Maternal Mental Health Maternal Mental Health Di

Maternal Mental Health
Maternal Mental Health Disorder impacts mothers globally. One
in three women experience birth trauma associated with the type
of delivery or medical interventions
One in five women face maternal mental disorders and can
affect the entire family
(O'Connell, 2019; Reed et al., 2017; Rees et al., 2019; Sukinik,
2018)
Purpose of the Project
To identify women who experienced trauma during childbirth
and work with them to cope effectively
Data collection will guide the practice of Providers in this
setting to eliminate factors that can contribute to these
outcomes
(Improving Maternal Mental Health Care, 2020; McKinney et
al., 2018)

Target Population
Postpartum patients
This Photo by Unknown Author is licensed under CC BY-SA
(Tappen, 2016)
Procedure Used to Gather Information
Patient interview will be performed via in person or telephone
This Photo by Unknown Author is licensed under CC BY-SA
This Photo by Unknown Author is licensed under CC BY-NC-
ND
(Tappen, 2016)
Questionnaire
Tell me about your birth experience

Was it how you expected
What went well
What could we have done differently
This Photo by Unknown Author is licensed under CC BY-SA-
NC
(Reed et al., 2017; Rees et al., 2019; Sukinik, 2018)
Tool used for data collection
5
Tell Me About Your Birth Experience
Having the patient talk about their birth experience can help
make the patient understand what happened during their
childbirth. The delivery note was reviewed before the interview
on EHR, which was vital so that we could answer any possible
questions the patients may have. Providing the opportunity to
talk about their memories, thoughts, feelings, and birth
experience are vital in a childbirth recovery process.
6

Total
Difficult Excellent Expected Good Satisfactory
Unexpected 3 4 1 5 1 3
Was it How You Expected?
Most of the patients did not expect what their birth experience
would be like, as some came in to induce labor, and some went
into labor sooner than the expected due date.
7

Total
No Yes 14 3
What Went Well?
When asked about their birth experience and focused on what
went well, Teamwork was one of our highest points of what
went well in the unit. This is vital to promote safety in the
team; partnership is vital to promote patient safety. Patients felt
that they were cared for during their childbirth experience.
8
Total
Care experience Communication No Comment
Teamwork 5 2 1 9
What Could We Have Done Differently

Most patients stated that they would not change anything, even
though they did not expect their childbirth experience to go as
they would think it would have gone. Things that we could have
done differently are communication, care experience, Courtesy
and Respect, and customer service, which could be improved.
9

Total
Care Expereince Communication Courtesy and Respect
Customer Service None 1 1 1 2 12
Summary
Trauma can have a negative impact on the mother-baby dyad
Early screening is essential in maintaining the mother’s
wellbeing
Debriefing after birth is a critical piece to assist closure on their
unexpected birth experiences
No matter how their birth played out, debriefing with the
mother and the team is vital to provide the opportunity to talk
about their memories, thoughts, feelings, and birth experience
(McKinney et al., 2018; Reed et al., 2017; Simpson & Catling,
2016)
10

Project Findings or Value of Project Finding
This project is generalizable to other locations and populations
(McKinney et al., 2018; Improving Maternal Mental Health
Care, 2020)
References
Improving maternal mental health care. (2020, March 2).
California Health Care Foundation. Retrieved September 4,
2020, from https://www.chcf.org/project/improving-maternal-
mental-health/
McKinney, J., Keyser, L., Clinton, S., & Pagliano, C. (2018).
Acog committee opinion no. 736: Optimizing Postpartum Care.
Obstetrics & Gynecology, 132(3), 784–785.
https://doi.org/10.1097/aog.0000000000002849
Midwifery services - southern alameda county. (2021). Southern
Alameda County. https://thrive.kaiserpermanente.org/care-near-
you/northern-california/gsaa/departments/midwifery-services/
O'Connell, M. (2019). Preventing, recognising, and responding
to fear of childbirth and birth trauma. BMJ, l2279.
https://doi.org/10.1136/bmj.l2279
Reed, R., Sharman, R., & Inglis, C. (2017). Women’s
descriptions of childbirth trauma relating to care provider
actions and interactions. BMC Pregnancy and Childbirth, 17(1).
https://doi.org/10.1186/s12884-016-1197-0
Rees, S., Channon, S., & Waters, C. S. (2019). The impact of
maternal prenatal and postnatal anxiety on children’s emotional
problems: a systematic review. European Child & Adolescent
Psychiatry, 28, 257–280. https://doi.org/10.1007/s00787-018-

