Understanding Maternal Mental Health

According to CDC research, postpartum depression impacts roughly 1 in 8 women who go through a childbirth experience. But what is “postpartum depression”? How is defined, how does it differ from general depression, what are the symptoms, and how can it be addressed by moms, their families, and the medical community. We’ll examine these questions and more in this episode of OK State of Mind.

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Thank you once again for accompanying us on the journey. Until next time!

Transcript

Chris: [00:00:00] CDC research from 2020 revealed that about one in eight women experience symptoms of postpartum depression. Today we're going to talk about what postpartum depression is and isn't. We'll look at common risk factors and preventive measures that can be taken to get ahead of postpartum depression And we'll ponder the question, why is conversation around the topic of postpartum depression so limited? This and more on OK State of Mind. My name is Chris Posey. 

Dee: I'm Dee Harris and with us today is Leah Meyer. She's the program manager for the FCS Maternal Mental Health Program. So, Leah, welcome. 

Leah: Thank you so much. 

Dee: It's so great to have you. I think we should start by discussing what is maternal mental health. I mean, I think we all think, Oh, of course it's how I feel and that I'm a mom, but I think it's a lot more complex than that.

Leah: It really is. And so whenever we get down into it, maternal mental health is Obviously, mental health around people who have [00:01:00] been pregnant or who have recently been pregnant or have given birth. So this also includes perinatal mood and anxiety disorders. That's a really clinical sounding term, but it's really just depression and anxiety OCD, sometimes bipolar disorder or even psychosis.

Now you guys may have heard of some of these mental health diagnoses before, but whenever we're talking about maternal mental health specifically or perinatal mood and anxiety disorders, it's whenever it starts or gets significantly worse during pregnancy or within about a year after giving birth. 

Dee: When I was pregnant with my kids, I went through a fair amount of emotional highs and lows.

I mean, your hormones are all over the place. Absolutely. So. When does it become a problem? 

Leah: So clinically, we look at how long has it been an issue and then also the severity of the symptoms. So if these symptoms are lasting ongoing for two or more weeks, we might be looking at a perinatal mood and anxiety disorder.

But also if it's. Impeding your [00:02:00] ability to get your day to day life done. So, if you have been sitting there for weeks and weeks on end, and you haven't been able to go to work, and you've been calling out because your depression is so bad while you're pregnant. Now we're suspicious here that this may be, something a little bit more than just feeling tired because you're pregnant and growing a human, right?

So we look at length of time and how much it's impacting your day to day life. 

Dee: So I know you talked about like, when you can't get up, you can't go to work, but what does that really look like? 

Leah: So, some of the most common symptoms that we see are people having difficulty bonding with their baby after baby's here. So, maybe the baby's making the sweet little cooing sounds, but the mom is just not having any kind of emotional connection or reaction to that.

They may take, an extra amount of time to respond to the baby whenever they're crying. Now, again, as you mentioned, Dee, like people who are pregnant or who recently had a baby, they may need a break for a little bit. And it's okay if you need to wait a minute, if you're really overstimulated, to go and respond to your baby.

[00:03:00] But it's whenever it's happening, More often than not that you need that break and you really don't feel that desire to go comfort your baby. Another thing that we hear a lot of as well is moms who will have this negative self talk. It's this internal dialogue that is just really defeatist.

of, I shouldn't have done this, and I'm a terrible mom, and everyone else can do this so much better than me. So those are some really, common thoughts that moms who experience some of these issues have. 

Chris: Can we talk a little bit about a few, terms. One pretty commonly heard, baby blues. How does that differ from postpartum depression, what you're talking about now, and perinatal mood and anxiety disorders? What's the difference in these? 

Leah: Yeah. There's a lot of misconception around it and it gets really confusing, especially whenever we're throwing out these clinical terms, but baby blues is more of a hormonal and emotional response that happens within the first couple of weeks after giving birth.

And some studies say that even up to 80 percent of people who give birth will experience baby blues. So this [00:04:00] is feeling sad, a lot of tearfulness, being tired, but of course that's going to make sense. You grew a human for nine months and then just this baby exited your body one way or another. And then most people start lactating within a couple days after that.

It's the most significant hormonal change that a woman is going to have in her life. So some of that emotional response makes complete sense. Now baby blues, it usually clears itself up on its own, definitely within the first month after having the baby. Postpartum depression is a specific diagnosis that's part of the perinatal mood and anxiety disorders.

