Postpartum Mood Disorders

Midwifery Today E-News, July 5, 2017 • Volume 19, Issue 14
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“Listen to the people who love you. Believe that they are worth living for even when you don’t believe it. Seek out the memories depression takes away and project them into the future. Be brave; be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds. Eat when food itself disgusts you. Reason with yourself when you have lost your reason.”

— Andrew Solomon, The Noonday Demon: An Atlas of Depression

Read about the third stage of labor!

The Third Stage of Labor e-book is packed with information about the umbilical cord, the placenta and natural approaches to this phase of birth. This collection of 15 articles from past issues of Midwifery Today magazine includes “Placenta Accreta” by Marion Toepke McLean, “Cord Burning” by Kelly Dunn, “On Meconium at Home and Delayed Cord-cutting” by Naolí Vinaver, “Placenta Rituals and Folklore from Around the World” by Sarah J. Buckley and “The Problem Is Induction, Not Meconium” by Gail Hart. Buy your copy and have it with you at the next birth you attend!

Order your copy on Amazon or on Smashwords in a variety of formats.

Conference Chatter

Imagine you walk into a room and are surrounded by some of the world’s most respected and well-known practitioners of the birth community. Now take it one step further and you can float from one circle to the next to learn from these amazing teachers. One of Midwifery Today’s most beloved learning formats allows participants to sit in on three interesting and inspiring roundtables of their choice.

As conference coordinator, I am often busy during conferences and I am not able to attend sessions. However, sometimes I have a free moment and have the opportunity to sit in on a session. As a birth practitioner myself, I find that these moments where I become a conference participant are a true treat and highlight for me.

This past April during our Eugene conference, “The Heart and Science of Birth,” I attended our roundtable evening—and it was one of my favorite parts of the conference. During this two-hour session, I sat and chatted with Marion Toepke McLean and learned all about tropical diseases and how they affect childbearing women and had an insanely amazing session with Sister MorningStar regarding solving shoulder dystocia. To top it off, I had the pleasure of sitting in with other doulas and Maryl Smith learning not only how to apply Cherokee wisdom in my own life, but also how to incorporate this sacred wisdom in my birthing community. It was an evening that will stay with me for many years to come and I feel like I not only learned a great deal, but I left that evening feeling so inspired.

As a practitioner and conference coordinator, I believe that one of the most important aspects of Midwifery Today’s conferences is the abundant moments where attendees not only walk away with an increased skill base, but also go home inspired and refreshed. As birth practitioners, we give so much of ourselves to our clients and our community. We do so happily, but not without cost to us personally. One of the ways we can actively recharge ourselves is to attend the Midwifery Today conferences and come together as a community to learn, support one another and walk away with our buckets filled, so we are able to give back to our clients.

On Saturday, October 7, 2017, from 4–6 pm during our conference in Helsinki, Finland, we will offer 13 cultural and clinical roundtables with a variety a learning opportunities. This evening—along with all the other incredible sessions offered throughout the conference—will offer a wide range of topics to glean from. We hope you join us for an amazing five days in beautiful Helsinki!
Cultural and Clinical Roundtables, Saturday, October 7, 2017, 4:00 pm 6:00 pm

  • Twins, Rebekka Visser
  • Posterior Babies, Jennifer Walker
  • Tear Prevention, Tine Greve
  • Issues with Grand Multiparas, Fernando Molina
  • New Research on Preeclampsia, Gail Hart
  • How to Involve the Partner in Antenatal Classes and Birth Classes, Thea van Tuyl and Mirjam de Keijzer
  • Women’s Health and Well-being, Kerstin Uvnas Moberg
  • How to Confirm Labor Progress without Vaginal Exam, Sally Kelly
  • And many more!

— Shea Baker Hardy

Inspiring speakers and exciting classes…

…are in store for you when you attend our conference in Helsinki, Finland, this October. Learn from teachers such as Elizabeth Davis, Fernando Molina, Cornelia Enning, Sally Kelly and Gail Hart. Planned classes include Acupressure and Cupping for Birth Practitioners, Gua Sha for Pregnancy and Birth, Placenta Medicine, and Shoulder Dystocia. Register today!

Postpartum Mood Disorders

While this article was still germinating in my mind, I sat down in front of my computer to reach out via social media. I asked folks to share their experience with postpartum depression (PPD) in three words. What happened next was something I was not entirely prepared for or expecting. Immediately, the responses began to flood in; it was a wave of intensity and vulnerability. Here are some examples of what was shared:

Dark Deep Alone
Awake Vulnerable Sinking
Rage Powerless Foggy
Lonely Disconnected Consuming
Zombie Trapped Paranoid
Incompetent Jumpy Disappearing

Overwhelmed Agitated Guilty
Crushing Exhausting Unpredictable
Isolated Confusing Robbed
Shame Hopeless Immobilized
Drowning Frantic Terrified
Racing Irrational Panic
Suffocating Inadequate Numb

Please take some time to sit with these words, breathe deep with their meanings, feel them and move through them. Initially, the heaviness of these words was overwhelming but then as I sat with them, the process became beautiful and fulfilling. One overarching theme of postpartum depression is the lack of awareness regarding how the sufferer feels alone. What happened on my Facebook page was that a group of women stood up and spoke out, sharing and recognizing this side of motherhood. The sadness then transformed into something inspirational.

