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Helping Others: Broadening Your Horizons

If you've suffered from postpartum depression, you may discover after you're well again that you have an urge to get involved with the postpartum education and support movement. Perhaps you feel compelled to give back because you appreciate the information and care you received during your own experience. Or perhaps you didn't get correct, appropriate, or prompt assistance and you want to change the system so this doesn't happen to someone else. Your motivation isn't important, but your intent is critical to furthering the field of maternal mental health. It may feel like a passion, a personal mission, or just the right thing to do. I feel a little of each of these, and together these motivations have steadied and sustained my work.

A Little History

The care of postpartum women changed when insurance companies and hospital administrators began shortening new mothers' length of stay in hospitals. When I was born in 1945, my mother stayed at the Palo Alto Hospital for three weeks. When I gave birth in 1972, my stay in Goleta Valley Hospital was three days. Now many women are lucky to get two full days of care after delivering their babies, and then they're sent home to make due as best they can. To make matters worse, we also commonly lack social structuring of postpartum and postadoption events and social recognition of role transitions. There are clearly several large gaps here, and our mental health as a society is at risk.

When my girlfriends and I started Postpartum Education for Parents in 1977, we started to fill the gap that existed in Santa Barbara, California for new families. We didn't consciously set out to improve mental health or prevent PPD. No one really talked about those concepts at that time.


Self-help forms of social support should strive to:
Address needs of at risk populations
(parents-to-be, new parents)
Confront social isolation
Serve as new sources of social support during
short-term crises, life transitions
Promote coping skills and self-esteem
Provide positive role models
Display benefits of helping others
Meet needs of underserved portions of population
Facilitate referrals to professionals when necessary
Enhance social ties to serve as buffer to stress
Help people cope with stress and adversity
Supplement clinical care through friendship
and peer support
Educate professionals about gaps and problems
in service-delivery
Assist in development of needed programming
for communities
Promote social action and funding needs
Promote new collaboration between self-help
and professional communities

Edward J. Madara, Prevention in Human Services, V7, No. 2, 1990, "Maximizing the Potential for Community Self-Help through Clearing-House Approaches."

What the Experts Say

Without knowing it, our formation of PEP met the criteria that define self-help forms of social support. It's reassuring to know that the research literature from those who study this topic confirm that social support plays an important role in the prevention, early intervention, and treatment of PPD. Here are some examples of writings on this topic from several of my favorite authors:

"Mutual self-help groups replicate many of the components of support found cross-culturally, and they have the potential to cushion or prevent expression of moderate depression."

 - Laurence Kruckman,
Postpartum Psychiatric Illness: The Picture Puzzle, 1992

"In general, mothers with high support are more satisfied with their babies, their maternal roles, and their lives overall. How this support is perceived by the mother is critical to its success. If she perceives an intervention as unhelpful, it will become counterproductive, and cause harm."

 - Kathleen Kendall -Tackett,
Postpartum Depression: A Comprehensive Approach for Nurses, 1994

Volunteer organizations can play a very important part in the support of new families, whether the parents are biological or adoptive. One of the main contributions volunteers can make is providing social support for the isolated mother. "Get out and make new friends" is a noble suggestion, but it can best be done in a community that offers free, self-help postpartum support. This practice is a simple approach. Peer support not only decreases isolation, it offers an atmosphere of common purpose for learning to cope. As early as 1978, the President's Commission on Mental Health recommended increased links between mental health services and community support networks.


What You Can Do

We know from years of scientific research and lay observation that our pregnant, postpartum, and postadoption families need help. It's no longer necessary to conduct a needs assessment in your community to determine this. What we don't know is the availability of appropriate information, education, support, and resources in each community.

The United Nations declared 1994 to be the International Year of the Family, while the World Health Organization made it the Year of the Midwife. To do my part in strengthening the link between childbearing and the future of our families, I developed a simple quiz to determine if a community is sensitive to the mental health needs of its mothers. See how your community does!


Pregnancy or Preadoption
Do midwives and obstetricians assess all of their patients for psychosocial factors during pregnancy? If they do, what happens next?
Are pregnant women informed about mental health-related issues? If so, what happens next?
Are pregnant women who are at risk for mood and anxiety disorders referred to mental health professionals with postpartum training? If so, who pays for them?
Are midwives and obstetricians familiar with family support agencies and organizations and their services? If so, do they make referrals?
Are there free self-help support groups for pregnant and postpartum families? If not, is anyone going to start one?
Are childbirth educators informing families about the need for emotional and physical support after birth? If so, can the families afford these services?

After the Baby Arrives
Are hospitals and clinics distributing literature about maternal mental health and adjustment issues? Is there a local referral phone number for new parents to call?
Do family support agencies offer services for postpartum families? If so, do they include phone and group support for mental health issues?
Do pediatricians and family physicians assess psychosocial and support needs for the first year postpartum? If so, what happens next?
Are new families encouraged to seek support for any and all mental health issues? If so, congratulations, you live in a beautiful community!

The Next Step

In 2000, I published Step by Step: A Guide to Organizing a Postpartum Parent Support Network in Your Community, a workbook that encourages individuals to work as a team to support parents and their families (click here to order). It provides a guideline or framework that can easily be adapted to achieve the kind of community described in my quiz.

Establishing a support group and/or network is a very individual experience with no rigid and absolute recipe. There is a process to follow, however, and I'll tell you what it takes to accomplish: time, patience, and commitment. (Remember, these are the same qualities that I mentioned in Chapter 1 as traits of a good volunteer!) My process includes specific steps within six stages. While the steps will vary from community to community, you must pass through each of the six stages to ensure the successful development of a postpartum support network for your community.

These stages are:

Brainstorming

Investigation

Planning

Implementation

Evaluation

Future Endeavors

I doubt if there's a village in the entire world that's as wonderful as I would like to imagine, but I have a fantasy that somewhere else they support postpartum families completely. As we strive toward improving our own villages, towns, and cities, there will be challenges in meeting the needs of every mother and her family. We need to work together now to evaluate and improve current policies and systems of practice for our families surrounding the transition to parenthood.

I know from my personal journey since the 1970's that we're becoming more sensitive to the mental health needs of families. With the continued expansion of our social support movement—and your help—someday every community will offer postpartum parent support.



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