Tag: perinatal mental health

Chapter 4

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By Sophie

As someone who lives with stage four bilateral endometriosis, I am no stranger to anxiety and depression. My journey to motherhood was fraught with surgery, clinical appointments, loss, risk in pregnancy, a slow postpartum recovery, and breastfeeding challenges. All these experiences, on top of my daily struggle with chronic pain led to an even more stressed mental state.

After the births of my son (now 7) and daughter (now 1), I struggled to cope. Even though I had access to a trusted counselor, loving partner, supportive family, and friends, I struggled. Still today, the demands of my disease and the NEED to care for my own body, are often at war with the needs of my children. I am learning that you can have all the support in the world, and still struggle with your mental health.

I often think: “If only I try harder, do more, I can push past the way I am feeling”. The truth is, we need to feel these feelings, with the right supports in place. We need to hold them close, not push them away. In fact, we may never push past the way we are feeling. Mental health isn’t about getting over something, it’s about learning to live safely with the what ifs, the down days and the panic.

The challenges around motherhood are deeply systemic, starting at the beginning, with how those of us with reproductive-related disease are treated in the health system, how postpartum bodies are NOT supported and how women are often expected to put aside their needs for EVERYONE else.

My story comes from a place of privilege. I am a cis-gender white woman surrounded by friends and family who support me. Imagine the postpartum experience of those who aren’t in the same position. I’m not yet out of the darkness. Some days are tough, and I want to be someplace else. I often wonder if I made the right choice having children. Is it supposed to be this hard? Or is it just hard for me? While I may not love being a mom every day, I do love my kids, and that is what matters most.

Chapter 3

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by Anneke VB

I have four kids. During all pregnancies and postpartum I was flagged as showing signs of depression. I wasn’t surprised; depression is something I had been familiar with. It was just always there, especially during the first 10 years that I was in Canada. As an immigrant, I had a hard time fitting in, and unsure how to access the resources I needed. I didn’t have a community, and though my husband is my best friend: he really was all I had.

Two years after first arriving in Canada, I got pregnant. It was planned, but I couldn’t have been less prepared emotionally. I was 26 and I hadn’t given parenting much thought, but I winged it. Child is 14 now, still alive and without major trauma, child says. In the following years, I just went from pregnancy to postpartum, always was screened and found to be scoring slightly too high on the (flawed) Edinburgh scale. A doctor would mention something about looking after myself, and that was it. I didn’t give it much thought, as I plodded along.

It wasn’t until my last one when things started to feel off for me. One of my earliest memories of postpartum with my 4th is what I now refer to as headlice day. It was the first day of winter break, and I had found headlice in all the kids’ hair, my husband’s and my own. It’s a rite of passage for most family with young kids, but it couldn’t have come at a worse day for my family.

With my husband having to work overtime, I spent the whole day doing headlice treatments, the nasty chemical kind. I was exhausted, which is to be expected 3 weeks postpartum from a c-section, and baby had to spend a lot of time unhappy in their crib. It was (and still is) the longest day of my life.
Once it was time for me to give myself treatment, I had given up. While the kids maybe had a few headlice here and there, my hair was literally full of them. I saw no other way out then cutting all my hair off, and giving myself a treatment, while husband put the kids to bed, way after their bedtime. There are benefits to wearing a head scarf and rarely having visitors. Nobody asked me a question.

While headlice day was an exhausting day for good reason, I never really recovered mentally. I was already not doing great after baby was born, but now I literally felt myself spiraling. I didn’t enjoy life and didn’t enjoy being me. My doctor got me on a waiting list for counselling, as we didn’t have insurance and due to our financial situation, we didn’t have many other options. I didn’t want medication, as I thought it too complicated, and I had no energy to research the options to make a well-informed decision.

Early March I had to drive my child to a birthday party, and while navigating traffic with 4 kids, I thought how much easier it would be if I just had an accident. I can’t say it was a scary thought, as it wasn’t. It felt like an option that I felt rather intrigued by.

After that day, slowly things got better. I started to realize that I had options and that felt very liberating. With the warmer weather I was able to get out more, which was only getting easier with baby getting older. Counselling had started and while I never thought it particularly helpful, it gave me the opportunity to reflect on my life and who I was beyond being a parent.

By summer, things had much improved, though it wasn’t really until I started working a part time job 10 months postpartum, that things really started to change. Work brought (and brings) me so much joy and I love what I am doing. An important part of my work now is to share my experiences as an immigrant parent with perinatal depression, but also to create services that support parents who are situations like I was. I did it (mostly) alone, but parents shouldn’t have to. There are so many resources out there now. Please, ask for help. It is the most courageous thing you can do for yourself.

