Transcript for
How holistic pregnancy care promotes infant mental health
Dr Lyndal Harborne (00:00): Their scenario isn’t just that window in time when you’re seeing them. It’s for the next months, years, whatever. And if you never address it, then for them it’s 100%. For you, your life just goes on, and you see the next patient, the next patient, the next patient. But for them, it’s 100%, and that can last for years. So, if there’s a small amount of kindness, small amount of care given at the right time, you can make a massive difference to people’s lives.
Narrator (00:31): Welcome to the Emerging Minds podcast.
Vicki Mansfield (00:37): Hi, I’m Vicki Mansfield from Emerging Minds. Today, we’re talking with Dr. Lyndal Harborne, obstetrician and gynaecologist. We’ll be talking with Dr. Harborne about the importance of developing a therapeutic alliance with parents in the perinatal period, and supporting them as they transition into the postpartum period. And we’ll explore how attuned care can positively impact both the parents’ mental health and the infant’s mental health.
Nice to have you with us today, Lyndal. To start off with today, Dr. Harborne, if you could tell us a little bit about your background.
Dr Lyndal Harborne (01:10): Thank you very much for having me. I’m Lyndal Harborne and I’m an obstetrician/gynaecologist, and I’ve been in private practice since 2008. Prior to that, I did general practice, which gave me a cross-the-board insight into holistic care, for patients and their families. And obviously not exclusively obstetrics and gynaecology, but a whole range of different medical fields. I then did my obstetrics and gynaecology training, and part of that, I did a medical doctorate on polycystic ovary syndrome. So my specific interest for obstetrics is high-risk pregnancy.
Vicki Mansfield (01:46): In terms of working with parents, you work with both mums and dads?
Dr Lyndal Harborne (01:50): I do. It’s quite common now for when couples come along for their visits, for mums and dads to both come along, for both partners. And I can remember when I was pregnant – my oldest is now 16 – it wasn’t particularly encouraged for fathers to come along. And I also noted at the time that my obstetrician only spoke solely to myself. They didn’t include my husband in the conversation. They didn’t even look at them.
(02:22): And I guess that gave me my first insight into, if you’re going to expect dads to be 50% of any relationship and rearing of children, it starts right back at the beginning where you have to include them. You have to make them feel that their presence is valid, worthy, and that they’re 50%. So I usually speak to mums and dads equally. I give father’s eye contacts to them equally. And it’s not just a massive change of people’s lifestyles when they have a baby for the woman. It’s also for the father. And I think often the father goes unnoticed.
Vicki Mansfield (02:55): It’s a big transition for the couple, and for each individual, in their role and identity as well.
Dr Lyndal Harborne (03:00): Yeah, it’s a massive change. It’s probably the most significant change you’ll have in your whole life. So when you look at getting married, buying your first house, they’re all things that are within your control. You can organise things, you can micromanage things.
(03:17): And everybody’s roles change. Your focus goes from each other to the newborn baby. And everybody’s very much time-poor, everybody’s sleep-deprived, everybody’s stressed, and that can have ripple effects throughout the whole extended family as well, with changing of identities. So it’s very tricky.
Vicki Mansfield (03:37): Yeah. It’s very dynamic, lots happening at that period.
Dr Lyndal Harborne (03:40): I think it’s more tricky that people give it credit for.
Vicki Mansfield (03:44): Hmm. And I think, as an obstetrician you get to meet, as you said, people in the early stages of pregnancy right through to the postnatal period. What do you think is your greatest joy in working with people as an obstetrician in that period of time?
Dr Lyndal Harborne (03:58): I don’t think there’s any other area of medicine where you have the privilege of being part of that much of a significant event of their lives. So it is a privilege. You really integrate into the person’s lives, and you’re looking at every aspect of their life. Not just their physical, but also their emotional, their mental, their relationships with other people, their financial… lots of different things.
Vicki Mansfield (04:27): So, looking at it as a much bigger picture than maybe just general physical wellbeing, and that that’s an important part of your role by the sounds of it.
Dr Lyndal Harborne (04:36): Yeah. Completely. Being an obstetrician is not just looking after people physically.
Vicki Mansfield (04:41): There’s lots of research now, and parents often talk about the importance of having a good relationship and continuity of care during the perinatal period. How do you think that makes a difference for parents in your experience as both their care provider and the feedback that you get from parents?
