My first panic attack happened while I was browsing shelving units at Ikea. I was shaking, my leg kept banging into my seven-month-old son’s stroller and my heart was beating like crazy. But as soon as I got into the parking lot, the feelings dissipated.
A second attack hit me a few days later at an empty grocery store: I felt like I was being squeezed tightly by the aisles around me, and this feeling followed me and my stroller all the way home and lingered for a few hours.
The third one literally knocked me to the ground. I vomited several times and hyperventilated, losing feeling in my legs and feet while my hands turned into claws I couldn’t move. Curled up on my bathroom floor, next to the bathtub and my daughter’s training potty, I didn’t know I was hyperventilating (which was slowing down the blood flow in my limbs) until the paramedics arrived half an hour later. The whole terrifying ordeal lasted about two hours. Exhaustion set in and, thankfully, my mom — who had been staying with us for the weekend — was able to help my husband out with my baby and daughter. I had a hard time sleeping that night, worried about another panic attack.
A few days later, alone with my baby — my husband at work, my older daughter at daycare and my mom back to the reserve — I took a sip of coffee and my heart started racing again. I began imagining scenarios and how helpless my little guy and I would be if I had another attack.
I started crying, and I knew something wasn’t right. I put down my coffee and called my family doctor. She saw me that day, prescribed an SSRI and referred me to the maternal health program at Mount Sinai Hospital in Toronto. Months later, after my first therapist visit, I was diagnosed with postpartum anxiety and a panic attack disorder.
I was happy with the speed and quality of my diagnosis and treatment and, within months of treatment, I began to feel more like myself. But after reaching out to friends and family who live on the reserve who have had postpartum anxiety or depression, I noticed one troubling theme: Despite the fact that the large southern Ontario community I’m from has one of the leading on-reserve birthing centres, these women had either diagnosed themselves (and done nothing about it) or rejected all modes of treatment. If they weren’t getting diagnosed with postpartum anxiety or depression, what do the mothers in isolated communities in northern Canada look like? Why is the quality of care so uneven for Indigenous women?
The need for better postpartum care
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Carol Couchie, a midwife who practises on Nipissing First Nation, says that, while I’m fortunate I got the mental health care I did, it shouldn’t be left up to luck. Proper prenatal and postnatal health services should be provided to all Indigenous women, regardless of their circumstances. “We want you to be the best mother you can be,” she says, “and that’s being well and happy so you can convey those feelings to your child.”
The 2015 Canadian Maternity Experiences Survey found that Indigenous women are twice as likely to suffer from postpartum depression as non-Indigenous women, due to decades of systemic racism and the effects of intergenerational trauma. The numbers are higher for us because we are disproportionately affected by poverty, alcoholism, substance use, domestic violence and discrimination that stem from colonial governing systems and policies like the Sixties Scoop, residential schools and assimilation, all of which cause stress and trauma. The biggest risk factors for prenatal and postnatal mood disorders are stressful life events and trauma, as well as a lack of support systems and/or a prior or family history of depression and mental health disorders.
The gap between healthcare on the reserve versus off is particularly stark up north, says Couchie. “In some ways, how can you even diagnose postpartum depression when people are living with no housing, bad food security and trauma?” she says. “I’ve worked in the north, and I can tell you that the resources are thin. People’s life situations are extremely difficult. In a city, you have resources, doctors, midwives and centres.”
But according to a recent health survey of Indigenous peoples in Toronto, 37 per cent of Indigenous adults in Toronto thought that there are inadequate mental health services available to Indigenous people in the city. The same survey stated that Indigenous adults in Toronto have a higher prevalence of mental health conditions than the overall adult population.
Despite an overabundance of physicians in downtown Toronto, Janet Smylie, director of St. Michael’s Hospital’s Well Living House and one of the leads on the Our Health Counts Toronto survey, sees many patients that could benefit from regular therapy but can’t find therapists to refer them to. “It’s really tragic that there’s a very acute shortage of services in many rural and remote indigenous communities across the country,” says Smylie, “but what’s more difficult to understand is that we have a large number of therapists and healthcare providers, yet Indigenous people aren’t able to access those services.”
As I went about my treatment, finding the right dosage for an SSRI over months of slowly building up tolerance and sorting out triggers and methods to approach the attacks, I realized something: I had access to one of the city’s best hospitals, with a doctor specialized in maternal mental health, all just a subway ride away from my home.
For most women, though, it doesn’t get any easier after diagnosis. There are barriers to access to treatment, such as being too far away to receive cognitive behavioral therapy, interpersonal therapy, traditional medicines and antidepressant medications. My friends mentioned fears over the shame of needing help or worries that other people in the community would gossip about their mental health issues.
Another obstacle is cost. “Therapy, which is often a treatment for postpartum mood disorders, isn’t covered unless you’re an Indigenous woman with coverage through the Non-Insured Health Benefits (NIHB) Program, which is about half of Indigenous women,” says Chaneesa Ryan, director of health at the Native Women’s Association of Canada (NWAC). She adds that, even with access to NIHB (a federal health coverage program for registered First Nations and recognized Inuit, excluding Métis, non-registered First Nations and unrecognized Inuit), there are long wait lists.
