ACT and post natal recovery

As a first time mum I think I’d underestimated how much was involved in post natal recovery – physically and emotionally. Given ACT has an evidence base as a good approach to coping with chronic pain, it’s a good fit with the post natal period. For me, I had a significant perineum repair to rehabilitate from my forceps delivery which took about seven months. I also had to acclimatise to chronic sore nipples for the first two months. My daughter wouldn’t sleep other than on me for the first few weeks until I gradually weaned her into co-sleeping so I was also permanently exhausted. I remember the hormone overload on day 5 when my milk came in and I couldn’t stop crying all day, which was triggered initially by a midwife trying to show me how to hold my daughter to feed sitting up (I could only feed lying down at this point), and said midwife nearly dropping her when she did her startle reflex unexpectedly. Most significantly for me though, I was holding onto a sense of trauma that my birth reality had been so different from how I’d expected, shock at the reality I had experienced and a feeling of stuckness that I hadn’t had space to unpack and process any of it due to the constant merry go round of checks and assessments from professionals and also from family. I hadn’t prepared for the gap in headspace or how I’d deal with that with my natural resources running on empty and a baby who from the moment she was born would always come first. What helped me most was the lovely midwife I’d had during my pregnancy coming to visit on day 10 and spending her whole morning listening while I poured out all my thoughts and feelings about it to her. She was able to help me out the jigsaw together and validate my experience in a way I could then hold and process emotionally from there with my husband and then in baby groups with other women, where I was amazed how typical my experience was – it seemed the other first time mums were not all enjoying perfect water births either. ACT emphasises how we all as humans have pleasure and pain in our experiences, that we all have joy and we all suffer. That of the 8 basic emotions we experience as humans, only 3 are positive. That about half of us at one point will struggle with our mental health in some form – that of those who don’t, they may well still have to deal with another chronic condition. A good point of reflection is to mentally consider of the people you know well as a mum, who hasnt had some form of pain or suffering to endure – whether in miscarriages, pregnancy complications, relationship struggles, money worries, difficult births, difficulty recovering in the post natal period, difficulty breastfeeding or difficulty with some aspect of parenting at least one of their children. I’d argue that both pain and joy are a universal part of motherhood which is a big reason I wanted to write this blog.

community and connection

Perhaps the most healing aspect of the post natal period for me was expanding my sense of community where I live through connecting with other mothers. So for someone reading this who doesn’t have that yet, these may be helpful questions to consider – where you live, how do you connect with other mothers? Drop in groups, baby clinics, parent and toddler groups, breastfeeding groups? Do you have an ante natal group to catch up with post natally, eg NCT? Do you enjoy online forums to connect like blogs or Mumsnet? Or perhaps Facebook groups – I joined one for example on baby led weaning and another which is a local under 5s parent forum. Or perhaps you have family members or friends who’ve had babies at a similar time you can meet up with?

Defusion

In the post natal period particularly I found it helpful to defuse from preconceived assumptions and expectations I’d had about how I would be as a mother, how my baby would respond, and how my husband would be as a father. For example, we’d bought a Moses basket which my daughter refused to go into, she had no interest whatsoever in naps and wanted to feed every ten minutes as a new born and certainly not every four hours as a parenting book I’d read pre baby informed me was the traditional feeding pattern. My daughter also did not want to go to anyone other than me for a cuddle as a new born due to the aforementioned wanting to feed constantly issue, so that didn’t match the exoectations of her grandparents for example. I’d thought my husband would be able to help with the housework and baths and baby changes but he wasn’t due to a flare up of a chronic condition causing muscle weakness and double vision. He couldn’t even hold our baby unless I was there in case his arm strength gave way without warning, which often it did. So given how many of my assumptions were unhelpful, I decided to let go of trying to make my family fit the books I’d read, and focus on doing what worked for us, and what it took to safely get us through one day at a time with the hope that the hard moments would pass and happier ones would come along soon. Three years later, that approach is still much more useful to me than any parenting book I’ve read or anyone elses advice. It’s worth remembering that there’s not really much evidence behind a lot of the published parenting books on sale for new mums – most of it is just information about what worked for others which may or may not for you.

Useful Defusion questions

What assumptions about birth, post natal recovery and post natal relationships might you have been fused with before having a baby? Of these, how many match up ro your experience? Have these assumptions helped or hindered your mental health? Your relationship with your baby? Your relationship with your partner (if you have one)?

