The Important Role Doulas Play in Recognizing Perinatal Mood and Anxiety Disorders
By Paige Bellenbaum, LMSW
In the past five years there has been a flurry of attention given to perinatal mood and anxiety disorders (PMADs) otherwise referred to as postpartum depression. High-profile women including Gwyneth Paltrow, Chrissy Teigen, Adele, and Adele’s friend, Laura Dockrill, who just shared her own postpartum psychosis story, have come forward with their personal PMAD struggles. National medical associations like the AAP (American Association of Pediatrics) and ACOG (American College of Obstetricians and Gynecologists) now recommend screening for PMADs during pregnancy, postpartum and at child well visits. These are critical steps in changing the conversation and stigma that have historically surrounded PMADs.
Another group of service providers that is growing in popularity nationwide can also play a key role in the identification of PMADs in new and expecting mothers — doulas. A doula is a person who offers non-clinical, judgement free support to others as they transition through major life experiences. Doulas specialize in different areas of care including labor and birth, postpartum, and, less often, death.
The doula movement arose in response to the lack of emotional and physical support during labor and birth and the limited postpartum care available from healthcare providers in the United States. Whereas the relationship between a woman and her OB/Gyn or her baby’s pediatrician are undeniably critical to the physical health and well-being of both, a doula establishes a more intimate relationship with the new or expecting mom — allowing her more exposure to mom’s emotional health. Often, doulas will come to the home prior to the delivery of the baby and have multiple meetings to establish a relationship and discuss the birth plan with the expecting mother, allowing a bird’s eye view to the woman’s immediate environment. In doing so, doulas may observe potential external stressors that may exist in the home or in the couple’s relationship — both of which put a woman at greater risk for the onset of a PMAD. They can also observe any obvious psychological changes in the woman over the perinatal period and in the immediate postpartum period.
Recently, doula groups like Carriage House Birth in New York City, are working with PMAD treatment providers like The Motherhood Center to recognize the importance of integrating PMAD awareness into their doula trainings. Doulas need the basic skills to do the following: recognize when a woman may be experiencing a PMAD; have the conversation with a new or expecting mother that appears to be suffering; and most importantly — refer a woman for support and treatment.
A doula doesn’t need to be a professional mental health provider to recognize a PMAD. The signs can be easily detected for someone trained:
- This woman is excessively worried about her pregnancy or the new baby — contacting the doula or pediatrician multiple times a day.
- She is crying frequently and saying that she is a failure, she can’t do anything right, or that she has made a huge mistake.
- She obsessively washes bottles, does laundry, ruminates about harm coming to the baby
- She tells you she feels helpless or hopeless — and she refrains from seeing friends and family or leaving the house.
- She can’t sleep when the baby sleeps at night, or she sleeps all the time — she has no appetite and is having a hard time caring for herself and/or the baby.
- She is irritable and angry, sometimes rageful.
- In severe cases, she may share that she has thoughts of ending her life or the baby’s life.
With proper awareness and training, a doula can feel comfortable and confident recognizing these symptoms and having a conversation about them. She could say, “Becoming a new mother is one of the hardest things a woman can do, and we don’t talk enough about the hard part. It’s very common for new mothers to feel anxious and overwhelmed by this new responsibility — being a new mom can feel like it’s too much. What has it been like for you?” If mom says she is really struggling, a doula can help her obtain outside evaluation or assistance: “I have heard so many women say exactly the same thing. You are not alone, and you can feel much better with the right support. I have some resources to help you get through this challenging time, and enjoy being a mother more. Should we make the call together?” Partners and other family members also play a critical role in the mental health of the pregnant or new mom and can be educated on where to go for help.
If untreated, PMADs can have a negative impact on the baby’s development and the bond between mother and child. It’s imperative for all providers that come in contact with new and expecting mothers to look out for the signs and symptoms of PMADs. PMADs are the most common birth complication among women. 1 in 5 new and expecting mothers experience a PMAD, and to her — it feels like she is drowning in an endless, dark sea, just waiting for someone to throw her a life preserver.
To learn more about PMADs and identify here and abroad resources for women that are struggling visit Postpartum Support International. If you are located in the New York Tri-State area visit The Motherhood Center at https://www.themotherhoodcenter.com/ or call 212–335–0034.
Paige Bellenbaum, LMSW is the Chief External Relations Officer of The Motherhood Center of New York. The Motherhood Center provides clinical treatment to new and expecting mothers suffering from perinatal mood and anxiety disorders (PMADs). She had her first child — Max — while working as the Director of Advocacy and Community for Habit Humanity — New York City. After Max was born, Paige suffered from severe postpartum depression and anxiety that nearly cost her her own life. Once she began to heal, she became committed to fighting for education, screening and treatment for postpartum depression so that no more women would have to suffer silently. Paige has been an outspoken advocate on the issue of postpartum depression, and uses her own story as a tool for change.