Integrated discussion, ideas, links and more

Both Prenatal Yoga (Relax, Stretch and Breathe) and Mother and Baby Yoga include an integrated discussion or informal prenatal or parenting class.  These discussions are always interested and varied after each session I share more information, ideas and links.  Here are some of those follow ups, for anyone who might find them useful...

On a very hot evening in August our discussion time in Prenatal Relax, Stretch and Breathe included how might one keep your baby cool during hot weather and warm during warm weather.  

Babies rely on their adult carers to help them thermoregulate and carrying a baby is a great way to do this. Carrying a baby in a sling or a baby carriers helps the adult monitor the baby's temperature constantly and helps cool them down through adult sweating and or warm them up from the adult's body temperature, or to change the environment around them - finding shade, or warmth depending on what the baby needs.

Caring for a baby in extremes of weather is hard.  The ideal temperature for a baby's sleeping place is 16-18 degrees (according to the Lullaby Trust Safe sleep Guidelines - as a side note it shows that guidelines are only guidelines and not rules - since sometimes guidelines simply can't be met), but the Lullaby Trust has excellent suggestions for caring for your baby during hot temperatures: https://www.lullabytrust.org.uk/safer-sleep-advice/baby-summer-safety/  and https://www.lullabytrust.org.uk/safer-sleep-advice/baby-room-temperature/.  In cold weather it can be tempting to heap lots of warm and cuddly things in the baby's sleeping space to keep them warm, but again, the Lullaby Trust has excellent guidance on keeping your baby warm without the risk of them overheating: https://www.lullabytrust.org.uk/safer-sleep-advice/safer-sleep-winter/

Pre and Postnatal mental health issues are becoming more widely talked about, but are still probably under- discussed, and under-diagnosed.

Our RSB session on 22 June focused particularly on postnatal mental health and some of the most common situations.  Here are three  scenarios, as a new parent might describe their situation to a sympathetic listener....and some thoughts about them:

1: 

Henry is three days old , and my partner Paula is not coping well and I don't know how to help.  Paula cries at everything (much more than Henry), even adverts on the TV can make her cry.  breastfeeding is harder than we expected but when I suggested making a bottle of formula for Henry, Paula shouted at me and refused.  Henry hates his cot and needs to be held all the time  so we are taking it in turns and we are both exhausted.  The apartment is a mess and we are living on takeaways and cereal.  Is this normal?

Yes - this does all sound really normal.  A really normal response to having a baby, and also a normal case of BABY BLUES.  Baby Blues occurs in about 70% of women between 3-5 days after the birth of their baby.  It is a hormonal and emotional rollercoaster, as the pregnancy hormones drop and the breastfeeding and nurturing hormones rise (and still happens in women who are not breastfeeding).  It usually last three or four days, and then passes.  It needs empathy, support, encouragement and reassurance, but not medical treatment.

2:  

Our gorgeous baby Stan was born just two months ago. My partner Fred took the parental leave at the time and we enjoyed learning how to be parents together. We laughed a lot at our incompetence and what a state we looked by the end of the day. It was crazy but we made the best of it.

But things have changed and he’s just not himself now. I know we are tired, but I think this is something more, something worrying.  He’s finding it hard to concentrate at work and so he’s worried he might be letting people down there.  He keeps making us lists to make sure we don’t forget anything important but then gets stressed if we can’t get it all done. He’s great with baby Stan but I don’t think he believes me when I tell him that. He’s just not enjoying being a Dad as much as we thought he would.  Is this normal?

Yes, this is very normal.  Having a baby does change us and most parents feel overwhelmed at times, and often a lot of the time.  However Fred's partner is right to be worried about them.  There are signs of POSTNATAL DEPRESSION in this description.  Anxiety and stress, inability to concentrate, feeling that one is a bad parent are all common features in postnatal depression.  Fathers are vulnerable to postnatal depression just as mothers are (and sadly, if one partner has postnatal depression that puts the other partner at a higher risk).  

3.  I’m so worried about my partner Juliana. Our beautiful, longed for baby Archie was born 12 weeks ago and is getting more and more gorgeous by the day. But Juliana is not doing so well. She seems to have lost her sparkle -we are tired I know but it’s more than that.  She’s not talking to her friends as much. She puts on a brave act for the BCT group, but it wears her out and she thinks they are all doing better than her.

I’m doing my best to support her. I’ve taken extra leave from work so I can take care of Archie and let her sleep.

 We should be enjoying this more. I imagined us snuggled up on the sofa watching Netflix and cuddling Archie. She says she’s too tired for TV even, that she can’t follow the story. It’s hard to get her to come for a walk even. I think she would forget to eat if I didn’t keep putting food in front of her.

