September 20, 2024 • 31 mins
Struggling with the complexities of motherhood? Join us for an eye-opening conversation with Robyn Klein, LCSW, who sheds light on maternal mental health and its profound effects on both mothers and their babies. Discover the critical signs to watch out for, including increased anxiety, depression, and the fear of being an inadequate parent. Robyn guides us through the fine line between typical early motherhood challenges and more severe mental health issues. Learn how these difficulties can strain familial relationships and why open communication and effective screening tools are vital for supporting new mothers.
Facing barriers to mental health care? We delve into the significant hurdles such as stigma, socioeconomic challenges, and the lack of support systems that new mothers often encounter. Robyn shares practical self-care strategies and emphasizes the importance of accepting help. Explore community resources like home visiting programs and organizations like WIC that can make a real difference. Additionally, get insightful tips on booking consultations through KinderMind and Headway, ensuring access to professional help in several states. This episode is an essential guide filled with supportive advice for navigating the journey of motherhood while prioritizing mental health.
If you or someone you know may be struggling with Postpartum Depression, the Edinburgh Postnatal Depression Scale (EPDS) may be a helpful tool for identifying and sharing symptoms with medical and mental health professionals.
Kinder Mind offers therapy services in Illinois, Maryland, Massachusetts, Mississippi, Pennsylvania, Virginia, and Texas. Follow us and feel free to share with anyone looking for therapy in a state where we're located.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Elizabeth Barlow (00:00):
Thanks so much for tuning in to another
episode of the KinderMindpodcast.
Today we're exploringmotherhood through maternal
mental health, and I have thepleasure of being joined by
Robin Klein, lcsw, to talk aboutthis subject.
Thanks so much for joining ustoday, robin.
Thank you for having me.
What is maternal mental healthand why is it a crucial aspect
(00:23):
of overall maternal well-being?
Robyn Klein, LCSW (00:24):
Maternal mental health focuses on the
quality of life for momsspecifically, and in this
(00:49):
conversation we're talking aboutthe perinatal and postpartum
periods that bookend a pregnancy.
The impact of poor mentalhealth can have detrimental
effects to a growing fetus,leading to more difficult
delivery, suicidal ideation,poor growth for the fetus and an
overall sense of helplessnessduring pregnancy and then, once
that baby's born, those symptomssometimes get better or
(01:11):
sometimes get worse, and momswho didn't have issues while
they were pregnant can also faceissues, and we rely on the
medical team, both at thehospital, at the postpartum
visits and at the pediatricianvisits, to be checking in with
mom as much as baby, because itis through mom's health that
(01:34):
babies can thrive and besuccessful, and what we're
seeing is that many women arefalling through the cracks and
their families are sufferingbecause of it that makes a lot
of sense that anything that themom is going through while she's
pregnant is going to have animpact on the baby.
Dr. Elizabeth Barlow (01:53):
So what are some common signs and
symptoms of maternal mentalhealth issues that new mothers
should be aware of?
Robyn Klein, LCSW (02:01):
Definitely an increase in anxiety and
depression.
When you're pregnant.
It's super scary, right,especially if it's the first
time that you're doing it.
You don't know what to expectand for some reason, women have
been doing this for hundreds ofthousands of years and we act
like the first time somebodygets pregnant, it's the first
time that it's ever happened,and so there's resources
(02:23):
everywhere that are incrediblyoverwhelming.
Every woman's experience isdifferent and, especially if you
have a more difficult pregnancy, some anxiety and depression is
to be exhausted and with theright support system in place,
those can be mitigated.
So feelings of sadness,excessive worry, fear that
you're going to be a horribleparent or that you're inevitably
(02:44):
going to mess up your childthat's something that we all
feel during pregnancy to somedegree.
It's when those feelings startto impair our ability to get
through our day that there'ssomething to be concerned about.
So if we can't stop worryingabout what we're doing or how
we're affecting the baby or whatkind of parent we'll be, those
(03:06):
will be super concerning.
Dr. Elizabeth Barlow (03:07):
So it sounds like worrying about what
type of mother will I be, or amI going to be a good mom?
Stressful worries and thoughtsand anxiety might be something,
like you said, every motherworries about, that every mother
worries about.
(03:27):
So then, in terms ofdifferentiating between the
typical challenges of earlymotherhood and more serious
mental health concerns, itsounds like those things that
kind of look more likedepression is something that you
want to be on the lookout for,and those are signs and symptoms
of not wanting to engage withother people and staying in your
room and isolating.
Are there any other kind ofparticular behaviors that you
(03:49):
could see that maybe a partneror a family member or even a
friend could be on the lookoutfor?
Robyn Klein, LCSW (03:56):
Absolutely.
Hormone changes occur in thebody, perinatal and postpartum,
and so after the baby's born,it's expected that your mood
will fluctuate within thosefirst six weeks Tearfulness,
crying, freaking out if the babyis crying because your blood
pressure is going up, and whatare you going to do?
Those are all super normalsigns postpartum.
(04:17):
But when you can't sleepbecause you're afraid that the
baby's going to stop breathing,or you don't trust anyone else
to take care of the baby so youcan do something like sleep or
take a shower so not trustinganyone else, if you have
feelings that you could orpotentially want to harm the
(04:42):
baby, those are signs to beconcerned about.
And not letting other peoplehelp you right.
Being a new mom super stressful.
We're all afraid that we'regoing to, you know, screw up our
kids in some capacity.
But at some point we have torealize that we can't do this by
ourselves and we need thesupport of others, even if it's
(05:04):
just to take a nap or take ashower, and so not letting
anybody else in would be a majorindicator to partners, friends
and family that something isgoing on with mom that needs to
be addressed.
Dr. Elizabeth Barlow (05:18):
And I know you mentioned it's a very
hormonally raced time.
Things are going on.
Maybe you have a short temper,maybe you're highly emotional,
thinking about maternal mentalhealth issues.
How can they affectrelationships with partners,
family members, other children?
Robyn Klein, LCSW (05:37):
No one likes to see mom in a state of
disarray.
