Pregnancy, birth and parenting blog

Being superwoman, you already are.

Just a quick note on “being superwoman”. 

Society puts so much pressure on women especially mothers to do everything and be superwoman and it’s not possible. But perhaps women just are  superwomen by doing everyday tasks. We’re expected to work or expected to run a home or expected to raise children and yet, still, men don’t seem to have that same pressure. The pressure we can be under can cause all sorts of anxiety, panic, stress, depression, it can be really overwhelming at times

The feelings and emotions that can be felt, as we have all this tasks and expectations upon us, are normal responses to all this. They are normal responses to having too much pressure. The theory of fight, flight, freeze can explain some of this, this is (on a basic level) where the body prepares to run from or to fight a threat/ a stress to our wellbeing. It sounds odd that we should have these feelings whilst doing what is deemed everyday tasks and it is odd. This should not be happening and yet so many do feel these things, which can then have an impact on negative self talk, thoughts of not being good enough. In my experiences these thoughts are really common amongst parents and somewhat more so within women. (But the latter could just be because of where I specialise in support).

We do not have to put up with this. There’s lots of talks about resilience, resilience to things that happen to us in life, but we don’t have to be resilient to things that cause us such stresses. We don’t have to try to be “superwoman”. We already are. If something is causing some stress or a negative feeling, something just doesn’t feel ok, then it may be time to reassess whether this has to be in your life. Some tasks don’t bring joy but need doing and that’s ok, it can be a balance.

The word “No” is something I’m learning well lately. It’s a full sentence of its own and lays boundaries, boundaries are important to own self wellbeing. It’s ok to say No, it’s ok to be selfish. It’s actually healthy to prioritise self wellbeing. Of course I’m not saying to neglect your children, there’s a balance there. There is the old saying that reminds of the instruction that is said on airplanes to put own oxygen mask on before a child’s. This is because if you aren’t well, you can’t help a child. Same goes in life really. You matter! Look at your own self care, your boundaries and what brings joy to you.

Seeking to be superwoman is no good, because you already are. 

Are home births safe?

There’s been quite the reporting about home birth in the last few months in relation to a couple of court cases. The conversation around whether they are safe has become a forefront again. In short, they can be safe. 

What is safety? What is danger?

A number of Research studies do suggest that home births does not increase the risk of mortality (death) or morbidity (medical problems) in comparison to hospital births. Further to this rates of interventions is lower in planned home births. The latter is partly to do with these not being available at home. However, it does suggest that there may be a lower need. 

The NHS website says this,

“But if you’re having your first baby, home birth slightly increases the risk of serious problems for the baby – including death or issues that might affect the baby’s quality of life – from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth.

If you’re having your second baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.”

Putting those figures into perspective chances are 0.5% chance of a problem for the baby in a hospital birth and a 0.9% chance at a home birth. Still relatively low, statistically. However, these numbers seem to be in contradiction with other research studies that suggest there’s no difference and possibly even safer to birth at home in low risk and some situations with a perceived added risk.

Within the NHS, families often find they are told of many reasons why a home birth may be dangerous and risky. This reasons may be “big baby”, small baby, bleeding, and even death. We’ve previously discussed the risk of death and that this does not appear to be as big as suggested but what about the other situations. The evidence on the risk of birth on many of those situations commonly mentioned is lacking. 

There are certain situations where home birth isn’t safe, such as a transverse presenting baby (lying across the womb) or placenta previa (placenta lying across the cervix/ opening to the womb). These situations require caesarean birth. 

To say home birth is not safe as a general statement is not based in any evidence. The risks and benefits in each situation is unique and for each woman and family to decide themselves. If a decision is deemed “against medical advice” then that is OK and within legal rights. As discussed above, the evidence around some of the “against medical advice” can be lacking in quantity and quality. Regardless of that, legally, a birthing woman can choose do to whatever she wants with her own body. She can decline whatever she wants too. No one should feel coerced into a decision

Final note.

Whilst debates around the safety of home births are happening there is a lack of discussion around the safety of hospital births. There are risks associated in those situations that are very rarely discussed. Perhaps, for the purpose of informed choice, these conversations are also happening. If you’re a professional and you’re questioning someone’s ability to make the right choice due to a home birth, perhaps ask if the same person was requesting various interventions would you be asking the same. If not, then maybe the person is absolutely fine to be making the decisions. 

