Maternal Anxiety

Maternal Anxiety

Anxiety is a far more common issue with new mums than postnatal depression. For many women, anxiety, not sadness, is what they feel after having their baby.

It can start in pregnancy and once the baby is born grow to a whole new level. Up to one in five pregnant or new mums and one in ten dads will experience perinatal anxiety or depression. About 100,000 families across Australia will be affected by this serious and common illness. 

What does it look like?

Anxiety is complex and how one mum sees it can be very different to another. Though there are some shared similarities. Anxiety is more than being concerned or a little worried. As a midwife and nurse I can often spot an anxious mum once I’m talking to them or reading their email. But not every mum feels brave enough to open up on the thoughts which just keep on flooding their brain.

anxiety
Mother With Baby Suffering From Post Natal Depression

Anxiety and anxious thoughts are all consuming. Anxiety is affected by the fight or flight hormone, adrenaline so can have an impact on the whole physical body not just the mind. Adrenaline is also known as the hormone of fear. It takes over any other feelings such as happiness, pleasure, joy and just feeling comfortable in your own skin. 

https://www.panda.org.au

It’s not uncommon to feel anxious about getting anxious. In those brief windows of time when anxiety symptoms aren’t as bad, women can feel apprehensive about their anxiety building again. There can be an overwhelming sense of “what’s the point of feeling good” when I’m soon going to feel anxious again.

Symptoms

  • Feeling scared and alone
  • Overwhelmed
  • Unable to complete a task, flitting from thing to thing but no completion
  • Unable to prioritise a situation
  • Weight loss, feeling nauseous, anorexic, no appetite
  • Problems getting to sleep and waking in the middle of the night with racing thoughts
  • Fast shallow breathing and heart rate
  • Not enjoying the baby or life, a feeling of being disconnected
  • Thinking there’s a problem with the baby when all appears normal to others
  • Panic attacks
  • Fear of going out and socialising (agrophobia)
  • Feeling stressed and seeing everything as stressful
  • Disordered thought patterns, jumping from thought to thought
  • Negative self talk
  • Mind racing and cannot calm it down
  • Unable to relax and sit down even for a few moments
  • Feeling depressed – anxiety and depression can be interlinked
anxiety
Exhausted mother and baby on the couch

Help and Ways to Cope

When you’re feeling anxious you’re in such overwhelm it’s hard to access help and even describe to another person exactly how you’re feeling. This is one of the biggest problems and yet getting help would make such a difference to your mood and coping mechanisms. Just know you can get better from anxiety and there is no need to live with it. 

Unless you ask for help no one can help you. Taking the first step is vital. Try opening up to someone you trust, maybe another mum, your local GP, your Child & Family Health Nurse, a friend who is a good listener or a helpline such as PANDA (Postnatal Depression and Anxiety Helpline) who have trained counsellors. 

Things You Can Do To Improve Your Anxiety

  • Reduce your caffeine intake – coffee, energy drinks, tea all have caffeine in. Rather than help you they will make your heart rate go faster and anxiety worse.
  • Look at your diet does it need an overhaul? Refined foods and sugar can contribute to your overall mood. Replace refined carbohydrates with low glycaemic and wholegrain alternatives. Or maybe quit gluten? 
  • Help increase your serotonin and endorphins by increasing the tryptophan rich foods in your diet. It’s important you also eat a balance of healthy carbs at the same meal to make sure these tryptophan rich foods reach the brain. A diet with no carbs is a disaster for anxiety and sleep. 
  • Seratonin is the hormone/neuro-transmitter you need for both a stable mood and a good nights sleep. This is why a paleo or low carb diet can be a disaster for anxiety, sleep and overall mood. 
  • Tryptophan is present in many common foods including Turkey, Chicken, Chia seeds, Mushrooms, Wholemeal and Wholegrains, Banana’s and Organic Cacao, etc. Have a look at this list for more info.

