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Birth Trauma: Unveiling the Impact (part 1)
So, you’ve come home from hospital with your baby. The first few weeks have been a whirlwind but things are now settling into a slightly lesser version of chaos. Or not? Maybe it’s been days, weeks or months and you are feeling constantly on high alert. You can’t help but feel like there will be an imminent catastrophe; there is no option not to. Your body and mind feel in complete disarray, you feel alone and the “old you” is a distant memory. What’s more, you start to feel guilt and shame linked to the idea of not being able to “hold it together” or cope like “everyone else”. Is this a sign you aren’t made to be a mother? Is the baby better off somewhere else? Is there something wrong with you?
IN BRIEF:
Birth trauma can relate to anything that happens before, during or after birth.
While linked to an event(s), the impact of trauma stems from how you felt during an event.
Birth trauma triggers our threat system and disrupts feelings of safety in the body and mind.
Birth trauma symptoms are automatic, varied and can be more or less intense.
Birth trauma is highly treatable and with the right support, most make a full recovery.
How Common is Birth Trauma?
Trauma is a bit of a buzzword these days with influencers, musicians and athletes alike openly talking about it. Curiously, the notion that trauma is something that only effects war veterans somehow continues. We know that around 4-6% of women experience Post-Ttaumatic Stress Disorder (PTSD) within the perinatal period. Many more will experience trauma symptoms to a lesser degree. In the UK, up to 700,000 women give birth every year which means 42,000 women could be impacted by birth trauma every year. So, in short, trauma within the perinatal period is common. In this blog, I hope to outline what trauma is, its impact and some steps toward healing. This blog is the first in a two part series with the second focussing on healing from trauma and strategies to help yourself or someone you care about.
What is Birth Trauma?
To understand this, lets first consider trauma more generally. Psychological trauma refers to the emotional aftershock of a deeply shocking or distressing event(s). Often these are situations where we are left feeling unsafe, helpless, powerless and our nervous system becomes completely overwhelmed. The term birth trauma is a bit misleading as it can refer to a traumatic event which occurs any time before, during or after birth. However, we know that the risk for PTSD is increased between one and six months after birth. Maybe you have experienced a traumatic event related to an antenatal appointment, severe sickness, fertility treatment, being in hospital, birth itself, delivery complications, going home or feeding. Maybe childbirth was not what you expected or you might feel angry that medical staff ignored or disrespected you. Trauma can relate to a single event (like traumatic birth), or it can be connected to multiple ongoing events (such as fertility treatment). PTSD during the perinatal period may also be entirely unrelated to pregnancy as old trauma from the past can surface or resurface.
While trauma is linked to an event, it may come as a surprise that trauma has less to do with what actually happened and has more to do with how it felt for you, how it was experienced and what happened afterwards. This makes sense because we know what might feel traumatic to one person may not to another. Birth trauma also has a lot to do with the medical system and societal expectations. Unfortunately, the narrative too often solely focuses on the mother. It has been suggested that the term “obstetric trauma” is a more fitting term. Of course it is important to note that birth and the medical system is not inherently unsafe.
When I am working with clients who have experienced birth trauma, I am interested in how the experience was for them and how it was perceived. Tell me about how it was for you? Did you feel fearful, unheard, unsafe? Did you feel out of control, helpless or powerless? Did you believe that either you, or your baby, would die? I’m also really interested in what your support was like, before, during and afterward. Did you feel cared for, listened to and supported? Who was there? Were you left alone? This is important as good support can act as a buffer against developing PTSD after a traumatic experience. So, if you went through something horrendous but you had quality care, this can significantly reduce your risk of developing PTSD. Importantly, not everyone who experiences a traumatic event will go on to develop trauma symptoms and not everyone who has trauma symptoms will develop PTSD. Indeed, the majority of people do not.
The transition to motherhood naturally involves a realigning of identity and adjustment on many levels which can of course, in of itself, evoke stress and anxiety. Therefore, parents navigating birth trauma suffer two-fold with trauma and the natural anxieties that occur with such a life-changing adjustment. Unfortunately, trauma symptoms too often get misdiagnosed or missed entirely.
Is Trauma just in the Mind?