Right In many families, mom isthe one that is the household
manager that is kind ofcorralling everyone, and to see
her in this unstable environmentcan be worrying for all members
of the family.
So the best case scenario wouldbe to have a conversation
(06:00):
before the baby arrives aboutthings that can be expected
beforehand or once the babycomes, and you can also stay in
touch with your family and docheck-ins.
There are postpartum depressionscreens that are administered
typically when women dischargefrom the hospital and when
(06:20):
they're at their postpartumvisit, and so it's easy for
partners to get a hold of thoseand know what to look for when
they're at home and to reach outto the providers when there's
something in need.
Being able to support mom in thebest way possible will kind of
help well everyone.
(06:40):
But if mom is unwilling orunable to receive that support,
there can be tension in thehousehold.
Like you said, the instabilitycan cause other children to act
out.
There could be more fightingbetween partners, which only
(07:00):
increases the stress level forall parties involved, and so
doing your best to stay on topof it as a mom and also
recognizing that your loved onesare there to support.
You is super important.
Dr. Elizabeth Barlow (07:15):
I love that you mentioned there's a
screening tool, and my mindimmediately goes towards.
You're getting ready todischarge from the hospital.
You've got a brand new baby,everything's kind of in disarray
and there's a screening toolBased on your work and knowledge
.
Is that the most effective timefor the tool, or would it be
(07:35):
better if that was delivered,maybe at the child's first
appointment?
What have you seen to be themost effective for accurately
capturing that information?
Robyn Klein, LCSW (07:47):
Well, it's really hard because there really
is no good time.
You're absolutely right.
When you're discharged from thehospital you're freaking out
because, like you have this newhuman being that you are
responsible for keeping alive.
You have a million things goingon in your head and then the
nurses show up and are like here, please take this like 21
question assessment to let usknow how you're doing.
(08:09):
And so it's really easy to getfalse positives in that sense
because, of course, your anxietyis going to be up and you're
going to be on edge.
So the biggest thing that thenursing team is looking for at
that time are thoughts to harmyourself or your baby, because
those are the biggest thingsthat put your safety and the
(08:31):
baby's safety in question.
So when women score high onthose tests, instead of a
six-week postpartum visitthere's often a two-week
postpartum so that the doctorcan do a check-in with mom and
make sure nothing is out of theordinary or worse than those
postpartum baby blues.
(08:52):
If you score high in thoseat-risk-for-harm categories,
they'll often keep you admittedfor another day or two to ensure
your safety and potentiallystart medication.
But a lot of moms are reluctantto answer those questions in
the affirmative because theydon't want to be separated from
their baby.
A lot of OBGYN offices doadminister them at the six-week
(09:16):
visit, but not all of them do,and it's currently not routine
for pediatricians to do thosetrips as well.
But the pediatricians see thebaby at such frequent intervals
that first year it's really amissed opportunity to be
checking in with mom and makingsure that she's getting
everything that she needs.
Dr. Elizabeth Barlow (09:37):
Is there a particular postpartum screening
tool that you think is like themost accurate or effective in
capturing that and, if so, couldwe maybe share a copy on the
podcast page for anyonelistening who might have a loved
one or might actually be goingthrough something that they
think might align withpostpartum that they could take?
Robyn Klein, LCSW (10:01):
Absolutely.
The gold standard right now iscalled the Edinburgh Postnatal
Depression Scale.
It's also given prenatally.
It's just most commonly givenin that postpartum period.
It's 10 questions.
It's really a snapshot of howyou're doing and how you're
feeling and gives the staff anidea of how close of an eye do
(10:26):
they need to keep up on you.
So this is the gold standardthat we can absolutely post on
the podcast page and it's areally good thing for partners
to take a look at so they knowwhat to be keeping an eye out
for when mom comes home withbaby as well.
Dr. Elizabeth Barlow (10:42):
I'm trying to think of it from a mom's
space, of where I'm stressed outand I think as I don't want to
say like as moms especially, butI'm going to say as moms
especially we put a lot ofweight on ourselves and
expectations to keep it alltogether.
Look like you have everythingunder control, you know.
(11:02):
Not admit that you don't,because then maybe that scares.
You think it's going to scareother people in your life.
So I'm trying to think of ifI'm a mom and I do have some
concerns about am I okay?
What are some recommendationsthat you can give me to really
be honest and check in withmyself?
(11:24):
What steps should I then take?
And I guess, like the barrierthere that I keep thinking about
is how do I get to a placewhere I can be comfortable
admitting that I'm not okay andhow can I come out of holding
back because I'm worried or Ithink I've got it all together
as a clinician, what are somerecommendations that you could
(11:46):
make for someone that's feelingstuck or feeling worried but
afraid to really admit it?
Robyn Klein, LCSW (11:52):
That's such a good question, because so many
women come into my practice anddid not realize that they were
not okay.
So they don't remember thefirst six months of the baby's
life, and it's not until sixmonths later that they're like
hey, wait a minute, likesomething is going on and it's
(12:12):
not okay.
A lot of women will also beresistant if a partner or family
member says, hey, I don't thinkeverything's okay right now
because the sanctity of ourmotherhood feels threatened.
Right, how dare you tell methat I am not being the best
mother I can be?
(12:32):
It's like one of the worstthings that someone can say to
us, especially when we're not ina good place and we feel like
from to our child is the worstpossible thing that can happen.
And so a huge portion of it isgoing to be having those
(12:54):
conversations with your partneror your family and being open to
their feedback.
So you go over the postpartumdepression scale.
You say, please, let me know ifthese things are happening, and
then being open to them, saying, hey, I've really noticed that
you're blaming yourself for alot of things lately that are
(13:16):
not your fault, and beingreceptive to that feedback and
having that open dialogue,that's going to be critical.
Some women reach out to theirobese and get on medication,
which is absolutely a viableoption, even if you're
breastfeeding.
There has been so many studiestalking about the minimal risk
(13:39):
to the infant if you're nursingand the benefits to mom's mental
health that outweigh thoseminimal risks.
For example, if you are in aconstant state of stress and
you're not dealing with iteither through therapy, support
or medication, your cortisollevels, your stress hormones,
(13:59):
are just flowing all throughoutyour body.