1173-5
Simpson, M., & Catling, C. (2016). Understanding
psychological traumatic birth experiences: A literature review.
Women and Birth, 29(3), 203–207.
https://doi.org/10.1016/j.wombi.2015.10.009
Sukinik, U. S. (2018, August 3). Debriefing after birth - birth
you desire. Birth You Desire.
https://birthyoudesire.com/debriefing-after-birth/
Tappen, R. A. (2016). Advanced nursing research from theory
to practice (2nd ed.) [Kindle]. Jones & Bartlett Learning.
"The Lottery" (1948)
by Shirley Jackson
The morning of June 27th was clear and sunny, with the fresh
warmth of a full-summer day; the flowers were blossoming
profusely and the grass was richly green. The people of the
village began to gather in the square, between the post office
and the bank, around ten o'clock; in some towns there were so
many people that the lottery took two days and had to be started
on June 2th. but in this village, where there were only about
three hundred people, the whole lottery took less than two
hours, so it could begin at ten o'clock in the morning and still
be through in time to allow the villagers to get home for noon
dinner.
The children assembled first, of course. School was recently
over for the summer, and the feeling of liberty sat uneasily on
most of them; they tended to gather together quietly for a while
before they broke into boisterous play. and their talk was still of
the classroom and the teacher, of books and reprimands. Bobby
Martin had already stuffed his pockets full of stones, and the
other boys soon followed his example, selecting the smoothest

and roundest stones; Bobby and Harry Jones and Dickie
Delacroix-- the villagers pronounced this name "Dellacroy"--
eventually made a great pile of stones in one corner of the
square and guarded it against the raids of the other boys. The
girls stood aside, talking among themselves, looking over their
shoulders at rolled in the dust or clung to the hands of their
older brothers or sisters.
Soon the men began to gather. surveying their own children,
speaking of planting and rain, tractors and taxes. They stood
together, away from the pile of stones in the corner, and their
jokes were quiet and they smiled rather than laughed. The
women, wearing faded house dresses and sweaters, came shortly
after their menfolk. They greeted one another and exchanged
bits of gossip as they went to join their husbands. Soon the
women, standing by their husbands, began to call to their
children, and the children came reluctantly, having to be called
four or five times. Bobby Martin ducked under his mother's
grasping hand and ran, laughing, back to the pile of stones. His
father spoke up sharply, and Bobby came quickly and took his
place between his father and his oldest brother.
The lottery was conducted--as were the square dances, the teen
club, the Halloween program--by Mr. Summers. who had time
and energy to devote to civic activities. He was a round-faced,
jovial man and he ran the coal business, and people were sorry
for him. because he had no children and his wife was a scold.
When he arrived in the square, carrying the black wooden box,
there was a murmur of conversation among the villagers, and he
waved and called. "Little late today, folks." The postmaster, Mr.
Graves, followed him, carrying a three- legged stool, and the
stool was put in the center of the square and Mr. Summers set
the black box down on it. The villagers kept their distance,
leaving a space between themselves and the stool. and when Mr.
Summers said, "Some of you fellows want to give me a hand?"
there was a hesitation before two men. Mr. Martin and his

