NASHVILLE, Tenn. (WKRN) – News 2 has teamed up with March of Dimes Tennessee to host “It Starts With Mom,” a series of virtual panels with experts about moms, babies, and ultimately, healthy outcomes for all.
In addition to moderating each panel of experts, News 2’s Nikki Burdine discusses her experience with her own preemie daughter, who was born at 28 weeks in 2019.
In “Building a Community: Creating a Postpartum Network,” panelists discuss the postpartum period and supporting women during such a trying time.
Building a Community: Creating a Postpartum Network Panelists
- Amy Green: Founder and Executive Director of The Rooted Bridge/owner and founder of Nashville Collaborative Counseling Center
- Dr. Kimberlee Wyche-Etheridge: Director of the Master of Public Health Program at the School of Graduate Studies and Research at Meharry School of Public Health
- Kristen Brust: Writer and podcast host of “In Kristen We Brust”/full-time stay at home mom
- Camielle Fishel: Director of Perinatal Services at Baptist Memorial Health Care
The ongoing process of postpartum
Postpartum period is considered to be the six weeks after delivery, but it is an ongoing process
“As I like to tell my patients, the babies don’t read the book that says it stops at six weeks, which means it’s really an ongoing process. As far as the recovery of the getting my body back, as we say, as well as the bonding and getting used to having a new baby. When we think about some of the things that would really benefit moms. In that post period, postpartum period, one of the major ones is making sure that moms continue to have coverage for medical care. And postpartum period is a significant risk for especially for African American women. But for all women as far as looking at where we stand as a country within regards to maternal mortality, almost putting us at the rate of some third world countries when we think of how many of our moms are dying as a result of pregnancy. So ensuring that women have medical cover comprehensive medical coverage during that post period, postpartum period ensures that at least they have access to care. That can be checked to see if there is something that was going on that needs to be checked and dealt with in order to put them at let at less risk,” said Dr. Kimberlee Wyche-Etheridge.
Dr. Wyche-Etheridge also spoke about having universal home-visiting to moms in a ‘pre-natal bundle,’ to help make sure women have the comprehensive care they need.
“We need to realize the uterus is part of the body, you can’t just treat a uterus. You can’t just treat a body without realizing there’s a head attached to it, which means that we have to deal with the mental health and the mental wellness of women. And realizing when postpartum depression, which is you know, people say the baby blues, it’s a real thing, it is a real thing that is identified and women get the help and the services that they need. So policies that support programs that will address postpartum depression, that will address universal home visiting that will address making sure that women continue to have health coverage, and also policies that support community organizations that continue education for moms with young babies in a way that will again create that village of support camaraderie, and just having another sister, a sister, mama, that is going through the same thing…Women are gatherers, we come from a history of working together as women, and to be able to put that back into place is something that will really help postpartum women do best. One of the easiest ways to do that also is through the group prenatal care and group pediatric care, which allows you to have that cohort of people that you continue with all of these things just create the atmosphere of you’re not doing this alone. And if you’re not doing it alone, and you understand what the red flags are, then we’re more likely to see those healthy babies celebrating their first birthday with their mothers, which is essential.”
She also spoke on the massive health disparities being brought to light amid the pandemic.
“Yes, and in capital letters, the disparity is real. And the stress of COVID, and how it has affected all aspects of the community is real. Women who, again, do not have that village, or even are taken out of their village, because now you’re quarantining or you’re isolating, don’t have that, that support, we always have to take stock into the small population of women that are in dangerous situations, and now are stuck in those situations because they don’t have as much of an outlet as they normally had if they’re going out to their prenatal care visits or out to the supermarket and things like that,” said Wyche-Etheridge.
“Everybody is feeling it in one way or another. I see it in my in my children in and pediatric clinic. I see it in the parents and it’s actually the first question I asked them, I said, How are you doing? How you doing with COVID just to find out the food insecurity, the housing insecurity, the rest of the lack of resources, the loss of wages, just the stress is amazing. And as we know, stress is a major risk factor for poor birth outcomes for women, so anyone that was on the edge in the first place has really just been pushed off the cliff.”
