Impact of poverty and stress on infants

This is another article that addresses the importance of caring for women before birth as a way of serving our community for a long time after.

New York Times: At Risk From the Womb

Here’s a quote:

Perhaps the most striking finding is that a stressful uterine environment may be a mechanism that allows poverty to replicate itself generation after generation. Pregnant women in low-income areas tend to be more exposed to anxiety, depression, chemicals and toxins from car exhaust to pesticides, and they’re more likely to drink or smoke and less likely to take vitamin supplements, eat healthy food and get meticulous pre-natal care.

The result is children who start life at a disadvantage — for kids facing stresses before birth appear to have lower educational attainment, lower incomes and worse health throughout their lives. If that’s true, then even early childhood education may be a bit late as a way to break the cycles of poverty.

“Given the odds stacked against poor women and their fetuses, the most effective antipoverty program might be one that starts before birth,” writes Annie Murphy Paul in a terrific and important new book called “Origins: How the Nine Months Before Birth Shape the Rest of Our Lives.”

When you consider the far-reaching effects of stress during the prenatal time listed in this article – impacting educational level, heart disease, mental illness, and obesity among others, it makes sense to ensure that women feel nurtured and supported. It’s not just that we want pregnant women to “feel good” – it turns out to be good for those babies growing and developing.

The article talks about the impact of poverty on stress. People may have ideas about what poverty means – and the image might not be what you imagine. I was shocked to learn that a living income (defined as “the minimum income that a family needs to provide the basic necessities of life”) for two working adults and two children in King and Snohomish County was $71,374 in 2008! It’s easy to see how families can not have a lot left over even above that, and many, many jobs don’t make nearly that amount – over three quarters of jobs (76%) in King County don’t make enough for a living wage for a single wage earner with a toddler and a school age child. Yes, 76%! Think of how many dual-income working couples with kids are one layoff away from facing those statistics. The living wage for two adults with a single worker and two children (not needing childcare etc) is close to $50,000 annually. The clients that Open Arms serves are at 200% of poverty level or below – which in Seattle is $40,000 per year. Read the Communities Count A Report on the Strength of King County’s Communities which is where I got these figures – it’ll shock you.  Note: That report is delivered every three years, but they update it due to the rapidly changing economic conditions. You can read the latest figures and updates on the Communities Count website.

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Focus on healthy pregnancy

My mom pointed me to Time Magazine this month, which features articles about prenatal life affecting future mental and physical health and well-being. One article (there may be more, I don’t have the magazine in front of me) is this one:

How the First Nine Months Shape the Rest of Your Life

There are more and more articles about epigenetics coming out in the news, and it underscores the importance of creating healthy, supported environments for moms and babies to start life in the best possible way. It truly does make a proven difference, and science and researchers are showing us time and time again that the environment pre-birth is an essential and extremely important time for babies in terms of development and health.

Recently I attended a wonderful presentation by the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Children’s Hospital right here in the Seattle area. You should check them out – they do wonderful work and are right at the cutting edge of research on a global scale. The GAPPS mission is to “lead a collaborative, global effort to increase awareness and accelerate innovative research and interventions that will improve maternal, newborn and child health outcomes.” Their research will contribute to a currently small but growing body of knowledge about improving maternal and infant outcomes and reducing prematurity and stillbirth, two issues that deeply impact the health of our next generation.

With current interest levels high on maternal, infant and child health, and the importance of supporting health from the beginning (pre-conception into pregnancy and birth, and then onto the more traditional times for intervention in infancy and childhood), I hope that we’ll continue to see improvements in these areas.

We at Open Arms are doing our part to support health and well-being of families locally here in our community, and we are grateful for all those who do such work on a global level as well. You can’t have one without the other.

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Gates Foundation pledges $1.5B for maternal, child health

I just saw this news from the Gates Foundation, announced in June:

Gates Foundation pledges $1.5B for maternal, child health

This is an incredible statement of the importance of maternal and child health in our world. Melinda Gates says, “The goal is to design our work around the needs and wants of women and children, not around our own areas of expertise.” The Gates Foundation works with deep consideration to the needs of the communities they serve, for that is the way to achieve the greatest results.

