June 9, 2023

Kristin chats about processing birth trauma with Angela Mancini of La Luna Counseling and Wellness.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you find your podcasts.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello, hello!  This is Kristin with Ask the Doulas, and I am here today with Angela Mancini.  Angela owns La Luna Counseling and Wellness.  She’s a mental health therapist, a birth doula, a yoga therapist, placenta encapsulator, and childbirth educator.  So happy to chat with you today, Angela!

Angela:  Hi!  I’m so happy to be here.  Thank you for inviting me.

Kristin:  Of course!  So I know, obviously, you have so much that we can chat about, whether it’s parenting experiences, work as a doula.  But our main focus today is going to be talking about birth trauma and how to process some of the experiences in a positive way after delivering.

Angela:  And I feel like it’s a lot more common now.  I’m getting a lot more women coming out and talking about it.  I feel like a lot of that has to do with the news right now, and we’ll get more into that, but with what’s going on in Massachusetts.  There’s a lot going on.

Kristin:  Absolutely.  That story is – yeah, with perinatal mood disorders and even if you’re getting help – I mean, obviously, with that story in Massachusetts, she’s a nurse and was in therapy.  It seemed like a day program, outpatient, and she still struggled.  So we need more support.  PTSD after a birth is real.  Perinatal mood disorders are seeming to be more and more common.  So I would love, yeah, your insight, not only witnessing trauma as a birth doula, but also in your work in counseling and wellness.

Angela:  Yeah.  So I’m very transparent on social media about my struggles.  I have three kids; 5, almost 3, and 1.  So after my first was born, I had pretty significant postpartum anxiety and rage, which I also think is something that’s not really spoken about a lot, the postpartum rage component.  He was a very colicky baby, so I just assumed – who would be a happy person, having to deal with a baby that’s crying 24/7?  They’re not a happy baby.  So I have vivid memories of me, crying, screaming, cursing at this little newborn, and it’s – in the time, it felt justifiable.  Now I look back, and I’m like, what the heck?  And I didn’t get help.  I was like, oh, this is normal.  Totally fine.  I got pregnant with my second.  I gave birth April 2020, which was crazy COVID time, so I had that stress.  And then he was born, and he was perfect.  Literally perfect.  Never cried.  Never did anything.  And I was like, wow, this is what everybody deals with.  And I was just not okay.  I was crying.  I felt like a failure.  I had textbook depression and anxiety.  And then it got to a point where I was having suicidal thoughts, and I’m like, okay, wait.  This is not okay.  No one should be feeling like this as a new mom.

Kristin:  Exactly.

Angela:  So I sought help, but, you know, we were in COVID times, and there wasn’t much help out there for new moms, especially in that time.  So I got the help, but it wasn’t exactly what I needed.  But I really rallied my tribe, and I got better.  And I said, okay, I’m going to make what I couldn’t find at the time.  So I opened La Luna Counseling and Wellness in September of 2020.  I thought I would just work one day a week, see clients here and there, kind of just do it as a hobby.  And it just took off, and there were so many women that really are looking for this help.  So I love it.  I got pregnant with my third, and I’m like, oh, I’m going to do all the things.  I’m going to eat my placenta.  I’m going to do all the things.  And I got diagnosed with preeclampsia, and that came completely out of left field because statistically, you really are only supposed to – textbook “supposed to” – get preeclampsia with your first.  And I got it with my third.  So I was so taken off guard.  I was induced at 38 weeks because my blood pressure was skyrocketing.  I had protein in my urine.  I couldn’t really see.  So I got induced, and I don’t think they classified it as a precipitous labor, but it was a three-hour induction.  He came out extremely fast.  So he inhaled his amniotic fluid on the way out.  He had to go to the NICU.  They took my placenta away, so I didn’t get to do anything.  And I just felt like they whisked him out of the room and I was just left there on the bed and everybody left.  And I’m like, what the eff is going on?  No one explained anything to me.  It was so traumatic to me to have this little, little baby in the NICU with all these tubes and everything.  So it was just – it goes to show you, which I know you’ve probably experienced, but you have a plan for this beautiful birth, and it’s just going to go the way it goes, and that’s it.

Kristin:  Exactly.  I mean, so much is out of our control.  It’s up to baby, how baby responds, how our body – I had preeclampsia with my first.  She ended up in the NICU.  I was induced as well at 39 weeks and bed rest before that.  So yeah, just processing not only what’s happening to you, the risks to baby, but then also dealing with an unexpected NICU stay, especially with your third.  I mean, for me, again, I was right on statistically with my first and then not having it with my second.

Angela:  Right.  And I really think that preeclampsia is not – I feel like a lot of things are not really spoken about, but especially that – it’s relatively common.  Like, it’s not an absurd diagnosis, but it’s a very scary diagnosis for you and baby.  Like, it is life threatening, and I don’t think people realize that.

