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  • Chloe Bernard

Review of Dear Scarlet, the story of my postpartum depression by Teresa Wong


Dear Scarlet is Teresa Wong’s first graphic novel, her postpartum chronicles. The Canadian author calls Dear Scarlet her graphic memoir, revealing the autobiographic nature of it. “Graphic” because illustrated but also “graphic” in the sense of “detailed”: raspberry-nipples and grape-haemorrhoids come as starters. The author warns regularly: "not for the faint of heart!"

The narration takes the form of a letter to Scarlet, the author’s first born daughter.

Scarlet, this bright red, colour of fresh blood, colour of the maternal haemorrhage that took place after Scarlet’s birth. Red, like the apples Teresa dreams of: she visualises them raining down over her body at the grocery store, burying her into a bin. Red is symbolically the colour of extremes: love and violence. Red represents that bloody contradiction: the joy of meeting this innocent baby and the inadequacy, the uneasiness of being a new mother. Teresa delivers her deeper feelings to her daughter, to her readers. She questions the maternal instinct, the pressure to perform. She recalls her dreams as a child, her aspirations as a woman. Spoiler alert: becoming a mother wasn’t initially one of them.

This is raw, funny, emotional, heart-breaking, heart-melting and so sincere! We witness the first signs of depression, the self-doubting, the guilt, the excessive crying, the anger, the fantasies of vanishing, the impression everyone is staring, the emotional rollercoasters, the moments of relief, of hope too.




Just like in a fairy tale, the protagonist encounters obstacles (a long and traumatic birth, a postpartum depression), opponents (the nurse calling her “emotional”, the doctor dismissing her symptoms of depression) but also adjuvants (her supportive husband, her nurturing mother, the comforting lactation consultant, the non-judgmental postpartum doula, postpartum counselling, little thoughts from family and strangers). In the end, we wish the heroine gets self-confidence and realises all the powers reside in herself. I appreciate a lot the depiction of the traditional Chinese “sitting the month”: a one-month postpartum confinement sponsored here by Teresa’s mother (Poh-poh). The grandmother comes to take care of her daughter, feeds her (pickled pig feet, red date soup, poached chicken and pork liver soup), and cuddles with the baby while Teresa can sleep.

It seems that Teresa has a love-hate relationship with these traditions: wearing a hat indoors and not washing her hair are not her favourite rituals. Nevertheless, she understands what it means for her mother who travelled from China to Canada to meet Teresa’s dad, worked in a factory and learnt English while pregnant and spent her first month postpartum all alone.

Matrescence, we call it. This is a real time for metamorphosis, just like adolescence. A time for vulnerability. Teresa Wong was not a professional illustrator, initially. Her friends convinced her to use her own illustrations, simple and fresh, to reflect that vulnerability and sincerity. This is her, strong enough to show the world her “naked”, raw and real drawings.

In different cultures, the postpartum first forty days are often described as an open tomb, some kind of limbo. Your old self dies and you are born again. The transition can be scary, painful, destabilising. All your marks are shuffled.

“I wanted to show you that you don’t always have to be strong. And that you can come back after losing yourself.”

This books comes with an original soundtrack that you can sing in your head starting with Anthem by Leonard Cohen and ending up with Calendar Girl by Stars.


Notes:

The introduction of the grandmother comes after a short anecdote of a tiger mother and her cub. I can’t help thinking of the tiger parenting phenomenon. Strict parenting can lead to socially prescribed perfectionism: the belief that one needs to meet unrealistically high expectations, possibly resulting in higher risks for depression and anxiety. I also think back to Rachelle Seliga’s class about postpartum dis-ease, weeks ago: perinatal mood disorders are the symptom, not the problem. Postpartum depression can be a healthy way of expressing, releasing one’s emotions that have been prisoner for too long. The teacher talks about disturbed birth, obstetric violence, postnatal depletion, lack of community support, true nurturance, separation (dyad or families) and intergenerational trauma. So many subjects to investigate, fight, resolve, heal.


