Episode Transcript
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Speaker 1 (00:11):
Welcome to psychobabbl Dashmi.
Speaker 2 (00:13):
I'm your host, Danielle Minch along with mehor Mar Weeks.
Speaker 1 (00:17):
Hi everybody, before we start episode eleven, our last episode
of this season right there.
Speaker 2 (00:22):
Yeah, for the summer.
Speaker 1 (00:23):
We want to put out a disclaimer that this episode
may be triggering for some people and is in no
way meant to replace mental health treatment or therapy. So
today we have a special guest on. So we have
Rhonda who is a Matt has a master's in social work,
is a licensed independent clinical social worker and also a
(00:44):
perinatal mental health counselor. So, Ronda, that was a mouthful.
Can you explain to us what a peri natal mental
health counselor does exactly?
Speaker 3 (00:53):
So I'm certified through Postpartum Support International to be able
to provide the counseling services to perinatal women, which includes
pregnant and postpartum periods, and they specify depression, anxiety, OCD,
and psychosis.
Speaker 1 (01:12):
Okay, so I guess you just covered my second question.
What issues can occur during pregnancy that would require counseling.
So everything you just said.
Speaker 3 (01:23):
Yes, one in five women and one in ten men
actually suffer from postpartum well pregnant or postpartum depression and anxiety.
There aren't quite rates for the OCD or psychosis. The
psychosis is more rare and it is actually I do
(01:45):
have rates, I'm sorry. One in two out of one
thousand women have the potential for postpartum psychosis.
Speaker 1 (01:53):
So let me ask you this. Do they develop this
during the ignancy or because of the pregnancy, or these
already pre existing conditions or is it both?
Speaker 3 (02:04):
In some circumstances, they do have a diagnosis of schizophrenia
or bipolar prior, but it can result from the pregnancy.
And it's also that fifty percent of bipolar women have
been diagnosed after pregnancy.
Speaker 1 (02:20):
Wow, remember we did that one in season one? We
had the guests on had she had OCD and she
said it became so unbearable during her pregnancy and after
it became so much worse. She had some psychosis too.
Speaker 2 (02:34):
She was real paranoid.
Speaker 1 (02:36):
Yeah, postpart she was like delusional.
Speaker 3 (02:38):
Yeah. And so the depression and anxiety are concerns of course,
as are the OCD, but the psychosis is a medical emergency.
So if there is a psychosis present, then that puts
more of a danger for the parent and the child,
the infant, so most likely hospitalization will be required. And
(03:03):
that psychosis, of course involves hallucinations, delusions, severe detachment, loss
of emotion to where they believe their delusions, they believe
that their thoughts are okay and normal, and that poses
a huge risk, just like with anyone, right, yes, but
when you're talking an infant with.
Speaker 1 (03:23):
Who's depending on these thoughts about.
Speaker 3 (03:26):
And too.
Speaker 2 (03:29):
To look back and read stories and stuff like that,
the infant and the other children also, right, pose a
huge danger.
Speaker 3 (03:37):
Yes, And so that's where partners can play a huge
role in knowing what's going on with the birth mother,
knowing if they're acting different, knowing if they're saying things
that they've kind of never said before, and of course
detaching from the infant, not feeding the infant, not changing
(03:58):
the infant, leaving the infant alone for hours when of
course after birth and psychosis most often occurs two weeks
within two weeks after birth, so those are pretty detrimental
times for the infant to have constant care.
Speaker 1 (04:13):
So someone was if someone out there was seeing these
signs in their significant other or their you know, daughter
or whatever, you would tell them what go to the
emergency immediately.
Speaker 3 (04:26):
Yeah, go to the nearest emergency room to keep them safe.
Speaker 1 (04:31):
So, I know you talked about traumatic births, So what
exactly would constitute what you would classify as a traumatic birth.
Speaker 3 (04:40):
So sometimes in situations, people try to get their birth
plan in place with their physician and they want it
to be natural, or they want it to be you know,
they get an epidural at the least last possible minute.
Sometimes that does occur because there can be emergencies. So
(05:03):
you know, pretty clamsia is not necessarily an emergent situation,
but can result in an emergency sea section.
Speaker 1 (05:09):
What is that for people?
Speaker 3 (05:10):
It would be high blood pressure and so that would
put the mother in the infant at risk, So emergency
sea sections if the infant is not dropping. We'll say
some mothers never wanted to have a sea section, so
they can see that as traumatic. But there's also tearing
(05:32):
which can cause hemorrhaging. There are situations where the infant
has already tried to draw through the birth canal and
they may have a broken shoulder from being pulled through.
If they have to use four sets, that can be traumatic.
There are also situations where again hemorrhaging can occur. And
the mother has severe health problems as a result of
(05:55):
the birth, So she could lose a lot of blood,
she could go unconscious, she could be rush into emergency surgery.
We've had situations that where the placenta was not fully
removed and then the mother became septic had to be
readmitted to the hospital, taking her away from her infant,
because most times the infant isn't able to stay in
(06:17):
that situation.
Speaker 1 (06:19):
There can also be I guess sometimes they make women
carry the fetus full term, even though the fetus is
not viable anymore.
Speaker 3 (06:28):
Also, right, well, that is a little bit of a Yes,
that's a huge trauma. And after twenty weeks, the mother
will have to birth the infant. And so if the
infant is deceased, the mother has to birth the infant.
It's not where they can there's they're past the point
(06:49):
of the DNC. And so I've worked with many mothers
where that is extremely traumatic.
