Maternal Mental Health & PND: An Interview with Clinical Psychologist Laura Forlani

Maternal Mental Health & PND: An Interview with Clinical Psychologist Laura Forlani

Nicky: Hi, I'm Nicky from Little Ones. And today, I'm going to be talking to Laura Forlani who is a Clinical Psychologist from Melbourne. She's the Director of Your Mind Matters Psychology Services.

She has a passion for working with clients who are struggling with starting a family and also helping parents adjust to life once they have a baby. I will link her website and Facebook group below and also a couple of Facebook support groups that she runs in case you're interested.

Today, we're going to be talking about maternal and paternal mental health, about postnatal depression and anxiety, and most importantly, how sleep and sleep deprivation affects our mental and physical health as parents.

Welcome, Laura. It's really good to have you with us.

Laura: Thank you so much for having me. It's a pleasure.

Nicky: Let's just kick this off with a really easy one. Can you just tell me about your own journey into motherhood. What did you find easy? What was challenging becoming a mother?

Laura: I became a mother about 11 months ago, and I can't believe I'm already planning his first birthday. It took us a bit about over a year to get through the first trimester and to have a healthy pregnancy so we were just over the moon. We spent so long just focused on pregnancy that when bub actually came along, it was a bit of a reality shock. I knew it was going to be difficult and I knew there was sleep deprivation involved. I didn't really get the full gamut of the first month how difficult it can be.

What was easy though is how much I loved him. I work with a lot of women suffering from postnatal depression and I know it can hit anyone. And so, I did have in the back of my mind that I may have trouble bonding with him. I'm not immune. I may not just instantly fall in love with him like everyone tells you that you do. That's actually not the case. A lot of women don't. So I was really grateful when he came along and all those emotions just came and I loved him. And so, in the middle of the night when he's crying again, for the fifth time, because he wants milk, you kind of go, "Oh, really?" And then, you just look at this tiny little perfect human and it's all worth it. So, the sleep deprivation was really, really hard initially but loving him was really easy and compensated for that. But I was also juggling a business so that was tricky as well.

Nicky: I reckon.  Let's just talk about that initial tricky period at the start and the sleep deprivation, because that's obviously something that every new parent goes through. Nobody is immune to that either. There's just no way around it. It's foggy and messy, as you were saying, and you just have to ... it's like a right of passage. How did that affect your experience of motherhood? Your initial leap into motherhood?

Laura: Look, it was really full on. I felt really overwhelmed. It's so much to learn when you have a baby. And then, when he needed to feed every two or three hours. So let's say it was every three hours and it would take 45 minutes. And then, by the time I fell asleep, it was an hour. So you're sleeping in these really small chunks of time. And you wake up the next morning and you don't feel rested and everything is just harder. It's harder to do the dishes. It's harder to do the washing. It's harder to cook and feed yourself. Everything is just harder and more stressful. And there's also so much to learn. And your baby is doing all these things and you're wondering, "Is this normal? Is this not normal?" So, there was a lot of self-doubt as well. I'll deal with a lot of guilt if I felt like I wasn't doing something that I should have been doing.

So it was a big, big adjustment. Even though I work with a lot of parents and I did a lot of research, it was still all new to me, what you expect and the actuality of it is so different. And at the start, you do lose literally hours per night because bub needs you.

Nicky: You obviously work in mental health and do a lot of work with mothers as well. Do you see a strong link between continued sleep deprivation and a decline in mental health and function and relationships and things like that with ongoing sleep deprivation?

Laura: Absolutely. There is a plethora of research about sleep deprivation and depression, in particular, but also some anxiety. So we know that if you are clinically sleep deprived, which they consider to be less than seven hours a night and that goes on for a while which is pretty normal for mothers. And fathers, because I'm sure anyone in the house hears it. There's a tenfold risk of developing symptoms of depression. And we also know that people who do suffer from depression either report sleep loss or an excessive need to sleep. So there's a really, really strong link that's really well researched on depression and sleep deprivation. And sometimes they don't know which one actually comes first so that's why when we see parents who are chronically sleep deprived, we are really mindful that there's a huge chance that there's a drop in mood, that they're going to feel really tired, that they're going to feel overwhelmed. And it's completely understandable.