Do you suspect you suffer from postpartum depression? Edinburgh Postnatal Depression Scale can help you identify it. Seek help as soon as possible.

In Finland, you can contact:

  • Neuvola

  • A public or private doctor or psychiatrist

  • Psychologist or psychotherapist

  • Psychiatric polyclinic or emergency cover

  • Family counselling (Perhe neuvola)

  • Äimä ry’s peer support or any postpartum peer support group



  • Chloe Bernard

Oxytocin, commonly known as the love hormone, is secreted by the hypothalamus, a part of the brain shared by all vertebrates.


While a lot of people hear of oxytocin for the first time in the context of childbirth, the hormone is actually involved in all kinds of intimate feel-good situations like nursing, sex or a really nice dinner with friends in a safe atmosphere.


The origin of the word “oxytocin” is Greek: ὀξύς (oxús, “swift”) + τόκος ( tókos, “childbirth”) Oxytocin helps make the childbirth swift, fast, fluid and smooth.

Oxytocin's chemical structure

Oxytocin makes the uterus contract, slowly, gently, regularly, then progressively stronger and with shorter intervals as the labour progresses. Oxytocin also activates the brain’s pleasure and reward centres in preparation for bonding with the newborn baby.


The more relaxed and safe a person feels, the more this person will secrete oxytocin. It's a shy hormone so we need to respect and support the birth process, to hold space, for it to show up.


When non-human mammals are about to give birth, they first isolate themselves. The Bighorn ewe, for example, reaches the most inaccessible place in the mountain to feel safe. Nocturnal animals usually give birth during the day whereas diurnal animals prefer to give birth at night.


No wonder that when it comes to humans, the privacy of home seems to be the ideal setting to secrete the love hormone during child birth – while it is by no means the only one.


To facilitate natural oxytocin release in case of a hospital birth it's worth considering:

  • Staying at home in early labour as long as possible (except in case of complications)

  • Create or recreate a peaceful or familiar atmosphere (in the delivery room or in the recovery room)

How to support oxytocin release?


N.B.: We are all different, with a different cultural background, a different personal history and different phobias or traumas. Oxytocin is love, trust and consent. Only do what feels good, comfortable and right to you.

1. Privacy

Gentle lights for a gentle birth, Photo by Rebecca Peterson-Hall on Unsplash

Dimmed lights: This is relaxing for the eyes. The neocortex (part of the brain that enables analysis, sensory processing, decision-making, reasoning, and problem-solving) can more easily switch to sleep mode. It also preserves the intimacy, the privacy of the birthing person. Candles can calm the mind and set up a warm and cosy atmosphere. In hospital, you can use electric candles.

Doors are closed and curtains are shut: nobody should come uninvited. The birthing person doesn’t feel observed, exposed (or listened to).


2. Safety

It is important to feel safe in your nest, Photo by Jeremy Wermeille on Unsplash

Trust: Knowing that each person present in the room supports you, respects you, listens to you, doesn't hurt you. You feel confidence in you, your baby, your body, your birth team.

Food and drinks: it is important to feel nourished and hydrated. Hunger and thirst don’t make us feel at peace. And if these food and drinks are delicious, bonus!

Elimination needs are met: How to totally let go if your bladder or bowels are full or ready to move? Free access to the toilet or simply allowing your body to release different types of fluids, is rather liberating.

Physical comfort: Loose clothes, no clothes at all, soft fabric, cushions, towels, peanut ball, all props are welcome to reach a nice and ergonomic position.


3. Connection

Connecting, feeling part of the whole, Photo by Jeremy Bishop on Unsplash

Feeling loved: Hugs and kisses, soft looks, sweet words.

Petting an animal. The company of your own dog, cat or other furry friend can be comforting. See how protective of you and your baby they can be.

Closeness to nature: walking barefoot in the grass, stroking the bark of a tree, feeling the sun kissing your hair, breathing the smell of fresh forest after the rain, letting the sand vanish between your fingers. If there is no nature around, natural elements can bring peace: seashells, stones, a feather, a flower.

