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Book Review: “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers”

May 28th, 2015 by avatar

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

monograph cover_tn_kenKathleen Kendall-Tackett, Ph.D, author, IBCLC, researcher, internationally acclaimed speaker and occasional contributor to our blog, has written a new book – “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers,” that tries to lay to rest the myth that receiving help for a postpartum mood disorder and breastfeeding are not compatible.  I asked Cynthia Good Mojab to share her expert review of the book to commemorate the end of Perinatal Mood Disorders Awareness Month.  Cynthia is the perfect person for this task as she wears the hat of both a lactation consultant and a clinical counselor.  As birth professionals who work with families throughout the childbearing year, we have a sincere responsibility to provide information and screening resources so that families can be evaluated and directed to receive help that continues to support the breastfeeding dyad if breastfeeding is the parent’s desire.  Read Cynthia’s review and consider what you can do to increase awareness of perinatal mood disorders and offer your clients and students the best evidence based information available about how treatment options and breastfeeding are not mutually exclusive. – Sharon Muza, Community Manager, Science & Sensibility

Globally, the prevalence of postpartum depression is as high as 82.1% when measured using self-report questionnaires and as high as 26.3% when measured using structured clinical interviews (Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). These high rates mean that a significant proportion of families navigate breastfeeding in the context of postpartum depression.

As a perinatal mental health care provider and an IBCLC, I am frequently contacted by parents who found me after having been unable to access breastfeeding-compatible mental health care for postpartum depression (Good Mojab, 2014). They report feeling as though they are caught between a rock and a hard place: they’ve been diagnosed with postpartum depression and have been told by their primary care provider and/or their mental health care provider that they must wean in order to treat their depression. Sometimes they are even told that breastfeeding is causing their depression. Not only is that not true, but the relationship between infant feeding and postpartum depression is actually quite complex (Nonacs, 2014). While breastfeeding problems increase the risk of postpartum depression, breastfeeding itself is protective (Kendall-Tacket, n.d.). And research shows that infant-feeding intentions matter: breastfeeding mothers who are unable to accomplish their breastfeeding goals are two-and-a-half times more likely to develop postpartum depression (Borra et al., 2015). These research findings match what I see in my private practice: the partial or complete loss of a parent’s desired experience of breastfeeding can precipitate deep grief and worsen or precede the onset of postpartum depression.

Fortunately, there are many breastfeeding-compatible treatments for postpartum depression which health care providers and mental health care providers can use to effectively treat the vast majority of their clients. Dr. Kathleen Kendall-Tackett’s new book, “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers,” presents an up-to-date overview of the related research in an outline format that is quick and easy to read. She presents a compelling case for ensuring that families coping with breastfeeding problems receive additional lactation support and that breastfeeding parents coping with postpartum depression have access to treatment that is compatible with the continuation of breastfeeding.

In the first chapter, Kendall-Tackett introduces the rationale for screening for, referring for, and treating postpartum depression: postpartum depression is common in new parents and untreated postpartum depression has significant, immediate, and long-term negative consequences for both parent and child. She then presents research showing that breastfeeding does not cause depression (as some health care providers falsely believe); rather, breastfeeding serves to protect the dyad from the deleterious consequences of postpartum depression via its dampening of the stress response and via its facilitation of ongoing engagement between parent and baby. (When we shift our culturally based reference frame in recognition that breastfeeding is the biological norm for humans, we can see that this research also shows that formula feeding increases the risk of deleterious consequences from postpartum depression through increasing the stress response and potentially lessening ongoing engagement between parent and baby.) The substantial evidence base for why the effective treatment of postpartum depression is so critical—briefly introduced in chapter 1—is presented in more detail in chapter 3. Psychological disorders that often co-occur with postpartum depression, such as posttraumatic stress disorder, bipolar disorder, eating disorders, and obsessive-compulsive disorder, are then described. Chapter 5 reviews the complex causes of postpartum depression, including inflammation, fatigue and sleep disturbance, pain, traumatic birth experiences, infant characteristics such as illness and prematurity, and maternal characteristics, life history, psychiatric history, and social context.baby breastfeeding

Chapter 6 emphasizes the importance of screening for postpartum depression. Kendall-Tackett wisely advocates that validated screening tools be used (rather than relying merely on casual observation) and that screening occur in a variety of care settings—prenatal, hospital, home, and pediatric office visits. The recommendation for prenatal screening is very important. Depression during pregnancy is common (11% to 23% of pregnant women experience depression), is a risk factor for adverse reproductive outcomes such as preterm delivery, and is among the strongest predictors of postpartum depression (Gaynes, et al., 2005; Yonkers, et al., 2009; Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). Kendall-Tackett describes three reliable screening tools—two of which (the Patient Health Questionnaire-2 and the Edinburgh Postnatal Depression Scale) are in the public domain. This excellent chapter would be improved further with information about how to implement perinatal mental health screening in various settings, including the need to build a breastfeeding-friendly referral network prior to initiating screening and the need to develop or obtain materials (e.g., brochures, handouts, posters, resource lists, referral lists) that provide anticipatory guidance and help parents more easily access information, support, and treatment for postpartum depression (Good Mojab, 2015).

