The beginning of our journey

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My own journey into pregnancy and childbirth began many years before I had children myself. As a newly qualified clinical psychologist, in my first job, I saw many women who were distressed and struggling with their life and so often their problems were to do with the struggle of being a parent. As one father said to me, 'Why doesn't someone write a rule book and just make it easier for all of us?' Well, I soon realised that there was no rule book but many common themes did emerge: the juggling of responsibilities, the loneliness of women cut off from their former life, the sense of losing your identity and balancing your adult needs against the usually more immediate needs of your baby.

One woman whose story I have never forgotten was Sylvia, who was referred for help with depression. Sylvia was in her late sixties and said her life had been dominated by periods of depression and now she felt her final years were slipping away from her. Sylvia said she had always been depressed but when she thought about it, the depression had begun following the birth of her second child. Sylvia said she had rarely allowed herself to think back over that time since she felt embarrassed and ashamed about what had happened. She could remember little of the detail of her labour except that an emergency Caesarean had been necessary. Sylvia remembered feeling distraught and terrified after she had come round from the anaesthetic and she said it seemed like an eternity before she was allowed to see her son. Her husband was at home looking after their daughter and was only allowed to see them during visiting hours. Sylvia said that she had developed an 'illness' while in hospital which had caused her to sweat and shake for no reason. This illness had made her avoid the midwives, as she was terribly embarrassed. During the night Sylvia couldn't sleep and would lie awake wondering if her baby was safe in the nursery and if she was going to survive until the morning.Thus, Sylvia said the midwives clearly thought she was 'odd'and had moved her into a side room away from all the other mothers. Sylvia says she remembers the doctors talking about her on ward rounds but no one ever explained what was happening and so she became convinced she had a serious illness and began to worry that she would die and leave two children without a mother. Sylvia was surprised when a smiling doctor discharged her without warning. On returning home Sylvia felt she had had a lucky escape and although she was relieved, as the weeks went on she just couldn't seem to find the energy that she used to have and the care of the children seemed an enormous burden. Sylvia had moved to their home on marrying her husband and although she knew many local mothers to 'say hello to', she hadn't really made any friends in her new surroundings. She wondered why she wasn't like other mothers who seemed to take everything in their stride.

Sylvia was genuinely surprised to discover that her feelings were not unusual for women who had experienced a complicated delivery. She was particularly amazed to discover that her symptoms were anxiety symptoms: she had heard of post-natal depression but didn't realise that very many types of emotional reaction are common to having a baby. Sylvia had experienced little support and care from the professionals around her and, like many women of her generation, she was somewhat isolated from other new parents. It seemed heart-breaking that 40 years after having her baby, Sylvia was still trying to understand exactly what had happened to her.

We can learn a great deal from Sylvia's experience about the sort of care and support that women need when they have a baby. It is important to understand what is happening to you and your baby throughout your pregnancy and childbirth. Medical professionals involved in your care should explain exactly what is happening and why, and parents should be encouraged to ask questions and make their own decisions. New parents today are perhaps more aware of the psychological struggles that surround becoming a parent but often during a period of such rapid adjustment it is difficult to take in what is happening. At times, most parents will feel like Sylvia that there is something wrong with them and that the rest of the world appears to know what they are doing!

There are many books on the market that take us through the process of becoming pregnant and giving birth and this information is an important part of our journey. However, this book will not go into detail about the physical process of pregnancy but will concentrate on the emotional transition that takes place. Psychologists often talk about 'life events' as the significant building blocks that form our lives. These can be both positive and negative: getting married, moving house, changing career, bereavement, illness, and so forth. The more of these events you experience at one time, the more likely it is that you will feel pressurised, stressed or depressed. Becoming a parent is probably the biggest transition that many of us will make. So many things change: there are new roles to learn, new responsibilities to take on and parts of the old self to be given up. This is true for both mothers-to-be and fathers-to-be. Women also have to cope with the physical realities of pregnancy: a changing body shape, morning sickness and sometimes serious health complications such as raised blood pressure. Labour and birth also pose new challenges and experiences. As was the case for Sylvia, often the physical consequences of labour can lead to physical and emotional trauma.

Our journey, however, begins with deciding to have a baby.There may be no right way to decide but it is certainly an issue that many people spend many hours pondering. You may already be pregnant when you read this book but the decision to become pregnant is often revisited once pregnant: why did we do it? Why don't I feel so certain now? Chapter 2 looks at conception. The area of conception and problems with conception probably merits an entire book and here the issues of the pain and disappointment of fertility problems are only touched upon.

