Hi Red! As a midwife, you must be accustomed to seeing clients with postpartum depression (PPD). Are you able to recognise that your client is a potential PPD candidate even before giving birth? What are some of the symptoms?

It is possible to spot a woman who could be at higher risk for postnatal depression, yes. I’ll break down some of the risk factors here:

• SOMEONE WHO SEEMS ISOLATED There could be lots of reason for isolation. Here in Singapore a popular one is being a new expat in the city. Maybe not yet having a social network in place or any family able to come to visit after the birth. A healthy postnatal period includes a good support network! In big cities such as Singapore many partners work long hours at the office and on top of that, they don’t get much paternity leave. If the new mum’s sole support is her husband/partner, she will be really lost once the first few days are over and her spouse has to go back to work.

• HISTORY OF DEPRESSION, ANXIETY OR OTHER MOOD DISORDERS For most women, becoming a mum is like stepping onto another planet and there is a great potential for a ton of overwhelming feelings. Hormones, sleeplessness, recovering from birth, learning a new skill like breastfeeding, feeling the weight of the responsibility when caring after a demanding little person who doesn’t speak the same language as you, day-in day-out routines, brain fog… need I go on? The early postnatal period is a challenge for most women and for someone with a history of depression it can easily be triggered at these challenging times.

• AN UNSUPPORTIVE HEALTH CARE SYSTEM Sadly, 1 in 4 women describe their birth as ‘traumatic’. We must admit we are in a moment in time where our world has gotten faster and faster, maternity health systems have gotten fancier than ever, and machines have taken precedence over human touch. Interventions at birth are skyrocketing in Singapore like in most other places with sophisticated health care systems.

As a result, the holistic aspects of care are not attended to. Most primary care providers are not spending time checking in with where a woman is at emotionally, spiritually, or how the whole process is affecting her. It’s not their fault entirely, it is not how they were trained and they probably don’t have time. However, one of the most terrible symptoms of this ‘conveyer belt’ type of care is that women often feel broken after the birth process. Too many mothers today are starting off their parenting journey feeling like they failed or like something was their fault, at the same time recovering from a major surgery that might have caught them by surprise. I would say a risk factor for PPD is a woman who stays with a care provider who doesn’t support her birth philosophy.

And how about women who seem to “have it all” and yet they still end up with PPD?

You are right! It is important to recognize that PPD can come out of nowhere. The most together, most supported, most relaxed and joyful woman can also spiral into PPD just like anyone else. There are no specific ‘types’ for PPD and it is much more common then we think.

Did you know that dads can get postpartum depression too? Also, sometimes PPD does not turn up straight away. If your baby is already 6 months old when you start noticing the signs, it could still be PPD.

Sadly it is a topic that has been so shrouded in shame that we don’t hear about it as much as we need to. So grateful to Chapter Zero for getting the conversation going!

What can we do during pregnancy, and after birth, to prevent getting PPD?

It is pretty simple and usually includes: information, community and networks (start building your team!). Here are a few pointers:

1. PLAN FOR YOUR POSTPARTUM PERIOD EARLY ON

It is so important to start talking about postnatal plans early during pregnancy.

Who is visiting, who is supporting, who will be preparing (or bringing) meals, who will be sitting with the baby while you shower? What holistic practitioners do you know and can call once you are at home? Here are a few names to think about: • A lactation consultant • A doula • A postnatal doula • A massage person • A Mayan wrap woman • A midwife • Maybe someone who does body work (especially Biodynamic Craniosacral Therapy!) • And someone who will be on the other end of the phone anytime of the day or night for you.

GET INTO SIMPLE RELAXATION PRACTICES Yoga, swimming, walking, stopping to breath, singing, chanting, whatever helps you relax. Get really good at it while you are pregnant, it will all be super helpful later!

TAKE BIRTH PREPARATION CLASSES Do your research. In my opinion independent classes are the best. You can be sure there is more chance that hospitals classes will be geared more toward forming you into a good patient while independent classes will support you to know your rights, use your voice and actively participate in your care.

GO TO MUMS SUPPORT GROUPS Get out of the house and meet other mums who will be welcoming a baby around a similar time as you. Make plans for coffee dates after those first initial few weeks together.

EMBRACE THE IMPERFECTIONS Start giving yourself lots of permission to not be ‘perfect’! That doesn’t exist anyways.

TALK ABOUT PPD SIGNS AND SYMPTOMS I always bring this up prenatally if I know I might not see the couple during the postnatal period. One of the greatest things about midwifery care is that we do lots of house visits in the early days/weeks after the baby comes. Do you know in some countries like Germany the government pays for midwives to visit a new mum everyday at home for the first few weeks? How incredible is that! That way we can pick up early signs of PPD and intervene early. Care givers and other educators should give partners signs of normal third day type ‘baby blues’ and teach them how to differentiate that from something more. When we give the information we also give the responsibility to the people at home.

