Vol. 15, No. 2

Because it’s ancient

Postpartum Depression

CONTENTSLetter from the President ..........................................................................................................................1Notable Quotes ........................................................................................................................................2 Poetry ..................................................................................................................................................5, 11

Feature ArticleMy Birth Stories ........................................................................................................................................3

Updates and ReviewsResearch Update: Postpartum Depression ...............................................................................................6 Healthwise: Supplements............................................................................................................................9

Recipe Green Pasta Primavera ...........................................................................................................................10

Notes from the Field

Training and CertificationBirthWorks Childbirth Educator & Doula Training & Certification Classes. ............................................12 New Childbirth Educator and Doula Students ....................................................................................... 12 Newly Certified Birthworks Childbirth Educators ....................................................................................12

On the Business SideNotes from the BirthWorks Office .......................................................................................................... 13BirthWorks Advisory Board ....................................................................................................................14Office/Newsletter Staff ...........................................................................................................................14 Regional and International Ambassadors ..............................................................................................14 Membership ...........................................................................................................................................15 Ad Marketplace ......................................................................................................................................15

Information contained in the BirthWorks International newsletter is intended for general consumer understanding and education only and is not necessarily the view of BirthWorks International.

BirthWorks International does not officially sanction, monitor or endorse chat groups online, other than the BirthWorks CD or CCE Yahoo group. Members who participate in the discussion chat groups do so of their own accord.

BirthWorks International members who have questions about philosophies or policy are encouraged to contact the BirthWorks International office or their Regional Ambassadors.

Musings from a Doula Workshop .......................................................................................................... 11

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gradually decrease over the first few weeks after birth, and “coming down” can feel depressing to a woman. Pregnant women need to know this is normal.

Symptoms of postpartum depression and postpartum anxiety vary from woman to woman and may include: • dismay that they aren’t bonding with

their babies and worrying that their babies may be sensing this • wanting to say, “I can’t do this, and why

did I ever decide to get pregnant in the first place?” • a sense of guilt about not handling

motherhood as well as they think they should

• feeling overwhelmed, tired (from waking with their baby through the night), hopeless, and anxious about whether to go back to work• feeling confused, scared, hopeless, out-of-

control, enraged, and having difficulty concentrating and focusing. This can lead to numbness and the disconnection of just going through the motions and not feeling love for their babies.• crying from the depths of their souls and difficulty

being consoled. They may not realize they are crying.• eating and sleeping too much or too little• fearful of having an anxiety disorder and of never

being their “old self” again• or contemplating suicide.

In modern times, often there is not enough support for new mothers; they are expected to work until the last minute of their pregnancy and then go back to work a week or two after the birth. Many women are single mothers; others live apart from their family and relatives. Several communities around the world have more intact family units than the average family in the U.S. today, and provide support for new mothers.

After a previous co-worker of mine gave birth to her baby at 28 weeks gestation, the baby needed to be in the neonatal intensive-care unit (NICU) at the hospital. She wanted to be with her baby, but if she didn’t go back to work two weeks after the birth, she would lose her insurance which covered the $10,000 a day NICU fee. She didn’t have a choice and found herself, a teacher, taking care of other children when she desperately needed to be with her own baby.

Letter From The President

It is not easy for me to write about postpartum depression because I have never experienced it, but I have known numerous women that have suffered from it. In each case, there were a series of traumatic circumstances surrounding their pregnancies, labors, and births, as well as the postpartum period, that made it difficult for them to cope, and they began to feel themselves “losing it.”

Pregnancy is a time of great change in a woman’s life and in her hormones. Labor is hard work and is accompanied by fear for most women. This can be compounded by various traumas including both physical and/or emotional abuse, lack of respect, and a birth experience that wasn’t what was expected. After the birth, women are trying to adapt to these changes while taking care of their babies. Making these adjustments without support during labor and/or the postpartum period and sufficient sleep is a recipe for varying degrees of postpartum anxiety that can lead to postpartum depression.

How does the body handle this anxiety/depression? It secretes stress hormones. The body can tolerate short-term stress, but long-term stress is not healthy. The postpartum period is a time when a new mother needs to be secreting hormones of love which are needed for breastfeeding, but stress hormones can interfere with this process.

In a state of stress and anxiety, the body is no longer in balance, and a woman with postpartum anxiety can tip over into postpartum depression and may be unable to function well in daily life. A new mother who is suffering from postpartum depression is striving to take care of her baby but can hardly care for herself. Sometimes she may not even recognize the symptoms of postpartum depression; this is where a postpartum doula can be valuable by providing the new mother with references to seek professional help.

The role of hormones in pregnancy, labor, and birth is important to address in childbirth classes. For example, the beta endorphins secreted in labor help a woman cope with contractions, and create a state of euphoria that can be seen on the face of a woman who has just given birth naturally without obstetrical drugs or interventions. She is glowing. These endorphins

Cathy DaubPT, CCE (BWI)

CD (BWI)

LETTEr FrOm ThE PrESIDENTPostpartum Depression

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“This is a serious, serious condition that is also called postpartum psychosis. And that's where, literally, you get so bad that you end up either hurting the baby or killing yourself.”—Marie Osmond, entertainer

“When you study postpartum depression, there is a very clear understanding that in communities where you see more support, there is less depression.” —Ariel Gore

“It was really hard in the beginning; when I first became pregnant it was just such a shocker. I was depressed for about five years, and I don't know if I really had postpartum depression because back then no one would talk about it. I went to therapists that tried to prescribe me medication, but it didn't work.” —Leslie Mann, actress

"Just as despair can come to one only from other human beings, hope, too, can be given to one only by other human beings.” —Elie Weisel, author, Holocaust survivor

"I have been astonished to discover just how prevalent—and "closeted"—postpartum depression is. I make a point of "coming out" about it immediately to other moms and non-parents that I meet, and I inevitably hear a response like ‘I thought I was the only one.’ The wimpy paragraph in most standard parenting/babycare books doesn't begin to cover this. I would be delighted to share my experience." —Unknown

A postpartum doula can be of immense support helping to care for the baby, and perhaps siblings, while the new mother sleeps. A good rest can help milder symptoms of postpartum anxiety/depression melt away.