It's changing your breast milkand ultimately that's changing
what goes into the baby.
So the pros and cons of goingon something like medication
while you're nursing in myprofessional opinion, the pros
are absolutely of way morebenefit than the potential of
(14:21):
risk that could happen whileyou're breastfeeding.
The other portion is knowingwhere to go to help, because
ideally the OB's office will belike yep, let's get you in for a
visit, let's talk about whatyour options are and let's take
the next steps, but that doesn'talways happen.
One really great source ofsupport is your company's EAP.
(14:43):
Lot of companies right nowoffer employee assistance
programs to their staff andtheir dependents, which
typically offers anywhere fromthree I've seen as many as 10
free therapy sessions atabsolutely no cost to you, and
so if you're working or yourspouse is working and you have
(15:03):
access to EAP, that would be agreat inroad to getting somebody
to talk to.
Postpartum SupportInternational is another
fantastic resource.
They have a hotline that youcan call they also you can also
text in the middle of the nightand they can provide support.
They can answer questions, theycan connect you with providers
(15:28):
that are available in your area,and there is certification
through Postpartum SupportInternational for perinatal and
maternal mental health.
So these women and men havevery special training that makes
them even more able to supportmoms going through maternal
(15:52):
mental health conditions.
Dr. Elizabeth Barlow (15:56):
I know we discussed some of the common
barriers to potentially seekinghelp could be admitting to
yourself that something is wrongand having to admit to yourself
that you're not perfect.
I think, as humans, we allstruggle with because we get
into our heads about thisconstant chase for this
imaginary unicorn of perfection.
(16:16):
And what does it mean if Ican't?
X?
Does that make me weak?
Am I less than what are somecommon barriers that might
prevent mothers from seekinghelp for mental health issues?
Robyn Klein, LCSW (16:34):
help for mental health issues.
So stigma is probably thebiggest one, right?
Like, as far as we've come as acountry within the last five to
10 years talking about mentalhealth issues, there is still a
stigma attached to them, and ifyou come from a family where you
weren't allowed to haveemotions, let alone mental
health problems, then beingcomfortable asking your family
for help can be a major fear ofthe response that you're going
(16:58):
to get.
Another barrier would besocioeconomic status and job.
So do you even have thebenefits available to you to
access free or low-cost mentalhealth services?
And then, even if you do havethat access, do you have the
support in your household to beable to utilize them?
(17:21):
Right?
If you're a single parent or aparent of multiple children, you
have limited help in the homeand you work and or your partner
works, the kids are in school,they have their own mess.
Right Like, there are plenty oftherapists that work evenings
and weekend hours, but thosespots fill up fast, and so if
(17:43):
you don't have the support to beable to get help during the day
and are limited to when you canget those services, the options
get smaller and smaller andyou're left with kind of holding
the bag and saying, well, Ican't get this help and so I'm
just going to have to.
Power threat.
Dr. Elizabeth Barlow (18:04):
And I know another kind of effective
strategy for mental healthacross the board is really
engaging in self-care.
What are some effectiveself-care strategies that new
mothers can do to support theirmental health?
Robyn Klein, LCSW (18:19):
One of the mantras that I heard when I was
pregnant and just had anabsolutely miserable experience
was that you can't take care ofthe baby unless you take care of
yourself, and that follows thewhole thing.
You have to put your mask onfirst, on the airplane, before
(18:40):
you put anybody's mask on you.
By caring for yourself, you'recaring for the baby, right?
So an exhausted mom is lessable to provide her infant with
the support that it needs if shecan barely keep her eyes open.
Hasn't showered is probablylike munching throughout the day
(19:04):
and like barely exceeding 500calories, right?
So by not taking care ofourselves, we're doing our
children a disservice, andultimately it all comes back to
wanting to be the best mompossible.
And so to do that, you have totake care of yourself, and
constantly repeat it.
The next step, I would say, isbeing willing to accept and ask
(19:29):
for help.
So a lot of people will calland say, oh my gosh, the baby's
here.
Let me know what I can do.
And nobody wants to say, like,can you come over and do four
loads of laundry, right?
Like, that's not what most ofus have in mind, but the
majority of people I would liketo to think just truly do want
(19:51):
to help.
So take the opportunity and saycan you do my laundry?
Or ask them did you haveanything in mind?
Right, some people are willingto bring over meals.
Some people may watch yourother children.
Some people may want to spendtime with the baby so that you
can take a nap.
Figure out what needs to getdone so that you can, you know,
(20:12):
pull yourself out of thatsurvival mode and be willing to
accept help from other people.
Now, granted, that requires thatyou have a support system and
not everyone else does.
One thing that's available tolow-income families and, in some
communities, higher-incomefamilies and in some communities
, higher-income families, arephone visits with a nurse or a
(20:35):
social worker.
These are often through thehealth department or a local
hospital.
They're called home visitingprograms, where a nurse or a
social worker comes to you andensures that you have the tools
that you need, and theseprograms start prenatally or you
can pick them up postpartum.
They can help you acquire carseats or pack and plays.
(20:59):
If you don't have a crib.
They have access to programswith free diapers and other baby
supplies.
So there are resources in thecommunity that are available to
you.
You just have to be willing toask for them if they're not
presented to you by someone else.
Dr. Elizabeth Barlow (21:17):
I love that there are resources
available and I like that youcalled out to where it's the
point that you have to ask whatis available.
When I was the director of aWIC program and when I lived in
Massachusetts, we kept a prettynice sized list of resources
that were available to moms thatthey might not be aware of, and
(21:41):
we made it a point to sharethose resources with all of our
new moms like diaper pantriesreally, you name it.
So that might be anotherresource that you could use If
you qualify for WIC and youutilize those services.
Ask them hey, like I need helpwith this or I need help with
that, Do you have any resourcesI can reach out to?
(22:01):
I know in a lot of communitiesthere are nonprofit
organizations that can providethings that you need.
There's also religiousorganizations that can provide
things that you need.
