Loud Speaker-7th Issue Mother Infant Family

TH E Autumn 2018
LOUDSPEAKER Amplifying the voice of mental health
MOTHER, INFANT & FAMILY

6 Breast feeding
and emotions
Handling anxieties related to

CHILDBIRTH 8
10 Not just the grownups, infants too

have feelings and emotions:
they need proper nurturance
19 How to enhance
WELL-BEING IN PREGNANCY?
...Plus Our Regular Features

NIMHANS Center for Well-Being
A Center for Mental Health Promotion
#1/B, 9th main, 1st Phase, 1st Stage, BTM Layout, Bengaluru– 76.
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Offered
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Youth Well-Being
Workshops & training programs in mental health
Elderly helpline & mental health helpline
TH E
2 LOUDSPEAKER
Amplifying the voice of mental health
THE
Editor
Dr. Prabha S. Chandra

Professor and Head of Psychiatry
Coordinator
NIMHANS Centre for Well-Being
Chief Editor:
Dr. Prabha S Chandra
Editorial Team: Sub Editors

Dr. Prasanthi Nattala, Mrs. Padmavathy D, Dr. Meena.K.S.
Mr. Manoj Chandran, Mr. Prabhu Dev. Dr. Prasanthi Nattala
Additional Professor of Nursing
NIMHANS
Editor’s Note Smt. Padmavathy D
T
In-Charge Nursing Ofﬁcer
he anticipation and arrival of a new baby into a family is a time of
mixed emotions.
There is joy, yet there is anxiety. How will the family adapt to a newborn?
How will the mother cope with pregnancy and the postpartum period?
How does one sooth a baby? Do babies have emotions and if they do, how
does one ensure an atmosphere that nurtures the infant’s emotional state. Editorial Board
Mr. Manoj Chandran

How will the older siblings adapt and how can grandparents, aunts and
uncles help in this transition? Mr. Prabhu Dev
This issue that focuses on the infant and it’s environment is special to us
because it is being released on the occasion of the International Marce
Society Perinatal Mental Health conference being held at NIMHANS this Conceptualized and produced by
month.
Expertise and experience have been combined to give you this
Loudspeaker, that has nuggets of advice and wisdom on the topic.
Cover photos:
Photo Credits:
Flickr, creative commons
Printing of the Magazine funded by: Dr. Ramachandra N Moorthy National Institute of Mental
THE
Foundation for Mental Health and Neurological Sciences
LOUDSPEAKER
Health & Neuro Sciences
3
TH E
Breast feeding and emotions

Dr. Shaibya Saldanha
Handling anxieties related to

childbirth
Dr. Paulomi M. Sudhir
Not just the grownups, infants too

have feelings and emotions: they
need proper nurturance
Dr. Thomas Kishore
Father’s Mental Health

Dr Aravind Raj
In-Vitro Fertilization (IVF)

User Testimonial
TH
T HE
4 LLOUDSPEAKER
OUDSPEAKER
Amplifying
Amplifyin
mplif in
mplifyin
i g the voi
voice
ice
ce of men
mental
tal health
healt
he h
Garbha Sanskar and Mental Parenting mindfully:
Health Incorporating mindfulness in
Dr. Praerna Bhargav &
your day to day parenting
Dr. Rashmi Arasappa
Dr. Anindita
Grandparenting for beginners: “Hush little baby…” Infant

Lessons learnt from our grandson Soothing and establishing
By a Daadi & Baba rhythms!
(with a touch by Neel's Yaya bhua) Dr. Soumya Parameshwaran
Talk to your doctor

Dr Ashlesha Bagadia
How to enhance
well-being in pregnancy?
Dr Lakshmi Shiva
Dr Prabha S Chandra
Welcoming a Child to the

Family
How to prepare an older sibling
Dr. Kavita Jangam
for the new arrival Ms. Priyanka Nambiar
Dr. Kavita Jangam
Overcoming Postpartum Why mental health in pregnancy and

Depression postpartum period is important?
Dr. Madhuri
Padmavathy D THE
Dr. Veena Sathyanarayana LOUDSPEAKER

5
Breast
feeding and
emotions
¾The mental and emotional state of a woman, both and family members. Doctors would insist that she sit
during pregnancy and as new mother, deeply up in spite of her painful stitches and breastfeed, while
affects her ability to breast feed her baby. her grandmother said that women can lie down and feed
VJGKTDCDKGU$WTRKPICHVGTGXGT[HGGFRWVVKPICFKURQUCDNG
¾Breastfeeding is instinctive which means that FKCRGT IKXKPI ITKRG YCVGT CPF KOOWPK\CVKQP DGECOG
the baby is able to root for the nipple and suck at CTGCU QH EQPHWUKQP HQT VJG RCVKGPV #HVGT VJG FGNKXGT[ UJG
the breast from birth. But women need to learn YCUWRUGVD[VJGTGUVTKEVKQPUKPHQQFDGJCXKQWTCPFEJKNF
how to hold the baby and breast feed. Girls who care at home.
have grown up involved in the care of younger
siblings and observing their mothers/sisters/ ¾Sometimes a woman is forced to have a baby due
aunts breastfeeding are comfortable in handling to family pressure and is not emotionally ready
their own babies. This learning is missed if a girl for the baby; sometimes she feels that the family
has grown up without seeing this happening is disappointed in the gender or looks of the
around her. When she has a baby, she will child. This will impact her emotional state and
require education in how breastfeeding works, hence her breastfeeding.
how to take care of her own baby and trust her
own instincts. For example, Mamata (name changed) successfully
DTGCUVHGF JGT ſTUV FCWIJVGT HQT [GCTU DWV HCEGF KUUWGU
For example, Rahath (name changed) at 32 years, had CHVGT VJG FGNKXGT[ QH JGT UGEQPF EJKNF CNUQ C IKTN *GT
suffered two miscarriages before her present pregnancy. mother and mother-in-law expressed their disappointment
She was anxious throughout the nine months. She was that the child was not a boy. She was also concerned that
determined to breast feed her baby but was confused JGTUGEQPFFCWIJVGTYCUOWEJFCTMGTVJCPVJGſTUVQPG
DGECWUG QH VJG EQPƀKEVKPI CFXKEG HTQO FQEVQTU PWTUGU *CXKPIDGGPEQPUKFGTGFFCTMKPJGTQYPHCOKN[UJGMPGY
TH E
6 LOUDSPEAKER Amplifying the voice of mental health

JQY VJG VCWPVU QH TGNCVKXGU CPF HTKGPFU EQWNF JWTV 6JKU has to eat/bathe/ go to the bathroom in a hurry as
unexpressed anxiety was communicated to the baby who the baby invariably wakes up for a feed just then.
YQWNFVTQWDNGVQNCVEJQPET[CPFƀCKNJGTCTOUCPFNGIU
YJKNGQPVJGDTGCUVCPFYCUFKHſEWNVVQRCEKH[ If a new mother is feeling overtly sad, cries easily,
shows little interest in caring for her baby, keeps
Women often hear statements like: UC[KPI VJCV UJG JCU PQ OKNM ƀQY QT VJCV UJG JCU C
lot of pain and discomfort while breastfeeding, it is
x ‘Oh, I couldn’t breastfeed as I didn’t have a drop important to take her to a medico who can assess
of milk!’ if she is depressed or has a physical issue. These
x ‘I had too much milk, my breasts were leaking all symptoms are often put down to ‘new mother’
the time but my baby refused to suck!’ tiredness and the postnatal depression is ignored
till very late resulting in unnecessary trauma for the
x ‘My baby used to bite so hard that my nipple woman and consequentially, the child.
started bleeding. I ended with a breast abscess
and needed an operation and medicines to stop What makes the journey easier for a
the milk.’ woman?
These negative comments impact the thoughts and 9A supportive family – husband, mother, mother
feelings of an inexperienced new mother, causing in law, grandmother, friends and neighbours
anxiety and affecting the breastfeeding. can enormously reduce the stress … by making
positive statements, taking over household
Breastfeeding a baby exclusively for 6 months and chores, cooking her favourite foods, allowing her
RCTVKCNN[HQTō[GCTUKUPQVCPGCU[LQD6JGſTUV to sleep rather than forcing her to socialize when
few months are particularly tiring and stressful. The visitors come to the house or just taking the baby
new mother gets barely 3-4 hours of sleep in 24 and away after a feed to allow her a little quiet time.
9 It is important that they allow her to follow her
instincts with the baby and yet also help her if
she is confused or tired.
9 Attending antenatal classes or discussing doubts
about breastfeeding with the obstetrician before
and after delivery is useful
9 Reassuring the mother that having a ceasarean
section is not a failure on her part
9 Letting the woman understand that initially it is
a struggle to breastfeed. It takes time for the baby
and new mother to settle in to rhythm
9 Helping women to continue breastfeeding while
getting back to work through family support,
demanding maternity leave, and creches at the
workplace rather than forcing them to give up
their job.
Dr. Shaibya Saldanha

Founder
Enfold Proactive Health Trust
THE

7
Handling anxieties
related to childbirth
0KUJC KU [GCTU QNF OCTTKGF HQT NCUV ſXG [GCTU it can be helpful and motivate us to reach our goals.
CPFKUGZRGEVKPIJGTſTUVDCD[#NVJQWIJ0KUJCJCF Anxiety during pregnancy is similar to anxiety with
really looked forward to having a baby, as her date of respect to other life events that requires role changes,
FGNKXGT[KUPGCTKPIUJGſPFUJGTUGNHOQTGCPFOQTG CFLWUVOGPVUCPFOQFKſECVKQPUKPYQTMNKHGUV[NGCPF
anxious, apprehensive. She asks herself.. “how will I managing relationships, such as marriage, in laws.
manage my pregnancy.. what if I cannot tolerate the Childbirth however is a unique experience and may
pain..will my baby be ok”? GXQMGXGT[URGEKſEHGCTUKPGCEJYQOCPVJGUGHGCTU
are in turn shaped by what we have heard, or learned
Pregnancy is a period of mixed feelings of anxiety, from others around us.
anticipation and joy, with many physical, mental
and emotional changes that require adaptations with Recognizing anxiety
respect to daily routine, and relationships.
The experience of anxiety can be in the form of
Anxiety is a normal experience with respect to bodily sensations, (heart rate, sweating, dizziness)
pregnancy and childbirth. However at times, thinking related concerns, (negative thoughts,
excessive fears interferes with enjoying pregnancy YQTTKGUFKHſEWNVKGUKPEQPEGPVTCVKQPCPFDGJCXKQTU
and can have more serious impact on the course of
TGUVNGUUPGUU DGKPI ſFIGV[ CXQKFCPEG QH EWGU
pregnancy and requires more intensive intervention, Recognizing these symptoms is important so as to
under the guidance of a trained mental health choose the right and most effective intervention to
professional. Excessive anxiety during pregnancy manage anxiety.
also impacts self-care, bonding with the baby and
QXGTCNNRGTEGRVKQPQHQPGŏUTQNGCUCOQVJGT5RGEKſE Negative coping strategies
fears related to childbirth include fears of unbearable
pain, inability to manage one’s role as a mother, fears Coping refers to efforts made to reduce one’s negative
regarding outcome of the pregnancy and health of emotions and can be either adaptive or maladaptive.
the child. Typical negative or maladaptive strategies of dealing
with anxiety regarding childbirth are worrying,
Function of anxiety avoiding situations that could cause anxiety (e.g.
pictures of babies, talking about childbirth), asking
Anxiety is a state of arousal, characterized by bodily, others repeatedly for reassurance, using substances
cognitive and/or behavioral symptoms. Not all to reduce anxiety and so on. These strategies work
anxiety is bad, when at the optimum or right level temporarily, however they increase anxiety in the
TH E
8 LOUDSPEAKERAmplifying the voice of mental health

