Homestart volunteers and our PND training
www.homestartbarnet.org
www.homestartbarnet.org
“I really felt my post-natal depression was biological and situational”
This is a quote from a blog post I read recently, very courageously written by a mother of twins who suffered from PND and Anxiety, and who wanted to share her experience in the hope of helping others in a similar situation.
I have included a link to Ella’s Story so please go and read it now, then come back to this blog because I would like to explore and expand on some of her experiences which I feel are very important to try and understand.
No one knows exactly what causes PND/Anxiety or why it affects some people and not others but the generally accepted view is that it occurs due to hormonal changes in the mothers body and/or due to situational stresses, as described by Ella.
Currently we have little understanding of the hormonal aspect of pregnancy/birth that seems to make some women more vulnerable to PND/Anxiety but we do know about some of the external stresses that contribute to or exacerbate the situation.
Parenting can be an exhausting job at the best of times, but certain things make it much harder, such as a difficult or traumatic birth, maternal illness/pain, illness or problems with baby, or difficulties feeding.Sleep deprivation seems to play a major part, and social isolation, loneliness, and lack of support for the parents can make things worse, as can financial worries.
Basically, anything that adds stress can trigger PND/Anxiety, or make it worse, and that includes multiple births.
“Nearly twice as many mothers of twins suffer from post-natal depression as those of singletons”
In repeating this my aim is not to worry prospective parents, but to arm you with knowledge that you can use to try to avoid PND/Anxiety or minimise its effects
“You cannot avoid the biological reaction but I did not have enough support in place. Now I teach the antenatal courses for parents of multiples I am really adamant on planning your childcare in the months after birth.
Which friends and family can help and when will they help? Can you afford any support at home? What can you do to optimise your mental health and your sleep? I always emphasize the importance of getting out, being outside, meeting up with others”
I wholeheartedly agree with Ella about the importance of support for after baby is born, whether you have one baby or multiple, yet so often I see parents reluctant to ask for, or accept help.
I know a lot of parents want to manage by themselves, but historically we have never been isolated child rearers. We have always lived in communities and learned from, and received help from other people. Women helped each other give birth and fed each other’s babies, men hunted, other village members gathered food that was then shared, cooking was communal, older children, grandparents and elders joined in to help mind the babies and toddlers…we pulled together.
Nowadays we move away from our families and communities to find work, we often don’t know our neighbours, we have become isolated and vulnerable.
This is a worrying situation, but the good news is that babies seem to bring out the best in people, babies, if you let them, can bring us together.
There is no shame in asking for help from family, friends, neighbours, in fact they are probably dying to help. Health professionals are trained and available, so make use of them.I know not everyone has supportive family or friends, but please take time to think about who you could ask for help, or what you can do in preparation to make life easier after the birth.
Even asking a friend to sit and watch baby whilst mum has a relaxing bath without being interrupted for half an hour can make a difference so please don’t be proud.
“They were feeding and sleeping really well until about two and a half months they started to cry a lot more, they were really unsettled and wouldn’t sleep for more than half an hour….I stopped sleeping at that point, even when the girls were asleep I would just lie awake”
This quote from Ella’s story illustrates the fact that not all PND/Anxiety is apparent from birth. You can be totally fine for weeks or even months, before something changes biologically or situationally, so be aware of any changes in your mood or emotional state and don’t dismiss it.
It also identifies a symptom that should send you straight off to seek medical help. If you are exhausted but cannot sleep you must get help. It is not normal, not healthy and can rapidly send your mental health spiralling dangerously downwards.
“All everybody kept seeing was my anxiety — health visitor, doctors, family. I still held a fundamental belief that there was something wrong with the girls but it was so difficult to fight for them when people just saw my anxiety and neuroses. I should always have trusted my instincts, but when you are exhausted and intensely anxious you lose all your confidence in your parenting ability. I lost my ability to make decisions”
In this case a massive external stress was caused by reflux. Ella’s twins started showing signs of discomfort and distress, which is stressful in itself, but made even worse by the resulting sleep deprivation for the parents. The worry about the babies health, and the struggle to figure out what was wrong and get help was obviously a nightmare. In this case the family was let down by the health professionals who seem to have been focussed on the mother rather than on the babies.
This is such a difficult situation, and if it ever happens to you, please trust your instincts and keep asking for the help you need whether it is for your baby, for yourself or for your partner.