Kristin:  Definitely.  And then with any experience, I mean, whether it’s an intervention that wasn’t planned, like a vacuum delivery or an emergency surgical birth or even clients who have a breach baby and are processing that.  There’s a lot that a therapist can help you process, and I feel like as a birth doula, I witness clients who may not have fully journaled or went through their emotions with their first, and then you see that carry over to that birth, if they haven’t dealt with the trauma the first time around.

Angela:  100%.  And I think that’s what really pushed me to get my birth doula cert.  I wanted it – first, I was like, okay, I can use this education to help my therapy clients, and then I was like, oh, wait, this would be kind of cool to have a pregnant client and follow them all the way through, be at the delivery, and then go through postpartum with them.  It has been amazing because it’s beautiful.  We all know that.  But it’s nice to be able to have the therapeutic skills in the delivery room because it can get really crazy really fast.  I’m that middle man of trying to deescalate situations and really kind of give that validation and power back to the mom and dad.

Kristin:  Exactly, yes.  And so again if they’re comfortable, they can continue that care and see you as their therapist after, if they need to process trauma.  And I know as birth doulas, even those of us that aren’t trained as therapists, we do a lot of processing in that follow up postnatal visit and really encouraging them to write out their birth story, talk about it with others, because women – you know, even if you have this picture perfect ideal birth, you still feel isolated after delivering.  Our culture – it’s like your pregnancy is celebrated.  You get a baby shower.  Everyone is talking about your belly and excited for you.  And then you deliver your baby, and it’s all about the baby.  And then what happens to the mother?

Angela:  Right, right.  That’s exactly it.  And it is very isolating.  In the first two weeks, everyone wants to come over, give you food, and really kind of be present.  And then it’s three weeks, four weeks, when you desperately need that help and everybody’s kind of on to the next new shiny thing.

Kristin:  Or they celebrate you with the first baby and really want to help, but then what happens with baby three?  They think you’ve got it.  It’s like, okay, you’re a seasoned mom.  You don’t need my help.

Angela:  Yeah, and I feel like nothing taking away from the first time mom, but second and third babies, they’re rough.  Like, you’re almost outnumbered at that point.  Like, you need help.

Kristin:  Absolutely.  If your partner is going back to work and you have children to feed, so their meals are even more needed.  And for clients who are recovering from a surgical birth, if they don’t have a postpartum doula or family helping, then it’s even more of a struggle.  And so reaching out – and I’m so thankful for, again, like, virtual therapy as an option for clients who aren’t able to leave other kids and still be able to get some support.

Angela:  Right, exactly.  I think it’s so, so crucial, and it’s – I feel like everybody needs that support.  And I like what you said, too, where it’s like even if you had a picture perfect birth, I feel like everybody needs therapy.  I have a therapist.  Like, I think everybody needs one.

Kristin:  Absolutely.  And even as doulas, you know, we need to process things with our therapists.  I have a therapist.

Angela:  Yeah.  Even going back to, like, processing things as doulas, the way I run my doula practice is I have a doula partner, and I couldn’t imagine doing it without her.  Like, I give all the credit to the solo doula practitioners because I feel like at every birth, we’re calling each other, processing it, asking questions during.  And everybody should have that person.

Kristin:  Absolutely.  Yeah, we have a shared call model and work in partners.  Some doulas in our agency prefer to work solo, but they do rely on the team, again, for resources, processing, support, backup.  But I personally prefer a shared calling partner model, for many reasons.

Angela:  Yeah.  I actually never heard it worded like that, a shared calling – how did you say it?

Kristin:  A shared call partner model.  So two doulas work with a client throughout pregnancy, and ideally, one doula attends the birth for Gold Coast.  Obviously, with inductions that may be multi-days, we can trade out.  But it’s the benefit of two different doulas with different skill sets and personalities, having that support throughout pregnancy and also resources after delivery.

Angela:  Yeah, I love that.  That’s why I work with my partner for that same exact reason.  And even with – we just – we were able to attend a birth together at a birth center, which was really nice, to be able to doula together.

Kristin:  Yes, it’s beautiful!

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Kristin:  So what are your tips, Angela, as a therapist and doula, if any of our listeners are still struggling with processing their birth trauma and obviously, any resources, since our listeners are all over the country.  What would be your suggestion in finding support groups, a therapist, resources, as well as, again, how they can personally seek out support to process?

