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Book Review – Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth – Part Two

March 12th, 2015 by avatar

By Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

Dr. Walker Karraa has written an insightful book examining depression as a transformative event in the lives of women who have experienced it after the birth of a child. Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM, reviews Dr. Karraa’s book and interviews her in a three-part series on “Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth.”  Today, Cynthia examines two theories that relate to Dr. Karraa’s research and book and shares her commentary on the book’s findings.  Next week, Cynthia will share her interview with Walker Karraa, regarding her research and book. Find Part One of this series here. – Sharon Muza, Community Manager, Science & Sensibility.

walker book header

One of the many things I appreciate about Dr. Walker Karraa’s (2014) book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, is its multidisciplinary mindset. Not only does she contribute to broadening our understanding of postpartum depression beyond a worldview focused on pathology, Karraa seeks to understand the bigger theoretical picture in which postpartum depression as transformation can be placed. This isn’t just analysis for the sake of analysis. When we understand how and why something happens, we become more able to seek out and identify factors that help it happen and that get in the way of it happening. Having a good framework for understanding transformation through postpartum depression will help guide future research and application of that research with a goal of improving identification of, support for, and treatment of new parents with postpartum depression. In this commentary, I share my thoughts about two theoretical frameworks that can aid in our understanding of growth after postpartum depression: posttraumatic growth and positive disintegration.

Posttraumatic Growth or Positive Disintegration?

In chapter 7, “Trauma and Transformation,” Karraa (2014) reviews several theoretical frameworks that might explain how postpartum depression can be experienced as traumatic and precipitate transformation. She ultimately settles, quite insightfully, on posttraumatic growth (Tedeschi & Calhoun, 2004; Tedeschi & Calhoun, 2004). She also acknowledges the historical understanding that people often grow through experiencing life’s challenges. How many of us have heard some version of Nietzche’s maxim, “What does not destroy me, makes me stronger”?

When I read Karraa’s book, the explanatory theory that came to mind was Dabrowski’s theory of positive disintegration (Mendaglio, 2008a), which predates the coining of the term “posttraumatic growth” (Tedeschi & Calhoun, 2004a, 2004b; Nelson 1989). Positive disintegration is a theory of personality development that has been extensively researched and applied in the fields of giftedness and gifted education though it encompasses the development of all people. I have found Dabrowski’s theory both personally and professionally helpful in understanding how people are and are not changed by difficult life experiences, including the experience of postpartum depression. The theories of posttraumatic growth and positive disintegration have notable parallels and connections (Tillier, 2014; Mendaglio & Tillier, in press). Furthermore, the growth that can be experienced after a traumatic event fits well within the broader scope of the theory of positive disintegration.

Dabrowski’s theory of positive disintegration posits that personality has the potential to be dynamic—a possible journey toward authenticity and altruism—and that negative emotions are essential, though insufficient, for its development (Mendaglio, 2008a). (The quality of the social environment, for example, can support or hinder development.) Therefore, depression and anxiety, which we experience as negative symptoms we wish to eliminate, can also be understood positively as precursors of growth. A full description of the theory—and related research, analysis, and applications—is well beyond the scope of this commentary (see Mendaglio, 2008a). And, it understandably takes time to become accustomed to the terminology used to describe the theory. But, in brief, Dabrowski theorized that personality is shaped over the lifetime through two developmental processes, disintegration and reintegration, that involve five levels of development (Mendaglio, 2008b, pp. 34-39). We begin life with a less developed mental organization that seeks to meet basic biological instincts, needs, and drives and conforms to unquestioned social norms. (This is called level 1, “primary integration.”) As we struggle with internal conflicts caused by developmental milestones and life crises, we experience intense emotions, like anxiety and despair, as well as uncertainty and confusion about our identity. When we find that what we know and believe does not help us cope with and make sense of a crisis, our mental organization becomes less fixed and our distress increases. (This is called level 2, “unilevel disintegration.”) At that point, we have three basic options in our developmental path: 1) we can stay in a state of unilevel disintegration (which holds risks like suicidality, psychosis, and traumatic stress reactions), 2) we can return to (reintegrate at) our prior level of mental organization, or 3) we can move toward the transcendence of our original level of mental organization (we can grow).

Another way of describing the disintegration seen with depression and the possibility of personality development is the experience of existential depression. In existential depression, we struggle with our lack of control in our lives as well as with the very meaning of life and ourselves within it:

“While not universal, the experience of existential depression can challenge an individual’s very survival and represents both a great challenge and at the same time an opportunity—an opportunity to seize control over one’s life and turn the experience into a positive life lesson—an experience leading to personality growth.” (Webb, 2008, pp. 1-2).

This is exactly what Karraa (2013, 2014) describes in her research: postpartum depression threatening a woman’s physical and psychological survival (thus qualifying as a traumatic life experience) and resulting in transformation to an entirely new way of thinking, feeling, acting, and being in the world (e.g., more authentic and altruistic). Karraa is describing posttraumatic growth as well as the even bigger picture of personality development through positive disintegration.

walker head shot 2In Dabrowski’s theory, moving toward greater personality development after experiencing unilevel disintegration involves three more levels (Mendaglio, 2008b, pp. 37-39). In the first of these, we spontaneously start to examine, challenge, and reject beliefs and understandings that no longer work for us. We begin to see the clash between the actual (how things are) and the ideal (how things should be). We develop more autonomy and authenticity toward ourselves and others. And, we experience great distress while engaging in this work. (This level is called “spontaneous multilevel disintegration.”) In the next level of moving toward greater personality development, we cultivate a stronger sense of social justice, empathy, and responsibility for others. We become active agents in our learning, growing, and healing. And, our daily behavior is more consistently guided by higher values that are increasingly aligned with our transforming ideals. (This is called “organized multilevel disintegration.”) The last level is the full development of our personality. Our behavior is in alignment with the hierarchy of values that we consciously constructed during our developmental struggles—rather than with unexamined values that are common in our society or with our basic needs and drives. Because of this alignment, we are able to live in harmony with ourselves. (This is called “secondary integration.”) This very brief description of Dabrowski’s theory of positive disintegration leaves out a great deal of nuance and detail. But, I hope that it conveys that positive disintegration offers a useful framework for explaining transformation after postpartum depression.

