Blog

Birth Trauma and the Pelvic Floor

Nadia Qahwash
Pelvic Health Physiotherapist
Encompass Health & Wellness
https://www.encompasshealth.ca/

As a Pelvic Health physiotherapist, I have had the pleasure of meeting many wonderful birthing parents who have had the courage to share their birthing stories with me. These stories vary from positive experiences to extremely distressing, negative stories that have left these parents feeling alien to themselves, their bodies and their minds.

The postpartum stage in a birthing parent’s life can be both a mental and physical struggle that makes it difficult for one to function in their daily social life and relationships. They are dealing with hormonal changes, caring for a tiny human that relies heavily on them, and mentally trying to process the traumatic experience that labour and delivery can sometimes create.

Through my experience as a pelvic health physiotherapist, the best way to approach these stories is with a listening ear, empathy and stepping back to look at the person as whole, and what they may need. Trying to understand their traumatic birthing experience is the first step in a pelvic physiotherapy assessment. What is important to highlight here, is that some of the physical symptoms these patients present with in my office, can often be linked to the trauma they have gone through. Although you can gather some information from an internal vaginal exam during an assessment, it is not always the best route to take with patients who have experienced birth trauma or any other trauma for that matter. I rarely will do an internal assessment on an individual who is clearly still processing their emotions about the trauma they have endured. The whole premise of the assessment in these particular cases would be to calm the central nervous system using various breath work techniques that reduce tension in the muscles and develop a trust between you and the patient. At some point an internal examination may be completed only when the patient feels ready and with their consent. During the internal examination, I am making note of any tension or trigger points internally. I am also checking the strength and endurance of the muscle, and how these muscles respond to touch.

In most cases, birthing parents require additional help from other health care professionals, such as a licensed counselor. This may help sort out some of the lasting effects of the trauma they have experienced and help these patients move forward in the healthiest way possible. I often will refer my patients to a trauma counselor and work alongside them in order to provide the best patient centered care.

Every birth trauma story is very different and perceived differently by the individual. It is important to listen carefully to the story, the language used to describe their birth story and their current mental state in order to help accordingly.

If you are someone who has continued to struggle to mentally process your traumatic experience during birth, remember that you are not alone and that there is help out there!

Support Makes a Difference: Doula Care and Perinatal Mental Health

Kirsten Carney, Grace Van Bruwaene, and Geraldine Tait
https://www.circledoulacare.ca/

It feels pretty straightforward to say that having support makes a difference to how we feel about ourselves and how we navigate life events. Describing what this support looks like and how it can affect our experiences can feel a bit stickier. To examine the qualities of effective support and illustrate its impact, we drew from our own experiences in birth and postpartum life. All three of us described our second (and third) births as more positive than our first births. We understood that our own increased knowledge and personal growth were factors in this improvement. At the same time, we identified the presence of dedicated support people as being instrumental to the change in experience.

Our first babies entered the world in ways that left us struggling to cope. Some of the words that came to mind when describing this time were “overwhelming”, “scary”, and “dehumanizing”. Doctors rushed through procedures with barely an explanation. This left an information gap that undermined our attempts to grasp what was happening to our bodies and our babies. We felt ashamed of our apparent inability to do such natural things as birthing and feeding our babies. We felt scared of the unknown and dismissed as autonomous humans. From this level of vulnerability, we struggled to speak up for ourselves. Coming up with options seemed daunting, and we felt trapped in the healthcare system funnel. It was easy to catastrophize these challenging feelings as well. We felt like we failed right out of the gate, and we feared subjecting our babies to more failures. Surrounded by these whirlwinds of emotion and activity, we were thrown into the position of being fully responsible for our babies once home. These experiences all fell under one common theme: feeling de-centred in our own perinatal journeys.

For all of us, our first children sparked a journey of learning, but it was one born out of fear, stress, and rage. We didn’t just dip our toes into the pool of knowledge, we dove in obsessively. Let down by care providers, we felt forced to learn and do everything ourselves. The pressure was immense; we couldn’t trust anyone else to take care of us and our families. Because of all our research and reflection, though, when it came to having second babies, we made different choices and preparations. Some of us changed care providers and two of us chose to hire a doula.

