Why we need to stop normalizing postpartum mental health issues with Dr. Tina Montreuil

Navigating the tender complexities of mental health as a parent can often feel like a solitary journey, but it doesn't have to be. Nathalie shares candidly from the heart about her postpartum experiences, while Dr. Tina Montreuil of McGill University blends these personal narratives with academic insights. Together, we unravel the challenges and celebrate the resilience of birthing parents, marking World Maternal Mental Health Day as a beacon of support and solidarity.

In the warm embrace of this episode, we create a safe space where the intricate dance of psychological and physiological changes in parenthood is not just acknowledged, but deeply understood. We delve into the critical role of self-care for mothers, often overshadowed by the baby's needs, and how midwifery and culturally sensitive care can lighten the load. The transformative power of empathy, the necessity of accessible mental health tools, and the importance of self-compassion stitch together a narrative that advocates for a holistic approach to parental well-being.

We round out our conversation with a contemplation of the barriers that many new parents face when seeking mental health support, emphasizing the urgency of action before reaching a crisis point. Our dialogue calls for an empowered community, where parents feel seen, heard, and cared for, and where reaching out for help is seen not as a weakness but as an act of profound love and caring. Thank you again to Nathalie and Dr. Montreuil for their vulnerability and expertise, and to you, our listeners, for joining us on this journey to foster kinder, more compassionate parenting experiences.

Livre Blanc
Quebec Alliance for Perinatal Mental Health
Réseau des Centres de ressources périnatales du Québec

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Transcript

Speaker 1: 0:01

The fact that you're questioning your ability as a parent, the fact that you're struggling, in and of itself just frame it differently. It's evidence that you are a good parent because you're caring.

Speaker 2: 0:20

Hello, my dear friend, welcome back to another episode of the Curious Neuron podcast. My name is Cindy Huffington and I am your host. I am a mom of three from Montreal, canada, and I have a PhD in neuroscience. My goal here with Curious Neuron is to help you, the parent, nurture your emotional and psychological well-being. The reason why I think it's so important is because if we are not well, it is very difficult for us to take care of our children. We can't nurture them. If we are not well, it is very difficult for us to take care of our children. We can't nurture them if we are not nurturing ourselves. And the more I spoke to parents the past couple of years, as I was sharing the information I was through Curious Neuron, which was initially focused on the child, I realized that I can give you all the information you want on children, but if I don't give you some information about yourself and if I don't help you nurture yourself, then what's the point of the other info? You need to start with you, and today's episode focuses on new parents. Actually, you don't have to be a new parent. It could be your second child, your third child, your fourth child, but if you are expecting a child, or if you've had a child recently, then this episode is for you.

Speaker 2: 1:25

I'm doing something a little bit different today, where I have two guests. One is somebody who's had this lived experience and these struggles with mental health, and the other is a researcher and clinician from McGill University here in Montreal. Before we do move on to the episode, I'd like to thank the Tannenbaum Open Science Institute here at the Neuro for sponsoring the Cures Neuron podcast, as well as the McConnell Foundation, who is also sponsoring the podcast. Without these two organizations, this podcast would not be possible. So thank you, and also thank you to you for subscribing to the podcast, for downloading and listening to the podcast, and, if you haven't done so yet, please take a moment to leave a rating and a review wherever you're listening to it, whether it's Apple or Spotify or Audible, because doing all of these things is exactly what allows people to know that you want more, and I hope you do, because I enjoy doing this very much. If you haven't done so yet as well, I have the link in the show notes for my reflective parent journal, if you are looking for a resource that can guide you in your thinking, from work-life balance to the relationship with your child, to your own values, to your relationship with your partner, then this journal will give you reflection prompts to help you think through and problem solve these relationships and these challenges that you might be having in your life. I've already started booking school workshops for next August and September. So if you work at a preschool or at a school, whether it's elementary school or high school, and you want to support the well-being of the educators and the teachers, this could be through conflict resolution or emotion regulation training. I offer workshops both in person and on Zoom, so you can email me at info at curesneuroncom.

Speaker 2: 3:07

All right, so today we are focusing on a term that Dr Montreuil andI were having a conversation and we realized that we needed to really focus our conversation around this. When it comes to mental health and the word was normalizing, I think that it's very important for us to keep talking about experiences that we've had with our mental health, because that helps to normalize it and people feel that they're less alone, because sometimes, when we're struggling with our mental health, we feel that we are the only ones going through this. So that aspect is very important. However, sometimes it could kind of go in the wrong direction, in the sense that when we are normalizing something too much, we might not be being proactive and we might not be taking the necessary steps in order to support ourselves or take care of ourselves in a way that we should. And that's the conversation that we are having today.

Speaker 2: 4:03

So I have Nathalie, who's going to be sharing her journey with her postpartum mental health, and I've brought on a guest that has already been here. This is somebody that I did my PhD with and respect her so much. She is doing such fascinating work at McGill work at McGill. Dr Tina Montreuil will be joining us as well. Dr Montreuil is an associate professor at McGill University in the Department of Educational and Counseling Psychology. She's the director of Childhood Anxiety and Regulation of Emotions Laboratory called CARE, and that's a research group. She's the principal investigator of Montreal Antenatal Well-Being Study, the associate member of Faculty of Medicine and Health Sciences in the Department of Psychiatry. The list goes on. She's a scientist at the MUHC here in Montreal, and she is just doing such important work, and I'm really glad that she agreed to come back on this podcast and that we are launching this episode on the week of maternal mental health, which is the week of April 29th, starting today, may 1st.