long run as they do not allow the person to learn we feel. A negative view or interpretation (“This is
more adaptive or helpful strategies. terrible I cannot cope with this situation”) results
in the experience of sadness, anxiety, helplessness.
What are the ways in which you can These interpretations are also called appraisals
manage childbirth related anxiety? and they are often colored by self-view, your past
experiences of success and failures. Appraisals
Learning to relax: One of the most common ECP DG OQFKſGF UQ CU VQ EJCPIG JQY UVTQPIN[ [QW
methods of handling anxiety is to learn how to relax. experience an emotion and how frequently it is
Relaxation is a skill that can be learned with regular experienced. This is known as reappraisal and
practice. There are many methods by which you involves viewing the situation from a different
can learn to relax, such as deep breathing, learning perspective or considering positive outcomes to the
to understand muscle tension and relaxation (deep situation and different ways in which you can cope.
muscle relaxation), using pleasant imagery to cope One can also reduce the frequency and intensity of
with anxiety and other methods such as yoga, anxious thoughts by learning to recognize common
OGFKVCVKQP CPF UQ QP +V KU KORQTVCPV VQ ſPF VJG patterns of thinking that can increase anxiety (for
method that helps you best. All relaxation methods example magnifying the threat “It will be awful to
involve a mind body awareness and a let go attitude. go through it” and minimizing one’s coping “ I will
;QW ECP CNUQ NGCTP JQY VQ CRRN[ KV VQ URGEKſE never be able to manage the anxiety”). Noting down
situations of anxiety (called applied relaxation), or your thoughts emotions and situations in which they
use it by pairing it with imagining cues that cause occur is a simple yet effective way of capturing these
anxiety (desensitization). patterns. Once you have noticed the patterns, you
can try to generate alternate perspectives to the same
Facing your fears gradually and situation (asking yourself “ what is another way of
learning to cope effectively: looking at this situation”, what is the effective of this
thinking? What is the best, worst and most realistic
Avoidance is the most common response to fear. outcome to what I am predicting and how likely is
However, avoiding situations, events or things the worst outcome?”).
that remind you of childbirth can worsen anxiety,
simply because it does not allow you to learn that Learning to develop coping skills such as solving
you can cope differently and that the threat or feared day to day problems that contribute to anxiety are
outcome is not as bad as you have expected it to be also very important. This is because many a time,
or may never occur. either lack of or inadequate information leads to
more anxiety and misconceptions. Thus gathering
Learning to face fears, instead of avoiding them is relevant information, meeting and talking to people
an effective way of dealing with anxiety related to who can give accurate information and preparing
childbirth (exposure). You can do this systematically yourself would be helpful in dealing with anxiety.
with the help of your mental health care provider
or by yourself if the anxiety and avoidance are not Fears related to pregnancy and childbirth are
too high and disabling. You would be asked to make common however in some women, it can be very
a list all the things related to childbirth that make distressing and disabling. However remember, there
you anxious from least to most (e.g. visiting your are several methods that can be used to cope with this
doctor, meeting a friend who has delivered, going anxiety and are effective when used systematically.
to a maternity hospital). Once you have done this
you would be guided through a gradual exposure
to these fears, with the therapist’s help to start facing
these fears one by one, going up the list gradually
and at a pace you are comfortable with.
Dr. Paulomi M. Sudhir
Managing negative thoughts, worries PhD, Professor
related to childbirth: Department of Clinical Psychology
NIMHANS
How we view a situation often determines how
THE
LOUDSPEAKER
9
Not just the grownups, infants
too have feelings and emotions:
they need proper nurturance
We have this general notion that babies cannot feel Attachment is the foundation of
or emote. It is true that they cannot emote or express emotional development
their feelings the way the adults do because their
motor skills (e.g. facial expressions, smiling), verbal Just as infants depend primarily on caregivers to
expressions and mental abilities such as observational explore the environment and learn newer skills (e.g.
skills and memory capacity are still developing. But, speech imitation, playing, learning to eat), they will
babies can feel and experience different emotions. FGſPKVGN[PGGFCUVKOWNCVKPIGPXKTQPOGPVCPFECTKPI
Some emotions such as interest, distress, disgust, people to learn and deal with emotions as they grow.
and happiness are present from birth. And babies Attachment or emotional bonding between the
can communicate these through facial expressions infant and the primary caregiver is crucial for this
and body posture. For instance, babies may gaze at development. Though the primary caregiver for an
something when they like it and keep the body loose infant is generally the mother, it could be any other
when they are comfortable at being cuddled; and, secure adult. The strength of this bond indicates the
shift their gaze or become stiff when they do not like extent to which the infant can interact with others
the experience. and return to the caregiver during times of distress.
TH E
10 LOUDSPEAKER
Both positive and negative emotions are heavily separation from the mother is possible and they
KPƀWGPEGF D[ VJG GCTN[ GZRGTKGPEGU QH CVVCEJOGPV will respond to that in different ways- crying
and bonding. till the mother comes back; refusing to be
comforted by any person other than the mother;
Important social-emotional milestones and showing sadness or anger, etc. But, these
TGCEVKQPU TGƀGEV VJG VGORGTCOGPV
KG IGPGVKE
Birth to six months makeup) than any problem in the infant.
Ŗ (TQOFC[QPGVJGKPHCPVECPNQQMCVQVJGTUCPF Ŗ 6JQWIJ VJG KPHCPVU CV VJKU UVCIG CTG YCT[ QH
prefers to look at human faces than toys. But, strangers and unfamiliar situations, they tend to
the gaze becomes more directed and stable to interact with them because primary caregivers
indicate a particular preference only by 3 to 4 did. For example, the child may not like to wave
months. at a new person to indicate ‘hi’ or ‘bye’ but
Ŗ 5QEKCN UOKNG GOGTIGU CTQWPF YGGMU $WV may eventually do that if parents are doing it.
more spontaneous social smile occurs around Similarly the child will also learn to refrain from
3 months of age. interacting with others on clue from the primary
caregivers. This way, the child will gradually
Ŗ #V VJTGG QT HQWT OQPVJU VJG KPHCPV DGIKPU VQ learn more about social rules.
laugh, especially in response to the laughter of
other adults or the surprise at discovering a fun, Age 13 months to 18 months
novel situation.
Ŗ 5GNHCYCTGPGUU KPETGCUGU CU GXKFGPV D[ C
Ŗ (TWUVTCVKQP CPIGT CPF UCFPGUU DGEQOG OQTG preference to look at themselves in the mirror,
distinguishable by about six months. Till and recognizing self, others and objects by
language develops, they are generally expressed names.
by crying or withdrawing.
Ŗ +PHCPVUFGOQPUVTCVGJGNRKPICVVKVWFGD[HGVEJKPI
Ŗ 5GNHEQPVTQN DGJCXKQTU KP VJG EQPVGZV QH UNGGRŌ objects, offering toys, and comforting others, etc.
wake cycles and eating will emerge by around
2 months of age. But, waiting for feeding and Age 19 months to 24 months
comforting without fuss only stabilizes around
VJG ſTUV DKTVJFC[ 6JG[ OC[ UVKNN UNGGR FWTKPI Ŗ $[ VJKU UVCIG VJG EJKNF ECP TGƀGEV CPF HGGN VJG
the day and stay awake during night. emotions demonstrated by others, and try to
comfort them.
Ŗ ,WUVCUVJGEJKNFPGGFUCTQWVKPGVJG[ECPDGGCUKN[
overwhelmed with too much of stimulation. Ŗ 6JG KPHCPV DGEQOGU CYCTG QH VJG PCOGU HQT
The babies will indicate their distress by shifting various emotional states and starts to use them
their gaze away (known as gaze aversion). But, it to regulate his or her emotional experience.
does not mean that the mother or the caregiver is Ŗ $[VJGGPFQHVJKUUVCIGVJGEJKNFECPWPFGTUVCPF
wrong, it is just that the baby needs a break from the views of the others about self and feel
the ‘work’. complex emotions such as embarrassment, guilt,
and shame.
Seven months to 12 months
Ŗ 6JG OQUV KORQTVCPV OKNGUVQPGU FWTKPI VJKU
period are the development of the attachment
relationship, and the occurrence of stranger
wariness and separation anxiety. Children
will go around the house playing, but keep a
watch or come back regularly to the mother or
caregiver for comfort. Unlike the previous stage,
they do not like to be comforted by any person
KPFKUETKOKPCVGN[ 6JG[ URGEKſECNN[ UGGM QWV VJG
mother or the primary caregiver and demonstrate
anxiety when they are not available. And infants
will gradually learn that temporary or prolonged
THE

11
Ŗ 6JG KPVGPUKV[ QH UGRCTCVKQP CPZKGV[ FGETGCUGU 5. Ensure some predictability in activities, e.g.
TGƀGEVKPIVJGTGRGTVQKTGQHGOQVKQPCNTGIWNCVKQP taking for outing after bathing and dressing,
skills. They can postpone or delay engaging playing with toys after feeding, etc. This will
in enjoyable tasks by way of inhibiting on make the child regulate his or her behavior.
command. 6. Engaging the child with activities is important,
but it should not lead to overstimulation.
Optimizing social - emotional Caregivers need to look out for the signs of gaze
development aversion and fatigue, and provide small breaks.
During the initial stages the role of mother is very 7. If the baby shows any negative emotions such as
important for optimum development. However, if fear, disgust, anxiety, or sadness, gently talk to
the mother is not available for any reason or is not the baby as if the baby understands everything.
in a position to engage the baby, another caregiver What is important in this exercise is not the talk,
can step in. But, what is important than the ‘person’ but giving the experience to the infant that the
is the ‘quality of the engagement’. The mother or caregiver will be around when needed.
VJG ECTGIKXGT UJQWNF JCXG VJG EQPſFGPEG KP UGNH KP #NNQY VJG EJKNF UWHſEKGPV VKOG VQ FGCN YKVJ
engaging with the baby. Following tips may help: negative emotions, and verbalize if they can
talk.
1. Maintain a good eye contact while interacting 9. Separation anxiety can be dealt with gently by
with the baby from the beginning. way of reuniting with the mother and not forcing
2. Ensure secure contact with at least one primary the child to contain negative emotions.
caregiver if mother is not available or is not in a 10. Allow the child to observe how adults are
position to take care of the baby. handling people and situations. But, recognize
3. Call the baby’s name out before touching, that the babies have a a mind of their own, and
cooing, talking, cuddling. Over a period of time, they can respond adequately to a situation.
the baby will learn to anticipate the ‘activities’
when the name is called out.
Dr. Thomas Kishore
4. When the baby is too young and sleep cycles are
Additional Professor
not regularized, it is important for the adults to
Department of Clinical Psychology
adjust their schedules to suit the baby’s wake-up
NIMHANS
periods.
TH E

