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The tremendous social and emotional pressures and expectations of the modern world on new parents makes being a parent in the 21st century more challenging than it has ever been

Posted on 1 November, 2018 at 8:40 Comments comments (0)

Becoming a parent is in itself a life changing event. Becoming a parent in this day and age brings with it new and additional pressures. Even before the birth of the child parents are bombarded with a flood of readily available information from different sources; especially from the internet and social media. It can be said that today’s parents are fortunate to have so much information at their fingertips, our own parents had to rely on the advice of family and one or two books, but much of today’s information is conflicted and has resulted in anxiety becoming a hallmark of modern parenting. There are conflicting discussions about ‘breastfeeding versus bottle feeding, crib sleeping and co-sleeping, early versus delayed toilet training; various labels are bandied around such as attachment parenting. Parents are much more aware of the potential physical and psychological risks faced by their children, for instance prenatal testing can lead parents to worry much more about potential birth defects, something not available in the past. The media has a hand in stoking fears around child abductions, bullying, vaccines, additives, and environmental hazards. This, coupled with delayed parenthood, reduced birth rates and better educated parents, has led to an increased fixation on individual children, or what’s more commonly known as ‘helicopter parents.’ (www.psychologytoday.com) Interestingly a 2013 Unicef report rated Dutch children the happiest in the world and this is partly due to the freedom and responsibility they are afforded from a young age, which is more in keeping with past childhood experiences. (See: https/www.telegraph.co.uk/family/parenting/raise-worlds-happiest-children-time-went-dutch/)


As a result of globalisation and increased travel many of us live at a distance from other family members and so the experience of bringing a new baby home can feel very isolating. In the past, extended family provided a community of support for the new parents, in particular the mother. Western society and its busy pace of life holds an expectation that life should rapidly return to ‘normal’ after the birth of the baby. Expectant parents are not being adequately prepared for the sheer exhaustion and emotional adjustment that comes from having a child, instead the pleasures of parenthood are espoused, and if we do not fit into that idealised picture of joyful coping then we believe ourselves to be inadequate and somehow failing. Women in particular receive very little postpartum care and support in their transition to motherhood. In the past it was common for women to have a ‘lying-in’ period for a month to recover from the birth whilst being supported emotionally and practically by other women. This holding environment for the new mother (and father) also provided an environment conducive to caring for the baby in the way its immature nervous system requires, a social womb allowing for optimum brain growth and development (the human brain does 70% of its growth outside of the womb). Even today in many non-Western cultures the focus is on mothering the new mother so that she can focus on becoming a mother herself to her newborn. In countries such as Greece, China, Japan, India, Malaysia and Brazil there is a minimum of forty days of nurturing new mothers to allow them to recover and rest. Unfortunately for most of us ‘society and its technology are moving us into an age of disconnection and isolation at an incomprehensible pace.’ (Levin et al. 2012, p.128+129) We would do well to heed the call from the ancient wisdom and slow down so that new parents can absorb their new status at the same rate as their babies.


Since the women’s liberation movement of the 1970s women seem to have a lot more choices, we can seemingly have it all, but at what cost? What we really have are ‘tough trade-offs.’ (www.parenting.com) For instance, employers have not gone to great enough lengths to alter the work culture to accommodate parents’ changing roles. The experience of raising children is also unfortunately ‘still intimately connected with the role that sexism plays in our society.’ (Levin et al. 2012, p.126) Behind the ideology of the new egalitarian couple is a much more traditional setting whereby, in many cases, women continue to carry the overwhelming responsibility for managing the household and caring for the children, whilst many also continue to hold down jobs. Many modern women have no experience of babies or children yet there is this societal expectation that new mothers should instinctively know what to do and that they should fulfil the archetypal role of the self-sacrificing mother. Expectations of motherhood are ‘ingrained from the earliest age, when a little girl plays dress-up with the pram and dolly and role-plays the doting mother.’ (Levin et al. 2012, p.35) Even though some women seem to take to motherhood like a duck to water, most struggle on the journey towards motherhood. To some degree there seems to be a ‘conspiracy of silence’ (Levin et al. 2012, p.1) amongst mothers, a ‘willingness to gloss over the truth, to sugar-coat our experiences and even tell blatant lies to maintain the illusion that we are fine’ (Levin et al. 2012, p.1+2), for to do otherwise would be to admit our self-perceived failings. The truth is that the adjustment to parenthood is enormous for both men and women. Both have to forge new identities in their birth as father and mother and develop new skills in these totally new roles. It is therefore quite normal to feel physically and emotionally overwhelmed in the days that follow the birth, but when our emotions do not settle over time and our struggle continues to overwhelm us it may be the first sign of a postnatal mood disorder.