The way in which women react to traumas in their lives varies from person-to-person: what tips one person over the edge may not do so with another. When I had an unexpected cesarean with my daughter, I didn’t feel it was traumatic because I was respected and it was my choice. She was a single-footling breech. I labored as long as I could, and when the urge to push came

and I was six centimeters dilated, I decided to have the cesarean. Had I not been respected and if things had been done against my will, I would most likely have felt very differently. Unfortunately, that often is the case with many women.

Our true nature is to be happy and birth is a gift to all women, regardless of the outcome of the experience. Birth has the potential to increase our personal self-growth, and to help us feel strong and empowered. With help and support, a woman experiencing postpartum anxiety/depression can begin smiling again.

NOTaBLE quOTES“Postpartum depression is a very real and very serious problem for many mothers. It can happen to a first-time mom or a veteran mother. It can occur a few days... or a few months after childbirth.” —Richard James "Dick" Codey, Democratic politician

“The very damaging, frightening part of postpartum is the lack of perspective and the lack of priority and understanding what is really important.” —Brooke Shields, actress

“One of the problems with postpartum depression is that women usually aren't diagnosed until the disease is already established. If a woman's health care provider knew early on that a patient was slipping down this slope, he or she could intervene. It may not take much to screen for it, either—the questions in the fatigue test that we used took about two to three minutes to answer.” —Elizabeth Corwin, associate professor at the College of Nursing, Ohio State University

“Parenthood always comes as a shock. Postpartum blues? Postpartum panic is more like it. We set out to have a baby; what we get is a total take-over of our lives.”—Polly Berrien Berends

“I suffered from a mild case of postpartum depression after my second child and the physical challenge of maintaining an overnight shift at CBS, a marriage, and two in diapers made the symptoms worse and everyone in the house paid the price.“ —Mika Brzezinski

Letter From The President/Notable Quotes

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When I think back on my two births, I am amazed at how the universe was educating me for my future. This was all the evidence that I needed to know that birth really does work!

My first child was born in 1986. I became pregnant out of wedlock, while I was away from home in my second year at college. I left college, got married, and moved far away from all of my friends and family, thus severing my entire support system. It was an extremely difficult pregnancy for me both physically and emotionally.

When I was 8 weeks along, I began to bleed profusely, and was told that I was pregnant with fraternal twins and was miscarrying one of them. Throughout the pregnancy I don’t think my body ever realized that I wasn’t carrying twins anymore. I was extremely ill with morning sickness the first 4 months. I suffered blinding migraines and had too much amniotic fluid throughout the pregnancy, so I was huge. I started the pregnancy at 5’11”, weighing just 120 pounds, and ended the pregnancy at over 200 pounds.

I remember one prenatal visit where my doctor expressed concern about my weight gain. In one month I had gained 12 pounds and I was spilling protein in my urine. Along with the headaches, I was also experiencing extreme swelling and the doctor was becoming increasingly worried about pre-eclampsia. At 20 years old I had no clue what he was talking about, and my Lamaze class hadn’t started yet. Even after the class, I still didn’t have the slightest idea what was going on with my pregnancy.

My doctor didn’t take me aside and express how deep his concerns really were. I truly thought that this was the way it was supposed to be! Thankfully, I went into labor on my due date. My labor was 32 hours long from start to finish. I couldn’t understand why it was so horrifyingly painful. It was more than I expected and more than what I was led to believe that it would be like in my classes.

Throughout the entire labor I felt that something was wrong. I could not get a grip on the pain. I asked for drugs and was given a shot of Stadol when I was about 4cm dilated because I couldn’t imagine the pain getting any worse than it already was! Once the shot took effect, I felt as though I was trapped inside a body that was racked

with pain that I couldn’t bear, and I couldn’t escape or get any relief. I lay on the table on my side, drooling and moaning, completely out of control. I couldn’t have asked for help if I needed it. The only thing that the Stadol accomplished was that it allowed me to relax enough to let my body dilate to 7cm. Mind you, this was all after I had been in the hospital for 12 hours and had already labored at home for a good part of the prior day.

The doctor came in and broke my water as the Stadol was wearing off. I screamed at the nurse to get the anesthesiologist back and demanded an epidural, which they completely botched, because they told me they couldn’t get the needle between my vertebrae. It ended up only taking on one side of my body. The pain went through the roof and as they did another vaginal exam they suddenly realized that my son’s head was not the presenting part.

Several weeks earlier I had gone in for a prenatal visit and told my doctor that I was certain that my son was not head down. He did his usual flippant exam, barely touching me, and told me I was wrong! Well guess what—31 hours into labor, with a broken bag of water, he realized HE was wrong. My son was in a transverse lie with a shoulder presenting. Since I was now at 10cm and my son’s heartbeat was still OK, and with me screaming that I did not want a C-section at only 20 years old, they decided to do an internal version. They brought in a tiny little nurse who had the smallest hands I have ever seen. They had to go in twice to get him completely turned. I remember seeing the nurses’ arm covered with blood all the way up to her armpit. The pain was indescribable! I lost consciousness twice during the procedure to turn my son. I have since had 5 surgeries: one for a ruptured ovarian cyst that nearly took my life, and the most recent was a hysterectomy. There is no pain that I have experienced that can remotely compare to that experience.

After my son was turned, they told me I should push quickly because his heart rate was starting to dip. At that point I was terrified, exhausted, demoralized, and frightened for my son’s life. Not having a clue what I was doing, I pushed as hard as I could. I pushed twice in the labor room. Thankfully, he descended quickly and they moved me to the sterile delivery room! They gave me a small episiotomy as he was crowning, which extended to a second-degree tear as I blasted my son out after four more good pushes. Immediately, he cried a good, strong, healthy cry, and they whisked his purple, blood-stained body away to the nursery.

I didn’t see him again until I was in the recovery room over an hour later. I didn’t even recognize him. I sincerely thought they had given me back the wrong child. I could have sworn that I had given

mY BIrTh STOrIES

Janine Mayo

My Birth Stories

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birth to a dark-haired child, so who was this blonde-headed kid that they brought me? The truth is, I didn’t really even get a good look at him or get to hold him at that time, so how would I have known?

