What’s Happening Down There – Vaginal Birth Postpartum Care

In my first year working as a doula and childbirth educator, I have found that what surprises women the most is not how tired they feel in the third trimester, not the intensity or duration of labor, and not the overwhelming joy they feel when they see their baby for the first time, but rather, what it feels like to recover from a vaginal birth. First, let me be very clear: every woman experiences birth and recovery differently. Some women may feel like doing cartwheels just hours after birth, some women may experience mild discomfort, and some women may experience a rough recovery. Much like other variables in birth, there is no way to predict what your experience will be.

The ease or difficulty with which you recover from a vaginal birth may (or may not) depend on many factors: your level of fitness prior to birth, how many vaginal births you’ve had before, how your care provider cares for your perineum during pushing, how you pushed during birth (directed vs. following your natural urges), positions used for pushing, and the length of time that you spend in labor and during pushing. The following information shares tips for soothing some of the more common discomforts women experience after a vaginal birth. As with anything, be sure to with consult your care provider about treatment options.

Swelling – Unless you have a very rapid birth, you will most likely experience swelling “down there.” Your vulva will look and feel swollen. Don’t worry, though — it will go away within a few days. For soothing, many hospitals have special pads that turn magically into ice packs. You can also wet and freeze a regular pad — it will feel wonderful, trust me.

Soreness – As with most things on your body that swell (see above), your vagina and surrounding parts will most likely feel sore for a few days to a couple of weeks after giving birth. Even if you do not tear (see below), you still may feel tender from stretched and swollen tissues. The best thing you can do to recover is to take it easy and rest your body.

Burning/stinging – If your perineum tears (or if you have an episiotomy) during birth, you will most likely experience additional discomfort in the days and first couple of weeks after birth. Your best source of soothing is the peri bottle that is given to you during your hospital stay (basically, a squeeze bottle to squirt warm water over your perineum as you urinate to prevent stinging and to cleanse your genitals). Home birth mamas can purchase these online or use any small, clean squirt bottle. Some women also find that witch hazel pads and an anesthetic spray (like Dermoplast) can also provide soothing relief.

Hemorrhoids – You may have developed hemorrhoids during your pregnancy, and if you didn’t, you may experience them after birth (as a result of pushing). Either way, these swollen, bulging vericose veins near your anus can cause irritation, itching, and can even be painful. There are many remedies to soothe your sore bum, including ice packs, witch hazel pads, a sitz bath, medicated hemorrhoid cream, and over-the-counter anti-inflammatory medication (ibuprofen, acetaminophin). Avoiding standing or sitting for long periods of time will also aid in reducing swelling.

Weak abdominal muscles – Your mid-section goes through an amazing transformation from pregnancy to postpartum. Immediately after you have your baby, your “tummy” will still look as though it’s about 6-8 months pregnant, as a result of your uterus, which takes time to shrink back down. Additionally, similar to late in pregnancy, you may find yourself having a hard time sitting up from lying down and getting up from a sitting position. This difficulty comes not from the weight of your baby, of course, but from weak core muscles. Some women experience the normal stretching of skin and muscle that occurs with pregnancy and some women experience what is known as “diastasis recti,” which is the separation of the right and left side of your abdominal muscles. To aid in postpartum abdominal strength, you might consider wearing a belly binding apparatus, which provides more stability as you move around. For diagnosis and healing of diastasis recti, you will want to consult with your doctor and/or a physical therapist.

Lingering contractions – Otherwise known as “after pains,” these post-birth contractions are necessary to shrink down your uterus to its pre-pregnancy state, but may also may cause you to tap back into your deep breathing coping methods used for labor! The good news is that many first-time moms may not even notice these contractions, and for second-time moms and beyond, they are brief and will disappear completely after a few days.


What was your postpartum vaginal birth experience like? Did you experience something not on our list? Share in the comments!


