Last week we had a chance to talk to Shweta about Perinatal mental health, and her upcoming Yoga Therapy for Perinatal Mental Health course with Minded:
From your own experience, and your experience working with clients, can you provide an overview of perinatal mental health problems, what causes them, and how prevalent they are?
“Just so we’re clear, when we say perinatal period, we are referring to the period of time from conception to a year following childbirth. It’s an important distinction to make, as there are a number of unique or overlapping mental health issues that relate more directly to fertility and conceiving.”
“Firstly, it’s important to understand the context; it is estimated that 1 in 5 mothers experience a mental health problem during the perinatal period. As in other contexts, depression and anxiety are among the most common; but women in this position can experience a range of different problems relating to self-esteem, identity, social role, personal relationships or lifestyle.”
“I believe this should stand alone, and I very strongly believe that part of the problem is in assigning economic value to motherhood and affected individuals; however, to place this in an economic context, it is estimated that perinatal mental health problems cost the UK over £8.1b every year. Of this, 28% is related to the mother, but 72% is related to their children who experience mental health issues as a result of neglect, insecure attachment or unstable relationships with their primary caregiver.”
“Of the mental health problems recognised in the perinatal period, most are recognised in the post-natal phase (after childbirth). I believe this is partly because they are easier to spot relative to the mother’s ‘typical’ patterns of behaviour or emotions, but I am of the opinion there is also a sociological aspect at work; I think during pregnancy there is an assumption that extreme variations in emotions or behaviour are normal, and this absolutely should not the case.”
“It’s fair to say that physiological and hormonal changes during pregnancy can cause mood swings and disrupted emotional or behavioural patterns, but that should not lead us to assume these are not indicative of a problem or a developing mental health issue. I think sometimes minor and moderate mental health issues are too easily dismissed or invalidated for women as the result of ‘PMT’ or ‘hormones’, and this is particularly true during pregnancy.”
“Pregnancy is a challenging and tough time for mothers, and not just because of the physical and psychological demands and adjustments of being pregnant, giving birth, and nursing an infant. This is also a time of existential upheaval, as the mother transitions from one stage of her life to another.”
“With this can come a raft of uncertainty about her identity, her career and lifestyle, her relationships with significant others and friends or family, her place in society, and of course her body. Any or all of these can destabilise an individual, predisposing them or pushing them towards mental health and wellbeing problems. If left unacknowledged, unattended, or unprepared for, these can develop in to personal crises.”
“The purpose of my practise is to prepare mothers for this transition, and to encourage mindfulness and awareness of the inevitable changes that pregnancy and childbirth will bring.”
How does your approach to Yoga Therapy differ from other types of pregnancy yoga or childbirth preparation, and how does this help your clients face the challenges of motherhood?
“The majority of approaches to pregnancy yoga and birth planning involve preparation for the physical and psychological aspects of labour and childbirth. This typically involves focussing on relaxation techniques, as well as strength and flexibility. This type of preparation is very important, but it does not address the wider context of emotional discomfort experienced by many mothers. There is also the danger of over planning or becoming inflexible and dependent on strict plans; pregnancy and childbirth very much have their own plan.”
“What is important, from my point of view, is to be prepared to meet whatever circumstances occur and to be able to acknowledge and accept that things will change, and that this is okay – even to be celebrated.”
“My area of expertise is in raising awareness of the psychological and emotional changes that occur throughout pregnancy and after childbirth. I’m referring to a wide range of changes that relate to the life and body of the mother, her relationships with other people, and her relationship with herself; all of which are critical to her mental health and wellbeing. My practise attempts to use yoga and mindfulness to encourage a specific type of personal inquiry.”
“I try to help mothers address their personal situation and the inevitable changes they face, and encourage the unfolding of thoughts and feelings in a safe and compassionate space. And yes, I prefer the term ‘unfold’ to ‘evaluate’, because it can imply a layer of judgement which is often unhelpful.”
“Overall, my approach has two key components. I attempt to use yogic and mindful techniques to offer a state of regulation, relaxation and stability to calm and balance the nervous system; but I also use these techniques as a tool to encourage personal inquiry.”
What do you think is important for people to understand about the role of yogic philosophy in your approach to Yoga Therapy?
“My approach is definitely from the perspective that mental health interventions require an evidence-base to support their practise. This is something that is crucial to their recognition within the NHS, and therefore their accessibility; something that I believe is really important, and sometimes overlooked in complementary therapies. However, I also believe there is an important place for yogic philosophy within Yoga Therapy, particularly in the context of perinatal mental health.”
“I feel there is a great deal with can learn from the recognition in yogic philosophy of the stages of life. These stages, and their relevant transitions, are really important in the yogic framework. As a society, we seem to bypass, or fail to acknowledge the transitions between our life stages, potentially losing the opportunity to reflect on what the changes mean for us, and how we might physically, psychologically, and emotionally adapt to ‘arrive’ at our new life stage physically and mentally well.”
“It is very sad that we have evolved as a culture to undervalue motherhood, and to view very negatively some of the changes that come with it. This has, in turn, contributed to our problems in processing the changes in identity and role associated with pregnancy and childbirth.”
“It may be indirect, but my therapeutic strategy is very much to work from a yogic framework to introduce a new way of perceiving oneself, and the relationship one has with oneself as a mother. I don’t believe you can completely ignore the yogic framework in any form of Yoga Therapy, but perhaps we need to consider how to tailor this framework to our interventions. We need to recognise that wellbeing has a scope wider than conventional medicine or therapy, but we must be careful to fit the yogic framework with where we are as a culture.”
You’ve already touched on some sociological issues overlapping with perinatal mental health. Aside from increasing access to a wider-range of therapeutic interventions, would you like to see change at the policy, or even cultural, level?
“Absolutely. There has been some positive movement at the policy level to improve perinatal wellbeing. In the last few years we’ve seen money put in to a 5-year forward plan, with new mother and baby units built and set up for new mothers with mental health issues, and healthcare professionals including midwives are being trained to provide better mental health support to pregnant women and new parents. This is really great, but we still have an institutional problem of inaccessibility to the wider varieties of wellbeing and mental health interventions; I would very much like to see more complementary therapies available to all through the NHS.”
“I also fear there is a limit to how much we can combat perinatal mental health issues without a greater understanding of the social and cultural changes affecting women in pregnancy and after childbirth. We live in a culture which values human beings, both men and women, as commodities. Women bear the brunt of physical objectification and sexualisation, and men are objectified in a different but equally toxic way.”
“However, the identity shift that occurs during pregnancy and following childbirth directly affects women, particularly regarding body image and social role. Our ‘culture of youth’ defines our ideal body type as young and athletic, which is simply not a reality for most mothers. Combine this with a devaluing of the role of motherhood, both socially and economically; it is all too easy for mothers to devalue themselves despite the crucial role they serve in giving birth to, and often raising, future generations.”
“There are cultures on this planet that revere older women, and particularly mothers and grandmothers; within some, you may even be insulting someone to suggest they look ‘too young to have children’. We really need to be acknowledging and addressing the way we value the role of motherhood, and I believe personal inquiry using yogic philosophy is a great example of how this can be achieved.”
Shweta Panchal is a Yoga Therapist for Mental Health. She is supervisor and a lecturer at Minded, an Active Birth Pregnancy Yoga Teacher, an Ambassador for the Pre and Postnatal Depression and Anxiety charity PANDAS. She is currently designing a qualitative research study on the PsychoSocial factors influencing emotional wellbeing in the Perinatal Period and has recently completed a summer school training in Perinatal Mental Health at Kings College London.
by Tom Cardigan