oldest son, Baxter. came forward to hold the box steady on the
stool while Mr. Summers stirred up the papers inside it.
The original paraphernalia for the lottery had been lost long
ago, and the black box now resting on the stool had been put
into use even before Old Man Warner, the oldest man in town,
was born. Mr.
Summers spoke frequently to the villagers about making a new
box, but no one liked to upset even as much tradition as was
represented by the black box. There was a story that the present
box had been made with some pieces of the box that had
preceded it, the one that had been constructed when the first
people settled down to make a village here. Every year, after the
lottery, Mr. Summers began talking again about a new box, but
every year the subject was allowed to fade off without
anything's being done.
(
The Lottery--Shirley Jackson
)
(
file:///Users/carolynsigler/Desktop/lotry.html (
6
of 8)1/23/2005 7:58:04 AM
)
The black box grew shabbier each year: by now it was no longer
completely black but splintered badly along one side to show
the original wood color, and in some places faded or stained.
Mr. Martin and his oldest son, Baxter, held the black box
securely on the stool until Mr. Summers had stirred the papers
thoroughly with his hand. Because so much of the ritual had
been forgotten or discarded, Mr. Summers had been successful
in having slips of paper substituted for the chips of wood that
had been used for generations. Chips of wood, Mr. Summers
had argued. had been all very well when the village was tiny,

but now that the population was more than three hundred and
likely to keep on growing, it was necessary to use something
that would fit more easily into he black box. The night before
the lottery, Mr. Summers and Mr. Graves made up the slips of
paper and put them in the box, and it was then taken to the safe
of Mr. Summers' coal company and locked up until Mr.
Summers was ready to take it to the square next morning. The
rest of the year, the box was put way, sometimes one place,
sometimes another; it had spent one year in Mr. Graves's barn
and another year underfoot in the post office. and sometimes it
was set on a shelf in the Martin grocery and left there.
There was a great deal of fussing to be done before Mr.
Summers declared the lottery open. There were the lists to make
up--of heads of families. heads of households in each family.
members of each household in each family. There was the
proper swearing-in of Mr. Summers by the postmaster, as the
official of the lottery; at one time, some people remembered,
there had been a recital of some sort, performed by the official
of the lottery, a perfunctory. tuneless chant that had been rattled
off duly each year; some people believed that the official of the
lottery used to stand just so when he said or sang it, others
believed that he was supposed to walk among the people, but
years and years ago this p3rt of the ritual had been allowed to
lapse. There had been, also, a ritual salute, which the official of
the lottery had had to use in addressing each person who came
up to draw from the box, but this also had changed with time,
until now it was felt necessary only for the official to speak to
each person approaching. Mr.
Summers was very good at all this; in his clean white shirt and
blue jeans. with one hand resting carelessly on the black box. he
seemed very proper and important as he talked interminably to
Mr. Graves and the Martins.
Just as Mr. Summers finally left off talking and turned to the
assembled villagers, Mrs. Hutchinson came hurriedly along the

path to the square, her sweater thrown over her shoulders, and
slid into place in the back of the crowd. "Clean forgot what day
it was," she said to Mrs. Delacroix, who stood next to her, and
they both laughed softly. "Thought my old man was out back
stacking wood," Mrs. Hutchinson went on. "and then I looked
out the window and the kids was gone, and then I remembered it
was the twenty- seventh and came a-running." She dried her
hands on her apron, and Mrs. Delacroix said, "You're in time,
though. They're still talking away up there."
Mrs. Hutchinson craned her neck to see through the crowd and
found her husband and children standing near the front. She
tapped Mrs. Delacroix on the arm as a farewell and began to
make her way through the crowd. The people separated good-
humoredly to let her through: two or three people said. in voices
just loud enough to be heard across the crowd, "Here comes
your, Missus, Hutchinson," and "Bill, she made it after all."
Mrs. Hutchinson reached her husband, and Mr. Summers, who
had been waiting, said cheerfully. "Thought we were going to
have to get on without you, Tessie." Mrs. Hutchinson said.
grinning, "Wouldn't have me leave m'dishes in the sink, now,
would you. Joe?," and soft laughter ran through the crowd as the
people stirred back into position after Mrs. Hutchinson's arrival.
"Well, now." Mr. Summers said soberly, "guess we better get
started, get this over with, so's we can go back to work.
Anybody ain't here?"
"Dunbar." several people said. "Dunbar. Dunbar."
Mr. Summers consulted his list. "Clyde Dunbar." he said.
"That's right. He's broke his leg, hasn't he? Who's drawing for
him?"
"Me. I guess," a woman said. and Mr. Summers turned to look
at her. "Wife draws for her husband." Mr. Summers said. "Don't

