Support and Sanity Savers Handout

I’ve created so many resources over the years that I sometimes forget about some. I got an email today reminding me about this one I wrote back in 2003, with two other educators (Tawnya Ostrer and Jamie Olson)… I looked back and, you know, it’s pretty good! So, I updated it, and will share it here.

This is a handout to be used in a childbirth education class or with doula clients, which encourages expectant parents to plan ahead for practical support, emotional support, and peer support. It also includes a letter that they can give to friends or family members who ask how they can help.

Postpartum Support and Sanity Savers – PDF

Postpartum Support and Sanity Savers – Word (you are welcome to edit the document to substitute your local resources for the Seattle area resources I list. Otherwise, please use as written, with copyright info intact.)

And here’s a related handout to help them plan for a division of labor after birth: Baby Care Plan

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Talking about Prenatal Mood Disorders in Birth classes

pregnancydepressionMost childbirth educators are covering postpartum depression in their classes. Some are also covering other postpartum mood disorders such as anxiety and obsessive compulsive disorder which are quite common. (Depression affects 10 – 20% of new moms, Anxiety or panic disorder affects ~10% and OCD affects 3 – 5%). And hopefully they’re also pointing out that a person can experience multiple disorders at once – for example, she can have depression AND anxiety.

A few educators are remembering to include partners – about 5% of new dads have a postpartum mood disorder.

But I wonder how many of us are talking about mood disorders in pregnancy?

Incidence of Mood Disorders in Pregnancy

Of women who experience depression after birth, a third say it started during pregnancy. (Source) Sometimes, depression is missed because symptoms can be mistaken for the fatigue or appetite disturbances associated with pregnancy. Estimates of incidence of depression in pregnancy range:

Rates determined by structured interview have ranged from 2 to 21% and up to 38% for women of low SES. Estimates derived from self-report questionnaires have ranged from 8 to 31% and 20 to 51%, respectively. Source.

Almost one third of women with manic depression (aka Bipolar disorder) report onset during pregnancy. OCD often begins in pregnancy (pre-existing OCD is usually exacerbated by pregnancy). Interestingly, pre-existing anxiety / panic disorder  may actually decrease in pregnancy due to hormonal effects. Source

How do we talk about this in childbirth classes?

I see multiple places we could address this:

1) when talking about discomforts of pregnancy and the physical changes of pregnancy, you could also address emotional changes and challenges

2) when discussing self-care in pregnancy, could include emotional self care and talk about mood disorders there

3) when talking about postpartum mood disorders.

I find it works well for me to cover it when talking about postpartum mood disorders.When I’m almost done with that topic I say “Although you may hear a lot of talk these days about postpartum mood disorders, we know that they begin in pregnancy for a third of the women who experience them. If you were just listening to my description of symptoms and thinking ‘I feel that way now’, then you may be experiencing a prenatal mood disorder. All the resources for support and techniques for self care I just talked about can also help with pregnancy mood disorders. I would encourage you to reach out for support now – the sooner someone gets support, the sooner they start feeling better. If you have concerns or questions, you can talk to me after class or by email.”

So, it works well for me to cover it near the end of the series when I’m talking postpartum. But, I could also make an argument that it would be better to cover it as early in the series as possible so that parents who are experiencing it get support as early as possible.

When do you (could you) cover it in your classes?

For more resources on perinatal mood disorders, see http://ppmdsupport.com/index.html
photo credit: Maria & Michal P. via photopin cc

Grab Bags

Grab bags are a fun and interactive teaching technique that is easily adapted to a wide variety of topics. Basically, you gather up a collection of small items that symbolize each topic you want to cover – you may find these things around your house, in your kid’s toybox, at a Goodwill or a dollar store. Put them in a bag. At class, pass the bag around, and each student takes one (or each couple, depending on how many items there are). They then hold it up to show the other students, and they talk about how they think it relates to the topic, and you follow up with any additional information or discussion to add some more “meat” to the conversation.

What kinds of topics it works well for:

I use it for places where I have lots of little things I want to talk about that don’t need to come out in any special order… basically, whenever I find myself with a  lecture with 7 or more bullet points, I know that will seem like just an endless jumble of info to my students, so I start thinking about other techniques to use, and this is a great one.

I also find it works well for introducing the awkward topics. During the prenatal wellness section, when discussing all the things students “shouldn’t do”, it’s easy to turn into a nag. Here, when the candy cigarette appears, I “have to” talk about smoking but it  feels less judgmental. During postpartum, when the condom appears, it introduces the topic of sexuality after baby in a gentler way than me announcing “Sex” or writing it on the board.

However, don’t overuse it! I think it would feel gimmicky and tired if you used it multiple times in one series.