All this procures the feeling (conscious or not) of being part of the universe, the history. This unexpected communion can bring unconditional comfort.

4. Ambience

Nice and quiet, Photo by Kristina Flour on Unsplash

Silence, or at least no interview: Some words of encouragements and compliments can be welcome. Though, questions can become too much to process and force you to switch on your neocortex and burst your birth bubble.


5. All 5 senses are very receptive

Touch:

  • Massage: Massage is a nice way to disconnect, let go, let the oxytocin flow.

  • Caress: Gentle and light touch all other the body.

  • Hair brushing or hair braiding: It feels so good to be taken care of. It can give goose bumps.

  • Nipple stimulation: this can simply been achieved by the birthing person, the partner, an older child breastfeeding or even a breast pump.

  • Clitoral stimulation: this can be performed by the birthing person, the partner, or with the help of a sextoy (waterproof if used in the tub). It is possible to ask privacy to the midwives in case of a hospital birth.

  • Warmth: The temperature of the room, a warm bag of wheat and a blanket and wooly socks if needed. If you have access to a sauna, you can also sit there and relax at a comfortable temperature for you. The idea is not to sweat but liberate tensions. Don’t use sauna if you have high blood pressure.

  • Water: Shower, tub, a bucket of warm water (about 37,5 degrees Celsius) falling on the shoulders and all along the back like a waterfall, the feeling of floating and defying the laws of gravity, can be ecstatic.

Smell:

  • Agreeable smells: Lavender essential oil (with a carrier oil, on the skin), fresh flowers, pancakes, whatever brings positive thoughts or pleasant memories. It can also be the plush toy of your older child or your own bedroom pillow.

Taste:

  • Nice taste in mouth: if you hungry and thirsty, eat and drink. Dark chocolate is a good relaxant. I encourage the use of coconut water, filled with electrolytes and an exotic island trip. If you are not thirsty: drink or suck ice. If you feel nauseous, peppermint can help: essential oil drops on an handkerchief or a pastil to suck. You can of course brush your teeth to keep fresh (and offer a chewing gum to your support person). I wouldn’t recommend a chewing gum during labour (it tends to develop tension in the jaws) but according to studies it can be beneficial right after birth (the digestive system is activated faster, the recovery is accelerated especially after a c-section.)

Hearing:

  • Silence brings clarity and transparence for most people. It brings serenity and calm.

  • For some people silence can create anxiety, brings back memories of loneliness or emptiness. For those people, and some others, music can help fill the room with a vibrant energy. Notes can be a gentle and non-invasive company. They can also support the 3 Rs in labour: Relaxation, Rhythm and Ritual. It can help entering the “labour transe”.

  • Lyrics can disturb if they differ from mantras. The idea is to let the brain rest, let the mind escape.

  • Hospital sounds can inhibit this evasion. Sensors can slide, monitors can beep and worry unnecessarily. The monitoring sounds can be shut while still recording the baby’s heartbeat. In most cases monitoring doesn't have to be on-going. Studies show that continuous foetal heart monitoring during labor (vs hands-on listening) increases the rate of c-sections.

Sight:

  • At home, you have your marks and the place is yours, you feel free. You can decorate as much as you want, you reign in your realm.

  • In an hospital setting, the room is usually white, which brings calm and neutrality. But a few artefacts can make you act in a conditioned manner: if the first thing you see is a bed in the middle of the room, you might be tempted to lie on it as if it was expected from you. If the light is on, you might feel unauthorised to switch it off. If you are given an hospital gown you might feel owned by the institution you stepped in and unconsciously act in accordance to this idea. To be at ease and feel “at home” you are allowed to bring along personal items: your own nightgown, your socks, a picture of your grandmother, an amulet, a lucky charm, your electric candles, your ukulele or your hummus sandwich if you feel like it.

  • Sight is a sense that easily activates the neocortex, triggering memories or suggesting the interpretation of a vision. Closing the eyes or using an eye mask can help you stay in tune with your instinct.


