A Birth Story: Overcoming Society’s Standard

By Briana Padilla, El Paso, TX

I’m stationed in Texas and don’t have my family close by to give me all the support I needed. So from the time I shared the news of my pregnancy with my mom, she had encouraged me to buy a Lamaze book and take a Lamaze class to obtain the confidence I needed. She knew and supported my birth plan. I wanted to give birth as natural as possible without risking my baby’s health, which to me means drug-free and instrument free. My grandma, mom, aunt, and mother-in-law did it when epidurals weren’t as common as they are present day, therefore I knew I could.

Being the procrastinator I am, I put off buying the Lamaze book and taking the class until the end of my third trimester. My husband and I finally bought a book and took a one-day Lamaze class. We read the chapters that pertained to us at that point in the pregnancy and took a lot in from the few chapters we read. The class was informative as well. Between the two, we learned how drugs interfere with the mother’s body to release the hormones that it takes to give birth. The class taught me four breathing exercises and that breathing is important because when one holds their breath it actually makes the pain worse. Of course, during labor I could only do the simplest breathing technique. I also understood how important walking was to dilate my cervix and I wouldn’t of been able to do that if I was numb from drugs.

My husband and I also were trained on how important his role is to the whole experience. Without him massaging me through every contraction and letting me know my contraction was half way over, I couldn’t have done it. Before then I received a lot of criticism from my peers about my birth plan, but I wasn’t as accepting of medical interventions as they were. However, on my baby’s birth day with the information, techniques, and confidence the instructor and book gave us, I was able to get through my back labor and give birth 100 percent drug free. Our baby and I had no complications during labor. He came out healthy and I was able to walk to my postpartum room where I was able to get up and tend to him because I wasn’t numb from drugs.

I know that with the combination of Lamaze, my husband, and my knowledgeable mother and aunt I was able to do it! Not to mention, my active labor went so quick. Of course, I really wouldn’t of been able to do it without my AMAZING, STRONG, & SUPPORTIVE husband. I want other couples to hear our experience and know that they can do this too! I understand every women and every birth is different, but we are all created to give birth naturally and with the help of Lamaze, it makes it that much easier.

10 Healthy Pregnancy Tips


  1. Learn as much as possible about the wonderful ways that your body is changing and about how your baby is growing. Talk to your mother, your friends, and other women about pregnancy, labor, and birth. Attend an early pregnancy childbirth class, read books, and watch videos about normal pregnancy and childbirth.
  2. Think about whether you want to give birth at a hospital, at a birthing center, or at home. Choose a health care provider who will be able to assist you in your chosen location and who helps build your confidence for pregnancy and childbirth.
  3. Eat a well balanced diet, paying attention to the recommendations by the U.S. Department of Agriculture (www.choosemyplate.com). Drink more milk, or foods that substitute for milk, and eat a little extra protein. If you don’t eat several servings of fresh fruits and vegetables every day, take a prenatal vitamin that contains folic acid. Drink lots of water—six to ten glasses a day—and choose (real) fruit juices instead of sodas.
  4. Avoid substances that may be dangerous for you and your baby, such as cigarettes, alcohol, and street drugs. Do not take any medications, even over-the-counter medications, unless you have discussed them with your health care provider.
  5. Stay active! Continue exercise programs that you were doing before you became pregnant according to the recommendations of your health care provider. If you were not exercising before becoming pregnant, consider yoga, walking, or swimming. Start with short periods of exercise, and gradually increase the amount of time you are exercising.
  6. Get plenty of rest. Listen to your body to determine if you need short breaks during the day and to determine how many hours of sleep you need at night.
  7. Talk to your baby and enjoy your growing bond with him. Research now shows that babies react to the sense of touch as early as ten weeks of pregnancy. A little later, she can react to light, your voice, music, and other sounds.
  8. Try to minimize the stress in your life and practice stress management techniques such as slow, deep breathing and relaxing various muscle groups when you feel under stress. You can learn these techniques and other strategies for relaxation in childbirth education classes.
  9. Plan your baby’s birth. For most women, birth is normal, natural, and healthy. Learn as much as possible about what birth is like in the location you have chosen. Ask questions about the six care practices that are known to promote normal birth. Lamaze classes will help you understand what happens during childbirth and will help you and your partner learn positions and movements which will aid labor and ways to cope with the stress and pain.
  10. Enjoy this special time in your life! Your partner, your family and friends can help make the most of this wonderful transition. Have confidence in your body’s ability to grow, nourish, and give birth to this baby as women have done for centuries.

