In the previous blog we met Esther, who told us how lonely and excluded she often felt and how she fell into depression shortly after the birth of her son.

During our entire conversation I see how her brain is working at full speed and busy making connections between physical sensations and emotional experiences of things: “Jesus, I can feel it in my throat… another lump in my throat , which is now burning… And now that I think about it… was that why I had the heartburn during pregnancy? When I think about all this, I feel tingling all over my body…” I ask what the message could be. “I feel like something inside wants to get out. Maybe I want more territory! I want to take up space, find my place. That I noticed so often that they did not take time for me… I know they were busy, but still… it gave rise to the conviction that I did not matter…” She cries again, but also sounds like a warrior: “And that is not right, because over the years I have proven what I am capable of.” She now sits up straighter and I ask her what emotion she feels: “Pride! I am proud of my choices and what I have accomplished!”

However, currently, with the care for her young child, there is too much that requires energy and pride has disappeared into the background. She is in tears again when I ask what support has recently disappeared: “My mother’s; she was not there when I needed her after giving birth…” She sobs. “I feel like she did not prepare me for childbirth… for life, actually…” I ask if it was the first time she felt like she was on her own and then something special happens. She says that until then it was all manageable, but not anymore with the arrival of her child: “Now I was not strong enough…” I cringe a little, I notice, because she judges herself so harshly. She did that manageing herself. She could count on herself until then; she had enough strength to do it by herself, but even then she was often alone with it. So it is not that she is not strong enough now; what is going on is that now she had more to carry than her (tense) shoulders could manage. It is a completely new perspective, that it was not the first time that she did not receive support, but that it was the first time that she could not do it alone.

I propose a more compassionate formulation: “Even before, you needed support that you did not receive, but now you are fully aware that without that support you really cannot move forward. As a result, you can now slowly but surely start to see other times, in which you lacked that support, in a different light.” This formulation also places her depressive feelings in a different light. People are ‘wired for connection’, focused on the relational connection and co-regulation plays an extremely important role in this: are our closest loved ones able to empathise with what we need and how we feel? And are they able to fulfil that need?

We sometimes forget that even if we cannot identify the intellectual recollection of events with our cognitive brain, our body has stored a physical, emotional memory of them. That can make it complicated to understand what is happening. If something is preverbal (because you were too small) or nonverbal (because you could not put words to it), it can be difficult to put your finger on painful events. You did feel it at the time and even now older feelings stored in the body can be touched. In other words: feelings can be triggered. That means that they are not caused by what is happening in the present moment, but that they are awakened. They were already there.

There is, for example, the fact that Esther’s father actually thought two children were enough, something of which Esther of course has no verbal, conscious memory from when she was little. That does not mean, however, that she did not feel it, that she did not experience the tension from her mother during the pregnancy (‘what will happen with this new baby that my husband does not necessarily want…?’) in the form of stress hormones flowing through the umbilical cord. This means that her doubts about who she is can be seen from a different perspective. How visible is she to herself and others? How much space does she dare to take up? How powerfully does she dare to speak out…? How can she get rid of that lump in her throat, so that her words can flow freely and she can let her own Wisdom speak?

We talk about how important it is to take good care of yourself, because otherwise it is virtually impossible to take care of someone else, especially a small baby who needs so much from you. Esther is concerned about the fact that she has made her son cry several times because she simply ran out of energy and could no longer do it. She is strict with herself: “I could kick myself. I’m afraid I’ve damaged our secure attachment relationship…”

We conclude that no child grows up without moments when their parents are unable to meet all their needs. That happens to all of us as parents and that is okay, as long as there are enough other moments when the ‘rupture’ (the temporary severing of the connection) finds ‘repair’ (the restoration of it with sensitivity, attention, nurturing). That is part of what makes it difficult now: the ‘repair’ she needs from her mother is missing and that hurts. That appeals to all the times she missed that connection as a little girl. Especially now that she is actively committed to offering her son what he needs in that regard, she is even more confronted with how painful it is if you miss out on that as a young baby.

There is also a very big elephant in the room that cannot be named within her family. She did not have a free choice of partner and the fact that she followed her heart in the man she wanted to marry created a lot of unrest in the family. She was still living at home when she said she had chosen someone out of love, and her father did not speak to her for a year and a half. He ignored her, did not look at her, did not exchange a word. He then gave her an ultimatum: choose for her partner or for her parents. She did not allow herself to be pressured; she chose her partner and did not reject her parents, but the lack of support from her mother hurt her deeply. It was again a situation in which her authentic Self was not respected, in which her freedom was taken away.

Next week we will read about Esther’s brave first steps towards a freer, more sparkling life.

Esther came to me in a roundabout way because there were breastfeeding problems: overproduction, breast infections, a lot of pumping, endless feedings, a tongue tie… she got stuck and had help with that, but now there is another big hurdle: she has realised that the sadness that came over her a few weeks after birth was not just a ‘bad day’ or feeling a bit down, but postpartum depression, as it has been labelled. She lives far away from me, but another appointment nearby makes a combination possible, so that she does not have to make a long, stressful journey.

