Supporting & Improving Maternal Mental Health: An Interview with Suzanne Swanson

August 3, 2016

You have been a licensed psychologist and psychotherapist for 40 years. Tell me what led you to getting your master’s degree and then a PhD in this field in the first place?

I did my undergraduate degree in sociology at the University of Minnesota. At the time there was a nationwide program called the Teacher Corps, and the University of Minnesota version of that was called the Teacher Services Corps. I was hired as an advisor in the office of Interdepartmental Majors and Directed Studies. I was working with students who wanted to do something outside of their regular major. I really had to learn one-to-one to listen to people, and to not put them in a box. I really had to hear to what they needed, and then help them create that. Toward the end of that time, I asked myself, “How can I keep doing this?” There was, and still is, a PhD counseling program at the University of Minnesota that specifically prepares you to work within college counseling settings. So that’s what I did!

Your first child was born while you were in graduate school, correct? How did that experience influence your career? What were some of the challenges you faced at that time? What were some of the highlights of becoming a mother?

I think I will start with the highlight, which was falling in love with him. It opened me up and helped me find a different aspect of myself. That was also a challenge though. I was used to being able to set a goal and go after it on my own time. I was working on my dissertation in an office where there was another woman with a tiny baby. She had a carrier for the baby, and the baby would just sit there and sleep. That is not what my baby did! It really opened my eyes up to the fact that not every child is the same, and not every mother is the same. That changed the course of my professional career for sure.

I didn’t really have postpartum depression or anxiety, but I was very isolated. Almost nobody else in graduate school had children, and they were very perplexed by this decision to have a child. I began looking for what other people had felt or thought or said about this, and could find only one little book that said anything about the emotional experience of becoming a mother. To compare, by the time I closed my practice this past fall, I had a full bookcase on the postpartum experience, from all different perspectives.

SUZANNE IN THE EARLY PARENTING YEARS

For a time you played the role of doula around Minnesota. How did you find yourself supporting women in childbirth?

I had my second and third child at home. For a time, I wondered if I would become a midwife, or become a psychologist. My midwife needed help, so for about a year and a half I was apprenticing with her. Then she decided to stop practicing, and as I looked around, I couldn’t find another midwife with whom I felt a close fit. That got me asking myself, “Do you want to focus on the physical part of this, or the emotional and spiritual part of this?” Knowing that it’s all the same, really.

How did spending time in the birth room with women shape your practice as a psychologist and psychotherapist?

Although the births I attended were mostly at home during that period of my life, they let me see and experience and feel what a satisfying birth looked like for women. That became more than just a concept for me, but really was embodied in these women. Now I am able to really sit with a woman and listen and hear both her fears about the birth, but also hear what she can bring to the birth, and help her realize her capacity to make the choices she would like to make.

What have you noticed are some of the biggest issues facing women who are pregnant, giving birth, and starting out in their journey as new parents today?

Sadly there seems to be such a division between non-medicalized and medicalized birth, and women feel that they need to choose and then they have to perform, versus simply being present. Then they feel shame if they don’t perform how they want to perform, or how they believe somebody else wants them to perform. Maybe that looks like someone who doesn’t want to breastfeed, but feels pressure to. Or someone who really does want to breastfeed, but has very little support. If I live in a home birth community, and I want to have my baby in a hospital,  is that ok? If all my family members have had cesareans, is it ok if I decide I would like to have a baby without any medication. How do I manage those things?

And then the lack of real cultural, institutional, societal support for parents is just enormous. The fact that we have hardly any maternity or paternity leave.

What are some things that new families can do to help themselves have a positive birth experience?

First of all, find a health care provider that both practices safely, and also respects families, which a majority do. But women need to feel comfortable, and feel like they can speak with their providers and feel listened to, and can ask themselves if their care provider fits well for what they need. In my classes we ask, “What are the ways that you can figure out what you want? What are ways to say it, and what are ways to insist?” All of those conversations can be done respectfully. So it is a combination of intra-personal development of their own awareness and abilities, and then some intra-relational development and learning to how to communicate well.

