depression

Perinatal depression is depression experienced during pregnancy or after childbirth . Lots of people have heard  of postnatal depression (PND) but many are not aware that you can experience depression during pregnancy as well. 

Around 20%, one in five, expectant and new mums experience perinatal mental illness.  One in ten dads also experience poor mental well-being during this period. 

No one really knows what causes depression.  There are some biological factors, such as hormones and chemicals in the brain, which when combined with other factors can make someone more prone to poor mental well-being.  The following are risk factors for perinatal depression:

• Previous history of poor mental well-being or mental illness
• Family history of perinatal mental illness
• Poor marital relationship
• Lack of support network
• Recent stressful life events
• Traumatic delivery
• Multiple birth
• Social deprivation
• High achievers/white collar professionals
• Low self esteem 
• History of trauma or abuse 

• Depressed mood - feeling sad, tearful, unhappy
• Feeling anxious or nervous
• Exaggerated fears
• Sleep disturbance
• Appetite disturbance
• Exhaustion/fatigue
• Loss of libido
• Irritability and anger 
• Guilt/shame
• Feeling a failure
• Not a good enough mum
• Social withdrawal
• Poor concentration and memory loss
• Self harm 
• Suicidal ideas/plans

• Medication - antidepressants can provide a 'lifting effect' which provides a stepping stone to work of improving mental health.  There are lots of different types, including some that will allow you to continue breastfeeding if you wish. Research suggests that medication works best in conjunction with talking therapies. 

• Talking therapies/Psychological Intervention - counselling, talking therapy and Cognitive Behaviour Therapy (CBT) all provide a space to process and understand your feelings and work towards recovery

• Peer support - meeting other people who can understand and empathise with your feelings  helps build confidence and make you feel like you are not the only one feeling like this.  Please look at our peer support pages for details of our services in London. 

• Mindfulness/meditation - a chance to slow down our thinking and manage our thoughts.  Herre at Cocoon we are big fans of the Headspace app (available to download for free). which provides bitesize chunks of mindfulness on your phone or ipod. 

• Practical help and support - having a befriender or volunteer who can support you at home can be very helpful.  Home-Start match you with a volunteers to visit you and to provide support and information.  Find your local Home-Start here:

                    https://www.home-start.org.uk/find-your-nearest-home-start 

• Exercise and healthy living - Exercise releases endorphines that make you 'feel good'.  Lots of local leisure centres have creches and there are many exercise classes for new mums where baby is welcome.  Eating well and ensuring you have all the vitamins ansd minerals you need will also help to feel healthier.  

• Social media - We were hesitant to mention social media as it can make you feel worse - snapshots of other people's 'perfect' lives can make us feel like we are failing.  However there is also a wonderful supportive network through PND Hour on Twitter.  Use the hashtag #pndhour which runs on Wednesdays between 8pm - 9pm.

If you live in London, please look at our services in the 'What We Do' section.  We may be biased but they are pretty good! 

Mind, the mental health charity, has a wide range of information and support available

 https://www.mind.org.uk/ 

Perinatal anxiety is anxiety experienced during pregnancy or in the year after childbirth.  Sometimes it will be broken down and referred to as 'antenatal' or 'postnatal' anxiety, depending on when you experience it.  

People are very aware of depression before or after having a baby, but it's less well known that many women experience anxiety during and after pregnancy. In fact, it's common to experience depression and anxiety together.

About 10-15% of women experience anxiety during pregnancy and the year following birth. 

We don't know exactly what causes anxiety.   However we know a number of things make it more likely that you experience anxiety:

Going through a traumatic experience

If you've previously gone through a traumatic experience which you were unable to deal with emotionally, you may become anxious if a similar situation arises or seems likely to arise.

Family with anxiety 

We learn from others and imitate their behaviour. Feeling anxious could be something you learned early on in life. We may also inherit a genetic tendency to be more anxious.

Fearing you'll lose control

If you feel you’re not in control of aspects of your life, you may start to feel anxious about events beyond your control, all of which is common when having a child.

Your physical health

Having a long-term health condition, especially if it’s painful, can make you more likely to experience anxiety. Caffeine, too much sugar, unhealthy foods, drugs, exhaustion, stress and the side effects of certain medications can also make you feel anxious.

People often experience physical, psychological and behavioural symptoms when they feel anxious or stressed.

Some of the most common physical symptoms of anxiety are:

• Increased heart rate
• Increased muscle tension
• “Jelly legs”
• Tingling in the hands and feet
• Hyperventilation (over breathing)
• Dizziness
• Difficulty in breathing
• Wanting to use the toilet more often
• Feeling sick
• Tight band across the chest area
• Tension headaches
• Hot flushes
• Increased perspiration
• Dry mouth
• Shaking
• Choking sensations
• Palpitations

Some of the most common psychological symptoms (the thoughts or altered perceptions we have) of anxiety are:

• Thinking that you may lose control and/or go “mad”
• Thinking that you might die
• Thinking that you may have a heart attack/be sick/faint/have a brain tumour
• Feeling that people are looking at you and observing your anxiety
• Feeling as though things are speeding up/slowing down
• Feeling detached from your environment and the people in it
• Feeling like wanting to run away/escape from the situation
• Feeling on edge and alert to everything around you 

The most common behavioural symptom (the things we do when we are anxious) is avoidance. Although avoiding an anxiety provoking situation produces immediate relief from the anxiety, it is only a short term solution. This means that whilst it may seem like avoiding is the best thing to do at the time, the anxiety often returns the next time that you face the situation and avoiding it will only psychologically reinforce the message that there is danger. The problem with avoidance is that you never get to find out whether your fear about the situation and what would happen is actually true. 

