Lovely Book Review Over at Resplendent by Design

A friend of a friend, Bobbi Parish, therapist and author of the blog Resplendent by Design and book “Create Your Own Sacred Text” has written a very lovely book review of my book “One Mom’s Journey to Motherhood.”  Thank you, from the bottom of my heart, Bobbi, for taking the time out of your very busy schedule to read my book and write a book review.

One of the many rewards for writing my book–aside from the personal satisfaction of seeing the fruit of your six years of labor result an attractive book with content that can help make a positive difference for others–is making new connections, especially ones who would go out of their way to spread the word about a fellow mom’s book intended to help other moms.  Another reward is knowing that you are contributing in some small measure toward reaching mothers and their families with information that can help empower them to recognize when they are suffering from a perinatal mood disorder, where to go for help, what the treatment options are….not to mention, realize that what they are going through is experienced by more women than they will ever know, they have no need to feel guilty, and they will be well again with the right help.

The best part of Bobbi’s review is the fact that she is recommending my book for patients of obstetricians, midwives and doulas:

In my opinion, this is a book that should be on every Obstetrician, Midwife and Doula’s shelf and in their waiting room. It should also be on a list of resources about Postpartum Disorders handed out to every pregnant woman by their health care professional. It will absolutely help women battle this insidious mental health disorder and thereby enable them to have a healthier, happier postpartum period with the full capacity to care for and bond with their newborn.

Please go over to her blog and read the rest of her book review.

If you are an obstetrician, midwife or doula, please consider following Bobbi’s recommendation of 1) keeping a copy of my book in your waiting room and 2) including my book on a list of resources which I hope you already have (and if not, please consider putting one together now) about perinatal mood disorders handed out to your pregnant patients.

If you have stumbled across my blog and want to read more about my motherhood journey and what I learned from it, please consider buying a copy.  My book is available at Amazon via Kindle and both paperback and hard cover format.

If you know a mom who has found herself as blindsided and scared as I found myself when I was hit hard by postpartum depression, please consider buying her, or recommending she buy, a copy of my book.

Thank you, from the bottom of my heart.

The Importance of Mothering the New Mother

Chinese call it Zou Yue.
Mexicans call it la cuarentena.
Greeks call it sarántisma.
Indians (Hindi) call it Jaappa.

Regardless of what it’s called or how long it is observed–be it 30 or 40 days–the goal is the same.  Taking care of the mother, so she can take care of her baby and get adequate sleep to recover from childbirth.

Many other countries in Asia, the Middle East, South America, and Africa observe a traditional mothering the new mother period.  40 seems to be a magical number, a number that has survived through the centuries and therefore has special significance….no doubt it has something to do with the fact that 40 days is the average length of time for a new mother’s body to recover from childbirth and return to a pre-pregnant state.  That is also why your OB/GYN will say to you once you’ve given birth that he will see you in 6 weeks.

The May 11th NY Times Well section included an article How to Mother a Mother by Tara Parker-Pope.  In it she talks about Claudia Kolker’s new book, The Immigrant Advantage: What We Can Learn From Newcomers to America About Health, Happiness and Hope and how practices such as la cuarantena can help Americans (if they are willing to learn from immigrants) to achieve–just as the title says–health, happiness and hope.

Cuarentena sounds like how the word sounds in English for quarantine, or a period of isolation for illness.  The term refers to the first 40 days after childbirth in which the female family members and friends of the new mother surround her and provide her and her baby with care, so that the new mother’s only focus is on getting rest and bonding with/feeding her baby. They also help around the house and prepare meals.  Certain rituals are observed that are similar to those observed by the Chinese Zou Yue, such as the preparation of certain foods, like chicken soup, to help keep her body/system warm, as chicken is viewed as a warm food.  Foods that are considered cold, like cucumbers, are avoided.  She is to be protected from feeling overwhelmed; hence, visitors are kept away (or kept at a very minimum) during this time (this is probably how the term la cuarantena was derived).  She is told to avoid bathing for fear of catching cold.  All these rituals have the mother’s well-being in mind.  I am rather surprised to see such similarities between the Mexican and Chinese customs….after all, the countries are nowhere near each other!  In terms of breastfeeding, female family members are on hand to teach her how to do it. In these other cultures, there is no expectation that the new mother know how to breastfeed instinctively and easily.  There is a reason behind the phrase It takes a village.