Within Western culture there seems to be the illusion of ‘natural, instant and constant bliss at the onset of motherhood’, this creates a ‘fertile environment for shame and guilt to set in when our individual experiences are in fact so radically different.’ (Levin et al. 2012, p.129) When ‘shame, guilt and blame are turned in on oneself, depression is the next stage.’ (Levin et al. 2012, p.129) Although the media is partly to blame so are we all for perpetuating this unrealistic expectation. Our culture has a misconception of what depression is, we are told we are lazy, to pull ourselves together and be positive and grateful. It is important to recognise that depression is a medical condition ‘in which there are changes in chemicals, called neurotransmitters, in the brain’, it has little to do with what sort of person you are and is more a matter of ‘each individual’s biological make-up and the amount of flak life throws your way.’ (Aiken 2000, p.91) There is a ‘rainbow of reactions’ (Levin et al. 2012, p.2) a woman may have to the process of having a baby, ranging from antenatal depression (evident in about 10% of women), to the baby blues (which affect around 80% of women and is largely due to a sudden drop in hormone levels after birth), to a postpartum stress reaction (adjustment disorder), postnatal depression (PND), anxiety and mood disorders (ranging from generalised anxiety disorder, panic disorder, OCD, PTSD to bipolar mood disorder 1 or 2), postnatal psychosis (only affecting about 1 in a 1000 women) and, in the worst case scenario, infanticide and suicide. Fortunately these worst case scenarios are very rare but highlighted by the media which in turn may prevent women suffering from less severe symptoms from seeking help. In Australia more than 1 in 7 new mothers and up to 1 in 10 new fathers experience postnatal depression each year. Postnatal anxiety is just as common and many parents experience anxiety and depression at the same time. It usually presents within the first year after birth. (See: www.panda.org.au) The term postpartum (or postnatal) depression has been introduced within the last 40 years. Even though there has been a flood of studies into this condition in the last 30 years not enough has been done to tackle the stigma and lack of support and understanding in our society. There is, however, more awareness today, which was completely lacking back in our parents day when a woman might have just been considered to be neurotic, given a Valium and been sent on her way. It is the view of author Cara Aiken (2000) that postnatal depression occurs due to the ‘myth of perfect mothering.’ (Aiken 2000, p.150) Most mothers seem to have the same high self-expectations when it comes to motherhood and she feels that this can be contributed to four main factors: the pretty picture of motherhood painted by the media, which is not always in keeping with reality but that we ‘inevitably prepare ourselves for this image and try to live up to it.’ (Aiken 2000, p.151) The second factor is, society’s attitude, which holds an ‘idealised view of mothering-as a font of ever-giving unconditional love, a source of never-ending emotional nurturance.’ (Parker et al. 2014, p.158) Our own parent’s influence is another factor; ‘our parents seem to have very short memories’ in that, although they can be sympathetic, they too can ‘project an image of ‘perfect parenting.’ (Aiken 2000, p.151) Finally, the effects from our own childhood can play a role in that ‘there is usually something set deep within us that we strive hard to match up to, or something that we try even harder not to do.’ (Aiken 2000, p.152)


Postnatal depression (PND) may become apparent gradually or suddenly. It can present as ‘agitated depression’ or ‘depressed depression’ – symptoms for the former include: ‘loss of sleep, poor appetite, weight loss, pacing, panic and racing thoughts’ and for the latter: ‘feeling immobilised and withdrawn, with low self-esteem, low energy, poor concentration, difficulty making decisions, feelings of hopelessness and increased self-criticism.’ (Levin et al. 2012, p.8) It is common to feel overwhelmed, powerless and inadequate though it may be difficult to verbalise or even acknowledge feelings of depression and fear. Other symptoms may include ‘a sad or irritable mood, loss of pleasure or interest in normal activities, guilt feelings, anxiety for no valid reason, difficulty in sleeping that is unrelated to waking up for the baby and feelings of not coping or of being a bad mother. Thoughts of self-harm are actually quite common, but seldom acknowledged.’ (Levin et al. 2012, p.8) It is a very lonely personal experience and one that can impact the well-being of the whole family which is why it is important to give it the attention it deserves; and early intervention will result in a better outcome. It is important to recognise that PND is an illness that does not discriminate. It is a ‘physiological response to childbirth.’ (Levin et al. 2012, p.14) It requires a profound adaptation for a new healthy mother to care for a new baby as well as her family let alone a mother who is ‘sleep deprived, anxious, agitated and depressed.’ (Levin et al. 2012, p.15) According to research fathers are at an increased risk of developing depression if their partner has PND. Some men will also become ‘depressed following the birth of a baby even when their partner is not depressed.’ (Aiken 2000, p.90) For many men their depression arises out of a ‘stress-based response to adapting to parenthood, as well as any losses it represents to their career, relationship and aspirations’ (Parker et al. 2014, p.186) (perhaps even more so in a growing age of stay-at-home dads). There is a societal expectancy that men are to remain ‘stoical’ and ‘male’ (Aiken 2000, p.91) and so may not feel encouraged to talk about their depression. The risk factors that may enhance a vulnerability to PND follow a bio-psycho-social model. Biological factors include: hormone sensitivity; all women experience hormonal shifts during pregnancy and the postpartum period, antenatal depression or anxiety, a history of hormonal-related mood changes such as PMS, a history of taking oral contraceptives or fertility drugs, a personal and/or family history of mental illness, previous PND. Psychological risk factors include: personality traits such as being a worrier or perfectionist, negative thinking patterns, a history of abuse, body image issues, a difficult relationship with parents or partner. Social risk factors include: stressful events during or after pregnancy such as bereavement, big changes or an illness or accident, financial strain, limited support;, for instance in the case of immigration, disappointment about a baby’s gender, a colic or sick baby, other child related stressors, being out of control and unsupported during labour, previous stillbirth, miscarriage, termination or loss of child, an unwanted or unplanned pregnancy and maternal age; studies indicate that teenage mothers are more likely to develop PND although adjustment difficulties can arise for career women. Finally, breastfeeding issues are emotionally charged and bring physical, psychological and social issues into play. Even without conclusive evidence linking it to PND many women cite nursing issues as a huge trigger. In 2001 South Africa held the world conference on PND – Linda Lewis presented her master’s thesis study which found that ‘the reality of what women experience in their journey through motherhood is incongruent with society’s expectations of them. The women in the study felt they had to portray something different from what they were experiencing.’ This gap between ‘reality and their expectations was one of the most significant factors that predisposed them to PND.’ (Levin et al. 2012, p.12+13)