Danger and safety are subjective. Blanket statements do to help anyone. 

Home birth is safe.

Hospital birth is safe.

Both can also cause problems. 

The decision always lies with whoever is birthing.

Are we offering the right treatment for postnatal depression?

I have been doing a small bit of research into the use of antidepressants for postnatal depression and anxiety. In this I have struggled to find any statistics as to how often antidepressants are prescribed for postnatal women. 

In practice I know this is quite high. Most, if not all, new mothers who I see in practice that have seen their GP say they have been offered antidepressants as a first response to their depression or anxiety. The treatment pathway, according to the NHS guidance, should include the offer of psychological therapy. This means talking therapies such as seeing a counsellor or psychotherapist. In the perinatal period (pregnancy to 12 months postnatal) an appointment should be offered within 2 weeks of referral. This does seem to be hit and miss and some are told they cannot be seen by the service once they have had an assessment.

In addition to this, the ability to access this seems to depend on the offer. It remains the case that new mothers are expected to find childcare for therapy sessions that are between 9am and 5 pm. Evening and weekend appointments remain, somewhat, non-existent. This means the ability to access talking therapies for new mothers is extremely difficult. 

With all this, the offer of antidepressants seems logical. Research shows they do help the symptoms so using them will help in the immediate term. However, the withdrawal from this medication can be quite difficult and many do not wish to take them. Looking at what to expect in this is important. Antidepressants can be great for some people, there is the concern around what else is offered. Those of us who believe that the symptoms are more than a “chemical imbalance” (there’s a lack of evidence behind this but that’s another blog post) would suggest that antidepressants won’t work as a long time solution unless one continues to take them. There are those who do take them for a short period that do find they help to get through a particularly stressful moment in life and they can be wonderful for that. For some this could be the case with postnatal depression, however, for those whom I see in practice this does not tend to be the case. 

In my research I have become particularly interested in those who have been prescribed antidepressants years ago and report that they can not seem to stop taking them, they feel worse again when they stop and the dosage keeps being upped. There seems to be a lot of women who are 10, 20, 30 years on medication for what began as postnatal depression. I really struggle to find where this is ethical. What are we, as professionals, missing? Are we not looking for a “cure” for the depression/ anxiety? 

Years ago, the way society looked at mental illness was different. 20 something years ago Electric shock treatment (electro convulsive therapy) was still used commonly for post-natal depression and so some of this long-term use could be a bit of a hangover from that. Yet it does appear that the use of medication is a first offer for perinatal mental illness with a real lack of ability to access talking therapies. Working in this area for around 15 years now (as a parent and now professional) I am becoming very aware that little has changed in this time. I sit in meetings now where questions around “how do we engage the hard to reach communities?” are still being asked and yet no one seems to actually go do this. We must stop this. 

So, why am I writing this? To hope to trigger some thoughts, some discussions and some change. This is happening, I know I am not the only psychotherapist seeing this. 

Are you a professional working with new mothers? Let’s talk and see what could be different.

Are you a mother and this feels relevant to you? There are people willing to listen. I am here to listen. If you feel you can share your experience, then please do. 

A last note: medication has its place. 

How we are groomed in healthcare.

This post may be quite a difficult read for both professionals and parents.

If you feel you need some support then please call you GP, a mental health charity or call a trusted friend.

When we think about maternity care  we envisage wonderful people who just want to make a persons life better. We think of caring humans who are doing what they can to keep people alive. 

Yet within this grooming is happening. And yes, the same tactics that the typical vision of a groomer of young girls does also happen in maternity care. 

How? Many ways. 

Coercion is the big one. Coercion is actually usually done very subtly and in many forms.

Power imbalances play a part. The NHS and maternity system is seen as some amazing institution (it is) and the people within it often seen as untouchable. Yes, maternity staff are very knowledgeable, they are also human, with emotions and biases. This is OK. They do, however,  hold a lot of power and with this means that those who aren’t as knowledgeable, appear to  have less power. With every power difference those that hold higher perceived power can very easily coerce. Simply because we are taught to believe what the professionals, those with authority, tell us.