Since I blogged previously about the importance of social support and how through the years we seem to have lost perspective on things when it comes to the community coming together to help a new mother who has just had a baby, I won’t repeat myself here.  What I will say is–because we can’t emphasize it enough nowadays–that getting adequate social support–comprised of both emotional support (e.g., shoulder to cry on, listening non-judgmentally) and practical support (e.g., help with breastfeeding, cleaning, errands, laundry, taking care of the baby for a few hours so mom can take a nap or shower) IS CRITICAL FOR NEW MOMS.  Having enough support during the first 4-6 weeks–until your body recovers from childbirth and your hormone levels return to their pre-pregnancy state–can help keep anxiety levels down, help you get the rest you need from all the changes your body has gone through with childbirth, and minimize risk for postpartum depression.

Don’t be afraid to ask for help or accept help from your significant other, family members and/or friends.  Before baby’s arrival, you should try to line up 4-6 weeks’ worth of live-in help from a family member (mother, mother-in-law, sister) or at minimum help with night-time feedings those first few weeks is critical in allowing you to get adequate rest.  If you don’t have any family members nearby and/or willing or able to help, you may want to consider hiring a postpartum doula, if finances allow.  The presence of a doula that is experienced in infant care can help keep anxiety levels and concerns about infant care to a minimum, and provide comfort in knowing that both you and your baby are in good hands.  Click here to learn more about postpartum doulas and how to find one near you.

I devote a chapter in my book to the importance of social support, what social support entails, how to go about ensuring you get adequate support in your first postpartum weeks, postpartum rituals in various countries, and postpartum support services in this country (including support groups like Santa Barbara Postpartum Education for Parents, as well as doulas)–and unfortunate lack thereof and the trend of having postpartum doulas fill the void in support for new mothers.  I have Sally Placksin’s book Mothering the New Mother to thank for educating and inspiring me to write about social support in my own book and every chance I can get.

I started writing this blog post on Monday (late at night after my daughter went to bed), lost gas quickly and stopped.  I started it up again on Tuesday (late at night, again after my daughter went to bed) and lost gas quickly (the result of a combination of a long, stressful day and aging).  On Wednesday, I had a lovely time catching up with a good friend over dinner so I didn’t get a chance to write at all.  Just today, I happened to stumble across a website/blog named Mother Love Postpartum Doula Services that just recently linked up to me by way of its blogroll.  Thank you, Liz, for linking to my blog!    She happens to touch on the postpartum rituals I touch on in this post.  What fortuitous timing, as I just needed to finalize the post…and voila, I’m hitting the Publish button….now!

Upcoming Perinatal Mood Disorders Workshop – Long Island, NY

Thursday, May 5, 2011 – In celebration of Suffolk County’s, Long Island, NY Perinatal Mood Disorders Awareness Month the Long Island Doula Association (LIDA)–in collaboration with The Postpartum Resource Center of New York and the Suffolk Perinatal Coalition’s Perinatal Mood Disorders Task Force– is offering a Perinatal Mood Disorders Workshop with Sonia Murdock, Executive Director, Postpartum Resource Center of New York as the Guest Speaker.

Who should attend?   

  • Doulas who support pregnant and postpartum mothers. 
  • Medical and mental health care professionals who want to stay abreast of current and effective treatments for perinatal  mood disorders to ensure effective detection and diagnosis and establishment of screening protocols. 
  • PPD survivors and others interested in knowing more about perinatal mood disorders and how they can support other mothers and their families.  

For more details on this workshop, see workshop flyer.

Evolution of Midwives & Doulas to Fill the Void in Postpartum Support

I am a full believer in the benefit of doulas–both birthing and postpartum doulas.  Had I known about them, I would have considered hiring one or both.  I definitely regret not knowing about postpartum doulas, especially while I was suffering from postpartum depression (PPD)!

