Perinatal Mental Health

What is perinatal mental health?

Perinatal covers through pregnancy and the first year of your baby's life. Mental health is something we all have. Just like with physical health mental health can be good or we can be ill and sometimes we're not great but doing okay. Also, just like we can eat healthy food and keep our bodies active to keep our bodies in good physical health we can look after our minds and keep our mental health generally positive too. But we also need to be aware of how to know if we need extra support with our mental health just like we do with our physical health. The year around when our babies are born can be a time that our mental health needs some extra care and when we need to be especially aware that if it doesn't feel right it's okay to seek out support.

These slides were produced by our Committee Vice-Chair Sinead who is a counsellor with a special interest in perinatal mental health for one of our monthly meet-ups when mental health was our topic. You can hear her chatting more about this topic in the video below.

Our blog editor Sarah also had a chat with our Committee Secretary Sally who is a Doula and has personal experience of perinatal mental health challenges.

Risk factors for perinatal mental health issues.

Perinatal mental health issues can happen to everyone but if you have had previous mental health issues you may be more likely to have them reoccur during pregnancy or postnatally. However, if you've had mental health issues before you may also be more aware of what you can do to help yourself. If you have unresolved previous traumas including having had a previous traumatic birth finding support with this during pregnancy is a really good way of mitigating this potential risk factor. Check out our blog post about recovering from traumatic birth for more information on this including links to people who can support you. If you have a previous experience with psychosis it's very important that you and your care providers are aware that there is a risk of this recurring postnatally and are prepared if extra support is needed. Check out Action On Postpartum Psychosis for more information.

Your lifestyle and previous life expectations especially if you are pregnant for the first time at an older age and have had a lot of control in your professional life up to this point can be a risk factor. If you're used to being able to keep everything really perfect in your home and personal life you may need to prepare for the realities of life with a newborn for the sake of your mental health.

How can I help myself have good mental health?

These ideas won't cure your mental illness you will need professional support with that but they are very good for keeping yourself in good mental health.

Keep moving, gentle exercise isn't just good for your body it's good for your mind too. This can be combined with spending time in nature which is also good for your mental well being. Take walks in the wood or by the sea or in the park, wherever is accessible for you. Have a balanced diet. Keeping your blood sugar levels at a balanced level will help you have a steady mood.

Practice mindfulness. Become aware of your thought patterns and self-talk. If you find self-talk is a source of negativity for you you might want to consider a course in mindfulness and/or cognitive behavioural therapy. There are lots of people who can help and support you with this. One place that has a lot of local resources is the charity Mind. You can check out the local Solent Mind website for information.

If you want to try mindfulness you can find tracks on YouTube or on several different Podcasts on Spotify. If you don't feel comfortable with mindfulness you might find a creative activity has a similar positive effect of keeping you "in the moment". This could be art (again lots of simple learn to draw videos on YouTube for beginners) or a craft such as knitting or cross-stitch or it could be something like putting lego models together. The important thing is that it's fun for you.

Practice Gratitude. Pregnancy is a great time to take up journaling, which is just writing out your feelings to help you express them rather than letting them build up in your head. A gratitude journal where each day you list some things you are grateful for can really help to create positive thought processes.

Join groups. It doesn't have to be specific mental health support groups, although those are available, any group where you chat to people at a similar stage of life to you will allow you to feel you're not alone and other people have the same thoughts and struggles. You may want to start by joining Facebook groups as it sometimes feels a little easier to get into conversation and get to know people that way before meeting people face to face. You're always welcome to come along to our groups. If you're planning to breastfeed you might find it helpful to go along to a local breastfeeding support group while you're pregnant as learning to breastfeed can involve a lot of different feelings and experiences which peer support can be really vital in coming through happily.

Who can help me if my mental health becomes a problem?

The Daisy Team. Local to us in Portsmouth we have a team of specialist mental health midwives who support anyone who has mental health challenges including people with diagnosed mental health illnesses, those who are struggling with tokophobia (fear of pregnancy and birth) and people who have had previous traumatic birth experiences.

Your own GP. Your doctor can support you in pregnancy especially if you're already taking medication for a mental health condition such as depression or anxiety. It's really important not to suddenly stop taking your medication when you get pregnant. It may be that you will be fine on the same medication through pregnancy or that you change or wean off medication but you should only ever do this with your doctor's support.