If possible, document whatever is going on because when you are tired, stressed and unwell it is impossible to think straight. It can help if you can hand over times and notes to a doctor it can really help them understand what is going on, and video is even better so use your phone to record things too.
If you are struggling to explain properly try and take an advocate with you, someone who can speak for you and support you.
When something is stressing you or your baby, stop doing it. It may sound blunt but you and your baby should be happy and healthy, that is your priority.
“I was at the point where I would bring them in for a breastfeed and they would scream their heads off….. In the end I was so anxious I couldn’t even pump and the girls were so unhappy to breastfeed anyway so, gradually, I cut down and moved to bottles”
In this case, due to the reflux, breastfeeding and pumping had become a major source of stress for everyone involved, and Ella absolutely did the right thing by stopping and moving on to formula. However, she did this after persevering for such a long time that her emotional health was being harmed.
I know there is currently a lot of pressure to breastfeed, but breastfeeding should be comfortable and pleasurable for both mum and baby. If it isn’t, if you dread feeding time, if each feed is a battle, if baby isn’t thriving, or if you know it is making you feel worse…just stop. Your baby will do just fine on formula, and will be much better off with a mum who is taking care of herself.
Even when Ella’s twins were diagnosed with reflux and CMPA, and they were starting to make progress and improve, things didn’t improve for Ella.
“I couldn’t see that they were fine and still kept thinking something was wrong and obsessing about the minutiae of their routine. I still struggled to sleep and would wake really early, at 4–5am with severe panic, drenched in sweat, filled with absolute fear and dread. It was a fear that is so wretched, I would not wish it on anyone.
Then, finally, some increased levels of medication made a difference. Thanks to four different types, I could sleep and my anxiety levels started to come down. Thoughts of running away, intense soaking sweats at 4 am — slowly all that went away, but I had to be on medication to help that happen”
Medication seems to be the most feared, and least talked about aspect of PND/Anxiety which is a ridiculous and harmful state of affairs.Drugs are drugs. They do a job fixing something that has gone wrong, whether that be relieving pain, fighting infection, or rebalancing something that has got out of synch. Taking anti-depressants or anti-anxiety medication is no different from a diabetic taking insulin, or a heart patient taking beta blockers.
If a doctor suggests taking medication, listen to them. If you are unsure, ask questions and do research, do whatever you need to do but don’t for a second resist taking them because you think there is some sort of stigma attached to them.
Also, don’t give up if a particular drug or dose doesn’t work first time. Your body chemistry is complex and unique so it might take a few tries, just like it did with Ella, but it will be worth it to get you on the road to recovery.
Just read Ella’s next quote.
“It would be great if everyone talked more about issues we’ve had and medication we’ve taken! I’d really like to remove any stigma around medication — I was able to enjoy more of my babies’ first year thanks to the right medication.”
I know that a lot of women in the middle of depression and anxiety can feel distant from their baby, or worry that they haven’t bonded, or may never bond so I particularly wanted to include this message from Ella…
“I also want other parents to know that the girls have thrived ever since that time and we have an amazing relationship, a fantastic bond. I have never felt guilty about that time and no one else should feel that way (I know some do).”
I have worked with many women who have suffered from PND/Anxiety, from every social class, every income bracket, and every education level and profession.
No one is immune.
Every one of my clients had a different journey, with different symptoms, and different treatments…but, most importantly, they all made it in the end.
When I first read the blog that this is based on I was genuinely moved by what the mother, and the whole family had been through, but what created even more impact for me was the fact that I actually knew the author.
I know Ella as a strong, happy, healthy woman. A great mother, a respected paediatrician, and the leader of a team of people who create ante natal courses for parents of multiple babies along with the very excellent career development courses that I use in order to stay up to date with the latest developments in the baby world.
I had no idea that she had suffered in this way, none at all, and it brought home to me that PND and Anxiety really can be experienced by absolutely anyone. It is a subject that needs to be brought out in to the open and talked about to the point where it is no more unusual than any other illness.
I am very grateful to Ella for having the courage to write so openly about what she went through, and for giving me permission to use her story as the basis for the blog in an effort to help more people.
If anyone is around London and is interested in Ella’s private workshops for parents of multiple babies then please click here at Be Ready To Parent for more information.
If you are worried about, or are suffering from Postnatal Depression or Anxiety I would recommend you get in touch with Cocoon Family Support that provide a range of services around London, but in their Support Across The UK page have also complied a list of links and organisations that cover other areas.
Help me help others – If you have experienced anything that has been mentioned or covered in this blog, and feel able to share your stories, please comment below to try and help people feel that it is ok to talk openly about a very common condition.
