Category: More Than Mom

Amanda Farmer thought she was ready for anything that could come after giving birth. She’d read everything she could find on postpartum anxiety (PPA) and postpartum depression (PPD). She’d coached her husband on the signs and symptoms.
“I thought I had this in the bag. If I was going to develop PPD or PPA, I was going to be on top of it, and I’d ask for help the second I started feeling the baby blues,” the mom of one and writer tells HealthyWay.
Seven months after giving birth, on the day before her 35th birthday, Farmer says she fell apart.
“I hit rock bottom. I couldn’t get out of bed. I cried—sobbed, really—told my husband that he should take [our daughter] and move home with his parents because together they would be able to provide a better family for [her] than I could,” Farmer recalls. “I didn’t eat. I’d cry until my body was so exhausted that I’d sleep. My husband would wake me up to check on me, and then I’d cry until passing out again. I was a shell of who I once was. I didn’t feel like me. I felt like an imposter—an actor trying to portray a role that she wasn’t suited for.”
That was a Saturday. That Monday, Farmer went to see her OB-GYN, who quickly helped her get an appointment with an on-site psychologist.
The diagnosis was immediate: Farmer had postpartum anxiety.
“She prescribed me meds, gave me hug, told me that I wasn’t alone. She made me feel normal,” Farmer recalls.
Farmer is far from alone. Although discussions of PPD tend to outweigh those of PPA in new mom Facebook groups and parenting books, some researchers have posited that rates of postpartum anxiety may actually be higher than those of postpartum depression. A 2016 study performed by researchers at the University of British Columbia estimated that as many as three to four times more new moms could be suffering from PPA than PPD.
To put that in perspective, it’s estimated that postpartum depression affects one in seven women. That’s a huge number in and of itself. Now multiply it by four. That’s how many women might be suffering from postpartum anxiety.

What is postpartum anxiety?

Because they’re both mental health concerns and society tends to lump depression and anxiety together, postpartum anxiety is often confused with postpartum depression.
But the two have different roots, says Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California.
“Anxiety is informed by fear and worry, while depression is informed by sadness, low mood, discontent,” Mendez explains.
So why don’t you hear about postpartum anxiety as much as you do postpartum depression?
In part it’s because postpartum anxiety is not technically a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (commonly known as the DSM-V). That’s the “bible of diagnostic criteria for psychologists,” according to Hayley Hirschmann, PhD, a clinical psychologist in private practice with the Morris Psychological Group in Parsippany, New Jersey.
“Postpartum depression is not really a diagnosis there either, but someone can be diagnosed with major depression with a specifier of postpartum or peripartum onset,” she explains. “This means the symptoms began during pregnancy or in the four weeks after delivery.”
But just because it’s not in the DSM-V doesn’t mean postpartum anxiety isn’t real or that it’s all in a mom’s head.
“You can be a postpartum parent who is suffering from a specific anxiety disorder, e.g. panic disorder, generalized anxiety disorder, [et cetera],” Hirschmann says. That there’s no official diagnosis for postpartum anxiety comes down largely to semantics, she says.
If you’re presenting in her office with anxiety symptoms, and they’re spurred by the recent birth of your baby, it’s fairly easy for a clinician to put two and two together.
What’s more difficult is to break down societal myths about anxiety and depression.
“People use the words anxious or depressed all the time,” Hirschmann points out. “We say ‘Oh, I’m so anxious about that test,’ but it’s not the same as having anxiety. Even having some anxiety about a new baby is not the same.”
So what are the signs of postpartum anxiety, and how do clinicians differentiate between postpartum anxiety and postpartum depression?

Postpartum Anxiety Symptoms

There’s a certain amount of overlap in symptoms between postpartum depression and postpartum anxiety and that can make sussing out which a mom is facing hard for those who aren’t trained clinicians. It’s also possible for a new mom to be suffering from both, Hirschmann says, which makes it all the more important to talk to your doctor.
That said, here’s a look at the symptoms most commonly associated with anxiety disorders, according to the National Institutes of Health:

• Restlessness or feeling wound-up or on edge
• Being easily fatigued
• Difficulty concentrating or having your mind go blank
• Irritability
• Muscle tension
• Difficulty controlling your worry
• Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)

By contrast, postpartum depression (again from the National Institutes of Health) is typically characterized by:

