Are you Pregnant?  Have you given birth within the last few months?  I want to ask you a question many people, your doctor included, may not think to ask:  how are you REALLY doing?

Recently I spoke to a lovely pregnant mama in a doctor’s waiting room.  As a doula for 22 years, my Spidey senses told me something was up.  I initiated some general conversation, and after a while asked her mom-to-mom about how she was feeling . A shadow fell across her face.  “Well, you know, okay I guess.”

“Yeah?” I responded, and waited.  And breathed.  In a small voi
ce she said, “Not so good. Everyone keeps telling me it’s just hormones, but it’s not passing.  I’m unhappy.  If it’s like this now, I’m afraid of what will happen when the baby comes.  Can you get postpartum depression BEFORE the baby is born?”

The woman agreed to my gentle encouragement to speak to her care provider about getting a referral to a mental health professional, just for a check in.  If we have blood pressure or blood sugar issues in pregnancy, we get checked out.  Mental health care should be as easy and accessible to perinatal women as a childbirth ed class.  It sadly isn’t, but that’s another blog.

In honour of Mental Health Week here in Canada, I want to shed light upon the fact that up to 20% of women experience anxiety and/or other mood disorders like depression in the time surrounding the birth of a baby, making mental health challenges among the most common complications of childbirth.  It can happen postpartum AND in pregnancy.

When a woman experiences feelings of sadness, overwhelm, panic, intrusive thoughts, obsessive-compulsive issues, and/or anger (among others), she may be reluctant to share what’s going on for her.  She can be afraid people will think she’s about to harm her baby or herself, and take the baby away from her.  She often thinks her feelings are a character flaw, and that if she were a “better” person, she could pull it all together and be a “good”, happy mom.

While in some cases thoughts of self-harm/harm to the baby turn into reality, the vast majority of women will not experience this extreme. But left untreated, mental health crises can and most certainly do arise, which make life feel unmanageable.  While maternal death is very rare in developed nations, suicide remains among its leading causes.  Any time someone feels at risk of harming themselves or their baby, this is an EMERGENCY, and must be treated as such.

Many women feel shame for being overwhelmed or apathetic when their pregnancies/babies are healthy.  There is a stigma around mental illness in general which deepens when it comes to motherhood.  If there appears to be nothing to complain about, many women feel guilty about expressing their pain.

But there is good news.  To quote Postpartum Support International, “You are not alone.  You are not to blame.  With help, you will be well.”

A doula, being a trained, experienced birth/parenting support professional, spends ample time with her client, and can often recognize some of the signs that something is amiss. She can ensure the mother gets the help she needs as soon as possible.  Because the sooner the mother feels better, the more space she has to enjoy her pregnancy and her baby, which is healthier for the family long term.  We want to ensure a mental health professional can intervene before a downward spiral potentially happens.  Even though wait times to see one can be inappropriately long, feeling like something is done can be a relieving first step.

These are five ways doulas can help when it’s beyond “the blues”:

1) Doulas Listen

As a doula, I get to know the people in my care.  I listen deeply not just for the words said, but for the feelings behind the words.  I’m not afraid to ask, “Hey, how are you really feeling today?”  and am comfortable not glossing the spaces over with chatter.

If the mother is receiving messages from her friends and family that her feelings will pass, that it’s “just pregnancy hormones” or “just the baby blues” even though her anxious/depressed feelings are persistent, we may be the only ones to speak up and say, “maybe this requires further investigation.  Why don’t we call your midwife and you can tell her what you’ve been sharing with me?” Or, “I have the number of an amazing psychologist who specializes in perinatal mental health.  Why don’t we call her right now for an appointment?”

A diagnosis made by a qualified mental health professional is important to get the ball rolling in the exploration of treatment.

2) Doulas Provide Resources

Professional doulas tend to be very community minded folks, and are well connected to the available maternity support resources.  A doula can share information about the importance of the woman contacting her care provider, and then help her follow up on the doctor’s referrals to the appropriate mental health professionals.  A doula herself will often have a list of psychiatrists or psychologists who specialize in perinatal anxiety and mood disorders, and can share these resources with her client.

A doula will also have resources for extra support while the mother is waiting to see her mental health professional, or is in treatment.  The mom may be interested in seeing a massage therapist, nutritionist, or joining a support group for other moms going through similar things.

3) Doulas Provide Respite

Many doulas are trained/experienced in providing respite for struggling families, throughout the day or the night.  Feelings of isolation and inadequacy can make mental health struggles worse, especially when they’re compounded by the exhaustion of the postpartum period.

 A postpartum doula can help mothers feel like they have a handle on things while she supports feeds, keeps the mom company, and tucks her into bed where she can rest secure knowing the doula is keeping Baby happy.  Or, perhaps Mom might need time with her baby and a little tidying or meal preparation done while she relaxes and bonds.

A doula always seeks to support bonding and to foster a sense of confidence and mastery in new parenthood. Occasional respite care can make all the difference when the mother is getting treatment or waiting to.

4) Doulas are on the Family’s Side

Unsolicited advice is the bane of the pregnant/new parent’s existence.  Everyone wants to tell them where it’s at.  Your baby should sleep through the night at birth, you should be planning an all natural delivery, you should have an epidural, you should start your baby on a bottle right away, you should breastfeed exclusively.  Parents can feel like they’ll never do anything right, which can weigh heavily on a person experiencing mental health challenges.

Doulas are there to provide parents support for their choices.  Period.  A family’s life isn’t played to the tune of any personal doula agenda.  Doulas most certainly provide parents with evidence based information, giving them more tools with which to make informed choices, however, they know that things must work for the ultimate health and well-being of the family.  When parents have explored their options and made a decision that contributes to the family’s happiness (which generally contributes to Baby’s well-being too), the doula will support them.

5) Doulas Honour Mothers

In our fast paced Western culture, we are often so busy trying to do everything “right” by finding the best information, we often forget to slow down and pat ourselves on the back for growing/birthing/parenting a new little citizen as best we can.  We are all already whole.  It’s just that when things feel overwhelming, we forget.  Your doula will not forget.

As a doula, one of the things I try to do for people is uplift them with the honour I have for them.  Sometimes I will look at a mama with a new baby, tears of overwhelm streaming down her face, and I will hold her gaze for a while, seeing her in her wholeness (even when she can’t see it herself). I see her tender vulnerability as well as her wild mama strength .  “I see you,” I’ll say.  And I will smile at her with my whole heart to show her that I uphold her as worthy an beautiful, letting her know that I believe in her.  Reflecting someone’s wholeness back to them helps them to remember who they really are.

You are not alone.  This is not your fault.  With help, you will be well.

With love,