On Becoming What I Needed: How my experience with a perinatal mood and anxiety diagnosis helped me to be a better doula.
In 2011, my son was born at a birth center in NYC. I labored for five hours in a bath, catching sleep between contractions, with my husband and my doula by my side. Midwives and nurses looked on and offered encouraging words. After 20 minutes of pushing I held my newborn son in my arms. I was comfortable with the surrender of birth and trusted my body: it was the picture of an ideal and safe birth.
In 2014, my daughter was born in under three hours. I was eight cm when we arrived at the hospital. My doula, midwife and husband gently encouraged me through my fast labor. When she was born, my attending supporters looked on in awe, seeing what was to many of them their first en caul birth. She had a full head of black hair and the most beautiful hands I’d ever seen.
I’ve had guilt around the ease of my first two births. During each postpartum period, nursing was natural and parenting felt intuitive. I know many women who suffered endlessly in their birth experience and so I never felt it was appropriate to speak about how much I enjoyed giving birth.
Then, my third child was born: in my apartment bathtub, in less than an hour, medically unassisted by my husband. I had three minor contractions and a sudden strong desire to be in cold water. My husband entered our bathroom and saw me bracing the towel rack in our shower while I was bearing down. My waters gushed and it was tainted with meconium. Moments later, a second push brought my son earthside. My husband pinched his nose and used his fingers to clear his airways – and then he started breathing. My husband also managed to text our doula, call the midwife and 9-1-1. (Hey Seth Meyers and Alexi Ashe…I see you. We could start a club!)
Eight firemen from Engine 240 in Brooklyn burst through our apartment door. I know these men well because the station is next door to my home. Now I am standing in front of them wet, shivering, and bleeding while cradling my newborn son. They cut our umbilical cord and I lost sight of my husband and baby. I remember feeling cold and paralyzed. Instead of reveling in the beautiful new human I’d just birthed, all I could think about was how humiliated I was, how I’d robbed my baby of a decent birth, and how my body didn’t wait to deliver him in a sanitary, supervised place. There was no skin-to-skin, no delayed cord clamping, no magic hour. I fixated on how I could have lost him.
As if by divine providence, my doula arrived along with the EMTs. She dried me off with a towel and covered me with my robe. She made sure I was given back my baby, insisted we sit in my bedroom together as a new family and nurse before being transferred to the hospital. She took photographs, she said my son was beautiful and, most importantly, she normalized and reclaimed the moment for us.
But later, when my older two children came to meet their new brother, I felt no tenderness— only absolute fear and panic as they held him and cooed at his tiny hands and feet. I have little memory after week four other than the problematic, disruptive, and intrusive thoughts that I couldn’t curb; I was unable to focus and felt disconnected from life. I was hypervigilant, I wouldn’t let my new baby out of my sight but was afraid to be alone with all three of my children. What if I couldn’t protect us? The ceiling could collapse we could be swarmed by mosquitoes, a meteor could hit. I was restless, pacing, not sleeping and terrified of everything. I wept, and raged; I was paranoid and fixated, I cried endlessly. Then one day my 5-year-old son wrote me a letter. It read, “Mommy, I’m so sorry you are so sad these days,” alongside a note that read, “Daddy, I know you have a lot of work to do, I want you to know I’m here to help.” I was fortunate to understand that it was time to seek help.
My midwives introduced me to The Motherhood Center of New York. During that first phone call, I was met with compassion, insight, and wisdom. I was told something I will never forget – “You will get better with help because I’ve seen other mothers get better.” When I arrived at the center I scored very high on the Edinburgh Postnatal Depression Scale — a scale determined to screen for perinatal mood and anxiety disorders (PMADs) and was admitted to their day program. I began an intensive daily routine designed to help reframe my experience. I met thoughtful, strong, smart women who were having similar experiences as me and we shared our stories, shared meals together, held each other’s babies, and had the space to be truthful and authentic about motherhood. I experienced the village, which is missing in modern parenting, and was given the space to be “mothered”.
Here, I realized I perceived the trauma of my son’s birth in ways most didn’t because, to others, my son was fine and healthy. I’d heard “Jess, you have the best births!” or “He’s going to love telling that story someday!” But precipitous labor is not “lucky”. There is no time to prepare, no time to resolve yourself and no time to transition—it happens to you and your body is entirely out of control. I engaged an animal reflex not many people confront and this birth was painful, fearful and traumatic.
