Lifting the Stigma of Perinatal Depression

My work is hands on. It quickly builds trust with clients and I often see them starting to open up and talk during the treatment. I am well aware that osteopathy is not part of the medical system (NHS). However it's important to know the limits of my work and when I need to refer a client for more specialist help.

Depression is one of those taboo topics that needs far more open discussion. It's an issue in the peri- and post-natal periods - a time when society can sometimes assume a woman is blooming. I spoke to Mia Scotland, clinical psychologist, hypnobirthing practitioner and doula about her work in this field. Mia is also the author of "Why Perinatal Depression Matters" .

Thanks for taking the time to talk to me Mia. You're a clinical psychologist, hypnobirthing teacher and doula. Can you tell us how you went into the perinatal field?

Yes, I have been a clinical psychologist for over 25 years, and have been specialising in the perinatal period for over 10 years. I didn’t mean to become a birth doula. To be honest, the thought of being at some-one’s birth used to scare me. So when women started asking me if I could be there for them, I thought that I ought to address my fears and do some training! I trained with Michel Odent (the famous natural birth obstetrician) and I got hooked. I’m also co-founder of the one day Mindful Mamma hypnobirthing workshop for pregnant couples.

How did you get interested in pregnancy and birth?

I was working part time in a clinic within the NHS to help couples who were having problems with their sex lives. I was pretty rubbish at that job to be honest, but what I really learned from that post, is that birth matters. I was surprised at how many problems couples were having, as a direct result of the birth of their baby. And I wondered, quite naively, how birth can make such a dramatic difference to the functioning of a couple. Then I had my own babies, and I began to understand that birth is a major psychological event.

What drew you to working in the field of perinatal depression?

Exploring perinatal depression, helping people to avoid it and to manage it if they do suffer, is a natural product of the two things that I love – pregnancy and birth, along with understanding mental health. Putting the two together is almost inevitable. I have always been interested in how society shapes people, and how a society can make people crazy. I think our society makes mothers crazy, by not valuing what they do, and by expecting them to “get back to normal” as soon as possible, as if one can ever be the same once we have become parents. Society is now also beginning to make dads crazy, by expecting them to be a full on support to the mother, without having any support himself. For example, expecting him to be at the birth, but not preparing him emotionally for that roller coaster ride.

What are you currently most passionate about in your work?

I am passionate about putting psychology into midwifery. If the NHS can begin to understand the monumental importance of psychological care, and the direct impact that good psychological care will have on physical health and wellbeing, then we can turn around the costs and investments of the NHS. The research is out there to demonstrate that we need to take the mind-body connection seriously. We know that feeling listened to has a powerful effect on the immune system, we know about the power of the placebo effect on recovery, the importance of continuity of care, the damaging impact that a stressed out group of midwives can have on women’s wellbeing, the intricate connection between body and mind, and so on. Putting this knowledge into practice is what I am passionate about.

I thought the ’11 myths about PND’ in your book was particularly helpful with respect to hormones, stress, it not being just a woman’s issue and that it doesn’t damage the baby. Why do you think it’s such a misunderstood topic?

Women’s mental health has always been a misunderstood topic. This is true for mental health generally. We are trying to understand something that is the product of our own societal forces. The mental health of people in society, is sensitive to how the people in that society are treated. Our society has, for a long time, denigrated and restricted the roles of women, and mothers in particular. This affects mothers’ mental health, but in a society which holds double standards for mothers (such as that motherhood is a biological need that is enough to satisfy a woman, and that motherhood is drudgery and boring), there is going to be confusion, myths, and unrest about what actually causes maternal depression.

In your book you talk about ‘building a happy brain’. What are your tips to do this?

Research shows that spending time each day thinking of things we are grateful for, activates happy hormones. Spending time each day doing something kind for some-one else also helps. Spending time “in the moment” each day, such as noticing what you can here and smell around you, and paying attention to that for a good few minutes, can help the brain build happy neural connections. There are plenty more. It’s a bit like going to the gym. You need to keep at it over many weeks to build the muscles, or the brain connections that you want to build.  

Is this something you recommend to prevent as well as manage perinatal depression?

Absolutely. Mental wellbeing is on a continuum, just like physical health, and we should all take care of both, on a daily basis. I try to eat well, I try to sit in postures that are good for my back.  I don’t wait until I have diabetes, or until I slip a disc, to do that. Mental health is the same. Even if we don’t have depression, we should all be mindful of taking care of our basic needs, so that we can reduce the risk of getting a bout of depression or anxiety.

Why do you think there is still a taboo about depression, particularly perinatal depression. Do you think that’s changing? What do you think needs to happen?

The stigma of depression is so strong, that people will go to great lengths to hide their own depression. They are frightened of being  judged for being “weak” or “odd” or “crazy”. (The thing is, that when we are depressed, we actually believe that we are weak or odd or crazy, so we tend to assume that others think that too. There is absolutely no evidence to support these beliefs).

In my opinion, the only way that the stigma will lift, is when people start saying openly and honestly “I am suffering with depression”. It warms my heart when gorgeous successful celebrities tell the press that they have suffered perinatal depression, because it directly lifts the stigma. People respond with “oh. If they can be depressed, and they are liked and respected, then I can be depressed, and be liked and respected”. And non-sufferers are more likely to ask “what is it like for you to be depressed? What can I do to help?” rather than rush past them on the street because they are frightened of what they don’t know.

You highlight that lots of women aren’t good at asking for help. I think this is a huge issue in urban areas where there might be a lack of local community. How important do you consider groups such as pregnancy yoga, hypnobirthing or positive birthing to strengthen parent communities?

A yoga class might not be for every-one, but what we do know, is that every-one needs some-one. People need loving human contact, especially women, and especially in times of stress. The most important advice I can give an expectant mum, is to build your social network. It can be a life saver. Groups where new mums can meet new other new mums in a kind and supportive environment is crucial. No woman should be bringing up a child in a brick house, day in day out, with no one else around. That is not how we evolved to thrive, and it is a recipe for unhappiness.

Is there anything I haven’t asked that you would like to tell the audience about?

I would like to add, that the problems of stigma, how society treats parents, isolation and such are as much a problem for fathers and they are for mothers. Fathers are struggling to find a voice at the moment. Their roles have changed dramatically in recent years, in that they are expected to be a hands on dad, to be at the birth, to engage with their babies, to be emotionally sensitive, to support the mother. However, the support systems are not in place for them to cope with this increase in expectation. For example, after a birth, fathers don’t really have the opportunity to say “that was awful”. They are more likely to be laughed at, than to be asked if they might be suffering from post-traumatic stress disorder. It’s a big deal, and their mental health is also suffering as a result.

How can people find you to find out more, and where can they buy your book?

I am based in the East Midlands, my website is www.yourbirthright.co.uk and my Facebook page is www.facebook.com/whyperinataldepressionmatters/

The book is available directly through Pinter and Martin, here http://www.pinterandmartin.com/why-perinatal-depression-matters.html or from any good book store, including Amazon. If you’d like a signed copy, contact Mia directly and she’ll send you one.

Thanks Mia - as a practitioner I have found this book easy to dip into and a great resource.