Understanding the Effects of Alcohol on Your Body & Your Baby

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Spring break 2014, which, for some, actually fell at the end of winter this year, is in full swing. Many students are back to school working diligently toward their degree. For some students, Spring break means a trip back home, a trip abroad for cultural education and for others, it’s a time to let loose on a warm beach, usually with one (or many) alcoholic beverages. One young woman went on holiday to the Caribbean after a particularly stressful semester at college. After returning to school and missing her period, she called the MotherToBaby service. She was frantic after recalling the amount of alcohol she had consumed during her seven days in the sun.

In the last two decades, a change in social conventions, increased disposable income, and marketing, media, and other societal influences have encouraged women to drink more alcohol than in years past. These various factors have contributed to a higher number of women drinking alcohol during college, binge drinking during college and risking alcoholism. According to the Centers for Disease Control (CDC), the issue of women and alcohol drinking is an under-recognized problem. The CDC reports that approximately 24% of women 18-24 and 20% of women 25 to 34 report binge drinking.  Binge drinking is classified as four or more drinks in one occasion. Studies suggest that college-age women may be binge-drinking in higher numbers than men. This may be due in part to the fact that many women do not know that the recommendations for alcohol drinking for men are different  – and higher – than for women. These issues are very concerning because most pregnancies are unplanned and binge drinking is a threat to the healthy development of a pregnancy.

Fortunately, in the now worried “Spring Breaker” we spoke with, our counselor was able to reassure her after identifying her exposure as having occurred very early in pregnancy, prior to placental communication being established. However, the amount of exposure she had reported, four or more drinks daily, may have been a risk had it occurred later in the first trimester.

The U.S. Department of Health and Human Services recommendation for alcohol use by non-pregnant women is one drink per day (maximum of seven per week). Men have a recommendation of maximum two drinks per day. The reason that women have a lower dose recommendation is that women are more sensitive to the effects of alcohol. Specifically, the average woman that takes two drinks will have more alcohol in her system compared to a man drinking the same amount. This is due to a size difference, genes, and maybe, hormones too. Women are generally smaller than men and that means having less blood. Having less blood means less water. A woman’s body is made up of about 52% water and a man’s about 61%. Water dilutes alcohol, both in a glass and in the body. More dilution means less impact. Also, women have more fat and unfortunately, alcohol in fat can’t be metabolized as quickly and it ends up concentrating in blood.

There is an important enzyme(s) called alcohol dehydrogenase that breaks down alcohol. These enzymes are primarily stored in the liver and the stomach. These enzymes are found in greater abundance in men than women. The lower number of enzymes means that more alcohol gets into the blood and stays there longer.

Hormones may also play an important role in breaking down alcohol. Studies suggest that the premenstrual phase slows down alcohol and results in higher blood alcohol levels. There is some evidence that birth control pills that contain estrogen also slow the breakdown of alcohol.

So what does this all mean? Should Spring break mean all work and no play? Not necessarily. However, part of feeling empowered and making responsible decisions is learning the facts about how alcohol can affect us all differently. During April’s Alcohol Awareness Month, I encourage everyone to take a moment to think about those differences – It could make the difference in your future baby’s life.