“Hopeful”, “in control”, “empowered”: these were the words we chose to describe our second journeys through pregnancy, birth, and postpartum life. We had a better idea of what to expect from the healthcare system, ourselves, and our babies. We also had an understanding that these were challenging, layered, and personal experiences. With this lens, we didn’t feel like failures, but rather, like people trying their best at a new thing. In addition to these internal shifts, we also had effective external support. Our doulas were there for us and our families. They always checked in with us to see how we felt about what was happening, and the conversations grew from there. They accepted our lived experience as valid, and offered us a safe space in which to share our big scary feelings. Being heard and accepted in this way was affirming, and gave us confidence to keep talking and asking questions. When faced with a decision, our doulas provided us with information and helped us come up with a range of options. They facilitated informed decision-making, which empowered us in our relationships with primary healthcare providers. As Kirsten said, “I felt like I had more of a right to talk about what I wanted and needed. I didn’t care if they liked me or if I was being the perfect patient; I was going to have the experience I wanted.” With this support, we were able to reframe the whole situation, keeping ourselves firmly grounded in the centre. The healthcare system was one part of the story: we now could listen to their options and seek their advice, and we could also access further resources, make informed decisions, and discuss our feelings with our partners and support people. Moving from a place of hearing “no, but” to a place of saying “yes, and” took us from fear to empowerment.

Recent research on doulas and continuous support indicates many benefits, including shorter labours, reduced interventions, and lower postpartum depression. (https://evidencebasedbirth.com/the-evidence-for-doulas/) Evidence also suggests that doula support during labour can lower rates of indicated and non-indicated cesarean delivery, reducing medical costs and risks to the birthing person. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538578/) At the same time, there is a significant unmet demand for doulas. The main barrier to access, not surprisingly, is the out-of-pocket expense. Additional barriers include but are not limited to: geographical distance from professional support people, lack of understanding of doula support from partners or family members, and lack of culturally or linguistically aligned support. (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full) It’s important to recognize that many of these barriers have been created as a direct result of the colonization of birthwork and subsequent doula training industrial complex—from which we ourselves benefit. We feel strongly that doulas, birthworkers, and support people must operate with transparency, accountability, and sustainability with the goal of resisting white supremacy culture. We must incorporate community care/mutual aid, intersectionality, and anti-racism into our practices, and we must aim to provide inclusive and accessible services. We must also recognize that this is an ongoing process of unlearning and relearning, and it is our hope that this work extends to all birthworkers who benefit from systems founded in and catering to white, heteronormative privilege.

Between our lived experiences and the research, we strongly believe that doula support that upholds self-determination is vital to perinatal mental wellness. Effective doulas practice with the awareness that one-size-fits-all often ends up being one-size-fits-none. Consequently, they must continually centre the feelings and experiences of the people and families they are supporting. Not only is a supported experience less likely to lead to birth and postpartum trauma, doulas can also help families properly identify the challenges they are facing, become aware of their options, and put together a plan that works best for them. This process allows for more of their clients’ needs to be met, leading to improved mental and physical outcomes and a better experience overall.

Circle Doula Care logo. Circle with "Circle" written inside. Doula Care Supporting You Completely written underneath

Community Support Groups – A different approach to Perinatal Mental Health

Anneke van den Berg
Peer Health Worker
www.ourplacekw.ca

Feeling lonely is a feeling many perinatal parents identify with. Nothing is lonelier than being up with a fussy baby in the middle of the night, while you are exhausted and in tears yourself. Lonely is different than being alone. We can experience loneliness, even if there are people physically around us and these people might even be people we love. In this Pandemic, the physical presence of people is, of course, a bit more complicated. The current situation definitely has fueled the feelings of isolation, but is hardly unique to our Pandemic reality. It is sometimes hard for perinatal parents to understand that perinatal mental health struggles aren’t unique to the Pandemic either.

Loneliness is really about the absence of people with whom we can be authentically ourselves, with all the messy emotions, all the feelings and the hurt. Isolation, experienced by so many parents right now, is about not being seen, and not feeling supported.

While the support network of perinatal parents might have great ideas on how to feel better, it often overlooks the true nature of Perinatal Mood and Anxiety Disorders (PMADs). When one is struggling with a PMAD, advice just doesn’t cut it. Life with a PMAD is a rollercoaster, and while a good night’s sleep might make one feel better, there are going to be days when life just really sucks, whatever the circumstances. PMADs are unpredictable and exhausting.