Angela:  Yeah, so I – I mean, first and foremost, I would definitely recommend finding a therapist; finding a therapist that would be trained specifically for any sort of birth trauma, any sort of perinatal mood disorders.  Having that training and experience is really key.  So I would definitely, if you’re able to find someone who specializes in that, find that.  You can find that through Google, psychologytoday.com is a good resource.  It sounds funny but social media; that’s where a majority of my clients find me.  And with birth doula therapy, you could be – especially like out where you are, like the Midwest, the states are huge, so you could be seeing somebody six hours away from you and still be in the same state.  There’s also PSI, the Postpartum Support Initiative.  They have a big list of therapists that are trained in their program for perinatal mood disorders.  They also have online support groups, online programs, and a lot of information.  I always direct people there if they are just looking for –

Kristin:  Totally.  Yeah, PSI has groups for partners, as well.  Husbands can experience perinatal mood disorders, as well, or partners.  Or can be trying to process trauma that they witnessed and supporting their loved one through an experience like an emergency surgical birth or a NICU stay.

Angela:  And it’s funny because I always say this in the consults, but the moms are typically the ones who reach out.  They find me, book a consult, schedule, whatever.  But I spend so much time with the dads because they’re the ones that are really, like, worried.  They don’t know what’s going on, and rightfully so.  They’re seeing their partner in what appears to be a lot of pain, or things are just happening to their partner that they’re like, wait, is this okay?  Should we be doing this?  And I think they’re the ones that really need that support, as well.  And yes, they can get perinatal mood disorders postpartum; anxiety and depression.  It’s really not talked about, but everybody’s life changes after baby comes.  So it’s understandable as to – I mean, no one’s sleeping.  No one’s eating regularly.  There’s so many factors that are happening all at once in the blink of an eye.  So it’s just an unspoken thing, as well.

Kristin:  And you mentioned your personal experience with colic and the lack of sleep, and that just escalates and increases the chances of getting perinatal mood disorders.

Angela:  Right.  It’s just this perfect storm of situations that are going on all at the same time.  In my experience, I see more people with some sort of postpartum diagnosis than without.

Kristin:  Yes.  And you had mentioned there are so many other forms of a PMAD outside of depression or anxiety, so it could be OCD or rage or psychosis.  So, yeah.  And there’s often confusion with the hormone fluctuations and what would be considered baby blues versus other PMADs.

Angela:  Yeah.  So the first two weeks, pretty standard; everyone kind of goes through the baby blues.  Your hormones are all wonky, all over the place, trying to figure out what the heck happened.  So by day 15, 16, 17, if you’re still crying, you’re still having these anxious thoughts, irrational thoughts, intrusive thoughts, anything like that, say, 15, 16, 17, 18 days later, that’s when there’s a little bit more cause for concern.  I think that’s where it’s shifting.  And even in that first year of life, you could be like, okay, I definitely feel like I have some sort of anxiety or depression, but there’s waves of it.  It’s usually around the three-month mark, the six-month mark.  That’s where your hormones are shifting again.  People start losing their hair.  Your milk production is changing.  There’s all these factors.  People go back to work.  There’s all these factors that are going on in the first year and then some.  The second year, all of that.  I think people are just really focused on that first month, and then after that, it’s like, oh, you got it, and then they step back.  No, she needs help.

Kristin:  Exactly.  And even introducing solids can change hormone levels.  Weaning is often not talked about, but that’s another indicator.

Angela:  Yeah, it’s all – and even the introduction of solids is a really big trigger for many women with choking and allergies.  It’s just a lot.  It’s a lot.

Kristin:  Yes, for sure.  So obviously, if our listeners are working with a doula, doulas are there to provide resources, whether it’s a virtual support group, an in-person support group, or certainly offering therapist options that are trained to support trauma and/or PMADs.

Angela:  Yes.  Most doulas have a resource list of everything.  I have my little list of pelvic floor therapists, lactation consultants, postpartum doulas, everything.  Doulas are such a huge part of the community and they’re such a good resource.

Kristin:  Yes.  Any tips, Angela, for partners who may be listening on how they can best support or identify anything that would be beyond the basic baby blues?

Angela:  Yes.  So again, going back to PSI because they have so much information, they have – I’m not sure where I found it on their website specifically, but they have almost like a worksheet PDF, some things to look out for, specifically for PMADs.  And when I go to prenatal appointments, I print it out and I give it to the dads and I tell them to hang it up in their house just so that they have it to reference.  I think that finding a local group, whether it be an actual support group or just like a Facebook group for dads, which I feel like is a growing thing.  In New Jersey, at least, I’m noticing a lot more Facebook groups or meetups for dads.  Finding that and just maybe even talking to people at your work who maybe have a new baby, as well.  Like, you need that person to be able to bounce things off of.  Hey, my wife’s doing XYZ.  Is your wife doing XYZ?  And having that camaraderie I think is huge.  And going back to – I know I’m jumping a bit, but going back to finding a person, I always encourage new moms to find a pregnancy buddy.  Find a new mom that’s going to be up in the middle of the night as well so you guys can text, so you guys can just go back and forth, so you have that person.  We actually started, me and my doula partner, a Facebook group of our past and current clients so that they have those people to talk to who get it.