Speaker 1 (06:55):
So do these do these I know it's this is
like kind of a catch up that do these traumatic
birds result in like a post traumatic stress disorder?
Speaker 3 (07:06):
Yes, yes, so PTSD is a concern, and that would
be of course with any of these labor and delivery
stories that don't go as plants, and it can a
little off the subject that you just asked, But it
can happen with the father too, because there have been
(07:27):
circumstances where the father isn't prepared for an emergency c
section or he's not prepared to see the amount of
blood loss and it could be all over the room
to the point where it's on the floor around him,
and so that can be traumatic for the fathers as well.
But yes, I'm sorry, I'm all over the place. But
(07:50):
PTSD is a concern with you know, the traumatic bursts,
but also traumatic loss.
Speaker 2 (07:55):
So what symptoms are you seeing in patients that come
to you with these traumatic losses.
Speaker 3 (08:02):
Well, a big one is detachment and sometimes an inability
to bond with their infant. And I know that that
can happen sometimes when an infant is taken to the
NIKU and they didn't get to see their infant. And
that's also another traumatic aspect of birth. If the infant
(08:23):
is removed immediately, whether you know they've got stolen their
lungs or they're having withdraw symptoms, or it could just
be their vitals are weak not strong. They are removed
from the mother and she didn't get that skin to
skin that could be traumatic. So detachment, inability to discuss
(08:46):
the birth, hyper awareness, irritability, sensitivity, anxiety.
Speaker 1 (08:54):
Nightmares, flashbacks, Yes.
Speaker 3 (08:55):
The nightmares, flashbacks.
Speaker 1 (08:57):
Not to make this about me, but like everything you've
just said happened to me when I had my twins,
because my son was taken from me and taken to
the NICU in another town and I didn't see him
for four weeks and I didn't even like I knew
I was having depression and I went on medicine, but
I think that I might have had, yeah, a little
(09:20):
bit of what you're just talking about, because it was
a really hard time for us. And yeah, until I
saw him again, I'm gonna cry. It was really bad because, yeah,
it took me because I couldn't travel up there because
I had an infant and I had to have a
c section in a vaginal delivery, and my other daughter
was in his sister was in the incubator and they
(09:42):
let me nest in the hospital and then I was
pumping and my husband was taking my milk up to
Pittsburgh to feed the baby, and I didn't get to
see him again for four weeks. Until they brought him back.
Speaker 3 (09:54):
Yeah, so yeah, that was Yeah, that sounds like it
was a true Yeah.
Speaker 1 (09:58):
Well fuck eh, I wish I would that.
Speaker 2 (10:00):
I know, well, you kind of talked about it one
of the yah things about how.
Speaker 1 (10:06):
Yeah, okay, well let's not make this anymore about me.
But yeah, that just kind of put a little dagger mother.
Speaker 2 (10:11):
No, I think that you're talking about it, you know,
Yea gives it a great example.
Speaker 3 (10:17):
Yeah, and Danielle helped me out there. Nightmares and flashbacks,
and that can include avoiding discussing the birth at all,
or talking about birth or more children, or you know,
wanting to go for follow up even in aftercare. Yeah.
Speaker 1 (10:33):
I have a friend who had She said she had
one child and she said her that it was so
traumatic she was in labor for over a day and
she would never get pregnant again, and she she hasn't.
So what about miscarriages? What is the like do people
come to you when they have miscarriages and talk about
that the loss of the yes, pregnancy.
Speaker 3 (10:55):
Miscarriages and of course the infant loss would they had
to deliver the still born? Right, So miscarriages. I do
see a lot of people who struggle with infertility and miscarriages,
and of course they're grieving the loss of that hope
(11:16):
of pregnancy and having a baby, but also they're having
difficulty with self blame and that also happens with infant
loss and trying to come to terms with their bodies
working against them, their bodies not cooperating, and then they
feel like something's wrong with them, and they have a
lot of and grief over.
Speaker 2 (11:37):
The Yeah, and it probably makes it a lot harder
whenever they have an infant loss or a miscarriage, and
then they get pregnant again, and then it happens like
it's almost like the trauma happens all over again, right,
And I'm sure that they have so much anxiety right
when you get there.
Speaker 3 (11:57):
Yes, And so I see several women who have gone
through miscarriages and two who have gone through having to
deliver a stowborn and have a funeral and bury you know,
their baby, and that grief of you know PSI, the
postpartums when international concept kind of terms it as becoming
(12:19):
a psychological parent, Like when you're pregnant, you're preparing to
be a parent. Many women are, many dads are, they're
preparing to bring the baby home. They're they're getting their
home ready, they're buying things, they're planning reveal parties and
showers and all these things occur, and then their baby
passes away. They go and deliver, and then they don't
(12:40):
bring a baby home, so they have that feeling of
being a parent, but then they're not any longer. So
that's a bit of a different aspect from the miscarriage.
But the miscarriage is also you know, they're preparing and
then the miscarriage is you know, something that can often
happen multiple times in a row, Danielle had said. And
(13:03):
then when they do get pregnant again, they do have
that high level of anxiety after okay, this week, we're
going to be in the clear, or every time they
go to an altarsound, which is typically when they found
that the baby's heart was no longer beating, they have
that almost panic because they don't know what the ultrasound
tech is going to tell them.
Speaker 1 (13:22):
Do you see a lot of women who have a
failure to conceive, like who are going through IVF for something.
Speaker 3 (13:27):
Is not as common as the pregnant impostpartum or the
infant loss. Because I get a lot of referrals from
the local hospitals and their obg ns, and so I do,
but it's not as many.