Tryptophan rich foods per 100g include:

  • Turkey – 507 mg
  • Mushrooms – 494 mg
  • Chia seeds – 808 mg
  • Cooked spinach 594 mg
  • Pumpkin seeds – 578 mg
  • Tofu and soy products – 513 mg
  • Pumpkin – 400 mg
  • Canned Yellow fin Tuna – 472 mg
  • Tahini – 390 mg
  • Hummus – 60mg
  • Cheese – parmesan, cheddar, gruyere and Swiss cheese have particularly high amounts of tryptophan – 360 mg
  • Kidney beans – 303 mg
  • Sugar-free cacao – 283 mg
  • Chicken – 267 mg
  • Pork, lamb and beef – 220 mg
  • Salmon – 209 mg
  • Sardines (tinned) – 276mg
  • Snapper (fish) – 265mg
  • Tomatoes – 60mg
  • Weetbix and wholewheat foods e.g. wholewheat pasta – 108mg
  • Rye bread – 100mg
  • Pineapples – 10mg
  • Nuts and nut pastes such as almonds, cashews, peanuts and walnuts – 287 mg – 170 mg
  • Green leafy vegetables such as cabbage, spinach and broccoli – lettuce 275 mg, kale 233 mg, broccoli 229 mg
  • Buckwheat – 109mg
  • Oats – 182 mg
  • Eggs – 167 mg
  • Brown rice – 130 mg
  • Avocado – 54 mg per 234 mg
  • Full cream Cows Milk – 46 mg
  • Banana’s (each) – 11 mg
  • Semolina – 90mg
  • Quinoa – 87mg

Low Glycaemic Index Carbohydrates

  • Sweet potato
  • Porridge Oats
  • Muesli and Granola
  • Quinoa
  • Corn
  • Barley
  • Pasta
  • Wholegrain Rice
  • Wholewheat Bread
  • Lentils, Pulses, Lima and Butter Beans, Kidney Beans, Peas

Medium Glycaemic Index

  • Quick oats
  • Rye bread
  • Pumpkin
  • Brown and Basmati Rice

It takes about an hour for tryptophan to reach the brain, so plan the timing of your meal for optimum performance. Include low GI Carbohydrates and you’ve got a perfect evening meal to induce a lovely long nights sleep.

Sleep

A good nights sleep will reduce anxiety whereas severely broken sleep will increase it. Make your bedroom dark and in fact so dark you can’t see your hand in front of your face to help you get to sleep and stay asleep. Darkness is necessary to trigger melatonin.Even streetlights, LED lights on internet WiFi, TV’s, smart phones, tablets and other electronic devices can interfere with sleep. Stop using your smart phone or electronic screen devices at least 1-2 hours before bedtime.

Have a snack of cheese and biscuits, cup of hot chocolate or herbal tea to help you wind down. 

Melatonin is at it’s lowest at 5am so if your diet doesn’t have enough tryptophan, protein and carbohydrates of the right glycaemic index you may get pesky early morning waking.Increase those things and you may get a better night sleep.

meditation
meditation

Meditation & Mindfulness

Taking up meditation can help you learn to control your thoughts and your breathing. Meditation has been shown to reduce heart rate, blood pressure and cortisol the stress hormone. Just taking 10 minutes each day to meditate can be life changing. Meditation can be done on your own or in a group. There are many Apps and programs out there and it’s important you find the right meditation program for you. It’s not just for new age hippies, or yoga people, meditation can be for everyone. 

Yoga and Exercise

Expose your brain to daylight to help reset the circadian rhythm. Exercise helps increase endorphins and serotonin and is another good reason to do some regular exercise. Having a routine and ritual within your day decreases stress and anxiety. Think of ways you can manage your day and your week to benefit your mood. 

Gratitude

Practicing gratitude can help turn your thoughts and mood around. Too often we focus on what isn’t working vs. what is working rather than the other way around. At the end of each day think of 3 good things about your day you are grateful for. Tell yourself you are doing a great job at bringing your baby and children up. Repeat this mantra every single day. Little things such as this can often be the key to changing your mindset. When you’re doing the positives and gratitude do not allow any negative self-talk to enter your thoughts. Let them go.