Some useful defusion strategies if you decide you need them

Share any book advice that doesn’t suit your baby with a group of other mums of babies – online or in person. what do they have to say about their experience of that advice?

Pass any books that don’t help you onto a sale – or burn the book if you prefer

talk to your partner or best friend or mum about it – what’s their perspective?

Write unhelpful assumptions down on paper and rip them up

Type up unhelpful assumptions and play around with the font then delete them when your done

Try making up a poem about them

Lie on the grass and picture them all floating away on fluffy clouds

Values

If things are different from you expected before becoming a mum it might be helpful to review your parenting values and priorities

Useful questions

What really matters to me and to my partner right now?

How can we get more of what matters into our parenting journey?

Do we need to make compromises – if so can we agree what?

Is my baby different from how I expected? Do I need to be a different parent than I expected? How does that sit with my parenting values?

ACT and Breastfeeding

You can breastfeed anytime and anywhere you need to

Breastfeeding is definitely a time in my life that knowing about ACT has come in useful. There are lots of practical resources out there on the physical side and plenty support groups where I live – and I imagine in other urban areas of the UK too – but perhaps less on breastfeeding and mental health and wellbeing. ACT is a great model as a starter there.

Values

The most uppermost in my mind when I started breastfeeding my daughter was why I wanted to. I’d had a relatively tough time giving birth to her and it hadn’t gone how I’d planned at all. I had read lots about the benefits to my baby of breastfeeding and also the practical benefits for me. For example, reduced chance of asthma and allergies which both run in my husband’s family, association with reduced dental decay and higher IQ for the baby. Also less ear infections and tummy upsets for the baby linked with sharing my immune system. I found it interesting that there was less written about maternal mental health and breastfeeding. I would imagine that pressure to breastfeed without adequate emotional support would put many women’s mental health at risk – which is where ACT strategies could come in. There have definitely been benefits to my mental health when breastfeeding with these strategies. For example, the constant oxytocin hits, being able to snuggle with my daugher in baby cinema as a tiny baby since all she needed for comfort was a feed, the justification for snuggling up with a book for half an hour rather than doing the house work. Also, no need to get out of bed to feed at night due to mastering sleepy feeding lying down and co-sleeping. So for me, breastfeeding fit with my parenting values of doing my best for my daughter’s health, our respective mental health and our relationship with each other. I think it’s helpful however for every woman to make her own assessment of her own values as a woman and of her parenting values as mother and review whether breastfeeding fits those before starting. For example, a woman whose values would lead her to need to resume work away from her baby by 6 months might want to consider combination feeding, someone who strongly valued an adult social life with alcohol and late nights away from her baby might also want to consider combination feeding, and someone with several other children already might choose that the older children’s need for time meant exclusive breastfeeding wasn’t the most efficient way. Equally, someone with those values might strongly value

breastfeeding enough to want to make it work. The point is, taking time to reflect on values is helpful in choosing how to feed your baby.

Helpful values questions deciding whether to breastfeed

how do you feel about breastfeeding your baby?

Is it something you want to do for you and your baby, aside from any pressure from others?

How does your partner (if you have one) feel about breastfeeding?

If Breastfeeding is important to you, why?

Which benefits of breastfeeding fit with your own values?

What might you hope to gain from breastfeeding – for you? For your child?

What do you see as possible costs of breastfeeding? To you? To your child? To others important to you like a partner or children or friends? How do these costs sit with your values?

Am I willing to accept the costs I’ve identified in service of breastfeeding my child and accessing the benefits I’ve identified to what I value?

The answers will vary hugely woman to woman, and it is helpful to think only about what is right for your own situation rather than objectively what is right or wrong – this is about you and your baby and you decide.

Opening up to experience

Another helpful ACT concept here is about willingness. As humans we are highly motivated to avoid pain, and much as I’ve loved breastfeeding the first month particularly was hard. Toe curling pain at every feed, scabby nipples, learning to tolerate the initial awkwardness of feeding in public. I had permanent cabbage leaves in my bra and was constantly sending someone to a shop for more nipple cream. I also had the cluster feeding baby on the postnatal ward who occasionally came up for air only for a midwife to point out she was showing feeding cues (again). At 3am I remember one poor woman asking if she could please move ward away from us due to the noise. In my daughter’s defence, she’s very tenacious when she wants something – especially food – and couldn’t be expected to understand that my milk wouldn’t come in until day 5 (by which time we were home). I was willing to have all of that in the short term in return for the long term benefits of breast feeding. I’m lucky that the pay offs started when my milk came in – my daughter then gradually became willing to sleep on something other than me for short bursts of time, so I could sleep too. My appetite rose to my previous marathon training proportions and I enjoyed that I could out-eat my husband and still lose weight without leaving the sofa. My daughter gained weight well and remained an enthusiastic feeder but was generally happy provided I was with her.

