Butterfly Confessions: How Writer, Advocate and Mother A’Driane Nieves Gives Birth With Confidence


I am excited to introduce A’Driane Nieves to the Giving Birth with Confidence community. A’Driane is a well-known blogger and maternal mental health advocate. Her artwork inspires, and her chronicle of her pregnancy is a testament to self-advocacy in prenatal care. By sharing her journey through pregnancy and motherhood with bipolar II disorder, A’Driane gives courage to all women to give birth with confidence.


Tell us a little about this pregnancy.

 This pregnancy, my third has been…physically overwhelming. It’s honestly been one for the books! Every symptom the first trimester was far more intense than what I’d experienced previously, especially my morning sickness and the withdrawal symptoms I was experiencing from having to stop my mood stabilizer (Lamictal) until my second trimester. I also struggled with hypotension, migraines, and severe symphysis pubis, which rendered me immobile most days and landed me on bed rest quite often these past 9 months. Since the beginning of my third trimester I’ve had fairly strong contractions daily-ones that are usually 3-4 minutes apart most of the day and force me to stop and breathe through. I ended up in labor and delivery twice and given various medications to try and stop them, often to no avail, which led to stricter bed rest and having to be put on a monitor every appointment. Like I said, this has definitely been one for books…


How do you approach giving birth with confidence with this birth?

This is the first birth that I feel like I actually prepared for mentally in terms of actually learning about the labor process, birthing methods, pain management, etc. With my previous two births, the bulk of my preparation was external, ensuring everything I needed to care for my sons after they were born was purchased and at the ready. I simply didn’t place much value or emphasis on the experience-I solely cared about the end result.

However, with this pregnancy, I took time to really reflect on my previous labor experiences and came to realize that I hated both of them. I found that because external circumstances had me living in survival mode, I went into both of my labors anxious, stressed out, and uneducated about the labor process and mentally unprepared to manage what I was experiencing physically during each one; back labor with my first, and five days of prodromal and early labor with my second. With this pregnancy I decided that while the end result (healthy baby) was still what mattered most to me, I did want to enjoy my labor and delivery as best I could.

To help facilitate this goal, I’ve read several books, articles, and blog posts on various birthing methods, and have pulled different aspects from each to use that I found appealing. I’ve researched & practiced breathing & relaxation techniques I could employ to manage not just the pains of labor but any anxiety I will most likely experience. I explored the idea of hiring a doula, and talked at great length with my husband about what kind of role he felt comfortable fulfilling during my labor and what kind of atmosphere he’d like us to have during the process. This was a first for me, because with my first labor, I was a single mom, and on my own. With my second, my husband and I were together, but we never discussed anything about labor or what “kind” of birth experience we could have. This time I’ve made sure to include him, which has helped us bond in a way we didn’t my last pregnancy.

Taking the time to inform myself of my options, and actually read what happens during labor has definitely helped me approach my upcoming birth with a sense of vigor and enthusiasm I haven’t experienced before. I’ve been able to communicate more with my OB confidently, and feel far more empowered as a patient…


How has taking care of mental health played a role in that?

While being prepared and informed mentally for the birthing process has been important to me this pregnancy, my top priority from the moment I saw the plus sign on the test has been to take care of myself mentally. As a woman with a history of PPD and currently living with rapid cycling bipolar II, anxiety & OCD, I’ve worked hard this pregnancy to ensure I have what I need to do that. From finding an OB with experience treating pregnant women with mood disorders, to finding new psychiatrist who is knowledgeable and up to date with treatment methods, to educating myself on what treatment and medication options are available to me, to attending talk therapy, I’ve fought hard this pregnancy to advocate for my mental health both during pregnancy and in the postpartum period. I’ve asked both my husband and closest friends to help me be aware to any shifts in mood they may notice that I don’t, and to tell me if they notice anything that concerns them during this time or in the days and months to come. I’ve read up on my risk for postpartum psychosis and have talked with other mothers who have experienced it to gain their insight and support. I have also made it a point to ramp up on my self-care, even during periods of depression this pregnancy. Painting, watching a favorite show, listening to music, reading, and even some days just forcing myself to shower-these are all things that have helped me manage my illness aside from medication and therapy these past nine months.

Reflecting on my previous birth experiences and how they impacted me mentally-especially my last where I experienced prodromal and early labor that went nowhere without augmentation-also empowered me this time to talk at great length with my OB about what my options are this time. I’ve expressed how triggering the physical strain of this pregnancy has been on me, and how triggering the end of my last pregnancy and labor was on my mentally. I stressed my desire to not go into this labor exhausted and drained mentally, and my fear that doing so would increase my chances of struggling in the postpartum period. After two weeks of cervical checks that saw no change in my cervix despite having regular, moderate-severe contractions, and other early labor symptoms, we decided last week that scheduling an induction would be best, as I expressed I was already starting to cycle between moods-mostly depressive, and had reached my limit physically. I love my OB because he heard me and took my mental health into account and not just that of the baby’s at this stage. I’m grateful that he was able to look at my maternal health, the baby’s health, and my mental health, and come to a decision that benefitted all three. Very grateful for that.


How has the blogging and online community offer you support?

I’m also incredibly grateful this pregnancy for the online support system I have this time around. I found my online tribe and place in the blogging community three years ago while battling PPD, and both my tribe and the blogging community at large have become a lifeline for me. Thanks to the blogging, I’ve met strangers who have become my sisters and confidants, and I’ve found my voice as an advocate. They help me stay informed, encourage me, hold me accountable to taking care of myself, and are there to listen and sit with me when needed. They’ve enabled me to have a strength and confidence this pregnancy that I didn’t previously and even though I know being a mother of 3 with a mental illness such as mine will be a challenge, it’s one I know I’m capable of succeeding at.

I go in for my induction on Tuesday 11/12 at 6am….and I can barely contain my excitement and relief :)



I know I speak for everyone in wishing A’Driane well as she welcomes this beautiful baby into the world!


A’Driane Nieves is a writer, painter, mental health advocate, and speaker. She blogs at butterfly-confessions.com. She also is a contributer at Postpartum Progress. You can follow A’Driane on Twitter @addyeB.


How-to Guide for Building Your Postpartum Support Network – A Book Review

Community Support for New Families: A Guide to Organizing a Postpartum Support Network in Your Community, by Jane Honikman, M.S.

Having a network of support is an invaluable resource for new parents. Friends and family offer much needed meals, light housework, or pitching in with infant care or childcare for older siblings. This kind of postpartum support provides important ways those closest to us can both be helpful and participate in transition to parenthood. Once loved ones return to their own lives, however, caring for a newborn in the postpartum period can be lonely and confusing. This is where having access to a network of parents in your community can be invaluable to parents.

Community Support for New Families: A Guide to Organizing a Postpartum Parent Support Network in Your Community, by Jane Honikman, M.S., offers clear guidelines on how to create and maintain community-based parent support networks, and has received the highest praise and recommendation from leaders in the field of childbirth, postpartum health, lactation, and psychology.

Author Jane Honikman, founder of the most successful international postpartum support organization, Postpartum Support International (PSI), brings 40 years of experience to the acclaimed workbook, giving step-by-step instructions for building parent-support groups from the ground up, using local community resources and a team approach.

What I find so helpful is that this is the only workbook of its kind written and organized for parents.  In only 90 pages, Jane describes the six stages of building a parent support group and how to easily accomplish them. There is space provided to write directly in the workbook, while collecting resources and creating community support. By the end of the book, the reader has compiled all of the information and resources necessary to establish a group in their community. I recently asked Jane a few questions regarding the book and how it might apply to the Giving Birth with Confidence readers.

Jane, can you tell us about the importance of developing a parent support network?

The importance of developing a parent support network is to be able to reach 100% of those transitioning from pregnancy into parenthood.  It is my passionate quest to inspire communities to ease the adjustment of the developing family through trained parent volunteers.  They are the veteran parents who can provide peer-to-peer emotional support in a nonjudgmental environment at a critical and vulnerable moment.  A network gives access  to existing community resources.

Tell us why teamwork is so important in creating and sustaining a parent support network.