 She keeps saying she thinks she’s a terrible mum but when I look at how she is with Archie I am so proud of her and he clearly adores her.  Is this normal?

As with scenario 2, many things in this story are normal for all new parents - tiredness, feelings of uncertainty or imposter syndrome, difficulty in focussing, feeling overwhelmed.  These are all really common feelings in the first four or six weeks with a new baby, this is partly why PND is rarely diagnosed before 1 month.  For most families, the feelings over confusion, overwhelm, and uncertainty start to diminish after about six week, the parents realise that whilst they are still learning all the time, facing new experiences with their babies, still tired and worried about whether they are doing things right, they have gained confidence and recognise that they are doing okay.  Some parents don't, and that is what seems to be being described here, and that is where you might look for some help and support for PND.

Here is a fourth scenario:

I’m having a really hard time and I need to get some help from somewhere. Our baby Ralph is five weeks old now, but my partner Suze still hasn’t really got it together. 

I’m back at work in the home office, but I’m constantly interrupted by the sound of Ralph crying. When I come downstairs for lunch the place looks like a bomb site and there is never any food made so I end up just making a sandwich and eating it upstairs in the office. 

I have to cook every evening and then I get a load of abuse for not clearing up properly. 

I think Suze looks amazing, but she says she feels like her body isn’t hers anymore. I tried to give her a cuddle, but she pushed me away said “sex is definitely out of the question for the foreseeable future” -it was just a cuddle. I’m finding that tough to be honest. We used to be so close.

I’m starting to suspect she has postnatal depression and want to call a doctor....

Is this postnatal depression?  I would propose that Suze, the mother, does not have PND at this point. However, the partner writing is perhaps vulnerable to PND.  He/she seems to be struggling with the changes that come with having a new baby.  Whilst they come across, in this scenario as being a bit of an idiot, in fact they deserve sympathy and support to manage this transition and their feelings about it, in order to protect themselves and their partners against postnatal depression. 

Risk factors and triggers for PND:

There are various factors that have been shown to increase the risk of PND, being aware of these may be helpful.  The idea is not to make people worry but to help them take preventative or early action.

• Family or personal history of depression (including a parent who suffered from PND)
• Stressful life events (such as a bereavement, a relocation, a separation, a house move, a career change or end)
• Traumatic birth, birth disappointment or feeling disempowered during birth (that is, things happened during the birth that you weren't consulted on or you felt pressured into making decisions without enough time or information to make an informed decision)
• Pregnancy complications
• Fertility issue or previous pregnancy loss
• Relationship difficulties
• Family violence and controlling behaviours
• History of abuse or trauma
• Financial difficulties
• Difficult child hood experiences
• Limited social support

Further reading and useful resources:

https://www.nhs.uk/conditions/baby/support-and-services/feeling-depressed-after-childbirth/

https://childpsychotherapy.org.uk/resources-families/understanding-childhood/postnatal-depression-problem-all-family

http://www.fatherhoodinstitute.org/2007/fatherhood-institute-research-summary-fathers-and-post-natal-depression/

https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-natal-depression

Local resources and support:

https://baselchildrenstrust.ch/

https://postpartale-depression.ch/fr/

https://postpartale-depression.ch/de/hilfe/fachleute-listen/therapie/item/frauenklinik-universitaetsspital-basel.html

https://www.gesundheit.bs.ch/gesundheitsfoerderung/gesundheitsinformationen/Postpartale-Depression/Informationen-f-r-Eltern.html

Please do not hesitate to get in touch if you are worried about yourself, your partner or a friend and need help in finding support for them.

Most common treatment for PND in Basel is a combination of counselling, support at home, and often drug therapy.  Medical help can be accessed via your midwife, your paediatrician, your hausartz, your gynae, directly from the unispital frauenklinik.  Please do not hesitate to ask for help.

Prenatal Yoga for Sciatica

Sciatica is caused by compression of the sciatic nerve and is felt as pains down the inside of the leg, or numbness or tingling.

Good posture and keeping mobile rather than static (try using an exercise ball instead of a chair if you have to sit for long periods) can help, as can heat packs or hot water bottles.

There are a number of yoga stretches that can be safely down during pregnancy that can help.  However, as you do these stretches, listen to your body and stop or adapt them if they feel uncomfortable.

Downward facing dog – in late pregnancy hold for no more than 30 seconds.  Avoid this pose if you have high blood pressure or carpal tunnel syndrome.

Seated or reclining pigeon pose – either or a chair, or lying down, one ankle resting on the opposite knee.  

Supported forward bend – use a chair or the wall for this half way forward fold.  This gives a big calf and ham string stretch as well as releasing pressure on the back and the pelvis.  Use the wall or the chair to help you up as you come out of the pose.