Speaker 1 (13:45):
And what issues do you see in the men? Like
the same thing, the depression.
Speaker 3 (13:49):
The yes, depression and anxiety one in ten men. So
not so much OCD or psychosis of course, because they
don't have that biological change, but they have the psychological
and social change. So you know, pregnancy and birth is
a bi psychosocial event, like everything changes about you. But
the women it's biological because your body's changing, your hormones
(14:09):
are changing. Men psychologically and socially, you're now a parent.
You don't just worry about yourself to go out of
the house. You don't have the social freedom like you
used to. So they can suffer from depression and anxiety
for that, just due to their life changing so much
and having another responsibility.
Speaker 1 (14:28):
Yeah, I think a lot of people don't think of
the men. Yeah, it's you know, basically the quote the
woman who does everything end quote by.
Speaker 2 (14:37):
Now, whenever you talked about guilt, how do you help
a mother that has guilt and feels like it's their fault.
Speaker 3 (14:45):
I prefer cognitive behavioral therapy or interpersonal therapy. Those are
both of my approaches and helping them to process that.
We go through aspects of what they went through. We
try to process all of those feelings and help them
to reframe their thought patterns so that they aren't blaming themselves.
(15:10):
Because when the doctor can help the mother this is
what happened in Uterow, that helps them more. But when
there's no reason for it, that's a little bit harder
of a task.
Speaker 1 (15:25):
Can you kind of explain just briefly what those two
different types of therapy you mentioned are so people are well.
Speaker 3 (15:32):
Conitive behavioral therapy is the impact that your thoughts have
on your behavior. It is looking through your thought patterns
and try and reframe them so that they're more healthy,
more productive, so that your behaviors and functioning is more
healthy and productive. And it can look at past and present,
whereas interpersonal focus is more on present, like your current
(15:54):
interpersonal relationships and what's going on right now in your life.
I use am I to motivational interviewing, which is trying
to help them to be motivated to make change and
to identify their goals on their own and put them
into action. I also do ERP, which is exposure response
(16:16):
and that is mainly for OCD and high levels of anxiety,
and what that involves is exposing them. So with OCD,
they have obsessions and those are typically fears and intrusive,
sometimes negative thoughts, and they do compulsions in order to
less than the amount of distress. So ERP exposes them
(16:39):
to those obsessions without the compulsions, and so it is
distressing and many people don't like it, but it shows
them that they can handle that level of distress and
that the compulsions are not needed anymore.
Speaker 1 (16:54):
Can you off the top of your head, I'm putting
on the spot. Given an example of like a mother
who has developed OCD, what what like, explain how you
would do that? Like I would say.
Speaker 3 (17:05):
So, So for mothers, we'll just do a contamination. You know,
many mothers are like, you know, don't touch my baby,
wash your hands, which is all very common, don't kiss
my baby. RSD is a huge thing, which is very common.
But then there are extreme circumstances where they're constantly sanitizing
(17:28):
their hands. They may be using like chlorox wipes on
their skin, washing their hands multiple times a day, where
their hands are dry and cracked. And this is just
a minor example, but that they feel like, Okay, maybe
I have to wash my hands five times in a
row and then I have to wipe them with hand sanitizer.
(17:50):
And if I do that, then my baby won't get sick.
Speaker 1 (17:54):
So what do you I'm in your office and that's me.
What do you do to expose me to that?
Speaker 3 (17:58):
Okay, so I'd probably hand you one of the toys
I have in my room because I also see children
a dirty toy. A dirty toy. Yeah, so one then
a child has played with that's probably been in their
mouth or you know, they've sneezed on or something. And
have you hold that toy for fifteen minutes before you
could wash your hands? And of course the infant isn't
(18:19):
in there. I'm not gonna expose your infant to a
necessary journey.
Speaker 1 (18:21):
But I can just like just thinking about that. If
I was in that position, I can imagine I'd be
completely freaking out right.
Speaker 3 (18:27):
It's yes, and there are other so OCD can come
in different thoughts, like where if I walk down the
steps of my baby, I'm gonna drop my baby. And
you know that's not gonna happen every time you walk
down the steps with your baby and so it would
be like having them go up and down steps, which
I know seems very odd, but it would just show them,
(18:48):
like the distress does not have to be present.
Speaker 1 (18:51):
So back to the first example that I think people
can relate to. So you make me hold the toy
for fifteen minutes, and then after that, am I allowed
to go wash my hands?
Speaker 3 (19:00):
Ones? Yes?
Speaker 1 (19:01):
And then we and then you say you can wash
them memory you can wash your hands once?
Speaker 3 (19:06):
Yes, okay. So there's sub scale, which is the subjective
units of distressed scale that ERP uses and in zero two,
one hundred and so the client would be given this
scale and they would have that to look at, and
it just gives them different areas, and so they would
tell me where they're at on the subscale. If this
starts out in five minutes and they're hyperventilating in their
(19:26):
own A ninety, I'm gonna let them go wash their hands.
We're gonna work up to this, right, But yes, I
would say you can use hand sanitizer right now, because
ideally hand sanitizer should kill the germs that are on
that toy right right, and then see how long that
you could handle just the hand sanitizer and.
Speaker 1 (19:46):
I know this is a hard question to answer because
everyone's different, but on average, using this type of exposure therapy,
how long does it take to get a person so
they can do that and not you know, have a
two or a one or a on that scale.
Speaker 3 (20:01):
Okay, Well, the program itself is meant to last seventeen weeks,
and it's meant to build up to the exposure, and
so it depends on the person. Sometimes they're ready to
do it on like the third visit, and then sometimes
people don't want to do it at all.
