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Serving the Greater Los Angeles area
Serving the Greater Los Angeles area

Postpartum Depression and the Birth Experience

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Childbirth-education-classes-to-avoid-postpartum-birth-experience

Nancy Wainer, author of Silent Knife, and Open Season, writes about her years as a birth advocate and midwife and the thousands of women she has helped to process their birth experiences, either in the wake of postpartum depression (PPD) or not. She also draws from her own 3 birth and postpartum experiences – an unwanted, preventable cesarean, a medicated birth with unwanted interventions, and a natural homebirth.

When considering that how a woman gives birth influences whether or not she experiences postpartum depression, she found that nearly 100% of the women she had worked with over the past four decades who’d had the trademark symptoms of PPD soon after birth didn’t have it with their subsequent babies if they had different/positive birth experiences. What happens during labor, at the time of birth, and during the first hours following the baby’s arrival, has quite a bit to do with whether or not a woman is depressed after her baby is born. Few want to consider also that what takes place during the pregnancy, the kind of prenatal care—or non-care, which is what most American women receive—also has an influence on mood and adjustment after birth.

She found that the following elements put women at a disadvantage: 

-being seen by obstetricians or medical midwives who have never had a natural birth themselves—and who may or may not even be at the birth. 

-being given no solid counseling during pregnancy; discussions about nutrition, getting and staying healthy, avoiding postpartum depression, and learning about bonding are dismissed in favor of “the numbers”—weight gain, blood pressure, and fetal heart rate 

– having sat in waiting rooms for upward of 30–45 minutes, only to be seen by any one of a dozen providers for anywhere from 6 to 11 minutes

– having undesired interventions during the birth, including induction to make labor begin

In contrast, the women in her midwifery practice know that they will be seen for at least an hour, if not more. They know that there will be a discussion about nutrition, sex during pregnancy, and fear. They know that at birth they will be supported by two or three women whom they have come to know and who have themselves had natural births. They learn that a medicated birth can interfere with certain hormones that help the woman feel good after birth and keep her energized and focused. They learn what they can do to help increase the chances that they have a healthy baby. 

One of her clients had been seeing a psychiatrist and taking medications since her 4th cesarean birth. After spending 3 sessions with Nancy and being asked to tell her birth stories, in detail, sobbing, being rocked, and being given feedback on what had taken place, she left the psychiatrist and no longer needed the antidepressants. She understood that she had made the decisions about her births based on information at the time, fear, and concern for her babies. She realized that the lack of understanding about her disappointment regarding the births, having to recover from major surgery while taking care of newborn and young children, being up all night nursing, and everyone’s complete lack of empathy for her were key issues in her having had PPD. She had a home birth with her 5th child.

It is very healing and powerful when a woman tells her story over and over again, peels its layers, and is heard. She then doesn’t carry the weight of it with her wherever she goes. Letting her know that she is justified in feeling the way she does, after having either been treated poorly or ending up with a surgery she never expected or wanted, is validating and comforting. This puts things into a perspective that allows her to process the experience and learn from it. Being invalidated “all that matters is a healthy baby; you should be happy” is a recipe for PPD. It not only invalidates but adds guilt to any feelings of normal grief. This can interfere with bonding, which then adds another layer of postpartum distress.

Nancy has written books about helping women through feelings of sadness and sorrow after their babies were born. She has found that the more she works with women postpartum, the more she correlates PPD with the rising rates of unnatural births, inductions, epidurals, and cesareans in this culture. Much of prenatal testing, some of which is unreliable and unnecessary, adds to women’s disconnect from their own bodies and contributes to women feeling frightened, disempowered, and vulnerable rather than strong and ready—to birth and become mothers—which can lead to and later exacerbate PPD.

Childbirth education classes can hugely help with the prevention of PPD. We must talk about the kind of care they deserve during pregnancy and the kinds of things they can discuss. We acknowledge the changes/losses that women and their partners go through after the baby is born. Even after a normal, healthy, happy birth women lose their bodies as they knew them, and some lose the ability to bring in a paycheck for a period of time after the baby is born (unlike many countries in Europe and elsewhere, which provide a year paid maternity leave). Their relationship with their partner changes as does their connection to friends who don’t have kids. The spontaneity and freedom of their lives change. Their sexual connection to their partners may change for at least a period of time after the birth. Loss of sleep causes even the best of us to feel disoriented and upset. Dads/partners and their potential issues of anxiety, upheaval, and distress are essential subjects. All these losses and changes can set the stage for PPD when they are not expected or have not been discussed. When these subjects are included in classes on labor and birth, couples are far more prepared to face the first days and weeks with a realistic mindset, which helps them to cope and to keep any kind of serious PPD at bay. 

Our culture generally lives in isolated family units so that the woman is responsible for taking care of her newborn, herself, her other children, her home, and life in general—not to mention having to return to work within just a few weeks or months of the baby’s arrival. Anyone would feel overwhelmed and depressed having to deal with all that after having brought life to the planet.

Nancy reports seeing women who previously had miserable, interfered-with births that resulted in PPD—including feelings of failure, distance from their partners and babies, lack of energy, and feelings of anger, confusion, overwhelm, and sadness. These women were—or initially believed they were—candidates for PPD after their next birth and were delighted, surprised, and relieved when they birthed naturally and were free from any of the debilitating and disturbing symptoms that plagued them previously. 

Women need to feel well; they are taking care of beings who are dependent on them and who deserve happy, emotionally healthy beings at the helm. Women are generally resilient, creative, communicative, and resourceful and when they get the kind of support, caring, and listening they need, good things—including healing—happen. The increase in PPD that has been noted in this culture may very well be preventable, but in order to quell the tide, we must look at the whole picture and change much of how we view and “take care of” pregnant women before, during, and after their pregnancies, as they give birth, and during the postpartum period and beyond.

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