Absolutely not. Our body and physiology is central to understanding the impact of trauma, both during and after an event. Humans have a threat system which has evolved to keep us safe. The threat system is a full body response and when triggered you will notice all sorts of physical changes. During trauma, your body is flooded with stress hormones and the old fear centres deep in the brain, shut down unnecessary bodily processes, including the digestive system (because who needs to be digesting last night’s curry when being chased by a tiger!). This is a smart evolutionary response designed to free up resources so that our body and mind can better respond to threat, and be more likely to survive. For example, with more blood pumping to our muscles we are more likely to be able to flee any predator. With dilated pupils we increase vision and are more likely to see a threat. We rapidly move from a state of connection and safety into heightened state of threat. This can show up as anxiety and/or it may mean completing shutting down and feeling numb.
We have a system within the brain which is akin to a librarian and is responsible for information processing,. This system filters and processes incoming sensory data before moving it into our long term memory with a time-stamp. This system also shuts down during trauma. Because of this, the memory of the traumatic event does not get processed and can hang around in our awareness. This explains why we can be so easily triggered by sounds, smells, sights, tastes and feelings which transport our body and mind back to the time of the trauma. When it comes to trauma, the past is not the past. It is the present.
What Happens in the Body after the Traumatic Event?
The impact of trauma lingers long after a traumatic event. Slight tangent alert! Let’s consider a zebra who is eating grass when a hungry lion appears from nowhere and starts a chase. The zebra’s threat system automatically kicks in and it manages to escape, the lion is nowhere to be seen. So, what does the zebra do? It goes back to eating the grass and its body and mind swiftly return to a feeling of safety. So, what has this got to do with birth trauma? Well, the human brain operates slightly differently and while amazing, there are some glitches. Firstly, human brains have evolved in a way that leads us to be naturally sensitive to threat and anxiety. Our brains operate as if we are hunter gatherers, so, it’s really all about survival and being better safe than sorry. The human mind’s ability to time travel i.e. think about the past, future and create imagined scenarios is double edged. That is, when a traumatic event is over, we don’t return to feelings of safety like the zebra, we continue to be on high alert long afterwards. Constantly looking over our shoulder for the lion. Just in case. It’s like our internal fire alarm keeps alerting us to a fire long after it has been extinguished.
What are the Signs of Birth Trauma?
A heightened threat response shapes our thoughts, feelings, physiology and behaviours. It threatens our belief in safety and at worst, our ability to trust ourselves and others. It can also block our capacity to receive care and compassion.The signs might include :
Having unwanted distressing thoughts or memories
Flashbacks (images, memories, sensations or feelings that you felt at the time)
Nightmares
Physical or emotional distress when around reminders
Patchy memory of the event
Avoidance of situations that remind you of the trauma e.g. walking past the hospital or meeting new mothers
Avoidance of thinking about the event
Irritability and anger
Trouble getting to sleep or staying asleep
Poor concentration and focus
Hyper-vigilance
Worry that something awful might happen to you or your baby
Feeling on edge and jumpy
Feeling guilty or as if you are somehow to blame for what happened
Negative thoughts about yourself or the world
Despair, depression
Mothers who suffer from trauma symptoms often end up structuring their lives around it, doing everything they can to avoid triggers that remind them of their trauma. Many people report symptoms worsen in the evenings which also makes sense given that our ancient ancestors would be much more vulnerable in darkness due to being unable to see predators.
A diagnosis of PTSD is related to the severity of your symptoms, how long they have lasted and the impact they have your life. It is important to remember that all trauma symptoms are a fully natural response to circumstances. Our threat response is involuntary and you are not consciously choosing it. It is not your fault your body is responding in this way. Your body is trying to protect you and keep you safe from further threat. Indeed, a highly sensitive threat system is helpful when staring into the eye of a tiger, but when you are trying to juggle looking after a new-born, do the washing and make a sandwich, well, not quite so much! Your trauma symptoms are a completely normal response to abnormal events, and are not a sign of some inherent flaw.
Risk Factors for Birth Trauma…
While the psychology behind developing PTSD is complex, there are some known risk factors which make some individuals particularly vulnerable to experiencing trauma symptoms. Again, this does not mean you will definitely experience trauma if you have these risk factors, and most who experience a traumatic event will not go on to develop PTSD.
