Oct 27, 2022

Dr. Jones: You just had a baby and you're feeling a little or a lot overwhelmed. Surely this is common, but is this postpartum depression?

Being overwhelmed with a new baby is common, whether this is baby number one or baby number three, but when does this feeling of being overwhelmed suggest that the problem is more serious for the new mom and the baby?

Today, we're going to talk about postpartum depression. And in the virtual Scope Studio is Jamie Hales. And Jamie is the board co-chair for Postpartum Support International, our Utah Chapter, and she's a clinical manager of the Huntsman Mental Health Institute. Thank you very much for joining us, Jamie.

First of all, let's just dive right in. Well, what is postpartum depression? Why is it something different than just, "Oh my god, I'm sleepless and I'm overwhelmed"?

Jamie: Well, you've hit it right on the head. I mean, those are completely normal things that can happen with pregnancy, right? You're sleepy, you're feeling like you're not quite yourself, but I think that there is a difference for sure between really struggling with postpartum depression versus having what we would typically kind of term as the baby blues.

When we're thinking about postpartum depression, it's really more stuff that doesn't just come and go, right? After a couple of weeks having your baby, if you are still just really not feeling like yourself, and not sleeping when your baby is able to sleep, and possibly more irritable or more depressed, having thoughts of hurting yourself, anything along those lines, it's probably more likely to be heading into the territory of perinatal depression or anxiety versus just kind of a normal adjustment to having a baby.

Dr. Jones: Right. So I think all of us, particularly as new moms, feel like we are imposters, meaning we feel like someone gave me this baby and I don't know what to do. For new moms, we're all amateurs, but it's that feeling overwhelmed with this and being inadequate. "I can't do this. I need to check out. Someone needs to help me." But often women don't reach out for help. How common is this?

Jamie: It is absolutely the most common complication of pregnancy, which is why we need to talk about it more often.

I mean, if you really think about it, as an OB-GYN, you screen women for gestational diabetes. You screen them for gestational hypertension, any of these things that could happen. But it's been relatively new in practice to make sure that we're actually screening for postpartum depression and anxiety.

It impacts 1 in 10 men, which a lot of people don't think about, but it also impacts probably closer to 1 in 4 women, even though the official statistic is 1 in 7.

Dr. Jones: Right.

Jamie: And that's just because it's under-reported, is really what it comes down to.

Dr. Jones: I think the old-fashioned and probably still prevalent practice is you see women, deliver them, you see them for a day for postpartum, and this is the doctor, and then you have them come back for their six-week visits. But by that time, they've sunk or swum.

So, in Europe and in England, there's a midwife who goes and does a mom check. And unless we check at two weeks or three weeks and say, "How are you doing? Do you need help?" by the time six weeks comes along . . .

And a lot of women don't even come to their postpartum visit. We don't pick up as much as we should. So we are counting on the woman or her family, and that's why we're doing this podcast, this topic. When women or their family members see this happen, they need to reach out. So what should they do?

Jamie: I think that absolutely is key. As providers, if we see people, we absolutely want to make sure that we are asking every one of our new moms, "How are you doing?" Not, "How's the baby? How are you healing physically?" We have to really talk about, "How are you doing emotionally?"

And you're right, we may not get women in for those two-week or six-week appointments because sometimes insurance has changed or they're just feeling so underwater already that making it in for one more thing is really, really difficult.

My advice always to family members and to women in general is to speak up. If you really truly feel like your motherhood experience is just not going the way that you would thought that it would, getting around that stigma and actually saying, "I'm struggling. I don't know that this is normal," is a really helpful thing to do.

I think that there are a lot of people out there who have resources, and have the ability to jump in, and try to help you feel better, and to start getting back more to what your baseline was before you had a kid. So I think that that's a big piece.

And then for family members, please, please, please ask and make sure that you are paying attention to the emotional needs of those new parents, because it is harder for people to speak up and say, "I'm having a hard time."

Dr. Jones: Yeah, and it's not necessarily . . . You could have flown through the first one, but maybe you're not flying through the second, or maybe you had postpartum depression the first time and you didn't have it the second. Although women who've struggled with mental health issues before are a little more likely to have postpartum depression. Do I have that right?

Jamie: Yes, that's accurate. You're absolutely right. You could cruise through four pregnancies and not have any real postpartum symptoms. And then with that last one, you do. Or you could have really, really rough postpartum depression the first time and then not have it with your subsequent ones.

So it's important to make sure we're checking in with people during all of these different points in their motherhood journey to see how they're feeling. Dr. Jones: So if a woman has come right out, what do you do? As a reproductive endocrinologist, I think this is potentially the biopsychosocial model, meaning the psychological makeup of the individual matters, the social environment may matter, but there's the biology of having a hormone crash, and some women are vulnerable to that.

So when you think of these three parts that make up any kind of illness we might have, how do we approach this in terms of treatment?

Jamie: I'm really glad that you brought that up, Kirtly. I couldn't agree more. I mean, you do have this major hormone change that happens once you give birth, just the lack of sleep and all of the social factors that can change.

I think for a lot of people, becoming a mother is great, and maybe it was something that they were really excited about. It also could be the opposite. And it can be really tricky, I think, for people to recognize that all of those experiences are valid. So we want to de-stigmatize this as much as humanly possible.

Then you add the other kind of psychosocial factors into it. I mean, if you're in a difficult home situation or you don't have financial resources the way somebody else might, these are all things that could put a woman more at risk for experiencing complications. So it's good to assess really, I think, the full person.

