The Hidden Stigma of The Perfect Birth Culture


APA-BlogDayBadge-2013Today is the APA’s Annual Mental Health Blog Day. I’m diving into an aspect of Postpartum Mood & Anxiety Disorders which is often swept under the rug yet brings with it a very divisive and stigmatizing aspect to the birthing world. I dove into this topic somewhat with a blog post just a week ago, but today I’m diving in even further because beneath the exposure of THAT post, there is even more stigma and non-discussion going on among some of the largest birth support organizations (Lamaze, DONA, and CAPPA) in regard to Postpartum Mood & Anxiety Disorders.

If you read the post linked in the above intro paragraph, you’ll read that Henci Goer’s view of Postpartum Mood and Anxiety Disorders places the blame for experiencing them on the breakdown of the system of medical intrusions into the birthing experience. If we could just fix the system, she believes, Postpartum Mood & Anxiety Disorders (which are all PTSD related to intrusive medical occurrences during birth, by the way), would disappear and every single mother would be just fine.

Only it doesn’t work that way. We could have the most perfect birth in the world and still end up with some form of a Postpartum Mood & Anxiety Disorder. I’ve talked to mothers who have had this happen to them. Do the intrusions add to the potential? Sure. It’s a risk. Know what else is a risk? Being female and being pregnant. Researcher after researcher has proven that while yes, there are actions we can take to alleviate our risks or shorten our experiences, we are ALL at risk regardless of our stature in life or the manner in which we give birth. From those at the highest of society (Kim Kardashian, anyone?) to a woman in a third world country with the most meager access to care, we are ALL at risk. Different language may be used to express those experiences, but going “mad” after childbirth is something which has occurred since the time of Hippocrates and doesn’t show any signs of slowing down.

I’m not saying that we are all DOOMED to experience Postpartum Mood & Anxiety Disorders, absolutely not. I’m saying that our risk factors are similar. Additional stress adds to our risk weight but beyond that, pregnancy itself is a risk factor as it does things to our bodies, to our hormones, to ourselves, that we will never fully understand regardless of how much research we do. The best way, I think, to approach pregnancy, is to advocate for the best care for yourself, whatever that may be. If you need an epidural to give birth, then go for it. If you want to give birth naturally, go for it. But be aware that birth is a fluid and organic process over which we truly have no control. Things may happen for which we are either not prepared or not willing to have happen. However, if you’re open to the possibility that they *may* happen, the result may be less traumatic and therefore leave a shorter impression upon your psyche.

In reading through Lamaze’s Listening to Mothers III report, I’m hit with some thoughts about how well the birth community IS listening to mothers. So I decided to go hit some of the other websites to see where they stand on Postpartum Depression Mood & Anxiety Disorders. How well do they prepare Mothers for the possibility of these issues and/or how well do they welcome mothers who have birthed before and experienced these things and are now searching for a “better” way to birth in order to avoid similar issues?

The answers were not good.

ACOG, the American College of Obstetricians and Gynecologists, has a published Opinion Paper on Screening for Depression During and After Pregnancy. It was issued in 2010 and reaffirmed in 2012. This opinion includes a chart mentioning several different methods of screening, notes the amount of time it takes to go through each one, the sensitivity of the screening method, and if it’s available in Spanish. ACOG then concludes by saying the following:

“Depression is very common during pregnancy and the postpartum period. At this time there is insufficient evidence to support a firm recommendation for universal antepartum or postpartum screening. There are also insufficient data to recommend how often screening should be done. However, screening for depression has the potential to benefit a woman and her family and should be strongly considered. Women with a positive assessment require follow-up evaluation and treatment if indicated. Medical practices should have a referral process for identified cases. Women with current depression or a history of major depression warrant particularly close monitoring and evaluation.”

Not only do they recommend screening, they recommend development of a referral process AND note that women with current depression or a history thereof should be monitored. Kudos, ACOG.

DONA has several position papers available at their website. The one for the Postpartum Doula does not mention Postpartum Depression aside from the following sentence:

“We know that women who experience support from their family members, care providers, counselors and peer groups have greater breastfeeding success, greater self-confidence, less postpartum depression and a lower incidence of abuse than those who do not.”

DONA also offers up a Postpartum Plan worksheet for new mothers. Nowhere on this sheet does it at all mention what to do if a Postpartum Mood & Anxiety Disorder appears. To DONA’s credit, however, there are books included on their required reading list for their Postpartum Doula Certification by known Postpartum Mood & Anxiety Disorder experts. The books, however, are older, and the PDF for Postpartum Doulas has not been updated since 2009 while the list for the Birth Doulas was last updated in 2013.

