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


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

Walker Karraa, MFA, MA, CD(DONA)

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 walkerkarraa.com. 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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15 Responses to “Hel-loooo Birth World – the Sky is Blue: Part Two of an Interview with Walker Karraa MFA, MA CD(DONA)”

  • You know, it is interesting to read this..I can see how careful I was in my response. If anyone has more direct questions, I would be happy to reply.

  • what a great interview. Thank you for sharing.
    Charity recently posted..8 yearsMy Profile

  • Thanks Kathy and Charity,
    I hope birth professionals see the need to look at the elephant in the room, and the lack of recognition of the mental health of mothers in their own organizations. I truly believe this can’t be changed one doula or one childbirth educator at a time. The founders and board members need to address this issue and set the standard for their organizations. Much like Nancy Lantz has done at ICEA.

    I do wonder what the resistance is to putting information on the websites of Lamaze, DONA, CAPPA, and ICEA about mental health. No links? The usual discussion is the “beyond the scope of practice”–well we aren’t telling doulas to diagnose, we are telling birth professionals to give bridges! A link to PSI, for example, would give doulas and their clients immediate access to support and knowledge.

    I am starting to think more and more that there is a power dynamic we aren’t aware of regarding holding knowledge. Sharing information about help outside of the realm of childbirth education as it has been the last 50 years may be threatening to the status quo.

    I look more and more to the community based models such as Health Connect One and Open Arms Perinatal Services.

    • Hi Walker – Ahh yes the power dynamic is strong. I had a hard time working in a corporation b/c of this dynamic. It didn’t matter what was obviously good for a project or for the company, its whose empire was to be protected. It is how humans seem to operate…of course there are other levels,. but this level is quite prevalent.

  • Joy Twesigye:

    I really appreciate the part about the gap–or negative space. I think the space gives us clues about priorities and unspoken truths. I began exploring postpartum care because of the lack of organized education I experienced in nursing school at both RN and NP levels. Many of us can guess a variety of reasons of why that is the case—but despite what we know (not having organized postpartum care is a problem in the US)– we don’t apply systems solutions–we apply small scale solutions that rely on individual people’s passion and unwillingness to move to a new city (get sick, die, get a new job etc). The space keeps teaching me things and hopefully one day I can figure out a bridge, earth creator or map that allows us create solutions at a large scale.

    • Hi Joy – thanks for the input! You are right on about the need for systems solutions….I hope we can all influence the tide as we work together.

    • Thank you for your comment, Joy. There is so much to say and see in the gaps. How amazing that a few of us here get it!And the thing about the space in between is that it is free of judgment, it is not criticism–it is vastly informative. Unfortunately for me, and others I have known, not having community, support, to admit SEEING the gap is a psychic colonoscopy.

      Adrienne Rich said it best: “When someone with the authority of a teacher, say, describes the world and you are not in it, there is a moment of psychic disequilibrium, as if you looked into a mirror and saw nothing” — Invisibility in Academe.

      Anyone, everyone who has experienced this lack of reflection in the mirror of authority knows this crazy making as I do. And it too often silences us, me, you, our…I keep thinking I will get old enough to throw my head back and sing. 🙂

  • I really don’t understand why maternal mental health isn’t addressed by some of the birth organizations you mentioned. It truly feels like denial or a “blame-the-victim” mentality when it comes to the mother experiencing postpartum depression. No one wants the label of a diagnosis or to be told to take medications that may not be necessary, but PPD is a very real problem. New moms need to know that depression is real, that it’s not their fault, and that there is help available.
    Rachelle Norman recently posted..Forgiving ForgetfulnessMy Profile

  • Like Joy, I was struck by the idea of seeking solutions from the negative spaces–what a fascinating exploration of a visual concept. I think that the difficulty linking perinatal mental health issues to the broader scope of perinatal health issues is a microcosm of the challenges faced in addressing mental health across our social spectrum. I agree that the solutions for this need to be systemic–mental health needs to be an integrated part of health assessment and treatment across the board.
    Ann Becker-Schutte recently posted..Coping with The Daily Grind: Challenges of Chronic IllnessMy Profile

    • Hi Ann – I am so with you about the stigma around perinatal mental health issues is a reflection of the larger society’s issues with mental health in general.
      Kathy Morelli recently posted..Hel-loooo Birth World – the Sky is Blue: Part Two of an Interview with Walker Karraa MFA, MA CD(DONA)My Profile

    • Dear Ann,
      Thank you for your comment. I really hear your thoughts that, “the difficulty linking perinatal mental health issues to the broader scope of perinatal health issues is a microcosm of the challenges faced in addressing mental health across our social spectrum”–this resonates with many gaps in care for mentally ill. Rosalyn Carter has a wonderful book on her life long work for the mentally ill called: “Within Our Reach: Ending the Mental Health Crisis” (2010, Rodale. It is a comprehensive break-down of the social systems that keep the mental health needs ignored. You would really enjoy it. She points a poignant finger at stigma, plain and simple.

      “Stigma is the most damaging factor in the life of anyone who has a mental illness. It humiliates and embarrasses; it is painful; it generates stereotypes, fear, and rejection; it leads to terrible discrimination. Perhaps the greatest tragedy is that stigma keeps people from seeking help for fear of being labeled mentally ill”. (p. 1)

      This could not be more true for mothers and mental illness. The stigma of fear surrounding a woman, madness, and motherhood is the shadow behind so much. And I think the birth profession suffers from it, too. Not to mention, it isn’t profitable to help mental health as a birth professional. And for all the talking that is done against maternal health care by the birth world, including promoting Ricki Lake’s ‘Business of Being Born’–is what I call the Business of Being Bjorn–birth professionals make money off of joyful, orgasmic, natural, easy, painless, fearless social constructs. And while I support gainful employment for any one, the bells and whistles, combined with a steadfast organizational stance against better education, keeps the conversation off of the table.

      The spaces are there, the lacking gaps are what can truly lead us to accepting new paradigms of women, and our relationship with our reproduction in social context. Loved reading your comment, Ann…take care!

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