Childbirth not going to plan, or matching expectations
Needing intervention and assistance during labour
Delivery complications
You or your baby sustaining an injury
Still birth or neonatal death
Not receiving adequate and consistent care
Feeling a loss of control or lack of choice
Poor communication/not being respected
Previous trauma (including previous birth trauma)
A tendency toward anxiety
Worrying that you or your baby will die
You/your baby needing medical help after birth
Individuals affected by birth trauma unfortunately often find that there is nowhere to turn for support. They find that other mothers who have not had traumatising births find it hard to understand or relate to the impact of a traumatic birth. This leads to isolation and shame where woman may feel somehow weaker than other women. Too often, the focus is on having a healthy baby and the belief that this should make up for any trauma that has occurred. Individuals can feel incredibly guilty, it wasn’t that bad, I shouldn’t feel this way.
The Ripple Effect of Birth Trauma…
Birth trauma can have a ripple effect. Relationships with friends and family may worsen and considering another baby can feel impossible. Many women end up feeling conflicted by their desire for another child and their determination to avoid another pregnancy. Consequently, couples delay having another baby or avoid it altogether. Woman may also lose interest in sex or intimacy which adds to the existing strain on relationships. For many, it’s not until the next pregnancy that trauma symptoms surface and they become aware of the impact from the first. Some women also avoid any medical appointments that reminds them of their birth experience, including smear tests. Many also worry about the impact of birth trauma on bonding but the good news is that the majority of mothers are able to bond with their baby, despite trauma symptoms. Partners and medical staff are also at risk of PTSD but this is a lot less talked about.
Healing from Birth Trauma…
The body has a natural healing system and for many symptoms often settle down within a month or so naturally. For some, trauma symptoms persist, worsen and can develop into PTSD. This is not something that can be alleviated by “pulling yourself together” or “focusing on the positives”, despite what other people may say. Fortunately, PTSD is highly treatable and there a number of evidence-based approaches that can help you fully recover. The current recommendations for trauma treatment include Trauma-Focussed Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation Reprocessing (EMDR) therapy. Other approaches including Compassion Focussed Therapy (CFT) and Acceptance and Commitment Therapy (ACT) can also be helpful. Research shows that most people who go on to become pregnant will have a better experience next time.
If you have been impacted by birth trauma or would like to explore it further you can:
Talk to your GP or midwife about how you feel
Request professional mental health support (from a suitably qualified professional)
Ask for practical and emotional support from friends and family
Access support from organisations such as https://www.makebirthbetter.org/ and https://www.birthtraumaassociation.org.uk/
Stay Tuned for Part 2….
The Opposite of Rest Isn’t Work...Its Burnout
What is the healthiest way of dealing with burnout? Is it just keeping going and feeling the burn? Is it accepting that you can't continue in your role and downing tools? Jacinda Ardern has led by example recently, stepping down as New Zealands prime minister stating that she doesn't have "enough in the tank" to continue as a leader. While her announcement has come as a shock to many, I have to praise her honesty and self-awareness as well as the humility it must have taken to admit to herself, and the rest of the world when enough is enough.
Burnout is becoming a very fashionable term. I can barely open Instagram before my feed is flooded with tips and tricks to me come back from the brink of burnout. But how much do you really know about it? Let’s delve a bit deeper. Burnout is a natural response to prolonged stress. Burnout encompasses three different components: depersonalisation where you separate yourself emotionally from your work instead of investing yourself and feeling like it's meaningful; a decreased sense of accomplishment, where you just keep working harder and harder for less and less sense that what you are doing is making any difference; and emotional exhaustion, no need to explain that one any further. Whilst everyone who burns-out experiences all three of these factors, broadly speaking, for men, burnout tends to manifest more as depersonalisation whilst for women, burnout tends to manifest more as emotional exhaustion. Thus whilst anyone can experience burnout we will all experience it a little differently.
Although this description of burnout may be familiar there is a lot of overlap between burnout and many other experiences, including depression, anxiety, grief and rage. So for simplicity sake when we are talking about burnout here we are defining it as that feeling of being overwhelmed and exhausted by everything you have to do, while still worrying that you are not doing enough. It is also important to know that burnout is not a medical diagnosis. It is not a psychological illness. It is a condition related to overwhelming stress. You are not trapped in it forever. There are ways to put out the fire.