Dr. Jones: It's a thing about humans. We're the only mammal species, we're the only primate species that shares our baby. We are willing, as a social group, to let others keep an eye on our baby. So you can say, "I really need to go for a walk. I need some help. I would love to just have 10 minutes to myself."

But there are people who need an evaluation. And at least for those of us who are OBs, we always think they need to check their thyroid because low thyroid can be a player in this and it's not uncommon. But some women need medication. I would think that even group therapy would be ideal for this, to hear other women struggling. Is that something that's at all available?

Jamie: Oh, absolutely. There are a number of group therapy options out there for people. And I think what makes that so effective as an option is really that peer support. Being able to hear the stories of other women and just recognize that you're not alone in what you're experiencing really goes a long way toward helping them understand that it's not a normal complication, but it's definitely a common complication to experience these things. It goes a long way toward getting that stigma to not feel as acute.

Dr. Jones: So how long does it last? I mean, does it have its own natural course?

Jamie: So I think because of some of the biological factors, there is a course that comes along with it. I mean, we see a lot of people start to feel better again as they get toward the end of that first year, just because there are so many things that come up during that year, so many really positive milestones and also just lots of challenges that kind of come along with the experience of being a new parent.

When we really think about, "Is this postpartum versus something else? Is it pre-existing depression? Are there other complicating factors?" I always think about what was your emotional state and your experience like before you had this baby?

And really, if something changed with your pregnancy or in your postpartum experience and you're having struggles down the road, but you can still kind of pinpoint, "Yeah, that's when things really got to be a struggle," I think it's okay to still refer to that as being a perinatal mood and anxiety disorder.

I have worked with people who are several years out from their birth experiences and they're still sometimes coming in to talk about birth trauma or navigating being a parent, and they're years out.

Dr. Jones: I think all births are pretty traumatic.

Jamie: Yeah, that's fair.

Dr. Jones: This is just me. It's like, "Oh my God, how did that baby ever get out there?" But I think that there are women who come in with this hope for experience, and what happened wasn't really what they planned and they can't let go. They're healthy baby, healthy mom, but they have problems. And so that is a special subset of problems around birth.

Jamie: And I'm really glad that you bring that up, especially that last piece, because what we as providers may think of as, "Oh, that was a traumatic birth," there are some that you can look at and be like, "Yep, on paper, absolutely that was a terrible experience."

And then there are a lot of other people that maybe they don't have that exact presentation of what it could have looked like, but we're not there inside them experiencing it, or even for partners watching it. And it's always important to ask people about what their experience was like rather than assuming just because Mom is healthy and baby is healthy that everything is okay.

Dr. Jones: Exactly. I think it's getting back to asking the mom how she is. But when is this problem an emergency? A woman isn't feeling well, when does either the patient or . . . And sometimes a patient can't recognize it, but a family member say, "She needs help right now, today, this minute."

Jamie: Like with any other condition, mental health conditions can definitely come in varying degrees. I think there's always an argument to be made for if somebody is not doing well, jump on it and get them in and give them a safe place to be able to tell their story and potentially be able to get on medication. Sometimes that can take some time.

What I would say, all the way on the other end of the spectrum, is if you are working with somebody or you have a family member or your partner or somebody else who it seems like they've really lost touch with reality, and there could be some postpartum psychosis onboard, that is something that we absolutely consider to be emergent.

So there is a difference between having really kind of scary, intrusive thoughts. That can be something that can come along with just having postpartum anxiety or postpartum OCD. But if somebody is having all kinds of strange, outlandish thoughts about themselves or the baby, and it doesn't bother them, or it seems like it's something that really truly isn't connected to reality, I would make sure that you check in and get them some help pretty quickly. Same thing with suicide as well, suicidal thoughts.

Dr. Jones: Yeah. So if a woman is thinking of either harming herself for her baby . . . I mean, we do have mental health professionals in our emergency rooms . . .

Jamie: Yep, absolutely.

Dr. Jones: . . . who are aware and know what to do. So if that's what it takes, you just need to pack everybody up and come right in and get help right away.

Jamie: One of the things that I hear . . . and I'm sure you do as well. I've heard from plenty of parents, "I didn't want to say anything, because I don't want people to think I'm crazy," or, "I don't want them to put me in the hospital or pack my baby away to somebody else." The reality is that is not something that happens very often at all.

Dr. Jones: No. It's very uncommon.

Jamie: Yeah, it's a big fear people have, and I think it's a big barrier to having somebody come in sometimes to actually talk about these things. But that's so unlikely that something like that would ever happen. I mean, everyone's thought is trying to make sure that both you and your baby are being served and taken care of, and nobody likes separating you guys out.

Dr. Jones: Yeah. Well, as we wrap up, I think it's important to know that this is common. I know people want to be the ideal mother, but ideal mothers get depressed. And it's very important for your own mental health and for your baby's mental health, because your newborn is keyed into who you are.

So if you or a family member is depressed and struggling, that baby is struggling too. So all of us need to chip in. It takes a village to get a mom and a baby through their first year. And the more that we are attuned, the more we ask, the more likely we're going to have a healthy baby and a healthy mom make their way to Year 2. What fun.

Jamie: Yep, that is very true.

Dr. Jones: So, Jamie, thank you so much for joining us. And for all of you who are listening, thanks for joining us on The Scope.

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