One person cannot create a sustainable parent support group or network. It requires teamwork.  The individuality component refers to the uniqueness of each community.  What may work in Santa Barbara may not make sense someplace else.  For example, in 1970 there was a “hotline” to prevent child abuse in our community, but as new parents we felt the need to create a “warm line.”  There was nobody showing pregnant couples how to bathe the baby or change a diaper, therefore, we started “Baby Basics.”

How might families expecting a child benefit from beginning to build community networks of parents?

Expecting a child cannot be expected to begin to build community networks of parents alone.  Veteran parents, those who have “been there,” are the logical creators.  They can recognize the gaps in service that exist in their birth and postpartum community.  The goal is to increase self confidence in new parents to ease their adjustment.  The basis of success is giving back once you’ve received.  Three generations of PEP volunteers in Santa Barbara have continued what was not available for the founders in 1977.

What are common mistakes new organizers might avoid?

The most common mistake new organizers need to avoid is not investigating their own community before starting “something.”  Don’t rush the process! It requires patience, time and commitment to be ready to launch. Learn what is needed, reach out to existing groups. Be methodical. Financial sustainability is critical.  PEP operates on a low budget because it is entirely volunteer with little overhead.

How might childbirth educators, doulas, or other birth professionals benefit from developing parents support organizations? How might they benefit from reading Community Support for New Families?

The role of a professional in the development of a parent support organization is as an advisor.  The benefit of doing this is that there will then be a community resource for expectant and new parents.  It completes the circle of caring, a way for new families to make friends for life. A common misconception is that childbirth educators, doubles and other birth professionals “need” to be the organizers.  Their role is as mentors.  My book is designed to bring all the stakeholders to the table and start the conversation.  What is missing in our community for new families?  What happens after the arrival of an infant?  Who brings new families together and where and how?  Who is actively listening to the needs of our most vulnerable?  Who is not telling new parents what to do but rather bringing them together to share the highs and lows and parenthood?  Who knows where and how to refer to resources for special circumstances like difficulty with breastfeeding, colic, depression?

Community Support for New Families exemplifies completing the circle of caring through Jane’s sharing her knowledge with new parents. And experts agree.

Harvey Karp, MD, FAAP and author of The Happiest Baby on the Block stated, “You can make all the difference for moms and dads in your town! Ready to be inspired? Jane Honikman, renowned parent champion, will guide you—every step of the way—with this crisp, clear handbook!”

Marian Tompson, co-founder of La Leche League International described, “Community Support for New Families provides a goldmine of ideas for anyone moved to undertake an organized effort to strengthen families. There is no other book like it…”


I couldn’t agree more! I found Community Support for New Families: A Guide to Organizing a Postpartum Parent Support Network in Your Community to provide a wealth of ideas for anyone interested in helping to support new parents. Thank you to Jane Honikman for sharing her wisdom and leadership with Giving Birth with Confidence.

The Human Delivery System: An Interview with Beverly Hills OB/GYN Suzanne Gilberg-Lenz, MD

Dr. Suzanne Gilberg-Lenz is involved in women’s empowerment and public education, and appears frequently as an expert in women’s and integrative health on TV, online and in print. Dr. Suzanne completed her undergraduate education at Wesleyan University and post-baccalaureate pre-medical studies at Mills College. She earned her medical degree in 1996 from the University Of Southern California School Of Medicine, completed her residency in obstetrics and gynecology at Cedars Sinai Medical Center and has been in private practice of obstetrics and gynecology in Beverly Hills, CA since 2000. After many years of a personal yoga and meditation practice, she completed her Clinical Ayurvedic Specialist degree at California College of Ayurveda in 2010 and was board certified in Integrative and Holistic medicine in 2008.



What surprises you most about the work that you do?

Dr. Suzanne: EVERYTHING! I am constantly humbled, reminded of my own requirements for patience. That is a practice- One never gets it perfectly right, and that love really does heal, because it makes us more compassionate and unconditional, less judgmental and more open to a variety of tools.  It doesn’t mean we eschew evidence or science, but rather we wrap it in a human delivery system. I am also frequently surprised at how powerful my advice and words are.  Everything counts and we never know what is affecting other people, so we must be mindful of what we put out there.


You are an OBGYN in a high profile community and practice in Los Angeles; does that present unique challenges for you?

Dr. Suzanne: It actually provides unique opportunities. My patients are highly educated and discerning and not as homogeneous class-wise as people imagine “Beverly Hills” attracts. People who come to our practice are sophisticated and empowered enough to expect the best care possible. They seek and welcome partnership and dialogue but also accept that I have expertise that they do not. They are experts about their own experience of their bodies; I have nearly 20 years of medical experience and training. That is the perfect combination for enlightened high quality healthcare. Before I was completely “out” about my interests, training and participation in integrative and holistic medicine and mind-body practices, I was very concerned about being judged negatively by my community–more my peers and colleagues, not my patients. But that was merely part of my process of learning to own my skills, talents and journey.


What is your top advice to pregnant women approaching birth?

Dr. Suzanne: Know what you know and what you don’t know. Seek advice and counsel of trusted, knowledgeable sources. Don’t use or respond to fear as the basis for educating. Trust your gut instincts but be open to hearing things and information that maybe don’t fit into your fantasy of best case scenario. Trust yourself and your team. Get more than one opinion if necessary. Don’t assume conventional medical providers and institutions are not in support of your journey or not open to your wishes.


How do you integrate screening for mental health into your practice? 

Dr. Suzanne: I try to ask explicit questions about personal and family history of mood disorders, abuse and substance abuse. At this point, I am very lucky to have a practice where the majority of my pregnant patients are not new to me. In other words,  I have known many of them for a while prior to their conceiving — that helps a lot. I also use my instincts and when I encounter anxiety about body changes, the birth and control in general, I see these as red flags to open a dialogue. Anyone whom I suspect may be at risk for a postpartum mood disorder are seen by me at 2-3 weeks postpartum and not the standard 6 weeks.


What are the difficulties you experience in screening in pregnancy and postpartum?

Dr. Suzanne: Some people resist discussing matters that they themselves haven’t already recognized or addressed and I am not a trained psychotherapist, but people are mostly open to the discussion and appreciate that I am interested and have a ready arsenal or referrals who are experienced and trained. Honestly, time is the biggest constraint — but I’m a bit notorious for running late and this is one of the reasons why: I strive to be present for every patient encounter- some require more time and attention than others.


What do you think the difficulties for women are in communicating mental health needs to practitioners?

Dr. Suzanne:  Shame, guilt, and fear, confusion lack of support or understanding that help is available. If we don’t ask, we may not ever know — most patients won’t reveal unless asked directly. Some patients’ family members don’t get it and that can be a barrier. The Supermom Syndrome and unrealistic expectations of doing it all themselves can also be barriers.


If a woman does not feel her mental health concerns, or symptoms were addressed by her OBGYN, what should she do?

Dr. Suzanne: There are so many great resources online today– Postpartum Support International, the social media platforms, etc. I’d go there and get local resources — maybe anonymity helps some people to approach the topic too.


Do you see a lot of postpartum depression or anxiety in your practice?

Dr. Suzanne: Of course I don’t document stats but I’d say it runs at about 10-15% — that is a wild guess BTW! What is really interesting is that I have a number of patients who had a postpartum mood disorder in first pregnancy and we anticipated the second time with a plan and prevented a recurrence — that is really satisfying to me and also indicates that if we can recognize the risk, we can mitigate the occurrence — just like any other medical issue. If someone has an elevated GLUCOLA challenge (standard gestational diabetes screening tool), the GET Diagnostic testing and then dietary counseling to prevent the untoward effects of untreated carbohydrate intolerance and insulin resistance. We wouldn’t think of ignoring that!


What would your top advice be for a woman who thinks she may be experiencing postpartum depression or anxiety?

Dr. Suzanne: Don’t be afraid to say it out loud to someone who can help — ask for help — if you don’t get it at first ask again — talk to your provider, your partner, your friends — treatment is available and it works. Parenthood requires humility and surrender, not the façade of perfection.


Thank you, Dr. Suzanne for sharing your advice with Giving Birth With Confidence!


