The Darkest Light Kanya D'Almeida

Every year, 25 to 30 women in Sri Lanka commit suicide during pregnancy or within one year of delivery.

According to Sri Lanka’s Maternal & Child Morbidity & Mortality Surveillance Unit, the country reported nearly 450 maternal suicides between 2002 and 2018.

Despite these startling numbers, maternal mental health continues to be a hugely under-researched area of public health in Sri Lanka—we do not collect national-level data on perinatal mental health, and perinatal psychiatry is not a specialized field of study and training within the medical system.

For the final episode of Season 2, I talked to 3 mothers about their experiences with maternal mental health. What emerged in our conversation was a clear and disturbing pattern: until we ourselves experienced postpartum mental health issues, we were completely ignorant of the range and severity of disorders, illnesses and conditions that can afflict women during pregnancy, childbirth and several years postpartum.

As we each shared our personal stories, we realized that the lack of conversation, education and awareness around maternal mental health is as big of a barrier to mothers' wellbeing as the lack of medical training, support services and facilities dedicated to perinatal mental health.

Links and Resources:

Maternal Mental Health in Sri Lanka: Challenges and Solutions
(Cambridge University Press, 2020)

Antenatal depression in Sri Lanka: a qualitative study of public health midwives’ views and practices
(BMC Medical Journal, 2022)

Postpartum Support International Perinatal Mood and Anxiety Disorders
FACT SHEET
A Lonely Struggle: 9 mothers around the world share the mental health challenges they faced during the 'happiest time of their lives'
(CNN)

Post-traumatic stress disorder following childbirth
(BMC Psychiatry, 2021)

How many of us can say that our birth stories are truly our own? How many women in Sri Lanka can look back on their births and say, with absolute certainty, that their voices were heard, their choices were respected, their bodies were listened to, their needs were met, their consent was sought, and that their birth experience was their own?
I don’t know many. After nearly 3 years of collecting stories from women of all walks of life, I have very few examples of what I would call sovereign birth experiences. Stories where the birthing person led the way—the entire way. Stories where a woman knew, and demanded, and received exactly what she wanted to ensure that her birth remained hers. 

Enter Yasodhara Pathanjalie. She operates according to a very simple logic: my body, my choices, my baby—my birth story. From the start of her pregnancy to the moment she left the hospital with her newborn (12 hours after he entered the world), she ensured that she always retained full bodily autonomy.

This meant no tests, procedures or interventions without her explicit consent. It meant not allowing herself to be pressured, bullied or coerced into doing things she wasn't comfortable with. It meant writing a birth plan and sticking to it—no matter how unconventional, inconvenient, or unfathomable her birth preferences seemed to the medical professionals and hospital staff.

Links and resources:

On delayed cord clamping

In this podcast, Dr. Judith Mercer of University of Rhode Island discusses the science and medical research around delayed cord clamping:
https://academicobgyn.com/2011/02/26/academic-obgyn-podcast-episode-31-delayed-cord-clamping/

In this article, Dr. Rachel Reed discusses the science behind 'cord blood collection' and its impact on neonates:
https://midwifethinking.com/2015/09/16/cord-blood-collection-confessions-of-a-vampire-midwife/?amp

On internal vaginal exams/cervical checks during labor

According to the Association for Improvements in Maternity Services (AIMS), cervical checks are an OPTIONAL procedure that should always be preceded by explicit and informed consent:
https://www.aims.org.uk/information/item/vaginal-examinations-in-labour#post-heading-5

This article in the American Journal of Obstetrics and Gynecology discusses the risks of 'routine cervical checks' during labor:
https://www.ajog.org/article/S0002-9378(20)31575-1/fulltext

Research is emerging on the links between forced medical procedures during labor (such as non-consensual vaginal examinations) and sexual assault. This article published by the Oxford University Press discuss the theoretical framework for understanding obstetric violence as a form of sexual assault:
https://academic.oup.com/socpro/article/70/1/55/6324470

The US-based organization Birth Monopoly has begun a project of documenting the global epidemic of obstetric violence

Radha and Serena first met on Zoom. Serena is a doula and Radha was her first client in Sri Lanka. They had a whole plan: to get Radha through an unmedicated labor, and a spontaneous vaginal delivery. When Radha’s waters broke ahead of schedule, they had to rethink their plan, reframe their vision, and really double down on what they wanted—and didn’t want—in the birthing process.
There was a lot they couldn’t control and decisions that weren’t in their hands but they were sure about one thing: they were going to do it together, and have a heck of a good time along the way.
Tune in to hear an amazing story of strength, sisterhood and companionship during labor.

There was a time when birth was spiritual. When birth attendants possessed knowledge of traditional ayurvedic medicines and practices. When the care of pregnant, laboring and postpartum women was provided by people who felt like family. 
What happened to birth in Sri Lanka?  And what happened to the women who were once at the center of this story and now exist almost entirely in the margins? 
In our efforts to modernize maternal healthcare, what became of our traditional midwives?

Have you ever heard the term obstetric violence?
It’s when a person experiences pain, intimidation, fear, humiliation, or loss of dignity at the hands of a care provider during pregnancy, childbirth, or the immediate postpartum period.
It includes intentional acts of emotional, verbal or sexual violence; obstetric practices like unnecessary episiotomies; a lack of compassion or empathy towards a laboring person; or a lack of consent for obstetric interventions.

Obstetric violence occurs much more frequently than you might imagine. Often, women are not even aware they’ve been victims of it. That’s because it’s one of the most under-studied and under-reported aspects of gender-based violence in the world. 
Here in Sri Lanka, it might best be described as a kind of silent epidemic in our maternal healthcare system. 

Imagine raising your daughter in a household with FOUR generations of women.  

How would you navigate the opinions, expectations, history and needs of not only a grandmother, but a great-grandmother?

What if you had some unresolved questions from your childhood—how would that shape the kind of mother you want to be? Is it possible to make peace with your own parents, while becoming a parent yourself?

In this episode I talk to Wathmi about how she passed through all these challenges—and more.