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 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.
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.
Feeling scared and alone
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
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
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
Muesli and Granola
Lentils, Pulses, Lima and Butter Beans, Kidney Beans, Peas
Medium Glycaemic Index
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.
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 & 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.
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.
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’.
This tragic case of a newborn baby being suffocated and crushed whilst being breastfed, on a postnatal ward, is far from an isolated case. As many of you know by now, I’m a UK trained midwife of 29 years. I’ve heard this same story too many times. The scenario is all too familiar. Mum exhausted from labour is handed her baby to breastfeed in her hospital bed. The midwife may help latch the baby, supports the mum with pillows and leaves the mother to breastfeed alone. This scenario is more common during the night.
Some time passes and the exhausted mum falls asleep. She may have prescription drugs on board from labour and birth and may even have been given opiates on the postnatal ward. This combination together with birth exhaustion is a dangerous combination. Opiates such as endone, morphine and fentanyl depress the respiration. This can lead to a tired mum easily falling asleep.
A newborn baby cannot maintain their own airway and may have prescription drugs on board from the labour process. The prescribed drugs mum has taken may even have passed through her breast milk to her baby. It may even depress the baby’s respiration and lead to the bronchopulmonary infection in the Bolton hospital case.
The midwife should stay with the mum whilst she breastfeeds to ensure safety. Ideally, the mum should breastfeed her baby in the chair which is usually in each patient room in every postnatal ward. However, if you have a mum who is exhausted or has had a caesarian she may choose to stay in her bed. This is where it all goes wrong. There should be a hospital policy that states, breastfeeding in a bed should have a midwife present during the entire feed and the midwife should return the baby to the cot after a feed and place them safely according to SIDS guidelines.
The problem arises on a night shift of staffing levels and meal break times. In Australia, the staff ratio is usually 1 midwife to 6-8 mums and babies on postnatal at night. Once a midwife goes for a break she is gone for an hour and the other midwives cover her patient load. That increases the workload significantly.
During the first 3 days, newborn babies feed every 1-2 hours. Colostrum is high in protein but low in fat so doesn’t satiate a baby for long. During an average postnatal night, a baby will perhaps feed 6-8 times. It’s obvious based on those facts that the staffing levels on postnatal wards are completely inadequate. Skill mix would help address this issue and is something that would maintain safety. Nursery nurses and auxiliary nurses are a way to bridge the staff to patient ratio, cover breaks and keep babies safe.
17 years ago when I was still working as a midwife in the UK the staffing levels were even direr. This maybe explains our poor breastfeeding rates in the UK. In Manchester, I was the only midwife in charge of a 26-bed postnatal ward with an auxiliary nurse! However we had very few side rooms, most beds were part of an open plan ward divided into bays of 4. Are sidewards a safe option on postnatal wards or should we go back to open plan? It is much easier for a midwife to keep an eye on her babies and mums and avoid dangerous risky situations. In Australia, most of the postnatal wards are side rooms only. Is this a good plan for the safety of babies?
Should all babies be breastfed in chairs during the night? Are mums less likely to fall asleep in a chair or is it still risky because of the use of pillows to support a newborn breastfed baby? Ultimately no matter where a mum feeds we cannot escape the extreme exhaustion of those early postnatal days and nights. A mum should never be left alone to feed her baby when she is so tired. Period.
“Bed-sharing ‘raises cot death risk fivefold’,” BBC News reports. The news has featured in much of the media, with headlines based on a large analysis of previous studies into the risk of cot death, or sudden infant death syndrome (SIDS), associated with bed-sharing.
I have a particular issue with the comments of the midwifery manager of this case at The Royal Bolton Hospital. She says, ‘We are a Level Three UNICEF baby friendly initiative accredited unit which is the highest standard for breastfeeding and is a prestigious award, however, we always strive for improvement and so, taking into account the coroner’s comments, will review guidance.’
I have a feeling Baby Louie’s mum and family don’t give two hoots about her hospital’s breastfeeding award when all they have is a dead baby. RIP baby Louie and I’m dedicating this blog to Louie and all other babies who have passed away on postnatal wards in similar situations. There are too many and this is a risk we need to address immediately. As a midwife who spent so many hours on a postnatal ward on a night shift, I know this needn’t happen to another mum and baby.
Nurse Bracken is the reason I became a midwife. Growing up in a tiny English village, Levens, in the South of Cumbria near the Lake District, where families had their own midwife. It’s the type of village where everyone knows everyone else. We say hello when passing someone on the main street whether we know them or not. Levens has a corner shop, a post office, a hairdresser, two churches, two castles and the obligatory local pub.
Mum had laboured scrubbing the kitchen floor on all fours. Being a homebirth, Nurse Bracken was my midwife and my GP was present. My dad buried my placenta in the garden and planted a fruit tree on top. My grandparents were farmers and as country and farming people this is just what we did. I was lucky to have a very idyllic country childhood.
Nurse Bracken was also the community nurse, school nurse or as we called her the nit nurse and the local Health Visitor. In those days she was given a house for life, in the village, next door to the policeman’s house. I remember when my sister was born, she was an occipito-posterior position.
