Stephanie Sieberhagen
Psychologist

Relationship Specialist

Birth of a mother - what is Post Natal Depression?

Emotional changes after having a baby

The birth of a first child will probably be the biggest change you will undergo in your life. It involves more changes than emigrating to another country – everything changes – your body, your mind, your relationships, your career, your financial status, your responsibilities. It can be quite overwhelming initially to know that you are responsible for a helpless little baby 24 hours a day. In the beginning, nothing is automatic – one has to think about each moment – the feeding, sleeping, burping, changing. If you are feeling exhausted and confused – it's no wonder. All these changes would be stressful – even if you were getting 8 hours sleep a night – and that is most unlikely at this stage! It is important to remember that “The Birth of a Mother” may not happen at the same time as the birth of the baby! That may sound strange, but many first-time mothers do not feel like mothers immediately. All they know is that they feel very different – almost like a new person, and that is true. This is a new you, and it may take time to adjust to your new life.


What exactly is Post Natal Depression

Postnatal Depression (PND) is an emotional, or mood disorder that occurs after the birth of a baby. Three types of PND (and Anxiety) are found:

The “Baby Blues”: About 75% of all new mothers experience postpartum blues. Symptoms occur on about the 3rd-4th day after the birth, and include tearfulness, mood changes, irritability, agitation, and sleep disturbance. This is considered to be a biological response to changes in hormonal levels, associated with childbirth. It does not last long, and if the people around you are supportive and re-assuring, you should feel better within a week.

Postnatal Depression: Between 15 and 30 % of all mothers in all circumstances will have PND (Postnatal Depression). It can develop immediately after the birth (or she may have been depressed during pregnancy), or at any time in the first year after childbirth. PND is not “just hormonal”. Symptoms vary, but include unexplained feelings of sadness, feeling trapped and frustrated, feeling overwhelmed, incompetent, and helpless, feeling out of control, feeling disconnected from the baby, feeling numb, feeling unbearably anxious, panicky and scared, major changes in eating and sleeping patterns, feelings of loss of joy and motivation, and the experience of intrusive thoughts, and suicidal and homicidal ideas. PND is insidious, and may creep up slowly. It is very treatable with appropriate medication, support (including support groups), counselling and psychotherapy.

Postnatal/Postpartum Psychosis: Fortunately very few women (1 or 2 per 1000) develop this very serious illness. It develops very suddenly, soon after the birth, and the symptoms include hallucinations, delusions, severe insomnia, extreme anxiety, suicidal and homicidal thinking, and generally a loss of contact with reality. Mothers who develop postnatal psychosis need immediate and urgent medical attention. This will involve being hospitalized for the protection of the mother and those around her. With correct treatment, the mother will recover.

Postnatal Panic and Anxiety Disorders: Some women do not feel depressed, but extremely anxious. They may have panic attacks, with breathlessness, speeded up heart rates, and feelings of dizziness. The treatment is similar to that of Postnatal Depression (above).

Postnatal Obsessive-Compulsive symptoms: These are not uncommon. There may be repetitive intrusive thoughts of e.g., hurting the baby, that something bad will happen if you do not perform tasks in a set order, avoidance of certain people and situations because of irrational fears, that can be scary and uncharacteristic. Again, treatment is effective, and will be likely to include medication, counselling and appropriate support.


Vulnerability Factors

• Previous Depressions

• Depression during Pregnancy

• Previous PND

• Stress

• Attitude to Labour and Delivery

• Lack of Support

• Difficult Relationship with Baby’s Father

• Personality Factors

• Abuse

Exploding the Myths

In 1998 a research project was undertaken in England to identify women's expectations of birth and the period following. They discovered that there were five myths that were commonly held:

1. That bonding is automatic

2. That they would feel happy all the time

3. That breast feeding would be natural and easy

4. That one would be able to manage the baby on one's own – a one woman show

5. That after six weeks your sex life will return to normal


Back to basics - what you need to do:

Take Care of Yourself

Develop your Relationship with your Child

Take Care of your Relationship with your Partner


Strategies that work - what your therapist will help you with:

Assess sleeping problems

Assess eating patterns

Focus on the basics (Women with PND tend to be perfectionists)

Help the mother to develop a support system

Help her to identify and express her feelings

Ask the woman to tell you what she needs


The “N.U.R.S.E” approach - what your partner needs to do:

Nourishment

Understanding

Rest and Relaxation

Spirituality

Exercise


Recent research indicates that the partner who did not carry the baby can also suffer from PND.

