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The birth of a baby is usually associated with wonderful feelings of excitement and eager anticipation for this bundle of joy coming into your life. Many new mums, however, are sucked into an emotional vortex of heightened anxiety and/or depression, not to mention confusion and sometimes guilt.
Up to 30% of women may experience postnatal distress (PND). As you can see, I refer to the condition as postnatal distress because more often than not women feel more anxious than depressed so to label it only as depression is a misnomer.
WHAT IS PND?
We have all heard of the ‘Baby Blues’ – this is experienced by 85% of women and occurs in the first few days after childbirth. It is caused by hormonal shifts induced by pregnancy, delivery and lactation. You may feel sad, overwhelmed, tearful, a little anxious, agitated and unable to sleep. Don’t worry, this should only last a couple of days and it is not PND. If it continues for longer than two weeks then you should have yourself assessed by a professional.
On the other end of the spectrum is postnatal psychosis. This is very rare and is associated with disturbed thinking, delusions, hallucinations, agitation and manic behaviour. This is a medical emergency and requires hospitalisation. It is definitely not PND.
So what is PND? PND exists on a spectrum from mild to severe. For some, the symptoms don’t feel extremely distressing and may simply be adjustment difficulties – settling into a new chapter of your life which is unnavigated territory. For others the symptoms may feel overwhelming. At its essence PND refers to a period of time following the birth of a child when a mother feels that she is not quite herself. Of course every single mother will feel different once she’s had a child, but with PND there is a sense that you have to make a concerted effort to be the ‘you’ that you and every-one else knows you to be. There may be a sense of loss, a sense of things not being as you thought they would be, but you can’t actually put your finger on it. So you talk yourself into believing that the feeling is normal and that all moms must be experiencing this.
BREAKING THE SILENCEEven though you may feel alone, you are not. Many women hold up the mask of motherhood, portraying themselves as loving every bit of it and coping well. They look good, they say they’re doing well but I assure you, everyone has their dark moments in early motherhood. The problem is that no one talks about them for fear of being judged for not managing or, even worse, for not being a good mother. There is a conspiracy of silence around PND because of the shame associated with it. After all, you may have many blessings such as a healthy, undemanding baby, a supportive partner, domestic help, family nearby etc., but when you are suffering from PND none of these blessings make a difference to what you are feeling. You know all your blessings and you are deeply grateful for them and that is why you may not be getting the help you need – you feel too ashamed to admit to the pain you may be going through. That is why I called my book When Your Blessings Don’t Count.
HOW TO OVERCOME PNDIf you feel as though you may have PND, you need to be proactive in restoring your wellness not just for yourself but for your child. As hard as it is to hear, a well mother makes for a well family. And the good news is that everybody can recover from PND if you get the right help.
Nurse ProgramFirst of all you need to take care of yourself. Harvard Medical School designed the NURSE Program specifically for women and it is simple enough for anyone to implement every day:Learn more about the NURSE Program from the side box.
Psychotherapy Psychotherapy with someone who is familiar with PND is invaluable in the recovery process. It provides a non-judgemental, open and safe space to express yourself, work out practical plans and explore what feelings may have been evoked for you by motherhood.
Support groups These groups are probably one of the most powerful avenues for healing from PND. To be able to share with other mothers who are in the same position as you not only normalises your experience but also makes you realise that you are not alone.
MedicationPrescribed medication such as antidepressants or anxiolitics, may be an important solution to PND when all the other options don’t seem to be doing the job. Despite the myths around such medications, they are not addictive and there are many safe ones to use while breastfeeding.
CONCLUSIONPND is not a choice – no one would wish it upon themselves. You are not to blame. You need to give yourself permission to surrender to motherhood and address any distressing feelings as soon as possible. When you are in the midst of PND you won’t believe this, but I assure you that you will get better and, furthermore, you may even feel grateful for what PND has taught you in terms of who you are and what is really important to you and your family.
PND symptoms If you feel like the following feelings resonate with you then you may be suffering from PND and you should get professional help.You have trouble sleeping even when your baby is asleep.You get anxious over even the littlest of things.You feel like your emotions are on a roller coaster.You feel like you are losing your mind.You are afraid that you will never be your normal self again.You feel like you are not the mother you want to be.You have thoughts that death seems like the only way out of this living nightmare.