CAPPA’s position paper for Postpartum Doulas makes mention of Postpartum Depression and focuses on the “fourth trimester” as one which must be traversed as carefully as the three trimesters of pregnancy. The Postpartum Doula, according to CAPPA, is not to provide medical care, but to have a network of caregivers (none of which are therapists, psychologists, or psychiatrists) which they can refer the family to if so needed.

According to CAPPA, the Postpartum Doula does the following:

“Postpartum doulas are knowledgeable professionals who assist families during the critical period immediately after the birth of their baby. They “mother the mother” and offer physical, emotional and informational support to the family as well as practical help.”

Makes sense, yes? After all, we do need to be mothered after giving birth. We know how difficult it is to make that adjustment to having the baby on the outside instead of on the inside.

The reading list for the Postpartum Doula at CAPPA has only three Postpartum Mood & Anxiety Disorders books listed, two less than DONA. The Childbirth Educator certification list has NO books regarding Postpartum Mood & Anxiety Disorders.

In discussion with various OB’s, I’m told they spend less than 2 weeks on Postpartum Mood & Anxiety Disorders as they train for their specialty. Two weeks to understand the complexities of Psychiatric issues post-birth.

Bringing things full circle, the Lamaze Listening to Mother’s III report has this to offer about Postpartum Mood & Anxiety Disorders:

LTM III Page 32

I don’t know what’s more disturbing here – that 31% of the mothers were self-reporting as feeling down or depressed or that 44% of these women with regular feelings of depression in the two weeks prior to the survey HAD NOT CONSULTED A PROFESSIONAL SINCE GIVING BIRTH.

Going back to my article about Henci’s comment at a previous post over at Science & Sensibility, you’ll note that she mentions “Furthermore, on-site mental health services would be of little use to women suffering from childbirth-related emotional trauma because one of the prime protective responses is avoidance of environments and personnel that re-trigger traumatic memories.”

I cannot help but wonder if the training, the discussions, the passing down of the believe that if only your birth is perfect and free of all possible interventions (as is impressed upon by the Lamaze Healthy Birth Practices found here), you’ll be just fine attitude held by so many within the birthing community is……

HINDERING MOTHERS FROM SEEKING HELP?!?!?

There are the standard reasons, of course, lack of insurance (due to Medicaid), cost, transportation, childcare, stigma/denial from family members, etc.

But what if… what if this stigma and denial is also coming at women from their caregivers? I know I had it from my OB. I know women who have been told horrific things when they’ve managed to call for help – things from “Well, are you suicidal yet?” to “Oh, just go shopping or take a walk and you’ll be fine…” or what I heard which was “Your hormones slid back into place at 4wks postpartum so this can’t be Postpartum Depression.”

I’m pleading with the caregiving community as a whole – with Obstetricians, with midwives, with pediatricians, with doulas, with anyone and everyone who may come in contact within a medical capacity with a pregnant or new mom to accept what she has to say as truth. To not try to reframe it for her, to not brush it off, to not dismiss her very valid fears and concerns. Listen. Truly listen. Don’t run through all your evidence based research in your head as she’s pouring out her heart to you – because if she’s doing that, it took her a very long hard look inside to be able to do that and if you say the wrong thing, you’re going to shut her down very quickly and do harm to her recovery process.

For those who DO listen, who do educate themselves and go beyond the certification recommendations, thank you. Thank you for bringing awareness to this struggle that so many of us fight.

With every birth, a new mother is born. It does not matter if she’s been born into the role before, she is reborn with each child. For each child and each aftermath presents a different set of challenges with which she must learn to live. Be gentle. Be kind. Be supportive. Listen. Don’t shame. Don’t stigmatize. The trust of a new mother is an amazing thing.

Stop abusing it, stop re-framing it, and above all else, wrap it in love and return it with your own level of compassionate honesty.

We, the women of the world, the mothers of all of you, deserve at least that much.

Can Kangaroo Care prevent Postpartum Depression?


I’m sharing today’s blog post with you as part of Science & Sensibility and Giving Birth with Confidence’s Blogging Carnival. This year’s theme focuses on “Keeping Mothers and babies together after birth.” In keeping with this theme, I want to focus on the influence Kangaroo Care can have on the prevention/relief of Postpartum Depression. If you’re here from the Carnival, welcome. If you’re a regular reader – enjoy! Either way, thrilled to have you here.

When I first became a mother, I had  never heard about Kangaroo Care. My daughter, however, liked to be held next to my chest, resting her head on my bare skin as she slept when she was not nursing. Not officially Kangaroo Care but we made do with what worked. To this day, she still likes to snuggle with me.

