Valerie Gommon Midwife’s Blog

Archive for the ‘Postnatal Depression’ Category

This is a guest blog by Helen Potter.

There are several reasons why a woman may have a caesarean section. A planned section may be scheduled because of the position or health of the baby, the mother’s medical history or at her request if she has had a previous, traumatic vaginal birth. An emergency section usually occurs because complications have arisen during natural labour. A ceasarean section is a major operation that requires incisions through the abdomen and uterus and so the significant recovery period is well accepted by medical professionals and society in general. However, the emotional after effects of this type of birth remain less acknowledged and far less discussed. The silence and stigma surrounding mental health after a c-section can be detrimental to new mothers who’ve not only just been through major surgery, but now have a newborn baby to care for too. Here are just a few of the emotional issues that may arise following a c-section.

Shock

It’s extremely common for the body to go into shock immediately after the surgery is carried out. Many women report shaking from head to toe as medication from the epidural and affect the muscles. But further on into the recovery process many women experience delayed shock, especially when the c-section was carried out in emergency circumstances. They spend so long preparing for their labour, writing birth plans and building up expectations so when things don’t go to plan it can be a huge surprise. Using a debriefing service following a c-section can be a good way to come to terms with the experience and understand why it had to happen.

Guilt

A study carried out by Channel Mum found that one in five mothers said that opting for a ceasarean would mean that they’d ‘failed’ and with that sense of failure undoubtedly follows feelings of guilt. Outdated social views can lead to women believing that a drug-free, natural labour is the most honourable way to give birth. Some women even report that having a caesarean has made them to feel like less of a woman and less of a mother. Of course this is untrue and all that really matters in labour is that mother and baby both come through the process safely.

Post natal depression

Although all women who go through childbirth are at risk from postnatal depression, studies show that women who have an emergency caesarean are up to six times more likely to suffer from the condition. The longer recovery period and feelings of guilt, failure and lack of control over their own body are all thought to contribute to this, alongside the hormonal changes that all new mums face. It’ is important to speak to a health visitor or GP if you think you could be suffering from postnatal depression. Self help advice, medication and therapy can all help to alleviate the symptoms.

Trouble bonding

Some women report that they have struggled to bond with their babies following a caesarean section. There are several theories for this. Biologically, research indicates that they miss out on the release of the hormone oxytocin (otherwise known as the love hormone). Immediately after natural childbirth the release of this hormone is higher than ever and missing out it can impair the initial bonding process. In addition to this, skin to skin contact (vital for developing early closeness and bonding) is rarely possible straight after a c-section and in many cases the baby is taken away and checked over while the mother recovers. On a more practical level, the long recovery process can sometimes render a new mum unable to carry out day to day care of the child which can make her feel disengaged from her new baby.

Fear of future pregnancy

Sometimes all of these factors combined, along with the physical pain of a c-section, can make women so fearful of a repeat performance that they choose not to become pregnant again. Of course this can be a devastating choice for a woman who really wants another baby. After a c-section, the probability of a natural birth next time is good – research indicates 60-80% of women can potentially go on to have a vaginal birth after a ceasarean (VBAC). But there are risks and these, alongside the fear of another c-section, can be enough to put some women off for life. If you feel like this but still long to expand your family it is important to talk to your GP or debriefing service to familiarise yourself with all of the facts so that you can make an informed choice.

Citation Section

NHS Choices, Ceasarean section, accessed 25.02.16

Metro, Thousands of women with postnatal depression suffering in silence, accessed 25.02.16

The Royal College of Midwives, What is the purpose of debriefing women in the postnatal period, accessed 25.02.16

The Daily Mail, The women made to feel guilty because they didn’t have a ‘perfect’ drug free birth, accessed 25.02.16

NCBI, Increased risk of postnatal depression after emergency ceasarean section, accessed 25.02.16

Psychguides, Living with postpartum depression, accessed 25.02.16

Mail Online, Women who have ceasarean section ‘less likely to bond,’ accessed 25.02.16

Mayoclinic, Vaginal birth after c-section (VBAC), accessed 25.02.16

Homebirth

Posted on: July 17, 2010

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

The British Government policy is to encourage homebirth www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312) and in the Netherlands 30% of babies are born at home – would they really be supportive of homebirth if it were so dangerous?  A large retrospective cohort study from the Netherlands in 2009 http://www.welbornbaby.com/images/Home%20Birth%20Netherlands.pdf confirmed that the planned place of birth was not the main factor in contributing to perinatal morbidity and Low-risk women should be encouraged to “plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women’s choice”.  Furthermore, also published in 2009 was another study, from Canada http://www.sciencedaily.com/releases/2009/08/090831130043.htm which showed that planned home birth in low risk women were comparable to hospital births.  Both these studies concur with the latest US study http://www.sciencedaily.com/releases/2010/07/100701072730.htm demonstrating that women who plan home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birth weight infants.

