Podcast: Postnatal Depression & Aniexety with Psychotherapist, Anna Mathur

Postnatal Depression & Aniexety with Psychotherapist, Anna Mathur

Season 3, Episode 11

In today's episode, Psychotherapist, Author and Mother of 3 Anna Mathur & I discuss all things postnatal mental health. Whether you are currently pregnant and getting prepared for what to expect postnatally, or you're in the depths of the early days of motherhood, there's heartwarming chat, practical tools and tons of helpful info to takeaway from this conversation.

In this episode we explore:

The normal ups and downs of emotions in the first year

Recognising when what are feeling isn't 'normal'

The Baby Blues & postnatal hormones

Practical tools and techniques to protect our emotional health postnatally

Things to consider during pregnancy

Perfectionism, Control, Identity & 'Type A' personalities

The art of surrender

Where to seek more support/therapy

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TRANSCRIPT

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I know right now you have no idea what to expect from birth, what it's going to feel like, how it's going to pan out.

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When our first baby was born, we ended up with so many duplicate gifts or sized items for the wrong season.

So many generous friends and families wanted to give us a new baby gift.

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We've been making some big shifts to my two-year-old's bedtime here this month, and have been listening to the beautiful and relaxing new album from this week's sponsor, The Night Owl Sings Nursery Rhymes.

I'll let you know how we've been getting on a little later in the episode, but if you like what you hear, you can listen on Spotify, Apple Music, or your usual streaming service.

Just search The Night Owl Sings Nursery Rhymes, or follow the link in this episode's show notes.

Welcome to The birth-ed podcast.

If you're new here, I'm Megan, your host and founder of birth-ed, the warm, gentle voice you need in your ear when you're navigating this vulnerable time of pregnancy.

The birth-ed podcast brings together world leading experts in all things pregnancy, birth, postpartum, women's health and parenting, giving you the kind of in-depth knowledge, nuanced conversation and words of wisdom that you deserve when you're preparing for birth and becoming a parent.

I can't wait to share today's episode with you.

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Let's go.

Hi everybody.

Welcome back to the birth-ed podcast.

Today I am joined by the wonderful Laura Tilson.

Laura is an osteopath of 12 years, specializing in pediatrics and women's health, including pregnancy care and the postnatal period.

Laura runs two clinics and manages a team of osteopaths in Surrey and London with the aim of nurturing women through their journey to parenthood.

She is also a mum of four kids and a friend of mine.

So Laura, thank you so much for joining me today.

Thank you so much for having me.

So I suppose a really helpful place to start, which is maybe how many years ago, maybe two or three years ago, I didn't actually know what an osteopath is.

So maybe we can start there.

Can you tell us, anybody that's maybe heard of osteopathy or maybe hasn't heard of osteopathy, what is your job?

What do you do?

So you're not alone.

I hear this all the time.

I'm asked all the time, is it bones or something like that?

So it's a whole healthcare system of diagnosis and treatment of all sorts of conditions.

So we base our work on the principle that if the skeleton is moving well and functioning well, then that will have an impact on all the systems of the body.

And we want them all to be working well together.

So our wellbeing really relies on having a healthy body.

If our structure is good, then we function well.

So it's a manual therapy.

We use our hands and we work on the joints and soft tissues of the body using techniques with our hands.

So we don't use any drugs or surgery to improve people's health.

And so some people might have heard of cranial osteopathy.

It's quite a mouthful.

What is cranial osteopathy and how does that differ from if you'd booked an osteopath appointment, what would the difference be between the two?

Cranial osteopathy is a name given to a style of the treatment that we use.

So we could use quite forceful, strong, impactful, direct treatment on a tissue with sports massage and manipulating joints, using a technique called HVT, mobilizing joints, moving the body quite forcefully.

Or we can do really gentle techniques, which are what we do for babies, newborns, to work with the forces in the body to work into ease in the body.

So there are no forceful movements.

It's very gentle, using very light pressure and movement to guide the body into positions of comfort.

And that's what we call cranial osteopathy.

It's confusing because it was named when the people who came up with the idea were looking at the bones of the cranium, the bones of the skull and looking at techniques to treat them.

