Giving birth (or watching your partner to do so) is without a doubt one of the most momentous occasions in anyone’s life. It’s an enormous rollercoaster of emotions for all involved. From fear, through anxiety, pain, grief, to joy, elevation, pleasure and love, all underlined by utter exhaustion. Throw in a chaos of hormones and fast time changes in the physiology of the mother’s body and you have a perfect storm for a mental break down. And this is when all goes well during the birth, when it does not, it’s a whole other story.
Although, there have been some improvements in the health care system in the UK when it comes to looking after the mental health of new parents and especially birth mothers, it is still far from ideal and many slip through the wide eyed net. Only those experiencing psychosis or are at high risk of doing so are able to access immediate help and even that is not available in all NHS trusts without a waiting time. Those that fall below the line of high risk, but still experience severe symptoms are often not seen for months or even years unless they can afford private therapy. The NHS is obviously very stretched, so what can we do to protect our mental health as much as we possibly can to avoid needing the services of medical professionals? We’ll explore that here. However, remember that if you are experiencing severe symptoms of PND, PNA, PTSD and/or Intrusive thoughts with urges to act, do seek help immediately from your midwife or your GP, in an emergency go to an A&E or call 999. Let’s have a look at the symptoms first of all, so you know what signs you are looking for.
The most obvious signs that not all is well are intrusive thoughts, feeling of emotional numbness, severe fogginess and difficulties with focus, fear of harming your baby, suicidal thoughts, unaccounted for physical pain (usually back or abdominal pain with no medical reason), panic attacks, feeling stressed and/or anxious for no apparent reason, struggling to bond with your baby (not wanting to hold/feed baby), flashbacks to the birthing experience, sudden onsets of extreme sadness without obvious trigger, waves of visceral rage and/or manic episodes. If you are experiencing any of these symptoms and feelings or any others that just don’t feel right, please do reach out and ask for help, whether it is a health care professional, therapist, your partner, family member or a trusted friend, just tell someone. There is no shame in experiencing any of these. It is not your fault and these are hard to cope with on your own, which you certainly should not have to do.
These experiences during and after birth are more common than we think. Birth itself is a big life changing event, so it is bound to have an effect on our minds and emotions as well as our bodies. Just this fact alone puts us at a greater risk of depression even though we really wanted this change to our life and love our baby. Depression is our mind’s coping mechanism to emotional overwhelm. It’s like an emergency shut down. The problem is that once the lights are off and we had that initial respite we needed, the mind often struggles to find its way back to the light switch and after a while can start believing that it no longer exists and the darkness will prevail for ever. Sometimes, we just need a guiding hand to lead us back to the light. This can be your support network, a therapist or even a GP. There is some breastfeeding safe medication if that’s what is needed short term to help you out of the worst, but it is always advisable to seek therapy to deal with the causes not just the symptoms.
The unknown of birth, especially if it is your first or a negative previous birthing experience as well as the fear of the unknown new life with a big responsibility for this new fragile person in our arms can bring on feelings of anxiety. Anxiety is a heightened state of being, it’s a survival mode, a state in which we constantly look for risk and danger and over analyse every decision, we are tense, ready to fight, fly or freeze. The constant state of hyper-vigilance is exhausting for the mind and the body, if left unattended it can lead to panic attacks, depression or onset of chronic illness. CBT therapy and Mindfulness are incredibly effective when it comes to managing anxiety and many people swear by CBD oil to help them stay grounded.
Birth itself need not be a traumatic event and thankfully for many it is a smooth process, with no lasting negative impressions. However, not all births go according to plan. Pain on its own is not necessarily traumatic, especially if all the right hormones are kicking in as they are meant to and the mother is surrounded by supportive loved ones. However, pain experienced during induction, cervical sweeps and assisted births can in itself be traumatic as those important hormones are often not present. If there is a risk to life of mum or baby at any point during or after delivery, if there is abnormal bleeding, perineal tear, emergency c-section, use of medical tools to assist birth or long, painful and protracted labour, this can also cause trauma. Often just the fact the birth did not go as we have dreamed it would do can cause trauma. Unfortunately, in the moment the trauma is being experienced, we are often immobilised (through epidural, spinal tap or anaesthetics) and cannot act on our impulse to move, to scream the rage out, to shake the pain off and so we get stuck. If we are not aware this had happened and therefore cannot take timely action to release the trauma, we are likely to develop PTSD.
Post traumatic stress disorder is basically a result of a traumatic event, where a survival response could not take place and the event has not been processed, it is therefore stuck on a loop, often causing seemingly unrelated symptoms and getting triggered by benign events. The most common symptoms of PTSD are sudden feelings of anger or rage, violent outbursts (often out of character), flash backs (but not always), intrusive thoughts, nightmares, insomnia and phantom pain.