Ryan details the type of service that Indigenous women typically receive, which varies between on- and off-reserve patients. “If they’re getting access to mainstream services off-reserve, they may experience racism and discrimination, along with a lack of cultural competency,” she says, adding that it can still happen on-reserve with non-Indigenous service providers. “In institutions, such as the healthcare system, these systemic barriers prevent women from wanting to access care because there’s a fear of some level of discrimination.”
Helping the whole family
Depression during pregnancy can have a huge impact on the unborn child, with stress hormones wreaking havoc on both mom and baby, causing preterm birth, low birth weight and other pregnancy complications, says Amrita Roy, a family-medicine resident at the Schulich School of Medicine & Dentistry at the University of Western Ontario. “With postpartum depression, it can have an impact on a mother’s interactions with her kids and partner,” explains Roy, “and create a family environment that can affect the development of the kids and their own mental health going forward.”
Through her research as an MD-PhD student at the University of Calgary, Roy found a strong connection between colonization and Indigenous health, with intergenerational trauma leading to negative health effects. “If we want to create a Canada for all and honour the Indigenous people whose land this is, we need to take Indigenous health seriously,” says Roy. One way to do this is to educate healthcare and social service workers on the history of colonization and its long-term effects, as well as train staff on communication with Indigenous people. “Healthcare often focuses on efficiency and short-term solutions to acute issues and often misses the bigger picture,” says Roy. “We need a system with a more holistic approach that integrates the medical system with the social system.”
A growing number of Indigenous midwives and doulas are leading the charge on a holistic approach, offering a support system rooted in culture, Western and traditional medicines. Healthier mothers can cause a ripple effect for their babies and partners and, ultimately, lead to healthier Indigenous communities.
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“Indigenous doulas and midwives are doing amazing work to bring culturally specific prenatal and postpartum support to Indigenous women,” says Sarah Harney, NWAC’s project coordinator for the Partners for Engagement and Knowledge Exchange. “Increased support is really important in treating postpartum disorders, as is being able to receive specific emotional and spiritual care.”
“It’s like you would in the old days, sitting around the kitchen table and actively listening,” says Dorothy Green, a midwife and owner of Kenhtè:ke Midwives in Tyendinaga Mohawk Territory. In addition to the kitchen table, visits can be in the comfort of the clinic, by the water or around a fire. It’s there that midwives get to know the mothers, their relationships and their support network, and that informs their diagnosis of postpartum mood disorders.
“New intakes and referrals are accepted without question,” says Green. “We acknowledge and honour each woman for where she is on her journey. We know that this is the most vulnerable time in a woman’s life, as she brings new life to her family, community, nation and clan.”
“It’s important to know how to help when women don’t know how to ask,” says Trista Hill, an Indigenous midwife at Kenhtè:ke Midwives in London, Ontario. “We have to know what to watch for so that we can get ahold of it right away instead of waiting and getting a call from them about suicidal thoughts.”
Treatment for PPD from midwives differs than what I received from my doctors. It’s bespoke for each mother and can feature traditional ways (such as using plant medicine) and mainstream therapies. Indigenous birthing centres like the Southwest Ontario Aboriginal Health Access Centre (SOAHAC) and Kenhtè:ke Midwives also connect mothers to a network of support systems that include elders, traditional-medicine practitioners, traditional Knowledge Keepers, language speakers and social workers with experience in mental health and addictions.
The midwives themselves, as described by Green, are Onkwehón:we women who serve as traditional practitioners and primary healthcare providers. “They carry the ancestral knowledge and responsibility to sustain our way of life by birthing our children in the hands of our own people, on our land, using our language, traditions, culture and traditional medicines,” says Green.
Kenhtè:ke Midwives are addressing postpartum depression among Indigenous women, trauma-informed care and mental health and wellness and addictions in our practice by creating a network of support that benefits clients, families and the community, says Green. She adds that Kenhtè:ke Midwives also provide well-woman care, where they work together with each client to develop a mutual, culturally safe care plan that complements and supports her beliefs and guides her through her healing and wellness.
Unfortunately, full-service places like this are few and far between for women across Canada. In February 2017, the Ontario health minister announced the funding of $2 million to support six Indigenous midwifery programs, including Kenhtè:ke Midwives. Green says the demand is larger than that, with her new clinic having already outgrown its space.
“We know that there are hundreds of First Nations communities and Metis settlements within the province, so six is just the starting point,” says Ryan of the $2-million provincial allocation. “We still have a lot of work to do, and a lot of communities are still without these services.” In addition, last June, the federal government dedicated $6 million over five years to First Nations and Inuit community-based midwifery projects as part of its promise to improve Indigenous people’s health outcomes. While promising, there are more than 600 First Nations communities, 53 Inuit and hundreds of Metis settlements, so it will be interesting to see how far that money goes.
Despite the 24-7 job, Green and Kenhtè:ke Midwives are working in partnership with the Association of Ontario Midwives (AOM), Indigenous Midwifery and the National Aboriginal Council of Midwives (NACM) to advocate for education and resources with the Ontario Ministry of Health and Long-Term Care (MOHLTC) to address concerns of postpartum depression, trauma-informed care and mental health and wellness.
I’m no longer considered postpartum, but I still struggle with anxiety. I am thankful for the SSRIs that manage my panic attacks and for the continued guidance of my psychiatrist, but I sometimes wonder what my postpartum period would’ve been like if Indigenous traditional healing had been an accessible option for me.