Week 5: Design Thinking Paradigm and The Many Possibilities of Postpartum Depression

What do you think about this image?  Is it a quiet place to think?
A rambunctious place to play? It's all in the perspective.

This weeks blog entry has been ignited by Jacqueline Pizzuti Ashby.  She is a powerhouse of a women that is deeply committed to her work.  Her graduate work is focused in educational design and she has asked us to use the Design Thinking Paradigm for this weeks entry.

The Design Thinking Paradigm has five components:
1. Empathize
2. Define
3. Ideate
4. Prototype
5. Test

I have been working on this terms Major Paper.  Within my practice of working with women's health, specifically women's health during the childbearing year, I have been deeply affected by women who struggle to cope with the challenge of the postpartum period.

The article that I am applying the design thinking paradigm to is The Debate about Causes of Postpartum Depression.  This was published in Psychology Today, March 31, 2013 and the author is Paula J. Caplan, PhD.

1. Empathize: How well does the author make an emotional connection with the readers, and how effectively do you believe the author delivers a call to action?

I find that this article pulls in readers by bringing in her personal experience on becoming a mother.  She poses the questions that I hear almost all mothers ask.  How am I going to be a good mother? Her experience as a mother is used to share that she does understand how mothers feel.  Another good statement that causes anxiety in new mothers is ' the huge sense of responsibility of being a new mother, when we realize that being female does not automatically give us all the answers about how to be a good mother'.  I find many patients I work with feel this and turn 'experts'.  They read, peruse the internet and talk to varied sources.  Most of the time these new moms are confused with the contradicting information.  She feel more inadequate. Her call to action is focused on family and healthcare providers to consider all the possibilities why a mother may be 'depressed'.

2. Define: Is the definition consistent with your interpretation of the issue?

Dr. Caplan definition to this issue of postpartum depression resonates deeply with me. She discusses mother guilt and the pressures of expectations.  She draws from research of mothers and depression.  She exposes many of the common concerns of post partum mothers like exhaustion, guilt, isolation and the physicality of the postpartum period.  She also raises the alarm of labeling postpartum depression as a mental illness. There is research that points to more support (both physical and emotional) to the postpartum women decreasing  the symptoms of postpartum depression.  I am an advocate to empower women to create their support systems.  We are society with many superficial relationships and far away family.  Women need womenfolk for support, comfort and doing daily tasks.  She needs assistance and the Supermom expectation is very difficult to achieve and should not be aspired to.  From my experience, Supermom's lose focus on her personal health and well being and she thrives on external accolades.  When in turn there is a duality of internal self that may need more sleep, more personal stimulation and satisfaction.

3. Ideate: What are the author’s ideas or recommendations and how does she/he respond to the problem or possibility?

I think that Dr Caplan has expressed her view well.  She gives a few specific examples.  She does suggest recommendation to help clarify a mother's feelings. She states that when a mother says that she is depressed, to clarify what does that mean to her.  She may give more specific descriptions of her depression.  She may be tired, angry, sad, lonely, helpless, nostalgic or grief stricken.  These words give a healthcare provider a much clearer picture of what the mother is specifically working with.  What her deeper thoughts are.  Then she can begin to create the solution she needs.

4.  Prototype: Could you design a new practice, program, protocol, procedure, or policy?

I would love to see the return to the 30 day laying period.   In the Chinese culture, postpartum women are considered more susceptible to illness and infection are encouraged to stay warm. In the South Asian cultures, keeping the mother warm is a common theme.  The Vietnmese culture has a 'mother roasting' where a fire is kept burning in her proximity for a month.  The Indian culture follows Aryuvedic principles of warm massages and warm clear broths during the postpartum period.  Another common principle of the postpartum period is that the mother is mothered.  Family and friends descend upon the new mothers home, not to visit nor expect her to host, they descend to cook, clean and shield her from the hostile world.  Her job is to rest, recover and fall in love with her baby.

In the western culture, I have known postpartum women to be out on day four, grocery shopping!  These women don't have the help, assistance or luxury to rest and fall in love.  These women must shop, cook, clean and childmind (if they have older children) while their partner (if she has a partner) is at work.  Also, there is an interesting phenomenon called ' the mommy wars'. This is where mothers are comparing, competing and quietly unsupportive of each other.  It is very similar to bullying with using the babies or accomplishments as markers of excellence.  I have witnessed hostility, unfriendliness and mean mamas.  Postpartum women are in need of friendly support, friendly faces and secure safe people to be with.