Birthing Confidence into the Fourth Trimester

You took Lamaze classes. Your doula checked in on you, sometimes daily. You knew that you were going to give birth at your local birthing center, where you could move around and hold your baby immediately once she was born. Whether everything went as planned or not, you could say that you felt confident about giving birth—at least far more confident than you feel now that you have a baby at home. If you find your confidence has waned in the “fourth trimester”—the first three months of your baby’s life— know that you are not alone. Adjusting to your new mothering routine can be far more difficult than talking about it in parenting classes, but the skills that you gained in order to give birth confidently can also assist you through the fourth trimester.

Be Flexible

When giving birth, we respect that every infant is different and will have her own way of coming into the world. She will also have her own way of being in the world. Just as you allowed labor to begin on its own and allowed yourself to change positions as you gave birth, you will need to give yourself the time and space to align your parenting expectations with your newborn’s actual needs and desires. You may not accomplish everything that you set out to do in your day, and that’s okay. You may be surprised by your own feelings—it’s not unusual to experience some postpartum depression, or to struggle with your new postpartum body. Keep an open mind and remember that having a healthy baby is still your ultimate goal.

Be Mindful of Your Urges

Natural birth encourages mothers to follow their urges—to eat if they’re hungry, and of course, to push when the body says push.  Our bodies know how to give birth. Remaining aware of your body’s urges will also help you mother into the fourth trimester. Our bodies know how to mother. Remember that the baby blues are normal. We go through tremendous hormonal shifts in the days following labor, and it’s common to worry about your baby’s safety. Mindfulness will also help you to be aware of whether you feel like you might be a danger to your baby’s safety. If you notice that you’re having urges that you don’t understand, seek help. Activities such as conscious breathing will keep you centered and aware through your baby’s first three months.

Seek Support

If you notice yourself experiencing severe postpartum depression, you should obviously speak to a doctor, counselor, or doula and get connected with the resources that will help you to function and thrive. However, even those who feel mentally stable after birth shouldn’t feel pressure to mother alone. Hiring a postpartum doula can help encourage confident mothering beyond the fourth trimester, in addition to assisting with lactation issues. If you have a supportive partner, be open about how you’re feeling. Postpartum support groups can connect you with mothers who may be experiencing what you’re experiencing, which can decrease any lingering sense of isolation.

Hold Your Baby

We acknowledge that it’s important to hold our babies after birth, but the need to be home and bond with our babies continues into the fourth trimester. The old tradition—pre-19th century—was that women weren’t to leave their beds for nine days after giving birth. This is far from realistic in our modern context, even when we seek the support we need, but we should strive to spend as much time with our infants as possible, getting to know their sounds, smells, faces, and habits. We want to attune to our babies, to empathize with them in order to know their needs. This site has a great chart that shows the difference between the womb and the outside world that supports why your baby likely wants to be held all the time, or walked or rocked. Taking a moment to empathize with our babies will help us to confidently address their needs.

Incorporating the skills we learned to birth confidently provide a great foundation for confident parenting in addition to addressing other challenges such as tuning out messages about how our bodies should once we’re out of maternity clothes and learning how to breastfeed. As you give yourself the flexibility and support to get to know your infant, you will be able to reflect on your personal mothering style and to support other women—and perhaps your next child—through the challenges of the fourth trimester.

Kristen Hurst is a blogger, a mother, a doula, and a fashionista. She received her bachelor’s degree in fashion marketing, and writes for Seraphine Maternity. When she’s not trying to juggle the lives of Casey, Austin and Ben, she practices yoga and designs her dream house on Pinterest.
photo credit: hugabub.com via photopin cc

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.


