My dear friend and colleague, Divya Kumar, does amazing work. She's certified as a postpartum doula and lactation counselor, runs groups for new moms, and uses her public health background to develop and advocate for effective programs that actually improve access to comprehensive support for pregnant and postpartum women. All in the name of not just treating postpartum depression, but fostering emotional wellness. Here's my interview with her about the pilot program that was funded* by the state of Massachusetts to integrate postpartum support into existing medical systems.
Tell me how the pilot program came about.
DK: I was transitioning back to working outside the home after my second child was born and I started working as a postpartum doula. I have a public health background, and I tend to think in terms of systems and programs. I think about who has access to what services--and how and why. Every new mom can benefit from a postpartum doula, but not every mom knows what one is or can afford one, so I started thinking about how to increase access to postpartum doula services for all moms, and I thought it would be fantastic to have a postpartum doula in every pediatrician's office so that new moms could get emotional support, ask questions about things like sleep and soothing, and get help with breastfeeding.
When my first child was a newborn, I had met Jessie Colbert at a local new moms' group. She is the administrative aide for Rep. Ellen Story, who chairs the Postpartum Depression Commission. So later, when I came up with the idea of integrating postpartum support into pediatric health settings, Jessie suggested that we develop this program as a postpartum depression prevention initiative. Rep. Story pushed for funding and the pilot program received $200,000 in 2013 to be split across four community health centers that serve a diverse patient population, including folks who are disenfranchised and under-served.
What exactly does the pilot program look like?
DK: The pilot looks a little different at the different community health centers, meaning that the centers have incorporated and built upon different aspects of perinatal care based on the capabilities of their own sites and the needs of their patients. In Lynn, mental health providers do home visits for new moms experiencing perinatal emotional complications. In Worcester, a team of OB advocates work with moms from pregnancy through the first two years of their child's life. In Jamaica Plain, we provide lactation support in our pediatric service, regardless of whether a baby's mom is a patient at the health center.
What makes this different than other efforts to address postpartum depression?
DK: One of the big differences is that the pilot program integrates perinatal support into existing medical systems, and this integration reduces barriers and increases timely access to care for folks who need it. Being a new parent can be exhausting and overwhelming, and for folks who are disenfranchised by poverty or other extenuating circumstances, timely access to comprehensive services is key. At Southern JP Health Center (where I work), we see all new babies at their first pediatric visit--as early as 3 days postpartum! I come into the exam room after a physician sees a baby and screen the new mom for postpartum depression with the EPDS [Edinburgh Postnatal Depression Scale]. Also, providing comprehensive services means that we approach the mom and baby as a dyad. So, if a mom is struggling with perinatal emotional complications, I can connect her with a mental health provider in-house or in the community, and I can also help with issues within the dyad (breastfeeding and lack of sleep are the usual culprits here!) that can be exacerbating these complications.
What difference do you see yourself and the program having in people’s lives?
DK: I have had many moms tell me that they would have given up on breastfeeding if I hadn't walked into that exam room! It is such an honor to be in a position to help someone in that moment of distress. I have also walked patients who were having a mental or emotional health crisis up to our mental health department, where they were seen within the hour. Without screening them at their child's appointment, there's no way to know whether that crisis would have been identified and if they would have received mental health support. Also, I have had numerous moms contact me months after their babies were born to ask questions, get referrals, or just additional support, and many of these moms say to me, "It's so helpful to know that you're here to help me figure all of this out!" Having someone that they know they can contact with questions or concerns (especially those that are not directly related to their baby's health) is very reassuring for moms.
What do you see happening next for the pilot program?
What’s one thing you would tell all mothers of newborns?
DK: You're not supposed to do this by yourself! New moms are really isolated these days--many of us don't live with our parents or siblings, or in a home where friends and relative are constantly coming and going. I have heard many moms say, "I feel like I'm supposed to be able to do this by myself, but it's really hard!" Taking care of a newborn, figuring out breastfeeding, and adjusting to life as a parent involves a HUGE learning curve...while being utterly exhausted and recovering from the actual birth. Doing it yourself is often a very, very difficult task, and not one that new moms should have to take on. Ask for help. Accept help. Call a lactation professional. Call a friend. Go to a moms' group. Parenthood is better when we do it together! And, if I could tell expectant parents one thing, it would be to make a postpartum plan and get to know their local resources *before* their baby arrives. Make a list of lactation professionals, postpartum doulas, new parents' groups, meal delivery options, etc.
I want to thank Divya Kumar for answering these questions and most importantly for all her work supporting new moms and advocating for better systems to care for new families. Have any questions for Divya? Continue the conversation in the comments!
*In 2014, the funding for this pilot program was cut out of the budget. Rep. Story has again introduced a line item to fund the 4 locations of the pilot program in the new budget. Please consider calling your legislator to ask them to support budget line item 4510-0112.
How did you come to start offering and be involved with the Expectant Mamas' Group?
LS: When I really started seeing a lot of pregnant women in my practice, they were consistently telling me that they did not have any pregnant friends and were hoping to develop a community of people going through pregnancy at the same time they were. I initially started the group with a childbirth educator who wanted to start it as a paid program, but we had trouble getting it off the ground. She decided to stop working on it, but instead of shutting it down, I decided to keep it going as a free weekly discussion. It took some time to gain momentum, but since Erica joined it has become much better, more consistent, and with a wider variety of topics covered.