Speaker 2: 5:10

This week will be World Maternal Mental Health Day and I think it's important that we draw attention to these topics, because sometimes moms feel alone and we think that our intrusive thoughts are, you know, just something that we are going through and no one else. So let's continue that conversation. But, more importantly, in today's conversation, let's find out how to be more proactive, not only as individuals, but as friends and as a society. I hope you enjoy my conversation with Dr Tina Montreuil and Nathalie. Welcome back to the Curious Drone Podcast everyone. I am joined by two very special guests Nathalie and Dr Tina Montreuil. Welcome to the podcast, nathalie, it's your first time and I'm excited to share your journey with everyone. And Dr Montreuil, as I said before in the intro, you had been here before. We spoke about emotion regulation skills. Today we're focusing on mental health in the postpartum period. I'd love for you to share a little bit more about the research that you've been doing and what led us to this conversation.

Speaker 1: 6:10

Yes, thank you again for having me, cindy.

Speaker 1: 6:13

It's really a pleasure to be returning.

Speaker 1: 6:15

So similar as to what we were doing in the past, the idea of right now working in pregnancy, it's still to better equip parents, make them feel that they're capable of facing this transition to parenthood either for the first time or, in some cases, multiple times. But essentially, what we're really focusing on right now is the idea of not simply providing these types of tools to parents once they are parents and they are experiencing parenting challenges with their children parents, then they are experiencing parenting challenges with their children but sort of a more of a preventive approach is to actually address some potential parenting challenges, but mostly addressing parental needs during pregnancy and using, I guess, the motivation that we have during pregnancy for self-improvement and preparation that often accompanies the prenatal care phase is basically using that motivational aspect to really, you know, equip parents, promote their well-being theoretical framework, to add a big word. But essentially we're basing ourselves on a very sort of well-known model, which is, you know, parents that are doing well socially and emotionally and psychologically will most likely be in a better position to offer parenting, sound parenting, more adaptive parenting to children. So that's the only difference.

Speaker 2: 7:46

You know, we're doing the same exact thing supporting parents, but supporting them during pregnancy, in preparation for parenthood Time, and time again, when I speak to parents, this is exactly what they talk about, where the sort of gap is, where they feel like they're sent home with this brand new little human in their arms and they feel equipped in the sense of well, they've learned how, or they're ready to change diapers or figure out what to do, when you know, when it comes to sleep, but they don't feel equipped when it comes to their own mental health and their own needs. And sometimes it only hits us a little bit later, right when, oh, I thought I had the tools, but I don't have the tools. And I'm so happy that we're going to have this conversation, and this is what led to us bringing up Nathalie, where we really wanted to share somebody's journey, and I think that's what's missing sometimes. Nathalie, welcome, and I would love for you to share your journey, how you came into contact and connection with Dr Montreuil and maybe a little bit of your postpartum journey.

Speaker 3: 8:44

Well, thank you for having me. So I'm a mom of a two-year-old little girl. I had a good pregnancy so I have nothing to say about this and I did suffer from depression last fall. So I was back to work and I started to feel some symptoms that I was not myself and I didn't like it, and it led to even a leave of absence because my mental and physical health really hit like a breakdown and it's been really really tough. The return to work in in fall.

Speaker 3: 9:26

So, looking for some resource, help or anything, I kind of just drop on the uh and tina's work on the on the web and I already told tina um, I already thanked her um, because I was finding that someone is doing work, someone is doing research on that and so important and gave me hope that, ok, some someday prevention will be there, someday parents might not live what I have lived, and that's how I connect with her. They were asking for some messages or testimony of people, of mom and dad living it, and so I reached out to them, not knowing if I would really really receive an answer, but they did and we connect like this and I felt so. I felt understood, I felt listened and for once, I felt that, okay, there's someone who understands what I'm living and it's going to be using what I'm living right now to maybe have better tools in the future. So that's how I connect with Tina. So thank you again, tina, for working on this. It's important.

Speaker 1: 10:37

Thank you so much, and I think you know I would say reciprocally. It's so critical to have people like you that are so inspiring and that lead to be able to inform our work as well.

Speaker 2: 10:48

Well, thank you Parents that are listening. I know that something has stood out to them. You mentioned last fall and that your child is too. I think, when a lot of parents think of the postpartum period and postpartum depression or anxiety, that it happens soon after we have that child, but you're talking about a year or more later, right, when you started seeing symptoms.

Speaker 3: 11:08

Yes, I went back to work after 30 months of mat leave, so before that I didn't. Of course I had ups and downs, like everybody else. I know the body and the mind is changing, so of course there were days that I didn't feel myself. The mind is changing, so of course there were days that I didn't feel myself, but the next day, or just looking at my baby smiling, and I was feeling better. But it was really when I got back to work that I had symptoms and I think one of the things is that I realized how much a maternity and parenting changes us and I didn't expect that.

Speaker 3: 11:45

At work also, it was like a bit frustrating that, oh my God, okay, even at work I'm not the same person and you know so. I didn't like that. And more of this, I had really real symptoms of depression that I knew it was. It was symptoms of that. It's not right after giving birth, it can be later. And I knew it was symptoms of that. It's not right after giving birth, it can be later. And I knew about it. I heard about it before. I just didn't expect that, I wasn't to that and when I tried to talk about it I was not afraid of just saying I don't feel myself, I don't know what to do. People just answered oh, you'll see, it's normal. This is parenting, this is having a child is tough, but it'll pass. Hold on. I'm like, okay, it's normal.