you have a grown boy to do it for you, Janey?" Although Mr.
Summers and everyone else in the village knew the answer
perfectly well, it was the business of the official of the lottery
to ask such questions formally. Mr. Summers waited with an
expression of polite interest while Mrs. Dunbar answered.
"Horace's not but sixteen vet." Mrs. Dunbar said regretfully.
"Guess I gotta fill in for the old man this year."
"Right." Sr. Summers said. He made a note on the list he was
holding. Then he asked, "Watson boy drawing this year?"
A tall boy in the crowd raised his hand. "Here," he said. "I'm
drawing for my mother and me." He blinked his eyes nervously
and ducked his head as several voices in the crowd said thin#s
like "Good fellow, lack." and "Glad to see your mother's got a
man to do it."
"Well," Mr. Summers said, "guess that's everyone. Old Man
Warner make it?" "Here," a voice said. and Mr. Summers
nodded.
A sudden hush fell on the crowd as Mr. Summers cleared his
throat and looked at the list. "All ready?" he called. "Now, I'll
read the names--heads of families first--and the men come up
and take a paper out of the box. Keep the paper folded in your
hand without looking at it until everyone has had a turn.
Everything clear?"
The people had done it so many times that they only half
listened to the directions: most of them were quiet. wetting their
lips. not looking around. Then Mr. Summers raised one hand
high and said, "Adams." A man disengaged himself from the
crowd and came forward. "Hi. Steve." Mr. Summers said. and
Mr.
Adams said. "Hi. Joe." They grinned at one another humorlessly
and nervously. Then Mr. Adams reached into the black box and

took out a folded paper. He held it firmly by one corner as he
turned and went hastily back to his place in the crowd. where he
stood a little apart from his family. not looking down at his
hand.
"Allen." Mr. Summers said. "Anderson.... Bentham."
"Seems like there's no time at all between lotteries any more."
Mrs. Delacroix said to Mrs. Graves in the back row.
"Seems like we got through with the last one only last week."
"Time sure goes fast.-- Mrs. Graves said.
"Clark.... Delacroix"
"There goes my old man." Mrs. Delacroix said. She held her
breath while her husband went forward.
"Dunbar," Mr. Summers said, and Mrs. Dunbar went steadily to
the box while one of the women said. "Go on. Janey," and
another said, "There she goes."
"We're next." Mrs. Graves said. She watched while Mr. Graves
came around from the side of the box, greeted Mr. Summers
gravely and selected a slip of paper from the box. By now, all
through the crowd there were men holding the small folded
papers in their large hand. turning them over and over nervously
Mrs. Dunbar and her two sons stood together, Mrs. Dunbar
holding the slip of paper.
"Harburt.... Hutchinson."
"Get up there, Bill," Mrs. Hutchinson said. and the people near
her laughed. "Jones."
"They do say," Mr. Adams said to Old Man Warner, who stood

next to him, "that over in the north village they're talking of
giving up the lottery."
Old Man Warner snorted. "Pack of crazy fools," he said.
"Listening to the young folks, nothing's good enough for them.
Next thing you know, they'll be wanting to go back to living in
caves, nobody work any more, live hat way for a while. Used to
be a saying about 'Lottery in June, corn be heavy soon.' First
thing you know, we'd all be eating stewed chickweed and
acorns. There's always been a lottery," he added petulantly.
"Bad enough to see young Joe Summers up there joking with
everybody."
"Some places have already quit lotteries." Mrs. Adams sai d.
"Nothing but trouble in that," Old Man Warner said stoutly.
"Pack of young fools." "Martin." And Bobby Martin watched his
father go forward. "Overdyke.... Percy." "I wish they'd hurry,"
Mrs. Dunbar said to her older son. "I wish they'd hurry."
"They're almost through," her son said.
"You get ready to run tell Dad," Mrs. Dunbar said.
Mr. Summers called his own name and then stepped forward
precisely and selected a slip from the box. Then he called,
"Warner."
"Seventy-seventh year I been in the lottery," Old Man Warner
said as he went through the crowd. "Seventy-seventh time."
"Watson" The tall boy came awkwardly through the crowd.
Someone said, "Don't be nervous, Jack," and Mr. Summers said,
"Take your time, son."
"Zanini."

