Imagine for a moment, that you are at your annual medical check up. What if, in addition to asking about your diet, taking your vitals, and conducting routine labs, your doctor also asked about your emotional health?  And what if, when you said you had some concerns about your mood, your doctor walked you down the hall to meet with the therapist embedded in her practice. This is integrated mental health care!

Rounding out my series on traumatic birth experiences are some tips on how to best support a friend or loved one after a birth trauma. I also offer some suggestions for OB’s, midwives, and other birth support professionals on how to offer more supportive care. But first, some REAL examples culled from clients (they have given me permission to share their experiences) of things that were said to them by their medical teams and loved ones. 

In this episode of the Psych Central Show, hosts Gabe Howard and Vincent M. Wales welcome guest Dr. Emma Basch. Dr. Basch is a licensed clinical psychologist as well as the author of PsychCentral’s Maternity Matters blog. She joins our hosts (two childless men, it should be noted) to discuss the many aspects of postpartum depression. Listen in to learn some surprising facts and statistics about postpartum depression, including how common it is. Learn how it differs from “regular” depression, the ties it has to anxiety, the known causes of postpartum depression, and several suggestions for how to treat it.

For many women who have experienced a traumatic birth, contemplating a subsequent pregnancy is fraught. This can be true for those who have experienced continued post-traumatic symptoms, as well as for those who’ve felt relatively at peace for some time. In my experience, with a lot of planning and proper supports, it is possible to have a positive birth experience after a traumatic one. Of course, as pregnancy and birth are unpredictable, it may not be the birth you envisioned, but it could still be a reparative and healing experience.

Last week I began to address the topic of traumatic births and postpartum PTSD. This week I want to delve more into the emotional experiences of new moms following a traumatic birth. In my work with postpartum clients, I’ve observed that these reactions often come in waves, with some shifts and changes with time and distance from the trauma. Below are some examples culled from my clinical practice. 

Perhaps you have been imagining your “perfect” birth experience for months. You have a playlist ready to go, a doula, and birth plan on hand. You are prepared, you’ve done your due diligence, you’ve read every book, and then things fall apart.

In the last few years there has been a significant push to screen pregnant and postpartum women for symptoms of depression. In fact, in 2015 the American College of Obstetrics and Gynecologists (ACOG) recommended screening at least once during the perinatal period for symptoms of anxiety and depression using a clinically validated assessment tool such as the EDPS (Edinburgh Postnatal Depression Scale) or the PHQ-9 (Patient Health Questionnaire-9). Several states have followed suit in mandating depression screenings for perinatal populations.

I encourage all my pregnant and postpartum clients to draft a list of ways they would like their medical care providers to interact with them which are supportive of  their emotional needs and bolster their mental health. I refer to this as their Pregnancy/Postpartum Bill of Rights.  Yes, it’s strong rhetoric but the language is intentional as I often see women who are reluctant to advocate for themselves. They don’t want to be difficult, they don’t want to offend, they want to be “good patients.” Consequently, they feel disempowered and their emotional wellbeing suffers.

A few weeks ago, ProPublica published a sobering article entitled The Last Person You’d Expect to Die in Childbirth. The article addressed the extremely high maternal mortality rates in the United States, which are contrasted significantly with low infant mortality rates.

In trying to understand this enormous discrepancy, the authors note numerous examples in which our medical system: from medical education, to Medicaid spending, to hospital credentialing, to routine obstetric and postpartum care protocols; privileges the health of babies while ignoring the health of moms.

Parenting, and particularly parenting a baby, requires an enormous amount of mental and physical effort.  There are the logistical challenges of making sure everyone is fed, clothed, and bathed.  And that everyone gets to where they need to be on time.  There are intense physical demands such as healing a postpartum body, nursing, and getting very little sleep.  And of course, there are significant emotional challenges.  Adjusting to the significant shift in identity (great piece on this here,) struggling with the very real problem of mommy guilt, and managing the emotional labor of a family can take a real toll on one’s emotional wellbeing.