So we know that the skull is made up of lots of little bones and joints.

And so it was a style to treat that part of the body.

But actually you can use it to treat any part of the body.

And so if you were coming to an osteo appointment, is that a decision that the osteopath themselves would make in terms of the most appropriate way to treat whatever you were visiting them with?

Or do you kind of book in specifically for a cranial osteopath appointment or a normal osteopath appointment?

So it's really a two way decision and based on that osteopath's preferences and experience as well.

So all newborns, all babies that we see in the clinic are treated very, very gently.

Their tissues are soft and supple and full of health.

And you don't need to do a lot to those tissues to guide that change or encourage that change in the body for then the body to take over and do it.

It's saying and that's what I love about osteopathy in pediatrics anyway.

But some people come in saying they've got shoulder pain or back pain and this has really helped in the past.

This technique, they really want this technique that really helps them.

And so you work with your osteopath to guide the style of treatment that you want.

It's a bit like if you go for a massage and they ask you, what pressure do you like?

There are certain types of patients, the way we would only use very gentle treatment styles.

But if you like a certain style of treatment, then you would discuss that with your osteopath.

So can you talk us through, for somebody that's imagined they've never been to an osteopath appointment before, and they are maybe an issue has arisen for them in pregnancy or postnatally, or they just want to kind of go for like a general sort of checkup, can you sort of walk us through what that first initial appointment might look like?

Because I think this is sort of people's, it's always the first time that is the kind of, oh, I feel a bit anxious, I don't know what's going to happen.

What would that look like, the kind of the very first appointment?

Yeah, so you self-refer, so you don't need to be referred by a GP or a doctor or anything, unless you're using some private medical insurance.

But you would book your appointment, turn up to the clinic.

You would go into a treatment room and be asked lots of questions about your current situation, maybe a bit about your past medical history.

If you're coming after the birth, we would talk through the pregnancy and the birth.

Lots and lots of questions to form part of the diagnosis.

Then the osteopath would examine you or your baby, looking for any tension in the body, either from an injury or what your body is going through at that time.

We'd look for restrictions, changing muscle tone, that sort of thing.

Then we would explain what we found and what we think is going on and how we might be able to help.

The treatment is, like I said, for babies it's very gentle, guiding the body into positions of comfort.

For adults, it can be anything from a sort of sports massage type experience to very gentle treatment like the cranial treatment.

You'd have that all as an hour's appointment for the initial consultation if it was appropriate and you felt like that's what you wanted to do.

We also refer back to other specialists if we feel like we're not the people to treat that injury or that situation.

As a paediatric osteopath, I work with a lot of lactation consultants and tongue tie practitioners, midwives to also support women.

Within that, in terms of working with a wider multidisciplinary team, what is the difference?

I think this is probably another question that a lot of people would want to know the answer to.

What is the difference or the key differences between osteopathy, chiropractic and physiotherapy?

Because they sort of fall into like a similar, if you were experiencing, I don't know, back pain, those would sort of be three options that you might consider.

What are the differences between those?

Yeah, so there is a huge overlap because we're all musculoskeletal therapists or specialists.

So we all work on the soft tissues and joints of the body.

There are slightly different approaches based on the theoretical perspectives or theoretical models.

So talking about osteopathy, which is what I know about, we, if you come in with low back pain, we won't necessarily just treat your low back.

We might treat your feet and your shoulders and your diaphragm.

And we look at it from a whole body perspective.

And it's a lot of manual therapy, hands on treatments.

If you saw a physio, you might be given some exercises for your low back, some strengthening.

If you saw a chiropractor, you might have lots of clicks done to your spine.

So those are the those are very general differences, but there's huge overlap.

And it depends on what style of treatment that osteopath specializes in.

And what groups of people they see and what postgraduate training they've done.

So I know, for example, we do visceral work, which is manual therapy to the soft tissue surrounding the organs of the body.

But I know physios who also work in that style and vice versa.

So it's the there's huge overlap and it depends on who you're seeing.

And what are some of the kind of most common, if we're thinking like pregnancy, postnatal, so from like adult perspective, what are some of the most common reasons that people are coming to see you during pregnancy or after they've had a baby?