Mental Illness Awareness Week – Postpartum Mood Disorders

Last week, a mother named Miriam Carey was killed after a succession of tragic events. We will never know what compelled Miriam to drive her car into the White House barriers. What we do know, however, is that Miriam suffered from a postpartum mood disorder. And what we can do — to honor Miriam and to support and protect women and babies everywhere — is spread the word:

  • Postpartum mental illness (postpartum mood disorders) is real and it affects as many as 950,000 women annually
  • Postpartum (and perinatal) mood disorders represent more than depression — anxiety, psychosis, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)
  • Postpartum mood disorders are treatable
  • You are NOT ALONE and this is NOT YOUR FAULT

If you think you may be suffering from a postpartum mood disorder, seek help right away. The following two resources provide resources for getting help in your area, as well as support and information:

The Edinburgh Postnatal Depression Scale (EPDS) also is a resource for women wanting to know more about their postpartum depression symptoms. You can easily take this test in the comfort of your own home to learn more about your symptoms and begin the evaluation process. The test is not meant to replace clinical diagnosis or advice, but the results should be shared with your doctor. You can take the test online here: http://psychology-tools.com/epds/.

You can join other women from across the globe in honoring Miriam and mothers everywhere who have and are experiencing postpartum mood disorders by checking out the Facebook page “For Miriam.”




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.

You Just had a Baby, Now What? Self-Care Tips for the Postpartum Weeks

A recent article on The Daily Beast exposes the lack of importance Americans place on postpartum rest and care, and the pressure moms feel to get back to pre-pregnancy standards almost immediately. Despite countries all around us that encourage new mothers to rest for a substantial period, the American culture is notorious for short maternity leaves and tabloids that tout celebrities who lose baby weight weeks after giving birth.

Birth is normal, yes. But it is also a major physical event in a woman’s life. Under ideal circumstances, a new mom should be given the freedom to truly recover from her birth. With the average uncomplicated vaginal birth, blood loss can be up to 500 mL (more is considered a hemorrhage), hormones are in a major state of flux, the body is working to get rid of excess fluid, and the uterus begins the important job of shrinking back to normal size (it grows 20 times its size during pregnancy). Women who experience complications during birth, including cesarean, experience normal recovery plus additional care needed for healing. What does a true postpartum recovery look like? No housework, no older child tending, no errand running, and no working in or out of the home. In countries where a traditional postpartum rest period is observed, a new mother will enjoy 30-40 days of nothing but nourishment, sleep, and new baby cuddling.

Of course, in the United States, where we often return to work within six weeks, where spouses work outside of the house, where family members live far away, and where finances are strained, this is an impossible extreme. There are things you can do, however, to facilitate a more restful and healing postpartum period.

Create your village. If you don’t have family or friends nearby, or if you are a single mom, there are things you can do to create your village — a local community of people who can support and help you during postpartum and throughout parenthood. Once you have your village, let them know that you’ll be working extra hard to not work hard once baby comes. Let them know you’ll call on them for help.

Cook in advance. In the last couple of months during your pregnancy, make freezer meals for yourself to enjoy when the baby comes. If you’re not receiving regular meals made for you during postpartum, the next best thing are meals that require almost no preparation and little clean up.

Limit your errands. Unless it’s for necessities, a trip to Target can wait — or someone else can do it. For groceries, enlist your neighbors to add a few items to their shopping list and give them cash or reimburse them when they drop it off.

Ask for favors. If you have older children, especially those who aren’t in school, ask friends or family if they can watch your other kids for a while — outside of your house. Even if it’s for a couple of hours, it will give you much needed time for yourself. Let your helpers know that you would LOVE to repay the favor — in a few months.

Limit visiting hours. People love to stop by and see the new baby, but moms often feel the need to clean or even entertain for these visits. Don’t get caught in that trap. Let your visitors know in advance that your house will not be clean, that you will not have snacks set out, and that you are very tired and can only spend about 30 minutes before you and the baby will need to rest or nurse — alone.

Stop cleaning. Stop worrying about cleaning. Just stop. Really. Your house will survive — YOU will survive. There’s just no need to mop your floors. If the baby is sleeping and you have the choice between cleaning your bathroom and sleeping or surfing the internet, choose the latter. Your bathroom can wait.

