A Free Guide to Mental Health in Pregnancy and Postpartum

Becoming a mother is one of the most significant transitions in a woman’s life. Not only is there the physical growth and birth of the baby, but there is a parallel emotional journey towards motherhood.

The way a woman experiences her pregnancy is individual to her. We all come to pregnancy with our own important personal histories. You may have been through many cycles of fertility treatment; you may not want children; you may have conceived in a blended cultural family; you may have experienced a previous pregnancy loss; you may have conceived straight away and are ecstatic; you may be recently bereaved; you may have experienced birth trauma; you may have become pregnant at the same time as your best friend… this is by no means a complete list, but highlights how each and every woman will be experiencing and living her pregnancy differently.

Most women experience changes in their mood and relationships during pregnancy. This is to be expected as it is a huge life-changing time. For most, these feelings come and go, and may feel momentarily overwhelming, but you are able to continue living your life as you would like. For some, however, these feelings and emotions can be all-consuming, and they hinder every-day life. A pre-existing mental health diagnosis can sometimes be an indication of maternal mental health challenges in pregnancy or with a new baby, although not always.

Please know, that the behaviours and thoughts I list below are not to be used to diagnose, these are for personal reference only. The list is not exhaustive, and there may be symptoms and behaviours not mentioned. If you are concerned about yourself or a loved one, please speak to a professional.

Ante/Postnatal Anxiety – anxiety can heighten during pregnancy. This can feel like restlessness; running thoughts; heart thumping; sweaty palms; panic; breathlessness; hypervigilance; insomnia; exhaustion.

Ante/Postnatal Depression – can feel like a heavy dampening of everything; a lack of joy and excitement; some describe feeling empty and no variation in mood; struggling to sleep, sheer exhaustion; no motivation.

Ante/Postnatal Obsessive and compulsive behaviours and thought patterns (OCD). Thoughts that can feel overwhelming, intrusive and terrifying. Obsessively counting kicks/movement. Fear of baby dying. Compulsively cleaning, disinfecting, bathing.

Postnatal maternal OCD can sometimes present as relentless thoughts around the terror of harming your baby. Although you know you will never act upon these thoughts, they can be so chilling and abhorrent, and flood your mind. Please know these thoughts are common, and your baby is safe.

Birth Trauma – is when you were or perceived that you or your baby were under threat of death or serious injury. Re-experiencing the trauma through flashbacks, intrusive thoughts and nightmares; being hypervigilant, especially around the baby; feel guilt around the birth, or feelings of depression.

Postpartum Psychosis – is a rare, but treatable medical emergency. It can present in many different ways but is often accompanied by hallucinations, delusions and mania. It can appear suddenly and can change from moment to moment. If you suspect yourself or a loved one of experience postpartum psychosis, please read the APP website and call a healthcare professional immediately.

Although I have listed some of the occasions when mental health is strained, please know that for many women, the experience of becoming a mother is positive and fulfilling.

However, if you are struggling, there are some things you can do to help alleviate this.

• Speak to your midwife or GP.

• Speak to your friends.

• Join ante/postnatal classes.

• Gentle exercise (especially outdoors).

• Try and carve out some alone time, or social time – whichever is most comforting to you.

• Care for your body.

• Journal or note your thoughts down in a way that feels right to you. Sometimes telling someone else feels too much, and by writing you are telling yourself, and this can be surprisingly effective.

An incredibly uplifting and hopeful thought to hold on to is that with help and support, most perinatal mental health challenges are temporary.

 Some really useful websites:

• Mental Health Support Through Pregnancy and after Birth  

• Making Birth Better

• Birth Trauma Association

• Maternal OCD

• Postnatal Depression Awareness & Support   

• Mothers for Mothers

• Counselling Directory

• Stillbirth and Neonatal Death Society  

• Fertility Network UK

You can find a FREE shareable PDF of this and many other resources HERE.

…………………………………………………………………………………………………

Elisha Nunhofer is a person-centred psychotherapist who specialises in maternal mental health. She has extensive experience of working with clients who are exploring the possibility of having children; going through fertility treatment; have experienced all forms of pregnancy loss and termination; ante and postnatal depression and anxiety; adoption and surrogacy.

She sees clients via video call or in-person in East Sussex. For more information, please visit her website.

A Free Guide to Having a Doula

To doula or not to doula…that is the question!

Ever heard of a doula? Wondered what one is, what they do and how they can help? Is it all witchcraft and incense? Hopefully, I can dispel a few myths here!

What is a doula?
A doula supports women and those that birth through pregnancy, birth and the postnatal period. How do we do that…. well, to start with we are non-judgemental and incredibly open in our approach. We appreciate that everyone makes decisions that are right for them at any given moment and our aim is to make sure that you feel fully informed and supported to make the choices that suit you.

We can help by signposting good evidenced-based research (no opinions, judgement or advice here, we want you to explore what feels right for YOU) and by exploring the emotional and practical needs a doula can bring, it means we will respond to the individual needs of each pregnant person…with the idea that you feel confident and empowered, and that any gaps in knowledge, care, understanding or communication is bridged.