I was in the hospital for nearly four miserable days. My diaphragm was horribly bruised, my lung nearly collapsed, I had hemorrhaged profusely, and my son was in the nursery the entire time. I saw him only briefly and I was too ill to care. All the while, I was still under the impression that this is the way it was supposed to be. On the morning of day four they released us to go home. I had no clue what I was doing and had only minimal breastfeeding instruction in my Lamaze class and at the hospital. Thank god that my son was a vigorous nurser. He took to it like a champion! I, on the other hand, was miserable and developed two breast infections in the first 8 weeks postpartum and had cracked nipples, but I kept on.

By the time my son was 4 weeks old I had developed a severe case of postpartum depression, bordering on a psychosis that I kept to myself. I was all alone with my son. I was back on my feet and doing all of the housework, making the meals, etc., the week after my son was born because I thought that was what I was supposed to do. Still I was clueless and couldn’t understand what was wrong with me. My son is lucky to have survived the awful thoughts that ran through my head. Through this experience, I gained a tremendous compassion for moms who are like I was: all alone without other women to support them in their time of greatest need.

I went away from that pregnancy and birth with great fear and confusion as to what had happened to me. I felt betrayed by the doctor and the staff at the hospital. I felt that they had purposefully kept me in the dark throughout my pregnancy because the more ignorant they kept me, the easier I was to control. I felt they placed me and my son in danger by not being more proactive about the situation, and that my prenatal care was less than satisfactory. I loved my son dearly, but had such a bad taste in my mouth about the whole experience that I refused to even think about trying for a second child for four-and-a-half years!

My second child, a daughter, was born almost

six years later. Mentally, emotionally, and spiritually I had a wonderful pregnancy. This time it was a planned pregnancy. I was ready to have another child. Physically though, I suffered from hyperemesis gravidarum, severe pubic symphysis dysfunction, pregnancy-induced asthma and 103º fevers that required several trips to the emergency room for breathing treatments. All the while in my mind’s eye, I imagined two hands holding my daughter in the womb, cradling her and keeping her safe. We took Bradley classes with this birth, and I felt I was well-prepared for labor and determined to make this labor a better experience for me and for my daughter. I had a wonderful teacher who was my lifeline and a great friend. I credit her with giving me the tools that made this pregnancy a life-changing experience for me and inspiring me to follow my life path.

I started having false labor five weeks before my due date. In this birth, I focused myself inward and found my power. I relaxed into my contractions and allowed my body to do the work that I knew that it was capable of doing. I visualized each step of my daughter’s journey into my arms. It was amazing! I gave birth naturally, 26 hours after labor had begun, and was able to walk to my postpartum recovery room an hour later.

With the birth of my daughter, not only had I become a mother for a second time, I had claimed my power as a woman. Over the next couple of years that power grew into a search for the fire that was consuming me—a love for the birthing process and a compassion for women and their babies. I don’t want anyone to have to go through the fear, humiliation, ignorance, and loneliness that I went through in my first pregnancy. I realized when my newborn daughter looked up into my eyes and connected with me in a way that my son (who was taken away at the moment of birth) did not, that every child deserves to be born clear of mind, into a peaceful, supportive environment where the mother feels completely safe and empowered.

Janine is studying counseling psychology in California. Her heart’s deepest passion is with birth and she totally believes in BirthWorks.

BirthWorks believes...Birth is instinctive...

We believe that the knowledge about how to give birth is born within every woman. We help women to have more trust and faith in their own body knowledge

that already knows how to give birth.

My Birth Stories

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Six months have come and gone since my sweet baby came to beTime enough, you'd think, for me to move on and be free.

But the pain of all I went through sits within me like a weightAnd I cry, and I am angry, and sometimes I even hate.

I cannot stop reliving it, the fear and all the painWhen I try to talk about it, I get looks like I'm insane.

But the books teach natural birthing, to let nature take its courseTo just let the mother birth her child...there is no need to force.

Books written twenty years ago with proof that less is moreAnd still, we give birth blindly, never knowing what's in store.

I checked in so excited, the picture of good healthAnd I walked out cut and broke, a shadow of my former self.

They put an IV in my arm, they said it was the rulesAnd though it hurt, I let them...just like a passive fool.

Next they stuck their fingers in me "to see just where you are"Then they pumped me full of drugs because "you're really not that far."

They dressed me in uncomfortable clothes, they said I couldn't leaveThen they ripped apart my birth plan, and all that I believed.

When the drug-induced contractions came, the pain was just too muchNext came the epidural, then I was numb to any touch.

Each time they touched my body, they took part of my dreamAnd they never even blinked...as cruel as that may seem.

They made me push for hours, but didn't feed me for two daysAnd when she didn't come, they tried to pull her out their way.

But I was so exhausted that I could lift my headI no longer cared who saw me lying there, with my legs spread.

Before I could say "yes" or "no" they said that it was timeAnd I knew that this experience was never really mine.

I couldn't keep from shaking as they wheeled me in the roomAnd they talked of their vacations as they pulled her from my womb.

This poem was written six months after I gave birth to my first child, my daughter Cameron. I was extremely depressed for a long time after I had her, and looking back, I can see that I had post-traumatic stress from a c-section that I neither expected or truly needed. Becoming a BirthWorks instructor helped me to deal with

my experience, as did things like writing this poem.Still, seven years later, I can feel my own pain as I read this, and I still mourn for the birth that could have been.

I only got a glance before they took my child awayAnd I won't forget that emptiness until my dying day.

It was many hours later when they wheeled her to my bedBut where had they been keeping her? What had she been fed?

After days of being jabbed at, bullied, and kept up all nightAfter weeks of sadness and regret and pain I couldn't face

I realized that I should have stayed at home, where I was safe.

My daughter was a victim, and I was a victim, tooIf only I had stood up strong for all I'd read and knew.

But there is no going back now...it's over and it's doneAnd they'll never know what they did wrong...

so in a way, they've won.

I wanted an experience to sustain me through the yearsInstead I got a nightmare that has only brought me tears.

And yes, I have my daughter and she's healthy and she's wholeBut they took the joy that was my right

and robbed me, heart and soul.

So now each time I shower and I look down at my scarI think of how our doctors haven't really come that far.

The power and control that they have taken from us allWill someday turn around and it will lead to their downfall.

They have no right to handle us or take our dreams awayNo right to touch our babies or to rob us of our say.

They only have the right to do what we allow them toSo we must stand up ourselves and all that we believe is true.