Dr. Suzanne’ s diverse background includes research experience combining Ayurveda and conventional medicine, an exploration of the relationship between psychosocial risk factors in pregnant urban teens and participation on a MacArthur Foundation funded team at University of California at San Francisco. She has worked at San Francisco’s famed Haight Ashbury Free Clinic and supervised midwives and residents at an inner city hospital in Los Angeles, California. Dr. Suzanne has taught at Cedars Sinai Medical Center, The National Ayurvedic Medical Association, Yoga Studios and Childbirth conferences and appeared TV shows such as Dr. Drew’s Lifechangers, The Tyra Banks Show, The Today Show, Headline News and Bill O’Reilly’s No Spin Zone.Find out more about Dr. Suzanne Gilberg-LenzPractice: www.womencareofbeverlyhills.com

Website: www.thedrsuzanne.com

Twitter: @askdrsuzanne

Facebook:  https://www.facebook.com/pages/Dr-Suzanne-Gilberg-lenz/


A special thanks to article transcriber, Miles Moon Karraa.



Finding a Voice for Homebirth Cesarean

The following is an interview with Courtney Jarecki, co-author of the Homebirth Cesarean project. Courtney also runs a homebirth cesarean support group in Portland, Oregan.


Tell us about how Homebirth Cesarean  was born.

The term Homebirth Cesarean (HBC) originated as a way for me to distinguish my birth from the options on doctor’s intake forms. My ego wouldn’t allow me to select the cesarean checkbox and my shame at a failed homebirth kept me away from the homebirth selection. I spent nine months preparing for a homebirth and even though I had a cesarean, the spirit and philosophies of the natural childbirth movement still applied to my experience. So, to make myself feel better, I wrote homebirth over the cesarean option on an intake form and I started calling myself a Homebirth Cesarean mama.

The Homebirth Cesarean book began as a conversation between me and my midwives, eight months after my birth. I reached out to provide feedback about their care and we were able to process the birth together. This topic sparked an interest in Laurie, one of my midwives, and she wanted to write an article on homebirth transfers that end in cesarean. I wanted to write a book about my experience, but knew it needed to be bigger than just me. I asked her to partner with me on a book that shares both the mom’s and midwife’s perspective of homebirth cesareans. From that conversation, this project was born.

A few months later I created the Homebirth Cesarean Facebook page and invited every birth worker and HBC mom I knew. I wasn’t sure what my purpose with the group was, but knew it needed to be out there. An hour later there were 50 new members and now, a year later, there are over 800. It quickly became clear that the intention of the Facebook group is to bring both HBC moms and birth professionals together so practitioners can listen, observe, ask questions and learn how to better support HBC mothers. This group has helped so many moms in their healing process and changed the way midwives, doulas an childbirth educators talk to their homebirth clients about cesarean.


What have been the key components to your moving through this experience?

For years prior to becoming pregnant I was studying to become a homebirth midwife. I had completed a year of apprenticeship at a birth center and had my own doula and childbirth education business (http://fullmoonsdaughter.com/). My entire identity and career was based on the idea that low risk women can birth at home.

The cesarean experience left me devastated, isolated and feeling like a failure. My shame and hatred of myself was deepened when, no matter what I tried, I wasn’t able to make breast milk. It felt I couldn’t do anything right and like I was an outcast from the homebirth and natural birth community. I was ashamed of my birth, my body and my lack of ability to feed my daughter.

I started talk therapy at 6 weeks, which saved me. Over the course of two years I have sought many healing modalities for my body, scar and spirit. Of course, this book has been the biggest component of my healing.

Laurie calls HBC the homebirth community’s dark secret. And it’s true! Other homebirth moms don’t want to hear about our births, midwives don’t post our birth stories on their websites and friends and family members tell us that we should just be grateful for a healthy baby.

Our homebirth cesarean work is focused on providing a platform to discuss these births so that mothers and midwives can regain the power and confidence that can be lost in the process.

For mothers, we seek to hold space so they can tell their sacred birth stories. For midwives, we seek to provide new opportunities for them to talk to, for, and on behalf of these mothers.


Is there any evidence yet as to rates of homebirth transfers resulting in C-sections?

We are still awaiting data from MANA, an organization that is conducting a large homebirth study in the US. However, many midwives we’ve spoken with estimate that of homebirth transfers that occur in labor, about 50% result in cesarean.

Individually, homebirth midwives have a very low cesarean rate.  For example, a typical midwife in the Portland, Oregon area transports about 10 out of every 100 clients to the hospital – some prior to labor, some in labor, and some just after birth.  Of those 10, if half have cesareans, the midwife will have an overall 5% cesarean rate.  For a midwife seeing 50 clients per year, that means she will have at least 2 or 3 clients who will have a cesarean every year.

Stats aside, if a homebirth cesarean happens to a mom, it doesn’t matter if her midwife had a 0% cesarean rate, for this mom it is 100%.


What are some ways women considering home births could prepare for the occurrence of an unexpected hospital transfer and C-section?

Every midwife needs to be talking to their clients about the realistic possibility of transport AND cesarean throughout their care, not just in the initial interview or at 36 weeks.

A lot of homebirth women never even consider that a cesarean could actually be their story, and they don’t know what the experience would be like if it did happen for them. When women have a realistic sense that they could have a homebirth cesarean, they are more willing to plan for what that birth would look like. In turn, if women can clarify their hopes and options for a hospital stay and cesarean birth, they will be more satisfied with the outcome, despite it not being their first choice.

Therefore, many moms report feeling blindsided and unprepared for a cesarean. The moms who had a midwife that suggested a hospital tour or had frank discussions about all interventions, including cesarean, had an easier time integrating their birth experience.


How do you see partners involved in the discussion, preparation, education, etc.?

Partners play a big role in our book. We plan on sharing birth stories from the partner perspective as well as highlighting partner’s intuition during the birth and those critical minutes when the partner is away from mama as she’s being prepped for surgery.

In 100% of our interviews with partners they, at some point, felt helpless in the birth or caregiving process. They also never thought of self-care for themselves in those early postpartum weeks. Helping midwives bring a bit more attention to the partner during the birth and postpartum can go a long way for mom’s own healing.


How would you advise women to approach concerns about HBC with a homebirth care provider?

Ask lots of questions and really feel how your care provider is responding to your questions. If you tell your midwife you’re worried about being able to push a big baby out and her response is that she’s helped many women do that very thing, does that feel helpful for you? If it does, great. If you tell her your worst fear is cesarean and her reply is that it probably won’t happen to you, that certainly isn’t helpful.

Sometimes it can be hard to get really clear on what your deep fears are around birth. If you feel like a fear is hanging around or you feel like something just isn’t right, talk about it. Conversation around what’s bothering you will bring it out to the light and, hopefully, transform the fear into conversation to plan for all possible outcomes.

Women and their providers need to be open when planning for birth and not be bound to a specific place of birth. Approaching birth as a journey into parenting, which is all about flexibility, resilience and open-mindedness is a great place to being.


What have been some of the surprises in this project?

A big ah-ha moment is how close to death, either physical or spiritual, so many HBC moms feel during transport or the cesarean. Even if moms aren’t physically close to dying, they may feel like they are. When women experience HBC, they are faced with the daunting physical recovery from labor, then major surgery, then the emotional fallout from the birth, all the while providing for the intense needs of a newborn! This makes it hard to process the fear and trauma they experienced during the birth and it plays into their postpartum recovery and coping skills as a new mom.


Co-authors Courtney & Laurie.


Co-authors Courtney Jarecki and Laurie Perron Mednick have been interviewing HBC moms, midwives, birth professionals and care providers since 2012. They are done with the majority of the interviews and we will have interviewed more than 150 people when the project is complete. Their goal is to find a publisher this year and have this book available to the public in the next couple of years.


Maternal Mental Health: Anxiety Disorders in Pregnancy

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.


