pregnancy

Bringing new mothers’ pain out of the shadows

More needs to be done to raise awareness about the devastation of postpartum depression among the public and medical community and to make effective treatment widely available.

Kimberly Wong

Public defender Kimberly Wong, who suffered severe postpartum depression, founded the Los Angeles County Perinatal Mental Health Task Force to raise awareness about the illness. (Christina House, For The Times / July 29, 2012)

By Kurt StreeterJuly 29, 2012 

Just like for so many others, including my wife, Kimberly Wong didn’t see the darkness coming, and nobody warned her that it could.

Here’s what happened. After years of trying, Wong got pregnant and at first everything went perfectly. The lead-up, the birth, the first week with the new baby, a cute little girl she and her husband named Marley.

Then out of nowhere this tough-minded public defender crumbled. Wong’s skin felt like it was being zapped by a cattle prod. Her resting heart rate was often 100. She could barely eat, sleep, slow down or think cogent thoughts.

Her doctor told her she was simply a high-strung lawyer who needed to relax. So she blamed herself, which made matters worse.

It didn’t help that the doctor’s advice made no sense. Wong had something relaxation can’t cure. She’d been hit by postpartum depression, brought on by, more than anything else, whipsaw hormonal changes that come with giving birth.

This isn’t something we can afford to keep sweeping into the shadows.

Experts say 10% to 20% of new mothers experience it: a steep drop in mood that’s far more devastating and lasts far longer than two or three weeks of the so-called baby blues.

Wong had the worst type. She penned a suicide note. By luck, her husband walked in on her. He took her to a Mid-City mental hospital so she wouldn’t harm herself. Nobody at the hospital had much expertise in what she was battling.

That’s when Wong realized how few options there are for women who need psychological help related specifically to motherhood. She had to drive 50 miles to find a doctor and a support group that really understood.

You should know that time has passed, about eight years since the height of it, and Wong and her family have bounced back. In fact, she has turned her struggles into something good.

“I’m trying to make sure other moms don’t go through what I did,” she says.

When she’s not working at the public defender’s office, she focuses on the nonprofit she started: the Los Angeles County Perinatal Mental Health Task Force. Sure, clunky name, but can there be a more important cause?

Experts say that in L.A. County alone, about 22,000 new mothers suffer from this awful malady every year.That’s 22,000 women — as well as their babies and partners — who need special support and too often aren’t getting it.

The task force — bare bones, operating largely on the energy of volunteers — aims to push us out of the shadows: moms and families who need help but are too embarrassed or just don’t know where to turn; doctors and social workers who are either ill-informed on the nuances of this illness or just don’t look hard enough for the warning signs.

Wong’s doctors didn’t really talk about the possibility she could grow terribly depressed after giving birth, she said. They should have.

She’d suffered childhood trauma: Her mother died when Wong was 11. There was a history of mental illness in her family, and she’d struggled to conceive. Those three facts put her at risk, but no doctors warned her, nobody came up with a plan that could have shielded her from near-fatal darkness.

“There’s just so much stigma that needs to be shattered,” Wong says. “I want people to talk about this like they talk about diabetes or having a bad heart. Not enough has changed since this happened and when it did happen I could barely get help.

“I’m a professional from West L.A. and it was hard enough for me,” she adds. “So think about women in poor communities with little access to good healthcare. Add it up and so many are suffering and the long-term effects for families can be devastating. Yeah, we need to talk.”

I know.

After the birth of our son in 2010, my wife battled postpartum depression. It wasn’t anywhere nearly as serious as what Wong went through and that’s important to know: This malady shows up in different strengths.

My wife’s was a more typical case. She wasn’t close to hurting herself or being put in a hospital. She did everything anyone could ask for our son. But for long, long months she lived in a world of sharp, shattering emotion that could have been avoided if we’d known more or had more aggressive help.

It could have broken my wife. What if she hadn’t had a partner to help? What if she had been poor? We’re insured, and even then it took a while for her doctors to understand how serious this was. But eventually she found a therapist who could talk her through the trouble.

