Due to my first child’s traumatic birth 3.5 years ago, I was uneasy about the thought of going through labor again with my new baby. My husband and I decided early on to hire a doula to increase our chances of having not only a physically healthy birth, but a psychologically and emotionally healthy one as well.

A labor doula is a professional birth attendant. She is not trained in the medical management of childbirth, like a midwife or doctor, but rather focuses on physical comfort and emotional support for the mother and the partner. Using a doula can reduce the need for birth interventions, and one study showed a decreased risk of postpartum depression in women who were supported by labor doulas during birth.

I wish I had known about doulas during my first pregnancy! I was surprised at how much time my husband and I spent alone during labor in the hospital (the nurses came and checked on us occasionally). The continuous support of a doula would have been helpful for this reason, plus I knew nothing of the different positions for labor and how they affect progress. Even though I took the prenatal classes offered by the hospital, I was still quite unprepared.

I met three doulas before we decided on the one we hired. It is important to meet at least a few (some families interview more) to ensure that your personalities and birth philosophies align. The fees were definitely a consideration (they range from anywhere from free to over $1500, depending on your financial circumstances, experience of the doula, your geographic region, etc), but the most important consideration was talking to the doula we chose made me feel excited to give birth inside of anxious.

References and further reading:

http://www.dona.org/mothers/index.php

http://www.researchgate.net/profile/Christine_Schetter/publication/14904420_Social_support_in_pregnancy_psychosocial_correlates_of_birth_outcomes_and_postpartum_depression/links/0912f4ff213d3baa57000000.pdf

Here are a few things I am doing differently this time:

1. Staying on my medication during pregnancy (discussed with doctor) because we feel that the risk of untreated depression outweighs the risk of continued medication use.

2. Being to alert to patterns of low mood and other symptoms of depression or anxiety. In contrast to what my doctor told me during my first pregnancy, being pregnant does not protect against mood disorders - this is an outdated belief.

3. Addressing problems before they spiral out of control. For example, I was experiencing some work-related stressors and chose to see a counselor before my stress level and coping skills worsened.

4. I am exercising most days of the week. I have many reasons for doing this, but the positive effect on my mood is definitely a big one. During my first pregnancy I was mostly sedentary besides some walking.

So what can you do when your health care worker downplays your symptoms, or gives you a diagnosis that you don’t believe is true? My OB/GYN minimized the symptoms of my mood disorder at my 6 week check-up, attributing my anxiety and trouble sleeping to just being a new mom, despite her being aware of my history of depression. I suspected that this wasn’t true, but unfortunately believed her despite my misgivings. This delayed my diagnosis.

In retrospect, I should have sought a second opinion immediately after this check-up with the OB instead of waiting for the next scheduled visit with a health professional (my daughter’s 2 month vaccinations). I could have talked to a counselor, another physician, or even told my OB about my disagreement with her. For my next baby, I will do better because I know better.

The issue may also be the proposed treatment plan, rather than the diagnosis. Some health care workers are reluctant to prescribe medication for pregnant or breastfeeding women, even though the benefit outweighs the risks in many cases. Conversely, your practitioner may hand you a prescription with no other avenues for support, such as counselling, which would also be a concern.

Sometimes women worry about offending their primary care practitioner by seeking a second opinion, from another doctor, or another health care professional altogether. Remember that you are the boss of your own health, you know yourself better than anyone else does, and an inaccurate diagnosis or substandard care plan will negatively affect both you and your family. You are entitled to a second opinion, and it may be life-changing.

Recommended reading:  

http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=ug5094

In many cultures, a postpartum plan would be completely unneeded: women are automatically cared for according to cultural traditions. In Western society though, women are expected to cope on their own fairly early on. A plan helps spell out details rather than assuming your partner and family will know what you want, and can decrease your stress in the early weeks.

Some of the things you may wish to plan ahead for are how visitors will be handled (when can they come, and for how long), who will take care of household chores while the mom is recovering from the birth, and how any older children will be cared for. Picture your ideal postpartum period just like you would picture your ideal birth, and be clear about your expectations and desires. Assumptions will not translate into reality!

Postpartum Progress - This is an excellent blog written by a woman who has overcome severe postpartum depression, with many guest posts from other women. It features personal stories as well as helpful information and tips on handling and recovering from all kinds of perinatal mood disorders.

http://www.postpartumprogress.com

Postpartum Support International - This organization has a helpful website, with lots of information for women and their families. Most importantly, they also havea a helpline! Call 800.944.4PPD (4773) to speak to a trained volunteer about your perinatal mood disorder.

http://www.postpartum.net

Perinatal Mood Disorders Awareness Ltd - Of course I need to highlight our own website! PMDA has worked hard to develop a website with many resources. Besides information, you can also find more personalized support through our organization. See here for a list of volunteers who can provide peer support, or message us to be added to our private facebook support group.