If they do experience a traumatic or difficult birth, what do you suggest they do to seek healing?

First, I suggest really good therapy. I don’t feel like you need to over-professionalize support, but sometimes with trauma, my concern is that if there is a support group, you can reactivate yourself. If people aren’t careful about how to listen and speak, it can become more than sharing and validating, and can become comparison or it can re-trigger the trauma.

At the same time, I know that not everybody has access to therapy, or to people skilled in working with birth trauma. I have certainly heard of women dismissed even by therapists saying, “Well, you have a healthy child,” and that is not helpful to women. Not every trauma develops into PTSD, but it’s helpful for women to recognize that something didn’t just happen physiologically, but emotionally as well.

Online there are resources as well such as PATTCh and Solace for Mothers. And I don’t mean therapy or online resources to be mutually exclusive, or that you can't talk about your stories with others. Use all of the resources, including your personal support network! Let them help you ground you.

Also, I want people to understand that grief and trauma can come side by side. Even when the trauma is healed, there may be a sadness or wistfulness about the loss of the birth that was hoped for but not experienced. That is something for both women and professionals to be aware of, and to know that it is a normal experience.

Since those early years, you have gone on accomplish some amazing things for women who are experiencing postpartum mood disorders and/or experienced birth trauma, including creating a local class for families seeking to resolve previous birth trauma called “Another Birth, Another Story,” which you co-teach with a certified doula, Susan Lane, becoming the state coordinator for Postpartum Support International in Minnesota, and becoming a member with Penny Simkin on the board of the Prevention and Treatment of Traumatic Childbirth (PATTCh). How did your work serving women and families evolve from the local level to the state and then national level? Looking back, are you amazed at where your journey has led you?

I just kept going along, doing my own classes and talks for years. I was involved in the homebirth community. I was one of the only therapists serving women around birth topics, and that was somewhat isolating. I contacted the Minnesota Women and Psychology organization, and told them I wanted to have a meeting. From that meeting grew Pregnancy and Postpartum Support Minnesota. There weren’t many people, but it gave me a group of people who were like-minded. Not necessarily about their views of birth, but their views of how important mental health is in childbearing years.

Over the years I had also heard of Postpartum Support International, and when I met Wendy Davis, PSI's Executive Director, she encouraged me to become the first Minnesota coordinator. This was pre-internet, of course! I met a lot of great people through becoming involved with them. Susan and I did a presentation on our “Another Birth, Another Story” class at a PSI conference that Penny Simkin attended. Later I got invited to be on the board of her new (at the time) organization, PATTCh, and we have been colleagues since. Through PATTCh we, and many other wonderful birth professionals, have started to develop webinars specifically for other birth professionals. We have one coming up in October in fact. So yes, I am amazed when I look back! It all just kind of unfolded.

The best things always happen like that! Now you teach many workshops and classes across the country for birth workers. What is your goal as you talk with other doulas, childbirth educators, mental health professionals, doctors, midwives, and anyone else in a birth related field?

The focus of PATTCh is on helping not just parents (primary birth trauma) but also the professionals who witness birth trauma (secondary).  That's really where I'm headed. I have a workshop coming up for a high-risk OB symposium. Many OB’s don’t hear this information, and how to navigate patients through difficult or traumatic births, and the impact it can have on a woman’s mental health!

What is some advice you would give to doulas or childbirth educators who are just starting out in this field and want to positively impact new families?

The thing that I think really is critical for all of us that work with birth, is to connect the information with the person. Put the mother at the center, so that we are not imposing a framework on her. We are listening, and listening, and listening. It becomes less about concepts, theory, and even evidence, and it becomes just about her.

Where can people go to find out more about your work, or to connect with you?

My email is suzanne.m.swanson@gmail.com, and people can also follow me on Facebook if they would like at Mother's Matter. They can also check out the wonderful resources I am apart of at the PATTCh website!

Readers can also find a sampling of Dr. Swanson's poetry at her website, MothersMatterMN.com, and in her book, "What Other Worlds: Postpartum Poetry."