Archive for the ‘perinatal illness’ 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.

Have you written a postnatal care plan yet?

October 10, 2016

You wrote a birth plan, because birth is a big deal. But did you write a postnatal care plan? After your baby is born, your whole body and mind are in transition. Transition can be so tough, it’s even got a psychiatric label attached to it (Adjustment Disorder). Your body is physically transitioning in crazy, magical ways, and you are mentally transforming to get used to being instantly interrupt-able, having strange sleep patterns, putting yourself second, and grieving your lost carefree past. You are learning to know and love your baby. (Honeymoons were designed to help you love your new partner. Babymoons should also be designed to help you love your baby). Your brain is processing the birth. The list goes on and on and on and on. So, don’t just go home and hope for the best. Here is an example of what your postnatal care plan might look like:

“My Postnatal Care Plan

I have written a postnatal care plan because I very much want to enjoy my first few weeks getting to know my baby. I am aware that I have a tendency to do too much, and to feel guilty when I’m not getting stuff done. I want to ensure that this doesn’t happen following the birth of my baby, and so I am planning how to take care of myself in the first two precious weeks with my baby.

Generally, I wish to spend time skin to skin with my baby, I wish to establish breastfeeding, and I would like my husband to be an integral part of this with us.

Immediately upon coming home:

My husband would like to carry me and our baby over the threshold.

I would like a warm bath with rejuvenating bath salts, and then I would like to get into fresh (new) pyjamas and into our king size bed with new fresh sheets, and my baby.

I would like the lights kept low, my phone and my remote control next to me.

I would like to eat a huge, warm, filling meal of cottage pie and peas, washed down with camomile tea and a glass of champagne.

I would like my husband to join us as much as possible in bed.

For the first two weeks after coming home:

I would like visitors to stay away for at least 12 hours, apart from the midwife and my lactation consultant, who I have pre-arranged support with.

In the first three days, I would like very close members of my family only, to visit.

I do not want my baby to be held by anybody else in the first three days, other than her father.

We have arranged for a food delivery of fresh fruit, salads, sandwiches, chocolates and champagne. There are plenty of ready cooked meals in the freezer too.

I have arranged for a cleaner to come in every other day to tidy and clean the house, as per my husband’s requests (she will not clean our bedroom).

I have specific herbal/homeopathic remedies that I will be taking each day.

After the first three days, I have arranged for a postnatal doula to come in and provide emotional and practical support every three days.

My husband will help to ensure that I get plenty of rest, by regularly encouraging me to go to bed, and ensuring that the household and visitors are taken care of.

My husband will take a few hours out of the house each day, to do something to help him to feel refreshed also.

According to how I feel, I plan to spend most of the first two weeks in and out of bed. I might take a walk or potter around the house if I feel restless, but if not, I will stay in bed to recover and adjust, both physically and mentally, and to help me to fall in love with my baby and establish breastfeeding.”

What do you think? If you are thinking “that’s a bit overindulgent” then you are totally not getting how important this time is. If you are thinking “it’s only relevant to rich people” then drop the champagne and the au-pair, but stick with bed and help from family. If you’re thinking “what if I’m a single mum” then think even harder about your postnatal care plan, because support matters, whether its from a husband, a mother, the NHS, a best friend or social services.

It’s my prediction that postnatal care plans will become more and more common. If you’ve ever used one, I’d love to hear from you.

Mia Scotland

Perinatal Clinical Psychologist

http://www.yourbirthright.co.uk

“I’m scared I’m going to harm my baby…”

April 28, 2016

mia brochure photoWhat do you say when you hear the words “I’m terrified that I’m going to harm my baby”

Those words are ones that would be hard to say if you’re a mother. But if you’re a professional, be it a midwife, a health visitor, a doula or a counsellor, they can be hard to hear too. Those words represent an ultimate taboo.  A mother wanting to harm her own baby…..

But just wait a minute. If you are very astute, you will have spotted my deliberate error there. Can you see it? They are not the same thing. “I’m terrified I’m going to harm my baby” is not the same as “I want to harm my baby”.

If you hear a mother say “I’m terrified I’m going to harm my baby” the chances are she is suffering from an anxiety disorder, and she is not a danger to her baby. She is about as dangerous as some-one with fear of heights, who stands near(ish) a cliff and says “I’m terrified I’m going to jump off”.  You wouldn’t call the crisis team in this instance would you? Instead, you might say “no you’re not, you’re just scared”. It’s the same with mothers. If a mother is anxious (and especially if she is suffering from perinatal or maternal Obsessive Compulsive Disorder) then she might talk about suffocating her baby, but she can be reassured that she isn’t mad or bad, she is scared.  And of course, if you make the mistake of reacting like she is mad or bad, and call the crisis team, you certainly aren’t going to ease her anxiety!

To find out more about perinatal mental health problems, come to my workshop for birthing professionals on Friday 10th June 2016. For details, click here 

Mia Scotland, Author of “Why Perinatal Depression Matters” and Perinatal Clinical Psychologist.

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.

Torturing new mothers and then wondering why they get mentally ill.

December 8, 2015

 

Woman SleepingTorturing new mothers? Who does that? Well, as a society, we all do. I’m not kidding, I’m perfectly serious, and I’m going to stop mincing my words and say it how it is. We torture mothers.