In chapter 7, Kendall-Tackett presents the development of a breastfeeding-friendly treatment plan as being grounded in the facilitation of informed decision making—something perinatal care providers are ethically obligated to do. Informed decision making requires that parents be offered evidence-based information that will allow them to weigh the risks and benefits of a variety of treatment options. This final chapter presents such information in the form of a succinct review of the available research on treatments that have been shown to be effective in treating depression, including: 1) “alternative” treatments (i.e., long-chain omega-3 fatty acids, exercise, S-Adenosyl-L-Methionine, and bright light therapy), 2) psychotherapeutic treatments (i.e., cognitive behavioral therapy and interpersonal therapy), 3) herbal medications (i.e., St. John’s Wort); and 4) anti-depressant medications. The reader is referred to the Infant Risk Center for up-to-date information about the use of particular anti-depressant medications during breastfeeding. Additionally, Medications and Mothers’ Milk: A Manual of Lactational Pharmacology is listed among the references. The LactMed app, though not mentioned in the book, is another useful resource for facilitating informed decision making regarding the use of drugs and supplements during breastfeeding.

The appendices are helpful for readers who have not yet begun to screen for perinatal depression and are looking for appropriate screening tools. Included are the Postpartum Depression Predictors Inventory—which can be used to identify risk factors for postpartum depression—and the Edinburgh Postnatal Depression Scale—which is well-validated as a screening tool for perinatal depression in mothers, in many cultures and languages, and in fathers. (A gender/prenatal/postpartum inclusive version of the EPDS is available here.) Because postpartum depression often includes symptoms of anxiety and/or co-occurs with an anxiety disorder, the appendices would have been improved by including the well-validated Generalized Anxiety Disorder 7-item (GAD-7) Scale, which is also in the public domain.

Scattered throughout the book are links to video clips that provide information on topics such as how breastfeeding protects maternal mental health and how breastfeeding ameliorates the negative effects of sexual assault. Readers with an auditory learning style will especially appreciate this access to online interviews and mini-presentations. Unfortunately, the dark gray links on a light gray background can sometimes be hard to read, leaving the reader to wonder “is that character a capital I, a lowercase L, or a numeric 1?” But, the video resources are worth the trial and error needed to open a couple of the links. Those with access to a smartphone with a QR code reader or barcode scanner can simply scan the code for each video clip to open the links, which greatly simplifies the process.

While the title of the book, “A Breastfeeding-Friendly Approach to Postpartum Depression,” is gender neutral, readers should know that the book is focused on cisgender mothers and uses cisnormative language. Certainly, there is a dearth of research on transgender and gender non-conforming parents which makes it difficult to write an evidence-based book addressing their needs in the context of breastfeeding/chestfeeding and postpartum depression. Nonetheless, we can infer that the high rate of clinical depression (44.1%) among transgender individuals means that transgender parents are at high risk for postpartum depression. And, the fact that transgender individuals experience “gender insensitivity, displays of discomfort, denied services, substandard care, verbal abuse, and forced care” in health care settings (Bockting, et al., 2013) means that transgender parents are also at high risk of being unable to access effective mental health care, much less breastfeeding/chestfeeding-compatible mental health care. Perinatal care providers need to be aware of these higher risks and learn how to bring their services into compliance with the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (Bockting, et al., 2011). The lactation-friendly treatment options for postpartum depression that are reviewed in the book are likely to also be effective for transgender and gender non-conforming parents who breastfeed, chestfeed, or feed their expressed milk to their babies. The effective treatment of breastfeeding/chestfeeding parents with postpartum depression will also need to include responding to whether and how they are experiencing gender dysphoria during lactation.

Although written for health care providers, “A Breastfeeding-Friendly Approach to Postpartum Depression” will also be useful for childbirth educators, doulas, lay supporters, lactation specialists, and perinatal mental health care providers as they strive to do their part to offer families evidence-based anticipatory guidance about postpartum depression and its treatment options, advocate for more lactation support for families coping with breastfeeding difficulties, screen for postpartum depression, refer to and effectively collaborate with other breastfeeding-friendly perinatal care providers, and provide services that avoid iatrogenically increasing the risk of negative health, developmental, and mental health consequences for parents and babies through the unnecessary undermining of breastfeeding. The more widely Dr. Kendall-Tackett’s powerful little book is read and applied in practice, the more breastfeeding families will have access to breastfeeding-compatible treatment that truly meets their needs in the context of postpartum depression.