After that, there was a long pause, a breathless pause, until Mr.
Summers. holding his slip of paper in the air, said, "All right,
fellows." For a minute, no one moved, and then all the slips of
paper were opened.
Suddenly, all the women began to speak at once, saving. "Who
is it?," "Who's got it?," "Is it the Dunbars?," "Is it the
Watsons?" Then the voices began to say, "It's Hutchinson. It's
Bill," "Bill Hutchinson's got it."
"Go tell your father," Mrs. Dunbar said to her older son.
People began to look around to see the Hutchinsons. Bill
Hutchinson was standing quiet, staring down at the paper in his
hand. Suddenly. Tessie Hutchinson shouted to Mr. Summers.
"You didn't give him time enough to take any paper he wanted.
I saw you. It wasn't fair!"
"Be a good sport, Tessie." Mrs. Delacroix called, and Mrs.
Graves said, "All of us took the same chance." "Shut up,
Tessie," Bill Hutchinson said.
"Well, everyone," Mr. Summers said, "that was done pretty fast,
and now we've got to be hurrying a little more to get done in
time." He consulted his next list. "Bill," he said, "you draw for
the Hutchinson family. You got any other households in the
Hutchinsons?"
"There's Don and Eva," Mrs. Hutchinson yelled. "Make them
take their chance!"
"Daughters draw with their husbands' families, Tessie," Mr.
Summers said gently. "You know that as well as anyone else."
"It wasn't fair," Tessie said.
"I guess not, Joe." Bill Hutchinson said regretfully. "My
daughter draws with her husband's family; that's only fair. And

I've got no other family except the kids."
"Then, as far as drawing for families is concerned, it's you," Mr.
Summers said in explanation, "and as far as drawing for
households is concerned, that's you, too. Right?"
"Right," Bill Hutchinson said.
"How many kids, Bill?" Mr. Summers asked formally. "Three,"
Bill Hutchinson said.
"There's Bill, Jr., and Nancy, and little Dave. And Tessie and
me."
"All right, then," Mr. Summers said. "Harry, you got their
tickets back?"
Mr. Graves nodded and held up the slips of paper. "Put them in
the box, then," Mr. Summers directed. "Take Bill's and put it
in."
"I think we ought to start over," Mrs. Hutchinson said, as
quietly as she could. "I tell you it wasn't fair. You didn't give
him time enough to choose. Everybody saw that."
Mr. Graves had selected the five slips and put them in the box.
and he dropped all the papers but those onto the ground. where
the breeze caught them and lifted them off.
"Listen, everybody," Mrs. Hutchinson was saying to the people
around her.
"Ready, Bill?" Mr. Summers asked. and Bill Hutchinson, with
one quick glance around at his wife and children. nodded.

