An Interview With Lucinda Koza
High-Quality Prenatal Care
First, we need to begin supporting families before birth with robust prenatal care. Most people in the US receive prenatal care that consists of visits about every month (more frequent towards the end of pregnancy) which last about 15 minutes. Research shows that this translates into 6–8 minutes of face-to-face time with a provider. This simply is inadequate for guidance, preparation and supporting families during this critical time. We need to set people up for success with support and information about postpartum planning prior to birth, this is simply not possible given the inadequacy of our current prenatal care system.
Postpartum depression is a significant challenge that many new mothers face. The journey to recovery is unique for each individual, involving emotional resilience, self-care strategies, and often the support of healthcare professionals. Addressing postpartum depression is crucial for the well-being of both the mother and her family. Sharing these personal journeys can provide hope, support, and practical advice to others facing similar challenges. As a part of this series, I had the pleasure of interviewing Sara Holt, CNM, MS, CAS, PMH-C.
Certified Nurse Midwife Sara Holt has been practicing midwifery for more than 25 years. During her career, she has caught more than 3500 babies and has helped thousands more families navigate their pregnancies.
Ms Holt is the founder of Byenveni Baby which offers unique programs designed to address gaps within the current pregnancy care model. The Byenveni Baby collective offers support groups, lactation services, gynecology, and full-scope midwifery. Midwife Sara provides consultation for high risk pregnancies, pregnancy navigation services and her unique Supported Pregnancy Program. Additionally, Sara offers assessment and medical management for perinatal mood and anxiety disorders.
Ms Holt is a frequent presenter on the following: How to Navigate Your Hospital Birth, Promoting Physiologic Birth, Making Sense of Your High Risk Diagnosis, and Beyond the Basics: Reviewing ALL the Options For Comfort in Labor. Her passions are true informed consent, perinatal mental healthcare, neutral presentation of risk, patient-led decision making, and supporting patients to maintain their agency and autonomy during birth. When she’s not doing birth-y things you’ll find Midwife Sara reading, biking, practicing yoga, or hanging out with her husband and big family. She lives and practices in Portland, Oregon.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you tell us a bit about you and your backstory?
Yes, I would love to! First, of all- thank you so much for chatting with me, I am so grateful for the opportunity to tell my story. I am a Certified Nurse Midwife practicing in Portland, Oregon. Recently I opened my business, Byenveni Baby, which is a community center for growing families. As a midwife, it’s important to me for people to have access to very high quality consultations, providers, and educational offerings. So, I am extremely careful about the people who I have chosen to partner with. The collective offers consultation for High-Risk Pregnancy and Birth Planning, clinical birth debriefing visits, full-scope midwifery care, lactation consultation, support groups, childbirth education and more. Having my own experiences with traumatic birth and with postpartum depression, as well as decades of catching babies and working with families, has informed the services that I have chosen to provide. It’s quite a unique place and I find the work that I do there to be extremely fulfilling.
Can you share a little about your childbirth experience with us?
It’s hard to even believe it, but I was due to have an induction of labor. I went in, sat down on the labor bed, and my water bag released! I immediately began experiencing very painful contractions. There was no lead in, no early labor or pre-labor. It was like 0–60 mph in 10 minutes. Every now and again, my son’s heart rate would drop very low and stay down for a couple of minutes and then slowly climb back up to normal. So that was concerning, but the rest of the time he looked great.
Of course, as a midwife, and someone who worked at the hospital, I was trying to put on a brave face, but I was really struggling to cope with the pain. Eventually, my midwife suggested that due to fetal heart rate tracing concerns, it would likely be a good idea to have an epidural in place in case we needed to move towards a cesarean. I was so grateful she suggested it! I was in this inner world where I couldn’t really come out or problem solve to ask for help or pain medication! The epidural gave me complete pain relief and I labored for another hour or so. My son’s heart rate took another drop and did not come back up. It turned out that his umbilical cord had slipped out in front of his head — something called a cord prolapse (this is an incredibly rare thing to happen). I just remember that his heart rate was extremely low and there were tons of people running into the room — it was terrifying. I remember saying, “hurry up, just go, just go” when anesthesia was testing me to see if I was numb enough to proceed with the surgery. Anyway, he was born and he screamed right away and everyone just cheered for him. It was the best feeling — I can still see the moment in my mind. I loved that little guy something fierce — I still do!
How did you know you had postpartum depression? How quickly did these symptoms seem to inhabit you after giving birth?