Many parents coming to our perinatal support program feel that there is something wrong with them. “Why am I not able to enjoy this stage of my life? I wanted to be a parent!” “I do not even know if I really love my baby, I’m looking forward to every minute that I can be without them.” It is not until they join a program and talk to other parents that they realize these feelings are more typical than they’d ever thought. Normalizing the big feelings, and the intrusive thoughts, is most effective in a group. Nothing beats a room nodding and responding “me too,” when one is sharing their feelings of hopelessness or despair. Realizing that one is not alone in feeling one way or another, is liberating and it creates an instant connection. It immediately makes one feel less lonely.

Peer programs aren’t usually thought of as a treatment plan for PMADs, and we would never claim it is a treatment by itself. However, we do know, that for many participants Stork Secrets, our peer program focused on perinatal mental health, has made a world of difference. As one participant said: “I have used many supports throughout my perinatal journey, however, I have found the supports and resources offered in the peer program most supportive.”

What are peer programs and why do they make such a difference for many new or expecting parents? Peer programs at their core put a lot of value on lived experience. At Stork Secrets, the peer facilitators have had their struggles with perinatal mental health, and are willing and able to share some of this in program. In addition, peer programs are about meeting the needs of participants. Unlike many other programs in the community, peer programs do not follow a set curriculum and topics are decided upon within in the group. The facilitator is not a leader or instructor, and responding to the needs of the participants is crucial for the peer model to work.

At Stork Secrets we have made the conscious decision to welcome parents with perinatal mental health struggles from point of conception until up to two years after birth. We understand that perinatal mental health can affect lives of parents even beyond that, but two years seems to feel like the most natural cut-off point for our program. We also welcome adoptive parents, recognizing that PMADs can occur in adoptive parents as well, just like birth parents and their partners. We also recognize that most perinatal parents are not actively looking to get a formal diagnosis, even though they would self-identify to be struggling with Postpartum Anxiety, for example. Some other parents just want the support on their perinatal mental health journey, without labelling this as a PMAD. While a lot of Stork Secrets talks about PMADs, we generally just refer to it as perinatal mental health, understanding that parents are joining this program because they are looking for support.

Can people feel this connection and support virtually, just like they would do in person? We recognize that online programming is not for everyone, and confidentiality is definitely challenging online. On the other hand, virtual programs have made our programs more accessible for parents of very young babies and parents who have limited access to public transportation. We also see more parents trickling in from beyond Waterloo Region. There are both upsides and downsides to virtual programming, but it is definitely something we will continue to explore in the future. In recent program evaluations at Our Place, many participants actually said that they have felt more supported through virtual peer programs in the Pandemic, than ever before. Who’d have thought?

How PMADs are experienced can be very different, even if the diagnosis is the same. Loneliness and isolation, however, is something most of the new and expecting parents have in common. Finding safe spaces, like community groups and peer support programs, can make a world of difference on their road of recovery. Group-based programs offer a sounding board, and a place to share your experiences and thoughts. It is a place where you can hear: “Me too.” Peer workers, especially, can tell you that PMADs are something one can overcome. It might be dark, gloomy and anxiety-inducing right now, but you are not alone, and there is a bright world ahead of you. It will get better, and until then, there are others to support you.

A Naturopathic Perspective on Perinatal Mood and Anxiety Disorders

Dr. Melanie Reidl, N.D
http://melaniereidlnd.com/

The postpartum period can be a transformative, beautiful experience for new parents, however, it is not without a dark side for many. I personally experienced both the euphoric stage of new motherhood, as well as the anxious and depressed state that many women experience.

Perinatal/postpartum mood and anxiety disorders (PMAD) affect approximately 15 to 20% of new mothers. This may underestimate the prevalence of PMAD; the signs and symptoms may be missed and attributed to being a ‘normal’ part of motherhood, or, mothers may resist acknowledging the signs because of stigma or societal pressures.

If prolonged and untreated, PMAD’s can be detrimental to maternal health and the child’s development. As such, is important that we work to improve our screening/identification and treatment approaches for this group of women.

Naturopathic Medicine, with its emphasis on treating root causes and viewing health more holistically, is well suited to support women with PMAD’s. There are many factors or root causes that may be involved in the development of a PMAD, including but not limited to the following: personal history, family history, social support, birth experiences/trauma, stressors, nutritional status, and thyroid/hormonal factors.

