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”

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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

Happy mummy, happy baby

September 1, 2015

So, I’m eating a slice of toast while reading a blog from my facebook page this morning.  I can do that now, because my children are older.  I can even finish my cup of tea, and make sure that I am wearing appropriate clothes to walk the dog in. I no longer find myself rushing around to make sure my children have their hats and scarves on, and then to go out realising I am wearing no jacket.  Putting others first seems to be what mothers do, to the detriment of their own mental health. This is partly related to guilt.  Guilt is a big deal in new mothers.

So, as I read this blog about babies’ mental health, I am struck by how easy it would be for this blog to make mothers feel even more guilty.  It is littered with phrases such as “what parents do profoundly shapes who we will become” and “early experiences matter – a lot”. It tells us how our handling of our babies shapes their personality, their future mental health, their critical thinking skills and so on.

Then it goes on to say that the good news is that “nurturing strong mental health in young children is not a specific undertaking in which parents need to engage – as if it were a “job” or task.  It is how parents are with their babies that matters….delighting in the joy of young children’s daily discoveries”.  Well, frankly, that this is good news is debatable.  If it were “a task” it would be easier to complete.  You could have a checklist in the morning, and make sure you have done your jobs.

  1. Dress baby
  2. Feed baby
  3. Smile at baby and make eye contact

But no.  Now, we have to “delight in the joy of young children’s daily discoveries”.  Actually, if you have ever tried to get a toddler out of the house on your own, with a baby still in their jumpsuit, having to get to pre-school on time, not having eaten yourself, or finished your cup of tea, with baby sick still on your shirt, and your toddler says “look, a leaf on the ground”, you do not delight in this.  You do not feel like cooing, smiling and delighting in your toddler’s very slow progress along the pavement.  You grit your teeth and say “come on” in a voice that is far too squeaky, desperately wanting your toddler to move it, so that you won’t be late again.

The blog is correct. It is the delight and joy that people share with their babies, that helps the baby develop.  Mother and baby create a “dance” of interaction.  With each positive interaction, the baby’s brain fires more neurons, lays down the foundations for feeling loved, trusting and explorative.  Nature designed mothers to look into their baby’s eyes and feel joy, for this very reason.  But nature did not design us to be able to do this on our own in a rather large, otherwise empty, house.  It is not fair to tell a mother who is doing this job on her own, that she “just” needs to be joyful, if you expect her to do a job that is stressful, lonely, unsupported and practically impossible, and then ask them to be joyful while they are doing it.  Not only do we as a society do just that, but we then actually have the gall to suggest that if they aren’t joyful they are damaging their baby’s mental health!  You cannot feel guilty and joyful at the same time.   This is because stress hormones (associated with feelings of guilt, shame, depression, anxiety, worry) and very different to calm and joy hormones (associated with relaxation, mindfulness, connection, warmth, compassion, mutual joy and sharing).  Stress cuts across joyful feelings immediately because nature designed us to prioritise being alive over being happy.  So if a mother is stressed, she will find it harder to “delight in the joy of young children’s daily discoveries”.  When a mother has her baby, she is recovering from a birth physically and psychologically, she is learning to adapt to being a mother (being responsible for a little being, no longer able to put her needs first, no sleep and so on), she is  grieving her old life and adapting to her very different new life, she is having to manage the housework, cleaning, ironing, cooking, school runs, worrying about her weight, worrying that her husband still feels included and loved, and so on.  This is too much for a new mother.  She needs to rest.  She needs to be looked after.  She needs people around her.  She needs her privacy.  I have to say, a little part of me envies Mormon mothers (yes, I actually wrote that!). While some people think it dreadful that they should share a husband, I see it slightly differently, because in Mormon households, the mother is not alone. Imagine if you always had other “wives” around you in the house, to help with housework. Imagine if you only had to be responsible for feeding your children one or two days per week, because some-one else is cooking the other five days.  Imagine if, when you need a wee, but your child needs to put their shoes on because you are late, imagine some-one saying “I’ll do it, you pop to the loo”.  Imagine, when your child has had a dreadful tantrum, and you feel like you’ve been dragged through a hedge backwards, some-one says “you poor thing.  I’m going to make you a cup of tea, and settle your toddler down with a drawing for you”.  Imagine, when you are about to shout at your toddler because you are tired and wired, you can turn to some-one and say “I feel like screaming” and she can laugh and say “I know that feeling.  Off you go, I’ll spend 5 minutes with her”.  Imagine on a day when you have a cold and you feel wretched, a woman says firmly to you “go to bed and stay there.  I’ll do this”.