Father’s
Mental Health
Introduction role of ‘Dad’ which also takes the family to the next
stage of their family life cycle. Becoming a father also
The observation of father’s mental health day on gives lots of happiness while caring for the child,
18th June every year talks about the need to focus on playing with the child and enjoying each and every
the mental health of fathers during the perinatal and moment of the child’s growth and development.
early parenthood period. According to Postpartum
Support International, an organization that creates However, there are also chances for them to be
awareness on mental health issues related to anxious about becoming a father for various reasons.
childbearing, research evidences shows that 10% +VKPENWFGUYQTTKGUCDQWVVJGſPCPEKCNEJCNNGPIGUQH
of fathers have paternal postpartum depression growing the family or worry about spouses or baby’s
(PSI, 2018). At this juncture, it would be useful for health. Men who are anxious before pregnancy may
both men and women to know about the mental be more prone to depression after their child is born,
health aspects in the process of becoming a father. which can have serious consequences. Paternal
The knowledge would help in understanding and anxiety may also increase a new mother’s risk
positively coping with the situation. for postpartum depression or exacerbate existing
depression issues.
‘Good’and ‘not-so-good’ feelings about
becoming a father Tips for Fathers to handle stressful
situations and maintaining a good
The period of pregnancy will give a transforming mental health
experience for expectant fathers. The prospect of
becoming a father can generate strong feelings, It is inevitable that expectant fathers and fathers
including joy and excitement of donning the new experience few stress reactions that is emotional,
THE
LOUDSPEAKERAmplifying the voice of mental health

13
behavioural and interpersonal in nature. However, challenging aspects of becoming a father can be
it is possible to overcome these stressful situations DGPGſEKCN6JKUYKNNCNUQJGNR[QWVQTGCNKUGVJCV
by managing the emotions and situations through VJGTG CTG QVJGTU YJQ OC[ CNUQ DG ſPFKPI VJG
positive coping strategies. This would result in experience both rewarding and challenging.
positive parenting and enhance marital relationship Ŗ &QPŏVVJKPMVJCVDGKPIKPRTQXKFGTŏUTQNGOGCPU
followed by child birth. The following are some tips that you need to make everything perfect. By
for the expectant fathers. just being there, taking the lead when you
can, offering support and sharing challenges
During Pregnancy: together, this can greatly help.
Ŗ .GCTP OQTG CDQWV VJG DKQNQIKECN CPF GOQVKQPCN Ŗ -GGR C EJGEM QP [QWT QYP CPF [QWT RCTVPGTŏU
changes of pregnant women and to be fathers emotions that varies suddenly and get the
from the treating doctor or the mental health immediate support from the doctors as early as
professionals. possible
Ŗ 6CMKPIVKOGHQTQPGUGNHCPFIGVVKPIGPICIGFKP
some pleasurable activities suchas going for a
walk, talking to friends, listening to or playing Dealing with anger and irritability of
music etc. This would help to divert oneself from your spouse
the stress reactions.
Ŗ /CMG UWTG UJG GCVU QP VKOG CPF JCXG CFGSWCVG
Ŗ .QQMQWVHQTUWRRQTVFWTKPIVJGVKOGUQHőHGGNKPI sleep during pregnancy and after child birth.
not so good” rather than keeping with oneself. This reduces the chances of getting angry and
The support can be from family or the treating irritable.
team which would help oneself to relieve from
the stress. Ŗ 9JGPUJGKUGZRTGUUKPIVJGCPIGTCPFHTWUVTCVKQPU
just be with her by listening to her rather than
Ŗ 'ZRGEVCPV HCVJGTU ECP IGV KPXQNXGF CU OWEJ CU advising or shouting back on her. This reduces
possible in the pregnancy process by attending VJGEQPƀKEVDGVYGGP[QW
prenatal classes and doctor visits.
Ŗ 8GTDCNKUG [QWT HGGNKPIU VQ [QWT URQWUG VJCP
Ŗ 4GCUUWTKPIVJGURQWUGYKVJ[QWTUWRRQTVFWTKPI distancing yourself from her. This would help
JGTFKHſEWNVVKOGUKPRTGIPCPE[D[WPFGTUVCPFKPI to deal with the situation now and then. If not
the emotional reactions that happens during conducive, inform that you can discuss about the
pregnancy. issues later.
Ŗ 5RGPF SWCNKV[ VKOG YKVJ URQWUG FWTKPI JGT
pregnancy and share the household work which Conclusion
would help her to experience the support you
provide for her. Encourage your spouse too to Mental health of fathers is as essential as that of
take time for herself to relax. mother’s mental health during child bearing and
rearing period. In this context, the above discussions
After becoming a father: would help in enhancing the mental health of
Ŗ #EEGRV VJG PGY TQNG QH ő(CVJGTŒ YJKEJ YQWNF couples as parents and their child. This would lead
help in rescheduling your time for yourself as to effective positive parenting which would have a
well as for your spouse and the new born. positive impact on the mental health of the children.
Ŗ ;QWECPJGNR[QWTURQWUGYJKNGUJGPWTUGUVJG
baby by making her sit in a comfortable position
or helping out to get things what she wants.
Ŗ ;QWOC[PQVJCXGVJGOQVJGTŏUKPUVKPEVVQIGVWR Dr Aravind Raj
as easily when the baby cries but you can sleep Associate Professor
aside the baby so that you can be wake up with Department of Psychiatric
baby’s cry and help out your spouse. social Work, NIMHANS
Ŗ 6CNMKPI CDQWV [QWT GZRGTKGPEGU YKVJ HTKGPFU
and workmates about the positive and the
TH E THE

14
Garbha Sanskar
and Mental Health
Introduction status, age, consanguineous marriage (gotra), psyche

while performing coitus, diet, rituals, mother’s daily
Pregnancy, one of the most wonderful nature’s gifts CPF FKGVCT[ TGIKOG FWTKPI RTGIPCPE[ CNN KPƀWGPEG
to womanhood, comes with a lot of excitement, the physical, psychological and spiritual constitution
joy and anticipation but also brings along a period of the progeny. Modern science also agrees that the
of enormous physiological and psychological anatomical, physiological & psychological build of
adaptation in a woman’s life. It is a normal the offspring is dependent on parents who provide
physiological process and not a disease. genes and environment for its growth.
Pregnancy, although a natural phenomenon can be In the light of the above, some preparation and
UVTGUUHWN FWG VQ UKIPKſECPV JQTOQPCN CPF RJ[UKECN prerequisites to have a healthy baby are outlined
changes as well as social factors. Along with these, below.
thoughts like what will happen, will I be able to
bear these changes and many other apprehensions Garbha Sanskar
regarding pregnancy, fear related to approaching
labor, can further increase the amount of stress. So, Garbh Sanskar also mentioned in Ayurveda, has been
pregnancy can be a vulnerable period with increased a part of Hindu tradition since time immemorial and
risk for mental health conditions like depression, is evidenced by stories of how Garbh Sanskar had
anxiety, psychosis which may have ill effect on both a very positive effect on mythological characters
mother and unborn fetus. It has been seen that such like #DJKOCP[W #UVCXCMTC and Prahlad, who were
conditions, if not paid timely due attention, may enlightened in their mother’s womb. Garbha Sanskar
lead to conditions such as poor weight gain, pre- aims at well-being of the mother and healthy
eclampsia, premature labor and trouble bonding development of the child.
with the baby. It comprises of two Sanskrit words, Garbha means
fetus in the womb and Samskara means training the
It is known since ancient times that parents’ health mind. Thus Garbha Sanskar is a process of educating
THE
LOUDSPEAKER
15
the mind of unborn baby. Also it emphasizes on wisdom to the growing baby in womb itself.
formation of an everlasting bond between the mother
and the child. A healthy diet, positive thoughts, Regular yoga / exercise
regular exercise and a loving eternal bond, are the Some form of light exercises should be included
components of Garbha Sanskar. in the daily regimen along with pranayama such as
nadi shodhana, bhramari, seetali, seetkari and certain
Garbha Sanskar and Mental Health yoga asanas such as CTFJCMCVKEJCMTCUCPCX[CIJTCUCPC
Setubandhasana, etc., as it helps in increasing
Healthy diet and eating habits ƀGZKDKNKV[ KORTQXKPI DNQQF EKTEWNCVKQP DTGCVJ
Dietary regime in pregnancy should include a control and reducing pregnancy-related backaches.
balanced sattvic, nutrient-rich diet, full of vitamins Meditation is also important as it de-stresses the
and minerals and balanced amounts of calcium, mother and improves bonding.
KTQPCPFHQNKECEKFGPTKEJGFYKVJCNNVJGſXGVCUVGU
Use of medicated ghee made from cow’s milk has Forming a healthy bond between mother and baby
been advised in #[WTXGFC from the fourth month of As bonding between the mother and the baby starts
RTGIPCPE[+VKUUCKFVQDGDGPGſEKCNHQTVJGOGPVCN right from the time of conception, Garbha Samwad
and physical development of the baby and helps to i.e. communication, helps in establishment of a
prevent congenital abnormalities in the fetus. Also it positive and eternal bond as well as induces a feel-
might help in achieving full-term normal delivery. IQQF HCEVQT KP VJG OQVJGT 8CTKQWU VGEJPKSWGU ECP
be used for communication like visualizing noble
Staying Happy and Positive things, optimistic thinking, talking to baby and most
Negative thoughts/emotions can be controlled importantly connecting to the baby in a positive way.
by engaging in spiritual practices like prayer,
meditation, chanting etc. Listening to soft melodious Conclusion
music along with spiritual songs / shlokas improves
the mood. Also, taking up a hobby of choice that Garbha Sanskar brings about a positive state of mind
doesn’t cause strain can help, e.g. reading/seeing and mood, which reduces the risk of depression /
things that give happiness, knitting, painting etc. anxiety symptoms in mothers. It calms and soothes
Reading good books can help in passing down the the fetus, improves the bonding with mother,
ultimately leading to baby’s mental well-being.
Long-term positive effects in the child have also been
claimed like better sleeping patterns, activeness,
good personality, and ability to handle stress.
Overall, it ensures the mental, physical, emotional
and spiritual well-being of both mother and baby.
Acknowledgement: We are thankful to Dr. Shivarama

8CTCODCNN[HQTJKUMKPFIWKFCPEGCPFGFKVKPI
Dr. Rashmi Arasappa

NIMHANS Integrated Centre for
Yoga, Department of Psychiatry
NIMHANS, Bengaluru
Dr. Praerna Bhargav