Speaker 1 (20:18):
Yeah, So seventeen weeks is four months, and you see
them like once a week.
Speaker 3 (20:22):
It's it's really supposed to be twice a week, but
with work schedules sometimes it ends up being once interesting. Yeah,
And so with the ERP again, there's different levels of OCD.
There's contamination, there's you know, the religious component, there's some
people have intrusive sexual images or thoughts. There's a lot
(20:47):
of different variations. So I mean, that's just like the
simplest example that I can pick of that that's.
Speaker 1 (20:53):
The one that most yeah, I think is most common.
Probably is that contamination.
Speaker 2 (20:56):
One, yes, right, yeah, because that girl had it.
Speaker 1 (20:59):
The one we talked about.
Speaker 2 (21:01):
We interviewed one of the mothers.
Speaker 3 (21:03):
Sorry, the challenge at home would be to only wash
your hands once and to see if you could wait
fifteen minutes and then if your sub scale would go
up to seventy to eighty, then you could get wash
your hands again.
Speaker 1 (21:16):
So they do it at home. They keep the like
they keep challenge.
Speaker 3 (21:20):
Them to continue to handle the distress as long as
they're able to right right.
Speaker 4 (21:27):
Any resources you could give us that they can you
know they're getting therapy, anything on the outside, resources that
they could use.
Speaker 3 (21:38):
Postpartum Support International has a website. They have lots of information,
they have statistics. They have a directory that will set
you up with providers in your area wherever that may be.
And if there are support groups in your area, they
have those listed as well. And in Wheeling, Virginia, on
(22:01):
June twenty first, PSI and Park Valley Behavioral Healthcare are
hosting the Climb, which is a local event to raise
awareness for periinatal mental health disorders. And they'll be like
events and activities and information there to help people. The
goal of PSI is to bring awareness of periinatal mental
(22:22):
health and where would that be in heritage Port.
Speaker 1 (22:25):
Okay, So if you're around, yeah, go there.
Speaker 3 (22:28):
Yes, and if you guys wanted to, you could also
set up a table and get on information today.
Speaker 2 (22:34):
Yeah, yeah, for sure. I mean this is some great information.
Now do you see these patients. Are they usually on
a medication?
Speaker 1 (22:46):
Yes?
Speaker 3 (22:46):
So I work in conjunction at my office with a
PA physician assistant, Brittany Cummings, And she is also PSI
certified in a psychiatric UH Services for paranial Women, and
so she is educated in what medications are best to
(23:08):
use and which ones are not. So the concern is
in the past obs have just stopped medications and that
could be really unhealthy for people who are pregnant and
already have the diagnosis and have been maintained on their medicine,
and that can increase symptoms. And so sometimes there are risks,
but you have to consider the risk versus the benefit.
(23:32):
And if the mother has a history of psychosis or
manic episodes or suicidality, is the risk worth taking her
off of.
Speaker 1 (23:41):
The pay In my practice, I always.
Speaker 2 (23:44):
Call and talk to the obt yn But I did
have this specialist.
Speaker 5 (23:48):
This lady was on Latuda and she had a lot
of anger issues and stuff, and he kind of didn't
wander on it, and she's like, I flat, I told
him I have to be on it because I have
of other kids.
Speaker 3 (24:00):
At home that you know what I.
Speaker 2 (24:02):
Mean that I yeah, is litta, Yeah, but this specialist
for some reason. But I do generally call and talk
to the ob and, you know, just so that they know,
because sometimes they don't know all the symptoms that the
mothers haven't yea.
Speaker 3 (24:20):
With the disorders, they don't because that's not their specialty,
you know. And so I agree, I think it's a
good idea to call them in touch.
Speaker 2 (24:28):
Base and the patient to be an advocate for themselves too,
Like this girl did absolutely.
Speaker 1 (24:35):
Anything else you want to cover that we did not
touch on.
Speaker 3 (24:38):
Just for the grief aspect of it, Men and women
tend to grieve differently, and children grieve differently, so I
think it's important just to keep that in mind. And
if you have young children in the home and they're
grieving a infant loss as well, because if they're expecting
a brother or sister to come and they no longer are,
that can be difficult. But there's lots of books there
(25:01):
that you can read to little kids. You know, I
have one something very sad happened and it is pretty
simple but explains illness and you know, people not being
around anymore, and so you know, that's something to think
about too. A lot of people want to hold their
grief in and think that they can't talk about it
(25:21):
or that they're the only ones going through it, when
just because people grieve differently doesn't mean it shouldn't be
brought up or disgust or out in the open. Yea.
Speaker 1 (25:29):
And it affects the whole family.
Speaker 3 (25:30):
Yeah, yeah, And I also you asked me what I use,
So family systems theory is a big theory that I
use also, and that just represents like the family unit
changes as a whole and not just one person. So
if we're doing family therapy or trying to help, you know,
people who can't conceive couples, it's important that the whole
(25:55):
unit is aware of what's going on and changes as
a whole.
Speaker 1 (25:58):
See even encourage like if another comes and you would
encourage her to bring her children and also.
Speaker 3 (26:03):
And her partner, that may be right, that's awesome.
Speaker 1 (26:07):
Yeah, that's great.
Speaker 2 (26:08):
Yeah, thank you so much.
Speaker 1 (26:10):
It was so educational. Thank you, rond A wonderful job.
Speaker 2 (26:14):
And just always remember you're not alone.
