Resources for Providers

Normalizing the Postpartum Experience:

How providers talk to patients about the postpartum experience matters. See sample questions below for ideas on how to start a conversation with your patients about normalizing the postpartum experience, exploring expectations, and assessing for additional support needs. These questions can be asked during prenatal or postpartum care visits, in-home visits, or telehealth visits.

For prenatal providers:

1. What are some beliefs you hold around the postpartum time period?

2. How do you see yourself spending your days postpartum?

3. Do you expect to have any extra in-home support postpartum (from a partner, other family members, older children, etc)

4. If this is not your first baby, is there anything you would like to try and do differently this time around during the first 40 days postpartum?

5. If this is your first baby, is there anything you are particularly worried or concerned about when you think about bringing your baby home?

For postpartum providers:

1. What did you envision the hours/days postpartum might look like (the experience of labor, meeting your baby, recovering from labor/delivery, establishing new rhythms with breastfeeding/bottling/sleep, etc.)?

2. How has the reality compared to your expectations? If the reality is different from what you expected, what has the experience been like for you? And who can you talk to about this?

3. If this is not your first baby, does this postpartum experience feel similar to your others? Different? In what ways?

Mental Wellbeing:

Talking to patients about postpartum mental wellbeing is as important as discussing expectations for physical recovery after childbirth. Consider using some or all of the questions below to engage your patients in conversation around postpartum mental wellness.

For prenatal providers:

1. What discussions have you had with your loved ones about postpartum wellness?

2. Have you thought about what might be helpful to your wellbeing when you are postpartum?

3. Just as we plan and prepare for birth, it is important to plan and prepare for postpartum. Have you thought about creating a postpartum wellness plan?

For postpartum providers:

1. How do you feel you are functioning in your roles outside of motherhood? (Partner, sister, friend, student, etc.)

2. How do you feel you are functioning in your role as a mother?

3. Is there anything that used to be easy for you that has become difficult since becoming a mother?

4. Are your typical coping mechanisms still helpful to you during times of stress?

Building Your Social Networks:

One of the biggest predictors of postpartum functioning and wellbeing is access to a quality support system that can anticipate and respond to the needs of the mother. Assessment of access to social support can help to determine if patients are in need of additional support resources to supplement any personal supports they may have.

1. It is important to have different types of support available after you have a baby. Do you have people who can help you with: childcare and household tasks like cooking, cleaning and laundry?

1. Do you have people who you can talk to freely without fear of judgment?

2. Do you have people you can count on for words of encouragement or affirmation?

3. Are you familiar with social support resources such as motherhood support groups, childcare resources, etc.?

Self-Care

Self-care as a concept for reaching and sustaining mental wellness has become highly popular over the last several years. While all of your patients have likely heard the term "self-care," it is important to assess their understanding of the meaning behind it and how self-care can realistically be applied to their daily lives. Consider using the questions below to assess a client's understanding of self-care as a concept as well as their access to self-care practices that will promote wellbeing.

1. What does self-care mean to you?

2. Is there anything you have been doing to care for yourself during your pregnancy that you would like to continue once the baby has arrived?

3. Self-care looks different for everyone and can change depending on what stage of life someone is in. Have you thought about how your self-care practices might change after the baby has arrived?

4. The recommendation for practicing self-care is not meant to create more stress or add another task to your to-do list. Self-care can be as simple as a phone call to a friend, enjoying a favorite meal, or using downtime in the way that feels best to you in that moment.

1. Postpartum Social Support Screening Tool - From the Artemis Center for Guidance.

2. Birth Trauma Scale - From the City University of London.

3. Postpartum Mood Disorder Risk Factor Checklist - From Pregnancy and Postpartum Support Minnesota.

4. Edinburgh Postnatal Depression Scale - Find the online Edinburgh scale.

5. PHQ-9 Depression Screen - Find this general depression scale.

6. Perinatal Anxiety Screening Scale (PASS) - Government of Western Australia Department of Health.

Trauma assessment questions for postpartum providers:

1. At any point during your pregnancy, labor or birth were you concerned about your physical safety or the safety of your baby?

   • If yes, have you spoken with anyone about those fears?

2. Are there any periods of time during your labor or birth that you have difficulty remembering? Are there gaps in your memory of your birth experience?

   • If yes, would you like assistance with reviewing your medical chart/documentation of your birth with your providers?