Sleep deprivation is a method of torture that has been used for at least 500 years, and is still used today. It was used extensively in Guantanamo Bay. The difference between sleep deprivation in Guantanamo bay and in new mothers is that no-one is systematically and intentionally hurting new mothers. But the effect is the same. Sleep torture is designed to create psychological changes, which are supposed to encourage the victim to submit, to lose their sense of reality, and to talk.

Chronic sleep deprivation is not good for you. It leads to cognitive impairment, anger and irritability, anxiety, and even psychosis.  Yes, you read that right. Chronic sleep deprivation is known to cause psychosis. Puerperal psychosis in new mothers is not common thankfully, but it is dangerous.  I’ve been lucky enough to attend a few study days on perinatal mental health recently, and they have all included really valuable talks by people who have recovered from severe postnatal depression, post traumatic stress disorder and psychosis. What I noticed was that they all had one thing in common . They all mentioned lack of sleep as a factor in their illness. The lovely Sinead Willis talked about “lack of sleep started to catch up with me….I couldn’t sleep more than an hour at night and I became very disorientated”. One of the effects of sleep deprivation is disorientation, or a feeling of “altered reality”. At another talk I was lucky enough to hear, the mother told us that she hadn’t slept at all for the first three days of her baby’s life, but no one noticed, because she was in a private hospital room on her own. She developed psychosis within a matter of days.  Elaine Hanzak, author of “Eyes without sparkle” talks about the fact that during her treatment, she would look forward to her Electro-Convulsive Therapy sessions, because “they have to put you to sleep first….bliss”.

Chronic sleep deprivation is when you have no opportunity to make up your sleep debt. You go on, night after night, suffering from not enough sleep. Acute sleep deprivation is when you lose sleep for one night, but you can then catch up. Even acute sleep deprivation has a marked effect on our mental health. In one study by Walker and colleagues, healthy young students were split into two groups. One group were sleep deprived, the other group slept normally.  The next day, both groups were shown disturbing, upsetting and gory pictures. The researchers found that there were significant differences in the brain activity of the two groups, as measured by MRI scans. The sleep deprived group showed reactions similar to anxiety reactions. Their amygdala lit up like an alarm bell to the disturbing images, firing off stress hormones, whilst the normal group’s brain showed a more balanced reaction, with the parts of the brain that “panic and worry” being balanced by the part of the brain that “reasons and rationalises”. In the sleep deprived group, their ability to process and mediate the anxiety was damaged.

People have always thought that anxiety and depression causes disturbed sleep. But this research suggests that lack of sleep can cause anxiety.  All on its own, and in only one night.  Whilst new mums aren’t shown disturbing images by scientists, they do have disturbing images all of their own. Worries and concerns about the baby, feelings of guilt, not being good enough, intrusions of hurting the baby, concerns about baby’s feeding, and so on. And of course, once anxiety sets in, it becomes more difficult to sleep, increasing the chances of depression setting in, and a vicious cycle begins with a force of its own.

With all this in mind, is it any wonder that we have such high rates of anxiety, depression, and psychosis postnatally? Women usually give birth overnight, sometimes over two or three nights. They are then put in a busy maternity ward with lights on, other women and babies crying, constant interruptions from staff and so on. Or they are sent home alone with just a very tired husband. Either way, they have a baby with them, who they need to keep alive, learn to feed, and look after. On no sleep.  Then, when the father goes back to work after his 2 weeks of paternity leave, it is perfectly acceptable in our society for her to say “I’ll do the night feeds, because you have to work all day”. She isn’t understanding the value, the necessity, of her sleep for her mental health. Neither is the father, or the health visitor, or society in general.   Her sleep debt builds, increasing the risk to her mental health.

In other cultures, mums are made to rest, recuperate, stay in bed, and do nothing but get to know baby. They are fed, washed, pampered with hot stone massages, and so on. Almost all non-westernised cultures have a ritual similar to this, which lasts about 40 days.  In the West, mums are not made to rest. They are expected to go on as normal, with the washing, the school run, losing baby weight, going shopping and so on.  Mums are told “sleep when baby sleeps”. However, this simply is not good enough. Because mum needs to eat, and she needs to shower, and she needs to get dressed sometimes, and she needs to go to see the health visitor and have baby weighed, and baby might only sleep for 20 minutes at a time. Then, when dad goes back to work, it gets even more chronic, because she offers to do the night feeds so that he can get up and work the next day. The importance of her physical and emotional health is ignored, at a high cost to the devastation that perinatal mental illness causes, and a high cost to the NHS.

Let’s stop torturing mothers. Let’s stop ignoring the problem of expecting new mums to get back to normal. They are not normal, they are super important, and we need to value them and treat them with the greatest respect, if we don’t want them to break into a million pieces, shattering the lives of all those around them. The NHS needs to prioritise maternal mental health, not just with adequate treatment facilities once the damage is done, but also with prevention in the first place. Proper paternity leave, decent postnatal wards with midwives who have time to care, regular home visits, continuity of care. Change needs to happen in attitudes as well. We need to start telling other people how important it is, to look after mum. Encourage partners to “put mum to sleep”. Tuck her up in bed with a chamomile tea (or a G and T) and tell her to stay there. Turn the lights off for her, bring her an extra pillow, tell visitors to go away because she is sleeping, bring the baby to her when he or she needs a feed. The cost of not doing so, could be her mental health.

Mia Scotland, Clinical Psychologist, Author of “Why Perinatal Depression Matters”