We have every right to look at them and say a loud, strong "no"We have a right to be informed, we have the right to go.

Let's demand that we be treated kindly and humaneLet's be smart when they insist that we should numb the pain.

For one thing leads to another...they must think that we are dumbThey blame us, but it's their fault, and now our time has come.

We are built to birth our babies, we were meant to do the danceJust follow what your body says and give yourself a chance.

Let's all take back what used to be our own, God-given rightTo have our babies naturally, by the will of our own might.

Birth DayTrisha Lawrie

Poem: Birth Day

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Research Update

Pregnancy, the postpartum period, and parenting present both joys and challenges for the new mother, her partner, and the family. In fact, in their article entitled “Hormones and Depression in Women,” Studd & Panay claim that, “Pregnancy, labor, and birth are perhaps the most significant life experiences that a woman and her partner will encounter. It is a time of extreme physical and emotional transition with intense hormonal, psychological, and biological changes, all of which can have an effect on the central nervous system” (Climateric, 2004, Vol. 7, No. 4: 338-346). Yet many women are reluctant to admit to anyone, including their partners, that they are unhappy after the birth of their baby. Many women either delay reaching out for help, or never do. This is hugely problematic when it comes to women who experience postpartum depression, since research and experience clearly show that early detection and treatment are key to a full recovery. Additionally, the Listening to Mothers II survey found that “improving the knowledge and skills of childbearing women” must be a priority, in addition to providing reliable and trustworthy maternity care (http://www.childbirthconnection.org/pdfs/LTMII_report.pdf). As childbirth educators and doulas, we have a unique opportunity to help women and their families.

The other day when I was talking about pregnancy and birth in my Sociology of Family class, one of my students asked if the rates of postpartum depression (PPD) were less for women who gave birth at home. Given today’s birthing climate, this is a reasonable question to ask. However, before I address that question more fully, let’s look at what we know about PPD.

What is PPD, What Are the Symptoms, and Who is Most Likely to Experience It?

Postpartum depression, which is not the same as the “baby blues”, refers to a group of poorly-defined, severe, depressive-type symptoms which begin at four to eight weeks postpartum. These symptoms can also occur later in the first year and can sometimes persist for more than a year. The American Psychological Association (APA) defines Postpartum Depression as a “serious mental health problem characterized by a prolonged period of emotional disturbance, occurring at a time of major life change and increased

responsibilities in the care of a newborn infant” (http://www.apa.org/pi/women/resources/reports/postpartum-dep.aspx).

For mothers, PPD can:• affect the ability to function in everyday life and increase risk for anxiety, cognitive impairment, guilt, self-blame, and fear• lead to difficulty in providing developmentally appropriate care to infants• lead to a loss of pleasure or interest in life, sleep disturbance, feelings of irritability or anxiety, withdrawal from family and friends, crying, and thoughts of hurting oneself or one’s child• and be particularly problematic because of the social role adjustments expected of new mothers, which include immediate and constant infant care, redefining spousal and familial relationships, and work role.

In addition, according to the APA, children of mothers with PPD can:• become withdrawn, irritable, or inconsolable• display insecure attachment and behavioral problems• experience problems in cognitive, social, and emotional development• have a higher risk of anxiety disorders and major depression in childhood and adolescence

Klaus, M., Kennell, J., & Klaus, P., in their book Mothering the Mother; How a Doula Can Help you Have a Shorter, Easier, and Healthier Birth, (De Capo Press, 1993), provide a more detailed list of the symptoms of PPD, many of which could be “explained away” as a “normal” postpartum response to birth:• exhaustion• irritability• frequent crying• feelings of helplessness and hopelessness• lack of energy and motivation• lack of interest in sex• disturbances of appetite and sleep• feelings of being unable to cope with the new demands placed on her• anxiety about the infant’s welfare• lack of affection for the baby resulting in self-blame and guilt• and psychosomatic symptoms such as headache, backache, vaginal discharge, and abdominal pain for which no organic cause can be found.

Unfortunately, as the APA openly admits, many of these symptoms are indicative of PPD, which can have significant consequences for both the new mother and her family. An estimated 9-16 percent of postpartum women will experience PPD. PPD also tends to recur, with a 41 percent prevalence estimate among those women who have already experienced PPD. While it is not often talked about, fathers can also be

rESEarCh uPDaTEPostpartum Depression

Sally Dear-Healey, Ph.D., CCE BWI

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Research Update

depressed in the postpartum period, especially if the mother is depressed, or if the father is not satisfied with the marital relationship or with life after the birth of the child (http://www.apa.org/pi/women/resources/reports/postpartum-dep.aspx).

It has also been suggested that women who experience depressive symptoms during their pregnancy will be more susceptible to PPD, constituting a recurrence or exacerbation of an existing illness rather than the onset of a new condition. About half of the cases of diagnosable PPD may actually start during pregnancy (http://www.apa.org/pi/women/programs/depression/postpartum.aspx).

A study of 10,000 women by Northwestern Medicine® researcher Katherine L. Wisner, M.D., funded by the NIH/NIMH, was—to date—the largest scale depression screening of postpartum women and the first time a full psychiatric assessment was done in a study of postpartum women who screened positive for depressions. The study found that “in the U.S., the vast majority of postpartum women with depression are not identified or treated even though they are at higher risk for psychiatric disorders.” In this study, fourteen percent of the women screened positive for depression and 826 received full psychiatric assessments. Some of the key findings of those assessments include:

• In women who screened positive for depression, 19.3 percent thought of harming themselves. Suicide accounts for about 20 percent of postpartum deaths and is the second most common cause of mortality in postpartum women.

• 30 percent women had depression onset prior to pregnancy, 40 percent postpartum, and 30 percent during pregnancy. More than two-thirds also had an anxiety disorder.

• Many women who screened positive for major depression, 22 percent had bipolar disorder, the majority of whom had not been diagnosed by their physicians. “This is significant because antidepressant drug treatment alone can worsen the course of bipolar disorder.”

• Depression affects a woman’s appetite, nutrition, and prenatal care and is associated with increased alcohol and drug use. In addition, women with untreated depression have a higher body mass index preconception, which carries additional risks.

• Maternal prenatal stress and depression is linked to preterm birth and low infant birth weight.