So perinatal mood and anxiety disorders includes the depression, anxiety, OCD, all of those things. And those can start in pregnancy. or during postpartum. So, really, I try to use the term postpartum depression a little bit less because it's really not very, all encompassing of everything that can go wrong.

And actually, about 50 percent of people who experience postpartum [00:05:00] depression, they actually first experience depression during pregnancy. And people don't realize that. So we try to use this other term of, it's a mouthful, but perinatal mood and anxiety disorders because it's more comprehensive and it's more representative of what's actually going on.

Although postpartum depression is still the most common one. 

Dee: Yeah, that is the one you always hear about. You know, when you have a child and then you don't have a child inside of you, your body is going haywire. You don't even feel like you're in your own physical body, what are the common risks if somebody weren't to take their postpartum depression seriously. 

Leah: So the biggest thing that we're going to see is that lack of attachment and bonding with the baby is going to be the biggest risk factor which can turn into poor outcomes for that child including a lot of times emotionally and not performing well in school.

So there can be some negative outcomes on the child and then also people who experience a Perinatal mood and Anxiety Disorder, they are at a higher risk of having thoughts of suicide and abusing substances [00:06:00] as well. So those are some of the more concerning risk factors that are for untreated Perinatal Mood and Anxiety Disorders.

 Another risk that we can see is an additional pressure on the health system because if they are not seeking help early on, then they are going to be going to the emergency department.

They are going to be calling their OB, trying to get in at the last minute. They're going to be calling these crisis lines and potentially going inpatient for mental health treatment. So it's this bigger strain on society as a whole. And then they may be returning to work later and just not able to contribute to society as well.

So it's a bigger strain on the community as well. 

Dee: Well, and I know mothers, they want to be the best mothers they can be, and, you know, having a depressed mother or a non functioning mother, I think, is a significant, risk for that child, like you mentioned. does that contribute to ACEs for that child, childhood trauma? 

Leah: There's not a specific ACEs for a mom with mental health, but we do know that perinatal mood and anxiety [00:07:00] disorders correlates with intimate partner violence, which is on the ACEs. So actually in Oklahoma, we have pretty concerning statistics around intimate partner violence if you are in the perinatal period. I read it just recently and I believe we are third in the nation for being highest rate of IPV, during this time period.

So that could definitely contribute. 

Chris: About how widespread are these situations, particularly postpartum depression?

Leah: Postpartum depression is around 1 in 7 or 1 in 8 depending upon the study that you look at. Now, if we are looking at perinatal mood and anxiety disorders altogether, so including the pregnancy and postpartum period, it's about 1 in 5. And furthermore, there's been some newer research coming out around the partners of these moms and about 1 in 10 of these partners will also get a diagnosable mental health condition during this time period.

And Even beyond that, adoptive parents can also get a perinatal mood and anxiety disorder. There's going to be less of a [00:08:00] hormonal response, but some studies have shown that involved fathers do have a hormonal response. They have a hormonal change whenever baby is there. So we know that even if you don't give birth, it's still impacting you, not to mention all the significant role changes that happen once a baby comes into your life. 

Dee: You know, the hormones are such a critical physical part of this. So we're dealing with mental health issues and talk therapy and EBTs around that. is there anything that's being done on the hormonal side or is it addressed in the EBT that you use?

Leah: So on the hormonal side, we do know that it takes 12 to 24 months depending upon which study that you're looking at. for these hormones to level out after giving birth. So as far as therapy goes, there's nothing we can really do in talk therapy that's going to address those hormonal imbalances. However, there are a couple new medications that are out on the market that are supposed to be helping specifically postpartum depression and maybe leveling out some of those a little bit.

We haven't seen major research on it yet because it just came [00:09:00] onto the market within the last year or two and they're still working to get approved by insurance panels right now. It's pretty pricey like a price tag of about 16 grand to get some of these treatments. So it is a work in progress and it is happening, but unfortunately it's something that we have to kind of grin and bear it, and figure out tools that we can use on how can I live through this?

How can I simplify my life? What can I offload? How can I make my life easier whenever I have these million and one new responsibilities on top of this massive role change that I'm undergoing? 

Chris: So why are these situations so common? Why isn't there more discussion around the topic? 

Leah: Well, it's so common just because of the significant hormonal reaction that's happening. And then on top of that, the massive role shift, you go from just caring about yourself and what you're going to do that day and have for dinner to now keeping a tiny human alive and having to watch them 24 seven.