This World is Not Flat: Anxiety Disorders in Pregnancy

Imagine you are sitting in your care provider’s office, and next to the scary “universal pain chart” with the not-so-happy faces getting progressively more distressed and discolored, is this chart:

1 in 8 pregnant women will develop an illness that poses these risks:

  • preterm birth (the leading cause of infant mortality and disability in US)1,2,3
  • low birth weight4
  • low APGAR scores5
  • a more difficult labor and delivery with increase of PTSD symptoms related to birth6,7,8,9
  • increased chance of Postpartum Depression/Anxiety Disorders after birth10,11
  • newborn may have increased agitation12,13
  • jittery infants up to 6 months after delivery14
  • breastfeeding difficulties15
  • child may develop learning and attention disorders later in childhood16,17,18

Genetic Disorder? Pre-ecamplsia? STD?

Nope. Perinatal Anxiety Disorder.

Current estimates are that anywhere from 5% to nearly 25% of pregnant women (1 in 8 ) will have a mood or anxiety disorder.19,20,21 And for pregnant women with anxiety disorders, high levels of cortisol cross the placenta and have long-term effects noted long after birth.22

With my first pregnancy, I began developing symptoms of depression and anxiety shortly after my second trimester. I knew something was wrong, and had both physical and emotional symptoms that were getting progressively worse. At the time (10 years ago), my providers didn’t know to ask about depression and anxiety during pregnancy—and I did a darned good job covering it up. My illness went untreated, and I ended up suffering Post-Traumatic Stress Disorder (PTSD) in labor and developing severe postpartum depression and anxiety after the birth. I was three months postpartum before my illness got severe enough, and life threatening, to the point where any of us knew I needed immediate medical treatment.

Anxiety in pregnancy and birth is universal and normal. It is a normal reaction to a physically and emotionally stressful, life-altering event. Secondly, an anxiety disorder in pregnancy is a medical illness, not a character flaw or personality trait. Its etiology is currently traced to an interplay of hormonal, genetic, environmental and immunological systems of the body23,24 – not the half shot of espresso in your latte, your character, or your inability to relax in your [irritating] prenatal yoga class. Newer research is looking at the role of increased oxytocin around the time of birth in influencing the onset of Perinatal Anxiety Disorders (PAD).25 Bottom line: It is not your fault.


Symptoms of Anxiety Disorders
Anxiety in pregnancy is normal. But when anxiety in pregnancy is significant enough to cause physical, emotional, and cognitive distress — a perinatal anxiety disorder may be occurring and you need help.26

Pec Indman, EdD, MFT and co-author of the award winning book, Beyond the Blues: Understanding and Treating Prenatal and Postpartum Mood/Anxiety Disorders offered this in a recent interview for this post:

While it’s normal to have some worries during pregnancy (for example, “Will my baby be healthy? or, “ Will I be a good mom”?)–women with anxiety find the worry gets in the way of enjoying the pregnancy and other aspects of life. Women with anxiety may also have appetite changes (often difficulty eating), and find that the worry makes it difficult to fall asleep. Some women experience panic episodes during pregnancy. These are times of extreme anxiety where there may be hot or cold feelings, difficulty breathing or a smothering sensation, numbness or tingling in the fingers or around the mouth, a racing heart, and a feeling of loss of control.

There are several types of anxiety disorders that occur in pregnancy and postpartum, including Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, and PTSD. You can learn more about each type at www.postpartum.net under “Get the Facts.” But generally, symptoms27 of an anxiety disorder include:

  • Excessive, ongoing worry that impacts your day to day activities
  • Thoughts of worry regarding the future, or catastrophic events occurring
  • Insomnia
  • Poor appetite
  • Physical restlessness, inability to sit still
  • Dizziness, hot flashes, nausea
  • Panic attacks


Risk Factors
Research shows that there are some risk factors that may predispose some of us to anxiety disorders in pregnancy, and can be discussed with your care provider, partner, family or trained professional. Risk factors28,29 include:

  • Family history of anxiety disorders
  • Personal history of depression or anxiety
  • Thyroid imbalance


What do you do if you have symptoms or risk factors for an anxiety disorder in pregnancy?

1. Get help. Talk to a care provider. If you can’t talk yourself, find someone you trust to do so with you. The risks are too great. Pec Indman, EdD, MFT, shares:
If a woman is struggling during pregnancy it is essential to get help. Talk to a trained (many providers have not been trained in this area) and understanding professional. There are lots of kinds of effective treatments including counseling (in particular Cognitive-Behavioral Therapy and Interpersonal Therapy), social support, exercise, Omega-3 fatty acids, acupuncture, and medication.

Regarding women currently on medication, Pec continues:
Women who are on medication for depression, bipolar disorder, or anxiety, should consult with a prenatal (or perinatal) mental health expert before stopping medication. We know that over 50% of women who stop their medication before, or when they are find out they are pregnant, become ill again. Many medications can be taken during pregnancy and will help prevent a relapse.30

2. Ask your care providers (OB/GYN, Midwife, Nurse Practitioner, Family Practitioner) if they are trained in depression and anxiety in pregnancy. One tip I give women is to phrase it this way: “If I develop depression or anxiety during pregnancy or after, how will you be able to help me?” or “How do you help women who develop anxiety or depression in pregnancy?” If it is too difficult to do that, ask a trusted friend, partner, or family member to go with you to your next appointment and help you approach your care provider. Write a list of questions and concerns before you go. Calling ahead to let the front office know you need extra time in your appointment is also a good idea.

What if? If your only option is a care provider who is not trained in this area, go to Postpartum Support International (PSI) for excellent resources to take with you to your appointment, or to find local support systems, or call the warm-line for volunteer support on getting help in your area (1-800-944-4773). If making that call or going online is anxiety producing, ask a trusted friend, partner, or family member to go online for you or with you, to PSI and get the information you need.

3. GET A TRAINED DOULA!!! Birth and postpartum doulas can help you get through birth and postpartum adjustment. I strongly suggest you hire a doula who has training in this area (birth doulas are not required to know this information and postpartum doulas often receive little and/or outdated training on anxiety and depression disorders in pregnancy). Some good questions when interviewing doulas are:

  • What training do you have in anxiety and depression disorders in pregnancy?
  • If I get depressed or anxious, how will you know and how will you help?
  • What local resources do you give to clients?
  • How do you feel about anti-depressant medication during pregnancy and breastfeeding? Any doula who is completely “anti-medication” for any medical illness needs to turn in their birth ball and get with the program (it’s a blog, I can say things like that!). They do not have the skills to help you. Go to PSI and ask therapists in your area for referrals to doulas with experience.


Nothing Flat About this World of Anxiety Disorders
Pec Indman notes, “Healthcare professionals used to think pregnant women didn’t experience depression or anxiety. We also used to think the world was flat! Thinking has changed about a lot of things.”

Just as thinking and care regarding birth has changed, health care providers are starting to get it regarding mood and anxiety disorders in pregnancy. But much like our births, women have to raise our voices to raise awareness, and in turn get the care we so desperately deserve and need, for our brains and our reproductive systems.

With my second pregnancy, I knew before I peed on the stick — based on my first pregnancy — I had significant risks for depression and anxiety, that it was a physical illness, and that the risks to me and my baby were real and needed to be avoided. I was extremely fortunate to have the financial access to good, trained providers — they are forever in my heart. And I went through a mine field of providers who didn’t know current research and made me feel like a bad mother until I found the ones who “got it.” I firmly believe that when given the right information regarding our bodies, and particularly our pregnant bodies, we do a damn good job to learn more, discuss with those who could help us with treatment, and make the best informed choices for our lives. Once we remind ourselves and our care providers that our brain and uterus inhabit the same body and need the same kind of care, we will be part of the move to see that the world is not flat.

A special thanks to Pec Indman, EdD, MFT for her contribution to this article, humor, and support.

Pec Indman EdD, MFT, is a mom with over 20 years experience as a perinatal mental health psychotherapist and educator. She is the chair of education and training for Postpartum Support International, and co-author of the award-winning book, Beyond the Blues. An updated edition will be available the end of Oct. 2010. Beyond the Blues, Understanding and Treating Prenatal and Postpartum Depression & Anxiety.




