Archive for the ‘birth professionals’ Category

Meerkats and Perinatal Mental Health: What is the one thing I do when meeting some-one who is depressed or anxious?

November 9, 2016

It’s help them to calm their brain.

meerkat-alert

Picture a meerkat, up on the tips of his feet, eyes and ears peeled for danger. Red Alert. The meerkat is on patrol for the night. His brain and nervous system are hypervigilant, sensitive to all dangers, out to protect his clan.

Now picture the other miakats (that’s how I like to spell it!). They are asleep. They are warm and curled up, maybe cuddling up to a fellow miakat. They feel safe. They feel relaxed. They are resting and reenergising for the next round of activity.

They swap. Once the patrol miakat has done his patrol, he can rest, while some-one else takes over patrol duty.

The problem with anxiety and depression, is that the brain’s alert/danger system is stuck to “on”, leading to exhaustion. This alert/danger system shows itself in the inability to sleep well, the constant worrying about whether you are good enough, or whether your baby is healthy enough, or whether other people are talking about you, constant restlessness mixed with tiredness, irritability, and so on.

So, the first thing I do when I meet some-one who is depressed or anxious, is help their brain to switch from the alert/danger system, into the calm/relaxed system. I relax them in session, and then I give them a relaxation MP3 to listen to every evening as they go to bed. It’s like a sleeping tablet that has no side effects. It’s like a respite for the brain, from that constant struggle. It’s the start of things getting better for them.

meerkat-sleeping

Mia Scotland

Clinical Psychologist

http://www.yourbirthright.co.uk.

Pass The Bomb: who is going to contain your anxiety when you are with your newborn baby?

January 26, 2016

iStock_000064471321_SmallNew parents are anxious. And according to research, they are getting more and more anxious. I often hear cases of mums unable to sleep because they are terrified. Terrifed that their babies aren’t breathing. Terrified that the room is too hot. Terrified that baby hasn’t fed enough. Terrified that they will damage their baby. Dads are getting postnatal depression too, at rates almost as high as for women. They are scared too. I want to talk about a psychological piece of gold, that can ease anxiety, but that new parents are lacking in our modern lives.

Containment is a psychology term that basically means; the process of stopping anxiety from bouncing around the room.  Containing situations and emotions is something that all good parents do (and therapists too). It’s not easy to explain, but I’ll give you an example of when containment is NOT happening. My son may come to me in a flap because his friends have said to him (in a flap) that he has to start job hunting now, because a teacher said to his friends (in a flap) that jobs are very competitive and they need to take this seriously and start job hunting now. I can continue the flapping by saying “what? Are you serious? Now? That’s crazy. Can it really be that bad? Oh my goodness, I don’t know what we are supposed to do with that information, it’s a crazy world out there”. And in my exasperation, I tell my friends, who are also parents, and pass the flapping on. The anxiety continues down the line, because no one has contained it.

Or, as a parent, I can provide some containment. In doing so, the anxiety disperses. I do this by “containing” my own feelings of exasperation or anxiety, and I can calmly and warmly say “honey, that sounds very pressurising, I can understand that you’re worried (empathy). But you know what? It’s going to be fine, because you have at least a year before you need a job, you’ve already got a great CV, and I’m going to help you get yourself sorted. Shall we take a look this week-end?”  He relaxes, and the “containment” goes back down the line, because he tells his mates “actually, we do have a year, and we’ve got our CVs done already, and I’m not worried about it” and so on. Containment kills anxiety.

I was watching an episode of the British Sitcom “On the Buses” recently. It’s an amazing watch, because it is a rare glimpse into social history. It is set in working class London, in the early 1970s. It is clear, watching this, that it was normal to go through your first pregnancy, birth and babyhood, whilst still living with your parents. This was common before the 1970s, because newly weds couldn’t afford their own house. In one particular episode, a pregnant woman and her mother were chatting about the baby in a tiny kitchen, which serves as a wash room and a living room all in one. The pregnant woman was expressing anxieties about becoming a mum. The mother’s mother responded with something along the lines of “I’ll be ‘ere anyways, so you ain’t got narfin’ ta worry abart” (I made that bit up, I can’t remember exactly what she said). She was replying with reassurances, in a tone that kind of said “I totally get why you’re anxious, because I was” (empathy) and added “but really, it is so easy to look after a new baby, that you have nothing to worry about”. She was nonchalant, but empathic too, and containing.