Chapter 2

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by Catherine M

My journey with Perinatal Mental Health includes a pre-existing mental health condition diagnosed in childhood (OCD) that had been managed for decades before I got pregnant. I wasn’t educated on how pregnancy and postpartum could affect my experience of OCD. Nor was I educated to know that in becoming a parent I would experience increasing and challenging sensory overstimulation. It would leave me feeling like my skin was aching daily, and my ears would ring and throb to the point of making sleep difficult. With my first pregnancy and birth, I was fortunate at the time to live in Toronto and receive care after my first was born. When I gave birth to my second in Waterloo Region, I realized how few supports were available once outside an urban community.

I once made a list of all the people I thought could raise my first child for me, because the weight of the responsibility sent me spiraling into a cyclone of intrusive thoughts, every hour of every day. I was certain I had made a horrible mistake and that I wasn’t supposed to be raising him. Instead of sleeping, I listed all the people that I could ask to take him for me. And that if I was lucky, it would be someone in my family so I would still get to be a part of his life, see him grow up. I was heartbroken and lost, more than I had ever been in my life or in my experience of my disorder up until then.

I still struggle. I will always struggle. I know this. That doesn’t mean I’m a mess every day, but some days I definitely can be. I have never loved anything more in my life than my children. And though that is a gift I get to live every day, it can also turn to fear and terror very quickly.

I am a white, female passing, womyn who lives within a circle of privilege – including a strong community and support system around me. Imagine those who aren’t the same position.

Chapter 1

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by Lisette W

Postpartum hit me like a brick. On the outside I was happy, keeping it together. Inside I felt like I was drowning. So much doubt. So much self-loathing.

My first’s birth was traumatic, followed by a NICU stay where we fell through the cracks of support and had to find our way ourselves. Add the struggle to breastfeed and I was gone.

I was diagnosed with postpartum depression and anxiety. I was screaming at a three week old. I would snap with sudden rage at a little baby who thought I was her whole world. I didn’t want to be her mom. I wanted to run away. There must be someone out there who can love and care for her more than me. Better than me.

This side of parenthood isn’t talked about. The ugly side where you’re at the door with your keys wondering where you could go that isn’t here. The feelings of utter failure because you’re incapable of nursing – the thing everyone notes as natural and easy. Being surrounded by people but not knowing how to ask for help that’s helpful. Surrounded by people but grasping for sanity.

Thankfully I was able to start seeing a therapist who specialized in perinatal mood and anxiety disorders and got onto medication. I am a much better mom for my kids when I take care of my needs first.

Postpartum Psychosis

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Postpartum Psychosis is a medical emergency. Please go to nearest Hospital Emergency Room. 
Here 24/7: Call anytime at 1 844 437 3247 (HERE247)
or TTY: 1-877-688-5501

1-2 in every 1000 deliveries but the risk for parents with bi-polar is 25-50%.

“The symptoms of Postpartum Psychosis may appear very similar to those of other psychotic disorders but they are usually unexpected and develop very rapidly, within hours. They most often appear within 72 hours to four weeks after the baby is born. The episode lasts at least a day and may last up to one month with eventual return to the woman’s previous level of functioning. Immediate treatment is required for the safety of the woman and her baby.” – BC Women’s Hospital and Health Centre

Symptoms may include:
Mania

Feeling “high”, “up”, elated, over-excited, or “on top of the world”

Increased energy, activity, or productivity

Racing thoughts, being more talkative, a “busy” brain, increased creativity, or pressured speech

Needing less or no sleep or not wanting sleep

Feeling restless, agitated, or unable to keep still

Losing inhibitions, spending a lot of money, or being much more sexually or socially forward

Extreme irritability, impatience, or anger

Very increased interest in your surroundings

Easily distracted, starting many things but not necessarily finishing them

Depression

Feeling low, flat, tearful, emotional, or crying easily

Anxiety, feeling tense, nervousness

Feeling withdrawn and not wanting to talk to or be near others

Tired, heavy, or without energy

Having a harder time taking care of yourself or your baby

Psychosis

Severe confusion or delirium

Seeing, hearing, or feeling things that aren’t there – hallucinations

Thoughts or beliefs that aren’t within reality or that people around you think are strange and out-of-character – delusions

Feeling suspicious or afraid of people or events, paranoia

Acting like you aren’t yourself

Feeling detached from reality, unreal, or like you’re in a dream

Additional Resources
Resources During Recovery
PSI Provider Directory

PSI Postpartum Psychosis For Moms Support Group

Support for Families
PSI Support for Families Touched by Postpartum Psychosis

Birth Trauma and the Pelvic Floor

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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

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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

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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

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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

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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.