Parents of today have become much more aware of their children’s psychological needs; the days of children should be seen and not heard, largely gone. Nowadays we often encounter terms like ‘attachment, ‘bonding’ and ‘formative years’ which, if used out of context, can lead parents to believe that ‘if I am not perfect now, I may do irreversible damage to my child’. (Levin et al. 2012, p.135) Although a baby’s needs must be met, this responsibility can be shared, and bonding with your child is a lifetime process. The late paediatrician and psychoanalyst, Dr Donald Winnicott, conducted research on the effects of parenting on infants and contended that ‘parents did not need to be perfectly attuned, just ‘good enough’ to protect the baby from too often experiencing extremes of discomfort and distress, either emotional or physical.’ (Parker et al. 2014, p.93+94) This brought about the concept of the ‘good enough parent’ who is more likely to be ‘realistic, pragmatic and relaxed.’ (Parker et al. 2014, p.94) Therefore, expressing negative emotions will not damage your child, in fact, being honest about what you are feeling teaches parents and children alike about having true relationships in a world filled with unpredictable demands and challenges and helps them to foster functional attachments through life. So being ‘authentic makes you a good enough mother.’ (Levin et al. 2012, p.138) You also don’t always have to be a ‘happy mother, nor a perfect mother’, striving instead to be a ‘good enough’ and an authentic mother.’ (Levin et al. 2012, p.141) An unhealthy mother is ultimately a less effective mother but there is a conflicting belief that ‘selflessness is synonymous with good parenting’ (Parker et al. 2014, p.96) when in fact the healthiest thing you can do is to take some time to yourself. Having children does not automatically mean that a mother has to ‘lose the ‘right’ to her own life just because she has had children.’ (Levin et al. 2012, p.125) These are themes that can helpfully be discussed in a therapeutic setting. Although there can be long-term effects on the ‘cognitive, behavioural and emotional development of children whose mothers had significant and severe PND’ (Parker et al. 2014, p.160) these, although very distressing, are not necessarily permanent. Children have a ‘self-correcting capacity and can bounce back from earlier distressing experiences-subject to their care being ‘good enough’. (Parker et al. 2014, p.161) Overcoming a mood disorder can be punctuated by an acute sense of loss and pain but it can also enhance your empathy for others, increase self-awareness and enhance relationships with family and friends as well as fostering a deeper relationship with your child over the years.


Nothing can prepare you for the reality of having a child. It affects the new parents on a physical, mental, emotional and relational level. Having children is challenging, enriching, joyous but certainly not easy. Parenting, the most difficult job in the word, for which there is no real training or preparation, is hard enough (without throwing PND into the mix) and without ‘society condemning the actions, the behaviour, of parents and children in the way that is does.’ (Aiken 2000, p.161) A more supportive, open and accepting society, one which is kinder to new mothers (and fathers) would go ‘a long way towards reducing the incidence of, and speeding up the recovery from, post-natal depression’ (Aiken 2000, p.161) and would be the kind of society we would like our own children to inherit. Support should begin as soon as a pregnancy is confirmed.


Therapy can offer empathetic support to new parents. Often simply confiding in someone can bring much needed relief. It can also serve as a useful reminder that we are living in challenging times and new parents should give themselves the credit they deserve. Becoming mindful of social media and the role it can play, particularly on self-esteem, both positively and negatively, is important. As is relaxation, addressing unhelpful thinking patterns, dealing with unresolved trauma or relationship issues, developing more co-operative ways of parenting, setting realistic expectations and support systems in place. It is important not to ‘underestimate the value of perseverance and how taking care of yourself is also taking care of your children.’ (Levin et al. 2012, p.144) Working in conjunction with your medical practitioner can assist with many issues such as ruling out any other medical conditions that may present with similar symptoms to PND, such as an underactive or overactive thyroid gland, and discussing treatment strategies for PND which may include antidepressants. A holistic approach to wellbeing could include multi-disciplinary support such as acupuncture, yoga, naturopathy, homeopathy and meditation.


Parents need to set up their own standards of parenting that fulfil a ‘joint vision’ of their roles, remembering that each family and circumstances are unique, and that parenting ‘requires ongoing reassessment, redefinition and recommitment.’ (Levin et al. 2012, p.35) It is heartening to note that in comparison to their 1950s counterparts, parents today spend more ‘face-to-face time with their children,’ and the fact is ‘that parents today are, on average, closer to their adult children than in the past.’ (www.psychologytoday.com)





References:


1. ACOSTA, R.M. & HUTCHISON, M. (2017) They raise the world’s happiest children – so is it time you went Dutch? The Telegraph. Weblog (Online). Available from: https://www.telegraph.co.uk/family/parenting/raise-worlds-happiest-children-time-went-dutch/

2. AIKEN, C. (2000). Surviving Post-Natal Depression. London and Philadelphia: Jessica Kingsley Publishers.

3. Anxiety & Depression in Pregnancy & Early Parenthood. PANDA. Weblog (Online). Available from: https://www.panda.org.au/images/resources/Resources-Factsheets/Anxiety-And-Depression-In-Early-Parenthood-And-Pregnancy.pdf

4. AUSTRALIAN FAMILY RELATIONSHIPS CLEARINGHOUSE (2011) Supporting couples across the transition to parenthood. Available from: https://aifs.gov.au/cfca/sites/default/files/publication-documents/bp020.pdf

5. BROCKINGTON, I.F., MACDONALD, E., & WAINSCOTT, G. (2006). Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium. Archives of Women’s Mental Health, 9(5), 253-263.

6. COOK-SHONKOFF, A. We owe it to one another to be honest about the crazy mess that is motherhood. The Washington Post. Weblog (Online). Available from: https://www.washingtonpost.com/news/parenting/wp/2018/08/03/we-owe-it-to-one-another-to-be-honest-about-the-crazy-mess-that-is-motherhood/?noredirect=on&utm_term=.b1e93c57ecdf

7. GLOVER, E. (2017) New report: The pressures on moms are stronger than ever. Motherly. Weblog (Online). Available from: https://www.mother.ly/news/pressure-on-moms-is-a-serious-issuetime-says-it

8. HOUPPERT, K. Pressure and the modern day mom. Parenting. Weblog (Online) Available from: https://www.parenting.com/article/pressure-and-the-modern-day-mom

9. KITZINGER, S. (2003). The New Pregnancy & Childbirth Choices and Challenges. London: Dorling Kindersley Limited.

10. LEVIN, P., AARONS, Z. & TAUB-DA-COSTA, A. (2012). Recognising Postnatal Depression. South Africa: Penguin Books.

11. MILGROM, J. ET AL. (2008). Antenatal risk factors for postnatal depression: A large prospective study. Journal of Affective Disorders, 108(1-2), 147-157.