Speaker 3: 12:37

I'll wait yeah.

Speaker 2: 12:40

And that's the word we need to focus on, right, so many parents, whether it's your first or second or your third, sometimes we have these emotions and it's really hard. I've spoken to some parents who look up the symptoms online to know like, am I perhaps experiencing postpartum depression or anxiety? But then when they read them, they're not even sure. At that point they're like well, sometimes maybe I'm not sure, and they speak to parents or you know other parents or friends in their community and they're told it's normal. I went through that and then nothing happens.

Speaker 2: 13:11

So this is something that we wanted to also make sure we highlight where being we're trying to normalize. You know certain mental health symptoms, but are we actually turning it into something that's not allowing somebody to get the help that they need? Right, dr Montreuil? What do you see on your end? You know, when it comes to clients with the research Normalizing I know it's coming from a good place we're trying to make people feel like well, we all experience these symptoms of anxiety. I went through this as well after my first. But then at what point do we need to take action as a parent or speak to someone?

Speaker 1: 13:43

Yeah. So I think it's so critical and that's what really inspired me. From what Nathalie was saying, she's like, you know, I recognize it. I wasn't quite sure but I knew I had to speak about it and I think that's the thing we have to really, you know, I guess for people like Nathalie you know she was up front, she came, she discussed, she reached out.

Speaker 1: 14:12

For other people that's not their experience, for them, like, we need to almost create a safe space around, you know, mental health issues more generally, but especially create a space and I think this is our responsibility as clinicians and researchers to really create a space where perhaps we are facilitating this dialogue on mental health issue or just psychological distress, if the mental health, you know, piece is ostracizing or stigmatizing, you know, I think one of the things that is noticeable is that, you know, we know literature, you know we see it. There's the visual, like you know that all the physical aspect of pregnancy that you know is visible. Our body changes, but that's just the tip of the iceberg. During pregnancy there are neuroanatomical changes and I feel we often talk about those neuroanatomical changes, those hormonal changes, in a way that you know promotes nurturing and that's true, like attunement to our baby. So we really sort of depict it on an evolutionary basis. Why those are good? Maybe suppress the serotonin release and secretion where that would impede on our sentiment or impression of being happy and content, and combine that with the environmental changes, the true hardship of what comes with sleep deprivation and not knowing what is the best course of action. And so I would even say, add to that, if your experience of parenting, as you receiving the parenting, was not a positive one, you come with those sort of standards of or fears I should say about you know, sort of predisposing factor about how yourself perhaps as a parent and your parenting approaches will be compromised.

Speaker 1: 16:09

So I think one of the things that I want to highlight is this issue of needing to create a space, because currently what's happening is that you know I highlighted some of the changes that happen and there's almost this notion that once you give birth to that baby, you know, basically your body goes back to reset pre-pregnancy. But I think that has to be questioned. Maybe for some that's the case, but I think many at the health level it's going to cause lifelong changes in the woman's health. And then there's that one thing about you know, the aspect of permanent changes as a result of pregnancy or not. And then there's the other piece that you know once your baby is born, you know the care is turned towards the baby.

Speaker 1: 17:05

The baby will have periodic appointments postnatally and what I've heard a lot from women and birthing people is that essentially, you know what happens to me, you know where is my space, that if I were to say that I'm not well or sort of claim that maternal or that sort of parental space, that it might actually be maybe an indicator that I'm not really caring as much for my baby as others.

Speaker 1: 17:35

So there's almost that stigma, not just around mental health issues or psychological distress, but also perhaps stigma around I'm wanting space when really now I'm a mom and it should all be about my baby. So I think we have to question, you know, like we and Nathalie is the one that actually inspired us to think that way you know we prepare so much for the prenatal phase of the child. The mother is a receptacle of this living being that is being formed and then, once we give birth, there's not really a systemic plan nor a medical plan in place to really care for the mom and her health and her capacity, as I was going back to the introduction to parent. So this whole aspect of parental wellbeing, maternal wellbeing in order to be able to ensure the sustained well-being of that child as we're facing these parenting challenges.

Speaker 2: 18:33

I know that so many parents feel seen with what you just said and feel like this needs to happen sooner than later. You know that sort of support for the parents. Is it like that across all cultures? I just had this idea pop into my mind because I know that I've spoken to some people in Northern Europe or other countries that feel that either it's a cultural thing where there's more of that family support once you have a child and the family sort of comes together to support that new parent, new mom, and then after there's, I've heard some people talk about like not a doula, but some sort of person that comes with you and stays with you. That's part of the healthcare system, so that the mom has somebody there to do the laundry. It's not a family member, it's truly part of the healthcare system. So are we lagging behind here in North America?

Speaker 1: 19:19

So definitely a lot of the models of care, of prenatal care and postpartum care. If we look at models like models that have, you know, like I would say, models that have a lot of guidelines in place in terms of postpartum care that align with the world health organization's uh recommendations, which is, you know, to have between three to six visits postnatally as a minimum right, which is, in essence, that's really not what's taking place in North America, but countries like Australia, countries like the UK, where again, the midwifery takes or has a good portion of the care of mother and child during pregnancy but also postpartum. It's clear in our experience working with midwives in the Montreal area and also our connections across Canada, that the type of care, the framework in which midwifery is exercised when I was talking before about creating a space for dialogue for, you know, sort of almost like I don't know empathy, you know working relationship caters more to that sort of postpartum or, I would say, ideal postpartum care. It doesn't mean that in, let's say, our first care in the medical system, that we wouldn't be able to do that, but it would require some sort of a shift. And in the care provider's defense, you know we work very closely with them as well.