  1. Perkin, M.R., Bland J.M. et al. 1993. The effect of anxiety and depression during pregnancy on obstetrical complications. BrJournal of Obstet Gynaecol 100:629-34.
  2. Wadwa, P.D., Sandman, C.A. et al. 1993. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol 169:858-64.
  3. Orr, S. T., J. P. Reiter, D. G. Blazer, and S. A. James. 2007. Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine 69 (6):566-70.
  4. Ibid.
  5. Ibid.
  6. Beck, C. T., 2004a. Birth trauma: In the eye of the beholder. Nursing Research 53, 28-35.
  7. Beck, C. T., 2004b. Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research 53, 216-224.
  8. Keogh, E., S. Ayers, and H. Francis. 2002. Does anxiety sensitivity predict post-traumatic stress symptoms following childbirth? A preliminary report. Cognitive Behavioral Therapy 31 (4): 145-55.
  9. Kelly, R. H., J. Russo, and W. Katon. 2001. Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptoms amplification revisited? General Hospital Psychiatry 23 (3):107-113.
  10. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  11. Rambelli, C., Montagnani, M.S. et al. 2010. Panic disorder as a risk factor for post-partum depression: results from the perinatal depression-research and screening unit study. Journal of Affect Disord,122(1-2):139-143.
  12. Coplan, R. J., K. O”Neil, and K. A. Arbeau. 2005. Maternal anxiety during and after pregnancy and infant temperament at three months of age. Journal of Prenatal and Perinatal Psychology and Health 19 (3):199-215.
  13. Tagle, N., Neal, C., Glover, V. 2007. Antenatal maternal stress and long term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48, 245-261.
  14. Ibid.
  15. Britton, J.R. 2007. Postpartum anxiety and breastfeeding. Journal of Reproductive Medicine, 52:689-695.
  16. Weinberg, M. Tronic, E.Z. 1998. The impact of maternal illness on infant development. J Clinc. Psychiatry 59(suppl 2):53-61
  17. O’Connor, T. G., J. Heron, and V. Glover. 2002. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child and Adolescent Psychiatry 41 (12): 1470-77.
  18. Ibid.
  19. Onunaku, N. 2005. Improving maternal and infant mental health: Focus on maternal depression. National Center for Infant and Early Childhood Health Policy at UCLA.
  20. Knitzer, J., Theberge, S., Johnson, K. 2008. Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework. National Center for Children in Poverty, Project Five Issue Brief 2.
  21. Gaynes B., Gavin, N., Melter-Brody, S., Lhor, K., Swinson, T., Gartlehner, G., et al. 2005. Perinatal depression prevalence, screening accuracy, and screening outcomes: Summary, evidence report and technology assessment, No 119. AHRQ Publication No. 05-E006-1.
  22. Ibid.
  23. Altemus, M. 2001. Obsessive-compulsive disorder during pregnancy and postpartum. In: Yonkers, K., Little., B. (eds) Management of psychiatric disorder in pregnancy. Oxford University Press, NY, pp 149-163.
  24. Stein, D.J., Hollander, E., Simeon, D., et al. 1993. Pregnancy and obsessive-compulsive disorder. Am J Psychiatry 150:1131-1132.
  25. Bartz, J.A., Hollander, E. 2008. Oxytocin and experimental therapeutics in autism spectrum disorders. Progressive Brain Research, 170:451-462.
  26. American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (4th ed, text revision). Author, Washington, DC.
  27. Ibid.
  28. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  29. Ibid.
  30. Cohen, L.S., Altshuler, L.L. 2006. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA, 295:499-507

Reading Beyond the Headlines: A Closer Look at the Study on Antidepressants During Pregnancy

A recent study regarding the use of antidepressants has been gaining a lot of media attention. The actual study, The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond (Domar, Moragianni, Ryley & Urato, 2012) has been described by media with a fair amount of fear-based headlines. Safety regarding the use of a specific type of antidepressant medication, selective serotonin reuptake inhibitor (SSRIs), is an important topic of research,  as care providers from many fields address the prevalence and negative effects of depression and other mood disorders in pregnancy.


Understandably, pregnant women and their families may be greatly alarmed by these dramatic press releases, and in some cases may consider suddenly discontinuing their medication, without realizing the significant risks that accompany suddenly stopping medication. What do the experts say?


I asked the study’s lead researcher, Alice Domar, MD what advice she would offer a pregnant woman who is currently on one of the SSRI medications listed in the study to do, and she kindly offered this response:


I would never recommend the sudden discontinuation of an SSRI during pregnancy. There are significant side effects associated with the abrupt cessation of antidepressants and we don’t know the impact on the developing fetus. The three main points we were trying to make with the paper were: 1) there are risks associated with taking SSRIs during pregnancy, 2) there are no clear benefits, and 3) each patient needs to have a discussion with her physician about her individual risk/benefit ratio.  There is a huge difference between a woman who is suicidal, who in all likelihood should remain on medication, versus women with mild or moderate symptoms who would benefit from a different approach, such as cognitive behavioral therapy, or physical exercise, both of which are very effective in the treatment of depressive symptoms.” –Alice Domar, MD (personal email communication, 11/2/12)


Another of the study’s researchers, Dr. Adam Urato, offered this follow-up:

“Your question is a good one (What would you advise a pregnant woman who is currently on one of the SSRI medications listed in the study to do?) and it is one I deal with several times each week as an Maternal-Fetal Medicine specialist.  I agree with Dr. Domar’s comments.  Sudden discontinuation of the SSRIs is not recommended.  They should be tapered for those who plan to discontinue them. The patient and their pregnancy health care provider (and their mental health provider) need to be aware of the scientific evidence regarding these drugs.  That evidence shows significant risk of pregnancy complications (like miscarriage and preterm birth) and no evidence of benefit for moms and babies.  In non-pregnant populations, alternatives like cognitive behavioral therapy and exercise appear to be as effective as the SSRI antidepressants and without the side effects and pregnancy risks.” (Personal email communication, 11/2/12)


Reaching out to experts in the field provided roundtable perspective. Christina Chambers, MPH, PhD, California Teratogen Information Specialist (CTIS) and director of the Pregnancy Health Information Line, had these thoughts:

“I agree with the authors’ comments. Caution is warranted, treatment makes sense when benefits are clear, and women with less severe illness might consider alternative approaches if they work, abrupt discontinuation without doctor’s advice is not a good idea, and care needs to be taken to address the issue of complications for mother and baby of untreated or poorly treated maternal depression. If a woman has questions, she should consult her doctor. She can also call the Organization of Teratology Information Specialists (OTIS) at 866-626-6847 to speak to an expert in this field.” (Personal email communication, 11/2/12)


Lucy Puryear, MD, immediate past president of Postpartum Support International (PSI) and Medical Director of The Women’s Place: Center for Reproductive Psychiatry offered:

“For women with mild to moderate depression psychotherapy and alternative treatments are absolutely the first choice. But for women with moderate to severe depression that is impairing functioning, antidepressants must be an option. Antidepressants do work in this population and save lives. Our challenge is to continue to look for the safest and most effective treatments for women during this vulnerable period.” (Personal email communication, 11/2/12)


PSI’s Executive Director Wendy N. Davis, PhD, agreed,

“We are most concerned that women will be unduly frightened by articles that discuss risks of antidepressants but do not discuss positive experiences or research studies that show little statistical relationship between SSRI use and pregnancy outcome. We want to connect women with reliable resources and experts in perinatal psychiatry so they can make thoughtful decisions about treatment options for depression and anxiety during pregnancy.”


A word about the science….

One of the pre-eminent researchers in the field, Adrienne Einarson of The Motherisk Program, shared some important criticisms of this study:

Here are my main problems with this publication:

1) It is said to be a review on treatment for infertility patients, however, one-third of the paper is about the lack of efficacy of antidepressants in general.
2) To say there is no evidence for effectiveness in pregnancy is true, but that is simply because there are no RCTs (randomized control studies), not because this has been proven.
3) All of the studies that were picked were ones that found negative effects, with no mention of how marginal the statistical significance really was.
4) The paragraph that is the most concerning is the one starting with “There is compelling evidence that SSRI use prior to and during pregnancy can pose significant risks to the pregnancy and to the short- and long-term health of the baby…” Of course there is compelling evidence when you choose your studies to fit your hypothesis.