Clinical Experience with Positive Disintegration through Postpartum Depression

In my experience as a perinatal mental health care provider, parents coping with perinatal depression, anxiety, and trauma are often helped by Dabrowski’s positive reframing of their symptoms as potential harbingers of growth; they become less afraid of what they are going through as well as more hopeful about the future. The analogy I use is that sometimes we have to take something that isn’t working apart so that we can re-assemble it in a better way. Like a child knocking over a tower of blocks, we can build anew. And, this is what I often see in postpartum depression, particularly in the context of moderate to severe postpartum depression: something isn’t working at a very fundamental level. Our conscious and unconscious expectations may have been shattered by our experiences in pregnancy, birth, parenting, and/or life. We may grieve the loss of roles that were intertwined with our very identities. Our relationship to ourselves and to others may be jolted profoundly out of balance by the arrival of a completely dependent baby whose unrelenting needs chronically supersede our own in a widespread context of insufficient social support. Our very paradigm of who we are and how the world works may be challenged to the core right when sleep deprivation diminishes our capacity to even try to make sense of it all. Our lifeways may not support our experience of severe stress, creating an inflammatory response (Kendall-Tackett, 2007) and a diminished capacity to physiologically sustain our mental well being. And, the dominant culture in the US impossibly expects us to return quickly to our before-baby lives and selves as though nothing out of the ordinary has happened and without feeling anything negative because “having a baby is a happy event.”

If this doesn’t qualify as a developmental milestone—as well as a life crisis—with the potential to trigger what Dabrowski calls “unilevel disintegration,” I don’t know what does! No wonder so many new parents experience postpartum depression. When our depression is on the more severe end of the spectrum, we disintegrate. We fall apart. We are shocked by the onset, magnitude, and nature of the symptoms of our devastation (Karraa’s “I Was Shattered;” Dabrowski’s “disintegration”). We experience this disintegration as a threat to our survival—meeting the definition of a traumatic event. If we stay in a prolonged state of disintegration, we may become suicidal, experience psychosis, or live with the debilitating symptoms of traumatic stress. Or, our recovery can return us to our prior level of functioning (Karraa’s “Getting Better;” Dabrowski’s reintegrating at the level of “primary integration”). Or we may instead take control of our development and healing, intentionally choose higher values to guide our behavior, increase our empathy and authenticity, and experience transformation and reintegration at a higher level of personality development (Karraa’s “I Was a Different Person” and “Metamorphosis;” Dabrowski’s “organized multilevel disintegration” and “secondary integration”).

Perinatal researchers and clinicians whose worldview is solely a medical model of postpartum depression may not recognize its developmental potential (Karraa’s “posttraumatic growth;” Dabrowski’s “positive disintegration”), viewing the goal of treatment only as the elimination of “negative” symptoms rather than as the facilitation of transformation. But individual experience, clinical experience, and now Karraa’s research show that both recovery and transformation are possible.

Whose Voices Were Heard?

The goal of Karraa’s research was to deeply explore the nature of transformation through postpartum depression—something that had not yet been studied. Her qualitative approach matches this goal perfectly. In a small qualitative study, it’s not surprising that she did not collect much demographic data related to the social group membership of the 20 women who participated in her study. She does report ascertaining their occupations (e.g., mental health care provision, marketing, finance, higher education, computer science, volunteer), which suggest that many participants had at least a middle class socioeconomic status (SES). Speaking English and having access to internet, email, and phone communication were inclusion criteria for the study. So, overall, the reported demographic data hint that many participants had access to resources, opportunities, and power that are disproportionately available to members of dominant social groups (e.g., white, at least middle class SES, cisgender, heterosexual, able-bodied).

I am left wondering: whose voices were included and whose were excluded in this initial research? If they were not included in this small study, what would we learn from the voices of depressed new mothers who cannot afford to attend college or to volunteer; who live in the chronic stress of poverty (Isaacs, 2004); and/or who do not have equitable access to culturally competent mental health care, support, and information? If they were not included in this small study, what would we learn if we had heard the voices of depressed new parents of a variety of gender identities/expressions and sexual orientations (Abelsohn, Epstein, & Ross, 2013) who live with intergenerational trauma (Graff, 2014) and the trauma of inescapable, ongoing racism (Bryant-Davis & Ocampo, 2005), cisgenderism (Mizock & Lewis, 2008), classism (Collins et al., 2010), ableism (Browridge, 2006), and/or other systems of oppression?

Dabrowski’s theory of positive disintegration recognizes the role of a variety of factors on personality development, including the effect of the social milieu (Mendaglio, 2008a). Do those who live as members of social groups targeted by systems of oppression have equitable access to experiencing postpartum depression as both suffering and recovery, much less as growth? Are there circumstances in which the human spirit is so persistently crushed that transformation after postpartum depression cannot occur even when the potential for growth exists? Or would the resiliency that can manifest even amidst chronic stress and trauma (Mullings & Wali, 2001) allow growth to still be possible? Further research and analysis is needed to uncover 1) how growth is and is not experienced by depressed new parents who hold membership in a wide variety of social groups, 2) what social factors support or undermine transformation after postpartum depression, 3) what kind of information, support, and treatment best supports growth after postpartum depression in a variety of social contexts, and 4) how perinatal organizations, care providers, and lay supporters can contribute to the dismantling of institutional oppression that creates inequitable access to resources and services that support recovery and growth from postpartum depression. And, then we need to take action to provide effective support and treatment that is equitably accessible to all new parents.

Conclusion

That people have the capacity for growing through life’s challenges has long been recognized. Karraa’s (2014) book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, offers a moving account of such transformation in the context of postpartum depression. The fact that the women in her study experienced physical and psychological symptoms that threatened their survival led Karraa to insightfully frame their transformation as an example of posttraumatic growth. Transformation through postpartum depression can also be understood through the lens of the theory of positive disintegration—a theory which subsumes and is broader than the experience of growth after trauma. Positive disintegration explains the possible outcomes of 1) transformation through a traumatic experience of postpartum depression, 2) recovery without transformation, and 3) remaining in a prolonged state of disintegration (e.g., suicidality, psychosis, traumatic stress reactions). Both theories offer hope to new parents experiencing the devastation of moderate to severe postpartum depression. Postpartum depression is more than pathology; it can lead to deeply meaningful transformation. Regardless of which theoretical framework is used to explain growth after postpartum depression, Dr. Karra’s findings are a compelling invitation for further exploration and application. I hope that her work will inspire more multidisciplinary research and analysis of the development that can come from postpartum depression so that more new parents will have access to the information, support, and treatment that they need to recover—and possibly even to be transformed.

