Chapter 7: Worry, Fear and Upsetting Thoughts

From the Diary

Week 10, after midnight. I got up three times tonight to check that our daughter was breathing. She was asleep in her cot next to our bed, perfectly fine, and each time I stood there with my hand above her chest until I felt it rise. Then I lay down again, and after a few minutes the worry started again: what if she stops while I am asleep? My husband said, half awake, that she was fine and that I should rest. I know she is fine. My body does not seem to know it. My heart beats fast, my shoulders are up near my ears, and my mind runs ahead to every bad thing that could happen. I am so tired, and still I cannot let myself sleep.

Week 11. I want to write this down, because I have not told anyone. Yesterday, as I carried our daughter down the stairs, a picture flashed into my head of me tripping and her falling. It was so sudden and so clear that I had to stop and hold the rail. Today I was cutting bread in the kitchen while she lay in her little chair on the floor, and another picture came. I put the knife away in a drawer and could not finish the bread. These pictures make me feel sick. I love her more than anything, and I would never hurt her. So why does my mind show me these things? I am afraid that if I say them out loud, someone will think I am a danger to my own baby.

Week 11, two days later. I told the midwife. I had to stop twice, but I said it all: the checking at night, the pictures on the stairs and in the kitchen. She did not look shocked at all. She said that many new parents have exactly these kinds of thoughts, that they often come from a mind working very hard to keep a baby safe, and that my fear of them showed how much I did not want them. She asked me some calm questions and said she was glad I had told her. Then she asked me about the birth, and I started crying, because I still think about that night: the long hours, the moment they said I needed a caesarean, the bright lights, my husband's face. It did not go the way I had imagined. The midwife said we could talk about it properly at another visit, and that the doctor could help too.

Month 3, a quiet morning. The pictures still come sometimes, but now I can say to myself, "That is one of those thoughts," and let it pass, the way the midwife explained. I still check our daughter at night, but usually once, not again and again, and on some nights my husband does the checking so that I can sleep. Last week the midwife and I went through the birth from beginning to end. It was hard. I learned some things I had not understood that night, and I said things I had not said to anyone. I came home feeling lighter. In the evening my husband held my hand and said that the night of the birth had frightened him too. We had never told each other that.

Worry After a Baby Arrives

Some worry is a normal part of becoming a parent. A newborn is small and depends on you for everything, and your mind turns naturally to watching over the baby. Most new parents check on a sleeping baby, wonder whether the baby is eating enough, and feel a jump of fear at a strange cough. This kind of worry comes and goes, and it usually settles when you see that your baby is well. It is one of the ways in which parents learn to care for a baby, and it does not mean that anything is wrong with you.

For some parents, though, the worry grows much bigger than the situation. Doctors and midwives call this anxiety after birth, or postnatal anxiety. It can begin in the first days or later in the first year, and it can come on its own or together with a low mood. It can affect the parent who gave birth, and it can also affect the other parent. Postnatal anxiety is common, and, like postnatal depression, it is nobody's fault. It is not a sign of weakness, and it is not a sign that you are a bad parent. Often it is the opposite: a loving parent whose protective feelings have been turned up too high.

Anxiety shows itself in the mind and in the body. In the mind, there may be constant worry that is hard to switch off, a racing mind that jumps from one fear to the next, and a feeling that something terrible is about to happen. In the body, there may be tension in the shoulders and jaw, a fast heartbeat, a tight feeling in the stomach, restlessness, and trouble falling asleep even when the baby is asleep and someone else is listening. Many anxious parents check things again and again: the baby's breathing, the door lock, the bottle, the warmth of the room. Like the mother in the diary, they know that the baby is fine, yet the feeling of danger does not go away.

There is often no single reason why worry grows so large after a birth. Many things can add to it at once: very little sleep, the sudden weight of being responsible for a tiny person, the big changes in the body, a birth that was frightening, a baby who needed extra care in the first days, or worries about money, work or family. Some parents have always been inclined to worry, and the new responsibility makes that side of them stronger. Others have never felt anything like it before and are surprised by how strong it is. Knowing these reasons does not make the worry disappear, but it can help you to see it as something that is happening to you, not something that you have done wrong.

