Perinatal Anxiety and Depression

PANDA Week 2020

November 8-14

Deal all the cards.

Baby bliss. Baby stress.

Baby spews. Baby blues.

Everything that is involved in preparing for and having a new human enter your world should be able to be on the table, no judgement. This is a time of mammoth change, especially if this is your first child. It is a transition period in your life that is worthy of even more dedicated time and energy as getting married; building a home; or learning to drive…having a baby involves elements of ALL big life events in ONE.

How do we prepare for such a major change in life, with so many unknowns?

How much time do you really have to get as ready as you can?

The perinatal period can be considered across roughly 92 weeks, or just shy of a 2 year timeframe, starting at conception right through the first year of life for the newborn.

Let’s say you are at the very beginning of the perinatal period. You have just found out you are pregnant.

You may have googled ‘what to do to get ready for a new baby’ and huge checklists appeared detailing how many nappies, bottles and onesies you should need. Wow! Seems like a lot of stuff! Perhaps, at the same time as this list, on the very same page, one that looks a bit more like this should pop up as well…

It’s easy for the zaniness of the gender reveals, planning a baby shower or decorating the nursery to overshadow the importance of the mental health needs of both the parents and infant. It may be that all the time and energy we talked about needing is there to invest - it may just be a question of where and how that time is being spent, or where we feel it is expected to be spent in this publicly diarised, open for comment, fast-paced, do-more modern time.

So what we offer here are suggestions on how to prepare the deeper layers for perinatal health at the very same time as you are checking off the list of the more common ‘TO DO’s’ as you get ready for your baby to arrive.

BABY SHOWER and FIND YOUR FIVE

There are truckloads of joy and excitement you will want to share with your Family and Friends when you are preparing for your little one to come. A special someone, or lots of awesome someone’s, may plan beautifully thoughtful and epically gorgeous events for the Parents to be. Parties for bub can be a great way to share your good news and build your stockpile of practical essentials - along with cuteness galore.

Around this time it may also help to host a small deliberate gathering of key trusted supports. Some might say you need to ‘find your five’ and bring them together. They might be:

· Family - your Mum, Dad, a Grandparent, a Sibling, Aunt, Uncle or a Cousin

· A dear friend

· Another parent you relate to really well, or whose parenting style you particularly like

· Your neighbour or a friend from down the road, and

· Your loyal cheerleader – someone you know always has your back and lifts you

You come together with the purpose of having real conversations. To be held in a safe space where all the fears you are holding inside can be let out, because they are already known, in so many different ways, by those that know and love the real YOU, and those that have been there before you. You come together to tell those who really care what you are concerned about now and what you think you might need when your baby comes. Your close circle is then more prepared to be there for you in the best ways because you’ve had a chance to let them know what appropriate support looks like to you.

Who you are going to need and want around you, especially if you are a first-time parent, is deep down something only you will know. The idea of help comes in many different styles, but what and who is most helpful to you, and those you feel most comfortable having closest at this intense time, is vital to recognise and respect. To be negotiating additional stress, when you are already so vulnerable post-partum, can be the tipping point for more serious mental health challenges.

You will have your own reasons to not really want certain people around you or your newborn as well. Perhaps your oldest friend is very caring, and you love her dearly, but she smokes a lot and you have serious concerns about the impact that will have on your fragile newborn. You’ve just read some alarming SID statistics on the red nose website relating to any infant exposure to cigarette smoke in peoples hair, or on their breath or clothing. Your anxiety is rising. It should be, without question, absolutely ok for you to voice your concerns. Your supportive network could also help here if you chose to focus on intimate Family bonding and minimising early visits.

DECORATE NURSERY and PARENT ACTION PLAN

The babies room is such a loving space to furnish and decorate. You might be planning to make the space relaxing or enriching, colourful or serene…or anything in between. It will be lovely.

Furnishing and decorating might be something you and your partner plan and do together. Perhaps while you are building flat-pack, or waiting for the paint to dry before the next coat, you could scribble out an ‘I’m worried about this…’ agenda on the cardboard you’re using as a drop sheet. A running list of things you need to set aside time to chat about as the pregnancy progresses and for when you bring your little love home. Items like: sharing night time responsibilities; finances; agreed parenting strategies; returning to work; maintaining individual identity beyond the baby…all the push and pull that marks this time of remarkable change.

