• There are a few different types of doulas: labor, postpartum, sibling, to name a few.
• In general, it is more helpful to a midwife for a laboring person to have a labor doula.
• A doula doesn’t have to be certified. Some of them do have some kind of a certification, but they don’t have to. 
• A doula is a support person who is there for you during your pregnancy, labor and postpartum (depending on the type of doula).The main difference between an OBGYN and a midwife is that an OBGYN is a medical doctor and trainer surgeon. A midwife is not.
• A certified nurse midwife is an RN (so they have a BA in nursing) and also have either a master or doctorate degree. They have passed a certified board exam to be a midwife. They can practice in a hospital or birth center or home. 
• Certified professional midwives are not licensed to practice in all states but they are certified. They aren’t required to have any kind of education. They take a licensing exam and follow an internship model.
• Questions to ask your OBGYN and Midwife before hiring your provider depends 100% on you, and you have to weigh risks and benefits. Example questions: What’s your C section rate? What’s your episiotomy rate (that’s actually something that should only be performed in an emergency situation).
• Sarah recommends a book called The Thinking Woman’s Guide to a Better Birth by Henci Goer because it gives a great rundown of all scenarios to help you decide what kind of provider you want, and what kind of birth you’re comfortable with.
• Sarah discusses a condition her daughter had for the first month after she was born called Torticollis, which is a condition that effects the muscles of the neck from the head being stuck in tilted position in the womb.
• Sarah discusses a term called PMADS, which stands for Perinatal Mood and Anxiety Disorders. It an umbrella terms for all of the mood disorders associated with pregnancy and postpartum (anxiety, depression, psychosis, baby blues, OCD, rage, etc.).
• About 20% of people experience postpartum depression. 
• Postpartum anxiety hasn’t been as well studied as postpartum depression so the numbers are not as exact. The estimates are anywhere from 10-30%. 
• The baby blues is another mood disorder believed to affect most if not all postpartum women. It’s defined as weeping and crying that lasts up to 2 weeks after the baby is born. It’s caused by shifting hormones, lack of sleep up to 2 weeks after the baby is born. 
• It can be dangerous to dismiss everyone is having the baby blues because in doing so, you may miss other disorders, like postpartum psychosis. This kind of disorder is often the horrific stories you hear in the news about mothers harming their infant children and/or themselves. If you think they are talking to God or getting a vision or acting very out of character, hearing voices and just recently had a baby, that is postpartum psychosis.
• Postpartum OCD generally tends to manifest during reproductive transitions, and it tends to manifest around the baby.
• The difference between postpartum depression and postpartum anxiety is that in postpartum depression, it looks a lot like being disinterested, it might be sadness, weepiness, it might be lethargy, it might be feeling disconnected from your baby, not bonding with your baby. It might be losing interest in your activity disconnecting from your family and friends. 
• Postpartum anxiety might be feeling really unsettled. It might be worrying so much that you can’t relax. It might be worrying more than 8 hours a day. It might be being fidgety and restless. It might be some anger. 
• Postpartum rage can occur in both postpartum anxiety and postpartum depression.
• One of the biggest risk factors for any type of mood disorder is a past history of mood disorders.
• If you don’t have to fit the exact description or any disorder, all that matter is if you’re not feeling right or like yourself, you can go get help. 
• Unfortunately, many people don’t know what to do with postpartum women. Most care providers don’t know what to do. There is an international organization called Postpartum.net. You can call your local chapter, and they will be able to refer you to someone who specializes in postpartum mood disorders. 
• Our healthcare system isn’t set up to help women in their postpartum phase. For example, The American Academy of Pediatrics recommends that all women are screened for every visit in the first year. But most pediatricians don’t screen because they can’t treat the women and they don’t really know what to do. 
• The treatment for postpartum mood disorders might not be in a bottle. It’s probably the way we have structured our communities and our economy and it probably has a lot to do with the American work ethic. We send women back to work too early after having a baby.

About Sarah

Sarah Toler is a Doctor of Nursing Practice and Certified Nurse Midwife who specializes in postpartum mood disorders. Sarah currently works to spread awareness about reproductive health and postpartum mood disorders by educating people about their bodies and minds through her writing. She also works with Postpartum Support International through their annual Climb Out of the Darkness Walk. Sarah is a survivor of postpartum depression, anxiety and OCD.

CONTACT INFO:

Linked In: https://www.linkedin.com/in/sarahtoler/

Resources in this episode

• ACOG: American College of Obstetricians and Gynecologists
• Book recommendation:The Thinking Woman’s Guide to a Better Birth by Henci Goer
• Sarah’s paper on Postpartum Anxiety: “Screening for postpartum anxiety: A quality improvement project to promote the screening of women suffering in silence”
• Postpartum.net – visit them if you feel like you are afflicted with ANY kind of perinatal or postpartum mood disorder. There is help!
• Reproductive Health App Clue (and the corresponding website, Hello Clue)
• Sarah’s article in Hello Clue:How Coronavirus Impacts Pregnancy, Breastfeeding and Postpartum
  

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