Dr Alex Niven outlines the causes, symptoms and treatment of outer ear infection in dogs so that you can be prepared if your best friend is afflicted with this common condition.
This article is a basic introduction to the management of Chronic Ear Disease in the dog and specifically that of the external ear – Otitis Externa. This is one of the most common, and easily recognisable, skin conditions of the dog.
‘To play it out is the most natural self-healing measure childhood affords.’ – Developmental psychologist Erik Erikson1
WHAT IS PLAY?Play allows opportunities for physical, emotional, cognitive and social growth and is often pleasurable, spontaneous and creative. Play can reduce frightening and traumatic events; it may relieve anxiety and tension and can aid in relaxation, amusement and enjoyment.
We know how important play is from a pioneering study done in the Caribbean to work out how best to help deprived and malnourished young children. A small group of children received extra food, another group got time for play, guided by an expert. Food and play both improved intelligence and behaviour substantially, and a follow-up study showed that the effects were long-lasting.3 It seems that play can sometimes be as important as a decent diet.Play therapist Janet West4 notes that through play children learn about the world and relationships, it offers an opportunity for rehearsal, for reality testing, for exploring emotions and roles. Play can also enable children to express aggression and buried feelings and can act as a bridge between fantasy and reality.As summarised by West:4■ Play is a child’s natural medium for self-expression, experimentation and learning.■ Feeling at home in a play setting, the child can readily relate to toys and play out concerns with them.■ Play facilitates a child’s communication and expression.■ Play allows for a cathartic release of feelings and frustrations.■ Play can be renewing, wholesome and constructive.■ An adult can more naturally understand the child’s world by observing the child at play and can more readily relate to the child via play activities than through an entirely verbal discussion.
Child therapist Violet Oaklander explains:5‘Playing is how children try out and learn about their world. Play is therefore essential for healthy development. For children, play is serious, purposeful business through which they develop mentally, physically and socially. Play is the child’s form of self-therapy through which confusions, anxieties and conflicts are often worked through. Through the safety of play children can try out their own new ways of being. Play performs a vital function for the child. It is far more than just the frivolous, light-hearted, pleasurable activity that adults usually make of it. Play also serves as a symbolic language. Children experience much that they cannot as yet express in language, and so they use play to formulate and assimilate what they experience.’
AN ADULT’S ROLE WHEN PLAYING WITH A CHILDAllow the child to lead during play and let him give direction. Let the child determine what you will play and how within the limits of safety and time constraints. Join in a child’s play but only when invited to do so. As the child lets you into his world of imagination and creativity, give him complete control. Remember this is his world. This attention you are showing while playing with a child is essential to building his self-esteem. You are giving him the message that his world is fun and important to you, too.Child psychologist and executive producer of the BBC series Child of Our Time, Dr Tessa Livingstone, offers play tips: 3■ Pick games you will both enjoy■ Follow the child’s lead■ Appreciate the effort rather than praise the ability■ Don’t lecture or criticise■ Don’t force the child to follow rules■ Allow the child to take things apart■ Give your undivided attention
Just think about how good you feel when you have participated in something you really enjoy. That is what play is all about. When we play we have fun. Press the reset button and take a look at how we allow children to spend play time. Set boundaries for yourself and for the children around screen time and take a back-to-basics approach. Incorporate play into your family time and limit structured activities age-appropriately. While structured activities are part of growing up and an essential part of early childhood development, it remains imperative that young children have:■ Enough free time to play – daily■ A safe place to play. Children need to be in a se- cure place before they are brave enough to stretch their intellectual boundaries and play imaginative games. ■ Friendly, responsible adults to play with.
CONCLUSIONBy allowing children their right to play and making sure that they have time for daily, free, unstructured play, we are enhancing their natural capabilities for intense, self-motivated learning.
Just let them get on with the business of play!
References1. Erikson EH. Childhood and Society. Triad/Granada. 1975:200.2. Axline VM. Play Therapy. New York: Ballantine Books. 1969:9.3. Livingstone, T. Child of our Time. London: Bantam Press. 2005:280.4. West J. Child-Centred Play Therapy. London: Edward Arnold. 1994:11.5. Oaklander V. Windows to Our Children. Utah: Real People Press. 1978:1606. Stevenson HW, Lee. SY. Contexts of achievement: a study of American, Chinese and Japanese children. Monogr Soc Res Child Dev. 1990. 55(1-2):1-123.
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