Expert Interview: Psychotherapy for perinatal anxiety and depression

Expert Interview: Psychotherapy for perinatal anxiety and depression

Written on 10/14/2017
Nadine Richardson

This week’s blog is brought to us by a great friend and psychotherapist, Jo Schaeffer. We are addressing the very complex and often painful subject of perinatal anxiety and depression. By no means can we cover in one blog what work is available to do before or after birth to helps mums avoid these experiences – there are so many factors to consider within the complexities of pregnancy, birth, motherhood and our unique human expression.

From my experience as a doula and educator over the last 15 years, the effects of synthetic oxytocin during birth and its correlation to anxiety/depression rates is very real. All too often its impact is under-estimated. But it’s also still very hit and miss who it seems to effect.

I also see mums who work incredibly hard prior to birth, only to enter the postnatal period depleted and unprepared for the physical onslaught of parenting/feeding. I do believe that a lack of good lifestyle and nutritional support pre and post birth can be a great contributor to depression, or severe depletion. And of course, every woman’s endocrine system and organs cope differently with the dramatic reductions in progesterone and oestrogen after birth.

Our research, published in the British Medical Journal last year, showed a 50% reduction of syntocinon (synthetic oxytocin) used by She Births® mothers.

At She Births®, we empower women and families to have better births with significantly reduced medical intervention. I believe that this is the big factor that is enabling us to reduce the general 1 in 3 traumatic birth stat to around 2% for She Births® mums surveyed.

I also believe the She Births® program reminds us of how worthy we are as women, as mothers, as holders of the feminine – and this makes such a huge difference as we move into fully domestic workers for a while. We are the hand that rocks the cradle and that is the most important role to have on our planet – we are providing the healing of the earth through love, food and cuddles. Of course, our beautiful Soul Mama Circles and She Births® Show events create community and a container of support for families which is also critical.

If you are highly anxious about birth then I highly recommend preparing for your maternal and birthing transformation with your own personal guide. I have seen women bring other traumas from numerous life experiences into their birth – and then blame birth.

It is important to realise that most of us will be processing our births forever. Like a ball of red wool that we pass around at a Blessing Way, we will never fully untangle the wool or reach the bottom of the ocean. This is how psychoanalysis and giving birth are so alike.

We can’t strategise our way through birth nor post birth understanding but we can explore, reflect and feel held as we uncover and learn. I have experienced both severe anxiety disorder and clinical depression in my life – and I found my way through, fully healed with a lot of support from numerous places. In a way my holistic approach to finding answers and solutions became the foundation of She Births® and its philosophy.

As I change in myself I continue to reflect on my birthing experiences and remember most importantly that life is a mystery unfolding, that I have very little control over. Depression and anxiety can hit us at any point, when we least expect it sometimes, and for no obvious reasons. But it is always a great initiator of change and self discovery.

Love and gratitude,

Nadine xxx

What does a session with a psychotherapist involve?

The process of psychotherapy is an opportunity to take a deeper look at yourself, your relationships and your life and how things are really going. Psychotherapy is not necessarily about setting goals and helping you achieve them, although this does happen. But it is more about opening your mind and awareness to how things really are and being on a journey of discovery about how you might want them to be different. The purpose of psychotherapy is more to develop your sense of self and your relationship with yourself and all the people and areas in your life. It is a weekly commitment to sit in a room and be with your therapist and explore what comes up for you in that safe space. Each psychotherapy is unique and different depending on the individual or couple in the room. The process is driven by the client with the therapist serving as a container and guide in the process.

When is it beneficial to see a psychotherapist before giving birth?

It is normal to have some worry and anxiety about giving birth and entering motherhood, as it is a huge life transition and archetypal right of passage for a woman. If the negative experiences are impeding your capacity to also enjoy the process, psychotherapy can hold a space for your to address these anxieties and be supported in your process. Or if you are wanting to explore your experience or entering motherhood more fully and understand what is happening for you and how this fits in with your narrative in a way that your usual social/family relationships do not allow for, then psychotherapy may be an opportunity for you to do this. Developing your relationship with yourself, your sense of self, your capacity for self care and self regulation are central to the process of psychotherapy and essential for any woman on this journey.