The point isn’t that we should become polygamous, the point is that society needs to look after mothers if we want mothers to look after babies.  The research shows us that mothers who feel the “joy” of parenting do a great job raising kids.  However, one cannot force “joyful” parenting on some-one, especially not by increasing guilt.  You create the conditions for joy.  In response to the research, society has to do a great job taking care of mothers. The flipside of joyful parenting is sad, scared parenting.  Perinatal mental health problems are on the rise, and we know that this is not good for babies.  The government is addressing this by increasing “identification” and “treatment”.  This is important, but we are putting sticking plasters on a bigger problem.  Isolating and burdening women is the problem.  And it’s affecting fathers too now, as they are increasingly expected to juggle full time work, house, children and looking after mum.  They are getting sick too.

Stop the guilt. Stop the scare mongering.  Prioritise taking care of our families, so they can thrive in joyful, relaxed interactions.  Simples.

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

Website:  www.yourbirthright.co.uk.

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

Compassion is for sissies, right?

April 29, 2015

Wrong.

Compassion is for strength.  After all, if you want to help people, you’ve got to have the strength to actually do so.

But can you be “tough” and “caring” at the same time?

Absolutely you can. There’s a stereotype that “soft” and “caring” are not compatible with “tough” and “resilient”. There’s also a view that being tough means not taking care of yourself, because only “softies” need to take regular breaks and rest up after a hard day’s work.

Well, psychology is making new ground in this area, and I find it all really exciting.  It seems to be the case that those of us who are kindest to ourselves, cope the best.  So, you don’t need to “have a word” with yourself, or mentally beat yourself up to get the best out of yourself.  On the contrary, you need to be a compassionate friend to yourself .  When you have been made to feel foolish, you don’t tell yourself “crikey, what on earth was I thinking, I can’t believe I made that mistake, others must think I’m an idiot” because that isn’t what a compassionate friend would do. A compassionate friend would sweep you up in her arms and tell you that we all make mistakes and that you’re amazing just the way you are.  Similarly, you are not more valuable to the NHS if you don’t take regular breaks, or if you work beyond your shift hours. This is because you are in danger of making yourself weaker, and of not keeping yourself strong enough to be a gem of a worker.  If you are not compassionate towards yourself, your compassion towards others will run on empty at some point.

So, you can stay tough and resilient at the same time as being kind and caring to yourself.  You can be tough and caring at the same time. This is what compassion is. Tough and caring.  And it is very good for our mental health, for the health of the nation, and for keeping us strong enough on the inside, so that we can help others on the outside.

Written two years ago. My tribute to Sheila Kitzinger. RIP Sheila.

April 25, 2015

Mia's Blog

  • Sheila.  Oh Sheila.  What can I say?  You brought me into a hypnotic state with your wonderful story telling approach to speaking. I watched and listened in awe.  My subconscious took it all in, and I was hooked. You were amazing.  It was so gripping, my conscious mind remembers nothing.  I  took away, that women matter. That birth matters. And we can all do something about it. I felt joy, empowered and excited. Thank you.  What I wrote down was that you are the first person to talk about something that should be talked about a lot more.  Drug companies.  You told us that you had approached the Advertising Standards Association, to complain about an advert that Bayer has produced, with dodgy statistical claims about maternal death in childbirth. The ASA upheld your claim. The advert was changed.  Go girl! You also said that Doulas protect birth.  And Doulas protect…

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It’s Mother’s Day

March 15, 2015

From many years ago – Happy Mother’s Day every-one.

Mia's Blog

It’s Mother’s Day.  For all those of you who are mothers for the first time this year, congratulations.  As you know, you have entered an incredible and crazy world – which makes you incredible (hopefully, it doesn’t make you crazy.  If it is doing so, get yourself some help).  For those of you soon to become mums for the first time, congratulations also.  What a very special time.  Three quotes come to mind when I think of being a mother.

1.  “I haven’t done anything all day, except for put the washing out”.  A distraught and frustrated mum said to me from her bed.  She had forgotten that she had been doing a job that no-one else could do, and one that is super important – being a mother to her baby, and bringing up this nation’s future generation.  She is the one that her baby knows by smell, sound…

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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.

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