"Remember," Mr. Summers said. "take the slips and keep them
folded until each person has taken one. Harry, you help little
Dave." Mr. Graves took the hand of the little boy, who came
willingly with him up to the box. "Take a paper out of the box,
Davy." Mr. Summers said. Davy put his hand into the box and
laughed. "Take just one paper." Mr. Summers said. "Harry, you
hold it for him." Mr. Graves took the child's hand and removed
the folded paper from the tight fist and held it while little Dave
stood next to him and looked up at him wonderingly.
"Nancy next," Mr. Summers said. Nancy was twelve, and her
school friends breathed heavily as she went forward switching
her skirt, and took a slip daintily from the box "Bill, Jr.," Mr.
Summers said, and Billy, his face red and his feet overlarge,
near knocked the box over as he got a paper out. "Tessie," Mr.
Summers said. She hesitated for a minute, looking around
defiantly. and then set her lips and went up to the box. She
snatched a paper out and held it behind her.
"Bill," Mr. Summers said, and Bill Hutchinson reached into the
box and felt around, bringing his hand out at last with the slip
of paper in it.
The crowd was quiet. A girl whispered, "I hope it's not Nancy,"
and the sound of the whisper reached the edges of the crowd.
"It's not the way it used to be." Old Man Warner said clearly.
"People ain't the way they used to be." "All right," Mr.
Summers said. "Open the papers. Harry, you open little Dave's."
Mr. Graves opened the slip of paper and there was a general
sigh through the crowd as he held it up and everyone could see
that it was blank. Nancy and Bill. Jr.. opened theirs at the same
time. and both beamed and laughed. turning around to the crowd
and holding their slips of paper above their heads.
"Tessie," Mr. Summers said. There was a pause, and then Mr.

Summers looked at Bill Hutchinson, and Bill unfolded his paper
and showed it. It was blank.
"It's Tessie," Mr. Summers said, and his voice was hushed.
"Show us her paper. Bill."
Bill Hutchinson went over to his wife and forced the slip of
paper out of her hand. It had a black spot on it, the black spot
Mr. Summers had made the night before with the heavy pencil
in the coal company office. Bill Hutchinson held it up, and there
was a stir in the crowd.
"All right, folks." Mr. Summers said. "Let's finish quickly."
Although the villagers had forgotten the ritual and lost the
original black box, they still remembered to use stones. The pile
of stones the boys had made earlier was ready; there were
stones on the ground with the blowing scraps of paper that had
come out of the box Delacroix selected a stone so large she had
to pick it up with both hands and turned to Mrs. Dunbar. "Come
on," she said. "Hurry up."
Mr. Dunbar had small stones in both hands, and she said.
gasping for breath. "I can't run at all. You'll have to go ahead
and I'll catch up with you."
The children had stones already. And someone gave little Davy
Hutchinson few pebbles.
Tessie Hutchinson was in the center of a cleared space by now,
and she held her hands out desperately as the villagers moved in
on her. "It isn't fair," she said. A stone hit her on the side of the
head. Old Man Warner was saying, "Come on, come on,
everyone." Steve Adams was in the front of the crowd of
villagers, with Mrs. Graves beside him.

"It isn't fair, it isn't right," Mrs. Hutchinson screamed, and then
they were upon her.
•••••••••••••••••••••••••••••••••
Discussion Questions:
1. Were you surprised by the ending of the story? If not, at what
point did you know what was going to happen? How does
Jackson start to foreshadow the ending in paragraphs 2 and 3?
Conversely, how does Jackson lull us into thinking that this is
just an ordinary story with an ordinary town?
2. Where does the story take place? In what way does the
setting affect the story? Does it make you more or less likely to
anticipate the ending?
3. In what ways are the characters differentiated from one
another? Looking back at the story, can you see why Tessie
Hutchinson is singled out as the "winner"?
4. What are some examples of irony in this story? For example,
why might the title, "The Lottery," or the opening description in
paragraph one, be considered ironic?
5. Jackson gives interesting names to a number of her
characters. Explain the possible allusions, irony or symbolism
of some of these:
· Delacroix
· Graves
· Summers
· Bentham
· Hutchinson
· Warner
· Martin

7. Take a close look at Jackson's description of the black
wooden box (paragraph 5) and of the black spot on the fatal slip
of paper (paragraph 72). What do these objects suggest to you?
Why is the black box described as "battered"? Are there any
other symbols in the story?
8. What do you understand to be the writer's own attitude
toward the lottery and the stoning? Exactly what in the story
makes her attitude clear to us?
9. This story satirizes a number of social issues, including the
reluctance of people to reject outdated traditions, ideas, rules,
laws, and practices. What kinds of traditions, practices, laws,
etc. might "The Lottery" represent?
10. This story was published in 1948, just after World War II.
What other cultural or historical events, attitudes, institutions,
or rituals might Jackson be satirizing in this story?

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