Talking therapies. These can be very useful for all kinds of mental health issues and can work well alongside medication or other alternative therapies such as acupuncture, chiropractic care, homoeopathy. You can access talking therapies through self-referral In Portsmouth through Talking Change and Hampshire through italk (in other areas you should find your local service with a web search for talking therapy self-referral *placename*).

Doulas. Doulas are people who are trained to support families through the perinatal years. They provide practical and emotional support which has been shown to have a very positive impact on mental health and can provide signposting when more intensive mental health support is needed. A good place to start finding out more is via Doula UK.

What about partners can they have perinatal mental health challenges too?

Absolutely mental health issues can happen for anyone in times of change in their lives and you don't have to be the one who is pregnant for this time to be challenging for you. Partners can use all the same positive mental health supports and can access support from their GP and from self-referral to talking therapies also. There are also organisations that can offer specific support Dad's Matter is a national organisation, Dadzclub is local to us in Portsmouth and The Queer Parenting Partnership offers support to partners and families who are LGBTQ+

Information not advice

As with everything we produce this blog is just information, not advice. If you need advice on your own mental health please always speak to your doctor or midwife.

Labour and Birth at Home

This post isn't just for people who plan to birth at home. That's why the title is labour and birth at home rather than homebirth. Unless your labour starts by being induced in the hospital (check out our post about that if that might be offered to you) some of your birth experience will be at home. If you have a super-fast labour it might all be at home whether you planned it that way or not. If you have a moderately fast labour it might be just a short time at home before you transfer to the birth centre or labour ward. If you have a slower burning longer labour it might be at home for a relatively long time before you transfer to your chosen birth location. So for everyone, there's some time labouring in the comfort of your own home. The good news about this is there's plenty of evidence that the home comforts can be very beneficial to you during that time.

So this post is going to be all about what you can do to help yourself labour and birth comfortably at home. If you're still wondering if choosing to birth at home as well as labour is for you or not you might want to check out the page about homebirth on Cathy William's Chilled Mama website too. It covers lots of information about statistics on the safety of birthing at home. Cathy's the author of the quote in the picture here "All births that start spontaneously are homebirths. It's just that some have planned transfers. This quote is mentioned by our committee secretary Sally during the video chat we recently had about home birth which you can watch below.

This is the link to the video Sinead mentioned in the chat.

Our practical tips for labour and birth at home.

If you don't already know about oxytocin you might want to do some reading up about it wherever you plan to birth. One place you could start is our blog post of ideas for helping yourself through labour.

In your own home, you have the safety and comfort you need to build up your own oxytocin and endorphin levels. In early labour, this might include privacy for smooching or massage etc from your partner. Or if you don't feel like being touched at the time it's a space and facilities for watching funny TV or listening to funny podcasts.

It's completely up to you who you have with you in your own home, have your older children with you, or have someone else around to look after them whichever helps you feel the most relaxed. Have family members or friends who make you feel relaxed and happy or who can make you laugh. Or ask everyone to leave or go downstairs while you shut yourself in the bathroom in the quiet and dark.

Your own bathroom is a brilliant tool for helping yourself to progress in labour, the safety and natural feeling of release you get when you sit on the toilet can be really helpful Or you can take a bath or a shower and the water can be fantastic for helping you relax.

Your own kitchen means you can eat what you like when you like and so can your birth partner and team. Some people find making a cake is a great distraction for during early

labour.

You can set yourself up a birthing nest in your favourite room of your house. Set up a birth pool that you know will be available for you. Set up a display of your favouite positive affirmations, put up fairy lights, make it cosy for yourself. Also remember that when you're in labour you may find yourself picking some other place around the house. But even if you do that in labour the positives from just preparing that space are all the relaxing effects during the last days of your pregnancy. Plus wherever you birth you will have that lovely set up to relax in once baby arrives.

Being able to cuddle up in your own bed once baby is here and everyone but your new family is gone is such a lovely feeling. One brilliant tip from the team is to make your bed with lovely sheets, then cover those with a waterproof layer then a set of old sheets. So if the bed gets messy during labour you can peel off the top layer, pop it in the washing machine and snuggle down in your nice clean sheets when you're ready.