References

Bockting, W., Miner, M., Swinburne, R., Hamilton, A., and Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health, 103:943–951. Accessed: May 23, 2015. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698807/pdf/AJPH.2013.301241.pdf

Borra, C., Iacovou, M., and Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal, 19:897–907. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353856/pdf/10995_2014_Article_1591.pdf

Coleman, E., Bockting, W., Botzer, M., et al. (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13:165–232. Accessed May 23, 2015. Url: http://www.wpath.org/uploaded_files/140/files/IJT%20soc,%20v7.pdf

Gaynes, B., Gavin, N., Meltzer-Brody, S., Lohr, K., Swinson, T., Gartlehner, G., Brody, S., Miller, W., et al. (2005). Perinatal depression: Prevalence, screening accuracy and screening outcomes;Evid Rep Technol Assess (Summ). 119:1–8.

Good Mojab, C. (2014). Mental Health Care for Postpartum Depression During Breastfeeding. Lynnwood, WA: LifeCircle Counseling and Consulting, LLC. Accessed May 23, 2015. Url: http://lifecirclecc.com/yahoo_site_admin/assets/docs/MentalHealthCarePPDBfd2014.pdf

Good Mojab, C. (2015). The Basics of Perinatal Screening. Accessed May 23, 2015. Url: http://www.lifecirclecc.com/professionals/perinatal_screening

Hale, T. and Rowe, H. (2014). Medications and Mothers’ Milk: A Manual of Lactational Pharmacology. Amarillo, TX: Hale Publishing.

Kendall-Tackett, K. (n.d). Why Breastfeeding and Omega-3s Help Prevent Depression in Pregnant and Postpartum Women. Accessed May 23, 2015. Url: http://www.uppitysciencechick.com/why_bfand_omega_3s.pdf

Kosenko, K., Rintamaki, L., Raney, S., and Maness, K. (2013). Transgender patient perceptions of stigma in health care contexts. Med Care, 51(9):819-22.

Nonacs, R. (2014). Breastfeeding and Postpartum Depression: Further Insights Into a Complicated Relationship. Massachusetts General Hospital Center for Women’s Mental Health. Accessed: May 23, 2015. Url: http://womensmentalhealth.org/posts/breastfeeding-postpartum-depression-insights-complicated-relationship/

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.

Yonkers, K. Wisner, K., Stewart, D. Oberlander, T., Dell, D., Stotland, N., Ramin, S., et al. (2009). The management of depression during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol. 114(3):703–713. Accessed: May 28, 2015. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094693/pdf/nihms293837.pdf 

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, including breastfeeding-compatible treatment for postpartum depression. 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.

 

Babies, Book Reviews, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, Maternal Mental Health, New Research, Newborns, Perinatal Mood Disorders, Postpartum Depression, Uncategorized , , , , , , , ,

Book Review: Birth Ambassadors; Doulas and the Re-Emergence of Woman-Supported Birth in America.

May 7th, 2015 by avatar

By Kim James, BA, BDT(DONA), CD(PALS), ICCE, LCCE

May is International Doula Month and Lamaze International recognizes the importance of labor support. (Note – there are both birth and postpartum doulas who work with families during the childbearing year. We are grateful for the work that they both do.)  In fact, our third Healthy Birth Practice specifically addresses doulas and support people as an effective component of safe and healthy birth. The American College of Obstetricians and Gynecologists (ACOG) in their 2014 Safe Prevention of the Primary Cesarean Obstetric Care Consensus Statement stated “published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”  Childbirth educators and health care providers have ample opportunity to inform parents about the benefits of a doula when they are meeting with families and patients.  

In mid-2014, sociologist Christine Morton, Ph.D. with Elayne G. Clift, MA, wrote a book, Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America examining doulas from both an historical perspective as well as an assessment of the role of the doula in current American society . Kim James, LCCE and certified DONA birth doula, reviews this book and shares her perspective and take-aways with readers of this blog.

This book would make a great read for a book club book for birth professionals, and Kim generously shares some discussion questions at the end of today’s post to facilitate your discussion, should you wish to participate.  Alternately, if you have read the book, please feel free to respond in our comments section. 

Science & Sensibility and Lamaze International want to thank all the doulas who work tirelessly to support families as they birth their babies and transition to parenthood. Happy International Doula Month. – Sharon Muza, Science & Sensibility Community Manager. 

idm15 lamazeBirth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, written by Christine Morton, Ph.D. with Elayne G. Clift, MAis a thorough and compelling documentary of the history of doula support, the current dilemmas and issues facing the doula occupation, what drives doulas to pursue this work and how the work of doula support might fit into the future as the United States strains to find better ways of providing quality improvements in maternity care. For doula trainers and doulas looking to pursue this work in a professional manner, Birth Ambassadors is critical, mandatory reading. (For trainers and doulas interested in how to use this book to critically assess your work, please see the discussion questions below this article).

But what about for childbirth educators? What in it for them?

