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Narrative Medicine Explains Why Birth Stories Are So Important

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Like nearly every new mom, I found myself back in the doctor’s office six weeks after I popped out my bundle of joy... filling out a form.

I quickly answered questions about my mood ("OK" most of the time, I guess); about my feelings toward my daughter (nope, I don’t want to harm her); and about my general state of wellbeing (fine?) — everything but my actual birth story.

The doctor glanced at my answers, gave me a physical exam and sent me on my way.

What she didn’t know was that a week after coming home with my newborn, her sweet head nestled in her white bassinet... I raged. I was furious.

If I had been in an office with a doctor who studied narrative medicine, the results of my appointment would have probably been different.

“Narrative medicine would allow the doctor a better opportunity to dig deeper into the mother’s feelings, which would result in the discovery of why the new mother is feeling angry,” says Ashley Wood, a registered nurse with Demystifying Your Health, LLC. “This would help guide the doctor’s treatment plan in a way that traditional medicine wouldn’t have.”

My doctor didn’t know that I was angry at my child, who couldn’t seen to nap longer than 5 minutes at a time. I was exploding with fury at my friends who didn’t warn me about how much my life would change. I looked at my husband for help, and he waited for me to instruct him. Why should I instruct him? I didn’t know what I was doing either.

I was crying, not because I felt depressed, but because I was so angry. I had wished for a child my entire life, but now it all felt so wrong, and I was angry about the whole mess I found myself in.

Every person has a story that goes far beyond the symptoms that bring them into a doctor’s office.

But none of the doctor’s questions hit specifically on my feelings, my narrative. I had a wonderful pregnancy and fantastic birth experience. So it would make sense that I would feel fabulous. But I didn’t. I felt like I didn’t deserve to be angry: I had everything I wanted. So I left the office without a prescription for help.

It never crossed my mind that I might have postpartum depression, or another perinatal mood and anxiety disorder (PMAD), because I wasn’t depressed.

“Behind typical symptoms is the patient, and that’s what narrative medicine looks at,” says Adina Mahalli, a certified mental health expert and a family-care specialist with a master's in social work at Maple Holistics. “It creates an open dialogue so underlying causes or reasons for things don’t get swept under the rug or ignored.”

Narrative medicine, a focus within the medical field founded at Columbia University, examines the entire illness experience and narrative understanding. It’s sort of a psychological route to understanding your problem, if you may.

“Every person has a story that goes far beyond the symptoms that bring them into a doctor’s office,” Wood says. “The key thing to realize is that these stories can shed light on how the person became ill, what drove them to seek help, and the challenges that they face in getting better.”

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A patient's stories offer background that may be needed not just to treat the disease, but to actually help the person heal. The difference, Wood says, can improve patient care.

“Narrative medicine helps to answer the how and why questions, rather than just the what questions,” she says. “It allows medical professionals to treat the whole person.”

While narrative medicine can be used in any area of medicine, it can have a significant impact on new moms with PMADs — or any other issues that may arise after birth. It makes intuitive sense: think of the importance we place on our birth stories.

We don't think of ourselves as simply one of a thousand people giving birth on that day — we each bring individual factors, personalities, and so on into the delivery room. We remember the play-by-plays of every moment of a 40-hour labor. But medical research, by nature, flattens out this experience to get to solid recommendations (for example, that a birthing person's cervix "should" progress a certain amount in an hour).

Researcher Trisha Greenhalgh explained in a 1999 paper in BMJ that, "in large research trials the individual participant’s unique and multidimensional experience is expressed as (say) a single dot on a scatter plot to which we apply mathematical tools to produce a story about the sample as a whole."

Its goal is to promote healing by looking at the psychological and relational aspects that are part of physical illness,

In contrast, using narrative medicine to understand all aspects of a new mom’s life provides a clearer picture of what she is dealing with, and this is crucial to providing the best care for her and for her family.

“This is a completely different approach than traditional medicine, which only focuses on the symptoms and getting rid of them without taking a look at the whole picture,” Wood says.

Essentially, narrative medicine is like a combination of therapy and traditional medicine. It has been branded as "radical listening" among the medical community, but truly listening to patients is a tenet long understood by other birth workers, like doulas, midwives, and healers.

“Its goal is to promote healing by looking at the psychological and relational aspects that are part of physical illness,” Mahalli says.

While stories abound about the positive impact of the narrative medicine field, there’s still little scientific evidence about it, according to a 2018 report published in Canada Family Physician ("The healing power of narrative is repeatedly attested to but the scientific evidence is sparse"). The report recommends that more research be done.

Still, moms are reporting their own positive findings when it comes to narrative medicine, even if they didn’t realize there was a name for what they were doing.

Angela James, a singer/songwriter in Chicago, was suicidal following the birth of her daughter. She felt like it would be better for everyone if she were to just go away — but she kept those thought to herself.

She only began feeling better when she started sharing her feelings first with her infant (and non-comprehending) daughter in the form of music while trying to get her to sleep, humming tunes she’d think of and writing songs like “I don’t know what you know/ I don’t need what you need.”

Then, James went public with her music.

The songs she composed were sentimental, sad and also a balm to her mind, battered with depressive thoughts.

“That process has been very healing,” James says. “It was hard to be so vulnerable, but I consider myself so lucky that I was given the gift of this music during that dark time, and that I have the opportunity to possibly help others accept and heal through honesty and music. It’s been a transformative creative and life experience to confront buried shame and guilt.”

One more reason to tell your story.

If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.