Advice for Health Care Providers
Women provided advice to healthcare providers about the need for improvements in communication, education, compassion and support for both moms and babies throughout the perinatal period. Specifically, comments addressed the following areas:
- Improved communication and coordination
- Greater awareness, education and training about postpartum depression (PPD) and psychosis
- More emotional and psychosocial supports for pregnant or new moms
- Compassionate, holistic care for women and their babies
The women that we spoke to commented that providers were less aware about perinatal mental health and postpartum depression (PPD) than expected.
Susan would like to see greater awareness of PPD and more support for women.
Transcript
I think just the raising awareness about it. Making pregnant moms, pregnant women, first time moms especially aware that, and maybe providing them with information, you know, for supports or contacts in the community and maybe, you know, warning signs to look for. And you know, not just giving it […]
Communication and Coordination
Amanda1 wanted healthcare providers to “please talk honestly” about mental health and risks of pregnancy loss and not speak in general or vague terms. Women described feeling significant stress and confusion when different providers offered vague, inconsistent or conflicting information. Likewise, women felt confused and frustrated when professionals were not willing to communicate directly with other providers – leaving it to the patient to convey important details. Zoe describes a disappointing experience with a provider who did not skillfully address the issue of depression medication and pregnancy and did not refer her to someone else with more expertise.
Zoe wanted clear, tailored care that applied to her specific situation.
Written testimony
When you’re told by a social workers at [healthcare clinic], I don’t think you should be pregnant on Paxil [an antidepressant medication], that’s not the information I was looking for. Also, so either refer me somewhere or have the damn right information instead… – I think professionals whether they’re pharmacists, GP’s have to approach it in a more nuanced way. I mean they should really, I get it. It’s one thing to open the book and say you can’t take this medication because it’ll cause – but, the way I see it is it’s the woman’s body, it’s the woman’s mind and body and spirit that’s carrying this child, right? Shouldn’t you ensure the wellbeing of the carrier of this new life?
Amanda1 feels that professionals should communicate directly with each other, and not rely on patients for information.
Transcript
Another thing I would suggest is to not rely on the patient always to do the communicating. I don’t think I would have got such great care as I did if the public health nurse hadn’t communicated with the family doctor. And the family doctor hadn’t communicated with the social […]
Leah says improved consistency of information and better teamwork means less stress for women.
Transcript
I think one of the problems that I have with my first is, I was seen by so many different people and getting such conflicting information from the different people. That was really stressful for me. Yeah, we had that nurse that was coming into the home and then I […]
Education and Training
Women felt strongly that knowing the warning signs and symptoms of mental health problems during and after pregnancy, including post-partum depression and/or psychosis should be a priority for providers and women alike. Information was given to women in ways that was not always helpful – sometimes too late, too much all at once, or missing important contacts that would have been helpful. Overloading women with a stack of handouts when they are overwhelmed with a newborn was not appreciated. Pre-natal visits, routine check– ups, and pre-birth tours offer many opportunities to discuss mental health, provide education about signs and symptoms of post-partum psychosis and depression.
Julie advises giving women information at the appropriate times, when they can absorb it.
Written testimony
The one actually really concrete piece of advice I would have that I think is very easy to fix is, you know, upon discharge we were given, like, pages and pages and pages and pages of material to take home to read. Like, why wasn’t that given to us prior to our [baby] being born? Like, I just – and, you know, within that there was, you know, probably 15 pages deep, there was stuff about from a physiotherapy perspective about doing, like, Kegels and stuff, which I missed. I completely missed all of that. Like, you know, I had no idea of what I was or wasn’t supposed to be doing from a physical perspective. And I was actually told by the discharge nurse to walk as much as I possibly could. Well, if you tell a walker to walk as much as possibly could and that was the way I processed stress, I walked and walked and walked and walked and walked a ton, and that actually I think contributed further to my physical harm and not resting. “So my point to all of this is that, you know, when we think about best practices for educating people, it’s not during their time when they’re completely overwhelmed and sleep deprived and, like, dealing with trying to keep a little human alive and breastfeeding and doing all this stuff. Like, there should be – material and that kind of education it should be done, like, way in advance of someone actually going, like, you know, at the same time.
