Three Critical Ways That Birthworkers Can Support Perinatal Mental Health

by Ebonie Megibow

I am the 1 in 5.

One out of every five birthing people will suffer from Perinatal Mood and Anxiety Disorders (PMADs): a group of mental health conditions that can develop during or after pregnancy and childbirth.

I am 4 in 10.

Forty percent of Black mothers, twice as many, suffer from PMADS.

I am 3 in 100.

Three percent of mothers will have complications related to bipolar disorder during or after pregnancy.  

My pregnancy was wracked with traumas such as a threatened miscarriage at 20 weeks, several triage visits for signs of early labor, and a near postpartum hemorrhage during an urgent c-section.

For me, postpartum depression started as a trickle then it crashed over me like a wave. Seven months after I delivered my son, I nearly drowned and was hospitalized before a team of mental health professionals and family support helped me to stabilize.

However there was a missing piece: Postpartum birthworker support. The role of the birthworker has gained more recognition in the labor and delivery space. Even still, birthworkers remain an underutilized resource. 

Here are three ways that birthworkers can support birthing people’s mental health. 

1. Postpartum birthworkers provide a comprehensive outside look into the health and mental health of the birthing person.

Medical professionals screen for postpartum depression at the 1, 2, and 6 month well-child visits. Many women's health providers will also screen for postpartum depression during the six week visit. For me, postpartum depression started about three weeks after delivery and continued to escalate. The screening during my son's pediatrician visits felt rushed and impersonal. 

Postpartum birthworkers can structure their services to provide more frequent check-ins after delivery and in the early postpartum period.

Even though postpartum birthworkers are not mental health professionals, frequent check ins allow for opportunities to recognize changes in mood and affect that could be signs of more serious mental health conditions. For example, 85% of birthing people will experience the “baby blues” which are closely related to hormonal fluctuations after child birth but these symptoms resolve without treatment after 2-3 weeks. 

Offering postpartum support for at least 6 weeks after delivery serves as a way for birthworkers to gather information about the progression of mental health symptoms. 

2. Postpartum birthworkers can identify common difficulties that may worsen mental health symptoms. 

More than half of postpartum individuals will experience breastfeeding difficulties. For me, low milk production was the catalyst to my postpartum mental decline. Feelings of inadequacy and problems bonding with my son made me feel isolated. The only lactation education that I received was in the hospital and it was wholly inadequate. 

Most certified postpartum birthworkers receive lactation education or advanced chest feeding training such as certified lactation counselor (CLC) or International Board Certified Lactation Consultant (IBCLC).

 Furthermore, lack of sleep significantly contributes to postpartum mood changes. Postpartum birthworkers offer infant care so that mothers can attend to their physical and mental health. Overnight Visits are especially helpful for allowing new parents to get crucial and needed rest. 

3. All birthworkers can prioritize the health of the birthing person and their family. 

The World Health Organization defines wellbeing as "a state of complete physical, mental and social well-being and not merely the absence of disease.”

I believe that the primary function of a birthworker is to advocate for the wellbeing of the birthing person and their family.

I am a Master of Public Health trained researcher with a specialization in Maternal and Child Health. During my first course, my professor, Dr. Karen McDonnell presented a lecture called “Where is the ‘M’ in Maternal and Child Health?” The goal of the lecture was to call out that in research and medical practice birthing people are viewed in the context of their children, not as whole people themselves with needs outside of their family.

I can say strongly and without hesitation that the society of the United States does not value mothers and birthing people.

A Pew Research Study found that out of 41 countries, the United States is the only one that does not have guaranteed, unconditional, paid family leave. Insurance is tied to your employment. The absence of affordable childcare leaves parents in an impossible situation forced to choose between leaving the workforce to act as a childcare provider which impacts your lifetime earnings or becoming a working parent. 

So what now?

Policy changes remain stalled in the halls of Congress, so we cannot look to the government of the United States to protect the health of pregnant and birthing people.

Birthworker care before, during, and after childbirth provides a space where birthing people are not just prioritized but celebrated and validated.

Birthworkers must serve as the first line of defense for noticing mental health changes, provide resources around common pregnancy and postpartum changes, and elevate the needs and wellbeing of birthing people.

All birthworkers have a role in ensuring that birthing people thrive and don’t become part of the other 1 in 5. One in five pregnancy related deaths are due to suicide or overdose. 

Birthworkers must stand in the gap.

If you or someone you know is struggling the PMADS here are some essential resources: 

The National Maternal Mental Health Hotline is a free, confidential 24/7 resource for pregnant and postpartum birthing people.

1-833-TLC-MAMA

Postpartum Support International is a free, confidential 24/7 help line and online resource for postpartum support.

1-800-944-4773

Text “Help” to 800-944-4773 (EN)

The National Suicide Prevention Hotline can be reached at 988.

Ebonie Megibow is a maternal health researcher, fertility, postpartum doula, and parenthood coach based in Northern California. She is inspired by her legacy of Black birthing people and chose to name her business Divine Ancestors Birthworks LLC in their honor. In her free time she enjoys being outdoors with her husband Carl and son Solomon. She is currently learning to crochet (and seeking any helpful tips too!). You can learn more about her services at: divineancestors.com, on Instagram: divineancestors_births or Tiktok @divineancestors_ca