Some bodily feelings of strong anxiety, such as a racing heart or a feeling of being short of breath, can be frightening in themselves. After a birth, chest pain and trouble breathing are also warning signs for the mother's body, so they should never simply be explained away as worry. If you have chest pain or real trouble breathing, call the emergency number straight away, as Chapter 2 explains. A doctor can check what is happening, and if it turns out to be anxiety, that is useful to know too, because anxiety can be helped.

Unwanted Thoughts That Frighten You

Many new parents have a kind of thought that almost nobody talks about. A sudden picture or idea pops into the mind, often about the baby being hurt: dropping the baby on the stairs, the baby slipping in the bath, an accident with a knife or in the car. Sometimes the thought is even more upsetting, a flash of the parent doing something harmful. These thoughts arrive without warning and without being wanted. Health workers call them unwanted thoughts or intrusive thoughts, which simply means thoughts that push their way in.

Doctors, midwives and nurses who care for new parents know that these thoughts are very common. They are often explained as a side of the strong need to protect a baby: the mind keeps scanning for danger, and sometimes it shows you the danger as a vivid picture. Lack of sleep, worry and a low mood can make the thoughts come more often. The most important thing to know is this: having such a thought does not mean that you want it to happen, and it does not mean that you will act on it. The fear and disgust you feel are a sign that the thought goes against everything you want for your baby.

Because the thoughts feel so shocking, many parents try hard to push them away, or begin to avoid things. The mother in the diary put the knife in a drawer; other parents stop carrying the baby on the stairs, avoid bathing the baby alone, or keep checking. These steps are understandable, but they can make the thoughts feel more powerful, as if they were real warnings. Pushing a thought away often makes it come back more strongly. Many parents find that it helps to notice the thought, give it a name in their mind, such as "This is one of those unwanted thoughts," and let it pass without arguing with it, while they carry on with what they were doing.

Telling someone about these thoughts is safe, and it helps. Many parents keep them secret because they fear that a doctor or midwife will think they are dangerous, or will take the baby away. Health workers hear about unwanted thoughts often, and they understand the difference between a frightening thought that a parent does not want and a real wish to cause harm. When the mother in the diary finally spoke, the midwife was calm and glad that she had said it. Saying a thought out loud often takes away some of its power. If the thoughts come very often, or take up a lot of your day, your doctor or midwife can explain the kinds of help that exist.

There is one difference to keep clear. Unwanted thoughts frighten the parent who has them, and the parent pushes against them. If you ever notice something different, such as thoughts that you might really act, a wish to harm yourself or your baby, or a feeling that you cannot go on, that is a reason to get help straight away, as the end of this chapter explains. You do not need to be sure which kind of thought you are having. If you are unsure, tell a doctor or midwife now; helping you sort it out is part of their work.

When Worry Takes Over the Day

It can be hard to tell when ordinary worry has become something more. One way to think about it is to ask how much space the worry takes in your life. If worry fills most of your day, if you cannot rest even when someone else is watching the baby, if you lie awake while the baby sleeps, or if you are checking, searching for answers or asking others to reassure you many times a day, the worry may be taking over. The same is true if fear makes you avoid ordinary things, such as going out, being alone with the baby or letting anyone else hold the baby.

A good guide is the same as for a low mood: if worry or fear is there most days, for more than a couple of weeks, it is worth telling a doctor, midwife or nurse. You do not need to wait that long if the worry feels very strong, or if it makes it hard to look after yourself or your baby. You can mention it at a check-up for the baby, at your own check-up after the birth, or in a call made just for this. It may help to write down a few examples before you go, because worry can make it hard to think clearly in the room.

Some small steps in daily life can soften anxiety while you wait for help, and alongside it. Slow breathing helps the body calm down: breathe in gently through the nose, then breathe out a little longer than you breathed in, several times. Short walks in daylight, regular meals and any rest you can get also help the body settle. Searching the internet for frightening stories late at night often feeds worry rather than calming it, so it can help to write your questions down and save them for the midwife or nurse. Talking to someone you trust, and saying the worry out loud, often makes it feel smaller.