Dr Lyndal Harborne (04:59): Birth can be daunting. It can be scary. It’s a very anxiety-provoking thing for lots of women. And to have the same person follow them through their pregnancy, and to feel like that person has their back and is an advocate for them, I think is invaluable. I can’t count the number of people who have said to me that when I came into the room, they just knew that everything was going to be okay. And that’s not because I’m anything special. It’s because I have that rapport with a patient, and they know that I have their back. Yeah.
Vicki Mansfield (05:38): I’ve had a woman say they knew that their provider understood them. And it sounds like you take a lot of caring, understanding your patients and the families that you work with.
Dr Lyndal Harborne (05:48): I think there’s nothing more important than the birth of your first child, because it’s such a massive upheaval in your life that if I can provide the woman a good experience with whatever she desires, then that’s my job done.
(06:03): So I often say to people that when they come to see me for their pregnancy, that my job is to, first and foremost, keep them and their baby and their family safe. And the second is to try to facilitate the kind of delivery that they would like.
Dr Lyndal Harborne (06:18): And that’s really, really important because traditionally obstetricians have been seen as being caesarean section eager, for want of a better word, because it’s perceived that it makes our lives easier. But there are some women who come to my door and they just want a caesarean section because they want that predictability, that control.
(06:39): And so I feel that to force women to have a vaginal delivery when their desire’s to have a caesarean section would be like to force a woman to have a caesarean section when she wishes to have an attempt at a vaginal delivery. And my job is to keep them safe and to provide them the kind of delivery that they would like. So they have a rewarding experience, and that will have flow-on effects for bonding of the baby, and as a child grows up.
Vicki Mansfield (07:08): Yeah. And the flow-on effect is certainly something that’s really significant from an Emerging Minds point of view. So, yeah. Having a sense of control and a sense of choice in that period, sounds like, is really important throughout life, but really important in that process.
Dr Lyndal Harborne (07:26): For me personally, I had postnatal depression, and I probably had some antenatal depression, but wasn’t completely aware of it. And then after my baby was born, I did the Edinburgh Depression Score, and I underplayed it. And my obstetrician didn’t actually acknowledge my Edinburgh Depression Score, although they did get me to do it.
(07:47): And how I ended up getting help was, I actually ran into the Head of the Postnatal Depression Service from John Hunter in Coles at Toronto, 15 minutes before it closed. Because up until that point, everybody was just telling me that it was sleep deprivation. That it was hormones. And really, I had postnatal depression. So I got help for that when my child was nine weeks old, and I just didn’t want that to happen to anyone else. Because once you have your baby, the visits with your obstetrician ordinarily stop.
(08:18): So you can easily feel like you’ve been abandoned, because you have all these intensive visits up until the birth, and then they just stop. And there are certainly some people who you think there are certain things about them that will put them at risk of postnatal depression, and that’s a terrible, terrible feeling. And you can often feel like you are swimming around in this ocean of blackness. And I think that if you have a good supportive team, and you know there’s someone that you can contact, it makes a world of difference.
(08:52): Because when you have postnatal depression, you often don’t want to contact people, because it’s very hard to see outside yourself. Your perception changes. So, if I think someone’s at risk, I will call them. And I also say to their partners… Well, actually I say to both of them before they leave hospital, “If either one of you feels that you are more weepy than not, and you just don’t feel like yourself anymore, you have a loss of identity. If either one of you, then you need to call me. And if you don’t, then the other one needs to call me.”
(09:25): And I will often just send them a text or check in with them about a week or so after they go home. That way, they know that they’re supported, there’s someone out there who’s thinking about them. There’s someone out there who is accessible to them, and it can just make that change in their lives a whole lot easier.
Vicki Mansfield (09:43): So it sounds like you’re attuned and sensitive to that, and reach out when you feel like it’s appropriate and needed.
Dr Lyndal Harborne (09:51): I think society’s very difficult in this current day and age. With globalisation, we’ve lost the extended family. There’s this feeling that you should be independent and capable and have everything all together, and everything should be perfect. But you’ve never done it before. A newborn baby’s completely uncontrolled. Your partner’s often freaked out, because they don’t know how to deal with it either.
