Deepening the Conversation: Helping Prenatal and Postpartum Professionals Ask Important Questions

*This blog was from 2016, but so great we had to share again!

 May is Maternal Mental Health Awareness Month—a month dedicated to education and awareness of perinatal women and their mental health. I feel it’s also an opportunity to reflect on the path we’ve each taken as professionals, to arrive at this point in our lives and careers.

Whether you’re a doula, midwife, lactation specialist, mental health provider, or other birth-oriented professional, we each gravitated to the perinatal field for a reason. I’d venture to say you’ve had a personal experience that has touched your life, directly, indirectly or a combination of the two. Something powerful and meaningful ignited your passion for working with perinatal women and their families that set this leg of your career in motion.

Personally, I was quite ignorant to the issues of maternal mental health when I first looked it right in the face. This likely wasn’t my first brush with a struggling mother, but it touched me deeply. It was after college and I was traveling through Guatemala. I was in a rural mountain village waiting for the rain to clear so I could hike a famous volcano. It was the rainy season, so I wound up spending several weeks waiting out the rain while studying weaving and living with a local indigenous family.

The eldest daughter, Maria, was 18. She was a single mother with a three-year-old son, Daniel, who she carried in a sling on her back wherever she went. He was disabled and couldn’t walk, talk or feed himself. I learned from others in the community that Maria had tried to abort her son, taking homemade concoctions and pills to no avail; the result was his disabled state. She hid her pregnancy from friends and family until weeks before he was due to arrive.

During my stay with her family, Maria was evidently pregnant with a second child. The father of that child lived in a neighboring village with his family. Their relationship seemed tense and Maria wore signs of that on her face. I quietly noted her anguish, her pain, though I said nothing.

Her story remained with me when I returned to the U.S. months later, I had a fire burning inside. Eventually I enrolled in graduate school intent on increasing access to medical and mental health for women in Latin America. I soon realized there was ample work to be done right at home in New York City. And thus began my work in maternal mental health.

I wasn’t confident enough or trained in the signs, symptoms, or risk factors for developing Perinatal Mood and Anxiety Disorders (PMADs) back in 1999 when I met Maria. Today, however, in addition to maintaining a private practice, I provide educational trainings to other perinatal specialists. I’ve become acutely aware of how intimidating it can feel to professionals who don’t have a degree in mental health to ask these hard questions. Practitioners talk of their insecurity and uncertainty about how to ask vital questions without being perceived as intrusive, how carefully word their inquiries, and how to empathically express their recommendations for mental health when a client reveals that she is struggling. There’s little doubt that these hard questions need to be asked, but how to do so remains a question for many.

The May Campaign (May 2-6, 2016) launched Maternal Mental Health Awareness Month. This year the focus of the campaign was on the importance of bringing the conversation from baby, back to mom, to #AskHer: how are you doing? How are you feeling? Are you sleeping?

Here are 5 recommendations for ways to increase your confidence and to #AskHer those difficult questions and provide the support she needs.

• Screen her!— Not only is Prenatal and Postpartum screening for depression recommended by the U.S. Task Force for Preventative Services, but screenings open up a dialogue between you and your client. The screening itself acts as an intervention that normalizes the prevalence of perinatal mood and anxiety disorders. By asking questions, you let her know that her mental health is important and valued. The Edinburgh Postnatal Depression Scale and the Perinatal Anxiety Screening Scale are both free and widely available for use.
• Develop a list of resources where you can refer your clients. Make sure you know several doctors, psychiatrists and therapists who are sensitive and trained in perinatal health. If you don’t know anyone—join the Postpartum Health Alliance (insert link: https://postpartumhealthalliance.org/membership) here in San Diego and develop your network. If you’re outside of San Diego, connect with your local chapter of Postpartum Support International(link: http://www.postpartum.net/get-help/locations/united-states/).
• Get more advanced training. Did you know that Postpartum Support International (PSI) offers an online certificate program in Maternal Mental Health? PSI’s annual conference will be in San Diego this June—an opportunity to immerse yourself in the latest research, treatment and recommendations around issues related to perinatal mental health. Pre-conference events include the 2-day certificate program as well.
• Trust your intuition. If you think something isn’t right, you’re probably correct. But don’t forget to #AskHer. Karen Kleiman of the Postpartum Stress Center has developed many valuable tools that are free to the public, including “Are You Asking the Right Questions?,” which you can download here. http://postpartumstress.com/professional-development/assessments/
• Believe in your ability to help. You chose this work because you are passionate, caring and dedicated. Your empathy is your most precious gift. Listening: verbal and nonverbal communication skills count equally. Let her know you hear her, that you care, that she is not alone, and that with help she will feel better.

Rachel Rabinor is a psychotherapist and Licensed Clinical Social Worker with over 15 years of clinical experience. She maintains a private practice where she specializes in maternal mental health, including: infertility, perinatal loss, pregnancy and postpartum mood and anxiety disorders and early parenting.