Joanne currently contracts to facilitate Wānanga Hapūtanga for the Auckland District Health Board, Te Kaha o Te Rangatahi and E Tipu e Rea.

In commemoration of Perinatal Mental Health Awareness Week this May, we had the privilege of speaking with Joanne Rama. Joanne has been facilitating wānanga hapūtanga for over 30 years and believes that the best treatment or recovery approach to Maternal mental health dis-ease is to reconnect whānau to both cultural knowledge and experiences.

The Tāmaki Makaurau Wānanga Hapūtanga was first established in 1994, with one couple at a little Wharenui, Torere, in Howick, under the Kaitiakitanga of Whaea Taini Drummond Joanne’s whanaunga. This then blossomed across Tamaki and found its first permanent home at Te Kaha o te Rangatahi.

Throughout her career, Joanne has facilitated wananga to restore traditional birthing practices, including Karanga, Oriori, moteatea, Komirimiri, Romiromi, Taonga, Puoro, and maramataka. Joanne has witnessed how restoring traditional birth practices can produce intergenerational healing, by healing past birth trauma. Through her restorative efforts, Joanne has seen the reconnecting of disconnected urban Māori to their marae through the return of the whenua – eventually resulting in mokopuna being born on whānau whenua once again.

We spoke to Joanne about her passion for supporting Māori perinatal mental wellness through the revitalisation of traditional Māori birth knowledge, her experiences engaging and working in the maternal mental health sector, and her perspectives on the state of Māori perinatal mental health in Aotearoa today.

Joanne is the current Kaumātua and Kaiarahi Māori to Perinatal Anxiety & Depression Aotearoa (PADA), after having been on the board for four years and supporting their transition to a Two Whare Te Tiriti honouring governance model. She has recently supported Jasmine Davis, a Pacific Educator responsible for delivering the Tama’ita’toa Pacific Maternal Mental Health training to PADA.

Joanne facilitates Hine Tu Hine Ora a Kaupapa Māori maternal mental health – a 6hr training program for Health and social service providers, which was piloted in 2021 and is now available for the Maternal health and social services workforces. She will also be training more facilitators for this program and facilitating the MAMI (voices of mothers affected Mental illness) project.

Joanne had the privilege of working for Ngati Porou Hauora as a locum at the only Iwi-owned and operated Primary birthing center and wishes that all Iwi would aspire to have a Taonga such as this. She continues to have huge respect for Corina, the Maaori midwife who has been working there for over 20 years.

Joanne has recently completed her Havening practitioner training at the Institute of Neuroscience with Dr. Robin Youngson. This is a new trauma treatment proving to be effective in treating stress, trauma, and anxiety, which is being led by Dr. Youngson a world leader in Compassion in health care and author.

What brought you to work in the kaupapa Māori maternal mental health sector?

It was my own lived experience that brought me into this space. I was never diagnosed with depression during my first three pregnancies – I just thought that emotional swings were a normal part of pregnancy and parenting new babies. There was no “Dr. Google” back then, and there was very little evidence about antenatal depression and its link to Adverse Childhood Experiences. I only began to connect the dots during my nursing studies, when I went on a mental health placement and first learned about Post Traumatic Stress Disorder. From that point on I began my own research into traumatic births.

I began training to become a midwife in 1991 because my nursing training had given me some insight into how a good birth could equal a better experience of being a parent. Towards the end of my nursing training, my best friend had a Māori midwifery student, who encouraged me to become a midwife. At first, I didn’t get in, but someone never turned up so I got a call a day before the training started! For that whole first month, I was working full-time night shifts, and going to class every day. During my second week, one of the program leaders said “If any of you get pregnant, you’ll be kicked out” – I found out I was pregnant the very next day.

So it was a concealed pregnancy, with a concealed depression. I was made worse because while studying I was seeing birth trauma and racism in front of my face. I was so angry but I was also powerless – people told me that was just how things were done.

I finished midwifery training, and two weeks later had a beautiful home birth. Unfortunately, I still developed severe postnatal depression when she was 8 weeks old, and my partner was unsupportive. I became pregnant again when she was 4 months old and gave birth again one year after I finished midwifery.

From the time I became qualified I had not been able to get a job as a midwife. I was told it was because I had the wrong attitude – I was too ‘pro-Māori’. People told me that if I toned it down I might get a job – well I never toned it down, and in fact, got even louder over the years.