Good willingness questions

Am I willing to tolerate pain in service of breastfeeding my child? If I gave my willingness a mark out of ten, what score would I give?

Are there limits to this, eg what if I get thrush or mastitis?

Is it helpful to set myself an initial goal length and then review if I want to continue?

If I am willing to do this accepting there may be pain, what coping strategies am I open to trying? Cabbage leaves? Nipple shields? Nipple cream?

How do I feel about feeding in front of my family, in front of extended family, my friends, the public?

Am I willing to feed in front of those people? Am I willing to tolerate the feelings that might come up? Are there compromises that might work? Do I want to use a cover up when feeding?

Defusion

Normally Defusion is helpful for getting space from my own thoughts and feelings. In a breastfeeding context though, I’ve often found it most helpful for getting space from other people’s. For example, my husband’s mum managed 6 weeks of breastfeeding and he often expressed not expecting me to last longer than that, although I wanted to try to. So when I was complaining of pain after the first couple of weeks, he said “so my mum managed 6 weeks and you’ve only done 2”. I was able to take a couple of deep breaths and consider that I hadn’t had the opportunity yet to manage more than 2 weeks but that didn’t mean I couldn’t, and I was still willing to try.

#breastfeeding #ACT #mental health

My first experience of giving birth

I’m aware writing this of how different this post might have gone had I written it before, during or soon after my daughter’s birth happened. Time has altered my lens. That in itself is a defusion strategy I often find helpful when considering something I find both very important and very emotive – questions like how will I feel about this a year from now? In two years? In ten? In twenty? What do I want to remember about it? What do I want this moment to be about? What do I want to stand for? Its a way to get enough space from this topic to view it clearly enough to do it justice.

As a first time mum, I have the thought that I was very naive about the reality of birth. People would say ‘good luck’ and I’d puzzle over their knowing looks – I wanted a beautiful natural water birth and with my renowned high pain threshold and marathon running experience and all my exhaustive pregnancy yoga prep, listening to the pregnancy podcast and research of Mumsnet I should be able to use my ACT strategies to cope fine in the birth centre, right?

Like most first time mums I’ve discussed this with, the answer for me was NO. Nor did my labour confirm to the nice neat graph in my antenatal class. My contractions never behaved how they were meant to. My pain display didn’t match what the midwives were looking for either – which led to the assumption I was ‘coping well’. I’ve learned that I go quiet naturally when I’m in either emotional or physical pain and this can often be mistaken for meaning I’m ok. Midwives are trained that women in established labour make noise, leading to the assumption that quiet = not in established labour. For me, this meant my husband put off going to the hospital because of the worry we’d be sent home for not being very far along. When I’d vomited over enough stuff for it to be inconvenient, we went. The midwife who examined me when I arrived started with the chat about why hadn’t I tried paracetamol and a tens machine before the examination, which then showed I was indeed in established labour, just minus sound effects. I then asked for gas and air, which became my new best friend. To start with that is. The pain ramped up, and was continuous rather than those neatly graphed waves I’d prepared for. So I got told off for overdoing the gas and air and my husband took the role of rationing it. This had the benefit of making me clear headed enough to backtrack on my birth plan to ask for an epidural. The midwife didn’t do that straight away because I seemed to be coping well (aka quiet due to constantly breathing gas and air). When she did, an anaesthetist couldn’t come straight away due to dealing with emergencies (which I do appreciate writhing round in agony is not, but if my pain display was more typical maybe I’d have been in the queue sooner and suffered less). An anaesthetist then came at about 4am but immediately left just as she was about to inject me to deal with another emergency. I then eventually did get my epidural a couple of hours later and got an hour or so of sleep in before the pushing stage. Accepting I needed to change plan and accept pain relief was definitely following my reverse compass, especially when I had no understanding then of why my pain was so intense and continuous. As such, to the extent I had coherent thoughts they were about being out of control and unsafe. In the pushing stage my daughter’s heart beat dipped twice indicating she wasn’t coping, the emergency buzzer was pushed and there were suddenly a team of about twelve people there. While I’d researched what could go wrong with birth and the options if it did, I hadn’t prepared to be spoken to as a lay person. I knew I didn’t want keighland forceps due to the high risk for the baby, but because they weren’t referred to by the technical term I missed the chance to protest. We had also prepared that we would opt for a ceasarean in that scenario as lower risk for the baby. However given I thought I was choosing a straightforward forceps delivery over a caesarean I consented, my instinct being that despite my husband’s puzzlement at my apparent u turn, this was the right decision. So perhaps the most useful part of my birth prep was holding into the advice to trust my maternal instincts. Because my daughter – following my pretending the anaesthetic top up had worked to avoid a delay causjng a risk to my baby – she was born safely with no complications – albeit a bit cranky at her abrupt arrival. So my ability to be quiet during pain and choose to have pain in the service of what I value most – motherhood – was still useful for me when I needed it most, even if not in the way I planned. I also learned the reason for the continuous agony I couldn’t manage on gas and air was that my baby had got stuck in a back to back position which I now know other women also struggle to tolerate and no longer feel like a failure for needing that epidural. My daughter’s head was on the 91st percentile which also helps me rationalise my pain relief choice. I then had a post partum haemorrhage, tachycardia an episiotomy and a significant additional tear to heal which would give me lots of opportunity to use my ACT skills. I’d seen birth as the marathon – but through this retrospective lens I can see that it was only the start line – motherhood is the real marathon and where those ACT skills really come in for me.