3. Have you been able to share your birth story with a trusted support person?

   • Were there any parts of your birth story that were particularly difficult to share?

   • Did you notice any changes in your physical state of being while sharing your birth story (breathing changes, temperature changes, heart changes, vision changes, etc.)?

   • Do you find yourself experiencing flashbacks to or visions of any certain part of the labor or delivery?

If yes to any of the questions above, strongly consider providing trauma-specific resources to the patient, a referral to the hospital/clinic social worker or psychologist, and crisis resources.

Other Trauma Resources for Providers:

• • Mother-Baby Hopeline 612-873-4673 - The Mother-Baby HopeLine is a free telephone support service for pregnant women and parents of children aged 3 or younger. When you call, you will be asked to leave a message. A staff person will call you back within two business days. The Mother-Baby Hopeline is not a crisis line.

  • Birth Trauma Screening - City University London Birth Trauma Scale

  • Birth Trauma Facebook Support Group - a layperson support group, meant to encourage, share resources and offer peer support

  • The Minnesota Trauma Project has put together a list of Minnesota resources for healing. The list includes various types of therapy (music, movement, psychotherapy), support groups, acupuncture, homeopathy, massage, yoga, etc.

40-Day Project Resources

• Postpartum: What to Expect (Somali)

• Postpartum: What to Expect (English)

• Mental Flourishing (Somali)

• Mental Flourishing (English)

• Postpartum: Social Support Plan (Somali)

• Postpartum: Social Support Plan (English)

• Identifying Sources of Support and Friendship (Somali)

• Identifying Sources of Support and Friendship (English)

• Taking Care of Yourself in the Time of Covid-19 (Somali)

• Taking Care of Yourself in the Time of Covid-19 (English)

• Toddlerhood: What to Expect (Somali)

• Toddlerhood: What to Expect (English)

Additional Resources

• The 4th Trimester Factsheet - English (flyer)

• Healthy & Fit on the Go: Stress Relief (Somali)

• Healthy & Fit on the Go: Stress Relief (English)

• Depression or Anxiety During and After Pregnancy (Somali)

• Depression or Anxiety During and After Pregnancy (English)

• What Every Provider Type Should Know and Do for Maternal Mental Health - Learn provider core competencies for maternal mental health were developed and published this year by the California Task Force on Maternal Mental Health Care.

• A New Way to Think About the Transition to Motherhood - Watch Reproductive psychiatrist Alexandra Sacks as she makes the parallel between the transition to adolescence and the transition to motherhood (body morphing and hormone changes) and suggests the word 'matrescence' to name this transition. She notes how often in her practice new mothers think they should have the desire to put their baby first, have natural caretaking instincts, etc. Dr. Sacks suggests that instead of a reflection of PPD, these are unrealistic expectations that lead to discomfort for new mothers.

• The Minnesota Healing Justice Network is an intergenerational community of healers and cultural workers that center black and brown wellness through mutual aid, holistic care and solidarity work. Find MN BIPOC health and wellness providers.

• The Minnesota Association for Children's Mental Health (MACMH) - Infant and Early Childhood Division - Brings together professionals from across Minnesota who are shaping the field of infant and early childhood mental health. Find training, membership, consultation, etc.

• Brianna and Tanya is a case study about infant and early childhood mental health. Read about the experiences of a young mother and her child as they navigate struggle, strengths and growth.

• National Maternal Mental Health Hotline - The first national crisis line dedicated to providing mental health support to individuals experiencing a perinatal mental health crisis. Call or text 1-833-9-HELP4MOMS (1-833-943-5746). Services are available 24/7 nationally.

• Suicide and Crisis Lifeline - Free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States. Call or text 988. also 1-800-273-TALK (8255)

• Minnesota Mental Health Crisis Line - Free help for those who are having a mental health crisis or are contemplating suicide. Call **CRISIS (**274747) or text “MN” to 741741 from a cell phone to talk to a team of professionals who can help you. Services are available 24/7 across Minnesota.

• Minnesota Warmline - A safe, anonymous, confidential, and free hotline open 12 p.m. -10 p.m. Monday-Saturday. Call toll-free 855-WARMLINE or text “Support” to 85511.

• SAMHSA's National Helpline - A confidential, free, 24-hour/36 days information service, (English and Spanish) for individuals and family members facing mental and/or substance use disorders. Call 1-800-662-HELP (4357). Provides referrals to local treatment facilities, support groups and community-based organizations.