While the history is fascinating, it’s the critical sociological analysis of the current dilemmas and issues facing the doula occupation that childbirth educators’ need to thoroughly understand, especially Lamaze certified childbirth educators.

Lamaze International’s third Healthy Care Practice, ‘Bring a Loved One, Friend or Doula for Continuous Support’, outlines why continuous support is important and how a doula performs their work:

  • Continuous support can help alleviate fear and worry.
  • A doula’s intuitive sense and training mean emotional and physical needs are met with timely, individualized care.
  • Greater emotional and physical comfort may encourage the most efficient and healthy labor progress.

While most childbirth educators are aware of the intended benefits of doula care, not all are aware of the dilemmas doulas face in performing their work and the institutional and cultural issues that prevent doulas from having the greatest beneficial impact. Lamaze certified childbirth educators must have a firm understanding of these dilemmas so as not to ‘over-promise’ what the third Lamaze Healthy Care Practice is intended to deliver.

I want to highlight three dilemmas facing doulas that childbirth educators should be aware of and what they can do to educate parents who want doula-supported birth experiences:

Kim James' well read Birth  Ambassadors

Kim James’ well read Birth Ambassadors

First dilemma

The ecological fallacy of applying aggregate results of research that show doula efficacy to an individual family’s outcome. The cultural and institutional context of most US hospital births limit the doula’s efficacy, often by prohibiting truly continuous support and refusing to recognize a doula’s unique scope of practice. Childbirth educators should lead discussions with parents about what hospitals and which care providers in their areas are most and least supportive of doula care. Childbirth educators are instrumental in helping parents understand the questions they can ask during hospital tours and prenatal visits to find out if their chosen place of birth and attendant understand and support doulas attending families at births.

Second dilemma

The frequent contradiction between a doula’s personal values (often a deep belief in the optimality of the midwifery model of care, natural, drug-free childbirth or specific parenting practices) and her obligation to provide unconditional support for parents’ birth and parenting choices. Childbirth educators must help parents clarify their values around birth and parenting so that parents can find the support people who suit them best. Not every doula will be the best support for every parent.

Third dilemma

No occupation-wide standard for training or certification. The competing tensions within doula organizations between increased professionalization and maintaining low barriers to entry for all people to become doulas remain unresolved. While the majority of doulas are well-trained through recognized, long-standing organizations, some will only have received light, if any, training possibly through correspondence and online courses. Not every doula’s skill set is the same. Not every doula will practice within a scope of practice that is evidence based. Not every doula will pledge to follow a recognized code of ethics backed by an organization with an active grievance policy. Childbirth educators who make referrals to families asking for doulas should always make referrals to doulas who are well-trained, consistently receive excellent feedback from the families they serve and most importantly practice in a manner that is consistent with the evidence based third Lamaze Healthy Care Practice.

As a current Lamaze certified childbirth educator and professionally-working certified doula, I found my own experiences reflected in this book. While at times uncomfortable to confront the dilemmas and issues our occupation faces, Birth Ambassadors is well worth reading for the history and reflections for the future. It will give childbirth educators who are not currently practicing doulas good data on what the real impact of doula support means for the families that hire them.

Book club discussion questions

When Birth Ambassadors was newly released, I hosted a book club-style discussion group with several local doulas to discuss this book’s implications for our current and future work. Here are the big questions that came up for our group representing doulas who were well-established in their practices, those who were just starting out and both certified and non-certified doulas.

  • When is your personal bias stronger than your ability to offer unconditional support? (Reference: page 195).
  • Analyze this: “Doulas advocate evidence-based care for physiologic birth, yet are not trained clinically to recognize or treat women when their pregnancies and labors become non-normal”. (Reference: page 37).
  • The original purpose of the first doula organizations was to provide moral support for each other. What do we need from our organizations now? (Reference: page 90)
  • Do we have the training to be professionally non-judgmental? (Reference: page 196).
  • Doula neutrality –When do you abandon it? How do you maintain it? (Reference: page 261).
  • What are the current debates around our standard of practice and code of ethics? (Reference: page 81).
  • Outcome-based care vs emotional companionship: What are you drawn to in this work? (Reference: page 260)
  • Are you comfortable with the “outsider-within” role? Does attract or repel you? (Reference: page 36)

How do you talk about doulas in your childbirth classes?  In your midwifery or obstetrical practice?  Have you read Birth Ambassadors?  What were your big take-aways?  Have you shared Lamaze International’s “Who Says Three’s a Crowd?” infographic with the families you work with?

Note: Christine Morton is a member of Lamaze International’s Board of Directors.

About Kim James 

Kim James HeadshotKim James BA, BDT(DONA), CD(PALS), ICCE, LCCE, is an ICEA and Lamaze certified childbirth educator teaching at Parent Trust for Washington Children/Great Starts where she sits on the Education Committee. She owns and operates www.DoulaMatch.net and is a DONA International and PALS Doulas certified birth doula as well as a DONA-approved birth doula trainer working at the Simkin Center/Bastyr University. Kim also volunteers her time on the Lamaze International membership committee and serves as Washington State DONA SPAR. Her daughters are 9 and 16 years old.  Kim and her family live in Seattle, Washington.