Nowadays, new parents go home to their own house when they have their baby. And they don’t really want the mother in law around too much. And they don’t want her advice, because advice has changed so much. So they go home and do it themselves. Here-in lies the danger: What they don’t realise is, they have no-one to contain the anxiety. This is critical, but overlooked. Hazel Douglas defines containment as being “when one person receives and understands the emotional communication of another without being overwhelmed by it, processes it and then communicates understanding and recognition back to the other person. This process can restore the capacity to think in the other person.” Thus, it is a powerful tool for helping the person become unstuck from paralysing anxiety, to help them become functional again, to “think” again. Because, you know what? Working out what to do when a baby cries, learning how to pick up a baby, rock a baby, feed a baby, change a baby, keep it alive, is quite a big task when you are new to it.

And when there is no-one around to contain the anxiety in the middle of the night, it all gets a lot more stressful. And if you are scared and anxious, you are passing that on to your baby. Your baby picks up on “something is the matter”. So your baby is more likely to cry. So it gets worse. What you need, is someone to come in and contain the situation. Some-one who has done it before, who can calmly, empathically and warmly turn the situation around with one look and one smile. She sprinkles magic fairy dust into the room, just like a real life fairy godmother. Who is going to do that for you? Traditionally, it would have been mothers, sisters, midwives or aunties.

Nowadays, fathers are courageously trying to fill this gap. They are mucking in with the night time nappy changes and the job of caring for the baby. That, in itself, is a big job if you’ve never done it before. But dads, you have an extra job. You are also there to support the mother, so that when she is crying on day three of the baby blues, you can hold her in your arms and tell her that you love her. All very well, but can you tell her, knowingly, that it’ll be okay? Can you tell her, from experience, that it’ll pass? Can you tell her, and feel, that you are calm and strong and capable of handling all of this? Can you contain the situation?

Probably not. Because you have never done this before, either. You are tired from the birth too. You are on unknown, scary territory. You haven’t got the benefit of wisdom and experience on your side. You need some-one to come in and say to you “it’ll be okay, hold her in your arms, tell her you love her, let her cry all over you, you are doing an amazing job by just being there for her”. Dad needs containment too, so that he can be there for the mother. The mother needs containment so that she can be there for the baby.

So, how can you build in the psychological gold nugget that is “containment” into your postnatal birth plan? Well, you haven’t got time to wait for the NHS to provide it in the form of regular midwife visits postnatally with continuity of care, so you need to do it yourself. Think about which members of your family help you feel safe, nurtured, and cared for. Bring them in to help. Ask them to move in! If no-one is available, think about paying for this kind of help. Lactation consultants, postnatal doulas, night nurses, private midwives, all do a fantastic job. Postnatal doulas are not expensive. They are trained in all aspects of new parenthood, and they are exceptional at taking care of your needs so that you can take care of your baby. This will take the pressure off the father too, so that he can remain strong, and enjoy the process.

Think twice before you spend your money on a travel system, or on pretty wall paper with matching bedding. Think about your emotional wellbeing before your physical wellbeing, and you, your partner and your baby can thrive as early as possible in your incredible journey as that most precious thing in the world: creating your very own family.

mia brochure photoMia Scotland is a Clinical Psychologist and author specialising in the Perinatal Period. See her website at www.yourbirthright.co.uk or buy her book, Why Perinatal Depression Matters from Pinter and Martin.

Fear of Birth, fear of the system.

July 10, 2015

I I’ve just spent a day with midwives at the Fear in Birth conference at Huddersfield.  I love going on midwifery conferences, because the energy in the room is always one of care, compassion, power and hope.

The many speakers were thought provoking, interesting, and inspiring.  The thread throughout the day was of the important of continuity of care – that if we can provide women with the same midwife throughout her perinatal journey, we can do so much to dispel her fear, and that will have a positive consequence for her  and her baby.    I don’t know why, after so many years of it being so obvious that continuity of care is a “no brainer”, we are still failing to provide this basic need in our NHS system.  It almost feels like every effort is being made to AVOID continuity of care, and the part of me that is prone to “conspiracy theories” begins to wonder if it is a subconscious but deliberate attempt to stop women connecting and uniting.