Speaker 1: 21:03

I think a lot of them, you know nurses, physicians they have a desire to service women postpartum. But I think what's really lacking is perhaps the knowledge, the mental health piece, like how do we assess? How do we assess in a way that's not going to be confrontational, or it's not going to be, for example, or it's going to be culturally adapted, since we're on that question, right, or it's not going to be, for example, or it's going to be culturally adapted, since we're on that question, right. So I think we also have to ask ourselves the question, like you know, what else could be done in this space to actually, you know, provide that care for women like myself, like you, like Nathalie, in order to ensure that ultimately, you know, we're going to be better prepared, not only for conception but for the job of being a parent. So that's the whole debate there.

Speaker 2: 21:53

That word better prepared. Nathalie, you mentioned this before where you just felt like you needed those tools. Looking back now and knowing what you know now because of the work that you've been doing with Dr Montreuil what needs to change for new moms and new parents, what would you have needed in that time?

Speaker 3: 22:10

Well, first, yes, try to avoid that thinking that once you give birth, the body and the mom just goes back to what she was before and just ignore. It's really, it's fascinating, you know that when someone gives birth and you ask how's the baby, yeah, yeah, what about me? You just forget it, but it continues after. So that shocked me. So if we could stop, you know, ignoring the parents and just and stop just focusing on the baby, I don't think I I can really say what exactly needs to be done, but just provide space where the parents could ask themselves am I okay? Or someone just ask them are you okay? Because I was not led to ask myself during and I said my depression started at work. Maybe it started before, but I just don't know it. My symptoms started because I started at work. Maybe it started before, but I just don't know it. My symptoms don't.

Speaker 3: 23:08

My symptoms started because I was at work, because maybe, but maybe it was before. I just didn't ask myself and I just don't even know how. It's not something that we ask ourselves daily. Am I doing okay today? No, so, and I still don't understand how come every month I was going to see a, a doctor or a nurse to see, to see if my baby's okay. No one ever asked me, never. No one ever looked me in the eyes like you. Are you okay physically, mentally? Just a simple question that could have made the difference. And just think about people who are isolated. I'm not, I was doing uh my boyfriend, my family, my friends. Just think about people who don't have access to those uh doctors and nurse, or don't have access to uh, to families that and are isolated. They less think about asking themselves am I doing okay?

Speaker 2: 24:09

so just that space of think, of the thinking of am I doing okay, it's not existing and you were also proactive in yourself, right where you started doing the research, and not everybody might think about doing that or some people might retreat and go back a little bit and and just kind of isolate themselves a little bit more. And, like you said, of course we were talking last time we also brought up accessibility versus availability and I think we need to bring that up because, with what you just said, right, if somebody was in a different area here of the province that didn't have access to dr montreux's work or was close to the university, would they have been able to get the help that you got? Probably?

Speaker 3: 24:48

not. And even for myself, like I asked myself, it was too late. I was already in depression. What if I would have had some resources or help just before getting to that point that I would have symptoms? But I didn't, because I didn't have myself, I didn't have any resource or any books about it. So the resources exist because I found it out in the fall when I was in it, and that's how I connect with the team now. So it's not because they don't exist. The accessibility is there. It's just not. It might not be at the right moment, and that's the proactive way that I don't feel that I've been that proactive. Knowing that it led to a leave of absence, at least I might have been a bit proactive. So I didn't. I left for just two months, I didn't leave for a whole year. So might have been a little bit proactive, but I don't feel I've been that much. I get that.

Speaker 2: 25:51

No, you, you know we talked about the normalization piece of you know somebody, people telling you, know us that it's normal and these symptoms happen to everybody. You know I've spoken to some moms who felt some rage out of nowhere during the postpartum period and felt so embarrassed and shamed not only in their, their relationship of this rage coming out of nowhere, but they didn't want to talk to people about it. There are so many different symptoms that people might isolate or not want to talk about even self-harm or harming their child too. People would not want to. Um, there's some moms who shared with me that. You know they don't want anything to happen, like with social services. You know, like, if you say that you have these intrusive thoughts, um, dr Montreux is, is this common Like cause? A lot of these symptoms might feel embarrassing or shameful to a parent or they have guilt around it. What would you recommend or suggest to that person who's listening and has these thoughts and because of those thoughts they're not sharing what they're really feeling with the people around them.

Speaker 1: 26:52

Yeah, absolutely so.

Speaker 1: 26:52

You're very true, and this is an experience I've had as well.

Speaker 1: 26:55

Both you know conducting either you know, mixed methods or qualitative interviews where we connect with people like Natalie and others who have experienced either just more generally mental health distress or psychological distress, or specifically surrounding the perinatal and transition to parenthood.

Speaker 1: 27:14

So it's very frightening because for a lot of people, like I said, for some people it's just the anticipation that, because you know I was sort of on the receiving end of poor parenting, that perhaps all these sort of beliefs about you know this, the fact that I'll be limited myself if I didn't get a good parenting, then probably I'll replicate the same thing. And I know, for some parents, just that thought of replicating this sort of intergenerational deprivation or, you know, maladaptive parenting is very distressful. And then there's just combined with that where you know, like we are often I was doing a presentation yesterday and you know kind of showing the image of like a lot of the times on. You know this will be on social media and it'll be, and this is the good side of social media. But sometimes social media and it'll be, and this is the good side of social media, but sometimes social media projects an unrealistic expectation.