Babies, Book Reviews, Childbirth Education, Doula Care, Guest Posts, Healthy Birth Practices, Lamaze International, Newborns , , , , , ,

“Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth”, Part Three, Interview with Walker Karraa

March 17th, 2015 by avatar

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

© Walker Karraa

© Walker Karraa

Last week, Cynthia Good Mojab provided Science & Sensibility readers with the first two parts of her three-part series on the book “Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth” by Dr. Walker Karraa. Today on the blog, Cynthia shares her recent interview with Karraa. Dr. Karraa provides additional insights on her research and discusses her thoughts on how the book has been received and can be beneficial to professionals and families alike. I recommend that you go back and read Part One and Part Two as well as today’s interview. – Sharon Muza, Community Manager, Science & Sensibility.

Cynthia Good Mojab: First, Walker, let me start with congratulations! I found your book to be a page-turner. I think what you’ve uncovered is very important. I’m so grateful that your book is now a resource for perinatal care providers, lay supporters, and new parents. Have you gotten reader feedback yet? 

Walker Karraa: I have gotten feedback. The feedback I’ve gotten has been very much like what you’ve just shared. People have said that it reads very quickly. I like that feedback because it says that it reads for clinicians and for lay people. It reads from the stories. I didn’t want to take out the literature review—I believe that it’s important for individuals and families that experience perinatal mood and anxiety disorders to have access to that information. I struggled with how to put context in and not have it be heavy. So, I’m glad to hear this. I did have one reader tell me that it was hard to read emotionally because the stories hit home. I think that it is a hard read. It certainly was hard to research. I didn’t see that coming. It was hard to hear the stories and be touched in my own experience of postpartum depression. I was so surprised by the stark, universal level of suicidal ideation. That was one of the most surprising things.

CGM: I think that the structure of the book, the writing style, and how statistics have been combined with real life experiences are very effective. That it’s a painful read is actually helpful because we need many more people to grasp postpartum depression at a deeper level so we can change whether we screen, how we screen, and what kind of services, support, and treatment we’re providing.

WK: I think that is what is different about my work—both in the approach I took to the research question and how I went in asking. I got answers that are that deep and that reveal a picture of postpartum depression experienced as trauma. And, that’s why it’s a hard read. I will always be thankful on a deep, profound, personal level to the twenty women who sat with me in those initial interviews and the women, another ten after, who shared the most difficult parts of their lives. So, I’m so thankful that they had that courage because it revealed that there’s more to the paradigm of postpartum depression than, how we think of it right now anyway, a form of depression with a pervasive sadness.

And, you know we all have social constructs of depression as lack of energy, sadness, incredible fatigue, sleeping too much, these kinds of general symptoms. There’s no diagnosis for postpartum depression [in the DSM-5]. It’s an onset specifier for major depression. So, we all look at these symptoms as depression. And, what the women in the study showed us is that their symptoms go beyond the symptoms of major depression. And that there’s something that happens within the context of having a major depressive episode and a new baby that is shattering to all that women have known prior to that to be things that they could count on in the world—all of those preconceived assumptions about what was predictable in the world were completely decimated. So, that collision and deconstruction of the self that they all shared is a trauma to witness, and they see it themselves; they watched themselves almost from a dissociative place. So, I do think and I hope that it offers the opportunity for everybody to have a larger conversation about how the effect of a mood disorder after the birth of a child can be traumatic.

CGM: Another thing that really struck me in your book, Walker, was how unprepared the women were when they experienced the onset of symptoms of postpartum depression. Tell me more about that.

WK: Even the women who had a history of mental health challenges were completely unprepared for the physical and psychological symptoms of postpartum depression. Their providers had not prepared them and their social world had not prepared them. So, when those symptoms hit, they had no context for being able to articulate to anyone what was happening. As a result, the “During” aspect of experiencing postpartum depression was unbelievable invisibility as the symptoms got worse and worse and worse because they had been so unprepared. Because perinatal care providers were not offering the feedback—I see you and you are feeling this way—the situation reached critical mass for all of them. And, what was so interesting to me is that every single participant was responsible for her own recovery. She alone found her way to help. They had all been asking for help….They weren’t shy—which was different than what we see in the literature. What we see in the literature is that stigma keeps women from talking. But, these women were saying “Hi, I want to die and you don’t see me.” Often a provider would say something like, “You’re telling me you want to die. Why don’t you try putting your iPod on when your baby cries.” And, what was it that made them decide to stay? I would say it was the love of their baby. And, that, no one has looked at in the research. All these women had a plan when they were nearest death. They all had suicidal ideation. They all had thoughts of harming themselves or others. They all were at that quintessential existential end of the rope when they then reached out to someone that they hadn’t yet reached out to, all on their own. And, they didn’t want to die. They wanted the symptoms to end. That is very important. And for some, treatment meant going to hospital. For some it meant getting medication. For some it meant both.