Although much of the commitment in this pledge will go toward developing countries and the need is great, it’s important to note that improving maternal and child health, reducing infant and maternal mortality, and other health issues are not limited to countries away from the United States. The article states:

Death rates also rose in a few high-income countries, including the United States, although changes in reporting practices may have contributed to the increase. Looking at maternal-mortality rates globally, the United States now ranks No. 39, between Macedonia and Lithuania.

We should not forget that this work in improving the health and well-being of mothers is not only something that happens far away, but something that we should be addressing in our own community.

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Open Arms Fall Newsletter Out!

Our fall newsletter is hot off the (online) press – check it out!

Topics include:

  • Labor of Love Fundraising Update
  • Open Arms in Washington, DC (link back to this blog)
  • Short & Sweet Auction at Theo Chocolate
  • milkmakers Donates 10% of August Profits to Open Arms
  • Pay It Forward: Interview with Ericka Pollard, Birth Doula


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This World is Not Flat: Anxiety Disorders in Pregnancy by Walker Karraa, MFA, MA, CD(DONA)

This excellent article on anxiety disorders is available for download here. The author Walker Karraa offers an in-depth Perinatal Anxiety Workshop which was well-loved at Open Arms. Email her directly for more information.

This World is Not Flat: Anxiety Disorders in Pregnancy, Walker Karraa, MFA, MA, CD(DONA)

Imagine you are sitting in your care provider’s office, and next to the scary “universal pain chart” with the not-so-happy faces getting progressively more distressed and discolored, is this chart:

1 in 8 pregnant women will develop an illness that poses these risks:

  • preterm birth (the leading cause of infant mortality and disability in US)1,2,3
  • low birth weight4
  • low APGAR scores5
  • a more difficult labor and delivery with increase of PTSD symptoms related to birth6,7,8,9
  • increased chance of Postpartum Depression/Anxiety Disorders after birth10,11
  • newborn may have increased agitation12,13
  • jittery infants up to 6 months after delivery14
  • breastfeeding difficulties15
  • · child may develop learning and attention disorders later in childhood 16,17,18

Genetic Disorder? Pre-eclampsia? STD?

Nope. Perinatal Anxiety Disorder.

Current estimates are that depression and anxiety effects anywhere from 5% to nearly 25% of pregnant women ( 1 in 8 ) will have a mood or anxiety disorder.19,20,21 Nearly half of that figure amounts to the depression women feel post pregnancy because of excessive weight, a slouch stature, etc. But these can, more often than not, be tackled through weight loss programs. For pregnant women with anxiety disorders, high levels of cortisol cross the placenta and have long term effects noted long after birth.

With my first pregnancy, I began developing symptoms of depression and anxiety shortly after my second trimester. I knew something was wrong, and had both physical and emotional symptoms that were getting progressively worse. At the time (ten years ago), my providers didn’t know to ask about depression and anxiety during pregnancy—and I did a damned good job covering it up. My illness went untreated, and I ended up suffering PTSD in labor and developing severe Postpartum Depression and Anxiety after the birth. I was three months postpartum before my illness got severe enough, and life threatening, before any of us knew I needed immediate medical treatment.

Anxiety in pregnancy and birth is universal and normal. It is a normal reaction to a physically and emotionally stressful, life-altering event. Secondly, an anxiety disorder in pregnancy is a medical illness, not a character flaw or personality trait. Its etiology is currently traced to an interplay of hormonal, genetic, environmental and immunological systems of the body23,24—not the half shot of espresso in your latte, your character, or your inability to relax in your irritating prenatal yoga class. Newer research is looking at the role increased oxytocin around the time of birth in influencing the onset of Perinatal Anxiety Disorders (PAD).25 Bottom line, it is not your fault.