6. Mammal instinct: your 6th sense awakes

Be wild! Photo by David Clode on Unsplash
  • The archaic brain rules: Thoughts can block the process. Let’s make room for intuition and spontaneity. The birthing person often develops a sort of omniscience during labour and birth. If sight becomes blurry or sounds become diffused, the birthing person feels the energies, the synergies and knows what is happening in the room.

  • Liberation of sounds: Feel free to express your emotions with sounds, mammal sounds.

  • Liberation of the body: Feel free to move, rock, dance, undulate, vibrate and shake. It is ok to lose control and let the process guide you.

What about synthetic oxytocin? Isn't that just the same? Natural oxytocin is stocked in the posterior pituitary gland and liberated in the blood stream, in a discontinued and pulsative way. Synthetic oxytocin is on the contrary administered intravenously (IV), and in constant, high doses, which can lead to maternal oxytocin levels that are more than double those in a physiological labour.

As a consequence, synthetic oxytocin causes contractions that are longer, stronger and closer together than the body would naturally produce. Synthetic oxytocin inhibits the secretion of endogenous (naturally produced) oxytocin. Although both synthetic and endogenous hormones share the same chemical structure, the synthetic one is not released in the brain so it doesn’t bring along the same soothing effect as the natural one. More info about the effects of synthetic oxytocin.

  • Chloe Bernard

Interview of Mari Koski, osteopath


Photo by Helena Eslon


How did you discover osteopathy and what made you choose this career?

Before being introduced to osteopathy, I was working as a freelance writer and editor. I have a university degree in literature studies and philosophy. Experiencing some health issues I found osteopathy to my aid. I was astonished by its effectiveness and the whole person approach. It was fascinating to feel the subtle changes in my body during the treatment and eventually I got free from difficult traveling hand pain and menstruation pain. I had been doing pilates for some time, and while lying on the table I could feel my body align in a similar manner without using any muscles. I got treated with more straight techniques as well, but I think it was this experience of my own body’s intelligence at work that really made me want to learn more. So I applied for the Metropolia University of Applied Sciences and got in at the first try.


Your approach is very gentle. Which techniques do you use and how does it work?

Yes, from the beginning it was clear that I would be using soft techniques since it is easy for me to feel the microscopic movements, tensions and fluctuations in the body. Often times lasting results follow gentle approach. We learn the same techniques in school, but every osteopath has her own handwriting so to speak. When it comes to techniques I utilize most fascial and functional techniques, cranial osteopathy and within it the biodynamic model. Originally osteopathy has not been about techniques, but philosophy of treatment. We try to see the whole of the patient and make sure the structure and function work reciprocally, so that the body can express health. First of the tenets of osteopathic medicine says that the body is a unit; the person is a unit of body, mind, and spirit. I try to respect that and wish to do it better every day.

The frame in which we work and study extensively is anatomy, including physiology and the functional side of anatomy. So everything that happens in the treatment comes down to anatomy, body systems and body’s own self-regulatory mechanisms that work without our help. I can help your body best by giving it a little directions, but the real correcting movements come from within.

Fascial manual techniques have been studied during the recent years and my approach includes fascial work. Fascial tissue actually surrounds and assembles the body mechanically and provides the underlay for the fluids to move in the body. The central nervous system and fascia are communicating all the time through different types of receptor cells located all around body. Recent studies have shown that fascial receptors react to very gentle touch and minimal amount of pressure. I have learned that steady and gentle touch is effective and it also has it’s place in the research map for manual treatment.


Who is this man on the picture?