Give yourself a break. You’ll feel normal eventually. You’ll get back into your pre-pregnancy jeans eventually. You’ll stop bleeding eventually. You’ll stop being engorged eventually. You’ll want to have sex eventually. Give yourself time — your body spent 40+ weeks pregnant. You aren’t Cinderella — you won’t change back in an instant. Motherhood — physically, mentally, and emotionally — is a process that requires patience, humility, and acceptance. You’ll get there.


What did you do — or what do you plan to do — to create a more restful postpartum period?


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.



Pregnancy and Postpartum Mental Health: Safety in the Storm

By Wendy Davis, PhD


The proper support of new mothers, babies, and their families requires a whole chain of care that goes from the earliest prenatal care all the way through the first early years of a child’s life. We are all links in that chain — families, providers, and communities:  we work best when we are collaborating, working together, creating nurturing environments for infants and their families.  The most important message about mental health and self-care for new parents is that it is a natural need to receive support during pregnancy and postpartum, and that includes emotional as well as physical and practical support.

How can families help when a mom has postpartum depression or anxiety? How do we learn about signs and symptoms in a way that feels empowering and not shaming? Sometimes it seems that our heaviest burden is our own self-criticism and judgment, our own expectations that a “good mom” would never feel any emotional distress.  Women who are depressed or anxious during or after pregnancy tell us that friends, family, and perfect strangers directly influence how they feel, whether they reach out, and even how they communicate with their partners. How a family responds to a new mother’s emotional and mental health can affect her through pregnancy, pregnancy loss, postpartum, and her developing self-image as a mother.

Here’s a good illustration.

I am standing in line at the grocery store and overhear a conversation between the two women in front of me. One is there with two children – a baby in the cart and an older child who calls her grandma. She is taking care of the little ones and talking to the silver-haired woman behind her, comparing notes about grandchildren. I hear the woman with the children mention that she’s helping because her daughter-in-law has “Postpartum Depression.” They pause and look at the kids. I wait…I wait for the inevitable: the rolling of the eyes, the talk about how women these days just want the easy way out, how everyone and her sister seems to have “Postpartum Depression.”  I ready myself, getting ready to tell them that it is real, it is rough, and that we are lucky to have real resources, volunteers who can help her connect, find resources, not feel alone. I want them to understand, to know that they should not judge. I want to tell them that it actually is almost true that “everyone and her sister” has it, and that we need to listen to them, not judge, and help them. I’m ready. I take a breath.

They surprise me.

The woman in front of me shakes her head. “Oh, I only wish we had help back in my day. I wish… She’s a lucky girl, your daughter-in-law. If I had been able to ask for help and have someone take the kids to the store….You know, she’s lucky to have you.” They smile at each other, and look down at the children. I feel like crying, with relief. If the grandmothers at the store understand, then we might just have a chance.

Times have changed, and they will continue to change. Although another day could have brought an insensitive conversation about depressed new moms, this day in this store reminded me that our families and communities are beginning to understand. New moms do get depressed and they get anxious. Pregnant women have as much chance of becoming depressed or anxious as their postpartum moms, and teenage moms have a greater chance than any. Even adoptive moms and dads can become depressed and anxious after a new baby arrives. We have been ignoring it and as a result families have suffered. Fortunately, communities around the world (and the internet)  are working together to create a safety net that includes raising awareness, connecting families with resources, educating providers, and forging partnerships to help families.

The earliest references to depression, fears, or psychosis around childbearing were recorded in the 4th century BCE!  In modern times, we stopped talking about them. Acknowledgement of despair seems to have been replaced by pretty media pictures of mommies and babies and shallow reassurances by families and doctors who tell mom to get a haircut, buy a new dress, or wean the baby. Traditional rituals to support new mothers and fathers were replaced by baby-shower games, and built-in help for new parents gave way to expectations that one parent will go to work and the other stay home to keep up with housework, her appearance, and the bliss of new motherhood. In this modern world, where is the language to describe mornings filled with anxious fears, dinner that remains uncooked,  and nights disrupted by mommy crying as much as the baby?