This was a biased review, not a systematic one as reviews should be. In fact, there was not a single study referenced in this paper that did not find any harmful effects when there are many that have been published. (Personal email communication, 11/4/12)


When I was pregnant with my daughter, I had a sinus infection. I went to a general practitioner for treatment and shared that I was on an SSRI. You would have thought I told her I was shooting heroine every hour on the hour while tossing back jello shots and chain smoking! If I hadn’t had the science from my research treatment team at the UCLA Women’s Life Center, I could have easily been scared into stopping my medication. Instead I pulled out a collection of evidence-based research I carried in my purse and left it with her.


Unfortunately, for a woman who is pregnant and has depression, trying to decipher headlines and the seemingly constant stream of warnings might be overwhelming. Not to mention the stigma that accompanies depression and motherhood. Most don’t realize that to be that mom means you have to be constantly armed with proof that you are not harming your child. This is where having Adrienne Einarson’s insights can help you navigate the science, and advocate for your health and well-being.


Take Home Message:

If you are currently pregnant and taking an SSRI, do not abruptly stop taking your medication until you talk health care provider about risks and benefits for your individual care. If you feel you may be experiencing depression or anxiety and are pregnant, you deserve help with your symptoms. Not getting help has been proven to have negative effects on a developing fetus and increases the risk of pre-term birth, lower birth weight, and postpartum depression. Discuss your symptoms with your care provider immediately. I highly recommend using the resources available at OTIS (866) 626-6847 to address your concerns and questions.



Walker would like to thank Alice Domar MD; Adam Urato, MD; Christina Chamber, PhD, MPH; Lucy Puryear, MD; Wendy Davis, PhD; and Adrienne Einarson for their contributions.



Domar, A. D., Moragianni, V. A., Ryley, D.A., & Urato, A.C. (2012). The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Human Reproduction, Vol.0(0) pp. 1–12 doi:10.1093/humrep/des383


Other Resources:

Department of Health and Human Services: Depression During and After Pregnancy: A Resource for Women, Their Families, & Friends

A Voice of Strength I Didn’t Know I Possessed: Part II of An Interview with Ivy Shih Leung

A Voice of Strength I Didn’t Know I Possessed: An Interview with Ivy Shih Leung, author of “One Mom’s Journey to Motherhood: Infertility, Childbirth Complications, and Postpartum Depression, Oh My!”


In this second part of my interview with Ivy, she shares insight into her Chinese culture and pregnancy and postpartum. Secondly, she delves into her experience with infertility and complications during pregnancy. Finally, Ivy shares wonderful thoughts as to how writing, blogging, and communication can help to end stigma about PPD and create the causes for healing. You can read the first part of our interview here.


How has culture affected your writing about your experience?

I don’t feel that my culture really affected my writing about my PPD experience.  Though, I have to say that I am one of the few Asian bloggers I’m aware of.  Unlike most of my Asian friends and acquaintances, I am very outspoken and opinionated.  The Chinese tend to keep their emotions bottled up and thoughts and experiences to themselves.  In general, they are a very proud people.  Everything is pretty much about “saving face,” which means not putting oneself out there when it comes to personal experiences, especially if there is anything in the least bit negative.  As we know from the Western culture, pregnancy and motherhood are supposed to be blissful experiences.  I, on the other hand, have a book that shares ALL my thoughts and experiences while suffering from PPD.  It’s a fairly big deal for any woman to share her PPD story, let alone publish a book about it.  It’s an even bigger deal for a Chinese woman to do either.  


What would you like mainstream culture to know about your culture regarding pregnancy and postpartum?

Although I am Chinese and even speak Mandarin fluently, I was born and raised here in the U.S.  As a result, I am very Westernized and do not observe many of the traditions my parents and the generations before them may have observed.  Actually, my mother gave birth here and was not privy to the custom of Zou Yue.  She gave birth in a foreign country with no loved ones around her.  She received less help with taking care of me when I was a newborn than I had when I had my own daughter.  At least when I had my daughter, my husband helped, and my mother and mother-in-law each stayed a week to help. 

Zou Yue is like some of the other mother-nurturing customs observed by other cultures (la cuarentena in Mexico, sarantisma in Greece, Jaappa in India) in terms of observing a 30 or 40 day period of taking care of the mother, so she can take care of her baby and get adequate sleep to recover from childbirth.  Forty seems to be a magical number, a number that has survived through the centuries and therefore has special significance….no doubt it has something to do with the fact that 40 days is the average length of time for a new mother’s body to recover from childbirth and return to a pre-pregnant state.  It’s also why an OB/GYN will tell the new mother, once she’s given birth, that he will see her in 6 weeks.  Each of these traditions involves female family members and friends of the new mother providing her and her baby with care, so that the new mother’s only focus is on getting rest and bonding with/feeding her baby.  They also help around the house and prepare meals.  Certain rituals are observed in which food is prepared a certain way to help keep her body/system warm. She is protected from feeling overwhelmed; hence, visitors are kept away (or kept at a very minimum) during this time. She is told to avoid bathing for fear of catching cold.  All these rituals have the mother’s well-being in mind.  In terms of breastfeeding, female family members are on hand to teach her how to do it. In these other cultures, there is no expectation that the new mother know how to breastfeed instinctively and easily.  There is a reason behind the phrase “it takes a village.”

I have blogged about the importance of social support and how, through the years, we seem to have lost perspective on things when it comes to the community coming together to help a new mother who has just had a baby.   Getting adequate social support—comprised of both emotional support (e.g., shoulder to cry on, listening non-judgmentally) and practical support (e.g., help with breastfeeding, cleaning, errands, laundry, taking care of the baby for a few hours so mom can take a nap or shower) is critical for new moms. Having enough support during the first 4-6 weeks—until a new mom’s body recovers from childbirth and her hormone levels return to their pre-pregnancy state—can help keep anxiety levels down, help her get the rest she needs from all the changes her body has gone through with childbirth.


When you were pregnant, how was your culture addressed by care providers in ways that were helpful? And what about during your recovery from PPD?

I don’t remember if my OB/GYN and hospital staff asked me any questions, either orally or via a written questionnaire, as to whether I had any cultural preferences that needed to be taken into consideration during or after childbirth.  There definitely was no attempt on the part of my OB/GYN to ask me if I had any preferences for the duration of my pregnancy.  Fortunately, I didn’t have any preferences, anyway.  I just wanted to be treated with respect and care, both of which my doctor ended up failing at. Now, in terms of the GP who treated me during my PPD, he was the ultimate example of a doctor with extremely poor bedside manner.  The way I was treated by him and my OB/GYN angered me so much that I wrote them both letters during my recovery from PPD, telling them that their treatment of me aggravated my already extremely painful experience, they should get with the program when it comes to PPD, and I was dropping them and moving on to doctors who didn’t lack bedside manner the way they did.


Infertility and Complications

Can you share a little about your experiences with both?

Without getting into the details as covered in my book about my infertility experience and childbirth complications, I’ll just say that, like more and more women these days, I got married late (at age 36 ), had a dermoid cyst removed a year later to increase the likelihood of getting pregnant and not having it get in the way of a developing fetus, tried to conceive naturally for over a year before being referred to an IVF center where we failed our first cycle (it was such less than optimal experience mostly because the staff and environmental overall were cold and disorganized), and got pregnant successfully via my 2nd IVF cycle at a different center.  What started off as 2 fetuses became only one after a car accident I had about 2 months into the pregnancy.  Other than nausea that lasted my entire pregnancy, some spotting, and overall anxiety that I would carry to term, my pregnancy went well.  I delivered vaginally (with an epidural and episiotomy), but ended up having my uterus removed 3 days afterwards due to placenta accreta.  During my entire 7-day stay, I was constantly woken up for blood work and extremely exhausted as a result.  On top of that, I was starved for nearly the whole time I was there.  Due to my surgical procedure, I was kept in an entirely different wing from my daughter for over a day, and whenever I called for a nurse, no one came.  Some nurses were not nice to me at all.  It was like a living hell for me most of the time I was in the hospital.  To get the full details of my infertility, childbirth complications, and PPD experiences, you can read my book. 


How can your experience help the readers of Giving Birth with Confidence?