Speaker 1: 28:09

I was talking about attunement before, like the mom that is smiling and sort of like cuddling and sort of like, you know, lifting the baby as if you know it's this marvel, and certainly parenthood is filled with those moments. But for a lot of parents, you know, it's, it's's being. There was another picture that I was displaying of a mother, you know, sort of lying on her back with the baby crying next to her and sort of being overwhelmed and not knowing how to deal with this. And probably in that very moment, if I were to put thoughts in that person's mind, it's like I can't handle this. I'm going to basically, you know, mark, or you know, affect my child's well-being forever. And the same goes for fathers. Let's not forget them, right? The notion that maybe in this case it's also I can't support my partner, I can't provide the assistance, and a lot of times just to throw in a little word there for our fathers there is that a lot of the times they haven't had the experience of parenth, of parenthood, or I should say the experience of pregnancy for them is very external, you know. They're not experiencing these sort of biological and biophysiological changes that somehow kind of get us as mothers or as birthing people to kind of get prepared for the you know the reality of this transition, whereas for fathers a lot of the times being more on the outside of this, they almost we're talking about beliefs they can maybe tell themselves that they don't get their partners, that you know they're not equipped for this, and then so, therefore, I think you know what we're essentially saying and maybe I can come back with this aspect of you know, availability versus acceptability.

Speaker 1: 29:51

I think you know there is an advantage in not just promoting the child or promoting you know the person here, but promoting the unit you know like. You know like, if the system is stronger, then essentially, most likely, each and every individual part of that system will also be reinforced. And this is speaking to the importance of really promoting the importance of family and families under all of its colors and shapes and definitions. Right, but this notion of you know strong family units, and this brings us back to this idea of accessibility and availability. So I guess you know we might have some time later to mention a few key resources.

Speaker 1: 30:35

Nathalie came to us through the Quebec alliance of perinatal mental health, but there's certainly, for example, a very good colleague of mine, marie-claude Dufour, who leads the Réseau des CRP, which is les centres de ressources perinatales du Québec, which they have amazing resources. More recently, we contributed to Le Livre Blanc de la Périnatalité, which is essentially, you know, it's filled with, like evidence-based research, but it's written in lay terms to be accessible to all and it contains a plethora of resources for parents. So I think that's, I think for me, that's the thing, I think we really have to promote support of mothers, definitely postnatally, but also, like, what are we doing to support families as well?

Speaker 2: 31:23

you know, I maybe I'm I'm going to oversimplify the the next steps for this, but I remember leaving the hospital and I had this very heavy book about like what's gonna. I forget what it's called, like zero to five or exactly so it was, you know, and it was a really heavy book, but I don't remember there, I don't remember that I'm talking about everything that we just talked about. Isn't there space for another one of these huge books, or just a pamphlet with with some of this information to get us started and towards positive changes? And I guess my questions to both of you, but Nathalie, would that have made you know because I'm thinking about myself as well like just knowing about the resources that we just heard from you know that Dr Montreuil talked about just knowing. That is a good start, right, nathalie?

Speaker 3: 32:16

It's a good point, and the first time I heard about depression postpartum depression was at T Tout Mon Empareil a few years ago, way before I was even thinking about having children.

Speaker 3: 32:29

It was from Jessica Barker. She pointed out that in that book at that time there was half a page and remember that the book is like this big. So there was half. It's huge but the pages are really small, are like half a real page. There was half a page about depression, but I don't know how many pages about how to latch or to do so. It was proving how there was a lack of information or in prevention how there was a lack of information or in prevention. I didn't look at mine a few years after to have more page but of course I read it and, like I said, it didn't really prepare me that what's going to be the symptom? When should I consult? Who should I talk to? So yes, there are spaces. You know it's not completely. I don't think it's silly to think that we could use the tools we have right now, just like this book or maybe the appointment I had personally with the doctors or nurses, just to ask me are you doing okay? So I think there are some chills right now. What's?

Speaker 2: 33:45

blocking. I don't know, tina, are we oversimplifying?

Speaker 1: 33:54

Yeah, well, just to answer your question about, like you know, Jessica Parker, who's a great person that we is a great supporter of this cause and I think she's definitely carried this um, this mission, um, at a at a Quebec level, if any. If not, uh, more Canadian Canada wide, but essentially, um, yes, we did. The exercise is about, like now, I think, currently about maybe a page, uh, if let's say, a page and a half. So certainly, um, there's, there's room for there's room for improvement when we consider the 400 other pages in there. Because I think what people need to understand is like this idea that you know, maybe I have, let's say, 25 pages about you know how to bathe the baby, how to wrap the baby, but if mentally I'm not doing well, if psychologically I'm depleted, it doesn't matter. If I have all this information, I can't consolidate it, I can't read through it, I don't have the volition to actually carry it out. And I've had people, a number of people you know, like via research or even in my office as a clinician, you know, tell us this. So the idea is that you know this sort of like the mind over mood. We have these principles in psychology by Padesky and Greenberger that are saying that, you know, in order to have, for example, the impression that we can do something, that we're doing well, like it needs to be sort of like preceded by you know, like a certain mindset, and then you know we need to be able to carry out those actions and then through those actions we get reinforced. But certainly there's room for improvement and I think on that what I would want to say, and there was one thing that I was actually informed by Natalie.