Part of the problem is we live in a world swaddled in golden-hued mythology about parenthood. It’s supposed to be full of nothing but joy. If it isn’t, then moms are told to get more sleep and toughen up. That’s not helpful when depression sinks in its claws.

“A lot of us hide from this issue,” says Wong. “That has to change.”

She’s talking. So am I. So is my wife, who pushed me to write about her ordeal. If you care about mothers and children and families, well, you should be talking too.

kurt.streeter@latimes.com

Copyright © 2012, Los Angeles Times

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What is a Doula and Why Do I Need One?

So you’re having a baby? Great! You’ve decided on a doctor or a midwife, you’ve been taking your prenatal vitamins and you may even be starting to think about the birth itself. You’re in the beginning stages of developing a team of people who are going to support you through the birth process.

Regardless of whether you planning on delivering your baby home, at a birthing center or at a hospital, one of these people you might consider having present at your birth to support you is a DOULA.

A DOULA? WHAT IS A DOULA?
In essence, a doula is a fancy word for an old concept. In cultures all over the world, women attend births. Women have assisted other women in giving birth for thousands of years. With the onset of industrialization and the tendency for birth to be a medical procedure, rather than a naturally occurring event, the concept of a birthing assistant has fallen by the wayside. In recent years, the idea of employing women to attend births has come back into favor and thus enters the doula.

A doula (usually a woman) is a person who assists women with the birthing process. A birth doula is “a supportive companion professionally trained to provide physical and emotional support during labor and birth…She provides continuous support, beginning during early or active labor, through birth, and for approximately two hours following the birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement, positioning, and massage. She also assists families with gathering information about the course of labor and their options. Her most critical role is providing continuous emotional reassurance and comfort.”

http://www.transitiontoparenthood.com/ttp/Doula/doulahome.htm

Some hospitals are even starting to provide doulas to women when they come to the hospital in labor, but this is rare. Woodwinds Hospital, a local hospital in MN, has a volunteer program providing this service called Doulas at Woodwinds.

WHAT DOES A DOULA COST?
Most doulas charge a flat rate for the entire pregnancy and delivery and all services rendered during this time. As I recall, the cost generally ranges from somewhere around $800.00 – $1,500.00. (Just an estimate.)

WHAT DO YOU GET FOR THE COST?
Doulas general provide services for three purposes: (a) prenatal visits, (b) delivery of the baby, and (c) postnatal visits. The doulas are on call during your birth and will be there regardless of the day or the time of day, unless they have informed you otherwise. The frequency and content of the visits may vary from doula to doula so be sure to ask lots of questions when interviewing your doulas.

1. Doulas usually do a few prenatal visits and will help you prepare a birth plan. They will talk to you about what you want during your labor and delivery and go over some of the choices you might have (types of pain relief, cord cutting, membrane stripping, etc.)

2. Doulas come to your house when you start to go into labor regardless of where you plan on giving birth. Their philosophy is geared towards laboring at home for as long as possible. If you go into labor quickly and are delivering at a hospital they will come as soon as you are admitted and will stay with you until the baby comes and for a few hours afterwards. Their rate includes your entire labor even if you labor for 48 hours, God forbid. If you deliver your baby in your home or in a birthing center, they would do the same thing, only in those places instead.

3. They also make one or two visits to your home after the baby has gone home with you. They will assist with breastfeeding, comforting your baby and adjusting to being a mom, if it’s your first time.

WHAT IS THE ROLE OF A DOULA DURING THE BIRTH?
The role of the doula is to assist the birthing mother with whatever it is that she needs. She is like a personal assistant. If you want her to clear the room of people, she will do that. If she wants you to get your husband or partner to help out or give a massage, she will do that. Basically she is at your beck and call throughout the labor. She will help you find good positions to labor in and will be very active or play a background role depending on what you want. If your partner is actively involved in the delivery she might provide gentle suggestions on helping you through the labor and delivery. Her main role is to act as your advocate and to see that you are getting your needs met such that the delivery is as comfortable as it possible can be.

If you end up having a Cesarean the doula can also enter the operating room. They usually have a limit on how many extra people can be there so you may have to choose between your birthing partner, if you have one, and the doula.