How to talk so kids will listen and listen so kids will talk

Based on the book by the same title by Adele Faber and Elaine Mazlish, authors of Liberated Parents/ Liberated Children

Help children deal with their feelings

There is a direct connection between how kids feel and how they behave, when they feel right, they behave right. So we have to ask – how can we help them feel right? And the answer is that we need to accept their feelings. We are socialized into stale and cliched responses that roll off the tongue so automatically and literally without any cognitive intervention, that we hardly notice we’ve spoken, our only desire - to change our child’s undesirable behaviour. When the response is not what we expected, our own emotions escalate, attempting to over-power in an effort to ‘just make it go away’. You know the drill – you’ve been down that road, right? Why am I so sure? Because you’re human, we’ve all done it. Unfortunately this socialization into stale responses cause a steady denial of our children’s feelings that confuse and enrage kids. They learn not to know or trust their feelings, e.g.:

Child, ‘ I’m sad.’

Parent, ‘Nonsense, you didn’t even know Sammy that well.’

Child thinks, ‘ O, so I have to know someone very well to be sad about them leaving, this must not be sadness that I’m feeling, but what is it then…’

We can learn new skills that, applied with dedication and effort, will bring more satisfactory results with our children, but we must be dedicated, there will be times, such as when what a child says makes us feel anxious or angry, that the old way of answering them will feel easier and come quicker than this new, studied way of doing things. To help acknowledge your child’s feelings:

  • Listen with your full attention (open body language and eye contact).
  • Acknowledge their feelings with a word, e.g. ‘Oh, mmm, I see’.
  • Give their feelings a name, e.g. ‘ You seem angry/ sad/ frightened/ despondent’.
  • Give them their wishes in fantasy, e.g. ‘ It would be enjoyable to eat a whole slab of chocolate, wouldn’t it – I wish I could give you as much chocolate as Charlie saw in the Chocolate Factory!’

I am passionate about no.3. As a previous high school English teacher and Counselor, it struck me that teenage girls knew very few words that could help them express how they felt. They were mostly limited to: angry, sad, happy, nice. Don’t steer away from using words like despondent, desperate, agitated, confused, etc. The more words we know to help us express accurately how we feel, the greater the relief at talking about our feelings. When we can’t adequately describe how we feel, we often have to resort to very, really very, or swear words – when an adjective (if only we knew one!) would actually have been much more effective in helping us.

For more on how to talk so kids will listen and listen so kids will talk, look out for next month’s Kids Rag.

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How to talk so kids will listen and listen so kids will talk

Based on the book by the same title by Adele Faber and Elaine Mazlish, authors of Liberated Parents/ Liberated Children

Part 2

In the last article we discussed:

  • Listen with your full attention (open body language and eye contact).
  • Acknowledge their feelings with a word, e.g. ‘Oh, mmm, I see’.
  • Give their feelings a name, e.g. ‘ You seem angry, sad, frightened, despondent’.
  • Give them their wishes in fantasy, e.g. ‘ It would be enjoyable to eat a whole slab of chocolate, wouldn’t it – I wish I could give you as much chocolate as Charlie saw in the Chocolate Factory!’

It is difficult to change any behaviour, so the best way to try and change the way you communicate with your children is to remind yourself of the benefits of the outcome, in other words, that there will be more peace and fun and less arguing and tension! The second way is to put reminders up in your house, these can be verbal, like an actual sentence written on some poster paper; they can be in picture format or they can be symbols – just a little heart here or there reminding you of your end goal.

In the meantime we have to realize that attitude is even more important than words and that our words need to be spoken with empathy – children are excellent at spotting when you are insincere! – otherwise your words will not have the desired effect. Once you have mastered the art of looking through your child’s emotional outburst to recognise and accurately name the emotion they are experiencing, you are empowering your child to use that word in future instead of having to resort to screaming or tantrumming in frustration because they know how they feel, but there’s no word for them to tell you how that is.

We are incredibly brain-washed into trying to ‘solve’ or ‘make better’ when others (especially our children) come to us with problems. We assume we know better or can see exactly what is actually going on. Thing is 90% of the time we are wrong, and the rest of the time those instant solutions disempower the person who receives the advice because they have just received a solution to 1 small problem, intsead of acquiring the skill to solve problems as they come up – which they do all the time.

At my FAMSA training sessions the new and willing counselors-in-training always want to know when they can stop with the empathising and start with the helping. But empathising is helping. You support someone else and provide them with the space and support to arrive at their own desirable outcomes.

For more on how to talk so kids will listen and listen so kids will talk, look out for next month’s Kids Rag.