Jones, MK,,& Jones BM. (1984). Ethanol metabolism in women taking oral contraceptives. Alcohol Clin Exp Res, Jan-Feb;8(1):24-8


Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about alcohol, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.
photo credit: opacity via photopin cc

Choose Wisely: Studies Show Increased Risk of Cesarean Linked to Choice of Doctor

By Jacqueline Levine

The cesarean rate in the United States has leveled off, as reported last year by the Center for Disease Control and Prevention (CDC). The information came from the National Center for Health Statistics, and it says, in sum: “After 12 years of consecutive increases [1998 to 2009], the preliminary cesarean delivery rate among singleton births was unchanged from 2009 to 2011”;  the report cites the current rate as 31.3%.  That the rate has stopped rising is good news. And that the rate is too high is not in dispute. The World Health Organization and other organizations that promote and support optimal maternity care have been making that case for a long time.

Most recently, the American Congress of Obstetricians and Gynecologists (ACOG) has come out with a report entitled “Safe Prevention of the Primary Cesarean Delivery,” with guidelines meant to prevent a first-time c-section. The study calls for revisiting the list of the common indications for cesarean. The various rationales for cesarean have held sway in maternity care for years.  These new guidelines can be seen as an admission that the rate of surgical birth is indeed far too high, and that current practices do not promote the ideal health of women and babies.

Added to this news are two studies that reveal additional factors that can affect a woman’s chance of having a cesarean. News from the American College of Obstetricians and Gynecologists’ (ACOG) 57th Annual Clinical Meeting, as reported in Medscape Today (Medscape Medical News, May 12, 2009), discussed an article entitled “Liability Fears May Be Linked to Rise in Cesarean Rates.”  The following is a direct quote (bold emphasis is mine):

“It has been suggested that medical-legal pressures are a factor in the high number of cesarean deliveries. A number of studies have borne this out.  Localio and colleagues (JAMA. 1993; 269:366-673) found a positive association between medical malpractice claims risk and the rate of cesarean delivery.   Murthy and colleagues (Obstetrics & Gynecology 2007; 110:1264-1269) found an association between professional liability premiums and rate of cesarean delivery — for every $10,000 increase in insurance premium there was a 15% increase in the rate of cesarean(s) delivery.  Dr. Barnhart said “First of all, I applaud the abstract, in that it quantifies a perceived problem,” ”We all anticipated that defensive medicine might be a reaction to litigation, and this paper demonstrates that that is indeed the case,”  ”So don’t just blame the doctor for doing a C-section, recognize that there’s probably a reason that [he or she is] doing it. And that fear of litigation is the reason,” Dr. Barnhart concluded.”

The study implies that what’s being done in the way of care might indeed be for the welfare of obstetricians who practice defensive medicine, and may not be for the best welfare of the woman in his care. The results of this study are not addressed in the recently released ACOG guidelines to eliminate the overuse of c-section, but it’s helpful to acknowledge the possible affect of malpractice insurance on women’s birth options.

We assume that the most fundamental tenet of care is that what a doctor does is for our benefit, and not for her or his well-being, convenience or safety. A doctor who picks up a scalpel and performs surgery for defensive reasons is behaving in a way that is the antithesis of ethical behavior, a betrayal of our trust in the doctor-patient relationship.

The other study addresses how an obstetrician’s personality affects your risk of having a cesarean. The article, “Women’s Risk of Having C-section May Depend on Her Obstetrician’s Personality,” discusses a study published in the Journal of Obstetrics and Gynecology in 2008. (Allcock, C., Griffiths, A., & Penketh, R., The effects of the attending obstetrician’s anxiety trait and the corresponding obstetric intervention rates. Journal of Obstetrics and Gynecology, 28(4), 390-393. [Abstract]). “Trait anxiety” is an integral and unchanging part of the human personality and is very different from “‘state anxiety’” which happens in response to a particular situation.

The results of the study are very concise (emphasis mine):

“Obstetricians were asked to complete a validated survey that measures ‘trait anxiety’ which is stable and enduring… The obstetricians with the least anxiety had the lowest emergency cesarean rates.  The obstetricians with the most anxiety had the highest rates.”