Dr Lyndal Harborne (10:18): So if you don’t have supportive family around you, or supportive friends, it’s extraordinarily difficult, because we’ve lost the extended family. And in time’s gone past, the village looked after the mum and the baby. We don’t have a village now. So, I guess what I’m trying to do is, in so much as I can, I try to create a little bit of that village.
Vicki Mansfield (10:43): Also, I understand that you also suggest to people getting additional supports when they need it as well, if you think that there’s some emotional vulnerability.
Dr Lyndal Harborne (10:53): Definitely. So, because you develop a relationship with a person throughout their pregnancy, and if you come across as approachable, people will tell you things. As a confidential environment, they will often tell you things about what’s happening in their lives. And some things are definitely significant.
(11:12): And sometimes it’s not what they say, it’s the feeling I get from them. Sometimes people will come in and they’ll just feel a little bit flat. And then when I ask them, how are they? That’s a pretty telling question because if people are not having a great time, that will often make them dissolve into tears.
(11:30): So even with women who have miscarriages, even with women who are struggling going through assisted conception, women who have had birth trauma, women who have had a loss, a foetal loss, women with postnatal depression. They’re all women that I think that need that added input.
(11:49): And it’s very difficult for a GP to do that, because GPs are flat out. It’s very, very difficult to get into a GP. So often what I do is I see the woman, sometimes I prescribe medications, sometimes I don’t, but generally it’s a multidisciplinary approach.
Vicki Mansfield (12:05): And as you said, having that antenatally can really be preventative, to support or prevent more crisis up postnatally as well, by the sounds of it. So it sounds like it has a positive impact for that transition.
Dr Lyndal Harborne (12:20): From my own experience, I didn’t feel like I had a choice in my delivery, and I was unable to breastfeed. And breastfeeding can really mess with your head, because you can often feel like you’ve failed in society’s eyes, and it’s actually quite difficult to do.
(12:37): And then I became under-confident. I felt that I was a failure as a mother. And then I became under-confident about being with my child, and that lasted until he was about two. So, when we see women in hospital and they have the kind of delivery that they have, or we see them antenatally, their scenario isn’t just that window in time when you’re seeing them. It’s for the next months, years, whatever. And if you never address it, then for them, it’s 100%. For you, your life just goes on and you see the next patient, the next patient, the next patient.
(13:07): But for them, it’s 100%. And that can last for years. So if there’s a small amount of kindness, small amount of care given at the right time, you can make a massive difference to people’s lives. So it’s really, really, really important to listen, to be attuned to how people are thinking and feeling, to be approachable, to try to facilitate the kind of delivery that they would like.
(13:35): Don’t get me wrong, I’m not God. I’m not mother nature. I don’t have a magic wand, so sometimes things don’t go as we like. But I try to give the woman as much choice as she can, because that will decrease her chance of postnatal depression. Because she feels that she’s been involved in the decisions.
Vicki Mansfield (13:53): Yeah. Yeah. So thinking around some of the vulnerabilities which you’ve mentioned already, and perinatal loss or past birth trauma can be a significant vulnerability for families in subsequent pregnancies at the time and in subsequent pregnancies. From your experience of working with families, I’m wondering if you can share with practitioners how you observe that this may impact the future pregnancies, or what clinicians might consider when they’re working with people who might have experienced birth trauma or loss.
Dr Lyndal Harborne (14:26): The thing about our society is, nobody often talks about the bad stuff that happens. We sensationalise stuff, don’t get me wrong, but if it’s truly tragic, people often don’t want to talk about it, because they think that they don’t want to upset the other person. But it’s really, really, really important to talk to people who have had a loss, because just because the baby isn’t with you physically doesn’t mean that they’re not still in your heart, and that you carry that child for the rest of your life.
(14:56): So it’s really important to acknowledge that child and to get parents to have the appropriate support. And often when you go home without a baby, you can feel completely and utterly abandoned by the system. It’s harder than average, because you have this mammoth amount of grief that you have to cope with, and your partner has a mammoth amount of grief. And often you can’t help your partner vice versa with their grief, because you’re too busy dealing with your own mammoth amount of grief.
(15:25): And often what happens is that the support after you go home, people are left to their own devices. They’ve never done grief and loss like that before, either. So often the couple is just left. So when they come time to think about falling pregnant for the next one, they’ve just got this massive amount of anxiety, and it can be overwhelming, even to the point that some people will consider just not going there again.