12. MINTZ, S. (2015) How parent-child relations have changed. Psychology Today. Weblog (Online). Available from: https://www.psychologytoday.com/au/blog/the-prime-life/201504/how-parent-child-relations-have-changed

13. MOTHER. How parenting has changed since we were kids. (Online) Available from: http://www.mothermag.com/parenting-today-vs-the-past/

14. O’HARA, M.W., & SWAIN, A.M. (1996). Rates and risk of postpartum depression – A meta-analysis. International Review of Psychiatry, 8(1), 37-54.

15. PARENTSWORLD (2017). Parenting in the past vs modern parenting: who has it easier? (Online) Available from: http://parentsworld.com.sg/2017/09/01/parenting-past-versus-modern/

16. PARFITT, Y. & AYERS, S. (2014). Transition to parenthood and mental health in first-time parents. Infant Mental Health Journal, vol. 35(3), 263-273.

17. PARKER, G., EYERS, K. & BOYCE, P. (2014). Overcoming Baby Blues. Sydney, Melbourne, Auckland, London: Allen & Unwin.

18. Perinatal Anxiety. beyondblue. Weblog (Online). Available from: https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/anxiety

19. SCARR, L. (2018) Secret pressure facing new mums: Australian women feel ‘judged’ over breastfeeding decisions. The Daily Telegraph. Weblog (Online). Available from: https://www.dailytelegraph.com.au/.../secret-pressure-facing-new-mums-australian-wom...

20. VOYTAS, L. (2018) Parental anxiety as you strive to be an informed parent. A Fine Parent. Weblog (Online). Available from: https://afineparent.com/

Anxiety Disorders During the Antenatal, Perinatal and Postnatal Period and the Response from Hypnosis

Posted on 7 April, 2018 at 10:50 Comments comments (0)

Pregnancy and childbirth can be profound and life-changing events in the lives of most women. It is therefore understandable that many women (and men), especially first-time parents, may feel slightly anxious. During pregnancy women may experience a range of conflicting emotions: excitement at having a baby but perhaps also apprehension. There could be concerns about bringing up a child alone if you are a single parent, or finding out you are having twins and worrying how you will cope, or if you already have a child worrying about how all of you will cope and if you will have enough time or love for the new baby. If the pregnancy was not planned but you decide to go ahead with it conflict may arise with a partner who is not quite ready. First time mothers may even experience a crisis of self-confidence and worry about not being a good enough mother or not having any maternal instincts; or there could be concerns about how your relationships will adapt as well as how your partner (and you) will feel about your changing shape. There may be worries about various pregnancy-related conditions such as pre-eclampsia or gestational diabetes and any medical tests or screenings can feel ‘emotionally invasive.’ (Kitzinger 2003, p.226) Although men do not have to cope with any physical changes the ‘passage into fatherhood is a major transition’ (Kitzinger 2003, p.30) and could also give rise to a range of emotions. Some men may have concerns about finances, especially if his partner is no longer working, he may worry about changes in his relationship, including sex, or his partner’s wellbeing. The sheer responsibility alone of having a baby can be frightening. A man’s emotional needs can sometimes be neglected as the main focus is often on how he can help his partner; this in turn can make him feel isolated. Whilst a certain amount of anxiety can actually have a positive function by nudging you to ‘examine options, develop coping strategies, plan ahead, prepare yourselves emotionally and practically for the future’, (Kitzinger 2003, p.31) the continuum of mild anxieties can also lead up to extreme fears and anxieties such as tokophobia, which is a fear of pregnancy and childbirth.


In Australia, perinatal mental health issues, experienced by both women and men, can vary in intensity and symptoms. Up to 1 in 10 women and 1 in 20 men experience antenatal depression, and anxiety is just as common, with many people experiencing both at the same time. (panda.org.au) Some of the different types of anxiety that may be experienced during the antenatal period may include: panic attacks, persistent, generalised worry, often focused on fears for the health or wellbeing of the baby, the development of obsessive or compulsive behaviours, specific phobias, such as a fear of hospitals, needles etc, social phobia, which can be marked by an intense fear of criticism or being embarrassed, and post-traumatic stress disorder, which could be the result of a previous birth trauma or sexual assault. (panda.org.au) (beyondblue.org.au) There are certain factors that may contribute to the development of perinatal anxiety and depression such as, a history of anxiety and depression or family history of mental health issues, a previous reproductive loss, such as a termination, miscarriage, stillbirth, a previously difficult pregnancy or birth trauma, a pre-existing physical illness, a history of childhood trauma or absence of a mothering figure, loss and grief issues and a lack of social connections or support. (panda.org.au) It is quite common for women to feel low in the last six weeks of pregnancy due to feeling physically tired and heavy or emotional for what lies ahead.