Statistical analysis revealed that the doctor’s trait anxiety levels were highly correlated with cesarean rates. 

These studies document just two of the many factors that affect a birthing mother’s chances of having a cesarean — factors that have nothing  to do with a mother’s or baby’s actual health status. The more we know about what influences doctors in the decisions they make about our care, the better our ability to recognize and request best-evidence care for ourselves and our babies. And so the question becomes, how can a birthing woman understand and avoid the influence of lesser-known factors on her chances of avoiding cesarean?

As our own best advocates, we must seek out the ethical caregivers who do not rely on routine interventions and who use surgery only to save the lives or health of babies and mothers. Before deciding  on a caregiver , it’s of critical importance to become familiar with best-evidence, optimal maternity care, so that you’re able to
question her/him about all the health care practices that will affect labor and birth. Knowing the facts about normal, healthy birth and conservative reasons for c-section based on our genuine health status help you make informed choices about your care.

Recommendations for OBs, hospitals and midwifery care from women across the United States can be found at the non-profit, all volunteer website www.thebirthsurvey.com. Question your prospective OB or midwife about his/her c-section rate, induction rate, episiotomy rate, and other routine and common practices that may not confer best-evidence care. If you perceive a defensive posture about his stats, or an air of reluctance to tell you what you want to know, consider it a red flag warning and seek a new caregiver for optimal care.


Looking for more information and resources surrounding cesarean and VBAC? Check out this list of online resources and test-your-knowledge quiz from Science & Sensibility.


About the Author

Jacqueline Levine, BA, LCCE, FACCE, CD(DONA), CLC has been a DONA doula and  lactation counselor  for 10 years, a Lamaze educator for twelve years, and a WIC educator.  She teaches Lamaze childbirth education at Planned Parenthood of Nassau County, where she volunteers birth doula services to the clients of Planned Parenthood, an underserved population.  She won the Lamaze Community Outreach Award for these services to the community, and she has taught and supported pregnant teens in local high schools.

She’s been a contributor to Science and Sensibility, the Lamaze research blog, since 2009, and writes for BreastfeedingUSA, the online peer-to-peer breastfeeding site as well.  Some of her articles for breastfeeding teens have been on the US Breastfeeding Committee site, and she is a guest lecturer in the Sociology Department of CW Post College of LIU, teaching a class in the History of Childbirth in the United States, as well as breastfeeding classes for DONA doula certification that stresses best-evidence care for mothers and newborns.

She is mother of three and grandmother of five, and came to the world of birth after she retired from a career as artist and designer in the Garment Center in NYC.

April is Cesarean Awareness Month

April is Cesarean Awareness Month — a time to learn about and share important information about how to avoid a first-time cesarean, discover your options for VBAC, and find resources for support in healing from a cesarean. Where to start? ICAN - the International Cesarean Awareness Network — is an excellent place to find several resources related to cesarean, including educational white papers, ways to get involved with advocacy, and links to your nearest ICAN chapter where you can find local resources and information about hospitals and caregivers in your area, as well as connect with other women living near you who have experienced cesarean and VBAC.

What are your favorite resources for cesarean? Please share them in the comments!

Travel During Pregnancy – What to Bring Along

With the onset of spring — and summer just around the corner — many of us will spend time traveling on vacation, likely to warmer climates. When you travel during pregnancy, you’ll want to add a few additional items to your packing list for optimal comfort and health. Consider adding the following to your carry on bag.


Pertinent medical information – You never know when you may need your medical information while traveling. It’s a good idea to have a paper copy (yes, paper) of your medical history for your pregnancy. This is especially true if you’re traveling outside the country as it may prove more difficult to obtain your records electronically or by fax.

Insurance card – In case you need to go to the doctor while traveling.

Vitamins and any medication related to your pregnancy – A must-have!