CGM: My clients also tell me that very few providers are screening them for perinatal mental health challenges or even asking a casual “How are you doing with this?” Or they tell me how they start trying to tell care providers how they feel and they will get the same kind of discounting response like what you’re describing. We have other research that shows how undetected perinatal mental health challenges are. It’s just so clear that we are collectively failing.

© CC Smoochi: http://flickr.com/photos/smadars/4758708634

© CC Smoochi: flickr.com/photos/smadars/4758708634

WK: I have a tremendous amount of respect for providers. I don’t think it’s their fault. I think that there is such stigma around mental illness—and in particular around mental illness in new mothers—that we’re blind. We are not receiving training to look at our own biases—to see that the elephant in the room is the belief that new mothers with mental illness are going to harm their babies. And we have Greek mythology and modern media to help support that belief. So, yes, it’s the primary responsibility of a care provider and that’s why women go to care providers because that’s who you go to when you say that you’re sick and you need help. But, the care providers themselves, including OBs, general doctors, ER doctors, psychiatrists, the whole realm of childbirth professionals…they haven’t been given the opportunity or the mandate to look at their own internalized and institutionalized stigma.

CGM: Like you said earlier, the stigma taps into our own fears. We’re afraid. It tugs on our own internal memories and experiences of when we’ve been vulnerable or someone significant in our life has been vulnerable.

WK: Yes. We are afraid. But women have been doing this for millennia. Most women get through it. And, this is what we need to help women know. The women in my book are just a tiny little window into the millions of women throughout the ages who have the fortitude, the skill, the strength, to be dragged through hell and survive. And not only survive, but be transformed. It’s beyond recovery. This is the trauma literature. This is the incredible literature from Tedeschi and Calhoun regarding posttraumatic growth that needs to be brought into the birth world. And, Viktor Frankl—the famous Viktor Frankl, Auschwitz survivor…. He endured that process. Every human being does that and women will do that. So we’re talking about what obstacles and paradigms are set against women. What I learned in the book is that women are more resourceful because of their attachment to their children—because of their unbelievable strength of love for their infant—than we know. I would even go so far as to say that, if I had a huge funding source, I would do a study on my hypothesis that women who have perinatal mood and anxiety disorders are more attached. We’re not less attached. We may have periods where we are less attached, but staying present while experiencing that makes us more connected.

CGM: Look at the love that it takes to feel so bad inside and still go and do these attachment building behaviors over and over and over again. The attachment is still being built even if parents can’t see it. And, the other thing I really appreciate about your work is that it’s such a refreshing focus on growth. Attending to growth is very effective and links well with cognitive behavioral therapy and solution-focused brief therapy. And, it makes me wonder, instead of what are all the risk factors, can we do some research on resiliency factors and on growth factors? What is it that helps parents grow through this and how can we nurture that?

WK: I hope more clinicians will read the book and think about these things. You know Tedeschi and Calhoun have a wonderful model for clinical intervention that’s growth based. And it’s only been used in situations that have already been identified as traumatic. But they have a really strong model for how to work with people who experience trauma, clinically, to develop more growth. And, I’m not a clinician. If I were, I would be interested in doing that kind of work. They were kind enough to let me use their scale. I found off the chart suicidal ideation. So, I asked them if I could use their posttraumatic growth inventory with the original sample and they obliged. And my wonderful original 20 women all took it. And they scored off the charts for growth. So then I interviewed somebody who is an expert in posttraumatic growth. And I also sent my result to Richard Tedeschi. I wanted some feedback: is this growth? And, they both said, well, it’s a small sample—it’s only 20—but yes. And, furthermore, they said that the level that I was getting off those scales is much higher than in other populations that they had looked at, such as people who had been through terrorist attacks or rape or surviving cancer. So, again, if I had money for research, applying that posttraumatic growth inventory to women who had been through a perinatal mood disorder would be really valuable on a larger scale.

CGM: I know it’s a small qualitative study, but what is your sense of how generalizable your findings might be?

WK: You know, generalizability in qualitative research is not necessarily a concern. Grounded theory would say that the generalizability of the findings has to do with if you’ve sampled well. And, theoretical sampling is about getting a condensed understanding. It’s like essential oil—you want the essence of it. I tell my doctoral students, who are just learning about the difference between qualitative and quantitative research, that quantitative research is like a fisherman casting a really wide net—huge—and you gather as much data in that net as far as you can go. And, that gives you information about the nature of the farthest reach of the ocean. Qualitative research goes straight down, plumbs straight down into the ocean—you know, a core area where the essence of that part of the ocean is. And, then you can take that and ask the same questions in other parts of the ocean. And, that would be the next part of the research.