Burnout happens when demand outweighs capacity. Most of us spend the majority of our waking hours working. Working hard. Often feeling that there is more to do than we have time for in each day. Each time we work through lunch, trade sleep for a few more hours of productivity, or reply to an email outside of work hours we normalise these things, to ourselves and to others. We also contribute to societal expectations that other people should do the same. Each time we overwork we are contributing it. Ultimately we are contributing to our own burnout. Now don’t misunderstand me here I am not anti hard work, I am pro deep rest and restoration. The kind of balance and restoration that can enable us to be highly proactive and hard working human beings. One thing we are not when we are burned out is productive.
Burnout can have a serious toll on your life. This toll can be wide spread and varied. Signs of burnout can be wide ranging including emotional, behaviour, cognitive and somatic symptoms. This may include including gastrointestinal problems, high blood pressure, poor immune function, reoccurring headaches, sleep issues, concentration issues, depressed mood, anxiety, loss of interest, fatigue, poor performance, reduced creativity and cynicism at work. How many times did you nod your head in agreement when you read through that list? Burned out people are 63% more likely to take a sick day and more than twice as likely to seek a different job than those who are not feeling burnt out.
WHO GETS BURNED OUT AND WHAT ARE THE RISK FACTORS?
Burnout levels are currently at a record high. 88% of the workforce in the UK have experienced burnout in the past two years according to recent research. A shocking and terrifying statistic. Whether this number reflects the western nations more generally remains to be seen, but what we do know is that burnout is on the rise. The COVID-19 pandemic introduced new stressors to nearly every domain of life, from increased demands at home to longer and often more fractured working hours, heightening everyone’s risk of burnout. Other issues such as like the politicisation of vaccines and feelings of lack of support from the government and workplaces further caused workers, especially those in the caring professions, to become cynical about their jobs. As the world heads into its fourth year of the pandemic, these stressors have become persistent and indefinite, add in economic uncertainty and daily stress around financial stability and we have the perfect recipe for burnout. In saying all of this, although it is likely that the burnout pandemic has has been exacerbated due to COVID, our society was ripe for a generation of burned out people long before the pandemic hit.
We know that some people in certain occupations are at higher risk of burnout symptoms than others, people working in caring roles in particular are at high risk. While burnout research has primarily focussed on healthcare professionals, it is now clear that burnout impacts people from all professional groups. According to research there are five job factors can contribute to employee burnout including: Unreasonable time pressures (those who have enough time to do their work are 70% less likely to experience burnout); lack of communication and support from management; lack of role clarity; unmanageable workload, and unfair treatment.
The factors that lead to burnout are not just professional ones however. Having a high stress job, for example, doesn’t make burnout a foregone conclusion. Parenting, relationships, running households, and keeping abreast of the mental load are just as significant when it comes to burnout. Basically anything where you need to care and invest, where there are ongoing and increasing demands, and where it is not possible to meet expectation with the resources you have. That is the formula for burnout, no matter what context it's in.
WHAT CAN HELP?
Burnout is not inevitable and it is not “just part of the job”. Believe it or not, there are people and organisations where the likelihood of experiencing burnout is close to zero. These employees share three things in common: they are engaged at work in a job they enjoy, they have high wellbeing, and their organisation has a strengths-based culture
GETTING HELP – IS IT WORTH IT?
So, if it’s not clear yet let me just highlight: burnout can be prevented and recovered from. But the cure is not simply getting enough rest and focusing on self care. How can you be expected to "self-care" your way out of burnout? That will only get you so far. The cure for burnout is all of us caring for each other. We can't do it alone. We need each other. Making that happen in real life is, of course, easier said than done. We can start with ourselves. We need to normalise nourishing lunch breaks. We need to normalise getting enough sleep. We need to normalise ignoring our emails out of hours. We need to normalise unfinished to-do lists. We need to normalise asking for help and saying no. This last one is a little reminder to myself; when I tell myself to dig in and have a little more grit, I actually need to ask for more help!
If you are currently experiencing burnout or are feeling the edges of the fire you are welcome to join our four week workshop on burnout. Click here for more information.
Online Therapy: Your questions answered & 8 top tips
IN BRIEF:
Popularity of online therapy has exploded over recent years.