If you've had a night where you've had no sleep, baby or no baby, the feeling of being tired is really unpleasant. You can't think straight. How you process things is a lot slower. We don't make as many good decisions. Our problem solving ability goes out the window. And of course, we just feel really heavy and low and unhappy. I don't know anyone who is tired and happy. I've never had anyone walk in like, "How are you feeling?" "I'm exhausted but happy." It's, "I'm exhausted." It's tiring. Everybody can relate to that.

Nicky: And so, do you see in your work specifically that sleep deprivation on those levels as a contributing factor to postnatal depression or anxiety and those kind of maternal mental health issues that we see?

Laura: Absolutely. So postnatal depression is really just depression that is due to having a baby. So it's not the baby blues. That normally resolves within a couple of days where with postnatal depression, it's about a month after bub is here. It's lasting for a couple of weeks. And we're also seeing that chronic sleep deprivation if it transitions into postnatal depression, which is really common. It's about one in seven women who give birth get postnatal depression. They have trouble bonding with their baby. It's not just, "I'm tired." It's, "I feel like a bad mother. I'm struggling to bond. I'm feeling angry. I'm feeling overwhelmed." There's lots of guilt involved. It's not just simply, "I'm tired."

And so, given the strong link between depression and anxiety and poor sleep, it's really not surprising that when we throw a baby in the mix and we get this surge of sleep deprivation that we also see increases in depression, particularly amongst mothers. And they're saying the research is about one in 10 fathers as well will experience low moods once a baby is introduced. So if you've got two parents struggling, of course, that also affects relationships which can exasperate the difficulty within the household and the adjustment. And it's a huge adjustment.

Nicky: Are you seeing that these statistics are rising? Are more and more mothers experiencing these feelings of depression and anxiety, do you think?

Laura: I don't know if the statistics are rising but I know women are coming forward and reporting it a lot more. The maternal health nurses are doing a fantastic job at detecting when women are struggling. It would be great if they were also working with the fathers a bit more as well. And so, they're really good at detecting it and referring them to psychologists early. And it's no longer taboo for the generation of women who are having babies now to see a psychologist. It's fairly well accepted. And so, we are having a lot more women put their hands up and say, "Hey, I'm struggling." But they're often suffering in silence and it's only to the maternal health nurse or it's to their best friend or it's to another mother. So we're trying to do a lot of awareness around that. It is really common and it responds really well to treatment.

Postnatal depression is something that is really well managed. If you have a GP onboard and a psychologist and you're willing to do the work. And we are all about working with mums. There is no shame in it. It is a privilege to support women and fathers in their journey and it's becoming more mainstream to see a psychologist. So highly treatable, really recommend that women get some support.

Nicky: I do feel and I've talked to quite a few people who also feel that these days we do try and suck it up. We have that whole, "I'm a women, I should be able to do this. It's just how hard can it be?" It's seen as a failure to admit that we're not coping. Do you think that plays into increased feelings of depression and anxiety. We're creating this cycle of putting pressure on ourselves and we don't feel like we're succeeding. And then, we feel like it's more of a failure to ask for help. How is that affecting our mental health?

Laura: Yeah. So there is, obviously, there's a huge movement now of women becoming the heads of companies and really educated and entering the workforce and becoming professionals. And it's really encouraged in today's society to multitask. It's not just you're just taking care of the baby and that's it. Women these days, and mothers, or even stay-at-home dads, they're taking care of the baby but they're also doing the shopping, the cleaning, the cooking. They're checking emails, answering phones. A lot of women are running their businesses from home. And it's celebrated to be doing a million things and to say, "How are you doing it?" And they're like, "Oh, I just don't sleep."

Or they're multitasking.  I have to admit,  I am actually guilty of this because I do run a business. In the early days, I would have my Baby Bjorn on, bub strapped in. I've got a standup desk and I would be responding to emails while bouncing him like this to keep him asleep and making phone calls and walking and walking just so I could get my work done. Even when I was in the hospital, I've got a baby two days old, but I run a business and I had to respond to things. So there was a lot of pressure. I absolutely felt like a failure and that I couldn't do it all. And you know what? It was too much. Looking back now ... and this is the unfortunate thing ... We often look back on what we did and we're like, "Why did I do that? Why didn't I delegate? Why didn't I ask for help? Why didn't I put some boundaries in place?"