Symptoms of Anxiety Disorders

Anxiety in pregnancy is normal. But when anxiety in pregnancy is significant enough to cause physical, emotional, and cognitive distress–a perinatal anxiety disorder may be occurring and you need help.26

Pec Indman, EdD, MFT and co-author of the award winning book, Beyond the Blues: Understanding and Treating Prenatal and Postpartum Mood/Anxiety Disorders” offered this in a recent interview for this blog:

While it’s normal to have some worries during pregnancy (for example, “Will my baby be healthy?– or, “ Will I be a good mom”?)–women with anxiety find the worry gets in the way of enjoying the pregnancy and other aspects of life.  Women with anxiety may also have appetite changes (often difficulty eating), and find that the worry makes it difficult to fall asleep.  Some women experience panic episodes during pregnancy.  These are times of extreme anxiety where there may be hot or cold feelings, difficulty breathing or a smothering sensation, numbness or tingling in the fingers or around the mouth, a racing heart, and a feeling of loss of control.

There are several types of anxiety disorders that occur in pregnancy and postpartum, including Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, and PTSD.  You can learn more about each type at under “Get the Facts”. But generally, symptoms of an anxiety disorder in include:27

  • Excessive, ongoing worry that impacts your day to day activities
  • Thoughts of worry regarding the future, or catastrophic events occurring
  • Insomnia
  • Poor appetite
  • Physical restlessness, inability to sit still
  • Dizziness, hot flashes, nausea
  • Panic attacks

Risk Factors

Research shows that there are some risk factors that may predispose some of us to anxiety disorders in pregnancy, and can be discussed with your care provider, partner, family or trained professional. Risk factors include:28,29

  • Family history of anxiety disorders
  • Personal history of depression or anxiety
  • Thyroid imbalance

What do you do if you have symptoms or risk factors for an anxiety disorder in pregnancy?

  1. Get help. Talk to a care provider. If you can’t talk yourself, find someone you trust to do so with you. The risks are too great. Pec Indman, EdD, MFT shares:

If a woman is struggling during pregnancy it is essential to get help.  Talk to a trained (many providers have not been trained in this area) and understanding professional.   There are lots of kinds of effective treatments including counseling (in particular Cognitive-Behavioral Therapy and Interpersonal Therapy), social support, exercise, Omega-3 fatty acids, acupuncture, and medication.

Regarding women currently on medication, Pec continues:

Women who are on medication for depression, bipolar disorder, or anxiety, should consult with a prenatal (or perinatal) mental health expert before stopping medication.  We know that over 50% of women who stop their medication before, or when they are find out they are pregnant, become ill again.  Many medications can be taken during pregnancy and will help prevent a relapse.30

  1. Ask your care providers (OB/GYN, midwife, Nurse Practitioner, Family Practitioner) if they are trained in depression and anxiety in pregnancy. One tip I give women is to phrase it this way: “If I develop depression or anxiety during pregnancy or after, how will you be able to help me?”, or “How do you help women who develop anxiety or depression in pregnancy?” If it is too difficult to do that, ask a trusted friend, partner, or family member to go with you to your next appointment and help you approach your care provider. Write a list of questions and concerns before you go. Calling ahead to let the front office know you need extra time in your appointment is also a good idea.

What if? If your only option is a care provider who is not trained in this area, go to Postpartum Support International (PSI) for excellent resources to take with you to your appointment, or to find local support systems, or call the warm-line for volunteer support on getting help in your area: 1-800-944-4773. If making that call, or going online is anxiety producing, ask a trusted friend, partner, or family member to go online for you, or with you, to PSI and get the information you need.

  1. GET A TRAINED DOULA!!! Birth and postpartum doulas can help you get through birth and postpartum adjustment. I strongly suggest you hire a doula who has training in this area (birth doulas are not required to know this information, and postpartum doulas often receive little and/or outdated training on anxiety and depression disorders in pregnancy). Some good questions when interviewing doulas are:
  • What training do you have in anxiety and depression disorders in pregnancy?
  • If I get depressed or anxious, how will you know and how will you help?
  • What local resources do you give to clients?
  • How do you feel about anti-depressant medication during pregnancy and breast feeding? Any doula who is completely “anti-medication” for any medical illness needs to turn in their birth ball and get with the program (it’s a blog, I can say things like that)!! They do not have the skills to help you. Go to PSI and ask therapists in your area for referrals to doulas with experience.