How to talk so kids will listen and listen so kids will talk

 

Based on the book by the same title by Adele Faber and Elaine Mazlish, authors of Liberated Parents/ Liberated Children

 

Part 3

 

In the last article in this series we discussed:

  • Reminding yourself of the benefits as you seek to change behaviour.
  • Words Need to be spoken with empathy if they are to have any real impact.
  • Giving your child an emotional vocabulary is key in having them cope with their emotions.
  • Don’t solve their problems for them – help them to find ways in which they may solve the problems themselves.

 

To conclude the first part of this series, here are the last few things to reinforce what you’ve learnt so far. 

 

You do not always have to empathize with your child, sometimes they’re also just passing on information like, ‘I’m going to a friend’s house after school.’, and you just need to acknowledge, ‘Thanks for letting me know.’, not empathize, ‘Oh, it’s so nice that you’re making friends.’

 

Keep on mirroring feelings rather than interrogating.  It’s seems much easier just to ask, ‘What is wrong, how are you feeling?’, but most children don’t respond well to these grown-up questions, so keep on reflecting what you see, ‘I see something is making you sad.’  This does not mean that you always agree with their feelings, you are just recognizing what your child is experiencing.  And what if you guess wrong?  Don’t be scared of this – it will happen!  Children will set you right, because they appreciate that you’re trying.

 

Simply saying, ‘I understand how you feel.’, is often not believed, but being specific to their needs, ‘That sounds very scary, there were so many new things you didn’t know.’, lets the child know you really do understand.

 

When children say hurtful things, you can point that out to them and request them to express themselves in a less hurtful way so that you can still help them.  They are being socialized and need to know how people feel in response to their words.

 

Accepting your child’s feelings does not mean you have to become an over-permissive parent.  You still have rules and boundaries but when you accept your child’s feelings, these will become easier for him/ her to accept.  If you realize you have been unhelpful or blunt in a response, don’t let your ego get in the way of going back to your child sometime after and saying, ‘I know I said … yesterday, but I’ve really been thinking about it and maybe …’,  this is a very positive lesson for kids, who can see that being right isn’t always the best way and that being humble and open to ideas is a good trait to have.

 

Just a few cautions.  Remember to paraphrase, don’t give the exact words back to the child.  Some children prefer just being held or sung to or rocked – they don’t like addressing their feelings verbally.  Be in tune with your child’s needs.  Always empathise, don’t try and be rational and reasonable when your child is emotional, but don’t respond with more intensity than the child feels!  If your child was called a name, don’t repeat the name when you paraphrase, it just doubles the hurt.

 

That’s quite a mouthful for this month!  If you need more practical examples, get a copy of this helpful book at amazon or exclusive books.co.za.

 

How to talk so kids will listen and listen so kids will talk

 

Based on the book by the same title by Adele Faber and Elaine Mazlish, authors of Liberated Parents/ Liberated Children

 

Part 4

 

In the last article in this series we discussed:

  • You don’t always need to empathise, e.g. when your child is just passing on information.
  • Mirror feelings instead of interrogating.
  • Be specific to your child’s needs.
  • Be mindful of becoming over-permissive.

Here is one mom’s experience of changing from her ‘usual’ way of doing things, to actually listening and responding in the way the authors of this book suggest:

‘I’ve just begun to realize what unnecessary pressure I’ve been putting myself under to make sure my kids are happy all the time. I first became aware of how far-gone I was when I found myself trying to scotch-tape a broken pretzel together to stop my 4 year old from crying. I’ve also begun to realize what a burden I’ve been putting on the children. Think of it! Not only are they upset about the original problem, but then they get more upset because they see me suffering over their suffering. My mother used to do that to me and I remember feeling so guilty – as if there was something wrong with me for not being happy all the time. I want my kids to know that they’re entitled to be miserable, without their mother falling apart.’

In the next series of these articles, we will be looking at Engaging Cooperation. In the normal run of things, we are typically trying to socialize our children into people with manners, hygiene and all their limbs intact! They don’t see it this way, however, and somehow the more intense we become, the more they resist. Take some time to think (or even write a list) of all the daily do’s and don’ts you try to impart to your children. Once you have finished your list, you will recognize that commonly used methods to enforce these do’s and don’ts include: blaming & accusing; name-calling; threats; commands; lecturing& moralizing; warnings; martyrdom statements; comparisons; sarcasm and prophecy. Now think about how the child in you would feel at being on the receiving end of all this.

There are 5 skills that could be enlisted to replace these old, tired and ineffective ways of trying to engage your child. These are:

  1. Describe. Describe what you see, or describe the problem.
  2. Give information.
  3. Say it with a word.
  4. Talk about your feelings.
  5. Write a note.