Here are examples of topics I have used it for:

Prenatal Wellness Lunchbox: I use one of my daughter’s old lunchboxes to contain this – I think it’s nice for our students to see signs that we are parents – it helps them connect. I fill  it with items that symbolize healthy choices for pregnancy, and not-so-healthy choices.

Sample items: calcium tablets, iron supplements, raisins, protein bar, tuna, caffeinated soda, a prenatal appointment reminder card, flyer for prenatal exercise class, cigarette, alcohol, Tylenol, condom, plastic baggies with “substances” in them. I label them so they know what it’s supposed to represent, and what it really is: “cocaine (baking powder)”, “marijuana (parsley)”, and so on.

Comfort items for labor: When I introduce it, I talk about how every pregnancy book has a list of items you should take to the hospital. But you often don’t need them all. For example, if it says “eye drops” and you don’t own any eye drops, you don’t need to go out and buy them! They’re not one of the comfort items you use in your life. But they are a good reminder to people who wear contacts to consider bringing contact supplies or a pair of glasses if needed. Then I say “So, this bag is just a collection of ideas about what kinds of things people find helpful for comfort in labor. Hold up your item, say how you think it would be useful in labor, and then say whether you think you would find it helpful.”

Sample items: heating pad, ice pack, massage tool, tennis ball, snack (clif bar, peanut butter crackers…), water bottle, CD (note that many students will use their smart-phone for music… the CD is a little dated, but I’m not putting my phone in the bag…), reflexology combs, toothbrush, mints, shorts, sweater, etc.

Postpartum adjustment: items that address physical, emotional, and lifestyle adjustment. Sample items: Maxi pad, peri bottle, tucks pads, stool softeners, condoms, breastmilk pads, kleenex (to symbolize baby blues), phone number for PPMD hotline, alarm clock (to represent sleep / frequent wake-ups), easy-to-eat food, phone to represent reaching out for support, red silk rose to talk about romance / relationship after baby.

A grab bag alternative… If you feel like you’re over-using the grab bag technique, but want some of the same effect, Teri Shilling from Passion for Birth has a postpartum bathrobe, where she fastens all these symbols all over a bathrobe that she wears when she presents this topic. It’s a very entertaining visual aid!

Try some experiments with grab bags. They’re always entertaining!

A note on number of items: My class size can vary from 6 couples to 14 couples. I may have 14 items in a bag. If I have 14 couples, they draw one item per couple. If I have 7 couples, they draw one item per person. But if I have ten couples, then I have two options for how to handle it. Pass the bag around once and have them take one item per couple, then pass it again, asking those who are willing to take a second so we can cover them all. Or, I can edit the bag before passing it around and only include the 10 most important items and put four others away.

An Icebreaker about the Postpartum Period

Today I taught about the postpartum period. I want to cover three areas under this topic – physical recovery, emotional adjustment and PPMD, and lifestyle changes / tips for coping with life with a new baby.

Over the years, I have done this as a lecture and as a grab bag exercise, I’ve had new parents visit class to talk about what the experience has been like for them, and I’ve had students read a series of quotes about the postpartum period (note: this just covered emotional stuff and lifestyle changes, not the physical recover topics).

Today, I tried something new, invented in the car as I drove to class.

I did a brief introduction, saying: “We’ll be talking about the postpartum period, after baby has arrived. I’m guessing that you have been hearing stories and advice from friends, family, and co-workers about this – probably some positive stories and some horror stories – some helpful advice and some not so helpful advice. I’m going to divide you into three small groups, and I want you to share with each other what you have heard about these topics.” Then I wrote on the board:

  • Physical recovery after birth
  • Emotional adjustment
  • Lifestyle changes – getting enough sleep, self care, juggling work and baby, housework, relationship changes

I let them talk in their small groups for about ten minutes. It was a lively discussion – this was week 3 of a class series, and we’ve been doing a lot to build community so, I knew they’d be willing to join in.

I then brought the group back together, and we talked more about each thing – what they’d heard, what they wondered, then I added more details.

If I lecture on this, it tends to take me 15 – 20 minutes, but in some ways that feels both too long a time of dumping information on them that they don’t yet know that they need, but at the same time, it feels like I skim over the basics but they don’t really connect / sink in as much as I’d like.

Today, it took ten minutes for the small group time,and about ten minutes to review together where I was able to cover all the content in a good level of detail. I felt that

  • it was a successful community building exercise that they enjoyed
  • during the discussion time, they realized that although they had lots of tidbits about the postpartum period, they didn’t really know much
  • and that realization then led them to be very engaged / interested in learning more, so they connected more with the discussion that followed – both in terms of absorbing practical information and connecting with it emotionally

Another successful classroom exercise invented on the drive to class!