Welcome and thank you for listening!
Marianne Littlejohn is a registered nurse and midwife, who qualified in 1979 and began practising as an independent midwife in 1982.
She has worked in hospital, birth centre and homebirth settings for approximately 40 years. Marianne also holds an Honours Psychology Degree and continued with studies in Infant Mental Health both with the School of Infant Mental Health in London and the Institute for Psychodynamic Child Psychotherapy in South Africa.
She attended a doula course with Michel Odent and attended local and international conferences as a delegate and occasionally as a speaker. Marianne says: ‘It is being ‘ just a midwife’ with women that has taught me so much’.
In today’s podcast she will be walking us through Perinatal Psychology…
Infant Mental Health for Medical Professionals
By Marianne Littlejohn
While a mother forms bonds towards and with her baby, the key word ‘attachment’ signifies the relationship of the baby to the mother/caregiver/parent. Attachment is a biologically driven need of the infant to seek safety in proximity to an adult figure. In other words, the baby needs to be close to a caregiver for survival and attaches to the presence of this caregiver. The first
year after birth is an intense period for attachment and growth and particularly the first three months after birth.
During the first three months after birth, the baby has an intense need to be close to one or two caregivers, to be handled and to be demanding of the mother/caregiver for food, warmth, responsiveness and comfort. This is precisely where the intensity of the baby’s need can trigger the mother/caregiver’s own unrecognised trauma, and create problems in the relationship between mother/caregiver and baby.
Infant mental health refers to the capacity of the baby to form close relationships and through the interface of early relations to learn, to develop via exploration of the outside world. This ‘secure base’ as it were, forms the foundation and the framework for all future thinking skills, social relations and emotional development of the infant.
When the early relationships between mother and baby are fraught with tension, this affects the development and mental health of the growing baby.
Types of Attachment
The way a baby and infant develops depends so heavily on how the attachment figure(Mother/caregiver) relates to her baby and essentially requires a mother to be happy and confident within herself, so that the baby, toddler and child can relate in a secure and confident way, and subsequently learn about his world and how to meet the challenges each growing child faces.
Attachment research focuses on the quality and the nature of the mother/caregiver’s sensitivity and responsivity to her infant. There are four generally accepted main styles of Attachment to the attachment figure:
- Secure Attachment
Describes an attachment where a baby and infant feels safe and protected by the caregiver and can rely on the caregiver/parent to provide consistent safe responses.
- Avoidant Attachment
Describes an attachment style an infant develops when the caregiver does not show care and responsiveness beyond providing essentials such as food and shelter.
- Ambivalent Attachment
Is characterised by a child’s feelings of anxiety and preoccupation as to whether the caregiver/parent is available. In other words, the caregivers responses are inconsistent, sometimes available and at other times absent, or unavailable.
- Disorganised Attachment
When the parents/caregivers show inconsistent responses and display erratic behaviour towards the baby or infant, the baby becomes fearful, chaotic and hypervigilant, and has difficulty forming close relationships with others. This style often presents when infants experience physical, emotional or sexual abuse from their caregiver’s/parents.
How Can Parents Prepare
The biggest task for parents/caregivers is to become self reflective and manage their own feelings and triggers so they are not reactive towards their babies and infants. How does this translate into real life? It means that all the thousand acts of kindness in caring for a baby such as feeding or changing a nappy are performed consistently and steadily while engaging with the baby/infant in warm responsive ways. It means taking care of one’s own needs and reaching out to others when one feels overwhelmed.
Looking at family constellations, family patterns of behaviour and one’s own style of attachment to one’s own parents becomes very important.
The parent’s own feelings of anxiety, attachment, loss, grief, anger or numbness will have an effect on how the baby/infant is able to relate and attach to the parent /caregiver.
Seek counseling during the pregnancy and ‘look back’ so as to clear the way ahead for one’s own parenting journey.
Good antenatal care with a listening midwife or doctor helps to alleviate anxiety during pregnancy and follow up on specific difficulties.
Bonding with the unborn baby during pregnancy can be facilitated by counselors specialising in perinatal psychology
SEEK help when life becomes overwhelming and find support systems, counselors, and networks of other mothers, family and friends who are supportive.
Antenatal Classes can help to allay anxiety about the birth and improve one’s coping skills.
How Can Midwives and Birth Workers Assist?
Midwives will do well to reflect on their own personal trauma and how their own story impacts on the work they do with mothers and caregivers in the early parenting year. Midwives need support too and will better serve their communities when they are fulfilled and well supported.
The Edinburgh Post Natal Depression Scale is a useful tool for midwives to assess which mothers/parents may be suffering from undue anxiety during pregnancy. Maternal Mental Health services are a great resource for mothers/parents and midwives, such as the Perinatal Mental Health Project in South Africa.
Tips for supporting responsive parenting:
- Prepare parents for birth and early parenting
- Give parents a chance to talk
- Listen, don’t judge, and try not to give advice
- Ask leading questions for more information
- Encourage skin to skin contact post birth
- Encourage postnatal support groups, well baby clinics and social gatherings
Be aware that depression during pregnancy can affect the pattern of fetal movements in the womb. Teaching pregnant parents to count the number of kicks and intra uterine movements is a way of being alerted to negative emotions as well as possible negative outcomes.
The Author Sue Gerhard who wrote the book ‘Why Love Matters’ in 2014 stated that “Gestation is a mutual construction process” and the dyadic relationships parenting begins in the womb. We are all involved and we are all part of the community that gestates our children of the future. It is incumbent on all of us to contribute to creating an environment in which babies can attach securely to their parents and caregiver.
Gerhardt, S. 2014 Why Love Matters. Routledge. Psychology ISBN 9781317635796
Mmabojalwa Mathibe-Neke J. & Masitenyane S. 2018.
Psychosocial Antenatal Care: A Midwifery Context. In Selected
Topics in Midwifery Care 2018 edited by Ana Polona Mivšek. DOI:10.5772/Intechopen 80394