Nothing Flat about  this world of Anxiety Disorders

Pec Indman notes, “Healthcare professionals used to think pregnant women didn’t experience depression or anxiety.  We also used to think the world was flat!  Thinking has changed about a lot of things.”

Just as thinking and care regarding birth has changed, health care providers are starting to get it regarding mood and anxiety disorders in pregnancy. But much like our births, women have to raise our voices to raise awareness, and in turn get the care we so desperately deserve and need, for our brains and our reproductive systems.

With my second pregnancy, I knew before I peed on the stick—based on my first pregnancy, I had significant risks for depression and anxiety, that it was a physical illness, and that the risks to me and my baby were real and needed to be avoided. I was extremely fortunate to have the financial access to good, trained providers—they are forever in my heart. And I went through a mind field of providers who didn’t know current research and made me feel like a bad mother until I found the ones who “got it”. I firmly believe when given the right information regarding our bodies and particularly our pregnant bodies, we do a damn good job to learn more, discuss with those who could help us with treatment, and make the best informed choices for our lives. Once we remind ourselves and our care providers that our brain and uterus inhabit the same body and need the same kind of care, we will be part of the move to see that the world is not flat.

A special thanks to Pec Indman, EdD, MFT for her contribution to this article, humor, and support.

Walker Karraa, MFA, MA, CD(DONA) is a certified birth doula (DONA), and maternal mental health advocate. She holds a Masters degree in Clinical Psychology (Marriage and Family Therapy) from Antioch University Seattle, and a BA and MFA degree in dance from UCLA. A survivor of postpartum depression and PTSD secondary to childbirth, Walker passionately advocates for the advancement of perinatal mental health in the birth community. She is a warm-line volunteer and member of Postpartum Support International (PSI). She is a member of the LA County Perinatal Mental Health Task Force, and presents trainings to doula organizations on perinatal mental health and doula intervention. She lives in Sherman Oaks, CA with her husband and two children, and is a humble practitioner of Mahayana Buddhism.; Twitter @allbelly;

Pec Indman EdD, MFT is a mom with over 20 years experience as a perinatal mental health psychotherapist and educator.  She is the chair of education and training for Postpartum Support International, and co-author of the award winning book, Beyond the Blues.  An updated edition will be available the end of Oct. 2010.  Beyond the Blues, Understanding and Treating Prenatal and Postpartum Depression & Anxiety.


1 Perkin, M.R., Bland J.M. et al. 1993. The effect of anxiety and depression during pregnancy on obstetrical complications. Journal of Obstet Gynaecol 100:629-34.

2 Wadwa, P.D., Sandman, C.A. et al. 1993. The association between prenatal stress and infant birth weight and    gestational age at birth: a prospective investigation. Am J Obstet Gynecol 169:858-64.

3 Orr, S. T., J. P. Reiter, D. G. Blazer, and S. A. James. 2007. Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine 69 (6):566-70.

4 Ibid.

5 Ibid.

6 Beck, C. T., 2004a. Birth trauma: In the eye of the beholder. Nursing Research 53, 28-35.

7 Beck, C. T., 2004b. Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research 53,           216-224.

8 Keogh, E., S. Ayers, and H. Francis. 2002. Does anxiety sensitivity predict           post-traumatic stress symptoms following childbirth? A preliminary report. Cognitive Behavioral Therapy 31 (4): 145-55.

9Kelly, R. H., J. Russo, and W. Katon. 2001. Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive              and anxiety        symptoms amplification revisited? General Hospital Psychiatry 23 (3):107-113.

10 Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.