Plans in advance and decisions on the day.

One of the things we talk about in the video and that we talk about very often is to remember that plans are flexible. You might plan a homebirth and on the day decide for some reason you want to go into hospital, you might plan a hospital birth and on the day

your baby might have other ideas and arrive before you expect while you're still at home.

It's really important to remember that there are no wrong decisions, you make the right decision for you at that moment with the information available to you at the time. Birth is not a pass or fail event, if you hear terms like failed homebirth remind yourself that language isn't helpful or accurate. It's much more accurate to say homebirth with transfer during labour or after the birth. Making the decision to do something differently to your plan A (including transfer to hospital) when information or events make that the right choice for you at the time is always part of the plan for any birth.

Sometimes labour can happen faster than expected and being prepared for the possibility that your baby could arrive before the midwife will make that a much less scary event should it happen to you. The team's ideas for being prepared include watching lots of homebirth videos (available on YouTube for example) so you're used to seeing the natural progress of uninterrupted birth and doing a course that covers first aid and specifically first aid for childbirth. Such as this one from midwife Joy Horner.

Homebirth Stories

Keep your eyes peeled here for when our new birth stories podcast launches soon. If you can't wait for that pop over to our Instagram and check out the Birth Stories Highlight.

Taking the mystery out of induction of labour.

What is induction of labour?

Induction of labour is any process that exerts external influence to try and start the body's process of labour and birth. This may include anything you try to do yourself such as having sex or eating curry and anything you have done by a holistic practitioner such as a chiropractor, acupuncturist or reflexologist to help your body do what you want it to do.

It also includes the 'stretch and sweep' or 'membrane sweep' procedure which involves your care provider inserting their (gloved) finger into your cervix and separating the membranes holding your waters away from the cervix with a circular sweeping motion. This is not always recognised as part of the induction of labour process but it is an intervention with the object of starting labour off. As with any intervention your care provider needs to make sure you're making an informed decision on whether or not to accept that intervention. So, they will be very happy to help you go through the benefits, risks and alternatives with you and to let you know what will happen if you do nothing. You can ask as many questions as you need and think through what your instincts are at the time before making your decision.

This way of thinking through your choices is very useful and you will notice we frequently reference it. We remember it with the acronym BRAIN.

Medical Induction Process

This process starts with you being admitted to hospital and having the usual checks to be sure you and your baby are healthy. An internal exam is given which allows your care giver to assess if your cervix is open enough for your waters to be broken. If it is then you skip to that step if not you go through a process of 'cervical ripening' which means moving your cervix from long and closed to short and slightly open. First a pessary is inserted into your cervix, either an artificial version of a hormone prostaglandin called prostin or a balloon catheter (a small absorbent rod that gradually expands to mechanically open the cervix). If this is effective you will then be offered a 'rupture of membranes' which allows your baby's head to press down onto your cervix and hopefully to tip your body over into the process of labour and birth. Sometimes your body will tip over during the first process (usually if it was very close to spontaneously beginning to labour anyway) and sometimes even after your waters are broken contractions won't start. Depending on how your body reacts to these interventions further interventions may or may not be offered. The process is individual to you and to how busy the labour ward is at the time. It may go faster or slower than originally anticipated.

Here are some flow charts produced by our local maternity department. Your care providers may assume that once you agree to start the process, you're expecting to agree automatically to each next step in the interventions process. However, they should also be clear with you that you have the right to make an informed decision about each intervention and that you can change your mind or make different decisions when it feels right to you.

Since these charts were produced, in Portsmouth, it has also become possible for anyone being induced to choose a balloon catheter rather than a prostin pessary. It's no longer just available for those who have had a previous caesarean birth.

The hormone drip.

If you go into labour after the induction process up to the point when your waters have gone you have every chance of going on with your original birth plan including water birth and active birth. However, if you don't start to have regular strong contractions shortly after your waters are broken you will then be offered a sytocinon drip (a synthetic form of the hormone oxytocin which among many things acts on the uterus to cause it to contract). In order to agree to the hormone drip, you can talk through all the benefits, risks, alternatives and what if you do nothing questions with your care provider before deciding what your instinct is to do. If you choose to have the drip you will also need to agree to continuous monitoring. This may limit the amount of moving about you are able to do but you may still be able to stand or kneel. At this point, you may find the methods you've been using to work with your contractions continue to be effective or you may find you want to talk through other alternatives such as an epidural with your care providers.