NIMHANS Integrated Centre for
Yoga, Department of Psychiatry
NIMHANS, Bengaluru
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16 LOUDSPEAKER
Grandparenting for beginners:
Lessons learnt from our grandson
One might think that looking after a grandchild is calls one stroke to be the daadi and another stroke the
the same as looking after your own child. We played baba. Is that how we look to him ! Taking the infant
the same games with our grandson, which we had or toddler out can be a fun educational activity. He
played with our children. It is therefore natural to can see the moon and stars around; he can be shown
make comparisons. Grandparents are lucky that they owls and puppies; he can touch the shells of snails
can pamper the grandchild mainly with their time. and caterpillars; he can chase bunnies and hold
Spending time with them is probably more fun for them or feed Kasper, our pet. Selecting suitable fun
the grandparent than the grandchild. However, it is VQ[UKUQHVGPCFKHſEWNVVCUMCUYJGVJGTVJGVQ[UCTG
important that they wait their turn to spend time with educative is beside the point; they should be accepted
the grandchild. The mother and father, in that order, by the child. His collection of soft toys could make
have a priority over the infant. Giving the parents up a Bannerghatta zoo, and Lego bricks could make
a break and time to rest from parenting activities is up a township with many windows.
an essential and enjoyable part of grandparenting.
But, there is also competition in spending time with When he falls and gets oo-aah [hurt], he wants
VJGITCPFEJKNF6JGſTUVQTFGTQHEQORGVKVKQPKUYKVJ attention and real or imagined medicine. His parents
the parents, and then more competition follows with show him the value of gentle touch when he throws
other grandparents. toys or plays rough with other younger babies.
Many times we see the infant walk like we walk
Playing with toys and games with the grandchild and let him see that we walk like him; watch him
is an exciting part of grand parenting, as many of wear your oversized shoes or put on your spectacles.
these toys did not exist when you played yourself Other games are hiding toys from him, in his sight,
or with your child. Letting him colour the walls of CPFNGVVKPIJKOſPFVJGO6JGPYGNGVJKOJKFGVJG
your house and trying to look for meaning in those VQ[UYJKEJYGECPPGXGTſPFVKNNJGſPFUVJGOHQT
drawings can be rather tricky. It is a delight to see us and chuckles.
that the grandchild scribbles a stroke or two and
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LOUDSPEAKER
17
Letting him pray with you is a meaningful activity.
He sits on his daadi’s lap and plays the bells and
dongs for the bhajan and aarti. He likes putting a
chandan tilakQPGXGT[QPGŏUHQTGJGCF68VKOGQPVJG
other hand, is a tricky business, as screen time for his
favourite programmes needs to be limited. Luckily,
KVNKOKVU[QWT68VKOGVQQ6JGHCXQWTKVGRTQITCOOG
falls out of favour before you bat an eyelid, replaced
by a new one, except some all-time favourites.
He insists on deciding his own clothes, food, games,

and everything else and protests if not allowed to
do so. He likes to imitate older cousins and play like
them. One needs to allow him do things on his own,
YJKEJJGNKMGUVQICKPUGNHEQPſFGPEGCPFCWVQPQO[
Overprotective grandparents need to respect his He probably also wonders why a grown up like you
autonomy, as he has one and is entitled to have it. is baby talking like him. And just when you think he
It is also important to help him make choices for is still a little toddler, he can surprise you by saying
his favourite eatables - whether it be cheesy snacks, sweet things like ‘Daadi, are you alright?’ – to a more
small chocolates or healthier options like yogurt. naughty- ‘Daadi, have you lost your mind!’ [a line
picked up from his current favourite Jungle Book
We have realised that at 18 months a child can play video].
a youtube video, change or stop the video, adjust the
volume, or throw the phone if the video does not
RNC[ #V VJKU CIG VJG EJKNF ECP YQTM C 68 TGOQVG By a Daadi & Baba
open the fridge, climb inside it, and open the child [with a touch by Neel’s Yaya bhua]
locks you so strategically put.
TH E
18 LOUDSPEAKER Amplifying the voice of mental health

How to enhance
well-being in
pregnancy?
Case description broke down and told the doctor that she no longer
wishes to have the baby. Her family was made aware
Mrs A is a 29-year-old lady, married for 5 years with of the situation and she was directed to a psychiatrist
a 3-year-old male child. She is currently pregnant where she was treated for depression.
with her second child. She continued to work while
her husband was away abroad on a work-related The above case is an illustration of how mental health
commitment. Though she had managed the care of of women can be affected during pregnancy. Hence,
JGTſTUVEJKNFTGCNN[YGNNPQYUJGDGICPVQHGGNVQQ we have attempted to understand and enumerate
tired to look after him. She would have excessive ways in which mental health during pregnancy can
worry about how she would manage both children be taken care of.
after delivery. By the 5th month of pregnancy, she
began to feel sad, her sleep became disturbed and Maternal and infant health is one of the strongest
had poor appetite. She no longer felt excited about indicators of progress of a nation. To ensure a
her new one and started regretting her decision good outcome in maternal and infant heath, well-
of conceiving the second time. She started having being of pregnant women should be of utmost
palpitations and sometimes thoughts about ending priority. According to the recent WHO report (2018),
her life. She did not share these thoughts with her worldwide about 10% of pregnant women and 13%
husband as she didn’t want him to worry while he of women who have just given birth experience a
was away. She was not comfortable talking about it OGPVCN FKUQTFGT 4GUGCTEJ EQPſTOU VJCV OQVJGTU
to her family as she felt they would think of her as who are stressed or anxious during pregnancy are
a bad or incapable mother. She blamed herself for more likely to have complications during delivery
all these problems and felt guilty. It was when her including having premature and low birth weight
obstetrician enquired about her mental state that she babies. The risk of suicide in psychotic illnesses and
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LOUDSPEAKER
19
the risk of infanticide, though rare, are also things x Find out about antenatal classes near to your
which have to be considered. Children of such place or online. Get information about the
mothers are more likely to be anxious and can have common symptoms during the various periods
long term developmental problems. Hence well- of pregnancy from your doctor, so that you are
being of pregnant mothers is important. reassured when you happen to face any. Get to
know about the process of labor in brief so that
Anxiety, fatigue, fear of giving birth, depression, are anxiety related to it decreases and you have the
some of the common problems women go through knowledge to gain control during labor.
during pregnancy. Pregnant women are in need of x Get support: An understanding and caring
emotional support from family members, expect the spouse can be the biggest support for pregnant
childbirth process to be joyful, and would like to women. Sharing your apprehensions with your
reduce the fear of giving birth, anxiety and fatigue. spouse will make you feel emotionally heard.
6JG[ YQWNF CNUQ YCPV VQ DG UGNHEQPſFGPV CPF Getting help from him in household chores
ready for the labor process. Support from spouse or care of an older child can be very helpful in
and family members would be very essential for the relieving stress. Support from extended family
pregnant mother to feel secure and calm. Some of members also becomes important. Seeking
the protective factors in pregnancy include positive support from parents or in-laws should not be
relationships, family connectedness, good social seen as a sign of helplessness, rather as a rightful
support, ability to make choices, active lifestyles, demand. When none of the family members are
good nutrition and good sleep habits. Awareness available, getting a help/maid/cook to assist in
of personal stress and taking actions regarding the daily chores can be of utmost use since you will
same also promote positive mental health, and are get the time to relax.
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x Exercise and meditation: The role of exercise
cannot be more stressed when it comes to
handling pregnancy issues. Keep yourself active
as much as possible. Pregnancy is not a disease and
hence doesn’t need “bed rest” unless suggested
by your doctor for any obstetric complications.
Antenatal yoga is being widely practised now,
which is known to prevent/decrease anxiety
and depression during pregnancy. Relaxation
exercises, breathing exercises, meditation,
pranayama, are all of immense help to maintain
good mental health in the mother.
x 0WVTKVKQP'CVJGCNVJ[CPFUWHſEKGPVN['PUWTKPI
a balanced healthy diet goes a long way in
We discuss some of the measures which can be taken addressing fatigue as well as mental health.
by the pregnant woman and her family with regard x Have time to engage in pleasurable activities
to well-being during pregnancy: like reading books, music or theatre or spa.
Pregnancy doesn’t mean you don’t live life your
x Share your problems: It is always good to share previous way.
concerns and anxieties with others than worrying
x Think and dream about your coming baby and
about those alone. Find people to talk to, among
talk to your baby. Engaging in positive thoughts
friends and family who can understand and
about the baby helps in mother-baby bonding.
empathize with you. Talk to other pregnant
Have no biases about the gender of the baby. Do
women or new mothers which can make you feel
not yield to the pressure of family in wanting to
you are not the only one facing these problems.
know the gender since this can be quite stressful.
There are also support groups of mothers in
social media where you can share your concerns x Most importantly, when none of the above
or chat online when you are not comfortable seem to work or you feel overwhelmed,
talking to anyone in person. get professional help. Talk to family/your
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20 LOUDSPEAKER
obstetrician about ways to meet a counsellor Mental health during pregnancy is as important as
or a psychiatrist. There are several methods in physical well-being. Pregnant women have the right
which mental health problems in pregnancy can to this well-being and it is the duty of the family
be addressed, including safer medications and and the society to ensure she has a safe and happy
therapy. Have no stigma attached to seeking pregnancy. Mental health professionals can offer
help from a mental health professional as feeling help in various ways to promote well-being during
stigmatized only adds to barriers in your well- pregnancy and postpartum period, therefore do not
being. Stress can cause some related hormones hesitate to seek help.
to be transferred to the growing fetus, hence it is
important that you are mentally relaxed during
your pregnancy. Dr. Lakshmi Shiva
Senior Resident
x Seek help at workplace: Pregnancy is often
Department of Psychiatry
thought as a barrier in the career of women.
NIMHANS
However, lot of women do manage good
work-life balance. Do not hesitate to mention
your concerns at workplace. There are various Dr. Prabha S Chandra
women-friendly laws in workplaces to help out Professor & Head
pregnant women. Know about your rights and Department of Psychiatry
claim them. NIMHANS
THE
LOUDSPEAKER
21
How to prepare an older
sibling for the new arrival
Arrival of a baby sibling can be overwhelming as Raju feels that the new baby is responsible for these
well as confusing event for the older siblings. The problems with mommy and him. Day by day, Raju is
reactions and responses of older siblings to the more annoyed. Mommy has not made an attempt to
arrival of new baby depend a lot on how they have understand what is happening with Raju. Once the
DGGPRTGRCTGFD[VJGRCTGPVUCPFUKIPKſECPVQVJGTU DCD[JCUCTTKXGF4CLWUJQYUUKIPKſECPVTGUGPVOGPV
Let us look at the reaction of 5 year old Raju who is towards the baby as the entire household including
expecting a younger sibling: mommy is attending to the new baby most of the
time. Raju has become irritable, throws tantrum and
5 year old Raju is expecting a younger sibling. Raju demands attention from his parents and in return he
JCUUGPUGFVJCVVJGTGKUUQOGVJKPIőſUJ[ŒIQKPIKP is being scolded for being fussy.
the family but he is not sure what it is. Over a period
of time, he sees his mommy’s swelling tummy and As seen in the example above, developmentally,
inquires about it. When mommy says that he is going younger children tend to feel lot more resentment
to get younger sibling, Raju feels disappointed. He is and feelings of rejection as compared to older
not sure how things are going to be once the baby children as the younger children tend to depend
arrives. As it is Raju feels that his mommy has been more on parents. Therefore, this article addresses
ignoring him of late as she is often tired and annoyed. issues of younger children expecting a new sibling.
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22 LOUDSPEAKER
Preparing older siblings to Consider letting the older child visit the mother
in the hospital as soon as possible after the baby is
welcome new baby born, ideally when no other visitors are around —
this helps reinforce the birth as an intimate family
During pregnancy: event.
It is advisable that parents inform their children Bringing home the new baby:
about arrival of the new baby. Children can sense the
changes taking place in their home and they might Let the older child participate in every step of
need a lot of information regarding these changes,e.g. planning to bring the baby home. Parents can inform
various rituals done for mother, mother’s various the child about changed schedules e.g. bathing,
visits to the doctors, changes in mother’s abilities sleeping etc. Often older children love to take care of
to attend to them and her mood, etc. These changes VJGKTPGYUKDNKPIUQURGEKſEVCUMUECPDGCUUKIPGFVQ
if not explained can make children feel insecure, them such as playing with the baby, making bed for
rejected and confused. Therefore, it is important baby etc. It is important that parents accommodate
that children are prepared through the stages of the needs of the older children too so that they feel
pregnancy of the mother. Children can be informed involved in baby care. Take advantage of chances for
using the developmentally appropriate language one-on-one time with older kids. Spend time together
that they can comprehend well. Somethings that while the baby is sleeping and, if possible, set aside
parents can communicate to their older child is: time each day for older kids to get one parent’s
undivided attention. Knowing that there’s special
¾ Talk about baby and its development in mother’s time just for them may help ease any resentment
YQODŌEJKNFTGPOKIJVſPFKVGZEKVKPI or anger about the new baby. Sometimes, mothers
¾ Make older children participate in preparation of might feel guilty for not spending time with older
new baby’s room, dress, toys, names for the baby children, but they must accept that they can only do
etc – children get a sense of belongingness so much and cannot stretch their limits.
¾ Talk to children about how babies are taken care
of and why such care is required – children can
Know child’s feelings and deal with it:
be shown their own baby pictures so that they
Children’s feelings are often ignored or given less
understand it well.
importance but it will be wise to understand what
¾ Talk to the children about how they want to take the child feels about new sibling and help child
care of their new sibling deal with negative feelings, if any. Children can feel
¾ Parents can take their older children during resentment, disappointment, rejection due to arrival
mother’s visits to the obstetrician – children can of sibling. It is important that parents address these
hear the heartbeat of their sibling – that creates feelings and assure the children of their presence.
excitement for them. Some children may not express anything, and they
probably need time to express their feelings. Parents
can continue encouraging them to take part in baby
Preparing for child birth:
rituals but not force them to talk about the new
sibling until they are ready.
In spite of preparing the older sublings duringthe
mother’s pregnancy and childbirth, it may still be
On the whole, while a few children may have
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FKHſEWNVKGUKPCFLWUVKPIYKVJCPGYUKDNKPI[QWOC[
sudden hospitalization for delivery. As the due date
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draws near, it is essential to make arrangements
for older kids for the time when mother is in the
hospital. Discuss these plans so that the kids know
Dr. Kavita Jangam
what to expect when the day arrives and it’s not
Associate Professor
overwhelming for them. During this period, a
Dept of Psychiatric Social Work
trusting adult can take care of the older child so that
NIMHANS
child does not have to take the brunt of being left
alone most of the time.
THE
LOUDSPEAKER
23
In-Vitro Fertilization (IVF)
I always thought infertility is something that happens After all the explanation and counseling from the
to others and being born in and getting married to FQEVQT + WPFGTUVQQF VJCV +8( YCU PQV CU GCU[ CU +
a family that seemed not to have infertility issues, I thought. I realized it takes good amount of time,
thought I would be blessed with a baby whenever I energy and money. I was ready to give my time
wished to. But that was not the case, I soon realized. CPF GPGTI[ YKVJ O[ JWUDCPFŏU ſPCPEKCN UWRRQTV
Postponing pregnancy for the initial few months and Finally the treatment started and I was excited but
then planning for it was not as easy as I thought. I underneath there was always this fear ‘what if I
ended up getting desperate as months passed by. don’t’. I have to admit, it was an individual struggle
+PHGTVKNKV[YCUPQVQPN[ſIJVKPIYKVJO[KPPGTHGCTU for me. Though family and friends were always
but also had more to do with struggling with the there to help, I somehow felt it has to be me who has
outer world. Answering all those people who simply to face it all. I had to draw strength and be positive
think that I am deliberately postponing can be a real because I knew only positivity can yield positive
challenge. Do I tell them what the matter is and results. I knew all the theory and being a counselor
end up getting judged? Or do I just say something I always used to tell others. But when it came to
untrue to escape the talk and end up getting more me ‘how do I do it’ was a big question. Where do
frustrated? This emotional roller coaster ride can I draw strength from? Of course family – husband
be overwhelming. That too, I was still in the initial and my mom especially were of great strength, but
years of marriage when we were getting to know was that enough? No. Sometimes I got restless and
each other and this problem did bog me down. Initial had sleepless nights. I had to overcome it somehow.
FGPKCNHQNNQYGFD[CEEGRVCPEGſPCNN[NGFVQXKUKVKPIC But how? I got an answer soon. While waiting to
doctor. With the medical reports in hand now I knew see the doctor one day, I started talking to the lady
that natural conception was nearly not possible. This seated next to me. She stared sharing her journey
news was so devastating that coming to terms with and I could easily put myself in her shoes and
it took some time. What next? A second opinion, understand her. I too opened up and spoke about
hoping to hear something nice from another doctor. my fears. Soon I realized I was not alone in this path.
I knew that was not true but still ‘what if’ questions There are thousands of women having struggles
rose. So I went for it and got the same opinion there like mine or sometimes more than mine. I started
as well. After trying alternative medicines and getting stronger and felt positive from within. Every
several other infertility treatments, there was no time I went to see the doctor, I met different people
QVJGTIQDWVVQQRVHQT+8(+JCFVQOCMGDKIGHHQTVU who had different stories to tell but I felt as if it
in convincing my family for the same. They were was my story. Infertility was more common than I
still in denial and wanted to wait but I was not, that thought. I also realized that being open with those
YCUJQYFGURGTCVG+YCU+8(OGCPVVJCVKVJCFKVU around me was a big part of my journey. The more
own pros and cons. It was just a chance I had to take, +VCNMGFVQRGQRNGCPFVJGOQTG+VCNMGFCDQWV+8(
spending a good amount of life savings without a the stronger I became. Yes one day pregnancy was
guaranteed result. We took a call and went for it. A EQPſTOGFCPFO[JCRRKPGUUMPGYPQDQWPFU'XGP
best decision of my life I would say. FWTKPIRTGIPCPE[+JCFVQHCEGFKHſEWNVKGUDWVPQPG
TH E
24 LOUDSPEAKER
CHHGEVGFOGNKMGDGHQTGCPF+YCUEQPſFGPV+EQWNF when we make it as one. But there is always a lesson
sail through this rough weather smoothly. to be learnt in the process. The biggest life lesson I
learnt and would like to convey to you all through
As I held my little one’s tiny hand, I said to myself this is, NEVER GIVE UP and never lose faith in
‘yes baby you are worth all the struggles’ and tears of yourself. I always remember this saying ‘Best things
JCRRKPGUUTQNNGFFQYP;GU+8(PQVQPN[ICXGOGVJG KPNKHGCTGYQTVJſIJVKPIHQTŏ.
happiness of motherhood but also made me realize
who I am and what I can be. Whether it is Infertility
or any other issue, it becomes overwhelming only - User testimonial
Overcoming Postpartum
Depression
‘Ms. Kavya, a 27 year old female had delivered a boy baby three months back, and she was brought to the
doctor with complaints of low appetite and sleep disturbances, crying spells, low mood, not enjoying the
baby, irritable with spouse and family members, expressing that she was not being a good mother, feeling
disinterested and occasionally worthless, and has death wishes. She also feels guilty that she is unable to
take care of her baby. All the symptoms are present since the time of delivery’.
The above case vignette typically illustrates what is fatigue, and excessive worry about one’s infant. The
known as Postpartum Depression. onset of symptoms is usually soon after birth of the
baby. However, in some women the symptoms may
What is Postpartum depression? start after a few weeks to months and last for several
weeks to months. Depression that occurs within 6
2QUVRCTVWO &GRTGUUKQP
22& KU FGſPGF CU RQUV months of childbirth may be called as postpartum
birth feelings that include extreme sadness, anxiety, depression.
THE

