These were the words spoken to me by a mental health nurse who had known me for all of ten minutes.
It was 2020, and we were deep in lockdown. I had not long moved to the borough of Waltham Forest in London, leaving behind Hackney and my excellent care team who had looked after me for the previous seven years with tenacity and kindness. It was a shock.
I had only moved three miles. The inconsistency of NHS services from borough to borough can be staggering.
In this awful moment, I was battling with the NHS’s broken mental health system, frustrated and desperate for some support. The depressive episode I was experiencing was lingering, creeping up to the ten-month mark. I just wanted to get better so that I could try to have a baby.
But nothing was working. I felt stuck.
In that moment, when I was so vulnerable, I took the nurse’s words to heart. Probably because it was the very question I had asked myself countless times … Would I be a good mum?
What I now know is that this is a question every single responsible person asks themselves when they face parenthood.
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My depression and anxiety, which is severe, started when I was very young. It was made immeasurably worse after my own mum died when I was 18.
Despite the severity of my episodes, I have been fairly successful; when I am well, I am often extremely highly functioning, and when I am unwell, I am often exceptionally good at hiding it. But there have been periods in my life when I have been unable to work or get out of bed. When I completely lost myself.
Williams with her mother aged two
Despite this I made it to director level at the publisher I worked at, and was working on-and-off as a composer on the side. I had toured Europe extensively as a musician and made several albums. I had a wonderful new husband, a lovely house in London and fantastic friends.
But I wanted more: I wanted a baby. And it felt like time was running out. Tests had shown that my ovarian reserves were low. I was 35, and everything I read online told me that my fertility was dropping off a cliff.
My own mother was very ill when I was small and this meant that she spent long periods in hospital. Her absence affected me deeply. In those first precious five years we develop our understanding of attachment. Mine had been disrupted. It explained a lot.
Given my history of serious mental illness, I worried that I was bringing a child into the world only to damage them in the same way. It had been explained to me in detail: I was at high risk of having an episode after my child was born. The risk was calculated by my psychiatrist at more than 60 per cent.
After I’d given up with the local mental health services, which were so bad they were making me sicker, my wonderful GP offered to refer me for preconception counselling. This would be a one-hour session with a specialist perinatal psychiatrist and it was available through the NHS. They would talk through the risks, review all of my medications to check they were safe for pregnancy and breastfeeding, and explain what support would be available to me. In essence, this would be a chance for me to learn more about how to stay well.
I had no idea that this service existed. But having a baby is one of the few triggering events that can be foreseen. It is a life-changing experience, and for those of us with a severe mental illness, there are interventions that both can minimise and prevent women from becoming unwell.
Williams and her daughter, Astrid
A word of advice: the pathway to access NHS preconception counselling, and the exact offering, differs depending on where you live in the UK but it is widely available. If you have a severe mental illness, or have a family history of maternal mental illness, speak to your psychiatrist, community team or GP and ask what services are available in your area.
In my session, the perinatal psychiatrist spoke to me kindly about the fact that many women who have mental health conditions have children and find a way through this time of staying healthy. She reassured me that for those who don’t stay well, they almost always get better. She explained that many women experience their first episode of mental illness after having a baby, having never been unwell before. We talked about my medication and she offered advice about staying well if and when I became pregnant. It was a transformative hour and I left feeling confident and positive about the future.
When I did eventually fall pregnant some time later, I was assigned a mental health specialist midwife at the Homerton hospital in Hackney, where I was having my baby.
Her name was Wendy, and she quickly became something between a fairy godmother and guardian angel. Throughout my pregnancy, which was plagued by other health issues including acute PGP (pelvic girdle pain), an extreme B12 deficiency, a suspected blood clot on my lung and thrombocytopenia (low platelets), Wendy was a rock.
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Wendy worked very closely with both me and my partner to monitor my mental health, as well as to plan for the birth, and any episodes that might follow. We felt that being equipped with as much information as possible was the best way through. (In my regular antenatal classes, maternal mental health wasn’t mentioned once but we had about six hours on the different ways you can be induced.)
My biggest fear was that I would become unwell and be separated from my daughter, locked up in a psychiatric ward indefinitely. Wendy showed me that this wouldn’t be the case and took us on a tour of the mother and baby inpatient unit at Homerton. It was a calm, quiet and supportive place: a place to get better.
I found a template for an advance directive document on the Bipolar UK website, which we used to make a plan in case my mental health deteriorated. Together with Wendy, my psychiatrist and the rest of my care team, we talked through it. I knew what my illness might look like in the early stages, and I knew better than anyone what interventions would be helpful. All of this went into the document, which was signed and shared with my team, and a copy printed and packed in my go-bag.
This document became an insurance policy.
When Astrid was born by c-section on July 8, 2022, she was very poorly. The crash team was called for her as I haemorrhaged on the table and she was put on a ventilator. It was, in hindsight, an extremely traumatic experience. It would be nine long days before we could take our baby home. We sat by her side every day from 7am, only going home for a few hours of sleep, which was broken by alarms every two hours telling me to wake up and pump milk. It was all I could do for her, so I threw myself into it.
Astrid spent her first nine days in hospital
Every day, when we arrived in the neonatal intensive care unit, Wendy would already be there, sitting beside Astrid. She would come in early to check on us before her shift started. Those nine strange days were both the most traumatic and most deeply nourishing time in my life. As it hit 40 degrees outside, I would sit in the air-conditioned quiet of the pumping room, broken, swollen, bleeding and full of love and admiration. Most of all, I was thankful.
Not just for my baby, and for the women supporting us — the doctors, nurses, midwives, healthcare workers, other mothers on the ward — but for the people who had supported me on this journey. Because somehow, I was OK. Even in this extreme circumstance, I felt well. I felt hopeful and I felt grounded. I felt tied to the earth in a new way by my baby girl.
When Astrid came home we were visited daily by midwives because I was a high-risk patient. Every day they would ask the same routine questions.
Did I feel low?
Did I want to hurt myself or my baby?
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Every day I woke up knowing that I was all right. The sticky, feathery beast stayed away. I would look at Astrid and know that the love I felt for her was more important than anything. That I was the only person who could give it to her and that was an enormous privilege. That I likely would feel very low again one day but that day wasn’t this day. And if it did happen, we would get through it together. I wouldn’t let a single day pass where I wasn’t taking action to stay well, or to get better.
Astrid, now three, enjoying a yoghurt
In the last 15 years, there has been an enormous and positive shift around how mental health is perceived. Now we need funding for these services to catch-up so that all women in the UK get the best support possible.
When I think about my own mother, and her mother, and all of the mothers who have come before, I feel a deep sense of empathy and sisterhood. I wish that they could have had the level of care that we have. Literature is full of women suffering with postnatal illness; “the baby blues” were written off a normal, unimportant women’s problem. The injustice of that stings.
That day that I am so watchful for, the day when the sadness comes back, hasn’t arrived. It has been nearly five years since I was last unwell. I take my medication, I eat healthily, I exercise, I try my best to balance work and sleep. I am stronger than I thought possible.
Williams: “I felt tied to the earth in a new way by my baby girl”
I believe that for me personally, alongside a great deal of good luck, a part of my staying well came down to the preparation I did and the support that I had along the way.
I spent so many years thinking that having a baby might break me.
I never considered that it might be the very thing to heal me.
Bitter Sweet by Hattie Williams (Orion £16.99). To order a copy go to timesbookshop.co.uk. Free UK standard P&P on orders over £25. Special discount available for Times+ members.
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