References

Abelsohn, K., Epstein, R., & Ross, L. (2013). Celebrating the “other” parent: Mental health and wellness of expecting lesbian, bisexual, and queer non-birth parents. Journal of Gay & Lesbian Mental Health, 17(4), 387-405.

Browridge, D. (2006). Partner violence against women with disabilities: Prevalence, risk, and explanations. Violence Against Women, 12(9), 805-822.

Bryant-Davis, T. & Ocampo, C. (2005). The trauma of racism: Implications for counseling, research, and education. Counseling Psychologist, 33(4), 574-578.

Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward, A., Kiser, L., Strieder, F., & Thompson, E. (2010). Understanding the Impact of Trauma and Urban Poverty on Family Systems: Risks, Resilience, and Interventions. Baltimore, MD: Family Informed Trauma Treatment Center.

Graff, G. (2014). The intergenerational trauma of slavery and its aftermath. Journal of Psychohistory, 41(3), 181-97.

Isaacs M. (2004). Community Care Networks for Depression in Low-Income Communities and Communities of Color: A Review of the Literature. Washington, DC: Howard University School of Social Work and the National Alliance of Multiethnic Behavioral Health Associations.

Karraa, W. (2013). Changing Depression: A Grounded Theory of the Transformational Dimension of Postpartum Depression. (Doctoral dissertation). Retrieved from ProQuest/UMI. (3607747.)

Karraa, W. (2014). Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth. Amarillo, TX: Praeclarus Press.

Kendall-Tackett, K. (2007). A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal, 2(6), 1-14.

Mendaglio, S. (Ed.) (2008a). Dabrowski’s Theory of Positive Disintegration. Scottsdale, AZ: Great Potential Press.

Mendaglio, S. (2008b). Dabrowski’s theory of positive disintegration: A personality theory for the 21st century. In S. Mendaglio (Ed.), Dabrowski’s Theory of Positive Disintegration. Scottsdale, AZ: Great Potential Press.

Mendaglio, S. & Tillier, W. (2006). Dabrowski’s theory of positive disintegration and giftedness: Overexcitability research findings. Journal for the Education of the Gifted, 30(1), 68-87.

Mendaglio, S. & Tillier, W. (in press). Discussing Dabrowski: Has the time come to emulate Jung? A response to Piechowski’s most recent rethinking of the theory of positive disintegration: I. The case against primary integration. Roeper Review.

Mizock, L. & Lewis, T. (2008). Trauma in transgender populations: Risk, resilience, and clinical care. Journal of Emotional Abuse, 8(3), 335-354.

Mullings, L. & Wali, A. (2001). Stress and Resilience: The Social Context of Reproduction in Central Harlem. New York: Kluwer.

Nelson, K. (2004). Dabrowski’s theory of positive disintegration. Advanced Development Journal. 1989; 1:1-14.

Tedeschi, R. & Calhoun, L. (2004a). Posttraumatic growth: A new perspective on psychotraumatology. Psychiatric Times, 21(4), 1-4.

Tedeschi, R. & Calhoun, L. (2004b). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18.

Tillier, W. (2014). Dąbrowski 201: An Introduction to Kazimierz Dąbrowski’s Theory of Positive Disintegration [PDF document]. Retrieved from http://www.positivedisintegration.com/Dabrowski201.pdf

Webb, J. (2008). Dabrowski’s theory and existential depression in gifted children and adults. The Eighth International Congress of the Institute for Positive Disintegration in Human Development. Calgary, Alberta, Canada.

About Cynthia Good Mojab

cynthia good mojab headshot 2015Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, award-winning researcher, and internationally recognized speaker. She is the Director of LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural competence; and social justice. She has authored, contributed to, and provided editorial review of numerous publications. Cynthia can be reached through her website.

 

 

Birth Trauma, Childbirth Education, Depression, Guest Posts, Maternal Mental Health, New Research, Parenting an Infant, Perinatal Mood Disorders, Postpartum Depression, Trauma work, Uncategorized , , , , , , , , ,

Book Review – Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, Part One

March 10th, 2015 by avatar

 By Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

transformed cover

Walker Karraa, PhD, a former contributor to Science & Sensibility, has authored a new book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, that speaks to what lies on the other side for the 20 women she interviewed about their experiences with postpartum depression. Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM, who specializes in supporting people with postpartum mood and anxiety disorders and birth trauma presents a three-part series related to Dr. Karraa’s book. Today on the blog, Cynthia outlines the books content and its implications for practice. On Thursday, Cynthia shares her commentary on some of Dr. Karraa’s research and conclusions. Next week we are offered a glimpse into the person behind the book, when an interview with Dr. Karraa is shared with blog readers. Follow all three parts of this series on “Transformed by Postpartum Depression.” – Sharon Muza, Science & Sensibility Community Manager.

 In the last several decades, our awareness and understanding of postpartum depression have steadily increased. A wealth of research now exists regarding its prevalence, risk factors, prevention, symptoms, consequences, and treatment. Organizations, like Postpartum Support International and Postpartum Progress, champion the needs of families touched by postpartum depression and other perinatal mental health challenges, counter stigma, and contribute critical support and information to the safety net that all new families need and deserve. Many states in the United States have enacted legislation or developed projects related to public education, screening, and/or treatment for perinatal mental health challenges. And, at the national level in the US, the 2020 Mom Project seeks to remove institutional barriers that prevent depressed new mothers from being identified and accessing treatment.

In spite of this progress, we do not see the prevalence of postpartum depression dropping. Globally, it is as high as 82.1% when measured using self-reported questionnaires and as high as 26.3% when measured using structured clinical interviews (Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). In fact, we see that depression during pregnancy and after birth routinely goes undetected and untreated (Miller et al., 2012). How is that possible? And, beyond the statistics that we have now amassed, what is it really like to experience postpartum depression, come out the other side, and make meaning from the experience?

Posttraumatic Growth after Postpartum Depression

In her new book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, Walker Karraa, PhD (2014) invites readers to join her in a touching and thought provoking exploration of the potentially transformative nature of postpartum depression. Her book, which is based on the findings of her dissertation research (Karraa, 2013), brings to light both the suffering and development that women can experience on this journey. In fact, her book is one of the fruits of her own transformation through her experience of severe postpartum depression. Parents, lay supporters, and perinatal care providers who appreciate the blend of research and women’s voices found in books like Depression in New Mothers: Causes, Consequences, and Treatment Alternatives (Kendall-Tackett, 2010) and Traumatic Childbirth (Beck, Driscoll, & Watson, 2013) will also appreciate Karraa’s book. It should certainly be considered “required reading” for perinatal care providers and lay supporters.

walker karraa head shot 2015Karraa begins with a brief review of the literature, including what postpartum depression is, who develops it, and its global prevalence, risk factors, and consequences. These facts and figures help orient the reader to the general nature and scope of a veritable global mental health pandemic. They also serve to illustrate the foundation of the dominant discourse regarding postpartum depression: an allopathic worldview that frames mental illness as pathology. The following five chapters, however, contribute to an expansion of that view by illustrating how postpartum depression can be experienced as a long and painful journey culminating in positive change.