11 Rambelli, C., Montagnani, M.S. et al. 2010. Panic disorder as a risk factor for post-partum depression: results from the perinatal depression-research and screening     unit study. Journal of Affect Disord,122(1-2):139-143.

12Coplan, R. J., K. O”Neil, and K. A. Arbeau. 2005. Maternal anxiety during and after pregnancy and infant temperament at three months of age. Journal of Prenatal and Perinatal Psychology and Health 19 (3):199-215.

13Tagle, N., Neal, C., Glover, V. 2007. Antenatal maternal stress and long term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48, 245-261.

14 Ibid.

15Britton, J.R. 2007. Postpartum anxiety and breastfeeding. Journal of Reproductive Medicine, 52:689-695.

16 Weinberg, M. Tronic, E.Z. 1998. The impact of maternal illness on infant development. J Clinc. Psychiatry 59(suppl 2):53-61

17O’Connor, T. G., J. Heron, and V. Glover. 2002. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child and Adolescent Psychiatry 41 (12): 1470-77.

18 Ibid.

19 Onunaku, N. 2005. Improving maternal and infant mental health: Focus on maternal depression. National Center for Infant and Early Childhood Health Policy at              UCLA.

20 Knitzer, J., Theberge, S., Johnson, K. 2008. Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework.  National Center for Children in Poverty, Project Five Issue Brief 2.

21 Gaynes B., Gavin, N., Melter-Brody, S., Lhor, K., Swinson, T., Gartlehner, G., et al. 2005. Perinatal depression prevalence, screening accuracy, and screening outcomes: Summary, evidence report and technology assessment, No 119. AHRQ Publication No. 05-E006-1.

22 Ibid.

23 Altemus, M. 2001. Obsessive-compulsive disorder during pregnancy and postpartum. In: Yonkers, K., Little., B. (eds) Management of psychiatric disorder in pregnancy. Oxford University Press, NY, pp 149-163.

24 Stein, D.J., Hollander, E., Simeon, D., et al. 1993. Pregnancy and obsessive-compulsive disorder. Am J Psychiatry 150:1131-1132.

25 Bartz, J.A., Hollander, E. 2008. Oxytocin and experimental therapeutics in autism spectrum disorders. Progressive Brain Research, 170:451-462.

26 American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (4th ed, text revision). Author, Washington, DC.

27 Ibid.

28 Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.

30 Cohen, L.S., Altshuler, L.L. 2006. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA, 295:499-507

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Quote of the Day

“You are a midwife assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must, take the lead, lead so that the mother is helped, yet still free and in charge. When the babe is born the mother will rightly say, “We did it ourselves!”

From the Tao Te Ching, Lao Tsu 5th Century B.C.

This applies to doulas too!

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The Two Gardens

This is a guest post by Jennifer McArthur – thanks Jennifer!

It was suggested that I attend the Health Connect One Reception on Saturday during the DONA Conference in Albuquerque New Mexico. At the reception each group was asked to stand and talk about the work that was happening in their organization. It wasn’t long before I realized I was sitting in a room of some of the most influential women in childbirth; women who both take their agenda straight to the White House and who are doulas in their communities. It was quite apparent that these doulas are passionate about birth, choices in birth, and the rights of laboring women. They are thoughtful, compassionate and focused. I was deeply moved and am glad that I was encouraged to attend. For me, it was the most impacting event during the entire conference. And, if I am ever honored to attend an event at the White House, I’ll be sure to leave the high heels at home!

I want to share something that happened to me at the conference. I felt safe with the women from the reception and with the best of intentions started an amazing conversation later in the evening with a doula from Georgia. I believe her name is Hanifah. We were the only two left at the table and I turned the discussion towards racism. I recounted an event that had happened to me earlier in the day where I had entered the elevator and then a black lady entered with me. The white family that was also headed towards the elevator made an obvious move backwards and said, “We will take the next elevator.” I was stunned and when the elevator doors closed, I turned to the other lady and said, “Are you serious?” After recounting this story to Hanifah, I told her that I didn’t understand this type of behavior and she said that this happens every day. She also said that my lack of understanding was my privilege, because I was white.