There were two areas that were not raised, which I have been mulling over.  One is the fact that midwives are the only NHS profession who understand what birth actually is.  I will repeat that.  Midwives are the only profession in the NHS who understand normal birth.  Every-other profession  shares the cultural view of society – that birth is dramatic, dangerous, fast, excruciatingly painful, and usually goes wrong.  Midwives, as a whole, do not share this view.  They know that birth can be joyful, empowering,  ecstatic, easy, and safe.  They know the joy of birth, the miracle of the birthing body. No one else in the NHS does. In my opinion, midwives are the only profession in the NHS who can really address birth fear, because they are the only ones who really get that it doesn’t have to be feared.

The second issue is about what causes birth fear and why it is growing so dramatically. I’m sorry to say, that one of the main reasons, is because women have had poor experiences of the system.  They don’t trust the system, and they are scared of it, because it has let them down so many times.  Only two hours ago, I have had a woman on the phone, looking for support.  She told me eloquently and clearly, why she wants a doula.  Her words saddened me deeply, and I can’t give the full depth of raw emotion and beautiful wording that she used, but here is a snap-shot.  She told me that at the last birth, “they left me on my back, in stirrups, with my leg up, I felt like I was being raped, there was so much wrong, I can’t even begin, in the end they wanted to do a c-section, and they told me that they were doing the c-section because they needed the bed”.  Whilst in tears, this strong, able women, tells me that while she is trying to negotiate a VBAC, “they make me feel like my choices are ridiculous, I feel so vulnerable, manipulated, their words are so heavy, they’re pushing on a bruise, I want to trust my instincts but they’ve taken that away from me”.  These stories are what scare women.  We can’t just blame media portrayals of birth, we can’t just blame individuals with a history of child abuse.  We also have to look to a system which denigrates women, belittles them, tells them what they are and aren’t allowed to do, puts them on their backs for “internal examinations” that do nothing to progress labour, leaves them on their backs against all the evidence, straps them to the bed with wires that they are told are necessary to keep their baby alive, even though the evidence tells us otherwise, tells them they are too old, too fat, too overdue, too thin, to have the baby, play the dead baby card (as if mum is putting her needs above her baby’s) and so on and so on.

So, midwives, you are so important in reducing birth fear.  You can spread the word, that birth is a positive incredible natural process.  And you can continue to fight to keep the midwifery-led units alive, along with their ability to respect birth and respect the woman.  The more of those we have, the better things will get.  You know that, I know that, but I just wanted to say it again.  Midwives, you rock!

Why I left the NHS and why I don’t want to become a midwife

May 26, 2015

I haven’t been able to put my finger on it, ever.  Until I read the chapter by Robin Youngson in “Roar behind the silence”.  And I’ve had an epiphany.  His honesty about the kind of anaesthetist that he was before he embraced compassion, and the kind of anaesthetist that he is now, his ability to face his shame and his demons, has helped me to do the same.  Thank-you Robin.  Thank-you so much.

When I am honest about the kind of psychologist I was before I left the NHS, and face my shame and my demons, I understand a little better, what went wrong.  I have never liked being a psychologist.  I have always grappled with why I don’t like being a psychologist.

I don’t want to be a midwife because I don’t want to work in an institution that can medicalise, depersonalise, and reduce women to bodies that need to have a finger put inside their vagina regularly to check whether they are “failing” or not.  I do not have the resilience, and I do not have the people skills, to go in and help in the tide of change – that tide of incredible midwives, doctors, lawyers, doulas and so on, fighting the system and building, piece by piece, a better maternity system. Thank-you to those amazing people.

I am clear about why I don’t want to be a midwife.  I don’t want to take on the system. I don’t want to have to witness it any more that I have to as a doula.

But I have never been clear about why I don’t want to be a practicing psychologist. I have never understood this struggle within me, this reluctance to sit in front of some-one in distress and try to help them.  I remember, 23 years ago, in my first year of Clinical Psychology training, sitting in front of my mentor, the lovely Professor Gilbert, telling him that “I’ve made a mistake. I don’t want to do this job after all”.  We didn’t understand my reticence.  I stuck at it. But I spent the next 13 years not enjoying my work.  Then, I left the NHS and began to apply my psychology to a different arena – that of “normal” people, people who are not in distress looking for me to solve the problems for them.  I began, finally, to enjoy my work. Why?

I have just read a chapter by the inspiring Robin Youngson in the amazing book “Roar behind the Silence” and all is clear. I’ve literally had an epiphany, and I’m sitting here, very excited, and very moved.  Waves of relief and emotion are washing over me.  I’m trying to formalise it and understand it as I write.