In the course of conducting her qualitative research, Karraa used grounded theory to analyze the answers of 20 women to four questions (Karraa, 2013) about their experience of postpartum depression:

  • How would you describe your process of transformation through postpartum depression?
  • In what ways did you experience the process of transformation through postpartum depression?
  • What were the ways you saw yourself transforming?
  • How do you experience this transformation currently?

She uncovered five stages of transformation through postpartum depression: before, during, ending, after, and beyond. That the women described 1) feeling shocked by the nature and magnitude of their symptoms, 2) enduring physical and psychological disintegration to which care providers seemed oblivious, and 3) slowly finding a path toward recovery will strike a familiar chord for lay supporters, perinatal care providers, and individuals who have worked and/or lived with postpartum depression. What might not be familiar to all readers are the last two stages that Karraa identified: 4) an increase in self-care, self-confidence, authenticity, and compassion; improved relationships; and alteration of perception of self and purpose in the world; and 5) coming to view postpartum depression as resulting—paradoxically—in a profoundly positive transformation.

In her 7th chapter, Karraa gives the reader a thoughtful tour of her consideration of several theories that might explain her research participants’ experiences of transformation through postpartum depression. Ultimately, she recognized that the prolonged endurance of threat to their physical and psychological survival was so great that the women experienced postpartum depression as a traumatic life event and that the transformative nature of their experience of postpartum depression is, thus, an example of posttraumatic growth: “positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (Tedeschi & Calhoun, 2004).

In chapter 8, Karraa shares the confirming feedback of four experts in the field of postpartum depression, including the illustrious Cheryl Tatano Beck, Jane Shakespeare-Finch, Karen Kleinman, and Jane Honikman. Then she closes with a chapter acknowledging that her work has revealed a connection that has been right under our noses waiting for us to formally notice and describe: postpartum depression is one of the adversities of life that can precipitate growth. Karraa researched, recognized, and named that connection. Naming an experience honors it. It also provides a language for new parents, lay supporters, perinatal care providers, and researchers to use as they seek to express, understand, provide support for, treat, recover from, and/or grow from the life-altering experience of postpartum depression. And, perhaps most importantly, it offers hope to those who are fighting their way back from the devastation of postpartum depression. Not only can recovery be found at the end of the darkest tunnel; transformation may await.

Care Provider Failure: A Call to Action

The power of Karraa’s book continues in its appendices, where she describes an informal survey that serves as an(other) urgent call to action for all of us: in spite of the high prevalence of postpartum depression and its negative consequences when untreated, we are collectively failing to help those who are experiencing it. Because so many women in her qualitative study reported that their care providers had failed to help them, Karraa conducted the Changing Depression Survey (n=486). When asked who was most responsible for their getting help for postpartum depression, 65.4% of her participants selected “Self,” 23.0% selected “Partner,” 16.9% selected “Family Member,” 11.7% selected “Medical Care Provider” (which includes OB/GYN, Midwife, General or Family Physician), 8.8% selected “Other (Friend),” and 6.6% selected “Therapist.” When asked who was least helpful in getting them help for postpartum depression, 43.2% of her participants selected “Medical Care Provider,” 21% reported “Family Members,” 20.6% reported “Partner,” 19.3% reported “Self,” and 6.8% reported “Therapist.”

While this is, admittedly, an informal survey, the patterns seen here match clinical experience as well as research findings that only a fraction of new mothers with postpartum depression are identified and treated (Milgrom & Gemmill, 2014). My own clients, who are new parents, frequently report finding me after seeing a series of care providers who did not formally screen or refer them for perinatal mental health challenges, did not informally ask them about how they are coping with new parenthood, and/or did not respond with sensitivity, validation, or assistance when they tried to share their struggles. A delay in diagnosis, support, and treatment can both worsen and prolong suffering for new parents struggling through postpartum depression. Karraa’s research suggests that, in some cases, it may also delay the experience of posttraumatic growth.

This call to action must be heard and effectively responded to by individuals as well as by institutions. Yes, perinatal care providers and lay supporters will benefit from reading Karraa’s book. But, reading the book is not the same as developing the skills to apply the book’s insights in practice. Her research is an invitation for organizations and credentialing institutions in the diverse fields that provide services to new families (e.g., childbirth education, doula care, midwifery, obstetrics, pediatrics, family practice medicine, lactation education, lactation consulting, counseling, social work, psychiatry, naturopathic medicine) to develop, offer, and require training related to perinatal mental health, including:

  • how to reduce stigma and increase awareness by educating expectant and new parents about perinatal mental health issues
  • why, when, and how to screen and refer
  • how to effectively provide care to new parents struggling with perinatal mental health challenges—including using approaches that incorporate an understanding of postpartum depression as potential transformation to be nurtured, not just as pathological symptoms to be eliminated.

Conclusion

Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth consistently engages the reader with the poignant and inspiring stories of 20 women, as well as with the intriguing insights of the author and four experts in the field. The moving narratives and cogent analysis effectively describe the women’s experience of postpartum depression as traumatic and the transformation of their suffering into growth. The book also invites us to transcend the dominant view of postpartum depression as pure pathology and to learn how to take effective action to keep new parents struggling with perinatal mental health challenges from falling through the cracks. I congratulate Dr. Karraa on authoring a book that makes such a meaningful contribution to our understanding of postpartum depression and, refreshingly, offers a significant focus on recovery and development. Join me here on this blog on Thursday to read my commentary regarding frameworks that might explain her findings as well as my hopes for future research.

References

Beck, C., Driscoll, J., & Watson, S. (2013). Traumatic Childbirth. New York: Routledge.

Karraa, W. (2013). Changing Depression: A Grounded Theory of the Transformational Dimension of Postpartum Depression. (Doctoral dissertation). Retrieved from ProQuest/UMI. (3607747.)