Cognitive Behavioural Therapy & Counselling

If you’ve tried any or all of the above and you’re still struggling then counselling or cognitive behavioural therapy may be helpful. Counselling takes many forms and can be listening visits where you talk through how you’re feeling. Or it may take the form of CBT. Cognitive behavioural Therapy or CBT as it’s often called helps reframe your thoughts by challenging your current mindset. For example you’re thinking you’re a hot mess and disorganised. The CBT therapist may challenge this by asking you ‘why do you think this is true?’ “what does a hot mess look like?’ he may reply and challenge by saying ‘you turned up for this appointment, is this what a disorganised hot mess does?’ or ‘you got out of bed today’ etc. you get the idea. 

Medication

The last option, which may be used in combination with other therapies is medication. This may be just a temporary solution until you’re feeling more yourself or it may be a longer term one. Medications such as Sertraline, Fluoxetine, Xanax and Zoloft may be prescribed or beta-blockers such as propranolol. There are many medications which can be used. Do not give up hope if the one you are taking isn’t having the desired effect. Go back to your local Dr and let them know. Most medications are short term and are not habit forming. And there is no shame in needing to take them.

Remind yourself daily you will feel better soon, much better days are on their way. There is absolutely no need to live with anxiety and struggle by yourself. And there is no shame associated with feeling anxious, if just means you’re human.

Remember the wise age-old saying, ‘a problem shared is a problem halved’. 

Talipes A Congenital Foot Abnormality

Talipes A Congenital Foot Abnormality

Common birth defect of the feet

Talipes is a fairly common issue in newborn babies, affecting 1 in every 1000 births and affecting one or both of the baby’s feet. The cause is unknown and is thought to be due to the position of the baby in the uterus. Positional talipes usually improves with gentle stretches of the foot.

clubfoot

https://thewomens.r.worldssl.net/images/uploads/fact-sheets/Positional-talipes-11Dec17.pdf

Managing the condition requires careful assessment and monitoring by the child’s doctor or physiotherapist. A baby with positional talipes should also have a hip examination to rule out developmental hip dysplasia as the two conditions may be linked. Researchers suggest 1;17 babies with congenital talipes will also have hip dysplasia.

https://www.ncbi.nlm.nih.gov/pubmed/21037357

Gentle exercises to the foot may help flexibility. These foot exercises should be performed regularly, and will be most effective when your baby is relaxed. Foot exercises should never ever feel painful

https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/POSITIONAL-TALIPES.pdf

Turned feet

Talipes means one or both feet are turned and in most cases the front of the foot is turned inwards and downwards (talipes equinovarus). Rarely the foot is turned downwards and outwards (talipes equinovalgus). In the past, talipes used to be known as clubfoot. The current best treatment is by casting and bracing according to the Ponseti method. The standard treatment for talipes has changed greatly in the past 10 years. Moving on from surgical interventions as the favoured approach 10 years ago to boots and braces currently.

Previously, extensive surgery was common in children born with this condition. Following the publication of long term evidence of positive outcomes with more minimally invasive methods, such as the Ponseti technique, has led to a change the approach. Ponseti treatment consists of sequential plasters and prolonged bracing, with minor surgical procedures.

https://www.bmj.com/content/340/bmj.c355

Exercises for positional talipes

Tips and tricks to help with a boots and bar brace (BNB)

Here’s a little boy I went to help with his sleep recently with his hip brace on. He sleeps really well and wears it each night and can roll over in it in his sleep too. He crawls around the house like a dynamo!

 

Superfine merino sleepwear is better for baby than cotton

Superfine merino sleepwear is better for baby than cotton

Parents of children with eczema

Parents of children with eczema were once advised their children should ‘avoid wearing wool at all costs’, for fear the rough and prickly fibre may irritate their skin and exacerbate the itch further. However, according to the Murdoch Children’s Research Institute (MCRI), there is now new evidence wearing superfine Merino wool may actually be good for eczema.

What is eczema?

Eczema is an inflammatory skin condition which dries up the skin. It causes redness, itching, and skin cracking which sometimes leads to bacterial infection. It is often related to allergies and can be worsened by temperature changes, particularly heat.