• When a new mother is depressed, her emotional state can interfere with child development and increases the rate of insecure attachment and poor cognitive performance of her child (“Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings,” May 2013, Vol. 70, No. 5: http://archpsyc.jamanetwork.

com/article.aspx?articleid=1666651).A Deeper Look Into the Psychosocial

Contributions to PPDJudy Edmunds, in “The Grand Finale to Birth”

(Midwifery Today, Issue No. 34), argues that “few families readily perceive the full extent of the woman’s vulnerability once labor has ceased. Many times, the intense focus and concentration that friends and family members direct toward the mother are abruptly withdrawn and transferred to the infant or elsewhere. Some women who are strongly dependent on this psychological/emotional support sense the loss acutely. This may contribute to postpartum depression.”

This premise is supported by Kate Kripke, LCSW, who writes that “what truly matters most in the connection between birth experience and whether or not a mom develops postpartum depression, postpartum PTSD, or any other mood disorder is whether or not she felt heard, seen, and supported, and whether or not that mom had the chance to process her experience and talk about what it means to her, both empowering and difficult” (http://www.postpartumprogress.com/childbirth-outcomes-and-postpartum-depression-are-they-linked).

A study by Marshall Klaus, published in the New England Journal of Medicine (1972), revealed that “holding the baby close released ‘dormant intelligences’ in the mother and can cause ‘precise shifts of brain functioning and permanent behavior changes’.” In turn, the bonding experience is a “biochemical process that forever changes the mother so that she knows more instinctively how to relate to her baby. Routine separation of mom and infant makes baby frightened and mom depressed. This may be why postpartum depression and difficult adjustments are so common in the U.S. and rare elsewhere.”

Klaus, this time with John Kennell and Phyllis Klaus, further argues that “the woman may be experiencing bereavement, the effects of unemployment or inadequate income, unsatisfactory housing, or unsupportive relationships. The experience of childbirth may have aroused memories of past stillbirth or miscarriage, abortion, or death of her mother. When a woman has had a poor relationship to her own mother or was separated from one or both parents before the age of eleven, she is more likely to be depressed and anxious. Another factor may be the woman’s inability to confide in her partner or a friend. Women are often embarrassed to tell another how badly she feels. Loneliness, isolation, and lack of support are serious contributors to postpartum depression. Some mothers may find it difficult to reconcile the realities of mothering with their prenatal fantasies” (Mothering the Mother, Addison Wesley, 1997).

Obviously, if we are going to truly support mothers

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Research Update/Upcoming Newsletter Themes

and families, we need to consider the full spectrum of the pre- and post-natal experience.

Rates of PPD: Homebirth vs. Hospital Birth Returning to the question posed by my student,

an article by Jennifer Griebenow, “Home Birth vs. Hospital Birth: How Safe?”, argues that homebirth offsets depression and cites the work of Shelia Kitzinger and British Physician Aidan McFarlane. In summary, Griebenow reported that “women who give birth in a hospital are much more likely to experience postpartum depression or even post-traumatic stress disorder.” Further, Shelia Kitzinger states that “the more interventions a woman experiences, the more likely she is to be depressed, with cesarean sections carrying the greatest risk.” In terms of the data, Aidan McFarlane notes that “while 68 percent of hospital mothers experience postpartum depression, only 16 percent of homebirth mothers do.” Comparatively, rates of PPD at The Farm in Summertown, TN, average 0.03 percent. The message is loud and clear: if a woman wants to avoid, or at least significantly diminish the experience of PPD, she should strongly consider a home birth (Birthing Magazine, Summer 1998).

Prevention and Treatment of PPDPsychological treatments may include cognitive-

behavioral and interpersonal therapy. A March 2015 Monitor on Psychology article entitled “Mindfulness Holds Promise for Treating Depression”, written by Stacy Lu, states that, “Women at high risk of depression who may want to avoid taking drugs during pregnancy may also benefit from Mindfulness-Based Cognitive Therapy (MBCT). MBCT, developed over a decade ago by three psychologists—Zindel Segal, John Teasdale, and Mark William—seeks to “teach people to disengage from the deeply ingrained dysfunctional thoughts that are common with depression.” The article reports on the work of Sona Dimidjian, PhD, who studied MBCT for pregnant women with a history of depression. Dimidjian found “significant improvement in self-reported depression symptoms and an 18 percent relapse rate six months postpartum, which compares favorably to the 30 percent found in an earlier study by collaborator Sherryl Goodman, PhD.”

Social treatments, especially those which are preventative in nature, are also highly successful. These include “ensuring social support from other mothers, friends, and relatives; getting sufficient rest and sleep; and cutting down on less important responsibilities (without giving up outside interests)” (http://www.apa.org/pi/women/programs/depression/postpartum.aspx). For example, mothers are encouraged to join a support group, hire a doula to assist in the home, enlist friends to call every day to chat and see how the mother is doing (Midwifery Today, Issue No. 34).

Other treatment options are also available. For

example, a 1999 issue of Midwifery Today (Vol. 1, Issue 13) focused on “Postpartum Blues/Depression,” and offered several tricks-of-the-trade, including “having the mother lie in a bath to which a few drops of jasmine oil have been added. If jasmine oil is not at hand, ylang ylang or clary sage oil is (sic) nearly as effective” (Maggie Tisserand, Aromatherapy for Women: A Practical Guide to Essential Oils for Health and Beauty, Healing Arts Press, 1996).

The Role of Childbirth Educators In today’s world, where so many women feel as if

they must manage on their own and are subsequently uncomfortable with feeling vulnerable, and for those who receive insufficient support or information from family, friends, and care providers, childbirth educators have the unique opportunity to include topics such as postpartum care, newborn care, and the prevention and identification of the signs of postpartum depression in their classes. In fact, according to Cheryl Zauderer (2009), “Childbirth education classes provide an opportunity to teach a new mother to anticipate the help and support she might need for the birth of her child” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684038/#bib32). This is particularly important as indicated in a study by Roux, Anderson, and Roan (2002) which showed that “postpartum women are unprepared for the feelings of stress, loneliness, and seclusion that they experience” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595131/). By teaching women and their partners about the symptoms of PPD, childbirth educators can significantly increase the possibility that women/couples will be aware of the symptoms and needs of women with PPD and will subsequently receive proper screening, diagnosis, and treatment.