So, definitely asking for helpand I also like that you pointed
out when someone calls to offerhelp and you're maybe afraid to
say, yeah, can you come overand do my laundry, Instead
(22:23):
asking I would love help, whatdid you have in mind?
I think that's a really greatway to maybe overcome that fear
or stress associated withlooking like you're admitting
that you need help, which again,like it's a human thing that I
think a lot of us deal with Iknow that I do.
I like to put myself in themindset of some of the topics we
(22:46):
talk about and think about okay, what would be my barrier?
What would make me feel cringy?
And I think it's my firstreaction when somebody asks like
hey, how are you, is thereanything I can help you with
around a topic, and especiallywhen I had my kids, my first
reaction was always oh no, thankyou, I'm good, but was I really
good?
I just I struggle withaccepting help.
(23:08):
So I think that's such a hugerecommendation to put that
question on the person to see ifthey are willing to do certain
things, so then you don't haveto then ask.
Robyn Klein, LCSW (23:21):
That makes it feel better at least from what
I can see, absolutely, and Ithink your call out to WIC is a
great one, because for tworeasons.
Right, a lot of women arereluctant to use WIC, even if
they qualify, because they thinkthat it sends a signal but we
go back to, you're trying to bethe best model that you can be,
(23:41):
and that means nourishingyourself and your baby, and WIC
gives you free money to spend onthose supplies.
I also know when I was livingin Virginia, wic had access to
free breast pumps that or likethrough that the women might not
have otherwise known to get,and when I worked in the
(24:04):
hospital setting, we were alwayshaving different nonprofits and
religious organizations callingand saying we offer these
things.
Please spread the word.
A lot of insurance companies now, if not all of them, offer case
management services, and moreand more of them are offering
them specifically duringpregnancy, and so one of the
(24:26):
things that moms can do prenatalpostpartum is call up their
insurance company, ask for casemanagement and say, hey, I'm
pregnant, is there a nurse or asocial worker available for me?
And so they call at regularintervals.
The nurses are wonderfulbecause they assess all of those
(24:47):
medical pieces.
The social workers are makingsure that you're maximizing
resources in the community.
Of course, you have to be ableto pick up the phone when they
call, so that sometimes there'strouble when we have a lot going
on.
But there are plenty of peoplein the community that are
begging for the opportunity toprovide you with support.
You just need to be willing toaccept it and able to partner.
Dr. Elizabeth Barlow (25:12):
That's a really great point.
And while we're talking aboutWIC again, I wanted to address a
common myth and misconception.
Common myth and misconceptionthere were a lot of moms who
would say I don't think I reallyneed WIC because I should be
able to make it, I should befine, even though they qualified
for WIC services, because theyfelt that they were taking away
(25:35):
from other moms that theythought might need the help more
.
And that's not how WIC works.
So if that mom doesn't use thebenefits, it doesn't free up
benefits for someone else.
So WIC is actually funded bythe USDA and it's based on need.
So if the moms aren't utilizingWIC services, then the funding
(25:56):
gets reduced.
It's not a situation of you'retaking away from someone else
who may need it more.
If you qualify for WIC services, definitely utilize those
services.
It can take a situation ofyou're taking away from someone
else who may need it more.
If you qualify for WIC services, definitely utilize those
services.
It can take a lot of stress offto have formula covered.
So definitely look into takingadvantage of those benefits if
you are a mom and you have aninfant or kiddos and I can't
(26:18):
remember specifically the cutoffage, I think it might have been
five years old- I think, sothat sounds right.
How can expecting mothersprepare themselves mentally for
the challenges of motherhood?
Robyn Klein, LCSW (26:30):
I think the biggest thing is knowing that
whatever you expect, it's goingto go differently.
So one of the things they tellyou to do during pregnancy is to
create your birth plan, and Ithink that's a really great
opportunity to learn about thebirthing process and all of the
different scenarios that can goon and to highlight your
(26:53):
preferences, right.
So a birth plan is really yourpreference of how your birth
happens.
But I have yet to speak to onemom in 10 years whose birth plan
played out the way theyintended, and I think having
that perspective for yourpregnancy and your delivery and
(27:13):
then the postpartum period is agreat way to prepare yourself
for the unexpected, becausethat's what being a parent is
right Like no day is the same.
You think your child's gonna doone thing.
What being a parent is rightLike no day is the same.
You think your child's going todo one thing.
They do something else, right.
Like they love yogurt.
And then you buy the yogurtfrom Costco and they don't love
the yogurt anymore, right?
That is parenthood in anutshell.
(27:34):
So understanding that things aregoing to take twists and turns
is step one.
The second step, I would say,is checking in with yourself.
How am I feeling right nowabout my pregnancy?
If I'm in a partnership, if Ihave a family, what is my
support system like?
Am I getting all of the thingsthat I need to keep my well full
(27:59):
in the event things don't go asI plan?
And if not, what do I need todo or what needs to happen in
order for me to fill that up?
As you go through the prenataland then postpartum experience,
those check-ins should happenregularly, and that means with
(28:19):
yourself, with your partner orother support system that you
have in place.
Am I doing everything that Ithink that I need to do in order
to be the best mom that I can,and do I recognize that being
the best mom that I can be meanstaking care of myself?
And if, at any point, theanswer to that question is no,
(28:45):
then you work with your supportsystem to identify where those
gaps are and the best way tofill that, because not
addressing them leads tolonger-term complications for
mom and for baby and for thefamily at large, because the
situations only continue toexacerbate and the problems that
(29:08):
you have get worse and insteadof just plugging a leak, you are
trying to put the overflowingtoilet you know the water in a
sink as the water keeps flowing,and so it's so much easier to
take care of that stuffbeforehand or as it arises
(29:29):
slowly, than trying to fix it onthe back end when you feel a
mess.
Dr. Elizabeth Barlow (29:36):
Thank you so much for sharing all of your
insight and knowledge with ustoday.
Robin Robin is a provider withKindermine in Virginia and
Pennsylvania, so if you wouldlike to book a consultation with
Robin, you can absolutely do soat Kinderminecom and Robin.
Did you want to share with ourlisteners how they can book a
(29:59):
time with you if they are in anyof the other states where
you're licensed?