Speaker 1 (26:16):
Thank thank you,
Welcome to psychobabbl Dashmi.
Speaker 2 (00:13):
I'm your host, Danielle Minch along with mehor Mar Weeks.
Speaker 1 (00:17):
Hi everybody, before we start episode eleven, our last episode
of this season right there.
Speaker 2 (00:22):
Yeah, for the summer.
Speaker 1 (00:23):
We want to put out a disclaimer that this episode
may be triggering for some people and is in no
way meant to replace mental health treatment or therapy. So
today we have a special guest on. So we have
Rhonda who is a Matt has a master's in social work,
is a licensed independent clinical social worker and also a
(00:44):
perinatal mental health counselor. So, Ronda, that was a mouthful.
Can you explain to us what a peri natal mental
health counselor does exactly?
Speaker 3 (00:53):
So I'm certified through Postpartum Support International to be able
to provide the counseling services to perinatal women, which includes
pregnant and postpartum periods, and they specify depression, anxiety, OCD,
and psychosis.
Speaker 1 (01:12):
Okay, so I guess you just covered my second question.
What issues can occur during pregnancy that would require counseling.
So everything you just said.
Speaker 3 (01:23):
Yes, one in five women and one in ten men
actually suffer from postpartum well pregnant or postpartum depression and anxiety.
There aren't quite rates for the OCD or psychosis. The
psychosis is more rare and it is actually I do
(01:45):
have rates, I'm sorry. One in two out of one
thousand women have the potential for postpartum psychosis.
Speaker 1 (01:53):
So let me ask you this. Do they develop this
during the ignancy or because of the pregnancy, or these
already pre existing conditions or is it both?
Speaker 3 (02:04):
In some circumstances, they do have a diagnosis of schizophrenia
or bipolar prior, but it can result from the pregnancy.
And it's also that fifty percent of bipolar women have
been diagnosed after pregnancy.
Speaker 1 (02:20):
Wow, remember we did that one in season one? We
had the guests on had she had OCD and she
said it became so unbearable during her pregnancy and after
it became so much worse. She had some psychosis too.
Speaker 2 (02:34):
She was real paranoid.
Speaker 1 (02:36):
Yeah, postpart she was like delusional.
Speaker 3 (02:38):
Yeah. And so the depression and anxiety are concerns of course,
as are the OCD, but the psychosis is a medical emergency.
So if there is a psychosis present, then that puts
more of a danger for the parent and the child,
the infant, so most likely hospitalization will be required. And
(03:03):
that psychosis, of course involves hallucinations, delusions, severe detachment, loss
of emotion to where they believe their delusions, they believe
that their thoughts are okay and normal, and that poses
a huge risk, just like with anyone, right, yes, but
when you're talking an infant with.
Speaker 1 (03:23):
Who's depending on these thoughts about.
Speaker 3 (03:26):
And too.
Speaker 2 (03:29):
To look back and read stories and stuff like that,
the infant and the other children also, right, pose a
huge danger.
Speaker 3 (03:37):
Yes, And so that's where partners can play a huge
role in knowing what's going on with the birth mother,
knowing if they're acting different, knowing if they're saying things
that they've kind of never said before, and of course
detaching from the infant, not feeding the infant, not changing
(03:58):
the infant, leaving the infant alone for hours when of
course after birth and psychosis most often occurs two weeks
within two weeks after birth, so those are pretty detrimental
times for the infant to have constant care.
Speaker 1 (04:13):
So someone was if someone out there was seeing these
signs in their significant other or their you know, daughter
or whatever, you would tell them what go to the
emergency immediately.
Speaker 3 (04:26):
Yeah, go to the nearest emergency room to keep them safe.
Speaker 1 (04:31):
So, I know you talked about traumatic births, So what
exactly would constitute what you would classify as a traumatic birth.
Speaker 3 (04:40):
So sometimes in situations, people try to get their birth
plan in place with their physician and they want it
to be natural, or they want it to be you know,
they get an epidural at the least last possible minute.
Sometimes that does occur because there can be emergencies. So
(05:03):
you know, pretty clamsia is not necessarily an emergent situation,
but can result in an emergency sea section.
Speaker 1 (05:09):
What is that for people?
Speaker 3 (05:10):
It would be high blood pressure and so that would
put the mother in the infant at risk, So emergency
sea sections if the infant is not dropping. We'll say
some mothers never wanted to have a sea section, so
they can see that as traumatic. But there's also tearing
(05:32):
which can cause hemorrhaging. There are situations where the infant
has already tried to draw through the birth canal and
they may have a broken shoulder from being pulled through.
If they have to use four sets, that can be traumatic.
There are also situations where again hemorrhaging can occur. And
the mother has severe health problems as a result of
(05:55):
the birth, So she could lose a lot of blood,
she could go unconscious, she could be rush into emergency surgery.
We've had situations that where the placenta was not fully
removed and then the mother became septic had to be
readmitted to the hospital, taking her away from her infant,
because most times the infant isn't able to stay in
(06:17):
that situation.
Speaker 1 (06:19):
There can also be I guess sometimes they make women
carry the fetus full term, even though the fetus is
not viable anymore.
Speaker 3 (06:28):
Also, right, well, that is a little bit of a Yes,
that's a huge trauma. And after twenty weeks, the mother
will have to birth the infant. And so if the
infant is deceased, the mother has to birth the infant.
It's not where they can there's they're past the point
(06:49):
of the DNC. And so I've worked with many mothers
where that is extremely traumatic.
