Always, when I think of an interview, I reflect on the things that I would have needed to know when my son was born and on the people who have taught me the best during all these years of discoveries, readings and personal relationships with experts in parenting, childbirth or psychology. . All are special and nourish me, in addition to allowing me to approach fascinating and wise people. And there are times, that because of the intensity of the subject, interviewing them I get to cry, as has happened to me this time. Babies and more interviews this week with the psychologist Gabriella Bianco that tells us about the puerperium and its lights and shadows.
Gabriella Bianco is born and grows in Italy, in a family of migrants and between cultures. He studied Psychology and Psychosocial Prevention and Health Promotion in Germany by the Freie Universität in Berlin, where he specializes in gender psychology, migration and psychotraumatology. In Germany, she develops her professional career as a psychologist and psychotherapist with immigrant and surviving families, refugees and victims of torture. She continues to train as a coach, postpartum doula and Gestalt psychotherapist.
Since 2001 he lives in Spain, where he develops professionally as a perinatal psychologist, teacher and international speaker. She is the mother of a son, the result of a relationship of almost 17 years with her current life partner. He is also an activist and member of numerous associations of users and gender health professionals.
Is there a "normal" or common puerperium for all emotionally healthy women?
This question could be answered from different points of view: philosophical, cultural, psychophysiological, salutogenic, clinical ... it's the million dollar question! And it is also a question that represents a "trap" for someone like me, who moves in a continuum between psychopathology and salutogenesis, both from a theoretical framework point of view and in psychological and psychotherapeutic practice.
I would answer you then there are many puerperiums ... as women. Although it is clear that there are shared experiences, more or less pleasant, more or less functional or healthy.
If we asked the puerperal women if their puerperium is a “normal puerperium” and they described it to us, each woman would probably have a different response and description, each one tinged with personal and cultural beliefs and values inherent in motherhood. And the quality of your feeling / living this moment would depend on many factors, including your crisis tolerance threshold, your ability to cope with stress, as well as the emotional self-regulation strategies that you have at the time you He finds himself in transit through the puerperium and / or living his motherhood. On the other hand, a Mental Health expert (psychiatrist or psychologist) with a classic clinical approach and an eye trained in recognizing and classifying mental pathologies, would clearly answer that the “normal puerperium” would be a “puerperium that presents no symptoms of depression or other psychopathology ”, referring to the classical instruments of classification, diagnosis and evaluation of mental disorders (DSM-IV, ICD-10). Clinical psychologists are trained to recognize and treat what deviates from normality; To turn this look around implies a radical change in posture, which, in turn, implies the effort directed to study health sciences, its promotion and prevention.
However, are there feelings or thoughts that are normal and not a depression?
The puerperium, as well as other critical moments in the woman's life, is a moment of passage, of changes (both on a physical, psychosocial and emotional level) that presents new challenges and situations that may be new and / or unknown. Postpartum depression is not mandatory. When we have the ability to understand what is happening in this moment of our life, we have tools to interact with the events in the puerperium and if we manage to make sense of what life brings us at this time, understanding the deepest meaning of The whole process of motherhood, then we will have a good sense of coherence, which will allow us to live the puerperium in an active way and with (more) health.
And on what does it depend to have or not have a good sense of coherence?
According to Dr. Antonowsky, the sense of coherence develops and is regulated in the Primal Period (from conception to the first year of life). If a woman has suffered prolonged and uncompensated distress experiences in her Primary Period, her systems will be regulated on a high level of cortisol and her ability to interact with vital events may be strongly inhibited. In this case, the woman-mother will develop a tendency to hyperreact in the face of apparently normal events (the birth of a child). In these circumstances it is very likely that he will not be able to respond adequately to the problems that arise and his mood will tend to depression.
And how is the “sense of coherence” improved?
Antonowsky talks about the possibility of modifying the sense of coherence through a good adaptation to crisis situations. According to his thesis we can say that the crisis (puerperium) gives us a great opportunity for growth. Konrad Lorenz points to the possibility of modifying the sense of coherence through the increase of skills, creativity and external support that we can receive (psychosocial and / or professional). Something similar affirms Dr. Boris Cyrulnik, who defends the capacity for resilience (human being's ability to overcome adverse situations or even get stronger from them). These authors agree that the growth and evolution after a critical situation is enhanced thanks to the psychotherapeutic support of the hand of an expert and properly trained professional.
When should a woman worry about feeling sad or runaway about her new motherhood?
A maternity should not be a cause for pre-occupation. And even less in a society with a high standard of living like ours. Pregnancy, childbirth and breastfeeding are healthy events and promoters of women's health. However, it is essential to consider how each woman goes through this vital moment, depending on her health on how she feels, regardless of the many factors surrounding pregnancy, childbirth and the puerperium.
What factors influence?
The quality of the experience of motherhood depends, among others, on the “personal biographical backpack” (including the Primal Period of women, their resources, their experience of sexuality, eventual sexual abuse or aggression and / or traumatic experiences that has suffered throughout his life, etc.), childbirth (intervened or by emergency caesarean section, the quality of childbirth care, the surrounding environmental factors, etc.), their relationship as well as the presence of a stable family and social network, its work and geographic situation as well as cultural, values and beliefs aspects with respect to motherhood, breastfeeding, parenting models and the support received by health professionals throughout The whole process of motherhood.
When to worry or take care?
It is important that the woman begins to take special care of her mental health when, beyond the first weeks after the birth of the baby and throughout her first year of life she feels a deep and persistent sadness, the feeling of being permanently overwhelmed, irritable, anxious, if you notice considerable changes in your appetite and need for sleep or if you feel emotionally distant, tired and impatient with the baby, physically and psychologically hurt by the aftermath of childbirth, or feel guilty, misunderstanding.
In this case it is recommended to ask for professional help for an assessment of the situation and avoid banalizing what could be the symptoms of postpartum depression, which can become chronic when left unattended.
We have continued to speak at length, delving into the soul of the recent mother, her reasons and her fears, and I believe that many of our readers may be reflected in what we have spoken. Tomorrow we will publish the second part of this interview with the psychologist Gabriella Bianco.