In my experience, the most overlooked factors are nutritional status, stress levels, and thyroid/hormonal imbalances. First, is not uncommon for women to be undernourished during their pregnancy and when a new baby enters the picture. She may have forgotten to take her prenatal multivitamin, have pre-existing nutrient deficiencies, or feel like she doesn’t have the time or energy to nourish herself properly.

Elevated stress hormones are also common in this group of women. The stress hormone, cortisol, may high be due a variety of factors, including but not limited to: birth trauma, lack of support, financial challenges, relationship stress, and lack of sleep.

Further, the risk for developing hypothyroidism (an under active thyroid) is greater in the postpartum period. Hypothyroidism may develop due to nutrient deficiencies, prolonged elevation in cortisol levels, and hormonal and immune system changes associated with pregnancy and postpartum. Hypothyroidism is a common cause of depression, anxiety, and fatigue, and must be ruled out in all cases of PMAD.

In my opinion, the treatment approach to PMAD should be collaborative in most cases. Involvement of the woman’s G.P., a Psychologist or Social Worker, and an N.D. would address several facets of the PMAD. In moderate to severe cases medication may be necessary for a period of time. Counselling or CBT is also important to develop healthy coping strategies and to re-frame negative thought patterns.

My approach as a Naturopathic Doctor would begin with a comprehensive screening of thyroid tests and nutrient levels (ie. Vitamin B12, Iron status, Vitamin D3) in these women in order to better identify and treat any possible physiological underpinnings. Following a careful assessment of patient history and blood work, I work with women to optimize their nutritional status and provide dietary counselling, I encourage healthy lifestyle factors such as exercise, self-care, and mindfulness practices, and provide individualized nutritional or herbal supplement recommendations.

As an ND who has seen many women with PMAD, in addition to my personal experience, I have developed a deep understanding and empathy for this group of women. They deserve a thorough assessment of their physical, mental, and emotional health, as well as an individualized treatment plan to help them cope, overcome their PMAD’s, and improve their well-being so that they can be more present mothers for their babies and be their best selves.

Parenting on the Margins

Dr. Lori E. Ross, PhD (she/her)
Associate Professor
Division of Social and Behavioural Health Sciences
Dalla Lana School of Public Health, University of Toronto
www.lgbtqhealth.ca

Over 20 years ago now, I remember wandering through the research posters at an international conference on perinatal mental health. I looked around me at all the important research helping us to understand what contributes to perinatal mental health problems, and what we can do to address them. And I thought to myself: where are the sexual minority women in this research? Are they here, but not named, so invisible to me and my colleagues? Or is all this research conducted with straight women, meaning that we actually know nothing about the experience of perinatal mental health for lesbian, bisexual, and other sexual minority women? As a queer woman myself who planned to have kids in the coming years, this question was not only of academic interest, but really personally important to me. Where was I, and my community, in this body of research I wanted to build a career contributing to?

That moment led to my first research study on perinatal mental health among sexual minority women – the “Mothering on the Margins” (MOMS) study. In this mixed methods (surveys and interviews) study of over 60 Ontario sexual minority women (some who had or intended to give birth, and some whose partners had or would give birth), we learned about mental health experiences through the processes of trying to conceive, pregnancy, and the first year postpartum. Fast forward 20 years, and I’ve had the pleasure of leading and contributing to numerous research studies that have continued to build our understanding of mental and reproductive health for sexual minority women, and all those within the 2SLGBTQ+ (two-spirit, lesbian, gay, bisexual, trans, and queer+) umbrella.

So based on these experiences, why does is matter that research on perinatal mental health properly include 2SLGBTQ+ parents? It matters because our experiences are not the same as those of heterosexual, cisgender parents, and these differences matter when it comes to the services, supports, and interventions we need to take care of our perinatal mental health. Perhaps the most important difference is that for our communities, one of the most profound determinants of our perinatal mental health is experiences of discrimination on the basis of sexual orientation and/or gender identity (often intersecting with other forms of discrimination). Members of our communities may come up against this discrimination at multiple points in their parenting process: when trying to access fertility services, from providers during the birthing process, from family members, friends and institutions (like daycares and schools) during their parenting years. Understanding this helps us to see that the kinds of interventions we need to address perinatal mental health for our communities include interventions to address discrimination, both on the interpersonal and on the systems levels. For example, I’ve had the privilege to use my team’s research to play a part in important policy change, in Ontario and elsewhere, to address previously discriminatory legislation that inadequately recognized 2SLGBTQ+ people as legal parents from the time of birth. I’ve also been able to use our research to contribute to interventions to educate service providers across disciplines about how to better meet the needs of their 2SLGBTQ+ clients. These kinds of interventions – while they might not be what we typically think about when we talk about interventions for perinatal mental health – are necessary to support the health and well-being of our communities.