We learn this at a very young age through our parents and teachers. Learning to listen to our parents isn’t a bad thing as it keeps us safe. Believing everything anyone with some authority tells us does not necessarily keep up safe (look up Milgram studies in authority for anyone interested in the deeper psychology.) 

A typical abuser will assert authority in order to control an manipulate/coerce. 

Language used in maternity and health care is often coercive. Think about conversations that are had around deciding a plan of care. “I’m not allowed”, “you’ll be against medical advice” etc. If you feel you cannot say no then it’s not consent and is legally assault. 

One for professionals who say “my ladies”, perhaps we should be using alternatives such as “women I work with… women I support”. Using the word “my” implies ownership. It implies control. 

Then we have gaslighting and guilt tripping involved. Gaslighting is a series of techniques that make the person its being done to feel confused and like they are wrong. Done to assert control and power. 

I would say, controversially, that birth debriefs (especially by the same person in the same unit) are a form of gaslighting the parents. (But debriefs are a whole other topic for another day) 

So, how does gaslighting exist in maternity? Usually if you’ve had one thoight and then come away with a different thought and not really sure how it happened. A lack of informed choice is likely happening which is coercive as the full information hasn’t been given therefore gaslit and manipulated into one way.

Again, this is not saying maternity workers are just abusing women. They’re not. There’s a systematic and societal problem teaching people that authority and power is good. 

As a birth worker and mental health worker it can be easy to assert authority to get someone to react favourably to your needs and often many do not even know they are doing it.

I believe if everyone has their power then no one needs to take any. 

I’ve worked in healthcare for around 18years now and we are STILL having the same conversations around power, control, coercion. This is NOT acceptable. It’s time to change this.

When a family asks questions we don’t like, let’s not scoff, let’s not talk about them in the staff room and definitely not in network meetings!  Take it to supervision! 

Let’s give workers decent supervision. Let’s give them decent breaks and pay. Let’s not burnout our care workers. Don’t accept toxic workplace environments. 

Parents, ask the questions, you have a right to know, you have a right to say no. Healthcare workers are there to care for you, but they are not the authority of you or your baby, you are. 

In short, society grooms is all to listen to authority. We’re therefore groomed to do whatever we’re told by healthcare staff. Healthcare staff do want to help and support. We need a huge societal shift but we also need to challenge behaviours that don’t allow for choices to be respected. 

Treating trauma -CPD isn’t enough

I’m just going to say it. You can’t treat trauma on a few days class.

This may be somewhat controversial and is short and rambly. I may write deeper later.

Trauma is a complex psychological and physiological situation that even the highly experienced and trained academics and mental health workers continue to discuss. 

There’s quite the influx in people doing a 1-3 day course and then selling themselves as “trauma specialists” and that they can “treat trauma”. A lot of these courses require little to no previous experience or training. (I wouldn’t count most Doula training courses  in being adequate enough and would even question whether some degrees are). 

With something such as trauma, a person seeking help could actually have worse outcomes from someone inadequately trained than they would without. I’ve seen it, I’ve had health workers contact me to ask if it’s our doulas providing this “treatment” as women have reported horrendous outcomes. It isn’t. I know our Doulas aren’t able to do that. That’s why we have Counsellors with specialist training and experience. Yes, therapy can make things feel worse before it gets better but it seems there’s a lack of this with such training. It’s really not possible to learn how to hold the space in this area within a few days. No matter how much the course is sold to you.

Doulas are amazing and can help massively in subsequent births but they do not “treat traumatic birth” nor provide “healing birth services”.  Midwives also can’t treat trauma. What can be done is help to inform and aid a peaceful birth space. As birthworkers we really need to look at where our competencies lie. 

If you’ve done a few days training in trauma awareness or “birth trauma treatment” then it’s really not likely you can “treat trauma”. Even if your clients don’t return it doesn’t mean you’ve done the job well and they are cured. It’s likely your training taught you how to respond to trauma and that is great and fantastic knowledge that’s needed and more of it. 

As I said at the beginning, this subject is complex. There are whole degree modules and postgraduate qualifications in the area. In working  in counselling and psychotherapy I know that just because a person doesn’t return, it doesn’t mean they feel better. 