Speaker 1 (06:55):
So do these do these I know it's this is
like kind of a catch up that do these traumatic
birds result in like a post traumatic stress disorder?
Speaker 3 (07:06):
Yes, yes, so PTSD is a concern, and that would
be of course with any of these labor and delivery
stories that don't go as plants, and it can a
little off the subject that you just asked, But it
can happen with the father too, because there have been
(07:27):
circumstances where the father isn't prepared for an emergency c
section or he's not prepared to see the amount of
blood loss and it could be all over the room
to the point where it's on the floor around him,
and so that can be traumatic for the fathers as well.
But yes, I'm sorry, I'm all over the place. But
(07:50):
PTSD is a concern with you know, the traumatic bursts,
but also traumatic loss.
Speaker 2 (07:55):
So what symptoms are you seeing in patients that come
to you with these traumatic losses.
Speaker 3 (08:02):
Well, a big one is detachment and sometimes an inability
to bond with their infant. And I know that that
can happen sometimes when an infant is taken to the
NIKU and they didn't get to see their infant. And
that's also another traumatic aspect of birth. If the infant
(08:23):
is removed immediately, whether you know they've got stolen their
lungs or they're having withdraw symptoms, or it could just
be their vitals are weak not strong. They are removed
from the mother and she didn't get that skin to
skin that could be traumatic. So detachment, inability to discuss
(08:46):
the birth, hyper awareness, irritability, sensitivity, anxiety.
Speaker 1 (08:54):
Nightmares, flashbacks, Yes.
Speaker 3 (08:55):
The nightmares, flashbacks.
Speaker 1 (08:57):
Not to make this about me, but like everything you've
just said happened to me when I had my twins,
because my son was taken from me and taken to
the NICU in another town and I didn't see him
for four weeks and I didn't even like I knew
I was having depression and I went on medicine, but
I think that I might have had, yeah, a little
(09:20):
bit of what you're just talking about, because it was
a really hard time for us. And yeah, until I
saw him again, I'm gonna cry. It was really bad because, yeah,
it took me because I couldn't travel up there because
I had an infant and I had to have a
c section in a vaginal delivery, and my other daughter
was in his sister was in the incubator and they
(09:42):
let me nest in the hospital and then I was
pumping and my husband was taking my milk up to
Pittsburgh to feed the baby, and I didn't get to
see him again for four weeks. Until they brought him back.
Speaker 3 (09:54):
Yeah, so yeah, that was Yeah, that sounds like it
was a true Yeah.
Speaker 1 (09:58):
Well fuck eh, I wish I would that.
Speaker 2 (10:00):
I know, well, you kind of talked about it one
of the yah things about how.
Speaker 1 (10:06):
Yeah, okay, well let's not make this anymore about me.
But yeah, that just kind of put a little dagger mother.
Speaker 2 (10:11):
No, I think that you're talking about it, you know,
Yea gives it a great example.
Speaker 3 (10:17):
Yeah, and Danielle helped me out there. Nightmares and flashbacks,
and that can include avoiding discussing the birth at all,
or talking about birth or more children, or you know,
wanting to go for follow up even in aftercare. Yeah.
Speaker 1 (10:33):
I have a friend who had She said she had
one child and she said her that it was so
traumatic she was in labor for over a day and
she would never get pregnant again, and she she hasn't.
So what about miscarriages? What is the like do people
come to you when they have miscarriages and talk about
that the loss of the yes, pregnancy.
Speaker 3 (10:55):
Miscarriages and of course the infant loss would they had
to deliver the still born? Right, So miscarriages. I do
see a lot of people who struggle with infertility and miscarriages,
and of course they're grieving the loss of that hope
(11:16):
of pregnancy and having a baby, but also they're having
difficulty with self blame and that also happens with infant
loss and trying to come to terms with their bodies
working against them, their bodies not cooperating, and then they
feel like something's wrong with them, and they have a
lot of and grief over.
Speaker 2 (11:37):
The Yeah, and it probably makes it a lot harder
whenever they have an infant loss or a miscarriage, and
then they get pregnant again, and then it happens like
it's almost like the trauma happens all over again, right,
And I'm sure that they have so much anxiety right
when you get there.
Speaker 3 (11:57):
Yes, And so I see several women who have gone
through miscarriages and two who have gone through having to
deliver a stowborn and have a funeral and bury you know,
their baby, and that grief of you know PSI, the
postpartums when international concept kind of terms it as becoming
(12:19):
a psychological parent, Like when you're pregnant, you're preparing to
be a parent. Many women are, many dads are, they're
preparing to bring the baby home. They're they're getting their
home ready, they're buying things, they're planning reveal parties and
showers and all these things occur, and then their baby
passes away. They go and deliver, and then they don't
(12:40):
bring a baby home, so they have that feeling of
being a parent, but then they're not any longer. So
that's a bit of a different aspect from the miscarriage.
But the miscarriage is also you know, they're preparing and
then the miscarriage is you know, something that can often
happen multiple times in a row, Danielle had said. And
(13:03):
then when they do get pregnant again, they do have
that high level of anxiety after okay, this week, we're
going to be in the clear, or every time they
go to an altarsound, which is typically when they found
that the baby's heart was no longer beating, they have
that almost panic because they don't know what the ultrasound
tech is going to tell them.
Speaker 1 (13:22):
Do you see a lot of women who have a
failure to conceive, like who are going through IVF for something.
Speaker 3 (13:27):
Is not as common as the pregnant impostpartum or the
infant loss. Because I get a lot of referrals from
the local hospitals and their obg ns, and so I do,
but it's not as many.