Hanifah went on to tell me an interesting story about a professor that bought a house which had two gardens. In one garden were flowers that had been previously planted. The other garden was empty. The professor decided to leave the previously planted garden to grow on it’s own and planted the empty garden with pink flowers, the professor’s favorite. The professor went on to tend lovingly to the newly planted garden, giving it time and nourishment. It grew a variety of beautiful, pink flowers. In the other garden, which was not lovingly tended to, the flowers struggled, only a few of the strongest surviving.

As the story unfolded, I began to see the racism differently. That story has impacted and challenged me as a privileged, white woman. The learning continued when I recounted the flower story to a Sheila Capestany at Open Arms, back in Seattle. Sheila corrected me when I said, “I can’t believe that the white family wouldn’t get into the elevator because a black lady was in it” by telling me that it wasn’t because a black lady was in the elevator, it was because the white family was racist. 

Starting with the reception through the table conversation, I gained a clearer understanding of the impact that these doulas have on the childbearing women and the communities they serve.

I am discovering that I am my own beautiful flower growing within the most amazing, colorful garden I’ve ever seen, nourished by the women who surround me. Now that is a privilege.

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“I wasn’t alone” – a Labor Day challenge

Open Arms clients say it best:

“I wasn’t alone. My doula spoke Spanish and it helped me understand better what the doctor and nurses were saying to me because I don’t speak English. I am so grateful for my doula.”

“My family gave me love but my doula gave me my strength. I couldn’t do this without her.”

“I wish I had this kind of support when I had my first baby ten years ago.  I’ve learned so much – it would have made things really different the first time.”

Imagine giving birth alone in a place where you don’t speak the language! I can’t even imagine, but it happens every day. What is the value of support at such a pivotal time in life? It can’t be measured. This is a time that can change the course of a woman’s life – and that of her newborn baby.

As you know, Open Arms provides services to low-income women, women of color, refugee and immigrant women, and teens. Of our clients, 84% are at one hundred percent of the poverty line or below; 60% are refugees or immigrants; and 27% do not speak English as their primary language. However there are more women asking for services than can be served and those we can’t serve, often go on to birth alone.

We don’t want to turn away clients. We want to have doula support available to every woman who wants one. You can help.

Why do doulas make a difference?

  • Pregnancy and birth are a transformative time in the lives of women and their families. Positive social and educational support during this time can have a tremendous impact on the health and well-being of new mothers and their families.
  • Research shows women who have doula support have fewer complications such as c-sections, lower rates of postpartum depression, and are more likely to breastfeed.
  • When a mom receives good support during birth and early postpartum, she’s more likely to attach well to her baby – and this decreases risk of infant mortality and early child abuse and neglect. It’s so much better to prevent these problems from even occurring!
  • Parent/child attachment is an essential element in creating a solid foundation that ensures that children thrive in their learning and readiness for kindergarten.

Open Arms has a challenge for you – by Labor Day, we’d like to fund five doulas for women who would otherwise birth alone. Will you help? Visit our Labor of Love fundraising page and donate to help fund a doula for a woman who needs one.

And if you’d like to help Open Arms by creating a fundraising page of your own, we’d love to have your help! Click the Labor of Love link above, click “I want to raise money too!” and choose “for this nonprofit.” Follow the instructions and help us ensure that every woman who wants one can have a doula.

If you are someone who cares about women’s work, families, birth, early education, child abuse, neglect, infant mortality, postpartum depression, health disparities – please help us give more women support during pregnancy, birth and postpartum. It makes a huge difference!

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Postpartum mood disorders booklet available

Postpartum Support International of Washington recently released their booklet about postpartum mood disorders called Beyond The Birth: What No One Ever Talks About. They write this on their website:

Beyond The Birth: What No One Ever Talks About is a short booklet that describes the emotional transitions to motherhood, and the difference between “baby blues” and more serious Postpartum Mood Disorders. It discusses causes, risk factors, and treatment options in easy-to-understand terms, and features a list of resources and further reading.

