PERINATAL — Self Psychology

Signs of birth trauma might include:

- Re-experiencing the event: flashbacks, nightmares, high levels of fear

- Intrusive thoughts or memories about labour and the early postpartum period

- Hyperarousal (vigilance, irritability, anger)

- Avoidance of situations that trigger memories

- Negative self-image, feeling worthless, defeated, or guilty

- Relationship problems

- Emotional dysregulation or numbness

- Dissociation (being disconnected) from yourself or the world around you

- Negative mood or thinking

- Avoiding intimacy

- Delaying further pregnancy

- Disconnection from baby

- Confusion about what happened during birth and why

- Distrust of medical professionals

Birth trauma or birth-related distress is a complex area, and a combined approach will help you deal with emotions and feelings that may surface and can promote healthy healing.

- One in five Australian mothers will experience mental health difficulties during their pregnancy

- One in ten men will experience mental health difficulties in the perinatal period

- One in ten women will experience postnatal depression

- One in seven women will experience postnatal anxiety

- One in three women describe their births as traumatic

- One in seven couples experience difficulties with conception

- One in four pregnancies end in loss

Perinatal depression and anxiety refer to changes in mood that may occur during pregnancy or the postnatal period. The childbearing years, especially the first few weeks after childbirth, are the peak period for the onset of depression in women.

Symptoms of postnatal depression:

There can be differences in the nature, severity and duration of the symptoms of depression seen in women who are pregnant or have recently given birth. Professional help is generally required to diagnose the type of depression and decide the best approach to treatment.

Common symptoms include:

• Loss of enjoyment in usual activities

• Loss of self-esteem and confidence

• Loss of appetite and weight or weight gain

• Difficulty with sleep (irrespective of the baby’s routine)

• A sense of hopelessness and of being a failure

• Suicidal thoughts or ideas

• Panic attacks

• Loss of libido

• Fears for the baby’s or partner’s safety or wellbeing.

Symptoms of postnatal anxiety:

While pregnancy and the arrival of a new baby can be very exciting, many parents experience some worries about things like having a healthy pregnancy, delivering the baby, keeping their baby safe, and potential impacts on their relationship, career, or finances. For some people, those worries can become overwhelming and unmanageable. Anxiety during pregnancy is often underdiagnosed. Symptoms may include excessive worry, a sense of dread, physical symptoms of anxiety such as elevated breathing and heart rate, stomach distress, and difficulty sleeping.

If you’re worried about yourself or someone you know, you must reach out for help as soon as possible.

For most women, birth is a positive experience. However, it can also be very confronting or traumatic for mothers and their partners. Birth can leave physical or psychological wounds that have a lasting impact on a family’s life due to fear, shame and embarrassment, or not knowing how to get help, and many women suffer for a long time. This can lead to difficulty with breastfeeding and bonding with the baby, fear, anger, guilt or detachment from their baby or partner, intrusive thoughts and/or anxiety about future pregnancies.

Melissa works closely with Dr Danny Tucker, a consultant Obstetrician with over 30 years of experience.

Melissa + Danny offer a multidisciplinary birth debrief service. A birth debrief offers the information to explain what happened, why and what this might mean for future pregnancies, if relevant: a space for you to prepare, to manage the feelings which may arise and help to understand and process them.

The typical course of support would look something like this, although support will be tailored to your specific need.

Visit 1: Melissa - intake, review of current symptoms relating to birth, which may include screening questionnaires and goal setting. This could take more than one session.

Visit 2: Melissa - preparation for birth debrief and strategies to prepare for emotions and feelings that might arise. Consideration of ways to support your well-being during and after the debrief.

Visit 3: Danny - birth debrief, which may include the following:

- A review of the documented events of your birth and/or antenatal care

- An explanation of why events might have taken place and an interpretation of the medical record

- A conversation about the medical implications of what happened for your next pregnancy or health in the future

- Referral to appropriate professionals to support your ongoing recovery, if needed

- Further follow-up as needed

Visit 4: Danny - birth debrief and planning for next time if relevant. Some women may not need two sessions; others may need more.

Visits 5 onwards: Melissa - ongoing therapy to help process what you have learned, manage new and long-standing symptoms, bring healing to your birth experience and explore your vision of parenthood. The number of sessions will be determined by your own goals and needs with the intention of strengthening the bond with your baby, and improving family well-being and self-compassion.

Consultations with Melissa and Danny can be provided face-to-face or via telehealth. This service is available to women and their partners from anywhere in Australia.

You may be eligible for a Medicare rebate for appointments with Melissa and/or Danny.

You can also see Danny separately, without seeing Melissa, for birth information and pre-natal planning. Please see further information here.

As with all forms of depression, there’s a range of physical, social and emotional factors that can contribute to fathers and non-birthing partners developing depression:

• a lack of social and emotional support

• stress and changes in your relationships

• a lack of sleep

• grief and loss issues

• difficulty adjusting to parenthood

• meeting expectations

• a negative or traumatic birth experience

Some fathers and non-birthing partners may find that the changes to their home life and family structure are difficult to cope with. Worries about extra responsibilities, financial stresses and managing work can also have an effect. For men, traditional attitudes towards fatherhood and masculinity can mean that men are less likely to talk about how they feel.

Some of the known risk factors associated with depression in paternal and non-birth partner depression include:

• the mother experiencing postnatal depression

• a previous history of depression

• relationship problems

• low self-esteem self-

• feelings of incompetence in the parenting role

• first-time parenthood

• an unsettled baby

Some of the symptoms associated with postnatal depression in men and non-birthing partners include:

• tiredness, headaches and pain

• irritability, anxiety and anger

• loss of libido