The best birth preparation I had was pregnancy yoga at the pregnancy and parents centre in Edinburgh – I’d recommend to any other pregnant mum. I’d just offer the suggestion of holding birth plans lightly and trying to resist fusing with it, and any stories that might associate with it. I had an old story associated with natural birth that meant I would be strong, successful and womanly if I could manage with the implication of the opposites if I couldn’t – now I’m distanced and defused I can see it for what it is – just a story reinforced by some women I know, some media and some movies. My now perspective is that how I mother my children says a lot more about my strength, womanlyness and success than how my birth stories unfolded – and to the extent that anyone really has the right to judge another mother I’d prefer to be judged on my mothering skills day in, day out.

My third pregnancy (aka baby tenacity)

I got pregnant for the third time two months before that trip to Australia. I was more than happy to forego those wine tours. I was even happy to embrace morning sickness as a sign that this pregnancy was going to be a sticky one. I held off this time on making my booking appointment with the midwives, waiting until my second lines got stronger until 6 weeks before phoning. I’d found deciding what to do with my scan invite too upsetting the first two times.

My booking appointment when it came coincided with my flight to Australia. That pleased me as it meant if I did miscarry and need to cancel again, I’d still have something positive to do that day. It was a milestone for me to make it that far for the first time, and it made the pregnancy feel more real and concrete.

What I struggled with in my third pregnancy was the first trimester constant anxiety and hypervigilance for cues a miscarriage might be coming once again. Every time I went for a wee, I half expected to see blood. Every emotional shift I noticed, I wondered if it correlated with hormone changes heralding miscarriage. The trouble with that is, early pregnancy, PMT and impending miscarriage all involve raging hormones and emotional shifts so that all becomes intractable.

I painfully missed tea and coffee, but I abstained completely from caffeine in the first trimester so I wouldn’t have the guilt that something I’d done could have caused a loss. I also abstained from my then favourite coping strategy of running for the same reason, and sorely missed the emotional release. But I was willing to do whatever it took to avoid another early miscarriage.

What helped me most in that time was the support thread on Mumsnet for women pregnant again after a loss – that thread helped me feel a sense of community and connection with others when I didn’t know anyone in the same position as me in real life. Distraction also helped – I focussed on planning a trip to the Isle of Skye as well as the aforementioned trip to Australia. Focussing on work also helped, but given how anxious I was feeling it was probably also a good thing I spent two chunks of my first trimester on holiday.

When we were on the Isle of Skye I started to feel very crampy at a restaurant and fearing the worst, miserably went off to the toilets to check for bleeding. I’ve never been so relieved to discover my only problem was trapped wind.