Speaker 1: 35:34

We had this conversation because I guess for me, as a clinical psychologist that's trained to implement interventions that are using a sort of cognitive behavioral therapy framework, we use a lot of psychoeducation. We were talking earlier in this podcast about normalization and, you know, mental health literacy, and there was something I remember sitting there in that, in that kind of virtual meeting, when Nathalie meeting her on the first time, and she said something. I hope it's okay if I paraphrase you, natalie, because for me it was a game changer. It made me, it opened my eyes to an important limitation that we have and that is, you know, she said something along the lines that, you know, mental health literacy, in the absence of actual resources and means, so strategies or tools is actually actually has a perverse effect, to which I had to ask her can you just explain to me?

Speaker 1: 36:27

And so, in, to use your words, I thought he was like, basically, like after a while, when you keep on hearing that it's normal and that others feel this way, it comes a time and probably you could best explain it, natalie but it comes to a time where you're like okay, well, it's been a while and I'm not, I'm still doing well, but I'm told that things is normal and things should technically improve. So if I'm not improving, like what's wrong with me? But in effect, like you're not being provided with tools, and so, as a clinician, a psychologist, not a physician, like in a, in a framework that I work and I operate in, we use literacy, we use mental health and normalization, but that's just to create the alliance, you know, create that space to make the person feel secure and to say you know what? Like take down your guards, you know like there's nothing wrong with you. This is very normal.

Speaker 1: 37:18

But that's just to kind of create that connection and quickly, as psychologists, as mental health experts, we go into okay, here's what you can do. There's more passive approach, for example, like mindfulness and relaxation. And then there's more sort of active things that you can do, such as like, for example, cognitive restructuring, more mindfulness-based and acceptance and tolerating distress. So we provide very quickly, we provide tools, and it made me reflect that a lot of the times in a lot of our campaigns, we just kind of like are okay with doing a lot of mental health literacy, which is good, but then what comes next, and this is what we're talking about now when are my tools? Where are they available? And how come I have to become sick to actually get those resources when in effect they were available, you know, before I got ill, but I just could not access them. So, obviously, mental health literacy is critical, but it's not sufficient to really provide the help that suffering and, you know, sort of like motivated parents need in a time, in a critical time which is like early infancy.

Speaker 2: 38:29

Yeah.

Speaker 3: 38:31

And I would have that, even if it's accessible, like in that book. You're saying that there may be one page, a page and a half, but there's still more information out to bait. In my mind, and probably in everybody's mind, if there's that information on baiting and that information on health, it gives me the idea of the risk of baiting is much higher than the risk of health. It's more important that the risk of happening will be higher in waiting than in mental health. So of course you're not lead to ask yourself or to get into action of I'm not doing okay and you're being told it's normal. You're not lead, you're not led to some action and then you just go on.

Speaker 3: 39:26

I could tell you there was someone saying the two first years are the toughest. So I was so and I didn't, I was not well. So I was secretly hoping that if I hold on on those two years and at the second birth of my, my girl, it was all it would all suddenly disappearing, dissipate. Yeah, it was. It's completely silly, but I was in that mind saying, okay, those two years.

Speaker 2: 39:54

Those two years you're waiting for it. But, nathalie, thank you for saying that, because that's a question I was going to ask as well. I'm sure that there are parents listening to this saying okay, so if I'm noticing a difference or a lack of motivation or something is off and I know something is off do I just let it pass? Is it a moment that's going to pass right? Like, am I going to get through it with time passing, and what I'm hearing from you, nathalie, and from what I understood with Dr Montreuil, is we can't. We need to take action.

Speaker 3: 40:20

Well, it will pass. But don't let it, don't just do nothing, just don't expect that it'll go away by itself, just as anything else in the world. If you're hurt, you will get. If you can't yourself, you'll get better. But you'll probably put a plaster or something. So, yes, talk about it, don't be, don't worry about it. Don't worry about it. Yes, it'll pass. It passed for me. But take some actions. Look at yourself, ask yourself what could you do for yourself, for your mental health. Talk to your partner, talk to your friends, your family. But don't just do nothing. It won't go away.

Speaker 2: 41:03

And if people tell you that it's normal, or a doctor perhaps dismisses it and says like it's part of the phase. You know, maybe we have to be a little bit more proactive in that sense of pushing to get support and help.

Speaker 3: 41:15

Yes, yes, to go to action. So, yes, it's normal, don't feel that you're the weak person, you're the weak mother, or You're the weak mother, or you're a bad one mother or a bad father. So that that part of normalization, I think it's well. It helped me at first saying, okay, I'm living a normal phase, but what I'm saying, that normal phase there's shouldn't lead to don't do nothing.

Speaker 2: 41:40

Do something to get better, better, and I'm I'm really happy you brought up that word, the weakness right, because I've heard this through. We spoke with dr docosta, who's also a montreal um, a mcgill professor, and she was talking about dads and how they felt. You know they didn't go through all of that and they shouldn't have symptoms, you know, postpartum depression or anxiety, or feel like this is difficult, and they felt like it was showing weakness right, and a mom might feel that as well like I need to be able to do it all and if I can't or I feel sad or I feel overwhelmed, like that means I'm not good enough at what I'm doing or I am showing signs of weakness. That is such an important word for us to say, because I know it'll help parents feel seen because they're not. It's not a weakness to to experience this.