Water – Staying hydrated during pregnancy is so important, since dehydration can cause preterm labor. If you’re flying, be sure to pick up a bottle after the security checkpoint to take on the plane, and then pick up a good supply once you’re at your destination. Depending on where you go, tap water may be a no-no for health reasons — be sure to check with your hotel.

Comfy shoes – Never has wearing comfortable shoes been more important than in pregnancy. Of course you can pack your cute heels, too, but for any amount of extended walking, you’ll want something more comfortable.

Snacks – High protein and easy-to-transport snacks are so important to take with you as you travel during your pregnancy, since you don’t know how long it may be between meals, depending on the availability of food.

Pregnancy pillow – This may be hard to pack on a flight, but if you’re traveling by car and there’s room, it’s can be so nice to have the same comforts of home while traveling. If you can’t pack your favorite pillow, extra pillows at your destination can go a long way to making your sleep more comfortable.

Camera – Whether it’s with your smart phone or a regular camera, snap at least a few pics of yourself during your trip to document your adventures during pregnancy.

Journal – Often, travel is a time when you can de-stress and take time out to reflect. Take a journal with you to write down thoughts and feelings about your life at the moment, including your pregnancy. Even if you never write in the journal again, you’ll cherish the snippet of history in your life.

Reading material — not pregnancy related – When you’re pregnant, so many of your thoughts and conversations center around pregnancy. When you pack reading material for your trip, it may be nice to take a break from all the belly talk and pack books and magazines on other interests.



Marijuana & Pregnancy – Is it Safe?

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Marijuana has been in the news a lot lately and for marijuana users who have had to smoke in illegally, it appears societal attitudes about pot smoking may be changing.  Twenty states have laws legalizing some form of marijuana use. Two states, Colorado and Washington, have legalized its recreational use. In an interview, the NFL Commissioner seemed to leave open the possibility that medicinal use could be considered for NFL players if there was scientific evidence that it was helpful to treat injuries and pain. Even President Obama has said that he doesn’t believe marijuana is any more dangerous than alcohol. Marijuana is currently listed as a Schedule I drug. Other Schedule I drugs include heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy).


What The Research Shows Us

According to studies, pregnant women who use illicit substances are more likely to use marijuana compared to other drugs. This is often due to the belief that marijuana is less harmful to the developing embryo and fetus, compared to other drugs such as cocaine or heroin.

Marijuana is Cannabis. The delta-9-tetrahydrocannabinol (THC) in the Cannabis plant produces the psychoactive effect or “high.” Marijuana can be smoked in a joint, inhaled through a bong or vaporizer, eaten in food and teas/beverages, used in tinctures, and topical balms.  Smoking and ingestion exposes the user to THC, producing the high. When smoked in a joint, the user is exposed to carbon monoxide from the burning of the leaf as well as tar, which can stay behind in the lungs.

Marijuana use during pregnancy has been studied since the 1960’s. Like all studies, there are weaknesses that have been pointed out. For example, asking women about past drug use may not be the most accurate way to make a connection between the dose of the drug and the adverse effects because the women may have forgotten. Also asking women to volunteer information about drug use, which they may fear disclosing even in a confidential setting, may make it difficult to know how frequently pregnant women use drugs overall. Still, a number of experts have reviewed hundreds of reports in humans and animals. At least to this point, the studies do not support an association between marijuana smoking and birth defects. One large study of 12,825 interviews done after delivery, did not find a statistical association between marijuana use and birth defects.

However, the studies also show that marijuana is not risk free. Studies have reported associations between marijuana smoking and growth restriction and lower birth weight, particularly in women who keep smoking through delivery or late in pregnancy. An Australian study of almost 420,000 live births reported a higher risk for neonatal intensive care admission for newborns exposed prenatally to pot. Also, there are reports of abnormal responses or behaviors in the newborn period and this suggests a toxicity or withdrawal. The symptoms include exaggerated and prolonged startle reflexes (sleep cycle disturbances with high-pitched crying.) In a Brazilian study, exposed newborns were “more irritable and less responsive to calming, cried more during the examination, and exhibited more jitteriness and startles than the non-exposed neonates.” Pregnant women who smoke daily and/or through delivery, have a higher risk for complications in their pregnancy compared to women who quit in the first trimester.

