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.

Let's Stop Writing Birth Plans

Last night I tuned into the #positivebirthhour on twitter, a fabulous forum for birth inspiration and the topic was ‘birth plans’. I got stuck in (in between mouthfuls of noodle soup) with full gusto and found myself debating in the esteemed company of Sheena Byrom (@SagefemmeSB), Milli Hill (@millihill), Tracey Cooper (@drtraceyc) and Shawn Walker (@SisterShawnRM). These are all heroes of mine, and for those of you who aren’t familiar with these women… they are positive birth power houses. Go check them out!

The debate was so engaging for me, that I woke up at 4am this morning, with a blog bubbling around my brain.

So here it is…

As a hypnobirthing teacher and midwife I encourage my clients to be deeply informed, and confidently know their options as they approach their births.

However I don’t encourage ‘birth plans’. And this is why….

The word ‘plan’ has powerful semantic connotations. Once you have a plan, the general intonation is that you should stick with it but what if you don’t? I have walked into many homes, meeting a postnatal mother for the first time, and had her break down in my arms. Why? Because her plan ‘went wrong’, and she felt like a failure. Like her body let her down and she wasn’t good enough.

So I incorporate this experience when I teach my hypnobirthing families.

Now let me be clear. I teach complete positivity, complete faith in the birth process and complete trust in your body. I spend hours releasing reservoirs of deep fear and building immense confidence.

But I am medically trained, scientifically minded and honest with my clients.

I teach what you can control, which is perhaps 75% of you birth or more. There is so very much that you can do, to take control of your birth and ensure that it is empowering and positive. I planned and enjoyed a homebirth with my first daughter, with no hospital bag packed ‘just in case’.

I teach what you can influence by making informed choices about the options available. I teach you to think outside the box and question the options that are presented by your care providers. Yes you CAN decline vaginal examinations, yes you CAN decline inductions of labour, yes you CAN birth out of the guidelines.

I also teach what you can’t control. And give you the confidence to acknowledge and let this go. I go through birth scenarios, so that if a highly unlikely but possible emergency occurs, you are prepared, calm and confident in the face of the storm. And I must be honest, I have had a hypnobirthing client who had a crash emergency section (one which must be performed immediately to save baby’s life). And this is what she said about it

'My mum (ex-midwife, pre-hypnobirthing era) was with Paul and I throughout and she couldn't believe how calm I was during the entire labour...even at the hospital when it became an emergency. I'm so glad I experienced contractions and some of 'labour' - it was the most exciting/spaced-out couple of days ever and I don't recall any pain. Pressure/energy, yes, but it really wasn't pain like I'd expected. Everything you taught was exactly how we experienced it and I couldn't have got through it without your knowledge and techniques. So thank you. Beatrice is a chilled-out easy-going little chick and smiles all day long.'

It’s a fine balance between empowering women and not acknowledging that birth is at times unpredictable.

So let’s stop writing birth plans and start writing fully informed birth preferences. Or plan A and plan B.

5 Tips for Positive Birth

Being a dreamy 25 year old student I went for the stereotypical hippy option, a pain-relief free homebirth on the living room floor. Using hypnobirthing breathing techniques and plenty of youthful naivety I had an incredibly powerful and positive birth experience. It put me on the road to where I am now, somewhat older, slightly wiser and considerably more grounded. What I learned from giving birth is that women are shape-shifting superheroes and are much tougher than we seem! Our bodies completely transform in birth and open up like blooming technicolour flowers.

These days I am a midwife working in a busy South London birth centre and a hypnobirthing teacher. I love my work passionately and feel lucky to have found what feels like a calling, something I never imagined I would find. A large part of my job is preparing parents and especially first time mums for their births. Now if you have had a baby or been with a birthing woman you will have your own take on what birth is, how it feels and what advice you will give to your friends when it’s their turn. From what I’ve seen every woman will have a strikingly individual experience and what would be a heavenly natural homebirth for one can be painful and traumatic for another.

Here are my TOP FIVE TIPS to have a positive birth experience, no matter which way you decide to birth your baby:

1. I’ve noticed that the women who stay active in their pregnancies tend to have easier births and quicker recoveries. This seems pretty obvious - of course if you are fit and healthy your body will work more efficiently. But this isn’t so easy when you are nine weeks pregnant with raging morning sickness that lasts all day and all you want to do is lie on the sofa with your duvet eating malted milk biscuits! When you get to your second trimester and have a little more energy get active again. Walking, swimming, pregnancy yoga and pilates are all fantastic.

2. Stay relaxed. Easier said than done when you have a two year old causing all kinds of crazy in the kitchen cupboards! Especially now that she has just figured out how to climb up and open the ones you didn’t think you would need to child proof. If you already have little people who need your constant attention, relaxation may mean you take ten minutes out at the end of the day to lie down quietly and do some breathing. Or find an obliging chap to give you a good long foot rub. Make time for yourself you deserve it!

3. Many of the women I see are very anxious and fearful about birth and pain. They are often very well informed and have definitely watched plenty of ‘One Born Every Minute’. To a certain extent you can choose what you fill your life up with so immerse yourselves with healthy, happy birth. Watch some beautiful water births on YouTube, talk to your friends who have had good experiences and read anything by Sheila Kitzinger, Ina-May Gaskin or Michel Odent.

4. These days most women will make a birth plan, a long wish list cherry picking all the best bits. I think it’s great to be well informed and know what you want! I have also noticed that from time to time babies don’t read the plan and have ideas of their own. How dare they! I recommend that you also write a ‘birth tweet’ (not that this should be published of course). A tweet has space for only 140 characters which is about two sentences. This enables you to condense down the essence of what is really important to you. This would be mine ‘We want our baby to be born in a calm, peaceful and loving environment’. Give it a go!

5. Can you guess my last top tip? Of course it’s hypnobirth. Having supported hundreds of birthing women and used hypnobirthing myself I know how well it works. Hypnobirthing provides the knowledge and understanding of normal birth, combined with relaxation techniques to keep you calm and in control no matter what happens. I have supported a couple who used hypnobirthing during an elective caesarian, the calmest I have ever attended!

Once you have had a baby you may suddenly realise how epic every woman who has ever gone before you really is. Something that your children may also realise about you when they finally grow up and stop climbing up the kitchen cupboards!