Rapid birth leaves room for lots of wounds – literal and figurative and birth PTSD is a risk factor for PMADs. However, many symptoms showed up while I was pregnant. I had jumped head first into managing a stressful large-scale project at work (which sent me to the hospital twice). I was not taking the proper care of myself, or preparing for the baby to arrive, or even paying much attention to my family. I kept insisting that I had to complete the project before I could go back to thinking about the baby, my family or myself and the anxiety was mounting. Shifts in priorities and distraction tactics: these are signs I can now recognize as red flags in others.
I felt a calling to train as a doula about a week into my experience at The Motherhood Center. I recognize very few people have access to this kind of specific treatment and care and saw the gaps in care needed for new families. When I found DTI, I felt aligned to its mission – the social justice component is essential, if part of your work is meant to amplify your mission. I’ve since co-founded MomTown, a preconception to postpartum support project focused on maternal mental wellbeing. I volunteer as a helpline operator for the Postpartum Support International where, during my shifts, I speak with people who are seeking help for PMADs and direct them to the trusted providers in their area through PSI’s vast care database. I know what that call feels like and I know what I needed to hear. I thought about my own doula and how instrumental she was in stewarding my traumatic experience. To me, maternal mental health is a public health crisis. If doula work is about empowering families to use evidence based information when decision-making, my PMAD experience is anecdotal evidence to assist families who are struggling to make choices for their physical and mental wellbeing.
Continuous support during labor can help mitigate risk factors for PMADs in the postpartum period – the most common complication of childbirth. Many birthing people believe the extreme feelings they are experiencing are normal and don’t seek treatment. Being a doula means supporting those who take the next steps for self-care, which is not a luxury – it is essential. Doulas can change the narrative for new parents struggling with identity shifts and help them navigate through the politics of self-care. This work puts me in front of families, supporting them as they make decisions about their health, pregnancy, birth and beyond.
I’d say that I not only survived a PMAD but I thrived because of one. I feel obligated to disclose my story – because while not normal, this is a very common biological shift which happens to many people (15 -20% of new mothers according to PSI). Additionally, 10% of people with partners who experience a PMAD will themselves suffer from the same diagnosis. I want to speak this out loud so others don’t feel so ashamed or alone. I want to have a real conversation about the trickle down effect of poor maternal mental health and why new parents need care as much as new babies. For me, treatment, community and self-care/loving kindness were instrumental when facing my PMAD. While I was treated by incredible clinicians who helped me through a genuinely tender time, it was authentically connecting with other people which was equally healing – and I find this is work that lives within the doula scope.
New parents shouldn’t require critical care to be well cared for. Parenthood is a great equalizer and ALL parents deserve permission to take care of themselves during the transition to parenthood. As a doula, one of my professional goals is to help parents understand their experiences are common and unique all at once. My doula reclaimed my experiences, held the feelings I couldn’t yet process myself and brought me back to the present. It felt like a magic trick. Being a doula means showing parents they are seen, they are known, and they are not alone.
Some support for doulas in regards to PMADs:
- Take note of your clients behavior during prenatals. Look for red flags and risk factors. Learn the symptoms and integrate tools into your postpartum practice to help your clients find help, if needed.
- If you can schedule one postpartum visit a few weeks after the baby is born, try to. Checking in after some routines have been established can be helpful if you suspect your client might have had a few risk factors for a PMAD. Be prepared with resources in your area.
- Enroll in a training (some are free and online) for birthworkers and providers to help you understand the many complexities of maternal mental health.
- Help your client establish a community through new parenting groups or breastfeeding support groups (This is nice to establish before their birth so they have something to look forward to). Community building helps because it reminds new families they are not alone, and if they are struggling, with help, they can get better.
- Take your cues from your client but be mindful – new parents often appear “fine”. In your prenatals and postnatals, don’t be afraid to ask the deep questions. Read about ways we can assist families within the doula scope. Early detection can help ward off longer periods of struggle.
Jessica Vanderberg is a birth and postpartum doula based in New York City. Jessica has a special interest in supporting people who have experienced past trauma or loss and people who have a history of mental illness, anxiety or depression. She is a perinatal mood disorder (PMAD) early screening advocate. Early intervention promotes stronger connections for new families.
Jessica lives in Brooklyn with her husband and three children. She will be attending graduate school in the fall of 2018 to pursue a Masters in Social Work with a focus on both maternal mental health and family leave policy development. She volunteers for Postpartum Support International as a warmline operator. She is the co-founder a MomTown: a preconception to postpartum care project with a focus on maternal mental health through movement, community building, education and support.
In her spare time, she enjoys singing with The Jalopy Chorus, which performs an eclectic mix of music from American heritage to Balkan folk in Red Hook, Brooklyn (and loves incorporating music into her postpartum visits…lullabies are a specialty!). Email her at jessica at momtownnyc.com.