If you are struggling and need support for any aspect of PND/Anxiety, feeding, sleep, routines or anything baby related please come along to my Baby Detective Parent Support Group which is full of lovely, supportive people, and is non biased and non judgemental. I keep a close eye on the group and am in there every day to help people if needed.
Sarah x
A mother told me she felt so symbiotically attached to her daughter that she couldn’t leave her with anyone without feeling anxious. A friend of mine who went through postnatal anxiety and depression tells me, on the opposite that she couldn’t connect to her baby from the begging and it was, of course, a very unexpected and uncomfortable feeling to have.
Either way, they ended up feeling anxious or depressed and that built up an unhealthy attachment to their baby that nobody around them spotted. According to the Guardian 2008 article on postnatal depression, there are more than 17,000 undetected and undiagnosed cases in the Uk. That’s why is called the ‘silent illness’.
The attachment styles described above are opposite but as it happens, psychologically, they both bring to the same result: An insecure attachment between mother and child, an unhappy mother and as a consequence, a mirroring unhappy child. Nowadays, psychoanalytic research teamed up with neurobiological confirmation on the importance of secure attachment in the treatment of inter-generationally transmitted personality disorders.
The good news is that there is a lot that can be done in personal therapy especially when the mother-child relationship is just being built up and the child is small. By helping the mum with her anxiety and/or depression is possible to make the mother-child relationship improve.
It’s proven that mothers with anxiety and depression following birth, give attention to more things for a shorter period of time and research has confirmed the psychoanalytic idea that through mirroring, the small child ends up doing exactly the same. Those children have more difficulty concentrating for a long time than children of mothers who are not sufferers.
Anxiety is contagious and is transmitted from one generation to the other. Awareness in therapy helps put the mother back in control of her emotions and starts up a journey of self-discovery and improvement, as I have encountered many times in my clinical work with mothers.
Have you heard of the ‘allergic/atopic march?’ – if not, read on….
Genes can predispose us to develop allergies – and that’s why it often runs in families… but the same genes which cause allergies can also lead to other atopic conditions: asthma, eczema, hayfever. It often begins with eczema in infancy although eczema could also be stand alone as a skin disease.
Unfortunately, when we see kids begin to outgrow their food allergies at or before 4/5 years of age, we frequently see new conditions appearing, usually allergic rhinitis (the persistent itchy/runny nose & sniffing, with a dry cough), and asthma. Sadly, children are increasingly NOT outgrowing their food allergies (or outgrowing them later) but still accumulating the other atopic conditions like asthma and rhinitis along the way.
The ‘march’ in the name ‘allergic march’ refers to the progression of diseases which we see unfold at different ages of atopic children. It does not affect ALL food-allergic children and is not a one size fits all, but the pattern we see is this:
From age 0 – eczema – eczema may be the first sign of atopy, then…
From age 6months – 2 years – food allergy starts to appear
From age 3 years onwards – rhinitis (a persistent runny nose, sniffing, itchiness of the nose/eyes)/hayfever symptoms
From age 7 years onwards – asthma
We know egg, milk and peanut allergies are independent risk factors for development of asthma later on. And if you had BOTH peanut and egg allergy, the risk of developing asthma is even higher. There is also evidence that severity of food allergies may be correlated with the risk and severity of asthma, and sensitization to aeroallergens (e.g. grass) is also associated with the development of asthma.
This is why, despite the fact that both Sarah and Thomas have outgrown allergies (all for Sarah, some for Thomas), I carry on with the things I talked about in ‘How I helped my children grow out of their allergies’ and monitor them closely. Thomas had SEVERE allergies to milk, egg and peanuts – he also had severe eczema as an infant. So in terms of risk factors for developing asthma, he ticks ALL the boxes (sigh!) and statistically speaking he has a very high chance of developing asthma later on, and I am definitely swimming against the tide here. I may not be able to alter his genetic destiny with the dietary and lifestyle changes I’ve adopted, but I am trying my damn best! I treated asthma patients day in day out as a family physician, and I knew the impact this had on the child and family.
Aside from lifestyle measures, there is some evidence to suggest immunotherapy could alter the course of allergic diseases and prevent asthma or at least reduce its severity. Thomas is on the wait list for immunotherapy currently, because I know statistically he has a very high chance of developing asthma. In the meantime, I will just keep trying to alter his epigenetics with lifestyle measures and stay positive. I’ll keep you updated on his progress.