I am happy to say that there have been many positive changes since that conference 20 years ago. Research on the perinatal mental health of 2SLGBTQ+ people has grown, services have developed and expanded to better meet our communities’ specific needs, and our policy context has dramatically improved in its recognition of the rights of 2SLGBTQ+ people, in family law and beyond. But there is still more work to do. For example, I know that many trans and non-binary people still face significant barriers to accessing inclusive perinatal care – so many of the services and programs in this sector are designed for “mothers”. Shifting our language to talk about birthing people is an important first step, and more work is needed to collaborate with trans and non-binary people to develop and deliver the perinatal care services they want and need. We also need to be paying more attention to the ways that other identities and experiences intersect with sexual orientation and gender identity to impact both perinatal mental health and the experiences people have when accessing care. Race, class, ability, experiences of trauma, and experiences of resilience and resistance all shape peoples’ experiences during the perinatal period. For example, anti-Black racism affects perinatal mental health for 2SLGBTQ+ communities. Lack of adequate policy for paid sick days affects perinatal mental health for 2SLGBTQ+ communities. We need to continue to work towards a society that values and supports the well-being of all parents and families, and to celebrate our 2SLGBTQ+ families as we do that work together.

The Importance of Treating Postpartum Depression for Mothers, Families, and Society

Dr. Ryan J Van Lieshout, MD, PhD, FRCPC

*A note from Climb Out of the Darkness Waterloo Region: Postpartum Depression is one of six diagnosable conditions which affect birthing parents during the postpartum period. This group of conditions, Perinatal Mood and Anxiety Disorders, can be experienced at any point during pregnancy and postpartum. The blog post below speaks directly to research, treatment and affects of Postpartum Depression. For more information regarding other Perinatal Mood and Anxiety Disorders, continue to follow us on Facebook at https://www.facebook.com/ClimbOutTeamWaterlooRegion throughout May and June as we share more knowledge and expertise from Waterloo Region.

Postpartum Depression and Its Impact
Postpartum depression (PPD) is the most common complication of childbirth, affecting 20% of mothers. Left untreated PPD increases the risk of future depressive episodes, parenting difficulties, and problems with mother-infant attachment. The children of mothers with PPD struggle more in school and are three times more likely to develop emotional and behavioural problems. They also have five times the risk of these problems in adolescence, and are eight times more likely to develop depression in adulthood.

The COVID-19 pandemic has further exposed vulnerabilities in systems that lead to inequalities for mothers with mental health problems and their children and has profoundly changed mothers’ preferences for receiving mental healthcare (i.e., to virtual/online). Even under ideal conditions, the healthcare system is poorly equipped to treat problems requiring urgent psychotherapy, and as few as one in ten mothers with PPD receive evidence-based care. Even when detected, mothers rarely have access to the treatments they most prefer (i.e., psychotherapy), and are treated by their family doctors with medications. They also face long wait times to access specialist psychiatric services or have to pay up to $225 per hour for private psychological treatment.

Current clinical practice guidelines recommend evidence-based psychotherapies (e.g., cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT)) for the majority of mothers with PPD. Medications are recommended after psychotherapy, but are often prescribed before them because psychotherapy is so difficult to access.

The Impact of Treatment
Without treatment, up to 40% of women will have PPD symptoms until their children enter school. While treating PPD can reduce its adverse effects, safe, timely, accessible interventions are essential to optimizing for mothers, their partners and their children. Treating PPD not only helps mothers, but can have significant positive effects for their partners and children. Indeed, studies of evidence-based psychotherapies or mother-infant interventions (those focused on mother-infant interactions) suggest that treating mothers has the potential to improve the mother-infant relationship and reduce expressions of sadness, fussiness and disengagement among infants. Treating PPD also reduces parenting stress and improves maternal reports of emotion regulation in infants. Emotion regulation is particularly important because it is associated with a 3-fold increase in the risk of later school failure, polysubstance dependence, and criminal conviction,11 and is implicated in the development of almost all forms of psychiatric problems.

