Debbie Chalk RNC, IBCLC-RLC, CPD Certified Postpartum Doula 603-340-7028 debbiechalk@familycareafterbirth.com Located in

1. Debbie Chalk RNC, IBCLC-RLC, CPDCertified Postpartum Doula603-340-7028debbiechalk@familycareafterbirth.comLocated in Bow, New Hampshire Family Roots Postpartum Doula Care & in home Lactation Consultant

2. Family Strength Requires Maternal and Family Support in the Postpartum Period Today we will learn: • about the universal need for family and community support. • to identify stressors and potential adverse short term and long term health effects if not alleviated. • to assist the family in understanding the benefits of support, sources and how to access them.

3. Importance of Social Support • Studies have shown that women who have social support during the postpartum period tend to have less postpartum depression, breastfeed for a longer duration and make a better adjustment to parenthood.

4. World wide cultures • Native Americans- “Longhouse” • China- “Man yuejue” • South America- “La quarentina” • Burma- “Thie-dwin” • Greece- “Doula” • Holland- “Kraamverzorgster”

5. Communities However help is provided it was recognized that the new mother couldn’t manage all these family duties herself, at least for several weeks. These traditions make a lot of sense! Historically, we recognized the importance of a community of women helping women…

6. Boston Lying-In Hospital Historically, in colonial America, there was a distinct postpartum period (6 weeks after birth). This was called a “lying in” period, a period of “apprenticeship” when more experienced mothers taught the new mother.

7. Cultures who had low incidence of postpartum mood disorders all had rituals that provided support and care for new mothers. Although different, they shared 5 protective social structures.

8. Five Protective Social Structures • A distinct postpartum period- set apart from normal life • Protective measures recognizing need for physical healing from pregnancy and birth • Social seclusion- for rest, care and for the parents to get to know their new baby • Assistance in the home- parents only responsibility was to rest and care for their baby • Recognition and respect for their accomplishments in the new roles as parents

9. A Day in the Life of Parents of a Newborn

10. Identifying common obstacles First time parents: • have no previous experience. • are recovering from pregnancy and birth. • are learning basic hands on infant care. Experienced parents: • may have had difficult previous circumstances. • are recovering from pregnancy and birth. • are integrating the new sibling into family life.

11. Unprecedented states of isolation. Sally Placksin, author of Mothering the New Mother, identifies that “many women today are entering into motherhood in unprecedented states of isolation”.

12. The Partner’s need for support: • They have assisted the Mom during pregnancy, managing labor and birth and now must assist her in recovery. • Fathers are redefining their roles; they may also be adjusting to sleep deprivation, financial pressure and other stressors, as well. • Lots of changes occur instantly at the moment of birth. • They must nourish and love more than one person and divide their time into multiple unpredictable circumstances.

13. “Back to Work” • Men can get “baby blues” and postpartum depression also. • Their signs and symptoms are different from the woman’s and can take the form of anger, irritability, physical pain and substance use. • They need a listening ear, support and an extra pair of hands too. • With most couples the partner must go back to work in a week or two with lots of sleep deprivation and added responsibilities on board. • They are expected to function fully in their job and pretend nothing ever happened.

14. Long Term Health Risks Associated with Stress Unrelieved stress can begin a vicious cycle of heath problems to include negative mental states and depression.

15. Sleep Deprivation • “Researchers at the University of Helsinki have now shown what kinds of biological mechanisms related to sleep loss affect the immune system and trigger an inflammatory response.” • “These results corroborate the idea that sleep does not only impact brain function, but also interacts with our immune system and metabolism… • Some of these changes appear to be long term…” red Orbit New Biological Links Between Sleep Deprivation and the Immune System Discovered 10/24/2013

16. Inflammation Molecule Linked With Depression From Social Stress • “A molecule linked to inflammation could play a role in depressive symptoms caused by social stress, a new study in mice suggests.” • “This may represent a legitimate biomarker for depression and could represent a new chapter in the effort to accurately diagnose and better treat mood disorders.” HUFFPOST Healthy Living Inflammation Molecule Linked With Depression From Social Stress 11/13/2013

17. Even short periods of sleep deprivation can increase the release of stress chemicals and adversely affect blood sugar levels. Poor sleep quality and depression often go hand in hand. McEwen, Biological Psychiatry 2003; 54:200-207 Kendall-Tackett, Trauma, Violence & Abuse; 8, 117-126

18. Depression increases the risk of both heart and vein disease. Negative Mental States Inflammation Chronic Disease Why Breastfeeding Prevents Maternal Metabolic Syndrome and CVD Kathleen Kendall-Tackett, Ph.D.,IBCLC, FAPA

19. Metabolic syndrome • Is the precursor syndrome to Type-2 diabetes • Includes symptoms such as: abnormal blood sugar processing, abnormal cholesterol levels and abdominal obesity These conditions also increase the chance of heart and vein disease.

20. Heart and Artery/Vein Disease Chronic stress, depression and hostility increases the risk of these diseases as well as metabolic syndrome, diabetes and degenerative brain diseases. Hostile people are more likely to experience constriction of the heart blood vessels when under stress as well as additional new heart problems. Why Breastfeeding Prevents Maternal Metabolic Syndrome and CVD Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA

21. Social connections are vital for good health and for parents to successfully welcome a newborn into their lives. Health Care Providers and Family supporters play an essential key role in educating and guiding parents .