• Feeling sad, hopeless, empty, or overwhelmed
• Crying more often than usual or for no apparent reason
• Worrying or feeling overly anxious
• Feeling moody, irritable, or restless
• Oversleeping or being unable to sleep even when your baby is asleep
• Having trouble concentrating, remembering details, and making decisions
• Experiencing anger or rage
• Losing interest in activities that are usually enjoyable
• Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
• Eating too little or too much
• Withdrawing from or avoiding friends and family
• Having trouble bonding or forming an emotional attachment with the baby
• Persistently doubting your ability to care for your baby

Notice an overlap? That’s what makes postpartum anxiety particularly confusing for new moms and their partners—and the differences can make it harder for some to seek treatment.
That’s what happened to Kimberly Rae Miller. The writer and mom of a now-2-year-old son says she had read up on postpartum depression and even had a feeling it might crop up after giving birth, but when it didn’t, the feelings that swam to the surface put her off keel.
“I was so consumed by how perfect my son was when he was born that I felt that there had to be a shoe that was about to drop,” Miller recalls. “I was petrified of everything. When he was born we lived in a third-floor walk-up in Manhattan. I constantly had images of tripping down the stairs while holding him, or tripping and him falling over the side of the banister. I wouldn’t leave the house, and when I did I always carried him in a baby carrier while I walked down the stairs very slowly, even if I was going to use a stroller while we were out.”
Miller and her partner moved to the suburbs just before her son turned 1, and she recalls panicking because the car gifted to them by her parents didn’t have a LATCH system in the middle seat for his car seat. She’d read that the middle was the safest spot, and the fear kept her up at night.
“I kept having images of us being in an accident on the side of the car his seat was on,” she says. “At one point I described my anxiety and how I hardly ever left the house with a mom’s group I was in and someone recommended I talk to someone at Seleni Institute in New York about what they said sounded an awful lot like postpartum anxiety.”
Like Farmer, Miller was eventually diagnosed with postpartum anxiety, but it’s a diagnosis she didn’t expect, in part because information about PPD was available everywhere she turned, but there was little to none on postpartum anxiety.
Adding to the confusion for moms are the “baby blues,” a normal (aka just about every mom has them) period after the birth when you just don’t know which way is up: You’re tired. The baby is screaming. You have no idea how to do this.
The baby blues may last up to two weeks, and it’s pretty typical to feel out of sorts during this time, Hirschmann says. After all, your body just went through a major trauma, and your sleep schedule (we use that term loosely) is likely out of whack, with baby waking up at odd hours demanding to be fed or changed. As many as 80 percent of moms will go through this period of change with at least some issues.
It’s when the so-called baby blues last beyond that two-week period that it starts to become a concern. If you’re feeling the same or worse at three weeks postpartum, call your doctor, Hirschmann says. And if you’ve gone past that three-week point, but you’re still struggling, make the call.
During your appointment, your provider will look at “intensity” of worry and anxiety, Hirschmann says. They may also ask you to answer the questions on the Edinburgh Postnatal Depression Scale, an assessment tool commonly used to suss out postpartum mental health issues.
“I’ll focus a lot in the clinical intake interview on the frequency, intensity, and duration of whatever symptoms they are reporting, which can vary a lot from individual to individual,” Hirschmann explains. “I’ll also try to get a good sense of how much of a change these symptoms are from prior functioning. A mom suffering from a generalized anxiety disorder is going to look very different from one suffering from a panic disorder. One is going to have excessive, ongoing, uncontrollable worry about lots of things they never worried about before.”

Who’s at risk of postpartum anxiety?

Moms don’t bring postpartum anxiety on themselves. There’s nothing that a mom does “wrong” that makes her wake up in the morning clutching at her throat and worrying that she or her baby won’t make it through the day.
But there are risk factors at play that make some moms more likely to progress from baby blues to diagnosable anxiety—risk factors that typically come down to things moms can’t control.
“The postpartum period adds a hormonal variable to the dysregulation of mood and emotions,” Mendez says. “Some women are at greater risk of experiencing postpartum anxiety and/or depression because of the hormonal changes in their bodies, but also because of life changes and demands.”
Also on the list of risk factors? Any prior history of anxiety and or depression. Even a battle with mental health issues in your teenage years that you thought you licked can come roaring back in the days or months after giving birth.
That’s not a flaw, Hirschmann says, it’s just life.