All types of health care providers, including pediatricians, obstetricians, social workers, nurses, doulas, midwives, family practice physicians and psychiatrists have found the book useful. Expectant and new mothers and their families also use it to understand what they are experience and, if necessary, look for help.

The cost of the book is $6.50 and it’s available in English and Spanish. You can buy the book here.

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Enter the cultural navigator

One of the most interesting things about being a community-based organization is that at work on a daily basis, cultures clash. I don’t mean that in a destructive way, although sometimes it can be uncomfortable to sort out. But because Open Arms has a community-based program and our communities are very diverse, we are finding that there’s a deep need to have help in navigating these cultural differences.

Culture is a fascinating thing. It permeates everything we (and yes, you) do, our attitudes, our decisions, our very way of life, and yet most of us are unaware of how deeply culture is ingrained in who we are.

Each community has a culture – not only individual communities such as the American, Somali or Latina communities that we work with, but the cultures within particular families, religions, and even different areas such as educational systems, social services, or health care and medicine. Whenever different cultures interact, there is the potential for misunderstanding, and with that comes either the opportunity to communicate and learn, or a risk of breaking down into conflict or avoidance.

Ideally everyone would be aware of our own culture enough to step away from the issues at hand to explain our own cultural assumptions and find the overlap and the areas of difference – but let’s face it, that is a lot of work. Most of us carry on without defining or even thinking about our basic cultural assumptions and then are shocked when suddenly we realize we had a conversation that failed to have any degree of connection or understanding. As a very simple example, how many marriages fall apart because spouses each come from a particular family culture – perhaps the wife’s family may argue loudly and passionately to reach a resolution in a conflict, whereas the husband’s family prefers to withdraw until the problem becomes clear and then discuss in a rational, unemotional way. Both thinks their way is the “normal” way, even the “right” way, because it’s ingrained in their family culture. It’s not a problem until the two different cultures meet in times of stress and neither understands or respects the other. If neither is able to address their cultural differences, the actual issues at hand will likely not be resolved either and the relationship eventually dissolves. Or, what if someone finds out they have a severe illness – if culture says that one must accept this and nothing can be done, then is that person able to follow instructions to improve health or begin treatments? If it’s pointless, why would someone make changes to improve health? Understanding cultural assumptions is critical.

The arrival of a new baby is filled with traditions in every culture. Most of the time, there isn’t a reason to clash. Yet Open Arms doulas regularly find themselves serving new families when suddenly a crisis happens: there is a medical event during the pregnancy, the baby is born ill, a severe illness in the family requires hospitalization and ongoing medical treatment, or any number of other situations. Once a family is thrown into the medical culture or the American culture in a time of crisis, communication and understanding can fall by the wayside and huge problems can occur unless this cultural component is addressed. The stakes are high – for example when a family finds themselves with a baby admitted to the hospital, the doctors want support from family to follow instructions, but if those instructions aren’t understandable in terms of the family’s culture, they won’t (and can’t) be followed. Each has the baby’s best interest at heart, but without a deeper understanding of both sides, communication will fall apart and frustration escalates.

Enter the role of cultural navigator. Open Arms doulas are from the communities they serve but are also very familiar with American culture, and therefore are truly able to help a client (and sometimes a caregiver) navigate not only the issue at hand but the culture as well. Families are better able to take care of themselves, ultimately leading to better outcomes. By empowering our clients with information about differences in culture and identifying underlying assumptions, and by helping the medical profession learn more about the culture of the patients they serve, everyone benefits.

The idea of cultural navigator is a concept that is just beginning to take form. What does it mean to be a cultural navigator? What does a cultural navigator do? Cultural navigation affects families, caregivers in the medical profession, educators and others. Although the Open Arms role is to serve women throughout the childbearing year, the need for cultural navigation is broad and deep. We hope to begin this discussion over the coming months.

We invite your comments and experience on this topic.

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