So we know that 80% of women will experience back pain at some point in their lives and particularly during pregnancy.

And 40% of women will experience pelvic pain in pregnancy.

So generally they will come in with some sort of pain or discomfort and will have been pointed in the direction of an osteopath.

So we would be focusing on reducing their pain levels and then optimizing their health in other areas to give their body space to adapt to those huge changes that are happening in the body during pregnancy.

And what about postnatally?

Are people just coming for general wellbeing checks or pelvic floor issues or a combo of everything?

Yeah, I mean, it can be all sorts of things.

A lot of women like to have a check because they know how much their body has changed from pregnancy.

So they just want to check that they are in good shape to return to exercise, that their tissues are recovering well from pregnancy and from the birth.

We do have a sort of standardised postnatal check, which would look at all the structures in the body that are most in demand during pregnancy.

So the spine, the diaphragm, the ribs, the ribs sort of flare out as the uterus grows.

So regaining that deep core connection, making sure that they can do an effective pelvic floor, contraction is quite a big one, working on scar tissue from episiotomies or caesarean sections.

It's things like that postnatally that we see in the clinic.

And so taking it back a little bit to pregnancy, so back pain or pelvic pain, what is it that leads to this pain that women so frequently experience in pregnancy?

Or what are the kind of influencing factors?

Well, the anatomy and physiology of a woman changes massively during pregnancy.

So the forces that are going through their joints and the work that their muscles have to do increases hugely.

As the uterus grows, it's very heavy, so the muscles in the spine have to work really hard to support a woman and help her stand up straight.

The pelvic floor is stretched and there's a lot of pressure going through that.

The hips change in a woman's gait widens, so the hips have to be able to compensate for that and allow for that.

So, yeah, huge changes in weight and pressures and forces go through the body, and that changes the angles in the spine, changes your center of gravity, and that if your tissues and your joints aren't flexible enough or mobile enough to accommodate that, that's when you can get little injuries and pain.

So I think it's just really important to kind of emphasize that there is something that you can do about this pain.

I think so frequently women are just told, oh, you know, it's just part of pregnancy, maybe get a support belt and just put up with it, take some paracetamol and it will go away when your baby's been born.

So I originally met Laura when I had horrible pelvic pain in pregnancy.

It was it was astonishing like how well it worked and the difference that it went from basically not being able to kind of walk around to being able to walk around quite freely.

And so it's it is quite a huge difference.

And I, you know, I don't know why it's not on the NHS and I don't know why it's not kind of widely, widely recommended because that that physical therapy, somebody actually feeling and manipulating joints in your body, it just for me definitely kind of released tension and made me so much more comfortable.

So if you are listening and you're in that that point in pregnancy where people have told you, you know, oh, we just kind of have to put up with it or or that it's, you know, it's only treatable if it's really bad, you know, to get sort of physio support on the NHS is basically, you know, here's some crutches.

If you've got completely, if you're completely immobilised by it, but anything from like slightly annoying discomfort to really kind of debilitating pain.

You might imagine being on crutches at eight months pregnant.

I mean, I think that's I think you're right that it's heartbreaking to me when women come at around seven months pregnant hobbling through the door and they've had this pain since, you know, the beginning of the second trimester and they haven't been told that they can get help for it.

There is absolutely people out there who know what they're doing in pregnancy to help support you and reduce your levels of pain.

And if you come in earlier on, it's a lot easier to get it sorted, get on top of it so that you can actually enjoy the rest of your pregnancy.

Yeah, and it goes back to that women's pain in general, just not being taken seriously ever at any point in our lives.

I think it's like eight trips to a GP on average before any women's health issue gets diagnosed or you get a referral or something.

Going back to you said, coming earlier in pregnancy, at what point in pregnancy would you recommend women seek support from an osteopath if they want to and is it something that you would recommend all women do or just if they are presenting with an issue or discomfort of some kind?

Well, I think each stage of pregnancy has its demands on the body, different demands.

I think in an ideal world, I would love to support women from about 12 weeks through their pregnancy, so maybe an appointment once a month, something like that, just to keep on top of the changes going on through their body.

Generally, people will come in when they start getting that niggly pain, and then we'll see, get them out of pain and go from there.