If you have a partner, sharing the worry can also mean sharing the night. In the diary, the husband sometimes took over the night check so that the mother could sleep. This works best as an agreement made in the daytime, when both parents are calm: who checks, when, and how the other parent can trust that it has been done. A partner can also help by listening without rushing to say that the fear is silly. "I can see this frightens you, and I am here" often helps more than "Don't worry."

A doctor, midwife or nurse can explain the kinds of help that exist for anxiety after birth, which may include talking regularly with a trained person and other kinds of support. Many parents find that once they have spoken about their worry, they can see it more clearly and feel less alone with it. Getting help early is a strong and caring step, for you and for your baby.

When the Birth Stays With You

For many parents, the birth is a happy memory. For others, it was long, painful, frightening or very different from what they had hoped. A birth may have ended in an emergency or in an unplanned caesarean, the baby may have been taken away for extra care, or there may have been moments when a parent feared for the baby's life or their own. Even when everyone is well in the end, the experience can stay in the mind. Like the mother in the diary, a parent may feel grateful that the baby is safe and still feel sad, angry or shaken about how it happened. Both feelings can be true at the same time.

A difficult birth can show itself in different ways in the weeks and months after. Memories may keep coming back, sometimes as sudden, vivid pictures or as bad dreams. A parent may feel tense and on edge, or be startled by small things. Some parents avoid reminders, such as the place where the baby was born, talking about the birth, or seeing birth scenes on a screen, while others find that they cannot stop going over the details. Some feel numb or far away from their own feelings. These reactions are common after a frightening experience, and they can affect the other parent too, who may have watched it all and felt helpless.

Talking the birth through can help a great deal. In many places, a midwife or doctor can sit with you, go through what happened step by step, and explain why certain decisions were made. This can fill gaps in your memory and answer questions that have been going round in your mind. In the diary, going through the birth with the midwife was hard, but it left the mother feeling lighter. You can ask for this conversation even months after the birth. It is never too late to want to understand your own story.

The other parent, or another person who was there, can be part of this healing. Like the husband in the diary, a partner may carry frightening memories of the birth, too, and may have kept quiet in order to stay strong. It can help to tell each other what each of you remembers, slowly and without judging, because each person saw the night from a different place. If you have a partner, you may also want to go through the birth with the midwife or doctor together. When one of you has a hard moment because of a reminder, the other can simply stay close and listen. Neither of you needs to be the strong one all the time.

If memories of the birth keep returning, if you keep avoiding reminders, or if the experience still upsets you most days, for more than a couple of weeks, tell a doctor, midwife or nurse. Help exists for a birth experience that stays in the mind, and a doctor can explain what kinds of help are available. It is also worth knowing that a difficult birth may affect how you feel about a future pregnancy, and that this, too, is something you can talk about when the time comes.

Some moments need help straight away. If you have thoughts of harming yourself or your baby, or you feel you cannot go on, call the emergency number, a crisis line or a doctor now, or tell someone close to you at once. In the first weeks after a birth, very sudden, unusual changes in a mother, such as confusion, seeing or hearing things that others do not, strange beliefs or very unusual behaviour, need emergency help at once; a partner or relative who notices them should call for help. Chapter 6 says more about this. Asking for help in such a moment is a strong and caring act, and it protects you and your baby.

A Checklist of Things to Prepare

A note of the worries you want to mention: write down two or three examples of your worry or of the thoughts you have, so that you can say them clearly at the next check-up even if you feel nervous.

A sentence to start the conversation: prepare one simple opening, such as "I have been having some thoughts that frighten me," so that the hardest part is already decided before you walk in.

The numbers for urgent help: keep the emergency number, a crisis line and your doctor's number where both parents and any helper can find them quickly, by day or by night.

A night agreement: decide with your partner, or with someone who stays with you, who checks the baby at night and when, so that each adult can rest knowing that it has been done.

A calming habit for hard moments: choose one thing that helps your body settle, such as slow breathing, a glass of water or a few minutes of fresh air while someone else holds the baby, and practise it on a calm day.

A time to talk about the birth: if the birth still troubles you, ask your midwife or doctor whether you can go through it together, and write down the questions you would like answered.

A trusted person who knows: tell one person close to you about your worries, so that this person can notice if things get harder and stand with you when you ask for help.