Robyn Klein, LCSW (30:05):
Absolutely, if you are in Colorado, idaho,
iowa, delaware, new Mexico orVermont I think I covered
everybody.
You can reach me on the Headwayplatform, headwaycom.
Just find a provider by name.
(30:26):
You can plug in my informationand request a consult.
I would be happy to meet withyou and talk about what's going
on and if I'm not the rightprovider for you, I will help
you find somebody who is abetter match.
Dr. Elizabeth Barlow (30:38):
Wonderful.
Well, thank you so much again,Robin.
I greatly appreciate your time.
Robyn Klein, LCSW (30:43):
Thank you so much for having me.
It's been a pleasure.
Thanks so much for tuning in to another
episode of the KinderMindpodcast.
Today we're exploringmotherhood through maternal
mental health, and I have thepleasure of being joined by
Robin Klein, lcsw, to talk aboutthis subject.
Thanks so much for joining ustoday, robin.
Thank you for having me.
What is maternal mental healthand why is it a crucial aspect
(00:23):
of overall maternal well-being?
Robyn Klein, LCSW (00:24):
Maternal mental health focuses on the
quality of life for momsspecifically, and in this
(00:49):
conversation we're talking aboutthe perinatal and postpartum
periods that bookend a pregnancy.
The impact of poor mentalhealth can have detrimental
effects to a growing fetus,leading to more difficult
delivery, suicidal ideation,poor growth for the fetus and an
overall sense of helplessnessduring pregnancy and then, once
that baby's born, those symptomssometimes get better or
(01:11):
sometimes get worse, and momswho didn't have issues while
they were pregnant can also faceissues, and we rely on the
medical team, both at thehospital, at the postpartum
visits and at the pediatricianvisits, to be checking in with
mom as much as baby, because itis through mom's health that
(01:34):
babies can thrive and besuccessful, and what we're
seeing is that many women arefalling through the cracks and
their families are sufferingbecause of it that makes a lot
of sense that anything that themom is going through while she's
pregnant is going to have animpact on the baby.
Dr. Elizabeth Barlow (01:53):
So what are some common signs and
symptoms of maternal mentalhealth issues that new mothers
should be aware of?
Robyn Klein, LCSW (02:01):
Definitely an increase in anxiety and
depression.
When you're pregnant.
It's super scary, right,especially if it's the first
time that you're doing it.
You don't know what to expectand for some reason, women have
been doing this for hundreds ofthousands of years and we act
like the first time somebodygets pregnant, it's the first
time that it's ever happened,and so there's resources
(02:23):
everywhere that are incrediblyoverwhelming.
Every woman's experience isdifferent and, especially if you
have a more difficult pregnancy, some anxiety and depression is
to be exhausted and with theright support system in place,
those can be mitigated.
So feelings of sadness,excessive worry, fear that
you're going to be a horribleparent or that you're inevitably
(02:44):
going to mess up your childthat's something that we all
feel during pregnancy to somedegree.
It's when those feelings startto impair our ability to get
through our day that there'ssomething to be concerned about.
So if we can't stop worryingabout what we're doing or how
we're affecting the baby or whatkind of parent we'll be, those
(03:06):
will be super concerning.
Dr. Elizabeth Barlow (03:07):
So it sounds like worrying about what
type of mother will I be, or amI going to be a good mom?
Stressful worries and thoughtsand anxiety might be something,
like you said, every motherworries about, that every mother
worries about.
(03:27):
So then, in terms ofdifferentiating between the
typical challenges of earlymotherhood and more serious
mental health concerns, itsounds like those things that
kind of look more likedepression is something that you
want to be on the lookout for,and those are signs and symptoms
of not wanting to engage withother people and staying in your
room and isolating.
Are there any other kind ofparticular behaviors that you
(03:49):
could see that maybe a partneror a family member or even a
friend could be on the lookoutfor?
Robyn Klein, LCSW (03:56):
Absolutely.
Hormone changes occur in thebody, perinatal and postpartum,
and so after the baby's born,it's expected that your mood
will fluctuate within thosefirst six weeks Tearfulness,
crying, freaking out if the babyis crying because your blood
pressure is going up, and whatare you going to do?
Those are all super normalsigns postpartum.
(04:17):
But when you can't sleepbecause you're afraid that the
baby's going to stop breathing,or you don't trust anyone else
to take care of the baby so youcan do something like sleep or
take a shower so not trustinganyone else, if you have
feelings that you could orpotentially want to harm the
(04:42):
baby, those are signs to beconcerned about.
And not letting other peoplehelp you right.
Being a new mom super stressful.
We're all afraid that we'regoing to, you know, screw up our
kids in some capacity.
But at some point we have torealize that we can't do this by
ourselves and we need thesupport of others, even if it's
(05:04):
just to take a nap or take ashower, and so not letting
anybody else in would be a majorindicator to partners, friends
and family that something isgoing on with mom that needs to
be addressed.
Dr. Elizabeth Barlow (05:18):
And I know you mentioned it's a very
hormonally raced time.
Things are going on.
Maybe you have a short temper,maybe you're highly emotional,
thinking about maternal mentalhealth issues.
How can they affectrelationships with partners,
family members, other children?
Robyn Klein, LCSW (05:37):
No one likes to see mom in a state of
disarray.
Right In many families, mom isthe one that is the household
manager that is kind ofcorralling everyone, and to see
her in this unstable environmentcan be worrying for all members
of the family.
So the best case scenario wouldbe to have a conversation
(06:00):
before the baby arrives aboutthings that can be expected
beforehand or once the babycomes, and you can also stay in
touch with your family and docheck-ins.
There are postpartum depressionscreens that are administered
typically when women dischargefrom the hospital and when
(06:20):
they're at their postpartumvisit, and so it's easy for
partners to get a hold of thoseand know what to look for when
they're at home and to reach outto the providers when there's
something in need.
Being able to support mom in thebest way possible will kind of
help well everyone.
(06:40):
But if mom is unwilling orunable to receive that support,
there can be tension in thehousehold.