I didn’t get my home birth due to him being premature but was, fortunately, able to connect with some Māori midwives during my hospital stay – the very midwife who had inspired me to become one myself, Charolette Waetford. Six months later, we formed Putea o Pua Trust, and successfully obtained a contract for a Māori midwifery service. That start-up now operates as Turuki health care. Janet Taiatini and I established a midwifery partnership through this and became the first independent Māori midwives in Counties Manukau. We also assisted with the establishment of Te Kaha o te Rangatahi, a teen parent support service, both giving our time on the boards.

I had another 4 babies from 1997 to 2000 and had a Māori midwife for them all. For the first time, I had some real support with my anxiety and depression, someone who cared – like Janet. Unfortunately, I later underwent a difficult pregnancy with my twins, and suffered a very traumatic birth at 32 weeks. Through that experience, I became depressed and experienced psychosis after five months.

At this point I was a single parent, raising seven tamariki without any support from their father. I was went on for five months with no sleep, and only received consistent support from my mother. In my psychotic state I planned to set fire to my house – but that same day Oprah had done a show about a mum that had killed all her children. It was, I believe, a Tupuna intervention, as at that moment I realised I was unwell.

From then on I stopped pretending I was okay. I spoke to some close friends and got some help – yet I still couldn’t access maternal mental health services. It was people like Papa Hohepa Delamere (who, thank goodness, had no criteria for referrals back then) that saved my life. Through intense Romiromi treatments and drowning myself in wānanga, I recovered fully and fortunately did no harm to myself or my children.

How do you believe a matauranga Māori approach to perinatal mental health can best serve whānau?

Through my journey of being a Māori midwife, I met many people who were also searching for matauranga Maaori. Through creating Ngaa Maia – the national Maaori midwifery ropu – we held regular hui to connect those who held the taonga about pregnancy and birthing.

My early midwifery career was then spent caring for whānau in Orakei, where I was blessed to have my Nan Talbot teach me key birthing wisdom. Being an urban Māori, all I had known was to keep my whenua – I didn’t know the richness of our pregnancy and birthing rituals. Today I’ve been privileged to have had influencers such as Papa Joe Delamere, Dr. Rose Pere, Moana Jackson, Takawai Murphy, and Professor Helen Moewaka Barnes. I’ve been living my life in wānanga, learning Te Reo, Kohunga Reo Kura Kaupapa, and decolonising and reconnecting to Te Ao Maaori. I also had the best midwifery mentors in Janet and Joan Donely who was a homebirth midwife.

I also worked for many years at Social Detox as an alcohol and drug professional alongside my Mother who was the Team Leader. I did a lot of research around intergenerational trauma and informed trauma – so eventually all the dots joined, and it all made sense. It all begins in the Whare Tangata – I roto te wananga Ahuru Mowai.

I have decided to commit the next 10 years to the Maaori Maternal Mental Health and Addiction space. I know that we have to take a long-term approach – not just being reactive to relapse. This space requires committing to the whole physical, emotional, mental, and whānau wellbeing. For some it’s a lifetime journey, It requires effort and persistence to find what works for you. I’m committed to helping people understand that this is an illness, born out of trauma and there’s not a one size fits all solution for everybody.

What are some of the barriers whānau Māori face to accessing perinatal mental health support?

Institutionalised racism within the District Health Boards and the Maternity and Well-child professions is sadly alive and well. Why is it that there is only one Kaupapa Maaori maternal mental health service in the country – when 57% of Maternal suicides are Maaori?

I have yet to see the New Zealand College of Midwives develop an antiracism statement – even with a Māori midwife as president, this has not happened. The midwifery council is only now making an effort to uphold their Te Tiriti obligations with their Aotearoa Midwifery project. I have had too many racist encounters with Midwives in my journey of being a proud Maaori woman and midwife – being told I can’t use Muka, being told I can’t use a pounamu to cut the pito. But that’s another story for another day.

The Midwifery workforce also doesn’t receive enough training about Mental Health and Addictions or Trauma-informed care – it’s not a compulsory part of their recertification. However, if we look at Peter Gluckman’s research into adverse childhood experiences, you can see that stress in pregnancy can impact the structure of the brain. If you combine that knowledge with the addiction, youth justice, criminal justice, and foetal alcohol statistics for our people – you see the root cause for what we see in the media daily – rangatahi on crime sprees and gangster shootouts on the streets of South Auckland. Sadly, many independent midwifery services cater only to the ‘well woman’ – if the mother is mentally unwell or an addict, she gets referred to secondary care.

It’s also important to acknowledge that most midwives aren’t screening for depression during pregnancy. Research conducted by Christine Mellor found that most midwives don’t do the Edinburgh Postnatal Depression Scale (EPDS) screening, because they feel overwhelmed and overstretched, or believe there’s nowhere to refer women who are presenting with mild to moderate symptoms.