In most Western cultures women (and men) have been socially conditioned to believe that childbirth is ‘an ordeal, essentially painful, dangerous and something to be endured and then forgotten.’ (Berry 2015, p.33) In a society where childbirth has become very medicalised it can thought that it is not safe to have a baby without depending on lifesaving machines and although they can be very useful when required the majority of women can give birth perfectly well without them should they choose to. Childbirth is much safer today than it was 100 years ago not due to advances in medicine but ‘improved conditions, better food and better general health.’ (Kitzinger 2003, p.153) These beliefs are fuelled in our society, right from the formative years of childhood, by the often skewed portrayal of childbirth in the media and by negative birth stories from just about anyone. In contrast, in many other cultures, childbirth is considered to be a perfectly normal physiological process that is experienced without fear and sometimes even without any discomfort. This attitude is passed on through the generations creating a positive expectation of childbirth. According to neuropsychologist Rick Hanson our brain ‘is like Velcro for bad experiences and stories and Teflon for the good.’ (cited in Berry 2015, p.33) It is no wonder then that many women may feel very anxious about labour and childbirth. The three main worries that many women tend to have are ‘fear of pain, fear of having an abnormal or dead baby, and fear of dying in labour.’ (England & Horowitz 1998, p.8) In addition to these there may be other fears such as having a long labour, intervention and the consequences, complications, fatigue, dreading a loss of control such as over behaviour and physical processes, fear of failing somehow or being judged and loss of autonomy or privacy. Women have very many different attitudes towards pregnancy and childbirth and if you are feeling extremely anxious it can cast a shadow over your experience, making it difficult to enjoy. Hypnobirthing can provide information and preparation for childbirth that can allow both mind and body to work in harmony, regardless of the type of birth chosen or the outcome, so that women can ‘look forward to labour as a peak experience, not just an ordeal to be endured,’ (Kitzinger 2003, p.151) whilst feeling calm, confident and in control.


All the messages you have ever received about pregnancy and childbirth is stored in the subconscious part of the mind, and ‘from the imprints held there we formulate emotions, beliefs and thoughts.’ (Berry 2015, p.44) Some women, an estimated 10% worldwide (McCulloch, 2018), develop a pathological fear of pregnancy and childbirth, known as tokophobia, which can be classed as either primary or secondary. Primary tokophobia may start in adolescence and result in pregnancy generally being avoided later in life although some women, if they do become pregnant, may opt for an abortion, caesarean or adoption. Primary tokophobia could be the result of exposure to negative portrayals of pregnancy and birth or more often can be due to a history of sexual abuse or traumatic experiences of pain or in medical settings. Secondary tokophobia, on the other hand, usually occurs in women who have had a previous traumatic pregnancy or birth experience. If a woman has had a very traumatic birth experience, one in which she felt disempowered, she may suffer from post-traumatic stress disorder which can be marked by flashbacks, nightmares, panic attacks and a sense of isolation. This condition is classed as ‘iatrogenic – a medically produced disorder’ and is different to postnatal depression. (Kitzinger 2003, p.414) During a hypnobirthing programme, whether in a group or one-to-one setting, women or couples can be given a safe space in which to voice and work through fears and anxieties as well as learning about and preparing for childbirth physically and emotionally. Participants are also taught how our emotions, beliefs and thoughts affect our nervous system and how they can help or hinder the birth process. In many Western cultures, including Western medicine, the mind and body are still considered as separate from each other. Hypnobirthing works by harnessing the mind-body connection. As mentioned, our brains acquire certain expectations throughout life based on our experiences and received messages, particularly negative ones, so if it expects pain, or even just the threat of it, it pulses fear signals and increases the likelihood of experiencing said pain. Interestingly women’s perception of labour pain can vary depending on their country or culture. Ina May Gaskin (2008) quotes a 1988 study (Senden et al.) comparing a group of Dutch women’s expectations of labour pain with those of a group of U.S. women. Nearly two-thirds of the Dutch group received no pain medication whereas two-thirds of the U.S. group did along with some type of nerve block for birth. The U.S. women expected labour to be more painful than the Dutch women did and they expected to be given medication for pain: ‘in both groups, the proportions of women expecting pain to those who actually received medication were nearly identical.’ (Gaskin 2008, p.151) Similarly a study by Lowe (2002) found that a woman’s ‘self-efficacy for labor’ or ‘confidence in her ability to cope has a powerful relationship to decreased pain perception and decreased medication/analgesia during labour. Anxiety is commonly associated with increased pain during labor, and may modify labor pain through psychological and physiologic mechanisms.’ (Lowe, 2002) In his book Childbirth Without Fear, the British obstetrician Dr Grantly Dick-Read (1890-1959) wrote that ‘the most important contributory cause of pain in otherwise normal labour is fear;’ this is known as the fear-tension-pain syndrome (Dick-Read 2004, p.45). The origins of most hypnobirthing programmes can be traced back to his pioneering work.


Stress and anxiety can have a ripple effect on mother and baby (and birth partner), physically and emotionally, during pregnancy, birth and post-natally. When we experience anxiety, whether in response to a real or perceived threat, our sympathetic nervous system (SNS) is activated; better known as our fight, flight or freeze response. Many studies have demonstrated how our brain is ‘stimulated by an imagined experience in exactly the same way as the actual experience,’ (Berry 2015, p.67) so when the SNS, our body’s natural defence mechanism against danger, is triggered by a woman feeling frightened, stressed or threatened, it ‘can slow down the unfolding process of childbirth and make it more difficult,’ (Kitzinger 2003, p.189) as it interprets the anxiety experienced as a sign that it is not safe to give birth. It does this by releasing stress hormones such as adrenaline and cortisol, both of which affect the production of oxytocin (the hormone of love), which is required in large amounts to keep labour progressing and contractions efficient, as well as endorphins, nature’s natural painkillers, which are up to ‘200 times more potent than morphine.’ (Berry 2015, p.26) Endorphins stimulate the secretion of prolactin, the key hormone of lactation. Activation of the SNS also diverts oxygenated blood and energy away from non-essential systems such as the reproductive system (also compromising the supply of oxygen to the baby) and so it affects the uterus, which becomes resistant and tight. The uterus can literally turn white with a loss of blood supply. Tension in the body can result in muscles working against each other, causing pain. Instead of thinning and opening, the muscles of the cervix, no longer soft and pliable, remain tightly closed causing the baby to push down on a tight band of muscle. This resistant birth path can be distressing to the baby. The clinical term for this, which in itself can cause distress to a labouring woman, is ‘failure to progress’ (Berry 2015, p.36) and it can in turn lead to a greater likelihood of intervention and its effects. The ripple effect of anxiety can also cause a birth partner to feel tense and anxious and a negative experience can produce a reluctance to have more children, inhibit bonding, strain the relationship with their partner, and could leave them with feelings of helplessness, inadequacy, disempowerment and anger. During pregnancy a low level of anxiety is prerequisite ‘for the optimal growth and development of the baby in the womb’ (Odent 2014, p.96) as well as being necessary for labour to establish itself, which it does by releasing oxytcin. A study headed by O’Connor in 2005 found that anxiety in late pregnancy has been linked to higher cortisol levels in children aged 10. (O’Connor et al., 2005) The peak production of oxytocin takes place right after giving birth and so the ripple effect of anxiety can also cause attachment and bonding difficulties after birth, influenced further by a mother’s energy post-birth and subjective experience of birth.