Treatment for Postpartum Anxiety

Treatment for postpartum anxiety is not one-size-fits-all, and some doctors may recommend therapy alone or medication alone, while others may recommend therapy plus medication.
“The most effective anxiety treatments focus on teaching coping skills to manage fears and worry and promote shifting of negative thinking patterns,” Mendez says.
While postpartum anxiety can last anywhere from a few months to a few years depending on a mom’s circumstances, the real key to finding your way out seems to be finding help.
“The sooner you get treatment, the sooner you start feeling better,” Hirschmann says.
For Farmer, treatment made all the difference, but even being acknowledged helped get that ball rolling. “Within 48 hours of being diagnosed with postpartum anxiety and starting medication, I felt different. I could breathe,” she recalls.
That’s a common reaction, although truly moving on toward “normal” can take awhile. Because medications can take as much as four to eight weeks to be effective, typically talk therapy is helpful in the early days or weeks after diagnosis, Hirschmann notes. Some moms may eschew medication entirely because they’re breastfeeding, although a number of selective serotonin reuptake inhibitors (SSRIs) get the nod from clinicians for being okay while nursing.
That’s information Miller wishes she’d known when she was diagnosed with postpartum anxiety, and she encourages other moms to look to the medical studies on anti-anxiety medications when they’re struggling with postpartum anxiety.
“My doctor … told me that he didn’t feel like there was enough research into breastfeeding and anti-anxiety meds and wouldn’t prescribe for me until I stopped breastfeeding,” she says. “I didn’t mind supplementing, but my son found huge comfort in breastfeeding, and I didn’t feel like it was fair for me to take that away from him, so I felt like I had to make the choice between his happiness and mine. I chose his and forwent medication. Looking back, I wish I’d gotten a second opinion.”
The fact is, Mendez says, “Symptoms of anxiety and/or depression can be managed effectively with treatment.”
If your doctor says you do have postpartum anxiety but isn’t supportive of the treatment options you want to pursue, don’t be afraid to find a second opinion.
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Rachel Cannon doesn’t wait for a pregnant woman to deliver her baby to start looking for signs of postpartum depression. Like most practitioners in her field, the Boston-based OB-GYN and instructor at Boston University begins screening for postpartum depression before a woman is anywhere near the postpartum period.
She wants to know if her patients have a history of depression or anxiety. She asks what their support system is like. She makes inroads at every prenatal visit.
Cannon isn’t trying to police the thoughts of moms-to-be, and she’s not being judgmental. She is trying to treat postpartum depression before it starts. What’s more, she’s aware that just 14 percent of postpartum depression sufferers actually seek and receive treatment in America, an unfortunate reality that comes down to a multitude of factors—from moms’ fear of judgment and recrimination to societal attitudes that make asking for help a taboo for hundreds of thousands of women every year.
For new parents in America, the fight for postpartum depression treatment isn’t just one of awareness. Moms need to feel safe recognizing the symptoms in themselves and to feel secure saying, “hey, I need a little help.”
Whether you’re expecting a baby soon or already delivered…if you’re wondering what’s part and parcel of the life changes that come with bringing a new one into the world and when it’s time to put up the white flag, here’s what the doctors say.

Postpartum Depression or Just the Baby Blues?

If you had a dime for everyone who told you that the days after you welcome a child are different, you’d be living it up like Bill Gates by now. But guess what: All those clichés that come at you during pregnancy come at you for a reason. You might as well be Dorothy waking up in Oz after you give birth.
Your life has just changed. Your body has been through the wringer. And your new baby has no idea how to do much of anything without you, save for sleeping and sounding out a cry-fueled alarm that they’re hungry, tired, or have a diaper full of yuck.
So it stands to reason that you might feel a little down and out in the days after having a baby, and that’s perfectly okay, Cannon says.
“Every woman, her life is going to change,” she notes. “Her sleep, her appetite, her libido is going to change, and that’s normal.”
And with all that change comes a plummet in mood. The American Pregnancy Association estimates that anywhere from 70 to 80 percent of new moms have these feelings, which usually hit them within a week of birth. You might feel tired. Weepy. Anxious. Unmoored. Usually dubbed the “baby blues,” this period of feeling very un-you doesn’t necessarily mean you have postpartum depression.
It could just mean you’re a new mom trying to figure out a whole new life, and those feelings will go away as you adjust to your new routine.  
So how do you know if you have postpartum depression? It’s when the symptoms of the baby blues stick around that you need to seek an evaluation by your doctor for something more serious.