My hope is that those who read about my experience in my book—which covers a lot, including key statistics and information on the biopsychosocial factors behind PPD (infertility and childbirth complications are risk factors)—will become more knowledgeable about perinatal mood disorders.  I hope that they will also read the growing numbers of blogs of mothers who are speaking up about their struggles with perinatal mood disorders.  Why?  Well, knowledge is power.  With more knowledge, there would be less ignorance and stigma, and motherhood myths will have less of a negative impact on mothers than they do today. I want to see fewer mothers being caught off guard and not knowing what is happening to them, should PPD strike.  Being ignorant and unprepared for it causes unnecessary fear, anxiety, guilt, and inability to appreciate one’s baby. For example, insomnia after the third week postpartum is a common first symptom of PPD. 

My blog is hit numerous times each day via Google and other search engines using words like “postpartum insomnia,” “new mom insomnia,” “insomnia four weeks after childbirth,” “can’t sleep when the baby sleeps,” “can’t sleep six weeks postpartum,” and so on, which means that there are many moms out there who are going through what I went through, in terms of insomnia as a symptom of PPD, beginning at around 40 days.  That’s right, there’s that magical number again!  Had I known about PPD before my daughter was born, I would not have been as scared as I was as to why I had insomnia and couldn’t sleep even though I was exhausted beyond words and even during the times she slept. My fear would not have escalated to full-blown anxiety attacks. I would’ve recognized other symptoms like loss of appetite (I lost so much weight so fast that within a couple of weeks I weighed less than I did before I got pregnant!). As soon as I started to have insomnia, instead of merely taking the Ambien prescribed to me by my OB/GYN, I would’ve immediately known to question it as a sign of PPD and gotten the right treatment then.  As they say, hindsight is 20/20….


I would like to thank Ivy for her wonderful work and sharing her experiences and knowledge with Giving Birth with Confidence. To learn more about Ivy, visit her blog at http://ivysppdblog.wordpress.com/.

A Voice of Strength I Didn’t Know I Possessed: An Interview with Ivy Shih Leung

A Voice of Strength I Didn’t Know I Possessed: An Interview with Ivy Shih Leung, author “One Mom’s Journey to Motherhood: Infertility, Childbirth Complications, and Postpartum Depression, Oh My!”


It is my pleasure to offer an interview with Ivy Shih Leung, author, and award winning blogger. In this first installment, Ivy describes her story, and how writing, and blogging has been instrumental to her growth following PPD.


How did you begin writing after your experience with PPD? What got you started?

In all honesty, the idea came to my mind to write a book about my PPD experience right after Tom Cruise’s infamous ranting “There’s no such thing as a chemical imbalance.”  So, yes, Mr. Cruise has the honor of angering me to the point that I decided I would write a book.  Well, it started with him because I soon realized that he’s NOT the only one who believes that mental illness is “mind over matter.” I decided I would channel all the energy stemming from my anger at that far-from-accurate way of thinking and do something positive and try to help others. I would tell my story to try to help and educate as many people as possible about this silent and potentially deadly condition. I wanted to share the horrific feelings and manifestations of PPD that I experienced so that others could know better what to look for.


What does writing about your experience mean to you personally?

Writing about my PPD experience was completely cathartic for me.  I started writing back in 2005 and didn’t finish until 2010, when I started to try to make some sense out of the jumbled mass of hundreds of pages thrown together from chronicling my thoughts and events that took place from when we first tried to get pregnant in 2001 through weaning off of my PPD medications in 2006.  From the time I decided to write a book in July 2005 to when I finally finished writing five years later in 2010, I had also carefully documented all that I learned from reading about PPD and all my reactions to things I ran across on a day-to-day basis concerning PPD.  At the end of my six year, four month publishing journey, I felt so much lighter.  I felt like I left my journey to motherhood and all that came with it—the infertility, childbirth complications that left me permanently unable to have children, and PPD—behind in my book, and now I am ready to start a new one, both figuratively and literally.


I have often felt myself that writing enables my own spiritual, creative, emotional and intellectual growth—how has that been for you?

My PPD experience—and subsequently writing my book and my blog—has given me a voice and a strength I didn’t previously know was possible for me to possess.  Would you believe it if I were to tell you that I used to hate writing assignments in school because I felt I was lousy at writing?  I mean, I always loved grammar, but writing was a whole different matter!  It didn’t help that I’ve always had an issue with self confidence. Negative thoughts and attitudes people had about me once had a crippling effect on me. Writing my book (and my blog) has made me realize that I am capable of a lot more than what I previously thought I was capable of doing.  After I completed my book, it’s like I came out of a cocoon.  I metamorphosed into new person.  This change has made such a positive difference in terms of my attitude at work and the attitude others have of me at work.  Though, I sometimes still feel bad when I can’t “click” with someone in a social and/or work setting, I don’t let things like that eat away at me the way it used to.  I know that it’s not possible to get along with everyone, no matter how nice of a person you are.  And if two people are on different wavelengths (like me and most of my neighbors), it makes it all the more difficult to establish a relationship with each other.


I write at home, when kids are at school, what I call “slash and burn” sessions where I barely get up to use the restroom before I go pick them up. Where and when do you write?

Now with my book done, my weeknights and weekends are available for me to try to spend more time with my family.  But I find it very difficult to stay unplugged each day.  If I get motivated to write a blog post, I will usually do that at night, after my daughter has gone to bed.  Usually, that means a couple hours of writing before I turn in, which is usually somewhere between 12:30 pm – 1:30 am.  That gives me about 5-6 hours of sleep before I have to get up at 6:30 am to go to work the next day.


How do you handle competitiveness among women?

Not very well.  My experiences while growing up—moving often, being bullied in school, lacking in self-esteem, and being uncomfortable with my own ethnicity—contributed toward my shyness, fear of rejection, and difficulty making friends….especially female friends.  That is why my friends were mostly guys until I realized, once they started getting married, that I needed to focus on establishing friendships with women.  Otherwise, I would be stuck as a pretty lonely adult.  In high school and in the decade or so after college, I found women to be petty, catty, gossip mongerers, and backstabbers.  Even though I ended up making some good female friends along the way, I was not close with any of them enough to rely on them for support during my PPD experience. My friends at that time were all single, married with no plans to have children, or married and had children a long time ago.  Even with the closest of friends that I have, I did not feel comfortable reaching out to them during my darkest days.


Tell us 4 or 5 benefits for writing through PPD.

Other than the fact that writing about your PPD experience can be a cathartic experience—as writing can help serve as an outlet for and as a way to process all your emotions, thoughts and feelings—it can help others who are in the process of struggling with PPD as well.  It will help other mothers feel less alone and help them realize that, with the right treatment, they will be well again.  All in all, it’s a very rewarding experience!



In the next installment of Ivy’s interview, she shares her insights as to her experience with infertility, the role of culture in her recovery and writing, and thoughts regarding how sharing her work might benefit readers.

Real Life Is…. An Interview With Mom, Postpartum Depression Survivor, and Photographer Melissa Miller

As happens between women who have experienced postpartum depression (PPD), we find our ways to each other. Out of seemingly nowhere — an email, a conversation — some sort of connection is formed and coincidence creates opportunity to share the extraordinary journey of motherhood with a postpartum mood disorder (PPMD).  In this case, Melissa and I were introduced to each other!  I watched her photo project, “PPMD“ and my heart was so moved. She captures the essence of the beauty and bravery of women who have walked through hell and back — not only recovering from PPD, but growing from it. What Melissa brings to Giving Birth with Confidence is the real story of a real mom realizing her creativity as an essential part of the healing process following postpartum depression.  I am honored to know her, and introduce her to you!


When did you realize you had postpartum depression?

This is actually a tough question for me.  Not for emotional reasons but because I think I was in denial or maybe even unaware I had PPD for a long time.  Postpartum depression came about after the birth of my 2nd child.  I am also beginning to realize I may have suffered with depression while I was pregnant with her too.  After she was born I made excuses for my depression and anxiety that it was due to lack of sleep and my daughter being colicky.  It was on a visit to my daughter’s naturopathic pediatrician that my having PPMD came out.  The doctor had been concerned about me when I brought my daughter in and it was during one of the visits that she addressed her concerns with me.  Although I felt there was something wrong with how I was feeling, I was still in denial about admitting I had postpartum depression.  I was scared to admit it.  I tried confiding in a few people and the look on their faces told me they didn’t understand and they were now scared.  Some even suggested taking my kids.  I clammed up.  I didn’t say another word.  Again, I was grateful for my daughter’s doctor.  She is also a midwife.  She was the one person I could speak to without judgment and I owe her so much.     