The emotions and feelings associated with trauma do not tend to fit a neat little package. Being trauma informed is great to help with understanding and how to not further impact as professionals. This and other cpd type training can not possibly be adequate. 

If you do want to learn about trauma then please check the qualifications and background of the person doing the training. 

If you are in need of some support then please check what the training of the person is and how long they trained for. 

Spoon theory in new parents

Spoon theory is usually spoken about in relation to those with Chronic illness, such as fibromyalgia, ME, migraines. 

It is the theory that a person has so many “spoons” to use in a day and that some tasks take more spoons than others. So, getting dressed may take one spoon whereas the school run may take three. 

And that once spoons are used then fatigue and other symptoms take over and the person is “down” for a period. 

I think this can also be transferred to new parenting. It’s well known that a lack of sleep impacts upon physical and mental functioning and new parents are lacking in sleep. However, new parents can become quite resilient to the lack of sleep. 

Lots of new parents report feeling guilty for not being able to do everything they feel they should be able to. But everyone has an amount of spoons. Maybe you have 10 spoons a day, take a couple off for a bad nights sleep, and you can see how everyone has limits. This is ok and healthy. 

Some days you may have more spoons so can do more and other days are depleted. Parenting isn’t always easy and takes energy. 

If we think about everyone having a level of spoons then we can begin to understand why some days seem better than others and how we can accept a day where things aren’t happeningZ 

Some days have more spoons, some days have more stressors, some people have more spoons. 

What takes your spoons? 

What gives you spoons? 

Postnatal depression reflections (part one)

Over the lockdown I have been watching some old DVDs of family moments.

I’ve gone back to being pregnant with my eldest (age 19, 15 years ago) and through his baby days and beyond.

Looking back at the times when he was a baby/toddler I felt a pang of sadness. I wanted to scoop me up and tell me it would all be OK! 

It took about 6 months to fully hit but I suffered from deep depression and anxiety for a good while after. Even watching  his first Christmas video I feel the anxiety coursing through as if I was back there. She’s still me, the 20yr old new mum is still part of me and she always will be. She has shaped who I am today, I doubt Snowdrop would exist had I not gone through those times. 

These old memories have been very much present in my mind and body when watching those times. Those memories shape things I do today too, I can  feel anxious in certain situations and will react in ways I remember doing then, the feeling of dread making me want to run. Sometimes I do, and that’s ok.. I’ve had a lot of therapy over the years and continue with these feelings coming up (even therapists have their own stuff to deal with). 

Watching these films have shown me that I have come along way and also acknowledge just how ill I was. 

I say I want to scoop her up but then what would I actually say? 

I know “it’ll all be ok” wouldn’t mean much to 20yr old me. She’d scoff. 

What would I say? 

I had zero confidence or self worth then. So maybe id need to hear, “you’ve got this.”

What would you say to a younger you if you could? Hard isn’t it. 

I think holding or simply a hand on shoulder would be enough. Knowing it’s ok to cry, be angry etc.

Those old feelings have definitely risen during lockdown. I think because I’m those times 15years ago my illness made me lockdown. Walking out the front door would give me an actual panic attack and now I’m forced in to some extent.  

Supporting new mothers going through similar situations I am aware of similarities and also the vast differences we can experience. I suppose I’d want to be more kind to myself as many mothers I support find helps. Just being there and riding the waves. 

I can now see those black moments do not last. There may be fleeting moments but they do not last and the black days can become fewer and manageable.

Watching these DVDs has shown me (reminded me), that people can go through some tough times and grow amazingly and that hindsight is a wonderful thing. 

Reminds me of this quote,

“Forgive yourself for not having the foresight to know now what seems so obvious in hindsight.”

How we shame women. (Part one)

I can see this maybe developing into a series of posts.

Having watched and participated in a few twitter discussions recently between mums and professionals I’ve been thinking. 

Can we ever really not be coercive in language? 

With health professionals (I’ll include doulas and Counsellors within that label) we strive to give information that’s the best for the individual. As Doulas we are not bound by the stricter policies that are within the NHS but we do have to be careful that we provide evidence based information. 