Like you said, the instabilitycan cause other children to act
out.
There could be more fightingbetween partners, which only
(07:00):
increases the stress level forall parties involved, and so
doing your best to stay on topof it as a mom and also
recognizing that your loved onesare there to support.
You is super important.
Dr. Elizabeth Barlow (07:15):
I love that you mentioned there's a
screening tool, and my mindimmediately goes towards.
You're getting ready todischarge from the hospital.
You've got a brand new baby,everything's kind of in disarray
and there's a screening toolBased on your work and knowledge
.
Is that the most effective timefor the tool, or would it be
(07:35):
better if that was delivered,maybe at the child's first
appointment?
What have you seen to be themost effective for accurately
capturing that information?
Robyn Klein, LCSW (07:47):
Well, it's really hard because there really
is no good time.
You're absolutely right.
When you're discharged from thehospital you're freaking out
because, like you have this newhuman being that you are
responsible for keeping alive.
You have a million things goingon in your head and then the
nurses show up and are like here, please take this like 21
question assessment to let usknow how you're doing.
(08:09):
And so it's really easy to getfalse positives in that sense
because, of course, your anxietyis going to be up and you're
going to be on edge.
So the biggest thing that thenursing team is looking for at
that time are thoughts to harmyourself or your baby, because
those are the biggest thingsthat put your safety and the
(08:31):
baby's safety in question.
So when women score high onthose tests, instead of a
six-week postpartum visitthere's often a two-week
postpartum so that the doctorcan do a check-in with mom and
make sure nothing is out of theordinary or worse than those
postpartum baby blues.
(08:52):
If you score high in thoseat-risk-for-harm categories,
they'll often keep you admittedfor another day or two to ensure
your safety and potentiallystart medication.
But a lot of moms are reluctantto answer those questions in
the affirmative because theydon't want to be separated from
their baby.
A lot of OBGYN offices doadminister them at the six-week
(09:16):
visit, but not all of them do,and it's currently not routine
for pediatricians to do thosetrips as well.
But the pediatricians see thebaby at such frequent intervals
that first year it's really amissed opportunity to be
checking in with mom and makingsure that she's getting
everything that she needs.
Dr. Elizabeth Barlow (09:37):
Is there a particular postpartum screening
tool that you think is like themost accurate or effective in
capturing that and, if so, couldwe maybe share a copy on the
podcast page for anyonelistening who might have a loved
one or might actually be goingthrough something that they
think might align withpostpartum that they could take?
Robyn Klein, LCSW (10:01):
Absolutely.
The gold standard right now iscalled the Edinburgh Postnatal
Depression Scale.
It's also given prenatally.
It's just most commonly givenin that postpartum period.
It's 10 questions.
It's really a snapshot of howyou're doing and how you're
feeling and gives the staff anidea of how close of an eye do
(10:26):
they need to keep up on you.
So this is the gold standardthat we can absolutely post on
the podcast page and it's areally good thing for partners
to take a look at so they knowwhat to be keeping an eye out
for when mom comes home withbaby as well.
Dr. Elizabeth Barlow (10:42):
I'm trying to think of it from a mom's
space, of where I'm stressed outand I think as I don't want to
say like as moms especially, butI'm going to say as moms
especially we put a lot ofweight on ourselves and
expectations to keep it alltogether.
Look like you have everythingunder control, you know.
(11:02):
Not admit that you don't,because then maybe that scares.
You think it's going to scareother people in your life.
So I'm trying to think of ifI'm a mom and I do have some
concerns about am I okay?
What are some recommendationsthat you can give me to really
be honest and check in withmyself?
(11:24):
What steps should I then take?
And I guess, like the barrierthere that I keep thinking about
is how do I get to a placewhere I can be comfortable
admitting that I'm not okay andhow can I come out of holding
back because I'm worried or Ithink I've got it all together
as a clinician, what are somerecommendations that you could
(11:46):
make for someone that's feelingstuck or feeling worried but
afraid to really admit it?
Robyn Klein, LCSW (11:52):
That's such a good question, because so many
women come into my practice anddid not realize that they were
not okay.
So they don't remember thefirst six months of the baby's
life, and it's not until sixmonths later that they're like
hey, wait a minute, likesomething is going on and it's
(12:12):
not okay.
A lot of women will also beresistant if a partner or family
member says, hey, I don't thinkeverything's okay right now
because the sanctity of ourmotherhood feels threatened.
Right, how dare you tell methat I am not being the best
mother I can be?
(12:32):
It's like one of the worstthings that someone can say to
us, especially when we're not ina good place and we feel like
from to our child is the worstpossible thing that can happen.
And so a huge portion of it isgoing to be having those
(12:54):
conversations with your partneror your family and being open to
their feedback.
So you go over the postpartumdepression scale.
You say, please, let me know ifthese things are happening, and
then being open to them, saying, hey, I've really noticed that
you're blaming yourself for alot of things lately that are
(13:16):
not your fault, and beingreceptive to that feedback and
having that open dialogue,that's going to be critical.
Some women reach out to theirobese and get on medication,
which is absolutely a viableoption, even if you're
breastfeeding.
There has been so many studiestalking about the minimal risk
(13:39):
to the infant if you're nursingand the benefits to mom's mental
health that outweigh thoseminimal risks.
For example, if you are in aconstant state of stress and
you're not dealing with iteither through therapy, support
or medication, your cortisollevels, your stress hormones,
(13:59):
are just flowing all throughoutyour body.
It's changing your breast milkand ultimately that's changing
what goes into the baby.
So the pros and cons of goingon something like medication
while you're nursing in myprofessional opinion, the pros
are absolutely of way morebenefit than the potential of
(14:21):
risk that could happen whileyou're breastfeeding.
The other portion is knowingwhere to go to help, because
ideally the OB's office will belike yep, let's get you in for a
visit, let's talk about whatyour options are and let's take
the next steps, but that doesn'talways happen.
One really great source ofsupport is your company's EAP.