By the time I’d got through my booking appointment and made it to Australia, I was starting to believe this baby was going to stick around, and live up to the nickname I’d given of baby tenacity. We were staying in b and b accomodation in the blue mountains when I was about 11 weeks pregnant with no cues of miscarriage and we felt confident enough to mention the pregnancy at breakfast to another couple – who were confident enough to say they were pregnant too, having just found out before the trip – and the husband of that couple still enjoyed his wine tour with his wife driving. Talking to them reinforced for me that you don’t have to follow anyone elses rules about what you do when you’re pregnant. There will be lots of conventions, other people’s expectations and advice around but each of us can choose to take what we like and leave the rest. Which is of course also true of my site – my answers might not be yours, and your experiences and mine will also differ. But maybe there’s something of value in offering to share our experiences and allow each other to decide what to take from it, and that’s my aim here.

I vividly remember my anxiety before my 12 week scan. I had a mental image of my blank womb on the screen, and a technician awkwardly explaining there was no baby and walking off to find a doctor. I’d read about lots of scenarios of non viable pregnancy that seem viable until 12 week scans – I like to be prepared, even if that means considering scary possibilities. We had agreed not to tell people in our real life this time until after a viable 12 week scan. I remember the feeling of overwhelming fear as the technician put cold jelly on my abdomen for the ultrasound. And almost straight away, I saw her – my baby, wriggling. Then I heard her strong, steady heart beat. I felt indescribable joy and relief. All my pieces felt back in place, and I felt solid and sure of who I needed to be and what I needed to do. That little wriggly creature was going to be my longed for first daughter, and I was going to love her even more. That was the point we told family and close friends.

During this pregnancy I ran five ACT groups and used the model a lot in 1:1 work. I also went to an ACT conference.

The plan was to wait until our 20 week scan before sharing the news more widely but I’m not that good at hiding a baby bump and people kept guessing. I found out one of my work colleagues had guessed when I was only 7 weeks pregnant and told the rest then, so the keeping it quiet at work effort was a waste of energy. I didn’t get to surprise anyone really. From the point everyone knew, I began to really settle into and enjoy pregnancy. I felt I had ownership of my life and my sense of self back. Authenticity is a key value for me and being genuine in my relationships with others is a really important aspect of that. Keeping something as major as a pregnancy secret had the effect of creating a rift valley between me and others, removing my sense of connection to my community. So for me, to feel connected to living with my values again transformed my wellbeing.

I built on that by starting pregnancy yoga which allowed me to spend time with and make friends with other pregnant women and discover that the real life version of Mumsnet was even more supportive. When my 20 week scan showed everything looked fine, I began to plan more seriously for the reality of having a baby – I’d spent so long thinking about pregnancy, I hadn’t fully processed the baby part until then. I was lucky that my baby daughter (scan confirmed my gut feeling that she was a girl) was very active so I never had to worry for long whether she was OK. I started to enjoy baby shopping, keeping a baby journal, a time capsule of my pregnancy and taking weekly baby bump photos to compare the growth. I applied for maternity leave. I began to finish up work commitments and look forward to my last Christmas as a wife but not yet a mother. I got round the pregnancy cheese rules by eating baked camembert with fake red wine. I made the decision to stop work at 37 weeks since I had no idea when my baby might come – and started mainlining raspberry leaf tea in the hope it would make my labour more efficient, having daily walks and penning my final diary entries. I reviewed my birth plan notes which covered all possible scenarios I could uncover. And I waited .. and waited .

Resources I found helpful during this pregnancy

https://www.mindthebump.org.au

A mindfulness app specific to pregnancy. I particularly liked the preparing for sleep audio clip but used this generally throughout pregnancy.

Welcome to the Pregnancy and Parents Centre

Wonderful centre based in Edinburgh offering various forms of support to pregnant women and parents of young children. For pregnant women – pregnancy yoga, active birth and preparing for breastfeeding workshops and regular sales featuring reusable nappies, second hand baby clothes and toys and slings and baby carriers to try. People who like to be prepared (like me) might also want to try a breastfeeding support meeting with la leche league hosted there or a baby first aid course in prep for the new arrival.

Workability

Another important ACT concept is doing what works rather than either repeating unhelpful patterns that have short term payoffs but long term downsides in terms of what you value, or pushing yourself so hard to do what you want to achieve that you end up adding excessive stress and exhaustion to your suffering.