Recently, our group used neurophysiological methods to show that PPD treatment results in healthy changes in the brain and behavioural systems core to emotion regulation in infants. In this work, maternal receipt of group CBT for PPD led to a normalization of brain and parasympathetic nervous system physiology to that seen in the infants of non-depressed mothers.

Innovation in Increasing Access to Psychotherapy
One of the biggest barriers to realizing these improvements is the difficulty women have accessing psychotherapy for PPD. The need for engaging, easily accessible, safe, and effective psychotherapeutic treatments is urgent. While computerized CBT and psychotherapy apps are widely available, significant time and motivation are required for success, discontinuation rates are high, and therapist support is required for clinically meaningful gains.

In order to meet the need of women for psychotherapy in the perinatal period, researchers have recently developed several novel methods of service delivery that can increase the number of women receiving effective treatment for PPD. These methods capitalize on the widespread availability of reliable internet connections, the efficiency of group therapy, and the concept of task-shifting (the process of delegation whereby tasks are moved from specialized experts to those with less training (e.g., nurses, recovered peers)).

For example, we recently trained public health nurses to provide group CBT for PPD, and recent data suggest that this is effective regardless of whether it is delivered in-person or online. We have also task-shifted group delivery of CBT-informed support for PPD to women who have previously experienced and recovered from PPD. Recovered peers are seen as a particularly credible, non-judgemental, and empathic source of support, reducing stigma and judgement. Peers can normalize symptoms for women with PPD, provide valuable knowledge based on experience, and serve as positive role models, highlighting different pathways to recovery. The early results of this work suggest that when such interventions are delivered by peers, they can increase treatment uptake and effectively treat PPD.

Finally, we recently developed and are in the process of testing a 1-day CBT-based workshop for PPD. The delivery of psychotherapy in large groups (up to 30 participants) is a relatively new idea, but may be capable of addressing mothers’ needs as well as treating the number of women with PPD that are required to reduce its burden on a large scale. Brief (i.e., 1-Day) interventions are appealing because contain the core content of longer treatments, but their efficiency makes them easier to deliver beyond traditional treatment settings. The early results of these workshops suggest that they may effectively reduce depression and anxiety whether they are delivered face-to-face or online. We now hope to test the effectiveness of these workshops delivered by public health nurses to increase their scalability.

The Future of PPD Treatment
Researchers around the world are also testing out different models of psychotherapy delivery that could increase availability and uptake. Refinements to online and app-delivered psychotherapies, as well as the evolution of chatbots (artificial intelligence software that can simulate a conversation or chat with a user in natural language through apps, website, and telephone) could improve access in Canada and around the world.

Research suggests that treating PPD can have benefits for mothers and their families, and that a many different types of interventions can be effective. However, the best outcomes are obtained by mothers and their families when they have easy access to the evidence-based treatments that they want and need. Many new and innovative approaches to increasing psychotherapy engagement and availability are being developed and tested, and could help mothers to recover and lead happier and healthier lives, with benefits for them and their families.

*Dr. Van Lieshout is a perinatal psychiatrist and Co-Director of Elle Psychotherapy (elletherapy.ca). He is also the Canada Research Chair in the Perinatal Programming of Mental Disorders and the Albert Einstein/Irving Zucker Chair in Neuroscience at McMaster University where his research focuses on increasing access to evidence-based psychotherapies, as well as their impact on offspring brain development.

Ayurvedic Postpartum Care

Lisa Brenner
http://www.wiserootstherapies.com/

The postpartum time, also referred to as the fourth trimester, in Ayurveda is known as the Sacred Window. It is said that the way the first 42 days after delivery are spent have a direct impact on the next 42 years of life.

So, what is Ayurveda and how does it relate to postpartum? Ayurveda is a centuries old practice originating in India known as the ‘Science of Life’ and offers a holistic and individual approach to health and wellness. Having an understanding of our constitution and the elements at play within us can help guide us in our day to day lives. This will help us find and maintain a balance of the three Doshas leading to greater overall well-being. The three Doshas are Vata (air/ether), Pitta (fire/water), and Kapha (earth/water). During birth and in the immediate postpartum (and longer if we are not adequately cared for) Vata is known to be high, vitiated, or out of balance. When Vata is unbalanced we can be fearful, anxious, angry, have trouble sleeping, become depressed, feel overwhelmed, and disconnected. When Vata is left unchecked this can lead to greater un-wellness and dis-ease.