You can read more about the role of the doula here and this is a great source of evidence-based information.

Are we just for the mother to be/birthing person?
No! As doulas we often support the partner, whoever that may be, so they too are informed and relaxed. By offering continuity of care, we build relationships with whoever needs that support so that when the day of birth arrives, everyone is as positive and included as they can be.

Are we clinical and can we give medical advice?
In short, no. We are not medics but fully appreciate there are roles we all play when supporting birthing women/people… although we have different roles, doulas keep the needs of those they support, at the forefront of their minds always. We want that oxytocin flowing so work hard to make your birth space as calm as possible!

Are there statistics to show the benefits of having a doula?
Yes! There is evidence to show that having a doula can:

• Reduce risk of caesarean birth.

• Reduce risk of instrumental birth.

• Reduce need for painkillers or epidural during birth.

• Reduce risk of induction of labour.

• Shorten labour.

• Increase parental satisfaction with the birth experience.

• Increase the likelihood of initiating breastfeeding.

• Increase the likelihood of successfully establishing breastfeeding and breastfeeding at six weeks.

• Lower incidence of depressive symptomology.

• Improve equity and provide culturally responsive care

(Brigstocke S. MIDIRS Midwifery Digest, vol 24, no 2, 2014, pp157-160)

The best doula for you?
Chat to a few! See who you connect with... when the rapport flows and you know you could chat about anything with ease…you’re on the right track!

You can download a FREE PDF of this piece and many other useful resources HERE.

………………………………………………………………………………………………………………………………………….

Sam is a married mum of two, has a cat, dog & bearded dragon & has lived in Essex all her life.

After training in 2008 with Nurturing Birth she dipped her toe further into the birth world (also attending the training & facilitating for Mindful Doulas) and went on to explore mental wellbeing, Birth Trauma (3 step rewind technique), infant massage, hypnobirthing and many other workshops and study days that caught her eye! Finding community, supporting those who need it and embracing who you are is at the heart of Sam’s drive and is why you’ll find her as ‘the unapologetic doula’ on social media!

She’s been a doula mentor for seven years and at the end of 2019 was overjoyed to be asked to join the Nurturing Birth team where she has branched out to facilitate the new doula courses 😊

Contact Sam via email – samshepp4@yahoo.com or call 07793970367 for a free chat on how a doula can benefit you, or check out the links on this guide for her FB page, more info and reviews/testimonials.

A Free Guide to Newborn Sleep

Helping your baby become a confident sleeper, is a gift that will last them a lifetime. But, with all the contradictory information out there, it can be difficult to know where to start.

Strong sleep foundations

By simply responding to our babies when they need us, we help them feel safe and secure, the two most important conditions for sleep.

For now, focus on getting to know your baby and enjoy those sweet cuddles!

If you want to help your baby build strong sleep foundations here’s what you can do

• Help your baby sleep before they are overtired. Look out for early sleep cues, such as staring or glazed eyes

• Create a predictable sleep routine that you enjoy

• Encourage regular naps. Day time sleep encourages night time sleep!

• Once a day, pop your baby in the cot and stay next to her, show her you are calm. This will help her build positive associations with the cot

• Help your baby sleep indoors and out

• Become familiar with baby’s sleep needs from evidence-based sources such as Basis

Myth-busting

As if parenting isn’t hard enough and we don’t constantly doubt ourselves, the world is ready with old fashioned, disproven advice. Here are some gems…

• You’re giving your baby bad habits

This is normally dished out to parents who rock, feed, shush their baby to sleep.

Fact:

In the uterus, your baby was constantly being rocked, feeding and hearing whooshing sounds. You are helping your baby have a gradual transition from womb

to world

• You are spoiling your baby

The suggestion here is that your newborn baby knows how to manipulate you to get what he wants. I despair…

Fact:

Babies cannot be spoilt. Their brain is too immature for calculated, spoilt behaviour. Being spoilt would mean your baby understands how their behaviour affects your actions, and pretend cries. Your baby will stop crying when picked up because she has evolved to be close to you where, back in the good old cave

days, she was far more likely to survive. You cannot undo what humans have evolved to do, not matter what Aunty Janet says…

• You must teach your baby to self soothe. Parents are often told that babies learn to sleep by self-soothing. However, this is based on outdated, harsh, sleep training methods.

Fact:

The evidence is clear for babies, the area of the brain responsible for self-soothing is not fully developed.

Therefore, allowing babies to cry unattended, in the hope they self-soothe is pointless.

In fact, it can be damaging as they fall asleep feeling unsafe and unheard, which will increase their cortisol levels.

So, when someone asks how your baby is sleeping, simply smile and say

“She sleeps like a baby”

Self-care

Have you heard friends saying ‘my baby comes first’? I worry when I hear parents, in particular mums, say this. I would suggest ‘My baby and I come first’ as Mum and baby function as one. Always putting your baby first can leave you depleted and anxious. And guess who will still need you when you’re overwhelmed from lack of sleep and putting yourself at the bottom of the list? Yep, your baby.