This same American study is often quoted by obstetric practitioners because a conclusion read that infant mortality was trebled by planning a home birth, but suggested “it was because of an increased need for resuscitation among home births and therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births.”  The methodology of this study has also been severely criticised www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth.

In conclusion, planned home births are very safe.  It is the presence of trained midwives with correct and necessary equipment that is most important factor, rather than location, in regards to safety of mother and baby.

A client who has previously suffered with postnatal depression has asked me to research placenta eating (or placentophagy).  Apparently it is traditionally practiced in many cultures, including Mexico, China, and the Pacific Islands, however British consultant obstetrician Maggie Blott dismisses prospect that eating the placenta helps with post-natal depression however there remain a number of women who are convinced that eating their placenta was helpful, indeed it is rich in iron and this alone will be beneficial.  Some women chop it into tablet size pieces, freeze them then swallow them!

Read more: http://www.brighthub.com/health/alternative-medicine/articles/43315.aspx#ixzz0UHDBQjT5

http://havingapoo.blogspot.com/2007/07/placenta-party.html

These are from ‘Mothering Magazine‘ – September 1983:

Work on the basis that each placenta weighs approximately 1/6 of the baby’s weight. To prepare a placenta, cut the meat away from the membranes with a sharp knife. Discard the membranes.


Roast Placenta

1-3lb fresh placenta (must be no more than 3 days old)
1 onion
1 green or red pepper (green will add colour)
1 cup tomato sauce
1 sleeve saltine crackers
1 tspn bay leaves
1 tspn black pepper
1 tspn white pepper
1 clove garlic (roasted and minced)

Method

(Preheat oven to 350 degrees)

1. Chop the onion and the pepper & crush the saltines into crumbs.
2. Combine the placenta, onion, pepper, saltines, bay leaves, white and black pepper, garlic and tomato sauce.
3. Place in a loaf pan, cover then bake for one and a half hours, occasionally pouring off excess liquid.
4. Serve and enjoy!


Placenta Cocktail

Ingredients:

1/4 cup fresh, raw placenta
8oz V-8 juice
2 ice cubes
1/2 cup carrot

Method: blend at high speed for 10 seconds. Serve. A tasty thirst quencher!


Placenta Lasagne

Ingredients:

1 fresh, ground, or minced placenta, prepared as above
2 tblspns olive oil
2 sliced cloves garlic
1/2 tspn oregano
1/2 diced onion
2 tblspns tomato paste, or 1 whole tomato

Method: use a recipe for lasagne and substitute this mixture for one layer of cheese. Quickly saut� all the ingredients in olive oil. Serve. Enjoy!


Placenta Spaghetti Bolognaise

Ingredients:

1 fresh placenta, prepared as above
1 tblspn butter
1 large can tomato puree
2 cans crushed pear tomatoes
1 onion
2 cloves garlic
1 tblspn molasses
1 bay leaf
1 tblspn rosemary
1 tspn each of: salt, honey, oregano, basil, and fennel

Method: cut the placenta meat into bite-sized pieces, then brown quickly in the butter and olive oil. Add the rest of the ingredients and simmer for 1-1.5 hours. Serve. Yummy!


Dehydrating your placenta

Instead of cooking your placenta whole, you can dehydrate it and then add it to meals! The following method is extracted from an article entitled “Thinking About Eating Your Placenta?” by Susan James, which appeared in the winter 1996 issue of “The Compleat Mother”. It was discovered posted on a newsgroup noticeboard, so we cannot absolutely guarantee its authenticity, or that it is an actual verbatim account of the magazine article.

Method:

Cut off the cord and membranes.

Steam the placenta, adding lemon grass, pepper and ginger to the steaming water. The placenta is “done” when no blood comes out when you pierce it with a fork.

Cut the placenta into thin slices (like making jerky) and bake in a low-heat oven (200-250 degrees F), until it is dry and crumbly (several hours).

Crush the placenta into a powder – using a food processor, blender, mortar and pestle, or by putting it in a bag and grinding it with rocks.

Put the powder into empty gel caps (available at drug and health food stores) or just add a spoonful to your cereal, blender drink, etc.

The recommended doses vary, some suggest up to 4 capsules a day, others just one. Perhaps the best advice is to take what makes you feel good.

It is also possible to have your placenta made into a homoepathic preparation contact www.ainsworths.com

I am probably not going to be able to do this subject justice in a short blog posting, but the subject was being discussed this afternoon on Radio 4 – “Am I Normal?” presented by Vivienne Parry www.bbc.co.uk/radio4/science/.

The programme debated many interesting issues, for example the increase in the diagnosis of postnatal depression and the changing role of women in society.

I apologise that the information below is perhaps written in a slightly “academic” or technical style as it is taken from an essay I submitted on my degree programme, however I think the information is largely valuable – if you feel you would like to discuss anything I have written do feel free to contact me info@3shiresmidwife.co.uk or telephone 01908 511247.