Researchers have attempted to assess the long-term effects of prenatal marijuana exposure. Studies of 3, 10 and 14-year old prenatally exposed children suggest that the prenatal exposure to high doses of marijuana may make it harder for children to learn and may affect their emotions (increased aggression) and increase depression symptoms. Studies are needed to assess which prenatally exposed children are most at risk. Its important to note that the children in these studies often have had prenatal exposure to other drugs as well, struggles with poverty and other life challenges, making it difficult to know that the findings are due to a single drug exposure.


So Where Does Marijuana Rank Compared To Other Drugs?

Alcohol: Specific to use during pregnancy, marijuana is not alcohol. Alcohol is still the drug with the highest risk and the widest range of birth defects, including physical, mental and behavioral. Alcohol is a drug with the highest use throughout the world, easy legal access, and social acceptance.

Cocaine: Cocaine, by comparison, is associated with a small risk for birth defects, and a higher risk for admission to newborn intensive care for withdrawal and toxicity. Additionally, cocaine is associated with prenatal growth retardation, lower birth weight, shorter length, and smaller head circumference. Studies suggest the effects on height extend into childhood.

Heroin: Heroin has not been associated with an increased risk for birth defects, however, is associated with a higher risk for withdrawal and admission to newborn intensive care and sudden infant death syndrome.


Bottomline: Snuff Out Smoking It

Clearly, marijuana use in pregnancy is not preferable, nor less risky, compared to most other drugs when a side-by-side comparison is made. Changing societal attitudes doesn’t change the fact that the developing embryo (and fetus) is dependent on the mother for oxygen, nutrients and a balance of hormones, chemicals and other substances to grow normally. Disrupting the normal fetal environment, through the introduction of marijuana or other recreational drugs, puts the pregnancy at risk in the short-term and possibly the long term as well.


Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.


MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about beauty products, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.
photo credit: MendezEnrique via photopin cc


Every Mother, Every Time – Petition for Universal Mental Health Screening

Earlier this month, perinatal mental health researcher, advocate and writer Walker Karraa, PhD, created a White House petition entitled “Every Mother, Every Time: Universal Mental Health Screening for Every Pregnancy and Postpartum Woman.” The deadline to reach 100,000 signatures for the petition to pass is Friday, April 4. Giving Birth with Confidence encourages you to take 5 minutes to sign the petition and SHARE it, asking others to do the same.


Tell us more about what the mental health screening for pregnant and postpartum petition, what it’s asking for, and what it would do if fulfilled.

Suicide is a leading cause of death for women during the first year after childbirth. 1 in 7 women will experience a mood or anxiety disorder during pregnancy or postpartum, yet nearly 50% remain untreated. In pregnancy, maternal mental illness negatively affects fetal development, and leads to adverse birth outcomes such as low birth weight and premature delivery. Perinatal mood and anxiety disorders (PMADs) can impair infant and early childhood cognitive and emotional development. Despite overwhelming empirical evidence, there is no universal mandate for care providers to screen pregnant and postpartum women for depression, anxiety, or family history of mental illness — a well-established risk factor. The petition calls to screen every mother, every time to prevent and treat perinatal mental illness.


For people reading this who have never experienced a mental health disorder (either first hand or otherwise), can you help explain why screening for mental health, especially for women who are pregnant or have just had a baby, is so important?

Well, I think I would say that we know someone who has a mental illness. The data is just too strong to think otherwise. We might not know it, but we all know someone who is, or has been struggling with mental illness. I say we might not know it, because of stigma. Stigma about mental illness shuts people down, and shames them into silence. The stigma of being mentally ill in this culture is so strong that we simply cannot share our suffering with others at risk of rejection, discrimination, and stereotyping. We run the risk of losing out on jobs, loss of dignity within our communities, being marginalized from volunteering in our schools, communities, churches. That is how strong the stigma is for mental illness. If you talk about your disease, you run a risk of being stigmatized in all areas of your life. Even with your partner.