DO DOULAS HAVE MEDICAL TRAINING?
Doulas are not medically trained in the traditional sense. They do come with tons of knowledge about birth and labor and will provide you with suggestions about when to rest and when to move around and what positions you might try during labor. However, they are trained not to communicate with the medical staff directly regarding your medical condition. They will prompt you to communicate to the medical staff about a wish or desire that you had (such as not wanting the cord cut or skin-to-skin contact, etc.).

HOW DO I GO ABOUT FINDING THE RIGHT DOULA FOR ME?
1. The hospital where you are delivering may have a list of doulas that you can contact. In addition, you can read about them on the web (they may have their own websites) and if they look like someone you are interested in they will meet with you so that you can see if you like them and if you want to hire them.

2. On-line directories such as this one: http://doulanetwork.com/directory/Minnesota/ may be available in your area as well.

3. In Minnesota we have something called the Childbirth Collective and they have a “Meet the Doulas” night. It’s a great thing because you can meet a bunch of doulas all at one time and if you see one you like you can try to get an appointment set up for a meet and greet to see if you want to hire them.

From their website: The Childbirth Collective is a “collective of birth professionals who support women and families during the childbearing year. Perhaps you are looking for a birth doula, midwife, birth photographer, massage therapist or a postpartum doula. The Childbirth Collective is the place to connect with a growing and passionate community that cares about how you birth.”

Regardless of where you find your doula, make sure you interview a few so that you are comfortable with the one you choose. She is going to see you through one of the most challenging and amazing experiences of your life. Liking your doula will only make it a more positive experience.

WHAT ARE THE BENEFITS OF A DOULA?

From: “What is a Doula?

  • Reduces the need for forceps or vacuum extractor by 41%
  • Reduces need for Cesarean by 26%
  • Decreases medical intervention in labor
  • Reduces use of pain medication by 28%
  • Reduces dissatisfaction with birth by 33%
  • Reduces length of labor

Six weeks after birth, mothers who had doulas were:

  • Less anxious and depressed
  • Had more confidence with baby
  • More satisfied w/ partner
  • More likely to be breastfeeding

Homebirth Midwifery Care, Birth and Postpartum Doula Support and Massage Therapy Center http://www.geneabirth.com/

These two women look they provide a wonderful array of services. They provide Midwifery services, Doula services and Birth Massage.

They will also assist in at-home births for VBAC women, also known as the HBAC (Home Birth After Cesarean).

Awesome!

The massage service includes a two and a half hour massage during your labor with a certified prenatal massage therapist. Their massage therapist has also been a doula for eleven years and can guide you with the best positions to be in for early and active labor. The service includes meeting with the therapist to discuss the type of massage you would like to use in labor, and picking out the scents/s you would like to use in labor. She will then make an oil using Young Living Oils that you will bring home with you. In labor, the massage therapist will come to your home or visit you at the hospital/birth center for a two and a half hour massage that will help you to enter your labor in a calm and centered place. This massage is specifically tailored to you and your needs. She can come at any point during your labor, but early labor is usually the best.

NOTE: I know that for you around the country this particularly birth center might not be a possibility but perhaps there are other birth centers in your area that offer similar services. It’s good to know that places like this exist.

Additional Resources:

What is a Doula? (http://www.dona.org/mothers/index.php)
DONA International (http://www.dona.org/)
What is a Doula? (www.transitiontoparenthood.com/ttp/Doula/doulahome.htm)

I Have Two Names Now: Mommy and Christina

To My Daughter, on Her Third Birthday

Three years and two days ago, I had one name: Christina.

I wore it and I wore it well. I studied, I worked and I played. I danced and climbed mountains and ran like the wind. I was free and there was no one to stop me. I loved life and it loved me.

But then one July a little seed was planted inside me and it grew. It grew and it grew and it grew. That little seed was you.

Then forty-two weeks later, on the nose, with a big belly about to explode, out you came, quicker than I thought. No long labor, no deliberation. It was time and the doctors and nurses knew, even before I did.