25
Difference between Postpartum blues and Postpartum depression
Postpartum blues/Baby blues Postpartum depression

After the delivery of the baby women may
After the delivery of the baby women may
experience sadness, dullness, excessive tiredness,
experience mood swings, restlessness, feel happy
feeling of guilt and worthlessness, decreased sleep
for a while and next moment start crying, have loss
and appetite, sometimes they may even think of
of appetite and be unable to sleep, feel exhausted.
suicide. These symptoms are called Postpartum
These symptoms are called postpartum blues.
depression.
They usually start about 3 to 4 days after delivery In some women the symptoms may start after
and go away within few days. Baby blues are few weeks to months and last for several weeks to
considered a normal part of early motherhood and months. In most cases, the symptoms do not just ‘go
usually go away within10 days after delivery. away’, and the mother typically needs treatment.
Factors that may trigger postpartum depression can Ŗ 7PCDNGVQVCMGECTGQHVJGEJKNFQTDQPFYKVJVJG

be - child
Ŗ 2U[EJQUQEKCN HCEVQTU NKMG FQOGUVKE XKQNGPEG
marital issues, lack of support from spouse or Cognitive symptoms
QVJGT HCOKN[ OGODGTU ſPCPEKCN KUUWGU EJCPIG Ŗ (GGNKPIU QH JQRGNGUUPGUU YQTVJNGUUPGUU CPF
of job, preference for a boy /girl baby, adverse helplessness
life events etc.
Ŗ 5WKEKFCNVJQWIJVUCPFFGCVJYKUJGU
Ŗ $KQNQIKECN HCEVQTUNKMG JQTOQPCN EJCPIGU
following the delivery, complications during What are the consequences of Postpartum
pregnancy, Previous infertility issues etc. depression?
Ŗ 2TKQT RJ[UKECN CPF RU[EJKCVTKE KNNPGUUGUNKMG
having a personal history of depression or Ŗ /QVJGT OC[ JCXG C HGCT QH JCTOKPI VJG EJKNF
psychiatric illness, having a family member fear of being alone with the child and be unable
with psychiatric illness, history of premenstrual to care for the child
syndrome (PMS). Ŗ 4GNCVKQPUJKRU YKVJ VJG DCD[ URQWUG QNFGT
What are the signs and symptoms of Postpartum children and other family members get affected
Depression? Ŗ 7PVTGCVGF RQUVRCTVWO FGRTGUUKQP ECP NGCF VQ
maternal suicide and infanticide, as the mother
Emotional symptoms may harm the baby (e.g. as a result of delusions)
Ŗ (GGNKPIUCFQTFGRTGUUGFHQTOQUVQHVJGFC[HQT
several weeks or months
Ŗ (GGNKPICPIT[QTKTTKVCDNG
Ŗ (GGNKPICPZKQWUCPFYQTT[KPI
Ŗ +PCDKNKV[VQNCWIJCPFGPLQ[VJKPIU
Behavioral symptoms
Ŗ (GGNKPI FGVCEJGF CPF YKVJFTCYP HTQO HCOKN[
friends and social circle
Ŗ .QUUQHKPVGTGUVKPFCKN[CEVKXKVKGU
Ŗ &KUVWTDCPEGKPUNGGRCPFCRRGVKVG
Ŗ (GGNKPI VKTGF OQUV QH VJG FC[ CPF NQY GPGTI[
levels
TH E

