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Hel-loooo Birth World – the Sky is Blue: Part Two of an Interview with Walker Karraa MFA, MA CD(DONA

Originally posted July 9, 2012.

Pregnant and postpartum women are particularly vulnerable to mood and anxiety disorders, and it is life threatening.”

How Long Must We Ask for Compassionate Care?

Why aren’t our childbirth websites and perinatal mental illness websites linked?

I had the pleasure of interviewing Walker Karraa about her dual roles in maternal health: as a professional working in the birth world and also in maternal mental health, and about her work to develop awareness of the overlap of both fields and to bring them together. I want to add, she is a wonderful person, very kind and giving and very much a visionary.

Kathy: It sounds like you have been through alot, emotionally and psychologically, in the birth community. From your experiences, in what ways do you see Childbirth Educators being able to help women and families understand the impact of perinatal mental illness?

Well, at this point in my work I would first ask if there is interest in understanding the impact of perinatal mental illness.

Are we ready to help women understand the impact of perinatal mental illness?

We have to acknowledge the elephant in the room:

Pregnant women suffer from mental health disorders that are physically significant, life threatening, and have proven negative impact on fetal development, birth, breastfeeding, attachment, and long term childhood development.

For childbirth educators, I truly feel that it must come from an organizational level. Educators need support and training to address these issues in their classes confidently, and consistently.

My hope is that childbirth organizations would begin, like the International Childbirth Education Association (ICEA), to publish position statements regarding perinatal mental health. Much like position statements on lactation, VBAC, and informed consent…these statements are powerful anchors for educators and doulas on the front line to feel educated, informed, and supported with evidence-based research, teaching tools and referrals.

Moreover, position papers tell the community at large that we are resources for their clients, and tell women that they will not have to be silent about their journey in our classes. We have a lot of work to do. But again, I don’t know if we are really ready to take on the growth of including perinatal mental illness–fingers crossed.

Kathy: Do you have positive suggestions to bring together differing birth organizations in order to help bridge the gap in the maternal mortality rate?

The word positive is an interesting word. I have learned that when the feminine examines issues from multiple, three-dimensions, it almost inevitably is called “negative”. All women know this, if we focus on the positive, we pass; if we shed light on what is missing, we are problematic. Rush Limbaugh’s recent rhetoric demonstrates this point quite well.

This is important. Building bridges to meet reproductive needs of women requires looking at the gap, the negative space, more than organizing more status quo resources to build the bridge. The negative space between objects is the most interesting, as it has an essence no one can speak to, but everyone is aware of! The space between breaths, the space between contractions, the space between thoughts, between people, between misconceptions… are beautiful examples of the beautiful ‘negative’. And in these spaces I believe we find interconnectivity, movement, energy, fluidity—the ingredients for change!

It takes guts to look at a garden and see what wasn’t planted, but needs to be in order to sustain the soil. However, in my experience, this is not for the faint of heart, or a good way to business success, or group inclusion.

Mental illness, as currently defined, is a disease-based pathology.

But birth professionals know in their gut that medical models don’t fit women’s needs. The perspective comes from what Penny Simkin has always taught–learning from our women, listening intersubjectively to what our clients and students tell us.

We have been silenced and defined so long.

I think birth professionals can learn to hold the space for women’s fullest range of experiences of birth and postpartum, including the number one complication in pregnancy–depression and anxiety, if there is interest.

Just as we do with birth, we need to participate in critical analysis of a priori assumptions about mental illness, mood, and motherhood. But again, if there is interest. If not, it will emerge in other forms and organizations, because mental health and pregnancy/postpartum has been around since the beginning of time, and prevalence rates demonstrate it getting worse. The need will be addressed somehow.

Kathy: What are some of your current projects?

My two biggest projects are my amazing children. Ziggy is 11, and my daughter, Miles, is 9.

Currently I am the President of PATTCh, a not-for profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth.

In 2008, Penny Simkin, Sharon Storton, Annie Kennedy, Teri Shilling, and Phyllis Klaus met to discuss traumatic birth and where the topic fits into maternity care issues. From that initial meeting, the group has grown to Penny Simkin, Phyllis Klaus, Teri Shilling, Kathleen Kendall-Tackett, Kathy McGrath, Heidi Koss, Leslie Butterfield, Suzanne Swanson, Katie Rohs and myself. Last December, we met at Penny’s house for two days of brainstorming and are now in the beginning phases of developing our organization. The honor of working with this group goes without saying. I am humbled and so grateful. This is very exciting news for the birth and mental health world. Look for news on PATTCh on the Lamaze website here!

And, I am in the process of designing my study for my dissertation. I am using grounded theory methods and have fallen in love with it! The area of inquiry will be changes in perception of self through the experience of postpartum depression.

I am creating a training for professionals who work with pregnant and postpartum women.

Sacred Passage, Self-Preservation: Spirituality and Self-Care for the Childbirth Professional combines Buddhist meditation and breathing practices to facilitate providers finding ways to use their own spirituality to combat physical, emotional, and professional burn-out.

I am presenting a poster on PTSD following childbirth at the APPPAH’s 17th International Congress in San Francisco this coming November. And I am continuing my writing for Science and Sensibility and Giving Birth With Confidence (until they kick me out).

Thank you for inviting me to share.


Walker can be reached via her website She is a birth doula specializing in supporting women with traumatic pasts. Walker is a regular contributor to the Lamaze blogs, Science and Sensibility and Giving Birth With Confidence. She is completing her doctorate at the Institute of Transpersonal Psychology. She lives in Los Angeles with her husband and two children.


Palladino, C. L., Singh, V., Campbell, J., Flynn, H., & Gold, K. J. (2011). Homicide and suicide during the perinatal period: Findings from the National Violent Death Reporting System. Obstetrics & Gynecology, 118(5). 1056-1063. doi: 10.1097/AOG.0b013e31823294da


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