More than 25% of all children are born with some degree of eczema. If you have eczema or are a parent of a child suffering from eczema, you will understand how painful it is to watch your child endure the discomfort of a flare-up.

Hello night kids

Many People think of wool as being itchy…or is it?

For years, dermatologists and doctors have recommended eczema sufferers avoid wearing wool for fear the wool might exacerbate need to itch further. But herein lies the problem.

The problem with this advice is it fails to distinguish between different types of wool fibres, of which there are many. Some wool fibres can indeed be coarse and hard, leaving an itchy feel against the skin.

However, superfine Merino wool is different.

Nurture Parenting Hello Night

What is superfine Merino wool?

Wool fibres come in a range of different diameters (thicknesses). The thicker the wool, the itchier it feels against the skin.

Merino wool is different to regular wool because it comes from the Merino sheep, selectively bred and highly regarded for producing the softest wool available.

Superfine Merino wool is even softer. In technical terms, superfine Merino wool has a low micron count (18.5 microns or less) and is lightweight (170-150gsm). Therefore, superfine Merino wool will feel like the softest of the softest wool on your skin. It is this miracle wool which has been used in the study to effectively debunk the myth.

Merino wool

The Study

In 2016, 40 children under the age of 3 who suffered from eczema were invited to participate in a study conducted by the Murdoch Children’s Research Institute (MCRI). Half of the children wore 100% superfine Merino wool for 6 weeks before changing over to cotton, with the remaining half starting with cotton before switching over to superfine Merino wool.

The conclusion

The researchers found that when children switched to superfine Merino wool after wearing cotton they showed a significant decrease in eczema severity, whereas, for the children who started wearing Superfine Merino wool and then switched to cotton, their eczema actually worsened.

“We found that wearing superfine Merino wool led to an overall greater improvement in eczema when compared with wearing outfits made of cotton,” said Associate Professor John Su.

toddler sleep

Myth busting

Prior to this, studies performed in the 1950’s used coarser and heavier wool garments. This resulted in cases of itching and discomfort for eczema sufferers and has been a major reason leading health professionals and dermatologists to advise sufferers to avoid wool altogether.

However, we now know that is not the case and the difference lies in the quality of wool. For eczema sufferers, regular wool that is coarse may cause itching and irritation. Superfine Merino wool, however, is not only comfortable to wear but also beneficial to alleviating eczema symptoms.

Why is superfine Merino wool sleepwear superior to cotton for eczema?

For eczema sufferers, symptoms can be greatly exacerbated by heat and sweat. The type of fibre worn against the skin can play a large part in increasing or reducing symptoms.

Superfine Merino wool has the unique ability to transfer and wick moisture and heat away from the body as it sweats, helping to keep the surface of the skin dry and less irritated.

Cotton, on the other hand, readily absorbs and holds moisture. This means sweat is absorbed and will sit longer on the surface of the skin, increasing the risk of irritation.

Superfine Merino wool is also unique because it contains lanolin, which gives it natural and powerful antibacterial and antimicrobial properties. This helps to keep the skin clean and avoid infections.

Superfine Merino wool, suitable for eczema sufferers

Given the research results by the MCRI, we now know superfine Merino wool can help alleviate the symptoms of eczema. If you have a child with eczema, choosing to clothe made from superfine Merino wool to be worn against their skin will help reduce irritation and ultimately be more comfortable to wear.

Hello Night Kids use 18.5micron superfine Merino wool for all their Pyjama sets.

https://www.mcri.edu.au/sites/default/files/media/sudessinewoolonlinebjdarticle.pdf

Hello Night Children’s Sleepwear in Merino wool

Managing eczema in babies and children

Complex medical cases and sleep training

Complex medical cases and sleep training

Skull surgery and sleep training

Occasionally I come across a very complex medical case I’m asked to help sleep train. My job as a baby whisperer is most definitely not for the faint-hearted. After 29 years as a registered midwife and nurse, I’ve seen a lot of rare and complicated cases as well as the run of the mill to sleep train. I’m really grateful for my medical training as it helps me understand babies at a more complex and deeper level. For example, I’ve worked for many years in neonatal Intensive and special care looking after extremely premature, ventilated sick babies.