How to Know if It’s Something More: Diagnosing Postpartum Depression

For 1 in 7 women, the baby blues don’t end, at least not without help. They still feel down and out of sorts well past their baby’s arrival, even as they fall into a routine of diapering and feeding and swaddling. For some, the feeling won’t even show up right after baby’s born. Postpartum depression can begin to rear its ugly head as long as three or even six months after baby’s arrival.
But before they can get help, many women face a host of misinformation that they need to wade through. In one BabyCenter poll, 77 percent of women confessed that they thought having postpartum depression meant you were a risk to your child’s safety.
It’s a myth perpetuated by alarmist headlines about desperate moms who have hurt their babies. And sadly it does happen. But causing harm to your baby or yourself is just one of the possible symptoms, and it’s one that’s experienced by fewer women than other issues that are still difficult for moms, such as insomnia or anxiety. No matter how minor you may feel your issues are, they are absolutely worth a follow-up with your physician.
The truth is, if you’ve gone two weeks with any of the following symptoms of postpartum depression (as outlined by the National Institutes of Health) it’s time to make that call:

• Feeling sad, hopeless, empty, or overwhelmed
• Crying more often than usual or for no apparent reason
• Worrying or feeling overly anxious
• Feeling moody, irritable, or restless
• Oversleeping or being unable to sleep even when the baby is asleep
• Having trouble concentrating, remembering details, and making decisions
• Experiencing anger or rage
• Losing interest in activities that are usually enjoyable
• Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
• Eating too little or too much
• Withdrawing from or avoiding friends and family
• Having trouble bonding or forming an emotional attachment with the baby
• Persistently doubting her ability to care for the baby

Not sure if you fit the bill? Many doctors use the Edinburgh Postnatal Depression Scale as an assessment tool, and the questions are available online. Although the test should not be used to self-diagnose, the 10 questions can help you make sense of what you’re feeling.
If you’ve had thoughts of hurting yourself or your baby, it’s particularly important that you don’t wait to make that call, Cannon says. You may be experiencing something called postpartum psychosis. Although it’s much rarer than postpartum depression, postpartum psychosis is the leading cause of maternal death in a baby’s first year. Postpartum psychosis can result in complete psychosis, cognitive impairment, and grossly disorganized behavior. The good news is, as with postpartum depression, there is treatment—but a mom and/or a loved one has to identify the problem and get her help.  
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The Risks of Postpartum Depression

The postpartum depression symptom list is a long one, and it’s one that many moms say makes them feel inadequate and scared even to broach the topic of postpartum depression with their healthcare providers.
For many, it’s something they’ve never felt before. For half of all postpartum depression sufferers, this is the first time they’ve ever experienced these feelings, which can quickly feel like a ding on their brand-new parenting record.
But postpartum depression isn’t a mom’s fault. It doesn’t mean she’s failing or that she’s ill equipped to be a parent.
It comes down to our own bodies and how they’re affected by pregnancy and motherhood, says Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California.
“Postpartum depression is a condition resulting in emotional dysregulation impacted by hormonal and chemical imbalance associated with pregnancy,” Mendez says. “The condition impairs decision making, interferes with perceptions, [and] may impair relationships and disrupt daily living routines.”
In that way, postpartum depression is much like clinical depression. Moms who struggle with postpartum depression show signs that are markedly similar to those of non-parents with depression. But a number of scientists surmise that postpartum depression differs from classic depression in large part because of the hormones that take control of a mom’s body. Although a pre-pregnancy depression diagnosis will increase a mom’s risk of developing depression postpartum, some moms have no history of depression and after treatment never experience symptoms again.
If you’re feeling like you need a little help—or a loved one has picked up on the cues—you can start at your OB-GYN’s office. And there’s no need to wait for your six-week postpartum checkup. Call your doctor’s office and explain that you’d like a postpartum depression screening.
Regardless of whether you’re feeling postpartum depression symptoms, the experts maintain that risk factors rest largely on genetics and societal factors.
Women who have a history of depression are at higher risk than their peers, as are moms who deliver a pre-term baby, moms who lack a support system, and moms who are under other undue stressors during pregnancy or in the postpartum period. Some science even indicates that women who give birth during the winter and spring months are at higher risk than those who have summer and fall babies.
Although exact causes have yet to be determined, doctors like Cannon keep a keen eye out for moms who are expressing anxious feelings during pregnancy, as postpartum depression is not singular to the days after a woman gives birth. Symptoms are as likely to crop up during pregnancy or even months after a baby’s arrival.