Kristin:  I love it.  Yeah, I have an online course called Becoming A Mother, so past students who’ve already had their babies interact with students who are currently pregnant, and it’s such a wonderful community, and they live all over.  I love that you have that as a local resource for your clients.  So any other tips on talking with providers, whether it’s their OB, their pediatrician, since they’re not seeing the OB or midwife typically until six weeks?  I feel like the pediatrician can be a good resource since their visits are much more frequent.

Angela:  Yeah.  I mean, I think just being open with your pediatrician and telling them how you’re feeling.  I know specifically with my pediatrician, every visit, I have to fill out a really shortened version of the Edinburgh Scale for postpartum.  I don’t know if that’s a universal thing or not, but anyone who doesn’t know that, it’s the quick little assessment that will indicate if you have any postpartum depression or anxiety symptoms.  But just be really open with them.  They are members of the community.  They have resources.  A huge trigger for women – I hear this a lot – is “I didn’t want to say anything because I don’t want them to take my kids away.  If I tell them I have these thoughts, they’re going to take my kids away.”  And I promise you, they’re not going to take your kids away.  That’s just this embedded fear in us for all of these child protective services.  It’s funny because I used to work for New Jersey Child Protective Services, so I know how hard it is to take a kid away.  They don’t want to.  They don’t want to take your kid away.  They know that the child – as long as it’s a safe situation, the best place for them to be is with their mom.  So they’re not going to take your kid away.  If you are having these thoughts, they want to help you.  They might become involved, possibly, if it’s something where it’s an unsafe situation, but they are a good source of resources, as well.

Kristin:  That’s such a good point.  Yeah, I didn’t even think about that fear cropping up and delaying getting help or even hiding it from a partner.

Angela:  Yeah, it’s a real thing, and it’s a scary thing.  But moms need to look out for themselves, and are you being the best mom you could be, if you’re having these feelings and symptoms?  There’s ways for you to get the help that you need, even if you don’t want to be as upfront as saying what these intrusive thoughts are.

Kristin:   Exactly.  So what are your thoughts on talking with friends about your birth story or journaling, writing out your experience with pregnancy, birth, and even early parenting?

Angela:  I love journaling.  I am always pushing people to journal, even though I don’t take my own advice.  I should be journaling more.  But I think it’s such a beautiful thing to first of all, get these thoughts out, especially kind of going back to what we said, it’s scary to say these thoughts, and it just might be easier for you to write them, just to get them out of your head and onto paper.  And I think it is a really beautiful way for people to share their birth stories, as well.  I always encourage moms, within the first week or two, write your birth story down, because the longer you go without writing it down, the fuzzier it’s going to be.

Kristin:  Absolutely.  I love that advice.  We do, as well, and I think there’s also – since you are trained in so many different areas, I would think as a yoga therapist and using meditation and affirmations, there can be some resources, even in breath work.  So I’m curious to hear your thoughts on that as far as processing trauma.

Angela:  Yes.  So I feel like breathwork is a very big buzzword, right?

Kristin:   Yes.  It is.

Angela:  And some people will say, like, oh, you know, I got to use this breath, or I have to use this breath.  And for all the different things and experiences I’ve had, I don’t care what breathwork you use; just breathe.  I just want to make sure you’re breathing.  You know?  And I think that’s the biggest thing, and just becoming aware of your breath brings you back into yourself.  And if that’s the only thing that the moms can do, then that’s all you need to.  Even with meditation, I hear this a lot.  “Oh, I don’t have time to meditate.  I can’t meditate.  I’ll think about a hundred other things.”  I think when you say, again, the buzzword of meditation, when you think of meditation, you think of this person sitting in criss-cross applesauce and just ohm-ing to themselves, and that’s not only what meditation is.  It’s being mindful, being in the moment, not thinking about a hundred other things that are going on in your life; just really feeling your feet in your socks and being aware of your breath and really being in the moment.  That’s meditation in and of itself.

Kristin:  Exactly.  Beautiful.  So let us know how our listeners can find you, Angela.  I know, obviously, you’ve got a great website for La Luna Counseling and Wellness.  What are your social media channels?

Angela:  So I am on Instagram @lalunacounseling.  I’m on Facebook, La Luna Counseling and Wellness.  I’m on TikTok @lalunacounselingandwellness.  And yeah, those are the best ways to find me.  I’m really active on most of them.  TikTok, I wish I was more active on.

Kristin:  Same.  Well, thank you so much for sharing all of your wisdom and resources, and I appreciate the work that you’re doing in this space so much.

Angela:  Yes, thank you so much!  You as well!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.