Speaker 1: 42:24

And I would even argue, like for a lot of parents I would say, like I often tell parents and we have this intervention that we're doing obviously not perinatally at the moment, but you know, one of them is just, it's called parenting with confidence and one of the things that you know you'd be surprised just by telling like yes, it's normal, but also telling them listen, the fact that you're questioning your ability as a parent, the fact that you're struggling, in and of itself just frame it differently it's evidence that you are a good parent because you're caring. That's driven by the fact that you're so concerned about the care that you wish your child to have that essentially it's causing you distress. So when we're going back to the weak, you know, let's reappraise this weakness. As you know what, like I'm just concerned, I just actually care. I don't know how, but because I care, I'm going to. You know, like my child is worth it. I'm worth it, I am a good parent and you know what, I will seek help. So I think you know one of the things that and we see just the fact that we're just changing the labels, we haven't done much yet, but we're just basically like telling parents that you know. That in and of itself is evidence that you are good parents and most parents out there, even if you're not doing exactly what might be best for your child or what you would want to do for your child, a lot of it is just because you know we're bombarded with so much information that we're not quite sure. But I would tell you that most parents that I've met are parents that actually are good parents. Intentfully they are good parents. There's just either too much information how do I know? Or there's for some people.

Speaker 1: 44:06

Now we're talking about Nathalie. You're fortunate enough to have a family support like friends, and you're well-educated and you're someone that is resourceful, and all those are individual, what we call social determinants of well-being and health For some people in certain demographics. And new arrivals that arrive to Canada, which are more socially isolated, maybe that you know their social economical status is lower, maybe they're even you know we've done a study with CHHSN, which is, you know, a community conglomerate or services that offer support to non-French-speaking Quebecers, so English-speaking Quebecers in the province, essentially even language. Language is something that basically also interferes with your access to care. So essentially, I think if Nathalie had difficulty with who she is accessing resources. It's clear that for other communities or individuals or demographics in the province and across Canada, access to the timely resources is an issue. So when you were saying, yes, things do get better. But unfortunately I can tell you, working with, for example, the Canadian Perinatal Mental Health Collaborative, that for some women the outcome is not a favorable one, and so we can't just sit on the fact that they're going to find resources.

Speaker 1: 45:31

What are we doing proactively, like you said, cindy, to actually make those resources at their disposal? At their disposal, if you allow me to just add as well you know, like when we're, you know immediate postpartum, you know what's the protocol of care. You know, like we basically have the parents test. We check to make sure that the car seat is not expired. We make sure that parents know how to buckle the children in adequately in the car seat.

Speaker 1: 45:59

We also talk about the baby, the shaken baby syndrome protocol, and I'm thinking to myself, like you know what precedes that. You know if you want the parent to be calm and be able to feel competent to put that baby in their car seat, if you want the parent to be meant we talk about emotion regulation if we want the parents to be regulated and be able to have the emotional space to deal with a crying baby. That is just not consolable, you know, and not shape, not resort to shaking their child. It's all about mental health and psychological balance. So for me, I always question, I think those protocols are amazing, but it just makes sense to me, or rather I'll say, on the flip side, it makes little sense to me why we can't have that dialogue while we have the parents under the care to basically empower them to feel better equipped or at least know where to go for resources. You were talking about a pamphlet, natalie.

Speaker 2: 46:54

Yeah, so that speaks to that as well, at the very least right that pamphlet. But we are there, they are with us, they are, you know, we are at the hospital and I do remember for all three kids they went through that shaken baby syndrome and and the protocol for that, what would be my action plan? And if it and I'm glad that they did that but it's not addressing why you would want to do that and the the emotion aspect of that and the mental health aspect of that which I experienced after my kids as well, where and it wasn't the first after the first, I know some parents that are listening it's like whew, nothing happened, I'm okay, I'm, you know, I have my second now. But for me it was after the second and the third where it just kept getting worse because I ignored my mental health after my second and had a baby soon after. So it just kind of like amplified itself and I do think that it's important that we keep talking about that.

Speaker 2: 47:47

And for myself, even after I stopped nursing, I had nursed for a few years in a row because I had babies so close that when I stopped nursing I went into a depression, not even understanding what was going on, and only when I started talking about it, people said, hey, I experienced that too, and I didn't even understand what had happened to me, you know. So I do think that there's lots of space for not just it's not the literacy part, but it's more of the action plan. This might happen to you. You might feel this way yes, it's okay, but now what? Right, like that's the part that's missing.

Speaker 2: 48:14

That's what we need to focus on, so I do think there's a lot of room for that.

Speaker 3: 48:19

Yes, yeah.

Speaker 2: 48:20

I unfortunately have to end this conversation. I really don't want to. Both of you have been truly important for this conversation and have added such an amazing part of this dialogue. I do want to end this conversation on a positive note, perhaps for parents that are listening what you know, what are the next steps? So, parents listening to this perhaps they're expecting their first, they're waiting, perhaps they're expecting their second and have one at home and they're starting to feel that something is off. Maybe we can start with you, Nathalie, like what advice do you have for this parent moving forward? And then we can follow that up with Dr Montreuil in terms of, like, what is possible, or we're're going to add a lot of resources to the show notes of this podcast, but you know, in terms of like, what the next steps would be for that parent.