(15:49): So often what happens is when they fall, they’ll have anxiety leading up to falling pregnant. Then when they do fall pregnant, that anxiety will increase. So you have to be mindful of that as well. And often I’ll book people into counselling and sometimes even EMDR, because if they’ve had a specifically traumatic experience, then EMDR can be very helpful for them to get their heads around having another baby.
(16:16): And also, there’s a lot of guilt associated with it too, because if you do have another baby and that baby is okay, you feel guilty about loving that baby, because that baby is with you. When you love that baby you feel guilty, because it may be perceived that you’ve forgotten your first baby. So it’s very, very, very difficult.
Vicki Mansfield (16:37): There’s lots of complexity in the emotional navigation of that, and it’s great that you’re attuned to that and it can link people into supports. Because otherwise, what you’re saying is that if you’re sitting and suffering in the silence of it, or the guilt of it, or the… That weighs heavy for their own psychological wellbeing, but also for future. How to navigate.
Dr Lyndal Harborne (17:03): Yeah. So not only just future pregnancies, but the flow and effect for that child as well. It may affect your bonding. It may affect your family dynamics. As I said, I became phobic about being with my son until he was about two, because I just didn’t think that I was doing a good enough job. And when you just had a baby, you’re super sensitive to everything.
(17:21): So you’ve just got to be really mindful that the person hasn’t done this before. There’s no instruction manual. You’re scared out of your poor wee mind that you’re going to do something wrong, or you’re not going to be a great parent. Or you’re just flailing under the weight of the responsibility of it. Your partner often has to go back to work, or vice versa. So you have financial stressors. Then you can be at home with a baby, who comes in all different shapes and sizes. You may get a baby that’s easy to deal with. You may get a baby that’s fractious. We all come in different shapes and sizes.
(17:56): But you can’t hand them back. So you’ve got to be able to deal with them. And you just sometimes… More often than not, you don’t know if you’re doing things right or not, but actually there is no right way. And it’s also okay to not be hard on yourself, to have days where you’re like, “I’m just not into this. I don’t like it. I regret not having my old life. I regret not being able to jump up and run out the door whenever I want to.”
(18:22): It’s okay to feel that, because at the end of the day, if you were to have chocolate every single day of your life, I’m sure there are some times when you think, “I can’t stand the sight of it.”
(18:32): The children are like chocolate, so it’s okay. It’s okay. None of us are perfect and we certainly don’t have to be perfect. But I get concerned that the world in which we live in at the moment expects us to be perfect. And it expects us to be perfect with less resources than we used to have.
(18:51): When a new patient comes to see me for their pregnancy, I give them a pack, and there are two pages in it which are handy hints for survival. And one of those handy hints is, join a mother’s group. But don’t join a mother’s group that’s all butterflies and bunny rabbits, because life’s not like that. You want a mother’s group to be honest and upfront, so when you’re having an awful time, people say they’re having an awful time. So you can be supportive of each other. Knock this facade that everything’s wonderful. Life is not Facebook. Life is more real than that.
(19:28): For example, this morning, I saw a woman who had had an assisted delivery, and then the baby’s shoulders had become stuck. And then she had a postpartum haemorrhage. And it was her first baby. She hadn’t ever done it before. Her partner was there. He had never done it before. There were a million people in the room. Everyone was rushing around. It’s a very traumatic experience.
(19:54): So the most important thing as a clinician is to give that person time. So for them not to feel rushed, for them to feel validated, for them to feel that what they’re saying is worthy. And it’s worthy of your time.
(20:09): And then you have to follow them up. And if appropriate, you need to get them a bigger part of the village. Otherwise, it just has ripple effects for the next whatever length of time. During your pregnancy, because your body shape’s changed, and if you have had complications, it can be very frustrating. It can affect your self-esteem. Your anxiety can increase. And as a clinician, you’ve got to be mindful that these things may potentially happen. And so you have to give the person support.
Vicki Mansfield (20:44): Thanks so much, Dr. Harborne. It’s been lovely to hear and talk with you today about your personal and professional insights into the emotional wellbeing of parents, and provide care that really helps parents navigate momentous changes that occur with parenting. We really appreciate you sharing your wisdom. Thank you.
Narrator (21:05): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian government Department of Health under the National Support for Child and Youth Mental Health program.