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A Conversation with Walker Karraa, PhD, on Perinatal Mental Illness

By Barbra Elenbaas, ACNM Writer & Editor

Be sure to check out the other half of my interview with Walker on page 32 of the Fall 2014 issue of Quickening.

In your words, what is Stigmama? is a writing site. It is a creative space. It is dedicated to sharing writing about the stigma of mental illness in motherhood. It’s not a resource site or a support site. If you have a client or patient needing treatment, assessment, interventions—don’t send them to Stigmama and call it a day. There are many professional resources that providers can access for information on training, screening, and current research on perinatal mental illness. For example, try The International Marce Society.

I started Stigmama to address stigma of mental illness as a mother. I wanted to create a space where women could express themselves without fear of retaliation or judgment. It was also important to me to encourage women to write. Writing our stories is transformative. Through telling our stories, our narratives of living with mental illness as mothers, we learn about that which we don’t understand and, in turn, change social constructs of stereotypes and discrimination.

What prompted you to get involved in maternal mental health and create

I have been an advocate for maternal mental health for over a decade. In March, shortly after I tried and failed to launch a White House petition for a national conversation about universal mental health screening for pregnant and postpartum women, there was an incident in which a pregnant mother, struggling with mental illness, drove her minivan into the ocean with her children in the car. The metaphor of this mother having no alternative but to literally drive into the ocean spoke to me. How many of us – how many mothers who struggle with depression or anxiety all alone – have sat behind the wheel of our minivans and thought about making the very same choice? More than would or could admit it, because of stigma.

Stigma of maternal mental illness has gone so thoroughly unaddressed that when a tragedy occurs, media fans the flames of what feels like archaic myth. Because it is hidden, society, communities, families, and individuals are easily influenced by ignorance about mental illness. Stereotypes are reinforced and eventually prejudice and discrimination occur. The juxtaposition of mental illness and motherhood is a construct our society just can’t handle.

In my research and work I have come to understand that how we currently view, treat, measure, and diagnose mental illness is limited to a reductionist interpretation by empirical, positivist science--namely medical science. Not all physical or psychiatric experiences are pathological. We must open that frame for childbearing women! How is it with all of the focus on maternal health, infant health, and birth outcomes, women with life threatening disease go untreated?

In your opinion, what is the top-priority tool or resource that you would like to see more health care professions develop for diagnosing and/or treating mental illness?

I am not an obstetric provider, so I wouldn’t try to speak to their needs. What’s interesting clinically, however, is that we already have the tools to accurately screen and diagnose perinatal mood and anxiety disorders – we just don’t always use them. We have the wealth of evidence showing the negative impact of maternal mood or anxiety disorders on the fetus, birth outcomes, and development of infants, children, and even adolescents – yet we don’t universally screen for PMADs in routine prenatal care. There is overwhelming evidence for the correlation between major depression and cardiovascular disease for women, yet we don’t screen. Why are we not fully integrating mental health screening into medical health screening? Time, reimbursement, false positives – I have heard the arguments and many are true, but poorly operating systems are not excuses for provider failure.

Here is a recent example. As part of the follow-up research I did for my study on transformation through postpartum depression, I anonymously surveyed 488 women who self-identified as having had postpartum depression. Part of the reason I did this was because in my original sample the report of care provider failure was nearly universal. Midwives, OBGYNs, general practitioners, emergency room physicians, family doctors, psychiatrists, doulas, and pediatricians were all listed as providers who failed to treat, screen, or diagnose women with PPD – even after disclosing!

I conducted a survey to further explore this failure. I asked who was MOST responsible for your getting help with your postpartum depression? With full respondents reporting:

Self65.57% (320)
Partner22.95% (112)
Therapist6.76% (33)
Medical care provider11.89% (58)
Family member17.01% (83)
Total respondents: 488

In a follow up question, who was LEAST helpful in getting you help for postpartum depression (PPD)? respondents reported the following:

Medical care providers (OBGYN, midwife,
general or family physician, etc.)
43.24% (211)
Therapist6.76% (33)
Partner20.7% (101)
Family member21.52% (105)
Self19.06% (93)
Total respondents: 488

This is one anecdotal example. There are many peer-reviewed, evidence-based studies demonstrating that a significant barrier to treatment is often provider-related, and many times underlying that is a construct of stigma.

My point here is that we have the evidence, we have already developed the methods to screen, assess, diagnose, and treat perinatal mental illness—but we don’t.

Do you have any advice for students and midwives who want to better address mental illness and mental health issues in their immediate study or current practice?

Join the Marcé Society. Get good information from the subject matter experts and take it back to your practice and studies. There is no single approach that will fix it immediately when many women and providers are both at a loss of knowledge. If you want to better address maternal mental illness, get good information, good guidance, good mentors, good trusted colleagues, and prepare for push back.

What are your hopes for the future of

That more and more women of all ages will share the wide range of motherhood with mental illness in ways that help them, their families, and their communities. I hope that Stigmama helps encourage women to write, to speak their truth. I hope that we will start to understand that mental illness is not all negative. It is common. It is treatable, it is difficult, and it is a constant, chronic condition that needs daily attention. But no one should have to be ashamed of it. Our value and capacity to love our children is not dictated by our mental illness. And in many ways, having a mental illness can be a gift, if not an opportunity for strength in our parenting.

Is there anything else you’d like to share with ACNM members?

The national suicide hotline:

Read ACNM’s position statement on Depression in Women, which advocates for universal screening in midwifery practice and public health policy, at

Posted By Barbra Elenbaas | 10/27/2014 4:59:42 PM



Any opinions expressed in this blog are those of the individual participant(s) and do not necessarily reflect the views of the American College of Nurse-Midwives. ACNM is not responsible for accuracy of any of the information provided by guest bloggers and/or members via the Comments section. We welcome all feedback – including comments, ideas and suggestions. We also welcome civil, friendly debates. However, any and all content that is deemed inflammatory or rude will not be posted.


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