The Darkest Light

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 SHEETA 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)

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.

When Chathuri first experienced postpartum depression, she had no idea what it was, or what was happening to her. For months she couldn't stop crying, couldn't eat or sleep, and didn't want to be around her baby. The experience impacted her so badly she decided she would never have another child.Six years later she gave birth to a baby girl. When those old shadows of depression started sneaking up on her, she knew she had to do something different this time around. Tune in to Episode 4 of The Darkest Light to hear how Chathuri fumbled her way through postpartum depression—and came out on the other side. 

Imagine if your doctor scheduled you for an induction without telling you. Imagine being chastised every time you asked a question during labor. Imagine being rushed in for an emergency C-section without fully understanding why.In Episode 3, The Darkest Light host Kanya D'Almeida talks to a woman named Ameena about her relationship with her OB-GYN, her battle to avoid an induction, and how she dealt with the unwritten rule that many hospitals follow during labor and delivery: Sorry, No Questions.

In Episode 2, The Darkest Light Host Kanya D'Almeida talks to a woman about her experience giving birth in a public hospital in Sri Lanka. Kanya compares her guest's story with her own experience of having her baby in a private healthcare facility. Only a tiny fraction of Sri Lankan women have the privilege of opting for private maternal healthcare—just 5 percent nationally. Over 94 percent of babies are born in government facilities. The differences—and similarities—in the quality and level of care both women received is what inspired this episode, "A Tale of Two Hospitals".

In the pilot episode, The Darkest Light host Kanya D'Almeida talks to her mother about what it was like to give birth in Sri Lanka a generation ago—in 1983. Their candid conversation is interspersed with Kanya's own birth story, from 2019.The two women gave birth just 30 years apart, but their experiences were so different they may as well have taken place in different centuries. 

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 clampingIn 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/?ampOn internal vaginal exams/cervical checks during laborAccording 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/fulltextResearch 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/70/1/55/6324470The US-based organization Birth Monopoly has begun a project of documenting the global epidemic of obstetric violence