Ŗ %CTGIKXKPI CEVKXKVKGU NKMG HGGFKPI RTCEVKEGU %GTVCKP .KHGUV[NG OQFKſECVKQPU ECP CNUQ JGNR VQ
especially breastfeeding, sleep routines, doctor’s reduce some symptoms of postpartum depression.
visits and child vaccinations,can be affected. These are outlined in the box.
Ŗ +PVGTCEVKQP FKHſEWNVKGU KP VJG EJKNF GI VJG
child may be less vocal, have less visual NESTS
communication, smile less; the child milestones
may be delayed. N – Nutrition. Eating healthy food at regular
Ŗ &GRTGUUGF OQVJGTU VQWEJ VJGKT KPHCPVU NGUU intervals as the mother is lactating
frequently and in a less affectionate manner ,
E – Exercise. Finding time to relax and exercise
leading to detachment.The child can be at risk
for developing insecure attachments in future. S – Sleep. Getting enough sleep.
What treatmentis available for Postpartum T – Time for yourself. Taking brief breaks while
depression? others are available to help with child care
S – Support. Support system by spouse, family
Treatment can be pharmacological and non-
members and friends will make the mother
pharmacological.
HGGN DGVVGT CPF ICKP EQPſFGPEG #VVGPFKPI
mother-baby support groups
Pharmacological treatment with antidepressants is
preferred choice. These medicines should be taken
under the supervision of a Psychiatrist. Symptoms 9JCVKUVJGDGPGſVQHGCTN[KPVGTXGPVKQP!
usually subside with the help of medications.
Prevents the illness running a long course that can
Non-pharmacological treatments such as: affect mother and the child
¾ Individual therapy Prevents other illnesses that can develop later in life
Ŗ %QIPKVKXGDGJCXKQTVJGTCR[ŌJGNRUVJGFGRTGUUGF
Important links:
mother to modify distorted patterns of negative
https://www.perinatalpsynimhans.org/
thinking and to make behavioral changes that
enhance coping skills and reduce distress.
Ŗ +PVGTRGTUQPCN2U[EJQVJGTCR[ŌJGNRUVJGOQVJGT
with communication skills that further help her Padmavathy D
in building relationships, stronger social support Ph.D Scholar
CPFKPETGCUGFUGNHEQPſFGPEG Dept. of Nursing
¾ Couples therapy – helps the mother as partner NIMHANS
support and feeling of being understood paves
way for recovery from the illness.
Dr. Veena Satyanarayana
¾ Family therapy – Family members are involved Associate Professor
in the therapy as they become the alternate care Dept. of Clinical Psychology
givers and their co-operation and support is NIMHANS.
essential for the mother and the baby.
THE
LOUDSPEAKER
27
Parenting mindfully:
Incorporating
mindfulness in your
day to day parenting
“I showed her the bright red hibiscus...and then the small little bug suckling sweet nectar from
the pink rose...the forza red Easter Lilies blooming on the corner of the garden...and the cute little
green bee eater sitting on the clothes line. It was a beautiful sunny day...and then I looked at her...
the bright sun made her squint her little eyes. She was just looking at me...
while I showed her the world...I realized I was the world for her”
The vignette above tries to catch the nuances of What can make a new mother bond well with her
parenthood as it’s experienced by a new mother. baby and at the same time deal with the myriad
emotions she’s feeling? What can provide a sense of
exhausting as being a new parent. It’s a role which well-being to both the mother and the baby?
brings with it mixed bags of emotions. A new
mommy can experience both exhilaration and A peep inside the interesting concept of mindfulness
extreme anxiety at the same time. As life takes a can provide us with some answers. Mindfulness has
whole new meaning the new mother feels herself DGGP FGſPGF KP XCTKQWU YC[U D[ FKHHGTGPV GZRGTVU
being at the center of everyone’s attention and the propounding it, but a common thread in all these
feeling of being completely responsible for another FGſPKVKQP KU VQ UGG /KPFHWNPGUU CU VJG ECRCEKV[ VQ
person gradually starts sinking in. be fully present and aware of one’s actual, moment-
to-moment experience as it is arising, and accepting
There are a lot of things new parents deal with things as they are without judging them.
simultaneously. A new mother may be worrying
simultaneously about breastfeeding her infant, In simple terms how can a new mother adopt this
managing daily chores, taking care of other family concept to the role of parenting?
members, taking care of her own health and
nutrition, and getting back into shape. There are Mindfulness in parenting is more about learning the
times when she may be feeling she is at the top of art of becoming more aware of one’s own feelings,
the world and times when she has so many anxious thoughts, behavior, needs, and then responding to
thoughts running inside her head that she has to the needs of one’s children. This involves not only
go about her chores mechanically. The reaction to becoming more aware of oneself, but also accepting
situations, people and thoughts also in turn may oneself and learning to show compassion to oneself
become automatic and knee-jerk, making her lose before tending to the needs of others. Raising a child
connection with herself and others. in a world obsessed with gadgets, technologies and
TH E
28 LOUDSPEAKER
instant information is not easy, and in this context YQWNF DG VQ RCWUG VCMG C FGGR DTGCVJ TGƀGEV
mindfulness provides the new mother with a means on what is causing the stress, the emotion one is
to slow down, absorb the experience of motherhood going through and then respond in a way which
and give her infant the gift of her complete presence. is more in sync with the situation.
Some of the simple things which can be done to x Being gentle on oneself: Often, there’s a tendency
enhance mindfulness and thereby the well-being of to be too harsh on oneself, especially since being
both mother and infant can be: thrown in an entirely new role of a parent brings
with itself a plethora of self-critical thoughts.
x Designate just a few minutes in a day as ‘me One has to embrace the idea that being a parent
time’ - this would mean spending just 5-10 is not a cake walk and every day, every situation
minutes every day to take stock of what one is is a new learning experience. One has to applaud
going through. Find a noise free place, a quiet one’s intention and be gentle on oneself for doing
time and bring one’s awareness to one’s breath the best one can do.
and try to just be there in that moment.
All this is easier said than done. But, with a little
x Another way would be to cherish the time she practice and small steps like spending those 5-10
spends with her baby. It’s important for the infant minutes every day, the results would speak for
to feel that the mother is present and attuned to themselves. Being in the moment without thinking
her needs. This could be by observing and being about the future or worrying about the past would
in the moment with her baby when she’s feeding bring a peaceful serenity to one’s life. The infant
her, observing his/her antics and noticing would also be able to sense this calmness and respond
the little things the baby is learning every day to it. All the challenges, stress and exhaustion may
without getting distracted by anything else. UVKNN DG TGCN DWV VJG RTCEVKEG QH SWKGV TGƀGEVKQP YKNN
help one choose a better response to these challenges.
x A new mother also needs to take care of herself
ſTUV DGHQTG VGPFKPI VQ VJG PGGFU QH JGT DCD[ +H
UJG KU UVTGUUGF QWV KV YKNN DG FKHſEWNV HQT JGT VQ
provide a nurturing environment for her infant. Dr. Anindita
Mindfulness in this case would mean to be aware Assistant Professor
of one’s own emotions, to observe what one is School of Liberal Studies
feeling and not immediately act on it. A simple Azim Premji University
activity when one is feeling extremely stressed
THE

29
“Hush little baby…”
Infant Soothing and
establishing rhythms!
Mr. & Mrs. Rakesh, both IT professionals from Bangalore, were delighted to bring home their
FCWIJVGTFC[UCIQ#UOQUVſTUVVKOGRCTGPVUVJG[YGTGGZEKVGFCPFYGTGYGNNRTGRCTGFYKVJC
ENGCPTQQOETKDDCD[ENQVJGU$CD[YCUHGFUYCFFNGFCPFRNCEGFKPJGTETKDHQTJGTPKIJVŏUUNGGR
5JGYQMGWRET[KPICHVGTJQWTUCPFYQWNFPŏVUVQRGXGPCHVGTHGGFKPICPFTQEMKPIJGTWPVKNPGZV
OQTPKPI6JGYJQNGPKIJVYCUCPGZJCWUVKPICFXGPVWTGHQTVJGEQWRNG
The above is not an uncommon scenario for many not yet synchronized with the 24-hour cycle and
new parents. In a country, such as ours we often the natural daylight and darkness related rhythms,
learn parenting by experience, with time. Many which are absent in the womb.
couples also have support from extended family,
which gives many parents some time to get used to Research studies suggest that babies synchronize
the new routines. With many people moving to cities sooner when we provide them with the right
HQTLQDUYGCNUQſPFEQWRNGUUWEJCU/TCPF/TU environmental cues and this helps reset their inner
Rakesh who manage by themselves with some help. clock. Exposing babies to natural light in the day
2CTGPVUQHVGPIGVVQJGCTOWNVKRNGEQPƀKEVKPICFXKEG CPFFKOOKPICTVKſEKCNNKIJVD[GXGPKPIJGNRUDCDKGU
about newborn sleep which leave them confused! reset their clock.
9GNNVJGTGKUPQQPGUK\GſVUCNNHQTOWNCCPFRCTGPVU
would slowly learn to understand what works best Blue light especially from mobile or computers are
for their little one! notorious for disrupting sleep and should be kept to
a minimum.
The art of soothing a baby and allowing her to
get used to new rhythms is something we will Professionals also recommend providing a consistent
discuss here, and to start with we will understand place and having a routine of relaxing activities at
a bit of newborn physiology and discuss the bed time, such as a warm bath, lullabies, reading a
science behind some of the old practices and newer book, which can help set a good predictable rhythm
recommendations through this article. for your baby.
Newborn sleep patterns Newborns often wake up for feeds at night and
avoiding turning night feeds into play time helps baby
Young babies are notorious for sleeping and waking fall back to sleep. Mothers attending to babies at night
at awkward times and this is because they have could keep the lights dim and behaviour low key.
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30 LOUDSPEAKER
Babies who are breastfed tend to experience more Experiments have also shown that parental emotions
frequent arousals than babies who are formula- have an effect on babies very early. Feeling anxious or
fed. Researchers suspect this is one reason why depressed are common experiences for new parents,
breastfed infants have lower rates of Sudden which can get communicated to babies, so parents’
Infant Death Syndrome. In addition to preventing psychological health is important, which can at
infections, studies suggest breastfeeding helps in times require taking help from health professionals.
better development of child’s airway, improves #PKPEQPUQNCDNGET[ECPQHVGPKPFKECVGEQNKEQTTGƀWZ
coordination of breathing and swallowing. which is a common problem in newborns. In most
Breastfeeding mothers are also more aware and cases, symptoms are mild and can get better with
responsive to baby’s behavioural cues which may be small feeds and by burping the baby frequently,
potentially protective. however in more severe forms where the baby has
poor appetite and weight gain, medical attention
So, it isn’t realistic to expect your baby to stop should be sought.
awakening at night nor would that be a good idea.
Babies in utero are bombarded with the whooshing
Overall a healthy newborn sleep may vary from 9 and gurgling sounds of their mother’s body and
hours a day to as much as 20 hours, and by 1 year a cradled by the walls of the womb. Thus, swaddling
healthy, well-fed baby sleeps for 10 to 16 hours. soothes babies by providing a secure feeling.
Positioning the baby in prone (lying on their stomach)
Soothing a crying baby position, shushing or white noise also helps calm a
baby. White noise is a noise produced by combing all
Coping with a baby’s cry is another challenge frequencies of sound together, and is used to mask
which new parents face, which often leaves them other sounds.
VGTTKſGF (QT PGYDQTPU ET[KPI HQTOU C OQFG QH
communication and with time most parents learn Professionals recommend sounds that are more low
different cries and are able to respond and soothe the and “rumbly” (like the sounds in the womb). Low
baby appropriately. pitched monotonous rumble of a rain, ocean, car,
planes, work for most babies. Some babies love to
8GT[QHVGPCDCD[ETKGUVQEQOOWPKECVGJWPIGTCPF UWEM CPF ſPF ITGCV EQOHQTV KP KV CPF CV VKOGU CTG
feeding the baby calms him/her down. But at other UQQVJGFD[CRCEKſGT
times babies cry when they are cold, away from
their caregivers or are in pain. Both experiments and When you can’t stop the tears despite all your efforts,
experience has made us understand that babies are give yourself some time, take help of your partner
soothed by rocking and skin to skin contact. Some of to watch your baby. It’s important to take a break
the newer experiments indicate that old wives’ tales before you get frustrated, as your baby may sense
or singing lullabies can have a remarkable effect on your mood and become even more upset. If you are
soothing the baby. NWEM[[QWOKIJVſPFVJCVCHVGTET[KPIHQTCDKV[QWT
baby would have fallen asleep on her own!
Babies are soothed by skin to skin contact and
gentle touches that are combined with other forms Finally, it’s a false assumption that all babies are
of communication, like talk or eye contact. Often alike and so parenting experiences do differ, so keep
talking to the infant could calm the baby. calm and enjoy parenting!
One study found that mothers who wore their

