silverguide.site –

It’s 7am in a postnatal ward. I’ve been brought here having given birth around four hours earlier. I’m hot and have not slept since arriving at the hospital at 9pm for an induction, only to go into labour spontaneously before it could begin. All around me is incandescent hospital light and the sound of crying newborns. This would be challenging enough for someone who isn’t neurodivergent, but coupled with my attention deficit hyperactivity disorder (ADHD) I could feel my ability to cope unravelling.

I remember looking around, crying, unable to shut off the noise in my brain. “What if I don’t ever sleep again,” the little voice asked. I shut my eyes and the noise grew. Then there was my newborn son, lying next to me in a cot, and the fact that I had absolutely no idea how to look after him. I pressed the emergency buzzer and told the midwife who arrived that I could not breathe and needed to be discharged immediately. She said they couldn’t do that because I was under the mental health team and needed to speak to them first. I cried more.

The rest of my stay in hospital is a blur. I begged anyone who came near my bed for sleeping pills. Eventually, with the help of my midwife and the mental health team, I was sent home that day.

It was only a year later, when I learned I was neurodivergent, that my struggles that day finally made sense. Certain parts of becoming a parent are simply harder with ADHD. Birth itself strips away any sense of predictability, and ADHD brains often manage anxiety by controlling their environment – being on a postnatal ward, with its constant lights, noises, and the feeling of being trapped inside, can be sensory overload.

The NHS currently has no consistent, ADHD-specific maternity pathway, so support for women with ADHD during childbirth varies widely and often depends on individual clinicians recognising and accommodating their needs, rather than on a standardised system.

When I gave birth, I was told afterwards that nothing really exists to support women and research is limited. It prompted me to write a book about ADHD and becoming a parent to help other women. Here’s a summary of what I learned.

Hormones affect those with ADHD more

Scientists believe that ADHD symptoms can be affected by hormones, and a study by King’s College London is aiming to look at exactly that. Oestrogen and progesterone are the two main female hormones, and both rise rapidly in pregnancy. Oestrogen has a stimulating effect on the brain – it boosts dopamine and serotonin, the chemicals behind focus, mood, and motivation – so when it’s high, ADHD symptoms tend to ease. Progesterone, which rises after ovulation and in pregnancy, may have an opposing effect on dopamine signalling to oestrogen and can even make ADHD medication less effective.

In the first trimester, both hormones rise fast. Things often improve in the second trimester, when oestrogen levels are higher and more stable. Anecdotally, I heard from psychiatrists I interviewed that some women find their ADHD symptoms ease in pregnancy as a result. For others, this isn’t the case. There’s no universal rule, as hormones are complicated.

A large study found that women with ADHD were over five times more likely to be diagnosed with postpartum depression than women without ADHD, because hormone levels drop suddenly after birth. In terms of coping, simply being aware of these changes is valuable – it lets you protect yourself during the periods when your endocrine system is affected most. Staying active can help as it releases endorphins and is a natural mood booster, as can putting together a postnatal plan in advance, to relieve pressure and make sure you have as much support as you need after birth.

Medication

For those with ADHD, the more pressing concern might be whether they can continue taking medication.

When I was pregnant with my son, I continued taking the antidepressant citalopram. My psychiatrist explained that the potential risks associated with the drug were relatively small, and that the evidence linking it to harm was inconclusive. I weighed things up and decided that, for me, the risks of stopping a medication I’d been taking for seven years were greater than the potential risks of continuing it.

As for ADHD medication, there isn’t a tremendous amount of research on its use during pregnancy, mainly due to the ethical challenges of studying pregnant women. Dr Catherine Durkin, joint presidential lead for women and mental health at the Royal College of Psychiatrists, says the key is to balance risk. “What are we treating? What are the risks of not treating it?” she says. Durkin also says that data on ADHD medication and breastfeeding is limited, and recommends discussing the matter with your specialist.

Know your rights

If you have ADHD, you have more power and agency in the healthcare system than you might think. Not every healthcare professional understands ADHD, so it’s vital to know where to access appropriate perinatal mental health support if you need it. People with ADHD may be more vulnerable to experiencing mental health difficulties during pregnancy and the postnatal period, making appropriate support particularly important. Victoria White, a doula who specialises in helping those who are neurodivergent, says that under the Equality Act 2010, anyone with a chronic illness or disability can request reasonable adjustments to their care. “Neurodivergence falls under that,” she says. “Technically, self-diagnosis should count too, though that can be more difficult.”

A reasonable adjustment could be as simple as visiting the birthing suite in advance to reduce anxiety. Laura Spence, a midwife who trained in Scotland 14 years ago, says: “Women have the right to most things; it’s their birth, their body, their baby. Nothing is set in stone.”

Create a birth plan

My son was measuring small, and my obstetrician wanted him to be born by 39 weeks because they were concerned he might not be growing as well as he should. His estimated size had dropped from the 14th to the 10th percentile – in other words, he was now smaller than approximately 90% of babies at the same stage of pregnancy. To help encourage labour to start, I was given a membrane sweep, a procedure where a midwife or doctor gently separates the membranes surrounding the baby from the cervix.

Three days later my waters broke and I was told I had 24 hours for labour to start before they would need to induce me due to the increased risk of infection that comes with the waters being broken for too long. Luckily, moments before my booked induction, contractions started. Labour progressed quickly and was around five hours in total.

If you have ADHD, do what you need to get through birth. Neurodivergent individuals may require more control, knowing when and how things will unfold. Or less. Ask for what you need.

Plan for the postnatal period

In the car on the way home from the hospital, I kept looking over at my son, worrying about every bump in the road and whether his tiny body could withstand it. My partner and I had no plan for what life would look like now. We hadn’t thought about a sleep schedule and barely had all the essentials such as a cot and a pram. In hindsight, a plan would have been smart. If I could go back, I’d focus on five key areas: sleep, feeding, changing clothes and nappies, stimulation, and love. That’s all your baby needs early on. I would have made a plan about how to manage each of these.

It’s also helpful to note down essential appointments in advance: vaccinations, health checks and registering with a GP. Delegate this type of admin to your partner or a family member. You’ll be recovering. If you need mental health support, arrange it in advance.

Ignore unhelpful expectations

The idea of the perfect mother is a myth, but those with ADHD may feel the sting of falling short more acutely. After all, if you have ADHD, you’ve likely been criticised your whole life for doing things “wrong”. Focus on your strengths, whatever they may be. Having ADHD has made me resilient and I am much more able to cope than I give myself credit for.

Watch out for burnout

Returning to work after having a child can sometimes mean the end of the workday simply marks the start of another shift – managing the household, bedtime routines and family needs. It can be hard to balance work, family and a social life. This challenge is amplified for those with ADHD, who tend to overcommit and then burn out. Watch for the key signs of burnout – exhaustion and fatigue, sadness and depression, a lack of motivation, and general disconnection from others – and prioritise your self-care. If you start to feel as if you might be about to hit a wall, then make more time for yourself.

• Mum, Interrupted by Sarah Marsh is out now (Jessica Kingsley, £14.99). To support the Guardian, order your copy at guardianbookshop.com. Delivery charges may apply.