My journey to Perinatal Psychiatry

A bit more about me!

 My name is Rebecca Moore. I am a perinatal psychiatrist working in London.

Essentially what this means is that I work with and support women through pregnancy and up to a year after birth who have new onset or pre-existing emotional health issues. This might include women experiencing Anxiety or Depression, women with a known Schizophrenia, women feeling suicidal or after having experienced Birth Trauma.

This time period is a vulnerable time for women with all the physical and psychological changes that are occurring. It’s my role to try to work together to keep women as well as possible so they start the massive leap to motherhood feeling mentally really well. The risk of relapse for Bipolar Disorder for example, is high in the early postnatal period so women need highly specialist care and support.

 I see women at least once a month at home or in clinic and we draw up a collaborative plan that involves looking at diet, exercise, working life, home life, their sense of self alongside biological symptoms, the use of therapies and/or medication. It’s very important to me to work as holistically as possible both within the NHS and privately.

 I was really lucky to be work with one of the pioneers of Perinatal Psychiatry Dr Liz MacDonald as a trainee in London and she really inspired me to want to work in this field. I believe passionately that if we empower women at this time in their life then we impact not only their own future health but the health of their children. I love my job, I have been in this field for twenty years and I learn something new every day plus I get to cuddle lots of babies which is always a good thing!

Birth Trauma

 My real area of expertise and passion has become helping women who have experienced a birth trauma.

Birth Trauma occurs when women find some aspect of their birth traumatic, distressing, fearful.

It’s really common and currently not well recognised or identified. Leaving Birth Trauma untreated in the long term can lead to long term health problems for mum and her family so it is very important to get it right.

 Currently around 30% of women find some aspect of their birth traumatic, that’s a huge number of women, over 200,000 per year!

 Not all these women will go on to develop Depression, Anxiety or Post Traumatic Stress Disorder but some will and if women have a prior history of Anxiety, Depression or sexual abuse coming into childbirth 1 in 5 of these women will develop PTSD after birth.

 I really want people to know that trauma at birth does not always mean a life threatening medical emergency such an emergency caesarean or bleed. This can be the trauma but just as often it’s about the care and language we give to women in labour.

This might mean women being spoken about not to, ignored or dismissed by staff and feeling unheard or not listened to. It might be about a lack of kindness or care, staff not introducing themselves or not respecting the woman’s wishes during birth or women feeling coerced during labour.  

It’s also important to recognise that fathers can be traumatised by birth and that midwifes, students, doulas in the room can be traumatised too.

We often focus postnatally on the baby and on mum feeding, her bleeding or her being depressed. It’s very important to recognise that not all postnatal illness is Depression!

 We should be asking all women how their birth experience felt as part of routine care alongside the six-week check. We need to give women enough time to talk through their feelings and tell their story and to know we are really listening and hearing them. Often women are never asked about their birth story and so all these traumatic feelings and emotions remain.

It’s common for me to see a woman in a second pregnancy who has had an undiagnosed PTSD for years as result of her first birth. It’s also not uncommon for women to never have another child because their birth experience was so traumatic.

If women feel traumatised by birth we should encourage them to feel able to speak to someone they trust, a partner, friend, midwife, health visitor or GP. If this feels too much to try and write down their story in a blog or use a journal. Online forums can be very helpful as it allows women to speak anonymously, this might be via twitter or a peer group forum.

Lots of things can help birth trauma, diet, exercise, sleep, social support, meditation, breathing, psychological or physical therapy and/or medication.

The prognosis is really good once identified and most women feel significantly better within 12-18 months with the right care. It can seem never ending and terrifying to be traumatised by birth but women do get better and we must always try to engender hope about recovery.

 Birth Trauma Resources

Annual Birth Trauma Conference run by myself in East London, free, run by myself, next 9/1/19 book via Rebecca.moore2@nhs.net

www.makebirthbetter.org 

PTSD piece by myself below,

 http://blogs.plos.org/mindthebrain/2016/08/24/perinatal-psychiatry-birth-trauma-and-perinatal-ptsd-an-interview-with-dr-rebecca-moore/