infants in soft baby carriers were more likely to Dr. Soumya Parameshwaran
have securely attached babies than were moms who Senior Resident
carried their babies in portable infant seats. (Anisfeld Department of Psychiatry
E, 1990) NIMHANS
THE

31
Talk to your doctor
Pregnancy is one of the most anticipated events There are many women who go through stress
of one’s life, often bringing on uncertainties and and anxiety during pregnancy even if there are no
unpredictable outcomes even for the most well medical complications, so you are not alone. Having
prepared mother. Most women are able to manage HCEGF OCP[ FKHſEWNVKGU KP VJG RCUV ECP OCMG [QW
without much strain on their emotional wellbeing. vulnerable. Not having family around and worries
But for some women, it can be a stressful time, which CDQWV [QWT ſPCPEKCN UKVWCVKQP OC[ CNUQ DG ECWUKPI
if left unattended can cause a lot of suffering both for you the stress.
the mother and the baby.
ő#UNQPICU+ŏOCDNGVQHQTEGO[UGNHVQGCVCPFDCD[
KUITQYKPIYGNNGXGT[VJKPIUJQWNFDGſPGPQ!Œ
Sandhya, a 32 year old receptionist from Bidar,
became pregnant after 6 years of marriage. She
It’s not enough if the baby seems to be growing well
had lost her father 10 years ago after which
physically. If you are emotionally upset it will affect
her mother managed to work as a teacher and
the baby now and after delivery. Untreated stress or
support her and her younger sister. Sandhya
depression during pregnancy can affect the growth
often sent some money home and her husband
of your baby and it may have a low weight at birth.
was supportive of the same. Initially she
Your delivery also may be earlier than normal if
YCU GZEKVGF VQ NGCTP CDQWV VJG RTGIPCPE[ DWV
you’re going through stress.
gradually she started getting worried. She was
not sure if she would cope with work when she
ő$WVCHVGTVJGDCD[EQOGUGXGT[VJKPIUJQWNFDGQM!Œ
returned after maternity leave. She worried
KH VJG[ŏNN DG CDNG VQ OCPCIG ſPCPEKCNN[ KH VJG[
After delivery your hormones will change even more
were on a single income. Her mother may not
drastically so if you’re a little stressed now then
DGCDNGVQUCXGGPQWIJHQTJGTUKUVGTŏUOCTTKCIG
there is a higher chance of you feeling worse after
without her help. She also had worries about her
delivery. That time is even more crucial for you to
ability to be a good mother and could not get
be emotionally available for your baby, so that your
the negative thoughts out of her head. Finally
baby’s bonding with you is not affected and you can
one day, she broke down during her routine
GPLQ[VJGſTUVRTGEKQWUOQPVJUQH[QWTDCD[ŏUNKHG
antenatal checkup. Her doctor asked her if she
was stressed in any way. She revealed some
ő'XGT[QPGŏU CUMKPI OG VQ VJKPM JCRR[ VJQWIJVUŗ
QH JGT EQPEGTPU CPF YCU UWTRTKUGF VQ ſPF JGT
+ŏOTGCNN[VT[KPIDWV+ŏOLWUVPQVCDNGVQŒ
doctor very understanding. She was able to ask
her many questions, some of which are outlined
It’s not so easy to switch off negative thoughts and
below:
it’s not your fault that you’re getting them. Long
periods of stress can lead to depression and anxiety
ő9J[ FQ + HGGN UQ UVTGUUGF CNN VJG VKOG! *CXG [QW which affects your mind in a way that you cannot
seen other women who are not happy during their control on your own. Talking to someone about
RTGIPCPE[!Œ these thoughts and learning some simple skills to
TH E

manage your emotions can be helpful. If you have worries. Both encouraged her to see the counselor
someone in your family who is understanding, then recommended by her obstetrician, who helped her
start by talking to them. If you want we can suggest manage the stress and she was able to stay well even
a counselor whom you can talk to. after delivery.
“If I see a counselor or psychiatrist they will give me 'OQVKQPCNFKHſEWNVKGUFWTKPICPFQTCHVGTRTGIPCPE[

OGFKECVKQPYJCVKHVJCVJCTOUO[DCD[!Œ are more common than you think, they have more
far reaching consequences than you can imagine.
Medications play only a small role in the treatment of However, they can be fully treated if you seek help
depression and are only used in severe cases. The main at the right time. Don’t hesitate to talk to your doctor
treatment will be getting professional counseling to about managing your emotional wellbeing during
work through your concerns.. Nowadays there are pregnancy and after childbirth.
many medications which are safe to take during
pregnancy and even breastfeeding. We have seen that
the harm that is caused by staying depressed is more
than that caused by the medication. If medications
are suggested, most likely you will only need to take Dr Ashlesha Bagadia
it for a short period of time and not lifelong .. Perinatal Psychiatrist
Bangalore
After the above session, Sandhya felt reassured and
decided to talk to her husband and mother about her
THE

33
Welcoming a
Child to the
Family
The process of adopting a child can be a rewarding resulting in emotional or behavioral problems in
yet challenging experience for parents. The couples them.
opt for adoption due to various reasons such as Ŗ +V YQWNF DG FKHſEWNV VQ RTGFKEV EGTVCKP
infertility, health related concerns, genetic issues, FGXGNQROGPVCN FKUCDKNKVKGU UWEJ CU URGEKſE
and also the sheer will for adoption. Adoption is a learning disabilities, borderline intelligence,
lifelong commitment and the adoptive parents will speech delays or autism, for which parents may
DGEQOGNGICNN[OQTCNN[CPFſPCPEKCNN[TGURQPUKDNG be unprepared, resulting in emotional distress in
for all aspects of the child’s care. Similar to the the parents.
adoption related anxieties in the couples, even the
EJKNF
PQVKPHCPVQTPGYDQTPOC[JCXGUKIPKſECPV Ŗ 6JG RJ[UKECN JGCNVJ QH EJKNFTGP ECP CNUQ DG C
worries about adjusting to the new people and matter of concern in many cases of adoption
environment. It is important to understand that CU VJG[ EQOG HTQO FKXGTUG CPF FKHſEWNV
these anxieties are normal and it may take weeks to circumstances.
months for both parents and adopted child to adjust
and adapt. However, it is expected that parents take STAGES OF WELCOMING THE CHILD
the lead in making this process less challenging and
more joyful for the child. Stage 1
Preparation of the adoptive parents
The key challengesto consider in adoption process:
The adoptive parents need to be thoughtful about
Ŗ +PECUGQHKPHCPVUKVYQWNFDGFKHſEWNVVQRTGFKEV their decision in adopting the child. Though adopting
the change in their temperament over time. a baby is a rewarding experience, it has its own
6JGTGHQTG VJG CFQRVKXG RCTGPVU OC[ ſPF KV challenges. The adoptive parents should be aware
UVTGUUHWN VQ FGCN YKVJ EJKNFTGP YKVJ FKHſEWNV about the information on adoption, issues related to
temperament. adoption, possible challenges and resources. There
Ŗ 6JGQNFGTEJKNFTGPVGPFVQJCXGXCTKQWUCFXGTUG might be lots of questions and worries in the parents’
experiences from their past child care agencies, minds about adoption such as - How willit be? Will
TH E
34 LOUDSPEAKER
it be smooth? What changes do they need to make in does not mean to be “permissive” in their parenting
their lifestyle?It is very normal for adoptive parents styles. It basically requires spending quality time
to have such queries. For biological parents, they together, doing play activities together,etc. The
tend to have adequate time to think and plan about parents may create a structured routine with the
these issues during pregnancy, which the adoptive child so that normalcy in family dynamics can be
parents may not get. There is a natural process of achieved as early as possible. The parents need to be
bonding and familiarization that takes place between physically present for the child. Besides just being
biological parents and their baby, which may not be there for the child when he needs it, it is important
there for the adoptive parents. The adoptive parents that the parents shower the child with affection and
might be incognizant about their baby’s nature and love, and createand maintain a comforting and
habits etc. nurturing atmosphere for the child.
Following are some measures which can help to Stage 3