As with many things in life, the good antenatal classes get snapped up early. This means that when you’re not telling people you’re expecting but are feeling what can only be described as ‘bleh’, you’re also trying to sign up to the right class.
I decided there would be two criteria to meet. Firstly, the course had to be taught by someone my techie hubby would respect and secondly, it had to stand out from the competition.
Ella’s “Be Ready To Parent” course has a snazzy website that shows she is a young mum of three and a paediatrician by trade. Been there done that recently – tick, and knows what she’s talking about in a medical sense – tick. My hubby Anthony was sold.
The Be Ready To Parent classes include a first aid course and a session where the birthing partners have time with Ella’s Psychiatrist husband so they can learn the difference between baby blues and post natal depression; two excellent differentiators in my opinion.
Ella gave us some pre course homework and also suggested we make a calendar of mother and baby activities in our area. This was so useful after Oscar was born but Ella is far from your stereotypical strict school teacher; she’s so warm hearted.
Each session is run by an expert in their field which means you can ask really in depth ‘what if’ questions and get a proper answer. My favourite sessions were those run by the midwife who was honest and reassuring. She helped the birth partners realise that their role was to be a voice for those of us giving birth and she helped us understand that we could remain in control of our labours by knowing all the possible scenarios and our choices if they arose.
But Ella’s Be Ready To Parent classes were more than just preparing us for giving birth; they were about ensuring we felt empowered after the birth. We were given expert advice on necessary and useful baby equipment; breastfeeding; nappies (I’ll say no more on that subject); first aid; our health after birth; religious baby ceremonies and childcare. Some of the sessions felt a bit premature but I have needed information from every session bar the first aid course so far. Right now I’m reviewing the childcare information as I return to my business, Gradia.co.uk (pardon the plug).
Every expert left their contact details and insisted we get back in touch if we had questions or concerns. I contacted the breastfeeding expert when I encountered a bump in the road, and I wouldn’t still be exclusively breastfeeding 6 months on if it wasn’t for her. And poor Ella, my hubby contacts her for advice with every rash, cough or sniffle Oscar encounters but she never minds and is always helpful.
Parents often tell you that when they first get their little one home from the hospital they look at them and think ‘Oh my gosh, what do I do now?’ We didn’t have that. Ella prepared us and we knew our roles, so when we arrived home, we took Oscar out of his car seat and the three of us just danced.
Written by Lisa Eskinazi, mum to Oscar and wife to Anthony, who attended my first ever antenatal course.
Double Trouble, help is at Hand!
http://www.the-archer.co.uk/
We made it to The Archer newspaper, fame at last!
We are all aware of the
recent baby boom but is
East Finchley in the grip
of an increase in multiple
births? It’s said that there
are four sets of twins in
Creighton Avenue alone.
“I used to be a celeb in
the park for having twins,”
says Dr Ella Rachamim, “but
now it’s rare for me notto see
another set of twins whilst out
and about.”
Ella, a local paediatrician, is aware of the joys
and pitfalls of having twins;
for a start there is twice the
likelihood that the mother
may suffer from post-natal
depression. She runs antenatal classes for prospective
parents tailored to both single
and multiple births. These
include advice and support
from a midwife, physiotherapist, breastfeeding counsellor
and a maternity nurse.
Parenting in the round
“We focus on more than
just the birth,” she says. “We
cover topics like practical parenting, basic first aid, dealing
with crying babies and issues
around emotional support and
post-natal depression. We
look at all aspects of feeding,
not just breast feeding.”
As well as these courses,
Ella offers free online
resources about local health
and childcare professionals,
support groups and organisations.
Her own experiences as
a mother of a toddler and
twin girls led her to set up
her courses, supporting all
prospective parents whether
expecting single or multiple
births. She has strong links
with the Whittington, Royal
Free and Barnet hospitals and
is on the committee of the
Finchley Twins Club.
Her next set of courses
starts on Sunday 13 October
(two Sundays and two weekday evenings) and cost £290
per couple. And if you happen
to be another set of parents-tobe of twins, there is a special
full day programme for you
on Saturday 21 September.
For further details see
www.bereadytoparent.com
or contact
ella@bereadytoparent.com or 07977 939721.
So I had to go to the dentist this morning. Although it is not usually my favourite place to go, I must admit to not being scared of the dentist. I do not avoid it or lie awake at night worrying about it.