I think there’s a problem in that in itself. “Evidence”, by its very nature, is biased. There’s always an element of researcher bias in studies. A good researcher will eliminate that as much as possible but it still exists. 

When giving information out there’s also an element of bias. I’ve witnessed it far too many times a health professional giving one side of evidence and this is not enough for informed choice. Informed choice being when a person makes a decision for themselves (autonomy) with all the benefits and risks for every option available. I know myself that I have my own views on what’s best for myself, yet that is not the same for everyone. 

For instance, one particular Twitter conversation/topic  I’ve been following recently is around breastfeeding. Some suggesting that the benefits of breastfeeding are negligible in a country such as the UK. I have read the research around this and it seems fairly solid, however, over the last 15 years I’ve read a lot more telling me the benefits of breastfeeding far outweigh benefits of formula. I’ve always questioned that this doesn’t take into account the individuals. The benefits for one family  is not the same for all. However, the health benefits of breastfeeding, without other factors, do outweigh those of formula. For instance formula does not have living immunoglobulins (the part of the immune system that helps fight diseases and infection). 

An example I often remember is when I supported, as a Doula, two families who worked in NICU. One wanted all the drugs possible and to be in an obstetric unit. The other wanted a possible home birth. Both said they were choosing this because of their experiences in work. To me, I thought that was a fairly stark example as to what’s best for one is not always what another will choose for themselves. Medicine and health care should never be a one size fits all approach. 

Back to the twitter topics around breastfeeding and I am reminded that maternal mental health is majorly important, not only to the mother but also to the baby and wider family. Successful breastfeeding may be important to mental health to one but being told “it’s ok to formula feed” could be of huge importance to another and, actually, for that family the benefits of formula could outweigh the benefits of breastfeeding. As a big advocate for breastfeeding and also mental health of new parents, it is definitely important to remember this. 

There should still be better support around breastfeeding but I do feel that there should be more around mental wellbeing of new families. I think there’s better support for breastfeeding than there is for mental health currently in the UK, although this could vary in different areas. If we support better mental health care then this should include infant feeding and the relationships within this. It’s widely known that oxytocin if a hormone that helps with bonding and mental health (amongst other things, such as orgasm) and this is needed for breastfeeding. So simply biology would conclude that breastfeeding increases oxytocin and therefore is good for mental health. However, some have a negative feeling around oxytocin. There are theories about the “dark side” of oxytocin in particular in relation to trauma survivors and how the brain learns that oxytocin feeling can also be linked to not so pleasant experiences. In those who haven’t really experienced oxytocic feelings (there is some research that many women have not ever experienced an orgasm) then it’s also said that the feeling could be a little bit scary as any new thing is. So, it definitely isn’t a once size fits all. 

Perhaps, currently in the UK, the risks to the whole family of current levels of mental health support outweigh the risks for the current level of breastfeeding support. It may be safe to say that the level of breastfeeding support for families is better that the level of mental health support. I’d suggest that is actually the case local to me where we’ve Gold standard BFI

Giving a bottle of formula or expressed milk is not a fix to mental health for many but I do acknowledge that for some, to be told it’s ok to not breastfeed may be of huge importance. The pressure put on new mums is huge and detrimental in many ways. Society really should change this. (This is a whole other post!) 

So, back to coercive language. Any policy, procedure, guideline, I would argue is coercive. They tend to require an outcome with certain ways to achieve. With little flexibility it can make it difficult for health care professionals to support, or inform, all choices. I’ve heard many say “I’m not allowed to tell you this but…” and actually that information/advice has been highly beneficial to the recipient. 

I, myself, have been in trouble many times when I’ve worked in the NHS and other care services, from doing things “out of policy”, even though those professionals agreed that what I was doing was of benefit to the person. (Usually simply sitting and listening with a person who just wanted something simple.) The phrase, “against medical advice” is always a really manipulative one, I feel. “Against medical advice”, usually means against a policy, or even a personal belief. I have supported many women who choose to do things “against medical advice” and each one of those decisions has been from a place of being fully informed of all the angles, usually having only been given one side by those medical professionals and once the other evidence is presented the response is simply “well this is against medical advice.” There is a culture of power and authority seeming to come from medical professionals and that is very coercive in itself.

Let’s remember the authority should be with the woman and the family.