Organizations like Postpartum Support International believe that we can prevent a crisis if new parents receive reliable information, resources, and adequate support before the baby arrives. If families learn that symptoms of emotional and mental distress during pregnancy and postpartum are common, treatable, and temporary, then they will not be consumed by fear or shame if it occurs. They might find ways to rest more, reach out sooner, and engage with informed providers and support services to prevent their distress and facilitate their recovery. Most importantly, by finding resources, they can make contact with real mothers, fathers, and grandparents who have gone through their own difficulties around childbearing, and they will learn that they are not alone and not to blame. Women should know that they can contact support organizations like PSI for support around any stress, adjustment, or distress related to childbearing; they don’t need a diagnosis and they won’t be pushed into any particular treatment.

Although we most often hear about “Postpartum Depression” when we talk about mental health around childbearing, there are in fact several ways that emotional distress commonly arises – not only depression, but anxiety, bipolar cycles, grief, trauma, and psychosis. The most recent research shows that more than 1 out of 8 pregnant and postpartum women develop significant depression or anxiety, and up to 1 out of 10 fathers also have depression after a new baby arrives.  Postpartum Psychosis, the most serious postpartum psychological disorder, occurs in 1 to 2 per 1000 births.

This means that one in eight women has enough disruption in her moods, sleep, appetite, confidence, and ability to function that she could be diagnosed with a clinical mood disorder. You can’t tell who it is by looking: moms will smile on the outside while they are feeling lost, scared, and emotionally numb. Our cultural taboo against maternal depression has thwarted us from talking compassionately about our emotional lives as mothers.

There are identifiable risk factors such as a history of PMS, depression, anxiety, or bipolar mood disorders, recent loss, or life stressors. Symptoms might include feeling overwhelmed, inadequate, anxious, or detached, and in some cases the difficult anxiety symptom of repetitive, intrusive thoughts that include unwanted images of harm to their babies. If the family and their caregivers do not have reliable information to help them distinguish between anxieties that are not dangerous and delusional thinking that is, anxious mothers live in fear and their symptoms increase.

If a mom is fortunate, people around her will remind her that she is worthy of care, treatment, and help. If she has emotional difficulties, they will tell her that these are symptoms of distress, not a sign of her inadequacy. Having negative feelings about becoming a mother is a symptom of depression; it is not a cause. We can be open to the truth about the difficult adjustment of becoming a parent. Can we accept that depression, fear, anger, and loss might exist side by side with love and attentive parenting? If we can become a culture of truth-tellers and fair listeners, we will make our families stronger and healthier, and change the environment into which children and their parents emerge.

So, let’s hear it for the grandmothers in line at the store. Thank you for listening, providing safety in the storm, telling the truth.

 Contact Postpartum Support International for support, information, resources, and volunteer opportunities at www.postpartum.net or 1-800-944-4PPD  (1-800-944-4773).


Wendy Davis, PhD, provides counseling, training, and consultation for mental health related to pregnancy, birth, loss, postpartum recovery. She was the founding director of Oregon’s Baby Blues Connection and is the Executive Director of Postpartum Support International.


How to Screen Yourself for Postpartum Depression

May is Mental Health Month. As childbirth education advocates, Lamaze believes that mental health during and after pregnancy is critical to the health and safety of moms and their babies. If you are experiencing depression, anxiety, psychosis, or any other mental health issues, contact your care provider and seek support and resources from Postpartum Progress and Postpartum Support International. You don’t have to suffer alone — and you don’t have to suffer. There is support and treatment available for mental health disorders. Also know that you are not alone — it has been found that 1 in 7 women will experience postpartum depression, though that rate is thought to be higher for all postpartum disorders.