Help for postpartum depression is on the way.

It’s because of this that postpartum depression treatment may begin well before the postpartum period, especially for women who come into pregnancy with a previous mental health diagnosis.
As many as 20 percent of women experience depression during pregnancy, and it’s been linked with adverse obstetric outcomes such as low birth weight and premature birth.
That alone could be reason enough to remain on an antidepressant for the nine months of pregnancy, but doctors have also found that a pre-pregnancy depression diagnosis is one of the leading indicators that a mom may suffer from postpartum depression. These days that’s enough to leave the barn door wide open on the topic, with doctors weighing a mom’s well-being against unknown risks to her fetus.
Although it was once customary for women to suspend taking antidepressants during pregnancy, an increasing number of doctors advise moms to stay the course if they feel they need the medicine in their system.
“Unfortunately, we don’t have a lot of data,” Cannon says of the safety of antidepressants for moms-to-be.
But what data they do have indicate that some formulations of medications are safer than others, and your OB-GYN may suggest a change to a specific medicine. The American College of Obstetricians and Gynecologists suggests that “the use of a single medication at a higher dosage is preferred over multiple medications, and those with fewer metabolites, higher protein binding, and fewer interactions with other medications are also preferred.”
And while studies continue to present a variety of factors for moms, recent research has shown that fears that antidepressants may hike a child’s autism risk are unfounded, as are fears that it will cause attention deficit disorder.
If you’re debating whether to start (or restart) antidepressants during pregnancy, be aware that antidepressants may need to be started at 36 weeks of pregnancy to get adequate blood levels in a woman’s system to ward off uncontrollable emotions once the baby is born.
That said, antidepressants aren’t the only tools in a mom’s arsenal if she’s fearing she may develop postpartum depression. Sherry Ross, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California, suggests adding visits with a therapist to your prenatal plans if you have concerns, as they can not only help you take control of your emotions during pregnancy but also help craft plans for the postpartum period. They’ll also suggest how other important people in your life—from a friend to a sibling to a partner—can provide you support.
“It’s important to establish a support team who will help you be successful avoiding the dark days associated with depression,” Ross notes. “The team should include your partner, therapist, and healthcare provider. Women suffering from this type of depression need to acknowledge and be communicative on how they are feeling and use their support team regularly.”
If you’ve already given birth when you start to experience issues, you may be in new territory, but it’s never too late to get help.
Symptoms for postpartum depression may crop up as long as six months after a woman gives birth, but treatment is out there.
“Symptoms associated with postpartum reactivity are usually temporary and responsive to treatment,” Mendez says. That treatment can include cognitive or behavioral therapy with a therapist and/or medication.
For moms who are considering breastfeeding, there’s even good news: Studies on moms with postpartum depression found that some antidepressants are safe for breastfeeding. What’s more, research on moms who stopped taking antidepressants versus those who stayed on the meds showed a direct link between staying on selective serotonin reuptake inhibitors (SSRIs) and extended breastfeeding.
Regardless of your medical treatment plan, there’s physical support out there too. Postpartum depression support groups exist across the country, and they’re all just a phone call away.

For the first month after Charlotte Edwards gave birth, she was confined to her home. No computer. No stepping outside. No doing laundry. Her father-in-law grocery shopped and washed her baby’s clothes (by hand). Her mother-in-law cooked and helped with the baby’s every need.
No, Edwards didn’t land in in-law heaven. This is tradition in China, where zuoyuezi, which literally means “sitting a month,” is observed by every mom…and in-laws are typically the ones who pitch in to make it happen.
And yet, when policy experts tally up various facts and figures, China doesn’t take the prize for “best place in the world to be a mom” (that honor goes to Iceland). Nor is it at the top of the best places to raise kids ranking (another Scandinavian country grabs that distinction).
We’re not going to steal work from the policy wonks out there who draw up these lists every year, but we wondered if there wasn’t something to learn from the way parenting is done and mothers are treated around the world.
Can we improve motherhood right here in the U.S. by picking and choosing some of the offerings from other countries? Or simply attain more appreciation for what we have?