The context of my life situation during my first pregnancy is important, so I will start there. When I was expecting my first baby, I was three years into my career as a Certified Nurse Midwife. So, I knew a lot about birth, but I really didn’t know much about parenting or postpartum mood disorders. My son is 25 now, and we got very little education or training about these things at that time.
I had wanted to be a parent for as long as I could remember but unfortunately I was experiencing a great deal of personal turmoil. My husband had disclosed an addiction to me just after we found out we were expecting, and went into drug treatment. Having a partner or family member in treatment is a very intense experience, and it felt like the pregnancy was almost an afterthought at time. I was also new in my career, so my profession took a lot of energy. I was embarrassed and ashamed of my situation, and also so afraid of what the future might look like for me and my son. Additionally, I felt like a fraud. I was supposed to be the person giving people advice and guiding them, and behind the scenes my life was a disaster. It was an extremely rough time.
It’s hard for me to know when my symptoms first began. I have very few memories of that first year. I feel I was quite diminished by my mood throughout that time. I was trying to follow the principles of attachment parenting, which was popular at the time. This involves near-constant baby wearing, co-sleeping and nursing on demand. It is designed to foster bonding and feelings of security in the baby. But for me, as I was doing most of these things alone, it felt too intense, which led to feelings of overwhelm, and then guilt and shame.
The months went by and I felt like I was in free fall. My marriage was ending, and I was losing myself in motherhood. It felt like my body didn’t belong to myself anymore. There were no boundaries, and I had no one to pass the baby off to. I had no perspective about my situation. I knew I felt awful, but I attributed it to lack of sleep and stressful circumstances (I was also selling my house, moving, and starting a new job!). I actually thought everyone with a baby turning one was probably miserable.
What was the most insidious way postpartum depression had an effect on your body, your new child, your relationship, your family, your work, your brain, your sense of identity? What scared you the most?
Looking back, the saddest thing for me is that I don’t remember big parts of my son’s first year, and that I didn’t get help sooner. Recently I found a little calendar that I would write things in- like when he clapped or smiled or ate this or that. It made me immensely happy, because it was tangible proof that I was there, that it seemed like I had moments of joy and of celebrating him, that maybe I was a good mom to him even though I was down a lot. I want desperately to think I was there for him, and that I was enough.
What has been the single most important tool in your arsenal as you have moved through and out of postpartum depression? Why?
For me, I did some counseling initially. This was familiar to me from my growing up years. However, the real game changer was medication. It wasn’t until I was about 10 days into my medication treatment that I began to feel like myself again. I was able to gain some perspective, I could laugh, I began to be better at coping. Most importantly, I felt that I could enjoy parenting and that made me feel so much more whole! My life still held some very real challenges, but I felt better able to address them and begin to plan for the future as a single parent.
In a perfect world, what do you think women need, structurally, to ensure this transition into motherhood is a healthy one?
1 . High-Quality Prenatal Care
First, we need to begin supporting families before birth with robust prenatal care. Most people in the US receive prenatal care that consists of visits about every month (more frequent towards the end of pregnancy) which last about 15 minutes. Research shows that this translates into 6–8 minutes of face-to-face time with a provider. This simply is inadequate for guidance, preparation and supporting families during this critical time. We need to set people up for success with support and information about postpartum planning prior to birth, this is simply not possible given the inadequacy of our current prenatal care system.
2 . Comprehensive Postpartum Care.
Families deserve high-quality postpartum care. Robust and thorough care during this vital time ensures the well-being of both mothers and babies. Home visits by a nurse or midwife have been proven to lead to higher rates of breastfeeding, as well as lower healthcare costs. Additionally, two-thirds of maternal deaths occur during the year after giving birth. Maternal suicide is a leading cause of death between 6 weeks and 12 months postpartum, accounting for 39% of those losses.
Regarding postpartum care, The American College of OB/GYN states,
“ All women should ideally have contact with a maternal care provider within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.”.
However, only 72% of birthing people receive even one postnatal check, which is typically at 6 weeks postpartum.
3 . Paid Family Leave
The United States is the only high income country without federally mandated paid leave. Women who are able to take paid leave are proven to experience less postpartum depression. Having financially supported time off allows for physical and psychological recovery, and helps ensure financial stability during a time when a family is undergoing an enormous transition.
4. Social Support
We were never meant to do this alone. Personally, I felt so isolated in my postpartum time and I know that contributed to developing depression. However, my experience with the disease changed who I am as a provider, and influenced me as a business owner. One of the aspects of Byenveni Baby that I am most proud of is our Postpartum Support Group. It’s an open community of new parents who support each other. It’s lovely to see people finding acceptance, and seeing the universality of their experiences. I certainly would have benefitted from a group like this.