So yeah, I mean, in an ideal world, you could come in your second trimester, have lovely treatment, see the bits, you know, you get to experience your body, what's working well, what needs a little bit more support.

And then we can guide you with the right sort of exercise and maintenance so that you can, you can look after your body between appointments and just stay out of pain through the rest of the pregnancy.

And then towards the end of the pregnancy, we can work on preparing your body for the birth and whatever birth you are hoping for.

Talk through postnatal care of your wound if you're having a C-section, what to look out for afterwards, how to look after your back, how to rehab after birth, that sort of thing.

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This episode is brought to you in partnership with The Night Owl, lullabies and music for babies and children.

We've been making some shifts to bedtimes at our house this month for my two and a half year old, as I've chosen to move away from breastfeeding him to sleep.

And the biggest barrier has actually been finding ways for him to chill out.

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I think something that's really, I found really fascinating is that, I mean, first of all, I don't know how you do it, but it's something magic where you can be like, oh, you've got like a weakness in this area or this bit feels really tight.

And you can feel that without necessarily me telling you or without your clients telling you.

And I think that's really a really useful thing to know for birth.

We've got a podcast episode with Molly O'Brien, who I think you are familiar with, who does a lot of work on the kind of biomechanics actually during labour as well.

And we talk in that about how things like if you had a previous ankle break, that can then impact some tension that you might have in your pelvis.

And it's fascinating to me that as an osteopath, you can kind of feel that and you could potentially kind of identify that and potentially help correct that.

So that's just a really helpful bit of knowledge, I think, to have about your body.

And when you start to understand how your body is feeling and how it is working and why it is feeling the way that it is feeling, it just, I think, is a really good way of giving you back that sense of like power and trust and understanding of your body into, you know, what is feeling good, what is not feeling good, and just listening to it.

I mean, sometimes you ask me things like, can you like breathe into this bit?

And I'm like, I literally have no idea what you're asking me to do.

And it's that actual, like...

It's the brain-body connection, isn't it?

A lot of what I do is working with that and the breath and perception.

But like you were talking about, Molly O'Brien, I love what she talks about with the biomechanics of birth and getting into certain positions are going to change the angles and the space in the birth canal.

We work a lot with space and creating, optimising space for the baby to move in and into hopefully an optimal birth position, but during birth, if a woman's hips are tight and they're not fully moving or they can't squat properly because of pain, they're not necessarily going to be able to move their body in an instinctive, pain-free way that allows for the birth and the movement of the baby through the birth canal.

And so, yeah, I'm fascinated by that as well.

There's so much we still don't know and still don't use.

But that, yeah, if we can help women be pain-free for the birth, I think that's really important.

And it's, I think, again, important to understand that this kind of treatment and that kind of knowledge that we were just talking about in terms of biomechanics, for some reason, this isn't like a standard part of midwifery education or obstetrics education.

It is a different approach to what you might be accessing kind of within standardized maternity care.

I think we kind of have the expectation that, well, you know, if you work with people that are giving birth, then of course you're going to know absolutely everything that there is to know.

But there are so many different kind of approaches and so many different things to learn that actually that kind of the musculoskeletal approach and understanding actually doesn't form the premise or the kind of pillar of education within midwifery or obstetric care.

So you do sometimes have to go and seek that knowledge and support elsewhere.

And so certainly an osteopath would be a very, very helpful place to go to kind of make sure you're or you're approaching it from sort of every angle.

So, you know, Yeah, because a lot of this, a lot of these tensions or restrictions come from, you know, a childhood injury or, you know, a car crash or something in your 20s or when you had this operation and the muscles didn't quite fully recover.

So there's a whole back history that you're coming into this pregnancy and this birth with that we take into account that perhaps could help.

Yeah, definitely.

And so moving sort of slightly forwards, then, let's imagine we've been, we've met our osteopath in pregnancy, we've built up great relationships, ta-da, had a baby.

Now, if we are thinking about using osteopathic care for our newborn baby, what does this look like?

Do people, again, do they just come for like a general check up just to check that they're okay?

Or are there kind of key issues or difficulties that people might be experiencing that might lead them to coming to seek your support?