There are 4 pillars of care for postpartum healing. Rest, Nutrition, Meditation and Breathwork, and Body Care. Let’s explore each of these in more detail.

Rest
In Western culture taking time to rest is often seen as a weakness. We are expected to get up and keep doing all the things. Ayurveda views the first six weeks postpartum as the most critical in ensuring our long-term health. Birthers are supported in resting so as to give their body, mind, and spirit time to balance and process everything they have just experienced. It is advised to have complete rest for at least two weeks, and try to stay off of your feet as much as possible for the remaining 4 weeks. The only task birthers should be doing during this timeframe is bonding with their baby.

Nutrition
The focus for postpartum nutrition should be on the following: warmth, comfort, nutrient dense, easy to digest, and well-spiced. This will aid in healing and rejuvenation and will help to promote good digestion for both the birther and their baby. Foods like soup, porridge, stew, rice pudding, dhal, kitchari, stewed fruit, and spices like cinnamon, ginger, cloves, nutmeg, cumin, and black pepper will provide much needed warmth and nourishment. It is also important to increase your healthy fats intake which will help to balance hormones quickly, build your milk supply, and improve your mood.

Meditation and Breathwork
Mindfulness techniques are a wonderful practice to utilize in postpartum. Practices like meditation, breathwork, journaling, or gratitude lists helps to focus the mind and calm the nervous system. This takes us out of the fight or flight response and into a more relaxed state where we can be calm and think clearly. The best way to do this is to integrate mindfulness into your day. As you are feeding the baby, taking a shower, or going for a walk, you can bring your awareness to your breath and feel it flowing in and out of the body; you can do a counting meditation, inhaling to 5 and exhaling to 5; you can simply take notice of your surroundings…what do you see or hear? Even 10 minutes a day can have a profound effect on your mental well-being.

Body Care
One of the most beautiful aspects of Ayurvedic care is bodywork. There are 3 key components of body care in postpartum. The first is massage. Warm oil massages known as Abhyanga are lovely to receive anytime, but especially in postpartum. One of the best ways to soothe and lower Vata is through touch. Massage is a wonderful tool for both the birther and their baby. Even 5-10 minutes of self-massage every day can have profound effects on your energy, mood, sleep, and overall well-being. Massaging your baby helps their digestion, enhances bonding and communication, promotes deeper sleep, tones muscles, and releases tension from being in the fetal position.The second component is herbal baths. A special blend of herbs that are healing and soothing for postpartum are made into a tea which can be added to the bathwater, used as a sitz bath, placed in a peri bottle for use after going to the washroom, or used diluted around the umbilical cord for healing. The third component is belly binding. A long piece of cotton muslin is wrapped around the body firmly but gently from just below the hip bones up to the lower ribs. This can help with stability in the hips and pelvis and reduces the feeling of emptiness in the womb. It is a gentle support for the muscles and organs.

Incorporating these practices into your postpartum care will help you to feel strong, empowered, and well: physically, mentally, and emotionally. Receiving proper care allows you to feel calm, radiant, and aligned, avoiding depletion, aging, overwhelm, anxiety, and depression.

As many of us no longer have a village around us to support us, it is necessary to create this for ourselves however we can. Before baby arrives make a list of everyone that you can call on for support. Family, friends, and neighbours can take turns preparing meals, cleaning the house, assisting with older siblings, and anything else that needs to be done. If you don’t have family nearby, hiring a postpartum doula is a great way to ensure you get the rest you need to not only fully heal and recover but also to thrive in your new role as a parent.

A Case For Comprehensive Pregnancy Education

TK Pritchard (they/he)
Executive Director
SHORE Centre
shorecentre.ca
Honouring sexuality, diversity and choice.

Think back to your experiences of sexual health education. What did you learn about pregnancy? Perhaps you learned how to prevent it – although I would hazard a guess that the information didn’t go far beyond “Wear a condom,” “Don’t have sex,” or “Birth control exists but we aren’t going to tell you much about it.” Maybe you learned about sperm and eggs, but I imagine few learned about emergency contraception or about pregnancy options including parenting, adoption and abortion. Perhaps you were taught nothing at all – and you wouldn’t be alone in that reality, either.

When we learn about pregnancy, it is often romanticized as a key journey in life-a milestone-which you will embark on only when you are older, financially stable, and in a heterosexual, cisgender marriage. You will create a pregnancy easily via sex involving a penis and vagina, being pregnant will be beautiful and uncomplicated, and you will naturally know what to do once the baby arrives.