So I'm absolutely guilty of it and I can completely relate to the pressure to do everything and be everything and succeed. And when you can't do it all that you feel like a failure even though it's such an unrealistic expectation.

Nicky: Yeah. I agree. We see it all the time actually. Parents who have just, "I need to do this and this and this and this and this. And I'm not sleeping." And I always think that if you're not taking care of your nutrition and your sleep that underpins everything else. You can't do all of those things if you're not taking care of yourself as well. And I think as mothers, we forget that we are just as important as our child.

Laura: We do forget. Absolutely.

Nicky: It's one thing to keep them alive but we also have to keep ourselves alive. And that doesn't mean I'm a physical shell of my former self. It means I'm healthy mentally and physically, and I think sleep is such a big thing.

Laura: We're meant to spend a third of our life sleeping so if we are messing with a third of our life, of course, the other two-thirds are going to be impacted as well. And we find that with the chronic sleep deprivation, not only do we see the concentration difficulties and the tiredness and the irritability and the mood changes, but then it does start to affect our physical health. Chronic sleep deprivation is really associated ... there's a strong link between depression, anxiety, heart disease, diabetes, stroke, obesity. So it really does long term start to affect your physical health as well. And it takes more than just one good night's sleep to fix it. It's consistently taking care of yourself.

Nicky: Is it selfish to want to sleep for yourself when you have a baby?

Laura: No. It is not. I can see how mothers think it's selfish. And again, it's this thing of the baby comes first. But we can't pour from an empty cup. So yes, if you can survive a few nights with a little bit less sleep, take care of baby, fine. But then, you need to take care of yourself as well. You need to say to someone, "Hey, I need a good night's sleep." Just one good night's sleep a week can be all you need just to really feel rejuvenated and like yourself again. And your baby will survive. You will thank yourself for it because you will be a new person the next day. You'll be more alert, you'll have more energy. You'll be happier. And your baby is going to love that.

So I would say that I know it's going to feel selfish because you're actually doing something for yourself, which you're not used to when you're caring for a newborn, but you really need to do it. It's not self-indulgent. It's self-care. And you need to do that, otherwise, you'll fall to pieces.

Nicky: And actually, a biological necessity. You know?

Laura: Yeah. I mean, how long can you go without sleep? You're not going to be the best version of yourself if you're not sleeping.

Interview Part 2

Nicky: If we're talking about post-natal depression and anxiety, what are things that mothers and fathers need to be looking out for as, I suppose, warning signs in themselves, and then also in each other, to then go and ask for some help?

Laura: Yeah. Sometimes people get really confused between post-natal depression, baby blues, and just being tired, because they all look similar. I guess the difference with post-natal depression is that it lingers, and it doesn't get better after a good night's sleep.

If you've had a few nights' bad sleep, and you say, "I need a good night's sleep," and you go and have that good night's sleep, and the next day you're still feeling like a bad person, that you're not enjoying spending time with your baby, that you're still really irritable, and you're just not feeling like yourself, and it's been going on for a few days, maybe between months one and two, or any time after one month, that's when we start thinking, "Okay, maybe it's something else." It's really about "I'm not coping," when we see post-natal depression, as well.

We see it in dads, as well. They may be really distant from their partner. They may not want to be spending time with their baby, as well. They may be coming home, and irritable, and tired, as well. Give each other a break. Give each other a night off from sleeping, and taking care of bub. Then re-evaluate. If the symptoms are still there, then get some help.

Things that we can do. You chat with the maternal health nurse, which mothers have access to, and I really encourage fathers, if they're having any of those feelings, to also chat with their GP. Do some research, as well, to find out is your experience really similar to others? Because a lot of the time, it's that parental guilt, but it's actually really normal, and it's not post-natal depression. It's unrealistic expectations. You're putting too much on your plate. That's why seeing a professional is really good, to work out what it is.

I would say educate yourself, as well. Do some readings. You can also call up some experts. Call up some psychologists and say, "Hey, this is what I'm experiencing. Do you think I'd benefit from some help?" They can also link you in with some services. There's some online services, as well as things like PANDA. They have a lot of resources there, and help determine if it's post-natal depression. Is it not? Am I just tired and a bit down in the dumps because of something else in my life that I'm unhappy about? Which, again, you can still get some support with.