In contrast, a woman who feels safe and warm, unobserved, free from fear and glaring lights, has privacy and familiarity and is free to move around will freely produce oxytocin and endorphins, along with dopamine, serotonin and melatonin, as she feels free to be ‘vulnerable, and open, and to surrender wholly to the experience that is overwhelming her entire body and mind’, (Bruijn & Gould, 2010) all of which allow her body to work with her. These prime conditions activate the parasympathetic nervous system (PNS), also known as the relaxation response, which is the ‘normal resting state of your body, brain and mind.’ (Berry 2015, p.34) The PNS and SNS are the two subsystems of the autonomic nervous system (ANS) and whilst both are always present, one will always be more dominant depending on what is happening around and within us. During labour oxytocin ‘triggers the muscles to work together in surges, and these surges stimulate more oxytocin and endorphins, which produce more surges in a positive feedback loop.’ (Berry 2015, p.37) The French obstetrician and child specialist Michael Odent remarked that the birth process is an ‘involuntary process’ under the control of ‘archaic’ or ‘primitive’ brain structures (Odent 2014, p.26) that needs to be protected against ‘all stimulants of the neocortex’ (Odent 2014, p.72) or ‘new brain’ (Odent 2014, p.26) (such as language) as ‘giving birth is not the business of the brain of the intellect.’ (Odent 2014, p.71) In short, ‘anything that disturbs a labouring woman’s sense of safety and privacy will disrupt the birth process’ and unfortunately ‘most of modern obstetrics involves disturbance, observation and monitoring, internal examinations, brightly-lit rooms, people coming and going and clock watching’ which can all ‘inhibit a birthing woman, just as they would any other mammal.’ (Berry 2015, p.37) Michael Odent notes that it is as if ‘we need scientific disciplines to unveil a common sense that has been repressed for thousands of years by cultural milieus’ (Odent 2014, p.74) and if we had a clearer understanding of the basic needs of labouring women ‘there would not be the promoters of home births on the one hand and the promoters of hospital births on the other hand’ as it would become apparent that ‘there is no universal recipe for feeling secure when giving birth’ (Odent 2014, p.76); some women feel more secure experiencing birth as a natural process with no intervention in a familiar place whereas others find security in a modern environment controlled by the obstetrician and machinery. In Australia the majority of women have their babies in hospital (either public or private). The option to give birth at home or in a birth centre is only really an option for women who are considered to be low risk. Although women have a legal right to give birth at home they are rapidly losing the support of health care supporters. In South Australia, in 2015, 5.8% of women gave birth in birth centres and 0.5% had planned home births. (sahealth.sa.gov.au) Regardless of place of birth, it is important for a woman to have a good quality relationship with her caregivers, including continuity of care, and for them to understand the importance of nurturing the prime conditions necessary for labour progression and emotional health. A Norwegian study found that a women’s subjective experience of giving birth has more impact on her mental condition afterwards than any real complications occurring in the delivery room. (Garthus-Niegel et al. 2013)


As the PNS is activated during hypnosis, the same hormones that play an important role in childbirth are produced during hypnosis as during undisturbed birth. The mental images a woman has of labour and birth are vitally important as ‘ninety per cent of birth, like 90 per cent of sex, has to do with what is going on in your head.’ (Kitzinger 2003, p.204) Hypnosis can be effective in replacing negative images and thoughts with more helpful and truthful ones; so helping to eliminate fear and anxiety in pregnancy and going into labour. Due to neuroscientific research we now know that our brains are not hardwired as previously thought and that we are in fact able to ‘continue to create new neural pathways,’ so repeated practice of self-hypnosis ‘can train and shape your brain and mind,’ (Berry 2015, p.47) changing your expectations and fostering a positive attitude. Hypnosis is also a wonderful tool for relaxation which is particularly vital for labour. Whilst preparing for labour it can be helpful to learn to anchor feelings of confidence and calmness to certain imagery, music or aromas, or to a partner’s voice or touch, which can then be recalled during labour and birth. Hypnobirthing teaches pain management skills and aims to boost a woman’s confidence and trust in her body’s ability to birth, allowing her to be able to ‘step gracefully out of the way and allow her body and baby to do what they know how to do.’ (Berry 2015, p.13) In addition, visualisation and breathing methods are used to prepare mind and body for birth. It can give couples ‘the confidence to navigate hospital policies and guidelines to make informed decisions.’ (Berry 2015, p.16) Hypnobirthing empowers women and couples to go into labour feeling calm and confident, and so being prepared ‘for any and all birth experiences.’ (Berry 2015, p.103) There is a wealth of research about the effects of anxiety on antenatal, perinatal and postnatal women and the positive response from hypnosis which includes: reducing morning sickness (and hyperemesis gravidarum) (Simon & Schwartz, 1999), reducing the incidence of premature labour (Reinhard et al., 2009; Omer & Friedlander, 1986), turning babies from breech to vertex position (Mehl, 1994), reducing the length of labour (Harmon et al., 1990; Gallagher, 2001), reducing anxiety and therefore having positive effects on mother and baby in pregnancy, during birth and post-natally (Zimmer et al., 1988; Downe, 2015), reducing the use of chemical analgesia and anaesthesia (Harmon et al., 1990; Smith et al., 2006; Lowe, 2002), lowering rates of intervention and complication (Harmon et al., 1990; Mehl-Madrona, 2004), reducing incidence of postpartum depression (Harmon et al., 1990; McCarthy, 1998), promoting lactation and successful breastfeeding (August, 1961; Cheek & LeCron, 1968; Kroger, 1977) and experiencing a better childbirth experience (Werner et al., 2013).