From the looks of the parenting books pushed out of publishing houses in recent decades, that’s exactly what an increasing number of moms are trying to do.
Amy Chua’s controversial 2011 parenting memoir Battle Hymn of the Tiger Mother gave us a how-to for parenting like a mom from China does. Though Chua herself is American—born in Illinois to parents who immigrated to the U.S.—her guide was quickly followed by tomes on how kids around the world get their smarts, tutorials on raising better eaters by pretending to be French, and, most recently, a German parenting waltz that shares its name with a hit U2 album.
As Brooklyn-based writer Catherine Crawford, whose adventures in parenting her two daughters like a French mom inspired her book French Twist: An American Mom’s Adventure in Parisian Parenting, tells HealthyWay, “The fact that we have so many ideas and approaches to borrow from is both lucky and unlucky. Choice is wonderful, but it can be overwhelming.”
So how do you choose? How do you know if you’re buying into the notion that the grass is always greener or truly finding inspiration in the right places? Let’s dive in.

Pregnancy Around the World

The parenting journey starts with pregnancy. Whether you give birth to your children or adopt, someone somewhere has to get pregnant.
Living in the land of the free and the home of the brave has its drawbacks here. A recent State of the World’s Mothers report by the charity Save the Children puts the United States dead last on a ranking of maternal health for moms in developed countries. Here in the U.S., a woman expecting a baby faces a 1 in 1,800 risk of maternal death.

The best places to live if you’re expecting a baby? If you can handle the winters, Scandinavia is the perfect place to gestate your little one. Norway takes the top spot on the Save the Children list, followed by Finland, Iceland, and Denmark, with Sweden rounding out the top five.
The hardest places to be pregnant are all on the African continent, with Somalia ranked at the very bottom, just below the Democratic Republic of Congo. In countries on that end of the spectrum, Save the Children estimates an average of 1 in 30 women will die from a pregnancy-related complication.
So what makes it so much harder to be a mom in one area of the world versus another?
Poverty and wealth play clear roles. The countries where moms struggle the most also tend to be some of the poorest in the world.
But what countries on the higher end of the spectrum all have in common is a focus on prenatal care, which ensures they have not only healthy moms but healthy babies.
Norway, for example, boasts one of the best healthcare systems in the world. (And you don’t have to take the Norwegians’ word for it: The World Health Organization agrees.)

The land of fjords, trolls, and Norse mythology is also home to svangerskapskontroll, also known as regular prenatal check-ups that are covered in full by the country’s universal healthcare. Norway also offers a maternity leave plan that extends for 49 weeks at full pay (or 59 weeks at 80 percent pay). Moms can choose between a midwife or an obstetrician, and their choices during their graviditet (Norwegian for pregnancy) guide the entire nine months. If a mom doesn’t want a test done, she says no.
Moving down the list a bit is New Zealand, which lands at No. 17 on Save the Children’s index. Kiwi mom Margo Marshall tells HealthyWay that midwives care for moms with regular (not high-risk) pregnancies from the time pregnancy is confirmed through week six postpartum.
“Prenatal care is as non-invasive as possible,” Marshall says. “So whilst we do refer for standard scans at 13 weeks (for chromosome abnormality detection) and at 20ish weeks (for anatomy scan) that’s all the routine scans that are offered unless clinical needs suggest otherwise.”
Not surprisingly, midwifery care has been linked by a number of studies to improved outcomes for moms, which is reason enough for this to be considered a perk of living down under, but Marshall says there’s another advantage, too.
“All of this is free to the mother, courtesy of global health care,” she notes. “It’s possible to opt to have an obstetrician look after your care, but only a small minority do so. This usually comes with a couple thousand in extra fees (because unless referred for a clinical reason, it’s considered ‘going private’), and the general feel is that an obstetrician in charge of maternity care for a normal, straightforward pregnancy is overkill.”