Many people who choose to use the hormone drip and/or an epidural will go on to have their baby without any further assistance. However, if the pushing stage of your labour goes on longer than expected you may be offered an assisted delivery (either vacuum-cup or forceps) or a caesarean birth. This is another point when you may want to go back to your BRAIN decision-making tool. As always, your decision is totally individual to you.

More details on the process of induction of labour can be found on the NHS website and on the NICE website.

Why Might I be Offered and induction of labour?

Sometimes induction of labour is offered because there is a concern for the wellbeing of you or your baby that means your care providers feel it would be safer for baby to be born now. One example of this is with pre-eclampsia. Sometimes induction of labour is offered after your waters have gone spontaneously but you haven't started having strong regular contractions within the first 24 hours and your care providers are concerned you or your baby might contract an infection. Sometimes induction of labour is offered because your baby seems to be bigger or smaller than expected.

But the most common reason you will be offered induction is to prevent 'prolonged pregnancy' which is defined as longer than 42 weeks. However, it's more and more common for various reasons for people to be offered induction before this point. Often induction at 41 weeks may be standard due to how long inductions can take and care providers wanting to try and ensure babies are born before 42 weeks. People who are over 40 years old and pregnant, people who have regular or gestational diabetes, babies conceived via IVF are all frequently offered induction at or before 40 weeks of pregnancy.

Because induction is part of the usual care plan offered to everyone by 41 weeks it can often be mentioned in conversation during routine appointments from as early as 36 weeks pregnancy.

Is induction of labour the only alternative? Am I being difficult if I would prefer to avoid induction?

As with every intervention induction of labour no matter how it's presented is an offer and there are risks as well as benefits and alternatives you can choose if your instincts tell you, they would be better for you. The main alternatives are what's called 'expectant management' - closer monitoring of your health and your baby's health until spontaneous labour begins- or planned caesarean birth.

If you are having a normal healthy pregnancy, you're not being difficult even if you let your care provider know in advance, you're not planning to have your labour induced and would prefer they leave any discussion of the option until you bring it up or there is a medical reason, they are suggesting immediate induction of labour. You're also not being difficult if you say I'll have to do some more research can you provide me with more information relevant to me personally to help me make my decision. And you're very much not being difficult if you say thanks for the offer but I will decline for now and chose expectant management.

If I consider all the options and decide induction of labour is right for me what can I do to help myself have as positive an experience as I can?

Knowing what to expect can be really helpful, talk through the process at your local hospital with your midwife or doctor, know what the facilities you will have access to will be, know who can be with you to support you and when they can be there.

Be prepared for this to be a long process. Sometimes, when your body was pretty much ready anyway induction works quickly and usual processes take over and babies are born quickly so still be prepared with all the plans you had made for spontaneous labour to help you work through your contractions, hypnobirthing, breathing, movement, using water etc.

But also, be prepared to keep yourself busy and relaxed and not wondering how much longer it's going to be. Take your own favourite and comforting smells with you, your own pillow or blanket or your favourite essential oils or your mums jumper that smells like her for example. Take and eye mask and headphones or earplugs and sleep if you can. Take a good book or download some funny TV or a funny podcast to take with you. Go for a walk, go relax in the cafe, go meditate or pray in the chapel or prayer rooms, do some gentle movement from your birthing class or pregnancy yoga, phone a friend, facetime your family, bounce on a birth pool, slow dance with your partner, snog a little bit, get your partner to give you a head massage or a foot rub, basically anything that makes you feel relaxed and happy.

Information is your tool to use as it helps you.

As with everything we post we hope you find the information useful and that it helps you to think through your own personal decisions. But we're very clear that we're not offering advice. Our only advice is to talk to your midwife or doctor and make sure you get all the answers you need to make your own informed decision.

You're invited to come and hang out with us.

We have 3 monthly meet-ups check out our home page for up to date details.