It is clear that our expectations and attitudes towards childbirth can influence and sometimes even determine the outcome of our experience. In order to have a satisfying experience it is important to feel secure and in control of what happens to you and your baby; only then can you allow yourself to let go and allow your body to work freely. Hypnobirthing offers not only ‘an amalgamation of lots of little things that, when brought together, create a huge shift in mindset,’ (Berry 2015, p.69) but also skills not just for birth but for life. There is no right way to give birth, it is not like winning a race or passing an exam, but ‘much more a question of learning how to adapt your responses to the particular challenges of your own labour.’ (Kitzinger 2003, p.181) Hypnobirthing does not guarantee that birth will be pain free; Dr Sarah Buckley as cited by Berry (2015) states that birth is a ‘peak bodily performance, for which our bodies are superbly designed’ and like an endurance athlete, a ‘woman’s task in birth is not to avoid the pain,’ (cited in Berry 2015, p.38), which can make it worse, but to optimise the functioning of our bodies and minds so that everything you have learned and practised becomes second nature and you can welcome your baby into the world calmly and joyfully.






References:


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Hypno-psychotherapy could help to provide an optimum environment conducive to conception in couples or individuals that are struggling with fertility

Posted on 16 January, 2018 at 8:35 Comments comments (0)

The decision to have a baby can be a very exciting time and many people assume it is something that they will experience no problems doing, but struggling with fertility, either naturally or using assisted reproductive technology (ART), can take couples and individuals on an emotional and physical rollercoaster which can leave them feeling mentally, emotionally, physically, spiritually (and financially) exhausted and depleted.


Infertility is defined as ‘the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse.’ In Australia one in six couples will struggle with infertility and in general it seems that infertility is on the rise in many countries worldwide. This could be attributed to various factors such as many women leaving it later to have a child. This is certainly the case in Australia where in 2007 ‘women aged 30-34 experienced the highest fertility of all Australian women.’ The switch from barrier to non-barrier contraception plays a role in raising the risk of STD’s such as chlamydia, and if using the Pill it could take time for the body to return to hormonal balance. Then there are health and lifestyle influences such as alcohol, drugs, smoking, caffeine, exercise, nutrition, weight and stress. The latter can have a profound effect on fertility. In addition, excessive exposure to environmental pollutants and chemicals can play a role. In Australia 40% of physiological fertility problems are associated with men and women respectively with 20% being attributed to both sexes. Between 15%-30% of fertility problems are defined as having no biological cause and are labelled as unexplained infertility. (http://fertilitysolutions.com.au/)


Trying for a baby can take the spontaneity and fun out of lovemaking, turning it instead into a precise science, which can leave many men feeling like sperm-producing machines. Sex can easily become associated with failure and the anxiety faced by many men to perform during a fertile window can result in impotence. Women in turn can experience stress and anxiety when confronted by negative test results, unwanted menstrual periods, stressful social interactions and hurtful self-talk. In response to this constant stress and anxiety, the sympathetic nervous system can become over-stimulated and the body’s fight-or-flight response can be continually activated resulting in the release of stress hormones such as adrenaline and cortisol, which affect the body’s natural biochemical balance; with energy being diverted away from systems deemed unnecessary for survival, such as the reproductive system. Both the stress response and sex hormones are regulated by the hypothalamus and so excessive stress can interfere with ovulation as it stops secreting gonadotrophin-releasing hormone (GnRH), which in turn impacts on the release of the luteinizing and follicle-stimulating hormones. In addition the pituitary glands will emit high levels of prolactin during times of stress which can inhibit fertility (this hormone is usually released to stimulate lactation, inhibiting conception during breastfeeding). Interestingly during times of stress men can also produce prolactin and as testosterone, responsible for sperm production, is also governed by the ‘hypothalamus-pituitary-axis which is sensitive to emotional tension,’ (Hugo 2009) sperm production can also be negatively impacted. Adrenaline can impede fertility as it inhibits the production of progesterone which is important for building and maintaining a lining of the uterus. The autonomic nervous system can remain in overdrive for many people if the parasympathetic nervous system, or our inborn relaxation response, is not also activated. This ‘assault on your body could contribute to insomnia, exhaustion, increased production of stomach acid, irritability, sexual dysfunction, and a host of other ailments.’ (Domar 2002) Our emotional and irrational subconscious mind can be very receptive in times of stress as our critical thinking is bypassed and so unhelpful and negative suggestions such as ‘you can’t get pregnant’ or ‘we are trying to get pregnant’, or the word ‘infertile’, can be taken on board literally and accepted as fact by the powerful subconscious mind. As we know ‘mind and body are integrated parts of a whole being; a change in one part affects the other.’ (Eastburn 2006) This cycle of emotional and physical triggers, not conducive to conception, can have a massive impact on those wanting to conceive and the longer it continues the harder it becomes.