Upcoming Newsletter Themes

Breastfeeding Optimal Pelvic Positioning

First Babies Choices in Childbirth

Contributions are needed:Articles • Stories • Tips • Poems Recipes • Book/Media Reviews

8 | Vol. 15 No. 2

BirthWorks International

9 | Vol. 14 No. 1

Healthwise

The safety of supplements has been an ongoing concern and has recently come to the foreground in the media with a National Public Radio segment a few weeks ago, articles published in the New York Times, and various health letters from medical institutions. Through it all, I have become even more concerned and want to share what I have learned with you.

Pregnancy is an exciting time of life and it also comes with many choices and decisions to make. A pregnant woman wants to do what is best for her baby. One thing she will need to decide is whether or not to take supplements and which ones are best for her and her baby. Her doctor has likely recommended that she take a prenatal multivitamin to give her baby all the vitamins and minerals she/he needs to help ensure good health. But according to recent research, there are concerns.

When deciding whether or not to take supplements, there are three questions to ask yourself.

1. Are supplements good for me? The answer is, “It depends on

the supplement.” The supplement industry is a non-regulated industry. What is non-regulated is not controlled. This means the bottles may not even contain what the labels say. According to the Dietary Supplement Health and Education Act (DSHEA) enacted two decades ago, companies do not need FDA approval to sell supplements to consumers and they do not have to provide proof that their products contain the ingredients listed on their labels.

2. Are supplements safe? • Supplements, especially herbs,

can have a powerful and unpre-dictable impact on the body, pos-sibly affecting blood sugar, blood clotting, blood pressure, hormone activity, liver function, and more.1

• Many supplements can interact with over-the-counter (OTC) and prescription medications.

• Supplements have been found to contain undisclosed prescription drugs as well as contaminants and toxic substances.

• Adverse effects from supple-ments are not often reported.

• A Journal of the Ameri-can Medical Association (JAMA) study found that more than two dozen supplements were pulled off the shelves because they were found to contain anabolic steroids or powerful prescription drugs or banned substances, and that two-thirds were back on the shelves a year later with the same illicit ingredients.2

3. How do I know if I’m getting what I paid for?

• For years it has been known that supplements may have much more or much less ingredients than what is on the label, and sometimes what is listed on the label isn’t even in the supplement. Tests on top-selling store brands of herbal supplements at four national retailers—GNC, Target, Walgreens, and Walmart—found four out of five of the products did not contain any of the herbs that were listed on their labels.3

The supplement industry is a 33 billion-dollar-per-year industry. There are tremendous monetary incentives to get the public to buy

supplements: • The public is all too willing to

purchase them because “they can help me.” Pregnant women believe vitamin supplements will help grow a healthy baby.

• Perhaps what the doctor prescribes may not be working, so people turn elsewhere.

• People don’t consider dietary supplements to be drugs; they think supplements are less toxic than allopathic medicines, and they also cost less.

• Many people believe every health problem can be solved with a pill and don’t think tak-ing them is harmful. Often dietary supplements are considered safe until proven otherwise and pulled from shelves.

What can you do?If you decide to take a

multivitamin supplement, look for a quality-assurance seal on the bottle. If the label carries a U.S. Pharmacopeia (USP) or National Sanitation Foundation (NSF) seal, or has been analyzed and certified by ConsumerLab.com, it is more likely that the multivitamin contains what the label says and that it disintegrates fast enough.

However, many companies aren’t willing to pay the USP’s or NSF’s fees, so the absence of a seal doesn’t mean that a multi isn’t well made. Only about one percent of supplements tested carried quality

Supplements: Are They Safe? Are They Necessary?

Cathy Daub, PT

hEaLThWISE

9 | Vol. 15 No. 2

BirthWorks International

10 | Vol. 14 No. 1

assurance seals on their labels. If you are pregnant or a nursing

mother, avoid supplements, except as advised by your health care providers.4 However, even though most randomized clinical trials on multivitamins have had disappointing results for the general population, they may be effective for pregnant women. Prescription prenatal multivitamins are regulated by the Food and Drug Administration (FDA) and give pregnant women at least ten vitamins and ten minerals and usually provide 100% of the Daily Value for most of these nutrients (though many contain higher doses).

Folic acid has been shown to decrease neural tube defects in pregnant women. Therefore, all women of childbearing age who are sexually active should be taking a folic acid supplement. Be careful to not overdose on folic acid, as research is still inconsistent with its risks. To be on the safe side, it is recommended that your total intake

of folic acid not exceed 1000 mcg. If you are taking 400 mcg of folic acid and also a multivitamin with 400 mcg, and perhaps eating a cereal fortified with folic acid or taking a B-complex supplement, you would be consuming more than 1000 mcg of folic acid.

There are two more supplements that are important. The first, vitamin D, is needed by the body for adequate bone health and muscle function. The second is vitamin B12 which is vital to almost every cell and body system, especially the blood and nervous systems. If you are a vegetarian or vegan, have your vitamin B12 levels checked, and if low or borderline low, take a B12 supplement or get a B12 injection if the level indicates deficiency which could be harmful for the baby.

If you experience side effects from a supplement, report it to the FDA by filing a report at www.fda.gov/medwatch.

The bottom line• Supplements should never

be taken as a substitute for a good diet or to cancel the effects of bad habits like smoking or not exercising.

• Pregnant or nursing women should avoid most supplements except as advised by their health care providers. The only exception would be a prescription prenatal multivitamin.

• Folic acid is important in helping to prevent neural tube defects, but limit your supplemental intake to 400 mcg per day so that your total intake from all sources does not exceed 1000 mcg.

References:1. “News and expert advice from

the School of Public Health” Berkeley Wellness Letter, University of California, Vol 31, Issue 10, Sprng/Summer 2015.

2. Pieter A. Cohen MD et al. “Presence of Banned Drugs in Dietary Supplements”,.JAMA, Oct 22/29. 2014. Vol 312, No. 16.

3. Nutrition Action Health Letter, Center for Science in the Public Interest, “Multiplex: What you need to know about multivitamins”, September, 2011.

4. Ibid. Berkeley Wellness Letter, University of California.

rECIPE Green Pasta PrimaveraYield: 6 servings, Prep Time: 30 minute or less

Tossing cooked pasta with puréed toasted pine nuts and pasta water creates a delicious “cheese-like” coating for the noodles.