So after my second miscarriage, I faced the thought that this could be my pattern – get pregnant easily and lose the pregnancy just as easily. A cruel fertility twist. It occurred to me conceiving might need to be a long game, allowing space for other areas of my life too. So rather than get frustrated at having to wait for a period, I tried to use the time positively to catch up with friends, host BBQs, enjoy some runs in the beautiful countryside where I live and focus also on work. This boosted my wellbeing much more than just allowing myself coffee and wine. From that perspective, we also booked a trip to Australia. I planned that if I wasn’t pregnant we could enjoy wine tours, and if I was, I’d be happy to forgo them. It helped me feel I’d set it up as win-win rather than all or nothing on getting that second line each month. As we got closer to the trip and I got the necessary period, I considered following my reverse compass and skipping trying for a month, but then decided to “not try, not prevent” as a compromise – and what happened next?

Useful questions to test the workability of what you’re doing

Why am I doing this?

Is doing this getting me closer to my goals?

what am I trying to achieve here, and is what I’m doing helping or hindering me?

Is what I’m doing making my quality of life richer or poorer? In what way? Which aspects of this matter most to me? To my family? To others?

What are the benefits of this course of action to me? To my family? To others?

What are the costs of this course of action to me? To my family? To others who I care about?

Some common short term payoffs that trap us in unhelpful patterns

The feel good factor of a couple of drinks – trouble is when you add a few more the suffering begins

The pleasure and comfort of a chocolate box – eat a few of those, and the suffering begins

Compulsive exercise – initial buzz and self esteem pay offs, long term pain and injuries await

Avoidance – short term relief, long term anxiety awaits

My second pregnancy (aka baby rainbow)

miscarrying for me turned my world upside down, with baby rainbow at the top of my view

Another key skill from ACT I had to use to get as far as my second pregnancy was psychological flexibility – the idea that you need to flexibly use the right skill at the right time and bring your knowledge in when you need it. So I needed mindfulness, defusion, clarity on my values, a broader perspective that my life was bigger than pregnancy and commited action to cope.

My first move was to follow my reverse compass albeit involuntarily by waiting to have a period before trying to get pregnant again. I found that frustrating at the time, and struggled with not being able to go after what I wanted. I also particularly struggled with other people’s pregnancy announcements then – a bit like they’d won a game of tennis I hadn’t been able to compete in due to an arm injury. It was Christmas when I was working through that, and I found it hard to put a happy face on for family and friends when my mood was on the floor. I was sad too that when I was pregnant I’d had visualisations of announcing my pregnancy around then, whereas instead I was grieving the loss of it and not knowing when or if it’d happen again. I also struggled with the well meant cliché s other people who did know about my loss shared – “it’ll happen when it’s ready”, “you haven’t been trying that long” and the also well intended “So are you thinking of having a baby soon?” from people who didn’t. I struggled with my emotions of sadness, guilt and shame around my loss and fear and desperate longing around trying again.

When we started trying again it was New Year and I embraced it like a new years resolution – Ovia, healthy diet, conception vitamins, supplements meant to increase the chances. My other half protested both about taking conception vitamins and my supplements – he was also a bit bemused about the reduction in wine intake. He was unconvinced the effort was either necessary or helpful. I then obsessively watched my symptoms once my fertile window was over until my period was due. I joined a Mumsnet support thread for women trying to get pregnant again after a loss and there I found empathy, validation, compassion and identification – my emotional crutch at that point of the month particularly.

I was flat and disappointed when the pregnancy tests I took refused to show a second line that cycle and then my period started, confirming I wasn’t pregnant. I consoled myself that I could at least allow myself coffee, wine, chocolate and running for a couple of weeks. That then gave me – and my long suffering other half – enough of a boost to try again in my next fertile window.

Another anxious two weeks later and another line appeared on my pregnancy test. It wasn’t as convincing a line as with my first pregnancy but it was definitely there. My heart got hopefully while my more cynical other half told me not to get my hopes up. Sadly, he was right. This time the miscarriage started suddenly at work. I phoned my GP who confirmed I was probably right about it being another miscarriage and mentioned that old school advice would have been to wait 6 months before trying again. I was horrified. I couldn’t have followed that. I also phoned the early pregnancy unit who gave me a follow up appointment for blood tests due to the previous suspicion of ectopic pregnancy and my increased chance of having one. Luckily for me, the follow up appointment ruled that out, but it’s a fear I’ll always carry prior to a scan due to the risk. What I find sad in retrospect is that I hid my miscarriage from my colleagues and went about my work as normal. I was in the same state of shock as with my first miscarriage, which made me numb, pragmatic and want to do something positive I could control, since I couldn’t stop myself miscarrying. It also made me sad that I’d named that pregnancy baby rainbow, and I’d seen a beautiful rainbow that morning on my way to work – like the baby had been saying “bye mummy, I’m off to play over the rainbow now”. I had a feeling she was a girl – I like to picture her swooping and looping with the bluebirds. “Somewhere over the rainbow” is my favourite lullaby to sing to my children at bedtime – I always think of my miscarried babies then too, and sing for them all.