The power of our communities and our shared experiences can and should be uplifting. Putting the harsh reality of this experience into words, writing them out and then sharing them with others can be liberating. Reading and then knowing that you are not alone can be empowering. There is an unfortunate stigma around PPD in our mainstream culture; we need to rise above it, speak out and use our collective voices to support each other through this often misunderstood side of motherhood.

What Are Postpartum Mood Disorders?

The term postpartum depression (PPD) can be misleading. It is perhaps an over-simplified and poor description of the array of experiences that postpartum women can have. The experience of PPD is much broader and can encompass much more than feelings of depression. For some it acts and feels like postpartum anxiety (PPA) or for others like obsessive-compulsive disorder (PPOCD). There is also perinatal-related posttraumatic stress disorder (PTSD). For some, a postpartum mood disorder will include symptoms of all of these. In very rare cases—one to two out of every 1000 births—postpartum psychosis (PPP) can occur. In reality this experience is better described as postpartum mood disorder (PPMD) and many professionals and organizations have begun to apply this more comprehensive term. PPMDs can be experienced by any postpartum woman; first-time moms or those with four children, single women, partnered people, folks from high or low socioeconomic groups, women of any age group. Basically, PPMDs are equal opportunity attackers and all women should be screened for these conditions.

What Are the Symptoms of PPMD?

Up to 80% of postpartum women will experience “baby blues,” which are characterized by crying or weepiness for no apparent reason, insomnia, mood swings, restlessness, irritability and poor concentration. When I talk with clients about this, I point out that in the immediate postpartum period our hormones often take us on a roller-coaster ride as they re-settle after the pregnancy and birth. That journey, coupled with the lack of sleep and adjustment to the new baby is enough to make many people feel these baby blues in the first few weeks after birth. This process is normal and requires gentle support from care providers and family, assistance with household chores and meal prep, encouragement to sleep and rest, friendly visits to prevent feelings of isolation, etc. Many women will find that such feelings resolve and they can move through the experience with the necessary support and rest.

For 10–15% of women, the baby blues will progress to become a PPMD. Many of the symptoms of PPMD are similar to those associated with the baby blues. However, these feelings will persist past the first two to four weeks and will be more intense. They include:

  • Loss of interest in activities previously enjoyed
  • Overwhelming sadness
  • Persistent anxiety or panic attacks
  • Intrusive, repetitive or racing thoughts
  • Insomnia
  • Excessive irritability, anger or agitation
  • Extreme mood swings
  • Disinterest in baby or family members
  • Changes in dietary habits—eating much more or much less than usual for the individual
  • Problems with concentration and memory
  • Feelings of guilt or being unworthy
  • Thoughts of harming self, baby or family members

People who experience these symptoms require the same gentle community support mentioned above and a more intensive, structured level of support. For midwives, it is critical to be aware of these symptoms and to actively screen our clients.

How and Whom Do We Screen for PPMD?

As stated above, any person can experience PPMD, so we cannot assume that a particular person is immune. Due to the stigma associated with PPMD and potential fear of speaking out, having a protocol for routine screening of all clients is helpful. That way, you can explain that it is standard so an individual does not feel singled out in any way. For example, at my practice, we routinely screen all clients at 28 weeks gestation during the pregnancy and at six weeks postpartum. If we have concerns about a particular person based on observation or risk factors, we will screen more often.

Several tools are available to use for screening. The most well established and widely used is the Edinburgh Postnatal Depression Scale or EPDS. Other tools are available, as well; the most important thing is to pick a tool and become familiar with how to use and score it. Also, be aware that numbers on a piece of paper are just that. Ideally, the tool should be used only as a jumping off point to open a dialogue.

Next, after screening, it is essential to have resources and intervention strategies available for those women who will benefit from them. We cannot simply screen and identify; we must take the next step to assist in healing and support. Additionally, it is critical to have a plan in place for immediate intervention if a client reports an active desire to harm herself or others. This will likely not happen often, however, when it does it cannot be ignored or brushed off. Know the resources in your area and develop a strong protocol for responding.


— Aubre Tompkins, Midwifery Today, Spring 2017, Issue 121

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Website Highlight

Learn about our domestic conference in New Jersey next year. The web page for the April 2018 conference in the beautiful town of Mount Laurel is now live. We have posted a letter from Jan Tritten, a list of excellent speakers and our sample of the over 50 topics to be presented. Visit page.

Do you work with laboring women?

Then you need the sixth edition of Anne Frye’s Healing Passage, A Midwife’s Guide to the Care and Repair of the Tissues Involved in Birth. Even if you have an earlier version, you’ll want this one, which is more than twice as long as the fifth and packed with vital information about the art and science of perineal care and repair. The anatomy section has been completely overhauled, the suturing lessons have been expanded and the information about tear repair has been updated. You’ll also find a completely new pelvic floor model with pattern and instructions in the appendices. Price: US $75.00 plus $10.95 S&H (US delivery).

Placenta rituals, remedies and recipes…

…are what you’ll find in Placenta: The Gift of Life. Read this book to discover the various ways placentas have been used by people around the world and throughout the ages. You’ll also find 15 recipes that will show you how to use the placenta in ointments, essences and other remedies for a variety of ailments. Price: US $21.95 plus $4.95 S&H (US delivery). Order your copy here.

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