The quiet before your baby enters the world may be a good time to give yourself the chance to put support structures in place and develop a relationship with your psychotherapist when you have the time and space. This way the connection is in place to hold you and whatever comes up for you in the lead up, birth and after birth once baby has arrived and there is less time for you.

How can a psychotherapist help you after giving birth?

After birth is a huge time of change and transition for everyone involved including Mum, Dad, bub, other siblings and extended family. The whole family dynamic shifts to adjust to the new addition. Becoming a mother is a huge metamorphosis for a woman. All her instincts adjust from being self-focussed to focussed on her child(ren). Feelings change, mental states change, relationships change and a whole new self emerges, within a new evolving family system. Psychotherapy can offer extra support and holding for a woman whose role it is to hold these changes and dynamics for everyone in the family around her, including herself.

In your experience, what causes prenatal and postnatal depression? Is there a link between birth trauma and PND / anxiety?

It is inevitable that in going through this metamorphosis into motherhood a woman will some how bump into, revisit, have come up for her or reconnect with, her own history and ancestral history of what it means to be a woman, a child and a mother. These are powerful archetypal patterns that each of us embody in this process in our own unique way.  Whilst women’s experiences of prenatal and postnatal anxiety and depression vary widely and each woman has her own unique story of development and reasons and causes for her experiences, these are all the manifestations of the archetypal patterns of woman, child and mother.

The ultimate enactment of wounding in these archetypes is in birth trauma. There are no specific events that must happen during childbirth for a woman to be traumatised. If you feel traumatised, you are. It is more common for women who have had an unexpectedly difficult childbirth. There are statistical links between birth trauma and the experience of postnatal depression/anxiety which may sometimes be a misdiagnosis of postnatal post traumatic stress. Studies suggest up to a third of women find labour traumatic, with as many as 6 per cent of new mothers going on to develop symptoms of PTSD. With all these statistics, diagnoses and technical terms aside, the experience of birth trauma is real, it is primal, it is wildish and it is something which can be worked with in a psychotherapeutic relationship in order to ensure the support structures are in place to be able to process the trauma in order to repair and restore the space in a woman for bonding and family.

The other side of the coin of birth trauma is the bond between mother and child. This is the most important part of the whole journey of motherhood and childhood. It is the template for our sense of self and our future relationships. A traumatic birthing experience can seriously effect a woman’s capacity to bond with her baby. Bonding effects the feeding and development of the baby as well as the emotional states of the baby and mother which are inextricably linked. Healthy bonding is connected to neurotransmitters in the brain of dopamine and oxytocin which effect our capacity for love and attachment, pleasure and self-regulation. Studies have shown that the baby’s body learns how to self-regulate by being in close proximity to the mother’s body. If a mother’s body and mind is preoccupied with dealing with the aftermath of a traumatic birth, she is not in an optimal state to be regulating herself or her baby. As baby is in need of a safe, consistent, loving container so too is Mum. The psychotherapeutic relationship can provide a holding structure for Mum, within which the trauma can be processed and the bonds can be repaired.

Do you often see that a woman’s relationship with her own mother has an impact on motherhood?

Clearly the archetypal experiences of woman, child and mother are rooted in our experiences of our relationship with our own mother, in whatever form that has taken. We experienced this relationship as a child and it formed a template for us to experience relationships in general, including with ourself. We continue to experience it evolving as a woman and mother. For a woman who has lost her own mother or who has any kind of relationship trauma or difficulties with her mother, no matter how minor, going through the process of becoming a mother can be very confronting and will inevitably bring up these wounds. Discovering the developing relationship with her own child(ren) will certainly force a mother to have to face the disowned aspects of her self and her relationship with her own mother. Psychotherapy holds the space to explore the wounding in the mother child relationship which we call the trans-generational trauma and how to heal this.

Jo Schaeffer is a psychotherapist with over 20 years experience working with individuals, couples and groups. She has worked in the psychiatric and not-for-profit sectors but mostly in private practice. She is a member of the Psychotherapy and Counselling Federation of Australia (PACFA) and her training is in Relational Transactional Analysis and Somatic Psychotherapy. Find out more at www.evolveyourself.com.au.