The one positive we have seen come from the pandemic, according to Dr. Wyche-Etheridge, is virtual health care.
“If you can’t be with somebody if you can at least interact on-screen with a group of women or a group of moms, it offers a little something, families are doing it. It’s just a way to keep building the community.”
Kristen Brust, shared her post-partum journey, one many women can relate to, while her husband was touring, she found herself alone.
“It just became a pretty heavy chapter and everything I kept reading was talking about not connecting with your baby, and that wasn’t my problem. I was obsessed with my daughter. That wasn’t the issue…So I was so confused. I thought something was wrong with me.”
Brust also dealt with the difficulties in breastfeeding, which can contribute to postpartum anxieties.
“I felt fortunate that the mothering came very naturally to me, the breastfeeding did not, so that did not help. That added to the postpartum anxiety and the depression,” said Brust. “I later did find out that postpartum anxiety is a real thing. For me, wanting everyone to not only be in our house, but be in our bed and checking everyone’s heartbeats, every five minutes was really like a real-life thing.”
Brust remembered a feeling she just couldn’t shake. “I call it ‘ironically lonely’ because I was never alone because I had our little girl attached to me, but it was an ironically lonely season for me and just a 180 from the life I had been living. There is a massive adjustment to in motherhood period and then when you’ve taken degrees and hard work and resumes and, and a title that you’ve kind of like placed on yourself and become part of and then you hang that up and you become Mom, it’s like, there’s this really strange period, I call it the foreign exchange student period with an infant where you don’t know if they like you, or you’re not sure if they understand you, you know, it’s like there’s this big language gap.”
The conflicting feelings of sadness and guilt for being sad were prominent for Brust.
“I thought, well, who am I to be sad? When there are people that can’t, that would pay all their money to have this, you know, that would pay all their money to feel ironically lonely. But I think what it comes down to is staying in your own story in your own walls and in your own feelings for a minute and allowing yourself the grace to just feel what you feel because attaching the judgment to feelings is what gets all of us in trouble. And it’s okay to feel alone because honestly, it’s it is lonely sometimes”
Amy Green spoke about her experience after having a baby.
“I think I’ve just steadily been in it for the last four years and forevermore will identify as postpartum because birth changes us. Having a baby changes everything. The stress and anxiety in this season is incredibly different. It is disruptive, and multitudes of ways what our daily life looks like. So feelings of depression anxiety would be really normal to have right now. In addition to what is already postpartum, depression, or anxiety, or pregnancy depression, anxiety.”
Through her work, Green helps her patients with their coping skills. “I think rallying our teams, our tribes, our villages around us, calling people staying connected as a new mom is incredibly important. That could be, via phone that could be scheduling walks, and going to the park with friends so that we can at least be outdoors. But we’re still connecting.”
For some women, postpartum depression is obvious, for others, not so much.
“We talk about not sleeping after we’ve given birth, and the drop in hormones that has to happen. And then like returning to pre-pregnancy levels and hormones for some of the things like progesterone, and then our milk coming in, which insinuates again, yet another hormone change, right?” Green asked.
“You have this trifecta of things that are going to happen. That might mean that when a cat video comes on, I start crying for no reason at all. And I have no explanation of it. We all have hilarious stories of where we’ve just started crying for no reason and postpartum. But it feels like a wave. You can kind of feel it coming on, you cry, or you release it and then it ends and you can go back it’s not interfering in my ability to daily function.”
Green also said medical care beyond six weeks postpartum should be standard. “Maternal mortality in Tennessee, occurs from six weeks to 52 weeks. The majority of deaths occur later and a significant number of them Include mental health and substance abuse. And so being able to have ongoing support beyond just OB care is absolutely essential to preventing and addressing perinatal mood disorders that do present. At the six-week period, we start to talk about symptoms like having what if thoughts, having these thoughts that come up that are scary, that feel intrusive, having worst case scenario, thoughts, and not being able to engage with baby, which is I think, again, what we typically think of postpartum depression, I’m so sad, I can’t get out of bed, I’m too tired to engage, you can have the opposite of that too, or I’m so anxious, I can’t sleep.”