EK: With my move to Boston in February 2013, I immediately became involved in the birthing community as a birth doula and photographer. I met Lizzie at the Partners in Perinatal Health Conference a few months after my move. She told me about the group and after coming to one meeting as a guest speaker I was hooked! It is such a fabulous resource and offers a safe place for new moms to meet other women, learn, ask questions, and be inspired.
I'm so excited to feature a two-for-one interview with Dr. Lizzie Sobel and Erica Kershner, the leaders of the Boston & Cambridge Expectant Mamas' Group. I hope you already know about this fabulous, free resource for pregnant women in the Cambridge area, but if not, head over to their Meetup page to learn about the group and upcoming speakers. Full disclosure: I'll be visiting on February 16th to talk about how couples can prepare for the postpartum period based on my Becoming Parents workshop.
What could a newly pregnant woman expect if she went to a group?
LS: We pick a different topic each week; sometimes Erica and I talk about a specific subject, sometimes we show a film about pregnancy or birth, and sometimes we invite special guests to speak with a wide range of expertise, such as home birth midwifery, breastfeeding, meditation, and more. No matter what the topic, a woman can expect to meet other pregnant women in the area, have a space to learn about pregnancy and birth, and also have lots of opportunities to ask questions and get answers.
EK: We love keeping it as a casual discussion and we try to leave plenty of time for questions at the end. You can find the topics for each week posted on the meetup website. The Breathing Room, where we meet, is a warm and intimate space. It offers a great setting for our group. On a weekly basis we get anywhere from 3-15 guests which can include partners, friends and family.
What happens after a woman gives birth? Do you ever hear from her again?
LS: We love getting updates from our mamas about how their birth went. Many women tell us that they have made lasting connections with others in the group and consistently get together with them and their babies after they deliver. This is what our group is all about: helping women educate and empower themselves, and connecting them with a like-minded community of people going though the same big transition into Motherhood.
EK: We love to hear from women after they give birth! It is always such a joy to hear the news from women who have shared and found value in the space. We have had many of the mamas come in as guest speakers to share their birth stories with the group and we want them to know they are always welcome back.
What other resources or supports do you wish were available for pregnant or postpartum women in the Boston/Cambridge area?
LS: I hear a lot of stress and anxiety about women going back to work and trying to balance their careers with their children. It would be awesome to see some kind of mentorship program where a pregnant woman could be connected with a working mom in her industry, to ask her questions about childcare, work/life balance, and just to have an emotional support person who understands what she is going through. [An aside from Laurie: I think this is such a great idea!]
EK: Our group is unique in that it is geared toward pregnant women. There are many new moms groups offered around the Cambridge area but often the pregnancy groups are harder to find. Many of the women who come to the group are first time moms who are either new to the area, or don't have many friends who have children themselves. They are looking to meet other women that they can talk with and relate to. It would be a wonderful thing if there was more education around prenatal physical and mental wellness.
Lizzie, tell us about being a chiropractor who treats pregnant women...
LS: The most common complaints that bring a pregnant woman into my office are: low back pain, pubic symphysis pain, and round ligament pain. I also see a ton of women coming because their baby is not in an ideal position for birth: presenting breech, transverse, or occiput posterior.
Chiropractic care can help with virtually any pregnancy related or non-pregnancy related ache and pain, ranging from migraine headaches, to wrist pain, to knee pain, to hip pain. I have also helped women who have urinary incontinence, constipation, and acid reflux, though this is not usually why they are presenting to the office.
I have always wanted to help women have safer, easier, and more natural births. I believe very strongly that birth is a natural process, and that every woman has the innate intelligence to give birth without the use of drugs or surgery. After graduating chiropractic college, I started a year long postgraduate program in Westwood, MA through the International Chiropractic Pediatric Association. We met for an entire weekend each month for a whole year and learned all about treating pregnant women and infants and children of all ages. We learned practical adjusting, and also all the theory and information behind treating these populations. This training gave me the knowledge and confidence to start working with these unique populations. I immediately connected with the amazing birth community of Boston, and am able to help fill the great need for these services.
I work very differently than many chiropractors. My adjustments are extremely gentle, with no cracking, twisting or popping. Most people feel extremely relaxed and even fall asleep during the treatments! If you are scared of going to a chiropractor, give me a call! I can guarantee that the adjustments will be comfortable and not at all scary.
Erica, tell us about being a birth doula & photographer...
EK: Dr. John Kennell once said "If a doula were a drug it would be unethical not to use it". Whether or not you are planning a natural childbirth, there are numerous benefits to hiring a doula. One of the biggest benefits is choosing an experienced birth worker that you know and trust who will be with you on your labor day. When birthing at a hospital, you most likely will have strangers coming in and out of your room throughout labor and birth. The doula (that you chose) will be with you from active labor until after the birth. She is working for you and no one else and is there to help you do all that is possible to get what you want out of the birth experience. She will be 24/7 support- there to guide and answer your questions- as you get closer to your estimated due date.
I started doing birth photography soon after I began working as a doula. I studied photography at Mason Gross School of the Arts. It started by offering my doula clients photos and I was soon after being hired just for the photography portion. A few months later I found myself doing pregnancy, newborn and family sessions as well! There is so much beauty, love, and emotion surrounding birth. As a lifestyle photographer my favorite moments to capture are the raw emotion that happen in such intimate spaces and times. There is nothing more fulfilling than hearing from a client how much they treasure and are moved by the images.
I want to thank Dr. Lizzie Sobel of Wholesome Healing Chiropractic and Erica Kershner of Birth Your Roots for answering my questions, and most importantly, for offering such a great resource to the community with the Expectant Mamas Group. Have any follow up questions? Post them in the comments and we'll see if we can answer them!