Once at Esther’s house I notice that she quickly becomes very open: she is ready for this process. She wants to leave the ‘mess’ of the past behind her, to break away from what she calls the toxic dynamics with people who are very close to her: the members of her family of origin. During the introduction, she does not say much at first about the impactful period that puberty was for her, but during our four-hour conversation she bravely and determinedly works towards talking about it. The systemic methodology with which we start immediately makes her tears well up. She feels a lump in her throat, a burning lump that she cannot swallow, almost taking her breath away.

When we evaluate together, she, like me, notices how positively she experiences the relationship with her partner. For quite a long time, he and his family were her refuge. She felt welcome and seen and they were happy with her as the wife of their son, their brother, their brother-in-law.

For a long time she did not want children, but now that her son has arrived, she is deeply moved by the amount of love he unleashes in her. However, he does not only unleash love, as we will see during our conversation – he also unleashes a lot of old sadness and her tears are the meltwater of everything that has become frozen within her and is stuck inside as a cold and inflexible mass.

She realises that she does not really know who she is, besides motherhood. Where does she stand now? How to go forward? How can she take up the space she did not have as a child? How can she powerfully claim her freedom and break loose from what hinders the development of her potential? These are big questions that are unavoidable, but at the same time they also frighten her and make her sad and silent and sometimes anxious. She regularly has the feeling that the walls are closing in on her, that she would like to leave and start a whole new life, in a place where no one knows her.

In her family, she was an afterthought; her two brothers were 11 and 8 when she was born. She would have liked to do something else in terms of work, but her parents would not allow her. To them, working for her brother seemed like the safest place for her. It reminds her of how, as a young girl, she was constantly protected and pampered, as she calls it, although it did not feel that way. It felt suffocating, like a lack of freedom that other children in her class were allowed to experience: walking to school themselves, choosing their own leisure activities, having space to just hang around and do nothing… For her, it was not like that: she was involved in so many extracurricular activities that her entire week was packed. She was brought and fetched everywhere; her parents did not allow her any independence in this regard. School was a particularly difficult situation: it was only a ten-minute walk, but she was taken by car at all times of the year. Her mother’s schedule caused her to be late every day. Esther repeats it a few times: ‘Every day, really every single day!’ Her classmates therefore thought she was strange. Esther felt like an outsider; she did not belong. “I could have walked or cycled that short distance, together with the others! I felt ridiculed. I experienced it as an enormous restriction of freedom.” It is therefore no wonder that she notices so much in her throat, so much that hinders the free flow of inhalation and speech…

After some time as an employee, her father started his own company and spent most of his time there. There was little attention for Esther. His companies flourished and there was always enough money, but Esther lacked attention and recognition for who she was and what she could do and what she dreamed of.

From the age of 55, her father no longer had any financial need to work and was usually at home, just like her mother, and she saw a dynamic between them that also lacked mutual interest, with little overlap between their activities. Her eldest brother lived on his own for a while, but is now in his early forties and lives with his parents again. He has taken up yet another study and started a company in which he collaborates with his younger brother.

Esther has seen all these developments and says: “I consider myself so stupid. I have much more to offer and I did not have to wait until this age to discover myself…” She cries again and we are silent together. I ask what it evokes in her body. She thinks with closed eyes and says: “Sadness… and also anger…” I ask her what that anger would say if it could talk. Now she does not have to think long: “Fuck off! I hate you for what you did!” She now also feels a tingling in her toes, tension in her lower back, and stiffness in her shoulders. We discuss all the sensations and what they might have to tell her.

“Since the day I can remember, I have never had freedom. That feeling is very old, really very old…” We talk about the emotions that must have arisen at the time as a result of her feeling of loneliness and we see if she can imagine a child of that age. If that does not work, we use her own son as an example, even though he is only little over a year old. I ask how he would feel if she and her partner treated him this way and what it would mean to her if he did not talk to her about it. Her tired eyes fill with tears again and she sobs as she says: “That would hurt me very much. It would mean that he thinks that I will not understand him, that I will not hear him or see him.” The fact that she did not talk to anyone about how she felt at school was for exactly the same reason: in the years before, she had already lost confidence that her mother would understand her. That was the child she was: sad, ashamed, alone with her pain.

I explain that she may not have expressed the emotions, but of course that did not make them go away; she was just ‘keeping them down’. I speak slowly, put a pause between ‘keeping’ and ‘down’. I catch her eyes and ask what could be another word for ‘keeping down’. She hesitates and shakes her head. I say: ‘de-pression’. She looks at me and says: “Ooooooh… woooow… Yes, that sounds very logical… but I have never made that connection myself…” We discuss that now she does seem to have space to express her feelings, that her own family offers her the security and listening ear that she used to miss.

That is a wonderful starting point for change. We will read more about that next week.

