Trisha Olow is a childbirth educator and birth doula with over 20 years of experience (CCE, CD(DONA), CLE). She was actually *my* childbirth educator while I was pregnant with my first ten years ago! We learned so much from her and used tools from her class in all four of my births. I interviewed her on the phone a few months ago and consolidated her answers into the following post.

As a childbirth educator, what do you teach about PMADs?

• Postpartum depression and other perinatal mood and anxiety disorders happen a lot! You are not a freak and there is nothing shameful about it—it is not your fault.
  • Kyleigh says: this is one of the main things I remember Trisha talking about in our birth class. It was key in me feeling no shame about calling my midwife when my intrusive thoughts started. I knew the signs, and I knew it was within the realm of normal, but also not how postpartum should be, so I got help right away
• It may be easy to ignore negative feelings, but don’t neglect them: if you get help sooner, it won’t be as bad.
• Postpartum especially, the hormonal fluctuations are massive. The bigger points at which they change are at the delivery of the placenta and when your milk comes in.
  • Speaking of the placenta, Trisha also encapsulates placentas and has seen it help women, though she says the technique of preparation and encapsulation makes a huge difference. I had my placenta encapsulated after my second, and I didn’t notice any specific ways it helped. However, some of Trisha’s clients rave about the benefits! She says she gets the best testimonials from moms having their 4^th or 5^th baby who have never tried placenta supplements and see a big difference in their recovery.
• Fatigue is another major factor in PMADs. Plan for extra support as you are able, and plan to rest as much as possible. Don’t try to do the new mom life on your own.
  • Trisha also does some work as a postpartum doula. Literally while we were speaking on the phone, she was watching a baby for a mother who had a repeat c-section after an attempted VBAC. This mom was doing much better emotionally this time because of her solid postpartum plan and extra support.
  • Also, just knowing that fatigue is a factor makes a huge difference for me!

What do you most want moms to know about PMADs?

• Worry is normal – but if it changes how you live, then you should talk to someone about it.
• Don’t ignore personal or family history when considering risk factors for PMADs. They both can play a huge role. Consider checking out the ACE Score if you experienced childhood trauma. However, PMADs also happen even without predisposition, so don’t ignore the possibility just because you don’t have certain risk factors.
• Other factors that can really affect moms are big events (such natural disasters or a death in the family), breastfeeding difficulties, and seasons—weather, anniversaries, and even time of day (such as feeling sad when the sun starts going down).
  • Trisha shared her own experience with how 9/11 triggered PMADs, and also about one of her clients who was doing well initially postpartum. Then the mother’s brother died 3-4 months after the birth, and she became depressed. The husband called Trisha to check in and verify. Some of this is a part of normal grief, but having a new baby can make moms even more sensitive to the emotions.

What have you seen help moms?

• Have a plan in place before you give birth!
  • I, Kyleigh, always start planning early in the third trimester, if not before, so that if anything happens earlier (preterm labor, etc.), I’m already prepared.
• Don’t ignore negative feelings.
• Support, support, support! Prepare with your husband, get friends rallied, and consider a doula for birth and/or postpartum!
• Nutrition, fresh air, and rest can also make a huge difference!
  • Some resources for nutrition and planning for rest:
    • New Mother Care Giving (doula website)
    • Real Food Postpartum Recovery Meals
    • First Steps for the Momma with PMADs
    • Postpartum Planner

What impact can a birth doula have on PMADs?

• A blurb on Trisha’s website says:  
  • Doulas are experienced labor assistants who provide non-medical, physical, emotional and informed choice support in prenatal care, during labor and birth and during the postpartum period. Studies have shown that having doula support during birth:
    • Reduced the caesareans rate by 50%
    • Reduced length of labor by 25%
    • Reduced the use of epidurals by 60%
    • Reduced the use of forceps by 30%
    • Decreases postpartum depression
    • Improves breastfeeding
      • From Mothering the Mother by Kennel, Kennel and Klaus

• A smoother entrance to motherhood (or adding more children!) generally leads to a mother feeling better immediately postpartum which has a huge effect down the road. If a mother is supported in birth, especially during a hard or traumatic birth, she’s much more likely to adjust more easily emotionally.
  • I didn’t pay for a doula until my 4^th birth. I’m glad I had her for processing fears before the birth and discussing the birth afterwards. During the birth, she provided more pain relief options and helped both my husband and I stay hydrated and fueled. Even though I didn’t end up needing support afterwards, it helped me relax knowing that if something went wrong in birth or postpartum, I had someone I trusted that would be able to process the trauma with and be an extra support for me and my husband.
• A doula often feels out of reach financially. Here are some ideas for making it possible:
  • Check with your insurance! Some insurance companies are starting to cover or reimburse at least some doula costs.
  • Have a “doula fund” friends and family can contribute to.
  • Ask around for a student doula or a doula collective with a sliding scale.
  • Save on a doula package by dropping what you don’t need (maybe you only want birth support and can drop extra pre- or post-natal visits).
  • Ask your hospital if they have a complimentary or discount doula program.
  • Cut back in some budget areas for a few months and set aside that extra for a doula – or generate some extra income for a few months to do the same.
  • It is expensive up front, but if you can find a way to afford it, a birth doula can make postpartum better because your birth was better.
    • If a doula is still not possible, read a book like The Bradley Method with your husband so that he is more equipped to support you! This is one of the big reasons I didn’t feel a strong need for a doula with our first two children. The main reason we had one with our fourth was because I’d heard mixed things about the hospital… but now I may be hooked!  

How do you as a doula care for yourself while supporting moms going through trauma/difficult times?

• The goal of a birth doula is to see moms flourish, so it’s especially difficult when they are not flourishing! It’s hard to feel helpless around those you want to help.
• At the time, a doula just has to put self aside to focus on the mom. But there will still be processing that needs to happen afterwards, both with other birth attendants as well as those who weren’t there.
  • Trisha recently had a client who had a very long and trying labor. Her midwife’s prenatal evaluation showed that she could use the help of a psychiatrist to have a plan in place in case she needed it. The client chose not to take this advice. She underestimated how hard labor would be. She ended up having psychiatric episodes during the labor and was hospitalized in the immediate postpartum time. All this possibly could’ve been avoided with a solid plan and collaboration of a medical professional to support her.
  • Two big takeaways from this episode for Trisha were that moms should trust a midwife’s advice about red flags. Second, it was important for the birth team (midwives + Trisha) to be able to process together and independently what happened. She said that even telling me about it was helpful.

Any tips for childbirth educators?

• Specifically when discussing PMADs, it can be helpful to separate the dads and talk to them directly about what to watch for and when and how to get help. Moms often downplay or ignore their symptoms, or don’t realize what’s going on, and so it’s important for those closest to her to be educated as well.
• Moms benefit from hearing from other moms! Let new parents share their birth story and/or experience with PMADs in class.
  • • This can also really help dads prepare, because they’re hearing a man’s perspective on watching his wife go through birth and postpartum—much easier to connect with than hearing from the mom!
• It’s become harder to teach because moms-to-be learn so much on social media now. Many will say “Oh, I already know that, I saw it on TikTok!” This isn’t all bad, but there is dangerous misinformation out there, and moms need to beware of self-proclaimed experts. The education and experience a childbirth educator, midwife, OB, or doula has are so important.
  • Moms, when something goes wrong, you can’t call the influencer on TikTok. You CAN call your CBE, doula, midwife, or OB—so foster that relationship, and as much as possible, find providers you trust!