Online therapy is convenient, increases choice and access to therapy.
Online therapy has repeatedly been shown to be at least as effective as in person therapy.
There are steps you can take to maximise your experience of online therapy.
WHAT IS ONLINE THERAPY?
Online therapy is an umbrella term which includes a whole range of digital mental health formats. This includes instant chat, telephone, virtual reality, mental health applications, email, video calls and online forums. In this blog, I am referring to online therapy delivered via online video link.
Online therapy is not new and it has not been birthed by the pandemic, in fact, it has been around for decades. The world has become heavily reliant on use of technology and this has been observed across many industries nearly a decade. Online therapy first became more widespread in the 00’s and of course later was catalysed beyond belief in a matter of days due to the pandemic. Estimates show around 43% therapists offered teletherapy prior to the pandemic with this increasing to 98% during the pandemic. The notion of therapy being delivered in a nice room with a nice comfy chair with a quality box of tissues nearby got flipped on its head.
DOES IT WORK?
Well, the evidence is clear-cut; online therapy is effective. Research has been completed exploring a number of problem areas including (anxiety, depression, OCD, trauma, relationship, complex trauma, family therapy, psychosis) using a number of different therapies (Cognitive Behavioural Therapy, Schema Therapy, Acceptance & Commitment Therapy, Compassion Focussed Therapy, EMDR, Psychodynamic, EFT) to name just a few.
There is no denying a healthy peppering of scepticism existed around whether you can develop a close therapeutic relationship with your therapist online, in a box, through a screen. You may have asked this question too. This is a really important and understandable question as time and time again, effectiveness studies highlight that it’s the relationship itself that you have with your therapist which is the most important ingredient to lasting change. Fortunately, the answer is yes. Robust evidence shows that a therapeutic relationship can be developed online just as it can in person. This is great news.
Moreover, it has been shown that online therapy leads to greater disinhibition and openness resulting from greater perceived safety and a reduced power imbalance. What this means is that it is possible that you may relax and feel comfortable to open up about difficult experiences and emotions more quickly in online therapy. This, on the whole, is helpful, however, it is important that your therapist guides you to disclose at a pace that is comfortable and safe for you.
WHY IS ONLINE THERAPY IMPORTANT?
Opportunity: As a therapist and a human who utilises online health services, I strongly believe that choice, flexibility and access are central to healthcare. Online therapy increases access while at the same time widening choice and flexibility for clients. What’s not to like? As a therapist, I love delivering online therapy and I enjoy drawing upon my creativity to maximise sessions with clients. It seems I’m not alone either – a recent study indicated that around 86% of therapists had a preference for delivering therapy online.
Increases access and reaches more: Seeking mental health support can bring about shame and stigma which can often block people from accessing the help they need; going to the clinic can simply feel too much or people can view their difficulties as not severe enough to use services. Online therapy helps with this as you can attend therapy from the comfort and privacy of your own home. This can be the port of entry for help that otherwise wouldn’t exist. This is especially true for young men who, in the past, have experienced significant barriers to accessing mental health care owing to outdated traditional masculinity scripts around emotional expression in men.
Flexible & Convenient. Online therapy is convenient. There is no travel time or costs incurred. This makes therapy more affordable. People who live in remote and rural locations have had less healthcare options and online therapy finally opens this up. Many people who seek therapy also struggle with debilitating health conditions and chronic pain which may impact upon their ability to travel. This again, offers a port of entry. Online therapy has increased attendance rates across the board.
Choice: The choice now available for therapist is quite frankly, astounding. This is good news as it means you are more likely to find a best fit for you. This is important as to be able to talk openly with a good connection is vital. This is especially helpful those in remote locations who are typically faced with few, if any, ‘anonymous’ options.
Unsurprisingly, there is a no ‘one size fits all’. If you live somewhere that has poor connectivity or signal, online therapy using videolink can be tricky. Furthermore, if you have sensory difficulties or struggle with technology it may be you need extra support. Your therapist is there to support you and that includes help with technology set up. You may also struggle with getting a private space in a busy household. If you are experiencing severe distress or are in a crisis it may be that an in person consultation will better meet your needs. You don’t have to make this decision alone; a therapist will help figure out what will meet your needs.