Wondering where else you can have a dream-like pregnancy (or not)? Here are some of the wins and hits moms take in other countries:

• In Japan, the mysteries of pregnancy aren’t left to the parenting books. The government offers women a special pregnancy handbook, which guides them through the process. Each expectant mother also receives a Maternity Mark, a special emblem moms can carry on keychains or bags that signals to society that they’re gestating and should receive kind treatment.
• In Tanzania, maternal mortality rates are among the world’s highest, with 454 maternal deaths per 100,000 live births. One of the biggest problems Tanzanians face is inadequate prenatal care. In this East African nation, only 15 percent of women seek out a doctor’s care during their first trimester. To combat that, health workers have created special awareness programs to convince moms to initiate prenatal care earlier. If they do go to the doctor, they’ll find one thing most American moms won’t: The average first-time prenatal visit in Tanzania lasts a whole 46 minutes.
• In China, Edwards found that moms don’t make prenatal appointments. Instead they line up at the doctor’s office and wait to be seen. “Because of this, we found a friend who would help and see me when she worked the night shift,” Edwards says of her pregnancies. Another concern she noted are Chinese legends surrounding pregnancy: “There are still many old wives’ tales that are followed like it’s the gospel truth,” she notes. “Sex is forbidden during the first and third trimesters because it’s believed to cause miscarriage. Women cut their hair short so the baby gets more nutrition.”

Birth: Who Gets It Right

Even if you’re having a marvelous pregnancy with plenty of pampering, eventually that baby has to come out.
If you plan to give birth in the United States, the numbers allude to an alarming tale. America’s infant mortality rate sits at 5.8 deaths per 1,000 births. That’s more than double the rates in Japan and Sweden, the countries with the lowest infant mortality rates in the world.

When Save the Children’s researchers took a look at capital cities in high-income countries, Washington, D.C., ranked the highest for infant death risk, with an infant mortality rate of 6.6 deaths per 1,000 live births. Those figures, which come from 2013, represented an all-time low for our nation’s capital, and yet they’re still three times higher than infant mortality rates in Japan’s capital, Tokyo, or Stockholm, the capital of Sweden. What’s more, they’re not the worst in the United States. Detroit’s infant mortality rate was reported at 12.4. In Cleveland, the figure jumped up to 14.1.
But before you start packing your bags to head out of the country, it’s important to note that infant mortality rates are declining in the United States, as is the number of babies born to teen moms.
What’s more, American moms are still at a vast advantage, as the U.S. comes in at No. 24 on the Save the Children list of best and worst places to give birth. By comparison, Haiti and Sierra Leone are tied for 170th on that list.

Here are some other birthing practices that impact delivery around the world:

• Exhausted after you give birth? Join the club. But if you want a little time to recover before you’re thrust into the world with your baby, your best bet is to deliver at a Ukrainian hospital. Moms there spend an average of 6.2 days in the hospital after birth. Egyptian moms, on the other hand, typically check out after just half a day.
• In Belgium, you can choose any name you like for your child, but beware! The government has the authority to make you change it! The government may weigh in on names that seem to cross gender barriers, sound “ridiculous,” or that an official deems offensive. If parents are dead set on the name, they may wind up in court appealing the official decision.
• Home birth is illegal in some countries and can even get midwives arrested in some parts of the United States. But if you have your heart set on delivering in the comfort of your own digs, you may want to learn Dutch. The Netherlands boasts the largest number of home births in the Western world, with a third of moms bringing their babies into the world at home.

Bringing Up Baby

Like pregnancy and birth before them, moms in different countries might as well be living on different planets when it comes to how they spend the days and months after giving birth.
Edwards, for instance, was at home being pampered by her in-laws. But unlike relatives in the United States who were instructed to head back to the obstetrician’s office for post-natal care within two months, she received no medical postpartum care in China. She also wasn’t expected to take her kids to the pediatrician for what American moms consider traditional check-ups.
That Chinese approach has its drawbacks, Edwards says, but some of the benefits are hard to ignore (including the benefits to a mom’s health).
“As frustrating as it was to not be allowed to have cold things, wash my hair (I did break that rule after a week), go outside, use the computer, it was nice to have the freedom to just rest,” she recalls. “My father-in-law shopped for foods and washed baby clothes (by hand; it’s considered more sanitary) and [my] mother-in-law cooked and helped with baby. All the nutritious meals and sleep helped me to lose all my baby weight—plus another 10 pounds—by the end of the month.”
In New Zealand, moms like Marshall qualify for visits from their midwives after they’re discharged from the hospital, beginning with a practitioner swinging by a mom’s home daily for the first two to three days, then every few days, then weekly until a mom is six weeks postpartum.
After that, Marshall says, many moms qualify for care under Plunket, a government-sponsored program that provides well-child checks with a registered nurse who will answer parents’ questions about everything from infant health to parenting practices.