Your baby will interpret their world through you (no pressure, right?). If you are feeling anxious your baby might become grouchy, which in turn, will make you more anxious. Without realising you might enter a downward spiral. You and your baby have evolved to function as one. Take care of yourself as you do your baby.

If you are feeling low, consider accessing NHS Talking Therapies and please visit the Lullaby Trust for evidence-based information on safe sleep.

You can download a FREE shareable PDF of this and many other resources here and listen to Marta offering her top tips for sleep HERE.

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Marta Gardner is a leading Sleep Consultant and mum of three. For over ten years Marta has relished being able to help hundreds of parents just like you, to support their children to become independent sleepers, without tears. The no tears methods Marta uses are age-appropriate, tailored to your child, evidence-based and compatible with responsive parenting.

With Marta’s support, you will become confident identifying when your baby needs to sleep. This will result in a predictable routine that you are both happy with and your baby will be able to sleep soundly in their cot.

https://www.martagardnersleepconsultant.com

Follow me on Instagram and Facebook

A Free Guide to Pelvic Floor Health

Many women first become aware and start to think about their pelvic floor muscles when they become pregnant. The pelvic floor muscles are an amazingly supportive muscle sling, that forms the base of your pelvis. They help to support your pelvic organs (bladder, rectum and uterus) and a growing baby whilst pregnant.

Ways to find them- 

1.      Blow. Sit upright and supported. Inhale through your nose and exhale through pursed lips (as if you are blowing through a thin straw. As you exhale, you may feel these pelvic floor foundations switching on.

2.      Feel. You can place a clean finger or 2 inside your vagina. As you exhale, try to tighten around your back passage and the finger. Inhale to relax. Did you feel the muscles tighten around your finger?

3.      See. Place you hand lightly over your perineum (the area between the vagina and your anal opening) or look at this area with a mirror. As you exhale, gather, and lift your back passage and vaginal opening. Does the perineum lift gently from your fingers? 

If you are still struggling to locate/activate them- you can try a Neen Pelvic Floor Educator, available online. This is a cheap and effective visual feedback device.

Ok, you found them, what do you do with them?

Practice gathering them up as you exhale and relaxing them as you inhale (breath down into your pelvic floor). This will help to keep your pelvic floor co-ordinated. You can do some extra reps of this to build up some strength.  

PF relaxation is also essential for normal function and learning how to relax and release your PF muscles can be especially useful prior to vaginal birth. It will also be valuable for postnatal pelvic floor recovery after a vaginal or C section birth. 

My tips on how to relax your pelvic floor :  

●       Deep belly breathing.  

●       Self- perineal massage/stretching.

●       Yoga positions like child pose stretch, a deep relaxed squat, hip stretches, and happy baby are great for this.

Day-to day signs that the pelvic floor isn’t functioning properly are: 

●     Pain in pelvis/perineum 

●     Persistent painful sex 

●     Leaking urine or faeces

●     Not fully voiding bladder 

●     A frequent heavy feeling in your vagina

●     A feeling of a bulge inside the vagina 

After the early postnatal days have passed, you can take an inventory of your vulva and vagina. This can be quite reassuring before trying sex for the first time too.

Wait for about 6-8 weeks after delivery to do the self-check, when the lochia and any swelling has settled. You can lie propped up with some pillows and use a mirror to look at your vulva, perineum and vagina. Touch the labia and perineum and labia, move them gently, do they hurt? do they pull? Try a pelvic floor contraction during your self-check. If this feels weak- then try some pelvic floor strengthening exercises. If it feels painful or tight, then spend some time breathing deeply and relaxing your pelvic floor so you see the perineum drop and let go a little. 

A mummy MOT/postnatal check with a pelvic health physio can be a great way to assess how your pelvic floor is doing after pregnancy, help you with any of the signs mentioned above and get you on the right track for recovery.

You can download a FREE shareable PDF of this and many other resources here and watch Niamh talking about pelvic floor health HERE.

…………………………………………………………………………………………………………

Niamh is a pelvic health physiotherapist with a special interest in pre and postnatal care.  She is skilled in helping women with conditions such as pelvic girdle pain, pelvic floor dysfunction, abdominal diastasis and urogynaecological issues like painful sex, urinary leaks and pelvic organ prolapse.  She also has a keen interest in guiding women back to exercise or whatever makes them feel good post pregnancy.

Niamh is a member of the Pelvic Obstetric and Gynaecological Physiotherapists, a Mummy MOT practitioner, a recommended practitioner on the pelvic partnership website and Mum to 3 boys.

Niamh works in Crouch End and at Fix London.

There are more pre and postnatal pelvic health articles available on her website “learn” section.

www.maternityphysio.co.uk

www.fixlondon.co.uk

info@maternityphysio.co.uk