Preparation is your key to being a confident and capable parent. No matter what stage you're at, having more information and support will help you. This is simple, but we all forget this. As you become a parent help yourself and your partner by adjusting your expectations and asking for help. Preventative therapy for new parents might be a good tool for you.
This past week we had the privilege of speaking with Singapore-based counselor and psychotherapist, Silvia Wetherell. This is the fourth part to our interview. Silvia is one of the leaders in maternal mental health in Singapore, a field which she believes could use a lot more attention.
Zach: It sounds like it's common that past trauma and issues are inflamed after becoming a parent. This makes me think that preparation in pregnancy, or before getting pregnant, if a couple plans for it, could be a good idea for your mental health.
Oh my goodness, yes! I wish we were doing more of this. When I got to Singapore I tried to set up some mindfulness based groups for pregnant women and there was very very low interest. When women are pregnant, it's like there are these blinders on: "I don't want to hear about that. I just want to hold onto this idea that everything will be fine, and I'll be fine, and I don't want to hear about it." So unfortunately the women that come and see me when they're pregnant, they've already had a baby. They've already gone through it all and now they know. So they're like "OK I'm pregnant again, I need some guidance. I want to work on my happiness. I want to be ready for this new baby."
Unfortunately it's really difficult to run such programs. That's my experience. I'm not sure if you've talked to academics and researchers and if they've said the same. But if you look at the research, there are lots and lots of articles about postpartum issues... Unfortunately there isn't enough education on these type of situations. They'll only be open to it if they're already anxious or depressed when they're pregnant. If they feel OK, they're very unlikely to seek information and support and guidance. I've contacted local providers and I've even offered to come and talk a little about mental health with women after they've had their babies, but these classes are just jam-packed with information about pain management during labor, breastfeeding, C-sections, and so on. So providers in general still don't feel that it's important enough. However good antenatal classes should have at least half an hour talking about the possibility of postpartum depression. But yes you're right. I wish we were doing more education. If the women were prepared they could look out for the symptoms and act sooner, not wait until it gets really bad.
Zach: If you could have a brochure in every pregnancy center, or make a public service announcement for pregnant women or women looking to get pregnant, with regard to mental health, what kind of tips would you include?
First of all, adjust your expectations. There's always this fantasy of what you're going to be like, and what your husband is going to be like, when the baby comes. Women are often not conscious of these very high expectations that they've put on themselves and their family. So clarifying expectations about what it will look like when the baby comes. For example, it's important to not be so attached to the notion that you're going to have a normal vaginal delivery. That might not be possible. That is not something within your control. Or "my husband is going to be amazing and change every single diaper and be up in the night with me." Really? Have you asked your husband about this? So I think a lot has to do with expectations, especially of oneself.
After going through delivery and that initial newborn period, women can feel like a failure. They find themselves doing things that they thought they weren't going to do. For instance, they'd say "I'm never going to give my baby a pacifier, that's such a lazy thing for a mom to do." And then after the baby is crying and crying, and has been consoled on the breast for days on end, they give the baby a pacifier and they feel really guilty and terrible because they never thought they'd have to do that and therefore they're some kind of failure.
So it's important to start off motherhood with flexible expectations, with openness. That's ideal.
The other main point is to get help and support. We're not meant to be doing this on our own. There is this trend of very nuclear isolated families and the woman tries to do everything. This is not sustainable. Practical and emotional support are both important. There is a lot of pressure for a woman to be supermom and do it all. And do it all on her own. And for the body to bounce back to pre-baby within a couple of months. And for her to go on dates with her husband and have makeup on. And for her to be at home baking organic muffins for her baby. This is just not realistic or sustainable. I often find with mothers that are struggling, if you look at their histories, have really struggled to reach out and be vulnerable. I say "be vulnerable." Ask for help from the people that are closest to you, whether that's your mother, your mother-in-law, or a close friend. Or for example in Singapore, I work a lot with the expat community, the expats don't have family there. So they'll hire a helper, or a cleaner, they'll pay for a midwife to come and visit, and they'll come and consult with me.
You can create a community around you, to support yourself. You're not meant to do this alone. For hundreds and hundreds of years we've raised children in a community.
It's good and healthy to have an unattached figure carry your baby for an hour or two so you can have a little bit of a break.
I'll share some of the main symptoms that signal when to ask for help. Some degree of anxiety is normal, and to be expected (for some techniques to deal with it click here). What is not normal is constant intrusive thoughts or images, such as something bad happening to the baby. Now and again it's OK, but not if they're happening all the time. A common example of that for a new mother is that she'll have the baby sleeping next to her, and the baby has been sleeping maybe for four hours. The mother will wake up in the middle of the night in a fright, worrying if the baby is still alive. So she'll wake up the baby to check if it's still alive. If you do this now and again, it's not a problem, it's very common. However, if you're hovering over your baby and can hardly sleep, just to make sure the baby is alive – you're watching it breathe thinking that something bad is going to happen to the baby – this is not normal.
You need to get professional support before that anxiety really escalates. So you can have a form of postpartum anxiety that is like Obsessive Compulsive Disorder (OCD), which consists of a lot of intrusive thoughts. It's very common, much more than depression. Postpartum depression doesn't look like normal depression because you're probably not hiding at home under the covers and not going out at all.
Sometimes it's called a smiling depression because mothers to the outside world will look like they're happy, but they're not. Inside, they can be really low, struggling, sad and overwhelmed.
It's like a numbness, a disconnection with the baby and with other people. You seem to be there, but you're not really there. You're going through the motions but you're not really there. This is what depression can feel like. Changes in appetite, eating a lot more or less. Disturbances in sleep, which could be really hard to spot because already the sleep is quite disturbed by the baby waking up in the night. Women can also get very emotional and angry. Sometimes angry feelings arise towards the baby, but more often towards the husband because she doesn't feel comfortable expressing that anger towards the baby. When I work with pregnant women I tell them that it's common for this to happen sometimes. However, if it's happening a lot, professional support is needed. These are some of the symptoms, but they can really very from woman to woman. Some women start having panic attacks – their heart starts beating fast, they can't breathe, and they feel dizzy and have shakes.
You go from just being responsible for you. And then all of a sudden when you're discharged from the hospital you've got this really vulnerable human being. All of a sudden you're supposed to know what to do with the baby? Even professionals will tell the mom "oh you'll be fine. Just trust your intuition, you'll pick it up." That can be very daunting. So women are often going home very unprepared. They usually haven't had experience looking after a newborn. So it makes perfect sense that a lot of anxiety arises around this period.
This concludes the fourth part of our interview with Silvia. This segment touched on why it's important to adjust expectations, build a support network, and some normal and abnormal behaviors for new parents. The subject matter largely relates to postpartum and postnatal depression. If you're interested in some more focused blog posts for dealing with these issues specifically, see how to identify the symptons and the techniques for dealing with them. Continue to follow our blog to hear more from Silvia on maternal mental health care.
To consult with Silvia Wetherell in-person or remotely from her Singapore office, contact her directly through her profile.