My mum reluctantly went to the local maternity hospital in Kendal (Helme chase) as a precaution. Nurse Bracken transported her in her old Morris Traveller van. The same van she drove her two Lakeland terrier dogs in!!
I think my mum was on all fours on the back seat in advanced labour!
Helping the family
The very next morning Nurse Bracken came round and helped my dad get me and brother ready for school. She brushed my hair and put it up in plaits. My dad was feeling a bit lost about how to sort out girls hair.
The passion and love Nurse Bracken had in helping families was my inspiration. From a very young age, I wanted to be just like her and help families. I knew at the age of 14 I was going to be a nurse. Growing up in Britain in the era of Maggie Thatcher’s politics and the coal mining strikes, I remember telling my careers advisor I wanted to be a nurse so I’d always have a job.
I’m not sure many 14-year-olds grow up nowadays with this mindset. Growing up in a tiny village may be amazing but I wanted to see and experience more than just village life. Applying to 50 colleges of nursing as far away as Aberdeen in Scotland and as far South as London, I planned my escape!
Moving to Leeds
At exactly 18 years and 5 days old I moved to Leeds in West Yorkshire and starting my training as a Registered General nurse at Leeds General Infirmary.
It was during my Obstetric experience at age 19 that I fell in love with all things pregnancy and babies. Having a very intuitive skill palpating a fetus in a pregnant mum, I recall an obstetrician asking me my findings. The obstetrician looked at me quizzically, ‘how did you know that?’ In my head, I was thinking how did you not know that? It just came naturally to me.
On completing my nurse training, I had a passion to move to London and gain expertise in Cardiac Medicine and surgery. Working at the world famous National Heart Hospital in central London I realised very quickly that old sick people were not my cup of tea career-wise. I lasted all of five and a half months.
Christmas In London
Christmas Day was one of my loneliest days ever. Snow was falling in Central London as I made my way along the deserted streets of W1 to a red public phone booth and called my mum to wish her a Happy Christmas.
It was so quiet as I walked, I could hear every snowflake fall on the pavement. The consultant surgeon and matron had cooked the obligatory roast turkey with trimmings. The medical and nursing staff, unlucky enough to work Christmas, tucked into dinner. The feast was served in the ward next door around a big table brought out especially, decorated with crackers and tinsel.
That very day I made my decision to move back to Leeds and train as a midwife.
Immediately I started my midwifery training I felt this was my path in life. St. James’s University Hospital or Jimmy’s as it is affectionately known is one of two large maternity hospitals in Leeds and has 5000 births each year. Nowadays it’s probably so much more. In my training, I delivered 40 babies and each one was memorable, one more so than the others.
Delivering a Romany Gypsy Baby
It was on my birthday in early August 1988 a pregnant mum arrived on labour ward. This was baby number 7 and she just happened to be a Romany Gypsy by birth. I’m not sure how much you know about Romany Gypsies but the true Romany are known to be psychics, fortune tellers and clairvoyant. She’d walked onto the labour ward and told me and my mentor midwife she was going to have her baby. However, she had not had any contractions.
My midwife instructed me to get her into a delivery room very quickly, get her on the bed, undo my delivery pack sharpish and get my gloves on! I started to say, ‘but she’s not in labour…’ My midwife told me not to ask questions and do as I was told! If I hadn’t witnessed this with my own eyes I’d have not believed it was possible. As I scrambled to get my gloves on, literally one contraction and the baby was out, born in the caul. I feel blessed to this day about this rare and unusual delivery. And even today I feel as passionate about being a midwife as I was in those early student days.
Fast forward to emigrating to Australia 16 years ago, this passion led to me establishing Nurture Parenting as a parenting and baby sleep support service exactly 8 years ago. By the end of this year, I’m hoping to recreate the village my families no longer have. And the girl from the village is about to go back to her roots, so to speak.
More parents are taking a babymoon before welcoming a new baby into their life. Approximately 1:5 parents have it on their bucket list. They are seeing it as one last opportunity to holiday as a couple before welcoming the new baby.
Things that you need to know before taking a babymoon
One in five parents are squeezing in one last holiday as a couple before their baby arrives, according to new research by finder.com.au
The survey of over 2,000 parents with children under 12, shows 22% of couples are enjoying one last getaway in the third trimester before the sleepless nights begin.
The majority (16%) of those who holiday in the final trimester of pregnancy do so within Australia while 5% travel internationally.
Travelling while pregnant was most popular with young mothers – with the figures showing almost one in four (24%) under 30-year-olds holiday before their due date, compared to just 16% of those mothers aged over 40.
Whilst a babymoon is a chance to relax you need to be aware of travel insurance and airline restrictions. These could put a dampner on your babymoon if something unexpected happens.
Travel insurance restrictions:
Many soon-to-be parents may not realise that most travel insurers won’t cover you for the entire length of your pregnancy – with some cutting off cover as early as the second trimester.