Speaker 1 (13:45):
And what issues do you see in the men? Like
the same thing, the depression.
Speaker 3 (13:49):
The yes, depression and anxiety one in ten men. So
not so much OCD or psychosis of course, because they
don't have that biological change, but they have the psychological
and social change. So you know, pregnancy and birth is
a bi psychosocial event, like everything changes about you. But
the women it's biological because your body's changing, your hormones
(14:09):
are changing. Men psychologically and socially, you're now a parent.
You don't just worry about yourself to go out of
the house. You don't have the social freedom like you
used to. So they can suffer from depression and anxiety
for that, just due to their life changing so much
and having another responsibility.
Speaker 1 (14:28):
Yeah, I think a lot of people don't think of
the men. Yeah, it's you know, basically the quote the
woman who does everything end quote by.
Speaker 2 (14:37):
Now, whenever you talked about guilt, how do you help
a mother that has guilt and feels like it's their fault.
Speaker 3 (14:45):
I prefer cognitive behavioral therapy or interpersonal therapy. Those are
both of my approaches and helping them to process that.
We go through aspects of what they went through. We
try to process all of those feelings and help them
to reframe their thought patterns so that they aren't blaming themselves.
(15:10):
Because when the doctor can help the mother this is
what happened in Uterow, that helps them more. But when
there's no reason for it, that's a little bit harder
of a task.
Speaker 1 (15:25):
Can you kind of explain just briefly what those two
different types of therapy you mentioned are so people are well.
Speaker 3 (15:32):
Conitive behavioral therapy is the impact that your thoughts have
on your behavior. It is looking through your thought patterns
and try and reframe them so that they're more healthy,
more productive, so that your behaviors and functioning is more
healthy and productive. And it can look at past and present,
whereas interpersonal focus is more on present, like your current
(15:54):
interpersonal relationships and what's going on right now in your life.
I use am I to motivational interviewing, which is trying
to help them to be motivated to make change and
to identify their goals on their own and put them
into action. I also do ERP, which is exposure response
(16:16):
and that is mainly for OCD and high levels of anxiety,
and what that involves is exposing them. So with OCD,
they have obsessions and those are typically fears and intrusive,
sometimes negative thoughts, and they do compulsions in order to
less than the amount of distress. So ERP exposes them
(16:39):
to those obsessions without the compulsions, and so it is
distressing and many people don't like it, but it shows
them that they can handle that level of distress and
that the compulsions are not needed anymore.
Speaker 1 (16:54):
Can you off the top of your head, I'm putting
on the spot. Given an example of like a mother
who has developed OCD, what what like, explain how you
would do that? Like I would say.
Speaker 3 (17:05):
So, So for mothers, we'll just do a contamination. You know,
many mothers are like, you know, don't touch my baby,
wash your hands, which is all very common, don't kiss
my baby. RSD is a huge thing, which is very common.
But then there are extreme circumstances where they're constantly sanitizing
(17:28):
their hands. They may be using like chlorox wipes on
their skin, washing their hands multiple times a day, where
their hands are dry and cracked. And this is just
a minor example, but that they feel like, Okay, maybe
I have to wash my hands five times in a
row and then I have to wipe them with hand sanitizer.
(17:50):
And if I do that, then my baby won't get sick.
Speaker 1 (17:54):
So what do you I'm in your office and that's me.
What do you do to expose me to that?
Speaker 3 (17:58):
Okay, so I'd probably hand you one of the toys
I have in my room because I also see children
a dirty toy. A dirty toy. Yeah, so one then
a child has played with that's probably been in their
mouth or you know, they've sneezed on or something. And
have you hold that toy for fifteen minutes before you
could wash your hands? And of course the infant isn't
(18:19):
in there. I'm not gonna expose your infant to a
necessary journey.
Speaker 1 (18:21):
But I can just like just thinking about that. If
I was in that position, I can imagine I'd be
completely freaking out right.
Speaker 3 (18:27):
It's yes, and there are other so OCD can come
in different thoughts, like where if I walk down the
steps of my baby, I'm gonna drop my baby. And
you know that's not gonna happen every time you walk
down the steps with your baby and so it would
be like having them go up and down steps, which
I know seems very odd, but it would just show them,
(18:48):
like the distress does not have to be present.
Speaker 1 (18:51):
So back to the first example that I think people
can relate to. So you make me hold the toy
for fifteen minutes, and then after that, am I allowed
to go wash my hands?
Speaker 3 (19:00):
Ones? Yes?
Speaker 1 (19:01):
And then we and then you say you can wash
them memory you can wash your hands once?
Speaker 3 (19:06):
Yes, okay. So there's sub scale, which is the subjective
units of distressed scale that ERP uses and in zero two,
one hundred and so the client would be given this
scale and they would have that to look at, and
it just gives them different areas, and so they would
tell me where they're at on the subscale. If this
starts out in five minutes and they're hyperventilating in their
(19:26):
own A ninety, I'm gonna let them go wash their hands.
We're gonna work up to this, right, But yes, I
would say you can use hand sanitizer right now, because
ideally hand sanitizer should kill the germs that are on
that toy right right, and then see how long that
you could handle just the hand sanitizer and.
Speaker 1 (19:46):
I know this is a hard question to answer because
everyone's different, but on average, using this type of exposure therapy,
how long does it take to get a person so
they can do that and not you know, have a
two or a one or a on that scale.
Speaker 3 (20:01):
Okay, Well, the program itself is meant to last seventeen weeks,
and it's meant to build up to the exposure, and
so it depends on the person. Sometimes they're ready to
do it on like the third visit, and then sometimes
people don't want to do it at all.
