Archive for the ‘postnatal depression’ 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”

Can a two year old be traumatised?

October 28, 2015

Can a two year old be traumatised?

I was asked recently how to help a two year old settle at night. The wonderful book “The Rabbit who Wants to Fall Asleep” wasn’t working, along with countless other things that the beleaguered parents had tried. This came up in conversation during a mindful hypnobirthing class, and myself and another CBT therapist both got completely side tracked, and set about trying to find the answer to the problem, by asking the parents (who are tired, sick of advice, and frankly, stuck), lots of questions about their troublesome two year old.

Given that I was supposed to be running a hypnobirthing class, I had to curb my curiosity, and my urge to help, and get the subject back to talking about birth and babies – which was the object of the day. However, my brain remembers that there was unfinished business, so I’m going to finish it in the form of this blog.

It got really interesting when they said that their little girl’s sleep patterns had been fine, until, during the summer, their cat had jumped in through the window, onto her bed, in the middle of the night, waking her up with an awful shock.

Since then, she fusses about going to bed, she imagines all sorts of things that are scary in her bedroom, and she waked up in the middle of the night, and can’t go back to sleep unless she gets into her parents bed. Sound familiar?  Of course it does. This is classic two year old behaviour. At the age of two, there is a strengthening of the child’s “attachment behaviour” (there is also one at about nine months old).  This means that she is more likely to get clingy and want to know that her parents are around, so they can keep her safe. It kind of makes sense, because at the age of two, a child becomes more independent physically (she can run much faster) but she is also becoming more independent psychologically, because her neocortex is developing at a very fast rate. This means she can plan ahead, be persuaded into things by others, she can plan exciting things like how to run away from home and have an adventure, and so on.  Thus, she is arguably a little more vulnerable to getting lost, or getting eaten by a wolf.  Nature protects her by providing an in-built mechanism to keep her parents close.  The attachment process is even stronger at night, because the child needs to be kept safe from the dark. Her imagination of “monsters” is formed at this age (tigers, wolves, strange men from warring tribes, etc.).  These monsters are as real to her, as dangers of heights, flying, spiders, or whatever your personal fear might be. She just does not feel safe, and she can’t explain why, just as we can’t explain why we don’t feel safe in the presence of a tiny cute spider that we know can’t harm us.

So, unfortunately, in the case of our little girl and her cat, this cat jumped on her bed at a critical point in her development. It fast tracked and heightened her need to know that her parents are close in the middle of the night, and made her needs for a strong attachment much stronger. However, I also think it traumatised her. This means, that the experience got “wedged” in the limbic system (the alarm signal of our brain) and hasn’t been processed as a memory. In other words, when she goes to bed at night, her alarm system triggers “oh no, this is where I’m not safe, this is where scary things happen to me”. Her alarm system is trying to protect her, but it has got it wrong. Her alarm system thinks that she is still in danger, when in fact, she is perfectly safe (the window is closed, and the cat cannot jump on her again).  However, with her amygdala firing off, she is struggling to settle at night, even when a lovely hypnotic cd is being played.

In therapy, when I help a person recover from trauma, the single most important thing is for the person to feel safe. You cannot recover from trauma while your alarm system is firing. It will listen to nothing else, no logic, no reason, no nothing. To get the brain to “listen” and process the memory, we have to calm the amygdala first and foremost.  I do this with relaxation and hypnotic techniques. But in the case of the little girl, the thing that helps her feel safe is the proximity of her parents. So, here is my advice for how to help this little girl settle at night, and how to help her parents get some much needed sleep.

  1. Go to bed with her (or sit in the room with her) and stay there silently, while she falls asleep. You can use this time to practice your meditation, or mindfulness techniques. You can use this time to notice her breathing near you, to notice the warmth of her body, to notice how jittery and lively your own mind is, and to learn to calm it. Do not focus on whether she is sleeping or not, as she will notice this tension. Just focus on your own wish to relax and be mindful. You might even get a power nap yourself. The need to do this will pass. It might take a few months to be honest, but a few weeks might be enough. At some point, she won’t care whether you are actually in the room or not, so long as she feels safe, and so long as she feels sleepy. The argument about whether you can “spoil” a child, or whether she might be attention seeking, or “playing you” is worthy of a whole other blog.  Just trust me for now, that if you meet her needs (for security) without additional gains (such as playing, or fun), then you will not make things worse.
  2. At other times in the day, talk to her about the cat incident that “happened when you were so little” or “that happened so long ago” or “that cannot not happen any-more”. Get her to tell the story, draw it, or act it out between the two of you. Make it a game, make it fun. Finish the “story” with a definitive “it’s over”. For example, if you are “playing” the cat game, and you are the cat, make a point of being thrown out of the room, and not ever being allowed back in. Or she can pretend to be “mummy” and cuddle her doll better, after the doll got a shock from the cat, and explain to her doll that the cat won’t do that again because the window is locked now.  (Being cuddled better might be important, because in my experience, a lot of trauma comes from a sense of having felt alone at the time of the trauma). You won’t need to do this more than a few times for it to have done the job of helping her brain to process the event as a “memory” rather than an ongoing “danger”.

I know that these parents have the wholehearted sympathy of so many parents who are tired, exhausted, confused, fed-up, worried, beyond caring, bewildered, all because they have the joys of a two year old in their lives.  Good luck with it, and know that it really does get an awful lot easier as they get older J

Leave mum holding the baby at your peril: Postnatal depression and what we expect of women

December 31, 2014

trauma mum n babyI just left a woman in her house with her baby.  I was her doula, and I was visiting her after the birth, to congratulate her, and make sure she is okay.  My role wasn’t actually to check that she is okay.  Most people want a doula for the birth process itself, not for after the birth.  But as a doula who is also a psychologist, I know that the time of settling in after you’ve had a baby can be much more of a roller coaster ride than the birth itself.  And it lasts much longer.