We already knew each other, Denise and I. Four years ago I had also visited her for a lactation consultation. Now she phoned me again, because she had given birth a week ago. The childbed nurse had just left; she had pain while breastfeeding and struggled with cracked nipples. We made an appointment and I went to see her. She opened the door, her four-year-old daughter in tow, shyly hiding behind her. Her son was sleeping in the playpen, but once picked up he was eager to feed. After I had done an oral exam, in which I found nothing special, mom put her son to breast. I made some suggestions and with a few adjustments breastfeeding was painless.

During a consultation, the way the mother experienced the birthing process is always discussed. Denise indicated that she had had a great delivery and that she looked back on it with a good feeling. She had gone to the hospital because, just like last time, the dilation was not progressing. She had started in the birth pool at home, according to how she wanted it. When, after a while of working through her contractions, she got stuck at three centimetres dilation, she was asked what she wanted. She could stay home a little longer or go to the hospital for pain relief. She chose the latter, with which her dream birth disappeared from view.

She went to the hospital, was given pain relief via a pump and then an IV with contraction inducers, because the strength of the contractions had subsided after the move from home to hospital. Once she was fully dilated, she pushed for another seven minutes until her son was born. She looked back on it well, she said; it had gone fine. The only problem now was the pain during breastfeeding and a feeling that things were not really going well yet. That was why she had called me: to help resolve what looked like a breastfeeding problem by means of a consultation. I had listened intently and all sorts of things came to my mind. I considered how I should continue the conversation with her.

After she told her story, I asked how she would have preferred her delivery. She was very clear about that: she had wanted to give birth in the birth pool at home, with her daughter there. They had discussed it extensively in advance that she could be there, and if mom had to go to the hospital, grandma would pick her up. When Denise had been in labour for a while at home, her daughter had woken up and come downstairs; she had been pleasantly present. If mom had a contraction, the girl was asked not to disturb mom for a while, but otherwise it felt very nice for Denise to have her daughter there.

When they called the midwife after a while, she was asked if she had any objections to an intern coming along. Denise had not minded. When they arrived, an internal examination had been done and it had been found that she was three centimetres dilated. Because it was a second child, the assumption was that it could go quickly. That is why the maternity care was immediately called as well. In an earlier phase, during the intake, Denise had indicated that a childbed nurse intern was no problem. During the delivery, she was not asked if she still agreed, so two more people joined. The situation thus looked like this. In a not so large house, with a not so large living room, the coffee table had to make way for the birth pool. Two large steps away from the tub was the kitchen table where the midwife, the maternity nurse and the two trainees were talking to each other. The maternity care intern was quite present and talked both a lot and loudly.

Giving birth is an intimate event, a life event that deserves safe, sacred space. The process has the best chance of a smooth and desired course if the birthing woman is not disturbed too much, if she is surrounded by people with whom she feels comfortable. You can compare it to sex: if you are observed having sex, an orgasm is highly unlikely for most people. If, on the other hand, you can find your own shape with your partner undisturbed and let everything go as it feels appropriate for you at the time, then an orgasm is much more obvious and will usually come easily.

During childbirth, the same basic principles apply in terms of privacy and a sense of security. If you are in an environment that feels safe for you with people you trust and who trust you, your body can relax and birthing your baby will go smoothly. Disruptions, such as people around you conversing loudly, detract from that safe environment and cause the process to stagnate. In this case, it happened the first time, probably because of the turmoil around Denise, which led to the birth not progressing. In the hospital, the process stagnated again because the new environment and the interventions contributed to the fact that the contractions stayed away.

Such a course also affects the self-confidence of the mother. Something lingers in the subconscious: “It has now happened twice, so I keep in mind that it may go the same way next time. Giving birth at home is not for me. I cannot do this; my body is letting me down. I’m not good enough for such a task… and possibly not for other tasks either…” That is very unfortunate and very sad for all kinds of reasons, because how your mother felt during pregnancy and childbirth, the way you came into the world has a major influence on how she begins her motherhood. Her experience has an influence on your mutual bond and therefore on the rest of life. Does your life begin in an atmosphere of peace and trust or does your mother feel a sense of failure because she (again) failed to give birth to you as she would have liked? How much grief does she carry with her?

And a deeper question: how come it was difficult for her and her partner to guard the ‘sacred space’ of the birthing place like lions, regardless of the opinion of the midwife or maternity care about it? What made it difficult for the expectant parents to stand up for their own needs? There are many more questions thinkable that deserve attention. For example, what made the childbed nurse trainee no longer aware of her place in the whole, of the importance of being silent and humble? What prevented both the midwife and the childbed nurse from pointing out to the intern that her loud talking was disrupting the situation? How come the care providers did not know in advance that the living conditions did not lend themselves to the presence of so many people?

With a trauma-sensitive view, it becomes clear that a more coordinated approach would have been possible at all levels. When we as a society have more knowledge about the effects of this kind of action on the beginning of a human life, we can all contribute to ensuring that that start is optimal, so that we do not stimulate ‘adverse’ but ‘awesome childhood experiences’!