Would hiring a confinement nanny or domestic helper be helpful?

Yes! Helpers and confinement nannies can definitely be helpful! Especially when they are on the same page and understand what the new mum wants and how to best support her.

If there already is a helper in the house, find out what she believes about the postnatal period and about babies care in general (e.g. feeding, bathing). What are the postnatal traditions and customs in her home country?

Please have these conversations BEFORE the baby comes! It will give you an opportunity to discuss what your beliefs are, how they might be similar or different and how she can best support your vision. Getting clear before hand will help avoid a collision from occurring when your more sensitive, more tired and way less patient!

The problems can arise form a strong difference of opinions and I do see nearly as many issues with the helpers and confinement ladies as I see positive experiences.

For example what if:

• She only cooks only food you don’t like?

• Wants to fully care for the baby but you want that role?

• Constantly tells you there is no milk in your breasts when baby cries?

• Is following more traditional confinement practices then what you are looking for?

When you are both on the same page it can make a massive positive impact. Imagine that during your first weeks as a new mum you are eating good nutritious food, you don’t have to worry about the housework or the shopping and you get massaged daily. If you are being nourished yourself, it will give you more capacity to be able to nurture your little one.

Many women do a lot to prepare for the birth of their child, including the preparation of their home. However, they struggle with breastfeeding, the intensity of the new role as a mother and subsequently, parenting in general. How else can women prepare before they give birth?

It is true many couples put a lot of focus on the prenatal and birth periods but forget to plan for the postnatal, but it needs equal time and focus. Taking a breastfeeding class for example can be really helpful as well as putting your support networks in place.

Many people think: what’s the big deal? My parents, grandparents, great grandparents - they all did it. And that is true and valid, we have been blossoming into families for centuries. At the same time our world is different today. We live in more isolation whether we know it or not. Most of us don’t have neighbors dropping in to bring meals or asking how they can help. I’m not sure about you but I don’t even know most of the people that live in my small apartment condo.

We are programed to feel we need to be ‘self sufficient’ more now then back then. We don’t give ourselves permission to rest. We have daily to-do lists longer then our arms. We are excellent multitaskers. The pressure to succeed that we put on ourselves is much greater today. Our need to control everything around us is REAL! This all puts us at higher risk for meltdown when our worlds are suddenly turned inside out with the arrival of that little bundle of noise and demands.

Build your networks now. What is worst-case scenario? You won’t end up needing to use them because you breeze thru new parenthood! Awesome!

My wife / girlfriend / best friend has postpartum depression. How can I help?

Call someone. If you are suspecting that something is not right, don’t wait. The earlier you get her help the better. Silvia Wetherell (of Mindful Mums and More Mindful Me) is a good contact to have. She is a very experienced counselor who works specifically with women prenatally and postnally who are finding it hard to cope.

You are also most welcome to contact me. While I am not specifically trained in this area, I have over ten years of experience in women health. I would be happy to come over and have a conversation and assess if you’d benefit from seeing someone else (there are numerous practitioners in the city). Please don’t suffer in silence.

I also do Biodynamic Craniosacral Therapy and I want to make it available for every mum and baby as soon after birth as possible! It is an incredible relaxing light touch therapy that can be incredibly restoring for both mum and baby on all levels, physical, emotional and spiritual.

For all the exact reasons we’ve just been talking about I am running a couples retreat in Bali this February. Please consider joining me! We will be covering many of the areas we discussed here as I help you prepare for the gentle birth of your baby. The retreat is an intensive over a long weekend so even the busiest couples can attend. You will learn hypnobirthing preparation for birth, luxuriate in couples massages and really get the chance to land on the same page as each other in a beautiful, luxurious setting. Take time to nurture your mind and body! For more information, check out Pregnancy Moon.

Wishing you all a gentle entrance into parenthood!

Thanks for speaking to us, Red!

Thanks Shumei! My pleasure to support you and your new project, Chapter Zero!

ABOUT THE INTERVIEWEE

Red is a midwife, registered Biodynamic Craniosacral Therapist and hypnobirthing practitioner. She brings 10 years of experience working with families all over the globe, the last 8 years spent in Asia. She co-founded a water birth center in Kerala, India in 2010. Birthvillage Natural Birthing Center is run by midwives and Red serves as a Director and Consultant to the center.

Her passion is easy to feel and she loves to focus on strengthening parents understanding of family centered care and how to become advocates for themselves. She teaches group, private and refresher hypnobirthing classes in Singapore.

For more information about Red, check out Orange Blossoms (also on Facebook) and Pregnancy Moon (Red’s new project – a hypnobirthing retreat in Bali). You can also contact Red at red@obbirths.com.