Of course postpartum care isn’t just medical. With the exception of the United States, paid maternity leave is guaranteed throughout the Western world, although how much and who gets it varies from place to place. In most countries with paid leave, just 1 in 5 dads gets some sort of benefit, while in places like Australia, it’s just 1 in 50.
Dads in Scandinavia tend to get the best chance at being physically present during their babies’ formative years. A full 40 percent of fathers take time off to relieve new mothers of some of the childcare burden, and they do so with the government’s blessing. In Denmark, for example, moms and their partners can split 32 weeks worth of paid leave so that between them, two parents can cover the first several years at home with a child without having to sacrifice their earnings.
But even in places where fathers are guaranteed leave, they’re not always comfortable making the most of it. Japanese fathers have a full year’s worth of time off that’s protected by their government, but it’s rare for them to take it.
Meanwhile, many moms in the U.S. aren’t even guaranteed a paycheck—nor do all employers have to hold women’s jobs for them if they take time off to give birth and establish breastfeeding routines. The Family and Medical Leave Act (FMLA) guarantees moms up to 12 weeks off after birth, adoption, or a foster care placement, but it doesn’t require employers to pay moms during that time. It also exempts any company that has fewer than 50 employees, meaning thousands of American businesses can legally fire a woman who wants to take a few days off to recover from birth. As for partners, the FMLA does recognize dads and same-sex partners, but it still lacks teeth when it comes to requiring payment and loses power due to the exemptions it affords a large sector of businesses.

So what’s that first year like around the world?

• In China, moms like Edwards practice elimination communication—an infant-led “potty training”—whereby moms hold their young ones over a toilet rather than depending on diapers.
• In Brazil, strict laws that limit how formula companies can advertise their wares are one of the many ways the government supports moms in breastfeeding. The country also boasts the largest number of human milk banks in the world, offering options to moms who are struggling with breastfeeding or who can’t or don’t want to breastfeed.

Growing Up Globally

So what’s it like raising a child in different parts of the world? Ask any mom, and you’ll get a different story, which can also be true of two parents who live in the exact same town in America but have different income levels, cultural backgrounds, and daily experiences.
Still, there are some distinct country-dependent differences in parenting styles and in how kids are treated. In addition to their considerations of moms and motherhood, Save the Children’s researchers have spent time around the world researching where kids have it best…and where they have it worst.
Countries wracked by poverty and war unsurprisingly fall low on the list, while the Nordic countries, with their focus on healthcare and education for all, are situated near the top. The researchers note that the highest rates of child mortality are found in sub-Saharan Africa, where basic medical care is often unavailable, too far away, or too expensive, and kids are also more likely to be born to mothers with limited education. Lack of education traps people in poverty, hurting moms and kids alike.
But even in the Western world, where kids usually have a more level playing field, there are disparities.

In the United Kingdom, parents are spending a third of their annual salaries on childcare, with American parents—who spend a quarter of their incomes on childcare—not far behind. Korean moms have it made in the shade on this account, though: Their government foots the bill for daycare.
As for education, U.S. parents have to funnel away a whole lot of dough if we want our kids to see the inside of a college classroom. Our tuition rates are highest in the world, while many Scandinavian countries offer kids a chance at higher ed for absolutely nothing.
Here’s more on what it’s like to raise a kid around the world:

• In conducting the research for her book, Crawford found that French moms readily assume their role as the boss, rather than allowing their kids to wear them down. “This was huge in cutting down on the negotiating and bargaining that usually just ended up in crying,” she recalls. “When I told my kids that I was the undisputed decision maker and no amount of whining would change that, everyone relaxed. It makes sense. A 35-year-old makes better decisions than a 2-year-old.”
• Mommy’s Netflix time after the kids go to sleep may be popular in America, but in places like Spain and Argentina, kids typically stay up until at least 10 p.m. in order to spend more time with their families.

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