Faster than I could blink an eye you were in the world. And there you were. They held you up and I saw you over the sheet. You were a baby. My baby! I couldn’t believe my eyes. 

They measured you and weighed you and then they brought you to me. They put you naked on my chest, just as I had asked, right next to the sheet that separated you and me from the men and women that had so carefully and attentively brought you into the world.

You cried and suckled and took to the world like it was yours to keep.

You stayed beside me while I healed. I never let you out of my sight. You lay on me and in the crook of my arm while I nursed you, watched you sleep, and nursed you some more. I learned how to swaddle you and to change your diaper and to feed you. I learned how to care for you.

Most importantly, I kept you next to me as much as I could. Not only had I read all of the books but I knew in my heart that that was where you belonged.

The little you, who was also a big part of me, lay beside me for four long days before I could take you home. 

At first I was uncertain about this new, crying being who needed so much from me and without a pause. Is this what I had wanted? Is this what I had asked for? Is this what I had expected?

Despite all the preparation, I did not feel prepared.

Oh sure, I had the co-sleeper and the swings and the bottles and the bibs and the onesies. It was all there. But somehow you can’t buy the one thing that one really needs: Experience.

I don’t think one can ever be truly prepared for what lies beyond the birth of a first child.

People had told me my life would change but I didn’t believe them. How can a little baby like that be so much work, I’d ask? My life will be the same; I’ll just have a baby along for the ride from now on.

They would just shake their head and smile. They knew it could not be explained. And they knew I was in for a shock.

After some time of getting used to you, I started to change.

“Here, give her to me. I know what to do,” I’d say to those who didn’t know.

We worked together—she at being in the world, and me at learning to give 100% of myself to someone other than myself.

We’ve seen some good times and some bad times. We’ve worked through some smiles and some tears. I’ve watched as she’s reached many milestones – usually without any help from me. I’ve had many sleepless nights and have cleaned up a number of messes in the middle of those long seemingly endless times. I’ve seen her grow from a little baby, into a toddler, and soon into a little girl.

After three years, I think I have finally made the transition.

Yes, it has taken that long.

Up until a few months ago, I was only known as “Momma!” “Momma!” “Momma!” Usually with arms stretched high. “Up!” she’d demand.

A few weeks ago, for the first time, my little girl looked at me and said something like “Mommy, what you doing?”

My heart melted. I almost cried.

Where had she learned this word? Where did “Mommy” come from? I knew it was me, but I still couldn’t believe it….Me? Mommy? Yes, I am Mommy!

So now I have two names: Christina AND Mommy.

And there are some things Mommy knows how to do better than Christina could have ever done them.

Mommy knows how to choose a cloth diaper, fit it, change it, and clean it.

Mommy knows how to call the doctor in the middle of the night and how to put a wheezing baby on the phone.

Mommy knows how to put an infant and a toddler to the breast.

Mommy knows how to soothe a colicky baby like nobody’s business! I lovingly refer to her as “The Baby Whisperer.”

Mommy knows how to give really big hugs and how to kiss really little toes.

Mommy knows what it’s like to have a baby sleep on her chest all night long while keeping one eye open, just in case.

Mommy knows that a cookie can fix just about anything and that a song can soothe most of what ails.

And Christina knows a thing or two, too.

Christina isn’t climbing rocks much these days. Christina isn’t running as fast as the wind anymore.

But Christina knows that special feeling of having a baby kick the inside of her stomach, and that amazing “thump, thump” when the doctor checks for a heartbeat.

Christina also knows what it’s like to go to work every day while still remembering that there’s a very little girl out there who needs her Mommy.

And Christina knows when it’s time to take her baby from some other caring adult just because her girl will only be soothed by her.

And, most importantly, Christina knows to bend down when she picks her baby girl up from school because there she’ll be, a little girl now, grinning from ear to ear, running towards her, reaching out, calling “Mommy, Mommy!”

And Christina knows, that no matter how much she may miss parts of who she used to be, the little girl who calls her Mommy fills an amazing spot in her heart that no one else can ever replace.

Happy birthday, Baby Girl.

Love, Your Mommy.