Well, in our clinic, I would say a lot of people, a lot of mums bring their babies because they've been told by their midwife or they've been told by their lactation consultant that the baby's head isn't turning fully or there's an issue with feeding and tongue tying, that sort of thing, maybe see the osteopath because they know that the babies can suffer from soft tissue injuries, from forceps deliveries or traumatic births.

So generally, generally, mums will come in and say, oh, my baby's really unsettled, not sleeping, doesn't seem comfortable.

And that's the starting point.

And so we examine them looking, like I said at the beginning, looking for any tension in their bodies, any restrictions and movements.

Generally, if there are any, we should be able to show that to the mum, look your baby can turn to the left and the chin meets the shoulder on the right.

The baby isn't happy to turn that way.

And that's because this baby has tension through the neck, perhaps something called tautocollis.

And we check all ranges of movement, head to toe.

So we can look for something called intrauterine moulding, which is the moulding pattern of the soft tissues, or the position that baby is in the womb.

And we can check that that baby has really unwound and stretched out of that position after the birth.

That should happen normally by about six to eight weeks.

And then we can look for tension caused by the birth process, however, that was, if it was a forceps or on tooth delivery, they may have some coning through their head or some swelling where the forceps, the von tooth was applied.

They might have some bruising around the temples or ears and around their eyes from a forceps delivery.

So that's the sort of thing we would be looking for.

And then treatment would be to try and relieve that tension.

So reduce muscle spasm, soften tight muscles, improve joint range of movement, that sort of thing.

And does that tend to be like a single appointment or a kind of series of treatments over a few weeks?

It really depends.

Sometimes a mum is really concerned about the baby and I think actually this isn't a musculoskeletal issue.

This is a feeding issue and I'll refer back to the lactation consultant or this is a tongue tie issue or you need to go back to your GP.

So sometimes it's not a musculoskeletal issue.

If it is and I treat it and it responds well, it might just be one or two sessions.

Like I said at the beginning, their bodies are so soft and malleable and want to change and are full of health.

It's just brilliant to treat babies because their tissues change so quickly.

So one or two sessions, some babies have a more complex history for various health reasons and then you might see them more regularly.

So it really depends on their history and their genetics and things like that.

This sort of ties into this, but also what we were just chatting about before.

I think something that often leads people to osteopaths when they are pregnant or when they have a newborn baby is because of the lack or the inability to access modern medicine in the way that we think about it, like in terms of being able to take medication and the reluctance to potentially give a baby medication.

And so it sort of opens up this new world.

I think a lot of the time people suddenly turn to like more holistic or hands-on therapies in a way that they might not have done before.

We might have kind of left to just take the ibuprofen or gone to the doctors and got, I don't know, I was just telling Laura that I at the moment I'm suffering with a stomach ulcer, so I'm on medication that is similar to what you'd give someone if they had reflux.

But we're sort of very used to, you know, the vast majority of people are very used to just automatically turning to medicine as a way of treating any kind of difficulties.

And when we are pregnant or when we've got a newborn baby, it opens up a kind of world of different ways of approaching or treating illnesses, pain.

And so I think something that I didn't really, I suppose, get about osteopathy before I came to you and before I met you was I sort of just had in my head that it was like a little bit in my head sat in the alternative therapies section.

So I sort of thought it might have been like, I don't know, a little bit like Reiki or somebody like not really doing very much and was it really going to do anything and say really understanding actually just how physical and hands-on and manipulative it can be.

I think that was something that actually took me by surprise.

It didn't feel as sort of alternative in inverted commas as I thought it might.

Yeah, it's classified as a complementary medicine, so it sits alongside your orthodox GP NHS appointments and something like reflux is really interesting because even in the 12 years that I've been in practice, the prescriptions that a GP would give for a reflux baby, the advice has changed massively.

We know that reflux is a normal physiological process for a baby under sort of 12 weeks as that sphincter develops neurologically and strengthens at the top of the stomach.

We know it's a normal physiological response in some babies, but the pain that goes with it when it's the disorder gastroesophageal reflux disorder can be caused by so many different things.

As pediatric osteopaths, a massive part of our job is to navigate that and work through the differential diagnoses so that we can try and find that root cause of the reflux and the pain.