Medical cases I’ve helped

Tetralogy  of Fallot

Some examples of complex medical cases I’ve helped include a 6-month baby, Tilly with a congenital heart defect – tetralogy of fallot. This comprises a VSD (Ventricular Septal Defect – hole in the heart) with Pulmonary Stenosis, with the Aorta “Overriding” (sitting ‘astride’) the VSD and with Right Ventricle ‘Hypertrophy’ (thickening of the muscle). These babies appear ‘blue’ or cyanosed and often require surgery in stages. Tilly had surgery not long after birth and then recently at 2-3 years old.

Reflux with Obstructive Sleep Apnoea and CPAP

I’ve also helped a few babies with very complex reflux requiring ventilation via Continuous Positive Airways Pressure to help their obstructed sleep apnoea.

https://www.parentingscience.com/baby-sleep-problems.html

complex medical cases

Being a mum instead of a paediatrician

What also sets this story apart is the mum is a consultant paediatrician. As I tell many parents, when emotion comes into parenting it affects your judgement to make decisions and to be able to sleep train. Many of you know I have helped many doctors, GP’s, and about 100 psychologists, including child psychologists with their babies and children’s sleep. At the end of the day, these are parents first and foremost. Parenting is the biggest leveller of life.

Craniosynostosis is a rare medical condition, where the skull bones fuse prematurely and usually requires surgery. In my career I’ve come across 6 cases of this condition, 4 I identified myself. If you’d like to read more about it here is a link.

https://www.mayoclinic.org/diseases-conditions/craniosynostosis/symptoms-causes/syc-20354513

https://www.chop.edu/treatments/surgical-treatment-craniosynostosis

Mums story

Karen came to help us with our 6-month-old, little girl. She’d had major skull surgery at a very young age (traumatic for everyone) and had spent a significant amount of time in the hospital. She was waking at least hourly all night and the only way to settle her was to feed her. After what she’d been through we didn’t want her to suffer anymore and couldn’t see any other solution, but everyone was exhausted and we had a hyperactive 2-year-old at home as well.

Karen had helped us with our first, so tentatively we asked if there was anything she could do to aid the situation. Karen was very empathetic but was able to interpret Cara’s cry and reassure us that she wasn’t in pain. We never left her to cry, we sat with her whilst she settled, sung to her, did some hands-on soothing and amazingly the length of time she spent crying was actually far less than one of our ‘normal’ nights!

The first night she only woke twice (previously hourly!!) and within a week she was going to bed happy and sleeping through the night 7-7. She was much happier and so were we!

baby in helmet

She had to start wearing a helmet shortly after, for 23 hours a day. I was dreading it and thought it would return her sleeping habits to old ways. Amazingly it didn’t affect her at all, she slept just as well in the helmet.

Had we not got Karen in prior to introducing this I think her sleep would have just become worse as we’d have interpreted every cry as discomfort. Having a baby with medical problems has a huge emotional impact on the family; sleep deprivation added to this only makes it harder. Seeing how much happier Cara was after learning to sleep made us wish we’d addressed it sooner. We also had the energy again for our toddler.

We are very grateful to Karen for restoring some normality to our family, thank you!

7 things you need to know about day naps and baby sleep

Baby not Sleeping and Waking a Lot at Night?

Keeping your 6-12 month baby safe

Keeping your 6-12 month baby safe

On the move

At around 7-10 months your baby will most likely be all 4’s crawling and the stage is important for learning. Between 9-18 months they start to pull to stand and take their first steps. The first thing you need to do is to childproof your home environment to prevent these inquisitive babies keeping out of trouble. Babies by nature are curious and saying NO means absolutely NOTHING! Impulse control is something all babies and toddlers do not have until past 3 years. As the parent, you have to protect your baby.

Bedroom childproofing

When it comes to sleep, even the bedroom needs childproofing. Prepare your cot for these changes by moving the mattress down to the lowest level. The last thing you want is a jumper and escapee in the middle of the night. My youngest jumper out of a cot was 9 months old! Eek.

Childproof your home

Also, think about safety in the home before starting to become more mobile.