Karraa, W. (2014). Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth. Amarillo, TX: Praeclarus Press.

Kendall-Tackett, K. (2010). Depression in New Mothers: Causes, Consequences, and Treatment Alternatives. New York: Routledge.

Milgrom, J. & Gemmill, A. (2014). Screening for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 13-23.

Miller, L., McGlynn, A., Suberlak, K., Rubin, L., Miller, M., & Pirec, V. (2012). Now What? Effects of On-Site Assessment on Treatment Entry After Perinatal Depression Screening. Journal of Women’s Health, 21(10), 1046-1052.

Norhayati, M., Nik Hazlina, N., Asrenee, A., & Wan Emilin, W. (2014). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175C, 34-52.

Tedeschi, R. & Calhoun, L. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18.

About Cynthia Good Mojab

cynthia good mojab headshot 2015Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, award-winning researcher, and internationally recognized speaker. She is the Director of LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural competence; and social justice. She has authored, contributed to, and provided editorial review of numerous publications. Cynthia can be reached through her website.

Guest Posts, Infant Attachment, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression, Research, Trauma work, Uncategorized , , , , , , ,

New Electronic Fetal Monitoring Infographic Along with Printables of All Infographics!

February 19th, 2015 by avatar

Screen Shot 2015-02-18 at 9.21.29 PM

Lamaze International has released a new infographic; “Can Good Intentions Backfire in Labor? A closer look at continuous electronic fetal monitoring (EFM). This infographic is suitable for childbirth educators, doulas and birth professionals to use and share with clients and students.

Many birthing people and their families feel that monitoring in the form of continuous EFM (CEFM) during labor means a safer outcome for both the pregnant person and baby.  But as the infographic clearly states, (and as the research shows) since the invention of the continuous EFM, more than 60 years ago, newborn outcomes have not improved and in fact worsened.  CEFM used on normal, healthy, low risk labors does not make things better and can often create a situation that requires action (such as a cesarean birth) when the reality is that all was fine.

EFMInfographic_FINALAs educators, we have a responsibility to the families we work with to share what the evidence shows about continuous fetal monitoring.  Families may be surprised to learn that CEFM is not necessary for a spontaneous labor that is progressing normally and with a baby who is tolerating labor well.  Many of us may cover this topic when we talk about the 4th Healthy Birth Practice – Avoid Interventions that are Not Medically Necessary.  CEFM during a low risk, spontaneous labor is not medically necessary.  Helping families to understand this information and setting them up to have conversations with their health care providers about when CEFM might become necessary is an important discussion to have in childbirth class. Now there is this Lamaze International infographic on CEFM to help you facilitate conversations with your clients and students.

Lamaze International has also listened to the needs of educators and in addition to having the infographics available on a web page, all of the infographics are available as printable 8 1/2″ x 11″ handouts that you can share with families.  Alternately, for versions to laminate or hang in your classroom or office, you can choose to print the jpg versions in the original format. And of course, they will also reside on the Lamaze International Professional website.  Hop on over to check out all the infographics on a variety of topics.

Parents can find the EFM infographic as part of the educational material on the EFM information page on the parent website.

How do you cover the topic of continuous electronic fetal monitoring in your classes?  Will you be likely to use this new infographic as part of your curriculum?  Let us know in the comments section below.

Childbirth Education, Evidence Based Medicine, Fetal Monitoring, Healthy Birth Practices, Lamaze International, Maternal Quality Improvement, Medical Interventions, Push for Your Baby, Uncategorized , , , , , ,

Sarah Buckley’s “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care” – A Review for Birth Educators and Doulas

January 13th, 2015 by avatar

by Penny Simkin, PT, CD(DONA)

Today, a long awaited report written by Dr. Sarah Buckley, “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care” is being released by Childbirth Connection. In this valuable report, Dr. Buckley gathers the most current research and provides the definitive guide for the role of hormones in normal, natural birth.  Esteemed childbirth educator, doula and author/filmmaker Penny Simkin has reviewed Dr. Buckley’s latest offering and shares today on Science & Sensibility how childbirth educators, doulas and other birth professionals can use this information to inform parents on how best to support the physiological process of childbirth.  In coordination with this research report, Dr. Buckley and Childbirth Connection are releasing a consumer booklet geared for families and consumers as well as other material, including infographics in support of this report.  On Thursday, Lamaze International Past President Michele Ondeck will share her interview with Dr. Buckley. In that interview,  S&S readers can get the full story directly from Dr. Buckley, on just what it took to create this remarkable tome. – Sharon Muza, Community Manager, Science & Sensibility.

© Childbirth Connection

© Childbirth Connection

Introduction

For many of us who work in the maternity field, Sarah Buckley’s fine work is well-known. Her book, “Gentle Birth, Gentle Mothering” (Buckley, 2009) has provided scholarly and enlightening guidance on natural childbirth and early parenting for many years. Her 16 page paper, “Ecstatic Birth,” (Buckley, 2010) guides educators and doula trainers, who rely heavily on her explanations of hormonal physiology in childbearing, for teaching about labor physiology and psychology and the impact of care practices.

Her newest publication, “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care,” (Buckley, 2015) is a gift to us all. It represents a massive scholarly effort, a review of all the related scientific literature on the topic. With 1141 references, most of which were published in recent years, Dr. Buckley’s overview provides the transparency to allow readers to trace her statements to the evidence on which they are based. She exercises caution in drawing concrete conclusions when the evidence is insufficient; she presents such information as theory (rather than fact), and points out when more research is necessary for concrete conclusions. The “theory” that undisturbed birth is safest and healthiest for most mothers and babies most of the time is impressively supported by her exhaustive review, as stated in the conclusion (Buckley, 2015):

“According to the evidence summarized in this report, the innate hormonal physiology of mothers and babies – when promoted, supported, and protected – has significant benefits for both during the critical transitions of labor, birth, and the early postpartum and newborn periods, likely extending into the future by optimizing breastfeeding and attachment. While beneficial in selected circumstances, maternity care interventions may disrupt these beneficial processes. Because of the possibility of enduring effects, including via epigenetics, the Precautionary Principle suggests caution in deviating from these healthy physiologic processes in childbearing.”

The Precautionary Principle, to which she refers, has been stated as follows:

“When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context the proponent of an activity, rather than the public, should bear the burden of proof. . . . It (the activity) must also involve an examination of the full range of alternatives, including no action.” (Science and Environmental Health Network, 1998).