So that's a pretty significant shift there. Additionally, People don't like to talk about it because there is so much shame [00:10:00] around it. And I think a lot of that also has to do with social media. So a lot of times whenever people are giving birth, they are, you know, early 20s and so they tend to be on social media where life is really glamorized and we all know social media for the most part it's just a highlight reel.

So you see these mommy fluencers and they're only showing snippets of their day or they have a significant other income where they can afford to cook or afford to send their laundry to get done by a service provider or they have an overnight nanny. So they were able to get a full eight hours of sleep.

So I think that's a big part of it. Also, another piece of it as well is perinatal mood and anxiety disorders. It's such a wide range of. symptoms, like we talked about, it's depression, it's anxiety, it's OCD, sometimes even psychosis. And so everyone's experience is so unique and it's going to be different from person to person.

So it can be really shameful to talk about. If you hear one person speak up about [00:11:00] their experience, it's like, Oh, mine was kind of like that. But I also had these really horrific intrusive thoughts about, you know, harming my baby or something. And that's horrible. It's horrifying to have, which by the way, 80 to 100 percent of new moms experience intrusive thoughts.

Dee: And it's so interesting.

Leah: Yeah. And the most common intrusive thought is around, harming their own baby, which they're terrified of. And so these intrusive thoughts, it's just your brain having just a little Fritz moment. And usually it comes from a place of protection. So you are thinking, what is the worst possible thing that could happen in this moment?

And for a new parent, it would be them harming their own child. 

Dee: Oh, wow. It doesn't feel intuitive at all. 

Leah: No, it doesn't. But it really makes sense whenever you think of it from that place of protection and being the person who grew that life and loved them so much. And so you're just constantly on high alert and making sure that they're safe.

Chris: So what can we do to improve this situation. What can new moms do to Remedy this situation or at least handle it differently? 

Leah: The [00:12:00] biggest thing that I recommend is having a postpartum plan. So many people have a birth plan which is usually is only good for a couple hours.

It's down to, you know, what position do they want to be in? What playlist do they want to have? Who do they want in the room? Which, that's a beautiful plan to have, but what about those first couple weeks, first couple months postpartum whenever you go home and you don't have a medical professional there where you can ask them questions and they can help you with lactation and all those things.

So a postpartum plan can include quite a few different things. So, you know, who's going to be the child's pediatrician? some new parents don't know that baby needs to go see the pediatrician within the first week. Who do you want to come to the hospital? Who do you want to come home and visit you?

Do you have some frozen meals prepared? Who is going to help you with overnight visits? If you have a partner, how quickly do they have to return to work? And whenever they do return to work, do you have someone else who could maybe come over and help you with overnight visits? That's the biggest thing that I always recommend are those postpartum plans.

So thinking about those first couple of weeks, [00:13:00] first couple of months after baby gets here because baby doesn't know day from night. And so you're going to need all the support that you can get. 

Dee: It's really about developing that support system. And when you make a plan, the anxiety goes down a little bit, right?

Leah: Oh, absolutely. Especially whenever you have it all in, One central location and you've offloaded that information. We talk about the mental load of motherhood as well. You're learning so many new things and you have a million and one new responsibilities. So if you can offload that onto a sheet of paper, it's like, okay, I don't need to worry about that because I have that written down and saved somewhere.

Dee: That's a good plan. You know, and I know families on the exterior of a new mother and child or a family unit, They may see warning signs. But are frightened to go and say, Are you okay? What's wrong? Can I help? I mean, what is a family to do if they see something happening that's concerning? 

Leah: I think the biggest thing that they can do first is making sure that that mom feels supported and supported does not mean coming over and holding the baby while mom goes and [00:14:00] does the dishes and scrubs the toilet.

Okay. That means you really talking to her and saying, Hey. What can I do that is going to take some of this load off of you? And it may be watching the baby so she can go get a couple hours of sleep. But it may also be you doing that load of laundry that's been sitting in the washer and dryer for the last three days because she hasn't had the energy to go do it.

Scrubbing those toilets, doing the dishes, making some meals so she can have a fresh meal. And additionally, just asking the question straight outright. saying how are you feeling? Are you really struggling? What is your sleep like? I know that it's hard to sleep when you've got a newborn that doesn't know day from night, but are you sleeping when the baby is sleeping?

do you have any thoughts that are scaring you? Because I heard that that's really common and asking those questions directly. And it's really important for family and friends to ask those questions because Um, some medical providers will ask those questions, maybe at their six week postpartum visit.