So how do you know if you are experiencing a postpartum disorder? Many moms downplay or dismiss their feelings, chalking them up to “hormones,” but it’s important to take notice and check in with yourself. A postpartum disorder is more than just a “bad day,” and even if you feel as though you are coping, a postpartum disorder ultimately affects your quality of life. If you feel as though something is “off” or if your partner expresses concern about your state of well-being, you can take a free, quick, confidential, online screening quiz to determine whether you may be suffering from postpartum depression.

The Edinburgh Postnatal Depression Scale (EDPS) was developed in 1987 to help doctors determine whether a mother may be suffering from postpartum depression. The scale has since been validated, and evidence from a number of research studies has confirmed the tool to be both reliable and sensitive in detecting depression. The EPDS Score is designed to assist — not replace — clinical judgment. If you feel you may be at risk or suffering from post natal depression, please share the results with your care provider.

Interview with Wendy Isnardi, Author of “Nobody Told Me… My Battle with Postpartum Depression and OCD

If you’re just tuning in piece, be sure to check out the first piece in this two-part post, Kathy’s review of Wendy’s book, “Nobody Told Me… My Battle with Postpartum Depression and Obsessive Compulsive Disorder.”

By Kathy Morelli, LPC

Meet Wendy

Wendy Isnardi lives in Suffolk County, New York, along with her husband and two young daughters. Since the birth of her first daughter, she has been a staunch supporter and volunteer for the Postpartum Resource Center of New York. This is a non-profit agency dedicated to helping women and their families survive their ordeals with depression during pregnancy and depression following the birth of their children. She has dedicated countless time and energy to assure that the center continues to exist and provide the support that women need in order to beat serious mental diseases. She has put fighting women’s depression on the forefront of her life with great personal sacrifice.


Q: First off, I am honored that you agreed to let me interview you! Tell me briefly about your current volunteer work at the Postpartum Resource Center of NY.  

I am currently the resource coordinator and phone support.  In addition, I speak at “Family Night”  for the Circle of Caring Support Groups and I have facilitated support groups as well.


Q:  Tell me what motivated you to write your book?

Being  a volunteer at the Resource Center doing phone support I saw how important it was for me to get my story out.  So many women were afraid and embarrassed to discuss their PPD issue with anyone.  They were so afraid that they would be judged and branded a bad mother.

There is such a stigma with mental health issues that no one wants to talk about it. 

There was nothing wrong with me; I was a great mother that loved my daughter more than anything.  I became extremely ill after her birth and I got the help that I needed and got better.  There is no shame in that so I figured “why not write a story about my situation” and try to normalize it. I also wanted to show moms that you can go on and have other children and not be affected by the disorder again.  If I could help at least one mother then it was all worth it.


Q: Do you find writing to be a healing experience?

Absolutely! I wouldn’t change one thing about my experience because it changed me.

I feel that it made me a better, more understanding person.  As I wrote the book it took my back to that place and helped me come to terms with what happened. I will never forget that dark time, but I will also never forget the rewards that I got from that experience, especially the undying love I have for my daughters and husband. I did it all for them.


Q: I was especially riveted by your descriptions of harm befalling you and your baby.  You were so brave to expose these thoughts.  In fact I used these in a presentation, and it was quite powerful for the audience to hear these thoughts. 

How do you feel about these scenes in your book? (shark feeding scene, escalator scene, gun fears, etc). Why did you include such detail?

The escalator scene for me is what really changed everything.  That’s when I decided I wanted to go back into the hospital.  The thoughts were so graphic that I got physically ill.  I was scared to death.  I thought the safest place for me and everyone else was in the hospital.

The shark incident was probably the first time that I ever seriously contemplated suicide.  Walking into the aquarium I was already extremely anxious and severely depressed.  I hadn’t really been out in public too many times and the aquarium was packed.  Besides the fact that I really wasn’t comprehending the whole OCD concept, so I was really believing in all of the crazy thoughts that were going on in my head.

Once we came upon the huge shark tank I started to panic.  As I looked over into this tremendous tank I saw sharks in all different sizes swimming about, looking for food.  The image of my babies body falling into the tank flooded my head and it was all I could think about.  The more I tried to stop the thoughts the stronger and more graphic they became.