½ cup, plus 2 Tbsp pine nuts¼ cup oil, divided1 Tbsp lemon juice8 cloves garlic, minced (3 Tbsp)2 medium leeks, sliced (2 cups)1 lb broccoli raab, chopped or just broccoli2 cups frozen peas, thawed6 cups baby spinach8 oz. farfalle pasta

1. Toast pine nuts in skillet over low heat 5 minutes or until golden, stir-ring frequently. Remove pan from heat. Blend ½ cup toasted pine nuts in food processor with 2 Tbsp oil, lemon juice, and 1 Tbsp water until smooth. Set aside remaining 3 Tbsp toasted pine nuts.2. Heat remaining 2 Tbsp oil in large skillet over medium heat. Add garlic and sauté 1 to 2 minutes or until golden. Stir in leeks, season with salt if desired. Sauté 5 min-utes. Add broccoli raab and cook 10 minutes, stirring occasionally. Add

peas, and cook 2 minutes more. Stir in spinach and remove from heat.3. Meanwhile, cook pasta according to package directions. Drain pasta, reserving ½ cup cooking water. Return pasta to pot, stir in sauce and reserved pasta cooking water. Fold in broccoli raab mixture. Serve topped with whole toasted pine nuts.

—Vegetarian Times

10 | Vol. 15 No. 2

Healthwise/Recipe

BirthWorks International

11 | Vol. 14 No. 1

This workshop was really not what I expected, so I was happily surprised when it was so wonderful. I thought there would be more chalk-boards, note taking, and testing, but it wasn't like that at all. Instead, the trainer used our senses. In a moth-erly manner, she simply spoke with us (so we heard), sharing her knowledge about the wonder of birth and how to be a doula. She also showed a few birth vid-eos (sight). We learned some nice massages one can use specifically during labor (but can be used outside of it, too!). All the participants got up and tried out quite a few comfortable postures/positions/motions to facili-tate labor (sense of touch), as well as role played dif-ferent birth scenarios—and what a scene we made! Then there was the yummy, good-for-you snacks giv-en, and sometimes freshly baked, by our dear host-ess. (and that is where the sense of taste comes in.) Lastly, her little 'flat' smelled good, too! That's a plus!

There were too many things I learned to write them all down here, but one thing that impressed me the most was how we searched into mother/daughter re-lationships. I never knew how important they were and how my mother is the most important person in my life. My heart was moved to tears by this discus-sion, and made me feel much closer to the other women (doulas-in-training) present. Now I appreciate and love my own mother much more. After having at-tended this, I do not feel like I am the same person anymore. I think going through these three days with our trainer made me grow! I wish other women could have the same wonderful opportunities that I have had!

Musings from Auckland, NZ

Doula WorkshopMary Pawlowski, PA

When I was young, I knew everything.Now, I am watching the eagle fly.

When the bird alights on the branches,I will lie down and remember.

I miscarried my baby.I can’t cry now. I am too tired to cry.

I feel frozen, and I don’t want to move.

In a little while, I will get up and make dinner.

Cooking feels life-affirming to me.I will eat, and I will give

some of the food to my neighbors.

Then the pain in my heart will lessen, and the screaming I can still hear

in my soul will be quiet.

Watching the Eagle FlyEpiphany Birth Poems Jane Beal PhD, CCE(BWI)

BirthWorks—a unique and innovative approach to birth that is empowering and transforming in nature which decreases fear

and increases confidence to birth.

Notes From The Field/Poem

11 | Vol. 15 No. 2

BirthWorks International

12 | Vol. 15 No. 2

Training & Certification

Workshops Childbirth Education 10/16-10/18:

Jupiter, FL

11/6-11/8: Cleveland, OH

Accelerated Childbirth Ed & Doula (ACED)

6/21-6/24: ChristchurchNew Zealand

7/5 to 7/8: Medford, NJ

Doula Education6/26-6/28: Auckland

New Zealand

9/25-9/27: Chicago, IL

BIrThWOrkS ChILDBIrTh EDuCaTOr aND/Or DOuLa TraININg & CErTIFICaTION

Host a Childbirth Educator and/or Doula Workshop

Are you interested in hosting a workshop for BirthWorks in your community? Could you benefit from getting a reduced training fee? We are looking for women who would like to bring BirthWorks to their area. Before applying, please have a location for the workshop in mind, suggestions for advertising in your area, and allow for six months’ planning time. Write to sandyr@birthworks.org for more information about this unique and rewarding opportunity.

Reviewers NeededWe need reviewers for new childbirth educators-in-training. If you are certified and have experience teaching BirthWorks classes, please contact the BirthWorks office at 1-888-TO BIRTH (862-4784) or info@birthworks.org. This is a great way to give back and help women who are working on their certification.

TrainersCathy Daub • Kathleen Furin

Sally Dear-Healey • Joan-e Rapine

BirthWorks has been an internationally recognized childbirth education program for over 25 years. Its innovative and experiential design develops a woman’s self-confidence, trust, and faith in her innate ability to give birth and nurture her child.

BirthWorks childbirth classes are approved by DONA (Doulas of North America) International to fulfill the childbirth educator requirement for birth doula certification.

BirthWorks began offering doula training in 2006. The same philosophies embodied in our childbirth education classes are also in our doula trainings. Offer women an extension of your childbirth classes by taking the BirthWorks Doula Training.

For information about attending BirthWorks childbirth education classes or doula training in your area, as well as information about BirthWorks childbirth educator workshops or finding a BirthWorks doula, visit www.birthworks.org.

Announcing BirthWorksOnline Postpartum Doula

Certification ProgramIf you love the BirthWorks philosophy, this opportunity may be for you, and. no workshop is required! Complete your training online, and work with your reviewer closely throughout. This is a way to be with women through pregnancy, birth, and postpartum providing a continuum of loving care as a BirthWorks Postpartum Doula.