I also feel very strongly that women are often given inadequate support in the postnatal period.  Indeed many women are reporting receiving only two or three postnatal visits from NHS midwives (and then it is not always a trained midwife who visits) and Health Visiting services are also very stretched.  As an Independent Midwife I am able to offer far more support postnatally and this is something that I believe all women deserve.

If you are struggling DO speak to your midwife, health visitor or GP – make a nuisance of yourself!  Self-help groups and lay groups like the National Childbirth Trust (NCT) www.nct.org.uk, La Leche League (LLL) www.laleche.org.uk Meet A Mum Association (MAMA) www.mama.co.uk and Association for Post Natal Illness (APNI) www.apni.org can all be very supportive.

Postnatal Depression

It can be predicted that the early days, months and even years after childbirth are a time of stress for the woman and her family.  Indeed there are also the major physiological changes from the pregnant state into lactation and the return to the usual non-pregnant state of monthly menstruation cycles.  These changes are normal physiological reactions to the changes undergone by the woman (Stables, 1999), often women as said to experience “baby blues” at this time.  Some women, however, go on to experience stronger reactions that may be described as “postnatal depression” or occasionally “puerperal psychosis” (Sweet, 1997).  A few women will be so traumatised by their experience that they develop “post traumatic stress disorder”.

Baby blues” is considered by many to be a normal phenomenon that happens around three or four days postpartum, and is associated with the rapid physiological and psychological changes taking place.  Many women experience a degree of transient emotional lability and changes or mood that is self-limiting and usually resolves quickly.  (Ball, 1996).

Postnatal depression (PND) is more severe.  Cox, 1986 suggests that 10% of all mothers develop clinical depression following childbirth and that a further 10% exhibit considerable emotional distress.  The onset is gradual and may last for 3-6 months (or longer).  PND is a reactive illness and can be associated with other stress factors (i.e. moving house, marital tension and low self-esteem).  Women suffering PND are usually able to sleep, but continue to feel tired and exhausted, often feeling worse as the day progresses.  PND can cause disruption to family life, and can affect mother-child relationships.  (Ball, 1996).

In recent years Health Visitors have been encouraged to use the Edinburgh Postnatal Depression Scale (developed by Cox et al, 1987) as a tool to detect postnatal depression.  Some authors have suggested that midwives should use the Edinburgh Postnatal Depression Scale (EPDS), (Sweet, 1997 and Clements, 1995) but the tool is not foolproof.   Postnatal women are asked to identify and report on their feelings and they may choose not to disclose feelings.  Feedback suggests that the scale is a useful tool, and can enable further discussion to ensue.  If indicated, the woman may then be offered “listening visits” when the Health Visitor will set aside time to talk on a one-to-one basis with the woman.  Some women may also be helped by medication and the Health Visitor will liaise with the General Practitioner and indeed the wider mental health team if it is thought appropriate.  It is thought that early treatment is most effective, midwives and health visitors should therefore be alert for early symptoms such as excessive anxiety and depression.  (Church and Scanlan, 2002, Bryant et al, 1999).

There has, however, been criticism of The Edinburgh Postnatal Depression Scale.  Robinson, 1998, suggests that it is ineffective because of indiscriminate usage, whilst Ballard et al, 1995 suggest that women often score highly on the EPDS and receive inappropriate treatment.

Puerperal psychosis is a severe form of mental illness that will affect approximately one or two mothers in 1000.  The onset is rapid and usually occurs within the first few days after delivery.  The condition presents as a depressive psychosis, manic illness and in some cases schizophrenia.  Primiparae are most often affected.  Women affected in this way need prompt admission to a psychiatric unit.  (Ball, 1996).

Women can experience Post Traumatic Stress following childbirth, this phenomenon has only been documented in the literature in recent years.  Indeed an extensive literature and internet search did not reveal any mention of post traumatic stress following childbirth until 1994 (Ralph and Alexander, 1994).

During the 1990s there were several articles discussing the merits of offering “debriefing” to postnatal women.  (Charles & Curtis, 1994, Jones, 1996, Westley, 1997, Robinson, 1998).  Interest in labour debriefing revealed that some women experience severe adverse reactions to their birth experience and it was suggested that a small number of women may experience post traumatic stress symptoms following childbirth.  The prevalence of post traumatic stress following childbirth has been estimated at between 1.5 per cent (Ayers & Pickering, 2001) and 1.7 per cent (Wijma et al, 1997), although Laing, 2001 argues that this is probably an underestimation of the problem.

I am very happy to offer a birth debrief to women within my catchment area, please see my website www.3shiresmidwife.co.uk for details.

Lastly, I should add that serious Postnatal Depression only affects a small number of women, but it is important that it is spoken about and that you seek help if you need it.


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