When misplaced glances turn into the sharing of smiles

Have you ever caught the magical moment between a mother and her baby when their eyes meet and a look of instant joy spreads across their faces? Well, I am fortunate this is something that I see in my work for perinatal services. Sharing the therapeutic space with an infant has its challenges, but that moment when misplaced glances turn into the sharing of smiles really resonates with me. It's an honour to be able to hold these moments with clients through their motherhood and recovery journey, particularly when a mother has struggled to connect with her baby (around 25 per cent of women have difficulties or delays in bonding with their infant; Lehnig et al., 2019).

Perinatal or maternal mental health services are for women who experience moderate to severe mental health problems during pregnancy or in the postnatal year. This includes those who may develop difficulties for the first time, or have difficulties exacerbated by the perinatal period (Maternal Mental Health Alliance, 2021). The services aim to meet women's needs through community support, or where needed psychiatric admission to a Mother and Baby Unit (MBU). It works with women during pregnancy and up to one year after birth, with recent developments to consider longer support as needed (NHS England, 2021). The Specialist Perinatal Community Mental Health Team (SPCMHT) I am a part of is made up of a multi-disciplinary team (MDT) that includes psychiatry, occupational therapy, nursery nurses, support staff, nurses and clinical psychologists working collaboratively.

Versions of motherhood

In one piece of work, a mum with post-partum psychosis was referred to me following her admission into an MBU. The therapeutic space focused on supporting her to process her experience, and to work towards an acceptance of the actual version of early motherhood she experienced whilst grieving the version she had so desperately wanted. In this instance, being aware of her preexisting mental illness, she had sought pre-conceptive counselling before planning her longed-for baby. Unfortunately, this had not prevented relapse after giving birth – women can be at high risk of relapse in the perinatal period (Wesseloo et al., 2015).

I often felt within our early sessions a strong transference of her sadness, frustration and overwhelming sense of loss. I spoke about this in my own supervision. I would often think about her fragility, particularly when she would hold herself whilst curled into a chair. I was familiar with supporting women through difficult experiences, but in this instance there was something so sad about her having done 'everything she was supposed to' in order to fulfil the role of a 'mother', and yet still relapsing despite having been stable for many years. This had led to a woman who was usually happy, outgoing and confident feeling completely disempowered.

Acceptance and self-compassion

As sessions progressed her compassionate self grew, alongside her confidence in being a mother whilst working to understand, accept and manage her illness. She was more animated, spontaneous and an incredible sense of humour now replaced the elements of fragility and sadness. This, alongside the development of a beautiful reciprocal relationship with her baby, was so lovely and powerful to observe. Watching her react well to her baby's cues and share smiles and giggles whilst speaking proudly of his milestones showed me the true power of not only therapy using compassion, but how a multidisciplinary approach could make a big difference.

In concluding our sessions, the overwhelming take-away for me was how much more empowered she felt through the acceptance of her experience. This even led her to choosing to share her story with doctors and healthcare professionals in an NHS Trust 'grand round' meeting – where patients' medical issues and treatments are discussed. A mother who initially had not wanted more children due to her experience with relapse, now felt that her illness would not prevent her from having more children. This felt like the best outcome for her, and had been unimaginable for me at the start of her therapy.

Seeing attachment theory at play

As an Assistant Psychologist in this developing specialist area of mental health, I am clinically supervised, building my skills in understanding the impact pregnancy, birth experience and the postnatal period can have on women whilst supporting them to manage difficulties. These include anxiety, obsessive compulsive disorder (OCD) and depression using approaches such as cognitive behavioural therapy, compassion focused therapy and dialectical behaviour therapy.

The caveat to this position in comparison to others that I have held is that we always need to work with baby in mind. This means that mother-infant observations are made and often the therapeutic space is shared with the baby – if not there physically, we hold a space to consider the parent-infant relationship in our discussions. This can involve exploring mum's feelings towards baby in a space that feels safe for her to acknowledge the difficult emotions that come with motherhood, and where she feels supported to receive compassion and give self-compassion. From my experience, sharing the space by having an infant present during sessions can noticeably promote bonding, co-regulation and can support improvements of difficulties such as post-natal depression (PND) which is supported by research in this area (Evans & Porter, 2009).

I am able to see attachment theory at play in my practice in the most notable ways, and this feels like such an important opportunity to support secure attachments right from an early and pivotal point. In having a MDT approach our mums are able to access the likes of infant massage and New Born Observations (NBO) with our staff able to identify and promote infant mental health, whilst supporting mothers with needs such as bonding.

Bridging the gaps

When I joined our team, the passion for helping mothers and infants was clear to see: barriers to women accessing the service are always part of discussion. For example, as we work in a diverse area in the north west of England where around 66 per cent of our community identify as White British, our service has needed to consider how we support all women to access our services.

Around nine in 10 women have experienced feelings of stigma around maternal mental health which could prevent them from accessing support (Russell, 2017). In 2021, the Maternal Mental Health Alliance said that seven in 10 women reported that they underplayed the severity of their illness. This could correlate to perceived stigma and our service's experience of women fearing support and what it might mean for their children. We find that there is often a misconception that children will be removed from the care of their mother if she is experiencing mental health difficulties.  

Recent steps taken to address the evidence of women struggling to access our specialist perinatal support has included the team having a presence in hospital antenatal clinics. As one in five women can develop perinatal mental health problems during the antenatal period (Tommy's, 2018). Our SPCMHT has plans to join community antenatal clinics too. The hope is that some of the barriers women may face in accessing pathways to our service can be further reduced by bridging the gap between physical and mental health services. NHS England (2021) has also pledged in its maternity transformation programme to increase the continuity of care for women, particularly of minority backgrounds, where choice and personalised care are made more readily available.

The feelings that I connect within my role have been levels of gratitude, compassion and job satisfaction that I had not reached before in my work. I hope that as perinatal mental health is more widely discussed, mothers feel more empowered to access support. As the African proverb states 'it takes a village to raise a child'. Our perinatal service is there to be a part of the village mums need to allow them and baby to have the best possible outcomes.

- Laura Waring is an Assistant Psychologist at the Pennine Specialist Perinatal Mental Health Team in Blackburn.

References

Blackburn.gov.uk. 2018. People | Blackburn with Darwen Borough Council.

England, N., 2021. NHS England » Maternity Transformation Programme. 

England, N., 2021. NHS England » Perinatal mental health. 

Evans, C. and Porter, C., 2009. The emergence of mother–infant co-regulation during the first year: Links to infants' developmental status and attachment. Infant Behavior and Development, [online] 32(2), pp.147-158. 

Lehnig, F., Nagl, M., Stepan, H. et al. Associations of postpartum mother-infant bonding with maternal childhood maltreatment and postpartum mental health: a cross-sectional study. BMC Pregnancy Childbirth 19, 278 (2019). https://doi.org/10.1186/s12884-019-2426-0

Russell, K. (2017). Maternal Mental Health - Women's Voices. Rcog.org.uk. 

The issue | Maternal Mental Health Alliance. Maternalmentalhealthalliance.org. (2021).

Tommy's, 2018. Getting help and support with mental health. 

Ugeo.urbistat.com. 2019. Municipality of BLACKBURN WITH DARWEN: demographic balance, population trend, death rate, birth rate, migration rate. 

Wesseloo, R., Kamperman, A., Munk-Olsen, T., Pop, V., Kushner, S., & Bergink, V. (2015). Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. Ajp.psychiatryonline.org. Retrieved 9 July 2021, from https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2015.15010124.