(14:43):
Lot of companies right nowoffer employee assistance
programs to their staff andtheir dependents, which
typically offers anywhere fromthree I've seen as many as 10
free therapy sessions atabsolutely no cost to you, and
so if you're working or yourspouse is working and you have
(15:03):
access to EAP, that would be agreat inroad to getting somebody
to talk to.
Postpartum SupportInternational is another
fantastic resource.
They have a hotline that youcan call they also you can also
text in the middle of the nightand they can provide support.
They can answer questions, theycan connect you with providers
(15:28):
that are available in your area,and there is certification
through Postpartum SupportInternational for perinatal and
maternal mental health.
So these women and men havevery special training that makes
them even more able to supportmoms going through maternal
(15:52):
mental health conditions.
Dr. Elizabeth Barlow (15:56):
I know we discussed some of the common
barriers to potentially seekinghelp could be admitting to
yourself that something is wrongand having to admit to yourself
that you're not perfect.
I think, as humans, we allstruggle with because we get
into our heads about thisconstant chase for this
imaginary unicorn of perfection.
(16:16):
And what does it mean if Ican't?
X?
Does that make me weak?
Am I less than what are somecommon barriers that might
prevent mothers from seekinghelp for mental health issues?
Robyn Klein, LCSW (16:34):
help for mental health issues.
So stigma is probably thebiggest one, right?
Like, as far as we've come as acountry within the last five to
10 years talking about mentalhealth issues, there is still a
stigma attached to them, and ifyou come from a family where you
weren't allowed to haveemotions, let alone mental
health problems, then beingcomfortable asking your family
for help can be a major fear ofthe response that you're going
(16:58):
to get.
Another barrier would besocioeconomic status and job.
So do you even have thebenefits available to you to
access free or low-cost mentalhealth services?
And then, even if you do havethat access, do you have the
support in your household to beable to utilize them?
(17:21):
Right?
If you're a single parent or aparent of multiple children, you
have limited help in the homeand you work and or your partner
works, the kids are in school,they have their own mess.
Right Like, there are plenty oftherapists that work evenings
and weekend hours, but thosespots fill up fast, and so if
(17:43):
you don't have the support to beable to get help during the day
and are limited to when you canget those services, the options
get smaller and smaller andyou're left with kind of holding
the bag and saying, well, Ican't get this help and so I'm
just going to have to.
Power threat.
Dr. Elizabeth Barlow (18:04):
And I know another kind of effective
strategy for mental healthacross the board is really
engaging in self-care.
What are some effectiveself-care strategies that new
mothers can do to support theirmental health?
Robyn Klein, LCSW (18:19):
One of the mantras that I heard when I was
pregnant and just had anabsolutely miserable experience
was that you can't take care ofthe baby unless you take care of
yourself, and that follows thewhole thing.
You have to put your mask onfirst, on the airplane, before
(18:40):
you put anybody's mask on you.
By caring for yourself, you'recaring for the baby, right?
So an exhausted mom is lessable to provide her infant with
the support that it needs if shecan barely keep her eyes open.
Hasn't showered is probablylike munching throughout the day
(19:04):
and like barely exceeding 500calories, right?
So by not taking care ofourselves, we're doing our
children a disservice, andultimately it all comes back to
wanting to be the best mompossible.
And so to do that, you have totake care of yourself, and
constantly repeat it.
The next step, I would say, isbeing willing to accept and ask
(19:29):
for help.
So a lot of people will calland say, oh my gosh, the baby's
here.
Let me know what I can do.
And nobody wants to say, like,can you come over and do four
loads of laundry, right?
Like, that's not what most ofus have in mind, but the
majority of people I would liketo to think just truly do want
(19:51):
to help.
So take the opportunity and saycan you do my laundry?
Or ask them did you haveanything in mind?
Right, some people are willingto bring over meals.
Some people may watch yourother children.
Some people may want to spendtime with the baby so that you
can take a nap.
Figure out what needs to getdone so that you can, you know,
(20:12):
pull yourself out of thatsurvival mode and be willing to
accept help from other people.
Now, granted, that requires thatyou have a support system and
not everyone else does.
One thing that's available tolow-income families and, in some
communities, higher-incomefamilies and in some communities
, higher-income families, arephone visits with a nurse or a
(20:35):
social worker.
These are often through thehealth department or a local
hospital.
They're called home visitingprograms, where a nurse or a
social worker comes to you andensures that you have the tools
that you need, and theseprograms start prenatally or you
can pick them up postpartum.
They can help you acquire carseats or pack and plays.
(20:59):
If you don't have a crib.
They have access to programswith free diapers and other baby
supplies.
So there are resources in thecommunity that are available to
you.
You just have to be willing toask for them if they're not
presented to you by someone else.
Dr. Elizabeth Barlow (21:17):
I love that there are resources
available and I like that youcalled out to where it's the
point that you have to ask whatis available.
When I was the director of aWIC program and when I lived in
Massachusetts, we kept a prettynice sized list of resources
that were available to moms thatthey might not be aware of, and
(21:41):
we made it a point to sharethose resources with all of our
new moms like diaper pantriesreally, you name it.
So that might be anotherresource that you could use If
you qualify for WIC and youutilize those services.
Ask them hey, like I need helpwith this or I need help with
that, Do you have any resourcesI can reach out to?
(22:01):
I know in a lot of communitiesthere are nonprofit
organizations that can providethings that you need.
There's also religiousorganizations that can provide
things that you need.
So, definitely asking for helpand I also like that you pointed
out when someone calls to offerhelp and you're maybe afraid to
say, yeah, can you come overand do my laundry, Instead
(22:23):
asking I would love help, whatdid you have in mind?
I think that's a really greatway to maybe overcome that fear
or stress associated withlooking like you're admitting
that you need help, which again,like it's a human thing that I
think a lot of us deal with Iknow that I do.
I like to put myself in themindset of some of the topics we
(22:46):
talk about and think about okay, what would be my barrier?
What would make me feel cringy?
And I think it's my firstreaction when somebody asks like
hey, how are you, is thereanything I can help you with
around a topic, and especiallywhen I had my kids, my first
reaction was always oh no, thankyou, I'm good, but was I really
good?
I just I struggle withaccepting help.