What is really, really, really helpful, though, is caring for yourself. It's things like making sure that you're eating, making sure you're getting enough sleep. Cut out the caffeine. Cut out the nicotine. Try to avoid screens in your bedroom. Find the time to switch off. Find the time to exercise. Put baby in the pram and go for a walk. These things are really, really important.

If all else fails, ask for help. It's the number one thing that we don't do when we are struggling, and yet the most helpful thing that we can do when we're feeling in over our head. So ask friends, family, your partner, anyone in your mothers' group, or a health professional for help. Most people are so happy to help.

Nicky: I agree. That's the one thing we don't do. We're very bad at doing it, I think. Everybody's going to say, "Yes, I'll help you. That's the thing. Nobody's going to say "Nah, I'm not going to help you. I don't care if you're struggling." Everybody's going to help you.

Laura: I know. People love to help. It feels good to help other people. I've made a career out of it. I love it. It's so rewarding. Normally, helping a mum means you get to spend time with bub. It's fantastic. Within my mothers' group, or if I've got friends who have a baby, I'll say to them, "Give me the baby. We're going to go for a walk. Go have a bath. Go have a shower. Go for a nap. Whatever it is that you need. I'm going to take this off you. Do not do the housework. That can wait."

Nicky: I know, right.

Laura: Because it's never going to be all done. There's always going to be something else that you could be doing, so ask yourself, "What do I need right now to get through the next minute, the next hour, the next day, the next week?" Start doing more of that, and prioritize it, as well.

Don't prioritize the housework. People aren't expecting to come to your house, and for it to look like a display home. Let some things slide. Work out your negotiables, your non-negotiables. Do the things that have to be done, and then cut yourself some slack.

Nicky: That's really good advice. What are some other ways that we, as a village, or as a community, can be helping these mothers, new mothers that are maybe, we can see that they're not really coping, or that have told us that they're not coping? Or actually just any new mother. How can we be helping them?

Laura: I think that just being a sounding board is really helpful. Being a new mum can be really isolating. Not a lot of women do have other mums around them that they feel comfortable to ask for help with. If you can imagine, you're a new mum. You're really tired. You're feeling overwhelmed. You're feeling like a bad parent.

You don't want to then go to your friend, who looks like they're coping with being a new mum, and saying, "I think I'm not coping with this at all." It's a really vulnerable position to be in, to be able to ask for help.

I think a lot of what they need is just to know there's other women going through the exact same thing, and that we're all feeling vulnerable. We're all feeling uncertain. We're all learning. Some of us are struggling more than others, and that's actually okay. It's okay to get some support. Having resources, which you're building, which is amazing, is really, really helpful. Just being given the okay that, "You're okay. You're doing amazing. Here's some things that you can do."

Nicky: I find, too, what I really actually dislike seeing, and I see it a lot, and you probably do, too, especially online, is someone reaching out for help, and saying, I mean, I see it in the field of sleep, but like, "I'm not coping. I'm fully sleep-deprived. My child's doing this, this, and this." What I always see is everybody going, "Oh, that's normal. It's fine. Welcome to motherhood."

It really irritates me, because this person is actually asking for help. We've just talked about how hard that is, to ask for help, and how we don't do it enough. I see these women doing it, and they're instantly shut down by people going, "That's normal." I'm like, "You're not giving that person a solution, or an idea, or a suggestion. You're basically just telling them to suck it up and stop whinging, because you're in the same boat, too." That's not helpful to anyone, is it?

Laura: It's not helpful. What I find is, and a lot of people who do that, they're actually, they're well-meaning. They're trying to validate the person's experience, and say, "It's normal. There's nothing wrong with you." But at the same time, it's not helpful to the other person.

It's like when someone comes to you with a problem, and you say, "Oh, don't worry about it."

Nicky: Yeah, they're obviously worried about it.