I would also love to see a policy of assistance for any new mother.  A person who will come to your house and be a temporary mother.  A person who will come and see that clothes need to be washed, food prepared, space tidied and mama encouraged.  To encourage the new mother to keep resting, eating, sleeping, breastfeeding, growing, and learning about her baby.  A new service being offered are postpartum doulas.  These are women that support breastfeeding and the new mother.  I would like to see a program that all mamas have access two to three times a week to have someone come for a few hours to just get stuff done.

5.  Test:  Consider sharing your prototype with a person that would be directly impacted by its implementation and gather constructive feedback.

The Chinese tradition of zuo yue zi, which translates into “doing the month,” dates back at least 2,600 years, says Wendy Chen, president of the California Alliance of Acupuncture Medicine. The belief is that during this period, one’s pores are “extra open” and that during this susceptible period, illness or infection could easily result from becoming chilled or exposed to wind. Even washing hands in cold water is avoided. Many Southeast Asian cultures subscribe to this idea, practicing “mother roasting”, or nam lua in Vietnamese, where a fire keeps the mother warm for a month. The practice involving an actual fire has largely disappeared in the United States, where indoor heaters now do the job. Among Indians, post-birth care is based on ancient Ayurvedic traditions, a health system dating back nearly 5,000 years that involves warm oil massages for both mother and child and eating heated foods like clear broths. - See more at: http://www.hyphenmagazine.com/magazine/issue-23-bittersweet/motherhood-rooted#sthash.IehH8urO.dpuf

The Chinese tradition of zuo yue zi, which translates into “doing the month,” dates back at least 2,600 years, says Wendy Chen, president of the California Alliance of Acupuncture Medicine. The belief is that during this period, one’s pores are “extra open” and that during this susceptible period, illness or infection could easily result from becoming chilled or exposed to wind. Even washing hands in cold water is avoided. Many Southeast Asian cultures subscribe to this idea, practicing “mother roasting”, or nam lua in Vietnamese, where a fire keeps the mother warm for a month. The practice involving an actual fire has largely disappeared in the United States, where indoor heaters now do the job. Among Indians, post-birth care is based on ancient Ayurvedic traditions, a health system dating back nearly 5,000 years that involves warm oil massages for both mother and child and eating heated foods like clear broths. - See more at: http://www.hyphenmagazine.com/magazine/issue-23-bittersweet/motherhood-rooted#sthash.IehH8urO.dpuf

The Chinese tradition of zuo yue zi, which translates into “doing the month,” dates back at least 2,600 years, says Wendy Chen, president of the California Alliance of Acupuncture Medicine. The belief is that during this period, one’s pores are “extra open” and that during this susceptible period, illness or infection could easily result from becoming chilled or exposed to wind. Even washing hands in cold water is avoided. Many Southeast Asian cultures subscribe to this idea, practicing “mother roasting”, or nam lua in Vietnamese, where a fire keeps the mother warm for a month. The practice involving an actual fire has largely disappeared in the United States, where indoor heaters now do the job. Among Indians, post-birth care is based on ancient Ayurvedic traditions, a health system dating back nearly 5,000 years that involves warm oil massages for both mother and child and eating heated foods like clear broths. - See more at: http://www.hyphenmagazine.com/magazine/issue-23-bittersweet/motherhood-rooted#sthash.IehH8urO.dpuf

I have shared my ideas for a few years. Almost all new moms would like a service like this.  The challenge lies in financial and ego.  New families with a decreased income and increased spending cannot afford this service.  If it was subsidized they would consider it.  I have played with the idea of grants, prepayments, volunteers, retired moms/grandmas and employees.  What would the business model be? A great idea is great.  An idea that cannot generate income won't last for very long, regardless how great it is.  People need to pay for the roof over their heads, get food in their bellies and gas in their car. There are many challenges to create a fair and sustainable program.

Thinking of your own experiences or of a friend or family member, how did you/they cope during the postpartum period? What were the gaps in care?

Article:
Caplan, Paula J. (2013 March 31). The Debate about Causes of Postpartum Depression: Why some Women Struggle Emotionally after Childbirth. Psychology Today, Science Isn't Golden.