Kangaroo Mother Care is when a human mother and her infant snuggle skin to skin with the infant lying prone on mom’s chest. It’s a term coined after the Kangaroo’s close relationship with her little joey who doesn’t come out of mom’s pouch for four months after birth. Instead, joey relies on mom’s warmth, nutrition, and support for his “fourth” trimester. More often than not by those in the birthing realm, the first few months of a human’s life are now called the “fourth” trimester as well. Research has concluded over and over again that Kangaroo Care is invaluable for both human moms and babies as well.

In 2007 a study published in the Oxford Tropical Pediatrics from researchers at the Instituto Materno Infantil in Brazil concluded Kangaroo Mother Care may prove helpful in warding off postpartum depression. Researchers evaluated mothers at the beginning of NICU care and at the end of their Kangaroo Mother Care. NO mother developed depression during their Kangaroo stay. Let me say that again. NO MOTHER developed depression during their Kangaroo stay.

WHO, the World Health Organization, also offers an article regarding Kangaroo Care in the early months of infancy. Their article focuses on the bonding and encouragement of breastfeeding that Kangaroo Care provides. Many of the after-birth procedures and examinations can take place while baby is on Mom’s stomach in the prone position thereby improving chances of maternal and infant bonding.

A new Mother-to-Infant Bonding Scale included in a 2006 study compared the score of the Mother-to-Infant Bonding Scale to Edinburgh Postnatal Depression Scale. Women who scored lower on the MIB Scale scored higher on the EPDS and vice versa.

One of the perks of Kangaroo Care is the increased production of Oxytocin initiated through skin-to-skin contact with an infant. Oxytocin is known as the “cuddle” or “love hormone and may help new mothers ward off severe episodes of Postpartum Depression. This is an extremely compelling reason to encourage hospitals to encourage the practices of rooming in and immediate after birth examinations while baby is on Mom’s tummy or chest. The first few hours of life are extremely important to successful bonding and nursing. If mother and child are separated, the risk of failure for bonding and successful breastfeeding may decrease.

There’s also another personal story proving the very value of Kangaroo Mother Care. Carolyn Isbister, a mom out of Edinburgh, saved her infant’s life with a Kangaroo Cuddle. Her little one had been given up on by doctors. Carolyn cuddled with her infant to say goodbye. She and her husband watched as their daughter’s breathing and heart beats regulated. They watched as she went from grey to pink. Carolyn’s little girl is now healthy and home, thanks to Kangaroo Mother Care.

One of the calmest moments I had in the midst of my own downward spiral was as I sat with Charlotte snuggled up on my chest. We were in the middle of the NICU, beeps and boops all around us. The fragility of life hung heavy in the air. Her many wires, tubes, and other non-baby items draped across me as well. But all that mattered was her soft warm head resting peacefully under my chin, her breath caressing my chest. I wrapped my arms as tightly as I dared around her tiny body and closed my eyes. This was a moment in which I wanted to get lost. I wasn’t experiencing many of those at the time. Time stopped as we stepped out of the NICU and into our own little world for a bit. Even as I type this I can still smell her fresh baby scent and feel the weight of her little body curled up on my chest. It is a moment I will always cherish and never forget. My eye in the midst of a hurricane from hell.

I also felt soothed when I held our first daughter skin-to-skin even though I did not know the  technical term for our action at the time. Our son was a natural snuggler as well. With him, I did not experience Postpartum Depression. Our skin to skin contact was not much higher than with the other two but it was much higher than my skin to skin contact with Charlotte. After I had Charlotte I was hospitalized for severe PPD & PP OCD, a very scary time in my life.

If you’re a new mom struggling with bonding with your new infant, please try Kangaroo Mother Care. It’s free, it’s easy (mostly naked baby, mostly topless parent) and it does wonders.

Looking back, I wish I had insisted my children stay with me instead of letting them be sent away. Our second daughter’s absence was a medical necessity but with the other two it was not. Keeping your infant with you, on your skin, and allowing your relationship to develop naturally may just be the ticket you need to help ward off a severe case of Postpartum Depression. Some women may do Kangaroo Care and develop Postpartum Depression despite their dedication to skin to skin contact. If this happens, please know you are not alone. Be sure to ask for a thyroid and anemia levels test when talking with your doctor or midwife. And be sure to reach out for help from a mental health professional if you need it. There’s no shame in going to therapy. None.

Even if you are not feeling up to it now, one day, you will mother with confidence, you may even birth with confidence again. But know there are mothers who have been where you are right now and are willing to hold their hands back for you to cling on to – with confidence they will carry you out of the deep dark place you are now trapped within.

Want to read more about the Lamaze International View on Keeping Mother & Baby together? You’re in luck. You can do so right here.