Laura: Yeah. Never in the history of "don't worry" has that actually worked. When someone says, "I need help with this," yes, validate their experience. "Yes, I've been through this. This is completely normal, but it's really hard. This is what you can do. This may be helpful." It is about doing the practical things that help. What do you need? Getting emotional support, as well, and then getting the education. I think if you've got those three things, it's really helpful.

Nicky: I think, for the rest of us, it's letting people ask for help that we need to be maybe a bit better at. If we see someone who is asking for help, whether it's online, or at a mums' group, or something, it's just listening to them and going, "Okay, whether or not I personally think that that is 'normal,'" which I hate that word, but, "I get that you don't feel that it is. How can I let you ask me for help? How can I help you best?"

It might be through giving them some information, or pointing them to some websites, or some people that they could talk to. I think that's something we all need to be better at

Laura: Yeah, and we need to be better at listening, too. I think we're all victim of being so caught up in the business of our own lives, that sometimes we don't tune in to the cues that somebody else may be struggling. Which is why I love that next month is our Are You Okay Day, and there's Mental Health Awareness Week. People are getting a lot better at asking other people, "Hey, are you okay?"

I really, I hope that people are becoming more comfortable with being vulnerable, and that we're creating more spaces for people to be vulnerable, and that that's okay, and there's so much power in being vulnerable, and getting the support that you need. I love when I see people come into my clinic, and they lay it all out on the table. I think it's so brave, and it's so amazing.

Then we get to put the pieces all together, and we really empower this person. We give them solutions, and we help them on their own journey. It's wonderful. But they need to go through that process of asking for help, being vulnerable, and then letting us in.

Nicky: Lastly, in general, not just to do with the things we talked about today, what would your, maybe your number one tip or piece of advice to new parents be? In general. Anything to do with babies.

Laura: Ask for help. You can't do in on your own. When you say that you've got a village, or the saying that "It takes a village," it's not wrong. It is so true. On my own journey, I've thought about all the times I've asked for help, and I think about single parents who are isolated, and then I think, "Holy. How do you do that on your own? It is so tough. It is really hard."

Ask for help. There's no shame in it. People are happy to help. You don't have to do it all on your own. You're not on your own. You don't have to be. Let other people help you.

Nicky: I agree. I think that's excellent and very, very valid advice.

Laura: Yes. Absolutely. Look, everybody needs help. I'm a mental health expert, and I still needed help. I work with this cohort of clients all the time. We just need help. I mean, you don't need it, but it makes stuff a lot easier if you get help. You don't need to torture yourself, if you can get help, so ask for it.

Nicky: I agree. Well, thank you so much. This has been very enlightening, and I think a lot of, I hope a lot of people who are in the position of maybe being first-time parents, or even, actually second and third time, or fourth or fifth-time parents, because if we're talking specifically about post-natal depression, and those really strong feelings that ... not limited to first-time parents, is it? I think a lot of people will have been able to take a lot away from this conversation, and-

Laura: I hope so.

Nicky: Yeah. Yeah. I'll link all of the relevant things in the comment box, as well, so people know where they can start looking, if they need some extra help.

Laura: Yeah, there is so much help available, so to anyone out there who is struggling, please just go and seek some help. Get help for yourself, practically, emotionally, socially, whatever it is that you need. You will thank yourself for it, in the end, and bub will be a lot happier, too.

Nicky: Thank you so much for that. It has been awesome talking to you today.

Laura: You're so welcome.

Nicky: Thank you, Laura, so much for joining us today. I know I certainly got a lot out of our conversation, and I hope you all did, too.

If you need some more help and support with your little one's sleep, please check out our website. If you need some help and support, if you feel like you're not coping, or experiencing any of those symptoms of post-natal depression or anxiety that we talked about, please look at Laura's website and the relevant Facebook pages, which I will link below. 

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About Laura 

Laura is a Clinical Psychologist based in Melbourne and the Director of Your Mind Matters Psychology Services. She has a passion for working with clients who are struggling with starting a family, and also helping parents adjust to life once they have had a baby.

Social links: 

Website: https://www.yourmindmatters.net.au

Facebook: https://www.facebook.com/psychology.y...

Laura also has a couple of FB groups that you can join: Fertility Support Group - Australia: https://www.facebook.com/groups/40299...

Pregnancy Loss & Grief Support Group – Australia: https://www.facebook.com/groups/65599...