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Maternal mental health was not something that was often talked about back in the 1960s, but thankfully, it is a conversation we are having far more frequently these days. With organizations like Postpartum Progress and Postpartum Support International, as well as many other informal “mom blogs” such as Baby Rabies, ScaryMommy, and Birth Without Fear having regular conversations about maternal mental health, some of the stigma seems to be falling away. But as far as we have come, there’s still a long way to go in the normalization of maternal mental health disorders. The way I look at it, mothers are absolutely the core of our society, and until we prioritize their mental health and well-being, we are doing a disservice to our future generations.
Most people consider pregnancy and birth to be an automatically joyous time in a woman’s life. Even women who so very desperately desired pregnancies can end up suffering from anxiety and depression during their pregnancies or in the postpartum period. This week on Call the Midwife, we met the Dobson family. Eunice appears to be quite far along in her pregnancy, and right away, I could see that something was a little off. It was her avoidance of the topic of the birth, and her purposeful lack of prenatal care that told me that Eunice was dealing with some deep-seated fears.
We learned that Eunice had a very traumatic first birth experience. She had a forceps delivery, which was painful, scary, and she felt very out of control during that entire experience. She tells Lucille that she was begging the doctor to stop, and he did not stop. Eunice was having flashbacks during this current pregnancy where all she could think about was being on her back in that hospital, powerless, and in immense pain. It immediately brought her to a state of panic, and soon she was gasping for air as if she was transported back to that first birth experience. That was hard to watch.
Many people may not realize that birth can trigger something as strong as PTSD, but honestly, it is something that I have seen as a midwife more times than you might think.
I was so grateful for Lucille and her willingness to provide constant support for Eunice. I kept thinking about what a valuable tool a doula would have been for Eunice (if they had even had formal doulas back then!). When you’ve had a previously traumatic birth experience, and know you will be working through some fears during your birth, it can be nice to have someone with you who knows your past and who you are comfortable and familiar with before the day of your birth. In today’s birthing world, it can be especially nice that the familiar support of the doula is guaranteed for your birth. Most modern midwifery practices use a call-based delivery schedule; that is, even if you’ve seen one midwife for all of your prenatal care, it might be a different midwife who is working the day you go into labor.
While the narrator at the end of the show mentioned that Eunice suffered from tocophobia, or a fear of childbirth, I think that fear stemmed from post-traumatic stress disorder (PTSD) after her first birth experience. Many people may not realize that birth can trigger something as strong as PTSD, but honestly, it is something that I have seen as a midwife more times than you might think. In fact, perinatal mood disorders (mood disorders that can happen any time in the pregnancy, birth, and postpartum periods) are much more common than most people think. I’m not sure if there is an actual rise in the numbers of women suffering from perinatal mood disorders, or if with careful screening and building relationships with our clients, we are just diagnosing it more often.
One of the midwives I work with at Henry Ford West Bloomfield Hospital, Sara Mertz, saw all too often that women didn’t have the support or resources she needed when faced with a mood disorder. Sara, who is Postpartum Support International certified provider, worked with the management at Henry Ford and put together a proposal for a perinatal mood disorder clinic. With a lot of hard work and planning, Sara was able to roll out the POST Project this past January! Women are referred by their provider if they are at risk for, or currently are experiencing anxiety, depression, PTSD, obsessive-compulsive disorder, or other significant life stressors. Through their POST visits, they not only get the appropriate clinical prenatal care for where they are at in their pregnancy, but also they can have extra time to ask questions and obtain resources, and have support and treatment of their perinatal mood disorder. Visits might include screening, education, medication, helping someone set up counseling, help identify resources, and assistance with birth planning.
The POST Project at Henry Ford West Bloomfield Hospital has been an overwhelming success thus far. Sara had previously set aside half of her office day specifically for POST visits, but the demand has caused her to add on extra time in order to accomodate mothers in a timely fashion. Sara is passionate about this project; she knew that it was unacceptable to make a woman wait weeks for an appointment when this type of care is not something that should wait. Sara’s success and the impact she has made for so many women has inspired me as a provider, and I’m hoping to also complete the Postpartum Support International training in the near future.
For more information or scheduling with the POST Project clinic at Henry Ford West Bloomfield Hospital, please call (248)-661-7002.
Andrea Altomaro (MS, RN, CNM) has been nurse-midwife for the past three years and is currently working for the Henry Ford Health System. Before becoming a midwife, she worked as a nurse in the emergency department and also in labor and delivery.
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