CGM: Exactly. I know the whole purpose of your study was not to answer the question how generalizable transformation is but to explore the phenomenon of transformation. Your study design allowed you to do that. The question I have is: who do you think the women in your study are? Do you think they had characteristics that make them different than the big broad ocean? What did you notice about their membership in different social groups even though that was not the focus of your study?

WK: I have a couple of responses to that. First, it would be definitely an indication of the need for future research. In the demographics that I got, I would say that it was pretty diverse regarding race. And, socioeconomic status was all over the place. It was very diverse in terms of educational status. I had women with professional degrees and women with a high school education. But they were all English speakers. And when I say racially diverse, I will say that they identified as “American.” So, I didn’t have folks who were immigrants and that’s definitely something that should be looked at. Regarding whether there is some different quality in women who transform through postpartum depression, again I look at the research done by Tedeschi and Calhoun. They’re looking at that very issue. Are there personality characteristics that lend themselves more toward being able to grow through a traumatic event? What they have found is that people who are more optimistic are slightly more likely to experience growth through trauma than those who are not. But, it’s not set in stone. In other words, the numbers aren’t so high that we can go out and say that if you’re an optimistic person you’re going to have this amazing growth. There are so many variables involved with the quality of the growth, the characteristics of the person, access to time, and the circumstances. I think that there are probably shades of growth—that anybody who has ever been through a clinical mood disorder following the birth of a child probably experiences some amount of growth. And, this is just me shooting from the hip. I think there’s something inherent in being a parent. All of the research about having a child in the NICU, losing a baby, losing a baby in pregnancy…these are all traumas. Anything that’s a life or death experience is a trauma. And every human being grows. That’s just my personal belief. It’s just the human experience that we have the ability to grow—because we need to make meaning about these horrible things that happen. And, that meaning usually comes from making choices to believe in our ability as a parent. 

CGM: What is your number one take away? How do you think your findings can be applied by childbirth educators, doulas, midwives, and other perinatal care providers?

WK: I think that the take away is that it’s a call to action. At the very least 1 in 7 of your clients or your students is going to have this experience. What are you going to do about it? What kinds of information do you need to be able to help them? And then ask your organizations to give you that.

CGM: In my work as a clinician and an educator, I need tools and resources that I can point people to that I think are useful. So, I’m really excited about your book. I think it’s going to have a lot of ripple effect in terms of new research but also in supporting a shift in broadening our worldview of postpartum depression to include growth. So, I think your work is great. I’m so delighted that you did the research and you published it.

WK: Thank you so much for spending this time. It’s been a pleasure and a gift. I so appreciate it.

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

Book Reviews, Childbirth Education, Depression, Guest Posts, Infant Attachment, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression , , , , , , , ,

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 , , , , , , ,

Book Review: “Lamaze: An International History” – Breath Control: The Rise and Decline of Psychoprophylaxis

March 7th, 2014 by avatar

Lamaze: An International History is  newly published book by Paula A. Michaels that takes a look at the historical concept of pain-free childbirth through breath control and other relaxation techniques.  Regular contributor, Deena Blumenfeld reviews this book and shares her thoughts on how accurate the book is, what the book does well and where the book falls short.  Read Deena’s review and if you also have read this perspective on the history of Lamaze, please share your thoughts in our comment section. – Sharon Muza, Science & Sensibility Community Manager.

lamaze history book cover

When we look back at the past, we often see it through the filter of our modern sensibilities, values and sociopolitical beliefs. However, the past is best understood within the context of the social, political and ethical values of the time period. “Lamaze, An International History” by Paula A. Michaels should be read and understood within its appropriate historical context.

 Most of us know the Cliff’s Notes version of the origins and history of Lamaze. What we may not know are the details of the development of psychoprophylaxis and its journey from Russia to France and then to the United States. We may also not know of its decline in use and the reasons behind the decline.

Psychoprophylaxis is the technique developed by Dr. Vel’vovskii, a psychologist, and his colleagues, in the 1920s. The technique included multiple weeks of childbirth education classes taught by the woman’s physician, patterned breathing (“hee, hee, hoo, hoo”) and relaxation techniques. This was a training method designed to help women have painless childbirth. The belief was that fear caused pain and through education and training, fear could be eliminated. This follows directly from the belief that women’s gynecological health issues were all in their heads. Victorian physicians espoused this idea and the emerging field of psychology latched on to it and perpetuated it.

Michaels seeks to elucidate the social, economic and political influences behind psychoprophylaxis and its relative importance with regards to women’s expectations for childbirth; the prevailing opinions on pain during labor; roles of the father and the doctor during birth and the overall social implications regarding feminism and paternalism. She explores not only psychoprophylaxis, but its creators, its rise in popularity and its decline in use. Michaels looks at the medical environment of the day, as well as the social, economic and political influences on women and childbirth at the time (1930s – 1980.)