In next month’s article we will fully discuss how to put these methods into practice, till then – spend some time on reviewing your current ways of eliciting cooperation and how they would make you feel.

If you need more practical examples, get a copy of this helpful book at amazon or exlusive books.co.za.

 How to talk so kids will listen and listen so kids will talk

 

Based on the book by the same title by Adele Faber and Elaine Mazlish, authors of Liberated Parents/ Liberated Children

 

Part 5

 

In the last article in this series we discussed:

  • How wanting your children to be happy all the time puts unnecessary pressure on you and the children
  • Ineffective ways of eliciting cooperation.
  • Mentioned the 5 effective ways of engaging your child.

Today we will discuss the 5 effective ways of engaging your child.

1.) Describe. Describe what you see or describe the problem.

e.g.:

Instead of:

‘You’re so irresponsible. You always start the tub and then forget about it. Do you want us to have a flood.’

‘You haven’t taken that dog out all day. You don’t deserve to have a pet.’

Describe:

‘Johnny, the water in the bath tub is getting too close to the top.’

‘I see Rover pacing up and down near the door

It’s hard to do what needs to be done when people are telling you what’s wrong with you. It’s easier to concentrate on the problem when someone just describes it to you.

2.) Give information

e.g.:

Instead of:

‘Who drank the milk and left the bottle standing out?’

‘That’s disgusting! Look at the apple cores on your bed. You live like a pig!’

Give information:

‘Kids, milk turns sour when it isn’t refrigerated.’

‘Apple cores belong in the garbage.’

Information is a lot easier to take than accusation.

3.) Say it with a word

e.g.:

Instead of:

‘I’ve been asking and asking you kids to get into pajamas and all you’ve been doing is clowning around. You agreed that before you watch TV you’d be in pajamas and I don’t see a sign of anyone doing anything about it!’

‘Look at you! You’re walking out the door without your lunch again. You’d forget your head if it weren’t attached to you.’

Say it with a word:

‘Kids, PAJAMAS!’

‘Jamie, your LUNCH.’

In this case, ‘less is more’.

4.) Talk about your feelings

e.g.:

Instead of:

‘Stop pulling on my sleeve, you’re a pain in the neck!’

‘What is wrong with you, you always leave the screen door open!’

Talk about your feelings:

‘I don’t like having my sleeve pulled.’

‘It bothers me when the screen door is left open. I don’t want flies around our food.’

Children are entitled to hear their parents’ honest feelings. By describing what we feel, we can be genuine without being hurtful. It’s possible to cooperate with someone who is expressing irritation or anger, as long as you’re not being attacked.

5.) Write a note

e.g.:

On the bathroom mirror: ‘Help! Hairs in my drain give me a pain. Glug, your stopped up sink.’

On the TV: ‘Before you turn this on – THINK – have I done my homework? Have I practiced?’

Sometimes nothing we say is as effective as the written word.

So there you have it, also remember to always be authentic and not revert to your old ways if you feel you’re not ‘getting through’ the first time.

If you need more practical examples, get a copy of this helpful book at amazon or exclusive books.co.za. (they also have other helpful titles like Raising Boys by Dr J Dobson and the ‘What to Expect’ (in pregnancy; in the first year; in the toddler years; etc. series).

Coping strategies to lower day to day stress:

Find someone positive to talk to

Join a group or groups that provide some kind of support:

Support groups

Group exercise like Run/ Walk for life

Lift club

Sports group

Get involved in a hobby:

Sailing

Kayaking

Pottery

Scrapbooking

Meet other people in your situation and socialize with them

We often feel isolated and alone. We feel as though we are the only ones having a specific problem. The difficulty is that it is so hard to see others are going through the same thing. Meeting up with them through church, school, sport, hobbies or other groups normalizes our own problems and helps with creative solutions

If you can afford it:

Get a cleaner, gardener, nanny, baby sitter (all or some of these) – for a few hours or as permanent as you are able. There’s no shame in having people help you!

Scale down, not out:

Don’t stop activities! Getting out into the fresh air is absolutely vital. If you suddenly can’t afford the luxury yacht anymore, then replace that outing with a walk in the forest or along the beach, but don’t stop getting fresh air and going places, you might just have to make some adjustments.

Adjust:

Find restaurants, holiday places, etc. that welcome children and have activities and places where they can play safely under your supervision.

Your schedule – make it work for you. Spend time on this. A week in the planning of a new and more realistic schedule will save you hours of frustration and fatigue

NBNBNBNB – Network:

Other parents are a vital source of info on where to go, what to do, how to adjust, what works and what doesn’t

Other ideas to look into: chores; shopping; weekends; yoga; diet; meditation; co-habiting