To help you narrow down your search always: check your therapist or psychologist is registered with a governing body. This ensures the quality of care you receive and requires the therapist to adhere to guidelines ensuring the practice they offer is safe and evidence based. If you are seeking a psychologist their governing body is the HCPC so you will want to check their registration status.
Here are my TOP 7 TIPS to help you get the most out of online therapy:
Find a PRIVATE, COMFORTABLE and QUIET SPACE. It is important to feel you can speak freely, openly and honesty. Sit upright in a comfortable spot and turn off any distracting notifications while you are in your session.
Use a BIG SCREEN. Being able to see your therapists face and upper body clearly is important. A lot of communication is non-verbal so try to stay in shot. Your emotions are expressed by your body and posture as much as by words so being visible will facilitate the process.
LIGHT YOUR FACE well with a light behind you. Try to avoid pointing your camera toward an open window as it might be difficult to see you.
Keep your CAMERA steady and use headphones to maximise SOUND and minimise any background noise.
TEST everything in advance. This includes your connection and access to the platform.
SCHEDULE. Arrange your therapy at a time of day where you can ease in to work or life after your session. Pencil in time to process post-therapy.
ASK questions – tell your therapist what you need. Whether it be for their position or light to be different, or perhaps you want materials to read at home or videos
Therapy is about choice. Online therapy creates greater choice but it does not negate the need for in person therapy. You get to choose. I hope this answers some of your questions. If you are interested in online therapy or have any questions just get in touch and I’d be happy to help.
What's the difference between baby blues and postnatal depression (PND)?
First published by Naytal in August 2021.
In brief:
Firstly, pregnancy, birth and transitioning to parenthood is hard - neither baby blues or Postnatal Depression is a sign of your inabilities as a mother
Baby blues is a natural response to the change of hormones immediately after birth - it is completely normal and tends to pass within 2 weeks
Symptoms of postnatal depression (PND) can start in pregnancy, or in the weeks and months following birth, and persist over time, getting in the way of your daily life
PND is highly treatable - it is important to reach out early and talk to your NHS GP or health visitor as soon as possible
Many women imagine new motherhood as a time of total fulfilment, days filled with baby bonding and abundant joy. This may well in part be true but we do need a hard reality check.
Pregnancy, giving birth and parenthood is hard, really hard. Transitioning into parenthood is a period of monumental change and spans all areas of life including social life, relationships, physical, emotional, career etc. Becoming a new mother (or father) is not instinctive. We don’t get trained up for what is a full-time 24/7 job. Oh, and you start this new job completely sleep-deprived and overwhelmed! The postnatal period is full of promise but it can involve a lot more than new parents bargained for.
Historically and even today in other cultures, rituals and community offerings would provide women with support for several months in order to recover. The culture we live in today has very different expectations of an individual compared to the times of community approach. Is it such a surprise that it may not all be plain sailing?
If you’ve come to this post, chances are you’re experiencing a form of ‘baby blues’ or postnatal depression (PND). Don’t worry, there is support out there for you. Read on to find out the difference between these two very common feelings and how you can get help.
What are the baby blues?
The baby blues is a natural response to the sudden and rapid drop of hormone levels after birth combined with sleep deprivation and changes in routine/identity. Women experience baby blues in their own unique way but common symptoms include fluctuating mood, tearfulness, irritability and anxiety.
When do baby blues start and how long do they last?
Up to 85% of new mothers experience baby blues and at most, it will last around 2 weeks.
Baby blues is a completely normal response and one which is not your fault. It’s certainly not a sign of your inability to cope as a mother! This may be hard to believe given the idealistic picture that modern-day society, social media and Hollywood presents us with; images of women after giving birth like it is a ‘non-event’. Baby blues can take women by surprise and they may question what it means for them, fuelling shame and comparison
So, what’s the difference between baby blues and postnatal depression?
The main difference between baby blues and postpartum depression comes down to persistence and severity of symptoms as well as the impact on life in general. Baby blues are transient and do not tend to get in the way of your daily functioning.
