Dr. Leslie Butterfield has heard a lot of birth stories in her many years as a clinical psychologist. In fact, she has built her practice around preventing or easing the pain of people suffering from pregnancy and postpartum mood disorders and other perinatal concerns. In Seattle, she is one of the go-to psychologists when it comes to helping parents repair after a reproductive loss or trauma.
In the weeks since the arrival of the COVID-19 virus in King County, Butterfield says she’s been fighting a new perinatal mental health battle — COVID-19 virus-related anxiety and fear among new and expectant parents.
Many of these parents, she says, feel sandwiched between worries. For example, they're alarmed about the health and safety of their own parents and at the same time stressed that those quarantined grandparents or other expected support people can’t help them with their newborns or young children after their upcoming birth.
[ Perinatal Support Washington offers warm, understanding, effective and private support for new parents and their family members.Call 1-888-404-7763. ]
“They are not just anxious about giving birth alone, but about doing everything else alone, too,” Butterfield says. “Some have already made plans – already talked about putting numerous types of support in place. Now they are watching their entire first month or two of postpartum planning disappear – and they’re thinking, ‘I’m going to be alone like before. I’m going to get depressed. No one will be able to help me.’”
Butterfield says many parents who are working hard to overcome past painful birth or postpartum experiences and are now panicked by the pandemic are particularly susceptible to falling prey to fears that their upcoming birth will be as traumatizing or possibly worse.
“I'm trying to help them get really, really specific and clear on how there is something in the middle,” she says. “It does not have to be like the last time, and it won't look like what they were hoping for. But there are still things that can be done and connections that can be made and help that can be had.”
For example, friends and family can still Zoom app in for face-to-face support and “drop and dash” meals on a new family’s doorstep.
To those who are stressed out by hospital policies that limit labor support to one person, Butterfield offers this:
“I think a lot of people planned on being supported by their partner and by their doula (exclusively). I ask them to come up with ideas about how they can be supported by the nursing staff, their obstetrician, or the midwife. How can they communicate to staff: ‘I’m going down a bad pathway?’”
“Most people don't say to the nursing staff, ‘I'm really scared,’ or, ‘Something happened to me before and now that it seems like it's happening again and I'm kind of freaking out,’” she explains. “Instead, they try to manage and when they're managing and covering up those feelings, they are not good communicators. The nurses cannot read their nonverbal signals clearly because the signals are mixed.”
She stresses that birthing in the current environment is an opportunity for new parents to practice two key elements of good parenting: flexibility and direct, clear communication. She encourages people to track their own internal body sensations, thoughts and images and to speak up early.
“Bluntly say, ‘Please help me. I'm frightened. I need to know blank, blank blank,'” she advises.
She wants parents to ponder what they might need to feel safe and prevent trauma or retraumatization before they go into labor:
“What is it they need to hear? Do they need frequent reassurance that things are progressing properly? Do they need reassurance that their blood loss is perfectly acceptable and not too much? Do they need reassurance that the baby is doing well?”
It helps, she says, to understand all birth providers have their best interests at heart. In most cases nurses will step up to provide the hands-on or informational support a family was counting on a doula to provide.
Butterfield encourages those giving birth to focus on what they can control rather than what they cannot. She urges them to get creative in finding ways to replace what they feel might be lost in the current pandemic-driven birth setting. To the client who was looking forward to her mother and sister singing with her through labor, Butterfield suggested an audio recording as well as asking her nurse to sing along. In doing so, Butterfield adds, the mother would also be helping her provider:
“Music comforts everybody, not just the listener but also the singer,” she says.
In the “taking charge of anxiety” approach, Butterfield asks her clients to try a cortisol containment exercise: Put a daily five- to seven-minute “worry time” on the calendar during which the parent “worries with abandon,” writing down key concerns. If there is an action that can be taken, do it. Otherwise, after the set time, move toward other activities with a freer mind: "You’ve done what you can and you won’t forget anything because it's all written down.”
She has other simple ideas for bringing calm in labor and delivery. Parents might, for example, explore how their expanded support team might help them virtually. Many doulas are now able to be in the labor room via Zoom.
During and after labor, Butterfield recommends having a beloved scent, beyond essential oils, to ease anxiety and remind parents of positive past moments.
“Smell is particularly useful, because the olfactory system is very, very connected to the emotional system,” Butterfield says. “The scent should be related to a good memory, perhaps the pine scent remembered from a camping trip, or a rose scent reminiscent of your garden. It should be personal and comforting.”
Using visual aids during birth and in the postpartum period is another helpful emotional coping strategy. She suggests finding images of other people successfully giving birth, nursing and getting through the first weeks of parenthood.
“For someone who has not had a baby before or who has only gone to a certain point of labor previously it can be helpful to see a visual that engages mirror neurons to stimulate the successful action-oriented pathway,” she says.
Butterfield suggests, for example, focusing on an image of someone successfully pushing a baby out may be more useful than an image of a flower opening up. A flower, says Butterfield, “is a fine picture, but it does not lend any direct competence to the body.”
Butterfield cautions her clients struggling with COVID-19-related anxiety to reduce their consumption of news to once a day and to turn to only two or three trustworthy, vetted sources for that news.
“Don't read everything that comes down the pike because it will only confuse you, and it will make you feel worse. Absolutely,” she says.
As a parent as well as a psychologist, Butterfield reminds expectant families of something they haven’t yet experienced related to birth and infancy: This too shall pass.
“When you have a newborn for the first time and are in the thick of it, you feel that it will never end. You haven't been through it before to know that one day you will sleep again and one day your baby will be happy and not crying and so forth and so on,” she says. “I think this situation is much the same. In our lifetimes we haven’t been through something like this – not as individuals, families, or as a nation. But we are adapting, and it will come to an end.”
Butterfield pushes anxious new parents to refrain as much as possible from negative absolutes. While unavoidable to some degree, negative thoughts and ruminations can increase the release of the stress hormone cortisol in the body and may create more distress for parent and baby than the pandemic itself. Once worries are identified and written down, it is time to search for positive experiences in the day and “pay them forward.” Text, FaceBook, WhatsApp or phone that meme, story, photograph or crazy thing the dog did to someone else.
“It’s a useful tool in this overall kind of chaos that we're in, when people are feeling helpless,” she explains.
On the other hand, if you run across something that is upsetting or another article that breeds anxiety, consider not passing it along.
Finally, Butterfield, who was alone in France four years ago when she was hospitalized for a stroke, suggests that parents manage anxiety by keeping a gratitude list. Noticing and listing things like the young doctor who held Butterfield’s hand as she cried, “saved me.”
“In making a gratitude list I increased my sense of safety and connection to others. It made my situation tolerable,” Butterfield says.
Moving out of fear takes discipline, Butterfield admits. It requires expectant families, people in labor and parents facing solo weeks with a newborn to look for the positives during what feels very difficult or very, very frightening.
“But it can be done, and it doesn't take long before your brain gets better at it,” she says.
Leslie Butterfield is on the board of directors for Perinatal Support Washington, which seeks to prevent perinatal distress and mood disorders by offering a telephone warm line (1-888-404-7763), online support groups, and referrals for those who are suffering from pregnancy, birth or postpartum related mental-health concerns.
Cheryl Murfin, CD, is a longtime writer, a certified doula and mother of two grownup humans, including a King County Public Health nurse. She owns Nesting Instincts Seattle.
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