The man in the picture is Andrew Taylor Still (1828-1917), the father of Osteopathy. He was a medical doctor and surgeon who worked in the frontiers of the American Civil War, explorer of anatomy, and a man who lost most of his family to spinal meningitis. Dr. Still was frustrated with the medical treatment of his time (whisky, mercury, ineffective surgery etc.) and searched for cures more in line with nature. He used bodily manipulations to successfully cure infectious diseases like flux (dysentery). He was acquainted with spiritual movements of his time and inspired by Native American traditional treatment methods. First Osteopathic medical school was founded in 1892 and Osteopathic Medicine continues to be a branch of medical studies in US where all osteopaths are full licensed DO’s (doctor of osteopathy) beside MD’s (medical doctor). In Europe osteopathy is a health care profession of its own and takes 4-5 years to finish. In Finland osteopaths are registered and supervised by Valvira.


You treat pregnant people. What are the common symptoms of pregnancy that you treat here? Are there contraindications to osteopathic treatment?

The most common symptoms pregnant people come with are lower back pain and pains in the pelvic area. Also quite common are breathing problems, tiredness and swelling. Pregnancy brings big musculoskeletal and hormonal changes that alter the normal biomechanics and those changes are often followed by ligamentous strains, muscle tensions and decreased range of motion. Many times diaphragm is found to be tensed, affecting the quality of breathing and fluid exchange within the body. Osteopathic treatment aims to balance these changes and also cultivate feelings of calm, well-being and relaxation. There are few contraindications to osteopathic treatment in general, but certain techniques are outruled for pregnancy. As health care professionals osteopaths are trained to recognize the red flags and refer to a physician.


Can you help an expectant person to have an easier birth? How? Do you help with breech babies or do you do ”natural inductions”?

There are several changing factors concerning birth. It is impossible to predict them all. We work with the whole of the person and I believe balancing the whole is the key in any preventive health care interventions. This said, in osteopathy we have effective treatment methods for biomechanically balancing the pelvis, releasing tension from areas important for normal birth ( i.e. diaphragm, psoas, pelvic floor, jawline), enhancing the fluid flow and affecting the autonomous nervous system. In breech positions I work with the body in a way that it can provide better chances for the baby to turn by itself. Natural inductions are a part of my repertoire also.


Why is it important to consult after the birth, for the person who gave birth but also for the baby? What about c-section or episiotomy scars? What about if the pudendal nerve has been injured?

Consultation after birth is advisable if there has been any complications, the birth has been prolonged or the fetal presentation has been challenging. In general consulting can be a good idea for all because there can be factors mother or parents are not aware of. Some problems may start as minor, but if unattended can lead to symptoms. To name a few possible conditions in a baby: strains or compressions in thoracic outlet, neck and occiput, strain in the head and vertical fasciae due to forceps used in delivery, bodily compressions in breech babies, craniofacial compressions in cephalic posterior babies etc. The most common symptoms that babies come to see me are reflux, colic, asymmetries in the body, tongue tie issues and constipation.

After the birth osteopathy can help the body to recover faster. In C-sections both the person who gave birth and the baby are good to treat as soon as possible. Scars can be treated after the wound is closed properly. Gentle stretches and localised soft tissue work help to remodel the scar tissue by promoting the release of collagen fibres as well as the vascular and lymphatic supply to the area. Nerve injuries need special medical care, but with osteopathic treatment it is possible to help the circulation in the area concerned and that way make the conditions better for healing.


You recently organised a breakfast in a café with a pilates teacher friend of yours to introduce your services. How did it go? Do you have more events to come? Any new project?

That was fun! I love to talk about osteopathy and I’m very pleased I have found Pilates Gym Jatta for co-operation. We talked about how osteopathy and pilates can help you during the pregnancy and postpartum. Jatta told about using pilates in diastasis recti (abdominal separation). It went well and I believe we will do it again. We have already planned a workshop where you will have a chance to learn and explore effects of osteopathy and pilates combined. Currently I’m busy with the office and post-graduate courses in biodynamic osteopathy and children’s osteopathy.


What’s your motto?

I don’t have a motto, but this quote by Rumi resonates in me:

Respond to every call that excites your spirit.

Photo by Philippe Perov

© Ilmatar Doula 2020. 

Ilmatar

Doula

Tel: 040 145 9457

Contact me
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