(23:08):
So I think that's such a hugerecommendation to put that
question on the person to see ifthey are willing to do certain
things, so then you don't haveto then ask.
Robyn Klein, LCSW (23:21):
That makes it feel better at least from what
I can see, absolutely, and Ithink your call out to WIC is a
great one, because for tworeasons.
Right, a lot of women arereluctant to use WIC, even if
they qualify, because they thinkthat it sends a signal but we
go back to, you're trying to bethe best model that you can be,
(23:41):
and that means nourishingyourself and your baby, and WIC
gives you free money to spend onthose supplies.
I also know when I was livingin Virginia, wic had access to
free breast pumps that or likethrough that the women might not
have otherwise known to get,and when I worked in the
(24:04):
hospital setting, we were alwayshaving different nonprofits and
religious organizations callingand saying we offer these
things.
Please spread the word.
A lot of insurance companies now, if not all of them, offer case
management services, and moreand more of them are offering
them specifically duringpregnancy, and so one of the
(24:26):
things that moms can do prenatalpostpartum is call up their
insurance company, ask for casemanagement and say, hey, I'm
pregnant, is there a nurse or asocial worker available for me?
And so they call at regularintervals.
The nurses are wonderfulbecause they assess all of those
(24:47):
medical pieces.
The social workers are makingsure that you're maximizing
resources in the community.
Of course, you have to be ableto pick up the phone when they
call, so that sometimes there'strouble when we have a lot going
on.
But there are plenty of peoplein the community that are
begging for the opportunity toprovide you with support.
You just need to be willing toaccept it and able to partner.
Dr. Elizabeth Barlow (25:12):
That's a really great point.
And while we're talking aboutWIC again, I wanted to address a
common myth and misconception.
Common myth and misconceptionthere were a lot of moms who
would say I don't think I reallyneed WIC because I should be
able to make it, I should befine, even though they qualified
for WIC services, because theyfelt that they were taking away
(25:35):
from other moms that theythought might need the help more
.
And that's not how WIC works.
So if that mom doesn't use thebenefits, it doesn't free up
benefits for someone else.
So WIC is actually funded bythe USDA and it's based on need.
So if the moms aren't utilizingWIC services, then the funding
(25:56):
gets reduced.
It's not a situation of you'retaking away from someone else
who may need it more.
If you qualify for WIC services, definitely utilize those
services.
It can take a situation ofyou're taking away from someone
else who may need it more.
If you qualify for WIC services, definitely utilize those
services.
It can take a lot of stress offto have formula covered.
So definitely look into takingadvantage of those benefits if
you are a mom and you have aninfant or kiddos and I can't
(26:18):
remember specifically the cutoffage, I think it might have been
five years old- I think, sothat sounds right.
How can expecting mothersprepare themselves mentally for
the challenges of motherhood?
Robyn Klein, LCSW (26:30):
I think the biggest thing is knowing that
whatever you expect, it's goingto go differently.
So one of the things they tellyou to do during pregnancy is to
create your birth plan, and Ithink that's a really great
opportunity to learn about thebirthing process and all of the
different scenarios that can goon and to highlight your
(26:53):
preferences, right.
So a birth plan is really yourpreference of how your birth
happens.
But I have yet to speak to onemom in 10 years whose birth plan
played out the way theyintended, and I think having
that perspective for yourpregnancy and your delivery and
(27:13):
then the postpartum period is agreat way to prepare yourself
for the unexpected, becausethat's what being a parent is
right Like no day is the same.
You think your child's gonna doone thing.
What being a parent is rightLike no day is the same.
You think your child's going todo one thing.
They do something else, right.
Like they love yogurt.
And then you buy the yogurtfrom Costco and they don't love
the yogurt anymore, right?
That is parenthood in anutshell.
(27:34):
So understanding that things aregoing to take twists and turns
is step one.
The second step, I would say,is checking in with yourself.
How am I feeling right nowabout my pregnancy?
If I'm in a partnership, if Ihave a family, what is my
support system like?
Am I getting all of the thingsthat I need to keep my well full
(27:59):
in the event things don't go asI plan?
And if not, what do I need todo or what needs to happen in
order for me to fill that up?
As you go through the prenataland then postpartum experience,
those check-ins should happenregularly, and that means with
(28:19):
yourself, with your partner orother support system that you
have in place.
Am I doing everything that Ithink that I need to do in order
to be the best mom that I can,and do I recognize that being
the best mom that I can be meanstaking care of myself?
And if, at any point, theanswer to that question is no,
(28:45):
then you work with your supportsystem to identify where those
gaps are and the best way tofill that, because not
addressing them leads tolonger-term complications for
mom and for baby and for thefamily at large, because the
situations only continue toexacerbate and the problems that
(29:08):
you have get worse and insteadof just plugging a leak, you are
trying to put the overflowingtoilet you know the water in a
sink as the water keeps flowing,and so it's so much easier to
take care of that stuffbeforehand or as it arises
(29:29):
slowly, than trying to fix it onthe back end when you feel a
mess.
Dr. Elizabeth Barlow (29:36):
Thank you so much for sharing all of your
insight and knowledge with ustoday.
Robin Robin is a provider withKindermine in Virginia and
Pennsylvania, so if you wouldlike to book a consultation with
Robin, you can absolutely do soat Kinderminecom and Robin.
Did you want to share with ourlisteners how they can book a
(29:59):
time with you if they are in anyof the other states where
you're licensed?
Robyn Klein, LCSW (30:05):
Absolutely, if you are in Colorado, idaho,
iowa, delaware, new Mexico orVermont I think I covered
everybody.
You can reach me on the Headwayplatform, headwaycom.
Just find a provider by name.
(30:26):
You can plug in my informationand request a consult.
I would be happy to meet withyou and talk about what's going
on and if I'm not the rightprovider for you, I will help
you find somebody who is abetter match.
Dr. Elizabeth Barlow (30:38):
Wonderful.
Well, thank you so much again,Robin.
I greatly appreciate your time.
Robyn Klein, LCSW (30:43):
Thank you so much for having me.
It's been a pleasure.
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