Yesterday we published the first part of the interview with the psychologist Gabriella Bianco. We have continued talking with her, and now we have wanted to ask her how it would be the way to prevent the puerperiums that lead to suffering, in addition to asking them questions about when it is necessary to ask a psychologist for help.
We will also talk in this interview with Gabriella Bianco about the role that midwives should have, the growth in demand for doulas and the value that groups of mothers have for the puerperium stage.
Let's continue, Gabriella, talking about prevention, which is something that seems indispensable to me, although I don't know how it could be considered. Is prevention convenient for mothers to know "what awaits them"?
Prevention is indispensable and in this case it would be clearly a promoter of perinatal health. Now, we don't have to forget that we live in a society that doesn't have a long tradition and experience in psychosocial prevention.
It is not an easy task to assimilate an experience (puerperium) anticipating it, especially if we are living an intense and often unknown present (pregnancy), investing much of our energy in living the present and preparing the immediately successive stage, nothing less than the birth of a / to child. For some women it is still a bit alien to prepare during pregnancy to the needs that they and their babies will have after birth / birth, depending on the puerperium of each woman of so many ingredients closely linked to her personal history and the experience of the same birth /birth.
How would we organize this prevention?
Given this reality, I consider it important to implement prevention strategies that emphasize the promotion of perinatal health from very early ages, transmitting truthful and simple information to our children about the physiology of childbirth / birth and clear messages that empower and hold their self-care responsible.
Does the type of delivery influence?
To be able to guarantee the maximum number of physiological births represents another preventive measure of the development of postpartum maternal psychopathology, because the hormonal cascade typical of a normal birth (oxytocin, endorphins and prolactin) has notorious antidepressant properties. At the same time it is essential to continue working with future mothers and childbirth professionals in individual and / or group sessions of (in) training, reflection and personal versus professional growth. Prevention is a great challenge and it is convenient to implement strategies at different levels, in a parallel and complementary way. Personally I am committed to a salutogenic approach to female health in general and perinatal in particular, with the aim of minimizing the need for psychological and psychotherapeutic intervention during postpartum. After years of intense work in the repair of trauma (perinatal) I concluded that it was urgent to find a new health paradigm and implement it in psychological work with young people, future mothers (and fathers) and perinatal health professionals.
Can you explain it to us in more detail?
Based on Dr. Antonowsky's model of salutogenesis and its application to the stage of motherhood according to the midwife and researcher Verena Schmid, I focus on identifying and activating the internal resources of women, increasing their ability to adapt in a continuum between health and disease, increasing the ability to cope as a way to awaken solidarity, responsibility and commitment to their health (sexual and perinatal) and life itself.
In this sense I bet for the empowerment of women (excellent protection factor for depression) in a corporal-cognitive-emotional-spiritual axis (relaxation techniques, truthful information, stress coping education, meditation through the use of voice and body, promoting the production of endorphins, protective hormones of depression). Finally, the horizontal, open and committed therapeutic relationship fosters women's self-dependence and self-efficacy.
And when the child arrives, what factors should put the mother or her relatives on alert?
From the first phase of the puerperium, it is essential that the mother develops a protective relationship with the baby in pursuit of the health promotion of both.
It is also important that the mother's environment (foster couple, family, friends, etc.) support her and provide the best conditions for her to feel competent: practical and empathic support, mother-baby dyad care and breastfeeding support maternal, since lactation hormones are natural antidepressants and compensate for the hormonal decrease due to the loss of the placenta.
What if those optimal conditions fail?
A woman who is alone, little sustained, lacking practical, expert and loving support, with little capacity for adaptation and reduced internal resources may appear sadder, overwhelmed, confused, hurt and tired physically and psychologically, especially after an intervened delivery (induction, forceps, episiotomy, etc.) or major surgery (caesarean section).
And if this persists?
If this situation persists over time, it is appropriate to be attentive, observe and monitor that your mood does not degenerate until you create a cluster of depressive symptoms that can lead to puerperal depression. Before the situation becomes chronic, it is recommended that the woman and / or her family ask for advice from a Mental Health professional, preferably an expert in Perinatal Psychiatry and Psychology, to whom the assessment and appropriate treatment of psychological health correspond. and emotional of the mother puerpera.