Following is why…and this goes hand in hand with one of my older posts, which happens to be about the importance of social support, the increasing gap that doulas happen to be filling in this country.

If there are no relatives or friends nearby that can help during the first few months, and if finances allow, consider doing the following as an investment in your mental health:  1) hiring a cleaning person once a month, 2) hiring a doula that can provide both practical support around the house and with the baby, and 3) ordering out a few nights a week.  Even if you and your husband have always been adverse to ordering out and hiring a cleaning person or someone to come into your home to care for your baby, now’s the time to be open-minded and explore other options you may never have considered before.  While continuous social support during childbirth has been in practice in other countries for centuries, the increase in doulas in this country is occurring due to the decrease in support provided to mothers from their extended families.

Until I started reading up on postpartum depression a few years back, I didn’t even know the difference between a midwife and a doula.

  • A midwife is medically trained to perform vaginal exams and deliver babies in either a patient’s home or in the hospital.  A doula is not medically trained to perform clinical tasks and deliver babies but instead is professionally trained to provide support during labor and after delivery in terms of childcare.
  • The word “doula” comes from the Greek word for the woman who helped the lady of the house during and just after childbirth.  [Mothering the Mother by Klaus, Kennel & Klaus] The word has come to refer to a woman who provides physical, emotional, and informational support to the mother before, during, and just after childbirth.  If you don’t know of any doula services in your area and your pediatrician and friends can’t refer you to one, it would be helpful to check out, the website for Doulas of North America.

Taken straight from DONA International’s Position Paper on the Postpartum Doula’s Role in Maternity Care, 2002:

“In traditional societies women and men grow up around birth, breastfeeding, infants and children.  After giving birth, women are surrounded by caring family members who have a great deal of experience and wisdom to offer.  This kind of help is rarely available to new parents in North America.  The doula’s support is intended to fill the gaps left by our customary postpartum practices, which usually include only medical procedures, occasional checkups and the purchase of baby-related paraphernalia.  The doula’s education, quiet support and guidance are a manifestation of the traditional postpartum support that our society is missing.”

Through the training that doulas receive through DONA International, they become knowledgeable about the physiology of labor, emotional needs of a woman in labor, infant care, breastfeeding and even postpartum mood disorders.  Doulas are trained to enter into the homes of new parents, providing them with any help they require, including the following:

  • Assist the woman and her husband to prepare for and carry out their plans for the birth.
  • Stay by the woman’s side during labor to help provide comfort during labor by way of massage or continuous reassurance, as well as facilitate communication between the woman, her husband and the doctor and hospital staff.
  • Provide guidance with adjusting to parenthood
  • Provide training on the basics of baby care and addressing concerns as they come up, like colic, cradle cap or eczema
  • Take care of any other children in the household
  • Provide guidance with breastfeeding and/or bottle feeding, including latching techniques, quantity of milk or formula intake, feeding schedules, what type of formula to use, what type of bottles and nipples to use, how to pump and store, and what to do when/if the baby has gas, reflux or spits up
  • Provide non-judgmental emotional support/companionship
  • Help with the baby whenever the mom and/or dad need to sleep/rest or even to take a shower
  • Help around the house, including cooking, cleaning, laundry, answering phones, taking messages and fielding visitors
  • Help with errands like shopping for groceries
  • Provide referrals to professional/community resources like doctors, therapists and/or PPD support groups, if necessary

Ultimately, the doula’s role is to help ensure the childbirth experience is as positive, easy and stress-free as possible. Having someone in your household who is experienced with baby care can provide the first-time mother with a much greater sense of security.  Knowing someone is there with you providing nonjudgmental guidance and addressing any concerns that come up can boost your comfort level and lower your anxiety level.  Other benefits of having a doula include:

  • Increased breastfeeding success
  • Content baby and better overall infant health (e.g., less issues with colic)
  • Moms get more sleep, which helps with postpartum recovery and prevention of PPD.
  • Studies have shown that having a postpartum doula can help reduce PPD rates.  The new mom can get more sleep, get help with breastfeeding and feel comforted knowing there’s someone in the house with them that is experienced with childcare (i.e., no need to feel anxious in terms of what to do).