Only in the final chapter does Michaels address the Lamaze of today. She alludes to the Six Healthy Birth Practices and modern teachings. She appropriately refers to modern Lamaze as more of a “philosophy” rather than a “method.”

Being that her intention is to address the origins of Lamaze, more specifically psychoprophylaxis, there is little need for her to discuss how classes are taught currently or about present day birthing culture. The reader should not impress the image of historical childbirth class, or the childbirth class of another culture, onto current day classes. Michaels does say that:

“The international history of psychoprophylaxis speaks to how we arrived at today’s status quo, but perhaps more significantly it also reminds us that the values and meanings that we attribute to certain obstetric interventions, like the use of anesthesia, are not constant, but provisional. Practices are historical products of specific technological, economic, social and political conditions. What constituted a desirable birth experience changed with the times, as issues of safety, dignity, control and power each came to be reconfigured under both national and international influence.”

There was a review of this book published on The New Republic recently. The review fell into this trap of imposing historical Lamaze and the practice of psychoprophylaxis onto modern Lamaze, thus presenting a false impression of the purpose and intention of current Lamaze childbirth classes and broader Lamaze International organizational work to improve maternity care for all women. It also misrepresented the intention of the book which is, as best I can tell, an historical perspective, set in the context of the prevailing beliefs at the time with regards to women’s place in society, proper behavior and issues of power and control.

Power and Control

The proponents of early childbirth education, including Dick-Read, Vel’vovskii (creator of psychoprophylaxis), Lamaze, Bradley and others sought to help women control their pain through education, managing expectations, breath control, and relaxation including very specific techniques for pain management. Their initial intentions fell within the scope of prevalent societal beliefs surrounding women’s role in society, religious beliefs, proper behavior, and origins of pain, patriarchy and the political climate of their respective countries.

The author posits that the Russian doctors used psychoprophylaxis as a method to control women during labor, such that they were calm, quiet and obedient. The technique relied on the doctor, nurse, or later, the woman’s husband, to assist the laboring mother in maintaining the breathing and relaxation such that she remained in a passive state. So we can see, how taken out of proper historical context, this is offensive to modern sensibilities.

When the Lamaze method, psychoprophylaxis, made its transatlantic trip to the United States the intention behind the technique changed. However, this shift was a transition, not an immediate change. It took a decade or so to adapt to the prevailing beliefs regarding women’s autonomy and desire for more control over their bodies. Once the method began to take root, it became more about the feminist movement and women’s empowerment as we moved into the latter 1960s and 1970s.

Final Thoughts on the Book and a Look Forward 

Being that I don’t have a TARDIS to go back in time and observe for myself the successes or failures of psychoprophylaxis; I will have to take into account history’s record and Michael’s analysis thereof.

“Lamaze, an International History” should have been more appropriately titled “Psychoprophylaxis, an International History,” although “Lamaze” is a more well understood title and has the potential to garner more readers. In the book, Michaels paints a paternalistic, often misogynistic, view of how birthing women were treated in mid-century Russia and the rest of the Western world. She describes how psychoprophylaxis, and the proponents of the Lamaze method, strived to reinforce the paternalism and pronatalism of the day, while offering women a non-pharmacological form of pain management during labor, childbirth education and support by bringing husbands into the delivery room.

Psychoprophylaxis and the early days of Lamaze should be viewed in their proper historical context and not through the lens of modern feminism, ethics or social mores. I find Michaels’ book to be an eye-opening perspective regarding a piece of the history of my profession. Her book, however, ends rather abruptly at about 1980, with a small concluding chapter of her own perspective on a more modern Lamaze and what her thoughts are as to what women need or want during birth. I would have liked to have seen her take the history of Lamaze through the 1980s, 1990s and into the 2000s.

There’s been a large paradigm shift in how we as Lamaze educators approach childbirth education since the decline of the use of psychoprophylaxis. The move from being a one method technique to a comprehensive, evidence-based, hands-on, multi-modal form of childbirth education has brought Lamaze effectively into the 21st century to reach mothers and families in the classroom, online and via social media. Our advocacy for women’s health is far reaching, and is not addressed in Michaels’ book. I do not find this to be a flaw in her book as her book is a look into our origins and early history. I do find that I want more from her. I want the rest of the story of Lamaze’s history. I’d love to see her write another 140 pages of well researched analysis of the social, economic and political influences on Lamaze in the past three plus decades.

A peek back into history can often help us determine why we do what we do today and how to make more appropriate changes for the future. My question to you, blog readers: “Where do you see Lamaze in 10 years? 15 years? 20 years? What social, economic and political factors will influence how we are educating and supporting women in the future?

Additional suggested readings

Childbirth Education, Guest Posts, Lamaze International, Uncategorized , , , , , ,