For example, I might see a baby and I think this is an allergic response.

I might see a baby and think this is an arophagy management issue where we need to change up the latch or we need to change up the bottle that that baby is using to stop that baby from swallowing so much air.

Maybe it's a burping or winding issue.

How can we improve that baby's ability to wind so that it doesn't get that reflux pain later on?

How can we calm the nervous system to help with digestion so that the milk passes well through the gut?

So is that baby tongue-tied?

So is that baby able to achieve a good latch?

How is that tongue functioning?

How does the neck movement, chin position, rib, diaphragm movement, how does that influence the esophagus and that sphincter?

How can we allow that baby to burp more easily, swallow more easily, and manage it that way?

So that's a huge part of my job, that sort of problem-solving, to find the root cause.

And parents will often think, actually, I want to go down that route, rather than taking the medication, which perhaps would only mask the symptoms.

Yeah, exactly.

And that's, that's, I talk a lot about the difference between like, like healthcare and like sickness care.

And so much of what we get within the NHS is just sickness care, just finding what the symptom is, and then sort of sticking a plaster on it and covering it up or waiting until people are very unwell, and then just trying to make them better, rather than actually caring for the whole health of a person, finding out what's actually causing it and correcting it or preventing it.

Because that takes time, which isn't always available to us through the GP.

But if we kept everybody healthy in the first instance, then they wouldn't necessarily need to seek medical care in the, yeah, in the later instance.

So finally, if somebody is thinking they would like to find out where they can access care from an osteopath, do you, is there a specific place that people can look?

Is there anything specific that they should be checking or looking for if they're hoping to book an appointment?

So yeah, there's, on the General Osteopathic Council's website, which we could put a link to maybe on the podcast notes or something, there is a registry and anyone who is legally allowed to call themselves an osteopath will be on that list.

From there, if you're looking for a women's health specialist or paediatric specialist osteopath, you'd need to ask around locally, check that they've had some specialist training and because it's just a huge base of knowledge that you would want your osteopath to have if you were seeing them for a gynae issue or a paediatric issue, so you'd ask around for people locally for recommendations of people who are good and can recommended.

And if you're local to either South West London or more centrally in Battersea, then you can go see Laura or one of her team.

They're amazing.

I've got an amazing team that I work with who all have that specialist training.

Yeah, amazing.

And I'll post Laura's links in the show notes as well.

We have a question I ask at the end of every podcast, which is if you could gift a pregnant or a new parent one thing, and Laura will have lots of personal, she has four children, which is just incredible.

What would it be?

What would you gift them or what would you wish you'd been gifted?

And it can be hypothetical or real.

I think I would, so for me, the thing I felt I needed each time was a real sense of a tribe around me.

Have you read the Chimp Paradox?

No, haven't.

I think for women having, being around other women after having your baby is really important.

We know we release oxytocin when that happens.

So having, creating your own tribe somehow, so maybe a one-to-one consultation with somebody who specializes postnatally, like a lactation consultant.

Can I do that?

Yeah.

Yeah, because I think women are so focused on the pregnancy, these mammoth tasks of going through the pregnancy and then the birth, and then sometimes there's an issue with feeding and they think, oh my god, there's another thing.

So having a one-to-one consultation with a lactation consultant, and that being sort of part of your support system afterwards, will be good.

Yeah, as many people as you can possibly get around you that are on the same page.

Yes, because we're not meant to do this on our own, are we?

We're not meant to bring these little people up on our own.

It's not how we've ever done it before.

I think we can be quite isolated.

And we're so frequently now not living near family or, you know, friends have got full-time jobs and it's different to a few generations ago.

We've got a lot around here in South West London.

People move for their jobs, then they have their families here and, yeah, they haven't, you know, they haven't got their childhood friends or their school friends and their family here to support them.

So, yeah, that sort of ability to find a tribe and have some support afterwards with feeding somehow if they can be linked.

Yes, absolutely.

Both of those.

You can have them both.

Yeah, thank you.

Thank you so much for joining me.

Hopefully that has really like busted some myths or misunderstandings about what visiting an osteopath might entail.

Thanks so much for having me, Megan.

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