So we may not have had a direct conversation with someone who said, “I have a mental disorder” — but we are working with them, loving them, learning from them and engaged with them every day.


Why is screening so important?

Because mental illness left untreated can be life threatening. And for women who experience a mental illness during pregnancy or postpartum? The baby is also affected. We now know that as early as implantation – around 5-7 days post conception — that a woman’s stress hormones present in depression, anxiety, and posttraumatic stress are carried to the baby. We know that even before conception — in preconception — that untreated mental illness of mother and father create stress response conditions that can impact pregnancy down the line.

We know that pregnant women with untreated depression or anxiety disorders have higher risk of preterm birth, low birth weight, and babies with lower APGAR scores.

So to me, screening for mental illness in pregnancy and postpartum is not different than screening for any other health condition that poses a risk to the health of the mother and child — just like gestational diabetes, HIV, Hepatitis, and the basic blood panel drawn to screen for anemia, etc. We have our heart rate and blood pressure checked, we have our babies heart rate and growth tracked, we have our protein in our urine checked. This is routine. So why is it so hard to ask a woman about her mental health while she’s there?

By 2030, the WHO predicts depression to be the leading cause of disease in the world. Mental illness, such as depression, is a physical disease that has devastating impact on personal and public health. We know that current global estimates are that 1 in 4 people have a mental illness. Depression is the second most common cause of hospitalization for all women in the U.S.; the first being childbirth (Blenning & Paladine, 2005; Gold & Marcus, 2008). Current estimates are that in the United States, postpartum depression (PPD) alone impacts 15% to 25% of women annually (N. Gavin et al., 2005; Keyes & Goodman, 2006; Zittel-Palamara, Cercone, & Rockmaker, 2009). It has been reported that there is a seven-fold increase in the risk of psychiatric hospitalization for all women following childbirth (Harlow et al., 2007), and that perinatal and postpartum mood and anxiety disorders affect up to 48% of women living in poverty (Knitzer et al., 2008). The World Health Organization (WHO) has suggested that global prevalence rates for women suffering from PPD are as high as 34% to 55% (WHO, 2003).

The list of public health, obstetric and pediatric organizations that endorse prevention is long. But U.S. organizations fall short of mandating universal screening, despite availability of free and validated tools that include a two-question screen.


What are the two questions?

They are two simple yes-or-no questions:

Over the past 2 weeks, have you often been bothered by:

1. Little interest or pleasure in doing things? 

2. Feeling down, depressed, or hopeless? 

If a woman answers yes, then she is given a more complete screening questionnaire.

What spurred you to create the petition?
I am tired of being told it can’t be done, or that it has to be done a certain way, with certain people—I just don’t buy it. I know the strength of women who have suffered from a perinatal mental illness, and we will not be stopped. Our greatest threat is trying to own different parts of a cause, or brand it for ourselves.

I have been greatly disheartened by the lack of support the petition has received. A petition for Alaska to secede to Russia received 6,000 signatures in 2 days, and yet this position has had only about 2,000 signatures in three weeks. And it’s not from lack of trying! Is it a lack of vision and lack of willingness to risk being seen as crazy to endorse something like a White House petition because it’s not guaranteed to work? We must do better — for ourselves, for our daughters, for our granddaughters, for all women.


Why isn’t something like this already in place?

My personal opinion? Stigma. It condones complacency and allows for systems of care to have more invested in women staying sick, than they do systems that help women achieve health and wellness. Stigma that is perpetuated in the media—combined with horrific lack of knowledge about the facts. Additionally, many allied maternal health associations have not prioritized the issue.


What else, in addition to universal mental health screening, can be done to improve the detection and treatment options for women with mental health disorders?