But this is so far from the lived experiences of many. We don’t talk openly about the myriad of ways families can be formed and when we do, we create hierarchies about the best ways to do this. LGBTQ2S+ people are commonly left out of pregnancy and parenting education all together. We still leave little room for the possibility that people may not want to get pregnant or parent at all, and we don’t talk about pregnancy options such as abortion. Many people who do want to get pregnant will struggle with infertility, miscarriage, and pregnancy loss. Additionally, countless will be coerced into continuing a pregnancy and others will have no financial, material, or emotional support systems in place.

We don’t talk nearly enough about the physical, emotional and social changes and realities of being pregnant, giving birth, and parenting. We set people up to struggle by not offering all the information, by glossing over how and why people may need support, and by painting a surface level ideal which all people are expected to successfully achieve. When we uphold a societal expectation that pregnancy and parenting are expected, manageable, and uncomplicated we are directly impacting people’s social, emotional, and mental health and well-being. This romanticized narrative provides such little information about what actually happens to people’s bodies when they are pregnant that the various changes and effects can be overwhelming and scary. When someone is struggling (which is common), the real lack of transparent information, and the normalization that pregnancy/parenting is purely wonderful and innate can leave them feeling helpless, alone and like a failure.

What if we stopped framing pregnancy as a beautiful mystery or life goal for when you are married, or as a punishment for having sex? What if we just talked about it honestly? Imagine a world where all people receive age-appropriate education which prioritizes choice and autonomy in every sense. Where young people learn that there are many different ways to create a family. Where we speak openly about the complexities of pregnancy, being clear that a person with a uterus gets to choose if they wish to be pregnant. Where education includes the idea that some people want to get pregnant and are unable to, and that pregnancy loss is common.

We could live in this world. We could build real, comprehensive information about pregnancy and all of the social, emotional, mental and physical components into the health and physical education curriculum. We could ensure it is also provided to people of all ages through healthcare providers, prenatal/parenting classes and more. This would allow people to make truly informed choices and provide vital and realistic information and expectations. Information is powerful both at an individual and collective level. If more people had a complex understanding of pregnancy it could shape so many important aspects of our communities. For example, it could dismantle stigma around needing support during pregnancy, after giving birth and after pregnancy loss, or change our healthcare system to better care for people experiencing pregnancies or provide more funding for inclusive, client-centered community services There is so much that we could do better.

It’s more than time that we recognize we need real, honest and inclusive education from the start. You are not broken or a failure if your experience does not look the way your schoolteacher or prenatal/parenting class described it to you. There is room for your story here, and in fact it’s our collective stories which can help make space for others. Pregnancy and parenting can be many things and your experiences are valid. You are not broken or alone, we just don’t talk about it.

SHORE Centre logo in green, red, blue circled by words Sexual Health, Options, Resources, Education.

Meet Lisette

Photo ID: Photo of Lisette in glasses, on a blue background. Words say Meet The Leaders: Lisette Weber

I am a full time mom, doula, and perinatal mental health activist. Before having kids, I worked in museum programming. After having my daughter, I have been active in the postpartum community. With the dawn of the pandemic, I began investing more time learning about perinatal mood and anxiety disorders. I am active with Postpartum Support International as a Climb Leader and Local PSI Coordinator. I am completing my Full Spectrum Doula training through Birthing Advocacy Doula Trainings.

From Lisette, “I always thought I would be great at having my own children. It was a dream I always had. It was so earth shattering to my identity when it didn’t go as I had planned. We were so excited when we found out that we were having a baby. We got into the midwives we wanted, we took the prenatal classes. My daughter was born five days before Christmas in 2017. Her birth was an induction that lead to a fast and furious labour. For reasons I still don’t understand my new baby was taken to NICU. And days before Christmas, all the supports we needed in those early days were closed for the holidays. It was traumatic and the start of my journey with perinatal mood and anxiety disorder. I honestly don’t remember a lot of her newborn life. What I do remember was the sadness, irritability, the feelings of failure. I knew something was wrong but struggled when I sought help. I saw my family doctor and started on medication to help with my anxiety.
I don’t want anyone to go through the experience I had so I began my education about perinatal mental health. The Climb is my big step towards bringing change to the region.”