                                                                                                                                                                -  Credit to Anxiety UK 

 Treatment is similar to that for depression.  Often depression and anxiety accompany each other.

• Medication - Some antidepressants can balance your mood enough to provide a stepping stone to work of improving anxiety.  There are lots of different types, including some that will allow you to continue breastfeeding if you wish. Research suggests that medication works best in conjunction with talking therapies. 

• Talking therapies/Psychological Intervention - counselling, talking therapy and Cognitive Behaviour Therapy (CBT) all provide a space to process and understand your feelings and work towards recovery

• Peer support - meeting other people who can understand and empathise with your feelings  helps build confidence and make you feel like you are not the only one feeling like this.  Please look at our peer support pages for details of our services in London. 

• Mindfulness/meditation - a chance to slow down our thinking and manage our thoughts.  Here at Cocoon we are big fans of the Headspace app (available to download for free). which provides bitesize chunks of mindfulness on your phone or ipod. 

• Practical help and support - having a befriender or volunteer who can support you at home can be very helpful.  Home-Start match you with a volunteers to visit you and to provide support and information.  Find your local Home-Start here:

                   https://www.home-start.org.uk/find-your-nearest-home-start 

• Exercise and healthy living - Exercise releases endorphines that make you 'feel good'.  Lots of local leisure centres have creches and there are many exercise classes for new mums where baby is welcome.  Eating well and ensuring you have all the vitamins and minerals you need will also help to feel healthier.  

• Social media - We were hesitant to mention social media as it can make you feel worse - snapshots of other people's 'perfect' lives can make us feel like we are failing.  However there is also a wonderful supportive network through PND Hour on Twitter.  Use the hashtag #pndhour which runs on Wednesdays between 8pm - 9pm.

• Relaxation - using relaxation and breathing techniques can help manage anxiety symptoms.  Mind has a good guide to relaxation:

                  https://www.mind.org.uk/information-support/tips-for-everyday-living/relaxation

If you live in London, please look at our services in the 'What We Do' section.  We may be biased but they are pretty good! 

Mind, the mental health charity, has a wide range of information and support available

 https://www.mind.org.uk/ 

Anxiety UK has a range of  information on anxiety and phobias

https://www.anxietyuk.org.uk/ 

Birth trauma is a type of post traumatic stress disorder (PTSD) that relates to the birth experience.  Often the symptoms are similar but not enough to meet the full diagnosis for PTSD. 

Perhaps you experienced or witnessed a difficult birth, complications or where you felt you weren't supported or listened to.  It displays itself through symptoms such as flashbacks, heightened anxiety, a constant 'fight or flight' feeling, and avoiding any reminders of the trauma.  

Birth trauma can also affect those who witnessed the birth, such as partners and family members. 

Birth trauma can make it difficult to bond with your baby and cause social isolation to avoid any reminders of birth such as other pregnant women or those with newborns.  

 About 30,000 women per year experience birth trauma in the UK.  We do not have figures for the number of fathers/birth partners are affected.   

 Factors that make birth trauma more likely are:

• Long labour
• Quick but very painful labour
• Induction
• Inadequate pain relief
• High levels of medical intervention
• Assisted birth (forceps)
• Emergenct caesarean section
• Unsupportive staff
• Not being listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby or mum's safety
• Stillbirth
• Birth of a child with additional needs due to birth 
• Baby needing special care/neonatal care
• Poor postnatal care
• Previous trauma

  There are four main symptoms:

• Re-experiencing the traumatic event through flashbacks, nightmares or intrusive memories. These make you feel distressed and panicky.
• Avoiding anything that reminds you of the trauma. This can mean refusing to walk past the hospital where you gave birth, or avoiding meeting other women with new babies.
• Feeling hypervigilant: this means that you are constantly alert, irritable and jumpy. You worry that something terrible is going to happen to your baby.
• Feeling low and unhappy (“negative cognition” in the medical jargon). You may feel guilty and blame yourself for your traumatic birth. You may have difficulty remembering parts of your birth experience.

This can lead to difficulties bonding with your baby.  If you would like help bonding with your baby, we can provide parent infant counselling to help improve the bond and give you confidence in understanding your baby's needs.  See more on our Counselling page. 

•  Talk to someone about how you are feeling - this can be friends and family, your midwife or health visitor or charities like us or The Birth Trauma Association
• Look after yourself - take care of yourself, eat well, exercise and most of all, do not blame yourself for how you are feeling
• Speak to the hospital -  Most hospitals offer a birth 'debrief' where you can review your birth experience and ask questions about what happened and why.  You also have a right to request a copy of your birth notes.  Your local Patient Advisory Liaison Service (PALS) can help you with this
• Medication -  Selective serotonin reuptake inhibitors (SSRIs) can help manage the symptoms. These are typically used as anti-depressants so if you are on anti-depressant medication it is worth checking whether it is an SSRI. 
• Psychotherapy - The two recommended therapies are trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR). 

Information courtesy of The Birth Trauma Association  

Find out more at

www.birthtraumaassociation.org.uk