Commited action

Possibly the most important part of ACT. Once you know what you care about and you have the tools to cope with climbing your own mountain to reach it, you set some goals to get you there – following the mountain analogy, like a series of camping posts on the way to reach.

After my first miscarriage, within my value of family my all consuming goal was starting one. Breaking that into steps, it looked something like –

Follow reverse compass by taking a month or two off trying to wait for a normal period before trying again.

Enlist other half in the goal of trying again.

Use Ovia (period tracker) to increase chances of getting pregnant again by trying on the right days.

Resume giving up wine, coffee and running.

review efficacy of plan every month and do what it takes to make it work – even if that brings up some difficult feelings. Commit to coping with what comes up – because it will come up and it will be hard, and there may be times giving up appeals and there’s a need to review whether it’s worth it.

Values

Values are one of my favourite aspects of the ACT model and one that distinguishes it from other forms of CBT. When we say values it’s too easy to think in terms of what we should want for ourselves and other people’s exoectations of us. It’s also too easy to stop at the basics. the basics that many people might include are perhaps health and wellbeing, family, education, career, friends. For me, creativity, compassion, social justice and authenticity are also important.

When I had my first miscarriage, the value uppermost in my mind was family, and wanting to become a mother. Within that I wanted to be a nurturing one. I’d wanted a child since my late teens but due to the combination of needing to meet the right person, establish my career and financial security first and plan and enjoy a wedding and honeymoon it waited until the honeymoon – because that was my first legitimate opportunity and I was willing to wait no longer. As such I was delighted but surprised to conceive immediately. Initially it all seemed to align perfectly, until it didn’t. It’s important to separate out values from goals at this point – values are more of a compass or guiding light in the dark. Goals can be achieved or not, but you can’t complete a value. And I’d still have valued family and motherhood even if I’d never carried a child to term. I’d have been a mother to those who didn’t make it still, and I’d have needed to look more creatively at ways I could follow my value of pursuing motherhood – maybe nurturing others in my family more, focussing on my marriage, adoption, work with children in need or caring for pets. Or maybe I’d have needed to follow my reverse compass for a while – to take a break from trying to mother and put my energy into an area of my life I also valued but had more control – like my career or my education perhaps. There are many areas of my life I value where I struggle with how little control I have – perhaps never more than with my first miscarriage because having a baby was all I wanted but I couldn’t stop losing the pregnancy. One comfort for me there was the idea that whenever you hurt most emotionally there is often a value underneath. Values and distress can often be two sides of the same coin. So useful questions for me at that point were – am I willing to tolerate this pain and the risk of going through this again to try to have a baby again someday, following my values? For me, the answer was yes.

Drop the struggle

Another key idea from ACT is that part of what distinguishes humans from other animals is language. Language allows us to have an internal dialogue about our experiences. When children learn to talk, they develop associations between words and objects. For example, they learn the word for cow. They instinctively then want to categorise their experiences but can over generalise often in their efforts, so they might call dogs, cats and horses cows too. That same human language habit can lead to distress for us as adults too. We see associations with our experience automatically and everywhere.

When i miscarried I found other people’s pregnancy announcements tough to take because it triggered my own associated memories of my loss and my fear that I might not conceive again and that even if I did I might miscarry again. I then felt guilty for not feeling happy for others. My instinct was initially to avoid potential triggers – to take a break from social media and social situations which might include pregnancy announcements or happy pregnant mums. The trouble with that is, even then there’s still pregnant women on TV and smiley babies in advert breaks. Reading a book still can include an unexpected pregnancy story line. At work, people might bring the subject up – especially to me as a recently married woman who had been open about wanting a baby soon prior to miscarrying and particularly given I hadn’t shared my pregnancy news due to the “wait to the 12 week scan” convention. So I found it impossible to avoid pregnancy and baby references while still living my life and pretending to be normal. Another approach I tried to avoid distress was to act as if all was well – the trouble with that was it felt like there was a huge barrier in the way of my relationships with just about everyone – I felt disconnected and alone in my grief. I remember crying all the way on my drive into work and all the way home, because it was the only time I could release my grief without impacting someone else.