In other words, when applied to maternity care, The Precautionary Principle states that when a practice, action, or policy may raise threats of harm to mother, baby, or family, the burden of proof that it will result in more good than harm falls on those who wish to adopt it – the policy maker, caregiver, or administrator, not on the pregnant person.

© Sarah Buckley

© Sarah Buckley

What’s new in this document and how might you use it and apply it in your classroom or practice?

This document represents the “State of the Science” regarding hormonal physiology of childbirth (HPOC). It should be the starting point for consideration of proposed changes in maternity care management and education. The question, “How might this policy, practice, or new information impact the HPOC and subsequent outcomes for mother and/or baby?” should be asked and answered about both existing and proposed interventions.

Sarah Buckley has asked and answered this question, and reveals the unintended consequences of numerous widespread practices, including scheduled birth – induced labor or planned cesarean; disturbance and excessive stress during labor; synthetic oxytocin (Pitocin); opioids and epidural analgesia for labor pain; early separation of mother from infant or wrapping the infant in a blanket to be held (i.e., no skin-to-skin contact); breastmilk substitutes, and many more. All of these practices cause more harm than good, except in unusual or abnormal circumstances.

One of the greatest contributions of this book is showing that hormonal physiology is affected by virtually every intervention –major and minor — and understanding this is the key to appropriate maternity care. The topic is complex and not nearly fully understood, but Sarah Buckley has pulled together just about everything that is now known on this topic. If you’re a maternity care practitioner or student, who wants to approach the care you give from a physiological perspective, or want information on the impact of common interventions on the physiological process, it’s all here. If you’re a researcher interested in studying some aspect of HPOC, your literature search has already been done for you and you can discover the many areas that have been insufficiently studied and plan where to go from there.

If you’re a childbirth educator seeking to give accurate information to expectant parents about how normal childbirth unfolds and how it can be altered (for better or worse) with common procedures and medications, you can learn it here. If you’re a doula who wants to understand how your presence and actions may contribute to normalcy, you can learn it here. If you’re an expectant parent who wants to make choices that maintain or improve the pregnant person and infant’s well-being, you can learn it here or access the consumer guide.

Organization of the Chapters

This book, with its numerous references, sheer number of pages, level of detail and broad scope, may seem daunting at first. However, if you take some time to familiarize yourself with the layout of the book before plunging in, you will find that the material in each chapter is arranged so that readers can explore each topic at varying levels of detail.

The book begins with a very helpful 10 page executive summary of the contents. There are then two chapters introducing concepts relevant to HPOC, and on the physiologic vs. scheduled onset of birth (induction and planned cesarean birth). The 7 chapters are organized with topics and subtopics. The first paragraph beneath the headings for each topic or sub-topic briefly and clearly summarizes the information in that section in italics, so that you can skim each topic by reading only the italicized summary. If you wish to investigate some subtopics more deeply, you can read everything included on those topics. Each chapter also ends with a summary of the entire chapter. Chapters 3, 4, 5, and 6 (Chapter 3 — “Oxytocin;” 4 —“Beta-Endorphins;” 5 —“Epinephrine-Norepinephrine and Related Stress Hormones;” ; and 6 —“Prolactin”) follow the same outline of topics and subtopics.

Using Chapter 6 (“Prolactin”) as an example, here is the outline:

  • 6.1 Normal physiology of prolactin
    • 6.1.1 Introduction: Prolactin
    • 6.1.2 Prolactin in pregnancy
    • 6.1.3 Prolactin in labor and birth
    • 6.1.4 Prolactin after birth
  • 6.2 Maternity care practices that may impact the physiology of prolactin
    • 6.2.1 Possible impacts of maternity care provider and birth environment on prolactin
    • 6.2.2 Prostaglandins for cervical ripening and labor induction: possible impacts on prolactin
    • 6.2.3 Synthetic Oxytocin in labor for induction, augmentation, and postpartum care: possible impacts on prolactin
    • 6.2.4 Opioid analgesic drugs: possible impacts on physiology of prolactin
    • 6.2.5 Epidural analgesia: possible impacts on physiology of prolactin
    • 6.2.6 Cesarean section: possible impacts on physiology of prolactin
    • 6.2.7 Early separation of healthy mothers and newborns: possible impact on physiology of prolactin
  • 6.3 Summary of all findings on prolactin

For childbirth educators: how might we use this information to benefit our students?

I especially appreciate that Dr. Buckley begins every section with a description of the relevant physiology. In order to be truly effective, we educators should do the same in our classes, to ensure that our students understand how and when their care is consistent with physiological childbearing and when (and why) it is not. “’Physiological childbearing’ refers to childbearing conforming to healthy biological processes,” (Buckley, 2015, page 11) as opposed to what many might refer to as “medicalized childbearing,” in which the physiologic process is altered or replaced with interventions and medications.

© Childbirth Connection

© Childbirth Connection

Childbirth education should be designed to allay the pregnant person’s anxiety, not by avoiding mention of potentially troubling labor situations, or minimizing concerns mentioned by the students, but rather by giving realistic portrayals of birth, encouraging expression of feelings, and dealing with them by informing, reframing, desensitizing, and strategizing ways to handle troubling situations. Following is an example of how an educator might include hormonal physiology of childbearing to teach about one critical topic – Physiologic Onset of Labor, which is Lamaze International’s First Healthy Birth Practice.

Let labor begin on its own: How to teach from the standpoint of HPOC

Chapter 2 in HPOC , “Physiologic Onset of Labor and Scheduled Birth,” details the ‘highly complex orchestrated events that lead to full readiness for labor, birth and the critical postpartum transitions of mother and baby.” (Buckley, 2015). As educators, we should try to convey this information, in simplified form, to help our students appreciate the beauty and connectedness of the whole mother-baby dyad. They need to understand the consequences of interrupting the chain of events that usually result in optimal timing of birth. Most parents (and many caregivers as well) have no idea that the fetus determines the onset of labor. Nor do they know that fetal readiness for labor (including protection against hypoxia and readiness for newborn transitions after birth) is coordinated with preparation of the mother’s body for labor, breastfeeding and mother-infant attachment. Once students have some grasp of these processes, they appreciate and want to protect them from interruption or replacement by medical means. As we know, most inductions and many planned cesareans are done without medical reason (ACOG, 2014). Out of ignorance and/or misinformation from their caregivers, parents often agree or even ask for these procedures.

While many educators know and teach about the risks and benefits of induction and planned cesarean, they often don’t convey the physiology on which the benefits and risks are based. It’s all here in HPOC, and this information may inspire parents to question, seek alternatives or decline these procedures.