Checklist

http://kidsafe.com.au/wp-content/uploads/2017/10/Kidsafe_Parents-Guide-to-Homes-NATIONAL.pdf

Unsettled babies and anxiety in mums

Unsettled babies and anxiety in mums

Finger pointing

This article in the Sydney Morning Herald needs more than just a cursory glance. It is saying more about the state of support for new mums than anything else. It’s so easy to end up with anxiety if your baby is doing nothing but vomiting and screaming literally all day long.

As a baby whisperer, I’m one of a number of baby sleep consultants, providing help and support to families the health service ought to be providing. It’s a national disgrace for mums to have to wait up to 3-4 months to be granted an appointment in sleep school. It’s only fast tracked if the mum says she is severely depressed or suicidal. Outrageous. Babies with reflux can vomit many times an hour. One baby I was visiting did a remarkable 17 vomits in an hour. He was medicated and somehow gaining weight. Poor mum, poor baby and poor carpet.

http://www.smh.com.au/national/reflux-risk-for-babies-of-anxious-mothers-20180213-p4z069.html

crying baby

Reflux

Babies with reflux will often wake at the 20-minute mark during the day. Gastro-oesophageal reflux is a common problem usually caused by an immature gastric sphincter. The valve at the top of the baby’s tummy is a bit loose allowing milk to come back up the food pipe (oesophagus). It’s then either spilt out as a vomit or silent reflux where it is immediately swallowed and can happen up to 30 times a day. The peak age of reflux is 4 months and most stop spitting up by 18 months of age.

https://nurtureparenting.com.au/your-baby-and-reflux/

Postnatal depression and anxiety

It’s so easy for a vomiting, screaming and unsettled baby to lead to a mum with postnatal depression and anxiety. Feeling out of your depth and not knowing where to turn. “The focus needs to be on giving mothers good psychosocial support to de-escalate this cycle and reduce the need to medicate the babies,” the researchers said.

Babies need to be taught how to self-soothe their babies and put them to sleep. It doesn’t happen by chance, despite what parents hope. A sleep-deprived baby can often look and sound very similar to a baby with reflux. It takes a highly trained medical or nursing professional to distinguish the two. Without observing a mum and baby in the home how is a 15-minute doctors appointment going to get to the bottom of this?

https://nurtureparenting.com.au/sleep-deprivation-and-mental-health-in-mums/

https://nurtureparenting.com.au/baby-sleep-learning/

https://nurtureparenting.com.au/page/2/?s=postnatal+depression

anxiety

Large research study

The researchers analysed the hospital records of more than 869,000 babies born between 2000 and 2011. A random audit of 326 admissions records to parenting services Tressillian or Karitane in NSW and focus groups with 45 nurses and doctors at the centres.

The authors of the study stressed the findings did not suggest reflux was caused by anxiety. Rather it is often bi-directional. They agree reflux is a legitimate medical issue, however, currently, it is rather over-diagnosed and medicated.

https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-0999-9

The study strengthens calls for mothers to be given more support as they care for their babies during what can be a stressful and lonely period. Exactly.

baby and mother

How do mums find help?

For some mums, the birth of their own baby will be the first time they have held and cared for a baby. The hospital antenatal classes focus on birth and breastfeeding. Other options are calm birth and private midwifery and physiotherapy antenatal classes. Nowhere in these classes are settling and the care of an unsettled baby covered in any detail. Mums are woefully unprepared by the hospital system. They are discharged home with a Blue Book for recording weights and immunisations etc. with a few phone numbers for government services. They receive one visit, at home if they are lucky with a Child & Family Health Nurse. Following this, they may attend a new mums group lasting 4 weeks for an hour each week. It’s a group environment so no time to look at individual issues and settling. Most of the time the advice is to hold the baby to sleep and feed to sleep. The risk increases of an overtired baby who is overfed, then you risk getting reflux. Rather than pointing the finger at the mum, we need to point the finger back where it belongs, on the health services doorstep.

This is why I set up Nurture Parenting 7 years ago. I could see what was not happening in the community and how poorly supported new parents are. It’s time for change to happen.