However, today I had to go to get a large filling. Now, I know I am to blame for perhaps eating too much of the naughty stuff and too little of the good stuff – ok, aren’t we all? But I think, and the male dentist agreed too, that when we enter the world of motherhood we start to spend less time caring about our teeth and forget to look after ourselves and subsequently end up with more fillings! And this is certainly the case for me – statistically I have had more dental work done post the twins being born than in the preceeding 10 years before the twins. Now, it may be age related but I think it is because:
1) I eat less well and eat scraps of their food as well as chocolate biscuits on the run AND
2) I, on occasion, admit to not brushing my teeth before I sometimes collapse into bed at night – shock horror – but I know I am not the only one, am I?? Please tell me I am not alone here.
So lying in the dentist chair – listening to the radio and a bit of Elton John and not the current favourite nursery rhyme “the muffin man” which has to be put on repeat in the car to stop all rioting ensuing – was actually rather enjoyable. I was so relaxed that despite having an injection into my gum and hearing the drilling going on in my mouth – I nodded off to sleep, briefly but sleep!
One whole hour to myself at the dentist with no interruptions and then went to the toilet alone, yes alone! – was actually pleasant despite having the numb cheek afterwards and an inability to eat and drink for 3 hours!
So weighing up the options for the future:
Poor eating and teeth brushing = filling = relaxation for one hour and independent toileting
“v”
Healthy eating and strict dental hygiene = no filling = “the muffin man” and a communal toilet experience
Which would you choose?
8th August 2013
Ella
Dr Ella Rachamim, ella@bereadytoparent.com
I saw this question being posted numerous times on facebook and wanted to do my own research into this. I have always been under the impression, and supported by my previous consultants, that follow-on formula was completely unnecessary and just a marketing loop-hole by formula companies. But I wanted to really investigate for myself the legislation around formula and its advertising. So what is the law surrounding this?
The World Health Organisation (WHO) has an ‘International Code of Marketing of Breast Milk Substitutes’.
On 1 March 1995 the Infant Formula and Follow-on Formula Regulations (SI 1995 No. 77) were adopted as law. Importantly it stated, in unison with the International Code that:
a) No person shall at any place where any infant formula is sold by retail—
(a)advertise any infant formula;
(b)make any special display of an infant formula designed to promote sales;
(c)give away—
(i)any infant formula as a free sample; or
(ii)any coupon which may be used to purchase an infant formula at a discount;
(d)promote the sale of an infant formula by means of premiums, special sales, loss– leaders or tie–in sales; or
(e)undertake any other promotional activity to induce the sale of an infant formula.
This is the most pertinent point. And the full legislation can be found at: (http://www.legislation.gov.uk/uksi/1995/77/contents/made).
However, “The law falls short of the International Code in important respects. Most notably, it allows advertising of products through the health care system, giving the baby food industry the perfect route to influence mothers. Such promotion is in direct contravention of the WHO International Code which the previous UK Government claimed to support. Now that the Government has changed Baby Milk Action is relaunching its campaign to have the UK Law brought into line with the International Code.” (Baby Milk Action http://www.babymilkaction.org/pages/uklaw.html)
The Law, with respect to follow-on formulas, ONLY states that: “No person shall publish or display any advertisement for a follow-on formula which does not comply with the requirements, prohibitions and restrictions relating to labelling contained in regulation 15.” (http://www.legislation.gov.uk/uksi/1995/77/contents/made). This means that “There are hardly any advertising restrictions on follow-on milks so milks which look almost identical to infant formulas can be legally advertised on TV, billboards, wherever….” (Baby Milk Action http://www.babymilkaction.org/pages/uklaw.html)
In summary, In the United Kingdom, infant formula advertising has been illegal since 1995, but advertising for “follow-on formula” is legal, which has been cited as a loophole allowing advertising of similarly-packaged formula.
On a positive note, the UK is trying to promote the Baby Friendly Initiative for example and hospitals can become accredited if they are able to implement these guidelines. Also the “previous Government can be congratulated for setting up a multi-sectorial working party to create these guidelines, but it has to be remembered that however strong they are they cannot counteract the law. Advertising will still be allowed.” (Baby Milk Action)
So my research has uncovered some disturbing news – could it really be that follow-on formula is all a scam by the formula companies to get away with advertising their own brand of formula? Meaning they are not allowed by law to advertise their own brand of stage one formula because of the direct conflict with breastfeeding, but to get around this they have invented follow-on formula which they are freely allowed to advertise because of a legal loophole in the system? I shall leave you to make up your own mind.
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