Most airlines have rules and restrictions for pregnant women travelling in the third trimester, with most requiring medical clearance after 28 weeks.
Major Australian airlines and their requirements for flying pregnant overseas:
28 – 36 weeks
Medical certificate stating fit for travel.
Flight more than 4 hours
36+ weeks (single birth)
32+ weeks (multiple births)
You will not be accepted to travel.
Flight less than 4 hours
38+ weeks (single birth)
36+ weeks (multiple births)
You will not be accepted to travel.
Qantas & Jetstar
28 – 36 weeks
Medical certificate stating fit for travel.
Flight more than 4 hours
36+ weeks (single birth)
32+ weeks (multiple births)
You will not be accepted to travel.
Flight less than 4 hours
Within 7 days of due date (single birth)
38+ weeks (multiple births)
Medical clearance required.
Commentary from Bessie Hassan, Insurance Expert at finder.com.au:
“For those couples set to welcome their first child, a babymoon can be the perfect time to relax and take a holiday on your own terms.”
“However, premature birth can happen without warning and could seriously disrupt what was supposed to be a relaxing holiday.”
“You are normally required to carry a medical certificate with you when flying after the second trimester, as flying can become more risky closer to the due date. Seek medical advice from your doctor prior to hopping on the plane so you have that clarity.”
“It’s also a good idea to check whether your travel insurance policy covers pregnancy, as you may not be eligible to claim if something goes wrong.”
“Bear in mind that you likely won’t be covered for any pregnancy-related complications if you’re travelling against medical advice, or are pregnant as the result of assisted reproductive technologies.”
“With this peace of mind you’ll be able to enjoy your last child-free holiday.”
It’s not very often that Karen has a WOW moment when she reads some medical research, but it has arrived and it’s huge.
We’ve known for a while that allergies in babies and children have had a massive increase in incidence. We’ve also realised that exposure to a few friendly bugs in a child’s environment is helpful in developing immunity to them. And that being too clean and creating sterile environments is not really good for a baby’s immune system.
Scientists have looked at it further and discovered that babies born vaginally have a head start on their immune system by being exposed to microbes in the vaginal birth canal. As the baby is born, it ingests the vaginal bacteria and this lines the gut. This provides a baby with its first exposure to bacteria and it helps build up a healthy resistance to bacteria.
Scientists knew that caesarian section babies were statistically more likely to have allergies, asthma, diabetes, and obesity. Now they understand the reasons why a little better. It’s all to do with the initial exposure at birth to natural bacteria in the vagina, and if they are breastfed they gain further protection.
So what does that mean for formula fed caesarian section babies?
Mother bottle feeding baby
It may be a good idea to either – give a probiotic or, give an infant formula that contains probiotics. This will protect their immune systems. Like I said huge stuff.
Probiotics help promote healthy gut flora. They can be given to breast and formula fed babies from newborn. Some preparations are mixed breast milk or infant formula, then given directly to the baby on their tongue and ingested.
So which infant formula’s in Australia have a probiotic in them?
Nan Ha Gold 1 and Nan Pro and Heinz Nurture Gold with digestiplus.
The study sample was only 20 babies but the results were statistically very significant. The researchers plan to take it the next stage and look at what particular risks are more likely by caesarian section babies and being formula fed.
It’s also important to look at a family’s genetics and risk factors for disease. It’s never as simplistic as the method of birth and the method of feeding. So all of you parents out there – don’t panic if your baby was born by caesarian section and has infant formula without pre or probiotics or bifidus.
Now I’m going to turn this all on its head! Literally.
I was born vaginally, a home birth. I was breastfed and I was brought up on a farm with a healthy exposure to dirt and animal fur. And I’ve got asthma, eczema, hay fever and an auto-immune disease. On the other hand, my sister was formula fed and a vaginal birth but no allergies whatsoever. Like I said sometimes our genetics play a larger part in things, but this research is certainly worth taking an interest in. Food for thought!
As a Midwife i saw a few pregnant women with this and they were really debilitated.
As a student midwife I was lucky enough to deliver a set of twins by myself. It was an amazing experience, one I will never forget and I’m so grateful for my midwife that mentored me and supported me.
I’ve had a lot of experience with twins and triplets as a midwife, in NICU and as a Child and Family Health Nurse on the Parent Support Team at Sydney Children’s Hospital, Randwick. We had four sets of Triplets in a year. WOWEE!
So I was thrilled when Jo invited me to attend the Twin Mothers group at Centennial Park in Sydney. Twins have their own unique challenges and experiences. The most important thing I think is the self care aspect and doing things for yourself as the mummy that help you enjoy the experience.
We talked about ‘filling the well’. How important it is to do things for yourself. Without a full well you can’t give out and end up feeling spent. Check in on your twins mummy’s on a regular basis and change a ‘how are you?’ into “How are you REALLY doing?” It may make all the difference.
So onto the VLOG. This was a truly lovely experience and thank you so much to all the mummy’s, gramdma’s and twins I met today. I really had the best day out! And a Happy Birthday to JO, she’s reached the big 40 just like my little sis.