Speaker 3: 49:09

Well, like I said before, if you think you're experiencing anything, and even if you think you're not experiencing depression, think about yourself. Being a good mom, a good dad, is also being good in health, mentally and physically. So if you think you're experiencing anything, go see, go talk, go see and try to see what's best for you and the baby also. So if it's taking day off or I don't know, and it's good also for going back to work, when you'll go back to work, try to see with your manager and your team what's best for a good return to work, going back to work day one, as you as a professional, as the professional were before.

Speaker 3: 49:58

Well, you might. You might think it's really hard after 12 months of a mat leave. So try to see and talk about what can be done so it's easier to get back to work or to get into a life of a mom or a dad. You know, try to adapt and try to adapt your baby, but try to adapt your life as a new mom, as a new dad. It's possible. There's no one size fits all, so that's what I think.

Speaker 2: 50:28

I just want to add to that, like some parents will say, like my relationship has changed or I'm struggling now with my relationship. So it's not meant. It's not necessarily that I'm feeling, you know, symptoms of depression or anxiety, but I'm feeling overwhelmed. There's an emotion that's being amplified because of this new baby. I'm feeling overwhelmed with my relationship. You know we're struggling with conflict resolution. All of that adds to our emotional and mental health, right? So I think it is that, in terms of looking at our overall life, maybe even with a parent, you know, like an or an in-law, something is happening. We have a new baby. Lots of parents and in-laws have advice for us sometimes and that adds to the stress. Yes, oh yes. And and Dr Montreuil, knowing you know, natalie, what she was saying but what would you add to that from a clinical and a research perspective?

Speaker 1: 51:12

so three points. First point what I would say is that um is uh, essentially that taking care of yourself is caring for your baby and your child. So basically that is so important. It's not like it's not something selfish, it's the analogy. I've been talking about this, you know, airline mask in case of emergency analogy since 2015. So that's not new for me, but it's become a bit more like sort of popular during since post COVID.

Speaker 1: 51:42

But essentially this notion that we understand when we're on a flight, that if we are to try to put on our child's mask because that's what parents are, you know or even for our elders, we'd be inclined to helping the powerless, that essentially, if we're going to be running out of oxygen and here the oxygen, parallel to psychological well being, is kind of emotion regulation is like, you know, being at a, you know, an optimal mental health or psychological capacity. If I'm to run out of oxygen, well, I won't be able to actually help my child or whoever else is is weaker or in a more powerless position than I. We get that, we would do it right. So the same goes like looking after your own well-being as a mom, as a new mom, you know it is not selfish. It's an act of love towards yourself and we know that from like, for example, like a lot of. You know dbt, you know dialect, uh therapy, behavioral therapy. You know it's like self-love is basically being able afterwards to care for others. You're caring for yourself because you're caring for your baby. So that's the first thing.

Speaker 1: 52:43

The second thing I would say that goes with that is self-compassion. You know, parenting is messy. It's messy but it's also beautiful because it's an opportunity to grow as an individual. Right, you're learning about yourself through those interactions with that little child that is so small but yet, you know, brings about so many elements. You know where we're. You know no one else would. We would never put up with any of that. You know, if it wasn't our own, you know our own offspring, our own child, right. So use a lot of self-compassion. It's not going to be perfect, but you know what there's beauty in, for example, the second time or the third time.

Speaker 1: 53:20

Right, and stop worrying about, you know, having had one negative reaction. Right, it's really sort of an additive thing. You know, if it's more often negative than not, like Natalie said, do seek help. But if once in a while, you know you slip, that's part of parenting, and we know it's like any other sport. If I told you I would win a marathon tomorrow when I've never, you know, practiced for it, you'd say, tina, that's ridiculous. Well, the same thing as parents. Like you know, this is all new to us, you know, like no one's really trained us to do this job.

Speaker 1: 53:48

And I would say, lastly, I would be hopeful, because we're in an era now where we're talking more and more about it and I really feel that in the next couple of years, a lot is going to happen in this space of perinatal and postpartum mental health, in terms of parenting. Like, I'm involved with various projects at, you know, the provincial level. There's going to be like some exciting things coming up in terms of resources. Decision makers are hearing, have heard. So I think, if anything, if you know, we've there's been times in maybe like in the past couple years, where things have been difficult. I really do feel that there's a lot of new things that are going to be arising or developing in this sphere of of perinatal mental health and everything having to do with the transition to parenthood.

Speaker 1: 54:34

Um, our minister, uh, minister, karma is very, very connected with the reality of parents, so it's very encouraging. So I would say, you know, with all those three, three aspects, I think there's a lot to just be hopeful for, and, and, and, and. And. You know, let's build a community. That's the whole point about these community resources. Let's build a community, let's access these, these community organizations that are there to provide support If you don't have a family Right.

Speaker 2: 55:06

Exactly, I will add all of those resources down in the show notes so people can click on it and get them, you know, get the accessibility to them. Dr Montreuil just mentioned self-compassion. We interviewed, I interviewed Dr Kristen Neff. I'm going to add that to the show notes as well.

Speaker 2: 55:17

Her work is pivotal around that Amazing. So I just want to say thank you to both of you. This conversation was amazing and I have a feeling there'll be a follow-up at some point because it is an important one. So thank you to both of you again thank you, cindy.

Speaker 1: 55:30

Thank you so much, cindy, for the opportunity, and thank you, natalie. Thank you so much. Uh, you know you're, you're, you're wonderful, you're welcome, thank you.