*Perinatal Mental Health from a Needs Perspective

I remember back in the early '90's' when the term “Mental Illness” was changed to “Mental Health”. It was done with the purpose of making it more ‘acceptable’. If it has worked, it has not gone far enough. 

And the one thing it has done is to confuse people. People will now say “I’ve got mental health” when they have everything but that. The ‘Needs’ model shows how we can have mental Health and also give insight into how mental illness develops.

In this blog I am talking about mild - moderate antenatal and postnatal anxiety and depression. I am not talking about severe perinatal psychosis - but if you want to know more about this, then please do read Sara Shoesmith’s story in the link at the end of this blog.

The factors that cause perinatal mental health problems can be the same - the difference is how the mind/body reacts.

If you consider yourself in relation to physical illness - when you are run down - do you tend to get a sore throat? An eczema flare up? Tummy troubles? 

Then look at yourself in relation to mental illness/health - when you are running on empty - do you tend to suffer low mood? Worry? Or reaching for comfort food/behaviours. The answer to this one gives a clue to whether you might succumb to depression, anxiety or addictive behaviours or thinking.

So why does the perinatal period bring about increased risk of mental health problems and why does it seem to be more common than ever? 

I have been working with people with perinatal illness for more than 30 years and for the last 20 years my understanding of the human givens approach has really helped me to help others. 

Let me tell you about the human givens approach.

Humans, just like all living organisms have needs that have to be met in balance in order for us to be physically and emotionally healthy. 

We can all look back at times in our lives where we felt happy, in flow and where all our needs were met. Some of us are lucky enough to feel this way for a long time and some for only short periods of time. 

When our needs are not met either very suddenly and significantly or over a longer period of time, we start to feel stressed, anxious, depressed, angry or more addicted to certain behaviours and thoughts.

Our ‘Given’ or ‘Innate’ needs are:

  • Food and Drink
  • Movement
  • Sleep
  • Attention
  • Security
  • Control
  • Achievement
  • Respect
  • Privacy
  • Meaning and Purpose
  • Community
  • Emotional Connection

When we go through a life change (such as pregnancy or becoming a parent) we find that we cannot always meet our needs in the same way as we did before. We have to spend some time re-mapping our lives in order to meet those needs.

Pregnancy is a huge time of change. Not only does our body change - growing far faster than it has since we were first born but our brains change as well. 

  • The changes that a body goes through in pregnancy are well documented, so I will not describe them here, but the feelings a woman goes through with these changes can be complex. It can be hard to appreciate the aches and pains, the veins and stretch marks and the change of shape and tone of many body parts. 
  • The changes in lifestyle are often challenging. We spend a lot of time at work and identify with our work colleagues and our work role. When we leave work to have a baby, we suddenly lose that connection with colleagues and can feel isolated and as if we have lost our ‘place’ in our community. We also lose the recognition and achievement that come with our work. Knowing this is OK rationally and feeling it emotionally are two different things!
  • Our brains change quite significantly during pregnancy and in the weeks afterwards. Most of us recognise our difficulty in thinking clearly, remembering simple things and concentrating. This is due to the changes in our brains that come about with childbirth and nurturing a baby. During this period of change it can feel that we do not recognise ourselves, this alone can cause anxiety. Once we have ‘rewired’ our brains, we think differently often having an ability to see the bigger picture and focus less on the detail than we did before pregnancy.
  • Apart from Body, Mind and Employment changes there can be other changes that women go through at this time. Moving House, reviewing their whole family relationships, living with their partner for the first time or coping with other life events such as bereavement or other loss.

Take these cases:

Trudy had been working as a teacher, she had been with James for 9 years and they felt that now was the time to have a baby. It wasn’t long before Trudy was pregnant, and they both enjoyed making preparations for the baby. Unfortunately, after a ten hour labour the baby became distressed and Trudy had to have an emergency caesarean, Baby Alfie was whisked away to NICU for four hours, and Trudy felt that it was an age before she was able to hold her baby.

Alfie and Trudy were well enough to go home 36 hours later. Although they were all tired, James was very supportive, and Alfie started Breastfeeding.

Two weeks later James went back to work and Trudy was alone with Alfie. Trudy couldn't believe her luck to have such a gorgeous baby and felt a rush of love whenever she saw him. Yet something was wrong. Trudy found she was really tired, weepy and unfocused. It was all she could do to feed Alfie and keep them both clean and (mostly) dressed. Trudy wasn’t sure if she was anxious or depressed, she kept checking on everything, felt that she had lost all powers of concentration and really felt that she ‘couldn’t be bothered’ to do anything she used to enjoy.