address the above concerns: Introducing the family
Ŗ 6JG CFQRVKXG RCTGPVU OC[ RTGRCTG VJGOUGNXGU Parents must remember that the family is a new
by reading up available information on adoption environment for the child. Seeing new people
and adopted children. suddenly might be an extremely frightening or
Ŗ 6JG[OC[EQPVCEVVJGUWRRQTVITQWRUQHCFQRVKXG anxiety provoking experience for the child. The
parents to understand their experiences and get parents need to introduce the family in a gradual
guidance from them. manner. If possible, parents may decide to limit the
Ŗ 6JG[ OC[ CXCKN IWKFCPEG HTQO EQWPUGNQTU HQT time with extended family members so that the child
worries and concerns over adoption. familiarizes with the immediate family members and
gets accustomed to their presence. Following this, it
Ŗ 6JG[ ECP OCMG CTTCPIGOGPVU HQT OGGVKPI VJG is imperative that the parents educate the extended
needs of the adopted child, such as nutrition, family members about the processes and challenges
clothing, etc. They can also get in touch with a of adoption and introduce them to the child.
paediatrician and counsellor for advice.
Ŗ &GURKVGVJGCTTCPIGOGPVUOCFGVJGHQTVJEQOKPI Ŗ Introducing the siblings: The biological or
events after adoption are unpredictable andthe previously adopted children of the parents
parents must be prepared for any crisisand have need to be introducedas siblings to the adopted
resources checklist in hand, for e.g., Iif the child child. Prior to adoption, parentsshould inform
isnot able to adjust initially, the parents must the previous child/children about the adoption
have list of child counselors to consult. plan and get their opinion on the same. Parents
must prepare the siblings for the newly adopted
Stage 2 child, as they might have various expectations
Forming emotional attachment from the adopted child. Parents should be
with the child honest in providing all the information about the
adopted child to the siblings so that unrealistic
Adoptive parents are often confused and anxious expectations (if any) can be addressed. To
about their attachment with the child. Parents must facilitate this process, the parents may encourage
understand that forming attachment is a process the sibling to spend more time with the adopted
that varies depending on the child’s temperament. child, in play and other family rituals. Also, the
Sometimes children/ babies may not respond parents can emphasize the importance of his/
according to the expectation of the adoptive parents. her role as an older brother or sister. Parents
As the child can sense the parent’s anxieties, it is vital must remember that the older child may take
for the parents to be relaxed and happy in the child’s slightly longer to adjust to his/her new sibling.
presence. The parents must also be patient and give However, over time, he or she will adjust to the
some time for the bonding to take place. Initially, new family dynamics and the sibling bond will
parents might have to devote a good deal of time be strengthened and sustained.
with the child to earn his trust and affection, which
THE
LOUDSPEAKER
35
child mental health for support. However, in normal
Stage 4
circumstances, (when the child doesn’t have any
Parenting the adopted children
emotional or behavioural issues) general parenting
principles can be applied effectively.
It is often said that adopted children can be treated
just as biological children. However, parents must
recognize that the adopted children, especially if
older,might have had varied experiences in their
Dr. Kavita Jangam
RCUV YJKEJ ECP TGƀGEV KP VJGKT DGJCXKQT RCVVGTPU
Associate Professor
Therefore, parents must be aware of the parenting
Dept of Psychiatric Social Work
issues related to adopted children. Further, the
(Child and Adolescent Psychiatry)
nature of disclosure of adoption, responses of various
NIMHANS
family members towards the adopted children,
child’s own temperament and developmental needs Ms. Priyanka Nambiar
may have impact on the style of parenting and Ph. D. Scholar, Dept of Psychiatric
parenting practices. Thus, for the child’s emotional, Social Work (Child and Adolescent
behavioral or developmental concerns, parents can Psychiatry), NIMHANS
CRRTQCEJOGPVCNJGCNVJRTQHGUUKQPCNUKPVJGſGNFQH
TH E

Why mental health in
pregnancy and postpartum
period is important?
A 38-year-old married lady, mother of 3 children Mental disorders during pregnancy

last one being 6 months old girl, developed severe and postpartum period
depression during her pregnancy resulting in poor
antenatal checkups, sleep deprivation, poor fetal Depression and anxiety are the most common mental
attachment with attempts to abort the fetus multiple health problems in pregnancy and postpartum
times. The psychiatric illness exacerbated during period. These affect about 10 to 15 out of every
her postpartum period, needing an inpatient care 100 women with higher prevalence in developing
in hospital and the mother also had developed countries. Women also experience many other
severe bonding disorder with the infant. Some of mental health problems like psychosis, bipolar
the psychosocial stressors, in this case, were poor disorders during pregnancy, just like at other times.
support, history of alcohol use in husband and Antenatal distress is known to persist through the
alleged history of intimate partner violence. postnatal period as well. The mechanism of mental
illness involves complex interactions between health
Pregnancy and childbirth behaviors, hormonal regulation and genetic factors.
Women’s mental health during pregnancy has
Pregnancy and childbirth are intensely emotional important implications for the well-being of the
events. Having a baby is a big life event, and it’s mother, and also for the development, health, and
natural to experience a range of emotions and well-being of the unborn child. Some of the risk
reactions during and after pregnancy. The majority factors for maternal depression can be past history of
of mental illnesses start before or during the depression, domestic violence, stressful life events,
child-bearing years, and many pregnant women marital disharmony, lack of social support, culture-
JCXG UKIPKſECPV RU[EJKCVTKE EQOQTDKFKV[ &WTKPI URGEKſE TKUM HCEVQTU
GI OCNG EJKNF RTGHGTGPEG
pregnancy, a variety of physical, hormonal, and which can result in adverse outcomes both for the
emotional changes occur. These changes can lead to mother and baby. Mental health problems can also
stress for the mother. Usually, many women have lead to maternal deaths by suicide.
good mental health during pregnancy. However,
some women may already have a mental illness when It has beenshown that anxiety and depression
they get pregnant or have mental health problems KPƀWGPEG QDUVGVTKE QWVEQOGU NKMG RTGVGTO FGNKXGT[
HQT VJG ſTUV VKOG KP RTGIPCPE[ 7PHQTVWPCVGN[ miscarriage, bleeding during pregnancy and a higher
pregnancy is not a protective factor for mental health risk of operative deliveries; neonatal outcomes
problems. like low birth weight, higher risk of stillbirth.
These outcomes appear to be most pronounced in
It is important to recognize mental health issues women in deprived social groups and in developing
during pregnancy and postpartum period and countries. They may also be at risk for seeking
support women for adequate maternal mental health less prenatal care, having a lower appetite and
and welfare of the child. inadequate weight gain and poor self-care in general,
THE

37
with impact on sleep cycles which may lead to How to maintain mental wellbeing during
more hospitalizations during pregnancy. Also, it is pregnancy?
well known that maternal-infant bonding develops Ŗ 'CVCJGCNVJ[DCNCPEGFFKGV
early during the pregnancy itself and maternal Ŗ )GVTGIWNCTUNGGR
JGCNVJ KPƀWGPEGU OCVGTPCNHGVCN CVVCEJOGPV 2QUV Ŗ #XQKF UWDUVCPEG WUG ŌCNEQJQN UOQMKPI CPF
child birth, a study (source to be cited) found other drugs.
that higher anxiety, depression, has resulted in Ŗ *CXGIQQFUQEKCNUWRRQTV
poor quality of attachment between mother and Ŗ 'ZGTEKUG
PQVVQQGZEGUU
baby and more negative attitudes toward self as Ŗ 4GNCZ
mother and towards motherhood. On a long-term, Ŗ (QNNQYJGCNVJ[HQQFJCDKVU
maternal mental illness, including depression and Ŗ &KUEWUU CP[ YQTTKGU [QW OC[ JCXG YKVJ [QWT
CPZKGV[KPƀWGPEGCEJKNFŏUGOQVKQPCNEQIPKVKXGCPF family or with your doctor.
behavior development and physical growth.Hence it
is very important to screen for psychological distress, To conclude, maternal mental health is important
particularly depression, and this should begin in the for safe motherhood. Risk factors for poor maternal
antenatal period itself.There is a role of fathers and OGPVCNJGCNVJUJQWNFDGKFGPVKſGFCUUQQPCURQUUKDNG
their sensitivity as a mediating factor for maternal and appropriate interventions should be offered.
depression. More sensitive fathers reduce the impact
of maternal depression by providing a supportive
environment. Dr. Madhuri
Senior Resident
Department of Psychiatry
NIMHANS
TH E
38 LOUDSPEAKER
OUTPATIENT SERVICE
Pre Pregnancy Counseling
For women with mental health problems
who want to become pregnant.
Advice and Treatment for women
Who are already pregnant and on
psychiatric medications
Who have concerns about a relapse in the
postpartum.
With postpartum mental health problems
– Postpartum Depression, Anxiety, OCD or
Psychosis
Mother Infant Bonding Disorders and
Breastfeeding concerns
Counseling and Support for
husbands and family members
INPATIENT SERVICE
Treatment of postpartum and pregnancy
related problems which need inpatient care
A dedicated 5 bedded Mother Baby ward
Specific interventions for Mother Infant
Bonding Disorders
Education and Information on Postpartum
psychiatric disorders for mothers with
mental health problems, spouses and
family members
NIMHANS
Department of Psychiatry This service is dedicated
to helping mothers,
infants and families who
need treatment, support
PERINATAL and guidance for any
mental health problem
PSYCHIATRY SERVICES related to pregnancy or
childbirth.
Contact details of
Consultants
Dr. Prabha S Chandra
080-26995272
Dr. Geetha Desai
080-26995251
Dr. Harish T
080-26995279
Email:
A Service Devoted to Women with Psychiatric perinatalpsychiatry@
Problems related to Pregnancy and the gmail.com
Postpartum
8KUKVVJGYGDUKVGHQT
more details:
www.nimhans.ac.in/
Perinatal Clinic Timings
perinatal/perinatal.htm
Fridays: 9 am to 2 pm
Venue
Ist Floor
New OPD Block, NIMHANS
Phone
080 - 26995547
Printing of the Magazine funded by: Dr. Ramachandra N Moorthy Foundation for Mental
Health and Neurological Sciences

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TH E Autumn 2018

LOUDSPEAKER Amplifying the voice of mental health

MOTHER, INFANT & FAMILY

Handling anxieties related to

10 Not just the grownups, infants too

...Plus Our Regular Features

Mental health for persons with medical illnesses

LOUDSPEAKER Amplifying the voice of mental health

Dr. Prabha S. Chandra

Editorial Team: Sub Editors

Editor’s Note Smt. Padmavathy D

Mr. Manoj Chandran

LOUDSPEAKER Amplifying the voice of mental health

Breast feeding and emotions

Handling anxieties related to

Not just the grownups, infants too

Father’s Mental Health

In-Vitro Fertilization (IVF)

Grandparenting for beginners: “Hush little baby…” Infant

Talk to your doctor

Welcoming a Child to the

Overcoming Postpartum Why mental health in pregnancy and

Dr. Veena Sathyanarayana LOUDSPEAKER

6 LOUDSPEAKER Amplifying the voice of mental health

Dr. Shaibya Saldanha

LOUDSPEAKER Amplifying the voice of mental health

8 LOUDSPEAKERAmplifying the voice of mental health

LOUDSPEAKER Amplifying the voice of mental health

12 LOUDSPEAKERAmplifying the voice of mental health

LOUDSPEAKERAmplifying the voice of mental health

14 LOUDSPEAKERAmplifying the voice of mental health

Introduction status, age, consanguineous marriage (gotra), psyche

Acknowledgement: We are thankful to Dr. Shivarama

Dr. Rashmi Arasappa

Dr. Praerna Bhargav

He insists on deciding his own clothes, food, games,

18 LOUDSPEAKER Amplifying the voice of mental health

LOUDSPEAKERAmplifying the voice of mental health

Postpartum blues/Baby blues Postpartum depression

Factors that may trigger postpartum depression can Ŗ 7PCDNGVQVCMGECTGQHVJGEJKNFQTDQPFYKVJVJG

26 LOUDSPEAKERAmplifying the voice of mental health

LOUDSPEAKER Amplifying the voice of mental health

One study found that mothers who wore their

LOUDSPEAKERAmplifying the voice of mental health

32 LOUDSPEAKERAmplifying the voice of mental health

“If I see a counselor or psychiatrist they will give me 'OQVKQPCNFKHſEWNVKGUFWTKPICPFQTCHVGTRTGIPCPE[

LOUDSPEAKERAmplifying the voice of mental health

Following are some measures which can help to Stage 3

36 LOUDSPEAKERAmplifying the voice of mental health

A 38-year-old married lady, mother of 3 children Mental disorders during pregnancy

LOUDSPEAKERAmplifying the voice of mental health

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