What postnatal depression (PND) is NOT - Myth Busting
Myth 1: It is caused by hormone imbalance or chemical imbalance Myth 6: It stops you from loving your baby
Myth 2: If you try hard enough you can snap out of it Myth 7: There is no cure
Myth 3: A depressed person is not stressed Myth 8: It doesn’t affect normal, healthy, successful people
Myth 4: PND only affects women Myth 9: If you have PND you are somehow weaker than others
Myth 5: It is not as serious as a physical problem Myth 10: If you have PND you will damage your baby
How common is PND?
Around 10-15% of mothers experience PND and for most, symptoms begin within pregnancy; thus, perinatal /antenatal depression may be more fitting.
What are PND symptoms?
When the joy we hope for is tempered with and despair endures we may be experiencing PND. Postnatal depression can sometimes start weeks or months after birth. The feelings an individual may have when experiencing PND are like those of depression at any other time in life.
Common PND symptoms include:
sleep disruption
feelings of despair and hopelessness
crying
obsessive thinking
anxiety and panic
irritability
negative ruminations
withdrawal and lack of interest / pleasure in activities previously enjoyed
Some women feel disconnected from their baby and have thoughts about harming themselves or their baby. A hallmark of depression is rumination and harsh self-critical thinking. Pressure and expectations from self as well as family, friends, society can perpetuate feelings of shame and inadequacy.
NOTE: If you are experiencing, severe symptoms such as hallucinations, delusions, mania, confusion, extreme low mood or other out of character symptoms, this could be a side of postpartum psychosis. This is a serious mental illness that affects around 1 in 500 mothers after giving birth and should be treated as a medical emergency.
Why does postnatal depression happen?
Although some debate exists around PND it can broadly be explained in terms of a biological, psychological and social adjustment. Compared to other life events, pregnancy can lead to extreme changes in feelings of control, routine and roles. For example, changing from a career role into a mother role. There are multiple simultaneous adjustments including relationships, body, mobility, emotional, responsibility, pace of life, loss of routine, identity, not putting yourself first, lack of focus to name a few.
In addition, it is important to understand the context of the pregnancy when we consider adjustments. Pregnancy may be unexpected and unplanned or a result of multiple rounds of IVF. Added to that is our previous experiences of being human that have led us here.
We also have a brain that is wired to be efficient for cavemen days, not our current glitzy fast-paced society. When we consider evolution, symptoms of depression like shutting down and withdrawal may have been helpful at one point in our history signalling a call for help to our surrounding community.
Self-criticism may also have an evolutionary role to motivate us and protect us from failure. Thus, postpartum depression is a human condition and should be viewed as a natural consequence of being human combined with a series of factors including our previous experiences, our tricky brains, birth experience, social support, relationships, societal expectations. Remember, you didn’t choose any of this; PND is not your fault and is not in any way a reflection of your capacity as a mother.
Getting help for postnatal depression
The key things to remember are:
Reach out and connect with others, tell someone how you feel
Mindfulness, gratitude, acts of kindness
Take care of your relationships
Make time for things that matter to you
Watch out for your harsh judgements and self-criticism – practice compassion
Gentle movement and activity (if you are able)
Rest/sleep when your baby is napping & maintain a healthy diet
Speak to a mental illness professional to get expert support
Accept help & support to care for your baby and you when possible
We know PND is highly treatable and there are many approaches shown to significantly improve women's functioning and well-being. It is important to reach out early and talk to your NHS GP, midwife or health visitor or as soon as possible; remember, you are not alone and it is their job to help you feel better. They will discuss your options – a number of support groups and talking therapies (CBT, CFT, MBCT) are available as well as other options including medication.
Unfortunately, mother and father’s experiences are too often clouded by stigma, shame and guilt which can get in the way of seeking support. Getting the right help firstly requires a system change and society to recognise and celebrate pregnancy, birth and parenting for what it is. This involves providing understanding, care and support as early as the first trimester.
References:
Cree, M. (2015). The compassionate mind approach to postnatal depression: Using compassion focused therapy to enhance mood, confidence and bonding. Hachette UK.
Wenzel, A., & Kleiman, K. (2014). Cognitive behavioural therapy for perinatal distress. Routledge.
Bardacke, N. (2012). Mindful birthing: training the mind, body, and heart for childbirth and beyond. Harper Collins.
Scotland, M. (2019). Why Post Natal Depression Matters (Vol. 15). Pinter & Martin Ltd.