Trauma can be released through body work like yoga, massage, acupuncture and craniosacral therapy, through energy work like reiki, theta healing, MDMR or EFT and through talking therapies like hypnotherapy, NLP and CBT or traditional counselling. Sometimes, trauma can release spontaneously during connected conscious movement like dance, yoga, pilates, horse riding, swimming or even sex. This release often comes in a form of physical shaking, crying and/or buzzing in the body. It is important not to interrupt this process, but rather hold the space for it till it passes on its own. This is often followed by an immense feeling of peace and relief.
Trauma is not something we can prevent. It either happens or it does not. We can however pro actively release the trauma before it starts negatively affecting our lives. Depression and anxiety are often coping mechanisms for unresolved trauma, while panic attacks and suicidal thoughts are the extreme ends of their symptoms. Trauma is a big subject to dive into and I encourage you to read up on it because if you are alive you have experienced trauma at some point in your life. Traumatic event does not have to be so in an obvious way, to another person the situation might seem benign, the trauma is caused by our perception of the event and we perceive the world around us through filters of our previous experiences, biases and unresolved traumas. Untangling this hot mess while sleep deprived and in the grasp of the hormonal rollercoaster can be rather difficult, so do reach out for help, you absolutely don’t need to and should not have to go through this alone and unsupported.
It is not just birth mothers that can experience PTSD after birth. Their birthing partners can be affected too, even if the birth went well. In the past, only women used to be present at births and often from a relatively young age. Birth was a part of life, all the women present would have an active role to play and supporting the mother and many would have given birth themselves and have seen plenty of births throughout their lifetimes. They were used to it, they knew what was coming and it was unlikely to be traumatic, unless the birth did not go well. In recent times, we have lost this tradition and witnessing a birth in person is rather rare for people unless they are chosen as a birthing partner. Most of the time, this role lands on the father of the child. If he has not watched a birth before, if he has not seen and smelled blood in large quantities, if he finds it hard to see his partner cry or to be in pain, even if the birth goes well, this experience can be traumatic. If there are complications, the trauma resulting from there can be quite severe. Unfortunately, this is not much talked about yet and many men go through PTSD, PNA and PND undiagnosed, their symptoms often having negative effect on their relationships and they have tendency to escape through addictive behaviours (alcohol, drugs, gambling, gaming, gym etc). Men are also likely to seek help or to confine in a friend. Of course, this applies to same sex couple too. If you notice that your partner seems to be experiencing any of the symptoms I mentioned earlier, do talk to them and encourage them to seek help.
As I mentioned before, there is little we can do to prevent trauma, however there are few things we can do reduce the risk of it having too much of an impact. If you have history of PTSD, anxiety or depression, speak to your therapist or GP and your midwife while you are pregnant, so you can put a solid plan in place to support you should you birth result in PND, PNA or PTSD. You can also address any possible triggers with your therapist and establish a toolkit that you can use to maintain your mental well being. If neither of these things are an issue, educating yourself about birth can really help reduce the risk of trauma occurring. Know your options to eliminate feelings of helplessness. Choose your birthing partner wisely. Experienced doula or a midwife, can make a lot of difference. Make sure you prepare your birthing partner, so they know exactly what you’ll need from them. I would recommend for them to watch some real life birthing videos to get accustomed to at least the sights. If you are able to, have your support network set up and ready for after birth, so you can focus solely on your recovery. The first six weeks at least, you should only be taking care of the baby and resting. Any symptoms of possible PTSD will only be amplified by sleep deprivation and tiredness.
PND can sometimes simply be a result of the hormones that are raging after birth. Some foods have calming effects while others can make it worse. Have a look at a hormone balancing diet, this might help to keep things in balance without the severe ups and downs.
There are many therapies that can help with any of the above. I have named a few at the start, but there are plenty more. If you are already in therapy or in receipt of therapeutic treatments, build a support plan with your therapist and keep them informed of any symptoms you might develop, so you can nip it in a bud before it gets any worse. I would recommend a craniosacral therapy for you and your baby around 2-3 months after birth just to be sure. If you do not have a CS therapist, try and find one that comes highly recommended by someone you trust. CS therapy is not regulated yet and not all therapists are equal in their practice, however when done well it is incredibly effective in birth trauma release.
I hope this has not come across as all doom and gloom. Fortunately, most birth are not traumatic and the recovery can be relatively smooth. However, if you find yourself spiralling down into any of these awful conditions, ask for help as soon as you notice the symptoms. The sooner you can get help, the quicker you’ll be able to relax into your new existence as a mother, the warm cuddles and sleepy smiles, while preserving your energy for those challenging nights, constant feeds and endless nappy changes. Motherhood can be hard without the added burden of poor mental health. Your baby needs you, so make sure you take care of yourself first.