How did your photography and creativity help your recovery?

Photography became my voice.  I remember days when I would be crying, anxious and filled with so much emotion that I didn’t know what to do. I could pick up my camera and in a way, detach myself from it all.  All of a sudden I was looking through my viewfinder and looking at life around me in a different way.  It is difficult for me to express but at that moment it helped me, it helped lift the anxiety and depression for just a minute.  It broke the cycle.  At other times I couldn’t express to people how I was feeling so I used my photography to express emotions in other ways.  Not specifically just my emotions and voice, but others too.  I couldn’t talk about what I was feeling because I didn’t feel anyone would understand.   As I poured myself into my photography I found myself wanting to do more, to learn more, so I went back to school.  It is funny how, in life, there are really no accidents.  If it hadn’t been for my picking up the camera as a way to stay creative being at home with my kids I wouldn’t have had this incredible gift to use while dealing with my PPMD.  And, if it hadn’t been for my having PPMD I wouldn’t have gone back to school and if I didn’t go back to school I wouldn’t have done my project, “PPMD.”


Walker: Tell us about your current photo project, “PPMD.”

 My project. Well, as I mentioned about no accidents in life, I was sitting in my Assignment and Editorial class and the topic of our final assignment came up.  We had weekly assignments throughout the 10 weeks of class while also working on a final assignment to be presented at the last class.  The instructor mentioned the best projects are those we can connect with.  I don’t know how it came out but all of a sudden postpartum mood disorder (PPMD) popped into my head.  I also immediately questioned how I was going to present a photo essay on postpartum mood disorder.  I had no idea but presented my idea anyhow.  My instructor loved the idea and encouraged me to include audio.  So, I decided I was going to take photos of women who had or were currently struggling with postpartum mood disorder.  I was going to pose them in their homes and then ask them to provide me with an experience, memory or something else of significance that related to their own experience with PPMD.  I was encouraged to have 10 images for my final and this meant 10 women.  I had no idea how I was going to find that many.  

I should also point out that my main goal was to create a project that would not only empower women who had experienced PPMD but to also educate people about PPMD in hopes of eliminating the judgment and stigma associated with it.  I didn’t want women to be scared, like me, to share their experiences and I wanted all women to get help and to not be ashamed.  I want women to look at these photos and hear the voices and say “hey, I am not alone,” and “these women don’t look crazy; I am not crazy either.”  I used my resources and emailed my local parents community yahoo group and the staff at the non-profit I volunteered for.  I was overwhelmed at the responses I got.  I had over 15 people respond.  It also awakened me to how many women suffer PPMD.  I scheduled time to meet with each woman without my camera.  I wanted to connect and hear their stories.  This was the most amazing experience.  I cried with these women, I laughed with these women.  I heard their stories, I shared mine.  We were not alone.  It was amazingly cathartic for me and for them.  I have received many thank yous, because for most of us, it was the first time we were able to share our stories without judgment.  The horrible things in our heads we were able to laugh about.  We knew they were not reality and we just needed to be heard.  My project shares the voices of the women and their portraits capture them in a way that is reflective of me and my experience.  This project has only just begun.  My dream is to share this project worldwide. To travel and meet with women and then photograph and audio record them.  At this time I am unsure how the project will continue to grow but am still going to school and this project is an active part of my education.  




Melissa Miller is a photographer, student, wife and mother of two living in Seattle, WA.  Photography came about as a way to explore her creative voice.  She’s done work for Open Arms Perinatal Services, PALS Doulas and Thrive by Five’s “Love.Talk.Play.” campaign.  She is currently enrolled at Photographic Center NW where she is taking classes and continuing her personal project, “PPMD“ on the subject of postpartum mood disorders.

Fathers and PTSD


This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Walker Karraa, MFA, MA, CD(DONA)

A 2012 study published in the Archives of Disease in Childhood: Fetal Neonatal Edition contributes to the growing awareness that partners are negatively impacted by traumatic childbirth. The first study of its kind, “Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery” (Harvey & Pattison, 2012) is a retrospective analysis of semi-structured interviews with 20 fathers who had witnessed the resuscitation of their baby immediately following delivery. While small in number, this study sheds invaluable light on the experience of fathers in the presence of trauma in childbirth.

Semi-structured, private interviews were audiotaped with consent, and the transcripts were analyzed for thematic content using the NVIVO-7 software in sequence. Analysis generated four themes (1) ‘preparation’; (2) ‘knowing what happened’; (3) ‘his response’; and (4) ‘impact on him’ (Harvey & Pattison, 2012, p. F2).


Theme One: “Preparation”

While over half of the fathers (n =12) had been given information prenatally regarding potential causes and instances for neonatal admission for their baby, none of the fathers had  been given information about newborn resuscitation. Fathers did not realize before birth that their baby might require this level of support at delivery, and most were only told by health care professionals (HCP) immediately before the birth that their baby would require resuscitation, if at all. Information was often vague, not forthcoming, or overheard and second-hand.


Theme Two: “Knowing What Happened”

The majority of fathers were unaware of the type of resuscitation given at time of interview, were unaware at the time, and had not been subsequently told. Contributing factors to the theme of not knowing what happened were his position in the room, and not having asked HCP directly what was happening during or after the event. Most fathers did not view the resuscitation due to obstructed view, or being focused on partner. When fathers attempted to stand up to see the baby, they were told to sit down. Those who did posed questions went unanswered, and still other fathers only learned about what was happening through cross-conversation among staff. Does this sound familiar to anyone?


Theme Three: “His Response”

Themes of conflict between partner and baby emerged from the father’s experience.  All fathers expressed doubt regarding their focus of concern, their partner or their baby. Many fathers reported that they thought either or both would die. In the interviews themselves, recalling the event caused fathers to become visibly upset. One father stopped the interview process momentarily during this line of inquiry.

Continued distress occurred for fathers regarding the conflict of whether to stay with partner or go to their baby being resuscitated. Most reported wanting to go to their baby, but felt they should stay with partner for reassurance. In some cases, staff contributed to this conflict by telling fathers to stay put. A variety of coping strategies were employed by fathers to endure the event—but most commonly emotional-controlling strategies were used, where they avoided looking at the baby, tried not to think about what was happening, leaving the room, or self-reassurance that there would be a positive outcome.


Theme Five: “Impact on Him”

  • There was general lack of memory of the event. While none reported regretting being there, all fathers reported feelings associated with the birth in terms such as: worried, distressed, petrified, scared, panic-stricken.
  • None of the fathers reported feeling supported from HCP’s during resuscitation
  • The majority of fathers who wanted to discuss their experience with someone after did not do so.
  • None of the fathers were given an opportunity to discuss the event with HCP’s afterward
  • Some reported symptoms of post-traumatic stress such as flashbacks, nightmares, agitation and hyper vigilance.


Conclusion and Discussion

The authors concluded:

“There is a growing awareness that meeting the needs of fathers facilitates their involvement in the lives of their children. Supporting fathers before, during and after newborn resuscitation could be a step towards achieving this.” (Harvey & Pattison, 2012, p. F5).

Hopefully this study will generate increased awareness the largely overlooked partners’ experience of traumatic events in childbirth.


Harvey, M., & Pattison H. (2012). Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery. Archives of Disease in Childhood: Fetal Neonatal Edition Arch Dis Child Fetal Neonatal Ed (2012). doi:10.1136/archdischild-F2 of F5 2011-301482.


Walker Karraa is a doctoral student at the Institute of Transpersonal Psychology. She is a birth doula, maternal mental health advocate, and researcher. She currently writes for the Lamaze research blog, Science and Sensibility. She presents at conferences, trainings, and organizational retreats pertaining to perinatal psychology, postpartum mood disorders, childbirth education, and labor support. Walker also is the President of PATTCh, a not-for-profit dedicated to the prevention and treatment of traumatic childbirth.




PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.