At this point? Women have to do it themselves. We have to take it upon ourselves to learn about the risk factors, namely a family history of mental illness or previous episodes of depression or anxiety. Then, unfortunately, we have to push through the stigma and tell our care providers. Especially if we have a history of bipolar disorders, or a first-degree relative with bipolar disorder. Women have fought for rights before — this isn’t our first rodeo — we now must fight for the right to mental health.


Walker Karraa, PhD is a perinatal mental health researcher, advocate and writer. She has been a regular perinatal mental health contributor for Lamaze International’s Science and SensibilityGiving Birth With Confidence. Walker has interviewed leading researchers, clinicians, and advocates such as Katherine Wisner, Cheryl Beck, Michael C. Lu, Karen Kleiman, Pec Indman. Walker was a certified birth doula CD(DONA), and the founding President of PATTCh, an organization founded by Penny Simkin dedicated to the prevention and treatment of traumatic childbirth. Walker is currently the Program Co-Chair for the American Psychological Association (APA) Trauma Psychology Division 56. Her book, Postpartum Depression: Trauma and Transformation, is being published by Praeclarus Press, LLC and is based on her extensive research into the ways women experience personal growth through postpartum depression. Walker is the founder of a community blog site, Stigmama.com, dedicated to breaking the cycle of stigma against mothers who have mental illnesses.

In Celebration of World Doula Week – 10 Things Doulas Do During Labor

This week marks World Doula Week, a celebration of the wonderful things that doulas do for families during pregnancy, birth, and in postpartum. Giving Birth with Confidence recognizes doulas with this list of 10 great things birth doulas do for women and their partners during labor. Keep in mind, too, that many doulas also offer excellent assistance in the postpartum period.


1. Suggest position changes to keep your labor progressing and help you find optimal comfort.

2. Serve as a resource to help you find answers to your questions about medical procedures, interventions, and labor and birth.

3. Help your partner remember the comfort measures learned during childbirth classes.

4. Water refill duty — yours, your partner’s, and her own!

5. Provide you with a few healthy snacks or drinks from her labor bag if you’ve forgotten your own.

6. Call on her knowledge of comfort measures and position changes to help ease and improve back labor.

7. Offer emotional support through encouragement and understanding of where you are and what you’re going through in labor.

8. Know your birth plan/preferences to help you communicate them to the nursing staff and your care provider.

9. Stay with you continuously through labor and after birth, usually until you have fed your baby for the first time.

10. Provide tips and assistance with the first time you breastfeed.


Do you plan to hire a doula, or have you had a doula at a previous birth? How did your doula help you?

Keeping it Simple: An Alternative Birth Plan

When writing a birth plan, it’s important to keep your list of preferences simple and succinct. Using bullet points and including the most critical information (ie: please don’t offer pain medication; I’m allergic to latex; please keep mom and baby together after birth, skin to skin; we are delaying Hepatitis B shot) will help ensure that your birth plan is read and heeded. The traditional birth plan format includes a one-page list of information grouped into categories like, “Labor,” “Birth,” “Newborn,” and “If Cesarean is Necessary.” For an alternative format, consider using the following graphic to lay out your birth plan. This visual four-square birth plan helps the reader find information quickly and simply, and leaves just enough room for the most important information.

birth plan squares














Ideas for filling in the four square birth plan:


  • Please don’t offer pain medication
  • Shower/tub for comfort
  • Experiment with many positions for pushing

Special Instructions

  • Mom is allergic to perfumes
  • Partner would like to cut cord and announce gender
  • Please delay cord clamping

In an Emergency

  • Please allow partner and doula to be present in case of cesarean
  • Partner will be skin to skin with baby if mom cannot
  • If baby requires NICU, mom will pump colostrum – please, no formula

Newborn Care

  • Please delay bath
  • No eye ointment
  • Please give vitamin K shot


These are just a few ideas to populate the squares — and perhaps your squares will have different categories! Experiment with the best format and contents to fit your preferences for birth.