Hypno-psychotherapy can assist on many levels by helping to restore mental, emotional, physical and spiritual balance, giving you the best chance of conceiving, either naturally or with reproductive assistance, by providing an emotional and physical environment conducive to conception. It can give you the space to unleash your feelings and help put you back in control of your life, instead of having a diagnosis of infertility control you. Hypno-psychotherapy in the treatment of infertility is underpinned by a mind/body approach and as such an understanding of how profoundly the mind can affect the body and vice versa. The world-renowned expert on infertility, Dr Alice Domar, stated that ‘mind/body treatment has been shown to be effective in both significantly increasing pregnancy rates as well as reducing psychological stress.’ (Sizer & Dean 2010)


The challenging journey of fertility treatment can be very overwhelming and exhausting on all levels, especially for women whose bodies usually take the brunt of most of the treatments and who may experience one loss after another from failed attempts. It is worth noting that just as much depression and anxiety is reported in women experiencing secondary infertility as those with primary infertility, and women with secondary infertility have a range of other secondary-only issues to deal with. Dr Alice Domar’s ground-breaking research reveals that ‘women who’ve been diagnosed as infertile are twice as likely to be depressed as a control group, and that this depression peaks about two years after they start trying to get pregnant.’ (Domar 1992) Interestingly the depression scores of infertile women are comparable to women with life-threatening illnesses such as heart disease, cancer or HIV. In addition, there is mounting evidence that ‘not only are depressive symptoms a very common side effect of infertility, but they may also impede your chances of getting pregnant as well.’ (Domar 2002) For men suffering from poor-quality sperm or no sperm (azoospermia) it can feel like a blow to their manhood and place them in a state of crisis which can result in sexual dysfunction, anger and depression. According to Dr Sammy Lee, who was an expert on male infertility, ‘up to 25% of couples experience problems with sex when the male partner’s infertility is identified.’ (Sizer & Dean 2010) Furthermore many men who may initially have tested with a normal sperm count find that upon retesting a year later their sperm count has dropped, highlighting how the emotional strain during a year of infertility tests and procedures can affect the body. (Eastburn 2006) It can be frustrating for couples undergoing fertility treatment when there are disagreements about treatment options and when or if they are worth pursuing. It can spell the end of the relationship for some. For others the choice to stop can be taken out of their hands due to the advice of doctors or having no more money to spend.


The experience of infertility can feel like you’re holding your breath until conception occurs and so the role of the hypno-psychotherapist is to help you to let go of that breath and rediscover a sense of yourself outside of fertility issues. Initially it can feel like a huge relief to just be able to offload and talk openly and honestly about how you are feeling in a safe and supported space. It is well documented that hypnotherapy ‘reduces stress and increases confidence, instilling a sense of control, which, in turn, enables you to maximize your chances of conceiving naturally and/or increases the success of medical assistance.’ (Eastburn 2006) If your mind and body is stressed and out of sync it is important to restore calm and balance and hypnotherapy is the perfect tool for achieving this as it activates the relaxation response which is driven by the parasympathetic nervous system. When activated it creates a physical state of deep rest which becomes apparent through a ‘measurable decrease in heart rate, blood pressure, breathing rate, stress hormone levels, and muscle tension.’ (Domar 2002) Once in this state of profound mental, emotional and physical relaxation, therapeutic work can take place within the powerful subconscious mind. The inclusion of visualisation, guided imagery and ego-strengthening can assist with the reduction of stress, increase feelings of relaxation and confidence and can help you to communicate with your mind and body. The language of the subconscious mind is ‘imagery, metaphor and symbols.’ (Hugo 2009) As we know from the work of Dr Alice Domar ‘women who learn to use mind/body strategies to manage the stress of infertility dramatically reduce their levels of depressive symptoms, anxiety, anger, and frustration’ (Domar 2002) and so increase their chances of becoming pregnant.


Hypno-psychotherapy can also help you to challenge limiting beliefs and combat negative thinking and/or behaviours. Assistance can also be offered with any necessary lifestyle changes such as smoking, diet, exercise, alcohol intake and sleep. Hypno-psychotherapy can work very effectively with infertility whether a physiological cause has been identified or not and can be used safely alongside conventional medical interventions. It can aid in the restoration of menstrual health all the way through to sperm mobility and count. Whichever area needs work, the client can explore the inner workings of their body and in doing so restore trust and a connection with their body. It can help clients undergoing ART to feel mentally, emotionally and physically prepared and so enhance their chances of success. It can also assist clients with fears and phobias, such as a fear of needles, and relaxation and visualisation for IVF has been shown to increase its effectiveness. An Israeli study conducted by Prof. Eliahu Levitas and his team from Soroka Hospital in Beersheba, demonstrated that hypnosis can double the success of IVF treatment during the embryo transfer stage. Levitas’s study of 185 women found that 28% of women in the group who were hypnotized became pregnant, compared with 14% of those who were not. Therapy sessions can be tailored to work in conjunction with the medical treatments being undertaken. The two-week wait period after the embryo transfer has taken place can be a very stressful time for many women, precisely when they need to be at their most relaxed, and so enhanced support can be offered during this time.


A hypno-psychotherapist can also help to identify and resolve any subconscious blocks to conception which may be present, such as unresolved trauma, previous miscarriage, abortion, abusive relationships, fears about pregnancy and birth or ability to cope as a parent, unresolved grief and so on. Working to resolve any relationship problems, improving communication between partners, and increasing sexual intimacy and affection may be other important areas to look at. The role of the therapist is to provide support in all instances; helping clients to build coping skills and develop inner resources, teaching self-help tools, helping clients to maintain changes and providing guidance to make decisions if conception does not occur. Just because a couple or individual has decided to stop trying, or the choice has been made for them, does not necessarily mean that they have to be childless, options such as sperm or egg donation, surrogacy and adoption could be explored or re-visited. In these instances, however, it is very important to grieve the loss of biological parenthood. Being childless can go to the core of a woman’s identity and can touch deep and painful emotions but it is important to recognise that whatever the outcome, you have value, you matter and you can be whole.






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