Forward lunge – this can be a static lunge, or even better with a gentle rock backwards and forwards.  Ensure that the knee is not extending beyond the ankle.  

For a half hour prenatal yoga sequence for sciatica I like this film:

https://www.youtube.com/watch?v=SFMoku8trIA

In RSB on Tuesday 26 May we were discussing how hypnosis birth style tracks can be useful at many different stages of pregnancy as well as during birth.  Here are link to more information about some off the different hypno birth offerings from different organisations, including free tracks to download.

These are not specific recommendations, I suggested that you browse through them all and listen to some of the sample tracks to ensure that you like the sound of the practitioners voice.  There will also be other resources available in different languages, google is great for this.

http://www.hypnobirthingplace.co.uk/pregnancy-birth-free-support - tracks, affirmations and activities, plus details about classes

https://thewisehippo.com/shop/ - free tracks to download, including some for morning sickness, plus details about classes

https://www.kghypnobirthing.com/ - classes, resources and free downloads

https://www.natalhypnotherapy.co.uk - the original UK offering (also available in a variety of languages), details about classes and packages plus downloads including for different stages of pregnancy and postnatal life 

http://hypnobirthingus.wob-web.me - the original American hypnobirthing

For local classes (on line or in person when possible), there is the truly wonderful Menna Keyes:

https://www.facebook.com/mennakeyesdoula/ 

There has been plenty of discussion this week on the RSB WhatsApp group about protecting the perineum during birth and how to avoid a tear on an episiotomy.  Episiotomies are not done so frequently in Switzerland - ideally there won't be any damage to the perineum at all, and the midwives here are quite hands on to help with that, but a tear is considered preferable to a cut - as it will usually be less deep and heal more quickly and more strongly.  An episiotomy is usually necessary for an assisted birth- one that uses ventouse or forceps.

Perineal massage, using water throughout the active labour (even if intermittently), spending time in the water or giving birth in the water, choosing particular positions and breathing patterns and making sure the midwife knows if you are fearful about tearing are probably all effective to prevent tearing.   Interventions (eg induction, or augmentation) can cause a cascade of other interventions which may include (earlier) epidural and therefore reduced mobility, less optimal position for baby and so bigger stretch for the perineum, and more likely use of ventouse, and therefore episiotomy). 

If it’s an option for you and appeals then the geburtshauses usually report extremely low rates of perineal trauma (for example 96% women have intact perineum at the Tagmond).  This is partly because of the lower rate of interventions; the protocols about the length of time for stages of labour are different (more time, which again leads to fewer interventions like augmentation) and very high rates of water birth, plus women using a v wide range of positions to birth in. If a geburtshaus is not for you you can absolutely recreate those conditions in a hospital setting, you may need to be more of an advocate for yourself, to consider the effect of any interventions that are suggested (the ins and outs of why there are more interventions in hospitals than home births and birth houses are fascinating and complex).

So to help avoid stitches:

In advance:

- perineal massage from 34 weeks (if this feels okay for you - if it makes you feel really stressed then that  might become counterproductive.  There is research that shows that perineal massage from 34 weeks has a statistically significant effect on reducing tears - but equally there are many women who never do perineal massage and don't tear)

- pelvic balancing work and pelvic floor work, basically what we do in RSB

In labour:

- staying mobile, upright/forward leaning

- using the bath or birth pool

- choosing not to have an epidural, or keeping the epidural low dose

During the second stage/pushing stage/ as the baby’s head is emerging

- telling the midwife you are worried about tearing, she can be hands on and also suggest positions and breathing

- panting or doing steam train impressions when the baby’s head is crowning

- using all fours positions/Sphinx pose over squat positions (but the midwife will guide/coach you with this.)

I rather like this article on this topic

Please stick within your limits and if anything feels uncomfortable please stop.  Whether you are pregnant or have a small baby, now is not the time to be pushing yourself, instead yoga should be about finding what feels good and keeping yourself within that feel good place.

Some prenatal Yoga from Yoga with Adrienne (also nice with a small baby):  https://youtu.be/0cKnStmV1dI

Some Spinning Babies Yoga moves from our regular RSB sessions.  See also www.spinningbabies.com

Some Mindful Mama relaxations and affirmations to listen to:  https://www.penguin.co.uk/articles/2016/mindful-hypnobirthing/

A Mother and Baby Yoga session, with sketch drawings and song ideas

RCOG guidelines on corona virus in pregnancy:  https://www.rcog.org.uk/coronavirus-pregnancy

Coronavirus and Breastfeeding: https://www.llli.org/coronavirus/