Knowing how hard it is to adjust to a new baby, I found it difficult to walk away.  She is doing really well.  I have no concerns about her or the baby at all.  She expressed the usual bewilderment, lack of confidence, tiredness, tearful days, that all new mothers experience.  Her tiredness and anxiety are “normal”.

But I came away questioning this once again.  How can it be that we accept it as “normal” to feel overwhelmed, anxious, tearful  and tired, after having a baby? Neuropsychology actually suggests that parents and babies are primed for joy, love and connection, not misery.  In fact, every time there is a joyful and loving interaction, the baby’s neural connections become stronger.  The baby’s brain literally grows in response to joy and oxytocin.  Evolution has encouraged this, and we can see it every time some-one comes in to look more closely at the baby (which, as it happens, is the prefect distance for the baby to be able to focus on you) and then smiles and coos at the baby.  And we simply can’t help ourselves when babies smile back at us.  We immediately laugh, smile, and coo even more (or is that just me?).  We all do it, adults and children alike.  In other words, the need for joy and connection is not just met by the mother, it is met by all of the baby’s social circle.

However, in our society, we seem to think it is normal to feel exhausted, overwhelmed and wretched in the first 6 weeks of babyhood. And if we “expect” mum to be struggling, then how do we spot when “normal” becomes “depression”?   Women I speak to whose diagnosis was missed,  say that they did tell their midwives and health visitors that something wasn’t right, and that they didn’t feel normal.  But they were told that that was normal.   We are also missing the signs in fathers too.  Postnatal depression amongst fathers is on the increase. This, I am sure, is related to the enormous pressure they are under to be a hands-on dad, to be at the birth, to look after mum, and to continue to work full time, with barely any paternal leave or additional support.

How did we get to a place where it is considered normal to feel rubbish after you’ve had a baby? Is it really normal to feel miserable and trapped and overwhelmed and exhausted?  While I was vaguely musing about this in the back of my head, I left my doula client on her own in her house.   As I left, I said “it doesn’t feel right leaving you alone”.  And it really didn’t feel alright.  Not because there’s anything wrong with her, or her ability to cope, or her mental health, or her bonding with her baby.  But because I was leaving a woman on her own in a house with a four week old baby.   If that seems okay to you, then that is because that is what our society does.  It’s normal in our eyes.  We have stopped being able to see just how wrong that is.  But it is wrong.

Looking after a baby is a full time job. Well, no, it isn’t actually.  With a full time job, we get to go home, sleep, eat, shower, tidy up, switch off mentally, and choose what to do in between the job.  A baby does not give you predictable time to do any of the above.  You might get to take the lunch out of the fridge and microwave it, but you might not get time to eat it.  You can never switch off, and you have to be always instantly interruptible.  Just having one other person in the house makes such an enormous difference to all of these things.  You can shower.  You can prepare lunch.  You can leave the house for hours!  You can sleep for hours.  You can turn to some-one and say “oh my goodness, this is ridiculous” and have a bit of a laugh together.  Just having one other person in the house makes such a difference.  And yet, we leave women on their own in the house all day every day, and think nothing of it.  Single women also have that burden all night too (I can’t even imagine how our society can fail to grant them utmost respect .  They certainly have mine.).  Not only are new mothers left with the constant rolling demands of looking after a baby, but they are left in a house which needs attention.  If it isn’t given attention, she will be living in her own mess and dirt.  No-one wants to do that, and yet, we happily say to new mothers “leave the housework, it will wait”. I disagree.  It won’t wait, unless you actually want to live in your own dirt.

Contrast this with other cultures.  Imagine , for a moment, that you have just had a baby.  You are tucked up in your bed, with your baby beside you (yes, you are allowed to sleep alongside your baby, just like every other mammal on the planet does).  Your room is clean and tidy, because some-one else is looking after that for you.  Every four hours, some-one comes in with delicious home cooked food for you to eat.  Every morning, some-one is there so that you can get out of bed and shower and freshen up.  Once a day, you are given a hot stone all-over body massage.  Yes, this really does happen in a number of cultures!  The daily food and massage are considered to be an essential part of your recovery, both physical and mental.  You and your baby are together. Your job is to get to know your baby, and enjoy being with your baby.  You feed and change your baby.  You get to know your baby. You sleep and recover.  After a number of weeks of this, you are considered transformed enough to emerge into the real world as a fully-fledged mother.  Like a butterfly emerging from its chrysalis, the transition to motherhood is viewed as a psychological and physical process, not as a on- off biological “event”.

Our culture doesn’t do that.  And we pay the toll.  Perinatal mental illness is a rising problem generally, and the government are trying to put in place strategies for identifying and treating people who are suffering. While identification and treatment is important, it does place the emphasis on the individual woman, with the risk of blaming her as some-one who “couldn’t cope”.  Also, thinking that all we need to do is “treat” her with tablets and therapy also risks us reducing postnatal problems to discreet illnesses that just need “medication”.  Postnatal depression is not the women’s fault, and it is not a discrete illness like diabetes.  It needs attention from our culture too.  We need to treat women better when they come home with their new babies.  We need to realise that what we are asking of them is too much.  Being on your own regularly in your house with a baby or toddler is asking too much.  We need to start honouring, and caring for, mothers and fathers, because that is how we built parents strong enough to really care for our future generation.    power of compassion