The journey from conception to delivery is one of the most taxing processes that a body can endure. Still, many women make the transition from pregnancy to parenthood with relative ease. For many others, pregnancy can be a debilitating experience, both physically and mentally. But with the standard of care administered throughout the birth continuum heavily centered on physical health, many expectant mothers and parents are left to grapple with mental health complications throughout and after their pregnancy. Doulas can be a critical part of the birth team, supporting the needs of the birthing person and helping to ring the alarm when there is a potential mental health issue arising.
According to the Anxiety & Depression Association of America, nearly 20% of women suffer from some form of Perinatal Mood and Anxiety Disorder (PMAD). PMADs can range from more manageable conditions such as baby blues or perinatal anxiety to more serious conditions such as postpartum psychosis which affects 1 in 500 women, or the most common PMAD, postpartum depression (PPD) which affects 1 in 7. Despite the name, signs of PPD can show up during pregnancy. But on average, PPD is usually diagnosed within the first three weeks following delivery. All PMADs, however, can become more severe if left untreated.
Doulas have long been attuned to the importance of holistic care and emotional reinforcement during the delicate perinatal period. As such, they are filling a vital gap in the scope of care for pregnant women and new mothers. In addition to the many physical and biological changes that women go through during pregnancy, there are various external factors that influence the mental state of an expectant or new mother such as lack of partner or community support, concerns about finances, and concerns about the health and wellbeing of the baby. And in the period leading up to birth, many women also experience increased anxiety about labor and delivery. A doula can provide informational support and reassurance by answering questions, assuaging lingering fears about the upcoming labor, or refer them to vital resources they may need.
In general, women are most susceptible to developing a PMAD in the period following birth. As such doula care has also become increasingly sought after, particularly during the critical labor, birth, and postpartum phases. A doula not only provides emotional support to both the birthing and supporting parents, but they can help alleviate or reduce many of the stressors that arise postpartum such as lack of sleep, difficulties with bonding with the baby, or breastfeeding. And a growing body of evidence supports that doula care is linked to reduced rates of postpartum depression and anxiety.
A doula is also able to monitor the new mother for signs of emotional or mental distress. Mama Glow founder, Latham Thomas, says while mild mood swings or baby blues can be typical, more serious signs of distress can include feelings of hopelessness expressed by new mothers, incapacity to or lack of interest in caring for themselves or their baby, or if they are processing a traumatic birth experience or navigating lack of support. She adds that doulas are watching out for “how well a mother or birthing person adjusts during postpartum”.
But although up to a quarter of all pregnant women experience some form PMADs, only a fraction of that number can access the care and support they need. African-American women and birthing people are disproportionately affected by PMADs but statistically less likely to receive care for symptoms of PMADs. And while having the extra support that a doula might provide during pregnancy or postpartum can be a literal lifeline, it remains a service that only a select few can access. There are, however, some services that are working to make mental health care in the perinatal period more accessible to those who need it most.
Many providers offer services on a sliding fee scale. And following the surge for mental services during the COVID-19 pandemic, providers such as http://www.americanwell.com/ and https://golantern.com are bridging a crucial gap by providing low-cost access to HIPPA-compliant mental health services remotely.
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