5 . Time away
As much as we love our babies and our partners (if we have one), new mothers and parents typically need time to recharge and be alone! This could be as simple as a daily walk around the block, or a solo trip to the grocery store. The point is, that doing something new every day, all day, is overwhelming. We need time to quiet ourselves, to decompress, and regroup.
In what ways did society support you as a new mother with postpartum depression? In what ways did you feel failed or overlooked?
In many ways I was isolated in my struggle. First, I didn’t realize I was suffering. I was very much alone in my parenting journey, I knew I felt miserable, but shame kept me from sharing these feelings. I also was so deeply depressed that I couldn’t imagine other people being happy or feeling joy. I honestly just thought that everyone who was caring for a baby must also be suffering. I feel so sad thinking about that now. I feel grief for the months spent in this private struggle. I know I still did feel delight at my baby, but I was so anxious about what the future might hold, and I couldn’t comprehend the situation that I was in, so I felt stuck in my head.
How did you navigate the balance between taking care of your newborn and prioritizing your own healing needs during the postpartum period?
I really didn’t, honestly. I was in survival mode and did not take care of myself. I was working as a midwife, taking night call and caring for an infant alone. There was no time for thinking of myself. Finding help to care for an infant and allowing time for healing is important for all new parents who may be struggling in the postpartum years.
Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. 🙂?
Someone that I have admired for many years sadly is no longer alive. I was reading a great deal about Rwanda before going there for medical missions in 2008 and 2010. I discovered the story of Rosamond Halsey Carr, a socialite from New York who went to the Belgian Congo with her hunter and explorer husband in 1949. Their marriage ended, but she stayed on, as a single woman, and purchased a flower plantation in Rwanda. She went on to have a very adventurous life there, learning to navigate her business, farming, and the local culture. She cultivated a rich group of friends that included Rwandans and expats alike- including Dian Fossey, the American primatologist who was murdered for her anti-poaching stance. Ms Carr watched the decades of political strife leading to the 1994 genocide, and made the decision to stay during that horrific time. Following the genocide she turned her plantation into an orphanage for Rwanda’s lost and orphaned children. Her life story is impactful to me for her adventurous spirit, independence, her commitment to her newfound country and its citizens. Her book is called Land of a Thousand Hills: My Life in Rwanda. It’s no longer in print but I buy every copy that I can find and make all of my friends read it. It is truly inspiring.
If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
My movement would be called, “Tout moun se moun”. This is a Haitian proverb that means, “every person is a human” or “all people are human”. It is a reminder that we see the humanity in those around us. I believe it also calls us to understand the struggles that others may have faced, and that everyone has intrinsic worth. I think many of us tend to think of our achievements exclusively as the result of our personal hard work, and forget all of the systems that served to provide advantage to us.
Father Greg Boyle is a Jesuit Priest and the Founder of Homeboy Industries, a foundation helping gang members with work skills, rehab and reentry into society. He speaks frequently about compassion for those on the margins and the “lottery of zip code”. This is the idea that simply where you are born may be one of the greatest influences of your destiny. Boyle says,
“We are all born wanting the same things…. It’s just kind of random. I won the lottery, the zip code lottery, the parent lottery, the mental health lottery; the list is long. And then there are folks here who have just had to carry way more than anybody else. Once you know that, then that’s a game changer”.
How can our readers follow your work online?
Your readers can follow me on Instagram @Byenvenibaby, or go to www.byenvenibaby.com to learn more about the programs that I am currently offering.
Thank you again for allowing me to share my story, it meant so much to me!
Thank you so much for joining us. This was very inspirational.
About the Interviewer: After becoming her father’s sole caregiver at a young age, Lucinda Koza founded I-Ally, a community-based app that provides access to services and support for millennial family caregivers. Mrs. Koza has had essays published in Thought Catalog, Medium Women, Caregiving.com and Hackernoon.com. She was featured in ‘Founded by Women: Inspiration and Advice from over 100 Female Founders’ by Sydney Horton. A filmmaker, Mrs. Koza premiered short film ‘Laura Point’ at the 2015 Cannes Film Festival and recently co-directed ‘Caregivers: A Story About Them’ with Egyptian filmmaker Roshdy Ahmed. Her most notable achievement, however, has been becoming a mother to fraternal twins in 2023. Reach out to Lucinda via social media or directly by email: [email protected].
Sara Holt Of Byenveni Baby On What I Did to Heal After Postpartum Depression was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.