Then you take the time to go through the list and develop a living action plan. You understand things you chat about might evolve from the agreement because new humans are capable of such unexpected curve balls. But you’ve taken the time to hear one another and come up with a plan together. Once you’ve got good at making one plan, you can always make another.

MEDICAL CHECK-UPS and MENTAL HEALTH CHECK-INS

Through your pregnancy you may feel like you are checked up on a lot…Obstetric GP visits, time with your midwife, ultrasounds, blood sugars, pee in this cup, let’s just take that blood pressure again, why don’t we jump on the CTG monitor for an hour or so and we’ll keep an eye on things…

Gains made in infant and mother mortality, exactly because of advances in access to medical testing and technologies, is phenomenal. Since 1990 child and maternal deaths have decreased by 50% globally. The check-ups save lives.

When you are checking up on the physical you also need to tune in and really listen to the deep parts of you that manage your mental health, not just you and your baby’s physical health. The parts of your brain involved in your mental health have an immediate top-down impact on your physical health as well. A good example of this could be the impact of stress on insulin resistance, increased stress can push blood sugar levels up. Physical and mental health hold equal importance.

Getting to know your mental health professional before you give birth is recommended, particularly now. Service providers, though they want to, may not be able to see you immediately, or may not have the capacity to take on new patients at all. Resources are stretched even in Australia.

Starting to build a relationship with a trusted mental health service provider in the early stages of your pregnancy is proactive and protective. This way they will know you, all your history, and you can both anticipate what may come up as your pregnancy progresses and after your little love arrives.

ANTENATAL CLASSES and SKILLS FOR WELLBEING

First time parents will be highly encouraged to attend antenatal classes. They may be a full day or evenings over a few weeks. It may be a regular program at the hospital where you plan to have your baby, or you may also choose from specific providers that run classes that cover topics that really interest you. Online education options are popping up all over the place. For Dads there are also ‘Beers and Bubs’ sessions held at pubs around town.

Antenatal classes will generally cover what to expect through each stage of your pregnancy, the birthing experience and the early weeks after your baby is born. These classes may touch on mental health concerns during the sessions, but often if more attention is needed a referral to someone for specific care is recommended.

As you develop your therapeutic relationship with your skilled mental health professional they will equip you with vital resources and skills you can be putting into practice every day. Empowering tools like biofeedback, mindfulness meditation and cognitive strategies for wellbeing, may all be a part of your mental health plan. The benefits of becoming really good at using skills like this goes far beyond the perinatal period. These tools for mental health can be used effectively for yours, and your babies, whole life.

Learning how to really ‘check in’ with yourself can be a tricky thing to do. We may externally default to big smiles and ‘I’m great! I’m soo happy! I can’t wait to meet my baby!’. We may wear a proud and positive mask for most of our public life. What is happening inside can be a vastly different story. It is ok to feel overwhelmed, confused, stressed, worried, tired, and emotional. The first step to improving how you are feeling is being able to give your feelings a name and rate how much you are feeling this way. Beyond Blue and PANDA have resources available to teach you get really good at making your ‘self-check’ a helpful habit.

Did you know you will spend roughly the equivalent of a fulltime job just feeding your new baby during their first year of life. Add this to everything else you somehow need to squeeze into each day and the mind starts to boggle. There are mindfulness and breathing exercises that you can do while you feed your baby. If you start learning and practicing them before your baby comes you will feel much more confident and comfortable using them.

SHOPPING FOR BABY STUFF and FIND SAFE TREATMENT OPTIONS

Do I need everything on the must have baby list I googled? Parent to parent, probably not.

When you are shopping for bub online, maybe at the same time open a few tabs so you can read up on safe and effective treatment options for you and your baby. This is possibly a time in your life when you will be most conscious of what options are available to you and how they work. There are many effective treatment options you may not yet know anything about.

Treatment for perinatal depression and anxiety is like the treatment of other types of depression and anxiety. The most common treatments are: medication; psychiatry; psychology; occupational therapy; support groups; brain treatments neurofeedback and transcranial direct current stimulation (TDCS); or a combination of these treatments.

Doing a bit of ‘window shopping’ and reading can help you feel you are making informed decisions for yourself and for your baby. You may also then feel better equipped to request more information from service providers and specific referrals from your GP.

The perinatal period can be a busy time, those 92 weeks are going to fly by!

We hope this TO DO list guides you some of the way when preparing the many layers of perinatal health.