That was where the focus of my thoughts started to surround me and my own mortality.  That’s when I was afraid that I was going to take my own life.  And was when the reality that my husband had loaded guns in a safe right in our bedroom.  I never attempted suicide, nor did I have a plan, but the thoughts were there and they sickened me.


Q: Have you gotten negative feedback on this?

So far, I have only gotten positive feed back, but I know that there will be critics that don’t truly understand the disease that would think of my story negatively and wonder why I wasn’t arrested or committed.


Q: I was interested in your experiences with OCD before your birth.  Do you look back on your behaviors before the pregnancy and wonder why this was not previously addressed ?

All the time.  I worried about everything, all day every day, since I was a little girl.  I remember reacting to certain situations and wondered why other people didn’t feel the same way I did.

Everyone around me knew how much of a worrier I was and always accused me of being a hypochondriac.  I just thought I worried more than most.

Not until after I gave birth to Madison did the worrying take on a life of its own and literally knocked me off my feet.


Q: Does OCD still rear its unwelcome symptoms? 

Yes it does.  I think it’s always there.  Now I know how to handle it.

I’m not nearly as anxious as I was in the past.  The thoughts are about everyday nonsense and pass as soon as they come.  I do find my OCD peaks a bit when I ovulate and right before my period, but it’s no big deal. 


Q: Do you have any particular information you’d like to impart to persons suffering from OCD about their healing work to do before pregnancy and OCD postpartum? 

Most important is not to buy into the crazy thoughts.  A thought is just a thought.  A change in mood and becoming depressed and anxious is temporary and will get better when treated properly. You are not alone and you are a good mother.  Education is key and taking care of yourself is also extremely important.


Q: Do you feel your confusing relationship with your father contributed to your particular mental health difficulties?  Or have you considered it is more genetic? Or a combination?

I guess my relationship with my father made me very insecure and there was a need for me to feel accepted.  There is a tremendous connection genetically; my father and his siblings all suffered from  mental illness (untreated).  I definitely think it is a combination.


Q: What type of self-care do you engage in now to help yourself maintain good mental health?

I eat very healthy and drink lots of water.  I try very hard to keep active and exercise whenever I can, which isn’t often. I try to avoid stressful situations and when I feel anxious I realize it will pass. Stress and aggravation can bring on mood changes. In my opinion a good sense of humor goes a long way too.


Q: How are you continuing your advocacy work?

I am currently the Resource Coordinator for The Postpartum Resource Center of New York. I also provide phone support there as well, talking to moms and families in need.  I speak at seminars regarding PPD and mood disorders, and co-facilitate support groups.  I will do media work for the resource center.  I will basically do whatever it takes to make a difference.


Q: What are some of your future projects?

Being the best advocate for PPD! And  helping the Postpartum Resource Center of New York, Inc.’s VISION for 
a Perinatal Depression Parent Support Network in every New York State community. I have dedicated myself to the cause.  As I said before — whatever it takes.


Q: What do you do to relax on beautiful Long Island?

I spend time with my beautiful family.  We love going to Montauk and especially love The East End in the fall.  We have four dogs and take them for walks.  We just love being together.  I am blessed!!!


Kathy Morelli, LPC, has a professional marriage and family counseling practice with a focus on pregnancy, birth, postpartum and trauma in Wayne, NJ. Kathy also offers phone consultations and web-based courses. She has a long-term interest in mindbody therapies and is trained in shiatsu, acupressure and Reiki. She writes and speaks on birth comfort measures and perinatal mental health and has appeared at various universities and conferences across the country. She writes on perinatal mental health for Lamaze’s Science & Sensibility, is a board member of Prevention and Treatment of Traumatic Childbirth (PATTCh) and is one of Postpartum Support International’s (PSI) Virtual Volunteers. Visit her at birthtouch.com and kathymorelli.com.