The main section of the book, Chapters 3 and 4, is about pregnancy. Pregnancy is usually thought of in terms of three trimesters and the development of the baby in this time. This book will look at the 'psychological stages' of pregnancy. How might you feel in those early weeks? What sorts of worries do newly pregnant women have? How do they cope with morning sickness or cut down their alcohol intake? The middle of pregnancy can be a somewhat different time emotionally. Most women have accepted the pregnancy and are getting used to their new identity of 'pregnant woman'. The focus therefore shifts away from the internal to the external: How can I prepare for this baby? How will my life change? As pregnancy draws to a close, some of the fears of early pregnancy may return. Predominantly these tend to be fears about labour and giving birth. As the pregnancy comes to an end, it is time to disengage from former responsibilities and reinvest in the new future.

However, every pregnancy is different and for some the experience of pregnancy can be overwhelmed by other problems and concerns.

Depression is just as common in pregnancy as it is post-natally. A great deal of attention is given to supporting mothers so that they do not get depressed following the birth of their baby but more attention should in fact be given to identifying problems in pregnancy and supporting women who are depressed or struggling. After all, there is much more time in pregnancy than there will be after the baby is born: time to think, to talk and to begin to make changes. It is all too easy to get wrapped up in the practical plans for the baby.

Chapter 5 on birth looks at some of the practical decisions to be made in pregnancy such as, shall I have a hospital or home birth? Labour is then considered: what does it feel like and how can I manage the pain? What are birth partners supposed to do? There is also discussion in this chapter and Chapter 3 of loss during pregnancy and birth.

Many books on pregnancy trail off after the discussion of giving birth and this may be because most books are read in pregnancy and it may just be too difficult to think so far ahead or imagine what the challenges will be when your baby is here. It is, however, better to approach this time from a position of some preparation and therefore there are two further chapters: the first few days (Chapter 6) and the first six weeks (Chapter 7). The chapters are divided this way since these two time periods seem to be significant. In the first few days new parents are faced with enormous physical and psychological challenges. A new mother has to recover from the experience of labour while at the same time being thrown immediately into the task of parenting. If you were climbing a mountain, you would rest before working your way back down but recovery from labour has to fit in around your new baby. Chapter 6 also discusses the feelings and reactions of the first few days which may be very different to how you might feel after six weeks. In those early days you might experience the baby blues and struggle to do very much at all. However, in the first six weeks mother and baby start to get to know each other and remarkably by six weeks most new parents feel like they have been through a lifetime with their baby and usually feel that they have 'become parents'. At the very least they will have recognised the basic needs of new babies: feeding and sleeping dispersed with moments of crying and being held. Things may still be very chaotic and difficult at the end of the first six weeks but usually the direction seems a little clearer.

For some women, however, the chaos is all that they see. By six weeks a significant number of women are depressed and feel that they are not coping. Chapter 8, therefore, offers some suggestions on how to deal with anxiety and depression, while the final chapter, Chapter 9, looks forward to the future.

Each chapter includes a 'who can help' section to direct you towards appropriate support. There are also discussion points. These are not a definitive guide, just some suggestions to help encourage discussion between parents-to-be. For new parents 'communication, communication, communication' is probably the key to survival. Try to discuss your thoughts, feelings and dilemmas with whoever is around to listen: partner, parent, friend or fellow new parent. Use the various professionals around you to get information and support too. Remember the things that they are interested in may not be your concerns. Most importantly, try to listen to and learn from your interactions with your baby and remember he is unique and will not behave in the same way as other people's babies do.

Throughout the book I have tried to use the stories of families that I have worked with to highlight the struggles that we all face in becoming parents. To protect the identities of those concerned I have changed the names and details of people's stories. I have also taken the decision to refer to babies as 'he'and 'him' throughout. I'm sorry if this offends but as I am the mother of two sons, it was always 'he' in our household and this seemed easier for me. I have also written this book to be read by both mothers-to-be and fathers-to-be and I hope this doesn't alienate the single parent reader. Often new fathers find it far more difficult to become involved in what is happening and it would be ideal if both parents-to-be were to read this book. Support does not necessarily need to come from a father but new parents do far better when they have the concerned support of others. Hopefully, this book can provide you with a little bit of concerned support.

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