But [00:15:00] who's the mom going to be more likely to open up to? This OB who they've only, you know, met a handful of times and who knows what their relationship was like, if that OB was even the one to deliver the baby, right? Sometimes that doesn't even happen. So the mom will be more likely to be more honest with those friends and family members.

So don't be afraid to ask outright and help in more practical ways. 

Chris: You were talking a little bit about the medical community. What can be done there to , improve things for women going through postpartum? 

Leah: So, in Oklahoma, we actually have a law that requires O.B.s and pediatricians to screen for depression for people who are pregnant and up to about a year postpartum.

But unfortunately, a lot of providers don't even know that law exists. So I think that we need to start there with having those screeners being done. Now, the negative thing about the law is that it doesn't require for any referrals to be made. So, another thing that providers could do as well is get familiar with resources that are in their community for trained mental health providers who are trained in perinatal mental [00:16:00] health.

 Or knowing of support groups or other resources in the community, or if you're lucky enough to have a social worker who works in the office, you know, getting that mom connected to that social worker and making sure that social worker knows those resources. one more thing about the screener as well is it would be great if these providers didn't hand those screeners to these parents just in the lobby while they're waiting.

It would be ideal if the providers could give just a little blurb about what maternal mental health is and normalizing some of the symptoms that they may have because, again, There's such a stigma around it and so much shame, so if these moms become aware that this is actually a medical condition that's happening, they're not crazy, they're not losing it, it's a real thing.

So if they can help dispel that stigma, we are going to get better responses on those screeners and then we're going to be able to get people to the right care. Right. 

Dee: So when somebody comes in for treatment, I know there's a lot of evidence based practices that [00:17:00] you do. , how do they differ from just some normal mental health treatment model?

Leah: So, some of the most common ones that we use are CBT and attachment based work. 

Dee: And what does cBT stand for? 

Leah: CBT is Cognitive Behavioral Therapy. So earlier I mentioned that these moms will have intrusive thoughts or believing that they're not good enough and they shouldn't have done that. So in Cognitive Behavioral Therapy, it's all about those cognitions, your thought processes.

So can we challenge those thoughts? Do we have any proof that you're, you're actually, you're actually doing it? Doing a really great job as a mom and these thoughts that you're having, they're just that. They're a thought and they're not true. So doing some work around those thoughts as well as working on attachment.

So if we can work on building that bond between mom and baby and them having a better connection to each other, you're usually going to get some better outcomes in terms of their depression or anxiety if they can feel that increased connection with their child. 

Dee: Well, I think that's so important [00:18:00] and, Is that just meeting with a therapist like once a week?

I mean, what is the time commitment of that? 

Leah: So it's really going to depend on a case by case basis, because as we've talked about, there is a wide range of severity. So sometimes people come because they are, you know, I'm having just a couple symptoms here, and I think I'm losing it. And some people wait until the very end. Until it's a crisis. So we've had some people who will be done with treatment in three or four months, but we've also had some people who need to stay on longer term because maybe they had a significant trauma history and suddenly some of these trauma symptoms are rearing their head now that they have a child in the home.

 So for those individuals, treatment may take you know, closer to a year or two. 

Dee: Okay. Is it in office or telehealth? 

Leah: So in office tends to be better. However, what we've noticed is that a lot of people prefer telehealth because you have a new baby and childcare is really expensive. So we do offer telehealth and that is a really popular choice with our clients.

So [00:19:00] then they don't have to arrange for childcare or transportation. 

Dee: Well, I think it's great that people can have lots of options for treatment and the way that they receive treatment, but who's more at risk for having these symptoms and having it escalate to this problem in the first place? 

Leah: So there's several risk factors out there and some of them are going to be common ones that you may expect, like if you've had a history of mental health concerns, or if you have family members with a history of, mental health diagnoses, that's going to put you at risk. Additionally, if you had an unplanned pregnancy, which by the way, the national average in Oklahoma's average is right around 50%. If you were a teenager, if you are having marital stress, If you are having financial difficulties, those are some of the main risk factors that we look out for in addition to trauma history. What we've seen a lot of is people who have experienced childhood trauma, like very early in their childhood.

And now whenever they have a baby, it's like, Oh, they see [00:20:00] themselves in this baby and suddenly all these trauma symptoms are ramping up.

Dee: Oh, that's so interesting. 

Leah: Especially if it's the same gender, like we've worked with clients. It's like, okay, I can, you know, get along with my son fine, but I'm having such a difficult time bonding with my daughter because she looks and acts and sounds just like me.