Anticipated start date: July 1, 2015

12 | Vol. 15 No. 2

New Students Childbirth Educator

Haley Skelley, IA Amy Townsend, OK

ACED Program Dr. Angela Lopez, CA

International ACED

Kate Wolfe New Zealand

Haley Macklin New Zealand

Newly Certified

Childbirth Educators

Michelle Chenevert, PA Uschi Heyd

New Zealand

BirthWorks International

13 | Vol. 14 No. 1

On the Business Side: Notes from the Office

ON ThE BuSINESS SIDE: NOTES FrOm ThE BIrThWOrkS OFFICE

FacebookWomen are attracted to our organization because of

its unique philosophies, evidence-based curriculum, and the comprehensive nature of our certification materials, as well as our educational and inspiring workshops.

BirthWorks currently has over 8,000 friends on our Facebook pages, and that number grows daily. You can help spread the word about BirthWorks by encouraging your friends to follow us on Facebook. You may ask birth-related questions, post inspirational quotes, or mention birth-related stories you’ve seen in the news. Also, be sure to watch Facebook for great deals on products and/or services.

Become an AmbassadorOur goal is to have 25 ambassadors by the end

of 2016! If you are a student in one or both of our certification programs, becoming an ambassador will help you make contacts to build your own small business, and at the same time promote the BirthWorks name. You can also be an ambassador even if you are not currently enrolled in one of our certification programs. If you, as a member, are attracted to our philosophies and want to help us further our mission and become a BirthWorks ambassador, please contact our office at info@birthworks.org.

Board Positions OpenBirthWorks continues to undergo exciting changes!

In order to enhance the support we can provide to our members, as well as the birthing and parenting community, we are expanding our Board of Directors. BirthWorks is currently accepting applications for the following positions: Director of Public Relations, Director of Marketing, and Director of Fundraising.

Not only is this an opportunity to contribute your time and expertise to BirthWorks, it is a great way to keep your skills up-to-date, and looks great on your resume! If are interested in applying for one of these positions, or you have questions about the requirements of a particular position, please contact the BirthWorks office at 1-888-TO BIRTH (862-4784) or info@birthworks.org.

Help Spread our Message GoodSearch.com and GoodShop.com are search

engines that donate half their revenues to the charities their users designate. You use them as you would any search engine, and they are powered by Yahoo. Enter “BirthWorks International” as the charity you want to support.

Online StorePlease note that all orders from the online store, or

those made through the office, will be sent by priority mail. We need to receive your orders at least two weeks in advance of your classes for you to receive them in time. If necessary, rush orders are available at an additional cost. You may also call the office to request UPS or FedEx options. Be sure to look for postal slips when looking for your package, as it has come to our attention that some orders have not been picked up.

iGive - You Save and We GrowWe invite you to make a difference by registering

with iGive to donate to BirthWorks International every time you shop at participating businesses.

After you register with iGive, which only takes a few minutes, whenever your make a purchase with a participating business, such as Amazon.com, a portion of your sale will go to BirthWorks. Right now there are over 1,000 participating stores, so sign up now!

Use this direct link to sign up: http://www.igive.com/C61Z1X0.

Give the Gift of BirthWorksBirthWorks helps women have better birth

experiences. By gifting tuition for the childbirth educator certification program or childbirth educator and/or doula workshops, more people are trained to teach childbirth classes in their communities. Financially contributing to the development of our postpartum doula certification program supports the training of more people to care for new mothers in the postpartum period. And remember, your gift is tax-deductible: click on the “Donations” tab on our website.

13 | Vol. 15 No. 2

sAvE thE DAtE!

BirthWorks International Conference

Finding The Truth About Birthoctober 14-16, 2016

BirthWorks International

14 | Vol. 15 No. 2

BirthWorks Advisory Board/Ambassadors/Office and Newsletter Staff

BIrThWOrkSaDVISOrY BOarD

Board of AdvisorsMichel Odent, MD

Susan Ludington, PhD, CNM

Kirsten Uvnas-Moberg MD, PhD

Mary Zwart, Midwife

Heloisa Lessa, CNM

Jan Tritten, Midwife

Henci Goer, BA, Author

Ina May Gaskin, Midwife

Bethany Hayes, MD

Barbara Harper, RN

Marshal Klaus, MD

Lewis Mehl Madrona, MD

Jean Sutton, Midwife

Suzanne Arms, Author

Nancy Wainer, Midwife

Ray DeVries, Sociologist

Phyllis Klaus, MFT, LCSW

Elizabeth Davis, Midwife

Board of DirectorsPresident: Cathy Daub

Secretary: Maria Pyanov

Treasurer: Sandy Riker

Director of Education: Tiffany Tice

Board Members at Large: Sally Dear-Healey and Valerie Akuffo

rEgIONaL & INTErNaTIONaLamBaSSaDOrS

Alaska/HawaiiJoan-e Rapine

jrapine@me.com

California/NevadaDeborah Bartle

mothersdoula@yahoo.com

iowaMaggie McCecil

maggiemccecil@gmail.com

New EnglandCt, MA, ME, Nh, ri, vt

Nancy Grygentengrygent@msn.com

New JerseyTiffany Hare

tiffany.d.hare@gmail.com

New MexicoBrenna Rothschild

brennadoula@gmail.com

NEWSLETTEr STaFFManaging Editor: Trisha Lawrie

Editor: Carolyn Githens

Contributors: Jane Beal • Cathy Daub • Sally Dear-Healey

Trisha Lawrie • Janine Mayo • Mary Pawlowski

OFFICE STaFFProgram Manager and Accountant: Sandy Riker

Open Regional PositionsLower Midwest (MO, NE, KS, IL), Mid-Atlantic (DC, MD, VA, WV)Pacific Northwest (OR, WA), Rocky Mtn (CO, MT, UT, WY, ID)

ohio river valleyiN, kY, Mi, ohNaomi Bongorno

nsikesgilbert@gmail.com

SoutheastAr, AL, FL, GA, Ms,

NC, sC, tNLuella Willaman

lwillaman@mail.com

SouthwesttX, AZ, LA

Emilie Cunninghambluejohnson@hotmail.com

tri-stateDE, NY, PAAnna Holder

aholder134@aol.com

BirthWorks International

15 | Vol. 15 No. 2

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Support BirthWorks programs and services, plus be a part of a larger

community of women who believe birth works!

Contact us to become a member:BirthWorks International

PO Box 2045 Medford, NJ 08055info@birthworks.org www.birthworks.org

Phone: 888-TOBIRTH Fax: 609-953-9380

Check out the new

mEmBEr CENTEron our website!