22. In my 35 years caring for parents and their newborns the NH family has changed. Most have short term help only, because of family members geographical locations, their place in the work force and peers/ friends being co-workers. • A new mother (parents) must be encouraged on a daily basis. Whether this is their first or fifth baby, they must be told they are doing a wonderful job. • Karen Kleiman states in her book Therapy and the Postpartum Woman “More than one woman has confessed to us that she secretly wishes her mother would look over her shoulder during the 3AM feeding and sweetly whisper: You must be so tired. You are doing a wonderful job, I’m so proud of you. You are such a good mother.” Promises of help give way to every day life in spite of everyone’s best intentions to stop by and help.

23. So what kinds of help do new parents need? • Assist the new family with household management and care so the focus can be on rest and feeding. • Education for the parents on proper positioning and assessment of their baby’s nursing/ feeding behaviors. • Light housekeeping, grocery shopping, errand running and family meal preparation are options families like. • Sibling care, assistance to get out for walks, appointments, an outing to a favorite store/ café all lift their spirits. • Guidance in setting and revising short and long term goals. • Assist parents to use shorter time availability to accomplish more goals related to rest and recovery. • One of the most important things a helper can do is listen. So much happens during pregnancy/birth/meeting the baby and incorporating them into life. The parents need time to sort it all out and to begin to accept the experience.

24. Listening Skills • They can be a skillful art. • Active listening is listening to understand the complete message as opposed to listening to respond. • Restatement allows clarification. • Interpretive listening enables you to gain an understanding of the underlying feelings. • The considered response is preceded by compassionate thought.

25. Please, come sit with me… Though baby shower gifts are nice, it is recommended to ask instead for someone to come sit with you, "listen wisely and non-judgmentally to all your questions and feelings after the baby comes". Sally PlacksinMothering the New Mother

26. Good Questions Types of questions to avoid: • close ended questions • why questions • rapid-fire questions • questions containing the answer- these can be manipulative • these questions also usually stop conversation. Instead try open ended questions because they: • focus on the speaker. • encourage conversation. • provide a model for solving future problems. • move conversation forward.

27. When you have to talk about something difficult… B L A S T • The goal must be to BENEFIT. • The motive must be LOVE / genuine concern. • The situation must be APPROPRIATE. • The terms must be SPECIFIC. • The context must be TRUST. The last thing we want to do….

28. Determininggoals Short term • Gain education through multimedia resources and supportive friends and family. • Before the baby is born invite and solidify a support network for day and night. Long term • Research community support groups and their contact information. • Consider what elements of your lifestyle it is important to you to retain (hobbies, outdoor interests, educational objectives). • Post numbers to reach health care providers with medical questions.

29. The challenges are universal… • “Although women are made to nurse babies that doesn’t mean it is easy.” • “I believe that happened (achieved my goals) because I knew someone, with particular knowledge and expertise, was going to be here for me a few times a week.”

30. Community Helpers Can take the form of: • Family • Friends • Coworkers • Trusted Neighbors • Older siblings • Mother’s helpers • Childbirth and Postpartum Doulas • Lactation Consultants • Visiting Nurses • Postpartum Support/Depression Counselors • Organizations who provide classes and support groups • Social Workers • Family Counselors • WIC Counselors • Social Clubs for parents • Local stores who provide classes as a community service

31. Capital Area Community Resources for Parents • www.concordmoms.com MOMS Club of Concord • www.greatbaydoulas.com  parenting, mom/baby activities/parent support • www.truebluematch.com    other parents new to area to find common interests/ friendship • Postpartum support, including postpartum depression support services Gerry Mitchell- Post Partum Support Coordinator Concord Hospital 603-225-2711 x4110 • Marisa McCutchen Barrington Counseling Center 603-534-2558 • Child and Family Services of New Hampshire Concord NH 800-894-5533 • www.postpartum.net- on line support and direction • Postpartum Support International S800-944-4PPD • Postpartum Dads- www.postpartumdads.org • Classes • Center for Health Promotion 49 South Main Street Concord, NH 03301 603-230-7300 Baby Steps Prenatal Breastfeeding Class Childbirth classes Amazing Newborns Back to Work Class (for breastfeeding mothers) Itsy Bitsy Yoga Active Parenting Now Art with Heart • Nini Bambini - A Place to Grow 166 South River Road Manchester, NH 03110 603-666-6464 www.ninibambini.commultiple class offerings

32. The need for community support takes on a different meaning. It is with a social support network that we feel a sense of belonging and more secure. As new parents increase their self-worth by not being isolated and struggling alone, the baby will feel this as well.

33. WWWee We did it!

34. References • Lactationmatters.wordpress.com 8/5/13, 9/5/13 • C.H. – Friend 11/9/13 • What is the Postpartum Period? By Rev. Pilar(Ma’at) Grant 10/3/13 • How Other Cultures Prevent Postpartum Depression: Social Structures that Protect New Mothers’ Mental Healthby Kathleen Kendall-Tackett, Pd.D., IBCLC 10/13 • Why Breastfeeding Prevents Maternal Metabolic Syndrome and CVD by Kathleen Kendall-Tackett Ph.D., IBCLC, FAPA 5/12 • Mother the New Mother by Sally Placksin p5 • Fathers, Breastfeeding and Bonding - Dr Lucas Godinez, MD,IBCLC lactationmatters.wordpress.com 8/17/13 • Haffner&Taegtmeyer, Circulation 2003; 108:1541-1545 • Huffpost Healthy Living November 16, 2013 • Red Orbit New Biological Links Between Sleep Deprivation and The Immune System Discovered October 24, 2013