“I thought this was supposed to be joyful”

Think of the birth of a new baby and most people will think of a happy event, full of love, delight and hope for the future. As a student midwife I remember looking forward to spending time on the postnatal ward and imagining that is would be full of women who would be feeling happy and fulfilled. I will never forget the reality. I soon learnt that transition to motherhood can be all the things I thought it would be, but it is often also mixed with not only physical discomfort and extreme tiredness but fear, bewilderment and an overwhelming sense of responsibility. I noted that some women actually looked ‘shell-shocked’.

As a qualified midwife working in the community again the pleasure and the pain of the new mother was much on my mind. These women obviously love their babies, but the process of becoming a mother does not always match their expectations, leaving them feeling sad and inadequate in their new role.  Add to this the unrealistic media image of motherhood. Of smiling mothers with perfect, contented babies. Worse still the celebrities who are portrayed as miraculously ‘snapping back into shape’ and getting back to glamorous and seemingly effortless normality (within a weeks if not days of birthing) and the potential for feeling like a failure is huge.

The reality is that many women find the transition to motherhood really hard. For most this will pass with no serious harm.  They may feel sad and low at times but they will get through it ok if they get the right support. However, other women will feel like this most of the time and they will not be ok. They may suffer from postnatal depression and/or other mental health problems. This is an issue for their long term health, their relationship with the baby and the health and wellbeing of the whole family. It is estimated that about 10-15 in 100 new mothers will suffer from postnatal depression in some form (Royal College of Psychiatrists website 2014).  Approximately 58% of new mothers with PND do not seek medical help (Research by The Charity 4Children report Suffering in Silence 2011). This is due to them not understanding the condition or fearing the consequences of reporting the problem.

With all this in mind and a BIG interest in compassion in practice, I attended Michelle Cree’s workshop on a Compassionate Mind Approach with Mothers and Babies.  This was part of The Compassionate Mind Foundation Conference in Birmingham last week

http://www.compassionatemind.co.uk/index.htm

Compassion Focussed Therapy (CFT) has been developed by Paul Gilbert for therapists and healthcare workers to utilise when working with people with a wide variety of problems.  Michelle has developed the method for perinatal maternal health and beyond. Michelle works as a Consultant Clinical Psychologist for the Derby Perinatal Mental Health Service. She provides both individual and group therapy using Compassion Focused Therapy.

It was a really fascinating day.  Michelle discussed the issues around the following topics:

• The current way of how we live our lives compared to what we have evolved to need to best mother
• our difficult evolved brain
• brain changes that occur during pregnancy and early motherhood
• experiences that have already shaped

Michelle explained how using the compassionate approach involves two main themes:

1) This is not your fault.  This is about moving away from self-blame, guilt and feelings of inadequacy

2) How to ‘grow’ your compassionate mind.  This is about learning to use compassion for self, baby and others as a tool for adapting to motherhood, relating to baby and building resilience.

One important point is that self-compassion techniques are vital. Compassion has to flow to self first.  Its like oxygen masks on an airplane.  In an emergency, the oxygen masks come down and you must put oxygen on yourself before you can help anybody else. Clearly you will be in trouble very quickly without your oxygen and thus will be unable to help anyone.  Same goes for compassion.

There was much to learn on this workshop. I was interested to learn that many Family Nurses have already been taught how to use this approach with younger mums. We were shown ways of spending a few moments being mindful (or checking in on yourself).  This is a useful tool when feeling anxious or angry. The CFT approach teaches the woman how to:

Put her compassionate self into the centre of her life and make her compassionate self her authority and her sense of safeness. This will assist her to enhance her mood, confidence and bonding with baby.

The CFT approach gives the woman some valuable life skills which she can use when she experiences feelings such as disappointment, anger, anxiety or inadequacy.

I am convinced that this approach could be really helpful if utilised by community midwives when working with women in the post-natal period. Midwives have an important role in detecting and referring women who have signs of postnatal depression but they need more skills to support all women with the very real difficulties of adapting to parenthood. Better still why not teach women the principles of this approach in the antenatal period so that they have some of these skills in place rather than just waiting until the child is born and screening for problems?