Luckily we also have a set of innate resources (the illustrations are from in8’s Anxiety Freedom Cards) Here are some suggestions for how Trudy could use these innate resources to help herself.

Trudy found it difficult to work out why she felt so low. There seemed to be no logic to this. 

But she started to make very short lists of things to do and enjoyed playing Sudoku - this helped her to re-engage here rational thinking.

She kept catastrophising and imagining that she would always feel like this. 

With her Mum she started to talk about the future, wondering where they would take Alfie and what games they might play as he got older, a much healthier way to use her imagination.

She couldn't remember much of what she had done in the last few weeks and remembered with fondness how much easier it had been for her to go to work. 

Talking to friends with babies helped her to remember some of the things she had hoped for and she started to be able to remember how much she had actually achieved on such little sleep and in only a few short weeks.

She  felt that she would always look drab and feel low, and when she looked at things that she used to enjoy all she felt was “well it isn't like that now!” 

With a bit of encouragement from James she saw that she had a pattern of always wanting to do everything ‘right’ or even ‘perfect’. Motherhood was never going to be like that. “Done is better than perfect” became her new pattern match. 

She saw that everyone around her coped well and she was the only one who found it hard. 

On a night out with some of her ‘mum friends’ conversation quickly turned to how exhausted everyone was and how hard they found it to be who they used to be, just taking time to get into genuine rapport really helped this.

She wasn’t sleeping well and longed to feel that feeling when you wake in the morning and the problems of the day before don’t feel that big.

Trudy talked to James and told him how much she needed sleep. They agreed that she would have an early night and sleep in the spare room while James took charge of Alfie, just bringing him to Trudy when he really needed to feed.

Although in some ways she felt ‘blank’, she felt that she was being hijacked by her emotions and it was only the love for Alfie that got her out of bed in the morning.

An old friend reminded her of how she used to ‘chill out’ by doing Yoga, going swimming and using 7-11 breathing techniques. She also taught Trudy how to scale her anxiety level on a 1-10 scale and then do something to lower the anxiety by just 1 or 2 points. Gradually the tsunami of emotions lessened.

Sometimes Trudy really felt that she had ‘lost herself’ and felt ‘disconnected’.

Trudy’s big sister came for a visit and seeing Trudy distressed just said “Trudy, Trudy, Trudy, what do you need right now?” Trudy looked at her sister and said - “I just need to know its ok” Trudy’s sister said “it’s ok” and indeed at that moment it was. Trudy found that she often said to Alfie “it’s ok” and she listened to herself too. 

Let’s check Trudy’s innate needs (in bold) ...

  1. Trudy wasn't eating and drinking as she used to. 
  2. She was hardly leaving the house and taking little exercise.
  3. Sleep seemed to be a distant memory
  4. The disturbing birth and the fact that she was home alone a lot made her feel more vulnerable she felt the need for security.
  5. She didn’t feel that she was getting any attention or giving any to anyone except Alfie.
  6. She didn't have an emotional connection with her friends, and hardly cuddled up with James as they used to do.
  7. Trudy felt that she had no control and that she could never do what she wanted when she wanted.
  8. Where Trudy used to enjoy looking back at all the things she had done in the day she felt that she was not achieving anything worthwhile
  9. From being a happy, active, sociable teacher gaining others and her own respect Trudy struggled with being ‘Just a Mum’
  10. Trudy missed her work colleagues and her students, and felt she had lost her community 
  11. The day to day looking after Alfie didn’t seem to fit with the true meaning and purpose of bringing up a happy healthy child.
  12. Trudy longed for a few moments’ privacy, just a time to think her own thoughts and be alone.

How might you help Trudy?

If you are a therapist, you will already have some tools to help but you might be able to be even more effective by helping Trudy to see how she can start to meet her emotional needs in this time of transition. For more info see in8’s Anxiety Freedom Cards

If you are wanting to help a mum who is struggling, together you could focus on how to help Trudy get her needs met and together use your resources to achieve this. For more info see in8’s Anxiety Freedom Cards

If you are a mummy (or daddy) who is struggling, talk to someone, it is much easier to make changes if you have friends, family or professionals to help.

In the first instance talk to someone close to you. Secondly reach out to your health professionals. Thirdly - contact me at www.bindigauntlett.uk

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Why having post-natal depression doesn't make you a bad parent - with Sara Shoesmith

*‘Perinatal’ covers both the antenatal and postnatal periods.

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