Amanda1 says an overwhelming 'information dump' challenges new moms.
Transcript
I think one of the challenges sometimes with information is a bit of a, you know, information dump. You think “Oh if I just give them 40 different brochures they’ll figure out which one’s right for them.” [laugh] And, and we tend to sort of dump it on them. And […]
Mirian recommends the use of a diagnostic questionnaire and to talk about treatment approaches.
Transcript
Like, here are a few things that we should look at specifically regarding postpartum depression. And I think that there should be some sort of questionnaire to maybe help with a diagnosis. And also I think they should be able to talk about the several types of therapy there are […]
Emotional and Psychosocial Support
Advice for healthcare providers highlighted the need for routine emotional check-ins with pregnant women and new moms, with a discussion about how they will cope after delivery. Practicing compassionate care was recommended by being aware of red flags and addressing concerns before they become extreme. Women wanted a more balanced, supportive approach to care. Susan felt pressured to choose breastfeeding over other choices, even if it did not work for her. Krysta advised healthcare providers to be alert to her mental health needs, alongside those of her baby’s. “To not dismiss red flags. To really – I feel like I was pretty open with, you know, the possibility of having post-partum depression and anxiety and even when I had it, I feel like many doctors saw the red flags but just I feel like it wasn’t until I was screaming like, “I’m really, really, really suffering. I need help,” then only did I get support.
Aurore encourages providers to do 'emotional check-ins' and find out about the support plan for the new baby.
Transcript
I guess what I would encourage the training to involve, and encourage new midwives to consider, is to have… to create space, and allow space in appointments for that emotional check-in. The how are you doing, not just physically, but, how is it feeling, what’s it like, are you… how […]
Offer support, reassurance and recognize that one approach does not fit all, advises Susan.
Transcript
I think in hospitals when you see all those breast is best posters, it really kind of brainwashes you into thinking that there’s no other way and when you’re pregnant you have this feeling of, you know, you’re going to have this perfect world and everything is going to be […]
Leah advises paying more attention to the health of mom and baby.
Transcript
I certainly wished in my experience, that they would have just been more direct with me and kind of treated things more as a treatment for my baby and for me. I wish that I guess, yeah, had been recognized a little more that my postpartum and mental health was […]
Inclusive Care for Mom and Baby
Postpartum care often focused on the baby, but moms need attention too, especially for their mental health and overall recovery. As Leah says “ I certainly wished in my experience, that they would have just been more direct with me and kind of treated things more as a treatment for my baby and for me”. Listening and validating with compassion and having greater sensitivity to trauma was recommended, recognizing that interaction with the medical system can contribute to traumatic experiences.
Karmin advises providers to use a trauma-informed care approach.
Transcript
From the health care provider perspective I think having that, like, trauma informed care and then also to, like, being aware of the signs and symptoms and – yeah. Just like somewhat normalizing the mental – the mental health – or the mental illnesses, like kind of normalizing them, but […]
Be accountable and aware of trauma, says Emma.
Transcript
I would definitely say that doctors and healthcare professionals that come into any contact with a pregnant woman or a birthing woman or person, they need trauma counseling, they need to hold accountability for their contribution to trauma, and support. And also, I think that there’s more services needed for […]
Julie wanted providers to advocate for and listen to women and to include them in a less medicalized birth. “I think you know, really listen to people and make space for people to share how they are doing. And for health professionals to also be advocates”.
Julie advocates for less medicalized approaches to birth.
Written testimony
One I would say just even around the birthing process is I wish I trusted my body more. And the experience was less medicalized. I think a lot of my problems started from the induction itself. And I – so whenever, you know, pregnant women talk to me and, you know, through my circle of friend network I’ll always just say to them, like, just make sure that you follow what – your gut and, like, what you want to do and listen to your voice. Because I think at the end of the day, like, I think our voices matter and I think the medical profession needs to listen more to women and their families as to what they want and what are their needs. And, you know, yes, you can throw statistics about stillbirths et cetera but at the end of the day, like, you know, to pressure someone to have an induction with a threat that if anything happens it’s the mom’s fault is not OK. So, I wish I had – if I could talk to myself back then I would, you know, encourage myself to push back more and to listen more to what I want the experience to look like.