Sleep is one of the biggest factors for postpartum mood disorder and should be a red flag. “If I have a hard time falling asleep, if I have a hard time staying asleep, you want to make sure sleep is like a sacred time, very sacred for both parents. And so those are typically the symptoms that we look at,” said Green. “When those interrupt our ability to function with whatever is required of us from day to day, whether it’s I can’t go to work and function, I can’t take care of baby and function. I can’t have a partnership, because we’re just arguing all the time and have big postpartum rage, which is a thing, right? Then it’s time to call in and ask for support.”
America is the most dangerous developed nation in which to give birth. Pregnancy related deaths have more than doubled over the past 25 years.
Camielle Fishel discussed recognizing health issues that can lead to dire outcomes.
“Our nurses take the blood pressure once they recognize it, they’ll take it within five minutes. Or if they have to severe range blood pressures within 15 minutes, we will go ahead and institute our saved order sets,” said Fishel.
The challenge of speaking up
One of the challenges many women face is having the confidence to speak up if something is wrong, and then actually being listened to by their doctors in some cases.
“A lot of what’s happening in the field with birth attendance with doulas and with other folks is, if you can’t speak up for yourself, or if that’s not your personality, your comfort zone, or you’re just frankly too sick to do that. There’s someone there that’s going to advocate for you, someone that knows the system enough to be able to say, no, that’s not the way that should work,” said Dr. Wyche-Etheridge.
“Really call out when there are there are issues. But honestly, teaching women to speak up for themselves is an upstream battle that goes back to, as a pediatrician, teaching our little girls to have a voice and working with them throughout that life course.”
The importance of support systems
All panelists agree building a support system for yourself is important, whether it be a family member, friend or a professional.
“I think just finding a place where your feelings are heard, whether that’s a therapist or a girlfriend, I found a lot of safety and moms that have gone before me,” said Brust. “And there’s some help in the women. They’re in the trenches with you. And then there’s some help of the people that are already a few years down the road that they can just identify what you’re feeling and how to help best. I really think in building a community, it doesn’t have to be the amount of people, it’s just the quality of the people that you have.”
It’s important for women to know their resources, said Fishell. “We have lactation classes that are virtual now. We have prenatal classes that are virtual. Another thing that we do is bundles. It’s a way for moms and babies to get together with nurses. Some of them are NICU nurses, some of them are mothers, baby nurses, some of them are nurse educators.”
Dr. Wyche-Etheridge said we should all try to remember, we can prepare as much as we want to, but the baby never read the book.
“We have to understand that there’s always going to be a variety. And we have to we have to accept things that are a little bit different than what we want them to be or expect them to be.”
“The other thing is giving ourselves grace. And the other is understanding that we survive being part of a whole, not necessarily just as an individual,” Wyche-Etheridge continued. “For all women to identify their village to figure out who’s in their tribe to know who’s around them, who’s their support system, who can you call at two o’clock in the morning, when the baby is driving you crazy and you can’t sleep, figure out who all those people are, and use them. We always say, Well, I don’t want to bother anybody. You’re not bothering anybody. We are, we are all in this together, whether it’s COVID, whether it’s, you know, just making sure that everybody makes it to the finish line, a lot of work to do. I think the first thing is identifying that there is an issue when it comes to disparities and racism, and bias. And once we identify it, anyone that’s taken any kind of oath is then obligated to work to fix it. And if we’re not all part of the solution, then by definition, we’re part of the problem.”
Even if you think things are going well postpartum, Green stressed it’s still okay to ask for help or reach out.
“Asking for help doesn’t mean that you have done something wrong or something is wrong with you. It’s a sign of courage at the sign of honoring yourself. And there are so many people here that would want to honor your story and be with you on this journey.”
“It’s really important to just remember that you’re walking your journey, your walls, your home, your body, your baby are all your own,” said Brust. “…It takes a village to raise a mom. But innately you have this intuition that gut response, the way you want to care for them, the things you want to do for them is all so uniquely made for you and your baby. So just don’t second guess yourself.”
You can learn more from March of Dimes on their Facebook page.