Speaker 1 (20:18):
Yeah, So seventeen weeks is four months, and you see
them like once a week.
Speaker 3 (20:22):
It's it's really supposed to be twice a week, but
with work schedules sometimes it ends up being once interesting. Yeah,
And so with the ERP again, there's different levels of OCD.
There's contamination, there's you know, the religious component, there's some
people have intrusive sexual images or thoughts. There's a lot
(20:47):
of different variations. So I mean, that's just like the
simplest example that I can pick of that that's.
Speaker 1 (20:53):
The one that most yeah, I think is most common.
Probably is that contamination.
Speaker 2 (20:56):
One, yes, right, yeah, because that girl had it.
Speaker 1 (20:59):
The one we talked about.
Speaker 2 (21:01):
We interviewed one of the mothers.
Speaker 3 (21:03):
Sorry, the challenge at home would be to only wash
your hands once and to see if you could wait
fifteen minutes and then if your sub scale would go
up to seventy to eighty, then you could get wash
your hands again.
Speaker 1 (21:16):
So they do it at home. They keep the like
they keep challenge.
Speaker 3 (21:20):
Them to continue to handle the distress as long as
they're able to right right.
Speaker 4 (21:27):
Any resources you could give us that they can you
know they're getting therapy, anything on the outside, resources that
they could use.
Speaker 3 (21:38):
Postpartum Support International has a website. They have lots of information,
they have statistics. They have a directory that will set
you up with providers in your area wherever that may be.
And if there are support groups in your area, they
have those listed as well. And in Wheeling, Virginia, on
(22:01):
June twenty first, PSI and Park Valley Behavioral Healthcare are
hosting the Climb, which is a local event to raise
awareness for periinatal mental health disorders. And they'll be like
events and activities and information there to help people. The
goal of PSI is to bring awareness of periinatal mental
(22:22):
health and where would that be in heritage Port.
Speaker 1 (22:25):
Okay, So if you're around, yeah, go there.
Speaker 3 (22:28):
Yes, and if you guys wanted to, you could also
set up a table and get on information today.
Speaker 2 (22:34):
Yeah, yeah, for sure. I mean this is some great information.
Now do you see these patients. Are they usually on
a medication?
Speaker 1 (22:46):
Yes?
Speaker 3 (22:46):
So I work in conjunction at my office with a
PA physician assistant, Brittany Cummings, And she is also PSI
certified in a psychiatric UH Services for paranial Women, and
so she is educated in what medications are best to
(23:08):
use and which ones are not. So the concern is
in the past obs have just stopped medications and that
could be really unhealthy for people who are pregnant and
already have the diagnosis and have been maintained on their medicine,
and that can increase symptoms. And so sometimes there are risks,
but you have to consider the risk versus the benefit.
(23:32):
And if the mother has a history of psychosis or
manic episodes or suicidality, is the risk worth taking her
off of.
Speaker 1 (23:41):
The pay In my practice, I always.
Speaker 2 (23:44):
Call and talk to the obt yn But I did
have this specialist.
Speaker 5 (23:48):
This lady was on Latuda and she had a lot
of anger issues and stuff, and he kind of didn't
wander on it, and she's like, I flat, I told
him I have to be on it because I have
of other kids.
Speaker 3 (24:00):
At home that you know what I.
Speaker 2 (24:02):
Mean that I yeah, is litta, Yeah, but this specialist
for some reason. But I do generally call and talk
to the ob and, you know, just so that they know,
because sometimes they don't know all the symptoms that the
mothers haven't yea.
Speaker 3 (24:20):
With the disorders, they don't because that's not their specialty,
you know. And so I agree, I think it's a
good idea to call them in touch.
Speaker 2 (24:28):
Base and the patient to be an advocate for themselves too,
Like this girl did absolutely.
Speaker 1 (24:35):
Anything else you want to cover that we did not
touch on.
Speaker 3 (24:38):
Just for the grief aspect of it, Men and women
tend to grieve differently, and children grieve differently, so I
think it's important just to keep that in mind. And
if you have young children in the home and they're
grieving a infant loss as well, because if they're expecting
a brother or sister to come and they no longer are,
that can be difficult. But there's lots of books there
(25:01):
that you can read to little kids. You know, I
have one something very sad happened and it is pretty
simple but explains illness and you know, people not being
around anymore, and so you know, that's something to think
about too. A lot of people want to hold their
grief in and think that they can't talk about it
(25:21):
or that they're the only ones going through it, when
just because people grieve differently doesn't mean it shouldn't be
brought up or disgust or out in the open. Yea.
Speaker 1 (25:29):
And it affects the whole family.
Speaker 3 (25:30):
Yeah, yeah, And I also you asked me what I use,
So family systems theory is a big theory that I
use also, and that just represents like the family unit
changes as a whole and not just one person. So
if we're doing family therapy or trying to help, you know,
people who can't conceive couples, it's important that the whole
(25:55):
unit is aware of what's going on and changes as
a whole.
Speaker 1 (25:58):
See even encourage like if another comes and you would
encourage her to bring her children and also.
Speaker 3 (26:03):
And her partner, that may be right, that's awesome.
Speaker 1 (26:07):
Yeah, that's great.
Speaker 2 (26:08):
Yeah, thank you so much.
Speaker 1 (26:10):
It was so educational. Thank you, rond A wonderful job.
Speaker 2 (26:14):
And just always remember you're not alone.
Speaker 1 (26:16):
Thank thank you,
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