Hey, if you were asked if you’d prefer to read a book or have a human being with experience in baby care show you what to do, address your concerns/questions as they come up, and help you transition into parenthood for the first time, which would you choose?  I would choose the latter, hands down.  In fact, had my husband and I known about doula’s and how they would benefit us, we would have hired one.  In all likelihood, having a doula would’ve helped keep my anxiety levels down and PPD may not have reared its ugly head.

The new parents would learn about PPD early, and the knowledge can reduce feelings of isolation and despair, if PPD were to occur anyway, despite all of the doula’s help. Having a doula that provides reassurance, encouragement and guidance from the very get-go, when a woman is at her most vulnerable, provides the best kind of start to motherhood there is.  It paves the way for a better motherhood experience overall.  The whole family—the mother, the baby, the father and any other children—benefit from having this kind of support.

You would think such services would be valued by society and the healthcare system, but they aren’t.  Insurance companies don’t typically cover the cost of doula services.  Hopefully, one day doula services are accessible to everyone who is in need of those services.  In order for that to happen, some sort of insurance reform needs to occur so that families who wouldn’t ordinarily be able to afford doula care can have access to it if need be.  Society should encourage and support anything that helps ensure families start off on the right foot, such as the work of a doula.

The importance of social support…..a historical perspective

It seems the main root behind the belief or “myth” that all mothers can and should be able to instinctively take care of a newborn lays deep in the historical trend away from social childbirth, where experienced mothers in the community used to help prepare the mother-to-be for motherhood, be there for her at childbirth, and provide emotional and practical support to her in the first month or so postpartum. These women in the community (extended family, friends, neighbors) used to educate the woman on what to expect, helping to ease that transition to motherhood. They used to provide breastfeeding support and be there to address questions and concerns as they came up. They took care of everything around the house, allowing the new mother to recover from childbirth, get the rest that she needed and focus on taking care of and bonding with her baby.

From what I’ve learned while reading all the books I’ve been reading, women started to have hospital births in the 1920s with hospital staff taking care of the baby and allowing her to rest in the first couple of weeks. By the 1960s women started wanting to have control of where and how they had their babies. Since then, the husband has become the main support team. But it was a lot to expect from someone who was becoming a parent for the first time while having to work at the same time. With more and more women having careers and extended family members moving farther away, the kind of support the new mother needed was often not feasible, which is why all too many mothers today have no choice but to do it all themselves. Many mothers today have never had any prior experience with caring for babies, even. With lack of guidance, emotional/practical support and role models, it’s no wonder first-time mothers are anxious, not sure what to do, and are exhausted. Not having had the opportunity to recover and rest up from childbirth, and in most cases with the partner off at work all day, she finds herself alone with the baby during the day, lacking self confidence, exhausted and overwhelmed.   During the first few weeks postpartum, the new mom is at her most vulnerable.   If she doesn’t get the rest she needs and let her body recover, the woman with high risk for mood disorders may fall prey to PPD.  It’s no wonder the rates of PPD are so high nowadays. I just received information yesterday from Postpartum Support International with a blurb that I briefly read over that shows a high correlation of social support and lower PPD rates from a study recently performed in Australia.

Starting from the 1980s, doulas have become more and more popular to provide the kind of support women in the community used to provide. Unfortunately, not everyone can afford a doula. My hope is that one day doulas–or even organizations like the Santa Barbara Postpartum Education for Parents founded by a group of mothers– will become standard for everyone, since it’s unlikely we will unwind the changes that have occurred in this society–e.g., women with careers, unavailability of extended families.   Had my husband and I known what a doula was and how one would’ve benefited us, we would have hired one.  As they say, hindsight is 20/20.  That’s why I’m sharing this with you.

It’s definitely a long road ahead of us in terms of lowering those PPD rates. If we can get the word out to everyone on what PPD really is and who is at greater risk and making sure they get appropriate emotional/practical support, we can help lower those rates…and the stigma associated with PPD.