What not to do if we fear suffering from postpartum depression or birth trauma?
We do not fear for no reason. Taking responsibility for one's own health also means taking yourself seriously and doing research in order to make informed decisions.
The worst attitude would then be to close our eyes, disregard and ignore our alarm signals. The most profitable attitude would be to seek information, understanding, help, qualified professional support, resources to face maternity with health, repair old emotional wounds with time and before arriving a few weeks after (next) childbirth.
What do you think of the proliferation of advertisements for doulas or puerperium companions on the internet?
I am not the one to comment on the professional and human quality of people I do not know, so I cannot confine myself to contemplating this phenomenon, inquire about their raison d'être and learn to respect the needs and changing reality of women in their maternity stage Finally, from my experience in consultation, it is clear to me how unprotected and disoriented the user is in the face of such an offer, since there is no guidance service or one of quality control that is dedicated to informing and guiding as in other European countries.
Shouldn't midwives meet this need?
In Spain there is a professional figure trained to care for women in each phase of their sexual and reproductive health. This professional is the midwife. Its functions clearly include the accompaniment of women throughout the puerperium. It is evident that currently not all midwives in Spain offer nor are they in a position to offer exhaustive follow-up in the puerperium, leaving the needs of the puerpera woman in some cases not sufficiently or duly taken care of. One of the consequences of this circumstance could be the proliferation of alternatives that fill this void. An interesting alternative to individual accompaniment and which I never tire of recommending to the puerperal women who ask for psychological advice are the networks of women and the support groups among the mothers themselves. They always represent an excellent complement to psychological counseling or psychotherapy, although they cannot always replace it.
Each case must be assessed individually, ensuring the health of the mother-baby dyad.
Do all women who "feel bad" need psychological help?
Naturally and fortunately not. It will depend on what factors we have mentioned above, if and when the psychological intervention will be appropriate and to what extent.
Personally, I am concerned about the lack of containment, abandonment and loneliness of many mother-in-law mothers and their babies. Today we know that the fragility and deterioration of the mother's psychic health during the entire Primary Period can affect - beyond breastfeeding - the quality of the mother-baby bond and family well-being. There is enough research to illustrate the importance of maternal mental health in relation to the bio-psycho-social health of the creature in the short, medium and long term.
It is necessary to be attentive, I understand.
Yes. Thanks to an early assessment of the mother's psycho-emotional state, it is possible to detect the presence of possible mood alterations in time and thus prevent them from deteriorating. Recognizing a postpartum depression or other possible psychopathology (puerperal psychosis, PTSD etc.) in the beginning allows us to prevent it from getting worse and, if the situation requires it, plan an ad hoc psychological intervention, reducing treatment and recovery times, as well as an evil and ab-use of psychiatric medication.
What role should the groups accompanying pregnancy and postpartum?
I understand maternity / paternity support groups during pregnancy a very important measure of prevention and empowerment, as well as training spaces, active listening and respectful support towards making informed decisions and in the search for responsible maternity / paternity, Committed and aware.
These groups offer a special social fabric, which allows addressing all issues related to motherhood and early parenting, sharing experiences and where the mother's experience is valued and finds a creative expression.
They are protected spaces, where to find answers and experiment, where solidarity is created between women in an amount proportional to the levels of oxytocin and prolactin present in the environment. These circumstances have been shown to protect maternal and child health, considerably preventing the development of depression in the postpartum
Postpartum groups during the first months, better if during the first year of the baby's life, they represent, in my view, the tool of excellence to respond to the needs of mothers.
The puerpera mother, especially if there are factors that can trigger emotional suffering or even postpartum depression, need a lot of support: from health professionals, the environment, her family and her partner, but above all she will need to be able, be it for her herself or with help, to empower her life and her health and that of her son.
In this Babies interview and more to the psychologist Gabriella Bianco We have dealt with these issues, but we have one aspect to address, which we will do in the next installment: the aftermath of a traumatic birth.