Over the years, I have wrestled with the challenge of conveying this information fairly simply and concisely, and now, with the help of Katie Rohs, developed a new animated PowerPoint slide, “The Events of Late Pregnancy” (Simkin, 2013) that I use in class. You may access this animated slide and accompanying discussion points/teacher guide here.© Penny Simkin

© Penny Simkin

This is just one example of how we may shift our focus as teachers to incorporate basic hormonal physiology as a starting point. Dr. Buckley gives us a solid understanding of what is known about the key role the endocrine system plays in orchestrating the whole childbearing process, and why we shouldn’t disrupt this elegant process without clear medical reasons. If we teachers and other birth workers incorporate this information in our practices and in our teaching, outcomes will improve.

“Hormonal Physiology of Childbearing” is surely the most extensive search ever done on this topic, and is a solid guide to learning this crucial information. Encyclopedic in its scope, and multi-layered in its depth, this book will be most useful as a reference text, rather than a book to read straight through. It is pretty dense reading, but when you have a question relating to reproductive physiology or the effects of interventions, you can search for well-explained answers. The evidence-based conclusions that Sarah Buckley has synthesized from an abundance of research (1141 references!) are authoritative and must be made accessible. This is truly “State of the Science” on Hormonal Physiology of Childbearing.

Conclusion

Typical maternity care today has departed so far from physiology that in many cases it causes more harm than good, as borne out by Dr. Buckley’s discussions throughout the book of the impact (i.e., unintended consequences) of common maternity care practices on hormonal physiology and mother-baby outcomes. Our job is to inform expectant parents of these things and help them translate information into preparedness and confident participation in their care. If we do our job well, our students will want to support, protect, and participate in the physiological process, which has yet to be improved upon. Parents and their babies will benefit! Our thanks should go out to Sarah Buckley and to Childbirth Connection for bringing this gift to us.

In conclusion, Sarah Buckley’s “Hormonal Physiology of Childbearing” is an impressive exploration of the major hormonal influences underlying all aspects of the labor and birth process. As we understand and incorporate the knowledge included in the book, the birth process will become safer, with effects lasting over the life span.

References 

American College of Obstetricians and Gynecologists and Society of Maternal-Fetal Medicine, 2014. Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus Number 1. Obstet Gynecol ;123:693–711.

Buckley S. Ecstatic Birth. Nature’s Hormonal Blueprint for Labor. 2010. www.sarahbuckley.com

Buckley S. 2009, Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, Berkeley

Buckley S. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care. Childbirth Connection, New York

Science & Environmental Health Network. 1998. Wingspread Conference on the Precautionary Principle. Accessed Jan. 8, 2015, https://www.google.com/search?q=The+Precautionary+Principle&ie=utf-8&oe=utf-8.

Simkin P. 2013, Events of Late Pregnancy. Childbirth Education Handout and Slide Penny Simkin, Inc. Seattle. https://www.pennysimkin.com/events-powerpoint

About Penny Simkin

penny_simkinPenny Simkin is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates she has prepared over 13,000 women, couples and siblings for childbirth, and has assisted hundreds of women or couples through childbirth as a doula. She has produced several birth-related films and is the author of many books and articles on birth for both parents and professionals. Her books include The Labor Progress Handbook (2011), with Ruth Ancheta, The Birth Partner (2013), and When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse of Childbearing Women (2004), with Phyllis Klaus. Penny and her husband have four adult children and eight grandchildren. Penny can be reached through her website.

 

Babies, Breastfeeding, Cesarean Birth, Childbirth Education, Guest Posts, Healthy Birth Practices, Infant Attachment, Maternity Care, Medical Interventions, New Research, Newborns, Uncategorized , , , , ,

New Series: “BABE”- Brilliant Activities for Birth Educators! “Got Oxytocin?”

January 9th, 2015 by avatar

By Kyndal May, MFA, LMP, CD(DONA), BDT(DONA), LCCE

Today on Science & Sensibility, we start a new series on teaching ideas and techniques for you to use in your birth classes. The BABE series (Brilliant Activities for Birth Educators) will bring you exciting and innovative methods to teach the topics normally covered in a Lamaze CBE series. We will be highlighting a variety of childbirth educators as they share some of their favorite activities from their classes.  Today, we welcome Kyndal May, a childbirth educator in Boise, ID, as she shares how she covers the hormones of birth, and the role of oxytocin.  Do you have a creative method of teaching a CB topic?  Let me know via email, and we can connect about sharing in a future BABE blog post!  Everyone loves to learn new ideas and refresh their class activities.  I would love to hear from you.- Sharon Muza, Community Manager, Science & Sensibility.

© Kyndal May

© Kyndal May

This past September, I was among many doulas and childbirth educators lucky to attend Sarah Buckley’s session on The Hormonal Physiology of Childbearing at the Lamaze International/DONA International Confluence in Kansas City, MO. Following Dr. Buckley’s U.S. tour of her Undisturbing Birth Workshops, I suspect many childbirth educators may be revisiting the way we approach and explore the topic of the hormones of labor in our classes.  After viewing her DVD, Undisturbed Birth: the Science and the Wisdom, I am currently working to adapt both my childbirth classes and my birth doula workshops to incorporate this information in a new way.

While I play with what that will look like and how best to make that learning both powerful and playful, I’ll share how I have long taught about the hormones of labor –with a focus on oxytocin and a few activities (both past and present) that make it meaningful and fun.

Like everything in my classes, both content and my facilitation style is constantly changing based on what I am reading at the time, what I am witnessing in births, and the dynamics of the group. My students’ interactions and participation bring so much to the experience that they unknowingly contribute (often month to month) to what stays and what gets tossed.

I doubt that I am that different from other passionate childbirth educators who tend to see life through a “birth lens” if you will, meaning that very often, what I see, hear, and experience goes through the “how does this relate to birth?” or “could I tweak this to be a teaching tool?” filter in my brain. So, in 2009, when I saw t-shirts with messages like “I love my midwife” and “My midwife helped me out,” I immediately starting thinking of a t-shirt message I could use in my class and quickly put in a custom order for my “Got Oxytocin?” t-shirt.

