – Where Mental Illness meets Protective Services

As my work as a psychiatrist often inspires my books perhaps it’s not so surprising I’m talking next Tuesday for the Mental Health Foundation on the above topic – which is something my heroine Natalie King deals with in This I Would Kill For. I wrote a short blog for them and anyone interested. You’ll find it here

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What I was Reading…

Check it out at Meanjin here

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