Another key idea in ACT is about how dropping the struggle to avoid feelings can set you free. Again metaphors can help illustrate. Imagine your distress is a monster and that monster is pulling you to a cliff edge with a rope. Avoidance of distress might have you pull harder on the rope to get free, but the monster just pulls harder back, so you get stuck – and sore. And tired. So what else could you do? You could drop the rope. Accept the monster (aka distress) will be there and go ahead anyway with your life – minus the avoidance effort.

For me, this way of thinking led me to gradually tell other people in my network about my miscarriage so I didn’t have to pretend to be normal as often – which in turn made me feel ok more often and more connected to others when I didn’t. I found it helped to give myself permission to feel sad, even when it was triggered by other people’s happy news, and tried to congratulate people anyway – even if it would take my emotions time to catch up. I also allowed myself a social media break as from an online support group I found, it’s common to find that tough after miscarriage and alright to have time out from anything that makes it harder without adding value. Those things that do add value on the other hand- relationships, family, work – are often more important than avoiding distress. To me, anyway.

Exercise

Hold a piece of paper in front of you while trying to have a conversation with someone else – does it make it easier or harder? That’s a bit what it’s like when trying to avoid thoughts and feelings, or to keep something secret from people you’re close to.

Self as context

One of the important ideas from ACT is that you are the context for your experiences rather than just your thoughts and feelings – you last your whole lifetime while your thoughts and feelings just pass by. What’s happening in your life now is one chapter of it. Not all chapters will be enjoyable, but together they could be seen as making a rich tapestry of experiences that give a sense of who you are. Without any of those experiences you might not be who you are today. I like the film ‘sliding doors’ for showing how even changing small details of how your journey unfolds can make a big difference.

For me, these ideas have been important in a few ways in the context of my miscarriages. My miscarriages are important in my journey as a mother, as that’s how motherhood began for me. I’ll always feel like I’m a mum to a larger brood of children than I’ve carried to full term. The yearning for more children will probably always be with me – fading in and out in intensity but never really gone. I have a much more developed empathy now for anyone facing infertility, pregnancy loss or a future without children than I would have if I’d never miscarried. I’d have less energy for speaking up for those without a voice. Less gratitude for the healthy children I’ve held extra close tonight. Less knowledge of how much fight, strength and tenacity I have in reserve. I’d have had less physical and emotional pain if I hadn’t miscarried. I find it hard to imagine who I’d be as a mum if I hadn’t though and it’s tempting to say I’d be a less good one.

Sometimes though in the coal face of emotional pain and suffering, it might feel during miscarriage like that is all there is. It might feel like that is who you are and who you always will be – that you’re defined by it. I’ve had moments like that.

What I’d say is that mindfulness and defusion can help get enough space from the pain sometimes to see that there is choice in how to respond and what to do with that.

The idea of self as context and how that differs from identifying yourself as being your thoughts and feelings can be abstract but helpful to get to grips with. Metaphors can help.

I live beside hills, so my favourite metaphor is that of a mountain with changing trees, flowers and plants across the seasons and stages of the climb. So in spring, the walk might include April showers and daffodils. In summer, there might be cherry blossom, bird song and bunny rabbits – though it might get a bit hot and sweaty. In the autumn, beautiful bright leaves might fall from the trees as the light shades change in the late afternoon. In winter, the ski slopes might cover with snow and it might get slippery for hikers. I’d put it to you that you are the unchanging mountain underneath while your thoughts and feelings are like the changing seasons. Your experience of miscarriage might be like a rocky eroded path on the mountain – always there but easier or harder to carry depending on the season. Like the mountain seasons, whenever it’s a painful bit to tolerate, if you can hold on another day it’ll often shift once again.

Exercise

Other than a mother through miscarriage – who are you?

Some questions to ponder –

If you could go anywhere in the world, where would you go and why?

If you could invite anyone you wanted round for dinner – who would you have?

in a film of your life who would play you? What would be your best bits? The bits you learned most from? The ones you hurt most over? The moments that healed you?

What words would you want others to say in a celebration of your life if you live to be 100?

What music would you want played in a soundtrack to a film about your life?

If you were an animal in another life, what would you be?

If you were a penny sweet, what would you be?

If you only had one day left on the planet, what would you do with it?

what have you always wanted to learn how to do?

What job would you do other than your current one?

What would an abstract colour painting of your soul look like?

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