That’s why part of my role as a childbirth educator is to inform them about the diversity of signs and symptoms. I show them how to utilise the PADA website and the EPDS tools, and I encourage them to self-screen as part of their wellness plan every three months. I also encourage the mother’s partners to screen as well – because 10% of partners experience depression and anxiety.

What can be done about these misconceptions about maternal mental health?

It’s important to reassure whānau that with the right support, they will get well and that every whanau will have a different journey in their recovery, but they will get better in the end.

I’m also trying to eliminate the idea that perinatal depression only looks like a pregnant woman bawling her eyes out all the time. If a māmā is telling someone that she is suicidal – please don’t ignore her. There is a misconception that being pregnant is a protective factor against suicide – but that is why it is the leading cause of maternal death. We just find it too hard a conversation to have.

We need to be brave and listen, seek help on her behalf and not stop until that is found. Getting the right help can be difficult, but it’s much easier for a well-minded person to achieve. Just imagine the māmā whose minds are not well, having to get through all of these obstacles – having to tell a stranger she is suicidal, and then fearing she could lose her baby.

How do you think the pandemic has impacted whānau receiving perinatal mental health support?

I would say that the isolation brought on by Covid has pushed us back about 10 years. I had a mother come to Wānanga Hapūtanga back in 2017, where she learned how to make muka, got reconnected to her culture, and stopped using meth. She stayed clean for three years. Then, because of Covid and not being able to access wānanga on a monthly basis, I’ve since found out she’s relapsed and lost all of her kids.

She is my reason for going back to Kanohi ki te Kanohi wananga, and to get the Wānanga Waiora operating. These wānanga are specifically for Whanau with Mental health and addiction histories. They are a collaboration between The ADHB Pregnancy and Parenting Education, Manawanui Maaori mental health, Parental and Pregnancy addiction service, and Aronui Ora Maternal mental health. They were sadly put on hold due to Covid – but they will be going ahead once the Manawanui Marae is open for Wānanaga.

The reality is that on a Zoom you miss out on the hugs, and can’t experience that space within wānanga for emotional support, for release, for that tangi. Being able to escape the hustle and bustle of the city, to sit down and reconnect – that’s what I believe creates the Waiora for our people within wananga.

The pandemic has also been hard for our urban Māori. Some whānau have suffered internalised racism and been disconnected from their tikanga their whole life, they haven’t been able to take their whenua home, and haven’t been able to have tangihanga when their babies have passed. But the reality is that they don’t want their baby to suffer the same, they want them to know their whakapapa.

Before Covid I felt we were on a good pathway in terms of wellness – we were having those important conversations about how being connected to our culture is an important part of our wellness. You need only look at the statistics of meth use increasing across the country to recognise that people have had a very difficult time over the last two years.

How can providers better serve the needs of Māori suffering from adverse perinatal mental health?

Through working across health for the past 35 years as a nurse, midwife, and educator, I have seen many changes. 2022 has brought the greatest ray of hope I have ever experienced for Māori health with the creation of the Maaori health authority. However, there is still a lot of work to be done. Health providers need to look at mental health problems from an informed trauma perspective and provide whanau with the opportunity to be self-determining in their recovery.

We need to stress to whānau that the impacts of colonisation can be undone and that they do not condemn them to hopelessness, there are solutions. Part of the solution to the restoration of Mana Māori is Whakamana Te Wharetangata. We need whānau to know it’s their responsibility to care for the Hapū Māmā, and that we need to stop putting a colonised lens of parenting on her. That’s why western brain science today aligns with our thousands of years of oral tradition – because our tūpuna were brain scientists themselves, they knew the importance of loving babies and supporting Mothers.

The focus on the first 1000 days must be inclusive of whānau, must be about keeping whānau well. That requires collaboration and whānau centered care, five sets of eyes? Just imagine if those five Kaitiaki all did something practical and meaningful for our māmā.

I feel frustrated seeing that we have all this science that we’ve had for generations that the system has not utilised. That’s why I joined the PADA board. One of my biggest challenges to the sector was that we needed to have a Māori maternal mental health hui. We kept talking about Māori statistics but had never held a Kaupapa Māori hui. So we had our first PADA Māori Maternal Mental Health Hui 2020 at Orakei, and our most recent over zoom. These hui have been blessed with kōrero from speakers such as Professor Helen Moewaka-Barnes, Dr Hinemoa Elder, Kelly Tikao and Jannine Tamiti-Elfie.

This year’s hui is in Rotorua, and we’re not just talking about what works practically – we’re going to experience it. A time for our Mama with lived experience and our Maternity workforce to connect and learn from each other.