Preventing Post Natal Anxiety and Depression

I was talking to someone about 'birth disappointment' the other day, and was told "women should not have such high expectations! Honestly women these days are just so fragile".  I took a deep breath before responding. If a healthy woman is expecting a 'normal birth' that is not a high expectation.  That is a reasonable and minimal expectation.  It is not 'fragile' to be disappointed by a birth that does not met this expectation.  For women to lower their expectations of birth, to the reality of the current birth climate, would set a new (horribly) low benchmark.  Along with "all that matters is a healthy baby" these comments tell us that women do not matter. First Class Maternity Care - it's a political choice (first class care should be the MINIMUM we expect!).  

You see...this birth disappointment may just be putting new mothers at greater risk of Post Natal Anxiety and ​Depression (1).   They begin their mothering journey full of self-doubt, and uncertainty. This can then be compounded by a mothering reality that does not meet their expectations.

PANDA
National Perinatal Anxiety & Depression Helpline offers free counselling and support for all new and expecting parents.
PANDA National Helpline 
(Mon to Fri, 9am - 7.30pm AEST/AEDT) 
Call 1300 726 306

My own mothering journey led to the writing of ​The Birth Map: boldly going where no birth plan has gone before.  This was a book that almost wrote itself (2).  It was a response to the inadequacies of the system, based on stories of my mother-friends and my subsequent journey into doulaing.  

I found myself on a mission (3):

To provide all women with the means to make  informed decisions regarding their pregnancy care, labour, birth and parenting.

My hypothesis is that this is the key to helping prevent PND.  That by giving women the means to make informed decisions about their birth, and beyond, during their pregnancy we are helping to safe guard families.  There is mounting evidence to support this, and a PhD looms in my future to look specifically at the impact of The Birth Map  as this means.
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​I would love to see a change in the system (4), one that values informed decision making, mothering and families.

The system requires women to 'provide informed consent' for various procedures and interventions.  Due to the 'unpredictable' nature of birth, this consent is sort in the moment...so is never informed.  This is a huge contributor to the feelings of disappointment, and even trauma, increasingly experienced by new (and unsuspecting) parents.  The disservice here being that there is a (misguided) assumption that the system cares (5).  Midwives care, but are held to account by the system.  It is for this reason that I focus on Informed Decisions rather than consent (6). 

In order to begin making informed decisions 
we need to know The Questions!

When we do not know what we do not know, we can not begin to be informed.  When hindsight reveals the gaps in our knowledge, this is where the sense of failure, disappointment or trauma can arise.  We begin to wonder, what else is not known.  And without guidance, this breeds anxiety.

THREE ELEMENTS TO HELP PREVENT PND:

1. The Birth Map provides the landscape, with an understanding of the key features, possible detours and the people you might met along the way.  Including beyond birth.
   
2. A doula provides the guidance (not unlike a sherpa aiding an Everest climb).  The guidance and support of a doula can be engaged before, during and after the birth.
   
3. Independent childbirth classes provides the training, if a natural birth is the expectation.  

Have you ever been told to leave your dignity at the door? 
​This (well meaning) advice, along with that in the opening statement of this piece, may also accompany "but your baby is healthy...".  This idea that women should be grateful for the state of maternity care is a feminist issue (7). 

Click here for Further Reading on how other cultures approach the postpartum period.

Modern Mothering tends to be a very isolating experience.  Just as wedding planning focuses on The Big Day, so too does most birth planning.  

Informed Birth Preparation includes focusing on life with a new baby.  One aspect of this is setting up support for the 'fourth trimester'.

This  practical support (chores, meals, help with older siblings) is often enough to help prevent post natal depression.  This kind of support acknowledges the importance of mothering and mothers, and ensures they are not isolated and swamped by non-mothering work* by default.

*this is called 'housework' and is the responsibility of all who dwell in, or even visit, a house. See also: self care are you making mountains out of washing piles

References:
(1) https://www.panda.org.au/info-support/after-birth/contributing-factors-for-postnatal-depression-or-anxiety 
​(2) more than just another birth book 
(3) Mothers Matter! 
(4) Talking about The Birth Map 
​(5) The care factor 
​(6) we should be focused on choice not consent 
(7) maternal feminism in the brave new world