© Kyndal May

© Kyndal May

I wore this t-shirt under another shirt through the first half of class one but I wait to show it to the class until we have explored the role of oxytocin in relation to birth. For example, oxytocin as a smooth muscle contractor – the perfect lead-in to discovering the unique structure of the myometrial musculature and watching as moms and their partners come to appreciate the uterine muscle and its work in labor in a new and meaningful way; oxytocin as ejection reflex initiator – the perfect lead-in to discussing oxytocin’s role both in the second stage and in orgasm and watching the connections made by each couple as they realize the essential environmental commonalities between the two and the need for a safe, private space for both.

At this point, orgasm becomes the perfect lead-in for understanding the role of beta-endorphins — as pain-suppressant and pleasure/transcendence producer — through a brief lesson on the etymology of the word (sometimes using smart phones).

Endorphin

With a consensus regarding the pleasure of orgasm and the pulsating rhythm of labor, everyone would very much like to know how to avoid inhibiting that process. So, epinephrine and norepinephrine become the perfect lead-in to receptors and …a short detour actually, to the brain, where we acknowledge the differences between a “typical male” and “typical female” brain through the perspective of the adolescent brain, in particular. Here, we compare the fight or flight response to ‘tending and befriending’ and what that can look like in different settings.

Throughout this process, we pause so that each couple can answer a few questions together and privately identify their own unique styles of co-creating an oxytocin-rich environment in their day-to-day living and connect it to their mutual vision of a safe birthing space.

Sound complex? It is – as complex as the interactions of these hormones, but just as rewarding and very fun. At this point, we take a break and when we come back together, I am sporting my “got oxytocin?” t-shirt for all the class to see.

As we turn our attention to how oxytocin and its partnering hormones set up both mother and baby for a thriving start together in the postpartum period, I pass out plain, white baby t-shirts to each couple. I invite them to take them home and design their own “Got Oxytocin?” baby t-shirt. I ask them to create it as if the baby was asking the question of everyone who comes into the birthing space.

© Kyndal May

© Kyndal May

My intention is to have them continue to think about oxytocin’s value in labor; to remember how it interacts with and is inhibited by the other hormones and how they might best co-create a space that supports the free-flow of the hormone. And most of all, because their canvas is the baby t-shirt, they are mindful how it benefits not only the mother but also the baby.

Each time I have used this activity, the response has been very positive. The first time, it was met with surprising enthusiasm and every couple chose to participate. Two weeks later, they returned with their amazingly creative t-shirts using everything from paint, to iron-on transfers, crochet to tie-die. One couple even reconstructed their t-shirt into a bowling shirt complete with buttons, color panels, collar and nametag. It was clear all of them not only enjoyed the activity, they enjoyed doing it together as a couple. A few commented that the activity provoked them to imagine their baby’s personality.

At least one couple took their baby t-shirt to their birth as a reminder to everyone who entered to support their efforts to create a safe and private birth space. Many couples commented how meaningful it was to them to have the t-shirt as a memento from the class in their baby book.

It has been a while since I have done this kind of an activity in class, but a new idea came to me last year. As we approached the holiday season, it seemed the perfect time of year to try it out.

© Kyndal May

© Kyndal May

At the end of class one, I handed each couple 2 clear plastic tree ornaments – one round and one in the shape of a heart. These ornaments can be opened and filled with paint, confetti or, in the case of the photo here, a piece of paper with some writing on it. I asked each couple to think of some way they might represent oxytocin or what oxytocin means to them and put it into the ornament. The objective is to work together to identify what is especially oxytocin producing for them. Once they do that, they’ll find a creative way to represent it and put it in the ornament that will then become their personal “mistletoe”.

They are invited to hang their “oxytocin ornament” and each time they walk under it, it will remind them to stop and spend a little time in an embrace — which we know, if they will hold for 10 seconds or more and do it 8 times a day, is a wonderful way to increase their own oxytocin levels.

Ornament music

© Kyndal May

This first group brought their oxytocin ornaments back and I had just a moment to photograph just a couple at the break. The first one is filled with berries that represent gooseberries for the couple who met a health store called “Gooseberries.”
Another couple filled theirs with sheet music as each of them is very musical and plan to use music as a comfort measure in their birth. One couple filled their ornament with small birthday candles to represent candlelit moments and another filled theirs with layers of colored cake decorations – each color representing something about their relationship. Overall, the project was met with positive interest and one couple said they enjoyed it so much they found themselves giggling through the process which became a very playful experience them.

Early in my teaching career one of the moms in class brought a gift to give everyone at the closing class of the session.   She told us all, “The way Kyndal talked about oxytocin, I just felt it was a ‘wonder-product’. It can contract the uterus and bring milk down, it can bond people to each other and more…maybe even get stains out of the carpet. So, I thought everyone should have their own bottle of oxytocin.” She passed out massage oil in tiny bottles with a label claiming the contents to be “oxytocin” and thus began an long tradition of sending each couple home with their own personal bottle of “oxytocin”.

I have since shifted my parting gifts but I revisit that one now and again as it was a long-running favorite. You can see more of the “Got Oxytocin” baby t-shirts by visiting my site.

Maybe you would like to incorporate some of the ideas listed here in your childbirth classes as you cover the hormones of labor.  If you do, please consider coming back to Science & Sensibility and sharing how it goes.  We’d love to hear from you. – SM

About Kyndal May 

© Kyndal May

© Kyndal May

Kyndal May, MFA, LMP, CD(DONA), BDT(DONA), LCCE, is a storyteller and facilitator; a confidence and commUnity builder for expectant parents, doulas and childbirth educators. She has been an active, private practice childbirth professional since 1995. Teaching her own curriculum, first in Seattle, WA and now in Boise, ID, she has well over 2000 hours of teaching experience and has attended nearly 300 births. A Licensed Massage Practitioner, she incorporates her background in bodywork and movement into her classes to facilitate awareness and help her students discover their own way to labor and birth. She refers to her Confident Birthing Childbirth Class as an ‘informed choice’ class and her unique education platform is used by educators in the United States and abroad.

She is a Lamaze Certified Childbirth Educator, a DONA Certified Birth Doula and Birth Doula Trainer offering advanced doula trainings in loss and communication. She serves as the consumer member of the Idaho State Board of Midwifery and on the DONA International Board of Directors as the Western Pacific US Regional Director.

Kyndal’s photography has been published in The Essential Homebirth Guide, Birth Ambassadors: Doulas and the Re-emergence of Woman Supported Childbirth in the United StatesA frequent speaker at professional conferences, her session, The Doula’s Field Guide to Birth Photography is available online through DONA International’s webinar series. To view more of her birth photography, visit her website at: www.kyndalmay.com

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