And that starts really, really early. That may not start quite as much whenever they're an infant. infant, whenever you don't really know exactly what they're going to look like. 

Dee: But it's such a sign to look out for as they become young children. 

Leah: Exactly. Exactly. So I know we were talking about EBTs earlier.

And so that's something that Um, we have to treat a lot of as well and we use EMDR and written exposure therapy. 

Dee: Okay. Tell everybody what EMDR, because personally I learned about EMDR about six years ago and I find it so interesting and I know that the outcomes are really good. 

Leah: Yeah, it's amazing.

So I am personally not trained in it, but I do have a couple of therapists on my team who are trained in it. Eye movement, desensitization and [00:21:00] reprocessing.

Dee: Thank you.

Leah: So, that has been shown to be really helpful with a wide variety of populations, perinatal population included. 

Dee: And that's basically for like watching the way the eyes move during a conversation, correct?

Leah: It's So

Dee: I'm sure it's more complex than that.

Leah: It's whenever you are talking about your trauma, you engage another part of your brain. body, which stimulates a different part of your brain while you're talking about the trauma. So oftentimes that is moving your eyes from side to side, but it can also be done with other senses, like tapping on opposite arms, or sometimes you can hold these nunchuck looking things and they'll vibrate because it's, stimulating the physical body and keeping you in the present moment and stimulating different parts of your brain while you're processing that trauma so you are not completely going back there in the trauma, you are also able to stay in the present. So you're reprocessing it in a healthy, safe way, in a safe environment. 

Dee: So fascinating.

Chris: Yeah. 

Leah: Another risk factor is being a woman of color. And [00:22:00] additionally, the maternal mortality rate for women of color, it's significantly higher compared to non Hispanic white women. So there are a lot of issues in the medical community, with, people of color in general and it's no different in the perinatal population, especially whenever it comes to childbirth and being listened to in that labor and delivery room.

So trauma can happen in the labor and delivery room and we treat people a lot who have a traumatic childbirth and so unfortunately women of color experience that trauma at a higher rate. So that's something that we look out for as well. 

Chris: So what, in light of these things, give you hope, Leah? 

Leah: When working with this population, this is the only population that I've worked with so far where there is a significant amount of progress that these individuals are making.

Whenever you are going through the process of matrescence, the process of becoming a mother, There tends to be a higher level of motivation to change because you are becoming [00:23:00] someone new and you are now ready to make these significant changes. So maybe you were never willing to make those changes for yourself because okay I had some trauma, but it's only impacting me.

It's not really impacting anybody else too terribly much But now I have a child who I have to raise and who I am trying to, you know, turn into a wonderful human. So I need to make sure that I'm taking the best care of myself and treating myself so that my child doesn't suffer because of any of the symptoms that I'm experiencing.

We've had quite a few people who come in during their pregnancy and they're like, Hey, I have this trauma and I want to deal with it before this baby gets here. Or I. I hate who the person that I am right now because I am just like my mother and I swore to myself I would never be like my mother and I need to make these changes now before my kid remembers how much I'm yelling at them or how inattentive I am to them.

So it's been the most rewarding population by far to work with because overall this population is motivated to change because they have such a significant [00:24:00] pivot happening in their life with their roles. 

Dee: Well, and I hope this conversation will help anybody out there that, you know, thought that this might be normal but realized that they maybe need to get a little bit of extra help.

Leah: Absolutely, and you can always come in as a preventative measure, too. You don't have to wait until there's a crisis. Come in for a checkup, see how things are. We've had people come in for that as well. If you've got a history, come in for a checkup and see how things are going so you can prevent it from happening again.

Dee: Thank you so much. This has been a great conversation today.

Leah: Thanks for having me.

Chris: Thanks for tuning in. If you found value in what you heard today, there are a few ways you can support and stay connected to us. First, be sure to hit that subscribe button wherever you're listening to us.

Subscribing ensures you never miss an episode and it's absolutely free. It also helps us continue bringing you quality content. Consider leaving us a review. Your reviews not only make our day, but they also help others [00:25:00] discover the podcast and join our community. Share this episode with friends, family, and anyone who might find it interesting.

Word of Mouth is a powerful way to grow our podcast family, and we truly appreciate your support. We're always eager to hear your thoughts, ideas, and suggestions for future episodes. Visit okstateofmind. com for all of our episodes. You can also email us at communications@fcsok.org with any episode ideas or questions.

We'd love to connect with you. Thank you once again for accompanying us on the journey. Until next time.