And I’ve realised that there is so much wrong with the way that I was trained in clinical psychology.  I couldn’t understand what was wrong, I couldn’t see what was wrong, and so I couldn’t address it.  I just felt uncomfortable the whole time.   And it seems so obvious to me now.  I was taught to be clinically detached.  I was part of a system that differentiated between “them” and “us”.  This suited me, because I am not particularly good at being warm and open when I first meet some-one.  And yet, it didn’t suit me, because I never enjoyed my job.  I always felt the responsibility of being the “expert” in an arena where I knew deep down that the person was the expert, and the problem was society.  How could I sit in front of some-one who was distressed, and pretend that they were struggling because of some fault in their thinking style?  Or try to help them in a little bubble of a therapy room, when I knew that it was their family, or their society that was crazy?

I remember the discomfort when I had to reject a lovely present that a client with Down’s Syndrome had given me. (I had been told never to accept presents, so I didn’t).  I remember not even questioning, during preparation for my interviews for a place as a trainee, why I was advised never to say that I “want to help people”.   I remember hiding all traces of my personal life, and not divulging anything during therapy because I was taught that that would spoil the transference (or something like that).

So, I left the NHS, which felt a little like severing an umbilical cord.  People envied me, and told me I was brave.  The change in me was very quick.  I began to free myself up to be warm, friendly, open and honest as a person. I no longer needed to be “clinically detached”.  I began to enjoy my job. Yippee. I could accept gifts.  I could have a laugh with people, chat to them about me, tell them it was okay to phone me before the next session, and so on.  Of course, I could have done all those things before I left the NHS, and all the good therapists that I know did it right from the start.  Just like all the good midwives don’t necessarily stick to the rule book, and they might get reprimanded for the times when their compassion got in the way of their diligent note taking.  The NHS is working on increasing compassion as one of the 6 C’s.  We know that compassion makes for resilience and job satisfaction.  It’s certainly helping me enjoy my job.  I ditched the detachment and opened up to compassion.  Thanks Robin, for spreading the word.

To find out more about Compassionate Midwifery workshops for all birth professionals, go to www.yourbirthright.co.uk/birth-professionals/. 

Mia Scotland

Clinical Psychologist, Birth Doula and Hypnobirthing practitioner

Compassionate care and marketing: things I love and hate

March 2, 2015

mia brochure photoArrgghhh!  I’m having a bit of a crisis with telling others what I do.  It’s called marketing and I absolutely hate marketing.  I’m stuck on the part about  “how do I actually get people to GET what my workshops are about, before they’ve come along to EXPERIENCE what they are about?”

People come back a lot to my workshops. But why do they come back? I don’t actually know, and any good marketing consultant will tell me I need to know that.  Okay, how do I go about that? I do feedback forms.  They tell me that people “loved it”, found it “inspiring” and “really useful”.  But I’m still left not really knowing.  It’s sometimes the same in therapy. People change and turn their lives around, but I’m left thinking “which bit actually made the difference?”

And the answer is in the question. It’s not one bit that does it.  It’s the package.  I use hypnosis in my work, and that means that I focus on how people feel more than what they know.  So, my workshops aren’t so much about what facts you learn.  You can learn facts by getting on your computer.  (And then, when you’ve got off your computer, if you’re anything like me, you can promptly forget them again).  I’ll give you an example of what I mean.  I heard a talk by the wonderful Sheila Kitzinger a few years ago.  She had me completely entranced.  She moved me.  But when it came to tweeting some parts of what she had said, I couldn’t remember a thing that she actually said!  She had immediately put me in a state of hypnosis with her storytelling (she didn’t know she was doing this to her whole audience, or rather, she may not have labelled it as “hypnosis”).  I came away feeling powerful, excited, enthused and motivated to change maternity for the better. Hypnosis works at a deeper level than your cognitive, rational mind. It transforms how you feel.

So, in my workshops, we integrate the facts bit. If it’s about compassion, I give you the science and physiology behind compassionate caring. I give you a working definition of compassion.  I tell you that there is a very important difference between compassion and empathy, and that you need to know the difference to protect yourself from burnout. But I also work at the emotional level.  The workshop is designed to enhance your motivation and excitement.   You leave feeling that you are an amazing midwife already, and the course helps unlock that potential even more.  I leave you wanting to get back to work, and be excited about your next appointment.  It also translates to home life, not just work.  I leave you wanting to go home and cuddle your children or your dog.  I leave you feeling encouraged.  Not just because it feels nice to feel great, but because research shows us that it makes you a more compassionate midwife.  Win-win.